Early Rehabilitation Programs Improve Pain and Disability in Patients with Lumbar Disc Protrusion: A Prospective Controlled Study

Low back pain is a common problem in the active population, and the second reason for visiting a physician. In patients with lumbar disc protrusion, the nucleus pulposus bulges against the disc and the latter protrudes into the spinal column, but the annulus fibrosus remains intact. The purpose of this study was to prove that starting an early complex rehabilitation treatment results into pain and disability reduction, and increased muscle strength and mobility in patients with lumbar disc protrusions. We performed a prospective cohort study, enrolling 60 patients (25 men and 35 women) aged between 26 to 76 years, diagnosed with lumbar disc protrusion. Patients in the experimental group registered significant improvements in all studied variables (pain, mobility, muscle strength, disability) after 6 months of treatment. The results of our study suggest that, in the lumbar disc disease, a combined rehabilitation program may be more effective in terms of pain and disability reduction, if it starts early after diagnosis. The current study proves the importance of combining electrotherapy with hydrotherapy and physical therapy. Patients who received this treatment combination showed an extremely significant improvement in pain relief, and reduction of functional disability after 6 months of treatment.

Contiguous-Level Unilateral Cervical Spine Facet Dislocation—A Report of a Less Discussed Subtype

Unilateral facet dislocation of subaxial cervical spine trauma is characterized by dislocation of inferior facet of superior vertebra over the superior facet of inferior vertebra. The injury is due to high-velocity trauma and associated with instability of spinal column. Such unilateral facet dislocations occurring at multiple adjacent levels for some reason are not reported or studied frequently. We have reported two cases of multiple-level dislocation of unilateral facets managed in our hospital with a review of available literature. The injury occurs as one side of the motion segment translates and rotates around an intact facet on the contralateral side. The major mechanism of injury is distractive flexion injury with axial rotation component. The injury is associated with instability secondary to loss of the discoligamentous complex. In cases with multiple-level dislocations of unilateral cervical facets, there are multiple mechanisms associated with significant neurological injury and most of them succumb at the site of injury. Only three other cases are available in English language literature. The neurological outcome is invariably poor. Multiple-level facet dislocations of subaxial cervical spine are reported sparsely in literature. We suspect that due to high-velocity nature of these injuries, most of them succumb soon after injury and not often reported. This article reports two cases of contiguous-level unilateral facet dislocation of subaxial cervical spine with associated injuries and the outcomes with review of literature.

CHANGES IN SPINAL RANGE OF MOTION AFTER 16 WEEKS TRAINING PROGRAM IN PUBERTAL CHILDREN

The aim of the present research was to improve the neglect behavior of pubertal children in an intervention program. Within the framework of the program, the main function of the spinal column and the strength and extensibility of the muscles responsible for posture were investigated. The participants included in the study are 7th grade children of the Neumann János Elementary School in Szombathely, Hungary, (nb=7); (ng=10). The Idiag M360 Spinal Mouse was used to investigate the physiological curvatures and main function of the spinal column before and after the program. The device was used to examine the children's spines in standing, bending forward and again in a standing position after the Matthiass test was performed. Pre-intervention (1) and post-intervention (2) data showed significant decreases in all assessed characteristics and similar increases in sacrum to hip ratio (Sac/Hip) (9.83±4.36 - 21.63±4.39); p<0.000. The greatest change was found in the Th11/12 dorsal vertebral body angles (4.50±2.05 - -0.30±0.25); p<0.000. As a result of the postural improvement program, the degree of pelvic tilt and, in parallel, the physiological curvature of lumbar lordosis was reduced to within the age-specific reference values.

Rehabilitation of a Patient with Wedge Compression with Paraplegia: A Case Report

Background: Despite the most significant efforts of many experts to provide natural therapeutic therapies, spinal cord injury (SCI) is a traumatic event with limited functional recovery. After a spinal cord injury, paraplegia can develop. Damage to the ligaments, vertebrae, or discs of the spinal column causes this. Paraplegia is the loss of muscle function in the lower half of the body, including both legs. Leg paralysis, in this case in which affects all parts of the pelvic organs, legs, and torso. This is partly owing to the complex character of SCI, which involves a great deal of disarray and malfunction as a result of the initial injury. Secondary degeneration is caused by neurotoxicity, vascular malfunction, neuroinflammation, apoptosis, and demyelination. Presentation of Case: 34year old male patient with wedge compression was diagnosed on x-ray after a fall from the tree. Discussion: The requirements for regeneration, rehabilitation, and neuroprotection appear to necessitate a diverse set of therapeutic approaches that can be used at different stages of the post-injury response. Conclusion: We'll focus on one strategy, in particular, physical training/exercise, which looks to have a wide range of applications and benefits for those with a chronic or acute SCI.

Spinal Cord Injuries in Emergency Medicine

Spinal cord injury is a serious medical disorder that frequently leads in significant morbidity and permanent impairment. Direct damage to the spinal cord or compression owing to broken vertebrae or masses such as epidural hematomas or abscesses are the most common causes of spinal cord injury. When examining a blunt trauma victim, medical professionals are taught to presume the patient has a spinal column damage unless it is proven otherwise. The early examination of a patient with a suspected cervical spinal injury in the emergency department (ED) is no different than that of any other trauma patient. The ABCs, or airway, breathing, and circulation, procedures are being taken into consideration. In acute spinal cord damage, hypotension can be hemorrhagic or neurogenic. Because of the high prevalence of concomitant injuries and vital sign confusion in acute spinal cord injury, a thorough search for hidden sources of bleeding is required. Surgical removal of bone fragments, foreign objects, herniated discs, or broken vertebrae that appear to be compressing the spine is frequently required. In order to avoid future discomfort or deformity, surgery may be required to stabilize the spine. In this review we’ll be looking at spinal cord injury, it’s diagnosis and treatment.

Osteopathic Treatment and Evaluation in the Clinical Setting of Childhood Hematological Malignancies

Children: adolescents, and young who are adults affected with hematological malignancies (CAYA-H) and who are undergoing intensive phases of cancer treatment, including hematopoietic stem cell transplantation (HSCT), experience diminished functional ability. This study was aimed at assessing the feasibility, efficacy, safety, and satisfaction of an osteopathic intervention in CAYA-H attending an 11-week precision-based exercise program (PEx). All of the participants were given 4–10 treatments according to the prescription ordered by the sports medicine doctor in charge of the PEx, and the following outcomes were assessed: (1) spinal column range of motion (ROM) by palpation; (2) lower and upper limb joints ROM by a goniometer; (3) orthostatic posture by plumb line assessment; (4) chest and abdomen mobility by inspection and palpation; (5) cranial-sacral rhythmic impulse (CRI) by palpation; and (6) adverse effects. Goal attainment scaling (GAS) was used to identify the accomplishment of a desired clinical result. Moreover, HSCT patients who were affected with graft-versus-host disease and/or osteonecrosis had their joints assessed in terms of ROM as tools to monitor the effectiveness of immunosuppressive treatment. A total of 231 CAYA-H were identified, and 104 participated in the study (age 10.66 ± 4.51 yrs; 43% F). PEx plus osteopathy reached positive GAS scores by improving the ROMs of the spinal column and/or limbs (81% and 78%, respectively), chest and abdomen mobility (82%), and CRI (76%). Only minor reversible adverse effects were noticed during the study. Together, our data seem to initiate a new course where osteopathy could be useful in evaluating structural edges due to the clinical history of each CAYA-H. Given the contributions that were obtained by the GAS scores, osteopathic treatment seems to reveal interesting potential that can be targeted in the future.

Magnetic resonance imaging findings and antemortem cytologic diagnosis of intramedullary spinal cord ependymoma in a dog

CASE DESCRIPTION A 3-year-old 31.1-kg castrated male mixed-breed dog was evaluated because of a 1- to 2-week history of paraparesis, knuckling of the hind feet, and difficulty posturing to urinate or defecate. CLINICAL FINDINGS The dog was paraparetic but weakly ambulatory with a kyphotic posture, a mildly decreased patellar reflex in the right pelvic limb, increased tone in both pelvic limbs, and marked hyperesthesia on paraspinal palpation of the lumbar region. The urinary bladder was enlarged and firm on palpation. Neuroanatomic findings were primarily consistent with localization to the T3-L3 spinal cord segments. Magenetic resonance imaging of the thoracolumbar spinal column revealed a discrete intramedullary spinal cord mass from the cranial aspect of L4 to the middle of L5. The mass was sampled by fine-needle aspiration, and on cytologic evaluation, the suspected diagnosis was an ependymoma. TREATMENT AND OUTCOME Owing to poor prognosis and limited treatment options, the owner elected euthanasia. Postmortem examination of the spinal cord and histologic findings for samples of the mass supported a likely diagnosis of ependymoma. CLINICAL RELEVANCE Ependymoma is a rare neoplasm in dogs but should be considered in young patients with evidence of a tumor in the CNS. Fine-needle aspiration of the spinal cord mass was possible in the dog of this report, and the cytologic findings provided useful diagnostic information.

Spinal cord detethering without laminectomy or laminotomy

Background: Tethered cord syndrome occurs when there is abnormal tension on the distal spinal cord, which limits its elevation as patients grow. This results in stretching of the neural elements and microvasculature, resulting in both direct and ischemic injury.[7] Animal studies suggest that impairment of oxidative metabolic pathways may contribute to neuronal injury.[7] Associated conditions include myelomeningocele, lipomyelomeningocele, intraspinal lipomas, diastematomyelia, thickened/fatty filum terminale, and trauma.[2] Tethering may be asymptomatic or result in a variety of symptoms including lower extremity weakness/sensory deficits, bowel/bladder dysfunction, scoliosis, pes cavus, and back/leg pain.[6] Early surgical intervention has been shown to improve outcomes and may be performed prophylactically or to prevent symptom progression.[1,3] More specifically, retrospective studies demonstrate that surgical intervention in patients under the age of 2 years is associated with improved outcomes.[5] In some cases, detethering may result in clinical improvement.[3] Case Description: We present a case of a 6-month-old male with a low-lying conus medullaris, lumbar syrinx, mildly abnormal urodynamic studies, and asymmetric utilization of his lower extremities observed during the evaluation of a Y-shaped gluteal cleft. He underwent elective spinal cord detethering via the safe and effective, minimally invasive technique described in the video. The patient’s parents gave informed consent for treatment and video recording. Institutional review board approval was deemed unnecessary. Conclusion: Given the variety of surgical techniques used for cord detethering, this video may assist other surgeons in developing techniques that require little to no compromise of the developing bony spinal column while achieving sufficient release of the spinal cord.[4]

Morphometric analysis of the lumbar vertebrae and intervertebral discs in relation to abdominal aorta: CT-based study

Purpose Although lumbar discectomy is the most common procedure in spine surgery, reports about anatomical relations between discs and prevertebral vessels are limited. Aim of this research was to investigate morphometric of the lumbar region and the relations between intervertebral discs (IVDs) and abdominal aorta. Methods 557 abdominal computed tomography scans were assessed. For each spinal column level from Th12/L1 down to L4/L5, we investigated: intervertebral disc’s and vertebra’s height, width, length, and distance from aorta or common iliac artery (CIA). Those arteries were also measured in two dimensions and classified based on location. Results 54.58% of patients were male. There was a significant difference in arterial-disc distances (ADDs) between genders at the levels: L1/L2 (1.32 ± 1.97 vs. 0.96 ± 1.78 mm; p = 0.0194), L2/L3 (1.97 ± 2.16 vs. 1.15 ± 2.01 mm; p < 0.0001), L3/L4 (2.54 ± 2.78 vs. 1.71 ± 2.61 mm; p = 0.0012), also for both CIAs (left CIA 3.64 ± 3.63 vs. 2.6 ± 3.06 mm; p = 0.0004 and right CIA: 7.96 ± 5.06 vs. 5.8 ± 4.57 mm; p < 0.001)—those ADDs were higher in men at all levels. The length and width of IVD increased alongside with disc level with the maximum at L4/L5. Conclusion Bifurcations of the aorta in most cases occurred at the L4 level. Collected data suggest that at the highest lumbar levels, there is a greater possibility to cause injury of the aorta due to its close anatomical relationship with discs. Females have limited, in comparison to males, ADD at L1/L2, L2/L3, and L3/L4 levels what should be taken into consideration during preoperative planning of surgical intervention.

INCIDENCE OF CERVICAL DISCOPATHY IN TOY BREEDS IN NECK AREA

The article is devoted to the determination of the incidence of discopathy in the cervical spine in dwarf dog breeds. Discopathies are widespread among all dog breeds. This pathology is common throughout the vertebral column, but in the cervical spine it occurs more often in dwarf breeds, due to the greater amplitude of movement of the vertebrae. Incidence allows a preliminary assessment of the need for surgical intervention or the use of a conservative method of treatment. This work is based on a study of 52 breeds of dogs with discopathies in the cervical spine, and in particular 21 decorative breeds. As a result of the surgical treatment of this pathology, the ventral slot technique was used. This technique allows performing an operative approach from the ventral side of the spinal column to eliminate hernial contents and ensure postoperative improvement.