Comparing the surgical efficacy of a newly designed endoscopic visualized trephine and a conventional trephine for percutaneous endoscopic lumbar discectomy with foraminoplasty for patients with single-segment lumbar disc herniation: A retrospective case -control study

Background Owing to the remarkable evolution of percutaneous endoscopic lumbar discectomy (PELD), the application of spinal endoscopy is shifting from the treatment of soft disk herniation to complex lumbar spinal stenosis. This study aim to compare the surgical efficacy of a newly designed endoscopic visualized trephine and a conventional trephine for PELD with foraminoplasty for patients with single-segment lumbar disc herniation (LDH). Methods A total of 54 patients who were diagnosed with single-segment LDH and received PELD with foraminoplasty at Xuzhou Central Hospital (Xuzhou, China) from January 2016 to June 2020 were included in this case-control study. Data related to the length of incision, amount of intraoperative bleeding, the time required to create the working channel, and intraoperative and postoperative complications were recorded. The Visual Analog Scale (VAS) score was used to assess low back pain and leg pain. Besides, the Oswestry Disability Index (ODI) and Japanese Orthopedic Association (JOA) scores were utilized to evaluate patients’ pain intensity and their sitting and standing abilities. The X-ray fluoroscopy was performed to measure the horizontal and angular displacements of lumbar extension-flexion, and to evaluate the stability of lumbar spine. Results All the patients successfully underwent surgical procedures, except for two patients with injuries in the spinal nerve root of the responsible segment in the conventional trephine group, who were given nutritional supplements for nerve treatment. Besides, there was no significant difference in incision length and operative blood loss between the modern trephine and the conventional trephine groups. However, the time required to create the channel and the duration of fluoroscopy in the modern trephine group were significantly less than those in the conventional trephine group (34.24 ± 5.38 vs. 44.76 ± 6.37 min, P < 0.05). In addition, the VAS, ODI, and JOA scores significantly decreased postoperatively in the two groups. We also found no significant difference in horizontal and angular displacements of lumbar extension-flexion between the two groups pre-operation and at 3- and 12-month post-operation. Conclusion In spite of similar surgical efficacy of the two techniques, the newly designed endoscopic visualized trephine outperformed in terms of operation time and duration of fluoroscopy.

Isolated Lumbar Extension Resistance Exercise in Limited Range of Motion for Patients with Lumbar Radiculopathy and Disk Herniation—Clinical Outcome and Influencing Factors

(1) Background: Reconditioning of the paraspinal lumbar extensor muscles by isolated lumbar extension resistance exercises (ILEX) has shown good clinical results for patients with chronic unspecific low back pain. However, the clinical value and safety for patients with specific spine pathologies is unclear. In this study, clinical outcome and influencing factors were retrospectively analyzed for patients with lumbar disk herniation (LDH) and radiculopathy. (2) Methods: 189 consecutive patients (123 men and 66 women; mean age, 36 years) with clinically diagnosed LDH and relative indications for surgery started a 9-week rehabilitation program (2x/week) including ILEX in limited range of motion (ROM) adjusted to patients’ symptoms. Patients diagnosed with advanced levels of spine degeneration were excluded. Pain/radiculopathy (PR), influence on mental health (IOMH), satisfaction rates were measured via Numeric Rating Scales (NRS, 0–10), and overall clinical outcome was stated in % (100% = full recovery). Isometric extension strength was tested before and after the program. (3) Results: 168 patients (88.9%) completed the program. For 162 out of 168 patients (96.4%) there was a significant reduction of clinical symptoms, whereas 6 patients reported no changes in symptoms. Scores (mean) for symptom intensity decreased from 4.2 (±1.5) to 1.9 (±1.5) (p < 0.001), the impact on mental health decreased from 5.9 (±2.3) to 2.4 (±2.0) (p < 0.001). There was a (weak) correlation between lower scores for PR and IOMH before the study and better clinical outcomes; PR also weakly correlated with satisfaction. Other factors such as age, strength increase, level/location and number of LDH did not have a significant impact on the clinical results. (4) Conclusion: The results indicate that ILEX in limited ROM can be an effective treatment for the majority of patients with LDH. For patients with high pain levels, the results are less consistent, and surgery may be considered.

Effect of Lower Back Extensors Fatigue on Athletic Performance Measured as Agility

Background: At high level of competition, sports require long periods of hard physical work. Each athlete should be able to perform desired actions efficiently, which will not be possible without coordinated activation of muscles in the kinetic chain. EMG studies demonstrate that lumbar paraspinal muscles fatigue is associated with Quadriceps Inhibition (QI), leading to speculation that these changes may not only have adverse effect for athletic performance but also increase the risk of injury in long term. This contrasts the evidence about the influence of fatigue on trunk muscles reflex activity. Method: 37 athletes (men) were recruited from city soccer clubs. The participants performed sub maximal isometric exercise of lower back extensors (Ito’s test) to induce fatigue. The two protocols were a single bout and repeated bouts of Lumbar Extension Isometric Exercise (LEIE). The Agility scores recorded at baseline, after single bout and after repeated bouts of LEIE were compared. Conclusion: The two experimental interventions differently affected the agility performance in the sample. On one hand, single bout intervention led to improved performance, repeated bout intervention resulted in relative deterioration of performance.

Partial Resection of Spinous Process for the Elderly Patients with Thoraco-Lumbar Kyphosis: Technical Report

Background and objectives: Global sagittal imbalance with lumbar hypo-lordosis can cause low back pain (LBP) during standing and/or walking. This condition has recently been well-known as one of the major causes of reduced health-related quality of life (HRQOL) in elderly populations. Decrease in disc space of anterior elements and an increase in the spinous process height of posterior elements may both contribute to the decrease in lordosis of the lumbar spine. To correct the sagittal imbalance, the mainstream option is still a highly invasive surgery, such as long-segment fusion with posterior wedge osteotomy. Therefore, we developed a treatment that is partial resection of several spinous processes of thoraco-lumbar spine (PRSP) and lumbar extension exercise to improve the flexibility of the spine as postoperative rehabilitation. Materials and Methods: Consecutively, seven patients with over 60 mm of sagittal vertical axis (SVA) underwent PRSP. The operation was performed with several small midline skin incisions under general anesthesia. After splitting the supraspinous ligaments, the cranial or caudal tip of the spinous process of several thoraco-lumbar spines was removed, and postoperative rehabilitation was followed to improve extension flexibility. Results: The average follow-up period was 13.0 months. The average blood loss and operation time were 11.4 mL and 47.4 min, respectively. The mean SVA improved from 119 to 93 mm but deteriorated in one case. The mean numerical rating scale of low back pain improved from 6.6 to 3.7 without any exacerbations. The mean Oswestry Disability Index score was improved from 32.4% to 19.1% in six cases, with one worsened case. Conclusions: We performed PRSP and lumbar extension exercise for the patients with LBP due to lumbar kyphosis. This minimally invasive treatment was considered to be effective in improving the symptoms of low back pain and HRQOL, especially of elderly patients with lumbar kyphosis.

Isometric and isokinetic muscle strength measurements of the lumbar flexors and extensors with BioniX Sim3 Pro in patients with chronic low back pain: A pilot study

BACKGROUND: The World Health Organization states that low back pain is the leading cause for disability worldwide. Patients with chronic low back pain (CLBP) show important decreases in lumbar strength and can now be assessed by using the new isokinetic dynamometer BioniX Sim3 Pro which offers very detailed measurements. OBJECTIVE: To compare lumbar flexion and extension strength values, as well as extension-flexion ratio (EFR) based on isokinetic velocity and gender, for patients with CLBP on the BioniX Sim3 Pro. METHODS: A retrospective analysis was performed on data from 20 men and 22 women with CLBP. Maximum torque in flexion and extension was measured isometrically and isokinetically. Statistical analysis was performed on these parameters. RESULTS: EFR shows a downward trend with increasing speed of measurement (isometric to isokinetic 30∘/s and isokinetic 30∘/s to isokinetic 90∘/s, respectively): in men from 1.21 to 1.04 (p< 0.001) and from 1.04 to 0.93 (p= 0.207). In women, EFR decreased from 1.41 to 1.13 (p< 0.001) and from 1.13 to 1.00 (p= 0.144). CONCLUSIONS: Patients with CLBP have a decreased strength in lumbar extension and flexion compared to the age-corrected normal values of Bionix Sim3 Pro. With increasing speed of testing protocol, a decrease in EFR is observed in this population.

Ergonomic and Biomechanical Analysis of the Manioc Root Harvest: Case Report

The aim of this case report was to evaluate the risks of musculoskeletal injuries from manual extraction of manioc roots in a Brazilian family farming production. It was used a lumbar extension isometric dynamometry, electromyography and infrared thermography of the surface at the back of the worker and the whole collection of data was made in loco. The results showed an increased temperature on the surface of the left lower back (+0.6 ℃), the values of isometric strength upon lumbar extension (143 ± 2.66 Kgf) and electromyography alteration in the muscles. The questionnaires indicate that the individual complains of discomfort along all of the back of his torso. The activity of manioc manual extraction can generate an overload on the lumbar and shoulder girdle muscles. It can affect the individual productive state.

Aged Lumbar Extension Strength of Chronic Low Back Pain in Korean Population of 10-80 Years

Background: The purpose of this study was to find the basic data of medical and exercise therapy by indexing lumbar extension muscle strength of low back pain (LBP) patients. Methods: In this cross-sectional study, 3078 chronic LBP participants from The J hospital, Seoul, Republic of Korea, from 2003 to 2010 were enrolled. Maximum muscle strength was measured at maximum flexion angle and maximum extension angle according to range of motion (ROM) results. For each isometric test, participants were seated and secured in the MEDX (medx lumbar extension machine, Ocala, FL, USA) machine. Results: The relative ROM (P=0.012) differed significantly among the aged groups in all participants. In addition, mean of strength (P<0.001), maximal of strength (P<0.001), mean of strength %BW (P<0.001) and maximal of strength %BW (P<0.001) are significant differences in all participants. The results of multiple regression analysis was the ‘model A’, maximal of strength for 32.1% of the variance in weigh, body mass index and range of motion. In addition, ‘model B’ was 30.4%, ‘model C’ was 28.8%, ‘model D’ was 28.5%, ‘model E’ was 21.7%, and ‘model F’ was 23.5% of the variance in weigh, body mass index and range of motion. Conclusion: We found the three predictor (weight, BMI, and ROM) variables accounted for 32.1% of the variance in maximal of strength %BW, the highest in < 29 yr groups. Our data indicate the basic data of medical and exercise therapy by indexing lumbar extension muscle strength of LBP patients.

Effect of Using an 8-Figure Shoulder Brace on Posture and Muscle Activities during the Performance of Dental Hygiene Procedures

The incidence of work-related musculoskeletal disorders (MSDs) among dental workers has been increasing. Many ergonomic devices and accessories have been introduced. The aim of this study was to investigate the effects of an 8-figure shoulder brace on posture-related muscle activities in dental hygiene practitioners during scaling procedures. In this study, 33 participants (age: 21.9 ± 2.1 years, height: 162.0 ± 6.0 cm, weight: 55.8 ± 9.0 kg, body mass index: 21.2 ± 2.4 kg/m2) performed the scaling procedure with and without the 8-figure shoulder brace in a randomized order. The normalized electromyography activity in the amplitude probability distribution function and joint angles (cervical, thoracic, lumbar, and shoulder joints) were simultaneously recorded during scaling. A paired t test was used to compare the differences in muscle kinematics, with the alpha level set at 0.05. The dental hygienists who wore the 8-figure shoulder brace during scaling showed thoracic and lumbar extension, improved sitting postures, and reduced shoulder joint abduction. However, we also observed an unintended increase in internal rotation. Use of the 8-figure shoulder brace could prevent work-related MSDs in lumbar and thoracic regions by reducing the effort exerted by the upper trapezius and deltoid muscles, despite the increased muscular effort of the cervical erector spinae.

An Evaluation of an Innovative Exercise to Relieve Chronic Low Back Pain in Sedentary Workers

Objective The purpose of the study was to examine the effectiveness of a novel supported dynamic lumbar extension with the abdominal drawing-in maneuver (ADIM) technique on stature change, deep abdominal muscle activity, trunk muscle fatigue, and pain intensity during prolonged sitting in chronic low back pain (CLBP) participants. Background Prolonged sitting can cause trunk muscle fatigue from continuous contraction of deep trunk muscles in seated postures. Deficiency of activity of deep muscles can reduce muscular support of the spine, causing stress on spinal structures, which could result in pain. Method Thirty participants with CLBP were randomly allocated: (a) control—sitting without exercise, and (b) intervention—supported dynamic lumbar extension with the ADIM technique. Results Compared to the intervention condition, the control condition demonstrated significantly greater deterioration in stature change, increased levels of deep trunk muscle fatigue, and an increase in pain during prolonged sitting. Conclusion The supported dynamic lumbar extension with the ADIM technique appears to provide a protective effect on detrimental stature change and deep trunk muscle fatigue. In addition, it prevented an increase in pain intensity during prolonged sitting in people with CLBP. Application Sedentary behavior harms health, particularly affecting the lower back. Clinicians can use the intervention to induce dynamic lumbar movement, and this exercise can maintain deep trunk muscle activity during prolonged sitting, thereby helping to prevent low back pain (LBP) problems.