स्पाइन जर्नल

Congenital vertebral anomalies are the collection of malformations of spine, which include alterations of the shape and number of vertebrae. Here is a case report of 15 years old male child with a combination of various vertebral anomalies such as hemi-vertebra, block-vertebra, butterfly vertebra, absence of S4 and S5 vertebras and the coccyx along with agenesis of left kidney who was detected by Karuna Foundation Nepal during its project instance.

LBP has been described as twentieth century health care disaster. Eighty percent (80%) of all adults have significant low back pain in their life time. The incidence of low back disability appears to have dramatically increased in Western society since about 1970. This is not indicative of an increase in prevalence of LBP but rather of an increase in work loss, sick certification, compensation, and a long-term disability awards. Almost anyone born today in Europe and North America has a great chance of suffering disabling back injury regardless of occupation. In the United States, LBP is the most common reason for activity limitation under the age of 45, and approximately 2% of the work force receives compensation for LBP annually. An estimated 1.3 billion days a year are lost from work because of LBP. Question and objective: To assess the role of exercises in chronic low back pain individuals. The purpose of this study: The purpose of this study is to validate and compare the effects of trunk balance exercises along with flexibility exercises and Strength training exercises along with flexibility exercises on pain and disability among chronic low back pain (CLBP) subjects. Design: Pre-test and post-test experimental study design. Participants: Chronic low back pain patients in the age group between 30-40 years, both males and females were included in the study predominantly White collar occupation. Intervention: Trunk balance exercises along with flexibility exercises for experimental group I and Strength training exercises along with flexibility exercises for experimental group II. Outcome measures: Pain was measured using visual analogue scale and Disability using Roland Morris Low Back Pain and Disability Questionnaire (RMQ). Results and Conclusion: Strength training exercises of the trunk and limbs along with flexibility exercises and Trunk balance exercises along with Flexibility exercises were effective in reducing pain and improving disability among CLBP subjects. When compared between groups between interventions there is no significant difference in reducing pain among chronic low back pain subjects (group A-trunk balance exercises along with flexibility exercises and group B-strengthening along with flexibility exercises) whereas there is significant difference between the groups in decreasing disability and so the trunk balance exercise with flexibility exercises is a superior choice in management of chronic low back pain.

A 74-year-old female with a 10-year history of Parkinson’s disease visited our hospital complaining of severe kyphoscoliosis deformity. Corrective spinal surgery was performed through a posterior approach. Oral anti-Parkinson medication was continued until the day of surgery, when continuous intravenous dopamine infusion was initiated; dopamine was discontinued and oral medication restarted on the day after surgery. Four weeks after surgery, the patient developed dyspnea. Laryngeal examination revealed rigidity of the neck muscles causing upper airway obstruction. Emergency tracheotomy was performed and the patient’s respiratory condition improved immediately. Because of difficulty of swallowing, gastrostomy was performed 2 weeks after tracheotomy. After tracheotomy and gastrostomy, the patient’s respiratory condition improved. Life-threatening upper airway obstruction can occur after corrective spine surgery in patients with Parkinson’s disease. It is important to ensure the oral administration of anti- Parkinson medication after surgery.

Introduction: To describe and discuss the diagnosis and chiropractic treatment of a patient with chronic idiopathic pudendal nerve entrapment that presented with saddle-like paresthesia and caused Restless Genital Syndrome.

Aim: A 43-year-old female patient had symptoms consistent with a pudendal nerve entrapment, saddle-like paresthesia, and restless genital syndrome for 1.5 years prior to starting care with a chiropractor. She had been to numerous medical providers, none of which offered the correct diagnosis or treatment options.

Methods and Results: Chiropractic manipulative therapy, myofascial release, and instrument-assisted soft-tissue mobilization was directed at the pelvic musculature with the primary focus on the right obturator internus. Through one month of chiropractic care the patient’s symptoms were resolved including restoration of regular sexual function.

Conclusion: Chronic perineal pain can be found in cases with numerous diagnoses, with pudendal nerve entrapment being one that is rarely documented. There are a wide variety of causes of PNE that include but not limited to direct injury, tumor, ganglion cysts, anatomical anomaly, and extended time cycling. Documented treatment for pudendal nerve entrapment is limited, primarily to pain injections. This case demonstrates how chiropractic care and soft tissue mobilization can correct the dysfunction.

Purpose: Total disc replacement must allow pain relief due to the resection of the painful disc, with preserving segmental mobility and function of the intervertebral joint. The aim of this study is to assess the efficacy and safety of a mobile-core lumbar prosthesis. This study reports both clinical (Part 1) and radiological (Part 2) assessments.

Method: Four hundred and eleven patients were included in a prospective and multicentric study with a 5-year follow-up. Radiological performance included mobility and lordosis of implanted segments. The occurrence of heterotopic ossification and the impact of the surgery on adjacent discs (motion and radiological signs of degeneration) were also explored.

Results: Restoration of segmental mobility (mean ROM=7.8 at 5 years), improvement and stabilization of lordosis as well as a reduced rate of heterotopic ossification were observed. Improvement of ROM in superior and inferior discs was observed but without hyper-mobility. Slight degeneration of superior and inferior discs was noted compared to preoperative status. The rate of reoperation on adjacent discs was low (3.2%).

Conclusion: This study showed satisfactory radiological results by restoring motion and preserving adjacent segments at 5 years’ follow-up and confirmed the safety and efficacy of this lumbar total disc prosthesis with specific controlled-mobility core.

Purpose: Total disc replacement is an alternative to arthrodesis in degenerative disc disease in young patients suffering from persistent chronic back pain refractory to conservative treatments. The aim of this study is to assess the efficacy and safety of a mobile-core lumbar prosthesis. This study reports both clinical (Part 1) and radiological (Part 2) assessments.

Methods: Four hundred and eleven patients were included in a prospective and multicenter study with 5-year follow-up. The clinical assessment investigated ODI, VAS (lumbar and radicular) score, quality of life (SF-36), medication consumption, professional status, and complication occurrence after surgery.

Results: ODI significantly decreased at 5 years after surgery with an average improvement of 27.3%. Low back pain and radicular pain significantly decreased. SF-36 significantly increased for both the mental and physical components. Medication consumption also significantly decreased at 5 years. Professional status was improved with an increase in the proportion of working patients and a decrease in sick leave up to 5 years after surgery. All complications were reported with an overall reoperation rate of 14.6% (regardless the cause and the level of the lumbar spine).

Conclusion: This study showed satisfactory clinical results and patient satisfaction at 5 years’ follow-up and confirmed the safety and efficacy of this lumbar total disc prosthesis with specific controlled-mobility core.

Microscopic lumbar spinous process–splitting laminectomy (LSPSL) has been previously reported as the least invasive surgery for patients with lumbar spinal canal stenosis (LSS). An 18-mm diameter tubular retractor was inserted between the split spinous processes and complete microscopic laminectomy performed in single-level decompressions. A cervical retractor was used to open the caudal parts of the individual halves of the spinous process through a single incision in multi-level decompressions. In this study, we examined long-term outcomes of patients undergoing microscopic LSPSL. Overall, 119 patients with a follow-up longer than 24 months were included in the study. All patients were divided into two groups: 1) the slip group, which included patients with spondylolisthesis-type LSS, and 2) the nonslip group, which included patients with spondylosis-type LSS. The clinical outcomes were evaluated using the Japanese Orthopedic Association score and improvement rate. The slip and instability rates were measured using radiographic imaging findings of the sagittal plane in patients in the slip group. Computed tomography was used to assess bony union of the split spinous process. Magnetic resonance imaging was used to evaluate signal changes of the multifidus muscle at different levels of LSPSL decompression. After LSPSL, pre-operative symptoms were improved with a significant difference in the Japanese Orthopedic Association score. The overall improvement rate was 62.2%; however, it was 48.6% in patients older than 79 years. No significant difference was seen in the slip or instability rate before and after LSPSL. The bony union rate of the split spinous process at the site between the process and the vertebral arch was 79.5%. Post-operative magnetic resonance imaging findings demonstrated a slight amount of fat infiltration in the multifidus muscles after LSPSL. In conclusion, the long-term outcome of patients undergoing LSPSL is satisfactory for a minimally invasive decompression surgery.

Total disc replacement has been developed as an alternative to fusion. However, several factors are associated with an inferior clinical mid-term outcome. There is a need for simple but well-defined preoperative factors, which have a predictive value and facilitate patient selection for lumbosacral total disc replacement (TDR). Therefore, in the present study we investigated preoperative radiological parameters to serve as predictors for the clinical outcome after TDR at the lumbosacral junction.

A total of 34 patients (16 females, 18 males) with the primary diagnosis of lumbosacral degenerative disc diseases who underwent TDR between 08/2005 and 12/2010 were evaluated in a clinical examination (Oswestry Disability Questionnaire (ODI) and visual analog scale (VAS) for overall, back, and leg pain) after a mean follow-up of 59.5 (24–87) months. A correlation analysis was performed between preoperative radiological parameters (segmental lordosis (SL), mean disc height (meanDH), anterior (aDH), middle (mDH), and posterior disc height (pDH) as well as geometrical relationships of these parameters: nA Index=aDH/meanDH, nP-Index=pDH/meanDH, AP-Index=aDH/ pDH, and nAP Index=aDH/pDH/meanDH) and clinical pain scales (ODI, VAS) at follow-up.

Particularly the relationships nA-Index, AP-Index, and nAP-Index were found to be strongly negatively correlated to the clinical outcome. Weaker correlation was found between: ODI and aDH, nA-Index, AP-Index (negative), and nP-Index (positive); VAS overall and SL, nP Index, mDH, and pDH (positive); and VAS back and nP-Index, and pDH (positive).

The preoperative normalized anterior-disc-height-index (nA Index) and the normalized anterior-posterior-discheight- index (nAP-Index) can serve as prognostic radiographic parameters before patients undergo lumbosacral TDR.

Background: Lumbar facet joint has been considered a significant source of chronic low back pain (LBP). Radiofrequency (RF) lumbar facet denervation is an effective treatment modality for patients with lumbar facet syndrome (LFS). We propose this protocol to study the effect of RF and the change in serum beta-endorphin level in the treatment of LFS.

Methods: This open-label, parallel, randomized controlled clinical trial enrolled patients with LFS. The study subjects were randomly assigned equally into two arms. The treatment arm received percutaneous RF and the control arm received medical treatment using non-steroidal anti-inflammatory drugs (NSAIDs). Patients were evaluated at days 0, 7 and 28 after randomization. Primary endpoints were the pain visual analogue scale on day 28. Secondary endpoints were visual analogue scale on day 7, quality of life evaluation using short-form 36 (SF-36) questionnaires and serum beta-endorphin level on days 0, 7 and 28.

Results: Until August of 2008, twenty-five patients were enrolled, including eleven in the treatment arm and fourteen in the control arm. Baseline characteristics between these two arms were comparable regarding age, sex, pain intensity, serum beta-endorphin level and short-form 36 score. The mean postoperative 7-day visual analogue pain scale for patients who had LBP in the control and treatment arm was 6.5 and 3.0. The mean postoperative 28-day visual analogue pain scale for patients who had LBP in the control and treatment arms was 6.0 and 2.5. On average, patients in the treatment arm had reduction of serum beta-endorphin compared to the control arm on day 7 (38.5% vs 0, p=0.141) and day 28 (37.9% vs 0, p=0.621).

Conclusion: RF lumbar facet denervation is an effective treatment modality and better than NSAIDs for patients with LFS. RF lumbar facet denervation demonstrated a trend to reduce serum beta-endorphin levels, although not statistically significant.