Histological characterization and biochemical analysis of paraspinal muscles in neuromuscularly healthy subjects.

Introduction: There are no generally accepted histopathological reference values in paraspinal skeletal muscle biopsies.

Methods: We examined multifidii muscle biopsies from 20 neuromuscularly healthy subjects using routine histological stains and biochemical analyses of respiratory chain enzymes.

Results: Staining showed incomplete myopathic features, such as increased variability in fiber size, type 1 hypertrophy, rounded fiber shape, endomysial fibrosis, and replacement by adipose tissue.

Circumferential dynamic stabilization of the lumbar spine: a biomechanical analysis.

Purpose: To assess segmental angulation and mobility following implantation of the Charité artificial disc in combination with the posterior dynamic fixation device dynamic stabilization system (DSS) and the interspinous spacer Coflex at the L4-L5 segment, respectively.

Methods: Six human L4-L5 specimens were loaded with pure moments of ±7.5 Nm in flexion/extension, lateral bending, and axial rotation in a custom-made spine tester.

Reliability of radiologic glenohumeral osteoarthritis classifications.

Background: This study was conducted to determine the intraobserver and interobserver reliability of glenohumeral osteoarthritis classification schemes.

Materials And Methods: The plain radiographs of 108 shoulder joints from 96 consecutive patients with glenohumeral osteoarthritis treated at our institution were graded into 6 classification systems by 2 observers on 2 occasions. The intraobserver and interobserver reliability of the classification schemes were determined by using Cohen's κ coefficient and weighted according to Landis and Koch.

Predictive value of preoperative clinical examination for subacromial decompression in impingement syndrome.

Purpose: Subacromial decompression is the standard surgical treatment of subacromial impingement syndrome. Unsatisfactory results have been reported for concomitant lesions as well as inadequate diagnosis. We sought to determine the predictive value of the preoperative examination for the results of arthroscopic subacromial decompression in impingement syndrome.

Prevalence of sleep deprivation in patients with chronic neck and back pain: a retrospective evaluation of 1016 patients.

Background: Chronic low back pain (CLBP) and chronic neck pain (CNP) have become a serious medical and socioeconomic problem in recent decades. Patients suffering from chronic pain seem to have a higher prevalence of sleep disorders.

Purpose: To calculate the prevalence of sleep deprivation in patients with CLBP and CNP and to evaluate the factors that may contribute to sleep impairment.

Radiation dose reduction in CT-guided sacroiliac joint injections to levels of pulsed fluoroscopy: a comparative study with technical considerations.

Background: The sacroiliac (SI) joint is frequently the primary source of low back pain. Over the past decades, a number of different SI injection techniques have been used in its diagnosis and therapy. Despite the concerns regarding exposure to radiation, image-guided injection techniques are the preferred method to achieve safe and precise intra-articular needle placement.

Effective Dose of CT-Guided Epidural and Periradicular Injections of the Lumbar Spine: A Retrospective Study.

Spinal injection procedures can be performed blindly or, more accurately, with fluoroscopic or computed tomography (CT) guidance. Radiographic guidance for selective nerve root blocks and epidural injections allows an accurate needle placement, reduces the procedure time and is more secure for the patient, especially in patients with marked degenerative changes and scoliosis, resulting in a narrowing of the interlaminar space. Limiting factors remain the availability of scanners and the radiation dose.

Radiation dose reduction in CT-guided periradicular injections in lumbar spine: Feasibility of a new institutional protocol for improved patient safety.

Background: Image guided spinal injections are successfully used in the management of low back pain and sciatica. The main benefit of CT-guided injections is the safe, fast and precise needle placement, but the radiation exposure remains a serious concern. The purpose of the study was to test a new institutional low-dose protocol for CT-guided periradicular injections in lumbar spine to reduce radiation exposure while increasing accuracy and safety for the patients.

Does the diagnosis influence the outcome in a multimodal outpatient pain management program for low back pain and sciatica? A comparative study.

The literature describes multimodal pain-management programs as successful therapy options in the conservative treatment of chronic low back pain. Yet, the intensity and inclusion criteria of such programs remain debatable. In many studies, the pain originating from spinal structures is described as nonspecific low back pain - a diffuse diagnosis without serious implications.

Intensive interdisciplinary outpatient pain management program for chronic back pain: a pilot study.

Background: Chronic back pain is relatively resistant to unimodal therapy regimes. The aim of this study was to introduce and evaluate the short-term outcome of a three-week intensive multidisciplinary outpatient program for patients with back pain and sciatica, measured according to decrease of functional impairment and pain.

Methods: The program was designed for patients suffering from chronic back pain to provide intensive interdisciplinary therapy in an outpatient setting, consisting of interventional injection techniques, medication, exercise therapy, back education, ergotherapy, traction, massage therapy, medical training, transcutaneous electrical nerve stimulation, aquatraining, and relaxation.

Effective radiation dose reduction in computed tomography-guided spinal injections: a prospective, comparative study with technical considerations.

Despite the good general patient acceptance, high patient comfort, safety and precision in the needle placement, exposure to radiation in computed tomography (CT)-guided spinal interventions remains a serious concern, and is often used to argue against its use. The aim of this study was to determine the technical possibilities of reducing the radiation dose in CT-guided epidural and periradicular injections in lumbar spine. We evaluated the possibilities of reducing radiation dose to the patient and operator during CT-guided injections on the lumbar spine using the following steps: significant reduction of the tube current and energy used for the topogram-acquisition, narrowing the area of interest in spiral CT-mode and reduction of tube current and radiation energy in the final intervention mode.

Diagnostic value of lumbar facet joint injection: a prospective triple cross-over study.

The diagnosis "lumbar facet syndrome" is common and often indicates severe lumbar spine surgery procedures. It is doubtful whether a painful facet joint (FJ) can be identified by a single FJ block. The aim of this study was to clarify the validity of a single and placebo controlled bilateral FJ blocks using local anesthetics.

Reliability of radiologic classification for cuff tear arthropathy.

Background: Several classification schemes have been proposed for cuff tear arthropathy and used for scientific and clinical purposes, even though their reliability has not been established and compared as of yet.

Materials And Methods: Two observers (O1 and O2) twice independently classified 52 shoulder radiographs into the cuff arthropathy schemes of Favard, Visotsky-Seebauer, Hamada, and Sirveaux. The schemes of Samilson and Prieto as well as Kellgren and Lawrence, commonly used for osteoarthritis of the shoulder, were also used for comparison.

Intraarticular lesions in calcifying tendinitis: incidence and association with the acromion index.

Introduction: Intraarticular pathologies are a common finding during arthroscopy for rotator cuff lesions. Both rotator cuff tears as well as cartilage lesions have been described as correlating with the acromion index.

Methods: In the current study, we aimed to determine the incidence of intraarticular lesions in calcifying tendinitis, to compare the incidence in patients with partial- and full-thickness tears of the rotator cuff, and to determine the acromion index in these groups.

The role of prosthesis design on segmental biomechanics: semi-constrained versus unconstrained prostheses and anterior versus posterior centre of rotation.

The purpose of this study was to evaluate the influence of different implant designs of total lumbar disc replacements on the segmental biomechanics of the lumbar spine. The unconstrained Charité, the semi-constrained Prodisc and a semi-constrained Prototype with more posterior centre of rotation than the Prodisc were tested in vitro using six human, lumbar spines L2-L5. The segmental lordosis was measured on plain radiographs and the range of motion (ROM) for all six degrees of freedom with a previously described spine tester.

Plain radiographs have limited sensitivity for glenohumeral cartilage lesions.

Glenohumeral cartilage lesions are frequently encountered during shoulder arthroscopy, but are not always represented on radiographs. We intended to define the diagnostic value of plain shoulder radiographs in detecting glenohumeral cartilage lesions. The radiographs of 167 patients undergoing shoulder arthroscopy were analyzed for signs of degenerative joint disease.

Resect or not to resect: the role of posterior longitudinal ligament in lumbar total disc replacement.

With regard to the literature, several factors are considered to have an impact on postoperative mobility after lumbar total disc replacement (TDR). As TDR results in a distraction of the ligamentous structures, theoretically the postoperatively disc height and ligamentous integrity have also an influence on biomechanics of a treated segment. The purpose of the study was to evaluate the influence of posterior longitudinal ligament (PLL) resection and segmental distraction on range of motion (ROM).

Early radiological outcome of ultrasound monitoring in infants with developmental dysplasia of the hips.

The purpose of this study was to evaluate the early radiological outcome after ultrasound-monitored treatment of developmental dysplasia of the hip (DDH) and to examine whether there was a correlation between the initial severity of DDH, measured by ultrasound, and the severity of residual dysplasia on the radiograph at the first follow-up. At the beginning of ultrasound-monitored treatment, the sonographic findings of 90 children (72 girls, 18 boys, mean age 7.2 weeks) with DDH (29 unilateral, 61 bilateral) were staged according to the Graf classification and assigned to four categories.

Infections after bone allograft surgery: a prospective study by a hospital bone bank using frozen femoral heads from living donors.

In the advent of the EU guidelines 2004/23/EG and 2006/17/EG requiring extensive safety and quality steps in bone banking, the prevalence and risk of infection disease transmission from bone allograft needs to be reconsidered. Therefore, we prospectively reviewed the screening process of bone donations and the outcome of surgeries utilizing bone allografts from our internal hospital bone bank with regard to infections according to CDC criteria. One-hundred and eighty-eight allogenic bone transplantation procedures in 160 patients were followed-up for 12-64 months (mean 32 months).

Index level mobility after total lumbar disc replacement: is it beneficial or detrimental?

Study Design: Analysis of segmental and total lumbar range of motion (ROM) before and after total lumbar disc replacement.

Objective: To examine the relationship between absolute segmental and total lumbar ROM and evolution of ROM on clinical outcome.

Summary Of Background Data: At the moment, data are scarce with regard to the evolution of total lumbar ROM (t-ROM) and segmental ROM (s-ROM) after total lumbar disc replacement.

Adjacent segment mobility after rigid and semirigid instrumentation of the lumbar spine.

Study Design: Retrospective radiographic analysis of lumbar spine range of motion (ROM) after monosegmental fusion and posterior dynamic stabilization at the level L4-L5.

Objective: Comparison of segmental ROM at the index level and the cranial and caudal adjacent levels and of global lumbar spine ROM after monosegmental fusion and posterior dynamic stabilization.

Summary Of Background Data: The postulated advantage of nonfusion technology compared with fusion is based on the assumption that preservation of motion at the treated segment reduces the incidence of adjacent segment effects.

Prognosis scores of Tokuhashi and Tomita for patients with spinal metastases of renal cancer.

Background: Retrospective evaluation of the prognosis scores of Tokuhashi and Tomita for life expectancy in 37 consecutive patients with spinal metastases secondary to renal cancer who underwent surgery. The score of Tokuhashi, composed of six parameters, each rated from zero to two, has been proposed in 1990 for the prognostic assessment of patients with spinal metastases. In 2001, Tomita et al.

Dynamic stabilization of the lumbar spine.

This study analyzed the outcome of patients treated with total disk replacement and posterior dynamic stabilization. For pathologies of different origin, dynamic stabilization of the lumbar spine is a novel alternative to fusion surgery. Although a physiological reconstruction of the sagittal profile was not always achieved, improvement was seen in all subscales of the clinical outcome measures in both treatment groups.