جستجوی مقالات مرتبط با کلیدواژه « Lumbar Spine » در نشریات گروه « پزشکی »

The present research aimed to determine the prevalence and incidence rate of low back pain and injury in 12 Olympic sports athletes presenting to the injury surveillance system of the Sports Medicine Federation of Iran.

A retrospective analysis was conducted on the data of athletes from the injury surveillance system of the Sports Medicine Federation of Iran, for three years. Descriptive statistic was used for the study. 

The incidence rate of 6.7 injuries per 10000 athletes registered was calculated for low back complaints in 12 sports disciplines. Weightlifting, wushu, and judo had the highest, and gymnastic and soccer had the lowest low back injuries incidence. More than one-third of the low back complaints involved the lumbar spine. Also, females were at higher risk of low back pain and injury than males. Of age categories, adults and elderlies had the highest prevalence of low back complaints with more involvement in the lumbar spine. 

According to the results, wushu, judo, and especially weightlifting should be the priority of prevention. Furthermore, females and elderlies require more focus on preventive measures.

Chordoma is a rare bone cancer which arises from undifferentiated notochordal remnants in the axial skeleton. It generally has slow-growing and locally aggressive behavior. This tumor is usually diagnosed by CT and MRI modalities and the role of SPECT/CT is still debated. It shows reduced or normal uptake of radioisotope on bone scanning and increased tracer uptake is infrequently reported. Here we present a 33-year-old man with complaint of low back pain and numbness of his right leg. The whole body bone scan showed relatively uniform radiotracer activity throughout the skeleton. A focal increased uptake in the second lumbar vertebra was noted on SPECT/CT images. SPECT/CT also demonstrated multiple lytic lesions in lumbar vertebrae. The lesions were proven to be chordoma on biopsy. Lumbar chordoma could be one of the differential diagnoses for lytic lesions of the vertebrae which show absent or minimal tracer uptake on bone scintigraphy and SPECT/CT imaging. Our case was unusual as the patient was very young for chordoma diagnosis and bone scan showed increased uptake adjacent to the involved vertebral lesion detected by SPECT/CT.

Occupational whole body vibration (WBV) plays a major role in determining dynamic responses of the lumbar spine. WBV has been shown to cause low-back problems and degenerative disc diseases. Fusion surgery such as trans-formal lumbar inter-body fusion (TLIF) have been widely utilized to treat such disorders.

In this study, finite element method (FEM) was used to investigate dynamic responses of the lumbar spine due to WBV with the frequency in the range of regular physiologic activities after TLIF. A FE model of the L1-L5 lumbar spine was modeled and cyclic loading with the frequency of 1 Hz and 5 Hz were exerted to the model. Then, the disc bulge and stress distribution on the annual ground substance and vertebral bodies were measured.

It was observed that the maximum disc bulge (MDB) and maximum von-Mises stress (MMS) occurred in proportion to the loading frequency; overall, in the 5 Hz model, MDB and MMS were detected to happen 5 times more frequently as compared to the 1 Hz model. However, the magnitude of MDB and MMS were not generally affected by the loading frequency.

It can be concluded that different frequency of WBV, although in the physiologic range, can alter dynamic responses of the lumbar spine and, thus, their fatigue behavior. In the results can be of assistance to broaden the understanding regarding the dynamic responses of the lumbar spine during WBV after TLIF.

An oscillating bone saw is rarely used to perform laminectomy. The purpose of this study was to describea relatively quick and harmless technique for multilevel laminectomy in patients with lumbar spinal stenosis (LSS) usingan oscillating bone saw to find out how this instrument affects the time of surgery and rate of complications. This prospective study was conducted on 45 patients with LSS who required multilevel laminectomy. Thebones were cut using an oscillating sagittal saw equipped with a fine 1-cm blade. Posterolateral fusion was performed ifany evidence of spinal instability occurred, or the correction of deformity was addressed. The time spent for laminectomyfrom initial cutting to the whole bone removal (T1) and the duration of laminectomy (i.e., from initiation to the end ofdecompression; T2) were recorded for the corresponding level. The volume of harvested autograft was also measured,and any dural injuries were reported. Posterolateral fusion was performed on 32 (71.1%) patients. The mean T1 and T2 per level were estimated at70.5±5.4 and 157.5±12.1 sec, respectively. In addition, the mean volume of harvested autograft per level was obtainedas 3.5±1.2 cc. No durotomy was observed during laminectomy using an oscillating bone saw. However, a dural tearoccurred in one patient when a Kerisson punch was utilized for ligamentum flavum removal and foraminotomy. Based on the findings, it can be concluded that laminectomy by means of the oscillating bone saw is asafe procedure that provides a sufficient volume of harvested autograft for fusion. This technique could also induce aremarkable reduction in the time of surgery.Level of evidence: IV

The quality and condition of the human body are of particular importance. This is because the positive and negative changes resulting from this matter could affect other conditions. The skeletal condition of the spine is an essential part of a person’s physical condition. Recognizing correct positions has always attracted the attention of sports scientists. The present study reviewed the normative data of the thoracic and lumbar curvature.

We investigated the studies conducted from 1980-2016. We studied and used related articles that measured spinal curvatures and investigated invasive and non-invasive methods. The authors reported previous studies without any bias.

The obtained results indicated that spine norms are different in research reports. Thus, further investigating this subject is required for recognizing, categorizing, screening, and decreasing the prevalence of spinal deformities.

We reviewed the studies on the prevalence of spinal abnormalities and the provision of natural alignment and the extent of injury to the area in athletes. The relevant data suggested a great variation in applying measurement methods, as well as the homogeneity between the studied communities. Therefore, comparing the present results and categorizing studies should be performed with great caution.

Digital radiography possesses a wide dynamic range and has a major advantage in producing an acceptable image of diagnostic value even though overexposure occurs. Lumbar spine (LS) radiography is the most common examinations that gives high radiation dose to patients and accounts for the highest collective population dose of any conventional radiographic examinations. As such, this study was carried out to ascertain the impact of image quality and entrance surface dose (ESD) with different exposure settings in the anteroposterior (AP) and lateral LS.

The torso of the PBU-50 phantom was exposed to medium and high kilovoltage peak (kVp). A total of 14 images for LS were obtained. Relative image quality was assessed using Leeds Test Objects TOR CDR whilst the ESD was ascertained using an optically stimulated luminescence dosimeter.

The results of Friedman test indicated a significant difference in image quality when using medium and high kVp. Wilcoxon signed-rank test also reflected a significant difference in ESD between the use of medium and high kVp for both AP and lateral LS.

Significant differences in image quality and ESD were obtained using medium and high kVp with medium kVp resulting in high contrast but low contrast sensitivity and vice versa. The findings of the present study indicated that the recommended kVp for AP LS was from 75kVp to 81kVp whilst for lateral LS the recommended kVp was from 85kVp to 90kVp for an average adult patient.

There are many unanswered questions about the characteristics and mechanism of the lumbosacral scoliotic list (LSL). In the current study, the pattern of LSL, the level of maximal opened disc space (take-off) in addition to the relationship between the location of disc herniation (DH) on magnetic resonance imaging (MRI) and LSL direction on radiographs, were investigated. A total of 37 patients, with extruded lumbar DH and LSL, were included in the current study. The following variables were measured on standing anteroposterior and lateral lumbar x-rays: LSL (from L1 to L5), the take-off level, and the coronal shift (the distance between the plumb line from T12 spinous process to the central sacral vertical line). The direction of LSL was recorded as the bending side of the patient opposite to the convexity of the curve. The location of DH was determined as right, left, or central on an MRI. The magnitude of the LSL curve averaged 9.9° ± 6.9°. Regarding the right or left herniation, the list occurred mostly toward the opposite side of the herniation direction (P = 0.04). There was no significant matching between the location of herniation and the take-off segment (P = 0.391); however, in 67.6% of patients with L4 - L5 or L5 - S1 herniation, the take-off point occurred one segment above the involved levels. The take-off was found only at L3 - L4 or L4 - L5 levels in all the patients. LSL usually occurs on the opposite side of the herniation location. Furthermore, take-off is found in L3 - L4 or L4 - L5 segments in most of the patients with LSL. It seems that LSL curve characters are not affected by the level of herniation.

Static and dynamic postures of lumbopelvic in low back pain (LBP) are considered as two important aspects of clinical assessment and management of LBP. Thus, the focus of the current study was to compare the posture and compensatory strategy of hip and lumbar region during trunk flexion between LBP subgroupsand health subjects. LBP cases are subdivided into active extension pattern (AEP) and flexion pattern (FP) based on O’Sullivan’s classification system (OCS). This work was a cross-sectional study involving 72 men, 21 low back pain patients with FP and 31 low back pain patients with AEP and 20 healthy groups. Lumbar and hip angles during trunk flexion were measured by a 3D motion analysis system in neutral standing posture and end-range of trunk flexion. The participants were asked to full bend without any flexion of the knees. The bending speed was preferential. Hip and lumbar ranges of motion were divided into four quartiles (Q). The quartiles were compared between groups. Data analysis was performed using oneway analysis of variance (ANOVA) and independent t-test. There was no statistically significant difference in lumbar lordosis in standing and full trunk flexion positions between the healthy groups and heterogeneous LBP groups. In addition, there was not any statistically significant difference between the healthy group and the homogenous LBP group (FP and AEP). Moreover, no statistically significant difference was observed in hip angles during standing between the healthy group and the heterogeneous LBP group, and between the healthy group and the homogenous LBP group (FP and AEP). In full trunk flexion position, there was statistically significant difference in hip angles between the healthy group and the heterogeneous LBP group (P=0.026). In this position, the difference in hip angles between the healthy group and FP group was statistically significant (P<0.05). In the second Q, there was no significant difference between the healthy group and the heterogeneous LBP group (P=0.062), however, there was a significant difference between FP group and the healthy group in the fourth Q of the total hip range of motion. There was no statistically significant difference between the healthy group and the heterogeneous LBP group (P=0.054) but there was a difference between FP group and the healthy group. Lumbar/hip motion ratio (L/H ratio) was different between and within the subgroups in the second Q. This study supported the subgrouping of LBP and showed that the difference between subgroups could be determined effectively through subdividing the total range of lumbar and hip motions into smaller portions. It is possible that the neuromuscular system selects different strategies to compensate and prevent further injury of the chain components (muscle, joint, nerve and etc.).
Level of evidence: IV

Diffuse Idiopathic Skeletal Hyperostosis (DISH) is a very rare cause of dysphagia when it occurs in the cervical spine. It can also affect the lumbar region where it causes deformity.
Case Report: In this article, a rare case of Diffuse Idiopathic Skeletal Hyperostosis involving both the cervical and lumbar spine, presenting with dysphagia and spinal stiffness leading to a stooping posture, is reported.
Cases of simultaneous involvement of cervical and lumbar vertebrae by Diffuse Idiopathic Skeletal Hyperostosis, presenting with symptoms of both area involvement, are rarely reported in the English literature. When investigating a case of dysphagia, a high level of suspicion is required to diagnose such a condition.

Low back pain is one of the most common musculoskeletal disorders, and lifting is one of its risk factors. The activity of lumbar muscles as the main muscles involved in lifting is important with regard to identification of the allowable limits and the injury mechanisms as well as the motor control aspects. This study aimed to investigate the effect of the lifting speed on the lumbar muscles activities during the lifting of the light loads by squat method.
In this study, 27 healthy men were tested using electromyography (EMG). The data were collected from the erector spinae and the multifidus muscles. The signal processing was performed using MATLAB software after normalization to MVC and the statistical analysis was performed with SPSS 16.
The muscles activities at fast, medium, and slow speeds were not statistically significantly different (P>0.05), however, the difference between the numerical values of muscles activities at low and high speeds were clearly visible in the diagram. The highest activity was observed in multifidus muscles and then in erector spinae muscles.
The results indicated that the lifting speed does not have significant effect on the activity of lumbar muscles during the lifting of light loads, but it should be noted that it can be a risk factor in the long term for individuals who are lifting a lot of loads in a day.

To examine the hypothesis that diffusion weighted imaging (DWI) in lumbosacral region could reveal sciatic nerve course swelling that lead to lower extremity pain. The aim of present article was to find and evaluate the diffusion weighted coefficients (b-values) for scrutinizing sciatic nerve tract changes in lumbosacral region.

Lumbar area was imaged in 30 patients with lower extremity pain in one side (left or right) at 1.5 T MR with routine protocols and DWI. Two stages for processing images were generated. Distance of sciatic nerve fibers between all patients In terms of Gray level average (GLA) and Contrast average (CA) on each side were calculated by MATLAB software. An appropriate statistical test such as Paired T test was used and. P<0.05 was considered as significant

In the first stage of image processing there was no significant result in affected side rather than normal side. In the second stage, the mean b-value was significantly correlated with affected side that represent nerve swelling and the mean ADC was positively related to affected side. In b-value images, the diameter of affected side is greater than the healthy side and P<0.001 showed significant results. The CA of affected side is greater than healthy side and P<0.001 illustrated significant results. For GLA, statistics showed the greater values for affected side in comparison to healthy side and P<0.001 was significant.

Based on the results of present study, neurography is possible way to visualize early changes, such as nerve indentation and swelling, and to qualitatively evaluate affected lumbar nerves course in patients with lower extremity pains.

This study purposed to investigate the relationship between physical activity level and bone mineral density (BMD) in the elderly of Amirkola in northern Iran. This cross-sectional study was part of a proposal to assess the situation of the elderly in Amirkola (AHAP) (Amirkola Health and Ageing Project) conducted on 1113 elderly individuals (616 males and 497 females) in Amirkola city. Physical activity was measured using a standard questionnaire of physical activity in the elderly (Physical Activity Scale for Elderly). Mineral bone mass was measured using dual energy X-ray absorptiometry in the femur neck and lumbar spines, and vitamin D levels were measured in morning blood samples. T-test, ANOVA, Pearson correlation, and linear regression tests were used to analyze data. The mean physical activity of women (118.6±55.5) was higher than that of men (110.3±71.1) (p=0.035). This study found a significant positive relationship between total physical activity and femur bone mineral density (p=0.001 and r=0.101), but this association was not significant in lumbar spines (p=0.597 and r=0.016), though bone mineral density increased in both areas with increased physical activity (p=0.098). A significant inverse relationship between age and physical activity (p=0.001) and between age and bone mineral density (p=0.001) was observed. Analyzing the influencing variables using the linear regression model indicated physical activity, age, and BMI had significant relationships with bone mineral density in the femur, but neither vitamin D nor calcium played a role. Given the positive correlation between bone mineral density and physical activity, it can be concluded that low intensity weight-bearing activities carried out in compliance with safety rules may be suitable for the elderly.

MRI is a new and expensive diagnostic technology, which has been used increasingly all over the world. Low back pain is a worldwide prevalent disorder and MRI technique is one of the several ways to diagnose it. This paper aims to identify the appropriateness of lumbar spine MRI prescriptions in Shiraz teaching hospitals using standardized RAND Appropriateness Method (RAM) criteria in 2012. This study consisted of two phases. The first phase involved a qualitative enquiry and the second phase had a quantitative cross-sectional nature. In the first phase RAM was used for developing lumbar spine MRI indications and scenarios. In the second phase, the finalized scenarios were compared with the history and physical examination of 300 patients with low back pain. The rate of appropriateness of lumbar spine MRI prescription was then calculated. Of 300 cases of lumbar spine MRI prescriptions, approximately 167 (56%) were considered inappropriate, 72 (24%) were uncertain, and 61 (20%) were deemed to be appropriate. The economic burden of inappropriate prescriptions was calculated at 88,009,000 Rials. In addition, the types of expertise and physical examination were considered as related factors to appropriateness of prescriptions. In conclusion, a large proportion of lumbar spine MRI prescriptions, which result in financial burden on the insurance companies and the patients alike is unnecessary. This study suggests that policy makers consider this evidence while decision-making. Our findings highlight the imperative role of Health Technology Assessment (HTA) and Clinical Practice Guidelines (CPGs). As a result, developing local clinical guidelines may create the commitment needed in physicians in prescribing appropriate prescriptions within the health sector. The study further recommends that appropriate scenarios should be considered as a criterion for payment and reimbursement.