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 29,987 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This study focused on the electromyographic activity of the trunk musculature, given the well-documented link between occupational twisting and the increased incidence of low back pain. Ten men and 15 women volunteered for this study, in which several aspects of muscle activity were examined. The first aspect assessed the myoelectric relationships during isometric exertions. There was great variability in this relationship between muscles and between subjects. Further, the myoelectric activity levels (normalized to maximal electrical activity) obtained from nontwist activities were not maximal despite maximal efforts to generate axial torque (e.g., rectus abdominis, maximum voluntary contraction; 22% external oblique, 52%; internal oblique, 55%; latissimus dorsi, 74%; upper erector spinae [T9], 61%; lower erector spinae [L3], 33%). In the second aspect of the study, muscle activity was examined during dynamic axial twist trials conducted at a velocity of 30 and 60 degrees/s. The latissimus dorsi and external oblique appeared to be strongly involved in the generation of axial torque throughout the twist range and activity in the upper erector spinae displayed a strong link with axial torque and direction of twist, even though they have no mechanical potential to contribute axial torque, suggesting a stabilization role. The third aspect of the study was comprised of the formulation of a model consisting of a three-dimensional pelvis, rib cage, and lumbar vertebrae and driven from kinematic measures of axial twist and muscle electromyograms. The relatively low levels of normalized myoelectric activity during maximal twisting efforts coupled with large levels of agonist-antagonist cocontraction caused the model to severely underpredict measured torques (e.g., 14 Nm predicted for 91 Nm measured). Such dominant coactivity suggests that stabilization of the joints during twisting is far more important to the lumbar spine than production of large levels of axial torque.
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PMID:Electromyographic activity of the abdominal and low back musculature during the generation of isometric and dynamic axial trunk torque: implications for lumbar mechanics. 182 71

Study of the mechanics of trunk twisting is of special interest given epidemiological evidence linking occupational twisting to increased incidence of low back pain. An anatomically detailed, three-dimensional model of the trunk (rib cage, pelvis, five lumbar vertebrae and 50 muscles), was used to predict maximum axial trunk torque. Predicted axial torques were compared with measured torques. Thirty-one (10 male and 21 female) subjects performed maximum effort isometric twisting exertions, at 0 degrees of twist and +/- 30 degrees of twist together with dynamic exertions, at 30 degrees s-1 and 60 degrees s-1. Females were able to generate approximately two-thirds of the torque of males (males, 97Nm; females 60Nm, isometric at 0 degrees). When the trunk was prerotated to 30 degrees, subjects were able to generate greater torque when the effort was toward the 0 degree position (approximately 105Nm by males and 68Nm by females). Experimental data indicated that velocity of rotation and amount of twist are important modulators of axial torque. Changes in muscle length were demonstrated to be minimal from model output as most muscle length changes during a twist from 0 degrees to 30 degrees, measured between the pelvis and the shoulder harness, were less than 1%, although some portions of the abdominal obliques underwent a length excursion of 5%. The small changes in the individual muscle force components that contribute to twist, i.e. the muscle unit vector about the axial twist axis and its moment arm that change as a function of twisted position, do not entirely account for the measured differences in torque, suggesting that additional mechanisms influence axial torque generation.
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PMID:Measured and modelled static and dynamic axial trunk torsion during twisting in males and females. 221 28

Interbody cage devices, used to assist interbody fusion, are rapidly gaining popularity in the surgical management of chronic low back pain. This update provides a structural classification of commonly used devices and assesses them against a set of clearly defined surgical goals, including ability to correct the existing mechanical deformation, ability to provide mechanical stability, ability to provide a suitable environment for arthrodesis, and ability to limit "built-in" morbidity. In addition, the materials used in the devices are examined regarding their biomechanical, biologic, and radiographic characteristics.
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PMID:Spine update lumbar interbody cages. 1172 49

Fifteen patients with Meyerding I spondylolisthesis causing disabling lumbago underwent threaded fusion cage implantation at the unstable segments. Low back pain and intermittent claudication subsided in all patients postoperatively. The preoperative Japan Orthopaedic Association score was 11.5 on average, and improved to 23.5 after surgery. Five patients achieved significant resolution of preoperative symptoms, six improved reasonably, and four required less medication. There was no failure of fixation. No patient required supplemental fixation such as pedicle screws to achieve stable fusion. One patient had an inflammatory course but re-surgery was not necessary. The threaded fusion cage is an effective and promising device for the relief of low back pain when used to promote fusion of the lumbar spine in patients with low-grade spondylolisthesis.
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PMID:Threaded fusion cage for lumbar spondylolisthesis. 959 58

Anterior and posterior thoracic cage translations in the sagittal plane have not been reported for their range of motion and effects on the lumbar spine and pelvis. Twenty subjects volunteered for full-spine radiography in neutral, anterior, and posterior thoracic cage translation postures in a standing position. While grasping an anterior vertical pole, with hands at elbow level, subjects were instructed on how to translate their thoracic cage without any flexion/extension, utilizing a full-length mirror. On the radiographs, all four vertebral body corners of T1 through S1 and the superior margin of the acetabulum were digitized. Segmental and global angles of thoracic kyphosis, sagittal lumbar curvature, and pelvic flexion/extension in translation postures were compared to alignment in the neutral posture. Using the femur heads as an origin, the mean range of thoracic cage translation, measured as horizontal movement of T12 from neutral posture, was found to be 85.1 mm anterior and 73 mm posterior. In anterior translation, the thoracic kyphosis is hypokyphotic (Cobb T1-T12 reduced by 16 degrees). In posterior translation, the segmental angles at T12-L1 and L1-L2 flexed, creating an "S" shape in the sagittal lumbar spine, while the thoracic kyphosis increased by 10 degrees. Using posterior tangents from L1 to L5 and T12 to S1, and Cobb angles at T12-S1, the lumbar curve reduced slightly (by less than 3.3 degrees for all global angle measurements) in anterior translation and reduced by 7.4 degrees, 5.7 degrees, and 8.1 degrees respectively in posterior thoracic translation. The angle of pelvic tilt (measured as the angle of intersection of a line through posterior-inferior S1 to the superior acetabulum and the horizontal) reduced by a mean of 15.9 degrees, and Ferguson's sacral base angle to horizontal reduced by a mean of 13.1 degrees in posterior translation. In anterior translation, pelvic tilt and Ferguson's sacral base angle increased by 15.1 degrees and 12.8 degrees, respectively. The findings of this study show that thoracic cage anterior/posterior translations cause significant changes in thoracic kyphosis (26 degrees ), lumbar curve, and pelvic tilt. An understanding of this main motion and consequent coupled movements might aid the understanding of spinal injury kinematics and spinal displacement analysis on full spine lateral radiographs of low back pain and spinal disorder populations.
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PMID:How do anterior/posterior translations of the thoracic cage affect the sagittal lumbar spine, pelvic tilt, and thoracic kyphosis? 1210 99

Intervertebral disc has been shown to be related to low back pain and nerve root injury in pathologic conditions. However, little is known about its influence on spinal fusion. With the development of minimal invasive operations, such as laparoscopic anterior spinal fusion with cages, insufficient discectomy may occur. With its inflammatory properties, the residue nucleus pulposus may have an effect on spinal fusion. In this study, a two-level lumbar spine interbody fusion (L3/4, L5/6) with a Brantigan cage was performed on ten Danish Landrace pigs. Each level was randomly assigned to one of the following methods: (1) implantation of Brantigan cage filled with autogenous iliac crest bone graft, or (2) implantation of Brantigan cage filled with a mixture of autograft and the nucleus pulposus tissue harvested from the disc level in which it was to be inserted. Each level was stabilized with two staples. The pigs were followed for 12 weeks in the same standardized condition. After sacrifice, the lumbar spines were taken out, and plain X-ray, computed tomographic (CT) scanning and histomorphometry were performed to study the fusion mass inside the cages. From plain radiographs, new bone formation could be seen inside and around the cage. CT evaluation showed that the nucleus pulposus level had a 20% (2/10) fusion rate, while the pure autograft level had a 70% (7/10) fusion rate ( P=0.07). The histological fusion rate was even lower in the nucleus pulposus level (10%), and was significantly different from the autograft level (70%, P=0.02). Histomorphometric parameters of new bone formation, bone marrow space and fibrous tissue differed significantly between the two levels ( P=0.04; P=0.02; P=0.04 respectively). We conclude that when nucleus pulposus is mixed with the autogenous bone graft, it can delay or decrease the bone formation inside the cage, thus influencing the final fusion.
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PMID:The influence of intervertebral disc tissue on anterior spinal interbody fusion: an experimental study on pigs. 1238 57

Posterior lumbar interbody fusion (PLIF) using threaded cages has gained wide popularity for lumbosacral spinal disease. Our biomechanical tests showed that PLIF using a single diagonal cage with unilateral facetectomy does add a little to spinal stability and provides equal or even higher postoperative stability than PLIF using two posterior cages with bilateral facetectomy. Studies also demonstrated that cages placed using a posterior approach did not cause the same increase in spinal stiffness seen with pedicle screw instrumentation, and we concluded that cages should not be used posteriorly without other forms of fixation. On the other hand, placement of two cages using a posterior approach does have the disadvantage of risk to the bilateral nerve roots. We therefore performed a prospective study to determine whether PLIF can be accomplished by utilizing a single diagonal fusion cage with the application of supplemental transpedicular screw/rod instrumentation. Twenty-seven patients underwent a PLIF using one single fusion cage (BAK, Sulzer Spine-Tech, Minneapolis, MN, USA) inserted posterolaterally and oriented anteromedially on the symptomatic side with unilateral facetectomy and at the same level supplemental fixation with a transpedicular screw/rod system. The internal fixation systems included 12 SOCON spinal systems (Aesculap AG, Germany) and 15 TSRH spinal systems (Medtronic Sofamor Danek, USA). The inclusion criteria were grade 1 to 2 lumbar isthmic spondylolisthesis, lumbar degenerative spondylolisthesis, and recurrent lumbar disc herniations with instability. Patients had at least 1 year of low back pain and/or unilateral sciatica and a severely restricted functional ability in individuals aged 28-55 years. Patients with more than grade 2 spondylolisthesis or adjacent-level degeneration were excluded from the study. Patients were clinically assessed prior to surgery by an independent assessor; they were then reassessed at 1, 3, 6, 12, 18, and 24 months postoperatively by the same assessor and put into four categories: excellent, good, fair, and poor. Operative time, blood loss, hospital expense, and complications were also recorded. All patients achieved successful radiographic fusion at 2 years, and this was achieved at 1 year in 25 out of 27 patients. At 2 years, clinical results were excellent in 15 patients, good in 10, fair in 1, and poor in 1. Regarding complications, one patient had a postoperative motor and sensory deficit of the nerve root. Reoperation was required in one patient due to migration of pedicle screws. No implant fractures or deformities occurred in any of the patients. PLIF using diagonal insertion of a single threaded cage with supplemental transpedicular screw/rod instrumentation enables sufficient decompression and solid interbody fusion to be achieved with minimal invasion of the posterior spinal elements. It is a clinically safer, easier, and more economical means of accomplishing PLIF.
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PMID:Posterior lumbar interbody fusion using one diagonal fusion cage with transpedicular screw/rod fixation. 1270 55

Intervertebral cages in the lumbar spine represent an advancement in spinal fusion to relieve low back pain. Different implant designs require different endplate preparations, but the question of to what extent preservation of the bony endplate might be necessary remains unanswered. In this study the effects of endplate properties and their distribution on stresses in a lumbar functional spinal unit were investigated using finite-element analyses. Three-dimensional finite-element models of L2-L3 with and without a cage were used. An anterior approach for a monobloc, box-shaped cage was modelled. The results showed that inserting a cage increased the maximum von Mises stress and changed the load distribution in the adjacent structures. A harder endplate led to increased concentration of the stress peaks and high stresses were propagated further into the vertebral body, into areas that would usually not experience such stresses. This may cause structural changes and provide an explanation for the damage occurring to the underlying bone, as well as for the subsequent subsidence of the cage. Stress distributions were similar for the two endplate preparation techniques of complete endplate preservation and partial endplate removal from the centre. It can be concluded that cages should be designed such that they rely on the strong peripheral part of the endplate for support and offer a large volume for the graft. Furthermore, the adjacent vertebrae should be assessed to ensure that they show sufficient density in the peripheral regions to tolerate the altered load transfer following cage insertion until an adequate adaptation to the new loading situation is produced by the remodelling process.
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PMID:The importance of the endplate for interbody cages in the lumbar spine. 1278 87

Bovine biomechanical data have demonstrated adequate stability of a single threaded interbody cage when combined with a unilateral facet screw during posterior lumbar disc excision and interbody fusion (PLIF). Instrumented PLIF surgery using 1 versus 2 interbody cages was studied in 35 military men with disc disease and chronic low back pain. All patients underwent instrumented PLIF with bilateral diskectomy and partial facetectomy, pedicle screws, autogenous iliac crest bone graft, 1 or 2 interbody cages, and posterior lateral fusion. After an average of 15 months' follow-up, the 2-cage group had a higher rate of dural tear, but rates of other complications, hospital stay, fusion rates, pain levels, functional outcomes, and patient satisfaction were good and did not differ between groups. Costs were higher for the 2-cage group by 1728 dollars per patient.
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PMID:Are 2 cages needed with instrumented PLIF? A comparison of 1 versus 2 interbody cages in a military population. 1289 78

Emerging techniques for management of degenerative disc disease include modern fusion interbody cage devices, intradiscal electrothermal therapy, and disc prostheses among others. The management of discogenic low back pain is controversial: its accurate diagnosis is difficult, and treatment is inconsistent. Before wide application, the advantages and disadvantages of each procedure must be considered in lieu of inadequate study design and the lack of sufficient long-term outcome studies.
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PMID:Summary statement: emerging techniques for treatment of degenerative lumbar disc disease. 1289 70


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