European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
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Comparative Study
The relationship of disability (Oswestry) and pain drawings to functional testing.
There was much enthusiasm about the development of computerized dynamometry in providing large quantities of data to objectively assess muscle performance. However, a much more basic issue arose questioning what these machines actual measure, particularly in pain populations. The purpose of the present study was to determine whether patients' self-reported disability and pain expression, as evaluated with simple questionnaires, were related to isokinetic performance in low back pain patients. ⋯ The results of this study indicate that isokinetic test values are significantly influenced by a patient's self-reported disability and pain expression, which can be evaluated using simple tools such as pain drawings and the Oswestry questionnaire. This study supports the supposition that dynamometry testing is related to factors other than muscle performance.
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Comparative Study
A method to evaluate the in vivo behaviour of lumbar spine implants.
The aim of the study was to design a method for evaluating the stabilizing effect of different lumbar spine implants in vivo, and to apply this method to a comparison of plates versus rods in lumbar spine posterolateral fusion using transpedicular screw fixation. Fourteen patients, seven operated on with transpedicular plates and screws (VSP), and seven operated on with rods and screws (Diapason), matched according to number of levels fused, had tantalum markers inserted in the vertebrae at surgery, enabling roentgen stereophotogrammetric analysis (RSA). Mean patient age was 45 (range 33-56) years. ⋯ One patient stabilized with rods and screws between L5 and S1 displayed a sagittal translation of 1.01 mm but no mobility along the transverse or vertical axes. In the remaining 13 patients, positional change from supine to standing did not provoke any intervertebral mobility above the RSA accuracy along any of the axes. With the limited provocation described, in line with the postoperative regimen for lumbar fusion patients, plates with transpedicular screws and rods with transpedicular screws both seem to give adequate intervertebral stability in posterolateral lumbar fusions.
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Scoliosis is a complex three-dimensional deformity of the spine and rib cage frequently treated by brace. Although bracing produces significant correction in the frontal plane, it generally reduces the normal sagittal plane curvatures and has limited effect in the transverse plane. The goal of this study is to develop a new optimization approach using a finite element model of the spine and rib cage in order to find optimal correction patterns. ⋯ The optimization produced an average of 56% and 51% reduction of the objective function respectively in the two studies. Optimal forces were mostly located on the convex side of the curve. This study demonstrates the feasibility of using an optimization approach with a finite element model of the trunk to analyze the biomechanics of bracing, and may be useful in the design of new and more effective braces.
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Comparative Study
Biomechanical evaluation of the New Zealand white rabbit lumbar spine: a physiologic characterization.
Physiologic motions of the human, sheep, and calf lumbar spines have been well characterized. The size, cost, and ease of care all make the rabbit an attractive alternative choice for an animal lumbar spine model. However, comparisons of normal biomechanical characteristics of the rabbit lumbar spine have not been made to the spines of larger species. ⋯ This relatively conserved physiologic flexibility supports the use of the rabbit as a model of the lumbar spine for kinematic studies. However, the overall NZ was found to be a greater percentage of ROM in the rabbit than the corresponding percentage in the human (60% as compared to 25%). This suggested that the rabbit lumbar spine has a greater laxity than that of the human.
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Case Reports
Pain pattern in multiple vertebral hemangiomas involving non-adjacent levels: report of two cases.
Hemangioma of the bone is a benign tumor usually involving the spine and the bones of the skull and pelvis. It may be either a single lesion or part of a generalized multifocal disease. Multiple lesions involving non-adjacent vertebrae are rare. ⋯ Investigation revealed multiple hemangiomas involving three non-adjacent vertebrae in the first patient and four in the second. We stress the fact that the existence of multiple non-adjacent lesions may remain undiagnosed for a considerable period of time and may be responsible for even longer-term recurrent episodes of pain. Multifocal location of back pain in patients with a known vertebral hemangioma may be considered a relative indication for the presence of multiple non-adjacent level lesions.