Diário da Espinha

Background and purpose: This case study reports patterns of muscle inhibition and techniques for therapeutic intervention in a well-trained cyclist with chronic low back pain (CLBP) following a discectomy at L5-S1. It has been shown that repeated or prolonged flexion can lead to inhibition of the spine stabilizing muscles. Competitive cyclists exert high effort in a flexed posture for prolonged periods. Segmental muscle inhibition could lead to LBP and segmental instability in this population. The purpose of our case study was 1) to determine if a competitive cyclist with CLBP would demonstrate muscle inhibition at the symptomatic level and 2) to determine if a therapeutic intervention (electrical muscle stimulation) applied to the symptomatic level for a short period, could affect function.

Methods: One subject, a 42-year-old male, rode a stationary bike trainer at various speeds and gear configurations for specified time periods. Surface EMG was recorded at L3-L4, L4-L5 and the L5-S1 segmental levels for 10 seconds during 7 trials. Electrical stimulation was applied in prone for a period of 15 minutes, using square waves with 120 ms pulse width at 35 Hz. Two cycling trials were conducted before therapeutic intervention and five were recorded after intervention.

Analysis/results: Analysis was performed using normalized RMS surface EMG. Therapeutic intervention, consisting of 15 minutes of electrical muscle stimulation, improved muscle recruitment at the symptomatic level to values better than adjacent segments. Further, this stimulation effect persisted up to 15 minutes while cycling continued. Discussion: Even though competitive cyclists are subjected to a flexed spine position for long periods of time, electrical stimulation may lead to improvement in lumbar muscle recruitment, and presumably to improved spinal stability and motor control. Further studies are needed to determine the optimal timing of stimulation and how long the effect can last under competitive conditions.

Conclusion: Cyclists with CLBP are at risk for inhibition of the lumbar stabilizing muscles. With electrical stimulation and proper rehabilitation, this inhibition may be reduced. Clinical Implications; This study exposes one of the neuromusculoskeletal risks competitive cyclists with CLBP can face, and proposes a relatively novel intervention. Further research is required to validate these results.

Despite of the fact that the earliest cases of Spinal Tuberculosis date from 2400 BC, the first modern description was made in 1779 by Sir Percival Pott in the European population. The improvement of public health measures and the introduction of effective anti-tuberculosis drugs have made the infection virtually eradicated in developed countries. However, migration phenomena, the infection by human immunodeficiency virus (HIV) and other causes of immunodeficiency as diabetes and cancer chemotherapy have led to a resurgence of tuberculosis in parts of the world where the disease was sporadic or unknown. It is currently considered a public health problem, both in developed and developing countries.

Recently the clinical and radiological features of Spinal Tuberculosis have changed considerably. Atypical presentations are more common nowadays. The improvement of diagnosis and terapeutic management has lead to better clinical outcomes. However, early diagnosis and appropriate treatment remain the mainstay predictors of successful outcomes, preventing the most serious complications of Spinal Tuberculosis: neurological deficits and spinal deformities.

The main aim of this review is to discuss the historical aspects of the disease management as well as the most recent challenges. The authors included articles with acceptable design, clearly explained results and justified conclusions according to the data, regardless of their time of publication.

Objectives:

1. To evaluate the socio-economic impact of the addition of fluoroscopic guidance to the lumbar puncture procedure through our institutional series from 2010 to 2013.

2. To investigate the increased cost and socio-economic impact associated with fluoroscopic guidance, which at our institution is used after failure of blind procedure.

3. To describe the utility of standardized training to decrease the number of failed bedside lumbar Patients and methods: A retrospective analysis of 211 lumbar punctures from LSU Health Sciences in Shreveport, LA was analyzed under the current neuroendovascular faculty (2010-2013) via use of billing data. Results were restricted to lumbar punctures performed for diagnostic (CPT 62270) or therapeutic codes (62272) with the addition of fluoroscopic guided placement of needle (77003). Neurosurgical resident lumbar punctures are not billed for by the department and therefore are not accounted for in analysis.

Results: 88 lumbar punctures performed were diagnostic and 123 were billed as therapeutic. 93 cases were done with addition of fluoroscopic guidance either directly from neurosurgical resident blind procedure failure or consulting service blind procedure failure. 70 patients were free care with no charge. The department billed $80,469 and collected $13,004 for the actual lumbar puncture procedure (62270 and 62272). The average additional billing cost for fluoroscopic guidance was $356. However, of the additional $41,649 billed only $2014 was collected. For the additional use of fluoroscopy, the mode for Medicaid re-imbursement was $19 and for Medicare was $41. This does not take into account the additional use of radiology technologists, procedural nursing, and recovery nursing.

Conclusion: This study is limited by information available for retrospective review. Fluoroscopic guided lumbar punctures utilize skills and procedural time of the neuro-interventionalist. Focused standardized training of residents, which has been proven to improve lumbar puncture success outcomes, would reduce the use of these valuable resources.

Background: The prevalence of postural changes is increasingly evident in our society, early detection plays an extremely important role in preventing complications in adult life. Thus, the objective of this study was to analyse the prevalence of postural deviation and risk factors in 2nd cycle students. Sample of 19 students aged between 10 and 11 years old.

Methodology: The collection methods used were postural evaluation through SAPO software, analysis of plantar pressure by Podoprint software and behavioural risk factors through the Back PEI questionnaire.

Results: The prevalence of postural deviations found in all body segments (pelvis, neck, shoulders, trunk, feet, and center of gravity) occurred in more than 70% of participants. Regarding the distribution of the plantar pressures and the maximum pressure point, the majority of individuals had the highest-pressure area in both heels and a high prevalence of foot cavus. 84.2% had a BMI below normal, and 57.9% had severe thinness. Most students take an improper posture when sitting at the table and lifting objects off the floor.

Conclusion: Several aspects related to the postural postures and habits of the children are determinant for the musculoskeletal development, especially in the period of osteoarticular growth, when the equilibrium search for the new proportions of the body occurs. This high prevalence of postural deviations, both lateral and anteroposterior, in the present study, the results obtained by other authors report a prevalence of around 70% for postural changes in children and adolescents.

Between the 80% and 90% of vertebral fractures in over 65 years people are due to osteoporosis. Over the 30% of patients affected by vertebral osteoporosis fractures needs of surgical treatment and the 12% presents complications requiring an invasive surgical approach. We report an unusual case of spontaneous corpectomy and anterior arthrodesis occurred in a patient suffering from Ankylosing Spondylitis. This event invites us to reflect about the magnitude of the biological power of the bone healing, even in adverse conditions

Surgery of lumbar disc herniation is most common procedure in neurosurgical practice. However poor outcomes, recurrent disc herniation and recurrence of low back and leg pain which affect quality of life, are still challenging. Lumbar spine instability develops as a result of a gradual degenerative process and lumbar segmental instability is one of main reason of failed back surgery. Presence of lumbar segmental instability or potential secondary instability after surgery should not be overlooked. Accurate preoperative evaluation of patients with lumbar disc herniation needs to understand biomechanics of spinal stability and predict possible result of postoperative instability. Thus failure of treatment modalities can be avoided.

Spinal cord contusion was an injury that had never been effectively treated. The general pathology of the spinal cord contusion had long been studied and published. The major point is that after spinal cord contusion there develops a secondary injury with a necrotic center, which induces gradual expansion of the injury. The logical treatment should be debridment of the necrotic center to terminate further expansion. An early neurosurgery of the spinal cord contusion was designed and practiced clinically. Basically, MRI to determine the level of spinal cord contusion, make a longitudinal incision of the dura mater to expose the injured part of spinal cord. Debride ts necrotic tissue. The operation was followed by intensive rehabilitation for three months. Thirty ASIA-A grade patients were admitted. All the patients resumed certain degree of walk ability. The best result occurred in 13 patients operated 4-14 days after injury (the optimal operation time window). Eleven of the 13 cases were able to walk with a pair of crutches or even to walk without any support.

A laboratory of cellular and molecular biology was established to study the mechanism of spinal cord injury. It has an SPF laboratory for making transgenic/knock-out mice, and SPF animal housing rooms with a maximum capacity of 8,000 mice.

In all, 103 SCI articles on spinal cord injury have been published.

The main aim of this article is to review the knowledge about the closure defect of the vertebral column calls spina bifida. The anatomic, embryologic and molecular biologic knowledge about this condition is reevaluated with checking the contentful dry bone collection. Determined spina bifida samples, types in any part of vertebral column reviewed under the light of increasing recent literature. The review also gives attention to the cervical, thoracic regional, anterior and partial closure defect possibilities and clinical conditions, which are not emphasized adequately and are thought as a separate case status but are severe or mild types of spina bifida. Most common sites, especially sacral region of spina bifida and present incidence in different nations assessed and compared with our dry bone series. Regional incidence, types and clinical conditions of spina bifida reviewed under the light of the recent embryologic and molecular biologic studies. This review will give tidy think and aspect of morphology and clinics of spina bifida throughout of the vertebral column.

Low back pain (LBP) has become a growing and serious public health problem in children and adolescents, presenting a relatively high prevalence during school age, representing a significant negative impact, being commonly associated with the demand for health care, medication use, increasing absenteeism and with a decrease in quality of life. Because of that, the presence of LBP can lead to very high economic consequences, both due to direct financial costs and due to absenteeism. Most cases of LBP are due to non-specific causes; however, the role of these risk factors is still controversial. Several factors may be involved in the pathogenesis of LBP, such as physical, genetic, mechanical, behavioural, and environmental factors. The school environment, including the postures adopted by students and the transportation of backpacks, and some lifestyle habits are factors that can also contribute to the development of these musculoskeletal disorder. Against this scenario, it´s necessary to promote intervention actions with the objective of promoting and preventing health, considering that most health problems and risk behaviors, which are associated with the environment and lifestyles modifiable risks, can be minimized, or prevented by increasing health literacy; this intervention actions mus involved not only students but the entire school community.

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