| 1. |
- Andersson, Eva A, et al.
(författare)
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Diverging intramuscular activity patterns in back and abdominal muscles during trunk rotation.
- 2002
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Ingår i: Spine. - : Ovid Technologies (Wolters Kluwer Health). - 1528-1159 .- 0362-2436. ; 27:6, s. E152-60
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Tidskriftsartikel (refereegranskat)abstract
- STUDY DESIGN: An intramuscular electromyographic study was performed on trunk rotations during sitting and standing. OBJECTIVE: The aim was to provide new information on activation levels for deep trunk muscles in various unresisted and resisted trunk rotations. SUMMARY AND BACKGROUND DATA: Frequent daily trunk twisting and decreased maximal strength during trunk rotation have been associated with low back pain or sciatic pain. However, the involvement of deep trunk muscles during different trunk rotations is relatively unknown. METHODS: Ten healthy subjects participated. Fine-wire electrodes were inserted, under ultrasound guidance, into psoas, quadratus lumborum, the superficial medial lumbar erector spinae (ES-s, multifidus) and its deep lateral portion (ES-d, iliocostalis), iliacus, rectus abdominis, obliquus externus, and obliquus internus. RESULTS: The highest involvement for all muscles was observed on the ipsilateral side, in maximal trunk twists with shoulder resistance, except obliquus externus, which showed a dominant contralateral side, and rectus abdominis, which was little activated in all rotations. In contrast, maximal trunk twist without shoulder resistance, i.e., freely performed, resulted generally in lower levels for all muscles involved and in a shift of side dominance for the lumbar muscles quadratus lumborum, psoas, and ES-s. CONCLUSIONS: During trunk rotations the activity patterns for various trunk muscles could drastically change, and even be the opposite, between the two body sides, within the same type of task, depending on several factors such as initial position, effort level, sitting or standing, and external shoulder resistance.
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| 2. |
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| 3. |
- Bauer, H
(författare)
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Surgical strategy for spinal metastases
- 2002
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Ingår i: Spine. - : Ovid Technologies (Wolters Kluwer Health). - 1528-1159 .- 0362-2436. ; 27:10, s. 1124-1125
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 4. |
- Brolin, Karin, et al.
(författare)
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Development of a finite element model of the upper cervical spine and a parameter study of ligament characteristics
- 2004
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Ingår i: Spine. - 0362-2436 .- 1528-1159. ; 29:4, s. 376-385
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Tidskriftsartikel (refereegranskat)abstract
- Study Design. Numeric techniques were used to study the upper cervical spine. Objectives. To develop and validate an anatomic detailed finite element model of the ligamentous upper cervical spine and to analyze the effect of material properties of the ligaments on spinal kinematics. Summary of Background Data. Cervical spinal injuries may be prevented with an increased knowledge of spinal behavior and injury mechanisms. The finite element method is tempting to use because stresses and strains in the different tissues can be studied during the course of loading. The authors know of no published results so far of validated finite element models that implement the complex geometry of the upper cervical spine. Methods. The finite element model was developed with anatomic detail from computed tomographic images of the occiput to the C3. The ligaments were modeled with nonlinear spring elements. The model was validated for axial rotation, flexion, extension, lateral bending, and tension for 1.5 Nm, 10 Nm, and 1500 N. A material property sensitivity study was conducted for the ligaments. Results. The model correlated with experimental data for all load cases. Moments of 1.5 Nm produced joint rotations of 3degrees to 23degrees depending on loading direction. The parameter study confirmed that the mechanical properties of the upper cervical ligaments play an important role in spinal kinematics. The capsular ligaments had the largest impact on spinal kinematics (40% change). Conclusions. The anatomic detailed finite element model of the upper cervical spine realistically simulates the complex kinematics of the craniocervical region. An injury that changes the material characteristics of any spinal ligament will influence the structural behavior of the upper cervical spine.
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| 5. |
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| 6. |
- Daggfeldt, Karl, et al.
(författare)
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The visible human anatomy of the lumbar erector spinae.
- 2000
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Ingår i: Spine. - : Ovid Technologies (Wolters Kluwer Health). - 0362-2436 .- 1528-1159. ; 25:21, s. 2719-25
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Tidskriftsartikel (refereegranskat)abstract
- STUDY DESIGN: Image data of the male and female cadavers from the Visible Human Project were visualized and quantified. OBJECTIVE: To clarify the anatomy of the lumbar part of the human lumbar erector spinae muscles. SUMMARY OF BACKGROUND DATA: Recent studies have shown discrepancies in the description of the anatomy of the lumbar part of the lumbar erector spinae. The main differences concern whether lumbar fascicles of iliocostalis lumborum exist and whether the lumbar fascicles have direct attachments to the ilium or attach via the erector spinae aponeurosis. With the Visible Human Project from the U.S. National Library of Medicine, a new powerful basis for anatomic investigation has become available. METHODS: Software was produced to visualize sections oriented in any direction and with maximum resolution of the Visible Human male and female. Three-dimensional coordinates of anatomic structures in the image space could be marked in the cross-sectional images. The geometry and the physiologic cross-sectional areas of the erector spinae fascicles of lumbar origin were thus derived. RESULTS AND CONCLUSIONS: The study supports a classification of the lateral fascicles of the lumbar part of the lumbar erector spinae as part of iliocostalis lumborum. In both the male and the female, a large part of the erector spinae fibers of lumbar origin attached to the erector spinae aponeurosis. These results are of importance for biomechanical analysis of force transmission in the lumbar spine.
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| 7. |
- Danielsson, Aina, 1953, et al.
(författare)
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Back pain and function 22 years after brace treatment for adolescent idiopathic scoliosis: A case-control study - Part I
- 2003
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Ingår i: Spine. - 0362-2436. ; 28, s. 2078-2085
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Tidskriftsartikel (refereegranskat)abstract
- Study Design. A consecutive series of patients with adolescent idiopathic scoliosis and brace-treated (BT) between 1968 and 1977 before age 21 years (BT: n = 127; 122 females and 5 males) were followed-up at least 20 years after completion of the treatment. Objectives. To determine the long-term outcome in terms of back pain and function in patients BT for adolescent idiopathic scoliosis. Summary of Background Data. Few reports on long-term outcome of back pain and function have previously been presented for consecutive groups of these patients. Materials and Methods. One hundred ten (87%) BT patients were reexamined as part of an unbiased personal follow-up. This included a clinical examination, evaluation of curve size (Cobb method), and degenerative findings in full standing frontal and lateral radiographs. Validated questionnaires in terms of general and disease-specific quality-of-life aspects as well as present back and pain symptoms were used. One hundred nine had complete follow-up. An age- and sex-matched control group of 100 persons was randomly selected and subjected to the same examinations. Results. The deterioration of the curves was a mean of 7.9 degrees for all curves, excluding the only patient who underwent operation after 4 years (increase = 27 degrees). The patients had significantly more degenerative disc changes than the controls. Lumbar and thoracic back pain, although mild (2.7 on visual analogue scale), was significantly more frequent among the patients than the controls (75 vs. 47%, P = 0.0050 and 35.8 vs. 22.0%, P = 0.033, respectively). Only 24% of the patients admitted daily pain and analgesics were sparsely used. The patients had a slightly, but significantly, worse back function as measured by the Oswestry Disability Index (9.2 vs. 4.8, P = 0.0012) and general function score (7.7 vs. 4.2, P = 0.0006), but general health-related quality of life was not affected. No differences could be seen in sociodemographic variables between the groups, except for having ever been on sick leave because of the back (38% vs. 19%, P = 0.0036). Furthermore, no differences could be found between patients with different curve types (single thoracic, n = 50; lumbar, n = 19; double curves, n = 40). No correlation could be found between pain and its localization and curve size, an increase of at least 10 degrees since end of treatment, curve type, degenerative changes on any of the two lowest lumbar disc levels, body mass index, or smoking. Conclusions. More than 20 years after brace treatment for AIS, minimal pain and no dysfunction occurred compared with normal controls. Compared with surgically treated patients with a mean end result similar to this group, no significant differences were found except that BT patients experience more affective components of their pain.
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| 8. |
- Danielsson, Aina, 1953, et al.
(författare)
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Childbearing, curve progression, and sexual function in women 22 years after treatment for adolescent idiopathic scoliosis: a case-control study.
- 2001
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Ingår i: Spine. - 0362-2436. ; 26:13, s. 1449-56
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Tidskriftsartikel (refereegranskat)abstract
- A consecutive series of female patients with adolescent idiopathic scoliosis treated between 1968 and 1977, either with distraction and fusion using Harrington rods (n = 145) or with a brace (n = 122), were followed for at least 20 years after completion of the treatment.To determine the long-term outcomes of childbearing and sexual life in women treated for adolescent idiopathic scoliosis, as compared with matched control subjects who did not have scoliosis.The effect of pregnancy on curve progression is not established, and results are contradictory. Few reports exist on the social life (marriage, childbearing, and sexual function) of formerly treated individuals with scoliosis.In this study, 136 surgically treated women (94%) and 111 brace-treated women (91%) completed the Scoliosis Research Society (SRS)/MODEM's questionnaire concerning childbearing and sexual life as a part of an unbiased personal follow-up examination. Of these, 129 surgically treated and 105 brace-treated women also underwent a radiographic examination. The Cobb method was used to measure curve size in present and earlier examinations. An age-matched control group of 90 women was randomly selected and subjected to the same examinations.The mean age for all the groups was 40 years. Of the surgically treated and brace-treated women, 85% were or had been married, as compared with 82% of the control women. In the total cohort, 628 pregnancies had occurred. No significant mean difference existed between the groups in the number of children born (1.8 for the surgically treated, 1.9 for the brace-treated, and 2 for the control women) (P = 0.25). The patients in the brace-treated group had a significantly higher mean age at first pregnancy (28 years) than the control subjects (25.9 years) (P = 0.011), whereas the age for the surgically treated women (26.6 years) did not differ significantly from that for the brace-treated women. There were no significant differences between the groups in rates for low back pain (35% for the surgically treated, 43% for the brace-treated, and 28% for the control group) or for cesarean section (19% for the surgically treated, 14% for the brace-treated, and 18% for the control group) during the first pregnancy. The rate of vacuum extractions was higher in the surgically treated group (16%) than in the control group (5%) (P = 0.036) or the brace-treated group(8%). Limitation of sexual function from the back was admitted by 33% of the surgically treated, 28% of the brace-treated, and 15% of the control women: surgically treated vs control subjects (P = 0.0042), brace-treated vs control subjects (P = 0.026), and brace-treated vs surgically treated subjects (P = 0.57, a nonsignificant difference). These limitations were largely because of difficulties participating physically in activities or self-consciousness about appearance. Pain was a minor reason for limitation. There was no correlation between progression of the major or lumbar curve and number of pregnancies, or between curve progression and age at first pregnancy.Patients treated for adolescent idiopathic scoliosis appeared to function well with regard to marital status and number of children. The scoliotic curve did not seem to increase as a result of childbearing. Minor problems occurred during pregnancy and delivery. Some patients, however, experienced a slight negative effect in their sexual life.
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| 9. |
- Danielsson, Aina, 1953, et al.
(författare)
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Radiologic findings and curve progression 22 years after treatment for adolescent idiopathic scoliosis: comparison of brace and surgical treatment with matching control group of straight individuals.
- 2001
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Ingår i: Spine. - 0362-2436. ; 26:5, s. 516-25
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Tidskriftsartikel (refereegranskat)abstract
- This study is a follow-up investigation for a consecutive series of patients with adolescent idiopathic scoliosis treated between 1968 and 1977. In this series, 156 patients underwent surgery with distraction and fusion using Harrington rods, and 127 were treated with brace.To determine the long-term outcome in terms of radiologic findings and curve progression at least 20 years after completion of the treatment.Radiologic appearance is important in comparing the outcome of different treatment options and in evaluating clinical results. Earlier studies have shown a slight increase of the Cobb angle in brace-treated patients with time, but not in fused patients.Of 283 patients, 252 attended a clinical and radiologic follow-up assessment by an unbiased observer (91% of the surgically treated and 87% of the brace-treated patients). This evaluation included chart reviews, validated questionnaires, clinical examination, and full-length standing frontal and lateral roentgenographs. Curve size was measured by the Cobb method on anteroposterior roentgenograms as well as by sagittal contour and balance on lateral films. The occurrence of any degenerative changes or other complications was noted. An age- and gender-matched control group of 100 individuals was randomly selected and subjected to the same examinations.The mean follow-up times were 23 years for surgically treated group and 22 years for brace-treated group. The deterioration of the curves was 3.5 degrees for all the surgically treated curves and 7.9 degrees for all the brace-treated curves (P < 0.001). Five patients, all brace-treated, had a curve increase of 20 degrees or more. The overall complication rate after surgery was low: Pseudarthrosis occurred in three patients, and flat back syndrome developed in four patients. Eight of the patients treated with fusion (5.1%) had undergone some additional curve-related surgical procedure. The lumbar lordosis was less in the surgically treated than in the brace-treated patients or the control group (mean, 33 degrees vs 45 degrees and 44 degrees, respectively). Both surgically treated and brace-treated patients had more degenerative disc changes than the control participants (P < 0.001), but no significant differences were found between the scoliosis groups. No statistically significant difference in terms of radiographically detectable degenerative changes in the unfused lumbar discs was found between patients fused below L3 or those fused to L3 and above (P = 0.22). A study on intra- and interobserver measurements of kyphosis, lordosis, and sagittal vertical axis on two films for each patient demonstrated that the repeatability of measuring sagittal plumbline on two different lateral radiographs, with patients moving between radiograms, was unreliable for comparison.Although more than 20 years had passed since completion of the treatment, most of the curves did not increase. The surgical complication rate was low. Degenerative disc changes were more common in both patient groups than in the control group.
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| 10. |
- Enthoven, Paul, 1955-, et al.
(författare)
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Clinical course in patients seeking primary care for back or neck pain : a prospective 5-year follow-up of outcome and health care consumption with subgroup analysis
- 2004
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Ingår i: Spine. - : Ovid Technologies (Wolters Kluwer Health). - 0362-2436 .- 1528-1159. ; 29:21, s. 2458-2465
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Tidskriftsartikel (refereegranskat)abstract
- Study Design. Prospective follow-up.Objective. To describe the 5-year clinical course in a cohort of patients treated for back or neck pain in primary care and compare results with the 1-year outcome both for the whole group and for subgroups.Summary of Background Data. A randomized study showed a decrease in perceived pain and disability after treatment by chiropractic or physiotherapy, but many reported recurrence or continual pain at the 1-year follow-up. Knowledge of the clinical course over longer follow-up periods is limited.Methods. A 5-year follow-up questionnaire was sent to 314 individuals. Main outcome measures were pain intensity, Oswestry score, and general health. Recurrence, health care consumption, and other measures were described.Results. Fifty-two percent of respondents reported pain (visual analog scale, >10 mm) and back-related disability (Oswestry, >10%) at the 5-year follow-up. This was similar to 1-year results, and 84% of these were the same individuals. Sixty-three percent reported recurrence or continual pain, and 32% reported health care consumption at the 5-year follow-up.Conclusions. In a cohort of individuals of working age seeking primary care for nonspecific back or neck pain, it can be expected that about half of the population will report pain and disability at the 5-year follow-up. A significant proportion will report recurrence or continual pain and health care consumption. Pain and disability were associated with recurrence or continual pain and health care consumption. Further analysis is needed to identify additional predictors for 5-year outcome, taking into account 1-year follow-up results. Since many patients will have recurrence or continual pain, health policies and clinical decision models for long-term outcome must allow for these aspects.
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