| 1. |
- Baranto, Adad, 1966, et al.
(författare)
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Acute chest pain in a top soccer player due to thoracic disc herniation
- 2009
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Ingår i: Spine (Phila Pa 1976). - 1528-1159. ; 34:10
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Tidskriftsartikel (refereegranskat)abstract
- STUDY DESIGN: Case report. OBJECTIVE: An unusual and previously not reported case of upper thoracic disc herniation combined with acute chest pain, is presented. SUMMARY OF BACKGROUND DATA: Disc herniation in the thoracic spine is rare. There are only a few cases of thoracic disc herniation in top athletes presented in the literature. The clinical presentation of a thoracic disc herniation can vary widely depending on its location and morphologic characteristics. Clinically, the acute symptoms may be severe. METHODS: A 24-year-old soccer player with acute left-sided chest pain that started in the middle of a soccer game has been followed clinically and with MRI examinations for 3 years. RESULTS: MRI of the thoracic spine showed a left-sided paramedial disc herniation at T2-T3 level and the right-sided paramedial disc herniation at T3-T4 level. The player was prescribed initial rest and subsequent physical rehabilitation. He had no further symptoms during rehabilitation to full training, and could resume play and remained symptom free for the rest of the season.The following season, the player experienced a similar sudden thoracic pain episode during training. This time the chest pain was right-sided. A new MRI of the thoracic spine showed unchanged findings. The initial rehabilitation was similar to the one used in the first episode. After 15 months with no symptoms during normal life the player was allowed to increase the intensity of training gradually and after 2 years the patient played soccer at elite level again. However, 3 years later the symptoms relapsed and the player ended his career after another rehabilitation period. CONCLUSION: In conclusion, it is important to consider thoracic disc herniation as acute chest pain in athletes and that the long-term prognosis of this entity is not always good.
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| 2. |
- Baranto, Adad, 1966, et al.
(författare)
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Back pain and degenerative abnormalities in the spine of young elite divers: a 5-year follow-up magnetic resonance imaging study
- 2006
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Ingår i: Knee Surg Sports Traumatol Arthrosc. - : Springer Science and Business Media LLC. - 0942-2056 .- 1433-7347. ; 14:9, s. 907-14
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Tidskriftsartikel (refereegranskat)abstract
- Several studies have been published on disc degeneration among young athletes in sports with great demands on the back, but few on competitive divers; however, there are no long-term follow-up studies. Twenty elite divers between 10 and 21 years of age, with the highest possible national ranking, were selected at random without knowledge of previous or present back injuries or symptoms for an MRI study of the thoraco-lumbar spine in a 5-year longitudinal study. The occurrence of MRI abnormalities and their correlation with back pain were evaluated. Eighty-nine percent of the divers had a history of back pain and the median age at the first episode of back pain was 15 years. Sixty-five percent of the divers had MRI abnormalities in the thoraco-lumbar spine already at baseline. Only one diver without abnormalities at baseline had developed abnormalities at follow-up. Deterioration of any type of abnormality was found in 9 of 17 (53%) divers. Including all disc levels in all divers, the total number of abnormalities increased by 29% at follow-up, as compared to baseline. The most common abnormalities were reduced disc signal, Schmorl's nodes, and disc height reduction. Since almost all divers had previous or present back pain, a differentiated analysis of the relationship between pain and MRI findings was not possible. However, the high frequency of both back pain and MRI changes suggests a causal relationship. In conclusion, elite divers had high frequency of back pain at young ages and they run a high risk of developing degenerative abnormalities of the thoraco-lumbar spine, probably due to injuries to the spine during the growth spurt.
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| 3. |
- Baranto, Adad, 1966, et al.
(författare)
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Back pain and MRI changes in the thoraco-lumbar spine of top athletes in four different sports: a 15-year follow-up study
- 2009
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Ingår i: Knee surgery, Sports traumatology, Arthroscopy. - : Springer Science and Business Media LLC. - 0942-2056 .- 1433-7347. ; 17:9, s. 1125-1134
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Tidskriftsartikel (refereegranskat)abstract
- A total 71 male athletes (weight lifters, wrestlers, orienteers, and ice-hockey players) and 21 non-athletes were randomly selected, for a baseline MRI study. After 15 years all the participants at baseline were invited to take part in a follow-up examination, including a questionnaire on back pain and a follow-up MRI examination. Thirty-two athletes and all non-athletes had disc height reduction at one or several disc levels. Disc degeneration was found in more than 90% of the athletes and deterioration had occurred in 88% of the athletes, with the highest frequency in weight lifters and ice-hockey players. 78% of the athletes and 38% of the non-athletes reported previous or present history of back pain at baseline and 71 and 75%, respectively at follow-up. There was no statistically significant correlation between back pain and MRI changes. In conclusion, athletes in sports with severe or moderate demands on the back run a high risk of developing disc degeneration and other abnormalities of the spine on MRI and they report high frequency of back pain. The study confirmed our hypothesis, i.e. that most of the spinal abnormalities in athletes seem to occur during the growth spurt, since the majority of the abnormalities demonstrated at follow-up MRI after the sports career were present already at baseline. The abnormalities found at young age deteriorated to a varying degree during the 15-year follow-up, probably due to a combination of continued high load sporting activities and normal ageing. Preventive measures should be considered to avoid the development of these injuries in young athletes.
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| 4. |
- Baranto, Adad, 1966, et al.
(författare)
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Fracture patterns of the adolescent porcine spine: an experimental loading study in bending-compression
- 2005
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Ingår i: Spine. - 1528-1159. ; 30:1, s. 75-82
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Tidskriftsartikel (refereegranskat)abstract
- STUDY DESIGN: To expose functional spinal units from adolescent porcine to mechanical flexion-compression and extension-compression to failure. The biomechanical, radiologic, magnetic resonance imaging, and histologic characteristics are described. OBJECTIVES: The aim of the present study was to investigate the fracture pattern of functional spinal units from adolescent porcine lumbar spines in in vitro compression loading and bending. SUMMARY OF BACKGROUND DATA: In several studies, it has been shown that the adolescent spine, especially the vertebral growth zones, is vulnerable to trauma. A high frequency of abnormalities affecting the spine has been found among athletes participating in sports with high demands on the back. The etiology of these abnormalities is still a controversial issue. METHODS: Sixteen functional spinal units obtained from eight adolescent male pigs were used. Eight functional spinal units were exposed to flexion-compression and eight functional spinal units to extension-compression loading to failure. They were examined with plain radiography and magnetic resonance imaging before and after the loading. The functional spinal units were finally examined macroscopically and histologically. RESULTS: Fractures/separations were seen in the growth zone anteriorly and more frequently, posteriorly in functional spinal units exposed to flexion-compression. In the extension-compression group, such injuries occurred only anteriorly. Only large fractures could be seen on plain radiographs and on magnetic resonance imaging. Macroscopically, a fracture/separation could be seen in 15 cases and histologically in all 16 cases. The median angle at failure for the flexion group was 17 degrees (range, 12-19) and for the extension group 17 degrees (range, 13-19 degrees). The median ultimate compression load in the flexion-compression group was 1894 N (range, 1607-3138 N) and in the extension-compression group 1801 N (range, 1158-2368 N). CONCLUSIONS: The weakest part of the growing porcine lumbar spine, when compressed into flexion- or extension-compression, was the growth zone. The injury was more extensive in extension loading than during flexion loading. Growth zone injuries of the adolescent spine may go undetected on plain radiographs and magnetic resonance imaging.
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| 5. |
- Baranto, Adad, 1966
(författare)
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Traumatic high-load injuries in the adolescent spine. Clinical, radiological and experimental studies
- 2005
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Disc degeneration and other radiological abnormalities are highly frequent among young athletes in sports with great demands on the back. It has also been reported that athletes with these abnormalities have more back pain than other athletes and non-athletes. There is, however, incomplete knowledge regarding the effect of intensive physical loading on the spine, at what age various abnormalities occur and regarding the long-term effects on the morphological abnormalities and on the occurrence of back pain. Aims: It was hypothesised that high loads on the spines of athletes are correlated to an increased frequency of abnormalities and to back pain. The aim was to study the long-term outcome with regard to MRI-abnormalities and back pain. With the aid of an experimental porcine model, an aim was also to try to elucidate the mechanisms behind traumatic displacement of the ring apophysis, disc degeneration and endplate injuries found in adolescent athletes.Methods: Clinical studies: Twenty young elite divers were studied longitudinally (5 years) regarding MRI changes in the thoracolumbar spine and back pain symptoms. The frequency of MRI changes and back pain were also studied longitudinally (15 years) in 71 athletes (weight-lifters, wrestlers, orienteers, ice-hockey players) and 21 non-athletes. Back pain was assessed by questionnaires. Experimental studies: Normal discs and discs with experimentally-induced degeneration from young pigs were mechanically loaded in axial compression, flexion compression and extension compression to failure. The compression load and angle at failure were measured. The segments were then examined for injuries using X-ray, MRI and morphological and histological techniques. Additionally, a group of intervertebral discs with experimentally-induced degeneration were histologically examined regarding reactive and degenerative changes. Results and conclusions: Clinical studies: At the baseline assessment, MRI changes (primarily reduced disc signal) were found in 65% of the young elite divers and at 5 year follow-up deterioration had occurred in half the cases. New abnormalities in previously unaffected individuals occurred in only one case. Current or previous back pain was reported in 89%. Among the four groups of athletes, an even higher prevalence of MRI changes (91%) was found, while back pain was found in 78%. Disc degeneration was the most prevalent abnormality, and it progressed in a large proportion. Experimental studies: The spine in this porcine model was more susceptible to trauma in extension compression than in flexion compression Flexion compression and extension compression caused a fracture or separation of the endplate from the vertebral body in the growth zone in both normal and degenerated discs from young pigs. Axial compression of degenerated discs caused a fracture through the endplate and dorsal part of the vertebral body. In the histological study, the main finding was the demonstration of reactive repair processes that had replaced injured and degenerative structures with vascularised scar tissue. In conclusion, elite athletes run a high risk of developing disc degeneration and back pain. The growth zone and the endplate are the weakest parts in both normal and degenerated discs in growing porcine lumbar spines, when loaded in axial compression, flexion compression and extension compression. Neo-vascularisation of the central parts of the disc is likely to be of key importance in turning the degenerative features of the remaining tissue into reactive more normal structures.
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| 6. |
- Baranto, Adad, 1966, et al.
(författare)
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Vertebral fractures and separations of endplates after traumatic loading of adolescent porcine spines with experimentally-induced disc degeneration
- 2005
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Ingår i: Clin Biomech (Bristol, Avon). - : Elsevier BV. - 0268-0033. ; 20:10, s. 1046-54
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Abnormalities of the intervertebral discs have been found in a high frequency among young elite athletes. Several studies have also reported that the adolescent spine, especially the vertebral growth zones, is vulnerable to trauma. However, there is incomplete knowledge regarding the injury mechanism of the growing spine. In this study, the injury patterns of the adolescent porcine spine with disc degeneration were examined. METHODS: Twenty-four male pigs were used. A degenerative disc was created by drilling a hole through the cranial endplate of a lumbar vertebra into the disc. Two months later the animals were sacrificed and the degenerative functional spinal units (segments) were harvested. The segments were divided into three groups and exposed to axial compression, flexion compression or extension compression to failure. The load and angle at failure were measured for each group. The segments were examined with magnetic resonance imaging and plain radiography before and after the loading and finally examined macroscopically and histologically. FINDINGS: The degenerated segments required considerably more compressive load to failure than non-degenerated segments. Creating a flexion injury required significantly more load than an extension injury. Fractures and/or separations of the endplates from the vertebral bodies were seen at the margins of the endplates and in the growth zone. Only severe separations and fractures could be seen on plain radiography and magnetic resonance imaging. INTERPRETATION: The weakest part of the adolescent porcine lumbar spine with experimentally-induced degeneration, when loaded in axial compression, flexion compression or extension compression, was the growth zone, and, to a lesser extent, the endplate. Degenerated discs seem to withstand higher mechanical loads than non-degenerated discs, probably due to altered stress distribution.
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| 7. |
- Holm, Sten, 1948, et al.
(författare)
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Reactive changes in the adolescent porcine spine with disc degeneration due to endplate injury
- 2007
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Ingår i: Vet Comp Orthop Traumatol. - 0932-0814. ; 20:1, s. 12-7
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Tidskriftsartikel (refereegranskat)abstract
- Degenerative and reactive structural alterations occurring after experimentally-induced disc degeneration were evaluated using a porcine model. A cranial perforation was made through the L4 vertebral endplate into the nucleus pulposus. Three months later, the lumbar intervertebral disc and adjacent vertebrae were dissected, fixed in formalin and further processed for histopathological analyses. The results showed that there were nucleus pulposus fragments, rather than a distinct border between the nucleus and annulus fibrosus. The central lamellae were distorted and delamination of the outer anterior layers was observed. Blood vessels emerged from the adjacent tissue, penetrated the annulus and branched into the residues of the nucleus. Nerve fibres accompanying the blood vessels could be recognized in the disc within the connective scar tissue. The epiphyseal cartilage plates in the vertebrae were hypertrophic in several areas and there was bone formation directed towards the centre of the vertebral body and the disc. Hypertrophic hyaline cartilage, newly formed bone and scar tissue filled the injury canal. A slight chronic inflammatory reaction was evident along vascular buds. The reactive changes dominated over the degenerated features in the operated disc. Physiological loading enhanced the infiltration of various tissue types characterizing immature cartilage formation. Prominent neovascularisation of the central parts of the disc is likely to be of key importance in turning the degenerative features of the remaining tissue into reactive healthy structures.
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| 8. |
- Magnusson, Lennart, 1959, et al.
(författare)
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The value of ultrasonography in the preoperative diagnostic evaluation of patients with recurrent anterior shoulder dislocation: a prospective study of 44 patients.
- 2007
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Ingår i: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA. - : Springer Science and Business Media LLC. - 0942-2056. ; 15:5, s. 649-53
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Tidskriftsartikel (refereegranskat)abstract
- The purpose of this study was to investigate the value of ultrasonography in the pre-operative assessment of patients with recurrent post-traumatic, anterior shoulder instability. Forty-four consecutive patients, 44 men and 12 women, with unilateral, post-traumatic, recurrent instability of the shoulder were included in the study. One experienced radiologist examined all patients, using a 5.0 or 7.5 MHz linear-array transducer, with the arm in different positions, one of which was used to provoke apprehension of the shoulder. Special attention was paid to the evaluation of the joint capsule, the anterior labrum, especially in terms of the presence of a Bankart lesion. All patients were subsequently treated surgically. After a diagnostic arthroscopy either an open or arthroscopic stabilisation of the shoulder was performed. Ultrasonography disclosed an unstable anterior labrum (equivalent to a Bankart lesion) in 36 shoulders; the lesion was verified in all 36 shoulders during arthroscopy. In three shoulders, arthroscopy disclosed an injured labrum, which had healed in an anterio-medial position on the scapular neck. In these three shoulders, ultrasonography failed to show any lesion. In five shoulders no Bankart lesion was found at arthroscopy. All these patients had increased shoulder laxity, and ultrasonography did not show any Bankart lesion. Furthermore a judgement of the joint capsule was not possible either. A bony Bankart lesion was found in four shoulders, using both arthroscopy and ultrasonography. The sensitivity of the ultrasonographic evaluation was 92%, and the specificity 100%. The positive predictive value was 100%, and the negative predictive value 63%. Ultrasonography showed a high correlation with the arthroscopic findings, with a high sensitivity and specificity. Therefore, we conclude that US can give important pre-operative information in patients with recurrent, unilateral, post-traumatic, anterior shoulder instability.
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