| 211. |
- Tullberg, T, et al.
(författare)
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Manipulation does not alter the position of the sacroiliac joint : a roentgen stereophotogrammetric analysis
- 1998
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Ingår i: Spine. - 0362-2436 .- 1528-1159. ; 23:10, s. 1124-1128, discussion 1129
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Tidskriftsartikel (refereegranskat)abstract
- STUDY DESIGN A roentgen stereophotogrammetric analysis study of patients with sacroiliac joint dysfunction. OBJECTIVES To investigate whether manipulation can influence the position between the ilium and the sacrum, and whether positional tests for the sacroiliac joint are valid. SUMMARY OF BACKGROUND DATA Sacroiliac joint dysfunction is a subject of controversy. The validity of different sacroiliac joint tests is unknown. Long-standing therapeutic tradition is to manipulate supposed dysfunctions of the sacroiliac joint. Many manual therapists claim that their good clinical results are a consequence of a reduction of subluxation. METHODS Ten patients with symptoms and sacroiliac joint tests results indicating unilateral sacroiliac joint dysfunction were recruited. Twelve sacroiliac joint tests were chosen. The results of most of these tests were required to be positive before manipulation and normalized after manipulation. Roentgen stereophotogrammetric analysis was performed with the patient in the standing position, before and after treatment. RESULTS In none of the 10 patients did manipulation alter the position of the sacrum in relation to the ilium, defined by roentgen stereophotogrammetric analysis. Positional test results changed from positive before manipulation to normal after. CONCLUSIONS Manipulation of the sacroiliac joint normalized different types of clinical test results but was not accompanied by altered position of the sacroiliac joint, according to roentgen stereophotogrammetric analysis. Therefore, the positional test results were not valid. However, the current results neither disprove nor prove possible beneficial clinical effects achieved by manipulation of the sacroiliac joint. Because the supposed positive effects are not a result of a reduction of subluxation, further studies of the effects of manipulation should focus on the soft tissue response.
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| 212. |
- Tveit, P, et al.
(författare)
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Erector spinae lever arm length variations with changes in spinal curvature.
- 1994
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Ingår i: Spine. - 0362-2436 .- 1528-1159. ; 19:2, s. 199-204
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Tidskriftsartikel (refereegranskat)abstract
- Magnetic resonance imaging was used to study the effect of different curvatures in the lumbar spine on lever arm lengths of the erector spinae musculature. Eleven subjects were instructed to simulate static lifts while lying supine in a magnetic resonance camera with the lumbar spine either in kyphosis or lordosis. A sagittal image of the spine was obtained to analyze the lumbosacral angle and to guide the imaging of transverse sections through each disc (L1/L2 to L5/S1). Images were analyzed for lever arm lengths of the erector spinae muscle (ES) and the erector spinae aponeurosis (ESA), the latter functioning as a tendon for superiorly positioned ES muscle portions. The lumbosacral angle (between superior surfaces of S1 and L4) averaged 44 degrees in the lordosed, 26 degrees in the kyphosed and 41 degrees in a neutral supine position. In lordosis, the lever arm lengths were significantly longer than in kyphosis for all levels, averaging 60-63 mm (ES) and 82-86 mm (ESA). The corresponding values for kyphosis were 49-57 mm (ES) and 67-77 mm (ESA), respectively. Thus, there was a considerable effect (10-24%) of lumbar curvature on lever arm lengths for the back extensor muscles. The change in leverage will affect the need for extensor muscle force and thus the magnitude of compression in the lumbar spine in loading situations such as lifting.
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| 217. |
- Vavruch, Ludvig, et al.
(författare)
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Surgical Outcomes of Anterior Versus Posterior Fusion in Lenke Type 1 Adolescent Idiopathic Scoliosis
- 2019
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Ingår i: Spine. - : Lippincott Williams & Wilkins. - 0362-2436 .- 1528-1159. ; 44:14, s. E823-E832
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Tidskriftsartikel (refereegranskat)abstract
- Mini Patients with Lenke type 1 idiopathic scoliosis can be effectively managed surgically with an anterior or posterior approach. However, each approach has specific advantages and challenges, as described in this study, which must be considered before treating each patient.Study Design. Retrospective study.Objective. To describe surgical results in two and three dimensions and patient-reported outcomes of scoliosis treatment for Lenke type 1 idiopathic curves with an open anterior or posterior approach.Summary of Background Data. Different surgical techniques have been described to prevent curve progression and to restore spinal alignment in idiopathic scoliosis. The spine can be accessed via an anterior or a posterior approach. However, the surgical outcomes, especially in three dimensions, for different surgical approaches remain unclear.Methods. Cohorts of Lenke curve type 1 idiopathic scoliosis patients, after anterior or posterior spinal fusion were recruited, to measure curve characteristics on conventional radiographs, before and after surgery and after 2 years follow-up, whereas the vertebral axial rotation, true mid-sagittal anterior–posterior height ratio of individual structures, and spinal height differences were measured on 3D reconstructions of the pre- and postoperative supine low-dose computed tomography (CT) scans. Additionally, the intraoperative parameters were described and the patients completed the SRS-22 and EQ-5D-3L questionnaire postoperatively.Results. Fifty-three patients with Lenke curve type 1 idiopathic scoliosis (26 in the anterior cohort and 27 in the posterior cohort) were analyzed. Fewer vertebrae were instrumented in the anterior cohort compared with the posterior cohort (P < 0.001), with less surgery time and lower intraoperative blood loss (P < 0.001). The Cobb angle correction of the primary thoracic curve directly after surgery was 57 ± 12% in the anterior cohort and 73 ± 12% in the posterior cohort (P < 0.001) and 55 ± 13% and 66 ± 12% (P = 0.001) at 2 years follow-up. Postoperative 3D alignment restoration and questionnaires showed no significant differences between the cohorts.Conclusion. This study suggests that Lenke type 1 curves can be effectively managed surgically with either an open anterior or posterior approach. Each approach, however, has specific advantages and challenges, as described in this study, which must be considered before treating each patient.Level of evidence: 3
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