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| 2. |
- Ahlqwist, Anna, et al.
(författare)
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Physical therapy treatment of back complaints on children and adolescents.
- 2008
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Ingår i: Spine. - 1528-1159. ; 33:20
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Tidskriftsartikel (refereegranskat)abstract
- STUDY DESIGN: A randomized controlled trial was performed. OBJECTIVES: To evaluate how 2 different treatment options affect perception of health, pain, and physical functioning over time among children and adolescents with low back pain (LBP). SUMMARY OF BACKGROUND DATA: LBP among children and adolescents has increased. The literature shows that children with LBP also suffer from this condition as adults. Thus, it is important to prevent and treat LBP in children and adolescents. METHODS: Forty-five children and adolescents were consecutively randomized into one of 2 treatment groups and were studied for 12 weeks. Group 1 was given individualized physical therapy and exercise and a standardized self-training program and back education. Group 2 was given self-training program and back education but no individualized therapy. The children and adolescents were tested before and after the treatment period. Child Health Questionnaire Child Form 87, Roland & Morris Disability Questionnaire, Painometer, Back Saver Sit and Reach, and test of trunk muscle endurance were used to evaluate the interventions. RESULTS: Both groups improved statistically significant in most parameters over time. On comparison between the groups the physical function measured by Roland & Morris Disability Questionnaire and the duration of pain measured by Painometer improved statistically significant in Group 1. CONCLUSION: An individual assessment by a knowledgeable physiotherapist and an active treatment model improve how children and adolescents experience their back problems with respect to health and physical function, pain, strength, and mobility, regardless of whether treatment consists of a home exercise program with follow-up or home exercise combined with exercise and treatment supervised by a physiotherapist.
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| 3. |
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| 4. |
- 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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| 5. |
- Baranto, Adad, 1966, et al.
(författare)
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Acute injury of an intervertebral disc in an elite tennis player: a case report.
- 2010
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Ingår i: Spine. - 1528-1159 .- 0362-2436. ; 35:6
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Tidskriftsartikel (refereegranskat)abstract
- A case report.To present a previously not described rare case of intradiscal hematoma due to acute trauma in an elite tennis player.Several studies have demonstrated a high frequency of radiological changes in the spine of athletes, especially in sports with high loads on the back. Signs of disc degeneration without disc herniation have frequently been found in magnetic resonance imaging (MRI) studies of the spine of athletes. It has also been shown that radiological abnormalities of the spine in young athletes are correlated to back pain.An elite male tennis player experienced pain in the right buttock after a backhand stroke. He was successfully treated for hip problems and started to play competitive tennis, 2 weeks later. After few games, a backhand stroke again resulted in intense pain projected in the os coccyx region. At examination, there were no neurologic disturbances. At palpation over the spinal processes (Springing test) of L1-L2, the patient experienced intense pain projected to the os coccyx region.MRI examination showed an injured L1-L2 disc with fluid inside the disc with a signal similar to blood. Four additional MRI examinations were performed 2 weeks and 2 years after the injury until disc degeneration is formed. Radiograph examination before and 2 years after the injury is available.In conclusion, trauma in athletes can cause intradiscal hematoma, which probably is a new etiology for disc degeneration. Also that sudden onset of pain in the hip or the gluteal region may be caused by referred pain due to a disc lesion. Intradiscal hematoma can be visualized using MRI.
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| 6. |
- 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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| 7. |
- Barreto Henriksson, Helena, et al.
(författare)
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Support of Concept that Migrating Progenitor Cells from Stem Cell Niches Contribute to Normal Regeneration of the Adult Mammal Intervertebral Disc: A Descriptive study in the New Zeeland white Rabbit.
- 2012
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Ingår i: Spine. - 0362-2436 .- 1528-1159. ; 37:9, s. 722-732
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Tidskriftsartikel (refereegranskat)abstract
- ABSTRACT: Study Design. Descriptive experimental study performed in rabbits of two age groups.Objective. To study and investigate presence of prechondrocytic cells and cell migration routes in the IVD region, to gain knowledge about the normal IVD regeneration pattern.Summary of Background Data. Disc degeneration is believed to play a major role in patients with chronic lumbar pain. Regeneration processes and cell migration within the intervertebral disc (IVD) have been sparsely described. Therefore it is of interest to increase knowledge of these processes in order to understand pathological conditions of the IVD.Methods. 5-bromo-2-deoxyuridine (BrdU) in vivo labelling was performed in two groups of rabbits, 3 and 9 months old at the beginning of the experiment, in total 27 rabbits. BrdU is incorporated into DNA during mitosis and then it is gradually diluted with each cell division until it finally disappears. Incorporation of BrdU was then visualized by immunohistochemistry (IHC) at different time points providing cell division pattern and presence of slow-cycling cells in the IVD region. IVD tissue was investigated by IHC for: Growth- and differentiation-factor-5 (GDF5), SOX9 (chondrogenic lineage markers), SNAIL homolog1 (SNAI1), SNAIL homolog2 (SLUG)(migration markers) and β1-INTEGRIN (cellular adhesion marker). In addition, GDF5, SOX9 and BMPRIB expression were investigated on genetic level.Results. BrdU+ cells were observed in early time points in the IVD niche, adjacent to the epiphyseal plate, at later time points mainly in outer region of the annulus fibrosus (AF) for both age groups of rabbits, indicating a gradual migration of cells. The presence of SLUG, SNAI1, GDF5, SOX9 and β1-INTEGRIN were found in same regions.Conclusion. The results suggest a cellular migration route from the IVD stem cell niche toward the AF and the inner parts of the IVD. These findings may be of importance for understanding IVD regenerative mechanisms and for future development of biological treatment strategies.
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| 8. |
- Barreto Henriksson, Helena, et al.
(författare)
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Transplantation of human mesenchymal stems cells into intervertebral discs in a xenogeneic porcine model.
- 2009
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Ingår i: Spine. - 1528-1159. ; 34:2, s. 141-8
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Tidskriftsartikel (refereegranskat)abstract
- STUDY DESIGN: Experimental and descriptive study of a xenotransplantation model in minipigs. OBJECTIVE: To study survival and function of human mesenchymal stem cells (hMSCs) after transplantation into injured porcine spinal discs, as a model for cell therapy. SUMMARY OF BACKGROUND DATA: Biologic treatment options of the intervertebral disc are suggested for patients with chronic low back pain caused by disc degeneration. METHODS: Three lumbar discs in each of 9 minipigs were injured by aspiration of the nucleus pulposus (NP), 2 weeks later hMSCs were injected in F12 media suspension (cell/med) or with a hydrogel carrier (Puramatrix) (cell/gel). The animals were sacrificed after 1, 3, or 6 months. Disc appearance was visualized by magnetic resonance imaging. Immunohistochemistry methods were used to detect hMSCs by antihuman nuclear antibody staining, and further performed for Collagen II, Aggrecan, and Collagen I. SOX 9, Aggrecan, Versican, Collagen IA, and Collagen IIA and Collagen IIB human mRNA expression was analyzed by real-time PCR. RESULTS: At magnetic resonance imaging all injured discs demonstrated degenerative signs. Cell/gel discs showed fewer changes compared with cell/med discs and only injured discs at later time points. hMSCs were detected in 9 of 10 of the cell/gel discs and in 8 of 9 of the cell/med discs. Immunostaining for Aggrecan and Collagen type II expression were observed in NP after 3 and 6 months in gel/cell discs and colocalized with the antihuman nuclear antibody. mRNA expression of Collagen IIA, Collagen IIB, Versican, Collagen 1A, Aggrecan, and SOX9 were detected in both cell/med and cell/gel discs at the time points 3 and 6 months by real-time PCR. CONCLUSION: hMSCs survive in the porcine disc for at least 6 months and express typical chondrocyte markers suggesting differentiation toward disc-like cells. As in autologous animal models the combination with a three-dimensional-hydrogel carrier seems to facilitate differentiation and survival of MSCs in the disc. Xenotransplantation seems to be valuable in evaluating the possibility for human cell therapy treatment for intervertebral discs.
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| 9. |
- Brisby, Helena, 1965, et al.
(författare)
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In vivo measurement of facet joint nitric oxide in patients with chronic low back pain.
- 2007
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Ingår i: Spine. - 1528-1159. ; 32:14, s. 1488-92
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Tidskriftsartikel (refereegranskat)abstract
- Prospective case-control study testing a new diagnostic method.The aim of the present study was to investigate the concentration of nitric oxide (NO) in the perifacetal region in patients with chronic low back pain and healthy controls.Facet joint arthrosis may be a pain source in chronic back pain. Increased concentrations of NO, an oxygen-free radical, have been demonstrated in temporomandibular and knee joints with osteoarthritis.Patients with at least 6 months' duration of chronic low back pain and signs of facet joint osteoarthrosis (n = 24) and healthy volunteers (n = 7) were included. A detailed questionnaire, including visual analogue scale, was completed before and 6 weeks after the measurements. NO was measured with a custom-designed electrochemical real-time NO sensor inserted under fluoroscopic guidance. All patients received corticosteroids and local anesthetics after NO measurements.NO measurements were obtained from all participants. No adverse effects were noted. The patients with chronic low back pain demonstrated higher concentrations of NO in the perifacetal region compared with healthy controls (1.66 +/- 0.28 vs. 0.46 +/- 0.14 nmol/L, P = 0.007). No association between NO concentration and pain duration or pain level was detected. Patients with a positive response to local anesthetics and corticosteroid injection (defined as a >or=20 mm reduction of visual analogue scale at the 6-week follow-up visit) had higher NO concentrations than patients without positive response.The study demonstrates that it is feasible and safe to measure NO with a real time-sensor in or around the facet joints. The findings of higher concentrations of NO in the perifacetal region in chronic low back patients compared with healthy controls indicate that the degenerative process of the joints in these patients may cause increased NO production. The observation of higher NO concentrations in the perifacetal region in patients responding to corticosteroid/local anesthetic infiltration indirectly suggest a more pronounced inflammatory process in these patients.
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| 10. |
- Brisby, Helena, 1965, et al.
(författare)
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Thalamic activation in a disc herniation model.
- 2007
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Ingår i: Spine. - 1528-1159. ; 32:25, s. 2846-52
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Tidskriftsartikel (refereegranskat)abstract
- STUDY DESIGN: A novel approach combining a rodent disc herniation model with electrophysiologic recordings of thalamic evoked responses. OBJECTIVE: To assess short-term effects of nucleus pulposus (NP) application on dorsal root ganglions (DRG) on high threshold afferent fiber evoked activation in the thalamus. SUMMARY OF BACKGROUND DATA: Epidural application of NP in combination with mechanical compression induces pain related behavior in rats associated with enhanced activity of pain-processing neurons in the dorsal horn of the spinal cord. However, possible effects on neuronal activity in the pain processing ventral posterior lateral (VPL) thalamic nucleus following NP application on DRG have not been investigated. METHODS: Responses in the contralateral VPL evoked by electrical stimulation of the sciatic nerve and of the fourth lumbar (L4) DRG were recorded in adult Sprague-Dawley rats. Records were obtained before and during application (5, 10, and 20 minutes) of NP or of adipose tissue (AT) to the L4 DRG. AT was used as control for mechanical effects of NP application. RESULTS: Application of NP resulted in an increase of evoked thalamic responses to 138% +/- 10% of control after 20 minutes (P < 0.01), whereas AT application for 20 minutes resulted in a reduction of evoked responses to 77% +/- 4% (P < 0.05). Recordings in control animals (i.e., with no application) demonstrated stable evoked neuronal thalamic activity for up to 40 minutes. CONCLUSION: The study demonstrates that NP application onto DRG increases afferent fiber evoked responses in the thalamus and in view of the opposite effects of AT application suggests that these effects may be specific for NP. The results show that NP affects sensory transmitting pathways within a few minutes, possibly due to rapid and reversible alterations in the neuronal excitability. The study thus introduces a rodent model for studying sensory afferent evoked thalamic activity related to DRG injury which may be used to evaluate analgesics and anti-inflammatory drugs used for pain relief in disc herniation and neuropathic pain patients.
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