Lumbosacral Region

Recent evidence suggests that musculoskeletal disorders (MSDs) may be the result of a fatigue failure process in affected tissues. This paper describes a new low back exposure assessment tool (the Lifting Fatigue Failure Tool [LiFFT]), which estimates a "daily dose" of cumulative loading on the low back using fatigue failure principles. Only three variables are necessary to derive the cumulative load associated with a lifting task: the weight of the load, the maximum horizontal distance from the spine to the load, and the number of repetitions for tasks performed during the workday. The new tool was validated using two existing epidemiological databases: the Lumbar Motion Monitor (LMM) database, and a database from a U.S. automotive manufacturer. The LiFFT cumulative damage metric explained 92% of the deviance in low back disorders (LBDs) in the LMM database and 72-95% of the deviance in low back outcomes in the automotive database (depending on the outcome measure). Thus,...

Want to demonstrate factors which effect appearance and severity of lumbosacral radiculopathy. We analysed 100 electromyoneurographically examined patients. Patients were categorised on bases of their BMI (body mass index), sex, age, job type (physical or intellectual job), and chronic diseases (diabetes mellitus, arterial hypertension and hyperlipidemia). Data were evaluated using the chi2 test with the significance of p < 0.05. Obese patients had severe radiculopathy more often than non-obese patients (p < 0.044). Severe radiculopathy appeared more frequently in male (p < 0.001), elderly patients (p < 0.023), and patients doing physically intensive jobs (p < 0.002). No statistic significance was found in relationship between patients suffering from diabetes mellitus, arterial hypertension, and hyperlipidemia, and the severity of lumbosacral radiculopathy. Obese patients, males, elderly patients, and patients doing physically intensive jobs are at a bigger risk of su...

From the Department of Radiologic Sciences, Drexel University College of Medicine, Mail Stop 206, 245 N. 15th Street, Philadelphia, Pennsylvania (TAH, RAK, FB, CKD); and Department of Neurosurgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania ...

Pain of lumbosacral segment of the vertebral column and the pelvis concerns about 45% of all pregnant women. The change of the body posture during pregnancy is the result of gravity centre relocation, which affects the musculosceletal system. Development of the joint, ligament and myofascial dysfunctions, as well as the pain in the lumbosacral segment and the pelvis, are the most common reasons of spine pain. The aim of this review is to present the current state of knowledge about lumbar spine pain in pregnant women with special focus on the pain connected with muscular, joint and ligament disorders. Pregnancy is a serious burden for the female osteo-skeletal system. Lumbar pain with different location and intensification is the negative consequence of the position changes during pregnancy. Pharmacotherapy could be useful only in cases of intensive low back pain, with possible application of small spectrum of drugs that are safe during pregnancy. Physical therapy including manual t...

Abstract.  Özçakar L, Kara M, Erol Ö, Kaymak B, Akıncı A, Taşkıran Ç, Ayhan A. A reappraisal on the management of lumbosacral plexopathies in gynecological malignancies: where do the physiatrists stand? Int J Gynecol Cancer 2005;15:915–917.Two patients are reported here with gynecological malignancies—an ovarian and a cervical carcinoma—who had suffered from lumbar plexopathies during their follow-up. Their management is discussed with an emphasis on the collaboration of the gynecologists and the rehabilitation physicians.

To present a radiculopathy case due to unilateral facet hypertrophy developing three years after a lumbar disc hernia operation. A fifty two-year-old female patient, who had been operated on for a left L5-S1 herniated lumbar disc three years ago, was hospitalized and re-operated with a diagnosis of unilateral facet hypertrophy. She had complaints of left leg pain and walking restrictions for the last six months. Left Straight Leg Raising test was positive at 40 degrees , left ankle dorsiflexion muscle strength was 4/5, left Extensor Hallucis Longus muscle strength was 3/5, and left Achilles reflex was hypoactive. Lumbar spinal Magnetic Resonance Imaging revealed left L5-S1 facet hypertrophy. Lumbar radiculopathy due to lumbar facet hypertrophy is a well-known neurological condition. Radicular pain develops during the late postoperative period following lumbar disc hernia operations that are often related to recurrent disc herniation or to formation of post-operative scar tissue. In ...

Background:  Percutaneous lysis of epidural adhesions is done worldwide. Over 1.7 million of these procedures were done in the U.S.A. by 2006. This interventional pain management technique is used to treat chronic low back pain (LBP) and/or radiculopathy. The primary object of the approach is to target drug delivery to areas of pathology in the spinal epidural space. The procedure involves removing barriers, such as epidural fibrosis, that prevent drug from reaching target sites.Literature search:  Primary sources of information for this manuscript include: (1) 2 systematic literature reviews that include literature published through September 2006; (2) expert opinions; and (3) peer reviewed publications from September 2006 to January 2008. The focus was on percutaneous entry using catheters via the sacral hiatus to treat pain in the lumbosacral region.Results:  The evidence is strong for short-term efficacy (3 months) and moderate for long-term efficacy (greater than 3 months). Complications do occur, but limited literature exists that documents incidence.Conclusion:  The cumulative evidence through January 2008 show that percutaneous adhesiolysis with targeted drug delivery is an effective treatment for LBP and/or radiculopathy. ▪

Work-related musculoskeletal disorders (WMSDs) are common among drivers and official workers. Musculoskeletal disorders are frequent causes of absenteeism in many countries. The aim of this study was to determine the prevalence of musculoskeletal disorders and risk factors associated with these symptoms. A total of 346 workers and truck drivers were participated in this case-control study. All the participants were interviewed using a self- administered questionnaire containing demographic data and a Nordic questionnaire about presence site and characteristics of pain. Then the data were gathered, and the prevalence of the mentioned parameters and the relationship between variables in the questionnaire were analyzed statistically. The results of this study revealed that 78.6% out of truck drivers and 55.5% out of official workers had musculoskeletal disorders in on-year and there was a significant difference between two groups in this regard (P<0.001). On the whole, the most comm...

Trunk bridging exercises are often used as therapeutic exercises for lumbopelvic stabilization. These exercises focus on the retraining of muscle coordination patterns in which optimal ratios between local segmental stabilizing and global torque producing muscle activity are assumed to be essential. However, a description of such ratios is lacking. The purpose of this study was to investigate both relative (as a percentage of maximal voluntary isometric contraction) muscle activity levels and ratios of local to global muscle activity, during bridging stabilization exercises. Thirty healthy university students (15 men, 15 women) with a mean age of 19.6 year volunteered to perform 3 bridging exercises (single bridging, ball bridge and unilateral bridging). The surface electromyographic activity of different trunk muscles was evaluated on both sides. During all bridging exercises, the ratio of the internal oblique to the rectus abdominis was very high due to minimal relative activity o...

A woman aged 70 years presented with several years' history of low back pain and bilateral lower limb pains. Her menstrual cycles ceased when she was 44 years of age. Plain X-ray of the lumbosacral spine revealed diffuse osteoporotic changes (figure 1). A battery of investigations was performed; the only abnormal results were slightly raised serum alkaline phosphatase (probably from vertebral fractures) and very low-serum 25-hydroxyvitmain D. Lumbosacral spine MRI was ordered (figure 2) and revealed several codfish vertebrae in addition to lumber spinal …

The increased utilization of three-point restraint systems has greatly reduced the incidence of spinal injuries in motor vehicle accidents. Nevertheless, several studies which rely upon the National Automotive Sampling System (NASS) have documented lower thoracic and upper lumbar fractures in restrained occupants involved in frontal collisions of moderate severities. Although it has been postulated that the injury mechanism may be related to the occupant being out-of-position or sitting in an unusual posture, conclusions with regard to the precise mechanism of injury are difficult due to the lack of information contained in the NASS database. In addition, previous studies have not reported statistical significance of these injuries. In this study, we combined statistical analysis of frontal collisions in the NASS database with the analysis of data acquired from sled and crash tests, which utilized anthropomorphic test devices (ATDs), in order to evaluate the incidence and potential ...

The tissue origin of low back pain (LBP) or referred lower extremity symptoms (LES) may be identified in about 70% of cases using advanced imaging, discography and facet or sacroiliac joint blocks. These techniques are invasive and availability varies. A clinical examination is non-invasive and widely available but its validity is questioned. Diagnostic studies usually examine single tests in relation to single reference standards, yet in clinical practice, clinicians use multiple tests and select from a range of possible diagnoses. There is a need for studies that evaluate the diagnostic performance of clinical diagnoses against available reference standards. We compared blinded clinical diagnoses with diagnoses based on available reference standards for known causes of LBP or LES such as discography, facet, sacroiliac or hip joint blocks, epidurals injections, advanced imaging studies or any combination of these tests. A prospective, blinded validity design was employed. Physiothe...

Low back pain (LBP) is an important health problem in all developed countries and is associated with high levels of disability. Evidence-based clinical practice guidelines usually recommend different physical therapy interventions to manage this condition. However, those interventions usually result in small to moderate clinical effects. Recent studies suggest that interventions based on subgroup classifications may improve the effect sizes compared to rehabilitation programs where the same interventions were applied to all patients. To investigate the efficacy of treatment based on a movement system impairment (MSI) based classification model for patients with chronic LBP compared to general exercise. The primary outcomes will be pain intensity and disability at two months after randomization. The study is a two-arm, prospectively registered, randomized controlled trial with a blinded assessor. The study setting will be a university physical therapy clinic in Brazil. A total of 148...