RESUMO
BACKGROUND: Multifidus is an important lumbar muscle with distinct superficial and deep fibers responsible for torque production and stabilization, respectively. Its mechanical properties change when transitioning from lying to sitting positions, necessitating enhanced stability. It holds crucial clinical relevance to assess these layers separately, especially in the sitting posture, which demands increased neuromuscular control compared to the prone position. OBJECTIVE: To compare lumbar multifidus stiffness in lying versus sitting postures, analyzing both superficial and deep layers. METHODS: Supersonic Shear Imaging captured elastographic images from 26 asymptomatic volunteers in prone and seated positions. RESULTS: Left multifidus shear modulus in lying: 5.98 ± 1.80/7.96 ± 1.59 kPa (deep/superficial) and sitting: 12.58 ± 4.22/16.04 ± 6.65 kPa. Right side lying: 6.08 ± 1.97/7.80 ± 1.76 kPa and sitting: 13.25 ± 4.61/17.95 ± 7.12 kPa. No side differences (lying p= 0.99, sitting p= 0.43). However, significant inter-postural differences occurred. CONCLUSION: Lumbar multifidus exhibits increased stiffness in sitting, both layers affected, with superior stiffness in superficial versus deep fibers. Applying these findings could enhance assessing multifidus stiffness changes, for classifying tension-induced low back pain stages.
Assuntos
Técnicas de Imagem por Elasticidade , Músculos Paraespinais , Postura Sentada , Humanos , Decúbito Ventral/fisiologia , Masculino , Feminino , Músculos Paraespinais/fisiologia , Músculos Paraespinais/diagnóstico por imagem , Adulto , Adulto Jovem , Voluntários Saudáveis , Região Lombossacral/diagnóstico por imagem , Região Lombossacral/fisiologia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/fisiologia , Postura/fisiologiaRESUMO
Abstract Background: Reduced lumbar lordosis may make the process of identifying the intervertebral distance easier. The primary aim of this study was to measure the L3-L4 intervertebral space in the same patients undergoing spinal anesthesia in three different sitting positions, including the classic sitting position (CSP), hamstring stretch position (HSP) and rider sitting position (RSP). The secondary aim was to compare ultrasonographic measurements of the depth of the ligamentum flavum and intrathecal space in these three defined positions. Methods: This study is a single-blinded, prospective, randomized study. Ninety patients were included in final analysis. the patients were positioned on the operating table in three different positions to perform ultrasonographic measurements of the spinal canal. The intervertebral distance (IVD), the distance between the skin and the ligamentum flavum (DBSLF) and the intrathecal space (IS) were measured in the L3 -L4 intervertebral space in three different positions. Results: The RSP produced the largest mean distance between the spinous processes. The RSP yielded a significantly larger IVD than did the CSP (p < 0.001) and HSP (p < 0.001). The DBSP was larger in the CSP than in the HSP (p = 0.001). The DBSLF was significantly larger in the RSP than in the HSP (p = 0.009). Conclusions: Positioning the patient in the RSP significantly increased the intervertebral distance between L3 -L4 vertebrae compared to the CSP and HSP, suggesting easier performance of lumbar neuraxial block.
Assuntos
Humanos , Postura Sentada , Raquianestesia , Estudos Prospectivos , Vértebras Lombares/diagnóstico por imagem , Região Lombossacral/diagnóstico por imagemRESUMO
BACKGROUND: Reduced lumbar lordosis may make the process of identifying the intervertebral distance easier. The primary aim of this study was to measure the L3...L4 intervertebral space in the same patients undergoing spinal anesthesia in three different sitting positions, including the classic sitting position (CSP), hamstring stretch position (HSP) and rider sitting position (RSP). The secondary aim was to compare ultrasonographic measurements of the depth of the ligamentum flavum and intrathecal space in these three defined positions. METHODS: This study is a single-blinded, prospective, randomized study. Ninety patients were included in final analysis. the patients were positioned on the operating table in three different positions to perform ultrasonographic measurements of the spinal canal. The intervertebral distance (IVD), the distance between the skin and the ligamentum flavum (DBSLF) and the intrathecal space (IS) were measured in the L3...L4 intervertebral space in three different positions. RESULTS: The RSP produced the largest mean distance between the spinous processes. The RSP yielded a significantly larger IVD than did the CSP (p < 0.001) and HSP (p < 0.001). The DBSP was larger in the CSP than in the HSP (p = 0.001). The DBSLF was significantly larger in the RSP than in the HSP (p = 0.009). CONCLUSIONS: Positioning the patient in the RSP significantly increased the intervertebral distance between L3...L4 vertebrae compared to the CSP and HSP, suggesting easier performance of lumbar neuraxial block.
Assuntos
Raquianestesia , Postura Sentada , Humanos , Estudos Prospectivos , Vértebras Lombares/diagnóstico por imagem , Região Lombossacral/diagnóstico por imagemRESUMO
INTRODUCTION: Ultrasonography has been used to understand the functional and biomechanical aspects of the lumbar multifidus muscle in vivo. To characterize the multifidus echogenicity, the peculiarities of their superficial and deep layers must be considered. PURPOSE: The present paper aimed to characterize the lumbar multifidus echo intensity (EI), in both superficial and deep layers, in ultrasonography images acquired in longitudinal and transversal orientations. METHODS: Evaluator obtained two images in each side of the lumbar of the volunteer, who was lying on prone position. Ultrasonography images were taken with probe in transversal and longitudinal orientations. EI was estimated by means average value of the grayscale distribution histogram, by extracting from region of interest of the superficial and deep layer. All participants returned for a second test day. Two-way MANOVA test was applied to compare EI measurements, considering layers and side factors. The reliability and variability were analyzed by the intraclass correlation coefficient and standard error measurements (SEM), respectively. Two-way MANOVA found significant difference between the layers in the transversal and longitudinal images, but not between the sides. RESULTS: Interdays reliability ranged of reasonable to excellent, and SEM values were lower than 17.08%. The superficial layer of the multifidus muscle showed higher EI values than the deeper one. CONCLUSIONS: These analyses can serve as a basis for future studies approaching multifidus of the people with low back pain.
Assuntos
Dor Lombar , Músculos Paraespinais , Humanos , Dor Lombar/diagnóstico por imagem , Região Lombossacral/diagnóstico por imagem , Músculos Paraespinais/diagnóstico por imagem , Reprodutibilidade dos Testes , UltrassonografiaRESUMO
Background: Lumbar multifidus impairments are associated with low back pain (LBP), with sustained impairments thought to contribute to recurrence and chronicity of pain. Ability to regain muscle function can be challenging. While neuromuscular electrical stimulation (NMES) may aid in muscle function recovery, validity of its ability to selectively recruit the lumbar multifidus and provide adequate dosage for muscle overload has not been demonstrated. Near infrared spectroscopy (NIRS) can be used to determine muscle selectivity and overload during NMES and offers advantages over electromyography (EMG), which is affected by electrical interference. Objective: The aim of this study was to determine the ability of NMES to activate and overload the lumbar multifidus in isolation. Methods: EMG and NIRS were collected over the trunk extensors during standardized movements followed by delivery of NMES in 10 healthy participants. NIRS was used to determine the ability of NMES to selectively recruit the lumbar multifidus at the L5 region relative to other trunk extensors. EMG and NIRS data were then entered into a linear regression model to predict muscle activity during NMES relative to the standardized movements. Results: There was a significant correlation (r = 0.81, p < 0.001) between EMG and NIRS in the lumbar multifidus. There was significantly greater activation of lumbar multifidus compared to lumbar erector spinae using specific NMES electrode placement (p < 0.001). Conclusion: NMES can preferentially activate lumbar multifidus with potential to provide a therapeutic overload to these muscles in healthy participants. It may be a promising intervention for individuals with LBP.
Assuntos
Estimulação Elétrica/métodos , Região Lombossacral/fisiologia , Músculos Paraespinais/fisiologia , Espectroscopia de Luz Próxima ao Infravermelho , Adulto , Feminino , Voluntários Saudáveis , Humanos , Região Lombossacral/diagnóstico por imagem , Masculino , Músculos Paraespinais/diagnóstico por imagemRESUMO
INTRODUCTION: Axial skeleton arthropathy and osteoporotic vertebral fractures are common findings in acromegalic patients and can result in severe spinal deformity. OBJECTIVE: To investigate the presence of spinal fractures and deformities, sagittal imbalances, and spinopelvic compensatory mechanisms in acromegalics. PATIENTS AND METHODS: 58 patients with acromegaly from a referral neuroendocrinology center were prospectively evaluated by panoramic spine radiographs to detect the presence of fractures and scoliosis, to measure thoracic kyphosis, lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT) and sagittal vertical axis (SVA). Sagittal imbalance criteria were considered: thoracic kyphosis > 50°, PI-LL > 10°, PT > 20° and SVA > 5 cm. Their medical records were analyzed for clinical and laboratorial data. RESULTS: The prevalence of fractures was 13.8%, predominantly in the thoracic spine, with mild and anterior wedge compressions. Scoliosis was present in 34.5% of the cases, all with degenerative lumbar curve apex. Thoracic kyphosis > 50º occurred in 36.8% of patients, PI-LL > 10° in 48.3%, PT > 20° in 41.4% and SVA > 5 cm in 12.1%. CONCLUSION: Increased number of vertebral fractures and high prevalence of spinal deformities related to sagittal imbalance were detected, indicating the importance of monitoring bone comorbidities in acromegaly, with radiological evaluation of the spine as part of the follow up.
Assuntos
Acromegalia/patologia , Acromegalia/diagnóstico por imagem , Acromegalia/metabolismo , Acromegalia/cirurgia , Adulto , Idoso , Cabergolina/uso terapêutico , Feminino , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/tratamento farmacológico , Fraturas Ósseas/cirurgia , Humanos , Fator de Crescimento Insulin-Like I/metabolismo , Lordose/diagnóstico por imagem , Lordose/tratamento farmacológico , Lordose/cirurgia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Região Lombossacral/diagnóstico por imagem , Região Lombossacral/cirurgia , Masculino , Pessoa de Meia-Idade , Octreotida/uso terapêutico , Estudos Prospectivos , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/tratamento farmacológico , Fraturas da Coluna Vertebral/cirurgiaRESUMO
The objective of this study was to describe the lumbosacral region of domestic felines using ultrasonography. The limits and dimensions of the epidural and subarachnoid spaces were identified and their correlation with sex and body score condition (BSC) were evaluated. Fourteen mongrel cat cadavers, nine males and five females, weighing between 2.0 and 4.5 kg and with BCS ranging from 2 to 5 (15) were used. The cadavers were put in sternal recumbency and ultrasonographic images of the lumbosacral region were obtained in the sagittal and transverse planes. There was no statistical difference in the measurements between males and females. The BCS was positively correlated with the distance between the skin and dorsal epidural space, the distance between the skin and dural sac, and the distance between the skin and the ventral floor. No correlations were identified between the BCS and the distance between epidural space and dural sac, BCS and the sagittal dural sac height, or BCS and transverse dural sac height. The study showed that animals with a higher body condition score present larger distances between structures, regardless of their sex. In addition, the sonographic study verified the close proximity of the epidural and subarachnoid spaces, highlighting the risk of inadvertent spinal puncture in felines.
O presente estudo objetivou avaliar a região lombossacra de felinos domésticos por meio da ultrassonografia, identificando os limites e dimensionando os espaços peridural e subaracnoide, relacionando essas medidas com o sexo e o escore corporal dos animais. Foram utilizados 14 cadáveres de gatos, sem raça definida, nove machos e cinco fêmeas, pesando entre 2,0 e 4,5 kg e com escore corporal variando de 2 a 5 (1-5). Para a avaliação da região lombossacra, os animais foram posicionados em decúbito esternal e imagens ultrassonográficas desta região foram adquiridas nos planos sagital e transversal. Não houve diferença estatística entre machos e fêmeas com relação às medidas. Houve correlação positiva entre o escore corporal e a distância entre a pele e o espaço peridural dorsal; escore corporal e a distância entre a pele e o saco dural; e escore corporal e a distância entre a pele e o assoalho ventral. Não foram identificadas correlações entre o escore corporal e a distância entre o espaço peridural e saco dural; escore corporal e altura do saco dural sagital; e escore corporal e altura saco dural transversal. Conclui-se que animais com maior escore corporal apresentam distâncias maiores, e não há diferença nas mensurações com relação ao sexo. Além disso, o estudo ultrassonográfico constatou a proximidade do espaço peridural e raquidiano, implicando no risco de punção inadvertida em felinos.
Assuntos
Animais , Gatos , Anestesia Epidural/veterinária , Raquianestesia/veterinária , Região Lombossacral/anatomia & histologia , Região Lombossacral/diagnóstico por imagem , Região Lombossacral/fisiologiaRESUMO
The objective of this study was to describe the lumbosacral region of domestic felines using ultrasonography. The limits and dimensions of the epidural and subarachnoid spaces were identified and their correlation with sex and body score condition (BSC) were evaluated. Fourteen mongrel cat cadavers, nine males and five females, weighing between 2.0 and 4.5 kg and with BCS ranging from 2 to 5 (15) were used. The cadavers were put in sternal recumbency and ultrasonographic images of the lumbosacral region were obtained in the sagittal and transverse planes. There was no statistical difference in the measurements between males and females. The BCS was positively correlated with the distance between the skin and dorsal epidural space, the distance between the skin and dural sac, and the distance between the skin and the ventral floor. No correlations were identified between the BCS and the distance between epidural space and dural sac, BCS and the sagittal dural sac height, or BCS and transverse dural sac height. The study showed that animals with a higher body condition score present larger distances between structures, regardless of their sex. In addition, the sonographic study verified the close proximity of the epidural and subarachnoid spaces, highlighting the risk of inadvertent spinal puncture in felines.(AU)
O presente estudo objetivou avaliar a região lombossacra de felinos domésticos por meio da ultrassonografia, identificando os limites e dimensionando os espaços peridural e subaracnoide, relacionando essas medidas com o sexo e o escore corporal dos animais. Foram utilizados 14 cadáveres de gatos, sem raça definida, nove machos e cinco fêmeas, pesando entre 2,0 e 4,5 kg e com escore corporal variando de 2 a 5 (1-5). Para a avaliação da região lombossacra, os animais foram posicionados em decúbito esternal e imagens ultrassonográficas desta região foram adquiridas nos planos sagital e transversal. Não houve diferença estatística entre machos e fêmeas com relação às medidas. Houve correlação positiva entre o escore corporal e a distância entre a pele e o espaço peridural dorsal; escore corporal e a distância entre a pele e o saco dural; e escore corporal e a distância entre a pele e o assoalho ventral. Não foram identificadas correlações entre o escore corporal e a distância entre o espaço peridural e saco dural; escore corporal e altura do saco dural sagital; e escore corporal e altura saco dural transversal. Conclui-se que animais com maior escore corporal apresentam distâncias maiores, e não há diferença nas mensurações com relação ao sexo. Além disso, o estudo ultrassonográfico constatou a proximidade do espaço peridural e raquidiano, implicando no risco de punção inadvertida em felinos.(AU)
Assuntos
Animais , Gatos , Anestesia Epidural/veterinária , Raquianestesia/veterinária , Região Lombossacral/anatomia & histologia , Região Lombossacral/fisiologia , Região Lombossacral/diagnóstico por imagemRESUMO
BACKGROUND/OBJECTIVES: Recent data have shown that dividing skeletal muscle (SM) into sub-ranges of radiodensity can improve the prediction of short-term outcomes in the oncology setting. We aim to investigate whether the skeletal muscle mass, when divided into sub-ranges of low or high-radiodensity, improves the prediction of short-term survival in endometrial cancer (EC) patients when compared to average muscle attenuation and to the overall skeletal muscle radiodensity. SUBJECTS/METHODS: EC patients who had computed tomography (CT) images available within 30 days before treatment were enrolled in this retrospective cohort (n = 232). CT images at the third lumbar vertebra (L3) were used to assess overall skeletal muscle index (SMI). Then we divided SMI into sub-ranges of radiation attenuation: low-radiodensity skeletal muscle index (LRSMI) and high-radiodensity skeletal muscle index (HRSMI). The average muscle radiation attenuation was also assessed. Low SMI was defined when SMI was <38.9 cm2/m2. One-year survival was evaluated by Kaplan-Meier method and Cox Regression. RESULTS: Sarcopenia was found in 25.8% of the patients. Roughly 80% of the patients in the highest quartile of LRSMI were obese. All the skeletal muscle parameters were significantly associated with shorter 1-year survival, LRSMI presented a trend for significance in the adjusted model. When the SM parameters were additionally adjusted for low SMI, only HRSMI and LRSMI remained in the model as early-mortality predictors. CONCLUSIONS: Classifying the skeletal muscle into sub-ranges of radiodensity have an additional value than using the average muscle attenuation of the overall skeletal muscle area and should be exploited in further studies.
Assuntos
Neoplasias do Endométrio , Músculo Esquelético , Sarcopenia , Idoso , Índice de Massa Corporal , Neoplasias do Endométrio/diagnóstico , Neoplasias do Endométrio/mortalidade , Neoplasias do Endométrio/fisiopatologia , Feminino , Humanos , Região Lombossacral/diagnóstico por imagem , Pessoa de Meia-Idade , Músculo Esquelético/diagnóstico por imagem , Músculo Esquelético/fisiologia , Prognóstico , Estudos Retrospectivos , Sarcopenia/diagnóstico por imagem , Sarcopenia/fisiopatologia , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: The aim of the study was to describe and correlate the skin, subcutaneous tissue, and superficial fascia thickness assessed by ultrasonography (US) with the lumbar erector spinae muscles contractile properties evaluated by tensiomyography (TMG). METHODS: A cross-sectional descriptive study with 50 healthy participants was performed. The point of maximum lordosis in the lumbar region of the right erector spinae was evaluated by US and TMG. First, the skin, subcutaneous tissue, and superficial fascia thicknesses (cm) were assessed by US. Second, the five contractile TMG parameters were analyzed from the right erector spinae muscles belly displacement-time curves: maximal radial displacement (Dm), contraction time (Tc), sustain time (Ts), delay time (Td), and half-relaxation time (Tr). Finally, correlation analyses using Pearson (r for parametric data) and Spearman (rs for non-parametric data) coefficients were performed. RESULTS: A strong negative correlation was shown between Dm and subcutaneous tissue thickness (rs=-0.668; P<.001). Furthermore, moderate negative correlations were observed between Dm and skin thickness (r=-0.329; P=0.020) as well as Tr and subcutaneous tissue thickness (rs=-0.369; P=0.008). The rest of the parameters did not show statistically significant correlations (P >.05). CONCLUSION: Therefore, the lumbar erector spinae contractile properties during TMG assessments, especially Dm and Tr, may be widely correlated by the skin and subcutaneous tissue thickness.