Search

Objective: To study the behaviour of Lumbar Lordosis (LL) after non-instrumented decompression surgery in patients diagnosed with Lumbar Spinal Stenosis (LSS). Methods and materials: Retrospective analysis of patients undergoing non-lumbar instrumented decompression surgery for lumbar spine stenosis, operated on between January 2011 and December 2017. The variables collected were age, sex, affected segment, and presence or not of degenerative spondylolisthesis (ELS). The Lumbar Lordosis (LL) parameter was analysed using conventional radiology in standing position pre and postoperatively. Results: 64 patients were selected, 17 women and 47 men, with an average age of 68 (35-83). 65% stenosis was located in a single level, and 39.1% had degenerative ELS grade I. The average follow-up was 26 months (6m-104m). A preoperative LL angle of 43.2º (9.8º-70.8º) and 47º (8º-76º) were found at the postoperative follow-up, with an average difference of 3.8º (-15.7º-20.2º). 9.4% (6 patients) of degenerative ELS evolved to grade II, and 8 patients needed reoperation for different reasons. In patients with ELS, we found a greater increase in postoperative LL (5.59º) than in patients without ELS (2.61º) (p = 0.08). No statistically significant relationship was found between the behaviour of the LL with the number of decompressed levels (p = 0.43) and the need for reoperation (p = 0.26). Conclusions: According to our study, the technique of posterior decompression without instrumentation of the lumbar spine stenosis is not associated with a decrease of lumbar lordosis parameter. Conversely, there is a slight tendency for LL to increase in cases where a degenerative ELS is present.

Background: The objective of this study is to compare surgical results (pain, function, and satisfaction) between a group of depressed patients and a nondepressed group who had been operated on for a degenerative lumbar condition. Methods: Prospective observational study. Preoperative pain (lumbar and radicular visual analog scale [VAS]), function (Oswestry Disability Index [ODI]), and depression (Zung depression scale) data were collected in patients listed to be operated on for a lumbar degenerative condition. One year postoperatively, ODI and VAS data were collected again as well as a satisfaction question (are you satisfied with the surgical results? Yes/no). Results: Ninety-seven patients were included in the study, 78 nondepressed patients (80.4%) and 19 depressed patients (19.6%). Preoperatively, depressed patients had more lumbar pain (P = .00) and more functional limitation (P = .01) than nondepressed patients. One year postoperatively, depressed patients had more radicular pain (P = .029) and more functional limitation (P = .03) than non-depressed patients. The overall improvement of pain and function was similar between both groups (not significant). Seventy percent of depressed patients and 80% of nondepressed patients were satisfied with the surgical outcome (P = .52) 1 year postoperatively. Conclusion: Depressed patients experience the same overall level of improvement as nondepressed patients, despite having more pain and functional limitation preoperatively and 1 year after elective lumbar spine surgery than nondepressed patients. The level of satisfaction does not differ significantly between the two groups. Level of Evidence: 2.

El síndrome de la espalda inclinada o camptocormia es una causa de desequilibrio sagital del tronco no estructurada de difícil manejo médico y quirúrgico. Puede ser secundario a enfermedades del sistema nervioso central o periférico, o de origen primario muscular, como la atrofia aislada de la musculatura paravertebral espinal. El diagnóstico se basa en la evaluación clínica, los estudios por imágenes, el electromiograma y la biopsia muscular. El síndrome de la espalda inclinada, cualquiera fuera su causa, tiene un pronóstico pobre, los síntomas suelen progresar hasta afectar la bipedestación de manera irreversible. Presentamos un análisis retrospectivo de cuatro casos de síndrome de la espalda inclinada tratados en nuestro centro y una revisión de la bibliografía. AbstractIntroduction: The bent spine syndrome (BSS) or camptocornia is a cause of unstructured sagittal imbalance of difficult medical and surgical management.Objective: To describe the causes of BSS and how to approach its treatment.Materials and Methods: Retrospective analysis of 4 cases of BSS treated at our center and review of the literature.Results: The 4 cases were women between 60 and 82 years of age, 3 due to an isolated atrophy of the paravertebral spinal erectorae musculature and 1 case due to an inflammatory myopathy.Conclusions: The prognosis of any BSS is poor, so the symptoms usually progress to irreversible difficulty to maintain upright posture.

Study Design: Retrospective analysis of prospectively collected data. Purpose: To describe the radiological characteristics of the occipitocervical area in patients with ankylosing spondylitis (AS) using the novel measure X-angle and to describe the correlation between the ankylosed occipitoatlantoaxial (OAA) joint and thoracic kyphosis (TK). Overview of Literature: AS affects the axial skeleton, leading to progressive ankylosis of all vertebral segments. The effect of ankylosis on the upper cervical area of these patients is not well documented. Methods: All patients with complete ankylosis of the spinal column between C3 and T1, treated for cervical spinal fracture between 2007 and 2014, were eligible for inclusion in this study. The level of cervical fracture was identified. The T1-12 and T5-12 angles were measured using preoperative lateral radiography. The progressive degeneration of the C0-C1-C2 joints was evaluated via the new indicator X-angle, through the measurement of the angle of the C0-C1-C2 articulations in the coronal plane using computed tomography. Results: We included 86 consecutive patients with AS (67 males) aged 69±12 years. The patients were divided into two groups according to the degenerative change in the C0-C1 joint (62 patients with a mobile joint and 24 patients with an ankylosed joint). There was no significant difference between the two groups in terms of age (p =0.094) and level of fracture (p =0.949). The most commonly affected level was C6. There was no requirement for revision due to non-union in any of the patients. There was a statistically significant difference observed in the T1-12, T5-12, and X-angles (p =0.004, 0.001, and

An appropriate protocol and unified management of thoracolumbar fractures without neurological impairment has not been well defined. This review attempts to elucidate some controversies regarding diagnostic tools, the ability to define the most appropriate treatment of classification systems and the evidence for conservative and surgical methods based on the recent literature. Cite this article: Vilà-Canet G, García de Frutos A, Covaro A, Ubierna MT, Caceres E. Thoracolumbar fractures without neurological impairment: a review of diagnosis and treatment. EFORT Open Rev 2016;1:332-338. DOI: 10.1302/2058-5241.1.000029

Seventy-five percent of the human population will live in urban areas by 2050, and urban vegetation will be the main source of ecosystem services. Unequal access to urban vegetation might exacerbate existing socioeconomic differences. Studies performed in cities of developed countries show that the population with higher socioeconomic status has more access to ecosystem services provided by vegetation. In urban areas, with small internal climatic variation, plant productivity measured through satellite imagery is a good indicator of vegetation availability that can be mapped. In this study, we characterized the distribution of plant productivity in 40 Argentine urban centers and we identified socio-environmental variables that control its spatial patterns within and among urban centers. We used socioeconomic indicators obtained from the 2010 National Population and Households Census and a 4-year mean plant productivity measured through the integration of NDVI values derived from MODIS satellite images. In most of the analyzed cities, plant productivity increased as socioeconomic status decreased; and only in 25% of the cities, we found a positive relationship between socioeconomic status and plant productivity. In the latter case, most of the cities were placed in arid environments, where both the cost of watering and the effect of subsidized water on plant productivity are proportionally higher. Buenos Aires and Bariloche, which also showed positive associations between socioeconomic status and plant productivity, are located in humid environments, but Buenos Aires is the most densely populated city of Argentina and Bariloche is a touristic city; in these cities, the relative cost of keeping green spaces instead of building housing infrastructure is also high. These results show that vegetation distribution among socioeconomic status is more diverse than suggested by the literature and that the appropriation of vegetation productivity by groups with higher socioeconomic status only occurs when vegetation cost increases to the point of becoming a luxury good., Facultad de Humanidades y Ciencias de la Educación

El síndrome de la espalda inclinada o camptocormia es una causa de desequilibrio sagital del tronco no estructurada de difícil manejo médico y quirúrgico. Puede ser secundario a enfermedades del sistema nervioso central o periférico, o de origen primario muscular, como la atrofia aislada de la musculatura paravertebral espinal. El diagnóstico se basa en la evaluación clínica, los estudios por imágenes, la electromiografía y la biopsia muscular. El síndrome de la espalda inclinada, cualquiera fuera su causa, tiene un pronóstico pobre, los síntomas suelen progresar hasta afectar la bipedestación de manera irreversible. Presentamos un análisis retrospectivo de cuatro casos de síndrome de la espalda inclinada tratados en nuestro centro y una revisión de la bibliografía. Objectives: Bent spine syndrome (BSS) or camptocormia is a cause of unstructured sagittal imbalance of difficult medical and surgical management. The purpose of this paper is to describe the causes of BSS and how to approach its treatment. Materials and Methods: Retrospective analysis of 4 cases of BSS treated at our center and review of the literature. Results: The 4 patients were women between 60 and 82 years of age. In 3 of them, BSS was due to an isolated atrophy of the paravertebral erector spinae muscles, and in 1 of them, it was due to an inflammatory myopathy. Conclusions: The prognosis of BSS is poor in all cases, so symptoms usually progress to an irreversible difficulty to stand upright.

An appropriate protocol and unified management of thoracolumbar fractures without neurological impairment has not been well defined. This review attempts to elucidate some controversies regarding diagnostic tools, the ability to define the most appropriate treatment of classification systems and the evidence for conservative and surgical methods based on the recent literature. Cite this article: Vilà-Canet G, García de Frutos A, Covaro A, Ubierna MT, Caceres E. Thoracolumbar fractures without neurological impairment: a review of diagnosis and treatment. EFORT Open Rev 2016;1:332-338. DOI: 10.1302/2058-5241.1.000029

To assess the changes of intradiscal pressure at the bridged and at the adjacent levels to a lumbar two-level hybrid instrumentation. The elimination of motion produced by spinal fusion may have potential consequences beyond the index level overloading the juxtaposed spinal motion segments and leading to the appearance of degenerative changes. Degeneration of the segments adjacent to instrumented levels has become a topic of increasing interest in the literature over the last years. In order to prevent degenerative disc changes at the adjacent segments to a fused level, a broad scope of techniques have been developed, one of them is hybrid constructs. In 6 human cadaveric lumbosacral specimens, pressure transducers quantified intradiscal pressure changes at three levels (L3–L4, L4–L5 and L5–S1) under axial compression (0–750 N), anterior flexion (+12°) and extension (−12°) in three different situations of spinal stability: intact, L5–S1 rigid rod pedicle screw instrumentation and L4–S1 two-level hybrid instrumentation (rigid at L5–S1 and dynamic at L4–L5). Once the L5–S1 segment had implanted the rigid instrumentation system (Diapason), the intradiscal pressure at this level decreased by 65 % while the intradiscal pressure at the disc above (L4–L5) increased 20 %. After augmenting the L5–S1 posterior construct with a dynamic stabilization device (Dynesys) at the superior adjacent level, the intradiscal pressure at this level, L4–L5, decreased by 50 % whereas intradiscal pressure at its adjacent level, L3–L4, only experienced a slight increase of 10 %. The raise of intradiscal pressure at the adjacent segment to a rigid instrumented segment can be reduced when the rigid construct is augmented with a dynamic stabilization device. Hybrid constructs might have a possible protecting role preventing the occurrence of degenerative disc changes at the adjacent segment to a rigid instrumented level. Augmentation with a dynamic stabilization device might protect the disc above a rigid rod pedicle screw construct.

Lumbar spinal stenosis has become one of the most disabling pathologies in the elderly population. Some additional conditions such as foraminal stenosis or degenerative spondylosis with a history of back pain and leg pain must be considered before treatment. A completely appropriate protocol and unified management of spinal stenosis have not yet been well defined. The objective of this literature review is to provide evidence-based recommendations reflected in the highest-quality clinical literature available to address key clinical questions surrounding the management of degenerative lumbar spinal stenosis. Cite this article: Covaro A, Vilà-Canet G, García de Frutos A, Ubierna MT, Ciccolo F, Caceres E. Management of degenerative lumbar spinal stenosis: an evidence-based review article. EFORT Open Rev 2016;1:267-274. DOI: 10.1302/2058-5241.1.000030.

Study Design: This was a retrospective analysis of prospectively collected data. Objective: The effect of C0-C1-C2 cervical ankylosis in patients with ankylosing spondylitis (AS) is not documented. The objective of this study is to describe the radiological characteristics of the occipitocervical junction in patients with AS operated for a cervical fracture and to correlate them with their clinical evolution. Materials and Methods: Analysis of patients with ankylosing spondylitis (AS) treated in a single institution of a cervical vertebral fracture between 2007 and 2014 who were prospectively followed through the SWESPINE registry. The integrity of the C0–C1–C2 joints was determined and classified into fused and nonfused joints. By determining the angle between C0–C1 and C1–C2 joints in the coronal view of the computed tomography scan (X-angle), the progressive degeneration of these joints was described. Intra- and inter-observer reliability of this test was determined. The instruments of health-related quality of life (QOL) and disability were EQ5D and Oswestry disability index (ODI), respectively. Results: A total of 86 patients with AS treated surgically for cervical fracture had complete facet ankylosis between C3 and T1 due to their pathology. Mean age 69.2 years (standard deviation [SD]: 11.7). The most common level of fracture was in C5–C6. In 24 patients, the C0–C1 joint was fused, and in 15 patients, C1–C2 joint was fused. The intra- and inter-class reliabilities for X-angle measurement were very high (intraclass correlation coefficients = 0.94; 0.92). The mean X-angle was 125° (SD: 12) in nonfused patients and 136° (SD: 14) in fused patients (P < 0.001). There were no differences in QOL and disability at 2 years between the two groups: EQ5D-index of 0.54 and 0.55 (P = 0.5), ODI of 26.4 and 24, (P = 0.35) respectively. Conclusions: X-angle is a reliable measure for joint integrity C0–C1–C2 in patients with AS. Total cervical ankylosis including the C0-C1-C2 segments is not related to poorer QOL and disability in these patients.

To assess whether patients undergoing lumbar spine surgery for the first time (Group 1) had different expectations from those undergoing lumbar spine surgery for a failed previous procedure (Group 2).A prospective study that included 77 patients. A set of self-reported questionnaires was pre-operatively administered including VAS, Oswestry Disability Index (ODI), Zung Depression Scale and the NASS lumbar spine questionnaire (expectations scale).Fifty-six patients in Group 1 and 21 patients in Group 2. Both groups had high expectations with regard to the surgical procedure (n.s.). Depressed patients, despite being more disabled than non-depressed according to ODI (p 0.001), had similar expectations than non-depressed patients (n.s.).Patients' expectations remained very high despite having had a failed previous surgery for the same procedure.

En Venezuela el sector informal de barberias y peluquerias constituye una fuente de absorcion de mano de obra desocupada, que tiene algunas ventajas respecto a ingresos y flexibilizacion laboral, pero por otro lado es un sector desprotegido y con accesos limitados o nulos a servicios de seguridad y salud laboral, lo que dificulta la inclusion en programas de prevencion de accidentes de trabajo y enfermedades ocupacionales. En este estudio observacional transversal y descriptivo se aplico "la encuesta de las condiciones de trabajo y salud en America Latina del Center for International Health" y se analizaron las actividades de 40 trabajadores de barberias y peluquerias: 50% del genero masculino y 50% femenino, 85% con edades comprendidas entre 20-49 anos. De ellos, 65% manipulaban productos quimicos, 62,5% utilizaban el secador y/o maquina de afeitar, 87,5% habian sufrido al menos una lesion en su area de trabajo y 100% refirio adoptar bipedestacion prolongada, hacer movimientos repetitivos y presentar algun tipo de trastorno musculo-esqueletico, cuyos sintomas mas frecuentes fueron dorsalgias y lumbalgias con 37,5% y 32,5% respectivamente. Por otro lado, las varices en miembros inferiores fueron la segunda causa de morbilidad reportada.

Redwood Systems' objective is to further accelerate the acceptance of solid state lighting (SSL) with fine grain and easy-to-use control. In addition, increased and improved sensor capability allows the building owner or user to gather data on the environment within the building. All of this at a cost equal to or less than that of code-compliant fluorescent lighting. The grant we requested and received has been used to further enhance the system with power conversion efficiency improvements and additional features. Some of these features, such as building management system (BMS) control, allow additional energy savings in non-lighting building systems.

Objectives To evaluate workers’ health outcomes and their association with work organisation (WOF) and violence (WV) factors among sectors of the economy in Argentina. Method We used data from the first Employment, Working conditions and Health Survey with face-to-face interviews. We selected 7200 sample cases representative of 3 000 000 workers from different economic sectors across Argentina. Multi-stage methods were applied. Sex and age were considered. The dependent variables were: reported work-injuries, occupational disease, health care visits and symptoms from the workers’ perspective. Psychosocial factors were classified as: work organisation factors, violence and harassment factors. To determine the association between health outcomes and risk factors, prevalence and Odds Ratios with 95% confidence intervals (OR) were estimated using and Logistic Regression. Results Exposed workers to WOF and WV had highest prevalence of injuries (18%, 17% vs. 9 and 11%), diseases (6.6, 7.5% vs. 3.5 y 3.8%) and health care visits, for both WOF and WF respectively (p Conclusions Is increasing the evidence of health outcomes related to work organisation factors, therefore, for designing and targeting preventive strategies, and for a comprehensive understanding of health outcomes in the working population, it is necessary to include variables from a psychosocial and gender point of view.

Toxoplasma gondii is capable of invading and multiplying within murine peritoneal macrophages. Previous studies have shown that treatment of macrophage monolayers with recombinant gamma interferon but not tumor necrosis factor (TNF) is associated with intracellular killing of T. gondii by macrophages. Furthermore, infection of macrophages with T. gondii prevents their stimulation for mycobactericidal activity by TNF. Since transforming growth factor beta (TGF-beta) is known to suppress a number of functions in macrophages, we investigated the influence of infection with T. gondii on macrophage TNF receptors and on production of TGF-beta. Infection with T. gondii was associated with increased production of TGF-beta and downregulation of TNF receptors. This effect was observed early after infection and was partially inhibited by anti-TGF-beta 1 antibody.