Purpose of the study. To assess the ability of magnetic resonance spectroscopy (MRS) to detect changes in spinal muscle metabolism after a 4-week exercise intervention. Background. Spinal muscle atrophy is associated with back pain and exercise interventions have been shown to reduce pain and improve function. It is not always clear, however, whether improvements are due to enhanced muscle performance or occur for other reasons (e.g. psychological, neurological). MRS can be used to measure muscle metabolism and could therefore be useful for assessing the mechanisms by which exercise improves function in back pain patients. Methods. Eleven healthy participants took part in a 4-week exercise intervention to strengthen the spinal muscles. Before and after the intervention, the participants underwent an assessment that included using MRS to monitor the phosphocreatine levels in the spinal muscles around the level of L3L4 whilst they performed a modified Biering-Sorensen test to fatigue. Results. Relative to the pre-intervention assessment, the post-intervention endurance time significantly increased (mean=20 s, 95% CI 7–34 s, p=0.01). The phosphocreatine depletion, taken at an equivalent time point in both assessments, significantly decreased (mean=12%, 95% CI 5–19%, p=0.006). Even at the point of the fatigue, the phosphocreatine depletion was lower post-intervention (mean=8%, 95%CI 1–15%, p=0.045). Conclusion. MRS can be used to detect changes in the metabolism of the spinal muscles after a 4-week exercise intervention

Purpose. Lumbar paraspinal muscle dysfunction and low back pain are strongly correlated. Muscle atrophy is common in LBP and is recognised by MRI scan. Corticosteroid injections and physical rehabilitation programs are advocated for treatment of LBP. The purpose is to evaluate efficacy of specific lumbar multifidus muscle retraining exercises and perifacet multifidus injections in treatment of Low Back Pain (LBP) and referred leg pain. Method. 63 patients with non-specific LBP, with or without leg pain, were randomised to three treatment groups. MR images of paraspinal muscle and the atrophy classified. A-Control group, standard physiotherapy for 10 weeks. B-Multifidus rehabilitation program for 10 weeks. C-Perifacet injection (multifidus injection) with methylprednisolone. ODI was primary outcome measure and the SF-36, modified Zung Depression Index and others were secondary outcome measures. Results. 56 patients completed trial. ODI improved from a mean of 29.9 to 25.9, but there were no statistically significant differences between groups. 62% of patients were at risk/had major psychological overlay. LBP improved most in group C (Perifacet injection) (P< 0.02), mean improvement in SF-36 bodily pain score was 21.2 (with a 95% CI of 2.1-44.0) while PF and SF were improved most in group B (multifidus rehabilitation) (P< 0.03). Conclusion. Perifacet injection and a multifidus retraining program are more effective than standard physiotherapy in relieving pain and improving physical capacity respectively. Multifidus rehabilitation program is the recommended treatment for non-specific LBP, as the ultimate goal should be to restore function. Perhaps the combination of perifacet injection to relieve pain followed by multifidus retraining program is the best treatment option. No change in the multifidus muscle was seen over time

Aims

It is uncertain whether instrumented spinal fixation in nonambulatory children with neuromuscular scoliosis should finish at L5 or be extended to the pelvis. Pelvic fixation has been shown to be associated with up to 30% complication rates, but is regarded by some as the standard for correction of deformity in these conditions. The incidence of failure when comparing the most caudal level of instrumentation, either L5 or the pelvis, using all-pedicle screw instrumentation has not previously been reported. In this retrospective study, we compared nonambulatory patients undergoing surgery at two centres: one that routinely instrumented to L5 and the other to the pelvis.

Aims

The aim of this study was to evaluate the time course of changes in parameters of diffusion tensor imaging (DTI) such as fractional anisotropy (FA) and apparent diffusion coefficient (ADC) in patients with symptomatic lumbar disc herniation. We also investigated the correlation between the severity of neurological symptoms and these parameters.

Spinal stenosis and disc herniation are the two most frequent causes of lumbosacral nerve root compression. This can result in muscle weakness and present with or without pain. The difficulty when managing patients with these conditions is knowing when surgery is better than non-operative treatment: the evidence is controversial. Younger patients with a lesser degree of weakness for a shorter period of time have been shown to respond better to surgical treatment than older patients with greater weakness for longer. However, they also constitute a group that fares better without surgery. The main indication for surgical treatment in the management of patients with lumbosacral nerve root compression should be pain rather than weakness.