Purposes And Background

Having found a significant limitation of neural movement (66.6%) during SLR performed on the symptomatic side in patients with sub-acute lumbar intervertebral disc herniation (LIDH), we followed up on the same patients over 1.5 years to ascertain if changes in cord excursion accompany changes in clinical symptoms.

Aims: The purpose was to assess the effect of discec-tomy surgery on postural control, lumbar perception and reßex activation of paraspinal muscles during sudden upper limb loading. Methods: The study included 20 patients selected for an operation for chronic low back pain due to disc herniation and 15 controls without chronic back pain. The paraspinal muscle responses for upper limb loading during unexpected and expected conditions were measured by surface EMG. The ability to sense lumbar rotation was assessed in a previously validated motorized trunk rotation unit in the seated position. The postural control was measured with a vertical force platform. Pain, disability and depression scores were recorded. Results: Patients had poorer lumbar perception (P=0.012) and postural control (P< 0.05) than healthy control subjects. The postural control remained unchanged but lumbar perception (P=0.054) and the lumbar feed-forward control (P=0.043) improved after the surgery. Conclusions: This study demonstrated impaired lumbar proprioception and postural control in sciatica patients. During short-term follow-up after operative treatment, postural control does not seem to change, but impaired lumbar proprioception and feed-forward control of paraspinal muscles seem to recover.

Aim of the study: We compared Aircast versus standard plastic cast immobilisation methods after ankle fractures surgery. Materials and methods: 32 patients who had had a low energy uni- or bimalleolar fracture were included into this prospective study in Kuopio University Hospital. They were randomised to use either standard cast or Aircast for 6 weeks after surgery. 18 patients (10 women and 8 men) average age 41 (20 – 63) years used Aircast and 14 patients (8 women and 6 men) average age 48 (19–69) years used standard cast. All fractures were treated operatively using standard A-O techniques. Patients were followed for 6 months; clinical and radiographic evaluation was carried out at nine and 26 weeks after surgery by senior doctors. The function of ankle joint after injury was evaluated as proposed by Kaikkonen et al. (Am J Sports Med 4:462–69, 1994). Results: All fractures healed without complications. There were no statistical difference between the study groups when evaluating the ability to walk or run, climbing down stairs, rising on heels or on toes with injured leg, single limb stance with injured leg, laxity of the ankle joint or range of foot dorsifl exion during the follow-up. The subjective assessment of the injured ankle was significantly better in the Aircast group nine weeks after the injury. In the Aircast group 13 patients had mild and 5 moderate symptoms but in the standard cast group 4 patients had mild, 9 moderate and 1 severe symptoms (p = 0.013). Rising on heels with injured leg was also remarkably different between the groups after nine weeks follow-up despite (p = 0.052). Conclusion: Aircast immobilisation seems to be safe method to immobilise ankle fractures after surgery. It seems to improve patient satisfaction and may not disturb function of ankle joint as much as the standard cast immobilisation.

Aims: To assess the paraspinal muscle innervation and endurance in LSSMethods: Study included 25 patients with clinically and radiologically diagnosed LSS. Electromyography (EMG) of the paraspinal muscles was performed at the L3 to S1 levels bilaterally using a concentric needle. At least 20 insertions were analysed from each muscle to detect abnormal spontaneous activity associated with axonal damage (þbrillation potentials, positive sharp waves and complex repetitive discharges). Paraspinal muscle activity during trunk ßexion-extension movement and muscle endurance during dynamic isoinertial back endurance test were assessed by surface EMG. Muscle fatigue was calculated using mean power frequency (MPF) analysis. Results: Abnormal þndings in needle EMG of the paraspinal muscles were observed in 18 out of the 22 (81.8%) examined patients. Abnormal ßexionextension activation of the paraspinal muscles was observed in all examined patients. The MPF change was signiþcantly smaller than in previously evaluated healthy subjects and non-speciþc CLBP patients (P< 0.001) not suffering from symptoms of LSS. Para-spinal muscle fatigability was not associated with the denervation of the muscles. Conclusions: Denervation and abnormal activation of lumbar paraspinal muscles are frequent þndings in non-operated LSS patients. The paraspinal muscle endurance of the patients was unexpectedly good