Soft Tissue: A Possible Source of Pain Pre and Post Minimally Invasive Spine Surgery

A standardized anesthetic/analgetic regimen compared to standard anesthetic/analgetic regimen for patients with high-risk factors undergoing open lumbar spine surgery: a prospective comparative single-center study

The objective of the study is to improve the results of patients undergoing lumbar spine surgery who are at high risk for anesthesia and/or surgical complications. Two independent groups were compared: the study group (SG, n = 40) (standardized neuroanesthetic protocol with multimodal analgesia) and the control group (CG, n = 40) (intravenous anesthesia based on propofol and fentanyl). The data were collected using prospective observation of early and long-term results of lumbar fusion. After 24 months, the level of functional state and quality of life were studied. Patients in the SG did not have statistically significant changes in intraoperative hemodynamics; the best indicators of cognitive functions were noted. The effectiveness of the SG compared with the CG was confirmed by a statistically significantly lower amount of perioperative opioid drugs required (p = 0.01) and a minimal level of incisional pain (p < 0.05). An intergroup comparison of the adverse effects of anesthesia revealed a significantly lower number in the SG (n = 4) compared to the CG (n = 16) (p = 0.004). The number of postoperative surgical complications was comparable (p = 0.72). Intergroup comparison showed improved ODI, SF-36, and the Macnab scale at 24 months after surgery in the SG compared to the CG (p < 0.05). Long-term clinical results correlated with the level of incisional pain in the first three postoperative days. Our standardized neuroanesthetic protocol ensured effective treatment of postoperative incisional pain, significantly decreased the perioperative use of opioids, reduced adverse anesthesia events, and improved long-term clinical results in patients with high risk factors for anesthetic complications who undergoing open lumbar spine surgery.

Variações baseadas em gênero no movimento e na força isométrica do tronco em jovens adultos com dor lombar: Um estudo de caso-controle prospectivo

Objective  To determine gender-based variations in trunk range of motion (RoM) and isometric strength (IS) in symptomatic and asymptomatic young adults.

Methods  In this prospective case-control study, 73 subjects with low back pain (LBP) and 80 asymptomatic subjects were analyzed. Dynamometer-based device trunk RoM and IS measurements in extension, flexion, and rotation were compared in both groups and gender-based subgroups. Multivariate analysis was used to determine factors influencing trunk RoM and IS.

Results  Symptomatic males had significantly less extension RoM and extension, flexion, and rotation isometric trunk strength (ITS) ( p  < 0.0001) compared with asymptomatic males, whereas no significant difference was found between asymptomatic and symptomatic females. However, the mean extension-flexion RoM and mean extension-flexion ITS ratios were significantly lower ( p  = 0.04) in asymptomatic females compared with symptomatic females. Female gender was significantly associated with less extension and flexion ITS in both asymptomatic and symptomatic subjects.

Conclusion  Males with LBP had significant global ITS weakness when compared with asymptomatic males. Despite no significant ITS difference in symptomatic versus asymptomatic females, LBP caused significant extension-flexion RoM and ITS imbalance in females. These gender-based variations in trunk RoM and IS, especially the extensor-flexor IS imbalance in females, must be considered while designing rehabilitation treatment protocols for LBP.

Normative Reference Values for Trunk Range of Motion and Isometric Muscle Strength in Asymptomatic Young Indian Adults

PURPOSE

To determine normative reference values for trunk range of motion (ROM) and isometric strength (TIS) in asymptomatic young, Indian adults.

METHODS

Age, gender, body mass index, lifestyle, and dynamometer-based device measurements of trunk ROM and TIS in extension (EXT), flexion (FLX), and rotation (ROT) were recorded and analysed in 80 asymptomatic subjects between 20 and 40 years of age. Correlation analysis was performed to determine factors influencing EXT and FLX ROM and TIS.

RESULTS

The normative reference values for mean trunk EXT, FLX, right ROT, and left ROT ROM were 23° (95th percentile 31.9°), 40.2°(95th percentile 51.5°), 36.8°(95th percentile 57.7°), and 35.4° (95th percentile 55.7°), respectively; and for mean EXT, FLX, right ROT, and left ROT TIS were 118.1 Nm (95th percentile 278.8 Nm), 63.8 Nm (95th percentile 159.4 Nm), 39.9 Nm (95th percentile 113.6 Nm), and 42.8 Nm (95th percentile 108.9 Nm), respectively. The mean EXT (p = 0.0002), right (p = 0.02), and left ROT ROM (p = 0.01), and the mean EXT, FLX, and ROT TIS (p < 0.0001) were significantly greater in males compared to females. The FLX, EXT, and ROT TIS showed significant strong correlation with EXT and FLX TIS. Mean TIS values in Indian subjects were lower when compared to subjects from other countries.

CONCLUSION

This study established normative reference values for trunk ROM and TIS in asymptomatic young Indian adults. These reference values can be helpful to diagnose trunk ROM and TIS deficits, identify subjects at risk for LBP and disability, and individualise rehabilitation treatment in them.