Effect of Core Stabilizing Training on Young Individuals Presenting Different Stages of Degenerative Disc Disease-Preliminary Report

Innovative Approaches for the Treatment of Spinal Disorders: A Comprehensive Review

This comprehensive review explores the latest advancements in the management of spinal disorders, including minimally invasive surgical techniques, treatment of complex deformities, disc replacement technologies, and non-surgical approaches. The review highlights the potential of innovations such as robotic-assisted surgeries, regenerative medicine, and artificial intelligence to enhance precision, reduce recovery times, and improve patient outcomes. It also discusses the integration of wearable technologies and personalized medicine in tailoring treatments. Challenges such as high costs, accessibility issues, and limited long-term data are critically analyzed, alongside gaps in research, including a lack of diversity in study populations and insufficient economic evaluations. Future directions emphasize the need for multidisciplinary collaboration to develop durable, accessible, and personalized solutions to address the global burden of spinal disorders.

Are Stabilisation Exercises Effective After Epidural Steroid Injection in Patients With Cervical Radiculopathy? A Prospective Randomised Controlled Trial

BACKGROUND

Cervical radiculopathy is caused by dysfunction of nerve roots in the cervical spine. While many studies have assessed the effectiveness of interlaminar epidural steroid injection (ILESI) and stabilisation exercises separately for this condition, our study aims to evaluate the impact of different stabilisation exercise programmes following ILESI on treatment outcomes in radiculopathy patients.

METHODS

Sixty-two patients with cervical radiculopathy were randomised into three groups: cervical ILESI-only (CO), neck stabilisation group (NSG) and scapular stabilisation group (SSG). The CO group received only ILESI, while NSG and SSG underwent stabilisation exercises following ILESI. Outcomes were assessed using the Numerical Rating Scale (NRS) for neck and arm pain, the Neck Disability Index (NDI) for functionality and the Short Form-12 (SF-12) for quality of life at baseline, 1 and 3 months posttreatment.

RESULTS

When NRS, NDI and SF-12 parameters were analysed in all groups, a statistically significant improvement was observed in the 1st and 3rd months compared to the pretreatment period. While the improvement in SF-12 physical parameters was significant in SSG and NSG in the 1st month compared to the pretreatment period, no significant difference was found in the CO group in the posttreatment periods. When the 1st and 3rd month results were analysed in NSG, a greater improvement was observed in terms of NRSNECK parameter in both evaluations compared to the other groups.

CONCLUSIONS

Stabilisation exercise programme, especially neck stabilisation, should be included after ILESI treatment due to positive effects on treatment outcomes.

SIGNIFICANCE

To the best of our knowledge, our study is the first to investigate the effect of a stabilisation exercise programme after ILESI on treatment outcomes in patients with radiculopathy due to cervical disc herniation. It is a valuable study in terms of its prospective design, its specific and homogeneous patient population and its results. Our study will help clinicians when prescribing exercise programmes for these patients.

TRIAL REGISTRATION

NCT05307211.

Gait analysis, trunk movements, and electromyographic patterns after minimally invasive spine surgery for lumbar instability: An observational prospective study

Objective

The aim of the present study was to investigate trunk kinematics and spine muscle activation during walking after minimally invasive surgery in patients with L4-L5 degenerative spondylolisthesis suffering from lumbar instability (LI).

Methods

Eleven patients suffering from LI and 13 healthy controls (HC) were enrolled. Trunk kinematics and spine muscle activation patterns during walking were collected. Maximal trunk ranges of motion were also recorded from standing position. Assessments were performed pre-operatively (T0), 1 month (T1) and 3 months (T2) after MIS.

Results

We found significant improvement in spine muscle activation during walking at T2 compared to T0, mainly involving right/left symmetry at the operated level (L4-L5) and up-down synchronization from L3 to S1. Significant improvements in trunk rotation nearing to the HC group during walking were also found at T2 after surgery, though no changes were observed in the maximal range of motion of the trunk during standing. Furthermore, trunk rotation improvement correlated with a lower grade of residual disability.

Conclusions

Our findings indicate that trunk rotation improves after surgery, and impaired aspects of spine muscle activation can be improved with surgery. These biomechanical parameters could represent novel tools for monitoring the effect of surgery in LI and preventing impaired spine mobility and muscle activation.

Evaluation of the degeneration of the multifidus and erector spinae muscles in patients with low back pain and healthy individuals

BACKGROUND

Although several studies have been conducted to determine the cause of low back pain (LBP), a sufficient correlation has not been found between research findings and symptoms. Therefore there seems to be a need for studies to explain the relationship between pain and morphological changes in the paraspinal muscles of patients with LBP through comparisons with healthy control subjects.

OBJECTIVE

The aim of this study was to examine degeneration in the lumbar musculus multifidus (LMF) and lumbar musculus erector spinae (LES) muscles in patients with chronic LBP with non-radiculopathy lumbar disc herniation (LDH), patients with mechanical LBP, and healthy individuals.

METHODS

The study included 35 patients with mechanical LBP, 38 patients with non-radiculopathy LDH, and a control group of 36 healthy participants. In all patients and the control group, evaluations were made on axial magnetic resonance imaging slices at L3-S1 level of the LMF and LES cross-sectional areas (CSA), total CSA (TCSA = LMF+LES), fat infiltrations and asymmetries.

RESULTS

The mean CSA values of the right and left LMF and LES showed significant differences between the groups (p< 0.001, p= 0.002, p= 0.002, p= 0.010, respectively). Fat infiltrations showed a difference between the right-left LMF and left LES groups (p= 0.007, p< 0.001, p= 0.026, respectively). Asymmetry was not observed between the CSA and TCSA of the right and left sides.

CONCLUSION

A correlation was found between fat infiltration in the LMF and mechanical LBP and LDH. However, no significant correlation was determined between LBP and the CSA and TCSA of the LMF and LES. This was thought to be due to an incorrect result of CSA and TCSA in the evaluation of muscle mass. Therefore, for a more accurate evaluation of muscle mass, it can be considered necessary to measure muscle atrophy associated with fat infiltration or functional CSA.

Is the novel suspension exercises superior to core stability exercises on some EMG coordinates, pain and range of motion of patients with disk herniation?

Information about comparing the effectiveness of exercise methods on management of disk herniation is limited. The aim of this study was to compare the effect of two programs of suspension and core stability exercises on some electromyography (EMG) coordinates, pain and range of motion of patients with disk herniation. Thirty-two men with disk herniation participated in this clinical trial study which was randomly divided into three groups of suspension exercises (n: 12, age: 34.25 ± 8.81, BMI: 24.01 ± 2.7), core stability exercises (n: 10, age: 35 ± 10.3, BMI: 25 ± 2.27) and control (n: 10, age: 34.4 ± 6.67, BMI: 23.76 ± 1.45). Electrical activity of rectus abdominis, internal and external oblique and erector spinae muscles was masured by superficial EMG, back pain by McGill Pain Questionnaire and range of motion by Modified Schober test, one day before and immediately after of intervention period. The experimental groups performed an 8-week training period while the control group was only followed up. Data were analyzed using paired sample t test and analysis of covariance test and statistical significance was set at 0.05. Suspension group showed significant improvement in EMG of rectus abdominis, internal and external oblique muscles (respectively, p = 0.030, p = 0.017, p = 0.022) and pain (p = 0.001) compared to core stability group; but there was no significant difference between two groups in EMG of erector spinae muscle and range of motion. Changes in both training groups were significant in all variables compared to control groups (p ˂ 0.05). Our findings showed that although both exercises were effective in patients with lumbar disk herniation, but the effectiveness of suspension exercises in increasing muscle activation and reducing pain was more pronounced than core stability exercises.

Iranian Registry of Clinical Trials (IRCT): IRCT20191016045136N1.