Search Results (38)

Background: Severe scoliosis can lead to chronic low back pain (cLBP) and may progress in adulthood. While day-time bracing is commonly used to alleviate pain and improve function, the role of night-time bracing remains unclear. This study aimed to assess the six-month effectiveness of a custom-made night-time brace in reducing pain in adults with scoliosis, compared to a prefabricated brace worn for 2–4 h during the day. Methods: A retrospective cohort study was conducted at a tertiary outpatient clinic specializing in spinal deformities. Adults with scoliosis (≥30° Cobb) and cLBP were divided into two groups: the study group used a custom-made night-time thoracolumbosacral orthosis (TLSO), while the control group wore a prefabricated brace (Peak) for 2–4 h daily. Pain and functional outcomes were assessed at baseline and after six months. Results: The study group included 25 women (mean age, 62.3 ± 9.5 years; Cobb angle, 60.4 ± 17.7°) who wore the night-time brace for an average of 7.2 ± 2.2 h per night. The control group comprised 20 women (mean age, 67.8 ± 10.5 years; Cobb angle, 61.9 ± 12.6°). At six months, the worst pain significantly improved in the TLSO group compared to the Peak group (F = 6.32, p = 0.0158). However, no statistically significant differences were observed between groups for back pain, leg pain, Core Outcome Measures Index (COMI), or Oswestry Disability Index (ODI). Conclusions: Night-time bracing shows interesting results on pain at six months in adults with severe scoliosis and back pain. These preliminary results open a new perspective that needs further verification and will help design more robust studies to verify what we found and identify the population more responsive to this approach. Full article

To investigate the failure evolution and structural response of transmission towers under the combined effects of foundation sliding and wind loads, this study used the foundation sliding incident of Tower No. 39 on the Xiaoxing transmission line as a case for numerical back-analysis. A transmission tower model was first developed based on the finite element method, and the simulation results were compared with field observations to validate the model, with particular focus on the consistency of typical failure modes such as leg bending and cross-bracing instability. On this basis, the structural response under the combined action of foundation lateral displacement, settlement, and wind loads was further simulated. The results indicate that foundation sliding significantly affects the structural stability of transmission towers, with single-foundation sliding being more destructive than the simultaneous sliding of multiple foundations on the same side. Moreover, the coupling of foundation sliding and wind load substantially reduces the critical displacement required to trigger structural failure. Finally, critical displacement thresholds are proposed, which can serve as reference criteria for damage assessment and engineering intervention when changes in foundation conditions occur. Full article

Background/Objectives: Chronic low back pain (CLBP) is prevalent among older adults and leads to significant functional limitations and reduced quality of life. Segmental stabilization exercises (SSEs) are commonly used to treat CLBP, but the selective activation of deep abdominal muscles during these exercises can be challenging for patients. To support muscle activation, physiotherapists use biofeedback methods such as palpation and ultrasound imaging. This randomized controlled pilot study aimed to compare the effectiveness of these two biofeedback techniques in older adults with CLBP. Methods: A total of 24 participants aged 65 years or older with CLBP were randomly assigned to one of two groups: one group performed self-palpation biofeedback, while the other group used real-time ultrasound imaging to visualize abdominal muscle activation. Muscle activation and thickness were continuously tracked using a semi-automated algorithm. The preferential activation ratio (PAR) was calculated to measure muscle activation, and statistical comparisons between groups were made using ANOVA. Results: Both groups achieved positive PAR values during all repetitions of the abdominal-draw-in maneuver (ADIM) and abdominal bracing (AB). Statistical analysis revealed no significant differences between the groups in terms of PAR during ADIM (F(2, 42) = 0.548, p = 0.58, partial η² = 0.025) or AB (F(2, 36) = 0.812, p = 0.45, partial η² = 0.043). Both groups reported high levels of exercise enjoyment and low task load. Conclusions: In conclusion, both palpation and ultrasound biofeedback appear to be effective for guiding older adults with CLBP during SSE. Larger studies are needed to confirm these results and examine the long-term effectiveness of these biofeedback methods. Full article

This study aimed to quantify the postures and muscle activity while parks and gardens workers operated ride-on mowers during a typical shift. Eight participants operated ride-on mowers in the same park but on different terrains (flat and undulating). Body postures and muscle activity were collected wirelessly and unobtrusively. Participants adopted a forward-flexed seated posture with the predominant movement being head rotation. Oscillatory movements (20–40° from neutral) of the thorax in all three planes of movement were noted in all participants. Low levels (<30% MVIC) of muscle activity were recorded in all muscles tested. These levels were elicited for most (>90%) of the recording time. Higher (>50% MVIC) activation levels were interspersed through the data, but these were not sustained. There was no difference in posture or muscle activity between the flat and undulating terrain. The forward-flexed posture combined with vibration can increase the risk of discomfort and injury in the low back while ride-on mowing. The low levels of muscle activity suggest participants did not actively brace for the occupational situation and task. The large inter-participant difference in posture attests to subjective variation to accommodate muscular stress, and this may not be optimal for injury mitigation. Full article

Chronic low back pain (CLBP) negatively impacts quality of life and contributes to a significant economic burden. One conservative management strategy for CLBP is lumbar back bracing. Despite the benefits of back bracing for improving pain and function, there remains hesitance to use the therapy long term due to unfounded fear related to muscle weakness, deconditioning, or joint contracture. Objective: The purpose of this study was to examine the outcomes for patients with CLBP who were managed with lumbar back bracing and physical therapy. Methods: This was a single-site, retrospective chart review. Results: Patients were included in the study if they were treated for CLBP with back bracing for at least one hour daily and physical therapy for twelve weeks. Pain was assessed at three, six, and twelve months using the 11-point Visual Analogue Scale (VAS). Function was assessed at three months using the Oswestry Disability Index (ODI). The VAS score reduced from 6.28 +/− 2.32 to 3.96 +/− 2.66 at three months (p < 0.001) for 198 patients. At six and twelve months, the VAS score reduced to 3.74 +/− 2.73 (p < 0.001) and 3.23 +/− 2.29 (p < 0.001), respectively. The total ODI score for 199 patients improved from 46.56 +/− 15.30 to 33.13 +/− 19.99 (p < 0.001) at three months. Conclusion: Back bracing in combination with physical therapy is effective for treating low back pain. Full article

Objectives: This scoping review explores the effectiveness of abdominal hollowing (AH) and abdominal bracing (AB) techniques in enhancing trunk stability and facilitating rehabilitation, particularly for individuals with lower back pain (LBP). Methods: The review synthesizes findings from 22 randomized controlled trials (RCTs) that assessed these techniques’ impacts on muscle activation, pain reduction, and functional outcomes. Results: The results demonstrate that both techniques can significantly improve trunk stability, muscle thickness, balance, and gait. However, a notable gap exists in studies directly comparing AH and AB, raising questions about whether they are equally effective. While AH is often associated with selective activation of the transversus abdominis, AB promotes a broader co-contraction of trunk muscles, contributing to robust spinal stability. Conclusions: This review underscores the need for further research to directly compare these techniques and refine their application in clinical practice. The findings suggest that personalized rehabilitation programs incorporating both AH and AB, tailored to individual patient needs and rehabilitation goals, can be effective in managing and preventing LBP. Full article

Background: Skeleton involvement is one of the most significant aspects of Gaucher disease (GD). However, the treatment for spinal involvement in GD among patients undergoing enzyme replacement therapy (ERT) is poorly characterized. We present a case of progressive kyphotic spinal deformity in a young child caused by vertebral involvement, which was managed by posterior spinal fusion without anterior spinal release under ERT. Case presentation: This is a retrospective study. A 10-year-old boy presenting with progression kyphosis (thoracic kyphotic angle of 113°) associated with type-IIIb GD had undergone posterior spinal fusion with segmental pedicle screw fixation (from T6-L3) and Ponte osteotomy. The patient went back to school without further brace protection. Proximal junctional kyphosis (PJK) was observed at 4 months postoperatively. Revision surgery was performed to prevent neurological impairment. Additional posterior spinal fusion from T2–T6 and decompressive laminectomy were performed during the revision surgery. A 2-year follow-up showed no recurrence of PJK and solid fusion was achieved in the patient under ERT and brace protection. Conclusions: Posterior spinal fusion without anterior spinal release is a good treatment option for severe spinal deformity in patients with GD. However, the fusion level and reinforced fixation require careful consideration. Revision surgery and brace protection is needed as long as PJK is observed. Full article

Background: Congenital kyphosis is a spinal deformity that arises from the inadequate anterior development or segmentation of the vertebrae in the sagittal plane during the initial embryonic stage. Consequently, this condition triggers atypical spinal growth, leading to the manifestation of deformity. Concurrently, other congenital abnormalities like renal or cardiac defects within the gastrointestinal tract may co-occur with spinal deformities due to their shared formation timeline. In light of the specific characteristics of the deformity, the age range of the patient, deformity sizes, and neurological conditions, surgical intervention emerges as the optimal course of action for such cases. The selection of the appropriate surgical approach is contingent upon the specific characteristics of the anomaly. Case Presentation: This investigation illustrates the utilization of a surgical posterior-only strategy for correcting pediatric congenital kyphoscoliosis through the implementation of a vertebral column resection method along with spine reconstruction employing a mesh cage. The individual in question, a 16-year-old female, exhibited symptoms such as a progressive rib hump, shoulder asymmetry, and back discomfort. Non-invasive interventions like bracing proved ineffective, leading to the progression of the spinal curvature. After the surgical procedure, diagnostic imaging displayed a marked enhancement across all three spatial dimensions. After a postoperative physical assessment, it was noted that the patient experienced significant enhancements in shoulder alignment and rib hump prominence, with no discernible neurological or other adverse effects. Conclusions: Surgical intervention is considered the optimal approach for addressing such congenital anomalies. Typically, timely surgical intervention leads to favorable results and has the potential to halt the advancement of deformity and curvature enlargement. Full article

Back pain in the presence of LSTVs (lumbosacral transitional vertebrae) was originally noted by Mario Bertolotti in 1917. The Lenke classification for scoliosis forms the current international standard. However, the connection between LSTVs and scoliosis is still poorly understood. The aim of this study is to show the connection between scoliosis and LSTVs in terms of their frequency and impact on further development. Our scoliosis outpatient clinic has an examination period that covers the years from 2014 to 2021. If LSTVs are radiologically suspected (AP and lateral X-ray of the spine) according to the Castellvi classification (II–IV), a further MRI investigation is initiated. Scoliosis shape is assigned according to the Lenke classification. Sagittal segmental differences are observed according to the vertical mean vertebral angle (VMVA) and its difference (Diff-VMVA). Assignment to the lumbar pain group is made in cases of a history of chronic or recurrent pain of more than 6 months. Differentiation is made at the initial presentation according to gender (male–female) and age (children and adults). Other associated diagnoses such as family correlations and the question of brace fitting are cited. Finally, the literature is reviewed from a scoliosis perspective and compared with the findings of the authors of this paper. A total of 1332 patients were evaluated, and LSTV Castellvi II–IV was confirmed in 72 of them (58 female and 14 male). The curvature extent of scoliosis in children and adults had a mean Cobb angle of 24.3° with a range from 11° to 55° (n-42) and 32.4° with a range from 12° to 66° (n-30), respectively. This indicates that 75% of n-54 patients were mostly classified as Castellvi II (pseudarthrosis) (IIA, 54.2%; IIB, 20.8%) in the total data. There were few patients classified with Castellvi III (22.2%) and IV (2.8%). A proportion of 87.5% of 72 patients were mostly classified as Lenke 1 (25.0% n-18) and Lenke 5 (62.5% n-45). According to the literature, the Diff-VMVA shows Cobb angles of 9.3° for Castellvi III and 5.3° for Castellvi IV. Half of the patients complain of chronic low back pain for at least 6 months or have recurrent complaints (48.6%). The complaints are mostly classified as Castellvi IIA (27.8%) and B (9.7%). The association of scoliosis and LSTVs yields only 13 studies (PubMed 04/18/2022) that focus on spine surgery issues and not on diagnostics. Attention should be given to the lumbosacral junction in Lenke 1 and Lenke 5. Nearly half of the patients in each category complain of chronic lumbar symptoms. This is notable in individual cases due to its rounding and thus its increased Diff-VMVA. Since only Castellvi II–IV is considered, a comparison of the frequency with other studies is not permissible. In conclusion, for scoliosis Lenke 5 and Lenke 1, the lumbosacral junction should be examined. Full article

Postoperative discitis (POD) accounts for 20% to 30% of all cases of pyogenic spondylodiscitis, while POD may be mis-or-under-diagnosed, due to the vague related symptomatology and the non-specific imaging findings. Most studies report infection rate of less than 1%, which increases with the addition of non-instrumented fusion to 2.4% to 6.2%. It remains controversial whether POD is caused by an aseptic or infectious process. Positive cultures are presented only in 42–73% of patients with Staphylococcus species being the most common invading organisms, while Staphylococcus aureus is isolated in almost 50% of cases. The onset of POD symptoms usually occurs at 2–4 weeks after an apparently uneventful operation. Back pain and muscle spasms are usually refractory to bed rest and analgesics. Magnetic Resonance Imaging (MRI) is the most sensitive and specific imaging diagnostic technique. Antimicrobial therapy depends on the results of tissue cultures, and along with bracing represents the mainstay of management. Surgical intervention is necessary in patients failing conservative treatment. For the majority of cases, extensive surgical debridement, antibiotic therapy, and orthosis immobilization are effective in eliminating the infection. According to this, we recommend an Algorithmic approach for the management of POD. Postoperative infections after spinal surgery pose a certain clinical challenge, and in most cases can be treated conservatively. Nevertheless, disability may be persistent, and surgery could be necessary. The purpose of this concise review is to describe the manifestation of post-discectomy infection, its pathogenesis and particularly a rational approach for its management. Full article

A sedentary lifestyle has caused adults to spend more than 6 h seated, which has led to inactivity and spinal issues. This context underscores the growing sedentary behavior, exemplified by extended sitting hours among adults and university students. Such inactivity triggers various health problems and spinal disorders, notably Upper Crossed Syndrome (UCS) and its association with thoracic kyphosis, which can cause severe spinal curvature and related complications. Traditional detection involves clinical assessments and corrective exercises; however, this work proposes a multi-layered system for a back brace to detect, monitor, and potentially prevent the main signs of UCS. Building and using a framework that detects and monitors signs of UCS has facilitated patient–doctor interaction, automated the detection process for improved patient–physician coordination, and helped improve patients’ spines over time. The smart wearable brace includes inertial measurement unit (IMU) sensors targeting hunched-back postures. The IMU sensors capture postural readings, which are then used for classification. Multiple classifiers were used where the long short-term memory (LSTM) model had the highest accuracy of 99.3%. Using the classifier helped detect and monitor UCS over time. Integrating the wearable device with a mobile interface enables real-time data visualization and immediate feedback for users to correct and mitigate UCS-related issues. Full article

Background: Traditional treatment modalities for vertebral compression fractures (VCFs) include bed rest, pain medications, muscle relaxants, back braces, and physical therapy. In cases where conservative treatment proves ineffective, a new procedure called core decompression of the vertebral body is explored. Core decompression of the vertebral body has the potential to lower and stabilize the intraosseous pressure, resulting in enhanced blood circulation, which contributes to pain reduction. In this trial, we evaluated the efficacy of core decompression of the vertebral body in patients with painful VCFs compared with conventional conservative treatment. Methods: This prospective randomized controlled trial was conducted at a tertiary education hospital between June 2017 and May 2020. The participants were randomly assigned in a 1:1 ratio to one of two treatment groups: the core decompression group and the conservative treatment group. The primary outcome measure was the visual analog scale (VAS) pain score of the back 3 months after the procedure. Secondary outcome measures included the Oswestry Disability Index (ODI) for lumbar disabilities, the European Quality of Life-5 Dimensions (EQ-5D) score for quality of life, and radiographic outcomes such as changes in compression rate. Results: All patients underwent the assigned intervention (48 core decompression and 50 conservative treatments). At both 1 month and 3 months, there were no significant differences between the core decompression group and conservative treatment group in VAS pain score (adjusted treatment effect: −0.1 and 2.0; 95% confidence interval [CI]: −7.5 to 7.3 and −5.6 to 9.6; p = 0.970 and p = 0.601, respectively). In addition, there were no significant inter-group differences in ODI and EQ-5D scores throughout the follow-up period (p = 0.917 and 0.704, respectively). Conclusion: Core decompression of the vertebral body did not demonstrate any significant improvement in pain and disability compared to conventional conservative treatment. Full article

This work proposes an innovative method, based on the use of low-cost infrared thermography (IRT) instrumentation, to assess in real time the effectiveness of scoliosis braces. Establishing the effectiveness of scoliosis braces means deciding whether the pressure exerted by the brace on the patient’s back is adequate for the intended therapeutic purpose. Traditionally, the evaluation of brace effectiveness relies on empirical, qualitative assessments carried out by orthopedists during routine follow-up examinations. Hence, it heavily depends on the expertise of the orthopedists involved. In the state of the art, the only objective methods used to confirm orthopedists’ opinions are based on the evaluation of how scoliosis progresses over time, often exposing people to ionizing radiation. To address these limitations, the method proposed in this work aims to provide a real-time, objective assessment of the effectiveness of scoliosis braces in a non-harmful way. This is achieved by exploiting the thermoelastic effect and correlating temperature changes on the patient’s back with the mechanical pressure exerted by the braces. A system based on this method is implemented and then validated through an experimental study on 21 patients conducted at an accredited orthopedic center. The experimental results demonstrate a classification accuracy slightly below 70% in discriminating between adequate and inadequate pressure, which is an encouraging result for further advancement in view of the clinical use of such systems in orthopedic centers. Full article

Rebound-associated vertebral fractures (RVFx) following denosumab discontinuation are typically multiple, are commonly associated with acute sharp pain, increase the risk of imminent fractures, and are pathogenetically different from common osteoporotic vertebral fractures (VFx). A clinically relevant question is whether patients with RVFx should be managed differently from patients with osteoporotic VFx. To address this question, we performed a systematic search of the PubMed database, and we reviewed current evidence on the optimal management of patients with RVFx. For pain relief of patients with RVFx, potent analgesics, often opioids, are essential. Information on the effectiveness of braces in these patients is scarce. Vertebroplasty and kyphoplasty are strongly contraindicated as they confer a substantial risk for new VFx. Exercise may be helpful, but again evidence is lacking. In contrast to patients with osteoporotic VFx, in whom initial treatment with bone-forming agents is recommended, patients with RVFx should initiate treatment with potent antiresorptives. To summarize, patients who have sustained RVFx following denosumab discontinuation are at a very high risk for new fractures, especially VFx. The management of such patients requires a multidisciplinary approach that should not be restricted to pain relief and administration of antiosteoporotic medication, but should also include back protection, early mobilization, and appropriate exercise. Full article

Exercises that improve muscle activation are essential for maintaining spinal stability and preventing low back pain. The purpose of this study was to compare the effects of abdominal hollowing and bracing on the activation of the core muscles in CrossFit^® participants using ultrasound and electromyography (EMG). Twenty-four healthy adults aged 21 to 42 years old with at least two years of CrossFit^® experience performed three core stability exercises (plank, side plank, bridge) with abdominal hollowing and bracing. We measured the ultrasound relative thickness of the local core muscles (transversus abdominis, internal oblique, and lumbar multifidus), and the EMG percentage of maximal voluntary contraction (MVC) of the global core muscles (rectus abdominis, external oblique, and iliocostalis lumborum). Analysis of variance tests showed that the relative thickness of the local core muscles was greater (p = 0.016) during hollowing (range from 26.8 ± 5.33 to 88.4 ± 11.9% of rest) than bracing (range from 15.9 ± 3.54 to 61.2 ± 15.9% of rest), while the EMG of the global muscles was greater (p = 0.001) in bracing (range from 24.4 ± 7.30 to 72.5 ± 9.17% of MVC) than hollowing (range from 16.4 ± 3.70 to 56.6 ± 7.65% of MVC). These results indicate that the recruitment of spinal muscles during popular exercises is achieved with both hollowing and bracing. Nevertheless, it appears that hollowing tends to recruit more of the local muscles, whilst bracing recruits more of the global muscles. The grading of the exercises varied between muscles and varied between maneuvers, especially for the surface abdominals and lumbar muscles. CrossFit^® practitioners can choose to use either hollowing or bracing to activate their core muscles more selectively or more appropriately, depending on the goal and purpose of the exercise. Full article