Comparison of Radicular Symptoms Caused by Lumbar Disc Herniation and Lumbar Spinal Stenosis in the Elderly.

Comparison of Radicular Symptoms Caused by Lumbar Disc Herniation and Lumbar Spinal Stenosis in the Elderly.

Spine (Phila Pa 1976). 2013 Mar 4;
Rainville J, Lopez E

Abstract. Comparison of Radicular Symptoms Caused by Lumbar Disc Herniation and Lumbar Spinal Stenosis in the ElderlyStudy Design. Comparative study using combined data from 2 prospective cohort studiesObjective. To expose the differences between the clinical characteristics of neurogenic claudication from MRI-documented lumbar spinal stenosis (LSS) and lumbosacral radicular syndrome from acute, MRI-documented, lumbar disk herniation (LDH).Summary of Background Data. LSS and LDH are the common lumbar disorders that produce lower extremity pain. Though known factors such as pain induced by walking for LSS and the rapid onset of symptoms for LDH are useful for differentiating these disorders, exploration of differences in other factors has received limited study.Methods. This study included participants age ? 60 from two previous studies. One examined walking limitations caused by LSS and the second the natural history of LDH in elderly adults. The clinical features of both groups were compared by calculating means, medians and standard deviations for continuous variables, and frequencies for categorical variables. Chi-square test was used to explore differences between LSS and LDH for categorical variables, and Student’s T-test or Mann-Whitney test for continuous variables.Results. Participants with LSS had more medical comorbidity, less intense leg pain, and less disability than those with LDH. Leg pain was more common in the anterior thigh, anterior knee and shin pain in LDH, and in the posterior knee in LSS. Trunk flexion was more impaired in LDH. Positive straight leg raising and femoral stretch signs were common in LDH, and rare in LSS. Abnormal Achilles reflexes were noted more frequently in LSS.Conclusion. In addition to established factors, greater leg pain intensity, greater disability, and pain in the anterior leg are more common in the elderly with LDH than in the elderly with LSS. Normal trunk flexion, absence of nerve root tension signs and abnormal Achilles reflexes are more common in LSS. HubMed – rehab

 

Pre-Operative MRI Imaging is Associated With Baseline Neurological Status and Can Predict Postoperative Recovery in Patients With Cervical Spondylotic Myelopathy.

Spine (Phila Pa 1976). 2013 Mar 4;
Arvin B, Kalsi-Ryan S, Mercier D, Furlan JC, Massicotte EM, Fehlings MG

Study Design. A blinded observational study of consecutive patients, prospectively enrolled and followed up to 1 year post-operatively.Objective. To assess whether quantitative assessment of preoperative Magnetic Resonance Imaging (MRI) predicts baseline patient status and post-operative neurological recovery.Summary of Background Data. Factors which can predict neurological recovery in cervical spondolytic myelopathy (CSM) patients postoperatively are of great interest. Currently, the literature regarding the significance of MRI signal changes in relation to prognosis is inconsistent and conflicting.Methods. A total of 57 consecutive patients with CSM were studied pre-operatively and 1 year post-operatively. Modified Japanese Orthopedic Association (mJOA), Nurick, SF-36, Neck Disability Index (NDI), 30m walk cadence (Wc) and time (Wt), grip strength and Berg Balance Scale (BBS) were administered at baseline and 1 year post-surgery. Preoperative status and postoperative recovery were assessed in relation to quantitative MRI measurements pre and postoperatively using univariate and multivariate analysis.Results. Low T1 signal change preoperatively was associated with a lower mJOA (P = 0.0030), higher Nurick (P = 0.0298), decreased grip (P = 0.0152), impaired Wt, Wc (P?0.0001) and poor BBS (P = 0.0005) at baseline. Focal high T2 signal was associated with lower mJOA scores and higher Nurick compared with diffuse T2 (P = 0.0035 P = 0.0079) or no T2 signal (P = 0.0680 P = 0.0122). Preoperative segmentation of T2 signal, showed a significant increase in Wt, Wc and BBS (P = 0.0266; P = 0.0167; P = 0.0042). Preoperative T1 signal was associated with lower postoperative grip (P = 0.0260), greater Wt, Wc (P = 0.0360, P = 0.0090). Preoperative focal T2 signal had a significant association with poorer postoperative Wt,Wc (P = 0.0220) and Nurick (P = 0.0230). Preoperative maximal cord compromise (MCC) was negatively correlated with postoperative SF-36 mental score (P = 0.0130).Conclusion. MRI signal changes are predictive of baseline neurological status and postoperative recovery. MRI indicators of poorer outcome include the presence of low T1 signal, focal increased T2 signal and segmentation of T2 signal changes. HubMed – rehab

 

Hoarding in the home: a toolkit for the home healthcare provider.

Home Healthc Nurse. 2013 Mar; 31(3): 144-54
Chater C, Shaw J, McKay SM

Hoarding is a mental health disorder characterized by difficulties with discarding possessions, yielding cluttered and chaotic home environments that can pose significant safety concerns, impairment to functioning, and distress for those who live in and encounter these situations. Understanding the condition and the strategies available to support individuals who hoard are important skills for the home care provider and are described here in the context of one community organization’s response via the development of a Community Clutter and Hoarding Toolkit. HubMed – rehab

 

Effect of hopping frequency on bilateral differences in leg stiffness.

J Appl Biomech. 2013 Feb; 29(1): 55-60
Hobara H, Inoue K, Kanosue K

Understanding the degree of leg stiffness during human movement would provide important information that may be used for injury prevention. In the current study, we investigated bilateral differences in leg stiffness during one-legged hopping. Ten male participants performed one-legged hopping in place, matching metronome beats at 1.5, 2.2, and 3.0 Hz. Based on a spring-mass model, we calculated leg stiffness, which is defined as the ratio of maximal ground reaction force to maximum center of mass displacement at the middle of the stance phase, measured from vertical ground reaction force. In all hopping frequency settings, there was no significant difference in leg stiffness between legs. Although not statistically significant, asymmetry was the greatest at 1.5 Hz, followed by 2.2 and 3.0 Hz for all dependent variables. Furthermore, the number of subjects with an asymmetry greater than the 10% criterion was larger at 1.5 Hz than those at 2.2 and 3.0 Hz. These results will assist in the formulation of treatment-specific training regimes and rehabilitation programs for lower extremity injuries. HubMed – rehab