We investigated the mechanical load of the lumbar spine caused by changes of posture and carried load.To clarify the relationship between the actual and theoretical load of the lumbar spine with and without application of external weights.There is sparse knowledge regarding the relationship between the intradiscal pressure and trunk muscle activities during forward bending motion.The measurements of intradiscal pressure, electromyogram activities of the trunk muscles, and motion analysis of the trunk in 3 young healthy men were performed simultaneously with and without lifting a weight of 10 kg. The recorded values were compared with theoretical values based on the principle of levers.The load of the lumbar spine and electromyogram activities of the back muscles increased in proportion to the tilting angle with and without external weights. However, the external weights induced no significant activity in the abdominal muscles. The actual measurement values were larger than the theoretical values at all tilting angles of the trunk.We found that the increase of the actual spinal load during trunk flexion in healthy individuals consisted of the theoretical spinal load and load generated by the back muscle activities.
Study Design. A cross-sectional study of 1804 consecutive patients. Objective. The aim of this study was to investigate the prevalence of pathological pain and its distribution features in patients with chronic lumbar spinal disorders. Summary of Background Data. Clinical spinal disorders can involve pathological neuropathic pain (NeP) as well as physiological nociceptive pain (NocP), as they have varied pathology, including spinal cord injury, stenosis, and compression. A study conducted by the Japanese Society for Spine Surgery and Related Research (JSSR) has determined a prevalence of 29.4% for NeP in patients with lumbar spinal disorder. However, the data did not include information on pain location. Methods. Patients aged 20 to 79 years with chronic lower back pain (≥3 months, visual analog scale score ≥30) were recruited from 137 JSSR-related institutions. Patient data included an NeP screening questionnaire score and pain location (lower back, buttock, and legs). The association between the pain pathology and its location was analyzed statistically using the unpaired t test and Chi-square test followed by Fisher test. P < 0.05 was considered significant. Results. Low back pain subjects showed 31.9% of NeP prevalence, and the pain distribution showed [NocP(%)/NeP(%)] low back pain only cases: 44/22, while low back pain with leg pain cases showed a prevalence of 56/78. This indicates that low back pain alone can significantly induce NocP rather than NeP (P < 0.01). Buttock pain was revealed to significantly induce both lower back pain and leg pain with NeP properties (P < 0.01). Leg pain was revealed to be predominantly neuropathic, especially when it included peripheral pain (P < 0.01). Conclusion. Low back pain with no buttock pain induces NocP rather than NeP. Buttock pain is significantly associated with NeP prevalence whether or not leg pain exists. Leg pain can increase the prevalence of NeP, especially when it contains a peripheral element. Level of Evidence: 3
The Japanese Orthopaedic Association decided to revise the JOA score for low back pain and to develop a new outcome measure. In February 2002, the first survey was performed with a preliminary questionnaire consisting of 60 evaluation items. Based on findings of that survey, 25 items were selected for a draft of the JOA Back Pain Evaluation Questionnaire (JOABPEQ). The second survey was performed to confirm the reliability of the draft questionnaire. This article further evaluates the validity of this questionnaire and establishes a measurement scale. The subjects of this study consisted of 355 patients with low back disorders of any type (201 men, 154 women; mean age 50.7 years). Each patient was asked to fill in a self-administered questionnaire. Superficial validity was checked in terms of the completion rate for filling out the entire questionnaire. Factor analysis was then performed to evaluate the validity of the questionnaire and establish a measurement scale. As a result of the factor analysis, 25 items were categorized into five factors. The factors were named based on the commonality of the items: social function, mental health, lumbar function, walking ability, and low back pain. To establish a measurement scale for each factor, we determined the coefficient for each item so the difference between the maximum factor scores and minimum factor scores was approximately 100. We adjusted the formula so the maximum for each factor score was 100 and the minimum was 0. We confirmed the validity of the JOA Back Pain Evaluation Questionnaire and est ablished a measurement scale.
Stress fracture of a tibia is rarely associated with osteoarthros of the knee joint (gonarthrosis), whereas the present authors experienced a case of tibial stress fracture with high level lateral flail. To make an analysis with the statics of an elastic body, the shape of the tibia was read from a roentgenogram with a digitizer. The bend of a tibia was expressed with curvature (the reciprocal with curvature radius); fracture was expected to occur where the curvature was large. From the analysis, the fracture had occurred near one of the maximums of the curvature when the knee side was fixed and a force was applied to the ankle side --walking situation, e.g. The analysis also has indicated that the tibia would be very weak when the ankle side was fixed--skiing situation, e.g.
In order to see the patients with low back pain and/or sciatica, it is most important to consider the pathophysiology of symptoms. We should know that the image findings such as X-ray and MRI do not always show the cause of symptom. Because degenerative changes in lumbar spine are common findings in asymptomatic group compared to symptomatic patients with low back pain and sciatica. According to pathophysiology (nerve root syndrome, cauda equina syndrome, facet syndrome, discogenic pain syndrome and intermittent claudication for low back pain), the treatment for low back pain and sciatica were described.
An outcome measure to evaluate the neurological function of cervical myelopathy was proposed by the Japanese Orthopaedic Association in 1975 (JOA score), and has been widely used in Japan. However, the JOA score does not include patients' satisfaction, disability, handicaps, or general health, which can be affected by cervical myelopathy. The purpose of this study was to develop a new outcome measure for patients with cervical myelopathy. This study was conducted in eight university hospitals and their affiliated hospitals from February to May 2002. The questionnaire included 77 items. Forty-one questions, which were originally listed by the authors, were for evaluation of the physical function of the cervical spine and spinal cord. The Medical Outcome Study Short-Form 36-Item Health Survey (SF-36) was used to examine health-related quality of life (QOL). Patients with cervical myelopathy and healthy volunteers were recruited at each institution. After analysis of the answers from patients and volunteers, irrelevant questions using the following criteria were excluded: (1) a question 80% of answers for which were concentrated on one choice, (2) a question whose answer was highly correlated with that of other questions, (3) a question that could be explained by other questions, and (4) a question for which the distribution of the answers obtained from the patients was not different from that obtained from the normal volunteers. The patients comprised 164 men and 86 women, and the healthy volunteers 96 men and 120 women. Thirteen items from the questions about the physical functions of the cervical spine and the spinal cord and 11 items from SF-36 remained as candidates that should be included in the final outcome measure questionnaire. Twenty-four questions remained as candidates for the final questionnaire. This new self-administered questionnaire might be used to evaluate the outcomes in patients with cervical myelopathy more efficiently.
Study Design. A cross-sectional and epidemiologic study investigated low back pain. Objective. To assess the correlation among outcome measures for low back pain, including sciatica, according to a proposed low back pain–related model. Summary of Background Data. Various outcome measures are used in low back pain research: pain, functional status, generic health status, and patient satisfaction. Correlation among these measures has been unclear. Methods. For this study, 816 subjects (369 men and 447 women; average age, 62 years) who underwent an adult medical examination. The patients were interviewed concerning their personal background, severity of low back pain and sciatica, functional status, general health perception, social participation, subjective happiness, and patient satisfaction. The correlation among these measures was analyzed systematically using path analysis based on a low back pain–related model hypothesizing that low back pain and sciatica worsen functional status and general health perception and then affect social participation, subjective happiness, and patient satisfaction. Results. Restriction of functional status was found to be the most closely correlated with severity of low back pain. A decrease in physical health was most closely correlated with restriction of function. Social participation, subjective happiness, and patient satisfaction were closely correlated with physical health status. There was a significant correlation among outcome measures concerning physical health, which was consistent with a low back pain–related model. Conclusions. The outcome measures concerning physical health in this study were found to be correlated significantly, consistent with the proposed low back pain–related model.
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