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Cardiovascular Symptoms: Is It Pregnancy or the Heart?
Published in Afshan B. Hameed, Diana S. Wolfe, Cardio-Obstetrics, 2020
Melissa Perez, Afshan B. Hameed
Back pain generally begins around mid-pregnancy. Onset may vary and start earlier in the first trimester, typically peaking at 24–36 weeks of gestation [32]. Mild to moderate low back pain is very common due to spinal changes, i.e., physiologic lordosis, and may be considered normal. In contrast, midclavicular or upper back pain is not typical for normal pregnancy and may be indicative of a serious etiology such as pulmonary PE or aortic dissection. If the pain is reproducible and/or relieved on physical exam, it is more reflective of musculoskeletal condition. There are a few case series suggestive of an association between neuraxial anesthesia and interscapular back pain, but this is not well studied [33].
Radiographic Analysis of Sagittal Plane Alignment and Balance in Standing Volunteers and Patients with Low Back Pain Matched for Age, Sex, and Size: A Prospective Controlled Clinical Study *
Published in Alexander R. Vaccaro, Charles G. Fisher, Jefferson R. Wilson, 50 Landmark Papers, 2018
Geoffrey Stricsek, James Harrop
Despite identifying a significant difference between the symptomatic and asymptomatic population, findings do not readily lend themselves to clinical application given their wide range and significant overlap; values for total lordosis ranged from −31° to −88° for volunteers, with a mean of −60.9° and standard deviation of 12.0°, and from −24° to −84° for patients, with a mean of −56.3° and standard deviation of 11.5°. Sparrey, in her review of lumbar lordosis and associated pathophysiology, observed this same variability and overlap in data and concluded that any attempt to define a threshold for a pathological condition based solely on absolute values of lumbar lordosis was “meaningless.”6
Trauma and orthopaedic surgery
Published in Janesh K Gupta, Core Clinical Cases in Surgery and Surgical Specialties, 2014
Nicole Abdul, Terence McLoughlin
Neurological examination is mandatory. The patient may not be able to stand but should be encouraged to do so if he or she can. If possible the patient should be asked to walk on tiptoes. This is the most reliable way of assessing plantar flexion (S1 nerve root-innervated muscular strength). Careful inspection of the back will show the lumbar spine to have a loss of lordosis as a result of paraspinal muscle spasm and there will often be a scoliosis concave to the side in which the nerve root is entrapped, resulting from greater muscle spasm on that side.
Spinal sagittal alignment, spinal shrinkage and back pain changes in office workers during a workday
Published in International Journal of Occupational Safety and Ergonomics, 2022
Juan Rabal-Pelay, Cristina Cimarras-Otal, César Berzosa, Marta Bernal-Lafuente, José Luis Ballestín-López, Carmen Laguna-Miranda, Juan Luis Planas-Barraguer, Ana Vanessa Bataller-Cervero
In the men’s group, pain in the neck correlated significantly in a positive way with spinal shrinkage analysed in the work environment. It appears that men, who lost more height during work, were those manifesting greater neck pain at the end of the day. In future research, strategies to prevent spinal shrinkage in men office workers may decrease pain in the neck area too. Interventions aimed at reducing height loss can focus on exercises of vertebral decompression, stretching, hydration and active breaks, including standing and walking movements throughout the workday [13,37]. The degrees of lumbar lordosis in women office workers correlated negatively with upper back pain at the end of the day (r = −0.440, p = 0.012). This finding shows that women who had lower lumbar lordosis had higher levels of upper back pain at the end of the day. Chun et al. [38] observed an association between attenuated lumbar lordosis and LBP when comparing a group of people with and without LBP. No studies have been found that relate a flatter lumbar lordosis to upper back pain. Strategies aimed at reducing upper back pain can focus on exercises to preserve the lumbar lordosis and avoid the lumbar flexion that produces a flattening of the lordosis [39]. These exercises can be focused on stretching of the hamstrings, activation of the lumbar extensor muscles and anterior pelvic tilt [39].
Effects of a contusion load on spinal cord with different curvatures
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2021
Qian-qian Yu, Si-qing Liu, Jian-jie Wang, Meng-lei Xu, Wen-xuan Zhang, Li-ming Cheng, Rui Zhu
Lordosis is a normal physiological curvature (Berthonnaud et al. 2005; Le Huec et al. 2015). Straight neck or kyphotic curvature change the biomechanical environment of the spine and spinal cord and may result in neck discomfort. Previous quantitative measurements of human spinal cord (Holsheimer et al. 1994) indicated that in all three spinal areas (C4–C6, T5–T6, T11–T12) they studied, approximately 40% of the subjects had an asymmetrical position of the spinal cord, which is a considerable proportion. Another report revealed spinal deformity that could cause spinal cord curvature anomalies was highly prevalent in individuals older than 65 years, affecting between 32% and 68% of that population (Diebo et al. 2019). This situation was expanding due to increased longevity and declining natality. However, overall the spinal curvature in population and their effect were less well studied. From the view of the maximum stress, the lordotic curvature didn’t show significant buffering effect. The physiological lordosis mainly carries head weight and reduces shock in global vertically direction. The contusion load is mainly a local horizontal load and thus global factors have little effect.
Outcome factors in surgically treated patients for cervical spondylotic myelopathy
Published in The Journal of Spinal Cord Medicine, 2020
Jiolanda Zika, George A. Alexiou, Sotirios Giannopoulos, Ioannis Kastanioudakis, Athanasios P. Kyritsis, Spyridon Voulgaris
Early surgical treatment may stop further deterioration and improve the neurological condition and quality of life by decompressing the neural elements, restoring lordosis and preventing further disease progression.2 Surgical treatment options include both anterior (cervical diskectomy and fusion, cervical corpectomy and fusion) and posterior (laminectomy, laminoplasty) approaches.2,4 The preoperative planning does not only involve the surgical approach, anterior or posterior, but also the number of levels that should be treated and the decision to perform fusion or arthroplasty after discectomy.6 Postoperatively most patients experience improvement; however, the key factors that predict the surgical outcome remain unclear.7 This is important in identifying ideal candidates for surgery and predicting the degree of functional improvement. To date several factors such as age, duration of symptoms and preoperative neurological function have been reported to have prognostic implications; however, few studies with long-term follow-up exist.7 The aim of the present study was to identify prognostic factors associated with the favorable outcome of patients treated surgically for CSM.