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Pain
Published in Michele Barletta, Jane Quandt, Rachel Reed, Equine Anesthesia and Pain Management, 2023
Jarred Williams, Katie Seabaugh, Molly Shepard, Dana Peroni
Rehabilitation techniques can be utilized for pain management by providing muscle strengthening and increased range of motion. Stabilization of the back by preactivation of the multifidus muscle and transversus abdominus reduced low back pain in people.
Research in the clinical setting
Published in Robert Jones, Fiona Jenkins, Managing and Leading in the Allied Health Professions, 2021
The research design represents the overall plan and structure of a piece of research;22 research methods are the specific techniques to be utilised in the research activity, e.g. sampling method, data collection methods and methods of analysis. Sim and Wright22 classify research questions into three types: exploratory questions, descriptive and normative questions, and explanatory questions. Exploratory questions set out to find out what is happening, to seek new insights, to ask questions and to assess phenomena in a new light. For example, an explorative question might be, what barriers do professional doctorate graduates face when researching in clinical practice?Descriptive and normative questions provide a descriptive account of a phenomenon within an established framework of knowledge. For example, what factors influence interprofessional learning within a high-dependency cardiorespiratory setting?Explanatory questions tend to be highly specific and set out to test a hypothesis. For example, there is no significant difference in right and left cross-sectional areas of multifidus muscle at L4-5 areas of the lumbar spine as measured by ultrasound imaging in elite high jumpers.
Treatment of a persistent lumbar dural tear
Published in Gregory D. Schroeder, Ali A. Baaj, Alexander R. Vaccaro, Revision Spine Surgery, 2019
Joseph S. Butler, Matthew S. Galetta, Barrett I. Woods
Several techniques can be used to augment the primary repair. Multifidus muscle or fat can be harvested and incorporated into the repair once the durotomy has been closed. The free ends of the suture are passed through the muscle and the tissue, slide down over the primary repair, and are secured with a locking knot. Fat harvested from the subcutaneous tissue can be used to cover the entire exposed dura and tucked into the lateral recess to prevent migration. Adjuvants to suture repair such as Dermabond, fibrin, and collagen-based products can be critical to the successful operative management of a durotomy. If the dural defect is ventral or adjacent to an exiting root suture, repair may not be feasible, making these products necessary to halt the egress of CSF.
Asymmetric atrophy of the multifidus in persons with hemiplegic presentation post-stroke
Published in Topics in Stroke Rehabilitation, 2021
Wookyung Park, Jongwook Kim, MinYoung Kim, Kyunghoon Min
We observed that in the chronic phase (>9 months) post-stroke, asymmetric atrophic change occurred in the multifidus muscle of the weak, more-affected side in persons who could independently ambulate (average mRS score 2.6) (Figure 4). The multifidus is a local stabilizer of the lumbar spine that is responsible for tonic trunk control.28 When the paraspinal muscle properties were compared between the less chronic and chronic phases, the erector spinae on the more-affected side and the multifidus on the less-affected side significantly increased in size in the chronic phase (Figure 5). The erector spinae is a phasic and dynamic muscle producing muscle torque, whereas the multifidus is a postural and tonic stabilizer.28 The larger size of the erector spinae on the more-affected side in the chronic phase could be interpreted to result from compensatory phasic muscle activation.15 On the less-affected side, the chronic phase group showed an increased size of functional multifidus muscle, which is responsible for spinal stability. These results suggest that the recovery pattern of the trunk muscles in unilateral hemiplegia could differ between sides.
Identification of the most relevant intervertebral effort indicators during gait of adolescents with idiopathic scoliosis
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2020
Samadi B, Raison M, Achiche S, Fortin C
The AP force graph (Figure 3b) shows that the differences are eventually more in the lower part (L2 to T9) of the spine than the upper part. It could be due to the multifidus muscle function that stabilizes the lumbar spine (Ward et al. 2009). This may also explain the higher amount of energy cost found during gait in adolescents with thoracolumbar or lumbar curves compared to controls (Mahaudens and Mousny 2010).
Endoscopic modified total laminoplasty for symptomatic lumbar spinal stenosis
Published in The Journal of Spinal Cord Medicine, 2022
Wen-Jie Du, Jue Wang, Qi Wang, Lian-Jing Yuan, Zhi-Xiang Lu
We will use the L4-L5 stenosis with L4-L5 vertebral instability as an example here. Following general anesthesia, the patient was positioned on the console, then disinfected and put on the sterile towel. The fourth lumbar spinous process was marked at the intersection of the line connecting the highest point of bilateral iliac spine and the posterior median line. Once the operation area was accurately positioned by C-arm, a posterior median incision of approximately 2.5 cm was made along the marked line. Fat fascia was separated layer by layer, while the left paraspinal muscle was separated along the left side of the multifidus muscle after sawing the spinous process. A self-made hooked half-channel (Fig. 1B/①) was used to expose the left laminar and facet joints and then protect the joint capsule. The L4 spinous process was transversely truncated with a pendulum saw, after which the free end spinous process, the accessory muscle and the ligament of the spinous process were retained and pulled to the right. This revealed the right lamina and facet joints and protected the right joint capsule. We then accessed the endoscope system (Fig. 1A, B/③④ and C, Patent No: 201820246752X), and inserted the pedicle screws after finding the bilateral pedicle insertion points of L4 and L5 with the aid of C-arm (Fig. 2B and C). The self-made belt loop half-channel (Fig. 1B/②) was used to construct the operation channel. The osteotome and coronal plane of the lamina were inclined at an angle of 45°, the sagittal plane of the lamina was inclined at an angle of 30°, and the entire lamina was carefully removed. The facet joints were then retained. After excision of part of the interspinous ligament – which does not affect the stability of the spine13 – the L4 proximal spinous process was raised with a handkerchief forcep and combined with the periosteum elevator to completely peel off the full lamina. An endoscope was used to protect the dura mater and nerve roots as well as to completely decompress the nerve root canal, lateral crypt, clear adhesion tissue, and hyperplastic bone. The degenerative nucleus pulposus between L4 and L5 was removed and the adjacent cartilage endplates were treated, after which moderate autologous bone and an appropriate cage type were inserted. C-arm fluoroscopy was used to confirm that the cage was in a good position, after which the L4 lamina was trimmed (removing the ligamentum flavum to help protect the spinal cord and nerve roots from damage) and the micro-small plate used to implant the lamina(Fig. 1D) back into place. (Since the osteotome and sagittal plane were at an angle of 30° when the lamina is removed, restenosis caused by laminar collapse was avoided)A bar was then placed on each side to reduce vertebral instability (Fig. 2B and C). Hypertrophic joints were then treated and then the free spinous process was stitched into the original position, and sutured layer by layer after flushing the surgical area.