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  • ISSN: 2373-9479
    Volume 4, Issue 1
    Review Article
    Donnellan CJ*, Jonathon Ball, Prashanth J. Rao, Kevin Phan, and Ralph J. Mobbs
    The cortical based trajectory for pedicle screw fixation of the lumbar spine is not a novel as it once was. This is a review of the background, indications, advantages, disadvantages of cortical based trajectory pedicle screw fixation with an emphasis on biomechanical evidence and recent clinical studies which only now are just coming to light.
    Pavlos Gkikas and Nicolas Mazis*
    Purpose: The aim of the current study was to investigate the differences of erector spinae EMG activity measurements on patients presenting NSLBP, after the implementation of a 3-week trunk stabilization exercise program.
    Methodology: Fifty AKMI Metropolitan College (AMC) students with NSLB were recruited and were randomly assigned to either an exercise group or a control group. Information regarding LBP prevalence were obtained by using the Nordic Questionnaire. The participants in the exercise group performed a trunk stabilization program consisting of 6low load activation exercises, for duration of 3 weeks and with a frequency of 5 times per week. Electromyographic (EMG) activity of erector spinae was recorded bilaterally, using surface EMG, during four different phases in the beginning of the study and 3 weeks later.
    Results: Significant differences were revealed on the EMG activity for the exercise group’s pre and post measurements as well as exercise post and control post in the full trunk flexion position (p< 0.0001). Similarly, significant differences for the exercise group pre and post measurements in FRR (p< 0.0001) were observed.
    Conclusions: The findings of the current study indicate that a 3 week stabilization exercise can facilitate the reduction of full flexion position and the improvement of FRP by amending erector spinae muscular alterations in patients with NSLBP.
    Research Article
    Martin H. Pouw*, Jan J. Rongen, Brian K. Kwon, Marcel M. Verbeek, Pieter E. Vos, Charles G. Fisher, John Street, Scott J. Paquette, Marcel F. Dvorak, Micheal C. Boyd, Allard JF Hosman, and Henk van de Meent
    Study design: Prospective cohort study
    Objective: To investigate the cerebrospinal fluid (CSF) concentration of myelin basic protein (MBP) in traumatic SCI within 24 hours post-injury and its correlation to the initial neurological severity according to the American Spinal Injury Association (ASIA) impairment scale (AIS).
    Setting: Patients with a traumatic Spinal Cord Injury (SCI) between C2 and T12 were prospectively included in three level 1 trauma centers.
    Methods: A lumbar puncture was performed to obtain CSF from sixteen acute traumatic SCI ppatients within 24 hours post-injury. Neurological examinations were performed within 24 hours of injury. Univariate analyses of variance were used to identify differences in CSF MBP concentrations between SCI patients with different AIS grades.
    Results: Eleven of the 16 patients suffered from a motor complete SCI (AIS grade A or B). CSF MBP concentration did not consistently exceed the age-dependent upper limit of the reference ranges (p-value = 0.23). Moreover, no differences were observed in CSF MBP concentrations between patients with different AIS grades (p-value = 0.33) nor between motor incomplete and complete SCI (p-value = 0.42).
    Conclusion: CSF MBP concentrations were not elevated in traumatic SCI patients. In addition, the CSF MBP appeared not to correspond with patients having a motor complete or incomplete SCI. Also no clear differences in CSF MBP concentrations were identified between the different AIS grades. Therefore it appears that CSF MBP is not a suitable CSF biomarker to predict outcome or prognosis after traumatic SCI within 24 hours post injury.
    Homagk N, Jarmuzek T, Meisel HJ, Hofmann GO, and Homagk L*
    Purpose: Clinical pathways as a tool to organize surgical, interventional or conservative therapies are more and more accepted in the German health care system. Does an IT-based clinical pathway offer advantages in the severity based surgical therapy of spondylodiscitis?
    Methods: Based on three severity grades of spondylodiscitis an IT-based working tool has been included in the hospital IT-system. From 01/01/2012 to 12/31/2013 32 patients with spondylodiscitis were randomized at admission and prospectively analysed regarding duration and costs of treatment, pain level and inflammatory markers.
    Results: Of the 32 patients treated for spondylodiscitis, who had not been transferred from another facility, 17 (53%) were treated according to a clinical pathway on the basis of three well-established treatment regimens depending on severity. The SponDT, as a parameter for the course of disease, was initially slightly higher in the pathway patient‘s group (6.82), than in the control group (6.2). Compared to the control group (n=15) there were differences in the total duration of stay (17.2 vs. 26.0) and the number of taken blood samples (7 vs.10). No differences could be shown for the extent of documentation, the physical and neurological outcome, and the level of pain and the course of inflammatory markers. The most prevalent germ was Staphylococcus aureus (18.8%). In 43.8% no infectious agent could be detected. Material costs and personnel-costs were significantly reduced in the pathway group (12.076 €) compared to 21.341€ in the control group.
    Conclusion: An IT-based clinical pathway is routinely applicable for the surgical therapy of spondylodiscitis based on three grades of severity and offers various advantages as a clinical and administrative regulative mechanism. Particularly the cost-effective treatment stands out.
    Anita Singh* and Sarah Townsend
    Paw withdrawal threshold (PWT) measured using von Frey hair (VFH) filament is used to measure mechanical allodynia. This study aims to investigate the effects of various testing platforms using wire meshes of various dimensions in a contusion spinal cord injury (SCI) animal. 36 rats were used: Group 1- Normal, Group 2- SCI and Group 3- SCI + body weight supported training (BWSTT). Groups 2 and 3 received moderate contusion injury. Group 3 SCI animals were subjected to BWSTT for 7 weeks. Baseline and Week 8 VFH testing was performed on two wire meshes: small (5x5mm) and large (10x10mm). Additional behavior tests including Basso, Beattie and Bresnahan motor test and Grid were performed at baseline and Week 8. Histological staining to estimate the lesion size and primary afferent sensory fibers (CGRP) immune reactivity was also performed. In normal rats, PWT on both the small and large mesh were in agreement with those reported in the literature. SCI only animals had similar response on both testing surfaces. When comparing the effect of BWSTT, small mesh setup appeared to be the most reliable in reporting non-allodynic near normal threshold in SCI+BWSTT. Furthermore, relationship study reported small mesh to be significantly related to other behavior and anatomical outcomes of functional recovery and neuropathic pain such as BBB, Grid and CGRP immune reactivity. In conclusion, testing surfaces play a significant role in determining the PWT using von Frey hair filament and a testing surface with an opening of 5x5 mm can reliably be used to study mechanical allodynia in SCI animals.
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