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Paul W Hodges - One of the best experts on this subject based on the ideXlab platform.
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clinimetric testing of the lumbar Spine Instability questionnaire
Journal of Orthopaedic & Sports Physical Therapy, 2018Co-Authors: Bruno T Saragiotto, Christopher G Maher, Mark J Catley, Mark J Hancock, Chad Cook, Paul W HodgesAbstract:Background The Lumbar Spine Instability Questionnaire (LSIQ) is a self-report measure of 15 items. Previous studies have used the LSIQ as a measure of clinical Instability; however, a comprehensive...
Nuno Neves - One of the best experts on this subject based on the ideXlab platform.
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cervical Spine Instability in rheumatoid arthritis
European Journal of Orthopaedic Surgery and Traumatology, 2013Co-Authors: Filipa Camacho Da Corte, Nuno NevesAbstract:Rheumatoid arthritis (RA) is the most common inflammatory disease of the cervical Spine (CS). After hands and feet, CS is the most commonly involved segment, being present in more than half of the patients with RA. Especially in the CS, RA may cause degeneration of ligaments, leading to laxity, Instability and subluxation of the vertebral bodies. This is often asymptomatic or symptoms are erroneously attributed to peripheral manifestations. Otherwise, this may cause compression of spinal cord (SC) and medulla oblongata leading to severe neurologic deficits and even sudden death. Owing to its potentially debilitating and life-threatening sequelae, inevitable progression once neurologic deficits occur and the poor medical condition of afflicted patients, CS involvement remains a priority in the diagnosis and its treatment will remain a challenge. The surgical approach aims a solid fixation of the upper cervical Spine, giving stability, preventing neurologic deterioration and injury to the SC, leading to improved neurologic function, vascular integrity and maintenance of sagittal balance. The recent advances in surgical techniques, complete understanding of the anatomy and precise preoperative evaluation led to safer and more effective procedures that have decreased complication rates. Based on the fact that when a patient becomes myelopathic the rate of long-term mortality increases and the chance of neurologic recovery decreases, many authors agree that early surgical intervention, before the onset of neurologic deficits, gives a more satisfactory outcome. However, the timing when a prophylactic stabilization should occur is poorly defined, and so, patients with radiographic Instability but without evidence of neurologic deficit are still the most difficult to manage.
Chad Cook - One of the best experts on this subject based on the ideXlab platform.
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Rehabilitation for Clinical Lumbar Instability in a Female Adolescent Competitive Diver with Spondylolisthesis
Journal of Manual & Manipulative Therapy, 2020Co-Authors: Chad Cook, Amy E Cook, Robert FlemingAbstract:AbstractFew studies have investigated conservative lumbar stabilization approaches with adolescent athletes, specifically those with radiographic evidence of a unilateral pars interarticularis fracture. The purpose of this case study was to describe a lumbar stabilization strengthening intervention for an adolescent competitive diver. A 12-year-old female was diagnosed with a grade-I, traumatic, unilateral, dysplastic spondylolisthesis, accompanied by ensuing symptoms of lumbar Spine Instability. Symptom provocation occurred during extension and torsion motions as well as long-term sitting and standing. A comprehensive lumbar stabilization program was associated with a reduction of symptoms, improvement in trunk stabilization, and a quick return to competitive diving. Because the case report involved one highly motivated subject, the results are not generalizable to all adolescent divers. Future studies should investigate the treatment of Spine Instability on a sample of adolescent athletes.
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clinimetric testing of the lumbar Spine Instability questionnaire
Journal of Orthopaedic & Sports Physical Therapy, 2018Co-Authors: Bruno T Saragiotto, Christopher G Maher, Mark J Catley, Mark J Hancock, Chad Cook, Paul W HodgesAbstract:Background The Lumbar Spine Instability Questionnaire (LSIQ) is a self-report measure of 15 items. Previous studies have used the LSIQ as a measure of clinical Instability; however, a comprehensive...
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subjective and objective descriptors of clinical lumbar Spine Instability a delphi study
Manual Therapy, 2006Co-Authors: Chad Cook, Jeanmichel Brismee, Philip SizerAbstract:Accurate ability to diagnose lumbar Spine clinical Instability is controversial for numerous reasons, including inaccuracy and limitations in capabilities of radiographic findings, poor reliability and validity of clinical special tests, and poor correlation between spinal motion and severity of symptoms. It has been suggested that common subjective and objective identifiers are specific to lumbar Spine clinical Instability. The purpose of this study was to determine if consensual, specific identifiers for subjective and objective lumbar Spine clinical Instability exist as determined by a Delphi survey instrument. One hundred and sixty eight physical therapists identified as Orthopaedic Clinical Specialists (OCS) or Fellows of the American Academy of Orthopaedic Manual Physical Therapists participated in three Delphi rounds designed to select specific identifiers for lumbar Spine clinical Instability. Round I consisted of open-ended questions designed to provide any relevant issues. Round II allowed the participants to rank the organized findings of Round I. Round III provided an opportunity to rescore the ranked variables after viewing other participant's results. The results suggest that those identifiers selected by the Delphi experts are synonymous with those represented in related Spine Instability literature and may be beneficial for use during clinical differential diagnosis.
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identifiers suggestive of clinical cervical Spine Instability a delphi study of physical therapists
Physical Therapy, 2005Co-Authors: Chad Cook, Jeanmichel Brismee, Robert E Fleming, Philip SizerAbstract:Background and Purpose. Clinical cervical Spine Instability (CCSI) is controversial and difficult to diagnose. Within the literature, no clinical or diagnostic tests that yield valid and reliable results have been described to differentially diagnose this condition. The purpose of this study was to attempt to obtain consensus on symptoms and physical examination findings that are associated with CCSI. Subjects. One hundred seventy-two physical therapists who were Orthopaedic Certified Specialists (OCS) or Fellows of the American Academy of Orthopaedic Manual Physical Therapists (FAAOMPT) participated in the survey. Methods. This study was a 3-round Delphi survey designed to obtain consensual symptoms and physical examination findings for CCSI. Results. The symptoms that reached the highest consensus among respondents were “intolerance to prolonged static postures,” “fatigue and inability to hold head up,” “better with external support, including hands or collar,” “frequent need for self-manipulation,” “feeling of Instability, shaking, or lack of control,” “frequent episodes of acute attacks,” and “sharp pain, possibly with sudden movements.” The physical examination findings related to cervical Instability that reached the highest consensus among respondents included “poor coordination/neuromuscular control, including poor recruitment and dissociation of cervical segments with movement,” “abnormal joint play,” “motion that is not smooth throughout range (of motion), including segmental hinging, pivoting, or fulcruming,” and “aberrant movement.” Discussion and Conclusion. The Delphi method is useful in situations where clinical judgments are encountered but empirical evidence to provide evidence-based decision making does not exist. Findings of this study may provide beneficial clinical information, specifically when the identifiers are clustered together, because no set of clinical examination and symptom standards for CCSI currently exists. Diagnosis of CCSI is challenging; therefore, appropriate clinical reasoning is required for distinctive physical therapy assessment using pertinent symptoms and physical examination findings.
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factors associated with physiotherapists confidence during assessment of clinical cervical and lumbar Spine Instability
Physiotherapy Research International, 2005Co-Authors: Chad Cook, Jeanmichel Brismee, Philip SizerAbstract:Background and Purpose. Physiotherapists commonly encounter patients with complaints of vague, indistinguishable neck and back pain, such as clinical Spine Instability. Since confidence is a component of expert clinical practice, we were interested in measuring expert clinicians' confidence in diagnosing and assessing clinical Spine Instability. The aims of the present study were to factor out the common ‘identifiers’ associated with physiotherapists' objective, physical diagnosis and assessment of clinical Spine Instability, and to determine the association of reported diagnostic confidence to these identifiers. Method. The study used data from a Delphi instrument for the factor analysis and a survey of APTA Board-certified orthopaedic specialists for report of confidence. Using an ologit regression analysis, the identifier themes and clinical background characteristics were associated with confidence in diagnosis of clinical Spine Instability. Results. Only clinical cervical Spine Instability obtained significant findings. The identifier ‘observable or palpable abnormalities of motion during movement assessment in clinical practice’ was positively associated with reported confidence in diagnosis, as was the influence of manual therapy background models: Cyriax, Maitland, McKenzie, NAIOMPT, Osteopathic, Paris and other. Male gender yielded negative association with reported confidence. No factors were associated with reported lumbar confidence. Conclusions. Multiple backgrounds of physiotherapists demonstrate confidence in detecting clinical Spine Instability using observable or palpable methods to detect abnormal movements. Copyright © 2005 Whurr Publishers Ltd.
Wolfgang Borm - One of the best experts on this subject based on the ideXlab platform.
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translaminar screws of the axis an alternative technique for rigid screw fixation in upper cervical Spine Instability
Neurosurgical Review, 2012Co-Authors: D Meyer, F Meyer, Th Kretschmer, Wolfgang BormAbstract:C2 pedicle screws or transarticular atlantoaxial screws are technically demanding and carry an increased risk of vertebral artery injury. In up to 20% of cases, pedicle and transarticular screw placement is not possible due to a high-riding vertebral artery or very small C2 pedicles in addition to other anatomical variations. Translaminar screws have been reported to rigidly capture posterior elements of C2 and therefore appear to be a suitable alternative. We present our first experiences and clinical results with this new method in two neurosurgical Spine centers. Twenty-seven adult patients were treated between 2007 and 2010 in two neurosurgical Spine departments with C2 translaminar screw fixation for upper cervical Spine Instability of various origins (e.g., trauma, tumor, dens pseudarthrosis). Eight patients were men and 19 were women. Mean age was 68.9 years. In most cases, translaminar screws were used because of contraindications for pedicle or transarticular screws as a salvage technique. All patients were clinically assessed and had CT scans postoperatively to verify correct screw placement. Follow-up was performed with reexamination on an ambulatory basis. Mean follow-up was 7.6 months for all patients. In 27 patients, 52 translaminar screws were placed. There were no intraoperative complications. Postoperatively, we identified four screw malpositions using a new accuracy grading scale. One screw had to be revised because of violation of the spinal canal >4 mm. None of the patients had additional neurological deficits postoperatively, and all showed stable cervical conditions at follow-up. Two patients died due to causes not associated with the stabilization technique. The fusion rate for patients with C1/C2 fixation is 92.9%. Translaminar screws can be used at least as an additional technique for cases of upper cervical Spine Instability when pedicle screw placement is contraindicated or not possible. The current data suggest comparable biomechanical stability and fusion rates of translaminar screws to other well-known posterior fixation procedures. In addition, translaminar screw placement is technically less demanding and reduces the risk of vertebral artery injury.
Patrick F Oleary - One of the best experts on this subject based on the ideXlab platform.
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lumbar Spine Instability
Journal of Spinal Disorders, 1992Co-Authors: Patrick F OlearyAbstract:This chapter addresses the biomechanical principles of spinal Instability and their practical application. For this purpose some simplified concepts of Instability are suggested and supported by specific case studies. These concepts include longitudinal Instability (L)—manifested by disc space collapse in disc degeneration and in the postdiscectomy syndrome; translational Instability (T)—exemplified by spondylolisthesis; angular Instability (A)—as is seen in the kyphotic deformity with wedge fractures; rotational Instability (R)—exemplified by scoliosis; and complex Instability (C)—which is a combination, either (T + L) or (T + L + R).
