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Biomedical subjects

N Kahanovitz

Publications and source records attributed to N Kahanovitz.

At least 37 records · Page 2Linked to original sources

1988 Volvo award in biomechanics. The triaxial coupling of torque generation of trunk muscles during isometric exertions and the effect of fatiguing isoinertial movements on the motor output and movement patterns.

Previous studies have shown that reduction of precise motor control accompanies local muscular fatigue. The effects of isodynamic fatiguing of flexion and extension trunk movements on the movement patterns and the motor output of the trunk were investigated. Twenty male subjects with no history of low-back pain for the past 6 months volunteered for the study. A triaxial dynamometer was used that simultaneously provided measurement of torque, angular position and velocity of each axis. Resistances were set independently for each axis by an interfaced computer. The subjects performed trunk flexion and extension movement against a sagittal plane resistance equal to 70% of their maximum isometric extension strength in the upright position. The minimum resistances in the coronal and transverse planes were set up at 7 Newton meters. The subjects were asked to perform trunk movement as quickly and as accurately as possible while exerting the maximum efforts until exhaustion. Analysis of variance, the MANOVA procedure with a repeated measure design, was performed among the selected parameters of the first, middle and last three repetition cycles. The selected parameters are the trunk motor output and movement patterns; the total angular excursion, range of motion, maximum and average torque and angular velocity of the trunk. All the selected parameters were significantly reduced in the sagittal plane. Subjects displayed significantly less motor control and greater range of motion in the coronal and transverse planes in performing the primary task of flexion and extension. The reduction in the functional capacity of the primary muscles performing the required task is compensated by secondary muscle groups and the spinal structure is loaded in a more injury prone pattern, as identified by finite element models. In addition it is suggested that the fatigued muscles would be less able to compensate any perturbation in the load or position of the trunk. The repetitive loading results in a weakening of the viscoelastic passive elements of the spineless structure. The loss of ability to protect these weakened passive elements makes the spine susceptible to industrial and recreational injuries.

Adult↗

A retrospective analysis of the efficacy of epidural steroid injections.

Forty patients were studied retrospectively to evaluate the effect of epidural steroid injections on low back pain and sciatica characteristic of spinal stenosis or a herniated lumbar disc. All but one of these patients had radicular symptoms. The average age was 55 years, and the average follow-up time was eight months. All patients were injected by the same anesthesiologist with 2 cc of Depomedrol-40. Thirty-six patients received either one, two, or three injections. Four patients received either four or five injections. The overall results were poor, with about 60% of patients reporting varying degrees of relief from leg and back pain immediately after injection. However, at follow-up examination, only 24% were asymptomatic; 40% reported no change in preinjection numbness, weakness, or pain; and approximately 35% had varying degrees of relief with no consistent pattern. Of those who had complete relief, there was no correlation between relief of pain, age, or number of injections. From this study, it appears that approximately 50% of patients with radicular symptoms may receive temporary relief with steroid injection. However, long-term relief occurs in less than 25% of patients.

Adult↗

Three-dimensional spinal motion measurements. Part 1: A technique for examining posture and functional spinal motion.

This study examines the application of a new noninvasive technology capable of accurately, reproducibly, and reliably measuring spinal motion, in real time, with 3 df. The mean values and SD of range of motion in the lumbar, thoracic, and cervical regions compares favorably with results reported by other authors. Pearson correlations yielded a statistically significant weak inverse relationship between age and range of motion in the sagittal and frontal planes (p less than .02). No correlation between sex, height, or weight and range of motion was found. There was no statistically significant evidence of organized coupling. However, a relationship between rotation and lateral motion in the thoracic region was noted.

Aging↗

Normal trunk muscle strength and endurance in women and the effect of exercises and electrical stimulation. Part 1: Normal endurance and trunk muscle strength in 101 women.

The lack of trunk muscle strength and endurance has frequently been cited as a suspected factor in the etiology of low-back pain. Several investigators have suggested that asymptomatic patients have stronger trunk muscles than patients with low-back pain. People who are physically fit appear to have a decreased incidence of low-back pain. Increased trunk muscle endurance also have been observed to decrease the incidence of low-back pain. The objective evaluation of the strength and endurance of trunk musculature may, therefore, be significant. Part 1 of this study was designed to develop a reproducible strength-endurance screening procedure and to establish normal isometric-isokinetic trunk muscle strength and endurance parameters for women. This study showed that isometric trunk flexion varied from 19-109 Nm and trunk extension from 38-168 Nm. Peak values for isokinetic trunk flexion at two speeds (30 degrees per second and 60 degrees per second) varied from 17-191 Nm and isokinetic trunk extension from 14-208 Nm. The average endurance time for trunk extensors tested with the Sorensen test was 196 seconds.

Adolescent↗

Normal trunk muscle strength and endurance in women and the effect of exercises and electrical stimulation. Part 2: Comparative analysis of electrical stimulation and exercises to increase trunk muscle strength and endurance.

Several studies have shown positive correlations between muscle strength, flexibility, and the frequency of low-back pain. Weak trunk musculature and decreased endurance have thereby come to be identified as significant risk factors in the development of occupational back problems. Because it is widely accepted that exercise plays an important role in the conservative treatment and prevention of low-back pain, the goals of most rehabilitative programs involves improving the strength and endurance of the low-back pain patient. Whereas electrical stimulation has been shown to increase the muscle strength of the lower extremities, this effect has not been demonstrated for the trunk muscles. Part 2 is a prospective controlled study designed to document and to compare objectively the effects of electrical stimulation and exercise on trunk muscle strength. A total of 117 healthy women were divided randomly into four groups. Two groups received electrical stimulation with different electrical parameters, one group received exercises, and one group acted as a control group. The results showed that low-frequency electrical stimulation and exercises significantly (P less than .05) increased isokinetic back-muscle strength compared to the control and medium-high-frequency electrical stimulation groups. Both types of electrical stimulation, however, significantly increased (P less than .05) the endurance in the back muscles compared with the control and the exercise groups. This study showed that electrical stimulation may be a valuable treatment in the early care of low-back pain patients in maintaining and increasing strength and endurance of back muscles when a more active exercise program is too painful to perform.

Adolescent↗

Automated percutaneous diskectomy: initial patient experience. Work in progress.

A new method has been developed for percutaneously decompressing herniated lumbar disks. The method entails gaining access to the disk space through the use of an introduction system and a cannula. A 2-mm aspiration probe called a Nucleotome is then placed through the cannula into the disk space, and the nucleus pulposus is aspirated. Thirty-six patients have undergone the procedure, with a successful result in 31. There were no significant complications encountered, and the procedure is now being done on an outpatient basis. These preliminary results indicate that automated percutaneous diskectomy has the potential to replace laminectomy in the treatment of uncomplicated herniated disks.

Humans↗

Acute increase in lateral bending of the canine lumbar disc following chymopapain injection.

Twenty-four lumbar discs in six adult beagle dogs were injected with either 0.1 ml CP (ChymodiactinR) (200 U) (12 discs) or 0.1 ml saline (12 discs) under direct vision at laparotomy. All animals were killed 1 hour later; the lumbar spine was immediately excised en bloc and frozen until biomechanical testing. After overnight thawing, test specimens were prepared and consisted of a disc and half a vertebral body on each side. The posterior elements were discarded. Each motion segment was mounted on a testing plate, with bone cement used for fixation. Lateral bending of the motion segment was tested as an analog to the motion of a disc during correction of a scoliotic spine with a distraction force. Lateral bending forces of 2 kg and 4 kg were applied for 30 minutes each. Lateral bending, creep, and residual deformity (in degrees) were recorded. CP injected disc showed an acute increase in lateral bending of 28% and 26%, respectively (2-kg and 4-kg loads) (P less than 0.001). In addition, CP injected discs showed a 25% increase in their residual angular deformity compared with the control discs (P less than 0.001). No significant changes were noted in creep values between CP and saline injected discs. This study demonstrates a significant acute increase of 28% and 26% in lateral bending of the canine disc following enzyme injection.

Animals↗

Lateral electrical surface stimulation (LESS) compliance in adolescent female scoliosis patients.

This retrospective study of lateral electrical surface stimulation (LESS) treatment for patients with progressive idiopathic scoliosis was performed to document patient compliance in the standard electrical stimulation program and to gain objective data to perform a relative comparison of electrical stimulation and bracing compliance. Forty mothers of adolescent female patients participating in the electrical stimulation program of one of the authors (NK) were interviewed confidentially by an independent observer (SW). Patients whose compliance was rated good or total were thought to have acceptable compliance rates. Overall, 50% showed good or total compliance, 10% fair, 5% poor, and 35% failures. It appeared that the failures tended to exaggerate their symptoms and use "skin irritation" as an excuse to discontinue treatment. The longer patients used the LESS (scolitron) device, the more compliant they became (P less than 0.0). This is opposite to the findings about brace compliance. Confidence of the mother in the device showed a positive correlation (P less than 0.008) with compliance, and a mother's concern of how others would react to her child's scoliosis had a negative correlation (P less than 0.003). From the results of this study, overall compliance appears to be somewhat better for electrical stimulation programs than for bracing programs. However, the high failure rate was both disappointing and surprising.

Adolescent↗

The comparative biomechanical, histologic, and radiographic analysis of canine lumbar discs treated by surgical excision or chemonucleolysis.

Previous experimental studies on the canine intervertebral disc treated with chemonucleolysis have shown encouraging results in preserving normal histologic, biomechanical, and radiographic disc appearance. These observations suggest that chemonucleolysis may have significant advantages over surgical disc excision in preserving normal function of the lumbar vertebral motion segment. An experimental canine study was devised to examine and compare the short and long-term effects of chemonucleolysis and surgical disc excision on the entire lumbar motion segment to determine if one treatment modality is superior to the other in providing better maintenance of motion segment function. Twenty adult beagle dogs underwent anterior laparotomy. In ten dogs, Chymodiactin was injected into the L4-5 disc and in the remaining ten, routine surgical discectomies were performed on the L4-5 disc. Preoperative and presacrifice lateral radiographs were obtained. All dogs were allowed to exercise freely. Five dogs that received Chymodiactin (Group A) and five dogs that had surgical excisions (Group B) were killed six weeks postoperatively. Five months postoperatively, five dogs given Chymodiactin (Group C) and 5 having surgery (Group D) were also killed. Mechanical testing was performed on each treated disc sample with a modified MTS machine (MTS Systems Corp., Minneapolis, MN). Axial compression, bending, shear, and torsion were assessed in ten modes. Stiffness values for each mode were calculated. Following the biomechanical tests, the facet joints and the disc with the adjacent endplate were removed intact and analyzed histologically and with high resolution radiography. Six-week biomechanical testing revealed a 50% loss of torsional stiffness, as well as loss of anterior and medial-lateral shear stiffness in the chemonucleolysis group.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

The effects of internal fixation on the articular cartilage of unfused canine facet joint cartilage.

Custom-made distraction instrumentation was placed in the lumbar spine of eight large dogs with care taken to preserve the integrity of two intervening apophyseal joints. Histologic staining of immobilized joint cartilage showed varying degrees of chondrolysis, cloning, invasion of the tide mark, and loss of proteoglycans as early as 2 months postoperatively. Every specimen had significant degenerative changes characteristic of osteoarthritis. The joints one segment caudal to the lower hooks also were examined and were found to have similar histologic evidence of degeneration. Three dogs had the instrumentation removed and were then sacrificed 1.5-3 months later. The degenerative changes were not reversible following instrumentation removal.

Animals↗

The effect of postoperative electromagnetic pulsing on canine posterior spinal fusions.

An experimental canine study was devised to evaluate the efficacy of a noninvasive adjunct to improve the rate and quality of the posterior fusion mass over the standard surgical technique. Ten large adult mongrel dogs underwent a three-level lumbar spinal fusion. Bone excised from the spinous processes was packed in removed facet joints and over the decorticated laminae. To insure rigid internal fixation, custom-made distraction instrumentation was placed bilaterally under the laminae of the vertebrae above and below the three fused vertebrae. Five dogs underwent electromagnetic pulsing, and five dogs acted as controls. Two dogs were sacrificed at 4, 6, 9, 12, and 15 weeks to assess the radiographic and histologic status of the fusion mass. Preoperative and preautopsy hematologic studies as well as gross and histologic autopsy specimens revealed no abnormalities attributable to the electromagnetic pulsing. High-resolution radiography and histologic studies showed earlier incorporation of the graft, improved new bone formation, and better organization of the fusion mass in the 4-, 6-, and 9-week stimulated specimens. However, by 12 and 15 weeks there did not appear to be any histologic or radiographic differences between the stimulated and control dogs. Although electromagnetic pulsing appears to produce an early accelerated osteogenic response, it does not appear to improve the overall results of primary canine spinal fusions.

Animals↗

The effect of internal fixation without arthrodesis on human facet joint cartilage.

Internal fixation of the spine combined with limited or no fusion has been advocated in the treatment of thoracolumbar fractures, spondylolisthesis, and severe juvenile spinal deformities. Internal fixation without arthrodesis of canine facet joints has been shown to result in the irreversible gross and histologic findings typical of osteoarthritis. Surgery was performed in eight patients for the treatment of thoracolumbar fractures. In each patient, Harrington distraction instrumentation was placed across at least two vertebral segments above and below the fused area. Instrumentation was removed six to 26 months following the initial surgery. A unilateral partial facetectomy was performed at the facet joint above the lower Harrington hook. Gross examination of the facet joints revealed areas of fibrillation, fissures, and thinning of the normal cartilaginous surface characteristic of osteoarthritis. Histologic examination revealed consistent areas of erosion of the vascular tidemark, osteophyte formation, subchondral remodeling, fibrillation, and loss of the normal cartilage cellularity. These findings were consistent with the histologic appearance of osteoarthritis. Internal fixation of the spine without arthrodesis is not an innocuous procedure and may be a predisposing factor in the development of symptomatic spinal arthritis.

Adolescent↗

Physical therapy management of familial dysautonomia.

This paper describes physical therapy programs to assist physical therapists in the rehabilitation of patients with familial dysautonomia. There have been no reports in the literature about a physical therapy program for patients with this disease. A retrospective analysis of the clinical manifestations in 80 patients in a dysautonomia clinic was performed. Scoliosis and kyphosis were found in 92 percent of the patients, 93 percent had ataxia, 74 percent had feeding difficulties, 69 percent had frequent pneumonias, and 63 percent exhibited delayed developmental milestones. Cardiovascular, gastrointestinal, pulmonary, musculoskeletal, and neurological symptoms and treatments are discussed.

Adolescent↗

Recurrent superior mesenteric artery syndrome complicating staged reconstructive spinal surgery: alternative methods of conservative treatment.

Recurrent superior mesenteric artery syndrome is an infrequent complication following reconstructive spinal surgery. However, if diagnosis and treatment are delayed, life-threatening dehydration and electrolyte abnormalities may occur. Recent advances in oral and parenteral alimentation have simplified the treatment of superior mesenteric artery syndrome following the early recognition of the characteristic clinical and radiographic presentation. This case report describes the early diagnosis and various methods of conservative treatment of recurrent superior mesenteric artery syndrome following staged reconstructive spinal surgery.

Adolescent↗

The part-time Milwaukee brace treatment of juvenile idiopathic scoliosis. Long-term follow-up.

A long-term follow-up in 15 patients who had juvenile idiopathic scoliosis was instituted to determine the efficacy of a part-time Milwaukee brace program. The patients were divided into two groups. In Group I patients, part-time bracing was successful in controlling the scoliosis. The average curvature at the onset of bracing was 32 degrees, and the final curvature was 28 degrees. None of the final curvatures increased more than 7 degrees from the initial curvatures. In Group II patients, following six years of part-time bracing, the patients ultimately were treated by posterior fusion and Harrington instrumentation. All of these patients had curvatures greater than 35 degrees at the onset of part-time bracing. All patients who had curvatures less than 35 degrees at the onset of part-time bracing and whose rib--vertebrate angle difference (RVAD) remained less than 20 degrees were successfully treated without surgery. All patients who had curvatures of greater than 45 degrees at the onset of bracing and whose RVAD exceeded 20 degrees eventually underwent spinal fusion. A consistent finding of vertebral body half-wedging was noted on the side of the concavity. The persistence of this finding appeared to correlate well with the patients clinical response.

Adolescent↗

The operative treatment of congenital scoliosis. A report of 23 patients.

Spinal fusion was performed in 23 patients with congenital scoliosis. Various procedures were used including posterior fusion and without instrumentation. No surgical procedure proved to be superior for obtaining correction regardless of the use of supplemental instrumentation. The use of Knodt or Harrington Instrumentation could not be correlated with a lower pseudoarthrosis rate, shorter postoperative immunobilization period, or a decrease in postoperative loss of correction. The morbidity associated with these surgical procedures was high (48%). Thoracic curves were more prone to lengthen or develop kyphoses postoperatively. A high incidence of varied congenital anomalies was found in association with congenital scoliosis. A through work-up including an intravenous pyelogram and myelogram is strongly recommended prior to the operative treatment of congenital scoliosis.

Adolescent↗