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Back muscle injury after posterior lumbar spine surgery. A histologic and enzymatic analysis.

STUDY DESIGN: Back muscle injury after posterior lumbar surgery was studied by muscle histology and serum creatine phosphokinase MM isoenzyme activity. OBJECTIVES: To investigate intraoperative factors influencing the magnitude of back muscle injury after posterior lumbar surgery. SUMMARY OF BACKGROUND DATA: The authors previously have reported iatrogenic back muscle injury in an animal model and in humans. Serious injury of the back muscle has been shown by short-term and long-term follow-up evaluation. METHODS: The retraction pressure was monitored, and the retraction pressure-time products were calculated in 24 patients. Early histologic changes of multifidus muscle, which were taken at completion of surgery, and serum creatine phosphokinase MM isoenzyme activity changes were examined. RESULTS: The magnitude of back muscle injury was significant as the pressure-time product increased. Creatine phosphokinase MM isoenzyme activity increased after surgery and reached a plateau 1 day after surgery, followed by recovery to the normal value 1 week after surgery. Creatine phosphokinase MM isoenzyme activity tended to be high in cases with multilevel exposure and with high pressure-time product. CONCLUSIONS: Back muscle injury occurs in all patients who underwent posterior lumbar surgery, and these injuries are related to the retraction pressure, time, and extent of exposure.

Adult↗

Psychotherapy with the chronic pain patient using coping skills development: outcome study.

This study provided outcome data measuring variables of a psychoeducational group approach to self-management of 88 chronic pain patients and 25 controls. Most of the injuries were back injuries and work related. At the completion of the 16 group sessions, patients reported decreased depression, pain severity, interference, and affective distress and increased life control and general activity. At 1-year follow-up, there was continued increased return to work, lowered workers' compensation, fewer health care visits, and less prescribed pain medication than demographically similar controls. Results suggest that a group psychoeducational program involving learning of general coping skills primarily and pain coping skills secondarily produces an effective approach for the management of chronic pain.

Adaptation, Psychological↗

A preliminary comparison of front and back squat exercises.

The purpose of this study was to compare the knee extensor demands and low back injury risks of the front and back squat exercises. Highly strength-trained college-aged males (n = 8), who performed each type of squat (Load = 75% of front squat one repetition maximum), were filmed (50 fps) from the sagittal view. The body was modeled as a five link system. Film data were digitized and reduced through Newtonian mechanics to obtain joint forces and muscle moments. Mean and individual subject data results were examined. The maximum knee extensor moment comparison indicated similar knee extensor demands, so either squat exercise could be used to develop knee extensor strength. Both exercises had similar low back injury risks for four subjects, but sizable maximum trunk extensor moment and maximum lumbar compressive and shear force differences existed between the squat types for the other subjects. The latter data revealed that with the influence of trunk inclination either exercise had the greatest low back injury risk (i.e., with greater trunk inclination: greater trunk extensor demands and lumbar shear forces, but smaller lumbar compressive forces). For these four subjects low back injury risk was influenced more by trunk inclination than squat exercise type.

Adult↗

Back muscle injury after posterior lumbar spine surgery. Topographic evaluation of intramuscular pressure and blood flow in the porcine back muscle during surgery.

STUDY DESIGN: Intramuscular pressure and blood flow of the back muscles were evaluated topographically during posterior lumbar spine surgery. The topographic damage of the back muscle after surgery was studied. OBJECTIVE: To investigate the relationship between intramuscular pressure or blood flow during posterior lumbar surgery and the back muscle injury after surgery. SUMMARY OF BACKGROUND DATA: Latrogenic back muscle injury in an animal and human model has been reported previously. Changes of intramuscular pressure and blood flow during surgery might be related to the muscle injury. No previous study on this issue has been published. METHODS: The contact pressure between the retractor blade and muscle tissue was monitored in 10 pigs during posterior surgery of the lumbar spine. On one side, intramuscular pressure at 5, 10, and 20 mm lateral to the retractor and on the other side blood flow of the back muscle at 5 and 20 mm during surgery were measured. Histologic changes of the back muscle at 5, 10, and 20 mm to the midline were evaluated 3 hours after surgery. RESULTS: The contact pressure decreased exponentially with time. Intramuscular pressure 5 mm lateral to the retractor was 114 +/- 31 mm Hg and was significantly higher than at 10 mm and 20 mm. Blood flow markedly decreased during surgery and recovered incompletely after releasing the retractor at 5 mm and 20 mm lateral to the retractor. Blood flow at 5 mm was significantly lower than at 20 mm throughout surgery. The muscle damage 3 hours after surgery was more severe near the retractor blade. CONCLUSIONS: The back muscles were exposed to pathophysiologic condition by a retractor during posterior lumbar spine surgery. External compression by a retractor increases intramuscular pressure to levels that impede local muscle blood flow. The muscle degeneration after surgery could be explained by direct mechanical damage and by the increased intramuscular pressure of muscle tissue by the retractor.

Animals↗

Occupational injuries and stressors among Canadian air medical health care professionals in rotor-wing programs.

INTRODUCTION: Air medical health care providers work in a unique environment that may affect occupational injury rates and patterns. Despite this knowledge, little high-quality evidence exists regarding occupational injuries specifically incurred by air medical health care professionals. We sought to characterize the epidemiology of occupational injuries experienced by Canadian rotor-wing health care providers. METHODS: A survey was sent to the 4 rotor-wing programs in Canada. All crewmembers participating directly in patient care were asked to complete the survey detailing any acute occupational injuries sustained within the previous year. A series of both open- and closed-ended questions was used to collect participant demographics and information regarding any injuries sustained. RESULTS: One hundred and six (40.6%) participants completed the survey. Three hundred and thirty acute injuries were reported. Hand lacerations and leg contusions were most prevalent (31 and 24 individuals incurred these injuries, respectively). Acute back injuries were also prevalent with 25 (23.6%) participants reporting at least one back injury. Overall, an injury rate of 3.2 injuries per person per year was reported. Lifting was cited as a common factor in injury (30 cases). Most injuries required little treatment, with only 17 needing physician intervention, and only 6 required more than 1 week off work. CONCLUSION: Injuries among Canadian air medical crews are common, but fortunately, the majority are minor. Specific injury prevention strategies may focus on stretcher design, cabin ergonomics, and extremity protective equipment.

Adult↗

Preventive measures of back muscle injury after posterior lumbar spine surgery in rats.

STUDY DESIGN: Postoperative back muscle injury was studied in rats. Postoperative findings were compared among three groups: 2-hour continuous back muscle retraction, 5-minute retraction release after 1 hour of retraction, and 5-minute release at every 40 minutes of retraction. OBJECTIVE: To determine whether intermittent release of the retractor during surgery is effective to prevent severe muscle injury. SUMMARY OF BACKGROUND DATA: In surgery performed on the extremities using a tourniquet, intermittent reperfusion intervals can permit extended tourniquet application when the operation is prolonged. However, there have been no specific studies on the effects of intermittent retraction release for postoperative back muscle injury. METHODS: The back muscle of rats was retracted using a self-retaining retractor for 2 hours. The 36 rats were divided equally into the following three groups: Group 1, 2 hours of continuous retraction; Group 2, two 1-hour retractions interposed with a 5-minute retraction release; and Group 3, three 40-minute retractions interposed with a 5-minute retraction release. In each group, the multifidus muscle was histologically analyzed at 48 hours, 1 week, and 6 weeks after surgery. The muscles were stained by a variety of histochemical methods. The level of serum CPK-MM isoenzyme was measured 48 hours after surgery. RESULTS: Postoperative back muscle degeneration was the most severe in Group 1. The concentration of CPK-MM in Group 1 was significantly higher than that in Groups 2 and 3. One week after surgery, the lesser diameter of regenerated fibers in Group 1 was smaller than that in Groups 2 and 3. The incidence of neurogenic muscle damage was the highest in Group 1. CONCLUSIONS: During posterior lumbar spine surgery, 5-minute retraction release after 1 hour or after 40 minutes of retraction was effective in preventing severe back muscle injury after surgery.

Animals↗

A prospective study of back belts for prevention of back pain and injury.

CONTEXT: Despite scientific uncertainties about effectiveness, wearing back belts in the hopes of preventing costly and disabling low back injury in employees is becoming common in the workplace. OBJECTIVE: To evaluate the effectiveness of using back belts in reducing back injury claims and low back pain. DESIGN AND SETTING: Prospective cohort study. From April 1996 through April 1998, we identified material-handling employees in 160 new retail merchandise stores (89 required back belt use; 71 had voluntary back belt use) in 30 states (from New Hampshire to Michigan in the north and from Florida to Texas in the south); data collection ended December 1998, median follow-up was 6(1/2) months. PARTICIPANTS: A referred sample of 13,873 material handling employees provided 9377 baseline interviews and 6311 (67%) follow-up interviews; 206 (1.4%) refused baseline interview. MAIN OUTCOME MEASURES: Incidence rate of material-handling back injury workers' compensation claims and 6-month incidence rate of self-reported low back pain. RESULTS: Neither frequent back belt use nor a belt-requirement store policy was significantly associated with back injury claim rates or self-reported back pain. Rate ratios comparing back injury claims of those who reported wearing back belts usually every day and once or twice a week vs those who reported wearing belts never or once or twice a month were 1.22 (95% confidence interval [CI], 0.87-1.70) and 0.95 (95% CI, 0.56-1.59), respectively. The respective odds ratios for low back pain incidence were 0.97 (95% CI, 0.83-1.13) and 0.92 (95% CI, 0.73-1.16). CONCLUSIONS: In the largest prospective cohort study of back belt use, adjusted for multiple individual risk factors, neither frequent back belt use nor a store policy that required belt use was associated with reduced incidence of back injury claims or low back pain. JAMA. 2000;284:2727-2732.

Adult↗

Evaluating the patient-handling tasks of nurses.

Nurses, nurses' aides, and orderlies are among the occupational groups at highest risk for back injury. The Kaiser Permanente Northwest Region developed a Back Injury Prevention Project (BIPP) to try to reduce the back injury rate among these groups. To obtain early data on program effectiveness, we developed an instrument, the BIPP Transfer Evaluation, to evaluate patient-handling tasks. Use of the BIPP Transfer Evaluation during the BIPP pilot study revealed a 19% +/- 5% SE (P = .0003) improvement in the quality of patient transfer in the intervention group. The BIPP Transfer Evaluation is an inexpensive way to get early, objective information about the quality of an intervention to reduce back injuries among nurses, nurses' aides, and orderlies.

Accidents, Occupational↗

Biomechanical analysis of peak and cumulative spinal loads during simulated patient-handling activities: a substudy of a randomized controlled trial to prevent lift and transfer injury of health care workers.

Back injuries are a serious problem for nursing personnel who perform frequent patient-handling activities. Common prevention strategies include body mechanics education, technique training, and ergonomic interventions such as the introduction of assistive equipment. This investigation assessed and compared the effectiveness of two patient-handling approaches to reducing injury risk. One strategy involved using improved patient-handling technique with existing equipment, and the other approach aimed at eliminating manual patient handling through the use of additional mechanical and other assistive equipment. Both intervention arms received training in back care, patient assessment, and use of the equipment available on their particular wards. An analysis of compliance with interventions and the effects of patient-handling methods on both peak and cumulative spinal compression and shear during various tasks was conducted. Results showed greater compliance with interventions that incorporated new assistive patient-handling equipment, as opposed to those consisting of education and technique training alone. In several tasks, subjects who were untrained or non-compliant with interventions experienced significantly higher peak spinal loading. However, patient-handling tasks conducted with the aid of assistive equipment took substantially longer than those performed manually. This, along with variations in techniques, led to increases in cumulative spinal loading with the use of patient-handling equipment on some tasks. Thus, the use of mechanical assistive devices may not always be the best approach to reducing back injuries in all situations. No single intervention can be recommended; instead all patient-handling tasks should be examined separately to determine which methods maximize reductions in both peak and cumulative lumbar forces during a manoeuver.

Adult↗

Industrial injuries in a plant.

This is a five year study of types of lost-time industrial injuries in a plant dealing with paper manufacturing and timber production. Back injuries accounted for 26% of all lost-time work accidents. Thirty-three point six percent of all back injuries were due to lifting or pulling of timbers at work. This occurred mainly in the timber yard of the plant where heavy manual work occurred. Males up to the age of 35 accounted for about 60% of back injuries. They have a higher tendency to injure their backs than do older males who were longer and more experienced workers. Back injuries were uncommon in the female workers. They accounted for a mere 0.3% of all back injuries. They were mainly clerical workers or cleaners reflecting lighter nature of their work. This study helps the company to plan better occupational safety programmes to reduce work hazards.

Accidents, Occupational↗

Risk of pediatric back-over injuries in residential driveways by vehicle type.

OBJECTIVE: Research suggests that children experience driveway back-over injuries at a significant rate and the severity of the resulting injuries differ by type of vehicle. Yet, no US study attempted to quantify "back-over risk" for classes of vehicles because of the difficulties with determining exposure. Using vehicle registration information, we set out to estimate the relative risk of driveway back-over injuries to children by type of vehicle. METHODS: Driveway back-over events were identified from state police reports and medical records from the state level 1 pediatric trauma center and compared with vehicle registration information to estimate injury incidence for 4 classes of vehicles (passenger cars, trucks, sport utility vehicles, and minivans) over 6 years in the state of Utah. RESULTS: Reported driveway back-over injuries represent an incidence of 7.09 per 100,000 children (<10 years old) per year. Overall, passenger cars account for 1.62 injuries per 100,000 registered vehicles. Compared with passenger cars, children were 53% more likely to be injured by a truck (P = 0.01) and 2.4 times more likely to be injured by a minivan (P < 0.001). Among children transported to a trauma center, admission (P = 0.01) and need for surgery (P = 0.03) were greater among children backed over by trucks, sport utility vehicles, and minivans compared with passenger cars. CONCLUSIONS: Findings suggest that when assessing driveway back-over injuries, larger high-profile vehicles are associated with a higher incidence and severity of injuries when compared with injuries resulting from passenger cars.

Accidents, Home↗

One approach to patient lifting.

In 1990, Canadian hospitals reported 30,487 time-loss injuries. Fifty-three percent were sustained by nurses. Almost half were back injuries. Back injury is now recognized as one of the major reasons for ill-health retirement from nursing. Not only is it the most frequent injury sustained by nurses. It also is the most debilitating.

Back Pain↗

Learning effects of a back education program.

STUDY DESIGN: This study involved a post-test only, control group design. OBJECTIVES: To analyze the learning effects of back education programs (video and classroom learning). SUMMARY OF BACKGROUND DATA: Previous research has examined lost work time and workers compensation costs but has not addressed the learning effects of back schools. This study used the American Back School as the education intervention. The American Back School teaches students to maintain the lumbarlordosis while lifting. METHODS: The subjects (n = 205) were assigned to three groups through modified randomization. Three employees who previously sustained low back injury were placed in the back school group. The back school group, Group 1, (n = 74) attended a back school program that included cognitive learning strategies and practice in correct lifting. A video group, Group II, (n =64) viewed a similar program that consisted of spinal anatomy and biomechanics and instruction in correct lifting technique. A control group, Group III, (n = 67) received no back education. One week after the education intervention, 145 of the subjects from the three groups had the lumbar lordosis measured with a flexible ruler while assuming a lifting position. The ruler was placed over the lumbar spinous processes, and the lordotic angle was calculated A 12-item multiple choice test and a 10-item. Likert scale were administrated to 199 of the subjects in the three groups to determine the cognitive learning effect and the perceived relevance of the program, respectively. RESULTS: Multivariate analysis of variance was used and demonstrated significant differences between the back school group and the control group on the cognitive, psychomotor, and affective measures at the 0.001 level. No significant differences were found between the video and control groups on the measures with additional univariate testing. CONCLUSIONS: The results indicate that the back school is an effective tool for influencing lifting posture and conveying information regarding spinal mechanics and lifting technique. In addition, the back school videos may not be an effective means of preventing low back injury.

Back Injuries↗

Relationship of lumbar strength in shipyard workers to workplace injury claims.

STUDY DESIGN: Strength testing of lumbar extensors of shipyard workers without back injury claims was accomplished to compare isolated lumbar strength with the severity of their workplace physical demands and the incidence of workplace back injury during a 2-year period. OBJECTIVES: To determine if strength is a predictor of workplace injury and if there is a relationship between the physical demands of the job and strength. SUMMARY OF BACKGROUND DATA: The role of preplacement strength testing has not been clarified as a potential means for predicting workplace injury. It has not been clarified whether work activity affects the strength of the worker. METHODS: One hundred fifty-two shipyard workers were strength tested for isometric lumbar extensor strength. They had been classified as to the severity of their job demands according to the Physical Demand Characteristics. All workers at this industry were likewise classified. Those workers who were tested were followed for 2 years to evaluate for claims of back injury. RESULTS: There was a higher incidence of low back injuries in the heavy and very heavy classification. There was, however, no difference in strength among those workers classified in medium, heavy, and very heavy work. Nine percent of those workers tested had back pains during the following 2 years. All but two had higher-than-average strength. CONCLUSIONS: There is no evidence that preplacement back strength testing would predict workplace claims of injury.

Adult↗