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BACKGROUND: While low back pain is one of the most prevalent, if not the most prevalent reasons for visits to physicians, a majority of patients with low back pain cannot be given a definitive diagnosis. While there have been substantial advances in imaging technologies over the past 30 years, relatively little has changed in the methodologies for evaluating functionality of the lumbar spine. The current standard of care for function assessment of the lumbar spine focuses on uncontrolled patient directed motion which results in increased inter-patient variability. Recent advancements in functional lumbar spine testing utilize controlled bending and computerized imaging evaluation. PURPOSE: To compare the measurement variability of lumbar spine motion when diagnosed using measurements of intervertebral motion taken from standard bending flexion/extension radiographs (FE) between uncontrolled and controlled motion. STUDY DESIGN: One-hundred nine patients (57 asymptomatic, 52 symptomatic) were consented in the prospective investigation. The research was designed to compare studies involving FE to controlled motion bending radiographs using the Vertebral Motion Analysis (VMA), (Ortho Kinematics, Inc) within the same patient. Each patient agreed to undergo fluoroscopic still imaging to capture FE data and to undergo cine fluoroscopic imaging to capture VMA data. OUTCOME MEASURES: Measurement variability was determined by the mean and standard deviation of intervertebral rotation when evaluated by 5 independent observers evaluating each of the 109 patients FE and VMA. The resulting standard deviation of the intervertebral rotation determinations was used as the measure of variability. METHODS: The VMA measurements for assessing intervertebral motion were characterized by the use of: (1) a handling device that assists patients through a standard arc of lumbar bending in both an upright and recumbent posture (70 degree flexion/extension arcs; 60 degree left/right bending arcs); (2) video fluoroscopy imaging of the lumbar spine during bending (capturing images at 8 frames per second); and (3) image processing software capable of automatic frame-to-frame registration and tracking of vertebral bodies across the sequence of video-fluoroscopic images to derive measurements of intervertebral rotation and translation. The FE data were assessed from voluntary bending by the patient. RESULTS: There was statistical greater measurement variability in intervertebral rotation in FE when compared to VMA (both standing and lying). When comparing measurement variability between FE and VMA, results indicate between a 26% to 46% decrease in measurement variability under VMA compared to FE. These findings are consistent across asymptomatic and symptomatic patients. CONCLUSIONS: The current standard of care for functional testing of the lumbar spine utilizes uncontrolled FE with a manual data evaluation process. Recent developments in using computerized imaging processes has improved, however there remains variability in patient bending due to the self-selected rate and position of the bending. VMA results in a significant reduction in measurement variability of intervertebral rotation measurements.

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Se realizó un estudio de población, de tipo prospectivo, descriptivo y observacional en pacientes que acudieron a la Unidad de Tumores Óseos y Partes Blandas (UTOPB) del Hospital Universitario “Dr. Manuel Núñez Tovar” entre enero de 2008 y julio de 2010, con el diagnóstico de Osteocondromatosis Múltiple Hereditaria (OMH) que afectaba las articulaciones de las extremidades inferiores; se estudiaron 26 pacientes, equivalentes a 52 extremidades inferiores, con predominio del sexo masculino 1,2:1, las edades de los pacientes comprendían entre los 6 y 15 años, con mayor registro de casos a los 12 años (19,2%). Se cuantificó el número de osteocondromas periarticulares en las articulaciones de cadera, rodilla y tobillo, observando un predominio en la rodilla (48,7%) a expensas de la metáfisis distal del fémur. Se clasificó la afectación funcional de las articulaciones en tres grados (leve, moderada y severa), tomando como referencia el movimiento de flexoextensión, siendo el tobillo la articulación que presento el mayor grado de limitación y la cadera la menos afectada a la presencia de osteocondromas

We conducted a prospective, descriptive and observational population-based study, in patients attending the Unit of Bone and Soft Tissue Tumors (UTOPB) at the Hospital "Dr. Manuel Núñez Tovar" between January 2008 and July 2010, with the diagnosis of Multiple Hereditary Osteochondromatosis (MHO), which affected the joints of the lower extremities, were studied 26 patients, equivalent to 52 lower extremities; with a male predominance 1,2:1, the age of the patients ranged between 6 and 15 years, with highest number of cases at 12 years (19.2%). We quantified the number of periarticular osteochondromas at the hip, knee and ankle, having predominance in the knee (48.7%) at the expense of the distal femur metaphysis. We scored the functional range of the joints in three grades (mild, moderate and severe), with reference to the movement of flexion-extension, the ankle joint had the highest degree of limitation and, the hip was less affected to the presence of osteochondromas

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El presente artículo tuvo como objetivo presentar un caso clínico de una paciente que buscó la clínica del SERVICIO ATM quejándose de graves chasquidos durante la masticación y dolor en los músculos masticatorios, que han comenzado poco después de sufrir un accidente de autobús. El diagnóstico fue sugestivo de desorden temporomandibulares asociado con injuria en flexión-extensión del cuello. Este tipo de lesión es secundaria a una fuerza súbita, lo que conduce a un mecanismo de aceleración-deceleración de energía transferida al cuello, que puede causar daños a los tejidos blandos y una variedad de manifestaciones clínicas. A menudo se produce después de los accidentes de tráfico y es responsable de la aparición de muchos casos de desorden temporomandibular. Los principales síntomas son graves chasquidos, sensibilidad dolorosa a la palpación de los músculos de la masticación, en la articulación temporomandibular durante la apertura de la boca, en el cuello y las estructuras adyacentes, además de dolor de cabeza. El tratamiento propuesto se instituyó el uso de férula oclusal, 24 horas al día, reduciendo el tiempo de uso de acuerdo a la regresión de los síntomas. Después de 5 meses de tratamiento, hubo regresión total del dolor y parcial del chasquido

The aim of this article is to report clinical case of a pacient that described severe "clicking sound" during the chewing and pain in the masticatory muscles, which began immediately after a motor vehicle accident. The suggestive diagnosis was temporomandibular joint disorder associated to a whiplash injury. It has been described as an acceleration-deceleration mechanism of energy transfer to the neck, which can lead to soft tissue injuries and a variety of clinical manifestations. These injuries usually occur after motor vehicle accidents and it's responsible for the occurrence of many cases of temporomandibular joint disorder. The main signs and symptoms are severe "clicking sound", pain in the masticatory muscles, temporomandibular joint pain during wide mouth opening, pain in the neck and adjacent structures and headache. The proposed treatment consisted of the use of oclusal splint, 24 hours per day. The decreasing of use was indicated accordingly to the decreasing of the symptoms. After five months, the pain was extinguished and clicking sound was partially decreased

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