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المؤلفون: Claire Bernier, Hélène Aubert, Jean-Marie Berthelot, Antoine Néel, Christian Agard, Sébastien Barbarot, Benoit Le Goff, Mohamed Hamidou, Agathe Masseau, Françoise Kraeber-Bodéré, Christelle Darrieutort-Laffite, Catherine Ansquer
المصدر: Arthritis Research & Therapy, Vol 22, Iss 1, Pp 1-10 (2020)
Arthritis Research & Therapyمصطلحات موضوعية: Male, medicine.medical_specialty, lcsh:Diseases of the musculoskeletal system, Interleukin 1 receptor antagonist, Single Center, Cohort Studies, 030207 dermatology & venereal diseases, 03 medical and health sciences, 0302 clinical medicine, Schnitzler syndrome, Musculoskeletal Pain, Internal medicine, medicine, Humans, Bone pain, Retrospective Studies, business.industry, Waldenstrom macroglobulinemia, Retrospective cohort study, Bone scan, medicine.disease, Rash, Rheumatology, Bone lesions, Cohort, Female, medicine.symptom, lcsh:RC925-935, business, 030215 immunology, Research Article, Follow-Up Studies
الوصف: Objective To report on the characteristics and long-term course of rheumatic manifestations in Schnitzler syndrome (SchS). Methods A retrospective cohort study of patients with SchS followed between 2000 and 2020. Inclusion criteria included a diagnosis of SchS (Strasbourg criteria). All available bone scans were reviewed and scored according to the intensity and number of pathological sites. The scintigraphic score was compared with the clinical activity score, CRP level, and treatments. Results Twenty-five patients were included. Median age at diagnosis was 68 years. Eighty patients (72%) had SchS-related rheumatic pain. Most patients had a long-standing isolated rash before constitutional and/or rheumatic symptoms appeared. The monoclonal component level was usually very low (IgMκ in 22/25). Rheumatic pain predominated around the knees. Bone scans revealed abnormal tracer uptake in 15/18 (85%). The scintigraphic score correlated with clinical activity (r = 0.4, p r = 0.47, p p Conclusions Rheumatic manifestations are very prevalent in SchS. However, bone pain can be misleading and contribute to misdiagnosis. Bone scan abnormalities are very prevalent and correlate with disease activity and treatments. IL1-Ra has a dramatic and durable efficacy but may not be required in every patient early on.
الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::52bd4540be4dcd843b01445f9f1276c5Test
http://link.springer.com/article/10.1186/s13075-020-02318-5Test -
2
المؤلفون: Catherine Chevalier, Julien Herman, Frédéric Blanchard, Julien De Lima, Christelle Darrieutort-Laffite, Benoit Le Goff, Régis Brion
المصدر: Arthritis Research & Therapy, Vol 23, Iss 1, Pp 1-11 (2021)
Arthritis Research & Therapyمصطلحات موضوعية: 0301 basic medicine, Rotator cuff tendons, Pathology, medicine.medical_specialty, Myeloid, Inflammasomes, Interleukin-1beta, Inflammation, Diseases of the musculoskeletal system, Inflammasome, 03 medical and health sciences, 0302 clinical medicine, In vivo, Apatites, NLR Family, Pyrin Domain-Containing 3 Protein, medicine, Humans, Apatite, 030203 arthritis & rheumatology, Chemistry, Caspase 1, Air pouch model, Interleukin, medicine.disease, In vitro, 030104 developmental biology, medicine.anatomical_structure, RC925-935, Tendinopathy, Tumor necrosis factor alpha, medicine.symptom, Research Article, Interleukin-1, medicine.drug, Calcification
الوصف: Background Calcific tendonitis of the rotator cuff is due to carbonated apatite deposits in the shoulder tendons. During the evolution of the disease, an acute inflammatory episode may occur leading to the disappearance of the calcification. Although hydroxyapatite crystal-induced inflammation has been previously studied with synthetic crystals, no data are available with calcifications extracted from patients suffering from calcific tendinopathy. The objective of the study was to explore the inflammatory properties of human calcifications and the pathways involved. Methods Human calcifications and synthetic hydroxyapatite were used in vitro to stimulate human monocytes and macrophages, the human myeloid cell line THP-1, and human tenocytes. The release of IL-1β, IL-6, and IL-8 by cells was quantified by ELISA. The gene expression of pro- and anti-inflammatory cytokines was evaluated by quantitative PCR. NF-kB activation and NLRP3 involvement were assessed in THP-1 cells using a NF-kB inhibitor and a caspase-1 inhibitor. The inflammatory properties were then assessed in vivo using a mouse air pouch model. Results Human calcifications were able to induce a significant release of IL-1β when incubated with monocytes, macrophages, and THP-1 only if they were first primed with LPS (monocytes and macrophages) or PMA (THP-1). Stimulation of THP-1 by human calcifications led to similar levels of IL-1β when compared to synthetic hydroxyapatite although these levels were significantly inferior in monocytes and macrophages. The patient’s crystals enhanced mRNA expression of pro-IL-1β, as well as IL-18, NF-kB, and TGFβ when IL-6 and TNFα expression were not. IL-1β production was reduced by the inhibition of caspase-1 indicating the role of NLRP3 inflammasome. In vivo, injection of human calcifications or synthetic hydroxyapatite in the air pouch led to a significant increase in membrane thickness although significant overexpression of IL-1β was only observed for synthetic hydroxyapatite. Conclusions As synthetic hydroxyapatite, human calcifications were able to induce an inflammatory response resulting in the production of IL-1β after NF-kB activation and through NLRP3 inflammasome. In some experiments, IL-1β induction was lower with human calcifications compared to synthetic apatite. Differences in size, shape, and protein content may explain this observation.
الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::a18bc9d94eb8b9d074ab6b6da7d601edTest
https://doi.org/10.21203/rs.3.rs-156807/v1Test -
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المؤلفون: Paul Arnolfo, Yves Maugars, Benoit Le Goff, Jean-Marie Berthelot, Christelle Darrieutort-Laffite, Joëlle Glémarec
المصدر: Joint bone spine. 88(1)
مصطلحات موضوعية: musculoskeletal diseases, medicine.medical_specialty, Lasègue test, Physical examination, Neurological examination, Sitting, 03 medical and health sciences, Sciatica, 0302 clinical medicine, Lumbar, Physical medicine and rehabilitation, Rheumatology, medicine, Humans, Medical history, 030212 general & internal medicine, Range of Motion, Articular, 030203 arthritis & rheumatology, Leg, Lumbar Vertebrae, medicine.diagnostic_test, business.industry, Lumbosacral Region, Test (assessment), medicine.symptom, business, Intervertebral Disc Displacement
الوصف: Diagnosis of sciatica mainly relies on pain reproduction by stretching of the lumbar roots since neurological examination and medical history are usually not sufficient to guarantee diagnosis. The Lasegue test is the most popular method, which starts with the straight leg-raising test (SLR). However it is not perfect, and is not always well performed or interpreted. Passive ankle dorsiflexion at the end of the SLR (Bragard test) is more sensitive, but can also remain normal in some cases of sciatica. Other stretching tests can help to recognise lumbar root damage in patients with poorly defined pain in a lower extremity: firstly, the Christodoulides test, i.e. reproduction of L5 sciatic pain by a femoral stretch test; secondly, the Slump test, performed on a patient in a sitting position, by slowly extending their painful leg then passively bending their neck (or the opposite); and thirdly, the Bowstring test, which requires, at the end of the Lasegue test, once the knee has been slightly flexed, pressing on the course of the peroneal and/or tibial nerves in the popliteal fossea to try and reproduce the exact pain felt by the patient. The combination of all these tests takes less than 2 minutes, and could improve both the sensitivity and specificity of the physical examination for the diagnosis of sciatica. This article is a review of the limitations of the Lasegue/SLR tests and of the efficacy of these other tests for stretching the lumbar roots.
الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::46a9eab49f1988767c89d527d2609134Test
https://pubmed.ncbi.nlm.nih.gov/32561431Test -
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المؤلفون: Philippe Montigny, Grégoire Cormier, Benoit Le Goff, Céline Cozic, Gilles Tanguy, Christelle Volteau, Yves Maugars, Stéphane Varin, Joëlle Glémarec, Christelle Darrieutort Laffite
المصدر: Joint Bone Spine. 85:359-363
مصطلحات موضوعية: Adult, Male, medicine.medical_specialty, Lidocaine, Visual analogue scale, medicine.drug_class, medicine.medical_treatment, Injections, Intralesional, Cortivazol, Placebo, Risk Assessment, Severity of Illness Index, Statistics, Nonparametric, 03 medical and health sciences, 0302 clinical medicine, Double-Blind Method, Rheumatology, Reference Values, 030202 anesthesiology, medicine, Humans, Prospective Studies, Anesthetics, Local, Glucocorticoids, Saline, Aged, Pain Measurement, Lumbar Vertebrae, Local anesthetic, business.industry, Lumbosacral Region, Middle Aged, Prognosis, Low back pain, Surgery, Treatment Outcome, Anesthesia, Drug Therapy, Combination, Female, medicine.symptom, Tomography, X-Ray Computed, business, Low Back Pain, 030217 neurology & neurosurgery, Lumbosacral joint, medicine.drug
الوصف: Objective The primary objective of this study was to compare the efficacy of local injection of a local anesthetic with a glucocorticoid versus a local anesthetic with saline to treat low back pain due to lumbosacral transitional vertebras (LSTV) with a pseudoarticulation. Methods A randomized placebo-controlled double-blind study was conducted in patients with unilateral low back pain ascribed clinically to LSTV. Patients were randomized to lidocaine plus saline (LS group) or lidocaine plus cortivazol (LC group) injected locally under computed tomography guidance. The primary outcome measure was the 24-hour mean visual analog scale (VAS) score for low back pain 4 weeks after the injection. Results Of 16 randomized patients, 15 were included in the analysis, 8 in the LS group and 7 in the LC group. The mean VAS pain score at week 4 was not significantly different between the two groups. In the two groups pooled, the mean VAS pain score decreased significantly from baseline to week 4, from 5.52 ± 0.99 to 3.86 ± 2.55 (P ≤ 0.05). The difference remained significant at week 12. Significant improvements occurred in the EIFEL disability index and items of the Dallas Pain Questionnaire. No adverse events were recorded. Conclusion In patients with chronic low back pain consistent with a symptomatic LSTV type II or IV in the Castellvi classification, a local injection of lidocaine with or without cortivazol may provide sustained improvements in pain and function. The underlying mechanism is unclear.
الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::a9bfad3bd3d962e0479cdcb9f6bd8f59Test
https://doi.org/10.1016/j.jbspin.2017.05.003Test -
5
المصدر: Joint Bone Spine. 85:41-45
مصطلحات موضوعية: medicine.medical_specialty, Nerve root, Dura mater, Diagnostic Techniques, Neurological, 03 medical and health sciences, 0302 clinical medicine, Lumbar, Rheumatology, Ganglia, Spinal, medicine, Humans, Radiculopathy, 030203 arthritis & rheumatology, Sciatica, business.industry, Nerve Compression Syndromes, Lumbosacral Region, Anatomy, medicine.disease, Surgery, Periradicular, medicine.anatomical_structure, Thecal sac, medicine.symptom, Arachnoiditis, Spinal Nerve Roots, Radiculopathies, business, 030217 neurology & neurosurgery
الوصف: Purpose To perform a synthesis of articles addressing the role of stretching on roots in the pathophysiology of radiculopathy. Methods Review of relevant articles on this topic available in the PubMed database. Results An intraoperative microscopy study of patients with sciatica showed that in all patients the hernia was adherent to the dura mater of nerve roots. During the SLR (Lasegue's) test, the limitation of nerve root movement occurs by periradicular adhesive tissue, and temporary ischemic changes in the nerve root induced by the root stretching cause transient conduction disturbances. Spinal roots are more frail than peripheral nerves, and other mechanical stresses than root compression can also induce radiculopathy, especially if they also impair intraradicular blood flow, or the function of the arachnoid villi intimately related to radicular veins. For instance arachnoiditis, the lack of peridural fat around the thecal sac, and epidural fibrosis following surgery, can all promote sciatica, especially in patients whose sciatic trunks also stick to piriformis or internus obturator muscles. Indeed, stretching of roots is greatly increased by adherence at two levels. Conclusions As excessive traction of nerve roots is not shown by imaging, many physicians have unlearned to think in terms of microscopic and physiologic changes, although nerve root compression in the lumbar MRI is lacking in more than 10% of patients with sciatica. It should be reminded that, while compression of a spinal nerve root implies stretching of this root, the reverse is not true: stretching of some roots can occur without any visible compression.
الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::5af4ecfabfd34a61a907e0e8f756e64bTest
https://doi.org/10.1016/j.jbspin.2017.01.004Test -
6
المؤلفون: Benoit Le Goff, Jean-Marie Berthelot, Noura Biha, Yves Maugars, Christelle Darrieutort-Laffite
المصدر: Pain Reports
PAIN Reports, Vol 4, Iss 3, p e739 (2019)مصطلحات موضوعية: Osteoporosis, Tendinopathies, 02 engineering and technology, Osteoarthritis, Daily, 01 natural sciences, lcsh:RD78.3-87.3, Tendinitis, Fibromyalgia, 0103 physical sciences, 0202 electrical engineering, electronic engineering, information engineering, Back pain, Medicine, 010306 general physics, Back, business.industry, Arthritis, Spondylarthrosis, medicine.disease, Anesthesiology and Pain Medicine, Duration, lcsh:Anesthesiology, Rheumatoid arthritis, Anesthesia, Musculoskeletal, PainDetect, 020201 artificial intelligence & image processing, medicine.symptom, Neuropathic, business, Radiculopathies, Research Paper
الوصف: Objectives:. We aimed to compare painDETECT scores in outpatients seen in a rheumatology department over a 1-month period and search for correlations between painDETECT scores and the estimated duration of daily pain and time elapsed since the onset of current pain. Patients and Methods:. A total of 529 of 738 outpatients agreed to complete a set of questionnaires, including painDETECT. Results:. The mean painDETECT score was 14.14 ± 7.59, and 31% of the patients had painDETECT scores of >18. Fibromyalgia ranked first (21.2 ± 6.0), followed by osteoarthritis of the lower limbs (17.8 ± 8.2), back pain and radiculopathies (16.1 ± 6.8), osteoarthritis of the upper limbs (15.7 ± 8.1), spondylarthrosis (15.1 ± 7.2), entrapment neuropathies (14.1 ± 2.4), rheumatoid arthritis (13.8 ± 7.1), miscellaneous conditions (13.8 ± 8.2), tendinitis (13.4 ± 7.9), connectivitis (11.5 ± 6.7), and osteoporosis (8.5 ± 6.9). The duration of daily pain was much longer in patients with painDETECT scores of >18 (12.41 ± 8.45 vs 6.53 ± 7.45 hours) (t = 0.0000), but very similar painDETECT scores were observed for patients suffering from pain for less than 1 week (13.7 ± 8.2; 38% > 18), for 1 month (14.5 ± 8.2; 25% > 18), several months (12.7 ± 7.3; 23% > 18), 1 year (13.8 ± 7.7; 29% > 18), or several years (14.7 ± 7.4; 33% > 18). Conclusion:. PainDETECT scores differed little depending on the musculoskeletal condition, strongly correlated with the duration of daily pain, and appeared to be as high in patients with recent pain as in those suffering for years.
الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::26400756998df32727fc18cf0b18d300Test
http://europepmc.org/articles/PMC6749904Test -
7
المؤلفون: Benoit Le Goff, Lucie Planche, Christelle Darrieutort-Laffite, Géraldine Bart, Yves Maugars, Joëlle Glémarec
المصدر: Joint Bone Spine. 82:356-361
مصطلحات موضوعية: Anesthesia, Epidural, Male, medicine.medical_specialty, Hydrocortisone, Visual analogue scale, medicine.medical_treatment, Anti-Inflammatory Agents, Injections, Epidural, Spinal Puncture, Palpation, law.invention, Sciatica, Lumbar, Rheumatology, Randomized controlled trial, law, medicine, Clinical endpoint, Humans, Single-Blind Method, Prospective Studies, Pain Measurement, Ultrasonography, Lumbar Vertebrae, medicine.diagnostic_test, Epidural steroid injection, business.industry, Lumbosacral Region, Middle Aged, Epidural space, Surgery, Treatment Outcome, medicine.anatomical_structure, Anesthesia, Feasibility Studies, Female, medicine.symptom, business, Low Back Pain
الوصف: Ultrasound (US) is widely used in rheumatology to study and guide injection of peripheral joints. It can also provide useful information about the anatomy of the lumbar spine. Studies have shown that US examination of the spine was a useful tool to help perform epidural anaesthesia. The purpose of the study was to determine if the selection of the optimum puncture level by US may facilitate epidural steroid injection in case of presumed difficult puncture (BMI30 kg/m(2), age60 years or lumbar scoliosis).We performed a prospective randomized controlled study. Eighty patients were randomized in two groups: US group (n=40) which underwent a pre-procedure spinal US to determine the optimal lumbar level for injection or control group (n=40) for which the level of injection was determined by palpation. Primary endpoint was the pain during the procedure assessed using the Visual Analogue Scale (VAS).We found a positive correlation between depth of the epidural space and BMI (P0.001) and a negative correlation between size of the interspinous spaces and age (P0.01). Visibility of the epidural space was not altered by obesity or age. We observed a trend toward a reduction in pain intensity during the procedure in the US group compared to the control group with a mean difference at -0.94 [-1.90; 0.02] but the difference was not significant (P=0.054).US of the lumbar spine was feasible in patients with lumbar conditions even in obese and old ones and allowed the visualization of the epidural space. However, pre-procedure US examination did not reduce pain during the procedure.
الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::19e267d8a378100ff867b09137e81d59Test
https://doi.org/10.1016/j.jbspin.2015.02.001Test -
8
المصدر: Joint bone spine. 83(4)
مصطلحات موضوعية: Adult, medicine.medical_specialty, Vena Cava, Inferior, Lumbar vertebrae, Inferior vena cava, Multimodal Imaging, Sensitivity and Specificity, Varicose Veins, 03 medical and health sciences, 0302 clinical medicine, Lumbar, Rheumatology, Medicine, Humans, Ultrasonography, Doppler, Color, Ultrasonography, Interventional, 030203 arthritis & rheumatology, Varix, Lumbar Vertebrae, medicine.diagnostic_test, business.industry, Ultrasound, Magnetic resonance imaging, medicine.disease, Low back pain, Magnetic Resonance Imaging, medicine.anatomical_structure, medicine.vein, Female, Radiology, medicine.symptom, business, Venous malformation, Tomography, X-Ray Computed, Low Back Pain, 030217 neurology & neurosurgery
الوصف: Ultrasonography is currently widely used in the rheumatology practice. Although mainly performed to study peripheral joint, several articles have underlined its interest to study spinal anatomy. However, its ability to provide diagnostic features is unknown. We studied the case of a 25-year-old woman having low back pain. Three different imaging modalities (Computed Tomography [CT], Magnetic Resonance Imaging [MRI] and Ultrasound) were used to explore it. CT and MRI showed a foraminal dilation of the lombo-ovarian vein at the L3-L4 level with a scalloping of the lateral edge of L3. We were able to detect it with Color Doppler Ultrasound and a malformation of the inferior vena cava was also found. We showed for the first time that Color Doppler Ultrasound can detect venous malformation of the spine. This imaging modality could help us in the diagnosis of atypical lesions of the spine to confirm their vascular origin.
الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::0783278b2a1d4075b4af21126ec53d8aTest
https://pubmed.ncbi.nlm.nih.gov/27068620Test -
9
المصدر: Annals of the Rheumatic Diseases. 73:298.1-298
مصطلحات موضوعية: Sciatica, medicine.medical_specialty, Cobb angle, Injection Procedure, business.industry, Visual analogue scale, Immunology, Ultrasound, General Biochemistry, Genetics and Molecular Biology, Epidural space, Surgery, medicine.anatomical_structure, Lumbar, Rheumatology, medicine, Clinical endpoint, Immunology and Allergy, medicine.symptom, business
الوصف: Background Ultrasound (US) is widely used in rheumatology to study and guide infiltration of peripheral joints. This imaging modality can also provide useful information about the anatomy of the lumbar spine. Studies have shown that US examination of the spine was an useful tool to help perform epidural anesthesia [1]. Objectives To determine if the identification of the optimum puncture level by a pre-puncture US examination of the lumbar spine may facilitate epidural corticosteroid injection in patients with a presumed difficult puncture. Methods We performed a prospective randomized single-blind controlled study (NCT01832844). All patients referred to our unit for the treatment of sciatica due to lumbar disc herniation were evaluated. Inclusion criteria were a BMI >30 kg/m 2 and/or age >60 years and/or lumbar scoliosis (Cobb angle >10°). Patients were randomized to a US (n=40) or a control (n=40) group. The US group underwent a pre-procedure spinal US (Esaote Mylab 70; 3-11 MHz probe). Interspinous spaces and depth of the epidural space were measured. Visibility and accessibility of the epidural space was thus rated as “poor”, “moderate” or “good”. The best lumbar level to perform the injection was selected according these results. Patients of the control group underwent a fake US examination to remain blind to the group allocation and the level of injection was selected using the traditional landmark technique. An interspinous injection of 5 ml of Hydrocortisone was thus performed. Primary endpoint was the pain during the procedure assessed using the Visual Analogue Scale (VAS). Each redirection of the needle was counted. Data are presented as the mean (±SD). A Student t-test and a Pearson correlation test were used for the statistical analysis. Results Mean age was 62,5 (±16) and 33% were men. 47/80 (58%) patients were over 60 years, 41/80 (51%) had a BMI>30 kg/m 2 and 14/80 (17%) had a lumbar scoliosis. Among the 80 patients, 21 (26%) had 2 or more criteria of presumed difficult puncture. Mean epidural space depth was 49.2 mm (±13.8) and mean interspinous distance was 14.22 mm (±5.1). We found a positive correlation between epidural space depth and BMI (p Conclusions US evaluation of the interspinous space and epidural depth is feasible even in obese or old patients. Identification of the optimum puncture level by a pre-puncture US decreased the pain during the epidural injection procedure. This benefit was greater in patients over 60 years. US of the lumbar spine represents an additional technique at the rheumatologist9s disposal to help guiding lumbar spine injections. References Grau T, Leipold RW, Conradi R, et al. Efficacy of ultrasound imaging in obstetric epidural anesthesia. J Clin Anesth. 2002;14:169-75. Disclosure of Interest : None declared DOI 10.1136/annrheumdis-2014-eular.3841
الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_________::35b63463ea002c96002f5a82ee949b48Test
https://doi.org/10.1136/annrheumdis-2014-eular.3841Test -
10
المؤلفون: Y. Maugars, B. Le Goff, Christelle Darrieutort-Laffite
المصدر: Annals of the Rheumatic Diseases. 72:A721.4-A722
مصطلحات موضوعية: Sciatica, medicine.medical_specialty, business.industry, Immunology, Ultrasound, General Biochemistry, Genetics and Molecular Biology, Sagittal plane, Epidural space, Rheumatology, Surgery, Lumbar, medicine.anatomical_structure, Interquartile range, Internal medicine, medicine, Immunology and Allergy, medicine.symptom, Ultrasonography, business, Nuclear medicine
الوصف: Background Epidural steroid injections are a common method used for the treatment of patients with sciatica. They are usually performed without imaging guidance using anatomical landmarks. However, injections are sometimes challenging resulting in prolonged procedure times, multiple needle passes and significant pain. Ultrasonography (US) is mainly used by rheumatologist for the guidance of peripheral joint injections. However, some studies have shown that US examination of the spine was useful before epidural anesthesia to predict which patients were at risk for a difficult procedure (1). Objectives The aim of our study was to evaluate the feasibility of a pre-procedure ultrasound examination of the spine before epidural steroid injections. Methods US examination of the lumbar spine was performed in 21 patients referred to our unit for the treatment of sciatica due to lumbar disc herniation. The scanning was performed with an Esaote My lab 70 unit using a curved-array, low-frequency (1–8 MHz) probe on a patient seated. L5-S1 intervertebral space was first located on a sagittal view, and the probe was then moved cranially. At each intervertebral level, we recorded our ability to depict the epidural space. We rated the visibility as ‘absent’, ‘poor’, ‘moderate’, ‘good’ with assigned numerical values of 0, 1, 2 and 3, respectively. We measured distance between spinous processes and depth of the epidural space in L3-L4, L4-L5 and L5-S1. Each measurement was performed 3 times and the mean was used for statistical analysis. Data are given as the median (+/- interquartile range). Differences between measurements at each lumbar levels was assessed with a Friedman’s Test and correlations between age, gender and Body mass index (BMI) and epidural visibility with a Pearson’s test. Results 21 patients (11 men and 10 women), mean age 46 years (38-60.5) were included in our study. Median weight was 73 kg (59-85) and median BMI 24.8 (20.85-27.05). Median depth of the epidural space was 44.5 mm (41.60-48.45) in L3-L4, 43.80 mm (41.35-45.85) in L4-L5 and 40.8 mm (39.2-46.9) in L5-S1. Median distance between spinous processes was 17.9 mm (12.95-20.75), 15.9 mm (13.15-17.8) and 16.4 mm (15.30-17.7) in L3-L4, L4-L5 and L5-S1, respectively. Visibility of the epidural space was significantly lower in L5-S1 (p Conclusions We accurately identified each intervertebral level, estimated depth to the epidural space, and located the most appropriate interspinous space for needle insertion. As expected, the distance between spinous processes and epidural accessibility was reduced in older patients. US might help us to predict which patients are at risk for a difficult epidural injection and help the physician to identify the optimal site of injection. Overall, US of the lumbar spine represents a new imaging modality available for the rheumatology to treat patients with lumbar conditions. References Weed JT, Taenzer AH, Finkel KJ, Sites BD. Evaluation of pre-procedure ultrasound examination as a screening tool for difficult spinal anaesthesia. Anaesthesia. 2011 Oct;66(10):925-30. Disclosure of Interest None Declared
الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_________::99f7e0d8c5cd3b0b7330c572609a9dfaTest
https://doi.org/10.1136/annrheumdis-2013-eular.2135Test
