Novel assessment of leukocyte-rich platelet-rich plasma on functional and patient-reported outcomes in knee osteoarthritis: a pilot study

Background: Leukocyte-rich platelet-rich plasma (LR-PRP) has demonstrated to be beneficial for patients with knee osteoarthritis (KOA); however, reliable objective end points to accurately assess its therapeutic effects is lacking. Aim: To investigate the efficacy of LR-PRP as assessed by functional and patient-reported outcomes at early time points (6 weeks). Materials & methods: We conducted a prospective cohort study in 12 patients with diagnosed KOA (Kellgren Lawrence score of II-III), who underwent a single ultrasound-guided LR-PRP injection. Results: There was significant improvement in timed up and go, pain and quality of life scales and balance parameters. There were nonsignificant improvements in range of motion and gait parameters. Conclusion: LR-PRP demonstrates efficacy in meaningful end points for functional and patient-reported outcomes at early time points in patients with KOA.

Variability in the size of the retroperitoneal oblique corridor: A magnetic resonance imaging-based analysis

Background:

A minimally invasive approach to the L2-S1 disc spaces through a single, left-sided, retroperitoneal oblique corridor has been previously described. However, the size of this corridor varies, limiting access to the disc space in certain patients. Here, the authors retrospectively reviewed lumbar spine magnetic resonance imaging (MRI) in 300 patients to better define the size and variability of the retroperitoneal oblique corridor.

Methods:

Lumbar spine MRI from 300 patients was reviewed. The size of the retroperitoneal oblique corridor from L2-S1 was measured. It was defined as the (1) distance between the medial aspect of the aorta and the lateral aspect of the psoas muscle from L2-L5 and (2) the distance between the midpoint of the L5-S1 disc and the medial aspect of the nearest major vessel on the left at L5-S1. In addition, the rostral-caudal location of the iliac bifurcation was measured.

Results:

The size of the retroperitoneal oblique corridor at L2/3, L3/4, L4/5, and L5/S1 was, respectively, 17.3 ± 6.4 mm, 16.2 ± 6.3 mm, 14.8 ± 7.8 cm, and 13.0 ± 8.3 mm. The incidence of corridor size <1 cm at L2/3, L3/4, L4/5, and L5/S1 was 10.3%, 16.0%, 30.0%, and 39.3%, respectively. The iliac bifurcation was most commonly found behind the L4 vertebral body (n = 158, 52.67%) followed by the L4/5 disc space (n = 74, 24.67%).

Conclusion:

The size of the retroperitoneal oblique corridor diminishes in a rostral-caudal direction, often limiting access to the L4/5 and L5/S1 disc spaces.

Experiences of patients with chronic low back disorder of the use of spinal stabilisation exercises--a qualitative study

BACKGROUND

There is limited evidence on the patients' perception of the treatment with spinal stabilisation exercises and their overall experience of the treatment programme.

OBJECTIVE

The aim of this study was to elicit valuable information of the experiences of patients who participated in a spinal stabilisation programme within a randomised controlled trial (RCT).

METHOD

A qualitative study.

PARTICIPANTS

Nine participants (male = 3, female = 6) were selected, to participate in focus group interviews from among those who participated in the RCT on the use of stabilization exercises in the treatment of chronic low back pain. A semi-structured interview comprising of open ended questions were used. Audio recording was used to record participants' opinions during the interview process. Careful checking, reading and correction of the transcript from the interviews were carried out and a thematic analysis was conducted on the data.

RESULTS

Participant's explanations for the perceived improvements were not limited to the positive effects of stabilisation exercise on pain severity, functional disability and quality of life but also reflected major increases in confidence and the formulation of self help strategies and the ability to exert better control over their back pain due to more knowledge of the spine and how it works.

CONCLUSION

Participants views on the benefit of stabilisation exercise programme are heterogeneous. However, the opinions of many of the participants in this study seem to have indicated satisfaction with the programme.

Plasma levels of beta-endorphin and serotonin in response to specific spinal based exercises

Exercises as the primary mode of treatment for low back disorders aim to achieve pain reduction, improvement in functional abilityand quality of life of for low back disorder sufferers. However the bio-chemical events associated with the use of these exercises in terms of theireffects on pain relieving neuropeptides have not been well established. Thisstudy was carried out to investigate the effects of spinal stabilisation, backextension and treadmill walking exercises on plasma levels of serotonin andbeta-endorphin.Twenty volunteers (10 males and 10 females) without low back pain participated in the study. They were randomly allocated either to one of theexercise groups, where participants carried out one of the spinal stabilisation, back extension and treadmill walkingexercises or the control (no exercise) group. The main outcome measures used in this study were plasma levels of serotonin and beta-endorphin measured with Enzyme linked immuno absorbent assay (ELISA) technique.The results of this study showed that spinal stabilisation and treadmill walking exercises produced significantincrease in plasma serotonin levels (P < 0.05) however there were no significant changes in the plasma levels of beta-endorphin in all the exercise groups (P > 0.05).It could be that biochemical effects associated with stabilisation and treadmill walking exercises therefore mayinvolve production of serotonin and its release into the plasma.