Deiary F. Kader

Evaluation of perifacet injections and paraspinal muscle rehabilitation in treatment of low back pain. A randomised controlled trial.

BACKGROUND Lumbar paraspinal muscle dysfunction and Low Back Pain are strongly correlated. The best treatment for non-specific Low Back Pain is still controversial. OBJECTIVE To evaluate the efficacy of lumbar multifidus muscle retraining exercises and perifacet multifidus injections in the treatment of Low Back Pain. MATERIAL AND METHODS 63 patients with non-specific LBP, with or without leg pain, and magnetic resonance images of paraspinal muscle degeneration only, were randomised to one of three treatment groups: A- Back education and standard physiotherapy for 10 weeks, B- Back education and gym ball exercise for 10 weeks or C- Perifacet injection into the lumbar multifidus muscle with methylprednisolone. The Oswestry Disability Index was used as the primary outcome measure and the SF-36, modified Zung depression index, modified somatic perception and McGill pain questionnaires were used as secondary outcome measures. RESULTS 56 patients completed the trial. The Oswestry Disability Index improved in general from a mean of 29.9 to 25.9, but there were no statistically significant differences between the groups. Low back pain improved most in group C (P<0.02), while physical activities and social functioning were improved the most in group B (P<0.03). CONCLUSION Perifacet injection and back education including a gym ball exercise program may be more effective than back education alone in relieving pain and improving physical capacity respectively. Back education including gym ball exercise could be used for non-specific Low Back Pain, as the ultimate goal should be to restore function.

Gym ball exercise leads to recruitment and increased water content of the paraspinal muscles: An MRI pilot study

Study design: Cross-sectional pilot study on 24 healthy volunteers. Objectives: Investigate the value of stabilization exercises using a gym ball in paraspinal muscle activation by measuring changes in muscle signal intensity on MRI before and after exercise. Background: The gym ball is commonly used for rehabilitating spinal dysfunction. It is thought to rehabilitate some key muscle groups in the trunk. Methods: Twenty-four healthy volunteers (aged 21–50, 13 female and 11 male) had special sequence MR images of the lumbar spine showing an axial section of the paraspinal muscles at L4/5 level. Afterwards all were subjected to 10 minutes of exercise on the gym ball followed by repeat MRI scans immediately, 5 and 10 minutes post exercise. Changes in the mean signal intensity at the same region of interest in multifidus, erector spinae and psoas muscles were evaluated using MRI software. Results: The mean signal intensity in the MR images of the same region in the multifidus (P < 0.03) and erector spinae (P < 0.005) muscles significantly increased after gym ball exercise. There was no statistically significant change in the signal intensity of the psoas muscle (P < 0.086). Conclusions: The multifidus and erector spinae muscles of a healthy individual can be activated by performing certain exercises

Postgraduate orthopaedics : the candidate's guide to the FRCS (Tr & Orth) examination

Machine generated contents note: General guidance / Prash Jesudason -- MCQ and EMI paper guidance / A. S. Rajeev -- The short cases / Andrew Sprowson -- The intermediate cases / Puneet Monga and Rajeev Bansal -- Shoulder and elbow clinical cases / Dave Cloke -- Hand and wrist clinical cases / John W. K. Harrison -- Spine clinical cases / Almas Khan -- Hip clinical cases / Paul A. Banaszkiewicz -- Knee clinical cases / Deiary F. Kader -- Foot and ankle clinical cases / Paul Patterson -- Paediatric clinical cases / Philip Henman -- General viva guidance / Tom Symes -- Shoulder and elbow oral core topics / Asir Aster and Shashi Kanth Godey -- Hip oral core topics / Paul A. Banaszkiewicz -- Knee oral core topics / Deiary F. Kader -- Foot and ankle oral core topics / Paul Patterson -- Spine oral core topics / Niall Craig -- Tumour oral topics / Craig H. Gerrand and Thomas B. Beckingsale -- Syllabus and general guidance / John W. K. Harrison -- Hand oral core topics / John W. K. Harrison -- Paediatric oral topics / S. L. Barker -- Trauma oral topics / Gunasekaran Kumar -- Basic science oral topics / Kevin P. Sherman -- Surgical exposures topics / S. Venkatachalam and Paul A. Banaszkiewicz -- Anatomy / Asir Aster and Paul A. Banaszkiewicz -- SAS doctors and the FRCS (Orth) exam / M. A. Bari -- Article 14 and the FRCS (Orth) exam / Mohan K. Pullagura -- Candidates accounts of the examination / Dave Cloke -- Examination failure / Andrew Port.