Kazimierz Rąpała

A comparative analysis of static balance between patients with lumbar spinal canal stenosis and asymptomatic participants.

OBJECTIVE The aim of this study was to assess static balance in patients with lumbar spinal canal stenosis who qualified for surgical decompression of associated neural structures and compare them with asymptomatic participants. METHODS This case-controlled study evaluated a sample of 50 patients with spinal canal stenosis (stenosis group) and 48 participants with no history of clinical symptoms of back pain. Static balance was assessed by conducting quantitative analysis of balance reaction parameters in quiet standing with the eyes closed. RESULTS Higher values were observed in total length of center of pressure (COP) path, length of COP path in the anterior-posterior plane, mean amplitude of COP projection in the anterior-posterior plane, maximal amplitude between the 2 most distant points in the anterior-posterior plane, mean COP velocity, and sway area marked by the moving COP in the stenosis group compared with the asymptomatic group. CONCLUSIONS This study showed statistically significant differences in static balance parameters between patients with spinal canal stenosis compared with the asymptomatic group.

Recurrence of tuberculosis after hip replacement 58 years after primary infection.

The paper presents the case of a 73-year-old patient with a history of tuberculosis of the hip in childhood who received an Exeter total hip prosthesis. Tuberculosis recurred 58 years after primary infection and 9 years after THA. The authors analyzed the available literature, which described only a few case reports, because Mycobacterium tuberculosis infections of a joint implant after THA are extremely rare. They are frequently the result of local reactivation of the pathogen or, less commonly, an overlooked diagnosis of tuberculosis at the time of endoprosthesis implantation. Proper diagnostic work-up of infection is particularly difficult because synovial fluid cultures are usually negative. In addition, a coexisting Staphylococcus aureus infection may obscure the clinical presentation. In post-THA patients, complete anti-TB treatment is recommended. Particular caution should be observed in patients from regions with high TB morbidity or with a history of pulmonary and operated joint tuberculosis.

Back pain in Polish military helicopter pilots

ObjectivesLow back pain in pilots of military helicopters is widely discussed in the world literature. Vibrations and improper seat configuration cause that cervical, thoracic and lumbar spine might be exposed to overloading. The aim of the study was to determine the incidence and intensity of pain in the spine as well as to identify subjective risk factors of back pain and its effect on the pilot’s actions while flying a helicopter.Materials and Methods112 pilots, aged 25–56 years (mean age: 34.8±6.3 years), actively flying helicopters, participated in the questionnaire survey. The questionnaire containing five groups of questions, elaborated by the authors, was used.Results70% of the pilots reported pain complaints. Pain was localized in different parts of the spine. Uncomfortable body posture during prolonged flights resulting from the lack of lumbar support exerted the highest effect on pain provocation.ConclusionsThis questionnaire survey enabled to determine the prevalence of pain, its type and intensity. Knowledge on low back pain imposes the necessity to eliminate the negative environmental effect on helicopter pilotage. Elimination of risk factors is possible through appropriate physical exercises and adjustment of pilots’ seats. The authors plan to conduct — in the future — detailed annual examinations among pilots with back pain and, based on the results, to elaborate a prophylactic program containing simple forms of isometric and isotonic training involving paravertebral and deep abdominal muscles designed specifically for pilots of military helicopters.

Return to work after spinal stenosis surgery and the patient’s quality of life

IntroductionThe return to work of patients who undergo spinal surgery poses important medical and social challenge.Objectives1) To establish whether patients who undergo spinal stenosis surgery later return to work. 2) To establish the patient’s attitude towards employment. 3) To assess the quality of life of the patients and its influence on their attitude to work.Materials and MethodsThe study population consisted of 58 patients aged from 21 to 80 years (the mean age was 52.33±14.12). There were 29 women (50%) and 29 men (50%) in the group. The patients’ quality of life was measured by the use of the WHOQOL-BREF instrument. Individual interviews were conducted 3 to 8 months (a mean of 5.72 months ±1.6) after the surgery.Results1) Although 13 patients (22.3%) returned to work, 44 (75.9%) did not, these being manual workers of vocational secondary education. 2) Almost half of the patients (27 patients, i.e. 44%) intend to apply for disability pension, 16 patients (27.6%) consider themselves unfit to work, 22 patients (37.9%) do not feel like working again. 3) The quality of life of the patients decreased. Domain scores for the WHOQOL-BREF are transformed to a 0-100 scale. The mean physical health amounted to 60.67 (±16.31), the mean psychological health was 58.78 (±16.01), while the mean social relations with family and friends were 59.91 (±20.69), and the mean environment 59.62 (±12.48).Conclusions1) A total of 75% of the patients operated for lumbar spinal stenosis do not return to their preoperative work. Difficulties in returning to work and decreased quality of life are associated with female sex, lower-level education, hard physical work and low income. 2) Physical health, psychological health, social relations and environment decreased to the mean of approximately 60. 3) The quality of life of the patients who did return to work was similar to that of healthy people.

Spinal tuberculosis with severe neurological symptoms as a complication of intravesical BCG therapy for carcinoma of the bladder

INTRODUCTION Non-invasive bladder cancer is effectively treated with intravesical BCG therapy. The administration of the BCG vaccine is to destroy the neoplastic lesion or prevent further recurrences. The activity of the vaccine involves boosting the immune system through the stimulation of the inflammation in the bladder. Adverse reactions after this immunotherapy are rare. The aim of the study was to present complications in the form of spinal tuberculosis and serious neurological symptoms that occurred during intravesical BCG immunotherapy for carcinoma of the bladder. The manuscript also describes a method for neurosurgical spinal cord decompression of the thoracic spine. MATERIAL AND METHODS In the first patient, aged 66, after intravesical BCG therapy for bladder carcinoma, back pain and spastic paralysis of the lower limbs were observed. The MRI and CT revealed destruction of the intervertebral disc and vertebral endplates Th11-Th12. Mycobacterium tuberculosis complex bacilli were cultured from the material obtained by puncture aspiration. In the second patient, aged 35 years, during intravesical BCG immunotherapy for carcinoma of the bladder, girdle thoracic spine pain was observed. The MRI and CT of the spine showed visible lesions characteristic of tuberculosis. Immobilization in a plaster corset and implementation of antituberculous treatment resulted in quick relief of the pain and healing of the tuberculosis focus in the spine. CONCLUSION The cases described in the work are the first documented reports in the Polish literature of spinal tuberculosis which occurred as a complication of intravesical administration of bacilli Calmette-Guérin. The diagnosis was based on the finding of BCG vaccine bacillus with molecular methods or PCR. Full antimycobacterial treatment was implemented.

The effect of unilateral osteoarthritis of the hip on postural balance disorders

Background Postural stability is of great importance because imbalances and muscle weakness are significant risk factors for falls experienced by the elderly. Hip arthrosis, which causes pain and gait disorders that affect balance control, is common in the ageing population. Aim The aim of this study was to assess postural stability in patients with unilateral hip arthrosis before total hip arthroplasty. Methods The study population consisted of 52 patients with hip arthrosis (study group) and 47 subjects with no history of clinical symptoms of hip pain. The groups did not differ statistically in terms of age and BMI. Static balance was assessed by conducting a quantitative analysis of balance reaction parameters in a quiet standing position with the eyes open and closed. Results Analysis of the collected data revealed numerous statistically significant differences between patients with unilateral hip arthrosis before total hip arthoplasty and the asymptomatic group for parameters tested with eyes closed (p<0.05). We observed higher values of total length of centre of pressure (COP), sway path (SP), length of COP path in the medial-lateral plane (SPML), maximal amplitude between the 2 most distant points in the medial-lateral plane (MaxML), mean COP velocity (MV), and mean COP velocity in medial-lateral (MVML) in the study group.

The foot deformity versus postural control in females aged over 65 years.

Purpose: Correct foot structure is important due to locomotion and postural stability. The aim of this study was to determine the relationships between morphological foot structure and balance indices in a quiet standing position in women over 65 years of age. Methods: The study included 116 women aged 65–90 years. The mean age was 70.6 ± 8.4 years and BMI 29.1 ± 3.4 m/kg 2 . The measured indices included postural control while standing on both feet and photogrammetric foot evaluation. An analysis was performed of the selected foot and balance indices. Results: There were no significant differences observed in the feet structure. Certain correlations between some foot indices and the indices of postural control were noted. The increased differences in the width indices between the right and the left foot lead to balance deterioration. Larger angles of valgity and varus deformity of toes and indices describing the longitudinal arch and transverse front arch of the foot have the greatest impact on the deterioration of balance in the medio-lateral axis. Conclusions: The differences between the indices and morphological indices for the right and the left foot are not significant, which indicates the proportionate formation of feet in the individual life. The increased differences in the width indices between the right and the left foot lead to balance deterioration. Larger angles of valgity and varus deformity of toes and indices describing the longitudinal arch and transverse front arch of the foot have the greatest impact on the deterioration of balance in the medio-lateral axis.

Postural stability in patients with osteoarthritis of the hip. Pilot study.

BACKGROUND Total hip arthroplasty involves division of the joint capsule, which can cause receptor damage, affecting postural stability and increasing the risk of falls. The aim of this study was to determine whether postural stability can be disturbed by total hip arthroplasty from a postero-lateral approach. MATERIAL AND METHODS Static balance was quantified with the use of a two plate tensometric platform in a study group of 16 patients (8 women and 8 men) with unilateral hip osteoarthritis, mean age 57.13 (± 10.7) years, height of 173.38 (± 9) cm, weight 90.21 (± 16.9) and BMI of 30.07 (± 2.87) kg/m2. RESULTS Postural balance improved after surgery, with a statistically significant decrease in the length of the sway path in the AP plane and a strong trend towards significance in the medio- lateral plane. The maximum deflection of the COP from the 0 in the Y direction was reduced. The average velocity of movement of the COP along the Y-axis was significantly reduced, and velocity along the X-axis in mm/s was reduced with a strong trend towards significance. CONCLUSIONS 1. THA from a postero-lateral approach did not lead to a deterioration of postural stability in the early postoperative period. 2. Balance parameters, including path length and the average velocity of the COP in the antero-posterior plane, improved in a statistically significant manner. 3. The maximum extension of the COP in the frontal plane decreased with a strong trend towards significance.

Diagnostic and therapeutic problems of back pain syndromes and their distribution according to a colour coding system of flags.

BACKGROUND Back pain poses a serious clinical problem in some cases, because under the clinical symptoms of back pain might be other hidden diseases. The aim of this study was to present difficulties in diagnosis and treatment of various diseases of the spine and 2. description to the flagship division, based on the traffic lights. MATERIALS AND METHODS The clinical material is based on a group of 20 patients with diagnostic and therapeutic difficulties, among 1825 patients treated due to low back pain. Diagnosis was based on clinical examination and various imaging techniques. In the case of cancer biopsy was performed, and in specific and nonspecific infections of the spine treated surgically toward the microscopic examination of tuberculous granulation tissue or inflammatory. The diagnosis of osteoporotic fractures was based on the digital 3D CT. The studied group of 20 patients were divided according to color flag system. RESULTS Among the analyzed patients 14 received red flag, 5 yellow and 1 black. The red flag has received seven patients with spinal infection, 3 patients with cancer and two with osteoporotic fracture, and 2 patients with low back pain due to an aortic aneurysm. Yellow flag received 5 patients with compensation claims. CONCLUSIONS 1. In patients with back pain, diagnostic examinations should be administered according to a particular order. Clinical and radiographic examinations are basic tools which should be supplemented by the modern techniques of MRI and CT. 2. Histopathological evaluation of tissue preparations facilitates the diagnosis of an infection or tumour. 3. Classification according to colored flags are useful in clinical practice. It describes the degree of risk of serious illness and difficulties in therapy.

Characteristics of selected parameters of body posture in patients with hip osteoarthritis.

BACKGROUND Osteoarthritis is the most common disorder of the musculoskeletal system. A unilateral change in the hip joint changes the position of the pelvis and spine, and therefore the patients body posture. Due to the uneven loading of the lower limbs asymmetry occurs in the trunk. Detailed dependencies of that have not been thorougly described in the available literature. The aim of the study was to characterize the posture parameters in patients with unilateral osteoarthritis of the hip. MATERIAL AND METHODS The study population consisted of 40 patients with unilateral hip osteoarthritis. There were 21 women and 19 men in the group, aged 41-80 years. The mean patient age was 65.39+/-8.69, the mean body mass was 82.98 ± 11.79 kg, the mean body height was 167.64 ± 8.59, and the mean Body Mass Index (BMI) was 29.6 ± 4.36. RESULTS Statistically significant differences were found on a number of parameters: lumbar inclination, thoraco-lumbar inclination and torso inclination were lower in patients with hip arthrosis, comparing to control group. Angle of thoracic kyphosis, depth of thoracic kyphosis, angle of lumbar lordosis, depth of lumbar lordosis were smaller in patients with hip arthrosis. Pelvic asymmetry in coronal plane was bigger in patients with hip arthrosis. CONCLUSION Body posture in patients with unilateral osteoarthritis characterizes a decrease of lumbar lordosis and thoracic kyphosis while the whole body tilt forward. The asymmetry of the pelvis and trunk settings should be taken be taken into account during physical therapy of patients with coxarthrosis also during the post-operative postural re-education process.