Robert Haładaj

The Effectiveness of Cervical Spondylosis Therapy with Saunders Traction Device and High-Intensity Laser Therapy: A Randomized Controlled Trial

Background Among all spinal therapies, treatment of the cervical segment is the most difficult. The cervical segment is particularly sensitive to injuries and pain, and it also requires special care due to its great mobility and most delicate construction. The aim of this research was to evaluate analgesic efficacy and improvement of active mobility of the cervical spine after traction therapy with the Saunders device and high-intensity laser therapy (HILT) immediately after therapy, and in short-, medium-, and long-term follow-up in patients with cervical spondylosis. Material/Methods The study included 174 patients (114 women and 60 men) aged 24–67 years. The patients were divided into two randomized groups. In group I (88 subjects) traction therapy with the Saunders device was applied, and in group II (86 subjects) HILT was applied. The measurement of the range of cervical spine movement, a subjective visual scale for pain (Visual Analog Scale [VAS]), and the Neck Disability Index-Polish Version (NDI) questionnaire were used. Results The results obtained by the Saunders and HILT methods were similar immediately after the therapy and after 4 weeks (the medium-term follow-up). However, in long-term follow-up, there was a significant increase in the maintenance of positive therapeutic effects with the HILT method. Conclusions Both therapeutic methods improved the efficiency and demonstrated analgesic efficacy in patients with cervical spondylosis immediately and in the medium term after the therapy. HILT was more effective than the Saunders method in long-term follow-up.

Multiple Impulse Therapy in the Assessment of Paraspinal Muscle Tone in Patients with Low Back Pain

BACKGROUND Back pain is quite common in contemporary society, whose expectations of an effective analgesic therapy in conservative treatment lead to a necessity of searching for new diagnostic and therapeutic methods in physiotherapy. Out of the numerous physical therapy methods, Multiple Impulse Therapy (MIT) deserves special consideration. This paper aims to present and analyse the outcomes of MIT concerning paraspinal muscle tone and pain intensity in patients with low back pain. MATERIAL AND METHODS The study enrolled 117 patients (50 women and 67 men; average age of 45.3 yrs) with lumbar conditions confirmed by imaging studies. The participants received five MIT sessions within 14 days. Moreover, both before and after the therapy all the patients underwent bilateral assessment of the paraspinal muscle tone by surface electromyography (sEMG) with the NoraxonMyoTrace 400 system and an interactive head of the PulStarFRAS device. A VAS was used for evaluation of pain severity. RESULTS The analysis of significance of differences between scores before and after treatment showed that all the parameters changed significantly (MIT: 11.11 Ibf before and 8.89 Ibf after the therapy; VAS: 6.04 before and 3.38 afterwards; sEMG: 9.29uV before and 7.51uV afterwards). CONCLUSIONS 1. Multiple Impulse Therapy (MIT) is an effective and non-invasive method of back pain treatment. 2. MIT significantly reduces paraspinal muscle tone, as confirmed by sEMG results, and shows a strong analgesic effect.

Anthropometric Study of the Piriformis Muscle and Sciatic Nerve: A Morphological Analysis in a Polish Population.

Background The aim of this study was to determine relationships between piriformis muscle (PM) and sciatic nerve (SN) with reference to sex and anatomical variations. Material/Methods Deep dissection of the gluteal region was performed on 30 randomized, formalin-fixed human lower limbs of adults of both sexes of the Polish population. Anthropometric measurements were taken and then statistically analyzed. Results The conducted research revealed that, apart from the typical structure of the piriformis muscle, the most common variation was division of the piriformis muscle into two heads, with the common peroneal nerve running between them (20%). The group with anatomical variations of the sciatic nerve course displayed greater diversity of morphometric measurement results. There was a statistically significant correlation between the lower limb length and the distance from the sciatic nerve to the greater trochanter in the male specimens. On the other hand, in the female specimens, a statistically significant correlation was observed between the lower limb length and the distance from the sciatic nerve to the ischial tuberosity. The shortest distance from the sciatic nerve to the greater trochanter measured at the level of the inferior edge of the piriformis was 21 mm, while the shortest distance to the ischial tuberosity was 63 mm. Such correlations should be taken into account during invasive medical procedures performed in the gluteal region. Conclusions It is possible to distinguish several anatomical variations of the sciatic nerve course within the deep gluteal region. The statistically significant correlations between some anthropometric measurements were only present within particular groups of male and female limbs.

Anatomic Variations of the Lateral Femoral Cutaneous Nerve: Remnants of Atypical Nerve Growth Pathways Revisited by Intraneural Fascicular Dissection and a Proposed Classification

OBJECTIVE To trace anatomic variations of the lateral femoral cutaneous nerve (LFCN) in its intrapelvic course. METHODS Forty cadavers (80 sides) fixed in 10% formalin solution were dissected. The following parameters were recorded: LFCN diameter and variations in its origin and number. The dissection comprised exposure and excision of the lumbar plexus, together with the roots of LFCN, followed by retrograde intraneural fascicular dissection using microsurgical instruments. RESULTS Several types of LFCN origin from the lumbar plexus were observed. Typically, the LFCN appears as a single trunk arising from dorsal divisions of the ventral rami of the lumbar plexus. The most prevalent origin of the nerve was from the L2 and L3 roots (47 cases; 58.75%). The LFCN took an origin from the L1-L2 level in 12 cases (15%) and from the L2 nerve in 9 cases (11.25%). The main observed variations were the presence of the accessory LFCN (2 cases; 2.5%) and branching of the LFCN from the femoral nerve (6 cases; 7.5%). Communications between the LFCN and the femoral or genitofemoral nerves also were observed occasionally. An atypical course of the LFCN with respect to the anterior psoas was observed in our material in 3 of the 80 sides (3.75% of the examined LFCN specimens). CONCLUSIONS Considerable variability in the origin and the course of the LFCN was observed, which should be taken into account during clinical assessment of nerve lesions and during surgery via transpsoas approaches to the lumbar spine.

Bilateral muscular slips between superior and inferior rectus muscles: case report with discussion on classification of accessory rectus muscles within the orbit

Accessory rectus muscles have rarely been reported as muscular ‘bands’ or ‘slips’ originating from the common tendinous ring (annulus of Zinn) and inserting in atypical location. This group of muscles is innervated by the inferior branch of the oculomotor nerve, lies on lateral side of the optic nerve and inserts in rectus muscles. Since there are only few descriptions of such unusual findings in the medical literature, the anatomical data on accessory rectus muscles is limited. Furthermore, existing reports vary in terms of studied objects (cadavers or living subjects), medical history (absence or presence of ocular movement disorders or eye movement abnormalities) and details of anatomical description. This report complements earlier publications and provides complete anatomical description of the accessory rectus muscle observed bilaterally during the dissection of a 68-year-old male cadaver with no eye movement abnormalities reported in the medical history. The accessory rectus muscle was divided into two ‘slips’ or ‘heads’—superior and inferior—running in the sagittal plane (laterally to the optic nerve and the main trunk of the ophthalmic artery) and attached to the superior and inferior rectus muscles. Noticeable thickening of both superior and inferior rectus muscles at the insertion point of the accessory muscle heads was observed only in the sagittal plane. On both sides, the inferior head of the accessory rectus muscle was innervated by one of sub-branches derived from the inferior branch of the oculomotor nerve. No sub-branches to the superior head were macroscopically observed during the dissection. The classification, embryological background and clinical relevance of this variation have been discussed.

Anatomical variations of the insular gyri: A morphological study and proposal of unified classification: Anatomical Variations of the Insular Gyri

The locations of gyral landmarks vary among individuals. This can be crucial during local landmark‐based mapping of the human cortex, so the aim of the present study was to establish criteria for classifying the morphological variability of the human insula. The study was conducted on 50 isolated, randomly‐selected adult cadaveric hemispheres, fixed in 10% formalin, and preserved in 70% ethanol (24 right and 26 left hemispheres). A thorough rating system, including bifid form (i.e., divided on top), branching or hypoplasia, was used to analyze the insular gyri. The number of all insular gyri ranged from four to six (mean = 5.16, SD = 0.65). Within the anterior lobule, the number of short gyri ranged from two to four (mean = 3.3, SD = 0.54). The middle short gyrus was the most variable. It was well‐developed in 25 of the 50 cases (50%). Within the posterior lobule there were one or two long insular gyri (mean = 1.88, SD = 0.32). In 48 cases (96%), the anterior long gyrus was well‐developed. A complete lack of the posterior long gyrus was noted in six of the 50 cases (12%). In conclusions, the accessory, the middle short, and the posterior long gyri of the insula were the most variable. The middle short gyrus was well‐developed in only half of the cases. The number of insular gyri found in horizontal sections of the brain does not necessarily indicate their true number. Clin. Anat. 31:347–356, 2018.

Bilateral Extensive Ossification of the Posterior Petroclinoid Ligament: An Anatomical Case Report and Literature Review

Background The posterior petroclinoid dural fold (commonly referred to as a ligament) forms the roof of the trigeminal porus and the roof of the petroclival venous confluence. It lies in close proximity to the oculomotor nerve that crosses it. Due to the low availability of research material, only a few cadaveric studies have been conducted on the microsurgical anatomy of the petroclinoid ligament in cases of its ossification. Thus our report complements earlier studies and provides detailed data on the spatial relationships between the ossified posterior petroclinoid ligament and the trigeminal, oculomotor, and abducens nerves, with special attention to the topographical relationships within the petroclival venous confluence and Dorellos canal. Case Description Bilateral massive ossification of the posterior petroclinoid ligament was observed during the dissection of a 76‐year‐old female cadaver. The presence of an osseous bridge over the trigeminal notch was also detected on the left side. No narrowing of the space occupied by the petroclival venous confluence was observed. However, the dural sheath of the oculomotor nerve was fixed much more than usual. Conclusions Because the ossification of the posterior petroclinoid ligament may be considered a factor influencing diagnostic and surgical procedures, neurosurgeons and neuroradiologists should be aware of this variation. Ossification of the posterior petroclinoid ligament may also potentially result in greater susceptibility of the oculomotor nerve to injury.

The High Origin of the Radial Artery (Brachioradial Artery): Its Anatomical Variations, Clinical Significance, and Contribution to the Blood Supply of the Hand

Background This study thoroughly analyzes the anatomic variations of the brachioradial artery (radial artery of high origin) based on the variability of its origin, the presence and types of anastomosis with the brachial artery in the cubital fossa (“cubital crossover” or “cubital connection”), and the pattern of radial recurrent arteries, as well as the vascular territory within the hand. Material and Methods One hundred and twenty randomly selected, isolated upper limbs fixed in 10% formalin solution were dissected. Results The radial artery was found to have a high origin in 9.2% of total number of the limbs: two cases from the axillary artery; nine cases from the brachial artery. Anastomosis between the brachioradial and “normal” brachial arteries in the cubital fossa was also frequently observed (54.6%). The anastomosis (“cubital crossover”) was dominant in one case, balanced in three cases, minimal in two cases, and absent in five cases. Conclusions The brachioradial artery may originate from the brachial and, less frequently, from the axillary artery. Anastomosis between the brachioradial and “normal” brachial arteries in the cubital fossa may be dominant, balanced, minimal, or absent. A complete radioulnar arch was found more often when the brachioradial artery was present as a variant.

Multiple Impulse Therapy and Saunders Lumbar Traction Methods in the Treatment of Low Back Pain: A Randomized Controlled Trial

Background: Low back pain is a serious medical and social problem. Despite many different research studies, no explicit standard therapy has been found so far. Material and Methods: The study included 193 adult patients of both genders (86 females, 107 males) with low back pain and pain-induced limited spinal mobility without lumbar spinal stenosis. The controlled, randomized clinical trials were used. Patients were randomly assigned to one of the two groups. Group A (Study group, n=95) was subjected to multiple impulse therapy (MIT) and in group B (Control group, n=98) – Saunders traction device was used. The Oswestry Low Back Pain Disability Questionnaire, Oswestry Disability Index-ODI were used to observe analgesic efficacy and to the analysis of functional progress.The collected results of the trial groups were presented statistically with the Student t-test for independent samples. In turn, comparing the patients’ efficiency (disability index-ODI), analysis of variance of repeated measurements immediately and 1, 3, and 6 months after the therapy, was used. The study assumed the coefficient of significance α=0.05. The calculations were performed using IBM SPSS Statistics 22.0. Results: Multiple impulse therapy (MIT) produces beneficial analgesic effects in significantly shorter time and improves the functional ability and performance of activities of daily living in the treated patients than in the group of patients treated by Saunders axial traction method. Conclusions: This randomized clinical trial proves that both applied therapies are useful in the treatment of low back pain. However, MIT therapy produces beneficial analgesic effects in significantly shorter time.