Biomedical subjects

Anthony Chiodo

Publications and source records attributed to Anthony Chiodo.

11 recordsLinked to original sources

PubMed2006

Predictors of pain and function in persons with spinal stenosis, low back pain, and no back pain.

STUDY DESIGN: Longitudinal masked, double-controlled cohort study. OBJECTIVES: To determine prognosis and predictors of function and pain in persons with spinal stenosis. SUMMARY OF BACKGROUND DATA: The clinical syndrome of spinal stenosis is common and disabling, but not clearly related to anatomic measures. Prognosis not well studied. METHODS: Persons 55 to 80 years of age with and without stenosis on preliminary review of magnetic resonance imaging (MRI), and asymptomatic volunteers underwent screening, questionnaires, physical examination, ambulation testing, masked electromyogram (EMG), and masked MRI scans; these were repeated at >18 months. RESULTS: Twenty-three asymptomatic, 28 back pain, and 32 clinically diagnosed stenosis subjects underwent follow-up. Although initial and follow-up diagnosis tended to agree (kappa = 0.394, P < 001), there were substantial shifts between the three groups. Among persons with clinically diagnosed stenosis, every measure trended for improvement, including significant changes in pain, ambulation, and EMG. Ambulation velocity and Pain Disability Index at follow-up were predicted by initial disability measures. Pain was predicted by initial sleep difficulty but not initial pain. EMG and MRI did not predict function or pain. CONCLUSION: Clinically recognized spinal stenosis is fluctuating and largely improving, and in continuum with back pain and no symptoms. Since anatomic and neurologic deficits do not predict future function, they should not be weighed heavily in surgical risk-benefit discussions.

Aged↗

PubMed2006

Cadaver evaluation of EMG needle insertion techniques used to target muscles of the thorax.

STUDY DESIGN: Measure the accuracy of needle insertion in thoracic muscles of human cadavers. OBJECTIVES: Evaluate the effectiveness of known EMG techniques for sampling thoracic innervated muscles. SUMMARY OF BACKGROUND DATA: The evaluation of thoracic radiculopathies requires accurate electrodiagnostic techniques for evaluating the thoracic myotomes. METHODS: An American Board of Electrodiagnostic Medicine certified physician placed needles into pertinent muscles of the thorax and an anatomist serving as a blinded dissector recorded the path and accuracy of needle. RESULTS: Needle examination of thoracic muscles was as accurate as limb needle examination. No notable risks are noted in multifidus sampling. However, in the cadaver, some risks were noted in association with placements in the intercostal muscles. The target muscle was reliably sampled, but the rib or vertebral level was difficult to landmark in the cadaver. CONCLUSIONS: Needle examination of the thoracic multifidus and intercostals is reliable, although further confirmation is needed to accurately verify the appropriate vertebral or rib level being sampled.

Adult↗

PubMed2006

Spinal stenosis, back pain, or no symptoms at all? A masked study comparing radiologic and electrodiagnostic diagnoses to the clinical impression.

OBJECTIVE: To assess the relations between clinically recognized lumbar spinal stenosis and the conclusions of masked radiologists and electrodiagnosticians. DESIGN: Prospective, masked, double-controlled trial. SETTING: University spine center. PARTICIPANTS: One hundred fifty persons age 55 to 80 years with or without back pain and with or without magnetic resonance imaging (MRI)-demonstrated stenosis, screened for neuropathy risk, previous surgery, or cancer. INTERVENTIONS: Questionnaires on pain and function; ambulation testing and physical examination; and masked electrodiagnotics and MRI. MAIN OUTCOME MEASURE: Diagnostic impressions of the examining clinician, radiologist, and electrodiagnostician. RESULTS: Following application of post hoc exclusion criteria and elimination of patients due to incomplete or inadequate test data, the clinical diagnosis was lumbar stenosis in 50 subjects, back pain in 44 subjects, and no pain in 32 subjects. Radiologic and clinical impression had no relation (P = .80 vs asymptomatic, P = .99 vs back pain controls). Electrodiagnostic impression trended to relate to clinical impression (P = .14 vs asymptomatic, P = .09 vs back pain). Retrospective application of age-related electrodiagnostic norms for paraspinal electromyographic and limb motor unit changes, established in this study, reclassified 13 of the 17 asymptomatic persons whom the electrodiagnostician thought had stenosis. The clinical impression did correspond to history and physical examination findings typically associated with spinal stenosis and to the independent impression of a neurosurgeon who examined MRI and clinical, but not to the electrodiagnostic data. CONCLUSIONS: The impression obtained from an MRI scan does not determine whether lumbar stenosis is a cause of pain. Electrodiagnostic consultation may be useful, especially if age-related norms obtained in this study are applied.

Activities of Daily Living↗

PubMed2006

Diaphragm needle placement techniques evaluated in cadaveric specimens.

OBJECTIVE: To evaluate the safest and most accurate method of diaphragm needle placement for electromyography. DESIGN: Single blinded study. SETTING: University anatomy laboratory. CADAVERS: Five cadavers. INTERVENTIONS: Needle placement in the diaphragm by an American Board of Electrodiagnostic Medicine physician, blinded dissection by a doctoral candidate anatomist. MAIN OUTCOME MEASURES: Accurate needle placement in the diaphragm, proximity or penetration of organs, vessels, or nerves, defined as cautions (proximity) and dangers (penetration). RESULTS: The anterior axillary approach was most accurate at the above-the-seventh and eighth-rib locations. The risk of dangers of needle placement in the diaphragm was greater on the right than left side. CONCLUSIONS: Needle placement in the diaphragm is safe and most accurate at the anterior axillary line superior to the eighth rib. If the side of needle placement does not matter for the study being done, the left side should be chosen because it leads to a lower risk of danger to the patient.

Cadaver↗

PubMed2005

The sensitivity and specificity of electrodiagnostic testing for the clinical syndrome of lumbar spinal stenosis.

STUDY DESIGN: Prospective, masked, double controlled diagnostic trial. OBJECTIVES: To determine the sensitivity and specificity of electrodiagnostic consultation (EDX) for the clinical syndrome of lumbar spinal stenosis. SUMMARY OF BACKGROUND DATA: EDX has been used for more than 50 years to diagnose spinal disorders but has not met the new standards of evidence-based medicine. METHODS: A total of 150 subjects (asymptomatic volunteers and patients with MRIs suggesting back pain or spinal stenosis; 55-80 years of age) underwent physiatrist history and physical examination, MRI, and review of this data by a neurosurgeon, with each clinician masked to any outside information, leading to a unanimous consensus on diagnosis in 55. After masked EDX testing, 7 subjects with undiagnosed neuromuscular disease were discovered. EDX findings were related to "clinical gold standard" diagnoses in 48 persons. RESULTS: Paraspinal mapping EMG score of >4 had 100% specificity and 30% sensitivity for stenosis compared with either the back pain or asymptomatic groups (each, P < 0.04). A composite limb and paraspinal fibrillation score had a sensitivity of 47.8% and specificity of 87.5% (P = 0.008), and H-wave sensitivity was 36.4, specificity 91.3 (P = 0.026) for stenosis versus all controls. CONCLUSIONS: This first masked study in the 60-year history of needle electromyography also introduces anatomically validated needle placement, quantified and reproducible examination of the paraspinal muscles, and dual control populations to EDX research in spinal disorders. EDX has statistically significant, clinically meaningful specificity for spinal stenosis and detects neuromuscular diseases that may masquerade as stenosis.

Aged↗

PubMed2005

Umbilical movement after spinal cord injury.

BACKGROUND/OBJECTIVE: Charles Beevor first discussed the movement of the umbilicus seen upon abdominal muscle contraction in neuromuscular diseases and spinal cord injury (SCI) over a century ago. Since then, other examples of this phenomenon have been reported in the literature. METHODS: This case review study documents movements of the umbilicus caused by abdominal muscle weakness after SCI. RESULTS: SCI results in characteristic weakness of the abdominal muscles resulting in predictable movement of the umbilicus upon abdominal muscle contraction. CONCLUSIONS: Observation of umbilical movement with abdominal muscle contraction after SCI gives further confirmatory information about neurological level and type of spinal cord lesion. Further study should include information about the effect of abdominal weakness on motor and respiratory function.

Abdominal Muscles↗

PubMed2005

Pain management with interventional spine therapy in patients with spinal cord injury: a case series.

BACKGROUND/OBJECTIVE: Chronic pain is common in patients with spinal cord injury (SCI). Any new strategy that is effective in treating this problem would be welcomed by this patient population. METHODS: A case series is presented of SCI with neuropathic pain. In these 3 cases, interventional spine therapy is used as a diagnostic and/or therapeutic tool in the management of pain. RESULTS: In the cases presented, interventional spine therapy proved useful in identifying the patient's pain generator. In most cases, the intervention was effective in reducing pain for a long enough period to serve as an effective pain management strategy. Other associated problems, such as spasticity, were similarly reduced. CONCLUSION: Interventional spine therapy should be considered as a tool in the armamentarium of any SCI physician managing their patient's chronic pain.

Adult↗

PubMed2005

Cadaveric study of methods for subscapularis muscle needle insertion.

OBJECTIVE: To evaluate the accuracy for three methods for needle insertion into the subscapularis muscle for electromyography, botulinum toxin injection, and phenol nerve block. DESIGN: Three needle insertion methods were evaluated by cadaver injection by an American Board of Electrodiagnostic Medicine certified physician. An anatomist, blinded to the method used, served as the dissector to evaluate the effectiveness of the methods tested. RESULTS: A posterior axillary approach was most effective for needle insertion into the subscapular muscle compared with a medial scapular or a superior scapular approach. No approach was ideal for subscapular nerve injection. CONCLUSIONS: A posterior axillary approach is best for needle insertion of the subscapularis muscle for electromyography or botulinum toxin injection. Subscapular nerve injection is difficult from all of the three approaches tested.

Adult↗

PubMed2003

Assessment of a holistic wellness program for persons with spinal cord injury.

OBJECTIVE: To test the effectiveness of a holistic (comprehensive and integrated) wellness program for adults with spinal cord injury. DESIGN: A total of 43 adults with spinal cord injury were randomly assigned to intervention or control groups. The intervention group attended six half-day wellness workshops during 3 mos, covering physical activity, nutrition, lifestyle management, and prevention of secondary conditions. Outcome measures included several physical measures and standard psychosocial measures. Statistical analyses included paired t tests, used to determine within-group differences, and multiple regression conducted to assess between-group differences. RESULTS: When comparing within-group baseline and final results, the intervention group reported fewer and less severe secondary conditions by the end of the study. Similarly, significant improvements were found in health-related self-efficacy and health behaviors. No significant changes in physiologic variables were observed. Although no significant between-group differences were observed, regression analyses suggested participation in the wellness program may be associated with improved health behaviors. CONCLUSION: Within-group comparisons suggest improvements in several areas of the participants' overall health behaviors. These findings, although preliminary, emphasize the potential role of health behaviors in positively influencing long-term health outcomes and quality of life.

Adult↗

PubMed2002

Lumbosacral radiculopathies: conservative approaches to management.

The prevalence of sciatica in Western society and its economic and functional impact make it an important problem to understand for treatment. Such understanding will impact greatly both medical management and decisions regarding activity, which could affect the perceived disability and financial dependence of a patient. This knowledge could be used to direct primary prevention, patient education, and future research efforts in back pain. The article also discusses that such strategies could improve health, decrease disability, and rein in costs.

Anti-Inflammatory Agents, Non-Steroidal↗

PubMedDate not supplied

Predicting outcomes of transforaminal epidural injections for sciatica.

BACKGROUND CONTEXT: Previous studies on epidural injections have focused on efficacy and have not evaluated factors predicting outcomes of epidural injections. PURPOSE: To determine which patient factors are associated with transforaminal epidural injection outcomes for sciatica. STUDY DESIGN: Cross-sectional study design at a university spine center. PATIENT SAMPLE: Consecutive patients with sciatica who have had an electromyography study and a transforaminal epidural injection between January 1999 and July 2001. OUTCOME VARIABLE: The outcome variable was a composite score of the patients' pain severity and medication use compared with their initial visit. Independent variables included demographics, previous back surgery, pain severity at initial presentation, pain medication use at initial presentation, litigation, having Social Security Disability Insurance (SSDI) or workers' compensation, electromyography results. METHODS: Medical information was gathered on the variables listed above. RESULTS: Seventy-six patients, mean age 50.4 years and 49% female, participated. At a mean follow-up of 122 days (SD 146.3), 35 (47%) were improved, 21 (28% were unchanged) and 12 (16%) were worse. Initial correlation analysis showed some relationship between outcomes and having SSDI or workers' compensation (R=.43, p<.001), lifting requirements at work (R=.44, p=.002), working status (R=-.31, p=.02), and electromyogram evidence of radiculopathy (R=-.25, p=.04). Regression analysis showed that having SSDI or workers' compensation was the primary factor associated with worse outcomes. CONCLUSIONS: When controlled for SSDI/workers' compensation, lifting requirements at work, but not working status and radiculopathy, also were associated with outcomes but the association was not as strong. This paper brings into question the utility of offering epidural injections to patients who are on SSDI/workers' compensation and require heavy lifting at work.

Adult↗