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Biomedical subjects

C G Greenough

Publications and source records attributed to C G Greenough.

At least 19 recordsLinked to original sources
PubMed2004

Juvenile spondylolysis: a comparative analysis of CT, SPECT and MRI.

OBJECTIVE: To evaluate whether MRI correlates with CT and SPECT imaging for the diagnosis of juvenile spondylolysis, and to determine whether MRI can be used as an exclusive image modality. DESIGN AND PATIENTS: Juveniles and young adults with a history of extension low back pain were evaluated by MRI, CT and SPECT imaging. All images were reviewed blindly. Correlative analyses included CT vs MRI for morphological grading and SPECT vs MRI for functional grading. Finally, an overall grading system compared MRI vs CT and SPECT combined. Statistical analysis was performed using the kappa statistic. RESULTS: Seventy-two patients (mean age 16 years) were recruited. Forty pars defects were identified in 22 patients (31%), of which 25 were chronic non-union, five acute complete defects and ten acute incomplete fractures. Kappa scores demonstrated a high level of agreement for all comparative analyses. MRI vs SPECT (kappa: 0.794), MRI vs CT (kappa: 0.829) and MRI vs CT/SPECT (kappa: 0.786). The main causes of discrepancy were between MRI and SPECT for the diagnosis of stress reaction in the absence of overt fracture, and distinguishing incomplete fractures from intact pars or complete defects. CONCLUSIONS: MRI can be used as an effective and reliable first-line image modality for diagnosis of juvenile spondylolysis. However, localised CT is recommended as a supplementary examination in selected cases as a baseline for assessment of healing and for evaluation of indeterminate cases.

Adolescent↗
PubMed2004

Condition-specific outcome measures for low back pain. Part I: validation.

A literature review of the nine most widely used, condition-specific, self-administered assessment questionnaires for low back pain has been undertaken. General and historic aspects, reliability, responsiveness and minimum clinically important difference, external validity, floor and ceiling effects and available languages were analysed for the nine most-used outcome tools. When considering which condition-specific measure to employ, the present overview on assessment tools should provide the necessary information to define the technical aspects of the nine questionnaires. These criteria, however, are only part of the consideration. In part II the construction of these scales in relationship to the measurement domains will be evaluated.

Disability Evaluation↗
PubMed2004

Condition-specific outcome measures for low back pain. Part II: scale construction.

A literature review of the most widely used, condition-specific, self-administered assessment questionnaires for low back pain has been undertaken. In part I, technical issues such as validity, reliability, availability and comparability were analyzed for the nine most widely used outcome tools. This second part focuses on the content and wording of questions and answers in each of the nine questionnaires, and an analysis of the different score results is performed. The issue of score bias is discussed and suggestions are given in order to increase the construct validity in the practical use of the individual questionnaires.

Disability Evaluation↗
PubMed2002

Day-case conventional discectomy: a randomised controlled trial.

A prospective randomised trial compared the results of conventional lumbar discectomy performed as day cases with those performed on an in-patient basis. The aim of the study was to investigate whether conventional discectomy can be performed safely on a day-case basis. Thirty-one patients were included in the study; 18 were randomised to day-case treatment and 13 to in-patient stay. Day patients mobilised more quickly immediately following surgery and were better able to walk at 2 weeks. The rate of complications was unchanged. It is concluded that conventional discectomy can be undertaken safely as day-case surgery and may indeed speed up the recovery process.

Adult↗
PubMed1999

Factors in the reproducibility of electromyographic power spectrum analysis of lumbar paraspinal muscle fatigue.

STUDY DESIGN: An investigation of the reliability of various factors used to analyze electromyograms of paraspinal muscles of the lumbar spine. OBJECTIVES: To determine the reproducibility of several electromyographic variables over time and to assess the influence of confounding factors. SUMMARY OF BACKGROUND DATA: Previous reliability studies have included small numbers of subjects and often have not explored the factors that can influence the reliability of this technique. METHODS: In the first study, 39 volunteers underwent electromyographic tests on three occasions at two loads. The time interval was 1 week between tests. Electromyographic variables measured included half-width (spectral width at half maximum amplitude), initial median frequency, median frequency slope, initial root mean square, root mean square, and root mean square slope. In the second study to determine the influence of posture, nine volunteers were tested on two occasions with a change in posture between tests. RESULTS: Reliability was better for tests at the higher loads. Initial median frequency, half-width, and root mean square all had acceptable reproducibility over time, with a coefficient of variation less than 10. Initial median frequency and half-width proved to be the most suitable variables; they yielded the largest between-subject variation and, of all variables, were affected the least by changes in load. The remaining variables were very load-dependent. A change in posture greatly influenced the reproducibility. CONCLUSION: These results demonstrate that only initial median frequency and half-width have acceptable reproducibility over time and at different loads, with the potential to be useful in discriminating between individuals. Changes in posture can greatly change an electromyographic result.

Adult↗
PubMed1998

Assessment of spinal musculature using surface electromyographic spectral color mapping.

STUDY DESIGN: A technique is described for analyzing electromyogram data from lumbar spinal muscles, with special reference to discrimination of people with back pain. The ability to discriminate was evaluated in 99 people (61 healthy and 38 with chronic or acute back pain), and the influence of load was assessed. OBJECTIVES: To evaluate methods of analysis of complex electromyogram data and to assess correlation of electromyogram information with clinical condition in people with and without back pain. SUMMARY OF BACKGROUND INFORMATION: In previous analyses of electromyogram data, only a small part of the data have been used. Spinal muscular decompensation has been postulated in chronic low back pain, but there has been no direct demonstration of this phenomenon. Objective measures are still elusive. METHODS: Lumbar spinal surface electromyograms were recorded during an isometric lifting task. The data were represented graphically as color-coded plots of electromyogram frequency, time, and electromyogram amplitude. Spectral width at half-peak amplitude (spectral half width) was calculated from the digitized, summed data. Ninety-nine people were tested: 48 men (29 with no recent [in the past 2 years] history of back pain, 16 with chronic back pain, 3 with acute back pain) and 51 women (32 with no recent back pain and 19 with chronic back pain). RESULTS: Spectral color maps in people with chronic back pain were markedly different from those in healthy people. Spectral half width was greater in people with chronic back pain than in healthy people (P < 0.01). Blinded analysis of spectral color maps allowed discrimination of people with back pain from healthy people with a sensitivity of 76% and a specificity of 81%. People with a history of back pain had markedly variable half widths. CONCLUSIONS: A new method of analysis of electromyogram data from lumbar spinal muscles has allowed discrimination between people with back pain and healthy people. This provides direct evidence of a correlation between muscular electrical function, measured by electromyogram, and low back pain. This technique may have potential as an objective measurement tool.

Adolescent↗
PubMed1998

Instrumented posterolateral lumbar fusion. Results and comparison with anterior interbody fusion.

STUDY DESIGN: Prospective case series. OBJECTIVES: To assess the results of instrumented posterolateral lumbar fusion, using recognized outcome assessment techniques, to evaluate the correlation between technical and clinical results and the effects of assessment techniques, and to compare the outcome with that of anterior lumbar fusion. SUMMARY OF BACKGROUND DATA: Assessments of lumbar spinal fusion results have frequently been published in forms that render direct comparison difficult and thus have not provided optimal assistance in the selection of a preferred method of treatment. METHODS: One hundred and thirty-five patients with intractable back pain underwent instrumented posterolateral lumbar spinal fusion performed by a single surgeon. Review of results was undertaken by independent observers, using a recognized outcome assessment measure. RESULTS: A solid bony fusion was obtained in 82% of patients. The method of outcome assessment profoundly affected the results; whereas 65% of patients rated themselves significantly improved by the procedure, only 19% achieved a good or excellent result on the Low Back Outcome Score. Patients undergoing a second procedure did not do well, and "salvage" surgery is not recommended. Compensation status was a significant prognostic factor. Psychological distress at review had a profound effect on the disability score and on patient satisfaction ratings. Overall, the results were inferior to those in a similar series treated by anterior lumbar fusion. CONCLUSION: It is recommended that in future studies a recognized outcome score be used and that the analysis specifically include compensation status and psychological distress.

Adult↗
PubMed1998

Reviewer's comment.

Explore the source record for details and available documents.

Attitude of Health Personnel↗
PubMed1996

Reproducibility of lumbar paraspinal surface electromyogram power spectra.

OBJECTIVE: To establish the reproducibility of surface recordings of electromyograms from lumbar erector spinae muscles. DESIGN: Repeated measurements in 10 male volunteers under controlled conditions. METHODS: While isometric load was held constant at (2/3) and (1/3) of maximum voluntary contraction, surface electromyograms were recorded from the 4th/5th lumbar interspace on three occasions separated by at least a day. Fresh surface electrodes were applied on each test occasion. The raw electromyographic signal was filtered and digitized and the signal processed by fast Fourier transformation to give median frequency and total amplitude spectra. Linear regression lines of median frequency and amplitude against time were calculated. The 'spectral halfwidth" was defined as the full width at half maximum of the composite amplitude spectrum. Reproducibility was assessed by calculation of the intraclass correlation coefficient. RESULTS: Reproducibility of initial median frequency and spectral halfwidth were found to be excellent at both (2/3) (ICCC 0.91 and 0.88) and (1/3) (ICCC 0.84 and 0.83) maximum voluntary contraction. Initial power and regression slopes of power and median frequency were not reproducible. CONCLUSIONS: The reproducibility of two electromyographic variables, the initial median frequency and the spectral halfwidth, were found to be satisfactory.

Journal Article↗
PubMed1996

The effect of pulsed electromagnetic fields on flexor tendon healing in the rabbit.

A double-blind controlled trial of the effects of pulsed electromagnetic fields on flexor tendon healing in adult New Zealand White rabbits was performed. A pulse burst waveform, previously demonstrated to influence new vessel growth in the rabbit, was employed. No significant effect was observed on either the healed strength of the tendon repair or the adhesion formation between the repair and the surrounding tissues. The model used for examination of adhesion formation was reproducible and is recommended for further work on the adhesion formation of healing tendons.

Animals↗
PubMed1994

Anterior lumbar fusion: results, assessment techniques and prognostic factors.

One hundred and fifty-one patients underwent anterior interbody lumbar spinal fusion for intractable back pain. A solid bony fusion was obtained in 76%. The method of outcome assessment profoundly affected the results; whereas 68% of patients rated themselves as significantly improved by the procedure, only 40% achieved a good or excellent result on the more objective low-back outcome score. Patients who underwent a second procedure did not do well, and "salvage" surgery is not recommended. Posterior distraction instrumentation neither increased the rate of union nor improved the final results. The rate of fusion was influenced by the presence of a compensation claim. Compensation status and psychological disturbance at presentation were significant prognostic factors. Psychological disturbance at review had a profound effect on the outcome and patient satisfaction ratings. It is recommended that future studies employ a recognised outcome score and that the analysis specifically includes compensation status and psychological disturbance.

Adult↗
PubMed1994

Aetiology, diagnosis and treatment of low back pain.

A total of 274 patients complaining of low back pain following injury was reviewed. Impact injuries were associated with soft-tissue strain, which was seen less often after twisting injuries. Twisting injuries were associated with disc prolapse more often than falls. Discogenic pain followed lifting injuries more often than jerking injuries. Slipping and jerking injuries were associated with poor outcomes, but the diagnosis was of no prognostic significance. The response to treatment was markedly influenced by the presence of a compensation claim. Only educational classes could be shown to have a significant effect on outcome.

Female↗
PubMed1994

Anterior lumbar fusion. A comparison of noncompensation patients with compensation patients.

One hundred fifty-one patients had an anterior interbody lumbar spinal fusion for intractable back pain. A solid bony fusion was obtained in 76% of the patients. Of patients unemployed before surgery, 50% had returned to work at review. Sixty-eight percent of patients rated themselves as significantly improved by the procedure. Posterior distraction instrumentation neither increased the rate of union nor improved the final results. Compensation status and psychological disturbance at presentation were significant prognostic factors. Psychological disturbance at review had a profound effect on the outcome and patient satisfaction ratings. It is recommended that in future studies compensation status and psychological disturbances are explicitly included in the outcome statistics.

Adolescent↗
PubMed1993

Recovery from low back pain. 1-5 year follow-up of 287 injury-related cases.

This study investigated the factors affecting recovery from low back injury. The study population was designed to be representative of patients presenting with back pain following soft tissue injury. A minimum follow up rate of 90 percent was achieved with a length of elapsed time from the injury of up to five years. Three established methods of assessment of disability and functional capacity (The Oswestry disability scale, The Waddell disability scale and The Waddell physical impairment rating) were compared to each other and a new scale (The Low-Back Outcome Scale) for the measurement of a patient's performance in employment, social activities and activities of daily living. The relationships of these scales to employment, psychological disturbance and other factors were defined. The Outcome Score designed for use in this study provided a comprehensive and discriminating assessment of patient function. Compensation (particularly lump sum claims), psychological disturbance at review, time off work, and age at injury were important factors in recovery; the diagnosis, type and severity of injury, migrant status and neurological deficits were not. Eight psychometric instruments were examined, and the combination of The Zung Depression Scale and The Modified Somatic Perception Questionnaire was found to be the most accurate in determining the presence of psychological disturbance in patients with low back pain.

Activities of Daily Living↗