Manual therapy and canal enlargement exercises versus conventional physiotherapy in lumbar stenosis – a study protocol

INTRODUCTION: Lumbar Canal Stenosis (LCS) is known as the well-established reason for pain and depleted walking capacity in patients with manifestations of paresthesia and pain in the lower back, gluteal region, posterior thigh, and legs which are termed as ‘Neurogenic Claudication’ (NC). Manual therapy combined with canal enlargement exercises and conventional physiotherapy may be considered in eradicating pain and NC symptoms, hence improving the quality of life. METHODS AND MATERIALS: Patients with LCS with canal diameter 8-12 mm at the level of L4 and below will be recruited for this study. Through the Block randomization method, they will be randomized into two interventional groups: Manual Therapy & Canal Enlargement (MTCE) (n=16) and Conventional Physiotherapy (Cp) (n=16) groups. MTCE group will receive manual therapy and canal enlargement exercises, while the Cp group will receive only conventional physiotherapy. Both interventional groups will receive 3 days of treatment per week for 4 weeks. Modified Oswestry Disability questionnaire (MODI), Antero-Posterior (AP) canal diameter, Numeric Pain Rating Scale (NPRS), and Claudication Distance (CD) will be used for the evaluation. In addition, modified Oswestry Disability Index, AP canal Diameter, NPRS, Claudication distance, an SLR will be measured at baseline and post-intervention. DISCUSSION: The results of this research will dictate the applicability of manual therapy with an exercise protocol of canal enlargement exercises on pain and functional disability in patients with LCS.

Comparative Study of Imaging Parameters between a New Cervical Full Lamina Back Shift Spinal Canal Enlargement Technique and Single Open-door Laminoplasty for Multisegment Cervical Spondylotic Myelopathy

Purpose To provide imaging evidence of the feasibility and clinical efficacy of a new full lamina back shift spinal canal enlargement technique by comparing its imaging parameters to those of single open-door miniature titanium plate internal fixation.Methods A retrospective analysis was conducted on 64 patients with multisegment cervical spondylotic myelopathy caused by cervical stenosis. Of these, 32 underwent the new full lamina back shift spinal canal enlargement technique (observation group), and 32 underwent single open-door miniature titanium plate internal fixation (control group). The CT data of both groups were imported into Mimics 17.0 software to measure the median sagittal diameter and cross-sectional area of the spinal canal. Photoshop CS5 was employed to measure the drift distance of the spinal cord on MR images to perform a comparative study of the imaging parameters from the two groups.Results The T2-weighted MR images in both groups showed continuous recovery of the cerebrospinal fluid signal in the C3–C7 range. The new full lamina back shift spinal canal enlargement technique was significantly superior to single open-door miniature titanium plate internal fixation with respect to the spinal canal cross-sectional area and the median sagittal diameter (P<0.05). No significant difference was detected in the drift distance of the spinal cord between the two groups (P>0.05).Conclusion The new full lamina back shift spinal canal enlargement technique achieved a thorough spinal canal decompression effect on imaging while ensuring a reasonable spinal drift distance and few surgical complications. The clinical curative effect of the new technique was precise.

Investigation of a Calcium Hydroxide Overflowing From Root Apex during Calcium Hydroxide Removal

Calcium hydroxide has been widely used as intracanal medicament recently. However, removing calcium hydroxide accumulated in the apical foramen was difficult, and there is a risk of overflowing outside of the apical foramen during removing procedure. In this study, we investigated (1) the status of overflow from root apex foramen in each removal method using hand file or ultrasonic scaler, (2) possibility of reducing overflow in combination with citric acid solution or EDTA solution. Twenty-four maxillary premolar artificial teeth were performed root canal enlargement using K-fail until No.25 or No.30 size of thickness in each 12 teeth. After finishing root canal enlargement, calcium hydroxide was filled within root canal apex completely. Then calcium hydroxide was removed using ultrasonic scaler or hand file. Furthermore purified water, citric acid solution or EDTA solution was prepared as auxiliary agents respectively. After removing calcium hydroxide from each root canal was finished, the condition of calcium hydroxide overflowing from root apex was observed using stereomicroscope. Calcium hydroxide in the root canal was sufficiently removed from root canals in the groups using ultrasonic scaler. However slighted calcium hydroxide was remained around root apex in the groups using hand file. Overflow of calcium hydroxide to outside around root apex was observed both using ultrasonic scaler and hand file. The tendency of calcium hydroxide overflowing was higher in the case of using ultrasonic scaler than using hand file. In the groups of using hand file, no significant difference was observed for the different size of root canal enlargement, however overflow of calcium hydroxide was clearly higher in 30 size of root canal enlargement using ultrasonic scaler. The use of citric acid solution and EDTA solution as auxiliary agents showed that overflow of calcium hydroxide was decreased compared without using them. In particular, the decrease of overflowing was more clearly using citric acid solution than using EDTA solution. It is recommended that using hand file on removal apex areas of calcium hydroxide to reduce amount of overflowing and improve the removal efficiency. Moreover reducing the risk of calcium hydroxide overflowing are expected using citric acid solution or EDTA solution.

Restoration of a Nonvital Tooth with Fiber Reinforce Composite (Wallpapering Technique)

Introduction. Reconstruction of endodontically treated tooth (ETT) is one of the greatest challenges in dentistry. Clinical success of fiber reinforcement composite (FRC) restorations in ETT depends on many factors like remaining tooth structure, knowing advantages of adhesive dentistry besides its drawbacks, and the correct use of fibers in combination with resin composite. Case Report. This article presents a case in which fibers have been used in composite buildup in order to increase the toughness and strength of the ETT direct restoration. In addition, this technique does not require root canal enlargement to eliminate the risk of root perforation. Also, this one visit treatment can be helpful for patients that could not pay the cost of indirect restoration and/or have no time. Conclusion. It seems in selected patients with special considerations, FRC composite restoration is valid alternatives for indirect restoration.

Triple Pelvic Osteotomy Fixed with Lag Screw for the Treatment of Pelvic Canal Stenosis in Five Cats

Objective The aim of this study was to describe the technique and the clinical outcome of cats with obstipation as a result of pelvic canal narrowing, treated using an alternative triple pelvic osteotomy technique. Methods Five cats with obstipation as a result of pelvic canal narrowing due to pelvic fracture malunion or secondary hyperparathyroidism were treated by triple pelvic osteotomy. After performing the iliac osteotomy and medial partial cortical debridement (4/5 cases), the pelvic canal was widened by moving the caudal fragment of the ilium to the lateral aspect of the cranial fragment. The iliac fragments were fixed by a 2.7-mm lag screw (5/5 cases) and an additional 2 Kirschner wires 0.8 mm (1/5 cases). Results The radiographic examination immediately postoperatively and 8 weeks postoperatively showed a mean pelvic canal enlargement of 20% (range 7–38%). Minor complication occurred in one case; this resolved 15 days postoperatively without any treatment. Complications and recurrence of obstipation did not occur during the final follow-up, ranging between 5 months and 1 year in any of these cases. Clinical Significance The use of lag screw fixed triple pelvic osteotomy resulted in widening of the pelvic canal and led to a satisfactory outcome with no major complications. This technique is fast, requires no expensive implants and it is relatively straightforward. Further cases are required to determine the success and complication risk of the procedure.