Physical predictors of favorable postoperative outcomes in patients undergoing laminectomy or laminotomy for central lumbar spinal stenosis: secondary analysis of a randomized controlled trial

Study Design: Secondary analysis of a randomized controlled trial. Objective: To identify preoperative physical variables associated with favorable postoperative outcome in individuals undergoing laminectomy or laminotomy for degenerative central lumbar spinal stenosis. Summary of Background Data: Clinical or condition specific variables have most commonly been studied as predictors of postoperative outcome in lumbar spinal stenosis. If associated to favorable postoperative outcome, modifiable physical variables would inform prehabilitation interventions for patients with degenerative central lumbar spinal stenosis. Methods: Patients awaiting surgery for central lumbar spinal stenosis were recruited to participate in a randomized controlled trial. Following baseline data collection of demographics, clinical portrait and physical testing, participants were randomized to either 6-week active prehabilitation program or hospital standard care. Complete baseline and postoperative data were obtained from 58 participants which were included in the present analysis. Favorable postoperative outcome was determined based on two outcome measures. Favorable outcome was defined as a decrease of ≥30% on the Numerical Rating Scale for leg pain intensity and a decrease of ≥30% on the Oswestry Disability Index for low back disability. Baseline physical variables were used to conduct binary logistic regression. Results: Sixty percent of participants were determined as having a favorable postoperative outcome. None of the included physical variables were found to be predictors of a favorable postoperative outcome based on leg pain intensity and low back pain-associated disability [trunk flexors muscle strength (OR = 0.73; 95%CI (0.02–27.12)] lumbar extensors muscle endurance [OR= 1.09; 95%CI (0.95–1.24)] total ambulation time [OR = 1.00 95%CI (0.99–1.01)] lumbar active range of motion in extension [OR = 1.08; 95%CI (0.95–1.23)] and knee extensors muscle strength [OR=1.02; 95%CI (0.98–1.06)]. Conclusion: Results show that none of the investigated variables, all related to low back and lower limbs physical capacity, were predictors of postoperative recovery. Further testing in larger cohort is needed to assess the full potential of physical outcome measures as predictors of postoperative recovery

Effectiveness of an exercise-based prehabilitation program for patients awaiting surgery for lumbar spinal stenosis: a randomized clinical trial

Lumbar spinal stenosis is the most common reason for spine surgery in older adults, but the effects of prehabilitation on perioperative outcomes among these patients have not been investigated. This study aims to evaluate the effectiveness of a preoperative exercise-based intervention program compared with usual care on the improvement of clinical status, physical capacities and postoperative recovery of patients awaiting surgery for lumbar spinal stenosis. Sixty-eight participants were randomised to receive either a 6-week supervised exercise-based prehabilitation program or hospital usual care. The outcomes included both clinical and physical measures. Data collection occurred at post-intervention, and 6 weeks, 3- and 6-months post-surgery. Significant but small improvements were found in favour of the experimental group at the post-intervention assessment for pain intensity, lumbar spinal stenosis-related disability, lumbar strength in flexion, low back extensor muscles endurance, total ambulation time, and sit to stand performance. A significant difference in favor of the intervention group was found starting at the 3-month postoperative follow-up for low back-related disability. No adverse events were reported. Exercise-based prehabilitation did not improve short-term postoperative recovery in patients with lumbar spinal stenosis. © 2021, The Author(s)

Comparison of walking variations during treadmill walking test between neurogenic and vascular claudication: a crossover study

Lumbar spinal stenosis (LSS) and peripheral arterial disease (PAD) are two distinct conditions characterized by similar symptoms including leg pain and walking limitations due to claudication. Differentiation between both origins can be difficult and characteristics such as symptom manifestations, time to relief in rest position and pain localization should be considered when determining diagnosis and the treatment plan. The objectives of this study were to compare changes in walking time to symptom change during treadmill tests and self-reported outcomes measures related to claudication, kinesophobia and global health between individuals with LSS, PAD and non-specific low back pain (nLBP)

The “NOMAD” Project – A Survey of Instructions Supplied with Machinery with Respect to Noise

The NOMAD project was a survey to examine the noise-related content of instructions supplied with machinery offered for purchase in Europe. The project collected more than 1 500 instructions from machines covering 40 broad machine-families and from 800 different manufacturing companies. These instructions were analyzed to determine compliance with the requirements of the Machinery Directive, and assess the quality of information. The general state of compliance of machinery instructions with the noise-related requirements of the Machinery Directive was found to be very poor: 80% of instructions did not meet legal requirements. Some required numerical values relating to noise emissions were often missing. Where values were given, they were often not traceable to machine operating conditions or measurement methods, and not credible either against stated conditions/methods or as warnings of likely risk in real use. As a consequence, it is considered highly likely that, in making a machinery procurement decision, employers are prevented from taking noise emissions into account, and understanding what is necessary to manage the risks from noise relating to equipment that is procured. Recommendations are made for actions aimed at bringing about a global improvement to the current situation. Targeted actions are now proposed by “ADCO Machinery Group” aimed at raising awareness of the legal requirements, responsibilities and actions required among the various groups who have parts to play in the system – machine manufacturers, machine users, occupational safety and health professionals, and standards-makers. Recommendations are also made aimed at providing, or improving, tools and resources for all these actors

The “NOMAD” Project – A Survey of Instructions Supplied with Machinery with Respect to Noise

The NOMAD project was a survey to examine the noise-related content of instructions supplied with machinery offered for purchase in Europe. The project collected more than 1 500 instructions from machines covering 40 broad machine-families and from 800 different manufacturing companies. These instructions were analyzed to determine compliance with the requirements of the Machinery Directive, and assess the quality of information. The general state of compliance of machinery instructions with the noise-related requirements of the Machinery Directive was found to be very poor: 80% of instructions did not meet legal requirements. Some required numerical values relating to noise emissions were often missing. Where values were given, they were often not traceable to machine operating conditions or measurement methods, and not credible either against stated conditions/methods or as warnings of likely risk in real use. As a consequence, it is considered highly likely that, in making a machinery procurement decision, employers are prevented from taking noise emissions into account, and understanding what is necessary to manage the risks from noise relating to equipment that is procured. Recommendations are made for actions aimed at bringing about a global improvement to the current situation. Targeted actions are now proposed by “ADCO Machinery Group” aimed at raising awareness of the legal requirements, responsibilities and actions required among the various groups who have parts to play in the system – machine manufacturers, machine users, occupational safety and health professionals, and standards-makers. Recommendations are also made aimed at providing, or improving, tools and resources for all these actors

Wideband Synthetic Aperture Mapping of the sea bottom

Seabed survey using wideband synthetic aperture sonar can provide high resolution images and maps (a cubic meter voxel at a few kilometres range) using a reasonable array size (2 metres) and a rather low frequency range (6-12 kHz). A low frequency profofype has been constructed in the frame of the MAST profect SAMI "Synthetic Aperture Mapping and Imaging". A large amount of experimental data was obtained at sea and stored for further processing. The paper will show some of these results. It will display bofh synthetic images and 3D maps