K. Kempeneers’s research while affiliated with Jessa Hospital and other places

Chronic low back pain (CLBP) is one of the most common chronic musculoskeletal disorders worldwide. Guidelines recommend exercise therapy (ET) in CLBP management, but more research is needed to investigate specific ET modalities and their underlying mechanisms. The primary goal of this study is to evaluate the short-term and long-term effectiveness of a time-contingent individualised high-intensity training (HIT) protocol on disability compared with a time-contingent moderate-intensity training (MIT) as used in usual care, in persons with severely disabling CLBP. Additionally, the effectiveness on central effects, the added value of prolonged training at home and technology support, and the cost-effectiveness are evaluated. In this randomised controlled trial, CLBP patients will be randomly divided into three groups of 56 participants. Group 1, ‘TechnoHIT’, receives HIT with technology-support in the home-phase. Group 2, ‘HIT’, receives HIT without technology support. Group 3, ‘MIT’, receives MIT, reflecting training intensity as used in usual care. The primary outcome is patient-reported disability, measured by the Modified Oswestry Disability Index. Secondary outcomes include quantitative sensory testing, psychosocial factors, broad physical fitness, quality of life, cost-effectiveness, adherence and usability of technology. Trial registration number NCT06491121.

We present the case of a child with neuritis ossificans after acute trauma, treated conservatively. The aim of the review is to compare several parameters in this disease. Emphasis is placed on the clinical-radiological features distinguishing neuritis ossificans from malignancy to avoid unnecessary biopsy and surgery. A literature review was performed. Only 18 cases were described. Except for one, all describe adults, and none had acute trauma. Nearly all were treated surgically. Our 13-year-old patient presented with posterior knee pain after trauma. MRI demonstrated a mass within the tibial nerve with oedema, some lymph nodes and increased avidity on 18fluoro-2-deoxyglucose-positron emission tomography. These findings can be reactive but also associated with malignancy. However, eggshell-like calcifications in the periphery of the mass were seen on CT. Biopsy and resection were proposed. Follow-up visits over the next weeks showed remarkable clinical improvement. Wait-and-scan was advised after international discussion. Follow-up imaging after 2 months showed resolution of the oedema and volume reduction of the mass, suggesting a benign pathology. Diagnosis of neuritis ossificans was proposed based on the clinical and radiological features. There was a favorable course with no complaints after two months. Imaging after seven months showed an almost complete regression. Neuritis ossificans should be considered within a painfull (mono)neuropathy. The initial inflammatory phase may mimic malignancy, misleading clinicians toward biopsy or surgery with the risk of nerve damage. As seen in our case, neuritis ossificans can be a self-limiting process. Therefore, conservative therapy should be considered with a wait-and-scan approach.

Lumbago as a symptom of an extramedullary tumour in acute myeloid leukaemia A 58-year-old man with acute myeloid leukaemia presents with low back pain. Because of his oncologic history and severe pain during the night, additional radiographic imaging was performed. These alarm signals or so-called red flags are described in the guidelines of the Belgian Health Care Knowledge Centre (KCE). Imaging showed a mass at the 10th thoracic vertebra, suspected to be an extramedullary tumour consisting of myeloblasts, originating from the previously diagnosed acute myeloid leukaemia. A biopsy confirmed this diagnosis. Since these tumours present with different symptoms and at different locations, every physician should be aware of them. They are treated systemically with chemotherapy, like the intramedullary disease, sometimes supplemented with local therapy. In some cases, this disease manifestation presents prior to or without the diagnosis of acute myeloid leukaemia. A correct histological diagnosis is then essential for a correct treatment.

A 13-year-old boy with progressive calf pain A 13-year-old boy was seen on the consultation because of progressively increasing pain in the posterior aspect of the right lower leg after falling off his bicycle about 6 weeks earlier. He described the pain as stabbing, burning and tingling. The clinical examination showed a positive straight leg raise test, an altered sensation in the painful region and an absent achilles reflex. These findings suggested a neurological problem at the level of the lumbosacral spine. Due to the presence of clusters of red flags, further diagnostic imaging of the lumbosacral spine was performed. An MRI showed an aneurysmal bone cyst with compression of nerve roots S1 and S2.

Objective: Decisions concerning the rehabilitation process and return to play (RTP) after cervical spine surgery in a general sporting population can be difficult and may be influenced by several factors. Moreover, no clear guidelines for this are currently available. The aim of this study was to create tentative guidelines for rehabilitation and RTP after cervical surgery in a general sporting population. Design: Five-step Delphi analysis. Settings: Primary, secondary, and tertiary medical practitioners. Participants: Panel of Belgian neurosurgeons, orthopedic surgeons, physiotherapists, and physical and rehabilitation medicine practitioners. Assessment: Round 1 (R1) was a brainstorm phase. A comprehensive list of answers from R1 was validated in round 2 (R2). In round 3 (R3), experts ranked these items in a chronological order. Contraindications and criteria to start each rehabilitation step were linked in round 4 (R4). In round 5 (R5), panelists ranked theses about contraindications and criteria on a 5-point Likert scale. Main outcome measures: Theses scoring ≥10% "oppose" or "strongly oppose" were rejected. Results: The response rate was 100% (n = 15) for R1, 93% (n = 14) for R2, 73% (n = 11) for R3, 53% (n = 8) for R4, and 67% (n = 10) for R5. In R5, 25 theses on absolute and relative contraindications and criteria were endorsed. Conclusions: This Delphi analysis resulted in contraindications and criteria for the rehabilitation process and RTP after cervical surgery in a general athletic population. Tentative guidelines and timetable are proposed. Key messages from these guidelines are (1) Rehabilitation should start before surgery with education; (2) Rehabilitation should be patient-tailored; and (3) An unstable arthrodesis is an absolute contraindication for RTP.

Introduction/Background Decisions concerning the rehabilitation process and return to play (RTP) after cervical spine surgery in a general sporting population can be difficult and may be influenced by several factors. Moreover, no guidelines are present for this. The aim of this study was to create a consensus on this topic. Material and method A 5-step Delphi analysis with panels of neurosurgeons, orthopaedic surgeons, physiotherapists and physical and rehabilitation medicine practitioners in Belgium was conducted. The first round (R1) was a brainstorm phase. A comprehensive list of answers from R1 was validated in round 2 (R2). In round 3 (R3) experts ranked these items in a chronological order. Next, contraindications and criteria to start each rehabilitation step were linked by experts in round 4 (R4). In round 5 (R5) panellists ranked theses about contraindications and criteria on a 5-point Likert scale. Results The response rate was 100% (n = 15) for R1, 93% (n = 14) for R2, 73% (n = 11) for R3, 53% (n = 8) for R4 and 67% (n = 10) for R5. In R5, 25 theses on absolute and relative contraindications and criteria were endorsed. Conclusion This Delphi analysis resulted in contraindications and criteria for the rehabilitation process and return to play after cervical surgery. Tentative guidelines and timetable are proposed.

Lusorian artery associated with thoracic outlet syndrome The medical history of a 36-year-old female with an arterial thoracic outlet syndrome (TOS) in association with a lusorian artery or aberrant right subclavian artery" (ARSA) is reported. An ARSA presenting as TOS is rare, as dysphagia lusoria is usually the typical clinical presentation of an ARSA. Diagnosing TOS can be challenging, but specific tests on clinical examination can implement further technical investigation. Through this case report relevant literature on TOS and ARSA is described