Formulation of Japanese Orthopaedic Association (JOA) clinical practice guideline for the management of low back pain- the revised 2019 edition

Canadian Association of Radiologists Spine Imaging Referral Guideline

The Canadian Association of Radiologists (CAR) Spine Expert Panel is made up of physicians from the disciplines of radiology, emergency medicine, neurology, neurosurgery, physiatry, a patient advisor, and an epidemiologist/guideline methodologist. After developing a list of 10 clinical/diagnostic scenarios, a rapid scoping review was undertaken to identify systematically produced referral guidelines that provide recommendations for one or more of these clinical/diagnostic scenarios. Recommendations from 23 guidelines and contextualization criteria in the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) for guidelines framework were used to develop 22 recommendation statements across the 8 scenarios (one scenario points to the CAR Trauma Referral Guideline and one scenario points to the CAR Musculoskeletal Guideline). This guideline presents the methods of development and the referral recommendations for myelopathy, suspected spinal infection, possible atlanto-axial instability (non-traumatic), axial pain (non-traumatic), radicular pain (non-traumatic), cauda equina syndrome, suspected spinal tumour, and suspected compression fracture. Spondyloarthropathies and spine trauma point to other CAR Diagnostic Imaging Referral Guidelines, Musculoskeletal and Trauma, respectively.

Analysis of Safety and Efficacy of Unilateral Biportal Endoscopy Combined With Oblique Lumbar Interbody Fusion in the Treatment of Lumbar Infectious Spondylitis

STUDY DESIGN

Retrospective case series.

OBJECTIVE

To explore the clinical efficacy and safety of unilateral biportal endoscopy (UBE) combined with oblique lumbar interbody fusion (OLIF) in the treatment of lumbar infectious spondylitis (LIS).

BACKGROUND

In recent years, there has been a notable increase in the incidence of LIS. Patients typically present with back pain, tenderness, and stiffness, which may be accompanied by fever, which significantly reduces their quality of life.

PATIENTS AND METHODS

This study selected 25 patients with LIS treated by UBE with OLIF from January 2018 to March 2023 in our hospital, including 14 males and 11 females. During the perioperative phase, key indicators such as white blood cell count, erythrocyte sedimentation rate, and C-reactive protein were monitored to evaluate the efficacy of the infection treatment. Surgical-related indicators and the frequency of complications were systematically recorded. Functional and imaging indicators before and after the operation were compared.

RESULTS

The surgical intervention was successful in all 25 patients. The average operation time was 155.2 ± 23.5 minutes, the average blood loss was 265.6 ± 46.8 mL, and the average follow-up time was 18.8 ± 6.9 months. Bacterial cultures of 12 patients were positive, and postoperative pathologic examination of all patients showed inflammation. Postoperative patients exhibited significant clinical symptom improvement, characterized by a gradual decrease in erythrocyte sedimentation rate, C-reactive protein, and white blood cell count, ultimately returning to normal levels. The Visual Analog Scale scores, Japanese Orthopedic Association scores, and Oswestry Disability Index were significantly improved after the operation (P < 0.001). In addition, the height of the intervertebral space and the angle of lumbar lordosis were optimally restored. At the last follow-up, the fusion rate of bone graft was 96%.

CONCLUSION

The combined treatment of LIS with UBE and OLIF is effective, thereby establishing itself as an effective, safe, and viable surgical technique.

Osteoporosis, spinal degenerative disorders, and their association with low back pain, activities of daily living, and physical performance in a general population

Osteoporosis, vertebral fractures, and spinal degenerative diseases are common conditions that often coexist in older adults. This study aimed to determine the factors influencing low back pain and its impact on activities of daily living (ADL) and physical performance in older individuals with multiple comorbidities. This cross-sectional study was part of a large-scale population-based cohort study in Japan, involving 1009 participants who underwent spinal magnetic resonance imaging (MRI) to assess cervical cord compression, radiographic lumbar spinal stenosis, and lumbar disc degeneration. Vertebral fractures in the thoracolumbar spine were evaluated using sagittal MRI with a semi-quantitative method. Bone mineral density was measured using dual-energy X-ray absorptiometry. Low back pain, Oswestry Disability Index (ODI), and physical performance tests, such as one-leg standing time, five times chair-stand time, maximum walking speed, and maximum step length, were assessed. Using clinical conditions as objective variables and image evaluation parameters as explanatory variables, multiple regression analysis showed that vertebral fractures were significantly associated with low back pain and ODI. Vertebral fractures and osteoporosis significantly impacted physical performance, whereas osteoporosis alone did not affect low back pain or ODI. Our findings contribute to new insights into low back pain and its impact on ADL and physical performance.

Quality appraisal of clinical practice guidelines addressing massage interventions using the AGREE II instrument

OBJECTIVE

The purpose of this study was to systematically evaluate the methodological quality of massage-related clinical practice guidelines (CPGs)/consensus on massage using the Appraisal of Guidelines Research and Evaluation (AGREE II) instrument and to summarize the current status of recommendations in the CPGs.

METHODS

The Chinese National Knowledge Infrastructure (CNKI), WanFang Data, China Science and Technology Journal Database (VIP), China Biology Medicine disc (CBM), PubMed, Embase, and guideline websites (such as the Chinese Medical Ace Base, the China Association of Chinese Medicine, the World Health Organization, Guideline International Network, National Institute for Health and Care Excellence, Scottish Intercollegiate Guidelines Network) were searched from inception to October 31, 2022. In addition, the reference lists of relevant studies were reviewed to identify domestic and overseas massage CPGs/consensus. The search terms adopted a combination of subject words and free words, mainly including traditional Chinese medicine, complementary therapies, Tuina, massage, manipulation, chiropractic/osteopathic, spinal, acupressure, guideline, and consensus. Two researchers independently completed the eligible records and extracted the data. Before the formal research, calibrations were performed twice on AGREE II, and all reviewers completed the pilot test three times until they understood and reached an agreement on the assessment items. Three researchers appraised the methodological quality of the included guidelines using the AGREE II instrument and calculated the overall intraclass correlation coefficient (ICC) of agreement.

RESULTS

The evaluation results showed that among the 49 eligible CPGs/consensus, 4 (8.2%) CPGs/consensus were considered "recommended", 15 (30.6%) CPGs/consensus were considered "recommended with modifications", and 30 (61.2%) CPGs/consensus were considered "not recommended", while the consensus was considered "not recommended". Generally, the scores in the six domains of the guidelines were all higher than the consensus. Evaluation results for the overall quality of 36 CPGs showed that 4 (11%) were "good quality", 15 (42%) were "sufficient quality" and 17 (47%) were "lower quality". The AGREE II quality scores of domains ranged from 0.30 to 0.75 ([ICC = 0.993, 95% CI (0.992, 0.995)]). The domain of scope and purpose (domain 1), with a median score of 0.75 (0.52~0.91), performed best in the guidelines with AGREE II, and stakeholder involvement (domain 2) [median 0.39 (0.31~0.56)] and application (domain 5) [median 0.30 (0.17~0.47] obtained lower scores. The consensus score of domain 1 was better at 26.0 (21.6~44.8), followed by rigor of development (domain 3) with a score of 18.0 (10.0~28.9). A total of 119 massage-related recommendations were extracted from 49 guidelines/consensuses, including "in favor" (102, 85.7%), "against" (9, 7.6%), and "did not make recommendations" (8, 6.7%).

CONCLUSION

The overall quality of the included guidelines was low, and most of the guidelines were not "recommended". In future guideline updates, the existing evidence should be used, the professional composition of members of the expert group should be enriched, and patients' values and preferences should be fully considered. It is necessary to clearly propose recognizable recommendations and strengthen the rigor and standardization of guideline formulation. Thus, clear standard guidelines can be formulated to better guide clinical practice.

Fear-Avoidance Beliefs Associated with Non-Specific Chronic Low Back Pain in College Athletes

Purpose

This study aimed to determine the psychosocial factors associated with non-specific chronic low back pain (NS-CLBP) among college athletes.

Material and Methods

A cross-sectional study was performed at one university. A non-anonymous, self-administered online questionnaire was collected from each athlete. Participants with a history of orthopaedic spine disease or surgery were excluded. Online responses from 368 college athletes belonging to 18 clubs were collected, among which 263 were included in the analysis. In the 263 responses, 41 individuals were identified as having NS-CLBP. Multivariate logistic regression analyses were performed to determine factors associated with presence of NS-CLBP. Independent variables included the Fear-Avoidance Beliefs Questionnaire physical activity subscale (FABQ-PA) score, Tampa Scale for Kinesiophobia-11 (TSK-11) score, Roland-Morris Disability Questionnaire (RDQ) score, and body mass index (BMI). Additionally, the Mann-Whitney U-test was utilized to compare FABQ-PA, TSK-11, RDQ scores, and BMI between the NS-CLBP and non-NS-CLBP groups.

Results

The FABQ-PA (odd ratio = 1.096, P = 0.003) was significantly associated with NS-CLBP. No significant association was observed between NS-CLBP and TSK-11 (P = 0.776), RDQ (P = 0.074), and BMI (P = 0.296). The scores for FABQ-PA, TSK-11, RDQ, and BMI in the group with NS-CLBP were found to be significantly higher compared to the group without NS-CLBP (P < 0.001, P = 0.034, P < 0.001, and P = 0.022, respectively).

Conclusion

The present study revealed a significant relationship between higher FABQ-PA scores and NS-CLBP among college athletes. Conversely, TSK-11 and BMI values showed no significant association with NS-CLBP presence. The findings suggest that addressing fear-avoidance beliefs may be crucial in managing NS-CLBP among college athletes.

Impact of Lumbar Surgery on Pharmacological Treatment for Patients with Lumbar Spinal Canal Stenosis: A Single-Center Retrospective Study

Treatment for lumbar spinal canal stenosis (LSCS) is mainly classified into conservative and surgical therapies. Among conservative therapies, pharmacological treatment is commonly prescribed for LSCS. Meanwhile, surgical treatment is the last option for LSCS. This study aimed to examine the impact of lumbar surgery on pharmacological treatment for patients with LSCS. Consecutive patients aged ≥ 40 years who underwent lumbar surgery for LSCS were identified. A total of 142 patients were retrospectively reviewed for preoperative and 6-month and 1-year postoperative LSCS medications. The results showed that the number of LSCS medications significantly decreased after lumbar surgery. The proportion of the patients taking non-steroidal anti-inflammatory drugs, pregabalin/mirogabalin, opioids, prostaglandin E1 analogs, and neurotropin was significantly decreased after lumbar surgery, but that of the patients taking mecobalamin, acetaminophen, and serotonin-noradrenalin reuptake inhibitors was not significantly changed. Additionally, around 15% of the participants showed an increase in LSCS medications even after lumbar surgery. Multivariable analysis revealed that individuals without improvements in walking ability (RR: 2.7, 95% CI: 1.3-5.9) or social life (RR: 2.3, 95% CI: 1.1-5.0) had a greater risk of a postoperative increase in LSCS medications. The study results may provide physicians with beneficial information on treatment for LSCS.

Mental status is significantly associated with low back pain: a survey-based cross-sectional study among Japanese women

OBJECTIVE

Low back pain (LBP) is a highly prevalent condition that poses significant patient burden. This cross-sectional study identified factors associated with LBP occurrence and developed a strategy to identify, prevent, and reduce LBP-related burden on patient health. A web-based questionnaire-answering system was used to assess the potential effects of LBP on mental health, assessing five domains (physical features, demographics, lifestyle, diet, and mental status) conceptually associated with hie, a common disease state traditionally described in the Japanese culture as a chilly sensation.

RESULTS

Of 1000 women, 354 had and 646 did not have LBP. The Chi test identified 21 factors, and subsequent multivariate logistic regression indicated eight factors significantly associated with LBP: age, history of physician consultation regarding anemia, history of analgesic agents, dietary limitations, nocturia, sauna use, hie, and fatigue. Furthermore, women with LBP exhibited a significantly lower body temperature (BT) in the axilla/on the forehead than women without LBP. LBP and hie are subjective and potentially affected by patient mental status. Stress reduces blood circulation, causing hypothermia and possibly worsening LBP. Therefore, mental-health support is important for patients with LBP to reduce physiological stress. Hyperthermia therapy, a traditionally prescribed intervention, is a potential intervention for future studies.

Efficacy and safety of Yaobitong capsule for acute lumbar disc herniation: A protocol for a multi-center randomized controlled trial

BACKGROUND

There are few effective conservative therapies for acute lumbar disc herniation (LDH), and the choice of nonsteroidal anti-inflammatory drugs is not recommended for all patients. The purpose of this study was to compare the effect of Yaobitong capsule with celecoxib capsule, and to further confirm the safety and efficacy of Yaobitong capsule.

METHODS

This study is a large sample multicenter randomized controlled trial. Eight hospitals served as sub centers to recruit patients. A total of 258 patients are divided into Yaobitong group and celecoxib group according to the ratio of 1:1. Celecoxib or Yaobitong capsule was taken orally for 14 days. Patients will complete the trial after 3 months of follow-up, and independent statisticians who are blinded to random assignment will analyze the data using SAS 9.3 software. The primary outcome was the visual analogue scale (VAS) score after 14 days of treatment, and Japanese Orthopaedic Association (JOA), Oswestry Disability Index (ODI), and SF-12 will be regarded as secondary outcomes. Safety indexes will be recorded before and after treatment, and adverse events (AEs) will be recorded throughout this trial.

DISCUSSION

This study will evaluate the efficacy and safety of Yaobitong capsule in treating LDH. The experimental results will provide evidence support to treat LDH with Yaobitong capsule.