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Acosta Julbe JI, Gottreich JR, Ermann J, Isaac Z, DeFilipp M, Andrew MN, Chang Y, Zampini JM, Katz JN, Mandell JC. Reporting of Facet Joint Inflammation in Lumbar Spine MRI Studies in Patients With Low Back Pain. Spine (Phila Pa 1976) 2024; 49:733-740. [PMID: 38229507 DOI: 10.1097/brs.0000000000004923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 12/22/2023] [Indexed: 01/18/2024]
Abstract
STUDY DESIGN Retrospective. OBJECTIVE We aimed to assess the frequency of facet joint inflammatory features noted in routine radiology reports of lumbar spine magnetic resonance imaging (MRI) studies among patients with chronic low back pain. SUMMARY OF BACKGROUND DATA Facet joint arthropathy is one of the most common causes of chronic low back pain. It may encompass various inflammatory imaging characteristics, such as facet joint effusion, bone marrow edema, and soft tissue edema. The extent to which radiology reports mention inflammatory features of the lumbar facet joints and the accuracy of these reports have not been investigated. MATERIALS AND METHODS The authors performed a chart review on 49 subjects with previous facet-related interventions ( i.e . medial branch blocks or intra-articular facet joint injection) and MRI available in the medical record. One senior musculoskeletal radiologist and a musculoskeletal radiology fellow graded the inflammatory features using a published facet joint inflammation grading system [Gold Standard (GS)]. The authors identified the inflammatory markers mentioned in the radiology reports and calculated the sensitivity and positive predictive value of the radiology reports compared with GS readings. RESULTS Compared with the GS, the sensitivity of radiology reports for facet joint effusion, bone marrow, and soft tissue edema ranged from 6% to 22%, and the positive predictive value ranged from 25% to 100%. L4/5 had the highest number of cases with inflammatory features noted on the reports. CONCLUSION Inflammatory findings, such as facet joint effusion, bone marrow edema, and soft tissue edema, are not commonly identified in radiology reports. Further investigations are needed to determine the clinical importance of MRI-detected lumbar facet joint inflammatory features as a potential mechanism of nociception and as a predictor of outcomes following injections or other therapies.
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Affiliation(s)
- José I Acosta Julbe
- Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, Boston, MA
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA
| | - Julia R Gottreich
- Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, Boston, MA
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA
| | - Joerg Ermann
- Harvard Medical School, Boston, MA
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, Boston, MA
| | - Zacharia Isaac
- Harvard Medical School, Boston, MA
- Department of Physical Medicine and Rehabilitation, Brigham and Women's Hospital, Boston, MA
| | - Miriam DeFilipp
- Harvard Medical School, Boston, MA
- Department of Radiology, Brigham and Women's Hospital, Boston, MA
| | - Michael N Andrew
- Harvard Medical School, Boston, MA
- Department of Physical Medicine and Rehabilitation, Brigham and Women's Hospital, Boston, MA
| | - Yuchiao Chang
- Harvard Medical School, Boston, MA
- Department of Medicine, Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA
| | - Jay M Zampini
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Jeffrey N Katz
- Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, Boston, MA
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, Boston, MA
| | - Jacob C Mandell
- Harvard Medical School, Boston, MA
- Department of Radiology, Brigham and Women's Hospital, Boston, MA
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Shi Y, Zhang X, Feng Y. Association between the dietary inflammatory index and pain in US adults from NHANES. Nutr Neurosci 2024; 27:460-469. [PMID: 37254575 DOI: 10.1080/1028415x.2023.2218122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVES The growing global burden of pain is gradually expanding from the medical field to public health. Dietary inflammatory potential correlates with inflammatory markers, and inflammation is one of the main mechanisms of pain. METHODS This study explored the association between dietary inflammatory index (DII) and pain from the NHANES database on DII and pain (neck pain, low back pain, joint pain, and headache or migraine) using logistic regression and stratified analysis. RESULTS The results show a stronger association between DII and joint pain (Q4 of DII adjusted-OR = 1.23, 95% CI = 1.08-1.40, P = 0.003) and headache or migraine (Q4 of DII adjusted-OR = 1.31, 95% CI = 1.15-1.48, P < 0.001), but no association is found in neck pain (Q4 of DII adjusted-OR = 1.03, 95% CI = 0.89-1.20, P = 0.65) and low back pain (Q4 of DII adjusted-OR = 1.04, 95% CI = 0.92-1.17, P = 0.54). After stratifying the data according to demographics, differences in the relationship between DII and pain are found at different levels of the population. DISCUSSION This study identifies high DII as a risk factor for joint pain and headache or migraine.
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Affiliation(s)
- Yue Shi
- Chengdu University of Traditional Chinese Medicine, Chengdu, People's Republic of China
| | - Xueyi Zhang
- Chengdu University of Traditional Chinese Medicine, Chengdu, People's Republic of China
| | - Yue Feng
- Chengdu University of Traditional Chinese Medicine, Chengdu, People's Republic of China
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Hingorani A, Ascher E, Chait J, Hingorani A. Risk factors for low back pain after iliac vein stenting for non-thrombotic iliac vein lesions. J Vasc Surg Venous Lymphat Disord 2024; 12:101822. [PMID: 38237676 DOI: 10.1016/j.jvsv.2024.101822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 01/04/2024] [Accepted: 01/07/2024] [Indexed: 02/10/2024]
Abstract
OBJECTIVE Iliac vein stenting is an option being explored to treat chronic venous insufficiency. We have noted that our most common postoperative complication is low back pain after stent placement, which is occasionally quite severe. We wanted to investigate risk factors that are involved in this phenomenon and identify potentially modifiable factors. METHODS Patients who failed 3 months of conservative therapy had iliac vein interrogation performed. We limited the scope of this database to non-thrombotic iliac vein lesions treated in the office in which Wallstents were placed. Data were collected from September 2012 to August 2020 for 2308 consecutive outpatients who underwent 3747 procedures. Before August 2016, patients received pre-procedure oral valium (n = 2679) and thereafter, patients received intravenous (IV) sedation (n = 1068). A pain score, on a Likert scale ranging from 0 to 10, was assessed within 1 hour postoperatively. We analyzed the medications administered and correlated them with pain scores. RESULTS The average of all the pain scores was 0.86 (range, 0-10; standard deviation [SD], 2.00). Age had a slight inverse effect on pain scores (r = -0.12; P < .00001). Presenting signs (based upon CEAP) (P = .11) and body mass index (P = .88) did not have a significant effect on pain scores. Average pain score for females (0.96) was slightly higher than for males (0.70), with P < .0001. Average pain score for procedures on the right side (0.67) was lower than for procedures on the left side (1.01), with P < .0001. Average pain score for patients who received IV sedation (mean, 0.68; SD, 1.58) was lower than that for those who did not (mean, 0.93; SD, 2.15), with P = .0004. When using a single agent, propofol was associated with the lowest pain scores (P < .0001). Toradol displayed a dose-dependent effect on pain score (P < .0001). The best combination of agents for pain control was propofol and toradol together. CONCLUSIONS Overall, the vast majority of pain scores were low. Factors that were associated with lower pain scores were older age, male sex, procedures on the right side, and IV sedation, in particular with the use of propofol. These data may help us better target patients anticipated to have high pain scores and suggest the preferential use of propofol and toradol.
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Affiliation(s)
- Amrit Hingorani
- Division of Vascular Surgery, Department of Surgery, NYU Brooklyn and Total Vascular Care, Brooklyn, NY
| | - Enrico Ascher
- Division of Vascular Surgery, Department of Surgery, NYU Brooklyn and Total Vascular Care, Brooklyn, NY
| | - Jesse Chait
- Division of Vascular Surgery, Department of Surgery, Mayo Clinic, Rochester, MN
| | - Anil Hingorani
- Division of Vascular Surgery, Department of Surgery, NYU Brooklyn and Total Vascular Care, Brooklyn, NY.
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Yuan X, Fu M, Gong X, Wang L, Zhao S, Zhang C, Wang H, Liu L. Exploring the body surface temperature of the lumbosacral region and relevant back- shu points in patients with lumbar disc herniation induced low back pain based on infrared thermography. Zhongguo Zhen Jiu 2024; 44:423-427. [PMID: 38621730 DOI: 10.13703/j.0255-2930.20230915-k0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
OBJECTIVES To observe the body surface temperature of the lumbosacral region and relevant back-shu points in patients with lumbar disc herniation (LDH) induced low back pain utilizing infrared thermography, and to explore the functional attribute changes of acupoints under pathological conditions. METHODS A total of 50 patients with LDH induced low back pain were included as the observation group, and 45 healthy subjects were included as the control group. Using infrared thermography, the body surface temperature of the lumbosacral region and bilateral Sanjiaoshu (BL 22), Shenshu (BL 23), Qihaishu (BL 24), Dachangshu (BL 25), Guanyuanshu (BL 26), Xiaochangshu (BL 27), and Pangguangshu (BL 28) was measured in both groups. The temperature difference values between the bilateral lumbosacral regions and back-shu points of the two groups were calculated. Additionally, the body surface temperature of the affected and healthy sides of the lumbosacral region and relevant back-shu points was compared in the observation group. RESULTS Compared with the control group, the body surface temperature of the lumbosacral region and the bilateral temperature difference values of the lumbosacral regions were increased in the observation group (P<0.001). The body surface temperature difference values of bilateral Shenshu (BL 23), Qihaishu (BL 24), Dachangshu (BL 25), Guanyuanshu (BL 26) and Xiaochangshu (BL 27) in the observation group were higher than those in the control group (P<0.05, P<0.01, P<0.001). In the observation group, the body surface temperature of the affected side of the lumbosacral region as well as Shenshu (BL 23) and Dachangshu (BL 25) was elevated compared with that of healthy side (P<0.001). CONCLUSIONS The patients with LDH induced low back pain have imbalanced and asymmetrical distribution of body surface temperature in the lumbosacral region and related back-shu points, Shenshu (BL 23) and Dachangshu (BL 25) have the relative specificity.
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Affiliation(s)
- Xiao Yuan
- Department of Acupuncture-Moxibustion and Rehabilitation, Affiliated Hospital of Nanjing University of Chinese Medicine/Jiangsu Province Hospital of TCM, Nanjing 210029, China.
- First Clinical Medical College of Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province.
| | - Mengyu Fu
- Institute of Health Care of Jiangsu Open University
| | - Xiaoyan Gong
- Department of Acupuncture-Moxibustion and Rehabilitation, Affiliated Hospital of Nanjing University of Chinese Medicine/Jiangsu Province Hospital of TCM, Nanjing 210029, China
- First Clinical Medical College of Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province
| | - Lingli Wang
- Department of Acupuncture-Moxibustion and Rehabilitation, Affiliated Hospital of Nanjing University of Chinese Medicine/Jiangsu Province Hospital of TCM, Nanjing 210029, China
- First Clinical Medical College of Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province
| | - Shumei Zhao
- Department of Acupuncture-Moxibustion and Rehabilitation, Affiliated Hospital of Nanjing University of Chinese Medicine/Jiangsu Province Hospital of TCM, Nanjing 210029, China
| | - Cong Zhang
- Department of Acupuncture-Moxibustion and Rehabilitation, Affiliated Hospital of Nanjing University of Chinese Medicine/Jiangsu Province Hospital of TCM, Nanjing 210029, China
| | - Hesheng Wang
- Department of Acupuncture-Moxibustion and Rehabilitation, Affiliated Hospital of Nanjing University of Chinese Medicine/Jiangsu Province Hospital of TCM, Nanjing 210029, China
- First Clinical Medical College of Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province
| | - Lanying Liu
- Department of Acupuncture-Moxibustion and Rehabilitation, Affiliated Hospital of Nanjing University of Chinese Medicine/Jiangsu Province Hospital of TCM, Nanjing 210029, China.
- First Clinical Medical College of Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province.
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Nasim ASM, Siddique AB, Devnath N, Zeba Z. Assessment of the prevalence and associated factors of lower back pain (LBP) among three different professionals in Bangladesh: Findings from a face-to-face survey. BMJ Open 2024; 14:e082849. [PMID: 38604644 PMCID: PMC11015216 DOI: 10.1136/bmjopen-2023-082849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 03/27/2024] [Indexed: 04/13/2024] Open
Abstract
OBJECTIVES This study aims to evaluate the prevalence and associated factors of lower back pain (LBP) among farmers, rickshaw pullers and office workers in Bangladesh, while also investigating potential contributors within these occupational groups. DESIGN This cross-sectional study aimed to determine the prevalence of LBP, associated factors and management procedures among farmers, rickshaw pullers and office workers in Bangladesh through face-to-face interviews. SETTING The study was conducted in different parts of the Bogura district in Bangladesh. PARTICIPANTS A total of 396 participants were included in the final analysis, all the participants were men and adult in age. MAIN OUTCOME MEASUREMENTS Data were collected using a semi-structured questionnaire based on previous research. Bivariate and multivariable logistic regression analyses were performed to identify significant associations. RESULTS The prevalence of LBP was found to be 42.7% among the participants. Farmers and rickshaw pullers had approximately four-times and three-times higher odds of experiencing LBP compared with office workers. Other significant factors associated with LBP included living in a nuclear family, having a normal body weight, lacking professional training, having a chronic disease, having a family history of LBP and experiencing numbness in the legs or feet. The majority of respondents sought medical attention and took medication for their LBP. CONCLUSION The study underscores occupational differences in LBP prevalence, emphasising the necessity for tailored interventions and occupational health policies. Identifying specific risk factors and management practices in these professions can aid in developing effective prevention strategies and enhancing healthcare services.
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Affiliation(s)
- A S M Nasim
- Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka -1342, Bangladesh
| | - Abu Bakkar Siddique
- Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka -1342, Bangladesh
- Centre for Advanced Research Excellence in Public Health, Savar, Dhaka-1342, Bangladesh
- International Centre for Research, Innovation, Training and Development (ICRITD), Dhaka, Bangladesh
- AMR Reference Laboratory (Research), Bangladesh Livestock Research Institute, Savar, Dhaka-1341, Bangladesh
- Health and Environmental Epidemiology Laboratory (HEEL), Jahangirnagar University, Savar, Dhaka-1342, Bangladesh
| | - Nishrita Devnath
- Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka -1342, Bangladesh
| | - Zebunnesa Zeba
- Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka -1342, Bangladesh
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Marcus JL, Westerhaus BD, Chernicki B, Giuffrida A. Basivertebral nerve ablation with concurrent lumbar laminotomy. BMJ Case Rep 2024; 17:e259695. [PMID: 38575334 PMCID: PMC11002411 DOI: 10.1136/bcr-2024-259695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024] Open
Abstract
Lumbar radiculopathy due to impingement of nerve roots from facet hypertrophy and/or disc herniation can often coincide with vertebrogenic low back pain. This is demonstrated on MRI with foraminal stenosis and Modic changes. We examine the potential of using a combination of basivertebral nerve ablation (BVNA) and lumbar laminotomy as an alternative to traditional spinal fusion in specific patient populations. This unique combination of surgical techniques has not been previously reported in the medical literature. We report a man in his late 30s with chronic low back pain and lumbar radiculopathy, treated with BVNA and concurrent laminotomy. The patient reported progressive improvements in his mobility and pain over the next 2 years. We discuss the advantages of using this technique for lumbar radiculopathy and Modic changes compared with conventional surgical modalities.
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Affiliation(s)
- Jason L Marcus
- Nova Southeastern University Dr Kiran C Patel College of Osteopathic Medicine, Clearwater, Florida, USA
- Cantor Spince Center, Interventional Spine, Paley Orthopedic & Spine Institute, Fort Lauderdale, Florida, USA
| | - Benjamin D Westerhaus
- Cantor Spince Center, Interventional Spine, Paley Orthopedic & Spine Institute, Fort Lauderdale, Florida, USA
| | - Brendan Chernicki
- Nova Southeastern University Dr Kiran C Patel College of Osteopathic Medicine, Clearwater, Florida, USA
| | - Anthony Giuffrida
- Cantor Spince Center, Interventional Spine, Paley Orthopedic & Spine Institute, Fort Lauderdale, Florida, USA
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Sima S, Chen X, Sheldrick K, Kuan J, Diwan AD. Reconsidering high intensity zones: its role in intervertebral disk degeneration and low back pain. Eur Spine J 2024; 33:1474-1483. [PMID: 38381388 DOI: 10.1007/s00586-024-08185-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 07/12/2023] [Accepted: 02/04/2024] [Indexed: 02/22/2024]
Abstract
PURPOSE High intensity zones (HIZ) in the lumbar intervertebral disk (IVD) can be associated with degenerative changes which may ultimately manifest as low back pain (LBP). However, the relationship between the prevalence of HIZ and lumbar degenerative parameters is still unclear. The purpose of this study was to determine the prevalence of HIZ in the lumbar spine, analyze the independent relationship between HIZ and lumbar degenerative parameters measured on MRI and X-ray and determine the association between HIZ and the presence of LBP. METHODS A retrospective review of MRI data, X-ray data, and radiology reports for 136 consecutively recruited patients, above 18-years-age and with both lumbar MRI and X-ray scans was conducted. 57 patients with HIZ were identified. Patients without HIZ (n = 79) made up the control group. RESULTS HIZ was prevalent in 41.9% of patients and in 11.0% of all lumbar IVDs. The odds of developing HIZ were 6.4 (Exp(B) 6.4, 95%CI [3.157-12.988]) and 3.0 (Exp(B) 3.0, 95%CI [1.603, 5.674]) times higher in IVDs with disk bulge/protrusion and nucleus degeneration, respectively. Odds of HIZ was also increased in disks with larger IVD angle (Exp(B) 1.1, 95%CI [1.034, 1.169]). The odds of patients presenting to imaging with LBP was 3.0 (OR 3.0, 95%CI [1.478-6.338]) times higher in the HIZ compared to the control group. CONCLUSIONS HIZ was prevalent in 41.9% of participants that were recruited in this study. Nucleus degeneration, disk bulge/protrusion and increased IVD angle were found to be independently associated with HIZ and since there is an increased likelihood of LBP, we posit that HIZ is likely a symptomatic and clinically meaningful diagnostic tool in the assessment of LBP.
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Affiliation(s)
- Stone Sima
- Spine Labs, St George and Sutherland Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Xiaolong Chen
- Spine Labs, St George and Sutherland Clinical School, University of New South Wales, Sydney, NSW, Australia.
- Department of Orthopaedic Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
| | - Kyle Sheldrick
- Spine Labs, St George and Sutherland Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Jeff Kuan
- St. George MRI, Healthcare Imaging, Kirk Place, Kogarah, NSW, Australia
| | - Ashish D Diwan
- Spine Labs, St George and Sutherland Clinical School, University of New South Wales, Sydney, NSW, Australia
- Spine Service, Department of Orthopaedic Surgery, St George and Sutherland Clinical School, University of New South Wales, Sydney, NSW, Australia
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Chiu AP, Chia C, Arendt-Nielsen L, Curatolo M. Lumbar intervertebral disc degeneration in low back pain. Minerva Anestesiol 2024; 90:330-338. [PMID: 38652452 DOI: 10.23736/s0375-9393.24.17843-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
Intervertebral disc degeneration is characterized by deterioration in structural support that is potentially followed by stimulated neuronal ingrowth, and dysfunction of cellular physiology in the disc. Discogenic low back pain originates from nociceptors within the intervertebral disc or the cartilage endplate. This narrative review examines the mechanisms of disc degeneration, the association between degeneration and pain, and the current diagnosis and treatment of discogenic low back pain. Mechanisms of disc degeneration include dysregulated homeostasis of the extracellular matrix of the disc, altered spine mechanics, DNA damage, oxidative stress, perturbed cell signaling pathways, and cellular senescence. Although disc degeneration is more common in individuals with low back pain than in asymptomatic ones, degeneration occurs in a large proportion of asymptomatic individuals. Therefore, degeneration itself is not sufficient to trigger low back pain. Imaging and discography are common diagnostic tools of discogenic low back pain but have limited validity to diagnose discogenic pain. Most of current treatments options are not specific to discogenic pain but are unspecific treatments of low back pain of any origin. There is an urgent need to clarify and distinguish the molecular mechanisms of discogenic pain from mechanisms of disc degeneration that are not involved in nociception. Future research should make use of current methods to study molecular mechanisms of human pain in comprehensively and quantitatively phenotyped patients with low back pain, with the objective to identify molecular triggers of discogenic pain and determine the relationship between molecular mechanisms, pain, and patient-relevant outcomes.
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Affiliation(s)
- Abby P Chiu
- Division of Pain Medicine, Department of Anesthesiology and Pain Medicine, Clinical Learning, Evidence And Research (CLEAR) Center for Musculoskeletal Research, University of Washington School of Medicine, Seattle, WA, USA
| | - Catherine Chia
- Division of Pain Medicine, Department of Anesthesiology and Pain Medicine, Clinical Learning, Evidence And Research (CLEAR) Center for Musculoskeletal Research, University of Washington School of Medicine, Seattle, WA, USA
| | - Lars Arendt-Nielsen
- Center for Neuroplasticity and Pain (CNAP), SMI, Aalborg University, School of Medicine, Aalborg, Denmark
- Department of Gastroenterology and Hepatology, Mech-Sense, Clinical Institute, Aalborg University Hospital, Aalborg, Denmark
- Steno Diabetes Center North Denmark, Clinical Institute, Aalborg University Hospital, Aalborg, Denmark
| | - Michele Curatolo
- Division of Pain Medicine, Department of Anesthesiology and Pain Medicine, Clinical Learning, Evidence And Research (CLEAR) Center for Musculoskeletal Research, University of Washington School of Medicine, Seattle, WA, USA -
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Morino S, Ishihara M, Umezaki F, Hatanaka H, Yamashita M, Aoyama T. History of pain around the lumbopelvic region during perinatal period: a prospective cohort study. Eur Spine J 2024; 33:1440-1446. [PMID: 38427055 DOI: 10.1007/s00586-024-08193-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 02/08/2024] [Accepted: 02/11/2024] [Indexed: 03/02/2024]
Abstract
PURPOSE Many women experience pain around the low back and pelvic girdle during/after pregnancy. These pains have different risk factors and require independent management strategies. Therefore, an epidemiological database is required to understand when each type of pain occurs, and how serious it could be. Thus, the history of pain in the lumbopelvic region throughout the perinatal period was investigated. METHODS The information of 170 women recruited at the obstetrics and gynecology clinics in Japan was collected at 12, 24, 30, and 36 weeks of pregnancy, in the early days after childbirth, and one month after childbirth. The presence and severity of sacroiliac joint pain, pubic pain, groin pain, and low back pain were assessed using a numerical rating scale. Descriptive statistics were used to determine changes in the prevalence of pain. In addition, the change in the severity of each type of pain was observed through descriptive statistics, by including only those who had pain. RESULTS The sacroiliac joint pain showed a twofold increase from 12 to 24 weeks, while the pubic pain suddenly increased after 24 weeks. The severity of pubic and groin pain increased sharply during pregnancy. Regarding low back pain, the change in the severity was lesser than the other pains. The sacroiliac joint pain was the highest among the four pains during pregnancy. CONCLUSION Each type of pain had a different incidence rate and a different time of onset and aggravation. These results help women and health professionals to manage, and prevent these harmful symptoms.
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Affiliation(s)
- Saori Morino
- Department of Rehabilitation Science, School of Medicine, Osaka Metropolitan University, 3-7-30 Habikino, Habikino-shi, Osaka, 583-8555, Japan.
| | | | | | | | | | - Tomoki Aoyama
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Shim GY, Kim MS, Kim HJ, Park Y, Kim SW, Yoo MC. A 42-year-old patient with renal cell carcinoma presenting as low back pain: A case report. Medicine (Baltimore) 2024; 103:e37639. [PMID: 38552083 PMCID: PMC10977550 DOI: 10.1097/md.0000000000037639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 02/27/2024] [Indexed: 04/02/2024] Open
Abstract
RATIONALE Renal cell carcinoma (RCC) is the most common renal neoplasm, accounting for 2.4% of all cancers in Korea. Although the usual clinical manifestations of RCC include flank pain, hematuria, and palpable mass, RCC is generally characterized by a lack of early warning signs and is mostly discovered incidentally in advanced stage. This case report describes a 42-year-old Korean man diagnosed with giant RCC who presented with simple back pain. PATIENT CONCERNS The clinical manifestation of a 42-year-old Korean man was chronic back pain. DIAGNOSES Contrast-enhanced computed tomography showed a 19.1-cm sized heterogeneous enhancing mass on the right kidney and tumor thrombosis extending into inferior vena cava. INTERVENTION Due to the large size of the tumor and extensive tumor thrombosis, the multidisciplinary team decided to administer neoadjuvant chemotherapy and an anticoagulant. Following 12 cycles of treatment with nivolumab and cabozantinib, he underwent a right radical nephrectomy with an adrenalectomy and tumor thrombectomy. OUTCOMES Treatment was successful and posttreatment he started a cancer rehabilitation program. He was followed-up as an outpatient and no longer complains of back pain. LESSONS RCC can manifest clinically as back pain, with diagnosis being difficult without appropriate imaging modalities. RCC should be included in the differential diagnosis of patients with low back pain, even at a young age.
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Affiliation(s)
- Ga Yang Shim
- Department of Physical and Rehabilitation Medicine, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Min-Su Kim
- Department of Physical and Rehabilitation Medicine, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Hong Jun Kim
- Division of Medical Oncology-Hematology, Department of Medicine, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Yewan Park
- Department of Internal Medicine, Kyung Hee University Medical Center, Seoul, Korea
| | - So-Woon Kim
- Department of Pathology, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Myung Chul Yoo
- Department of Physical and Rehabilitation Medicine, College of Medicine, Kyung Hee University, Seoul, Korea
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Chen K, Yang FG, Luo YC, He RJ. [Effect and complication among different kinds of spinal endoscopic surgery for lumbar disc herniation]. Zhongguo Gu Shang 2024; 37:228-34. [PMID: 38515408 DOI: 10.12200/j.issn.1003-0034.20220860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
OBJECTIVE To compare clinical efficacy and complication rate of percutaneous endoscopic transforaminal discectomy(PETD),percutaneous endoscopic interlaminar discectomy (PEID) and unilateral biportal endoscopic (UBE) in treating single-segment lumbar disc herniation(LDH). METHODS From October 2019 to August 2021,121 LDH patients with single-segment treated by spinal endoscopy were retrospectively analyzed and divided into three groups. In PETD group,there were 48 patients,including 19 males and 29 females,aged from 18 to 72 years old with an average of (44.0±13.9) years old;3 patients with L3,4 segments,27 patients with L4,5 segments,and 18 patients with L5S1 segments. In PEID group,there were 43 patients,including 23 males and 20 females,aged from 20 to 69 years old with an average of (40.1±12.1) years old;1 patient with L3,4 segments,15 patients with L4,5 segments,and 27 patients with L5S1 segments. In UBE group,there were 30 patients,including 12 males and 18 females,aged from 29 to 72 years old with an average of (41.2±15.0) years old;1 patient with L3,4 segments,18 patients with L4,5 segments,and 11 patients with L5S1 segments. Operation time,blood loss,fluoroscopy times and complications among three groups were observed and compared. Before opertaion,3 months after operation and at the latest follow-up,visual analogue scale (VAS) was used to evaluate low back pain and lower extremity pain,Oswestry disfunction index (ODI) was used to evaluate lumbar function,and modified MacNab was used to evaluate clinical efficacy at the latest follow-up. RESULTS All patients were performed endoscopic spinal surgery completly and were followed up for at least 12 months. One patient occurred dural sac rupture both in PETD and PEID group,and dural sac rupture was small,and there was no obvious discomfort after operation. Two patients were occurred intraoperative rupture of dural sac in UBE group. One patient was occurred cerebrospinal fluid leakage after operation,and was improved after rest in supine position and fluid rehydration. One patient without no significant postoperative discomfort. (1)There were no significant difference in operating time,blood loss and hospital stay between PETD and PEID group (P>0.05),while UBE group was higher than those of PETD and PEID group (P<0.05). There was no statistical significance in fluoroscopy times between PEID and UBE group (P>0.05),but PETD group was higher than that of PEID and UBE group (P<0.05). (2)VAS of low back pain at 3 months after operation in UBE group was higher than that in PETD and PEID group (P<0.05),but there was no significant difference between PETD and PEID group (P>0.05). At the latest follow-up,there was no significant difference in VAS of low back pain among three groups (P>0.05). (3)Lower extremity pain of VAS and ODI among 3 groups after operation were significantly improved at all time points compared with those before opertaion(P<0.05),and there were no statistical significance between groups (P>0.05),and there were no statistical significance in interaction between different time points and operation groups (P>0.05). (4) At the latest follow-up,according to the modified MacNab standard,the results of PETD group were excellent in 27 patients,good in 16 patients,moderate in 4 patients,poor in 1 patient;in PEID group,27 patients got excellent result,12 good,3 moderate,and 1 poor;in UBE group,16 patients got excellent,10 good,2 moderate,and 2 poor. There was no significant difference among three groups (χ2=0.308,P>0.05). Recurrence of lumbar disc herniation occurred in 1 patient among each three groups,symptoms were improved in 2 patients after symptomatic treatment,and 1 patient was treated in other hospitals. CONCLUSION PETD,PEID and UBE techniques could achieve good early clinical effects in treating lumbar disc herniation with similar complication rates. Both of PETD and PEID are single-channel minimally invasive surgery,with mild intraoperative tissue damage and quick postoperative recovery; while intraoperative fluoroscopy of PETD was relatively more frequent, and PEID was more suitable for L5S1 segment;UBE is a two-channel surgery,in which the intraoperative soft tissue damage is more severe,but exposure is broad,which is more suitable for complex cases.
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Affiliation(s)
- Kang Chen
- Department of Orthopaedics, the First People's Hospital of Zigong, Zigong 643000, Sichuan, China
| | - Fu-Guo Yang
- Department of Orthopaedics, the First People's Hospital of Zigong, Zigong 643000, Sichuan, China
| | - Yuan-Chao Luo
- Department of Orthopaedics, the First People's Hospital of Zigong, Zigong 643000, Sichuan, China
| | - Ren-Jian He
- Department of Orthopaedics, the First People's Hospital of Zigong, Zigong 643000, Sichuan, China
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Yoshinaga T, Kim K, Tajiri T, Fujihara F, Isobe M, Abe H, Isu T. Middle cluneal nerve entrapment sites in the surgical field. Acta Neurochir (Wien) 2024; 166:142. [PMID: 38499903 DOI: 10.1007/s00701-024-06031-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 02/22/2024] [Indexed: 03/20/2024]
Abstract
INTRODUCTION Middle cluneal nerve (MCN) entrapment around the sacroiliac joint elicits low back pain (LBP). For surgical decompression to be successful, the course of the MCN must be known. We retrospectively studied the MCN course in 15 patients who had undergone MCN neurolysis. METHODS Enrolled in this retrospective study were 15 patients (18 sides). We inspected their surgical records and videos to determine the course of the entrapped MCN. The area between the posterior superior- and the posterior inferior iliac spine was divided into areas A-D from the rostral side. The MCN transit points were identified at the midline and the lateral edge connecting the posterior superior- and posterior inferior iliac spine. Before and 6 months after surgery, the patients recorded the degree of LBP on the numerical rating scale and the Roland-Morris Disability Questionnaire. RESULTS We decompressed 24 MCNs. The mean number was 1.3 nerves per patient (range 1-2). The MCN course was oblique in the cranio-caudal direction; the nerve tended to be observed in areas C and D. In six patients (40%), we detected two MCN branches, they were in the same area and adjacent. Postoperatively, LBP was improved significantly in all patients. CONCLUSION Between the posterior superior- and the posterior inferior iliac spine, the MCN ran obliquely in the cranio-caudal direction; it was prominent in areas on the caudal side. In six (40%) patients, we decompressed two adjacent MCNs. Our findings are useful for MCN decompression surgery.
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Affiliation(s)
- Taisuke Yoshinaga
- Department of Neurosurgery, Kushiro Rosai Hospital, 13-25, Nakazono-cho, Kushiro City, Hokkaido, 085-0052, Japan.
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan.
| | - Kyongsong Kim
- Department of Neurological Surgery, Chiba Hokuso Hospital, Nippon Medical School, Chiba, Japan
| | - Takato Tajiri
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Fumiaki Fujihara
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Masanori Isobe
- Department of Neurosurgery, Kushiro Rosai Hospital, 13-25, Nakazono-cho, Kushiro City, Hokkaido, 085-0052, Japan
| | - Hiroshi Abe
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Toyohiko Isu
- Department of Neurosurgery, Kushiro Rosai Hospital, 13-25, Nakazono-cho, Kushiro City, Hokkaido, 085-0052, Japan
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Park CH, Lee SH. Relationships between the Spinal Dural Pulsations and the Short-Term Efficacy of Lumbar Epidural Steroid Injection. Pain Res Manag 2024; 2024:1824269. [PMID: 38528984 PMCID: PMC10963105 DOI: 10.1155/2024/1824269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 03/05/2024] [Accepted: 03/13/2024] [Indexed: 03/27/2024]
Abstract
Background Lumbar spinal stenosis (LSS) causes low back pain, leg pain, numbness in the leg, and neurogenic intermittent claudication. Epidural steroid injection (ESI) has been used for treating spinal stenosis symptoms. We hypothesized that dural pulsation was variable for lumbar spinal stenosis. In cases of the presence of dural pulsation, the pain relief after the ESI was better than in the absence of dural pulsation. This study aimed at investigating the relationships between the presence or absence of spinal dural pulsations and the efficacy of ESI. Methods A total of 71 patients were enrolled in this prospective study. Prior to the ESI, the dural pulsation was measured using a 5-1 MHz array ultrasound transducer. The visual analogue scale (VAS) score was measured pre-ESI and 2 weeks post-ESI and 4 weeks post-ESI. At 4 weeks post-ESI, dural pulsation was rechecked. Results The VAS scores improved after the ESI procedure regardless of the presence or absence of dural pulsation. There was a correlation between the pulsation of the dura and post-ESI VAS scores. However, VAS was not significantly different for different grades of stenosis. Conclusion The ESI was effective in patients with spinal stenosis in short-term follow-up. Dural pulsation of the spinal cord was a positive predictive factor for the ESI effect, but the grade of spinal stenosis severity had no effect on the effectiveness of ESI.
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Affiliation(s)
- Chan Hong Park
- Department of Anesthesiology and Pain Medicine, Daegu Wooridul Spine Hospital, Daegu, Republic of Korea
| | - Sang Ho Lee
- Department of Neurosurgery, Chungdam Wooridul Spine Hospital, Seoul, Republic of Korea
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韩 国, 马 力, 程 永, 郑 科, 祁 家, 董 洲, 张 之, 姚 登. [Comparison of effectiveness between unilateral biportal endoscopic and uniportal interlaminar endoscopic decompression in the treatment of lumbar spinal stenosis]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2024; 38:324-330. [PMID: 38500426 PMCID: PMC10982040 DOI: 10.7507/1002-1892.202312029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/30/2024] [Accepted: 01/30/2024] [Indexed: 03/20/2024]
Abstract
Objective To compare the effectiveness between unilateral laminotomy and bilateral decompression (ULBD) with unilateral biportal endoscopy (UBE) and uniportal interlaminar endoscopy (UIE) in the treatment of lumbar spinal stenosis. Methods A clinical data of 52 patients with lumbar spinal stenosis, who met the selection criteria and treated with ULBD between March 2021 and November 2022, was retrospectively analyzed. The patients were allocated into UBE group (23 cases) and UIE group (29 cases) according to the surgical methods. There was no significant difference ( P>0.05) in age, gender, body mass index, surgical segment, type of lumbar stenosis, and preoperative visual analogue scale (VAS) score of low back pain, VAS score of leg pain, Oswestry disability index (ODI), disc height, and dural sac area between the two groups. Perioperative indexes (incision length, operation time, hospital stay, and surgical complications), clinical indicators (VAS score of low back pain, VAS score of leg pain, and ODI before operation and at 3 days, 1 month, 6 months, and 12 months after operation), and imaging indicators (disc height and dural sac area before operation and at 1, 12 months after operation, and dural sac expansion area) were recorded and compared between the two group. Results All operations in both groups were successfully completed. Compared with the UIE group, the UBE group had shorter operation time and longer incision length, with significant differences ( P<0.05). But there was no significant difference in hospital stay and incidence of complications between the two groups ( P>0.05). All patients were followed up 12-20 months (mean, 14 months). The VAS scores of low back pain and leg pain and ODI after operation significantly improved when compared with preoperative values ( P<0.05), and there was no significant difference in the above indicators between different time points after operation ( P>0.05). There was no significant difference between the two groups at different time points ( P>0.05). Imaging examination showed that there was no significant difference in disc height between the two groups at different time points after operation ( P>0.05). However, the dural sac area and dural sac expansion area were significantly larger in the UBE group than in the UIE group ( P<0.05). Conclusion ULBD with UBE and UIE can achieve satisfactory effectiveness in the treatment of lumbar spinal stenosis. But the former has more thorough decompression and better dural sac expansion than the latter.
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Affiliation(s)
- 国嵩 韩
- 合肥市第一人民医院脊柱外科(合肥 230061)Department of Spine Surgery, Hefei First People’s Hospital, Hefei Anhui, 230061, P. R. China
| | - 力 马
- 合肥市第一人民医院脊柱外科(合肥 230061)Department of Spine Surgery, Hefei First People’s Hospital, Hefei Anhui, 230061, P. R. China
| | - 永红 程
- 合肥市第一人民医院脊柱外科(合肥 230061)Department of Spine Surgery, Hefei First People’s Hospital, Hefei Anhui, 230061, P. R. China
| | - 科 郑
- 合肥市第一人民医院脊柱外科(合肥 230061)Department of Spine Surgery, Hefei First People’s Hospital, Hefei Anhui, 230061, P. R. China
| | - 家龙 祁
- 合肥市第一人民医院脊柱外科(合肥 230061)Department of Spine Surgery, Hefei First People’s Hospital, Hefei Anhui, 230061, P. R. China
| | - 洲 董
- 合肥市第一人民医院脊柱外科(合肥 230061)Department of Spine Surgery, Hefei First People’s Hospital, Hefei Anhui, 230061, P. R. China
| | - 之栋 张
- 合肥市第一人民医院脊柱外科(合肥 230061)Department of Spine Surgery, Hefei First People’s Hospital, Hefei Anhui, 230061, P. R. China
| | - 登攀 姚
- 合肥市第一人民医院脊柱外科(合肥 230061)Department of Spine Surgery, Hefei First People’s Hospital, Hefei Anhui, 230061, P. R. China
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Sha S, Chen LJ, Brenner H, Schöttker B. Serum 25-Hydroxyvitamin D Status and Vitamin D Supplements Use Are Not Associated with Low Back Pain in the Large UK Biobank Cohort. Nutrients 2024; 16:806. [PMID: 38542718 PMCID: PMC10974643 DOI: 10.3390/nu16060806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 03/05/2024] [Accepted: 03/07/2024] [Indexed: 04/01/2024] Open
Abstract
Longitudinal studies assessing the association of vitamin D deficiency, defined by serum 25-hydroxyvitamin D levels < 30 nmol/L, and vitamin D supplement (VDS) use with low back pain (LBP) are sparse. This investigation assessed the cross-sectional and longitudinal association of vitamin D status and VDS use with LBP among 135,934 participants from the UK Biobank cohort. Approximately 21.6% of the participants had vitamin D deficiency, while only 4% regularly took VDS. In the month before study enrollment, 3.8% of the population reported experiencing LBP. An additional 3.3% of the population were diagnosed with LBP by their general practitioners for the first time during a median follow-up of 8.5 years. Vitamin D deficiency and VDS use were cross-sectionally associated with LBP in age- and sex-adjusted models, but these associations were not evident in comprehensively adjusted models. In longitudinal analyses, both vitamin D deficiency and VDS use were not associated with LBP in any model after correction for multiple testing. In conclusion, not unexpectedly due to the fact that LBP is multifactorial, our findings provide no evidence for the role of the vitamin D status in the etiology of LBP.
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Affiliation(s)
- Sha Sha
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120 Heidelberg, Germany; (S.S.); (L.-J.C.); (H.B.)
- Faculty of Medicine, University of Heidelberg, Im Neuenheimer Feld 672, 69120 Heidelberg, Germany
| | - Li-Ju Chen
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120 Heidelberg, Germany; (S.S.); (L.-J.C.); (H.B.)
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120 Heidelberg, Germany; (S.S.); (L.-J.C.); (H.B.)
- Division of Preventive Oncology, National Center for Tumor Diseases (NCT), Im Neuenheimer Feld 581, 69120 Heidelberg, Germany
| | - Ben Schöttker
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120 Heidelberg, Germany; (S.S.); (L.-J.C.); (H.B.)
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Munda M, Velnar T. Stem cell therapy for degenerative disc disease: Bridging the gap between preclinical promise and clinical potential. Biomol Biomed 2024; 24:210-218. [PMID: 37669102 PMCID: PMC10950333 DOI: 10.17305/bb.2023.9518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 08/23/2023] [Accepted: 09/04/2023] [Indexed: 09/06/2023]
Abstract
Stem cell therapy has gained attention in the field of regenerative medicine due to its potential to restore damaged tissue. This article focuses on the application of stem cell therapy for treating spinal pathologies, particularly intervertebral disc degeneration. Disc degeneration is a major cause of low back pain and is characterized by changes in the matrix and inflammation. Animal studies have demonstrated that the implantation of mesenchymal stem cells (MSCs) yields promising results, including increased disc height, improved hydration, and reduced inflammation. However, the number of clinical trials remains limited, necessitating further research to optimize MSCs therapy. Although preclinical studies offer valuable insights, caution is needed when extrapolating these findings to clinical practice. Stem cell therapy still faces multiple challenges, such as the durability and survival of MSCs upon implantation, uncertain pathways to discogenic differentiation, and the adverse impact of a harsh microenvironment on cell survival. The avascular nature of the intervertebral disc and dynamic loading conditions also affect the adaptation of transplanted cells. Despite these obstacles, stem cell therapy holds promise as a potential treatment for disc degeneration, and ongoing research aims to fill the current gap in conclusive data.
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Affiliation(s)
- Matic Munda
- Department of Neurosurgery, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Tomaz Velnar
- Department of Neurosurgery, University Medical Centre Ljubljana, Ljubljana, Slovenia
- AMEU-AMC Maribor, Maribor, Slovenia
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Trager RJ, Baumann AN, Perez JA, Dusek JA, Perfecto RPT, Goertz CM. Association between chiropractic spinal manipulation and cauda equina syndrome in adults with low back pain: Retrospective cohort study of US academic health centers. PLoS One 2024; 19:e0299159. [PMID: 38466710 PMCID: PMC10927125 DOI: 10.1371/journal.pone.0299159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 02/06/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND Cauda equina syndrome (CES) is a lumbosacral surgical emergency that has been associated with chiropractic spinal manipulation (CSM) in case reports. However, identifying if there is a potential causal effect is complicated by the heightened incidence of CES among those with low back pain (LBP). The study hypothesis was that there would be no increase in the risk of CES in adults with LBP following CSM compared to a propensity-matched cohort following physical therapy (PT) evaluation without spinal manipulation over a three-month follow-up period. METHODS A query of a United States network (TriNetX, Inc.) was conducted, searching health records of more than 107 million patients attending academic health centers, yielding data ranging from 20 years prior to the search date (July 30, 2023). Patients aged 18 or older with LBP were included, excluding those with pre-existing CES, incontinence, or serious pathology that may cause CES. Patients were divided into two cohorts: (1) LBP patients receiving CSM or (2) LBP patients receiving PT evaluation without spinal manipulation. Propensity score matching controlled for confounding variables associated with CES. RESULTS 67,220 patients per cohort (mean age 51 years) remained after propensity matching. CES incidence was 0.07% (95% confidence intervals [CI]: 0.05-0.09%) in the CSM cohort compared to 0.11% (95% CI: 0.09-0.14%) in the PT evaluation cohort, yielding a risk ratio and 95% CI of 0.60 (0.42-0.86; p = .0052). Both cohorts showed a higher rate of CES during the first two weeks of follow-up. CONCLUSIONS These findings suggest that CSM is not a risk factor for CES. Considering prior epidemiologic evidence, patients with LBP may have an elevated risk of CES independent of treatment. These findings warrant further corroboration. In the meantime, clinicians should be vigilant to identify LBP patients with CES and promptly refer them for surgical evaluation.
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Affiliation(s)
- Robert J. Trager
- Connor Whole Health, University Hospitals Cleveland Medical Center, Cleveland, Ohio, United States of America
- Department of Family Medicine and Community Health, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America
- Department of Biostatistics and Bioinformatics Clinical Research Training Program, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Anthony N. Baumann
- Department of Rehabilitation, University Hospitals Cleveland Medical Center, Cleveland, Ohio, United States of America
- College of Medicine, Northeast Ohio Medical University, Rootstown, Ohio, United States of America
| | - Jaime A. Perez
- Clinical Research Center, University Hospitals Cleveland Medical Center, Cleveland, Ohio, United States of America
| | - Jeffery A. Dusek
- Department of Family Medicine and Community Health, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America
| | - Romeo-Paolo T. Perfecto
- Department of Biostatistics and Bioinformatics Clinical Research Training Program, Duke University School of Medicine, Durham, North Carolina, United States of America
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, United States of America
- Duke Clinical Research Institute, Durham, North Carolina, United States of America
| | - Christine M. Goertz
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, United States of America
- Duke Clinical Research Institute, Durham, North Carolina, United States of America
- Robert J. Margolis, MD, Center for Health Policy, Duke University, Durham, North Carolina, and Washington, District of Columbia, United States of America
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Güngör E, Karakuzu Güngör Z. Obstetric-related lower back pain: the effect of number of pregnancy on development of chronic lower back pain, worsening of lumbar disc degeneration and alteration of lumbar sagittal balance. J Orthop Surg Res 2024; 19:174. [PMID: 38454457 PMCID: PMC10921574 DOI: 10.1186/s13018-024-04647-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 02/26/2024] [Indexed: 03/09/2024] Open
Abstract
OBJECTIVE This study aims to determine whether the number of pregnancies contributes to the development of chronic lower back pain, worsening the lumbar disc degeneration and altering the normal lumbar sagittal balance. MATERIAL METHOD There are 134 ladies participated in this study. They are divided into two groups based on their number of pregnancies (parity). All patients with chronic back pain were assessed using a visual analog scale for pain and the Oswestry Disability Index for their functional status assessment. Degenerative signs in lumbar MRI, which are Modic changes and the presence of Schmorl's node, were evaluated. Besides that, the sagittal balance of the lumbar spine was also measured via an erect lumbar plain radiograph. RESULTS Patients with parities < 5 were included in Group 1, and those with parities ≥ 5 in Group 2. The mean visual analog scale score of Group 2 was significantly higher than that of Group 1 (8.42 ± 1.34 vs.6.50 ± 1.61). The mean Oswestry Disability Index score in Group 2 was significantly higher than that of Group 1 (29.87 ± 6.75 vs.18.41 ± 7.97). This relationship between the groups in terms of Modic change was statistically significant. The relationship between the groups regarding the presence of Schmorl's nodes was also statistically significant. The difference between the groups in terms of sagittal balance parameters was not statistically significant. CONCLUSION Chronic lower back pain is significantly worse and associated with more disability in patients with more than five previous pregnancies. MRI degenerative changes are also significantly higher in these grand multipara groups.
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Affiliation(s)
- Erdal Güngör
- Batman Training and Research Hospital, Department of Orthopaedic and Traumatology, Batman, Turkey.
| | - Zeynep Karakuzu Güngör
- Batman Training and Research Hospital, Department of Physical Medicine and Rehabilitation, Batman, Turkey
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Takagi Y, Yamada H, Ebara H, Hayashi H, Inatani H, Toyooka K, Mori A, Kitano Y, Ryu Y, Nakanami A, Yahata T, Tsuchiya H. Conjoined lumbosacral nerve root: a case report. J Med Case Rep 2024; 18:91. [PMID: 38448995 PMCID: PMC10918913 DOI: 10.1186/s13256-024-04415-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 01/26/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND In patients with conjoined nerve roots, hemilaminectomy with sufficient exposure of the intervertebral foramen or lateral recess is required to prevent destabilization and ensure correct mobility of the lumbosacral spine. To the best of our knowledge, no case reports have detailed the long-term course of conjoined nerve roots after surgery. CASE PRESENTATION We report the case of a 51-year-old Japanese man with a conjoined nerve root. The main symptoms were acute low back pain, radiating pain, and right leg muscle weakness. Partial laminectomy was performed with adequate exposure to the conjoined nerve root. The symptoms completely resolved immediately after surgery. However, the same symptoms recurred 7 years postoperatively. The nerve root was compressed because of foraminal stenosis resulting from L5-S disc degeneration. L5-S transforaminal lumbar interbody fusion was performed on the contralateral side because of an immobile conjoined nerve root. At 44 months after the second surgery, the patient had no low back pain or radiating pain, and the muscle weakness in the right leg had improved. CONCLUSIONS This is the first report of the long-term course of conjoined nerve root after partial laminectomy. When foraminal stenosis occurs after partial laminectomy, transforaminal lumbar interbody fusion from the contralateral side may be required because of an immobile conjoined nerve root.
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Affiliation(s)
- Yasutaka Takagi
- Department of Orthopedic Surgery, Tonami General Hospital, 1-61 Shintomi-Cho, Tonami City, Toyama, 939-1395, Japan.
| | - Hiroshi Yamada
- Department of Orthopedic Surgery, Tonami General Hospital, 1-61 Shintomi-Cho, Tonami City, Toyama, 939-1395, Japan
| | - Hidehumi Ebara
- Department of Orthopedic Surgery, Tonami General Hospital, 1-61 Shintomi-Cho, Tonami City, Toyama, 939-1395, Japan
| | - Hiroyuki Hayashi
- Department of Orthopedic Surgery, Tonami General Hospital, 1-61 Shintomi-Cho, Tonami City, Toyama, 939-1395, Japan
| | - Hiroyuki Inatani
- Department of Orthopedic Surgery, Tonami General Hospital, 1-61 Shintomi-Cho, Tonami City, Toyama, 939-1395, Japan
| | - Kazu Toyooka
- Department of Orthopedic Surgery, Tonami General Hospital, 1-61 Shintomi-Cho, Tonami City, Toyama, 939-1395, Japan
| | - Akari Mori
- Department of Orthopedic Surgery, Tonami General Hospital, 1-61 Shintomi-Cho, Tonami City, Toyama, 939-1395, Japan
| | - Yoshiyuki Kitano
- Department of Orthopedic Surgery, Tonami General Hospital, 1-61 Shintomi-Cho, Tonami City, Toyama, 939-1395, Japan
| | - Yasuji Ryu
- Department of Radiology, Tonami General Hospital, 1-61 Shintomi-Cho, Tonami City, Toyama, 939-1395, Japan
| | - Aki Nakanami
- Department of Rehabilitation Medicine, Tonami General Hospital, 1-61 Shintomi-Cho, Tonami City, Toyama, 939-1395, Japan
| | - Tetsutaro Yahata
- Department of Rehabilitation Medicine, Kanazawa University Hospital, 13-1 Takara-Machi, Kanazawa City, Ishikawa, 920-8641, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopedic Surgery, Graduate School of Medicine, Kanazawa University, 13-1 Takara-Machi, Kanazawa City, Ishikawa, 920-8641, Japan
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Abel F, Altorfer FCS, Rohatgi V, Gibbs W, Chazen JL. Imaging of Discogenic and Vertebrogenic Pain. Radiol Clin North Am 2024; 62:217-228. [PMID: 38272616 DOI: 10.1016/j.rcl.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
Chronic low back pain is a major source of pain and disability globally involving multifactorial causes. Historically, intervertebral disc degeneration and disruption have been associated as primary back pain triggers of the anterior column, termed "discogenic pain." Recently, the vertebral endplates have been identified as another possible pain trigger of the anterior column. This "endplate-driven" model, defined "vertebrogenic pain," is often interconnected with disc degeneration. Diagnosis of vertebrogenic and discogenic pain relies on imaging techniques that isolate pain generators and exclude comorbid conditions. Traditional methods, like radiographs and discography, are augmented by more sensitive methods, including SPECT, CT, and MRI. Morphologic MRI is pivotal in revealing indicators of vertebrogenic (eg, Modic endplate changes) and discogenic pain (eg, disc degeneration and annular fissures). More advanced methods, like ultra-short-echo time imaging, and quantitative MRI further amplify MRI's accuracy in the detection of painful endplate and disc pathology. This review explores the pathophysiology of vertebrogenic and discogenic pain as well as the impact of different imaging modalities in the diagnosis of low back pain. We hope this information can help identify patients who may benefit from personalized clinical treatment and image-guided therapies.
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Affiliation(s)
- Frederik Abel
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 East 70th Street, NY 10021, USA
| | - Franziska C S Altorfer
- Department of Spine Surgery, Hospital for Special Surgery, 535 East 70th Street, NY 10021, USA; Department of Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Forchstrasse 340, Zurich 8008, Switzerland
| | - Varun Rohatgi
- Department of Radiology, Weill Cornell Medicine, 525 East 68th Street, NY 10065, USA
| | - Wende Gibbs
- Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 350 West Thomas Road, Phoenix, AZ 85013, USA
| | - Joseph Levi Chazen
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 East 70th Street, NY 10021, USA.
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21
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Segar AH, Baroncini A, Urban JPG, Fairbank J, Judge A, McCall I. Obesity increases the odds of intervertebral disc herniation and spinal stenosis; an MRI study of 1634 low back pain patients. Eur Spine J 2024; 33:915-923. [PMID: 38363366 DOI: 10.1007/s00586-024-08154-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 10/13/2023] [Accepted: 01/20/2024] [Indexed: 02/17/2024]
Abstract
PURPOSE The objective of this study was to examine the relationships between BMI and intervertebral disc degeneration (DD), disc herniation (DH) and spinal stenosis (SS) using a large, prospectively recruited and heterogeneous patient population. METHODS Patients were recruited through the European Genodisc Study. An experienced radiologist scored MRI images for DD, DH and SS. Multivariate linear and logistic regression analyses were used to model the relationship between these variables and BMI with adjustment for patient and MRI confounders. RESULTS We analysed 1684 patients with a mean age of 51 years and BMI of 27.2 kg/m2.
The mean DD score was 2.6 (out of 5) with greater DD severity with increasing age (R2 = 0.44). In the fully adjusted model, a 10-year increase in age and a 5 kg/m2 increase in BMI were associated, respectively, with a 0.31-unit [95% CI 0.29,0.34] and 0.04-unit [CI 0.01,0.07] increase in degeneration. Age (OR 1.23 [CI 1.06,1.43]) and BMI (OR 2.60 [CI 2.28,2.96]) were positively associated with SS. For DH, age was a negative predictor (OR 0.70 [CI 0.64,0.76]) but for BMI (OR 1.19 [CI 1.07,1.33]), the association was positive. BMI was the strongest predictor of all three features in the upper lumbar spine. CONCLUSIONS While an increase in BMI was associated with only a slight increase in DD, it was a stronger predictor for DH and SS, particularly in the upper lumbar discs, suggesting weight loss could be a useful strategy for helping prevent disorders associated with these pathologies.
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Affiliation(s)
- Anand H Segar
- Botnar Institute of Musculoskeletal Sciences, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, UK
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK
| | | | - Jocelyn P G Urban
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK
| | - Jeremy Fairbank
- Botnar Institute of Musculoskeletal Sciences, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Andrew Judge
- Centre for Statistics in Medicine, Nuffield, Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, University of Oxford, Oxford, UK
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Learning and Research Building, Level 1, Southmead Hospital, Bristol, UK
| | - Iain McCall
- Department of Radiology, Robert Jones and Agnes Hunt Hospital, Oswestry, UK
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22
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Rabanal Llevot JM, Muñoz Alonso A, Taborga Echevarría A, Martínez Agueros JA, Maldonado Vega S. Efficacy of epidural infiltration in the management of pain and disability due to acute and subacute lumbosacral radiculopathy. Neurocirugia (Astur : Engl Ed) 2024; 35:64-70. [PMID: 37838225 DOI: 10.1016/j.neucie.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 07/19/2023] [Indexed: 10/16/2023]
Abstract
BACKGROUND AND OBJECTIVE Epidural infiltrations are used for treatment of low back pain and sciatica. Linked to lumbar radiculopathy (lumbosacral radicular syndrome). This study evaluates the efficacy of epidural infiltration by different routes to reduce pain intensity, disability and return to work. METHODS Is a prospective observational study in one hundred consecutive patients sent to pain unit for severe lumbo-sacral radiculopaty. We analyze the efficacy on pain relief (Visual Analogue Scale) and funcional status at two weeks, one month, and three months after epidural injection of local anesthetics and esteroids with differents approachs (interlaminar, caudal and transforaminal). RESULTS Ninety nine patients (46.5% men, 53.5 women) were finally enrrolled in the study. Mean age was 57.47 ± 11.1 years. The caudal approach was used in 58.6% patients, 23.2% transforaminal approach, and 18.2% interlaminar approach. A significant pain relief was found in all times studied (EAV 7.48 ± 1.5 basal; 6.2 ± 0,9 at 15 days; 6.3 ± 1.2 at one month; 6.15 ± 1.3 at 3 months, p < 0.05). Transforaminal approach was superior to caudal or interlaminal. Seventy percent in time off work patients returned to work after epidural inyections. CONCLUSIONS Epidural local anesthetics with esteroids injections for lumbo-sacral radiculopathy were effective for low back pain, improved functional status and promoted return to work. Transforaminal approach is superior to others.
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Affiliation(s)
- Jose Manuel Rabanal Llevot
- Unidad del Dolor, Servicio de Anestesiología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain.
| | - Amaia Muñoz Alonso
- Unidad del Dolor, Servicio de Anestesiología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
| | - Alberto Taborga Echevarría
- Unidad del Dolor, Servicio de Anestesiología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
| | - Jose Angel Martínez Agueros
- Unidad de Raquis, Servicio de Neurocirugía, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
| | - Sergio Maldonado Vega
- Unidad del Dolor, Servicio de Anestesiología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
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23
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Nakamae T, Kamei N, Yamada K, Fujimoto Y, Maruyama T, Nakao K, Farid F, Fukui H, Adachi N. Short-segment spinal fusion for chronic low back pain with bone marrow edema adjacent to the vertebral endplate in adult spinal deformity. Eur Spine J 2024; 33:1061-1068. [PMID: 38072862 DOI: 10.1007/s00586-023-08028-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 09/18/2023] [Accepted: 10/25/2023] [Indexed: 03/19/2024]
Abstract
PURPOSE Corrective long spinal fusion is a widely accepted surgical method for patients with adult spinal deformities. However, instrumented long fusion is associated with a significant risk of complications. Therefore, we aimed to assess the success of short-segment spinal fusion, particularly for bone marrow edema (BME) adjacent to the vertebral endplate, in patients with low back pain (LBP) and spinal deformity. METHODS A prospective study was performed at multiple hospitals wherein we monitored patients with spinal deformities and accompanying LBP. Patients aged ≥ 50 years with a minimum LBP severity score of 40 mm on the visual analog scale (VAS) were included in the study. We also included patients with lumbar BME on magnetic resonance imaging. Short spinal fusion was performed on segments with BME. Clinical evaluations of LBP on VAS and Oswestry Disability Index (ODI), and radiological parameters for sagittal vertical axis (SVA), pelvic incidence (PI), lumbar lordosis (LL) and pelvic tilt (PT) were carried out. RESULTS Overall, 35 patients (22 men and 13 women), with a mean age of 66.7 years and a mean follow-up period of 32 months, were included in the study. The mean VAS and ODI scores were 72.4 mm and 49.0% before surgery and 25.5 mm and 29.9% at the final follow-up, respectively; these parameters significantly improved after surgery. The SVA, PI-LL, and PT scores were 70.1 mm, 20.9°, and 22.8° before surgery and 85.4 mm, 13.8°, and 22.7° at the final follow-up, respectively. The spinal alignment parameters did not change significantly after surgery. CONCLUSIONS Short-segment spinal fusion is effective for treating LBP and spinal deformity with BME adjacent to the vertebral endplate without spinal correction.
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Affiliation(s)
- Toshio Nakamae
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
| | - Naosuke Kamei
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Kiyotaka Yamada
- Department of Orthopaedic Surgery, JA Hiroshima General Hospital, Hiroshima, Japan
| | - Yoshinori Fujimoto
- Department of Orthopaedic Surgery, JA Hiroshima General Hospital, Hiroshima, Japan
| | - Toshiaki Maruyama
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Kazuto Nakao
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Fadlyansyah Farid
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
- Departement of Orthopaedic and Traumatology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Hiroki Fukui
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
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24
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Pan D, Liu K, Huang M, Sun T, Zhang Z. Multifidus lesions: A possible pathological component in patients with low back pain after posterior lumbar surgery. Medicine (Baltimore) 2024; 103:e37239. [PMID: 38428866 PMCID: PMC10906586 DOI: 10.1097/md.0000000000037239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 01/22/2024] [Indexed: 03/03/2024] Open
Abstract
There are few histological studies on multifidus after lumbar surgery, and it is not clear whether multifidus changes affect the clinical outcome after lumbar surgery. The aim of this study was to investigate the relationship between multifidus changes and clinical outcomes after lumbar surgery. Patients underwent internal fixation removal after lumbar posterior surgery were enrolled. Patients were divided into a low back pain (LBP) group (n = 15) and a non-low back pain (non-LBP) group (n = 10).The Oswestry disability index (ODI) and visual analog scale (VAS) were completed. 18 patients with lumbar fracture surgery were included as the control group. Multifidus morphological changes were observed by hematoxylin and eosin and Masson staining. The expression of TGF-β1 was observed by immunohistochemistry, immunofluorescence and Western blot. The cross-sectional area (CSA) of the multifidus in the non-LBP group and the control group were greater than those in the LBP group. TGF-β1 expression and gray value ratio in the non-LBP group and the control group were lower than those in the LBP group. The multifidus CSA and TGF-β1 expression in multifidus were strongly correlated with ODI and VAS. Patients with LBP after posterior lumbar surgery suffered from atrophy and fibrosis lesions in the multifidus, and the degree of multifidus lesions was closely related to dysfunction and pain, which might be one of the causes of LBP after posterior lumbar surgery.
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Affiliation(s)
- Dan Pan
- Department of Spinal Surgery, Zhuzhou Central Hospital, Zhuzhou, Hunan, China
| | - Ke Liu
- Department of Pharmacy, Zhuzhou Central Hospital, Zhuzhou, Hunan, China
| | - Meiyuan Huang
- Department of Pathology, Zhuzhou Central Hospital, Zhuzhou, Hunan, China
| | - Tiansheng Sun
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
| | - Zhicheng Zhang
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
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25
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Maharty DC, Hines SC, Brown RB. Chronic Low Back Pain in Adults: Evaluation and Management. Am Fam Physician 2024; 109:233-244. [PMID: 38574213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
Chronic low back pain, defined as lumbar pain persisting for 12 weeks or more, occurs in about 13% of U.S. adults. Patients with chronic low back pain should have a history and physical examination to identify red flags that may indicate serious conditions that warrant immediate intervention or yellow flags (i.e., psychological, environmental, and social factors) that indicate risk of disability. The examination should include an evaluation for radicular symptoms. Routine imaging is not recommended but is indicated when red flags are present, there is a neuromuscular deficit, or if pain does not resolve with conservative therapy. Patients should avoid bed rest. Nonpharmacologic treatment is first-line management and may include therapies with varying evidence of support, such as counseling, exercise therapy, spinal manipulation, massage, heat, dry needling, acupuncture, transcutaneous electrical nerve stimulation, and physical therapy. Pharmacologic interventions are second-line treatment. Nonsteroidal anti-inflammatory drugs are the initial medication of choice; duloxetine may also be beneficial. Evidence is inconclusive to recommend the use of benzodiazepines, muscle relaxants, antidepressants, corticosteroids, insomnia agents, anticonvulsants, cannabis, acetaminophen, or long-term opioids. Epidural corticosteroid injections are not recommended except for short-term symptom relief in patients with radicular pain. Most patients with chronic low back pain will not require surgery; evaluation for surgery may be considered in those with persistent functional disabilities and pain from progressive spinal stenosis, worsening spondylolisthesis, or herniated disk. Physicians should consider prevention of chronic low back pain when patients present with acute back pain. Screening tools are available to predict the progression from acute to chronic low back pain, and targeted treatment strategies are beneficial for preventing progression.
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Affiliation(s)
- Donald Clinton Maharty
- Cape Fear Valley Health, Fayetteville, North Carolina; Campbell University Jerry M. Wallace School of Osteopathic Medicine, Buies Creek, North Carolina
| | - Shaun C Hines
- Cape Fear Valley Bladen County Hospital and Campbell University Jerry M. Wallace School of Osteopathic Medicine, Bladenboro, North Carolina
| | - Regina Bray Brown
- Campbell University/Harnett Health Family Medicine Residency Program and Harnett Health, Lillington, North Carolina
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26
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Xue P, Wang Y, Lv L, Wang D, Wang Y. Roles of Chemokines in Intervertebral Disk Degeneration. Curr Pain Headache Rep 2024; 28:95-108. [PMID: 37976014 DOI: 10.1007/s11916-023-01188-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE OF REVIEW Intervertebral disc degeneration is the primary etiology of low back pain and radicular pain. This review examines the roles of crucial chemokines in different stages of degenerative disc disease, along with interventions targeting chemokine function to mitigate disc degeneration. RECENT FINDINGS The release of chemokines from degenerated discs facilitates the infiltration and activation of immune cells, thereby intensifying the inflammatory cascade response. The migration of immune cells into the venous lumen is concomitant with the emergence of microvascular tissue and nerve fibers. Furthermore, the presence of neurogenic factors secreted by disc cells and immune cells stimulates the activation of pain-related cation channels in the dorsal root ganglion, potentially exacerbating discogenic and neurogenic pain and intensifying the degenerative cascade response mediated by chemokines. Gaining a deeper comprehension of the functions of chemokines and immune cells in these processes involving catabolism, angiogenesis, and injury detection could offer novel therapeutic avenues for managing symptomatic disc disease.
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Affiliation(s)
- Pengfei Xue
- Medical School of Southeast University, Nanjing, Jiangsu, 210009, China
- Central Laboratory, Gaochun Hospital Affiliated to Jiangsu University, Nanjing, Jiangsu, 211300, China
| | - Yi Wang
- Department of Orthopaedics, Jiujiang Traditional Chinese Medicine Hospital, Jiujiang, Jiangxi, 332000, China
| | - Long Lv
- Central Laboratory, Gaochun Hospital Affiliated to Jiangsu University, Nanjing, Jiangsu, 211300, China
| | - Dongming Wang
- Central Laboratory, Gaochun Hospital Affiliated to Jiangsu University, Nanjing, Jiangsu, 211300, China.
| | - Yuntao Wang
- Medical School of Southeast University, Nanjing, Jiangsu, 210009, China.
- Department of Spine Center, Zhongda Hospital, Southeast University, Nanjing, Jiangsu, 210009, China.
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27
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Kobayashi K, Sato K, Ando T, Ando K. MRI characteristics of disc degeneration after condoliase injection in young patients: A consecutive case series. J Orthop Sci 2024; 29:494-501. [PMID: 36872214 DOI: 10.1016/j.jos.2023.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 02/08/2023] [Accepted: 02/18/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND Lumbar disc herniation (LDH) results in low back pain due to nerve root compression caused by nucleus pulposus degeneration. Chemonucleolysis of the nucleus pulposus by injection of condoliase is less invasive than surgery, but may cause disc degeneration. The purpose of the study was to examine outcomes of condoliase injection in patients in their teens and twenties using Pfirrmann criteria on MRI. METHODS A single-center retrospective study was performed in 26 consecutive patients (19 men, 7 women) who underwent condoliase injection (1 mL, 1.25 U/mL) for LDH and had MRI scans at 3 and 6 months. Cases with and without an increase in Pfirrmann grade at 3 months post-injection were included in groups D (disc degeneration, n = 16) and N (no degeneration, n = 10). Pain was measured on a visual analogue scale (VAS). MRI findings were evaluated using the % change in disc height index (ΔDHI). RESULTS The mean age of the patients was 21.1 ± 4.1 years and 12 were <20 years old. At baseline, 4, 21 and 1 were in Pfirrmann grades II, III and IV. In group D, no case had a further increase in Pfirrmann grade from 3 to 6 months. Pain significantly decreased in both groups. There were no adverse events. MRI showed a significant decrease in ΔDHI from 100% pre-injection to 89.4 ± 9.7% at 3 months in all cases (p < 0.05). There was a significant recovery in ΔDHI in group D from 3 to 6 months (85.4 ± 9.3% vs. 86.7 ± 9.1%, p < 0.05). CONCLUSIONS These results suggest that chemonucleolysis with condoliase is effective and safe for LDH in young patients. Progression of Pfirrmann criteria at 3 months post-injection occurred in 61.5% of cases, but disc degeneration showed recovery in these patients. A longer-term study of the clinical symptoms related to these changes is required.
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Affiliation(s)
- Kazuyoshi Kobayashi
- Department of Orthopaedic Surgery, Japan Red Cross Aichi Medical Center Nagoya Daini Hospital, Myokencho 2-9, Syowa-ku, Nagoya, Aichi, 466-8650, Japan.
| | - Koji Sato
- Department of Orthopaedic Surgery, Japan Red Cross Aichi Medical Center Nagoya Daini Hospital, Myokencho 2-9, Syowa-ku, Nagoya, Aichi, 466-8650, Japan
| | - Toshihiro Ando
- Department of Orthopaedic Surgery, Japan Red Cross Aichi Medical Center Nagoya Daini Hospital, Myokencho 2-9, Syowa-ku, Nagoya, Aichi, 466-8650, Japan
| | - Kei Ando
- Department of Orthopaedic Surgery, Japan Red Cross Aichi Medical Center Nagoya Daini Hospital, Myokencho 2-9, Syowa-ku, Nagoya, Aichi, 466-8650, Japan
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28
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de Bruin LJE, Hoegh M, Greve C, Reneman MF. Insufficient Evidence for Load as the Primary Cause of Nonspecific (Chronic) Low Back Pain. A Scoping Review. J Orthop Sports Phys Ther 2024; 54:1-14. [PMID: 38270054 DOI: 10.2519/jospt.2024.11314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
OBJECTIVE: To assess the causal role of the relationship between loading and the onset of nonspecific low back pain (NSLBP) and persistence of NSLBP (chronic low back pain [CLBP]). DESIGN: Scoping review. LITERATURE SEARCH: We searched the literature from 2010 until May 2021 using a combination of terms related to (spinal) load and the Bradford-Hill (BH) criteria. STUDY SELECTION CRITERIA: Operational definitions were developed for every criterion of the BH framework for causality. Study selection was based on the causal role of load in the onset of NSLBP and persistence of chronic low back pain. DATA SYNTHESIS: The BH criteria were operationalized, and causation was considered established when evidence supported the BH criteria strength, temporality, biological gradient, experiment, and biological plausibility. RESULTS: Twenty-two studies were included. There was no consistent support for an association between load and the incidence of NSLBP, or that more load increased the risk of NSLBP/CLBP. Half of the studies did not support specific load exposures to increase incidence of or increase pain in NSLBP/CLBP. Half of studies did not support load preceding NSLBP. No study supported plausible biological explanations to influence the relationship between load and NSLBP/CLBP, or that similar causes have similar effects on NSLBP. Nine of 10 experimental studies did not support that load results in NSLBP or that relieving load reduces NSLBP/CLBP. CONCLUSION: There was insufficient evidence to support a causal relationship between loading and the onset and persistence of NSLBP/CLBP based on the BH criteria. These results question the role of load management as the only/primary strategy to prevent onset and persistence of NSLBP/CLBP. J Orthop Sports Phys Ther 2024;54(3):1-15. Epub 25 January 2024. doi:10.2519/jospt.2024.11314.
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29
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Donaldson K, Meilan J, Rivers T, Rutherford K, Shine K, Manríquez V, Digesu GA, Edenfield A, Swift S. The Incidence of Pelvic and Low Back Pain in Patients with Pelvic Organ Prolapse. Int Urogynecol J 2024; 35:609-613. [PMID: 38265453 DOI: 10.1007/s00192-024-05732-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 01/02/2024] [Indexed: 01/25/2024]
Abstract
INTRODUCTION AND HYPOTHESIS To define the prevalence and incidence of pelvic/low back pain in patients with pelvic organ prolapse (POP). METHODS Patients presenting for POP to three urogynecology centers in the US, UK, and Chile were enrolled in an IRB-approved cross-sectional study assessing pain, GU, GI and sexual function symptoms. For prevalence, symptoms were noted as present if the participant recorded the symptom and reported the degree of bother as "somewhat," "a moderate amount," or "a lot." For incidence, participants were queried if the symptom's onset concurred with the POP. We also queried if they perceived the symptom was worsened by their POP. RESULTS Two hundred five participants were recruited: 100 from the US, 46 from the UK, and 59 from Chile. One US participant was excluded due a missing examination. The prevalence of pelvic pain was 42%. Seventy-three percent of these participants reported the onset of pelvic pain coinciding with prolapse onset, and 81% endorsed worsening pelvic pain with POP. The prevalence of low back pain was 46%, with 30% reporting the onset coincided with the onset of POP and 44% responded that prolapse worsened their pain. CONCLUSION A higher proportion of participants than expected endorsed pelvic/low back pain. Among patients with pelvic pain, the majority experienced symptom onset with POP onset and a worsening of pain with POP. While roughly half of participants reported low back pain; a minority correlated this to their POP. These findings highlight a high incidence of pelvic pain, challenging the perception of POP as a painless condition.
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Affiliation(s)
- Katelyn Donaldson
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC, USA.
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, 1700 6th Ave S, 176F Suite 10382, Birmingham, AL, 35233, USA.
| | - Julia Meilan
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC, USA
| | - Tiquez Rivers
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC, USA
| | - Kelly Rutherford
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC, USA
| | - Kayla Shine
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC, USA
| | - Valentín Manríquez
- Division of Urogynecology, Department Obstetrics and Gynecology, Hospital Clínico Universidad de Chile (HCUCH, Santiago, Chile
| | | | - Autumn Edenfield
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC, USA
| | - Steven Swift
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC, USA
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Anzai A, Katayama H, Spir IAZ, Nery MM, Anhesini M, Tiezzi OS, Spir PRN, Otani P, Bernardo WM. Treatment of refractory low back pain due to arthrosis of the lumbar spine with or without spondylolisthesis using anterior lumbar interbody fusion (ALIF). Rev Assoc Med Bras (1992) 2024; 70:e2023D702. [PMID: 38422324 PMCID: PMC10903269 DOI: 10.1590/1806-9282.2023d702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 01/12/2024] [Indexed: 03/02/2024]
Affiliation(s)
- Adriano Anzai
- Guidelines Program of the Brazilian Medical Association - São
Paulo (SP), Brazil
| | - Haroldo Katayama
- Guidelines Program of the Brazilian Medical Association - São
Paulo (SP), Brazil
| | | | - Mary Martins Nery
- Guidelines Program of the Brazilian Medical Association - São
Paulo (SP), Brazil
| | - Mauricio Anhesini
- Guidelines Program of the Brazilian Medical Association - São
Paulo (SP), Brazil
| | | | | | - Pericles Otani
- Guidelines Program of the Brazilian Medical Association - São
Paulo (SP), Brazil
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31
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Skive AW, Tønnesen R. Disc herniation associated with butterfly vertebra anomaly. Ugeskr Laeger 2024; 186:V09230590. [PMID: 38445324 DOI: 10.61409/v09230590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
Butterfly vertebra anomaly is a rare condition where the vertebral body fails to fuse during embryogenesis. In this case report, we present a 32-year-old male with progressive lower back pain and paralysis in both lower extremities. CT- and MR-scan showed an isolated L3 butterfly vertebra with a fusion of L2 and L3 discus through the defect and a discus prolapse compressing the spinal canal. The patient underwent successful decompressive surgery and experienced relief in symptoms post-operatively.
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Affiliation(s)
- Anders Weiland Skive
- Rygkirurgisk Afdeling, Københavns Universitetshospital - Rigshospitalet Glostrup
| | - Rune Tønnesen
- Rygkirurgisk Afdeling, Københavns Universitetshospital - Rigshospitalet Glostrup
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Yang S, Jia Y, Zhang J, Zhai W, Xie Y, Guo J. A randomized controlled trial: The efficacy and safety of Bushen Huoxue formula in the management of lower back pain from lumbar disc herniation. Medicine (Baltimore) 2024; 103:e37293. [PMID: 38363892 PMCID: PMC10869040 DOI: 10.1097/md.0000000000037293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 01/26/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Lower back pain (LBP) arising from lumbar disc herniation (LDH) poses a challenging health issue, often necessitating therapeutic interventions. Bushen Huoxue formula (BSHXF) has proved as a potential treatment option with great clinical effect. However, comprehensive investigations into its efficacy and safety in conjunction with celecoxib for managing LBP from LDH are lacking. The objective of this article is to investigate the efficacy and safety of BSHXF in the management of patients with LBP from LDH. METHODS This single center, randomized clinical trial was conducted from March 2023 to September 2023 and all patients suffered from LBP of LDH. Participants were randomly assigned to the BSHXF group (celecoxib and BSHXF) or the control group (celecoxib and placebo). The patients received treatment for 2 weeks. Assessment was conducted before treatment, the last day of the treatment, 4 weeks and 8 weeks after the treatment. Oswestry Disability Index (ODI), Visual Analog Scale (VAS), Roland-Morris Disability Questionnaire (RMDQ), Timed up and go test (TUGT), trunk range of movement (Trunk ROM), Hospital Anxiety and Depression Scale (HADS) were used for the evaluation. RESULTS A total of 206 subjects completed treatment, among whom 104 participants were randomized to the BSHXF group and 102 participants were randomized to the control group. There were no significant differences between groups in terms of the observed indicators (P > .05). After treatment, patients in BSHXF group obtained significant lower scores at 2-week, 4-week, 8-week of VAS, ODI, RMDQ, TUGT, Trunk ROM and HADS than the baseline data (P < .05). The ODI score was significantly lower than the control group at 2-week, 4-week, 8-week (2w: 11.30 ± 5.80 vs 14.23 ± 6.33, P < .001; 4w: 10.95 ± 4.93 vs 13.54 ± 6.35, P < .001; 8w: 10.27 ± 5.25 vs 12.84 ± 6.57, P = .002). Similarly, the scores of VAS, RMDQ, TUGT, Trunk ROM scores of the BSHXF group markedly decreased at 2, 4, and 8-week when compared to their control group (P < .05). Furthermore, no significant difference showed up in the score of HADS between the between the BSHXF and the control group after treatment (P > .05). CONCLUSION This randomized clinical trial found that BSXHF can help significantly improve the clinical outcomes of celecoxib including pain intensity reduction and lumbar function improvement in LBP patients.
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Affiliation(s)
- Shengqi Yang
- Guanghua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Shanghai Guanghua Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai, China
- Institute of Arthritis Research in Integrative Medicine, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
| | - Yongwei Jia
- Guanghua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Shanghai Guanghua Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai, China
- Institute of Arthritis Research in Integrative Medicine, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
- Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Jianpo Zhang
- Guanghua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Shanghai Guanghua Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai, China
- Institute of Arthritis Research in Integrative Medicine, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
| | - Weifeng Zhai
- Guanghua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Shanghai Guanghua Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai, China
- Institute of Arthritis Research in Integrative Medicine, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
| | - Yue Xie
- Guanghua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Shanghai Guanghua Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai, China
- Institute of Arthritis Research in Integrative Medicine, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
| | - Ji Guo
- Guanghua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Shanghai Guanghua Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai, China
- Institute of Arthritis Research in Integrative Medicine, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
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Fu H, Hu Y, Yang D, Wang X, Xu W. [Comparison of effectiveness between unilateral biportal endoscopic decompression and unilateral biportal endoscopic lumbar interbody fusion for degree Ⅰdegenerative lumbar spondylolisthesis]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2024; 38:169-175. [PMID: 38385229 PMCID: PMC10882227 DOI: 10.7507/1002-1892.202311025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
Objective To compare the effectiveness of unilateral biportal endoscopic decompression and unilateral biportal endoscopic lumbar interbody fusion (ULIF) in the treatment of degreeⅠdegenerative lumbar spondylolisthesis (DLS). Methods A clinical data of 58 patients with degreeⅠDLS who met the selection criteria between October 2021 and October 2022 was retrospectively analyzed. Among them, 28 cases were treated with unilateral biportal endoscopic decompression (decompression group) and 30 cases with ULIF (ULIF group). There was no significant difference between the two groups ( P>0.05) in the gender, age, lesion segment, and preoperative visual analogue scale (VAS) score of low back pain, VAS score of leg pain, Oswestry disability index (ODI), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), disk height (DH), segmental lordosis (SL), and other baseline data. The operation time, postoperative drainage volume, postoperative ambulation time, VAS score of low back pain, VAS score of leg pain, ODI, laboratory examination indexes (CRP, ESR), and imaging parameters (DH, SL) were compared between the two groups. Results Compared with the ULIF group, the decompression group had shorter operation time, less postoperative drainage, and earlier ambulation ( P<0.05). All incisions healed by first intention, and no complication such as nerve root injury, epidural hematoma, or infection occurred. All patients were followed up 12 months. Laboratory tests showed that ESR and CRP at 3 days after operation in decompression group were not significantly different from those before operation ( P>0.05), while the above indexes in ULIF group significantly increased at 3 days after operation compared to preoperative values ( P<0.05). There were significant differences in the changes of ESR and CRP before and after operation between the two groups ( P<0.05). Except that the VAS score of low back pain at 3 days after operation was not significantly different from that before operation in decompression group ( P>0.05), there were significant differences in VAS score of low back pain and VAS score of leg pain between the two groups at other time points ( P<0.05). The VAS score of low back pain in ULIF group was significantly higher than that in decompression group at 3 days after operation ( P<0.05), and there was no significant difference in VAS score of low back pain and VAS score of leg pain between the two groups at other time points ( P>0.05). The ODI of the two groups significantly improved after operation ( P<0.05), but there was no significant difference between 3 days and 6 months after operation ( P>0.05). There was no significant difference between the two groups at the two time points after operation ( P<0.05). Imaging examination showed that there was no significant difference in DH and SL between pre-operation and 12 months after operation in decompression group ( P>0.05). However, the above two indexes in ULIF group were significantly higher than those before operation ( P<0.05). There were significant differences in the changes of DH and SL before and after operation between the two groups ( P<0.05). Conclusion Unilateral biportal endoscopic decompression can achieve good effectiveness in the treatment of degree Ⅰ DLS. Compared with ULIF, it can shorten operation time, reduce postoperative drainage volume, promote early ambulation, reduce inflammatory reaction, and accelerate postoperative recovery. ULIF has more advantages in restoring intervertebral DH and SL.
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Affiliation(s)
- Hao Fu
- Graduate School of Dalian Medical University, Dalian Liaoning, 116044, P. R. China
- Department of Orthopedics, Dalian Central Hospital, Dalian Liaoning, 116033, P. R. China
| | - Yutong Hu
- Department of Orthopedics, Osteoporosis Clinical Center, the Second Affiliated Hospital of Soochow University, Suzhou Jiangsu, 215006, P. R. China
- Graduate School of Soochow University, Suzhou Jiangsu, 215006, P. R. China
| | - Dongfang Yang
- Department of Orthopedics, Dalian Central Hospital, Dalian Liaoning, 116033, P. R. China
| | - Xin Wang
- Department of Orthopedics, Dalian Central Hospital, Dalian Liaoning, 116033, P. R. China
| | - Weibing Xu
- Department of Orthopedics, Changzheng Hospital, Naval Medical University, Shanghai, 200003, P. R. China
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Geng X, Chen S. Discussion on "Five zang-organs all can lead to low back pain, not only the kidney". Zhongguo Zhen Jiu 2024; 44:204-208. [PMID: 38373768 DOI: 10.13703/j.0255-2930.20230503-0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
Low back pain (LBP) is the common disease in the department of acupuncture and moxibustion in hospital and is treated basically in terms of kidney deficiency. Through clinical observation and in association with classic literature, the authors proposes that the five zang-organs all can lead to LBP relevant to internal injury. Based on the analysis of typical cases, the authors expounds the nature of pain caused by each zang-organ and clarified the keys of the differentiation. LBP related to the liver is manifested mainly as lumbar soreness and distending pain, accompanied by the limited forward and backward extension of the lumbar vertebra. When the dysfunction of the heart and lung are involved, the hollow pain is dominant, combined with the weakness and emptiness feeling in the lumbar region. When LBP is caused by the dysfunction of the spleen, muscular pain is the chief complaint, combined with heaviness and soreness in the local, and the stiffness on palpation. When rooted at the kidney, LBP is manifested chiefly by dull pain, with deep location of illness, mostly around the lumbar sacral region.
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Affiliation(s)
- Xiaoxuan Geng
- Department of Acupuncture and Moxibustion, Dongzhimen Hospital of Beijing University of CM, Beijing 100700, China
| | - Sheng Chen
- Department of Acupuncture and Moxibustion, Dongzhimen Hospital of Beijing University of CM, Beijing 100700, China.
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Batista PA, de Oliveira C, da Costa RA, Francisco RPV, Cabar FR. Low back pain, pelvic pain, and associated factors in type 1 diabetic pregnant women. Clinics (Sao Paulo) 2024; 79:100325. [PMID: 38330787 PMCID: PMC10864871 DOI: 10.1016/j.clinsp.2024.100325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 12/19/2023] [Accepted: 12/31/2023] [Indexed: 02/10/2024] Open
Abstract
INTRODUCTION Pregnancy and diabetes mellitus promote several musculoskeletal changes predisposing this population to complaints of Lower Back (LB) and Pelvic Pain (PP). OBJECTIVE To assess the frequency of LB and PP and associated factors in type 1 Diabetic (DM1) pregnant women. METHOD An observational analytical cross-sectional study. Thirty-six pregnant women with DM1 were evaluated through a postural assessment with a focus on pelvic positioning and what patients reported. The associated factors were assessed using the State-Trait Anxiety Inventory (STAI), the International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF), and the Female Sexual Function Index (FSFI). RESULTS The frequency of LB and PP was 55.6 % and 30.6 %, respectively. The presence of anxiety was not associated with a higher prevalence of pain. The incidence of sexual dysfunctions was higher in the GD. DM1 duration had a mean of 14.9 years (± 8.2 SD) in the GD and 9.0 years (± 6.9 SD) in the GSD, which was statistically significant (p ≤ 0.050). In the multiple binary regression analysis for the occurrence of pain, the independent factor was DM1 duration ≥ 17 years (OR = 11.2; 95 % CI = 1.02‒124.75). The association between DM1 duration ≥ 17 years and being overweight showed a probability of 95 % for the studied population in the analysis of the probabilities of occurrence of the pain event. CONCLUSION There was a high frequency of LB and PP related to pregnancy in DM1 pregnant women in the second trimester of pregnancy. The incidence of sexual dysfunction and DM1 duration ≥ 17 years increases the chance that DM1 pregnant women will experience pain. There was no association between anxiety. urinary incontinence and pain in DM1 pregnant women.
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Affiliation(s)
- Patricia Andrade Batista
- Department of Obstetrics and Gynecology, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil.
| | - Cláudia de Oliveira
- Department of Physical Therapy, Universidade Santa Cecília (UNISANTA), Santos, SP, Brazil
| | - Rafaela Alkmin da Costa
- Department of Obstetrics and Gynecology, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | | | - Fabio Roberto Cabar
- Department of Obstetrics and Gynecology, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
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Xu Z, Qi L, Zhang H, Yu D, Shi Y, Yu Y, Zhu T. Smoking and BMI mediate the causal effect of education on lower back pain: observational and Mendelian randomization analyses. Front Endocrinol (Lausanne) 2024; 15:1288170. [PMID: 38390198 PMCID: PMC10882710 DOI: 10.3389/fendo.2024.1288170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 01/10/2024] [Indexed: 02/24/2024] Open
Abstract
Objective Low back pain (LBP) has been associated with education in previous observational studies, but the causality remains unclear. This study aims to assess the impact of education on LBP and to explore mediation by multiple lifestyle factors. Design Univariable Mendelian randomization (MR) was performed to examine the overall effect of education on LBP. Subsequently, multivariable MR was conducted to assess both the direct effect of education on LBP and the influence of potential mediators. Indirect effects were estimated using either the coefficient product method or the difference method, and the proportion of mediation was calculated by dividing the indirect effect by the total effect. The observational study utilized data from the NHANES database collected between 1999 and 2004, and included 15,580 participants aged 20 years and above. Results Increasing education by 4.2 years leads to a 48% reduction in the risk of LBP (OR=0.52; 95% CI: 0.46 to 0.59). Compared to individuals with less than a high school education, those with education beyond high school have a 28% lower risk of LBP (OR=0.72; 95% CI: 0.63 to 0.83). In the MR study, smoking accounts for 12.8% (95% CI: 1.04% to 20.8%) of the total effect, while BMI accounts for 5.9% (95% CI: 2.99% to 8.55%). The combined mediation effect of smoking and BMI is 27.6% (95% CI: 23.99% to 32.7%). In the NHANES study, only smoking exhibits a mediating effect, accounting for 34.3% (95% CI: 21.07% to 41.65%) of the effect, while BMI does not demonstrate a mediating role. Conclusions Higher levels of education provide a protective effect against the risk of LBP. Additionally, implementing interventions to reduce smoking and promote weight loss among individuals with lower levels of education can also decrease this risk.
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Affiliation(s)
- Zhangmeng Xu
- Department of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Luming Qi
- Department of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Huiwu Zhang
- Department of Sports Medicine, Sichuan Province Orthopedic Hospital, Chengdu, Sichuan, China
| | - Duoduo Yu
- Department of Sports Medicine, Sichuan Province Orthopedic Hospital, Chengdu, Sichuan, China
| | - Yushan Shi
- Department of Medical Laboratory, The Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Yaming Yu
- Department of Sports Medicine, Sichuan Province Orthopedic Hospital, Chengdu, Sichuan, China
| | - Tianmin Zhu
- Department of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
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Pesante BD, Paro MR, Nadeem T, Bulsara KR, Choi DB. Lumbar decompression and fusion for symptomatic spinal stenosis in a patient with chronic thoracic sensory level from prior transverse myelitis: a case report. J Med Case Rep 2024; 18:42. [PMID: 38310259 PMCID: PMC10838414 DOI: 10.1186/s13256-024-04367-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 01/05/2024] [Indexed: 02/05/2024] Open
Abstract
BACKGROUND Many patients with transverse myelitis suffer from sensory loss below the spinal level of the lesion. This is commonly associated with chronic neuropathic pain. However, the presence of somatic pain below a complete thoracic sensory level after transverse myelitis is exceptionally rare, and it is unclear if surgical decompression is an effective form of treatment for these patients. CASE PRESENTATION In this report, we describe a 22-year-old Caucasian female who suffered from chronic lumbar back pain despite a complete thoracic sensory level secondary to prior transverse myelitis. Imaging demonstrated multilevel central stenosis below the sensory level, and her pain improved after surgical decompression. To our knowledge, this is the first reported case of symptomatic lumbar stenosis below a sensory level after transverse myelitis successfully treated with surgical decompression. CONCLUSION This is the first reported case of a patient with symptomatic lumbar stenosis after transverse myelitis whose lower back pain and quality of life improved following surgical decompression and fusion. This case provides evidence that typical lumbago is possible in patients with sensory loss from transverse myelitis, and standard lumbar decompression may provide benefit for these patients.
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Affiliation(s)
- Benjamin D Pesante
- University of Connecticut School of Medicine, UConn Health Center, 263 Farmington Ave, Farmington, CT, 06030, USA.
| | - Mitch R Paro
- University of Connecticut School of Medicine, UConn Health Center, 263 Farmington Ave, Farmington, CT, 06030, USA
| | | | - Ketan R Bulsara
- Division of Neurosurgery, Department of Surgery, UConn Health, Farmington, CT, USA
| | - David B Choi
- Division of Neurosurgery, Department of Surgery, UConn Health, Farmington, CT, USA
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Koketsu K, Kim K, Isu T, Kokubo R, Ideguchi M, Mihara R, Murai Y. Identification and decompression of superior cluneal nerve implicated in low back pain. Acta Neurochir (Wien) 2024; 166:59. [PMID: 38305950 DOI: 10.1007/s00701-024-05960-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 12/21/2023] [Indexed: 02/03/2024]
Abstract
INTRODUCTION Low back pain (LBP) can be attributable to entrapment of the superior cluneal nerve (SCN) around the iliac crest. Surgical decompression is a useful treatment; however, finding all entrapped SCNs involved in patients with LBP can be difficult. We performed a retrospective study to help identify entrapped SCNs in the narrow surgical field. METHODS We enrolled 20 LBP patient (22 sides) with SCN entrapment. They were 9 males and 11 females; their mean age was 72.5 years. We developed a 3-step procedure for successful SCN decompression surgery. In step 1, the thoracolumbar fascia is exposed and the SCN penetrating the fascia is released. In step 2, the fascia is opened and the SCN is released. In step 3, the fascia above the iliac crest is opened and the SCN is released. RESULTS We successfully released 66 nerves; the average was 3.0 ± 0.8 (1-4) per patient. Step 1 detected 18 nerves (27.3%), step 2 identified 35 (53.0%), and in step 3, 13 (19.7%) were recognized. By tracing the thin nerves branching off the SCN, we found 7 nerves (10.6%). We performed 22 operations; step 1 identified 16 SCNs (72.7%), step 2 identified 21 (95.5%), and step 3 found 12 nerves (54.5%). CONCLUSIONS The SCN is most readily identified upon opening of the thoracolumbar fascia. To identify as many SCN branches as possible, our 3-step method may be useful.
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Affiliation(s)
- Kenta Koketsu
- Department of Neurological Surgery, Chiba Hokuso Hospital, Nippon Medical School, Inzai City, Chiba, Kamagari, 1715, Japan.
| | - Kyongsong Kim
- Department of Neurological Surgery, Chiba Hokuso Hospital, Nippon Medical School, Inzai City, Chiba, Kamagari, 1715, Japan
| | - Toyohiko Isu
- Department of Neurosurgery, Kushiro Rosai Hospital, Hokkaido, Japan
| | - Rinko Kokubo
- Department of Neurological Surgery, Chiba Hokuso Hospital, Nippon Medical School, Inzai City, Chiba, Kamagari, 1715, Japan
| | - Minoru Ideguchi
- Department of Neurological Surgery, Chiba Hokuso Hospital, Nippon Medical School, Inzai City, Chiba, Kamagari, 1715, Japan
| | - Riku Mihara
- Department of Neurological Surgery, Chiba Hokuso Hospital, Nippon Medical School, Inzai City, Chiba, Kamagari, 1715, Japan
| | - Yasuo Murai
- Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan
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Chitneni A, Kim R, Danssaert Z, Kumar S. A Proposed Treatment Algorithm for Low Back Pain Secondary to Bertolotti's Syndrome. Pain Physician 2024; 27:E275-E284. [PMID: 38324794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
BACKGROUND Chronic low back pain is widely prevalent, and there are a range of conditions that may result in the low back pain. In general, treatment of low back pain starts with conservative management such as medications, physical therapy, and home exercise regimens. If conservative measures fail, a range of interventional techniques can be employed to manage back pain. An uncommonly recognized cause of back pain is Bertolotti's syndrome which is a result of back pain due to lumbosacral transitional vertebrae (LSTV). LSTV is a congenital abnormality either characterized by the lumbarization of the sacrum where the first sacral bone fails to fuse with the rest of the sacrum or the sacralization of the lumbar spine where the L5 vertebra fuses with the sacrum creating a longer sacrum. In many cases, the condition can be recognized by imaging techniques such as an x-ray, computed tomography, or magnetic resonance imaging. OBJECTIVES To propose a treatment algorithm for patients with low back pain secondary to Bertolotti's syndrome. STUDY DESIGN Case study and treatment algorithm proposal. METHODS A treatment algorithm for patients with low back pain secondary to Bertolotti's Syndrome which involves starting with local anesthetic and steroid injection of the pseudo-articulation, followed by radiofrequency ablation of the pseudo-articulation, and then complete endoscopic resection of the pseudo joint. RESULTS The proposed stepwise treatment guideline has the ability to diagnose Bertolotti's syndrome as the cause of low back pain and provide symptomatic relief. LIMITATIONS Several limitations exist for the study including the fact that the algorithmic approach may not fit every patient. Additionally, there would be benefit in future research studies comparing each step of the algorithm with conservative measures to compare efficacy and long-term outcomes of the procedures. CONCLUSIONS Our stepwise approach to diagnosing and managing the pain resulting from Bertolotti's syndrome is an effective method of treatment for the condition.
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Affiliation(s)
- Ahish Chitneni
- Department of Rehabilitation and Regenerative Medicine, New York- Presbyterian Hospital - Columbia and Cornell, New York, NY
| | - Richard Kim
- Department of Rehabilitation and Regenerative Medicine, New York- Presbyterian Hospital - Columbia and Cornell, New York, NY
| | - Zachary Danssaert
- Department of Rehabilitation and Regenerative Medicine, New York- Presbyterian Hospital - Columbia and Cornell, New York, NY
| | - Sanjeev Kumar
- Anesthesiology and Pain Medicine, University of Florida, Gainesville, FL
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Schönnagel L, Zhu J, Camino-Willhuber G, Guven AE, Tani S, Caffard T, Haffer H, Muellner M, Chiapparelli E, Arzani A, Amoroso K, Moser M, Shue J, Tan ET, Carrino JA, Sama AA, Cammisa FP, Girardi FP, Hughes AP. Relationship between lumbar spinal stenosis and axial muscle wasting. Spine J 2024; 24:231-238. [PMID: 37788745 DOI: 10.1016/j.spinee.2023.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 09/14/2023] [Accepted: 09/26/2023] [Indexed: 10/05/2023]
Abstract
BACKGROUND CONTEXT Although the effect of lumbar spinal stenosis (LSS) on the lower extremities is well documented, limited research exists on the effect of spinal stenosis on the posterior paraspinal musculature (PPM). Similar to neurogenic claudication, moderate to severe spinal canal compression can also interfere with the innervation of the PPM, which may result in atrophy and increased fatty infiltration (FI). PURPOSE This study aims to assess the association between LSS and atrophy of the PPM. STUDY DESIGN Retrospective cross-sectional study. PATIENT SAMPLE Patients undergoing MRI scans at a tertiary orthopedic center for low back pain or as part of a preoperative evaluation. OUTCOME MEASURES The functional cross-sectional area (fCSA) and percent fatty infiltration (FI) of the PPM at L4. METHODS Lumbar MRIs of patients at a tertiary orthopedic center indicated due to lower back pain (LBP) or as a presurgical workup were analyzed. Patients with previous spinal fusion surgery or scoliosis were excluded. LSS was assessed according to the Schizas classification at all lumbar levels. The cross-sectional area of the PPM was measured on a T2-weighted MRI sequence at the upper endplate of L4. The fCSA and fatty infiltration (FI) were calculated using custom software. Crude differences in FI and fCSA between patients with no stenosis and at least mild stenosis were tested with the Wilcoxon signed-rank test. To account for possible confounders, a multivariable linear regression model was used to adjust for age, sex, body mass index (BMI), and disc degeneration. A subgroup analysis according to MRI indication was performed. RESULTS A total of 522 (55.7% female) patients were included. The median age was 61 years (IQR: 51-71). The greatest degree of moderate and severe stenosis was found at L4/5, 15.7%, and 9.2%, respectively. Stenosis was the least severe at L5/S1 and was found to be 2% for moderate and 0.2% for severe stenosis. The Wilcoxon test showed significantly increased FI of the PPM with stenosis at any lumbar level (p<.001), although no significant decrease in fCSA was observed. The multivariable regression model showed a significant increase in FI with increased LSS at L1/2, L2/3, and L3/4 (p=.013, p<.01 and p=.003). The severity of LSS at L4/5 showed a positive association with the fCSA (p=.019). The subgroup analysis showed, the effect of LSS was more pronounced in nonsurgical patients than in patients undergoing surgery. CONCLUSIONS In this study, we demonstrated a significant and independent association between LSS and the composition of the PPM, which was dependent on the level of LSS relative to the PPM. In addition to neurogenic claudication, patients with LSS might be especially susceptible to axial muscle wasting, which could worsen LSS due to increased spinal instability, leading to a positive feedback loop.
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Affiliation(s)
- Lukas Schönnagel
- Spine Care Institute, Hospital for Special Surgery, New York City, NY, USA; Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Jiaqi Zhu
- Biostatistics Core, Hospital for Special Surgery, New York City, NY, USA
| | | | - Ali E Guven
- Spine Care Institute, Hospital for Special Surgery, New York City, NY, USA; Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Soji Tani
- Spine Care Institute, Hospital for Special Surgery, New York City, NY, USA; Department of Orthopaedic Surgery, School of Medicine, Showa University Hospital, Tokyo, Japan
| | - Thomas Caffard
- Spine Care Institute, Hospital for Special Surgery, New York City, NY, USA; Universitätsklinikum Ulm, Klinik für Orthopädie, Ulm, Germany
| | - Henryk Haffer
- Spine Care Institute, Hospital for Special Surgery, New York City, NY, USA; Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Maximilian Muellner
- Spine Care Institute, Hospital for Special Surgery, New York City, NY, USA; Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Erika Chiapparelli
- Spine Care Institute, Hospital for Special Surgery, New York City, NY, USA
| | - Artine Arzani
- Spine Care Institute, Hospital for Special Surgery, New York City, NY, USA
| | - Krizia Amoroso
- Spine Care Institute, Hospital for Special Surgery, New York City, NY, USA
| | - Manuel Moser
- Spine Care Institute, Hospital for Special Surgery, New York City, NY, USA; Department of Spine Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Jennifer Shue
- Spine Care Institute, Hospital for Special Surgery, New York City, NY, USA
| | - Ek T Tan
- Department of Radiology and Imaging, Hospital for Special Surgery, New York City, NY, USA
| | - John A Carrino
- Department of Radiology and Imaging, Hospital for Special Surgery, New York City, NY, USA
| | - Andrew A Sama
- Spine Care Institute, Hospital for Special Surgery, New York City, NY, USA
| | - Frank P Cammisa
- Spine Care Institute, Hospital for Special Surgery, New York City, NY, USA
| | - Federico P Girardi
- Spine Care Institute, Hospital for Special Surgery, New York City, NY, USA
| | - Alexander P Hughes
- Spine Care Institute, Hospital for Special Surgery, New York City, NY, USA.
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Du R, Gao J, Wang B, Zhang J, Meng M, Wang J, Qu W, Li Z. Percutaneous radiofrequency ablation and endoscopic neurotomy for lumbar facet joint syndrome: are they good enough? Eur Spine J 2024; 33:463-473. [PMID: 38141106 DOI: 10.1007/s00586-023-08078-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 11/28/2023] [Accepted: 11/30/2023] [Indexed: 12/24/2023]
Abstract
OBJECTIVE Lumbar facet joint (LFJ) syndrome is one of the common causes of low back pain (LBP). There are different views on percutaneous and endoscopic radiofrequency. The purpose of this systematic review and meta-analysis is to explore the therapeutic effect of radiofrequency ablation on LBP originating from LFJ and compare the therapeutic effect of percutaneous radiofrequency ablation and endoscopic neurotomy. METHODS We included randomized controlled trials which compared the efficiency of percutaneous radiofrequency ablation and conservative treatment (sham procedures, facet joint injection, physiotherapy, exercise, or oral medication) or compared the efficiency of percutaneous radiofrequency ablation and endoscopic neurotomy for LFJ syndrome. We searched in PubMed and Web of Science from inception to March 27, 2023. Meta-analysis was performed using RevMan 5.4 software. RESULTS A total of 11 randomized controlled trials were included. Among them, nine studies were used for evaluating efficiency of percutaneous radiofrequency ablation, and two studies were used for evaluating efficiency of endoscopic neurotomy. Pooled data from two studies reporting outcomes at 1 year did not show a benefit from facet joint denervation by comparing the percutaneous radiofrequency ablation and conservative treatment (standardized mean difference (SMD) = -0.87, 95% confidence interval (CI) [-2.10, 0.37], P = 0.17). There was no significant difference between percutaneous radiofrequency ablation and endoscopic neurotomy at 1-month follow-up (mean difference (MD) = -0.13, 95%CI [-0.18, -0.44], P = 0.41). At 12-month follow-up the pain relief in the endoscopic neurotomy was significantly better than that in the percutaneous radiofrequency ablation group (MD = 1.98, 95%CI [1.60, 2.36], P < 0 .0001). CONCLUSION The LBP was significantly relieved shortly after percutaneous radiofrequency ablation. Compared with percutaneous radiofrequency ablation, endoscopic neurotomy seems to have a longer effect. A longer follow-up period is needed to confirm its effectiveness.
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Affiliation(s)
- Ruihuan Du
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, No. 5 Longbin Road, Development Zone, Dalian, 116011, People's Republic of China
| | - Jing Gao
- Department of Endocrinology, First Affiliated Hospital of Dalian Medical University, Dalian, People's Republic of China
| | - Bo Wang
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, No. 5 Longbin Road, Development Zone, Dalian, 116011, People's Republic of China
| | - Jing Zhang
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, No. 5 Longbin Road, Development Zone, Dalian, 116011, People's Republic of China
| | - Meng Meng
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, No. 5 Longbin Road, Development Zone, Dalian, 116011, People's Republic of China
| | - Jingzuo Wang
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, No. 5 Longbin Road, Development Zone, Dalian, 116011, People's Republic of China
| | - Wentao Qu
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, No. 5 Longbin Road, Development Zone, Dalian, 116011, People's Republic of China
| | - Zhonghai Li
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, No. 5 Longbin Road, Development Zone, Dalian, 116011, People's Republic of China.
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopedic Diseases, Dalian, Liaoning, People's Republic of China.
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Schönnagel L, Muellner M, Suwalski P, Guven AE, Camino-Willhuber G, Tani S, Caffard T, Zhu J, Haffer H, Arzani A, Chiapparelli E, Amoroso K, Shue J, Duculan R, Sama AA, Cammisa FP, Girardi FP, Mancuso CA, Hughes AP. Association of abdominal aortic calcification and lower back pain in patients with degenerative spondylolisthesis. Pain 2024; 165:376-382. [PMID: 37856648 DOI: 10.1097/j.pain.0000000000003018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 06/28/2023] [Indexed: 10/21/2023]
Abstract
ABSTRACT Abdominal aortic calcification (AAC) is hypothesized to lead to ischemic pain of the lower back. This retrospective study aims to identify the relationship between AAC and lower back pain (LBP) in patients with degenerative lumbar spondylolisthesis. Lower back pain was assessed preoperatively and 2 years after surgery using the numeric analogue scale. Abdominal aortic calcification was assessed according to the Kauppila classification and was grouped into no, moderate, and severe. A multivariable regression, adjusted for age, sex, body mass index, hypertension, and smoking status, was used to assess the association between AAC and preoperative/postoperative LBP as well as change in LBP after surgery. A total of 262 patients were included in the final analysis. The multivariable logistic regression demonstrated an increased odds ratio (OR) for preoperative LBP ≥ 4 numeric analogue scale (OR = 9.49, 95% confidence interval [CI]: 2.71-40.59, P < 0.001) and postoperative LBP ≥ 4 (OR = 1.72, 95% CI: 0.92-3.21, P = 0.008) in patients with severe AAC compared with patients with no AAC. Both moderate and severe AAC were associated with reduced improvement in LBP after surgery (moderate AAC: OR = 0.44, 95% CI: 0.22-0.85, P = 0.016; severe AAC: OR = 0.41, 95% CI: 0.2-0.82, P = 0.012). This study demonstrates an independent association between AAC and LBP and reduced improvement after surgery. Evaluation of AAC could play a role in patient education and might be considered part of the differential diagnosis for LBP, although further prospective studies are needed.
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Affiliation(s)
- Lukas Schönnagel
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, United States
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Maximilian Muellner
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, United States
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Phillip Suwalski
- Medical Heart Center of Charité CBF-Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Ali E Guven
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, United States
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Gaston Camino-Willhuber
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, United States
| | - Soji Tani
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, United States
- Department of Orthopaedic Surgery, School of Medicine, Showa University Hospital, Tokyo, Japan
| | - Thomas Caffard
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, United States
- Universitätsklinikum Ulm, Klinik für Orthopädie, Ulm, Germany
| | - Jiaqi Zhu
- Biostatistics Core, Hospital for Special Surgery, New York City, NY, United States
| | - Henryk Haffer
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, United States
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Artine Arzani
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, United States
| | - Erika Chiapparelli
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, United States
| | - Krizia Amoroso
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, United States
| | - Jennifer Shue
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, United States
| | - Roland Duculan
- Hospital for Special Surgery, New York City, NY, United States
| | - Andrew A Sama
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, United States
| | - Frank P Cammisa
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, United States
| | - Federico P Girardi
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, United States
| | - Carol A Mancuso
- Hospital for Special Surgery, New York City, NY, United States
- Weill Cornell Medical College, New York, NY, United States
| | - Alexander P Hughes
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, United States
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Camino-Willhuber G, Schönnagel L, Caffard T, Zhu J, Tani S, Chiapparelli E, Arzani A, Shue J, Duculan R, Bendersky M, Zelenty WD, Sokunbi G, Lebl DR, Cammisa FP, Girardi FP, Mancuso CA, Hughes AP, Sama AA. Severe Intervertebral Vacuum Phenomenon is Associated With Higher Preoperative Low Back Pain, ODI, and Indication for Fusion in Patients With Degenerative Lumbar Spondylolisthesis. Clin Spine Surg 2024; 37:E1-E8. [PMID: 37651562 DOI: 10.1097/bsd.0000000000001510] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 07/19/2023] [Indexed: 09/02/2023]
Abstract
STUDY DESIGN Retrospective study of prospective collected data. OBJECTIVE To analyze the association between intervertebral vacuum phenomenon (IVP) and clinical parameters in patients with degenerative spondylolisthesis. SUMMARY OF BACKGROUND DATA IVP is a sign of advanced disc degeneration. The correlation between IVP severity and low back pain in patients with degenerative spondylolisthesis has not been previously analyzed. METHODS We retrospectively analyzed patients with degenerative spondylolisthesis who underwent surgery. Vacuum phenomenon was measured on computed tomography scan and classified into mild, moderate, and severe. A lumbar vacuum severity (LVS) scale was developed based on vacuum severity. The associations between IVP at L4/5 and the LVS scale, preoperative and postoperative low back pain, as well as the Oswestry Disability Index was assessed. The association of IVP at L4/5 and the LVS scale and surgical decision-making, defined as decompression alone or decompression and fusion, was assessed through univariable logistic regression analysis. RESULTS A total of 167 patients (52.7% female) were included in the study. The median age was 69 years (interquartile range 62-72). Overall, 100 (59.9%) patients underwent decompression and fusion and 67 (40.1%) underwent decompression alone. The univariable regression demonstrated a significantly increased odds ratio (OR) for back pain in patients with more severe IVP at L4/5 [OR=1.69 (95% CI 1.12-2.60), P =0.01]. The univariable regressions demonstrated a significantly increased OR for increased disability with more severe L4/L5 IVP [OR=1.90 (95% CI 1.04-3.76), P =0.04] and with an increased LVS scale [OR=1.17 (95% CI 1.02-1.35), P =0.02]. IVP severity of the L4/L5 were associated with higher indication for fusion surgery. CONCLUSION Our study showed that in patients with degenerative spondylolisthesis undergoing surgery, the severity of vacuum phenomenon at L4/L5 was associated with greater preoperative back pain and worse Oswestry Disability Index. Patients with severe IVP were more likely to undergo fusion.
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Affiliation(s)
- Gaston Camino-Willhuber
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
| | - Lukas Schönnagel
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin
| | - Thomas Caffard
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
- Department of Orthopaedic Surgery, University of Ulm, Ulm, Germany
| | - Jiaqi Zhu
- Biostatistics Core, Hospital for Special Surgery, New York City, NY
| | - Soji Tani
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
- Department of Orthopaedic Surgery, School of Medicine, Showa University Hospital, Tokyo, Japan
| | - Erika Chiapparelli
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
| | - Artine Arzani
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
| | - Jennifer Shue
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
| | | | - Mariana Bendersky
- III Normal Anatomy Department, School of Medicine, University of Buenos Aires
- Intraoperative Monitoring, Department of Pediatric Neurology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - William D Zelenty
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
| | - Gbolabo Sokunbi
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
| | - Darren R Lebl
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
| | - Frank P Cammisa
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
| | - Federico P Girardi
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
| | - Carol A Mancuso
- Hospital for Special Surgery, New York City, NY
- Weill Cornell Medical College, New York, NY
| | - Alexander P Hughes
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
| | - Andrew A Sama
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
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Shen X, Gao YC, Zhang P, Song P, Jiang ZL, Wang F, Xuan WB, Gao ZX. Is unilateral-approach full-endoscopic lumbar fusion effective for single-level lumbar spondylolisthesis with bilateral symptoms? A preliminary report of 43 CT analysis. Eur Spine J 2024; 33:409-416. [PMID: 37378709 DOI: 10.1007/s00586-023-07667-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 02/14/2023] [Accepted: 03/17/2023] [Indexed: 06/29/2023]
Abstract
PURPOSE To investigate the clinical results and radiological parameters changes after unilateral-approach endoscopic lumbar interbody fusion (Endo-LIF) for lumbar spondylolisthesis with bilateral symptoms. METHODS 43 single-level lumbar spondylolisthesis patients with bilateral lower limb symptoms were included from June 2020 to May 2022. All patients underwent unilateral-approach Endo-LIF and postoperative computed tomography. Radiological parameters including disk height (DH), degree of upper vertebral slip (DUVS), and foramen intervertebral parameters including bilateral foraminal height (FH), contralateral foraminal areas (FA) were evaluated. The clinical outcomes including low back pain and bilateral leg pain were evaluated using Visual Analog Scale (VAS) and the Oswestry Disability Index (ODI) before and after surgery. RESULTS All cases were successfully completed surgery and followed for average 15.16 ± 5.2 months. DH (44% ± 11%) and DUVS were significantly improvement postoperatively compared with preoperatively (p < 0.05). Statistically significant increases in bilateral FH (25% ± 11% on the surgical side, 17% ± 8% on the contralateral side) and contralateral FA (26% ± 6%) were observed (p < 0.05). The VAS and the ODI scores were significantly decreased in comparison with the preoperative scores (p < 0.05). CONCLUSION Unilateral-approach with contralateral indirect decompression in Endo-LIF can acquire satisfactory clinical outcomes. Therefore, unilateral-approach Endo-LIF may be a promising option for lumbar spondylolisthesis with bilateral symptoms.
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Affiliation(s)
- Xu Shen
- School of Medicine, Southeast University, Nanjing, 210009, China
- Department of Orthopedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, China
| | - Yu-Cheng Gao
- School of Medicine, Southeast University, Nanjing, 210009, China
- Department of Orthopedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, China
| | - Pei Zhang
- School of Medicine, Southeast University, Nanjing, 210009, China
- Department of Orthopedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, China
| | - Peng Song
- School of Medicine, Southeast University, Nanjing, 210009, China
- Department of Orthopedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, China
| | - Zan-Li Jiang
- School of Medicine, Southeast University, Nanjing, 210009, China
- Department of Orthopedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, China
| | - Feng Wang
- School of Medicine, Southeast University, Nanjing, 210009, China
- Department of Orthopedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, China
| | - Wen-Bin Xuan
- School of Medicine, Southeast University, Nanjing, 210009, China
- Department of Orthopedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, China
| | - Zeng-Xin Gao
- School of Medicine, Southeast University, Nanjing, 210009, China.
- Department of Orthopedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, China.
- Department of Orthopedics, Nanjing Lishui People's Hospital, Zhongda Lishui Brach, Nanjing, 210009, China.
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Kanematsu R, Hanakita J, Takahashi T, Minami M, Miyasaka K, Shimauchi-Ohtaki H, Tomita Y. Severe low back pain with mild leg symptoms due to lumbar spine stenosis. Br J Neurosurg 2024; 38:35-38. [PMID: 33463390 DOI: 10.1080/02688697.2020.1868402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 12/21/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Some patients with lumbar spine stenosis (LSS) have severe low back pain (LBP) with only mild leg symptoms. The effects of decompression surgery for such patients remain unknown. METHODS Of 818 patients with LSS who underwent surgical treatment in our institution from 2011 to 2019, eight patients had a numeric rating scale (NRS) score of ≥7 for LBP and 3≤ for leg pain. The patients' age, sex, clinical characteristics, preoperative leg symptoms, and level of LSS were investigated. The detailed characteristics of LBP, such as the disease duration, location of LBP, and exacerbating factors, were obtained from each patient. The NRS and Japanese Orthopaedic Association (JOA) scores for LBP were evaluated on admission, at 1 and 3 months postoperatively, and at the final follow-up (>1 year postoperatively). RESULTS All patients were male with a mean age of 71.5 years (range, 57-82 years). LBP was exacerbated during walking in six patients and during an extension posture in three patients. The median duration of LBP was 2.9 years (range, 0.3-7 years). The stenosis was located at L2/3 in three patients, L3/4 in five patients, and L4/5 in seven patients. The stenosis involved one level in three patients and more than two levels in five patients. Other pathologies, such as sacroiliac joint lesions, facet pain, superior/middle cluneal nerve pain, and discogenic pain, were excluded by diagnostic anesthetic block and detailed physical examination. All patients underwent posterior decompression surgery without fusion. In all eight patients, the NRS score for LBP significantly improved from 7.6 (range, 7-10) to 1.7 (range, 0-3) and the JOA score improved from 13.1 (range, 4-19) to 21.8 (range, 18-27). CONCLUSION A low proportion of patients showed walking-evoked severe LBP with mild leg symptoms due to lumbar spine stenosis. The patients' pain was improved by decompression surgery with satisfactory results.
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Affiliation(s)
- Ryo Kanematsu
- Department of Spinal Disorders Center, Fujieda Heisei Memorial Hospital, Fujieda, Japan
| | - Junya Hanakita
- Department of Spinal Disorders Center, Fujieda Heisei Memorial Hospital, Fujieda, Japan
| | - Toshiyuki Takahashi
- Department of Spinal Disorders Center, Fujieda Heisei Memorial Hospital, Fujieda, Japan
| | - Manabu Minami
- Department of Spinal Disorders Center, Fujieda Heisei Memorial Hospital, Fujieda, Japan
| | - Kazuhiro Miyasaka
- Department of Spinal Disorders Center, Fujieda Heisei Memorial Hospital, Fujieda, Japan
| | | | - Yosuke Tomita
- Department of Spinal Disorders Center, Fujieda Heisei Memorial Hospital, Fujieda, Japan
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Schönnagel L, Caffard T, Vu-Han TL, Zhu J, Nathoo I, Finos K, Camino-Willhuber G, Tani S, Guven AE, Haffer H, Muellner M, Arzani A, Chiapparelli E, Amoroso K, Shue J, Duculan R, Pumberger M, Zippelius T, Sama AA, Cammisa FP, Girardi FP, Mancuso CA, Hughes AP. Predicting postoperative outcomes in lumbar spinal fusion: development of a machine learning model. Spine J 2024; 24:239-249. [PMID: 37866485 DOI: 10.1016/j.spinee.2023.09.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 09/16/2023] [Accepted: 09/30/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND CONTEXT Degenerative lumbar spondylolisthesis (DLS) is a prevalent spinal disorder, often requiring surgical intervention. Accurately predicting surgical outcomes is crucial to guide clinical decision-making, but this is challenging due to the multifactorial nature of postoperative results. Traditional risk assessment tools have limitations, and with the advent of machine learning, there is potential to enhance the precision and comprehensiveness of preoperative evaluations. PURPOSE We aimed to develop a machine-learning algorithm to predict surgical outcomes in patients with degenerative lumbar spondylolisthesis (DLS) undergoing spinal fusion surgery, only using preoperative data. STUDY DESIGN Retrospective cross-sectional study. PATIENT SAMPLE Patients with DLS undergoing lumbar spinal fusion surgery. OUTCOME MEASURES This study aimed to predict the occurrence of lower back pain (LBP) ≥4 on the numeric analogue scale (NAS) 2 years after surgery. LBP was evaluated as the average pain patients experienced at rest in the week before questioning. NAS ranges from 0 to 10, 0 representing no pain and 10 representing the worst pain imaginable. METHODS We conducted a retrospective analysis of prospectively enrolled patients who underwent spinal fusion surgery for degenerative lumbar spondylolistheses at our institution in the United States between January 2016 and December 2018. The initial patient characteristics to be included in the training of the model were chosen by clinical expertise and through a literature review and included demographic characteristics, comorbidities, and radiologic features. The data was split into a training and validation datasets using a 60/40 split. Four different machine learning models were trained, including the modern XGBoost model, logistic regression, random-forest, and support vector machine (SVM). The models were evaluated according to the area under the curve (AUC) of the receiver operating characteristics (ROC) curve. An AUC of 0.7 to 0.8 was considered fair, 0.8 to 0.9 good, and ≥ 0.9 excellent. Additionally, a calibration plot and the Brier score were calculated for each model. RESULTS A total of 135 patients (66% female) were included. A total of 38 (28%) patients reported LBP ≥ 4 after 2 years, representing the positive class. The XGBoost model demonstrated the best performance in the validation set with an AUC of 0.81 (95% CI 0.67-0.95). The other machine learning models performed significantly worse: with an AUC of 0.52 (95% CI 0.37-0.68) for the SVM, 0.56 (95% CI 0.37-0.76) for the logistic regression and an AUC of 0.56 (95% CI 0.37-0.78) for the random forest. In the XGBoost model age, composition of the erector spinae, and severity of lumbar spinal stenosis as were identified as the most important features. CONCLUSIONS This study represents a novel approach to predicting surgical outcomes in spinal fusion patients. The XGBoost demonstrated a better performance compared with classical models and highlighted the potential contributions of age and paraspinal musculature atrophy as significant factors. These findings have important implications for enhancing patient care through the identification of high-risk individuals and modifiable risk factors. As the incorporation of machine learning algorithms into clinical decision-making continues to gain traction in research and clinical practice, our insights reinforce this trajectory by showcasing the potential of these techniques in forecasting surgical results.
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Affiliation(s)
- Lukas Schönnagel
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA; Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Thomas Caffard
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA; Universitätsklinikum Ulm, Klinik für Orthopädie, Oberer Eselsberg 45, 89081 Ulm, Germany
| | - Tu-Lan Vu-Han
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Jiaqi Zhu
- Biostatistics Core, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Isaac Nathoo
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Kyle Finos
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Gaston Camino-Willhuber
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Soji Tani
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA; Department of Orthopaedic Surgery, School of Medicine, Showa University Hospital, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan
| | - Ali E Guven
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA; Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Henryk Haffer
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Maximilian Muellner
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Artine Arzani
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Erika Chiapparelli
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Krizia Amoroso
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Jennifer Shue
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Roland Duculan
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Matthias Pumberger
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Timo Zippelius
- Universitätsklinikum Ulm, Klinik für Orthopädie, Oberer Eselsberg 45, 89081 Ulm, Germany
| | - Andrew A Sama
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Frank P Cammisa
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Federico P Girardi
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Carol A Mancuso
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Alexander P Hughes
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA.
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Liu Y, Tang G, Li J. Causations between obesity, diabetes, lifestyle factors and the risk of low back pain. Eur Spine J 2024; 33:525-532. [PMID: 38123704 DOI: 10.1007/s00586-023-08069-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 11/13/2023] [Accepted: 11/27/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Despite numerous observational studies, the causal relationship between obesity-measured by body mass index (BMI) and waist circumference (WC)-as well as type 2 diabetes (T2D), lifestyle habits, and susceptibility to low back pain (LBP) remains obscure. METHODS This investigation employed two-sample Mendelian randomization (MR) analysis to explore causality, using genetic variants linked to relevant factors from genome-wide association studies (GWASs). Specifically, we selected independent genetic variants related to BMI, WC, T2D, smoking, alcohol consumption, and coffee intake from established GWASs, all of which demonstrated genome-wide significance. The comparative data for LBP were derived from a GWAS involving European subjects, under the auspices of the renowned MRC-IEU (Medical Research Council Integrative Epidemiology Unit) consortium. RESULTS Elevated BMI and WC were associated with odds ratios of 1.002 (95% confidence interval [CI] = 1.001-1.004, p < 0.001) and 1.003 (95% CI = 1.002-1.004, p < 0.001) for LBP per standard deviation (SD) increase, respectively. Regarding smoking initiation and coffee consumption, the odds ratios stood at 1.002 (95% CI = 1.001-1.004, p = 0.001) and 1.004 (95% CI = 1.001-1.008, p = 0.034) for LBP, respectively. However, an augmented log odds ratio for T2D and each SD rise in alcohol consumption frequency revealed no significant causal impact on LBP risk. CONCLUSION Our findings indicate a potential causal link between obesity, smoking, and coffee intake in the genesis of LBP, suggesting that mitigating these factors could contribute to LBP prevention.
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Affiliation(s)
- Yi Liu
- Department of Anesthesiology, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Nanjing, 210000, Jiangsu, China
| | - Gang Tang
- Department of Anesthesiology, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Nanjing, 210000, Jiangsu, China
| | - Jinyu Li
- Department of Anesthesiology, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Nanjing, 210000, Jiangsu, China.
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Liu S, Lv X, Deng X, Lai R, Du J, Wang C. Diet and risk of low back pain: a Mendelian randomization analysis. Eur Spine J 2024; 33:496-504. [PMID: 37934267 DOI: 10.1007/s00586-023-07970-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 09/08/2023] [Accepted: 09/22/2023] [Indexed: 11/08/2023]
Abstract
PURPOSE Previous epidemiological and other studies have shown an association between diet and low back pain (LBP). This study aimed to investigate the causal relationship between diet and LBP using a Mendelian randomization (MR) approach. METHODS The three main methods in this study were weighted median, MR-Egger, and inverse variance weighting (IVW). We utilized MR-PRESSO to eliminate abnormal SNPs. Additionally, tests for pleiotropy and heterogeneity were conducted. Utilizing IVW and MR-Egger's Cochran's Q test, heterogeneity was evaluated. MR-Egger intercepts were used in pleiotropy tests. A leave-one-out analysis was also used to evaluate the stability of the study's findings. RESULTS The frequency of alcohol intake was associated with an increased risk of LBP. Increased processed meat intake, dried fruit intake, cereal intake, and tea intake were causally associated with a decreased risk of LBP (alcohol intake frequency: odds ratio (OR) = 1.28; 95% confidence interval (CI), 1.11-1.47; P = 0.0006; processed meat intake: OR = 0.60, 95%CI 0.39-0.92, P = 0.019; dried fruit intake: OR = 0.43, 95%CI 0.29-0.66, P = 0.00008; cereal intake: OR = 0.62, 95%CI 0.42-0.92, P = 0.018; tea intake: OR = 0.75, 95%CI 0.58-0.97, P = 0.029). Heterogeneity and pleiotropy were also not found in the sensitivity analysis. The leave-one-out analysis also showed more robust results. Other dietary intakes were not causally associated with LBP. CONCLUSIONS This two-sample MR study found that frequency of alcohol intake was associated with an increased risk of LBP, and intake of processed meat, dried fruit, cereals, and tea was associated with a decreased risk of LBP. Moreover, no causal relationship was found with LBP in the other 13 diets.
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Affiliation(s)
- Shanshan Liu
- School of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, China
| | - Xiaofeng Lv
- School of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, China
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610072, Sichuan, China
| | - Xinmin Deng
- School of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, China
| | - Rui Lai
- School of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, China
| | - Jihang Du
- School of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, China
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610072, Sichuan, China
| | - Chao Wang
- Sichuan Integrative Medicine Hospital, Chengdu, 610042, Sichuan, China.
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Michels I, Jacobson L. Central Cord Syndrome After Fall From Inversion Table. WMJ 2024; 123:51-55. [PMID: 38436641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
INTRODUCTION Central cord syndrome, the most common incomplete traumatic spinal cord injury, often results in functional impairment with variable recovery. CASE PRESENTATION Central cord syndrome developed in a 64-year-old man during routine home use of an inversion table. DISCUSSION The incidence of central cord syndrome, which occurs most frequently after a fall, is increasing among older persons. Age-related changes in the cervical spine may predispose the spinal cord to compression and injury during a fall. Evidence for lumbar traction as treatment of low back pain is limited. CONCLUSIONS This unusual case of spinal cord injury during inversion table use highlights the relationship between anatomical changes in the cervical spine and the mechanism of injury typical in central cord syndrome. The resulting increased risk of central cord syndrome for older adults should be discussed with patients in the context of activities that could lead to falls or cervical spine extension.
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Affiliation(s)
| | - Lang Jacobson
- Mayo Clinic Health System - Northwest Wisconsin Region, Eau Claire, Wisconsin,
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Kim K, Shimizu J, Isu T, Morimoto D, Kubota A, Morita A, Murai Y. A clinicopathological study of low back pain due to middle cluneal nerve entrapment: case series. Eur Spine J 2024; 33:490-495. [PMID: 37924390 DOI: 10.1007/s00586-023-07944-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 08/12/2023] [Accepted: 09/04/2023] [Indexed: 11/06/2023]
Abstract
PURPOSE The middle cluneal nerve (MCN) is a pure sensory nerve around the middle buttock. Its entrapment between the iliac crest and the long posterior sacroiliac ligament elicits low back pain (LBP) that can be treated by MCN neurolysis or neurectomy. Because few studies examined the pathology of MCN entrapment (MCN-E) we subjected 7 neurectomized specimens from 6 LBP patients to pathologic study. METHODS We present 6 consecutive patients (7 sides) with intractable LBP who underwent successful MCN neurectomy. Their symptom duration ranged from 6 to 96 months (average 47.3 months); the follow-up period ranged from 6 to 17 months (average 11.7 months). The surgical outcomes were evaluated using the numerical rating scale (NRS) for LBP and the Roland-Morris Disability Questionnaire (RDQ) score. The resected MCNs underwent neuropathological analysis. RESULTS Postoperatively, all 6 patients reported immediate LBP amelioration; their NRS and RDQ scores were improved significantly. Pathological study of the 7 resected nerves showed that the myelinated fiber density was decreased in 6 nerves; we observed marked enlargement (n = 5), perineurial thickening and disruption (n = 6), intrafascicular fibrous changes (n = 5), myelinated fibers separated by fibrous cells under the perineurium (n = 4), and Renaut bodies (n = 3). The 7th nerve appeared normal with respect to the density and size of the myelinated fibers, however, the perineurium was slightly thickened. CONCLUSION We present pathological evidence at the MCN compression site of 7 nerves from 6 patients whose LBP was alleviated by MCN neurectomy, indicating that MCN entrapment can elicit LBP.
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Affiliation(s)
- Kyongsong Kim
- Department of Neurological Surgery, Nippon Medical School, Chiba Hokuso Hospital, 1715, Kamagari, Inzai-City, Chiba, Japan.
| | - Jun Shimizu
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Bunkyo-Ku, Tokyo, Japan
- Department of Rehabilitation, Tokyo University of Technology, Bunkyo-Ku, Tokyo, Japan
| | - Toyohiko Isu
- Department of Neurosurgery, Kushiro Rosai Hospital, Kushiro-City, Hokkaido, Japan
| | - Daijiro Morimoto
- Department of Neurological Surgery, Nippon Medical School, Bunkyo-Ku, Tokyo, Japan
| | - Akatsuki Kubota
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Bunkyo-Ku, Tokyo, Japan
| | - Akio Morita
- Department of Neurological Surgery, Nippon Medical School, Bunkyo-Ku, Tokyo, Japan
| | - Yasuo Murai
- Department of Neurological Surgery, Nippon Medical School, Bunkyo-Ku, Tokyo, Japan
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