Efficiency and predictive parameters of outcome of a multimodal pain management concept with spinal injections in patients with low back pain: a retrospective study of 445 patients

[Injection treatment for cervical and lumbar syndromes: principles, indications and general performance]

An intensive conservative treatment that exhausts all treatment options should fundamentally be carried out before every surgical intervention in the region of the spinal column. The therapeutic measures are determined by the extent of the cervical or lumbar syndrome. As a rule, in cases of local complaints symptomatic measures with physiotherapy or digital healthcare applications are indicated. In cases of referred cervical and lumbar syndromes targeted injections can be employed. Before targeted injection treatment a detailed orthopedic clarification with respect to the intensity of local, radicular or pseudoradicular complaints must be carried out. When carrying out minimally invasive injection treatment specific prerequisites with respect to spatial, personnel and technical conditions must be fulfilled. The indications and contraindications must be strictly controlled.

A clinical decision support system in back pain helps to find the diagnosis: a prospective correlation study

The aim of this study is to show the concordance of an app-based decision support system and the diagnosis given by spinal surgeons in cases of back pain. 86 patients took part within 2 months. They were seen by spine surgeons in the daily routine and then completed an app-based questionnaire that also led to a diagnosis independently. The results showed a Cramer's V = .711 (p < .001), which can be taken as a strong relation between the tool and the diagnosis of the medical doctor. Besides, in 67.4% of the cases, the diagnosis was concordant. An overestimation of the severity of the diagnosis occurred more often than underestimation (15.1% vs. 7%). The app-based tool is a safe tool to support healthcare professionals in back pain diagnosis.

Challenges and opportunities of pharmaceutical cocrystals: a focused review on non-steroidal anti-inflammatory drugs

The focus of the review is to discuss the relevant and essential aspects of pharmaceutical cocrystals in both academia and industry with an emphasis on non-steroidal anti-inflammatory drugs (NSAIDs). Although cocrystals have been prepared for a plethora of drugs, NSAID cocrystals are focused due to their humongous application in different fields of medication such as antipyretic, anti-inflammatory, analgesic, antiplatelet, antitumor, and anti-carcinogenic drugs. The highlights of the review are (a) background of cocrystals and other solid forms of an active pharmaceutical ingredient (API) based on the principles of crystal engineering, (b) why cocrystals are an excellent opportunity in the pharma industry, (c) common methods of preparation of cocrystals from the lab scale to bulk quantity, (d) some latest case studies of NSAIDs which have shown better physicochemical properties for example; mechanical properties (tabletability), hydration, solubility, bioavailability, and permeability, and (e) latest guidelines of the US FDA and EMA opening new opportunities and challenges.

Hospital admission and associated factors among individuals presenting to healthcare facilities for low back pain in Ethiopia

AIM

The aim of this paper is to analyze hospital admission and associated factors following presentation to healthcare facilities for low back pain (LBP) in Ethiopia.

METHODS

A population-based cross-sectional study was conducted between June and November 2018 in South-west Shewa zone of Oromia regional state. Data were collected by face-to-face interviews of adults (≥18 years) with self-reported LBP using a newly developed and validated instrument. All the statistical analyses of (n = 543) individuals with a 1-year history of presentation to healthcare facilities for LBP were performed using R version 3.5.1. The log-binomial regression model was fitted and prevalence ratios with 95% confidence intervals (CIs) were calculated to identify factors associated with hospitalization and the significance level was considered at the P value of ≤ .05.

RESULTS

The proportion of hospital admissions following presentation to healthcare facilities for LBP was 14.4%, 95% CI 11.4-17.3, with an average length of stay (LOS) 7.4 days, 95% CI 6.4-8.8. The admission rate was 18.5%, 95% CI 13.4-23.3 in females and 11.4%, 95% CI 8.0-15.1 in males. Multiple factors, such as gender, age, living conditions, residential environment, alcohol consumption status, intensity of pain, and presence of additional spinal pain, were found to be independently associated with hospitalization for LBP.

CONCLUSIONS

The burden on the individuals and the Ethiopian healthcare system as a result of LBP is evident by the rate of hospital admissions. Further evidence on LBP case referral procedures is needed to allow health policy makers to develop appropriate management strategies capable of dealing with the increasing epidemiology of LBP.

To fuse or not to fuse: a survey among members of the German Spine Society (DWG) regarding lumbar degenerative spondylolisthesis and spinal stenosis

INTRODUCTION

Surgical treatment methods for degenerative spondylolisthesis (decompression versus decompression and fusion) have been critically debated. The medical care situation is almost unknown for either treatment. Therefore, the aim of the present study was to provide information regarding the use of parameters for decision-making and the employment of surgical techniques.

MATERIALS AND METHODS

A web-based survey was performed among members of the German-Spine-Society (DWG). Information regarding participant characteristics (specialty, age, DWG certification status, number of spine surgeries performed at the participant's institution each year, institutional status), estimates of the use of both treatment options, clinical and morphological decision-making criteria for additive fusion, and the surgical technique used was queried.

RESULTS

305 members (45% neurosurgeons/ 55% orthopedic or trauma surgeons) participated in the present study. The participants estimated that in 41.7% of the cases, decompression only was required, while 55.6% would benefit from additional fusion. Among the participants, 74% reported that low back pain was an important indicator of the need for fusion if the numerical rating scale for back pain was at least 6/10. The most commonly used decompression technique was minimally invasive unilateral laminotomy, whereas open approach-based interbody fusion with transpedicular fixation and laminotomy was the most frequently used fusion technique. Specialty, age, certification status, and institutional status had a partial effect on the responses regarding indications, treatment and surgical technique.

CONCLUSIONS

The present survey depicts the diversity of approaches to surgery for degenerative spondylolistheses in Germany. Considerable differences in treatment selection were observed in relation to the participants' educational level and specialty.

The Role of a Decision Support System in Back Pain Diagnoses: A Pilot Study

It is the main goal of this study to investigate the concordance of a decision support system and the recommendation of spinal surgeons regarding back pain. 111 patients had to complete the decision support system. Furthermore, their illness was diagnosed by a spinal surgeon. The results showed significant medium relation between the DSS and the diagnosis of the medical doctor. Besides, in almost 50% of the cases the recommendation for the treatment was concordant and overestimation occurred more often than underestimation. The results are discussed in relation to the “symptom checker” literature and the claim of further evaluations.

[Lumbar facet joint disease : Classification, clinical diagnostics, and minimally invasive treatment]

BACKGROUND

The degeneration of the lumbar facet joint is a multi-factorial process that is closely linked to degeneration of the intervertebral discs and has been implicated as one of the causes of low-back pain of elderly patients in about 15 up to 40% of cases. Moreover, emerging data suggest that increased inflammatory features play an important role in the progression of lumbar facet joint disease and may serve as a link to the afferent pain nerve fibers.

OPERATIVE TECHNIQUES

Since the first description in 1975 of minimally invasive treatment of lumbar facet joint disease, different techniques have been developed and used with varying results. Today, the major techniques are thermorhizotomy, cryorhizotomy, and endoscopic or percutaneous facet debridement with different anatomical targets, such as the medial branch of the dorsal ramus or facet joint capsule.