Prevalence of lumbar spondylosis and its association with low back pain among community-dwelling Japanese women

Successful Management of Severe Low Back Pain with Ayurveda in Lumbar Spondylosis: A Case Report

Lumbar spondylosis is a common condition that is quite prevalent, affecting 57% of Indian men. Ayurveda, an indigenous medical system, is highly efficient in treating this ailment when it is in a mild to moderate state. This case report aims to provide a detailed account of a successfully managed case of lumbar spondylosis characterized by severe lumbar pain. A 59-year-old man, who has been suffering from lumbar spondylosis for the last 8 years, was presented with complaints of severe to moderate low back pain, disability, and pain in both legs. According to Ayurvedic principles, the condition was diagnosed as "Katigraha," and a nine-day treatment plan, including three Niruha Basti consecutively, followed by one Anuvasan Basti with the use of Ayurvedic medications was suggested. The lumbar pain severity fell from 8 to 2 points, while the leg pain decreased from 7 to 1 point. The Oswestry Low Back Disability Index (ODI) showed a significant reduction, from 49 to 18. The flexion and extension range of motion grew from 1 to 3 cm, and from 1 to 2 cm, respectively. The case study indicates a reduction in severe low back pain, but further investigation is required to determine the underlying mechanisms.

Enhancing contrast distribution with the far lateral approach in lumbar transforaminal epidural steroid injections: A retrospective analysis

BACKGROUND

Herniated intervertebral disc (HIVD) with radiculopathy is a common degenerative spine disorder. Transforaminal epidural steroid injection (TFESI) is one of the pain relief treatments for lumbar radiculopathy recommended by evidence-based guidelines. Adequate contrast distribution is correlated with better pain control, but the best approach has not been confirmed yet.

AIM

To confirm the distribution of contrast medium injected with a new approach of TFESI, that is, far lateral lateral recess approach (FLLR-TFESI).

METHODS

Patients receiving TFESI due to HIVD with radiculopathy between 2010 January and 2020 August were retrospectively enrolled. While the FLLR-TFESI was taken as the experimental group, the conventional approach was viewed as the control group. The baseline characteristics, the pattern of contrast enhancement under fluoroscopic guidance, and the complications of these patients were collected and analyzed.

RESULTS

A total of 380 patients were analyzed (143 in control group and 237 in experimental group). The two groups were balanced in most baseline characteristics, except disc extrusion (p = 0.01) and scoliosis (p = 0.04). The FLLR-TFESI have a better contrast distribution (p < 0.01), even after adjustment (p < 0.001). No intrathecal injection was noted, but higher rate of intra-disc injection was noted in FLLR-TFESI group (10% vs. 3%, p = 0.008).

CONCLUSION

The FLLR-TFESI has a superior contrast enhancement and distribution in comparison to conventional approach. Prospective study to confirm the study result as well as the clinical benefits is suggested in the future.

Influence of radiological factors, psychosocial factors, and central sensitization-related symptoms on clinical symptoms in patients with lumbar spinal canal stenosis

BACKGROUND

No study to date has concurrently evaluated the impact of radiological factors, psychosocial factors, and central sensitization (CS) related symptoms in a single lumbar spinal canal stenosis (LSS) patient cohort.

OBJECTIVE

To investigate the associations between these factors and clinical symptoms in LSS patients.

METHODS

We recruited 154 patients with LSS scheduled for surgery. Patient-reported outcome measures and imaging evaluation including clinical symptoms, psychosocial factors, CS-related symptoms, and radiological classifications. Spearman's rank correlation coefficient and multiple regression analyses were employed.

RESULTS

Spearman's correlation revealed CS-related symptoms positively correlated with low back pain (r= 0.25, p< 0.01), leg pain (r= 0.26, p< 0.01), and disability (r= 0.32, p< 0.01). Pain catastrophizing positively correlated with leg pain (r= 0.23, p< 0.01) and disability (r= 0.36, p< 0.01). Regression analysis showed that pain catastrophizing was associated with disability (β= 0.24, 95%CI = 0.03-0.18), and CS-related symptoms with low back pain (β= 0.28, 95%CI = 0.01-0.09). Radiological classifications were not associated with clinical symptoms.

CONCLUSION

Our findings suggest that psychosocial factors and CS-related symptoms, rather than radiological factors, seem to contribute to clinical symptoms in patients with LSS.

Novel elemental grading system for radiographic lumbar spondylosis in a population based-cohort study of a Japanese mountain village

Purpose

Lumbar radiography is a primary screening tool for lumbar spondylosis (LS). Kellgren-Lawrence (KL) classification is widely used to evaluate LS; however, it cannot individually evaluate each radiographic feature. The purpose of this study was to 1) evaluate radiographic LS using a novel elemental grading system and 2) investigate the relationship between the grades of radiographic LS and low back pain (LBP) in a population-based cohort study.

Methods

A total of 260 (75 men, 185 women; mean age, 71.5 ± 8.7 years) participants were included in this study. Participants were divided into two groups according to the presence of LBP (LBP- and LBP+ groups). Radiographic features, including osteophyte (OP), disc height narrowing (DHN), vertebral sclerosis (VS), and spondylolisthesis (SL), were classified between grades of 0–2 grades according to the extent of radiographic changes. The sum of grades at each intervertebral level was designated as the intervertebral grade (IG).

Results

Intra- and inter-observer reliability (kappa coefficient) of OP, DHN, VS, and SL were 0.82–0.92. OP, DHN, VS, and IG grades were significantly higher in the LBP+ group than in the LBP- group. There were no significant differences in KL grades between the LBP- and LBP+ groups. Logistic regression analysis demonstrated that VS grade was a significant independent factor associated with LBP.

Conclusion

The novel elemental grading system of LS would reflect LBP more accurately than the KL classification by individually evaluating each radiographic feature.

An alternative approach for lumbar transforaminal epidural steroid injection-Far lateral approach

INTRODUCTION

Transforaminal epidural steroid injection (TFESI) is one of the nonoperative interventions for lower back pain. In this study, we presented an alternative approach for TFESI, far lateral lateral recess TFESI (FLLR TFESI), which is targeted on lateral recess and anterior epidural space in patients with degenerative lumbar spondylosis-related radiculopathy.

TECHNIQUE

Under fluoroscopy, needle entry site and pathway are drawn according to the spinal anatomy. The needle is advanced toward the lateral recess and the needle tip is placed medially to the medial border of the pedicle under anteroposterior view and posteriorly to the posterior border of the upper endplate under lateral view. After checking optimal contrast spread, steroids and local anesthetics are injected.

CASE ILLUSTRATION

An 86-year-old woman who suffered from lower back pain with radiculopathy received interventional treatment. Comparing the "traditional" supraneural approach with the FLLR approach, the difference in contrast enhancement to lateral recess is clearly shown.

DISCUSSION

Compared to the pre-existing approaches, the FLLR approach may provide better ventral epidural and lateral recess enhancement. Furthermore, with the advanced needle tip, the injectate may enhance not only the at-level nerve root but also the nerve root of adjacent level during their existence in a single injection. With blunt needle usage, no nerve root injury or dura puncture was noted so far.

CONCLUSION

FLLR TFESI is a modified fluoroscopic technique targeted on lateral recess and anterior epidural space. However, subsequent trials are needed to confirm its efficacy in pain reduction and the rate of complications.

Examination of the changes in lower extremities related to progression of adult spinal deformity: a longitudinal study of over 22 years

This longitudinal observational study investigated the relationship between changes in spinal sagittal alignment and changes in lower extremity coronal alignment. A total of 58 female volunteers who visited our institution at least twice during the 1992 to 1997 and 2015 to 2019 periods were investigated. We reviewed whole-spine radiographs and lower extremity radiographs and measured standard spinal sagittal parameters including pelvic incidence [PI], lumbar lordosis [LL], pelvic tilt [PT], sacral slope [SS] and sagittal vertical axis [SVA], and coronal lower extremity parameters including femorotibial angle (FTA), hip–knee–ankle angle (HKA), mechanical lateral distal femoral angle (mLDFA), mechanical medial proximal tibial angle (mMPTA) and mechanical lateral distal tibial angle (mLDTA). Lumbar spondylosis and knee osteoarthritis were assessed using the Kellgren–Lawrence (KL) grading system at baseline and at final follow-up. We investigated the correlation between changes in spinal sagittal alignment and lower extremity alignment and changes in lumbar spondylosis. The mean age [standard deviation (SD)] was 48.3 (6.3) years at first visit and 70.2 (6.3) years at final follow-up. There was a correlation between changes in PI-LL and FTA (R = 0.449, P < 0.001) and between PI-LL and HKA (R = 0.412, P = 0.001). There was a correlation between changes in lumbar spondylosis at L3/4 (R = 0.383, P = 0.004) and L4/5 (R = 0.333, P = 0.012) and the knee joints. Changes in lumbar spondylosis at L3/4 and L4/5 were related to changes in KOA. Successful management of ASD must include evaluation of the state of lower extremity alignment, not only in the sagittal phase, but also the coronal phase.