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Odland K, Chanbour H, Zuckerman SL, Polly DW. Spinopelvic fixation failure in the adult spinal deformity population: systematic review and meta-analysis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024:10.1007/s00586-024-08241-6. [PMID: 38619634 DOI: 10.1007/s00586-024-08241-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 03/13/2024] [Accepted: 03/26/2024] [Indexed: 04/16/2024]
Abstract
INTRODUCTION Despite modern fixation techniques, spinopelvic fixation failure (SPFF) after adult spinal deformity (ASD) surgery ranges from 4.5 to 38.0%, with approximately 50% requiring reoperation. Compared to other well-studied complications after ASD surgery, less is known about the incidence and predictors of SPFF. AIMS/OBJECTIVES Given the high rates of SPFF and reoperation needed to treat it, the purpose of this systematic review and meta-analysis was to report the incidence and failure mechanisms of SPF after ASD surgery. MATERIALS/METHODS The literature search was executed across four databases: Medline via PubMed and Ovid, SPORTDiscus via EBSCO, Cochrane Library via Wiley, and Scopus. Study inclusion criteria were patients undergoing ASD surgery with spinopelvic instrumentation, report rates of SPFF and type of failure mechanism, patients over 18 years of age, minimum 1-year follow-up, and cohort or case-control studies. From each study, we collected general demographic information (age, gender, and body mass index), primary/revision, type of ASD, and mode of failure (screw loosening, rod breakage, pseudarthrosis, screw failure, SI joint pain, screw protrusion, set plug dislodgment, and sacral fracture) and recorded the overall rate of SPF as well as failure rate for each type. For the assessment of failure rate, we required a minimum of 12 months follow-up with radiographic assessment. RESULTS Of 206 studies queried, 14 met inclusion criteria comprising 3570 ASD patients who underwent ASD surgery with pelvic instrumentation (mean age 65.5 ± 3.6 years). The mean SPFF rate was 22.1% (range 3-41%). Stratification for type of failure resulted in a mean SPFF rate of 23.3% for the pseudarthrosis group; 16.5% for the rod fracture group; 13.5% for the iliac screw loosening group; 7.3% for the SIJ pain group; 6.1% for the iliac screw group; 3.6% for the set plug dislodgement group; 1.1% for the sacral fracture group; and 1% for the iliac screw prominence group. CONCLUSION The aggregate rate of SPFF after ASD surgery is 22.1%. The most common mechanisms of failure were pseudarthrosis, rod fracture, and iliac screw loosening. Studies of SPFF remain heterogeneous, and a consistent definition of what constitutes SPFF is needed. This study may enable surgeons to provide patient specific constructs with pelvic fixation constructs to minimize this risk of failure.
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Affiliation(s)
- Kari Odland
- Department of Orthopedic Surgery, University of Minnesota, 2450 Riverside Avenue South, Suite R200, Minneapolis, MN, 55454, USA.
| | - Hani Chanbour
- Department of Neurological Surgery, Vanderbilt University, Nashville, TN, 37204, USA
| | - Scott L Zuckerman
- Department of Neurological Surgery, Vanderbilt University, Nashville, TN, 37204, USA
| | - David W Polly
- Department of Orthopedic Surgery, University of Minnesota, 2450 Riverside Avenue South, Suite R200, Minneapolis, MN, 55454, USA
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Gushcha AO, Sharif S, Zileli M, Oertel J, Zygourakis CC, Yusupova AR. Acute back pain: Clinical and radiologic diagnosis: WFNS spine committee recommendations. World Neurosurg X 2024; 22:100278. [PMID: 38389960 PMCID: PMC10882106 DOI: 10.1016/j.wnsx.2024.100278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 02/01/2024] [Indexed: 02/24/2024] Open
Abstract
Objective To formulate the most current, evidence-based recommendations for the clinical and radiologic diagnosis of acute low back pain lasting <4 weeks. Methods A systematic literature search in PubMed and Google Scholar databases was performed from 2012 to 2022 using the search terms "acute back pain AND clinical diagnosis" and "acute back pain AND radiologic diagnosis". Screening criteria resulted in a total of 97 papers analyzed. Using the Delphi method and two rounds of voting, the WFNS (World Federation of Neurosurgical Societies) Spine Committee generated ten final consensus statements. Results Ten final consensus statements address the clinical diagnosis of acute LBP, including which clinical conditions cause acute LBP and how we can distinguish between the different causes of LBP, including discogenic, facet joint, sacroiliac joint, and myofascial pain. The most important step for the radiologic diagnosis of acute LBP is to evaluate the necessity of radiologic investigation, as well as its timing and the most appropriate type of imaging modality. Importantly, imaging should not be a routine diagnostic tool, unless red flag signs are present. In fact, routine imaging for acute LBP can actually have a negative effect as it may reveal incidental radiographic findings that exacerbate patient fear and anxiety. Conclusion Overall, the quality of evidence is not high for most of our consensus statements, and further studies are needed to validate the WFNS Spine Committee recommendations on the clinical and radiographic diagnosis of acute LBP.
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Affiliation(s)
- Artem O Gushcha
- Department of Neurosurgery, Research Center of Neurology, Moscow, Russia
| | - Salman Sharif
- Department of Neurosurgery, Liaquat National Hospital & Medical College, Karachi, Pakistan
| | - Mehmet Zileli
- Department of Neurosurgery, Ege University Faculty of Medicine, Izmir, Turkey
| | - Joachim Oertel
- Department of Neurosurgery, Saarland University Medical Center and Saarland University Faculty of Medicine, Kirrberger Str. 90.5, 66421, Homburg, Saar, Germany
| | - Corinna C Zygourakis
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Adilya R Yusupova
- Department of Neurosurgery, Research Center of Neurology, Moscow, Russia
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Pojskic M, Bisson E, Oertel J, Takami T, Zygourakis C, Costa F. Lumbar disc herniation: Epidemiology, clinical and radiologic diagnosis WFNS spine committee recommendations. World Neurosurg X 2024; 22:100279. [PMID: 38440379 PMCID: PMC10911853 DOI: 10.1016/j.wnsx.2024.100279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 02/01/2024] [Indexed: 03/06/2024] Open
Abstract
Objective To formulate the most current, evidence-based recommendations regarding the epidemiology, clinical diagnosis, and radiographic diagnosis of lumbar herniated disk (LDH). Methods A systematic literature search in PubMed, MEDLINE, and CENTRAL was performed from 2012 to 2022 using the search terms "herniated lumbar disc", "epidemiology", "prevention" "clinical diagnosis", and "radiological diagnosis". Screening criteria resulted in 17, 16, and 90 studies respectively that were analyzed regarding epidemiology, clinical diagnosis, and radiographic diagnosis of LDH. Using the Delphi method and two rounds of voting at two separate international meetings, ten members of the WFNS (World Federation of Neurosurgical Societies) Spine Committee generated eleven final consensus statements. Results The lifetime risk for symptomatic LDH is 1-3%; of these, 60-90% resolve spontaneously. Risk factors for LDH include genetic and environmental factors, strenuous activity, and smoking. LDH is more common in males and in 30-50 year olds. A set of clinical tests, including manual muscle testing, sensory testing, Lasegue sign, and crossed Lasegue sign are recommended to diagnose LDH. Magnetic resonance imaging (MRI) is the gold standard for confirming suspected LDH. Conclusions These eleven final consensus statements provide current, evidence-based guidelines on the epidemiology, clinical diagnosis, and radiographic diagnosis of LDH for practicing spine surgeons worldwide.
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Affiliation(s)
- Mirza Pojskic
- Department of Neurosurgery, University of Marburg, Germany
| | - Erica Bisson
- Department of Neurosurgery, University of Utah, Salt Lake City, UT, USA
| | - Joachim Oertel
- Department of Neurosurgery, Saarland University Medical Centre, Homburg, Saarland, Germany
| | - Toshihiro Takami
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University, Japan
| | - Corinna Zygourakis
- Department of Neurosurgery, Stanford University Medical Center, Stanford, CA, USA
| | - Francesco Costa
- Spine Surgery Unit (NCH4) - Department of Neurosurgery - Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
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Hu Y, Liu S, Yang R, Wang H. Biomechanical Analysis of a Newly Proposed Surgical Combination (MIS Screw-Rod System for Indirect Decompression+ Interspinous Fusion System for long Term Spinal Stability) in Treatment of Lumbar Degenerative Diseases. World Neurosurg 2024; 184:e809-e820. [PMID: 38364897 DOI: 10.1016/j.wneu.2024.02.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 02/10/2024] [Indexed: 02/18/2024]
Abstract
OBJECTIVE The aim of this study is to analyze the biomechanical stability of a newly proposed surgical combination (minimally invasive surgery of screw-rod system for indirect decompression + interspinous fusion system for long term spinal stability) in treatment of lumbar degenerative diseases. METHODS The three-dimensional (3D) computed tomography (CT) image data of an adult healthy male volunteer were selected. An intact model of L4/5 was further established and validated by using Mimic and 3-matic, 3D slicer, abaqus, Python. Four surgical models were constructed. The biomechanical stability among these surgical modes was compared and analyzed using finite element analysis. RESULTS The maximum von mises on fixation system in surgical models 2 and 3 exhibited comparable values. This finding suggested that the increase in interspinous fusion did not result in a significant elevation in maximum von mises on fixation system. Compared with the third surgical model, the fourth model, which received less average von mises experienced by the screw in contact with both cancellous and cortical bone. The findings indicated that the inclusion of facet joint fusion in surgical procedures might not be necessary to increase the average von Mises stress experienced by the screw in contact with both cancellous and cortical bone. CONCLUSIONS The biomechanical stability of the newly proposed surgical combination (MIS screw-rod for indirect decompression + interspinous fusion for long term spinal stability technique) was not lower than that of the other surgical combination groups, and it might not be necessary to perform facet joint fusion during the surgery.
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Affiliation(s)
- Yunxiang Hu
- School of Graduates, Dalian Medical University, Dalian City, Liaoning Province, China; Department of Orthopedics, Dalian Municipal Central Hospital Affiliated of Dalian Medical University, Dalian City, Liaoning Province, China
| | - Sanmao Liu
- School of Graduates, Dalian Medical University, Dalian City, Liaoning Province, China; Department of Orthopedics, Dalian Municipal Central Hospital Affiliated of Dalian Medical University, Dalian City, Liaoning Province, China
| | - Rui Yang
- School of Graduates, Dalian Medical University, Dalian City, Liaoning Province, China; Department of Orthopedics, Dalian Municipal Central Hospital Affiliated of Dalian Medical University, Dalian City, Liaoning Province, China
| | - Hong Wang
- Department of Orthopedics, Dalian Municipal Central Hospital Affiliated of Dalian Medical University, Dalian City, Liaoning Province, China.
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Polly DW. The Sacroiliac Joint: A Current State-of-the-Art Review. JBJS Rev 2024; 12:01874474-202402000-00001. [PMID: 38315777 DOI: 10.2106/jbjs.rvw.23.00151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
» The sacroiliac joint (SIJ) is a common cause of low back pain and should be included in the differential diagnosis.» Nonoperative treatment of sacroiliac pain is always the first line of therapy; however, when it is unsuccessful and becomes chronic, then recurrent nonoperative treatment becomes expensive.» Surgical treatment is cost-effective in appropriately selected patients. High-quality clinical trials have demonstrated statistically and clinically significant improvement compared with nonsurgical management in appropriately selected patients.» Spinal fusion to the sacrum increases degeneration of the SIJ and frequency of SIJ pain.
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Affiliation(s)
- David W Polly
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota
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López-Marcos JJ, Díaz-Arribas MJ, Valera-Calero JA, Navarro-Santana MJ, Izquierdo-García J, Ortiz-Gutiérrez RM, Plaza-Manzano G. The Added Value of Face-to-Face Supervision to a Therapeutic Exercise-Based App in the Management of Patients with Chronic Low Back Pain: A Randomized Clinical Trial. SENSORS (BASEL, SWITZERLAND) 2024; 24:567. [PMID: 38257659 PMCID: PMC10819225 DOI: 10.3390/s24020567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/28/2023] [Accepted: 01/15/2024] [Indexed: 01/24/2024]
Abstract
Low back pain (LBP) is a significant global health challenge due to its high prevalence, and chronicity and recurrence rates, with projections suggesting an increase in the next years due to population growth and aging. The chronic and recurrent nature of LBP, responsible for a significant percentage of years lived with disability, underscores the need for effective management strategies, including self-management strategies advocated by current guidelines, to empower patients and potentially improve healthcare efficiency and clinical outcomes. Therefore, the aim of this study was to analyze the added value of face-to-face visits in patients with chronic LBP undergoing a self-management program based on therapeutic exercises on pain intensity, disability, quality of life and treatment adherence and satisfaction. A randomized clinical trial was conducted, allocating 49 patients into a experimental group with a mobile health (mHealth) app usage and face-to-face sessions and 49 patients into an active control group without face-to-face sessions. Pain intensity, disability and quality of life were assessed at baseline, 4 weeks postintervention and 12 weeks postintervention. Patients' satisfaction and adherence were assessed at the end of the study. The multivariate general model revealed no statistically significant time × group interaction for any outcome (p > 0.0068) but mental quality of life (p = 0.006). Within-group differences revealed significant improvements for all the clinical indicators (all, p < 0.001). Patients allocated to the experimental group reported greater satisfaction and adherence (both, p < 0.001) compared to the control group. The use of mHealth apps such as Healthy Back® as part of digital health initiatives may serve as a beneficial approach to enhance the management of LBP.
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Affiliation(s)
- José Javier López-Marcos
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursery, Physiotherapy and Podiatry, Complutense University of Madrid, 28040 Madrid, Spain; (J.J.L.-M.); (J.A.V.-C.); (M.J.N.-S.); (J.I.-G.); (R.M.O.-G.); (G.P.-M.)
- Faculty of Life and Natural Sciences, Nebrija University, 28015 Madrid, Spain
| | - María José Díaz-Arribas
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursery, Physiotherapy and Podiatry, Complutense University of Madrid, 28040 Madrid, Spain; (J.J.L.-M.); (J.A.V.-C.); (M.J.N.-S.); (J.I.-G.); (R.M.O.-G.); (G.P.-M.)
- Grupo InPhysio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
| | - Juan Antonio Valera-Calero
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursery, Physiotherapy and Podiatry, Complutense University of Madrid, 28040 Madrid, Spain; (J.J.L.-M.); (J.A.V.-C.); (M.J.N.-S.); (J.I.-G.); (R.M.O.-G.); (G.P.-M.)
- Grupo InPhysio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
| | - Marcos José Navarro-Santana
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursery, Physiotherapy and Podiatry, Complutense University of Madrid, 28040 Madrid, Spain; (J.J.L.-M.); (J.A.V.-C.); (M.J.N.-S.); (J.I.-G.); (R.M.O.-G.); (G.P.-M.)
- Grupo InPhysio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
| | - Juan Izquierdo-García
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursery, Physiotherapy and Podiatry, Complutense University of Madrid, 28040 Madrid, Spain; (J.J.L.-M.); (J.A.V.-C.); (M.J.N.-S.); (J.I.-G.); (R.M.O.-G.); (G.P.-M.)
- Multidisciplinary Cardiac Rehabilitation Unit, University Hospital 12 de Octubre, 28041 Madrid, Spain
| | - Rosa María Ortiz-Gutiérrez
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursery, Physiotherapy and Podiatry, Complutense University of Madrid, 28040 Madrid, Spain; (J.J.L.-M.); (J.A.V.-C.); (M.J.N.-S.); (J.I.-G.); (R.M.O.-G.); (G.P.-M.)
| | - Gustavo Plaza-Manzano
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursery, Physiotherapy and Podiatry, Complutense University of Madrid, 28040 Madrid, Spain; (J.J.L.-M.); (J.A.V.-C.); (M.J.N.-S.); (J.I.-G.); (R.M.O.-G.); (G.P.-M.)
- Grupo InPhysio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
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Sariyildiz MA, Batmaz I, Hattapoğlu S. Predictors of successful treatment after transforaminal epidural steroid injections in patients with lumbar disc herniation. J Back Musculoskelet Rehabil 2024; 37:327-335. [PMID: 37840482 DOI: 10.3233/bmr-230051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
BACKGROUND Epidural steroid injections are common procedures used to treat lumbosacral radicular pain due to lumbar disc herniation (LDH). It is crucial for the clinician to anticipate which patients can benefit from interventional treatment options. OBJECTIVE This study aimed to examine the effect of radiological and clinical parameters on lumbar transforaminal epidural steroid injections (TFESI)/local anesthetic injection outcomes in patients with LDH. METHODS This study included 286 patients with LDH (146 males and 140 females). All patients received a fluoroscopically guided TFESI (triamcinolone acetonide 40 mg, lidocaine 2%, and 2.5 ml of physiological saline). Patients were evaluated according to radicular pain, the Oswestry Disability Index (ODI) and the Hospital Anxiety and Depression Scale at baseline and 3 months after the injections. Demographic, clinical and magnetic resonance imaging (MRI) findings were recorded to assess the predictive factors for TFESI outcomes. Pfirrmann Grades 1 and 2 were classified as low-grade nerve root compression and Grade 3 was classified as highgrade nerve root compression. RESULTS Compared to baseline measurements there were significant improvements in radicular pain, ODI score, Laseque angle, and Schober test scores 3 months after injection. Improvements of at least 50% in radicular pain relief and the ODI functionality index were (n= 214) 82%, (n= 182) 70% respectively at 3 months. Correlation analyses revealed that a shorter duration of symptoms, lowgrade nerve root compression and foraminal/extraforaminal location on MRI findings were associated with a favorable response. CONCLUSIONS Lowgrade nerve root compression was a predictor of a favorable response to TFESI.
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Affiliation(s)
- Mustafa Akif Sariyildiz
- Department of Physical Medicine and Rehabilitation, Memorial Dicle Hospital, Diyarbakır, Turkey
| | - Ibrahim Batmaz
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Dicle University, Diyarbakir, Turkey
| | - Salih Hattapoğlu
- Department of Radiology, Faculty of Medicine, Dicle University, Diyarbakır, Turkey
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Robinson C, Hussain N, Abd-Elsayed AA. Methods for percutaneous discectomy. DECOMPRESSIVE TECHNIQUES 2024:27-44. [DOI: 10.1016/b978-0-323-87751-0.00013-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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Danilov AB, Devlikamova FI, Kurushina OV, Karakulova YV, Butko DY, Smirnova AA. [Efficiency evaluation of the Neuromidin in the treatment of pain of the patients with discogenic lumbosacral radiculopathy: results of a multicenter post-registration prospective open comparative trial]. Zh Nevrol Psikhiatr Im S S Korsakova 2024; 124:97-107. [PMID: 38676684 DOI: 10.17116/jnevro202412404197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2024]
Abstract
OBJECTIVE Evaluation of the effect of Neuromidine on the dynamics of pain syndrome in the treatment of patients with discogenic lumbosacral radiculopathy. MATERIAL AND METHODS Patients with a confirmed diagnosis of discogenic lumbosacral radiculopathy no more than one year old and moderate intensity of pain syndrome on a visual analog scale were included in the main group (OH, n=62, age - 53.1±15.6 yrs) and the comparison group (HS, n=40, age - 53.7±12.9 yrs). OG patients received Neuromidine (15 mg/1 mL 1 once a day IM for 10 days, then 20 mg 3 times a day for 8 weeks) in addition to the standard drug therapy, HS patients received only standard drug therapy. The duration of the study was 8 weeks. The degree of decrease in the intensity and dynamics of pain syndrome, activity and frequency of pain in the lumbar spine, changes in the level of physical activity, and the severity of emotional disorders were evaluated. The level of inflammatory markers in the blood and the dynamics of monosynaptic spinal H-reflex parameters were evaluated. RESULTS Before the study, there were no statistically significant differences there were no results of clinical and laboratory-instrumental examination between groups. After 8 weeks, the reduction of pain by VAS in the main group was statistically significant in contrast to the comparison group (p=0.0001). In the main group there was a statistically significant increase in the mean cognitive impairment score (p=0.0029), as well as an improvement in psycho-emotional state with a significant decrease in GAD-7 (p=0.0002) and PHQ-9 (p=0.0096). After 8 weeks of therapy, IL-6 level in the main group was statistically significantly lower (p=0.0027) than in the comparison group. The results of H-reflex study revealed an increase in its amplitude and some shortening of latency at the end of Neuromidine therapy. The drug had no undesirable side effects and was well tolerated. CONCLUSION Administration of Neuromidine 15 mg/1 ml once a day intramuscularly for 10 days followed by 20 mg 3 times a day for 8 weeks has an effective analgesic effect as adjuvant therapy in patients with discogenic lumbosacral radiculopathy. The inclusion of Neuromidine in the complex treatment of patients with pain syndrome in discogenic radiculopathy is superior in efficacy to standard drug therapy.
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Affiliation(s)
- A B Danilov
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - F I Devlikamova
- Kazan State Medical Academy - branch of Russian medical Academy of continuing professional education, Kazan, Russia
| | - O V Kurushina
- Volgograd State Medical University, Volgograd, Russia
| | | | - D Yu Butko
- Saint Petersburg State Pediatric Medical University, St. Petersburg, Russia
| | - A A Smirnova
- Medical center «Admiralteyskie verfi», St. Petersburg, Russia
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Danazumi MS, Nuhu JM, Ibrahim SU, Falke MA, Rufai SA, Abdu UG, Adamu IA, Usman MH, Daniel Frederic A, Yakasai AM. Effects of spinal manipulation or mobilization as an adjunct to neurodynamic mobilization for lumbar disc herniation with radiculopathy: a randomized clinical trial. J Man Manip Ther 2023; 31:408-420. [PMID: 36950742 PMCID: PMC10642333 DOI: 10.1080/10669817.2023.2192975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 03/11/2023] [Indexed: 03/24/2023] Open
Abstract
OBJECTIVES To determine the long-term clinical effects of spinal manipulative therapy (SMT) or mobilization (MOB) as an adjunct to neurodynamic mobilization (NM) in the management of individuals with Lumbar Disc Herniation with Radiculopathy (DHR). DESIGN Parallel group, single-blind randomized clinical trial. SETTING The study was conducted in a governmental tertiary hospital. PARTICIPANTS Forty (40) participants diagnosed as having a chronic DHR (≥3 months) were randomly allocated into two groups with 20 participants each in the SMT and MOB groups. INTERVENTIONS Participants in the SMT group received high-velocity, low-amplitude manipulation, while those in the MOB group received Mulligans' spinal mobilization with leg movement. Each treatment group also received NM as a co-intervention, administered immediately after the SMT and MOB treatment sessions. Each group received treatment twice a week for 12 weeks. OUTCOME MEASURES The following outcomes were measured at baseline, 6, 12, 26, and 52 weeks post-randomization; back pain, leg pain, activity limitation, sciatica bothersomeness, sciatica frequency, functional mobility, quality of life, and global effect. The primary outcomes were pain and activity limitation at 12 weeks post-randomization. RESULTS The results indicate that the MOB group improved significantly better than the SMT group in all outcomes (p < 0.05), and at all timelines (6, 12, 26, and 52 weeks post-randomization), except for sensory deficit at 52 weeks, and reflex and motor deficits at 12 and 52 weeks. These improvements were also clinically meaningful for neurodynamic testing and sensory deficits at 12 weeks, back pain intensity at 6 weeks, and for activity limitation, functional mobility, and quality of life outcomes at 6, 12, 26, and 52 weeks of follow-ups. The risk of being improved at 12 weeks post-randomization was 40% lower (RR = 0.6, CI = 0.4 to 0.9, p = 0.007) in the SMT group compared to the MOB group. CONCLUSION This study found that individuals with DHR demonstrated better improvements when treated with MOB plus NM than when treated with SMT plus NM. These improvements were also clinically meaningful for activity limitation, functional mobility, and quality of life outcomes at long-term follow-up. TRIAL REGISTRATION Pan-African Clinical Trial Registry: PACTR201812840142310.
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Affiliation(s)
- Musa Sani Danazumi
- Discipline of Physiotherapy, School of Allied Health, Human Services and Sport, College of Sciences, Health and Engineering, La Trobe University, Bundoora, Victoria, Australia
| | - Jibril Mohammed Nuhu
- Department of Physiotherapy, Faculty of Allied Health Sciences, College of Health Sciences, Bayero University, Kano, Nigeria
| | - Shehu Usman Ibrahim
- Department of Physiotherapy, Faculty of Allied Health Sciences, College of Health Sciences, Bayero University, Kano, Nigeria
| | | | | | - Usman Garba Abdu
- Department of Physiotherapy, Muhammad Abdullahi Wase Teaching Hospital, Hospitals Management Board, Kano State, Nigeria
| | | | | | | | - Abdulsalam Mohammed Yakasai
- Medical Rehabilitation Therapists (Registration) Board of Nigeria, North-West Zonal Office, Kano State, Nigeria
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Abhinav K, Jadhav D, Agrawal AK, Agrawal R, Agrawal A. Postoperative Evaluation of Pain and Disability in Patients Undergoing Spinal Discectomy. Cureus 2023; 15:e49963. [PMID: 38179379 PMCID: PMC10765259 DOI: 10.7759/cureus.49963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 12/04/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND A spinal discectomy surgery (SDS) is a common surgical procedure performed to treat lumbosacral radiculopathy. AIM To evaluate postoperative patterns of pain and disability in patients undergoing spinal discectomy. METHODS AND MATERIALS This investigation was a retrospective longitudinal review of prospective information gathered from 543 enrolled patients for lumbar radiculoplasty. The study participants were divided into two categories: Category 1 (SDS) comprising patients of lumbar radiculoplasty managed with SDS (n=270) and Category 2 (non-SDS) comprising patients of lumbar radiculoplasty managed with therapy other than SDS (n=273). It included study participants taking medication for pain control including opioids and non-opioids and physiotherapy for strengthening lower back muscles. At baseline, three months, 12 months, and 24 months after surgery, patient-reported information was gathered. Leg pain magnitude, back pain magnitude, and pain-related impairment were the key outcome metrics of interest. RESULTS The mean postoperative visual analog scale (VAS) score for leg pain at three-month follow-up was 4.3±1.2 in study participants in SDS and 8.1±1.3 in the non-SDS category. The VAS score was lower in the SDS category showing greater reduction in postoperative pain with statistically meaningful results (p<0.001). The mean postoperative VAS score at 12-month follow-up was 2.8±1.1 in study participants in SDS and 7.9±1.5 in the non-SDS category. The VAS score was lower in the SDS category showing greater reduction in postoperative pain with statistically meaningful results (p<0.001). The mean postoperative VAS score at 24-month follow-up was 1.7±1.2 in study participants in SDS and 7.1±1.1 in the non-SDS category. The VAS score was lower in the SDS category showing greater reduction in postoperative pain with statistically meaningful results (p<0.001). CONCLUSION It was observed that after discectomy, patients suffering from lumbar radiculopathy have significant pain and disability recovery. According to these results, only a small percentage of individuals exhibit negative results at the level of impairment.
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Affiliation(s)
- Kumar Abhinav
- Department of Neurosurgery, Lilavati Hospital and Research Centre, Mumbai, IND
| | - Dikpal Jadhav
- Department of Neurosurgery, King Edward Memorial (KEM) Hospital, Mumbai, IND
| | - Arun Kumar Agrawal
- Department of Neurosurgery, Patna Medical College and Hospital, Patna, IND
| | - Rama Agrawal
- Department of Physiology, Patna Medical College and Hospital, Patna, IND
| | - Ankita Agrawal
- Department of Conservative Dentistry and Endodontics, Buddha Institute of Dental Sciences and Hospital, Patna, IND
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Baker SA, Billmire DA, Bilodeau RA, Emmett D, Gibbons AK, Mitchell UH, Bowden AE, Fullwood DT. Wearable Nanocomposite Sensor System for Motion Phenotyping Chronic Low Back Pain: A BACPAC Technology Research Site. PAIN MEDICINE (MALDEN, MASS.) 2023; 24:S160-S174. [PMID: 36799544 PMCID: PMC10403308 DOI: 10.1093/pm/pnad017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 01/25/2023] [Accepted: 02/06/2023] [Indexed: 02/18/2023]
Abstract
Chronic low back pain (cLBP) is a prevalent and multifactorial ailment. No single treatment has been shown to dramatically improve outcomes for all cLBP patients, and current techniques of linking a patient with their most effective treatment lack validation. It has long been recognized that spinal pathology alters motion. Therefore, one potential method to identify optimal treatments is to evaluate patient movement patterns (ie, motion-based phenotypes). Biomechanists, physical therapists, and surgeons each utilize a variety of tools and techniques to qualitatively assess movement as a critical element in their treatment paradigms. However, objectively characterizing and communicating this information is challenging due to the lack of economical, objective, and accurate clinical tools. In response to that need, we have developed a wearable array of nanocomposite stretch sensors that accurately capture the lumbar spinal kinematics, the SPINE Sense System. Data collected from this device are used to identify movement-based phenotypes and analyze correlations between spinal kinematics and patient-reported outcomes. The purpose of this paper is twofold: first, to describe the design and validity of the SPINE Sense System; and second, to describe the protocol and data analysis toward the application of this equipment to enhance understanding of the relationship between spinal movement patterns and patient metrics, which will facilitate the identification of optimal treatment paradigms for cLBP.
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Affiliation(s)
- Spencer A Baker
- Department of Mechanical Engineering, Brigham Young University, Provo, UT, United States
| | - Darci A Billmire
- Department of Mechanical Engineering, Brigham Young University, Provo, UT, United States
| | - R Adam Bilodeau
- Department of Mechanical Engineering, Brigham Young University, Provo, UT, United States
| | - Darian Emmett
- Department of Mechanical Engineering, Brigham Young University, Provo, UT, United States
| | - Andrew K Gibbons
- Department of Mechanical Engineering, Brigham Young University, Provo, UT, United States
| | - Ulrike H Mitchell
- Department of Exercise Sciences, Brigham Young University, Provo, UT, United States
| | - Anton E Bowden
- Department of Mechanical Engineering, Brigham Young University, Provo, UT, United States
| | - David T Fullwood
- Department of Mechanical Engineering, Brigham Young University, Provo, UT, United States
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Yue L, Zhang F, Mu G, Shang M, Lin Z, Sun H. Effectiveness and safety of intrathecal morphine for percutaneous endoscopic lumbar discectomy under low-dose ropivacaine: a prospective, randomized, double-blind clinical trial. Spine J 2023; 23:954-961. [PMID: 36931566 DOI: 10.1016/j.spinee.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 02/06/2023] [Accepted: 03/02/2023] [Indexed: 03/19/2023]
Abstract
BACKGROUND CONTEXT Percutaneous endoscopic lumbar discectomy (PELD) is a surgical setting that requires minimal motor impairment. Low-dose spinal ropivacaine induces little motor blockade and could be ideal for maintaining safety of PELD, but its analgesic efficacy is questionable. An adjunct analgesic approach is needed to maximize the benefits of low-dose spinal ropivacaine for PELD. PURPOSE This study aimed to explore the effectiveness and safety of 100 µg intrathecal morphine (ITM) as an adjuvant analgesic method for PELD under low-dose spinal ropivacaine. STUDY DESIGN A double-blind, randomized, placebo-controlled trial. TRIAL REGISTRATION ChiCTR2000039842 (www.chictr.org.cn). SAMPLE Ninety patients scheduled for elective single-level PELD under low-dose spinal ropivacaine. OUTCOME MEASURES The primary outcome was the overall intraoperative visual analogue scale (VAS) score for pain. Secondary outcomes were intraoperative VAS scores assessed at multiple timepoints; intraoperative rescue analgesic requirement; postoperative VAS scores; disability scale; patients' satisfaction with anesthesia; adverse events; and radiographic outcomes. METHODS Patients were randomized to receive low-dose ropivacaine spinal anesthesia with (ITM group, n=45) or without (control group, n=45) 100 µg ITM. RESULTS The overall intraoperative VAS score in the ITM group was significantly lower than that in the control group (0 [0, 1] vs 2 [1, 3], p<.001). During operation, the VAS scores at cannula insertion, 30 minutes after insertion, 60 minutes after insertion, and 120 minutes after insertion were all significantly lower in the ITM group (all p<.05). Less patients in the ITM group required rescue analgesia during operation compared with those in the control group (14% vs 42%, p= .003). The VAS score for back pain in the ITM group was lower than that in the control group at 1 hour, 12 hours, and 24 hours postoperatively. Besides, the satisfaction score in the ITM group was significantly higher than that in the control group (p=.017). For adverse events, 8/43 of ITM and 1/44 of control participants experienced pruritus (p=.014), with a relative risk (95% confidence interval) of 8.37 (1.09-64.16). The incidence of other adverse events was similar between the two groups. Of note, respiratory depression occurred in one ITM-treated patient. CONCLUSION The addition of 100 µg ITM to low-dose ropivacaine appears to be effective in analgesia without compromised motor function for PELD; however, ITM increased the risk of pruritus and clinicians should be vigilant about its potential risk of respiratory depression.
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Affiliation(s)
- Lei Yue
- Department of Orthopedics, Peking University First Hospital, 8th Xishuku Ave, Xicheng District, Beijing, 100034, China
| | - Feng Zhang
- Department of Anesthesiology, Peking University First Hospital, 8th Xishuku Ave, Xicheng District, Beijing, 100034, China
| | - Guanzhang Mu
- Department of Orthopedics, Peking University First Hospital, 8th Xishuku Ave, Xicheng District, Beijing, 100034, China
| | - Meixia Shang
- Department of Medical Statistics, Peking University First Hospital, 8th Xishuku Ave, Xicheng District, Beijing,100034, China
| | - Zengmao Lin
- Department of Anesthesiology, Peking University First Hospital, 8th Xishuku Ave, Xicheng District, Beijing, 100034, China.
| | - Haolin Sun
- Department of Orthopedics, Peking University First Hospital, 8th Xishuku Ave, Xicheng District, Beijing, 100034, China.
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Haselhuhn JJ, Mercado A, Soriano PBO, Polly DW. Halo Formation and Resolution at 7-Year Follow-Up After Sacroiliac Joint Fusion Revision: A Case Report. JBJS Case Connect 2023; 13:01709767-202309000-00054. [PMID: 37590559 DOI: 10.2106/jbjs.cc.23.00199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
CASE A 49-year-old woman presented with low back pain after a work-related injury. She failed 5 months of conservative management and subsequently underwent minimally invasive (MI) left sacroiliac joint (SIJ) fusion with 3 triangular titanium implants. Four months postoperatively, she developed recurrence of symptoms and radiographic halo phenomenon about the implants. The cephalad and caudal implants were replaced with threaded self-tapping implants, and the middle implant was unable to be removed. At 7-year follow-up, the halo phenomenon had resolved. CONCLUSION This is an unusual case of radiographic halo phenomenon formation after MI SIJ fusion and halo resolution after subsequent revision.
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Affiliation(s)
- Jason J Haselhuhn
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Arthur Mercado
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Paul Brian O Soriano
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota
| | - David W Polly
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota
- Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota
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15
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Cohen SP, Doshi TL, Dolomisiewicz E, Reece DE, Zhao Z, Anderson-White M, Kasuke A, Wang EJ, Hsu A, Davis SA, Yoo Y, Pasquina PF, Moon JY. Nonorganic (Behavioral) Signs and Their Association With Epidural Corticosteroid Injection Treatment Outcomes and Psychiatric Comorbidity in Cervical Radiculopathy: A Multicenter Study. Mayo Clin Proc 2023; 98:868-882. [PMID: 36803892 PMCID: PMC10358758 DOI: 10.1016/j.mayocp.2022.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 10/18/2022] [Accepted: 11/22/2022] [Indexed: 02/17/2023]
Abstract
OBJECTIVE To determine the association between cervical nonorganic pain signs and epidural corticosteroid injection outcomes and coexisting pain and psychiatric conditions. PATIENTS AND METHODS Seventy-eight patients with cervical radiculopathy who received epidural corticosteroid injection were observed to determine the effects that nonorganic signs have on treatment outcome. A positive outcome was a decrease of 2 or more points in average arm pain, coupled with a score of 5 on a 7-point Patient Global Impression of Change scale 4 weeks after treatment. Nine tests in 5 categories (abnormal tenderness, regional disturbances deviating from normal anatomy, overreaction, discrepancies in examination findings with distraction, and pain during sham stimulation) were modified from previous studies and standardized. Other variables examined for their association with nonorganic signs and outcomes included disease burden, psychopathology, coexisting pain conditions, and somatization. RESULTS Of the 78 patients, 29% (n=23) had no nonorganic signs, 21% (n=16) had signs in 1 category, 10% (n=8) had signs in 2 categories, 21% (n=16) had signs in 3 categories, 10% (n=8) had signs in 4 categories, and 9% (n=7) had signs in 5 categories. The most common nonorganic sign was superficial tenderness (44%; n=34). Mean number of positive nonorganic categories was higher in individuals with negative treatment outcomes (2.5±1.8; 95% CI, 2.0 to 3.1) compared with those with positive outcomes (1.1±1.3; 95% CI, 0.7 to 1.5; P=.0002). Negative treatment outcomes were most strongly associated with regional disturbances and overreaction. Positive associations were noted between nonorganic signs and multiple pain (P=.011) and multiple psychiatric (P=.028) conditions. CONCLUSION Cervical nonorganic signs correlate with treatment outcome, pain, and psychiatric comorbidities. Screening for these signs and psychiatric symptoms may improve treatment outcomes. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT04320836.
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Affiliation(s)
- Steven P Cohen
- Department of Anesthesiology and Critical Care Medicine, Pain Medicine Division, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Anesthesiology, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, MD; Department of Physical Medicine and Rehabilitation, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, MD.
| | - Tina L Doshi
- Department of Anesthesiology and Critical Care Medicine, Pain Medicine Division, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Edward Dolomisiewicz
- Department of Physical Medicine and Rehabilitation, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - David E Reece
- Department of Physical Medicine and Rehabilitation, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Zirong Zhao
- Departments of Neurology and Internal Medicine, District of Columbia Veterans Affairs Medical Center, Washington, DC
| | - Mirinda Anderson-White
- Department of Anesthesiology and Critical Care Medicine, Pain Medicine Division, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Angelia Kasuke
- Department of Physical Medicine and Rehabilitation, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Eric J Wang
- Department of Anesthesiology and Critical Care Medicine, Pain Medicine Division, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Annie Hsu
- Department of Anesthesiology and Critical Care Medicine, Pain Medicine Division, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Shelton A Davis
- Department of Physical Medicine and Rehabilitation, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Yongjae Yoo
- Department of Anesthesiology, Seoul National University, Seoul, Korea
| | - Paul F Pasquina
- Department of Physical Medicine and Rehabilitation, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, MD; Department of Orthopedic Surgery, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Jee Youn Moon
- Department of Anesthesiology, Seoul National University, Seoul, Korea
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Han CS, Hancock MJ, Sharma S, Sharma S, Harris IA, Cohen SP, Magnussen J, Maher CG, Traeger AC. Low back pain of disc, sacroiliac joint, or facet joint origin: a diagnostic accuracy systematic review. EClinicalMedicine 2023; 59:101960. [PMID: 37096189 PMCID: PMC10121397 DOI: 10.1016/j.eclinm.2023.101960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 03/17/2023] [Accepted: 03/23/2023] [Indexed: 04/26/2023] Open
Abstract
Background The accuracy of diagnostic tests available in primary care to identify the disc, sacroiliac joint, and facet joint as the source of low back pain is uncertain. Methods Systematic review of diagnostic tests available in primary care. MEDLINE, CINAHL, and EMBASE were searched between March 2006 and 25th January 2023. Pairs of reviewers independently screened all studies, extracted data, and assessed risk of bias using QUADAS-2. Pooling was performed for homogenous studies. Positive likelihood ratios (+LR) ≥2 and negative likelihood ratios (-LR) ≤0.5 were considered informative. This review is registered with PROSPERO (CRD42020169828). Findings We included 62 studies: 35 investigated the disc, 14 the facet joint, 11 the sacroiliac joint, and 2 investigated all three structures in patients with persistent low back pain. For risk of bias, the domain 'reference standard' scored worst, however approximately half the studies were of low risk of bias for every other domain. For the disc, pooling demonstrated MRI findings of disc degeneration and annular fissure resulted in informative +LRs: 2.53 (95% CI: 1.57-4.07) and 2.88 (95% CI: 2.02-4.10) and -LRs: 0.15 (95% CI: 0.09-0.24) and 0.24 (95% CI: 0.10-0.55) respectively. Pooled results for Modic type 1, Modic type 2, and HIZ on MRI, and centralisation phenomenon yielded informative +LRs: 10.00 (95% CI: 4.20-23.82), 8.03 (95% CI: 3.23-19.97), 3.10 (95% CI: 2.27-4.25), and 3.06 (95% CI: 1.44-6.50) respectively, but uninformative -LRs: 0.84 (95% CI: 0.74-0.96), 0.88 (95% CI: 0.80-0.96), 0.61 (95% CI: 0.48-0.77), and 0.66 (95% CI: 0.52-0.84) respectively. For the facet joint, pooling demonstrated facet joint uptake on SPECT resulted in informative +LRs: 2.80 (95% CI: 1.82-4.31) and -LRs: 0.44 (95% CI: 0.25-0.77). For the sacroiliac joint, a combination of pain provocation tests and absence of midline low back pain resulted in informative +LRs of 2.41 (95% CI: 1.89-3.07) and 2.44 (95% CI: 1.50-3.98) and -LRs of 0.35 (95% CI: 0.12-1.01) and 0.31 (95% CI: 0.21-0.47) respectively. Radionuclide imaging yielded an informative +LR 7.33 (95% CI: 1.42-37.80) but an uninformative -LR 0.74 (95% CI: 0.41-1.34). Interpretation There are informative diagnostic tests for the disc, sacroiliac joint, and facet joint (only one test). The evidence suggests a diagnosis may be possible for some patients with low back pain, potentially guiding targeted and specific treatment approaches. Funding There was no funding for this study.
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Affiliation(s)
- Christopher S. Han
- The University of Sydney, Sydney Musculoskeletal Health, Sydney, New South Wales, Australia
- Corresponding author.
| | - Mark J. Hancock
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Sweekriti Sharma
- The University of Sydney, Sydney Musculoskeletal Health, Sydney, New South Wales, Australia
| | - Saurab Sharma
- Department of Exercise Physiology, School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - Ian A. Harris
- The University of Sydney, Sydney Musculoskeletal Health, Sydney, New South Wales, Australia
- Ingham Institute for Applied Medical Research, School of Clinical Medicine, Faculty of Medicine, UNSW Sydney, Sydney, NSW, Australia
| | - Steven P. Cohen
- Anaesthesiology, Pain Medicine Division, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - John Magnussen
- Department of Clinical Medicine, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Chris G. Maher
- The University of Sydney, Sydney Musculoskeletal Health, Sydney, New South Wales, Australia
| | - Adrian C. Traeger
- The University of Sydney, Sydney Musculoskeletal Health, Sydney, New South Wales, Australia
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Cao S, Ma Y, Yang H, Luo G, Cheng H, Jin X, Sun T. Long noncoding RNA HCG18 Promotes Extracellular Matrix Degradation of Nucleus Pulposus Cells in Intervertebral Disc Degeneration by Regulating the miR-4306/EPAS1 Axis. World Neurosurg 2023; 172:e52-e61. [PMID: 36460200 DOI: 10.1016/j.wneu.2022.11.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 11/28/2022] [Indexed: 12/05/2022]
Abstract
BACKGROUND Intervertebral disc degeneration is a very common disease worldwide and the leading cause of low back pain. Long noncoding RNAs are novel players in intervertebral disc degeneration and have multiple functions. This study explored the role of long noncoding RNA HCG18 in regulating extracellular matrix (ECM) degradation in nucleus pulposus cells (NPCs) during intervertebral disc degeneration. METHODS NPCs were subjected to interleukin-1β to induce a degenerative model of NPCs. Cell viability was assessed using Cell Counting Kit-8 assay. Messenger RNA and protein expressions were examined by real-time quantitative polymerase chain reaction and Western blot. The location of HCG18 was determined by nucleocytoplasmic separation assay. The binding relationships between HCG18, MIR4306, and EPAS1 were verified by dual luciferase reporter gene assay and/or RNA immunoprecipitation assay. RESULTS HCG18 was highly expressed in interleukin-1β-induced degenerated NPCs, which was associated with reduced collagen II and aggrecan expression and increased MMP-13 and ADAMTS-4 expression. HCG18 knockdown could remarkably inhibit ECM degradation in IL-1β-induced degenerated NPCs, while HCG18 overexpression had the opposite effect. Our molecular study further revealed that HCG18 could sponge MIR4306, and HCG18 knockdown could suppress ECM degradation in degenerated NPCs by elevating MIR4306 expression. In addition, EPAS1 was identified as the direct target of MIR4306. As expected, MIR4306 overexpression inhibited ECM degradation in degenerated NPCs by downregulating EPAS1. CONCLUSIONS HCG18 promoted ECM degradation in degenerated NPCs via regulation of the MIR4306/EPAS1 axis.
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Affiliation(s)
- Sheng Cao
- Tianjin Medical University, Tianjin, China; Department of Spinal Surgery, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China
| | - Yuan Ma
- Tianjin Medical University, Tianjin, China; Department of Orthopedic, Nanyang Central Hospital, Nanyang, Henan, China
| | | | - Gan Luo
- Tianjin Medical University, Tianjin, China
| | | | - Xin Jin
- School of Medicine, Nankai University, Tianjin, China
| | - Tianwei Sun
- Tianjin Medical University, Tianjin, China; Department of Spinal Surgery, Tianjin Union Medical Center, Tianjin, China.
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18
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Hossain MS, Akter S, Siddique MAE, Siddique MKB, Reza GM, Alom FMM, Ali M, Noman MOR, Rahman MM, Islam MS, Hossain KMA. Multidisciplinary Conservative Treatment Outcomes of in-Patient Physiotherapy Set-Up Among Patients with Lumbar Disc Herniation in Dhaka City, Bangladesh: A Retrospective, Cross-Sectional Study. J Multidiscip Healthc 2023; 16:587-601. [PMID: 36883166 PMCID: PMC9985877 DOI: 10.2147/jmdh.s400021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 01/26/2023] [Indexed: 03/06/2023] Open
Abstract
Background The study aimed to determine the outcome of Multidisciplinary physiotherapist-led conservative treatment of lumbar disc herniation at an in-patient set-up of a specialized spine center in Dhaka, Bangladesh. Methods This was a retrospective cross-sectional study of 228 cases completing treatment and follow-up sessions. The outcome was evaluated as pain at rest and five different functional positions, neurological recovery, and Magnetic resonance imaging (MRI) changes during discharge and follow-up. Results 80.3% had a complete recovery with a typical motor and sensory status, no limitations in straight leg raise (SLR), no cauda equina symptom (CES), and no or <3 pain during more than 30 minutes of daily living activities. Statistically significant changes were noted at all outcome measures at the follow-up (day 90), compared to baseline (day 1) P<0.01. In the posthoc tests, pain, SLR, and CES had the most significant improvement at discharge (day 12) compared to the baseline (P < 0.01) and at follow-up compared to discharge (P < 0.01). No major adverse events noted. Conclusion Physiotherapist-led in-patient treatment results in significant resting and functional pain outcomes in 12 days. Also, the improvements in neurological recovery and normalizing disc position are statistically significant in 90 days.
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Affiliation(s)
| | - Sapia Akter
- Bangladesh Institute of Manual Therapy & Research, Dhaka, Bangladesh
| | | | - Md Kaoser Bin Siddique
- Department of Research, Planning & Development, Grand Health Sector, TMSS, Bogura, Bangladesh
| | - G M Reza
- Bangladesh Institute of Manual Therapy & Research, Dhaka, Bangladesh
| | - Foisal Mohammad Mosiul Alom
- Department of Physiotherapy, National Institute of Traumatology & Orthopaedic Rehabilitation (NITOR), Dhaka, Bangladesh
| | - Mohammad Ali
- Department of Physiotherapy and Rehabilitation, Uttara Adhunik Medical College and Hospital, Dhaka, Bangladesh
| | | | - M Mazibar Rahman
- Department of Statistics, Jahangirnagar University, Dhaka, Bangladesh
| | - Md Shofiqul Islam
- Department of Physiotherapy, Bangladesh Health Professions Institute (BHPI), Dhaka, Bangladesh
| | - K M Amran Hossain
- Department of Physiotherapy & Rehabilitation, Jashore University of Science & Technology (JUST), Jashore, Bangladesh
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Zale C, Mitsunaga K. Accuracy of Dermatomes in the Localization of Lumbar Disc Herniations for Pre-operative Planning: A Systematic Review. INTERDISCIPLINARY NEUROSURGERY 2023. [DOI: 10.1016/j.inat.2023.101728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
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20
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Firdous A, Gopalakrishnan V, Vo N, Sowa G. Challenges and opportunities for omics-based precision medicine in chronic low back pain. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022:10.1007/s00586-022-07457-8. [PMID: 36565345 DOI: 10.1007/s00586-022-07457-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 07/27/2022] [Accepted: 11/07/2022] [Indexed: 12/25/2022]
Abstract
PURPOSE Chronic low back pain (cLBP) is a common health condition worldwide and a leading cause of disability with an estimated lifetime prevalence of 80-90% in industrialized countries. However, we have had limited success in treating cLBP likely due to its non-specific heterogeneous nature that goes beyond detectable anatomical changes. We propose that omics technologies as precision medicine tools are well suited to provide insight into its pathophysiology and provide diagnostic markers and therapeutic targets. Therefore, in this review, we explore the current state of omics technologies in the diagnosis and classification of cLBP. We identify factors that may serve as markers to differentiate between acute and chronic cases of low back pain (LBP). Finally, we also discuss some challenges that must be overcome to successfully apply precision medicine to the diagnosis and treatment of cLBP. METHODS A literature search for the current applications of omics technologies to chronic low back pain was performed using the following search terms- "back pain," "low back pain," "proteomics," "transcriptomics", "epigenomics," "genomics," "omics." We reviewed molecular markers identified from 35 studies which hold promise in providing information regarding molecular insights into cLBP. RESULTS GWAS studies have found evidence for the role of single nucleotide polymorphisms (SNPs) associated with pain pathways in individuals with cLBP. Epigenomic modifications in patients with cLBP have been found to be enriched among genes involved in immune signaling and inflammation. Transcriptomics profiles of patients with cLBP show multiple lines of evidence for the role of inflammation in cLBP. The glycomics profiles of patients with cLBP are similar to those of patients with inflammatory conditions. Proteomics and microbiomics show promise but have limited studies currently. CONCLUSION Omics technologies have identified associations between inflammatory and pain pathways in the pathophysiology of cLBP. However, in order to integrate information across the range of studies, it is important for the field to identify and adopt standardized definitions of cLBP and control patients. Additionally, most papers have applied a single omics method to a sampling of cLBP patients which have yielded limited insight into the pathophysiology of cLBP. Therefore, we recommend a multi-omics approach applied to large global consortia for advancing subphenotyping and better management of cLBP, via improved identification of diagnostic markers and therapeutic targets.
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Affiliation(s)
- Ayesha Firdous
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA.
| | | | - Nam Vo
- Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Gwendolyn Sowa
- Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
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21
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Leung T, Lovo S, Irvine A, Trask C, Oosman S, McKinney V, McDonald T, Sari N, Carnegie B, Custer M, McIntosh S, Bath B. Experiences of Health Care Access Challenges for Back Pain Care Across the Rural-Urban Continuum in Canada: Protocol for Cross-sectional Research. JMIR Res Protoc 2022; 11:e42484. [PMID: 36534454 PMCID: PMC9808614 DOI: 10.2196/42484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/01/2022] [Accepted: 10/20/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Back pain is common and costly, with negative impacts on both individuals and the health care system. Rural, remote, and Indigenous populations are at greater risk of experiencing back pain compared to urban and non-Indigenous populations. Potential barriers to health care access among Canadians with chronic back pain (CBP) have been identified; however, no study has used lived experiences of people with CBP to drive the selection, analysis, and interpretation of variables most meaningful to patients. OBJECTIVE The aims of this study are to (1) engage with rural, remote, and urban Indigenous and non-Indigenous patients, health care providers, and health system decision makers to explore lived experiences among people with CBP in Saskatchewan, Canada; (2) cocreate meaningful indicators of CBP care access and effectiveness; and (3) identify program and policy recommendations to overcome access barriers to CBP care. METHODS In phase 1, one-on-one interviews with 30 people with current or past CBP and 10 health care providers residing or practicing in rural, remote, or urban Saskatchewan communities will be conducted. We will recruit Indigenous (n=10) and non-Indigenous (n=20) rural, remote, and urban people. In phase 2, findings from the interviews will inform development of a population-based telephone survey focused on access to health care barriers and facilitators among rural, remote, and urban people; this survey will be administered to 383 residents with CBP across Saskatchewan. In phase 3, phase 1 and 2 findings will be presented to provincial and national policy makers; health system decision makers; health care providers; rural, remote, and urban people with CBP and their communities; and other knowledge users at an interactive end-of-project knowledge translation event. A World Café method will facilitate interactive dialogue designed to catalyze future patient-oriented research and pathways to improve access to CBP care. Patient engagement will be conducted, wherein people with lived experience of CBP, including Indigenous and non-Indigenous people from rural, remote, and urban communities (ie, patient partners), are equal members of the research team. Patient partners are engaged throughout the research process, providing unique knowledge to ensure more comprehensive collection of data while shaping culturally appropriate messages and methods of sharing findings to knowledge users. RESULTS Participant recruitment began in January 2021. Phase 1 interviews occurred between January 2021 and September 2022. Phase 2 phone survey was administered in May 2022. Final results are anticipated in late 2022. CONCLUSIONS This study will privilege patient experiences to better understand current health care use and potential access challenges and facilitators among rural, remote, and urban people with CBP in Saskatchewan. We aim to inform the development of comprehensive measures that will be sensitive to geographical location and relevant to culturally diverse people with CBP, ultimately leading to enhanced access to more patient-centered care for CBP. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/42484.
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Affiliation(s)
| | - Stacey Lovo
- School of Rehabilitation Science, University of Saskatchewan, Saskatoon, SK, Canada
| | - Alison Irvine
- School of Rehabilitation Science, University of Saskatchewan, Saskatoon, SK, Canada
| | - Catherine Trask
- Department of Biomedical Engineering and Health Systems (Medicinteknik och Hälsosystem), School of Engineering Sciences in Chemistry, Biotechnology, & Health (Kemi, Bioteknologi och Hälsa), Kungliga Tekniska Högskolan Royal Institute of Technology, Stockholm, Sweden.,Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, SK, Canada
| | - Sarah Oosman
- School of Rehabilitation Science, University of Saskatchewan, Saskatoon, SK, Canada
| | - Veronica McKinney
- College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Terrence McDonald
- Departments of Family Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Nazmi Sari
- Department of Economics, University of Saskatchewan, Saskatoon, SK, Canada
| | - Bertha Carnegie
- Patient Partner, University of Saskatchewan, Saskatoon, SK, Canada
| | - Marie Custer
- Patient Partner, University of Saskatchewan, Saskatoon, SK, Canada
| | - Stacey McIntosh
- Patient Partner, University of Saskatchewan, Saskatoon, SK, Canada
| | - Brenna Bath
- School of Rehabilitation Science, University of Saskatchewan, Saskatoon, SK, Canada.,Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, SK, Canada
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22
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Han CS, Hancock MJ, Maher CG. Reconsidering non-specific low back pain: where to from here? Spine J 2022; 22:1927-1930. [PMID: 35944828 DOI: 10.1016/j.spinee.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 08/02/2022] [Accepted: 08/02/2022] [Indexed: 02/03/2023]
Affiliation(s)
- Christopher S Han
- The Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, PO Box M179, Missenden Rd, NSW 2050, Sydney, Australia.
| | - Mark J Hancock
- The Faculty of Medicine, Health and Human Sciences Level 3, 75 Talavera Rd, Macquarie University, NSW 2109, Australia
| | - Christopher G Maher
- The Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, PO Box M179, Missenden Rd, NSW 2050, Sydney, Australia
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23
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Ji Z, Guo R, Ma Z, Li H. Arctigenin inhibits apoptosis, extracellular matrix degradation, and inflammation in human nucleus pulposus cells by up-regulating miR-483-3p. J Clin Lab Anal 2022; 36:e24508. [PMID: 35689566 PMCID: PMC9280009 DOI: 10.1002/jcla.24508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 05/08/2022] [Accepted: 05/09/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Arctigenin (ATG) is the active ingredient of the Chinese herbal medicine Arctium lappa, with anti-inflammatory and antioxidant effects. Excessive inflammation and cell apoptosis are important causes of intervertebral disc degeneration (IDD). Hence, this study probed into the possible role of ATG in IDD. METHODS Interleukin (IL)-1β (10 ng/ml) was adopted to induce human nucleus pulposus cells (HNPCs) as a cell model for IDD. The effects of different concentrations of ATG (0, 2, 5, 10, 20, 50 μmol/L) on the viability of HNPCs and effects of ATG (10, 50 μmol/L) on the viability of IL-1β-induced HNPCs were detected by cell counting kit-8 (CCK-8). After IL-1β-induced HNPCs were transfected with miR-483-3p inhibitor and/or treated with ATG, cell viability and apoptosis were determined by CCK-8 and flow cytometry; the expressions of miR-483-3p, extracellular matrix (ECM)-related genes, and inflammation-related genes were measured by quantitative real time polymerase chain reaction (qRT-PCR), and expressions of ECM/apoptosis/NF-κB pathway-related proteins were quantified by Western blot. RESULTS ATG had no significant effect on the viability of HNPCs but could promote the viability of IL-1β-induced HNPCs. ATG inhibited apoptosis, ECM degradation, inflammation, and activation of NF-κB pathway in HNPCs induced by IL-1β, but promoted the expression of miR-483-3p. MiR-483-3p inhibitor reversed the above-mentioned regulatory effects of ATG. CONCLUSION Arctigenin suppresses apoptosis, ECM degradation, inflammation, and NF-κB pathway activation in HNPCs by up-regulating miR-483-3p.
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Affiliation(s)
- Zhe Ji
- Orthopedic Center Spine SurgeryPeople's Hospital of Xinjiang Uygur Autonomous RegionUrumqiChina
| | - Rui Guo
- Orthopedic Center Spine SurgeryPeople's Hospital of Xinjiang Uygur Autonomous RegionUrumqiChina
| | - Zhigang Ma
- Orthopedic Center Spine SurgeryPeople's Hospital of Xinjiang Uygur Autonomous RegionUrumqiChina
| | - Hongwei Li
- Orthopedic Center Spine SurgeryPeople's Hospital of Xinjiang Uygur Autonomous RegionUrumqiChina
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24
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Wang Q, Runhaar J, Kloppenburg M, Boers M, Bijlsma J, Bierma-Zeinstra S. Diagnosis for early stage knee osteoarthritis: probability stratification, internal and external validation; data from the CHECK and OAI cohorts. Semin Arthritis Rheum 2022; 55:152007. [DOI: 10.1016/j.semarthrit.2022.152007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 03/22/2022] [Accepted: 04/11/2022] [Indexed: 10/18/2022]
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25
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Yang L, Li Z, Ouyang Y. Taurine attenuates ER stress‑associated apoptosis and catabolism in nucleus pulposus cells. Mol Med Rep 2022; 25:172. [PMID: 35315493 PMCID: PMC8971911 DOI: 10.3892/mmr.2022.12688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 02/10/2022] [Indexed: 11/20/2022] Open
Abstract
Nucleus pulposus (NP) apoptosis and subsequent excessive degradation of the extracellular matrix (ECM) are key pathological characteristics of intervertebral disc degeneration (IDD). The present study aims to examine the signaling processes underlying the effects of taurine on IDD, with specific focus on endoplasmic reticulum (ER) stress-mediated apoptosis and ECM degradation, in NP cells. To clarify the role of taurine in IDD, NP cells were treated with various concentrations of taurine and IL-1β or thapsigargin (TG). Cell Counting Kit-8, western blotting, TUNEL, immunofluorescence assays and reverse transcription-quantitative PCR were applied to measure cell viability, the expression of ER stress-associated proteins (GRP78, CHOP and caspase-12), apoptosis and the levels of metabolic factors associated with ECM (MMP-1, 3, 9, ADAMTS-4, 5 and collagen II), respectively. Taurine was found to attenuate ER stress and prevent apoptosis in NP cells induced by IL-1β treatment. Additionally, taurine significantly decreased the expression of ER stress-activated glucose regulatory protein 78, C/EBP homologous protein and caspase-12. TUNEL results revealed that taurine decreased the number of apoptotic TG-treated NP cells. TG-treated NP cells also exhibited characteristics of increased ECM degradation, supported by observations of increased MMP-1, MMP-3, MMP-9 and A disintegrin and metalloproteinase with thrombospondin motifs (ADAMTS)-4 and ADAMTS-5 expression in addition to decreased collagen-II expression. However, taurine treatment significantly reversed all indicators of excessive ECM catabolism aforementioned. These data suggest that taurine can mediate protection against apoptosis and ECM degradation in NP cells by inhibiting ER stress, implicating therapeutic potential for the treatment of IDD.
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Affiliation(s)
- Liuxie Yang
- Department of Orthopedics, Shanghai Jing'an District Zhabei Central Hospital, Shanghai 200040, P.R. China
| | - Zhenhuan Li
- Department of Orthopedics, Shanghai Jing'an District Zhabei Central Hospital, Shanghai 200040, P.R. China
| | - Yueping Ouyang
- Department of Orthopedics, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai 200003, P.R. China
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26
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A High Body Mass Index and the Vacuum Phenomenon Upregulate Pain-Related Molecules in Human Degenerated Intervertebral Discs. Int J Mol Sci 2022; 23:ijms23062973. [PMID: 35328395 PMCID: PMC8953228 DOI: 10.3390/ijms23062973] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/05/2022] [Accepted: 03/09/2022] [Indexed: 01/02/2023] Open
Abstract
Animal studies suggest that pain-related-molecule upregulation in degenerated intervertebral discs (IVDs) potentially leads to low back pain (LBP). We hypothesized that IVD mechanical stress and axial loading contribute to discogenic LBP’s pathomechanism. This study aimed to elucidate the relationships among the clinical findings, radiographical findings, and pain-related-molecule expression in human degenerated IVDs. We harvested degenerated-IVD samples from 35 patients during spinal interbody fusion surgery. Pain-related molecules including tumor necrosis factor alpha (TNF-alpha), interleukin (IL)-6, calcitonin gene-related peptide (CGRP), microsomal prostaglandin E synthase-1 (mPGES1), and nerve growth factor (NGF) were determined. We also recorded preoperative clinical findings including body mass index (BMI), Oswestry Disability Index (ODI), and radiographical findings including the vacuum phenomenon (VP) and spinal instability. Furthermore, we compared pain-related-molecule expression between the VP (−) and (+) groups. BMI was significantly correlated with the ODI, CGRP, and mPGES-1 levels. In the VP (+) group, mPGES-1 levels were significantly higher than in the VP (−) group. Additionally, CGRP and mPGES-1 were significantly correlated. Axial loading and mechanical stress correlated with CGRP and mPGES-1 expression and not with inflammatory cytokine or NGF expression. Therefore, axial loading and mechanical stress upregulate CGRP and mPGES-1 in human degenerated IVDs, potentially leading to chronic discogenic LBP.
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27
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Bukowiec L, Megalla M, Bartzokis A, Hasley H, Carlson S, Koerner J. A response to comparison of different predicting models to assist the diagnosis of spinal lesions, Chu et al. 2021. Inform Health Soc Care 2022; 47:120-121. [DOI: 10.1080/17538157.2021.1994578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
| | | | | | | | | | - John Koerner
- Rothman Orthopaedic Insitute, Hackensack University Medical Center
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28
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Carbone J, Swink I, Muzzonigro T, Diehl D, Oh M, Lindsey DP, Yerby S, Cheng BC. Biomechanical Stability of Primary and Revision Sacroiliac Joint Fusion Devices: A Cadaveric Study. Global Spine J 2022; 12:45-52. [PMID: 32935574 PMCID: PMC8965313 DOI: 10.1177/2192568220948028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN An in vitro biomechanics study. OBJECTIVE To evaluate the efficacy of triangular titanium implants in providing mechanical stabilization to a sacroiliac joint with primary and revision sized implants. METHODS Ten lumbopelvic cadaveric specimens were tested in 4 stages: intact, pubic symphysis sectioned, primary, and simulated revision. Primary treatment was performed using 3 laterally placed triangular titanium implants. To simulate revision conditions before and after bone ingrowth and ongrowth on the implants, 7.5-mm and 10.75-mm implants were randomly assigned to one side of each specimen during the simulated revision stage. A 6 degrees of freedom spinal loading frame was used to load specimens in 4 directions: flexion extension, lateral bending, axial torsion, and axial compression. Biomechanical evaluation was based on measures of sacroiliac joint rotational and translational motion. RESULTS Both primary and revision implants showed the ability to reduce translational motion to a level significantly lower than the intact condition when loaded in axial compression. Simulated revision conditions showed no statistically significant differences compared with the primary implant condition, with the exception of flexion-extension range of motion where motions associated with the revised condition were significantly lower. Comparison of rotational and translation motions associated with the 7.5- and 10.75-mm implants showed no significant differences between the treatment conditions. CONCLUSIONS These results indicate that implantation of laterally placed triangular titanium implants significantly reduces the motion of a sacroiliac joint using either the primary and revision sized implants. No statistically significant differences were detected when comparing the efficacy of primary, 7.5-mm revision, or 10.75-mm revision implants.
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Affiliation(s)
| | - Isaac Swink
- Allegheny Health Network, Pittsburgh, PA, USA,Isaac Swink, Department of Neurosurgery, Allegheny Health Network, 320 East North Ave, Suite 311, Pittsburgh, PA 15212, USA.
| | | | | | - Michael Oh
- Allegheny Health Network, Pittsburgh, PA, USA
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29
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Zerbo Šporin D, Kozinc Ž, Prijon T, Šarabon N. The Prevalence and Severity of Sick Leave due to Low Back Disorders among Workers in Slovenia: Analysis of National Data across Gender, Age and Classification of Economic Activities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:131. [PMID: 35010390 PMCID: PMC8750890 DOI: 10.3390/ijerph19010131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 12/16/2021] [Accepted: 12/22/2021] [Indexed: 06/14/2023]
Abstract
Musculoskeletal disorders are the most common work-related health problems. As low back disorders (LBD) are the most problematic, the aim of this study was to provide an in-depth analysis of the nationwide data on sick leaves due to work-related LBDs among workers in Slovenia in 2015-2019 by gender, age and various economic activities (NACE Rev 2 classification). We retrospectively analyzed the Slovene national data for sick leave (SL) rates due to the LBDs between 2015 and 2019. The analyzed SL outcomes were (i) index of temporary disability as a diagnosis-specific loss of calendar days (all calendar days except Sundays) per employee, (ii) frequency of spells as the number of SL cases per 100 employees in one year and (iii) severity as the average duration of one absence from work due to a health condition. A high prevalence of sick leaves due to LBDs in Slovenia was present among young male workers in "mining and quarrying". In the next age group (20.0-44.9 years), LBD is most frequent in "water supply; sewerage, waste management and remediation activities". Particular attention should be paid to ''agriculture, forestry and fishing'' which shows a large average sick leave duration and probably a more demanding course of LBDs.
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Affiliation(s)
- Dorjana Zerbo Šporin
- Faculty of Health Sciences, University of Primorska, Polje 42, SI-6310 Izola, Slovenia; (D.Z.Š.); (Ž.K.)
| | - Žiga Kozinc
- Faculty of Health Sciences, University of Primorska, Polje 42, SI-6310 Izola, Slovenia; (D.Z.Š.); (Ž.K.)
- Andrej Marušič Institute, University of Primorska, Muzejski trg 2, SI-6000 Koper, Slovenia
| | - Ticijana Prijon
- National Institute of Public Health, Trubarjeva 2, SI-1000 Ljubljana, Slovenia;
| | - Nejc Šarabon
- Faculty of Health Sciences, University of Primorska, Polje 42, SI-6310 Izola, Slovenia; (D.Z.Š.); (Ž.K.)
- Human Health Department, InnoRenew CoE, Livade 6, SI-6310 Izola, Slovenia
- Laboratory for Motor Control and Motor Behavior, S2P, Science to Practice, Ltd., Tehnološki Park 19, SI-1000 Ljubljana, Slovenia
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30
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Lee DW, Pritzlaff S, Jung MJ, Ghosh P, Hagedorn JM, Tate J, Scarfo K, Strand N, Chakravarthy K, Sayed D, Deer TR, Amirdelfan K. Latest Evidence-Based Application for Radiofrequency Neurotomy (LEARN): Best Practice Guidelines from the American Society of Pain and Neuroscience (ASPN). J Pain Res 2021; 14:2807-2831. [PMID: 34526815 PMCID: PMC8436449 DOI: 10.2147/jpr.s325665] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 08/21/2021] [Indexed: 01/02/2023] Open
Abstract
Radiofrequency neurotomy (RFN), also known as radiofrequency ablation (RFA), is a common interventional procedure used to treat pain from an innervated structure. RFN has historically been used to treat chronic facet-joint mediated pain. The use of RFN has more recently expanded beyond facet-joint mediated pain to peripherally innervated targets. In addition, there has also been the emergence of different radiofrequency modalities, including pulsed and cooled RFN. The use of RFN has been particularly important where conservative and/or surgical measures have failed to provide pain relief. With the emergence of this therapeutic option and its novel applications, the American Society of Pain and Neuroscience (ASPN) identified the need for formal evidence-based guidance. The authors formed a multidisciplinary work group tasked to examine the latest evidence-based medicine for the various applications of RFN, including cervical, thoracic, lumbar spine; posterior sacroiliac joint pain; hip and knee joints; and occipital neuralgia. Best practice guidelines, evidence and consensus grading were provided for each anatomical target.
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Affiliation(s)
- David W Lee
- Fullerton Orthopedic Surgery Medical Group, Fullerton, CA, 92831, USA
| | - Scott Pritzlaff
- University of California, Davis.,Division of Pain Medicine, Sacramento, CA, USA
| | - Michael J Jung
- University of California, Davis.,Division of Pain Medicine, Sacramento, CA, USA
| | | | - Jonathan M Hagedorn
- Department of Anesthesiology and Perioperative Medicine, Division of Pain Medicine, Mayo Clinic, Rochester, MN, USA
| | - Jordan Tate
- Alliance Spine and Pain Centers, Canton, GA, USA
| | - Keith Scarfo
- Warren Alpert Medical School of Brown University Department of Neurosurgery - Norman Prince Spine Institute, Rhode Island Hospital, Providence, RI, USA
| | - Natalie Strand
- Department of Anesthesiology and Perioperative Medicine, Division of Pain Medicine, Mayo Clinic, Phoenix, AZ, USA
| | | | - Dawood Sayed
- University of Kansas Medical Center, Kansas City, KS, USA
| | - Timothy R Deer
- The Spine and Nerve Center of the Virginias, Inc., Charleston, WV, USA
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31
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Hmida J, Hilberg T, Krüger S, Jansen TR, Goldmann G, Oldenburg J, Wirtz DC, Strauss AC. Changes of static and dynamic spine alignment in patients with severe haemophilia. Haemophilia 2021; 27:e721-e729. [PMID: 34492141 DOI: 10.1111/hae.14406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 06/29/2021] [Accepted: 08/23/2021] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Haemophilic arthropathy results in a restricted range of motion and pain that often affects gait. The effect of these gait changes on spinal posture has not been studied. AIM To evaluate whether the altered joint situation in patients with haemophilia (PwH) leads to compensatory mechanisms evident in the trunk and spine, considering static and dynamic conditions. METHODS PwH and healthy controls (20-65 years) were examined using rasterstereography in a controlled cohort study. Analysis was performed in static and dynamic conditions in regard to gait phases. Joint status was determined using the Haemophilia Joint Health Score (HJHS). RESULTS Static measurements showed no group differences in PwH (n = 40) compared to healthy controls (n = 40) except pelvic torsion (median [25%-quartile;75%-quartile]: -1.9[-3.2;.9]° vs. .5[-1.1;1.9]°; P = .007). In contrast, under dynamic conditions PwH showed significantly higher trunk inclination and lower apex lumbar lordosis in all gait phases. Additionally, pelvic torsion was increased in mid stance and terminal swing. Considering joint status, PwH had a higher global HJHS (23.5[13.0;30.0] vs. 3.0[1.0;5.0]; P<.001). A significant moderate correlation was shown between the HJHS mobility score and spine parameters (r = .228-.588; P<.05). CONCLUSION Degenerative joint changes in PwH lead to altered spine posture during gait. A reason could be the reduced mobility in the affected joint. Changes in spinal and pelvic posture lead to higher structural burdens; therefore, clinicians should focus on posture of spinal column during gait in daily treatment.
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Affiliation(s)
- Jamil Hmida
- Department of Sports Medicine, University of Wuppertal, Wuppertal, Germany
| | - Thomas Hilberg
- Department of Sports Medicine, University of Wuppertal, Wuppertal, Germany
| | - Steffen Krüger
- Department of Sports Medicine, University of Wuppertal, Wuppertal, Germany
| | - Tom R Jansen
- Department of Orthopaedics and Trauma Surgery, University of Bonn, Bonn, Germany
| | - Georg Goldmann
- Institute for Experimental Haematology and Transfusion Medicine, University of Bonn, Bonn, Germany
| | - Johannes Oldenburg
- Institute for Experimental Haematology and Transfusion Medicine, University of Bonn, Bonn, Germany
| | - Dieter C Wirtz
- Department of Orthopaedics and Trauma Surgery, University of Bonn, Bonn, Germany
| | - Andreas C Strauss
- Department of Orthopaedics and Trauma Surgery, University of Bonn, Bonn, Germany
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32
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Chou SH, Lin SY, Shen PC, Tu HP, Huang HT, Shih CL, Lu CC. Pain Control Affects the Radiographic Diagnosis of Segmental Instability in Patients with Degenerative Lumbar Spondylolisthesis. J Clin Med 2021; 10:3984. [PMID: 34501429 PMCID: PMC8432229 DOI: 10.3390/jcm10173984] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 08/30/2021] [Accepted: 08/30/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Diagnosing intervertebral instability is crucial for the treatment of degenerative lumbar spondylolisthesis (DLS). Disabling back pain will reduce spinal mobility which leads to an underestimate of the incidence of intervertebral instability. We hypothesized that adequate analgesia could alter the flexion/extension exam performance, and thus increase the diagnostic accuracy of segmental instability. MATERIALS AND METHODS One hundred patients with low-grade DLS were prospectively enrolled in the before-after cohort study. Standing lateral flexion/extension radiographs of lumbar spines were examined and analyzed before and after intramuscular injections of 30 mg ketorolac. RESULTS Pain score decreased significantly after analgesic injections (p < 0.001). Dynamic slip (DS), dynamic segmental angle (DA), dynamic lumbar lordosis, and slip percentage (SP) were significantly increased after pain reduction (all p < 0.001). According to the diagnostic criteria for segmental instability (DS > 4.5 mm, DA > 15°, or SP > 15%), there were 4%, 4%, and 0.7% of total motion segments fulfilling the criteria which markedly increased to 42%, 32%, and 16.7% after analgesia was administered. The incidence of instability also increased from 6% to 38% after analgesia. CONCLUSIONS The diagnosis rate of intervertebral instability is commonly underestimated in the presence of low back pain. This short-term pain relief facilitates reliable functional imaging adding to the diagnosis of intervertebral instability.
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Affiliation(s)
- Shih-Hsiang Chou
- Department of Orthopaedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (S.-H.C.); (S.-Y.L.); (P.-C.S.); (H.-T.H.)
- Orthopaedic Research Centre, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Sung-Yen Lin
- Department of Orthopaedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (S.-H.C.); (S.-Y.L.); (P.-C.S.); (H.-T.H.)
- Orthopaedic Research Centre, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Department of Orthopaedics, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Po-Chih Shen
- Department of Orthopaedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (S.-H.C.); (S.-Y.L.); (P.-C.S.); (H.-T.H.)
- Orthopaedic Research Centre, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Hung-Pin Tu
- Department of Public Health and Environmental Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan;
| | - Hsuan-Ti Huang
- Department of Orthopaedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (S.-H.C.); (S.-Y.L.); (P.-C.S.); (H.-T.H.)
- Orthopaedic Research Centre, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Department of Orthopaedics, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Chia-Lung Shih
- Clinical Medicine Research Center, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi City 600, Taiwan;
| | - Cheng-Chang Lu
- Department of Orthopaedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (S.-H.C.); (S.-Y.L.); (P.-C.S.); (H.-T.H.)
- Orthopaedic Research Centre, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Department of Orthopaedics, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Department of Orthopaedics, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
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Diagnostic Accuracy of Clusters of Pain Provocation Tests for Detecting Sacroiliac Joint Pain: Systematic Review With Meta-analysis. J Orthop Sports Phys Ther 2021; 51:422-431. [PMID: 34210160 DOI: 10.2519/jospt.2021.10469] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To assess the diagnostic test accuracy of pain provocation tests for the sacroiliac joint. DESIGN Systematic review of diagnostic test accuracy. LITERATURE SEARCH Seven electronic databases and reference lists of included studies and previous reviews were searched. STUDY SELECTION CRITERIA Studies investigating the diagnostic accuracy of clusters of clinical tests for sacroiliac joint pain were included. DATA SYNTHESIS Bivariate random-effects meta-analysis was employed. Risk of bias and applicability concerns were assessed using the revised Quality Assessment of Diagnostic Accuracy Studies tool, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool was used to judge credibility of evidence. RESULTS From 2195 records identified in the search, 5 studies were included that assessed clusters of pain provocation tests for the sacroiliac joint. The estimated positive likelihood ratio was 2.13 (95% confidence interval [CI]: 1.2, 3.9), the negative likelihood ratio was 0.33 (95% CI: 0.11, 0.72), and the diagnostic odds ratio was 9.01 (95% CI: 1.72, 28.4). The GRADE ratings for the outcomes were of very low certainty. Assuming a point prevalence of sacroiliac joint pain of 20%, we calculated a positive posterior probability of 35% (95% CI: 32%, 37%) and negative posterior probability of 8% (95% CI: 6%, 10%). CONCLUSION A positive result on a sacroiliac joint pain provocation test cluster gives the clinician 35% certainty of having correctly identified sacroiliac joint pain. Clusters of pain provocation tests for the sacroiliac joint do not provide sufficient diagnostic accuracy for ruling in the sacroiliac joint as the source of pain. Clinicians can rule out the sacroiliac joint as the source of pain with more confidence: the negative posttest probability indicates that the clinician can conclude with 92% certainty that a negative test result is correct. J Orthop Sports Phys Ther 2021;51(9):422-431. Epub 1 Jul 2021. doi:10.2519/jospt.2021.10469.
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Vanti C, Ferrari S, Guccione AA, Pillastrini P. Lumbar spondylolisthesis: STATE of the art on assessment and conservative treatment. Arch Physiother 2021; 11:19. [PMID: 34372944 PMCID: PMC8351422 DOI: 10.1186/s40945-021-00113-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 07/21/2021] [Indexed: 12/23/2022] Open
Abstract
Introduction There is weak relationship between the presence of lumbar spondylolisthesis [SPL] and low back pain that is not always associated with instability, either at the involved lumbar segment or at different spinal levels. Therefore patients with lumbar symptomatic SPL can be divided into stable and unstable, based on the level of mobility during flexion and extension movements as general classifications for diagnostic and therapeutic purposes. Different opinions persist about best treatment (conservative vs. surgical) and among conservative treatments, on the type, dosage, and progression of physical therapy procedures. Purpose and importance to practice The aim of this Masterclass is to provide clinicians evidence-based indications for assessment and conservative treatment of SPL, taking into consideration some subgroups related to specific clinical presentations. Clinical implications This Masterclass addresses the different phases of the assessment of a patient with SPL, including history, imaging, physical exam, and questionnaires on disability and cognitive-behavioral components. Regarding conservative treatment, self- management approaches and graded supervised training, including therapeutic relationships, information and education, are explained. Primary therapeutic procedures for pain control, recovery of the function and the mobility through therapeutic exercise, passive mobilization and antalgic techniques are suggested. Moreover, some guidance is provided on conservative treatment in specific clinical presentations (lumbar SPL with radiating pain and/or lumbar stenosis, SPL complicated by other factors, and SPL in adolescents) and the number/duration of sessions. Future research priorities Some steps to improve the diagnostic-therapeutic approach in SPL are to identify the best cluster of clinical tests, define different lumbar SPL subgroups, and investigate the effects of treatments based on that classification, similarly to the approach already proposed for non-specific LBP.
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Affiliation(s)
- Carla Vanti
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum, University of Bologna, 40138, Bologna, Italy.
| | - Silvano Ferrari
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum, University of Bologna, 40138, Bologna, Italy
| | - Andrew A Guccione
- Department of Rehabilitation Science, College of Health and Human Services, George Mason University, Fairfax, VA, 22030, USA
| | - Paolo Pillastrini
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum, University of Bologna, 40138, Bologna, Italy
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Knezevic NN, Candido KD, Vlaeyen JWS, Van Zundert J, Cohen SP. Low back pain. Lancet 2021; 398:78-92. [PMID: 34115979 DOI: 10.1016/s0140-6736(21)00733-9] [Citation(s) in RCA: 384] [Impact Index Per Article: 128.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 12/23/2020] [Accepted: 02/16/2021] [Indexed: 12/31/2022]
Abstract
Low back pain covers a spectrum of different types of pain (eg, nociceptive, neuropathic and nociplastic, or non-specific) that frequently overlap. The elements comprising the lumbar spine (eg, soft tissue, vertebrae, zygapophyseal and sacroiliac joints, intervertebral discs, and neurovascular structures) are prone to different stressors, and each of these, alone or in combination, can contribute to low back pain. Due to numerous factors related to low back pain, and the low specificity of imaging and diagnostic injections, diagnostic methods for this condition continue to be a subject of controversy. The biopsychosocial model posits low back pain to be a dynamic interaction between social, psychological, and biological factors that can both predispose to and result from injury, and should be considered when devising interdisciplinary treatment plans. Prevention of low back pain is recognised as a pivotal challenge in high-risk populations to help tackle high health-care costs related to therapy and rehabilitation. To a large extent, therapy depends on pain classification, and usually starts with self-care and pharmacotherapy in combination with non-pharmacological methods, such as physical therapies and psychological treatments in appropriate patients. For refractory low back pain, a wide range of non-surgical (eg, epidural steroid injections and spinal cord stimulation for neuropathic pain, and radiofrequency ablation and intra-articular steroid injections for mechanical pain) and surgical (eg, decompression for neuropathic pain, disc replacement, and fusion for mechanical causes) treatment options are available in carefully selected patients. Most treatment options address only single, solitary causes and given the complex nature of low back pain, a multimodal interdisciplinary approach is necessary. Although globally recognised as an important health and socioeconomic challenge with an expected increase in prevalence, low back pain continues to have tremendous potential for improvement in both diagnostic and therapeutic aspects. Future research on low back pain should focus on improving the accuracy and objectivity of diagnostic assessments, and devising treatment algorithms that consider unique biological, psychological, and social factors. High-quality comparative-effectiveness and randomised controlled trials with longer follow-up periods that aim to establish the efficacy and cost-effectiveness of low back pain management are warranted.
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Affiliation(s)
- Nebojsa Nick Knezevic
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL, USA; Department of Anesthesiology, University of Illinois, Chicago, IL, USA; Department of Surgery, University of Illinois, Chicago, IL, USA.
| | - Kenneth D Candido
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL, USA; Department of Anesthesiology, University of Illinois, Chicago, IL, USA; Department of Surgery, University of Illinois, Chicago, IL, USA
| | - Johan W S Vlaeyen
- Research Group Health Psychology, University of Leuven, Leuven, Belgium; Research Group Experimental Health Psychology, Maastricht University, Maastricht, Netherlands; TRACE Center for Translational Health Research, KU, Leuven-Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Jan Van Zundert
- Department of Anesthesiology, Critical Care and Multidisciplinary Pain Center, Ziekenhuis Oost-Limburg, Genk, Belgium; Department of Anesthesiology and Pain Medicine, Maastricht University Medical Center, Maastricht, Netherlands
| | - Steven P Cohen
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Neurology, Physical Medicine and Rehabilitation, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Psychiatry and Behavioral Sciences, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Department of Physical Medicine and Rehabilitation and Anesthesiology, Walter Reed National Military Medical Center, Bethesda, MD, USA
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Rezvani M, Sabouri M, Mahmoodkhani M, Mokhtari A, Tehrani DS. A comparative study of L4-L5-S1 and L5-S1 vertebral fusion in high-grade L5-S1 spondylolisthesis. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2021; 12:202-208. [PMID: 34194169 PMCID: PMC8214227 DOI: 10.4103/jcvjs.jcvjs_41_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 04/05/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction: One of the most common types of spinal diseases is spondylolisthesis, which in advanced cases requires surgical intervention. This study aimed to compare the results of L4-L5-S1 and L5-S1 vertebral fusion treatment in high-grade L5-S1 spondylolisthesis. Methods: A study design that randomized controlled trial. A total of 70 consecutive patients who underwent surgery for the treatment of spondylolisthesis at Al-Zahra Hospital in Isfahan, Iran, were evaluated from July 2020 to February 2021 (35 patients underwent L4-L5-S1 and 35 received L5-S1 vertebral fusion treatment). The radicular and low back pain (LBP) intensity (Vanguard Australian Shares), blood loss, wound infection, reduction, and quality of life (SF-12 scores) were quantified before the surgery, 1, 3, and 6 months after surgery in two groups. Results: Patients involved in the two groups had similar baseline demographic characteristics. The percent slip in L4-L5-S1 and L5-S1 group, respectively, postoperative 81.11% and 57.89%, P = 0.0001. Intraoperative blood loss and postoperative were higher in the L4-L5-S1 group when compared to the L5-S1 group (P < 0.05). The wound infection rate of the L4-L5-S1 group was similar to that of the L5-S1 group (8.6% vs. 2.9%, P = 0.303). There was no difference in radicular and LBP intensity, SF-12 scores among patients with L4-L5-S1 and L5-S1 groups (P < 0.05). Conclusion: Both L4-L5-S1 and L5-S1 were equally beneficial in improving short-term functional outcomes for patients with high grade L5-S1 spondylolisthesis. However, L4-L5-S1 was associated with statistically significant higher incidences of blood loss, but it was accompanied by a better reduction. Therefore, caution should be exercised when considering L4-L5-S1.
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Affiliation(s)
- Majid Rezvani
- Department of Neurosurgery, School of Medicine, Neurosciences Research Center, Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Masih Sabouri
- Department of Neurosurgery, School of Medicine, Medical Image and Signal Processing Research Center, Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehdi Mahmoodkhani
- Department of Neurosurgery, School of Medicine, Neurosciences Research Center, Kashani Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali Mokhtari
- Department of Neurosurgery, Isfahan University of Medical Sciences, Isfahan, Iran
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Ribeiro RP, Guerrero FG, Camargo EN, Beraldo LM, Candotti CT. Validity and Reliability of Palpatory Clinical Tests of Sacroiliac Joint Mobility: A Systematic Review and Meta-analysis. J Manipulative Physiol Ther 2021; 44:307-318. [PMID: 33896601 DOI: 10.1016/j.jmpt.2021.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 07/18/2020] [Accepted: 01/20/2021] [Indexed: 01/16/2023]
Abstract
OBJECTIVE The primary objective of this review was to investigate the reliability and validity of palpatory clinical tests of sacroiliac mobility. The secondary objective was to investigate which palpatory clinical tests of sacroiliac mobility exist in the literature. METHODS PubMed, Embase, Scopus, Medline, and the Physiotherapy Evidence Database were searched. There was no restriction on the study design or participants. The data extracted from each study were sample size, study deign, and clinical test used. If there was information on reliability values, number of examiners, concurrent validity values, gold standard used, or inferential statistical test used, that was also extracted. For intraexaminer reliability, the data were expressed as κ values that were meta-analyzed using random effects. RESULTS Fifteen palpatory clinical tests of sacroiliac mobility were identified from 28 studies; 14 studies performed inferential statistical analysis, all including analysis of interexaminer reliability, with κ values ranging from -0.05 to 0.77. Analysis of intraexaminer reliability was performed in 8 studies, with κ values ranging from 0.08 to 0.73. No study included in this systematic review verified the concurrent validity of the tests. Our meta-analysis of intraexaminer reliability showed moderate to good agreement results for the Gillet test (κ = 0.46), the standing flexion test (κ = 0.61), and the sitting flexion test (κ = 0.68). CONCLUSION We found 15 palpatory clinical tests of sacroiliac mobility in this systematic review. According to our meta-analysis, only the sitting flexion test obtained a good and statistically significant intraexaminer agreement. Further studies are necessary to evaluate the reliability and validity of these tests.
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Affiliation(s)
- Rafael P Ribeiro
- School of Physical Education, Physiotherapy and Dance (ESEFID), Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.
| | - Filipe G Guerrero
- School of Physical Education, Physiotherapy and Dance (ESEFID), Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Eduardo N Camargo
- School of Physical Education, Physiotherapy and Dance (ESEFID), Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Lucas M Beraldo
- Institute of Mathematics and Statistics (IME), Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Cláudia T Candotti
- School of Physical Education, Physiotherapy and Dance (ESEFID), Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
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Zheng K, Wen Z, Li D. The Clinical Diagnostic Value of Lumbar Intervertebral Disc Herniation Based on MRI Images. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:5594920. [PMID: 33880169 PMCID: PMC8046570 DOI: 10.1155/2021/5594920] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 03/12/2021] [Accepted: 03/23/2021] [Indexed: 01/29/2023]
Abstract
MRI was used to measure the changes in the angle of the facet joints of the lumbar spine and analyze the relationship between it and the herniated lumbar intervertebral disc. Analysis of the causes of lumbar disc herniation from the anatomy and morphology of the spine provides a basis for the early diagnosis and prevention of lumbar disc herniation. There is a certain correlation between the changes shown in MRI imaging of lumbar disc herniation and the TCM syndromes of lumbar intervertebral disc herniation. There is a correlation between the syndromes of lumbar disc herniation and the direct signs of MRI: pathological type, herniated position, and degree of herniation. Indirect signs with MR, nerve root compression and dural sac compression, are related. The MRI examination results can help syndrome differentiation to improve its accuracy to a certain extent. MRI has high sensitivity for the measurement of the angle of the facet joints of the lumbar spine and can be used to study the correlation between the changes of the facet joint angles and the herniated disc. Facet joint asymmetry is closely related to lateral lumbar disc herniation, which may be one of its pathogenesis factors. The herniated intervertebral disc is mostly on the sagittal side of the facet joint, and the facet joint angle on the side of the herniated disc is more sagittal. The asymmetry of the facet joints is not related to the central lumbar disc herniation, and the angle of the facet joints on both sides of the central lumbar disc herniation is partial sagittal.
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Affiliation(s)
- Kangxing Zheng
- Shangrao Municipal Hospital, Shangrao, Jiangxi 334000, China
| | - Zihuan Wen
- Shangrao Municipal Hospital, Shangrao, Jiangxi 334000, China
| | - Dehuai Li
- Harbin Second Hospital, Harbin, Heilongjiang 150056, China
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Cheng ZX, Zheng YJ, Feng ZY, Fang HW, Zhang JY, Wang XR. Chinese Association for the Study of Pain: Expert consensus on diagnosis and treatment for lumbar disc herniation. World J Clin Cases 2021; 9:2058-2067. [PMID: 33850925 PMCID: PMC8017495 DOI: 10.12998/wjcc.v9.i9.2058] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 03/15/2021] [Accepted: 03/17/2021] [Indexed: 02/06/2023] Open
Abstract
Lumbar disc herniation is a common disease in the clinical context and does great harm to either the physical or mental health of patients suffering from this disease. Many guidelines and consensus for the diagnosis and treatment of lumbar disc herniation have been published domestically and internationally. According to the expert consensus, clinicians could adopt tailored and personalized diagnosis and treatment management strategies for lumbar disc herniation patients.
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Affiliation(s)
- Zhi-Xiang Cheng
- Department of Algology, The Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011, Jiangsu Province, China
| | - Yong-Jun Zheng
- Department of Algology, Huadong Hospital Affiliated to Fudan University, Shanghai 200040, China
| | - Zhi-Ying Feng
- Department of Anesthesiology and Pain Medicine, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310000, Zhejiang Province, China
| | - Hong-Wei Fang
- Department of Algology, East Hospital, Tongji University, Shanghai 200120, China
| | - Jin-Yuan Zhang
- Department of Algology, East Hospital, Tongji University, Shanghai 200120, China
| | - Xiang-Rui Wang
- Department of Algology, East Hospital, Tongji University, Shanghai 200120, China
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Inhibition of intervertebral disc disease progression via the circPKNOX1-miR-370-3p-KIAA0355 axis. Cell Death Discov 2021; 7:39. [PMID: 33637685 PMCID: PMC7910476 DOI: 10.1038/s41420-021-00420-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 01/10/2021] [Accepted: 02/03/2021] [Indexed: 12/13/2022] Open
Abstract
The molecular mechanism underlying the development of intervertebral disc disease (IVDD) is not completely understood. Circular RNAs (circRNAs) play a significant role in the occurrence and development of various diseases, and studies have shown that circPKNOX1 is involved in the compensatory response of extracellular matrix synthesis and secretion of the nucleus pulposus (NP) cells. However, the mechanism through which circRNAs regulate IVDD progression remains unclear; therefore, in this study, we explored the significance of circPKNOX1 in IVDD. The expression of circRNAs in NP cells of normal and degenerative patients was detected using microarray analysis, and the role of circPKNOX1 in IVDD was confirmed using RT-qPCR. The interaction networks of circRNAs, miRNAs, and miRNA target genes were detected using bioinformatics analysis, RNA fluorescence in situ hybridization, and immunofluorescence analysis. We found that the expression of circPKNOX1 decreased in IVDD cells. The expression of circPKNOX1 in NP cells, observed using RT-qPCR and western blotting, was consistent with that observed using array screening. Overexpression of circPKNOX1 increased the expression of collagen II, aggrecan, and SOX9 and decreased that of ADAMTS4, ADAMTS-5, MMP3, and MMP13. We further demonstrated that circPKNOX1 played the role of a sponge by competitively binding miR-370-3p to reverse the inhibition of KIAA0355 expression. Our findings indicated that circPKNOX1 affected the progression of IVDD by regulating the expression of KIAA0355 via miR-370-3p. Therefore, circPKNOX1-based therapy may serve as an effective IVDD treatment strategy.
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Merkulov Y, Chernova P, Lezina D, Biglova A, Gamburg A, Merkulova D. Optimizing the diagnosis and treatment of dorsalgia in real-world clinical practice: the primary endpoint of the DORISS multicenter observational study. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:24-32. [DOI: 10.17116/jnevro202112112124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Verhagen A, Hancock M. Research Note: Diagnostic test accuracy studies. J Physiother 2021; 67:69-71. [PMID: 33353831 DOI: 10.1016/j.jphys.2020.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 12/10/2020] [Indexed: 10/22/2022] Open
Affiliation(s)
- Arianne Verhagen
- Discipline of Physiotherapy, Graduate School of Health, University of Technology Sydney, Sydney, Australia.
| | - Mark Hancock
- Faculty of Medicine and Health Science, Macquarie University, Sydney, Australia
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Marchesini M, Putzu M. Ultrasound block of the medial branch: Learning the technique using CUSUM curves. Anesth Essays Res 2021; 15:385-390. [PMID: 35422558 PMCID: PMC9004262 DOI: 10.4103/aer.aer_162_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 02/04/2022] [Accepted: 02/04/2022] [Indexed: 11/28/2022] Open
Abstract
Background: Blocking the medial branch of the lumbar facet joints plays a fundamental diagnostic and therapeutic role in the treatment of lumbar pain. Attempts to replace the typical guided X-ray techniques with ultrasound-guided techniques have also involved treating the lumbar medial branches. By applying the cumulative sum control chart (CUSUM method), we sought to evaluate the learning curve associated with ultrasound-guided block of the lumbar medial branches in operators experienced in locoregional anesthesia but without expertise in pain therapy. Aim: This study aimed to use a repeatable method to identify the learning curve of the ultrasound-guided medial branch block. Settings and Design: This study was a prospective application of over forty consecutive procedures of ultrasound lumbar medial branch block. Materials and Methods: The ultrasound medial branch blocks were performed under ultrasound guidance with confirmation of correct positioning using fluoroscopy on a population of patients with low back pain with any body mass index (BMI). Statistical Analysis: The operator's performance was assessed using the learning curve cumulative summation test (LS-CUSUM). Results and Conclusions: The correct target was reached in 29 procedures out of a total of 40 (72.5%) and in 29 out of 36 procedures performed on patients with BMI <30 (80.5%). According to the CUSUM algorithm, 11 further consecutive successes would have been necessary (47 procedures in total) to achieve a proven learning of the technique in the group with only patients with a BMI <30, with a further 22 consecutive successes (62 procedures in total) in the general group. Ultrasound-guided block of the lumbar medial branch appears not to be optimal for training beginner/intermediate operators seeking to replace guided X-ray procedures with guided ultrasound.
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Lorio M, Kube R, Araghi A. International Society for the Advancement of Spine Surgery Policy 2020 Update-Minimally Invasive Surgical Sacroiliac Joint Fusion (for Chronic Sacroiliac Joint Pain): Coverage Indications, Limitations, and Medical Necessity. Int J Spine Surg 2020; 14:860-895. [PMID: 33560247 DOI: 10.14444/7156] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The index 2014 International Society for the Advancement of Spine Surgery Policy Statement-Minimally Invasive Surgical Sacroiliac Joint Fusion-was generated out of necessity to provide an International Classification of Diseases, Ninth Revision (ICD-9)-based background and emphasize tools to ensure correct diagnosis. A timely ICD-10-based 2016 update provided a granular threshold selection with improved level of evidence and a more robust and relevant database (Appendix Table A1). As procedures and treatment options have evolved, this 2020 update reviews and analyzes the expanding evidence base and provides guidance relating to differences between the lateral and dorsal surgical procedures for minimally invasive surgical sacroiliac joint fusion.
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Affiliation(s)
- Morgan Lorio
- Advanced Orthopedics, Altamonte Springs, Florida
| | - Richard Kube
- Prairie Spine & Pain Institute, Peoria, Illinois
| | - Ali Araghi
- The CORE Institute, Sun City West, Arizona
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The why, where, and how clinical reasoning model for the evaluation and treatment of patients with low back pain. Braz J Phys Ther 2020; 25:407-414. [PMID: 33371952 DOI: 10.1016/j.bjpt.2020.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 09/19/2020] [Accepted: 12/01/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND There is considerable overlap between pain referral patterns from the lumbar disc, lumbar facets, the sacroiliac joint (SIJ), and the hip. Additionally, sciatic like symptoms may originate from the lumbar spine or secondary to extra-spinal sources such as deep gluteal syndrome (GPS). Given that there are several overlapping potential anatomic sources of symptoms that may be synchronous in patients who have low back pain (LBP), it may not be realistic that a linear deductive approach can be used to establish a diagnosis and direct treatment in this group of patients. OBJECTIVE The objective of this theoretical clinical reasoning model is to provide a framework to help clinicians integrate linear and non-linear clinical reasoning approaches to minimize clinical reasoning errors related to logically fallacious thinking and cognitive biases. METHODS This masterclass proposes a hypothesis-driven and probabilistic approach that uses clinical reasoning for managing LBP that seeks to eliminate the challenges related to using any single diagnostic paradigm. CONCLUSIONS This model integrates the why (mechanism of primary symptoms), where (location of the primary driver of symptoms), and how (impact of mechanical input and how it may or may not modulate the patient's primary complaint). The integration of these components individually, in serial, or simultaneously may help to develop clinical reasoning through reflection on and in action. A better understanding of what these concepts are and how they are related through the proposed model may help to improve the clinical conversation, academic application of clinical reasoning, and clinical outcomes.
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Wang Q, Runhaar J, Kloppenburg M, Boers M, Bijlsma JWJ, Bierma-Zeinstra SMA. The Added Value of Radiographs in Diagnosing Knee Osteoarthritis Is Similar for General Practitioners and Secondary Care Physicians; Data from the CHECK Early Osteoarthritis Cohort. J Clin Med 2020; 9:jcm9103374. [PMID: 33096821 PMCID: PMC7594082 DOI: 10.3390/jcm9103374] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/08/2020] [Accepted: 10/19/2020] [Indexed: 01/18/2023] Open
Abstract
Objective: The purpose of this study was to evaluate the added value of radiographs for diagnosing knee osteoarthritis (KOA) by general practitioners (GPs) and secondary care physicians (SPs). Methods: Seventeen GPs and nineteen SPs were recruited to evaluate 1185 knees from the CHECK cohort (presenters with knee pain in primary care) for the presence of clinically relevant osteoarthritis (OA) during follow-up. Experts were required to make diagnoses independently, first based on clinical data only and then on clinical plus radiographic data, and to provide certainty scores (ranging from 1 to 100, where 1 was “certainly no OA” and 100 was “certainly OA”). Next, experts held consensus meetings to agree on the final diagnosis. With the final diagnosis as gold standard, diagnostic indicators were calculated (sensitivity, specificity, positive/negative predictive value, accuracy and positive/negative likelihood ratio) for all knees, as well as for clinically “certain” and “uncertain” knees, respectively. Student paired t-tests compared certainty scores. Results: Most diagnoses of GPs (86%) and SPs (82%) were “consistent” after assessment of radiographic data. Diagnostic indicators improved similarly for GPs and SPs after evaluating the radiographic data, but only improved relevantly in clinically “uncertain” knees. Radiographs added some certainty to “consistent” OA knees (GP 69 vs. 72, p < 0.001; SP 70 vs. 77, p < 0.001), but not to the consistent no OA knees (GP 21 vs. 22, p = 0.16; SP 20 vs. 21, p = 0.04). Conclusions: The added value of radiographs is similar for GP and SP, in terms of diagnostic accuracy and certainty. Radiographs appear to be redundant when clinicians are certain of their clinical diagnosis.
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Affiliation(s)
- Qiuke Wang
- Department of General Practice, Erasmus MC University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (Q.W.); (S.M.A.B.-Z.)
| | - Jos Runhaar
- Department of General Practice, Erasmus MC University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (Q.W.); (S.M.A.B.-Z.)
- Correspondence: ; Tel.: +31(0)-10-7044192; Fax: +31(0)-10-7044766
| | - Margreet Kloppenburg
- Department of Rheumatology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands;
| | - Maarten Boers
- Department of Epidemiology & Data Science, Amsterdam Rheumatology & Immunology Center, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands;
| | - Johannes W. J. Bijlsma
- Department of Rheumatology and Clinical Immunology, University Medical Centre Utrecht, 3584 CX Utrecht, The Netherlands;
| | - Sita M. A. Bierma-Zeinstra
- Department of General Practice, Erasmus MC University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (Q.W.); (S.M.A.B.-Z.)
- Department of Orthopaedics, Erasmus MC University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
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Toomey D, Reid D, White S. How manual therapy provided a gateway to a biopsychosocial management approach in an adult with chronic post-surgical low back pain: a case report. J Man Manip Ther 2020; 29:107-132. [PMID: 32930642 DOI: 10.1080/10669817.2020.1813472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND The management of patients with chronic post-surgical low back pain can be very challenging to surgeons, physiotherapists, and patients alike. Subsequent surgery is often associated with post-operative complications and even lower levels of success than the initial spinal surgery. Physiotherapy is often recommended as the first-line management, however, debate exists amongst physiotherapists regarding the optimal treatment strategy. A key focus of this debate has been the use of manual therapy in chronic pain populations, leading clinicians to reevaluate its use. CASE DESCRIPTION A 44-year-old female presented to physiotherapy with a 13-year history of persistent pain, having had a spinal fusion 12 years prior, following a skiing accident. Her primary complaints were pain and decreased self-efficacy. The patient was treated with a 12-week multimodal approach consisting of manual therapy, exercise rehabilitation, and pain neuroscience education. OUTCOMES The patient had a significant reduction in the Numerical Pain Rating Scale (NPRS), the Oswestry Disability Index (ODI) and the Fear Avoidance Belief Questionnaire Physical Activity Subscale (FABQ-PA) scores following the intervention. She returned to running and cycling, reporting that pain was something she would 'work with instead of against'. DISCUSSION This case study suggests that manual therapy can enhance an individualized biopsychosocial approach in the physiotherapy management of a patient with chronic post-surgical low back pain. Further research is needed to evaluate optimal intervention dosages and effective strategies in the management of patients with chronic low back pain following spinal surgery.
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Affiliation(s)
- David Toomey
- Auckland University of Technology, Auckland, New Zealand.,Waiheke Physiotherapy and Pilates, Auckland, New Zealand
| | - Duncan Reid
- Auckland University of Technology, Auckland, New Zealand
| | - Steven White
- Auckland University of Technology, Auckland, New Zealand
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Campos-Daziano M. HERNIA DEL DISCO INTERVETEBRAL LUMBAR: REVISIÓN NARRATIVA DE CLÍNICA Y MANEJO. REVISTA MÉDICA CLÍNICA LAS CONDES 2020. [DOI: 10.1016/j.rmclc.2020.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Cough Radiculopathy: Postinfectious Cough-Related Acute Lumbar Radiculopathy. Case Rep Med 2020; 2020:2360854. [PMID: 32855637 PMCID: PMC7442997 DOI: 10.1155/2020/2360854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 07/27/2020] [Indexed: 11/17/2022] Open
Abstract
Cough is a protective reflex of airways and lungs. Cough may result in several complications. Postinfectious cough is a cough that begins during an acute respiratory tract infection, usually is self-limited, and is due to airway hyperresponsiveness as a result of airway inflammation. Cough radiculopathy has been once reported by Torrington and Adornato in the form of acute cervical radiculopathy. This is a case of acute lumbar radiculopathy as a result of postinfectious cough. Literature review did not show a similar case.
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Shavlovskaya OA, Romanov ID. [The assessment of efficacy and tolerability of the complex therapy of low back pain]. Zh Nevrol Psikhiatr Im S S Korsakova 2020; 120:63-67. [PMID: 32790978 DOI: 10.17116/jnevro202012007163] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To assess the efficacy of the complex therapy of nonspecific low back pain (LBP) with amelotex, calmirex, kompligamB in comparison with the monotherapy with amelotex. MATERIAL AND METHODS This observational study included sixty patients, aged 53.73±11.84 53 years, with nonspecific LBP. Patients were divided into 2 groups: the basic group (n=30) received calmirex (150mg 2 times a day during 10 days), amelotex (7.5 mg 2 times a day, 7 days) and kompligamB (1 ml once a day, 10 days). The control group (n=30) received only amelotex (7.5 mg 2 times a day, 7 days). The dynamics of the condition was assessed on a 10-point numerical rating scale (at rest, walking, palpation), the Oswestry functional status questionnaire (Oswestry Disability Index; ODI), as well as indicators of laboratory markers reflecting the severity of the inflammatory process (erythrocyte sedimentation rate, C-reactive protein (CRP)). RESULTS The severity of pain syndrome significantly decreased in both groups, to a greater extent in the basic group, and ODI indicators also significantly improved in the basic group. CRP indicators showed more pronounced changes in the basic group. CONCLUSION The complex therapy that affects all links in the formation of pain syndrome should be recommended to patients with LBP.
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Affiliation(s)
- O A Shavlovskaya
- Sechenov First Moscow State Medical University (Sechenov University) Moscow, Russi, Sechenov First Moscow State Medical University (Sechenov University) Moscow, Russia
| | - I D Romanov
- Sechenov First Moscow State Medical University (Sechenov University) Moscow, Russi, Sechenov First Moscow State Medical University (Sechenov University) Moscow, Russia
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