Ability of Spine Specialists to Identify Psychosocial Risk Factors as Obstacles to Recovery in Patients with Low Back Pain-Related Disorders

Study Design

Prospective study.

Purpose

Yellow flags are psychosocial associated with a greater likelihood of progression to persistent pain and disability. These are referred to as obstacles to recovery. Despite their recognized importance, it is unknown how effective clinicians are in detecting them. The primary objective of this study was thus to determine the effectiveness of spine specialist clinicians in detecting the presence of yellow flags in patients presenting to an orthopedic outpatient clinic with low back-related disorders.

Overview of Literature

Psychosocial factors have been previously studied as important predictors of prognosis in patients with low back pain. However, the ability of spinal specialist to identify them remains unknown.

Methods

A prospective, single-center, consecutive cohort study was conducted over a period of 30 months. All new patients with low back-related disorders regardless of pathology completed a Yellow Flag Questionnaire that was adapted from the psychosocial flags framework. Clinicians assessing these patients completed a standardized form to determine which and how many yellow flags they had identified during the consultation.

Results

A total of 130 patients were included in the analysis, and the clinicians reported an average of 5 flags (range, 0–9). Fear of movement or injury was the most frequently reported yellow flag, reported by 87.7% (n=114) of patients. Clinician sensitivity in detecting yellow flags was poor, correctly identifying only 2 flags, on average, of the 5 reported by patients, with an overall sensitivity of only 39%.

Conclusions

The ability of spine specialists to identify yellow flags is poor and can be improved by asking patients to complete a simple screening questionnaire.

Recurrent thoracic intramedullary schwannoma: report of two cases with long term follow up

Occurrence of intramedullary schwannomas is rare as Schwann cells are generally present in the nerve root and not in the spinal cord. To date, approximately around 60 cases of intramedullary schwannoma in patients without neurofibromatosis have been reported in the English literature, of which only eight were children. We describe two cases of thoracic intramedullary schwannomas that recurred after primary excision. A 10 years old boy presented with weakness of both lower limbs. Magnetic resonance imaging showed a D10 to D12 intramedullary lesion, which was excised near totally and confirmed to be a schwannoma on histopathological examination. The tumour recurred twice after that and was re operated both times. Another 57 years old lady presented with weakness of both lower limbs and a history of being operated in the past for D9-D10 intramedullary lesion. She was re-operated with total removal of the lesion confirmed to be schwannoma on histopathological examination. Intramedullary schwannoma may recur after resection.

Application and use of subcutaneous stay sutures in anterior cervical spine surgeries with a transverse neck incision: A technical report

Objective/Purpose:

The objective of this study is to describe our experience with the use of stay sutures and transverse neck incision for anterior cervical spine surgeries involving multiple levels.

Summary of Background Data:

Transverse incisions on neck usually heal with minimal fibrosis resulting in cosmetically acceptable scars whereas vertical incision, although provides greater exposure, heals with extensive fibrosis resulting in ugly scars. Transverse incision is thus highly recommended. However, the fear of nonextensibility of transverse incision for multilevel fusion has led to the preference of vertical incision, development of techniques for identifying the optimal level of the incision, or has suggested the usage of two transverse incisions.

Materials and Methods:

Seventy-six patients underwent anterior cervical spine surgeries using a transverse neck incision for single or multilevel discectomy/corpectomy and fusion. Having divided the platysma, dissection was carried down to the anterior surface of the cervical spine between the carotid sheath laterally and the trachea and esophagus medially. Stay sutures were taken through the platysma and subcutaneous tissue, converting the transverse incision into a quadrilateral window providing access for as much as three-level corpectomy or five levels of fixation.

Results:

All the wounds healed with no evidence of wound-related complications, leaving a cosmetically acceptable scar.

Conclusion:

Using appropriately placed stay sutures, a transverse neck incision taken in the middle of the field of work can provide enough of a surgical window to perform multilevel fusion surgeries. Its simplicity and cost-effectiveness make it easily implementable, addressing the underlying pathology adequately with best possible cosmetic results.

Traumatic multiple cervical spine injuries in a patient with osteopetrosis and its management

STUDY DESIGN

Single case report.

OBJECTIVE/PURPOSE

To report multiple level fractures of cervical spine in a patient with osteopetrosis and its management. Osteopetrosis is a rare inherited condition characterized by defective remodeling resulting in hard and brittle bones with diffuse osteosclerosis. Fractures of spine are rare as compared to the common long bone fractures. We report a case of traumatic multiple level fractures of cervical spine in osteopetrosis and its management which has rarely been reported in the literature before, if any.

METHODS

17-year-old boy presented with severe tenderness in neck and restricted range of motion following a trivial injury to the neck in swimming pool. The neurology was normal and he was diagnosed to have autosomal dominant osteopetrosis on evaluation. Imagining findings, clinical course and the method of treatment are discussed.

RESULTS

Radiological evaluation revealed presence of multiple level fractures of cervical vertebrae with end plate sclerosis. Patient was managed with cervical skeletal traction in appropriate extension position for 6 weeks followed by hard cervical collar for another 6 weeks. Follow-up radiographs at 18 months and 2.5 years showed healed fractures with no residual instability or symptoms.

CONCLUSION

The case report discusses rare occurrence of multiple level fractures of cervical spine following trivial injury to the neck in a patient with osteopetrosis and its treatment with conservative management.