Severe low back or lower limb pain is associated with recurrent falls among older Australians.

ObjectiveConventional posterior‐approach decompression surgeries have a higher risk of nerve root injury and dura laceration. We explore the therapeutic strategy and effect of “inside disc out” discectomy under intervertebral foramen endoscope technique for discogenic lumbar spinal canal stenosis (DLSS) treatment.MethodsTwenty‐nine patients with DLSS in the responsible segment were treated with “inside disc out” discectomy under intervertebral foramen endoscope technique between October 2017 to October 2019. Lower limb and back pain were recorded before operation, and visual analogue scale (VAS) score and Oswestry disability index (ODI) were recorded for lower limb and back pain at 1, 3, 6, and 12 months postoperatively. The postoperative effects were evaluated using the modified MacNab method for all the patients.ResultsAll 29 patients successfully completed the operation. The operation time was 75–120 min, with an average of 90 ± 17 min. Postoperative lumbar CT examinations of all the patients showed full decompression of the spinal cord with no residual pressure. The average follow‐up time for all the patients was 13 ± 3.5 months (12–18 months). The VAS score for lower back and lower limb pain was 7.52 ± 1.25 before the operation, and 1.80 ± 0.63, 1.33 ± 0.88, 1.07 ± 0.89, and 0.81 ± 0.51 at 1, 3, 6, and 12 months after the surgery, respectively. The Oswestry dysfunction index was 59.43 ± 10.04 before surgery and 29.67 ± 10.35, 21.13 ± 9.32, 14.52 ± 5.98, and 9.84 ± 4.68 at 1, 3, 6, and 12 months after the surgery, respectively. The VAS score and ODI index of low back and lower limb pain at different time points after the surgery were significantly improved compared to those before the surgery (P < 0.01). The effect of the modified MacNab was excellent in 26 patients, good in two patients, and fair in one patient. The excellent and good rates were 91.4%. Among them, one patient had symptoms of hyperesthesia in the anterior aspect of the thigh and decreased quadriceps muscle strength after lumbar 4/5 segment endoscopic surgery. After symptomatic and conservative treatment, the symptoms disappeared 4 weeks postoperatively, and there were no other serious surgical complications.ConclusionsFollowing the “inside disc out” discectomy under intervertebral foramen endoscope protocols, the risk of nerve injury can greatly be reduced, with good postoperative efficacy. Overall, the procedure is safe and feasible for DLSS treatment.

Musculoskeletal problems have become endemic in agricultural work. The workers often complain about pain in various parts of the body while performing agricultural activities. The results revealed that during land preparation, sowing, irrigation most of the males and female agricultural workers reported very severe to severe pain in lower back and moderate pain in other body parts viz. neck, shoulder, upper arm, palm/fingers, upper back and thighs. In the activity of sowing, due to frequent changes in posture and continuous movement, 75 per cent of females and half of the male respondents reported pain. percentage of women reporting musculoskeletal problems in plant protection activity were less but 70 per cent of males reported very severe to moderate pain in neck, shoulders and upper arms as the act of spraying required considerable strength. While weeding activity all females experienced severe pain in lower back. In harvesting activity male and female agricultural workers experienced severe to very severe pain in upper arms, shoulders, neck, thighs and lower back because of the repetitive motion of the body part and the heavy loads, which they carried. The data of musculoskeletal problems during the activity of threshing indicated that the respondents perceived very severe to moderate pain in upper back, shoulders, upper arms and lower back although the intensity varied. Body Part Discomfort Score (BPDS) of the male and female respondents engaged in the agricultural activities reveal that it was highest in the activity of weeding followed by the activity of land preparation and the next in order were threshing, harvesting, irrigation and use of chemicals. The Overall Discomfort Rating scores shows that all the activities were in the range of ‘high discomfort’ both for males and females except irrigation in which the Overall Discomfort Rating scores were in the range of ‘moderate discomfort’ and the ODR of females in case of plant protection activity was in the range of ‘light discomfort’.

Objective To investigate the surgical techniques and clinical effects of percutaneous endoscopic transforaminal discectomy in the treatment of lumbar disc herniation in elderly patients. Methods A total of 67 patients with lumbar disc herniation in the elderly were treated by percutaneous endoscopic transforaminal discectomy from January 2016 to June 2018. There were 24 males and 43 females, whose average age was 68±7 years (range, 60-87 years). All cases had responsible single-level lumbar disc herniation, L3-4 in 11 cases, L4-5 in 42, L5-S1 in 14. The Visual Analogue Scale (VAS), Oswestry Disability Index (ODI) and modified MacNab criteria were used for the evaluation of clinical effects. Results The operation was completed successfully in all cases, The mean operation time was 105±18 min (range: 60-150 min). The 67 patients were followed up for 6-12 months (average 7.5±1.6 months), low back and leg pain, sensory disturbance and muscle weakness were alleviated in different degrees after the operation except for 1 patient. The VAS scores of low back pain and leg pain were (3.5±1.2) and (8.0±1.1) point preoperatively, (1.7±0.9) and (1.0±1.6) point at 6-12 months after the operation. The ODI scores were (70±18) preoperatively and (17±10) at 6-12 months after the operation. Statistically significant differences existed in the VAS scores of low back and leg pain and ODI scores preoperatively and at 6-12 months after the operation (t=13.718, t=30.973, t=23.059, P=0.000). The excellent and good rate was 89.55% in the latest follow up according to the modified MacNab criteria. There were no dural tears, nerve injuries and infections. 3 patient experienced neck pain during operation. The postoperative complications included transient lower limb numbness and pain in 5 cases, persistent leg pain caused by incomplete endoscopic discectomy in 2 cases, opposite leg pain occurring in 1 case, more severe low back pain in 2 cases, reoccurrence in 1 case. Conclusions Percutaneous endoscopic transforaminal discectomy for responsible single-level lumbar disc herniation in the elderly presents satisfactory short-term clinical outcomes due to reliable surgical technique and appropriate patients. Key words: Aged; Lumbar vertebrae; Discectomy; Endoscopy; Transforaminal approach

The Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ) was created to evaluate specific treatment outcomes in terms of physical functioning, social ability, and mental health in patients with back pain-related diseases. In this study, we investigated whether the JOABPEQ could be used to construct a regression model to quantify low back pain and lower limb symptoms in patients with lumbar disc herniation (LDH). We reviewed 114 patients with LDH scheduled to undergo surgery at our hospital. We measured the degrees of 1) lower back pain, 2) lower limb pain, and 3) lower limb numbness using the visual analog scale before the surgery. All answers and physical function data were subjected to partial least squares regression analysis. The degrees of lower back and lower limb pain could be used as a regression model from the JOABPEQ and had a significant causal relationship with them. However, the degree of lower limb numbness could not be used for the same. Based on our results, the questions of the JOABPEQ can be used to multilaterally understand the degree of lower back pain and lower limb pain in patients with LDH. However, the degree of lower limb numbness has no causal relationship, so actual measurement is essential.

Key Clinical MessageThe incidence of spinal fusion surgery and associated adjacent segment disease (ASD) is steadily increasing. We report three cases of ASD after posterior fixation, treated by oblique lateral interbody fusion (OLIF). All cases had a good postoperative course. Altogether, OLIF surgery may be a viable option for treating ASD.

Responsiveness of the Short-Form 36 and Oswestry Disability Questionnaire in Chronic Nonspecific Low Back and Lower Limb Pain Treated With Customized Foot Orthotics

To evaluate the results of lumbar epiduroscopic adhesiolysis using mechanical methods and a radiofrequency catheter followed by epidural steroid and local anesthetic administration in patients with postoperative fibrosis and persistent or recurrent symptoms. Prospective study. Patients with persistent or recurrent low back and/or lower limb pain after lumbar spine surgery, in whom no relevant findings were present on MR images besides epidural scar tissue, were submitted to epiduroscopic adhesiolysis. Patient-reported outcomes including pain and disability were assessed in predefined time intervals and compared to baseline. Twenty-four patients were enrolled. It was possible to elicit the patient's usual pain by probing the epidural scar tissue in all patients. Statistically significant improvement in low back and lower limb pain was observed in all assessment periods up to 12 months. A pain relief over 50% was achieved in 71% of the patients at 1 month, 63% at 3 and 6 months, and 38% at 12 months. Disability scores significantly improved for around 6 months. Mean patient satisfaction rates were 80% at 1 month, 75% at 3 months, 70% at 6 months, and 67% 1 year after intervention. Only 1 transient postprocedural complication was detected. Endoscopic adhesiolysis is a potentially useful treatment for the relief of chronic intractable low back and lower limb pain in patients with previous lumbar spine surgery and epidural fibrosis. The use of larger volumes of saline during endoscopy and the employment of radiofrequency for the lysis of epidural adhesions are safe procedures, which may provide an additional benefit to the intervention.

Lower backand lower limb pain can hamper the rehabilitation of cerebral stroke patients. We report that peripheral nerve blocks enabled two patients to continue rehabilitation. Case 1 was an 83-year-old female with left hemiparesis due to cerebral infarction of the right basal ganglia. Rehabilitation started on the day after the stroke onset. On the 7th post-stroke day, she reported right buttockand dorsal thigh pain. Lumbar MRI demonstrated no lumbar spinal canal stenosis and no nerve impingement. The middle cluneal nerve block alleviated her buttock pain. On the 29th post-stroke day, she suffered severe pain on the medial side of the right knee. Blocking the infrapatellar branch of the saphenous nerve lessened that pain, she was able to walk without assistance, and rehabilitation was resumed. Case 2 wasan 87-year-old female with sudden-onset left hemiparesis due to cardiogenic cerebral infarction. Intravenous thrombolysis and mechanical thrombectomy were performed. She presented with left hemiparesis due to infarcts at the right basal ganglia and the right temporal and parietal lobes. Her chronic low back pain worsened after admission and walking was difficult. Bilateral superiorand middle cluneal nerve blocks improved her right lower back pain. Left low back pain was alleviated by sacroiliac joint blockage and rehabilitation was possible due to the absence of back pain. The strain on the lower back and lower limbs attributable to paresis due to stroke may lead to entrapment neuropathy. Peripheral nerve blockage is relatively simple and safe and may be useful in acute stroke patients whose rehabilitation is difficult due to pain.

This study with 40 office workers investigated (a) the effect of time spent standing on low- back and lower limb pain during a 1-h laboratory-based task; (b) the standing time after which a significant increase in pain is likely; and (c) the individual, physical and psychosocial factors that predict pain. The primary outcome was bodily location of pain and pain intensity on a 100-mm Visual Analogue Scale recorded at baseline and every 15 min. Physical measures included trunk and hip motor control and endurance. Self-report history of pain, physical activity, psychosocial job characteristics, pain catastrophizing and general health status were collected. Univariate analysis and regression models were included. The prevalence of low-back pain increased from 15% to 40% after 30 min while feet pain increased to 25% from 0 at baseline. The intensity of low-back and lower limb pain also increased over time. A thirty-minute interval was identified as the threshold for the development and increase in low-back and feet pain. Modifiable factors were associated with low-back pain intensity—lower hip abductor muscle endurance and poorer physical health, and with feet symptoms—greater body mass index and less core stability.

BackgroundLow back pain (LBP) causes more disability than any other condition worldwide. Significant proportion of severe chronic low back pain (LBP) may be attributed to osteoarthritis (OA) and degenerative changes...

Objective To investigate the clinical efficacy of the 3-in-1 technique of Disc-FX system,namely:discectomy,radiofrequency ablation and annuloplasty for discogenic low back pain in the early stage.Methods From February 2010 to February 2011,40 patients with the discogenic low back pain underwent discectomy,radiofrequency ablation and annuloplasty using Disc-FX system were retrospectively analyzed,including 22 males and 18 females with an average age of 38.7 years (range,32-58 years).The visual analogue scale (VAS) scoring was applied to evaluate the back and low limb pain at preoperative,postoperative 1week,3 months,6 months,and last follow-up.The Macnab score was also evaluated at last follow-up.Results All the patients were followed up for average 13.8 months (range,6-18 months).The operative time averaged 26 min (range,20-40 min).No surgical complication was found during the follow-up.The VAS of preoperative low back pain was 6.60±1.47,VAS score of low back pain at postoperative 1 week,3 months,6 months,and final follow-up were 1.05±0.68,1.15±0.70,1.00±0.62,0.95±0.63,respectively.The postoperative VAS of low back pain decreased significantly compared with that preoperative.The VAS of preoperative limb pain was 3.05±1.23,VAS score of limb pain at postoperative 1 week,3 months,6 months,and final follow-up after operation were 1.10±0.74,1.15±0.70,1.10±0.72,0.95±0.54,respectively.The postoperative VAS of limb pain decreased significantly compared with that preoperative.The evaluation of Macnab score were excellent in 20 patients,good in 17,fair in 2,and poor in 1,suggesting an effective rate of 92.5％ (37/40).Conclusion Disc-FX system,which combined three surgical technique in one procedure,provides a new choice for orthopedics to treat discogenic low back pain.It can give satisfactory clinical outcomes during a short-term followup,but the long term clinical outcomes remains unknown. Key words: Low back pain; Diskectomy, percutaneous; Catheter ablation

Pregnancy and low back pain: physical therapy can reduce back and pelvic pain during and after pregnancy.

AIM: To analyze the prevalence of low backache among practicing dentists of Eastern Region of Nepal. METHODS: A descriptive cross-sectional, questionnaire based study was conducted among the practicing dentists of Eastern region of Nepal from April 2012 July 2012. A pre-tested, pre-calibrated self-administered verbal rating questionnaire "The Oswestry Low Back Pain Disability Questionnaire" was distributed to a random sample of 85 dentists from different parts of eastern region of Nepal through direct contact and e-mails. RESULTS: A total of 85 dentists were identified among which 76 dentists participated in the research. Research finding showed that the prevalence of back pain among practicing dentists in Eastern region of Nepal was 90.79% among which 50% (minimal), 36.84% (moderate) and3.95% (severe). Among 45 males 4.44% had no back pain, 53.33% had minimal, 37.77% had moderate and 4.44% had severe back pain. On contrary females (31 participants) showed lesser prevalence of low back pain with 16.12% no back pain, 45.16% minimal, 35.48% moderate and3.22% severe back pain. The participants were divided into 3 different age group intervals in which dentists between 25-30 years were 50 in which 8% had no back pain, 58% had minimal, 28% moderate and 6% had severe back pain. Between 31-35 years were 22 participants in which 50% had minimal, 50% moderate and 0% had severe low back pain. More than 35 years were 4 participants in which 75% had no back pain, 25 % had moderate. Similarly the participants were divided into 5 different groups according the years of clinical practice in dentists having 1- 2 years of clinical practice (37 participants) had 2.70% no back pain, 56.75% minimal, 35.13% moderate and 5.40% severe back pain. 16 participants had 3-4 years of clinical practice out of which 12.50% had no low back pain, 62.50% had minimal, 18.75% had moderate and 6.25% had severe back pain. 10 participants had 5-6 years of clinical practice out of which 10% had no low back pain, 50% had minimal and 40% had moderate. 9 participants had 7-8 years of clinical practice out of which 11.11% had no low back pain, 33.33% had minimal and 55.55% had moderate. 5 participants had &gt;9 years of clinical practice out of which 75% had no low back pain, 25% had minimal and 25% had moderate. CONCLUSION: The prevalence of back pain among dental personnel in Eastern region of Nepal was relatively high. The significant risk factors associated with it might be poor posture. Innovations for preventive and, ergonomic strategies should be undertaken to reduce the low back pain. DOI: http://dx.doi.org/10.3126/jucms.v1i4.9570 Journal of Universal College of Medical Sciences (2013) Vol.1 No.04: 29-32

BackgroundBacteria can influence a variety of gut functions. Some studies showed that stool consistency and constipation were associated with gut microbiome (GM) composition, and enterotype, dysbiosis. Growing evidence indicates the significant role of GM in the homeostatic function of the host body. The GM may regulate multiple neurochemical and neurometabolic pathways. Chronicity of the pain is actively modulated at the molecular to the network level by means of several neurotransmitters. The GM to some extent can affect pain perception.ObjectivesThe current study aimed at investigating the relationship between constipation state or usual stool form and pain severity of patients with chronic pain.MethodsThe current study was conducted on 365 patients with chronic pain. The participants were evaluated on their stool form (the Bristol stool form scale; BSFS), constipation state (the Cleveland clinic constipation score; CCCS), body mass index (BMI), and usual pain severity (numerical rating scale; NRS). In addition, the participants were assigned into five groups according to the pain region (i e, low back and/or lower limb, whole body, neck and/or upper back and/or upper limb, head and/or face, chest and/or abdominal).ResultsThe CCS showed a significant and positive association with the pain severity of the total patients and patients with low back and/or lower limb pain. Simultaneous multiple linear regression analyses revealed that a predictor of the pain severity was the CCS for the total patients and patients with low back and/or lower limb, whole body pain.ConclusionsConstipation displayed a significant and positive association with the pain severity of the total patients and patients with low back and/or lower limb pain, whole body.

Subcutaneous Stimulation as an Additional Therapy to Spinal Cord Stimulation for the Treatment of Lower Limb Pain and/or Back Pain: A Feasibility Study