Retrospective cohort study. To evaluate the safety and efficacy of polymethyl methacrylate bone cement combined with calcium phosphate bone cement in percutaneous vertebroplasty for postmenopausal women, compared with polymethyl methacrylate bone cement alone. We analyzed the clinical data of 114 postmenopausal female patients who underwent single-level thoracolumbar PVP surgery at the Orthopedics Department of Baiyun Hospital, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, from January 2023 to June 2024.A total of 55 patients were included in the conventional group and 59 patients were assigned to the combined group, based on the type of filler used during the procedure.Comparative assessments included general demographic characteristics, low back pain Visual Analog Scale (VAS) scores, Oswestry Disability Index (ODI) scores, perioperative parameters (e.g., operative duration, intraoperative blood loss, time to ambulation), imaging findings, postoperative complications, and adverse events. All patients successfully underwent the procedure and were followed up for at least one year. No significant differences were observed in baseline data between the two groups.At postoperative follow-up, both groups showed significantly lower low-back pain Visual Analog Scale (VAS) scores and Oswestry Disability Index (ODI) scores compared with preoperative values (P < 0.05). At 1day and 1 month after surgery, the combined group had significantly lower VAS and ODI scores than the conventional group (P < 0.05). However, by 1 year postoperatively, there were no significant differences in VAS or ODI scores between the two groups (P > 0.05).Compared with preoperative measurements, both groups exhibited significant improvement in lumbar lordosis angle, sagittal Cobb angle, thoracic kyphosis angle, thoracolumbar kyphosis angle, coronal Cobb angle, and vertebral body height at postoperative follow-up (P < 0.05).Furthermore, compared with the conventional group, the combined group demonstrated a lower incidence of cement leakage and adjacent vertebral refracture after PVP, as well as less residual postoperative back pain. In percutaneous vertebroplasty (PVP) for thoracolumbar vertebral compression fractures in postmenopausal women, the application of methyl methacrylate (PMMA) combined with calcium phosphate cement (CPC) is safe and effective. It significantly alleviates pain, improves surgical outcomes, and enhances patient satisfaction. The efficacy and safety of this combined approach are comparable to PMMA cement alone, with advantages in reducing back pain, improving quality of life, lowering the risk of cement leakage, and decreasing the incidence of adjacent vertebral fractures.

Non-secretory multiple myeloma (NSMM) is a rare variant of multiple myeloma with an incidence rate of 1.0% to 5.0% in all MM cases. It is characterized by symptomatic myeloma in the absence of detectable monoclonal immunoglobulin levels on serum or urine electrophoresis. It often poses a diagnostic dilemma due to its need for more evident features. We report such a non-secretory plasma cell myeloma that manifested as nonspecific back pain and a lytic lesion in the lumbar spine MRI. Confirming an accurate diagnosis early was difficult since no monoclonal immunoglobulin was detected on serum or urine electrophoresis. However, based on the bone marrow study, he was eventually diagnosed as having non-secretory multiple myeloma. He is currently being treated with chemotherapy and has already shown improvement. This case report emphasizes the need for early bone marrow studies and light chain assays in diagnosing non-secretory forms of multiple myeloma if the presentation is indicative. This will help to avoid diagnostic delays, which can finally lead to favorable outcomes if properly addressed.

Translation, cross-cultural adaptation, and measurement properties of the Back pain knowledge and beliefs survey (BacKS) for the Brazilian population.

Back pain, which has ahigh prevalence, is associated with substantial individual and socioeconomic burden. Mechanical irritation and local inflammation promote edema, neovascularization, and pain chronification. This article aims to provide an overview of the possible indications for and the performance of periradicular therapy (PRT), epidural injection therapy, facet joint infiltration, and facet denervation. This clinical narrative review presents workflows of the different techniques, the medications used, and potential complications. This paper does not constitute asystematic scientific review. Interventional pain therapies are useful after unsuccessful conservative treatment and in the presence of an appropriate clinical-imaging correlation. PRT is used for radicular symptoms. Epidural injection therapy, in contrast, is suitable for bilateral and multisegmental complaints. Facet joint infiltrations are used therapeutically for pain management and may also be employed diagnostically prior to denervation procedures.

Sleep chronotype and its association with coexisting pain outcomes: a systematic review and meta-analysis.

Although patients with THA may increase their use of hip flexion to compensate for loss of spinal motion after lumbar fusion, no studies have directly examined this relationship. Furthermore, the association between the number of fused levels on postoperative compensatory hip motion is not clear, making it difficult to anticipate these changes prior to lumbar fusion. (1) Is lumbar fusion after THA associated with resting spinopelvic alignment or compensatory changes at the hip? (2) Is the number of fused spinal segments associated with an increase in hip compensatory motion? (3) Can this increase in hip compensatory motion be anticipated prior to lumbar spine fusion? Between January 2017 and December 2023, we retrospectively identified 109 patients with lumbar fusion after THA. The minimum follow-up time after lumbar fusion was set at 6 months to account for implant stabilization and early dislocation events. Of these patients, 59% (64) were excluded because of incomplete questionnaires (17% [19 of 109]), neuromuscular disease (3% [3 of 109]), unavailable or obscured functional lateral radiographs before and/or after lumbar fusion (36% [39 of 109]), or lumbar fusion performed within 6 months after THA (3% [3 of 109]), leaving 41% (45 of 109) of patients for analysis. Among the included patients, 82% (37 of 45) were female, with a mean ± SD age of 74 ± 8 years. Functional lateral radiographs were obtained in three postures (free-standing, relaxed-seated, and flexed-seated) before and after lumbar fusion surgery. From these radiographs, spinopelvic alignment parameters were measured, including pelvic incidence, L1-S1 lumbar lordosis, sacral slope, pelvic tilt, pelvic-femoral angle (PFA), and pelvic incidence minus lumbar lordosis (PI-LL). The hip angle was defined as the PFA value calibrated for pelvic incidence. Lumbar, pelvic, and hip motion were assessed based on the degree of change between each posture. Multivariable regression analysis was performed to examine the association between the number of fused levels and the change in PFA in the flexed-seated position before and after lumbar fusion. After lumbar fusion, mean ± SD Oswestry Disability Index (ODI) total scores were lower (44% ± 18% versus 22% ± 16%, mean difference -21% [95% confidence interval (CI) -29% to -14%]; p < 0.001). Median (range) ODI item Q1 (back pain) scores were also lower (3 [0 to 5] versus 1 [0 to 3], median difference -2 points [95% CI -3 to -2]; p < 0.001). In the standing position, L1-S1 lumbar lordosis was larger (29° ± 22° versus 34° ± 14°, mean difference 6° [95% CI 1° to 10°]; p = 0.01) and PI-LL was smaller (19° [-13° to 76°] versus 11° [-12° to 76°], median difference -4° [95% CI -9° to 0°]; p = 0.02), while other standing parameters were no different. In the flexed-seated position, L1-S1 lumbar lordosis, PFA, and hip angle were larger after lumbar fusion (L1-S1 lumbar lordosis: -8° ± 14° versus 8° ± 14°, mean difference 16° [95% CI 11° to 22°]; p < 0.001; PFA: 83° ± 17° versus 97° ± 16°, mean difference 14° [95% CI 10° to 17°]; p < 0.001; hip angle: 93° [51° to 127°] versus 106° [87° to 132°], mean difference 13° [95% CI 10° to 16°]; p < 0.001), indicating greater compensatory hip flexion. The number of fused levels was associated with the magnitude of increase in PFA in the flexed-seated position after lumbar fusion (standardized β = 0.39 [95% CI 0.15 to 0.62]; p = 0.002) after accounting for age, BMI, and preoperative hip angle in the flexed-seated position. Using the multivariable model, the anticipated magnitude of postoperative increase in PFA in the flexed-seated position could be described based on the number of fused levels and the preoperative hip angle in the flexed-seated position (R 2 = 0.43; p < 0.001). The following regression equation was described to anticipate the increase in compensatory motion after lumbar fusion: ΔPFA flexed-seated = (-0.39 × preoperative flexed-seated hip angle) + (2.44 × number of fused levels) + 44.7. Our findings suggest that obtaining flexed-seated radiographs preoperatively in patients with prior THA who are scheduled to undergo lumbar fusion may be helpful. This information may assist spine surgeons in communicating the potential risk of postoperative dislocation with patients and hip surgeons and support shared decision-making before lumbar fusion. Future studies using three-dimensional imaging or motion-capture techniques will be necessary to determine how loss of lumbar motion is associated with multiplanar hip motion and dislocation risk during functional activities, particularly when considering acetabular and femoral component placement. Level III, therapeutic study.

Development of a Biphasic Modified-Release Ibuprofen Tablet Formulation: Single-Dose and Multiple-Dose Pharmacokinetics and Food-Effect Studies.

Evidence for a shift towards a proinflammatory/pronociceptive signature of gut dysbiosis in patients with axial chronic low back pain: A preliminary cross-sectional analysis.

High-definition transcranial direct current stimulation enhances exercise-induced hypoalgesia in patients with chronic low back pain

The primary objective of this study was to determine whether baseline conditioned pain modulation (CPM) is associated with pain and disability outcomes following a 6-week course of physical therapy intervention. Secondary objectives included investigating whether baseline temporal summation scores are associated with pain and disability outcomes and whether changes in CPM and temporal summation are correlated with clinical improvement. In this prospective cohort study, 34 individuals with cLBP completed baseline CPM and temporal summation testing, followed by a 6-week course of individualized physical therapy. Pain (Numeric Pain Rating Scale [NPRS]) and disability (Oswestry Disability Index [ODI]) were assessed at baseline and discharge. Post-intervention CPM and temporal summation were reassessed. Baseline-adjusted linear regression was used to analyze associations between baseline CPM and temporal summation and final NPRS and ODI scores. Pearson correlation coefficients were used to assess associations between changes in CPM and temporal summation and clinical outcome scores. Baseline CPM was not significantly associated with final ODI (β = 0.020, p = 0.273) or NPRS (β = 0.002, p = 0.561). Higher baseline temporal summation values were significantly associated with higher final NPRS (β = 0.036, p = 0.026). A moderate, statistically significant correlation was observed between CPM change scores and NPRS change scores (r = 0.375, p = 0.038). CPM demonstrated limited prognostic value in this cLBP cohort. Although baseline temporal summation was associated with final pain outcomes, the magnitude was small and limits clinical utility. This study examined whether baseline conditioned pain modulation (CPM) and temporal summation were associated with clinical outcomes after physical therapy in individuals with chronic low back pain (cLBP). Baseline CPM was not associated with pain or disability, while higher baseline temporal summation was associated with greater pain intensity at discharge, although the magnitude of this association was small. These findings suggest limited clinical utility of dynamic quantitative sensory testing (QST) as standalone prognostic tools for cLBP in physical therapy settings.

Intervertebral disc degeneration (IDD) is a common cause of low back pain that causes significant debilitation. The intricate mechanisms governing intervertebral disc homeostasis are substantially impacted by cellular senescence, which plays crucial roles in both pathological and physiological contexts. In this review, we provide a comprehensive overview of cellular senescence in the pathogenesis of IDD. Specifically, we summarize the merits and limitations of the methodologies utilized in prior investigations to determine cellular senescence and the potential regulatory mechanisms underlying it in the progression of IDD. Furthermore, we describe therapeutic strategies that aim to inhibit cellular senescence, which may alleviate the pathogenesis of IDD. At last, we discuss the challenges and prospects of translational research on targeting cellular senescence in IDD treatment.

Chronic low back pain (cLBP) is associated with fear-related behavioral adaptations and changes in brain function, but the spatial location and frequency of resting neural oscillations that underlie cLBP are not well-understood. In this study we used 128-channel resting-state electroencephalography in older adults with cLBP and high fear, cLBP and low fear, and healthy controls to close this critical gap. Source-space analyses and the Fitting Oscillations and One Over F algorithm were implemented to decompose resting electroencephalography spectra into periodic and aperiodic components. We offer 2 novel contributions to the literature. First, periodic alpha power was lower in the high fear group in temporal and occipital regions compared with the control group and the low fear group. Second, a progressive decrease in periodic beta power was evident across groups in temporal, parietal, and occipital regions, with the lowest power in the high fear group and greatest in the control group. Aperiodic components were not different between groups. Our findings suggest that the neurophysiological signature of cLBP is distinct from that observed in other chronic pain conditions and from a pattern of accelerated aging. Indeed, too little or too much beta power at rest may equally represent suboptimal neural function. Our findings advance our understanding of the neural oscillations that underlie cLBP, but also further highlight the complexity of identifying a single and generalizable neural signature of chronic pain.

Painful intervertebral disc degeneration is a leading cause of chronic low back pain. Proteolytic cleavage fragments of extracellular matrix components, particularly aggrecan and small leucine-rich proteoglycans (SLRPs), may act as endogenous danger signals activating inflammatory pathways. To determine whether proteolytic fragments of aggrecan and SLRPs correlate with disc degeneration severity and Toll-like receptor-2 (TLR-2) mediated inflammation. Human disc tissues were analysed from 20 non-degenerated cadaveric controls (Thompson Grades 1-2) and 35 patients with painful degeneration (Pfirrmann Grades 3-5). Western blotting assessed fragmentation of aggrecan and SLRPs (decorin, biglycan, lumican, fibromodulin, chondroadherin). Immunofluorescence localized these molecules in disc sections. Disc cells were cultured under four conditions: unstimulated controls, TLR-2 agonist Pam2CSK4-stimulated controls, cells extracted from degenerated discs, and those treated with the TLR-2 antagonist MMG-11. Cytokine profiles were determined using antibody array. Fragmented peptides of aggrecan and SLRPs (22-45 kDa) were predominantly detected in Pfirrmann Grades 4 and 5 discs. TLR-2 expression was significantly higher in degenerated disc cells versus controls (P < 0.001), further upregulated by Pam2CSK4 and attenuated by MMG-11. Cytokine analysis revealed marked pro-inflammatory shifts in patient discs (interleukin [IL]-6 ↑1.37×, IL-8 ↑1.30×, IL-1β ↑1.25×), while control discs exhibited an anabolic profile with elevated expressions of growth factors (TGF-β, EGF, VEGF). Aggrecan and SLRP fragments were observed alongside TLR-2 mediated inflammatory responses in advanced disc degeneration, suggesting a potential association with tissue catabolism. Targeting TLR-2 signaling may warrant further investigations as a potential therapeutic strategy for painful disc disease.

KLF2-Mediated Modulation of oxidative stress and pyroptosis by Vanillic acid in intervertebral disc degeneration.

Recent technological advances offer new perspectives for the assessment and management of low back pain (LBP). Due to the multidimensional nature of pain, assessment methods must continuously evolve. Although some studies have analyzed the impact of LBP on gait under real-world conditions, their clinical applicability remains limited by methodological constraints. Technology-based interventions with different levels of immersion (TBILI) are therefore being explored as an alternative, since locomotor behaviors appear to be largely preserved in simulated environments. The objective of this scoping review is to identify the potential contribution of TBILI to the assessment of LBP. In accordance with JBI recommendations and PRISMA-ScR guidelines, studies meeting the PCC criteria were selected. These included a population with low back pain, a concept using TBILI assessment, and a context focusing on the mechanisms of action of TBILI. Thirty-nine studies (2547 patients; mean age: 46.8 ± 10.4 years) were analyzed. Pain intensity (n = 31) and physical function (n = 28) were the most reported assessment outcomes. Feedback (n = 18) and motivation (n = 16) were the most identified mechanisms among a broad range of TBILI action mechanisms. Immersive technology seems used for bodily awareness or biopsychosocial approach while non-immersive technology seems used for motivation and sensory modulation. However, methodological heterogeneity and a lack of standardization limit the clinical applicability of TBILI. TBILI demonstrate strong potential for the assessment and management of LBP. Standardization of protocols and better integration of biopsychosocial dimensions are required to fully realize this potential.

Pain and trauma, beyond comorbidity: how trauma reshapes cognitive-threat circuits in chronic low back pain.

Factors associated with chronic low back pain and central sensitization in office workers: a multidimensional analysis.

Differences in three-dimensional spinal kinematics between individuals with chronic non-specific low back pain and age- and sex-matched asymptomatic controls.

Nonspecific low back pain is extremely common, with clinical symptoms mainly characterized by pain and functional impairment. Moreover, pain can further induce anxiety, depression, and sleep disorders. Although there are many existing rehabilitation methods, their therapeutic effects are limited and the recurrence rate is high. Therefore, we plan to conduct a clinical efficacy evaluation of extracorporeal radial shock wave therapy combined with repetitive transcranial magnetic stimulation for nonspecific low back pain and also explore the potential therapeutic mechanisms. This study employed a randomized, double-blind, parallel-controlled trial design (allocation ratio: 1:1:1:1). A total of 160 patients were enrolled and randomly assigned to four groups (n=40 per group): Extracorporeal Shock Wave Therapy group (Active ESWT+Sham rTMS), Repetitive Transcranial Magnetic Stimulation group (Sham ESWT+Active rTMS), Combined Treatment group (Active ESWT+Active rTMS), Placebo group (Sham ESWT+Sham rTMS). Outcome assessments were performed at baseline and after 4weeks of intervention, including the Visual Analog Scale (VAS), Short-Form McGill Pain Questionnaire (SF-MPQ), lumbar Range of Motion (ROM), Pittsburgh Sleep Quality Index (PSQI), Hamilton Anxiety Scale (HAMA), Zung Self-Rating Depression Scale (SDS Index), multimodal magnetic resonance imaging (MRI), and inflammatory factors. All participants were followed up for 3months. The primary outcome measure was the VAS score. Data were collected after treatment and subjected to statistical analysis. This study will verify the clinical intervention efficacy of ESWT combined with rTMS for nonspecific low back pain and explore the potential therapeutic mechanisms.

Bharatanatyam, a venerable and highly structured classical dance form from India, requires significant physical strength, postural control, and precise movements. Dancers often begin to training during adolescence, a crucial period of musculoskeletal development. A key posture in Bharatanatyam, the Araimandi (half-sitting position), involves sustained hip and knee flexion with external rotation, which imposes considerable stress on the lumbopelvic complex. Repeatedly practicing this position may lead to compensatory changes, such as increased lumbar lordosis and anterior pelvic tilt, which potentially predispose the dancers to low back pain (LBP). This study aims to examine the relationship between sitting posture and the severity of low back pain in female Bharatanatyam dancers. A total of 100 female Bharatanatyam dancers aged 16-35years were selected through convenience sampling to evaluate their sitting posture using GaitON Software. Low back pain intensity and functional disability were measured using the Visual Analog Scale and the Roland-Morris Disability Questionnaire. Statistical analysis was conducted using R-Studio. Age and BMI showed a moderate positive correlation (r=0.53). Hip-knee alignment was negatively correlated with trunk-thigh angle (r=-0.66) and knee angle (r=-0.59). A weak positive correlation was found between knee angle and trunk-thigh angle (r=0.38). The Roland-Morris Disability Score showed no significant relationship with biomechanical or demographic characteristics. The results indicated no significant correlation between low back pain and sitting postural parameters. Despite the physical demands and sustained postures involved in Bharatanatyam practice, this study found no significant link between sitting postural parameters and low back pain. This suggests that discomfort in dancers may be more influenced by dynamic performance factors, repetitive loading, and training intensity than by static sitting posture alone. The results highlight the intricate characteristics of low back pain in dancers and the necessity of focusing on movement patterns and muscular endurance in effective rehabilitation approaches.