Back Pain Research Articles

Enhanced Recovery After Surgery Protocols in One- or Two-Level Posterior Lumbar Fusion: Improving Postoperative Outcomes.

Background/Objectives: Enhanced recovery after surgery (ERAS) protocols optimize perioperative care and improve recovery. This study evaluated the effectiveness of ERAS in one- or two-level posterior lumbar fusion surgeries, focusing on perioperative medication use, pain management, and functional outcomes. Methods: Eighty-eight patients undergoing lumbar fusion surgery between March 2021 and February 2022 were allocated into pre-ERAS (n = 41) and post-ERAS (n = 47) groups. Outcomes included opioid and antiemetic consumption, pain scores (numerical rating scale (NRS)), functional recovery (Oswestry Disability Index (ODI) and EuroQol 5 Dimension (EQ-5D)), and complication rates. Pain was assessed daily for the first four postoperative days and at 6 months. Linear Mixed Effects Model analysis evaluated pain trajectories. Results: The post-ERAS group showed significantly lower opioid (p = 0.005) and antiemetic (p < 0.001) use. No significant differences were observed in NRS pain scores in the first 4 postoperative days. At 6 months, the post-ERAS group reported significantly lower leg pain (p = 0.002). The time:group interaction was not significant for back (p = 0.848) or leg (p = 0.503) pain. Functional outcomes at 6 months, particularly ODI and EQ-5D scores, showed significant improvement in the post-ERAS group. Complication rates were lower in the post-ERAS group (4.3% vs. 19.5%, p = 0.024), while hospital stay and fusion rates remained similar. Conclusions: The ERAS protocol significantly reduced opioid and antiemetic use, improved long-term pain management and functional recovery, and lowered complication rates in lumbar fusion patients. These findings support the implementation of ERAS protocols in spinal surgery, emphasizing their role in enhancing postoperative care.

Pain Management Methods and Techniques in Lumbar Disc Surgery: A Narrative Review Study

Background and Aim: This study examines the complex field of pain treatment related to lumbar disc disorders in a narrative review. Methods and Materials/Patients: Our search strategy involved utilizing specific terms, including ‘pain management,’ ‘lumbar disc surgery,’ ‘methods,’ and ‘techniques.’ We formulated a search query using Boolean operators: (‘Pain management’ OR ‘analgesia’) AND (‘lumbar disc surgery’ OR ‘spinal surgery’) AND (‘techniques’ OR ‘procedures’ OR ‘approaches’ OR ‘methods’) AND ‘narrative review.’ A systematic search was conducted across reputable medical databases including PubMed, MEDLINE, and Cochrane Library. Filters were applied to refine search results based on publication type and date, with a focus on material published within the past two decades to ensure the inclusion of current, high-quality literature. Results: This study synthesized information from several sources, demonstrating the changing methods used to address pain in lumbar disc disorders. The article explored the historical background of medical treatments, emphasized both contemporary surgical and non-surgical methods, and investigated the predicted factors that affect the results. The study investigated the range of surgical incidents and examined the clinical factors to be taken into account for treatments. The value of efficient pain treatment in alleviating chronic back pain and maximizing patient results was emphasized. Conclusion: In conclusion, this review underscores the paramount importance of comprehensive management of lumbar disc pain. It stresses that effective pain control not only alleviates immediate suffering but also plays a pivotal role in ensuring positive surgical experiences, enhancing patient outcomes, and promoting long-term well-being.

The association between perceived sensitivity to medicines, reported side effects and personal characteristics: A secondary analysis of an RCT.

A patient's perceived sensitivity to medicines (PSM) might influence the reported side effects of a treatment. The experience of side effects can result in personal and structural costs (such as nonadherence). Research on nocebo mechanisms and the workings of side effect reporting has been disproportionally smaller compared to the emerging evidence of the individual and clinical impact of the matter. In this study, we explored and re-examined the association between PSM and reported side effects within a specific population (chronic low back pain patients receiving acupuncture treatment), including possible mediating variables (i.e., gender, medical and nonmedical care utilization, optimism, pessimism, anxiety, depression and treatment expectation). We conducted a secondary analysis of a randomized controlled trial that examined the influence of treatment outcome expectations in chronic low back pain (CLBP) patients. All measures in the analysis were self-assessments. We explored the association between PSM, reported side effects and personal characteristics using correlational and regression analyses. Our sample consisted of 152 CLBP patients (65.8% female), the mean age was 39.5 years (SD = 12.5). We found positive correlations between PSM and reported side effects (r = 0.24; p < 0.01) and between PSM and anxiety (r = 0.21; p < 0.05). However, the subsequent regression analyses did not confirm a mediating or moderating effect of anxiety between PSM and reported side effects. We confirmed and extended earlier research on PSM. Our study involved a specific pain population receiving a nonpharmacological intervention. Our results highlight the importance of targeting PSM and anxiety within a treatment to take measures to mitigate the prevalence of side effects.

PRDM1 promotes nucleus pulposus cell pyroptosis leading to intervertebral disc degeneration via activating CASP1 transcription.

Intervertebral disc degeneration (IVDD) is a primary contributor to low back pain and poses a considerable burden to society. However, the molecular mechanisms underlying IVDD remain to be elucidated. PR/SET domain 1 (PRDM1) regulates cell proliferation, apoptosis, and inflammatory responses in various diseases. Despite these regulatory functions, the mechanism of action of PRDM1 in IVDD remains unexplored. In this study, we investigated the role and underlying mechanisms of action of PRDM1 in IVDD progression. The expression of PRDM1 in nucleus pulposus (NP) tissues and NP cells (NPCs) was assessed using western blotting, immunohistochemistry, and immunofluorescence. The effects of PRDM1 on IVDD progression were investigated in vitro and in vivo. Mechanistically, mRNA sequencing, chromatin immunoprecipitation, and dual-luciferase reporter assays were performed to confirm that PRDM1 triggered CASP1 transcription. Our study demonstrated for the first time that PRDM1 expression was substantially upregulated in degenerated NP tissues and NPCs. PRDM1 overexpression promoted NPCs pyroptosis by inhibiting mitophagy and exacerbating IVDD progression, whereas PRDM1 silencing exerted the opposite effect. Furthermore, PRDM1 activated CASP1 transcription, thereby promoting NPCs pyroptosis in vitro. Notably, CASP1 silencing reversed the effects of PRDM1 on the NPCs. To the best of our knowledge, this study is the first to demonstrate that PRDM1 silencing inhibits NPCs pyroptosis by repressing CASP1 transcription, which may be a promising new therapeutic target for IVDD.

Lumbar Sitting Behavior of Individuals with Low Back Pain: A Preliminary Study Using Extended Real-World Data

Low back pain affects 619 million people worldwide and is commonly provoked by sitting. Current assessment methods constrain task variability, removing real-world, task-switching behaviors. This study utilized accelerometers to provide an original validated method of in vivo real-world assessment of lumbar sitting behavior throughout a full day. A three-stage study design was used, which involved (1) blinded verification of our sitting detection algorithm, (2) full-day data collection from participants with low back discomfort, quantifying lumbar angles, and end-user acceptability explored, (3) case study application to two clinical low back pain (LBP) patients, incorporating measurement of provocative sitting. Focus group discussions demonstrated that data collection methods were acceptable. Sitting ‘windows’ were created and analyzed using novel histograms, amplitude probability distribution functions, and variability, demonstrating that sitting behavior was unique and varied across individuals. One LBP patient demonstrated two frequent lumbar postures (&lt;15% flexion and ~75% flexion), with pain provocation at 62% lumbar flexion. The second patient demonstrated a single dominant posture (~90% flexion), with pain provoked at 86% lumbar flexion. Our in vivo approach offers an acceptable method to gain new insights into provocative sitting behavior in individuals with LBP, allowing individualized unconstrained data for full-day postures and pain provocation behaviors to be quantified, which are otherwise unattainable.

Allogenic bone marrow–derived mesenchymal stromal cell–based therapy for patients with chronic low back pain: a prospective, multicentre, randomised placebo controlled trial (RESPINE study)

ObjectivesTo assess the efficacy of a single intradiscal injection of allogeneic bone marrow mesenchymal stromal cells (BM-MSCs) versus a sham placebo in patients with chronic low back pain (LBP).MethodsParticipants were...

Infected Primary Bone Mantle Cell Lymphoma with Multiple Vertebral Involvement

Primary vertebral lymphoma is an exceedingly rare entity. We hereby report a case of a 67-year-old male who presented to our department with fever, weight loss, and progressively worsening lower back pain radiating to the right hip. Physical examination showed pain on percussion of the dorsal and lumbar spine and tenderness on palpation of the right upper thigh area. The radiographic findings revealed numerous vertebral lesions with a right psoas abscess extending to the right upper thigh. Intravenous antibiotic therapy was initiated and the patient underwent an incision and drainage of the psoas abscess with a favourable outcome. However, given the suspicious imaging findings of the osseous lesions suggestive of malignancy, a vertebral biopsy was performed and yielded histo-pathological findings consistent with bone mantle cell lymphoma. To the best of our knowledge, this is the first case of an infected primary bone mantle cell lymphoma with multiple vertebral involvement. The diagnosis is challenging and can be confused with other diseases.

LIBERAÇÃO MIOFASCIAL COMO RECURSO NO TRATAMENTO DAS ALGIAS NA COLUNA VERTEBRAL - UMA REVISÃO DE LITERATURA

Myofascial release is a manual technique widely used in the treatment of musculoskeletal pain, including sciatica, back pain and low back pain. This study aims to review the existing literature on the effectiveness of myofascial release in the management of spinal pain, highlighting its applications, benefits and limitations. Scientific articles were analyzed that discuss the use of the technique alone or in conjunction with other therapeutic approaches, such as stabilization exercises, dry needling and joint manipulation. The results indicate that myofascial release can significantly reduce pain and improve patients' mobility, although effectiveness varies depending on the protocol used and the patient's profile. The combination of the technique with other therapies proved to be particularly effective in cases of chronic pain. However, little data was found on its application in the treatment of back pain, suggesting the need for more research focused on this condition. Furthermore, the lack of standardization in application methods and the limitation in the number of studies reviewed are critical points that must be considered. It is concluded that myofascial release is a promising approach, but requires greater methodological rigor in future research to consolidate its use in the management of spinal pain.

Muscle relaxers in acute musculoskeletal back pain

Treatment of patients with back pain is a global public health problem. The diagnosis of acute non-specific (musculoskeletal) back pain (ANBP) is made based on anamnestic data, results of somatic, neurological and neuroorthopaedic examinations, and exclusion of specific causes of back pain and discogenic radiculopathy. For ANBP, pharmacological treatment includes non-steroidal anti-inflammatory drugs (NSAIDs) and muscle relaxers (MR). Most modern clinical guidelines recommend non-benzodiazepine MR as the treatment of choice for ANBP. The results of randomized clinical trials have shown the efficacy and good tolerability of tolperisone (Mydocalm) as monotherapy and in combination with NSAIDs for ANBP. Tolperisone (Mydocalm) has analgesic properties and its main advantage over other MR is that it has no sedative effect.

Key Factors Driving Physiotherapy Use in Patients with Nonspecific Low Back Pain: Retrospective Clinical Data Analysis

Background/objectives: Understanding the factors that influence physiotherapy (PT) service use among patients with nonspecific lower back pain (LBP) is necessary to optimize treatment strategies, healthcare resource allocation, and the planning of value-based initiatives. We report factors that influence the number of PT visits per episode of care (defined as a referral from a physician) for an LBP population in Saudi Arabia, and compare them with patients experiencing their first and recurrent episodes of LBP. Methods: LBP patients were retrospectively enrolled from a clinical dataset derived from an outpatient PT clinic in Saudi Arabia. The primary outcome variable was the number of PT visits performed per episode of care. Multiple linear regression analysis was performed to examine the relationships between the numbers of PT visits per episode of care and independent variables. Results: The number of PT sessions per week (β 0.34, p &lt; 0.001), compliance with PT sessions (β 0.31, p &lt; 0.001), and pre-pain scores (β 0.29, p &lt; 0.001) explained 41.8% (adjusted R2 0.32) of the variance in the total number of PT visits per episode of care (p &lt; 0.001). Conclusions: Factors that might improve value-based care for LBP patients are reported. The more PT sessions per week, compliance with these sessions, and higher baseline pain scores predict a higher number of PT visits per episode of care among these patients. While reported for a Saudi Arabian population, there is no reason to believe that these findings do not apply internationally.

A keep-it-simple embolisation approach to treat pelvic congestion syndrome without compromising clinical effectiveness.

There are two approaches to treating pelvic congestion syndrome (PCS): (i) the keep-it-simple (KIS) approach, which involves embolising only the refluxing vein(s), typically the left ovarian vein (LOV) unless the right ovarian vein (ROV) or left/right internal iliac vein (IIV) tributaries are also refluxing; and (ii) the extensive (EXT) approach, which empirically embolises almost all of the LOV, ROV, and left and right IIV tributaries. The aim of this study is to determine whether the KIS approach can effectively treat PCS while minimising the number of treated veins and coils used, without the need for injecting sclerosing agents into pelvic veins or the use of occlusion balloons. This is a single-institution retrospective cohort study. Our records identified 154 women who underwent venograms for possible PCS, with the intent to proceed with embolisation. Refluxing veins were treated using the KIS approach, deploying minimal number of coils, 'sandwiching' sclerosing foam. Short-term follow-up was conducted at 6 weeks; long-term follow-ups (between 12 and 60 months) were conducted via an electronic survey consisting of 19 questions assessing pelvic pain/pressure, leg and back pain, fatigue, and bladder and menstrual symptoms. Fifteen women had negative venogram; 139 women had one or more refluxing veins on venogram. Most women (73%) required unilateral ovarian vein (OV) embolisation, 14% required bilateral OV embolisation, and 12% underwent pelvic vein embolisation. Most cases required only four pushable coils. Clinical success was 89% at 6 weeks and 84% at 1-5 years. A visual analogue scale reduction of 5.2 points (from 7.8 to 2.7) was achieved. There were no instances of coil dislodgement or other complications. The keep-it-simple approach, embolising only the refluxing ovarian and/or iliac veins, can achieve a successful clinical outcome for pelvic congestion syndrome. The extensive approach of empirically embolising all ovarian veins and internal iliac veins may not be necessary. This carries implications for potential savings in procedure time, cost and radiation dose.

Management of patients with chronic low back pain in outpatient practice: a clinical observation

Back pain is one of the most common reasons for visits to the doctor and temporary disability. In non-specific chronic low back pain (CLBP) most effective approach is a complex (multidisciplinary) approach, aimed at relieving pain and improving the quality of life by using an educational program, kinesiotherapy, psychological methods and optimization of drug therapy. We present the observation of a 48-year-old patient with CLBP whose treatment was ineffective during one year. The patient was repeatedly prescribed medications, and the methods of magnetotherapy, massage, phonophoresis with hydrocortisone. Educational program, kinesiotherapy and psychological methods were not applied. The examination of the patient revealed emotional disorders, misconceptions about the disease and a pronounced functional impairment due to pain. The application of a complex therapy, which included an educational program, individual kinesiotherapy, psychological methods, Dexalgin as a non-steroidal anti-inflammatory drug, led to a significant reduction in pain after 7 days and a complete regression of symptoms after 2 months. The issues of efficacy and safety of the use of Dexalgin and the possibility of introducing the complex approach into the clinical practice of management of patients with chronic back pain are discussed.

Typical tactics of treatment of patients with chronic non-specific back pain and tension-type headaches

Non-specific (musculoskeletal) back pain (NBP) and tension-type headache (THA) are among the most common conditions in neurological practice that significantly impair patients' ability to work. The typical practice of treating patients with NBP and THA has not been sufficiently investigated, which formed the basis for conducting this study.Objective: to evaluate the quality of diagnosis and treatment of chronic NBP and THA in real-life neurological practice.Material and methods. The study included 120 patients with chronic NBP and combined THA of different frequency (32 men and 88 women, mean age 38.4±9.6 years) who were treated in A.Ya. Kozhevnikov Clinic of Neurologic Diseases (CND) of Sechenov University with complaints of back pain and headache and who had previously been examined and treated by neurologists and therapists in other medical institutions on an outpatient and/or inpatient basis. All patients underwent a clinical interview to establish a diagnosis and analyze previous treatment, a neurological and neuro-orthopedic examination and a psychometric examination to assess anxiety and depression symptoms.Results. Prior to contacting CND, only 10% of patients had a diagnosis of chronic NBS, only 7% had a diagnosis of THA and the remaining patients had other misdiagnoses. All patients had previously undergone additional examinations, mainly neuroimaging of the spine and brain, ultrasound examination of the neck vessels, even if there were no "red flags" – signs of danger in back pain and headache. None of the patients had previously had their emotional state assessed, while 75% of patients had symptoms of depression of varying severity and all patients suffered from anxiety of varying severity. Neuro-orthopaedic examination was performed in only 10% of patients. All patients received nonsteroidal antiinflammatory drugs for back pain, and most patients received vascular and nootropic medication for headaches. Of the non-pharmacological methods, massage and passive physiotherapy were most frequently prescribed. Only 9% of patients were recommended kinesiotherapy, and only 5% of patients performed it.Conclusion. In real-life medical practice, chronic NBP and THA are inadequately diagnosed, excessive and unjustified additional examinations are prescribed, unsatisfactory level of treatment, and patients with chronic NBP and THA are rarely prescribed kinesiotherapy.

Investigating the Impact of PUBG on Academic Performance and Mental Health among Pakistani Teenagers

The PUBG game holds widespread popularity among Pakistani teenagers; however, concerns have surfaced regarding its potential impact on academic achievement and mental health. Prolonged play may result in migraines, eye strain, and back pain, while violent games could potentially influence harsh speech patterns in young individuals. The decision to ban PUBG has attracted attention due to its perceived violent nature. This research aims to ascertain PUBG's detrimental effects on students' academic performance in Pakistan and seeks to find interventions for addressing PUBG addiction. A quantitative study in Pakistan, with a sample size of 100 responders, aims to assess the game's effects on students' emotions and behavior. Thematic analysis, utilizing an interview guide, will be the final analytical strategy employed in this study.

Comparative analysis of the frequency of comorbid diseases in axial psoriatic arthritis and other variants of axial spondyloarthritis. Data from a hospital cohort

Objective: to compare the frequency of comorbid diseases in axial psoriatic arthritis (axSpA) and in other variants (OV) of axial spondyloarthritis (axSpA).Material and methods. We studied 60 patients, 30 with axPsA (15 men and 15 women, mean age – 49.1±10.4 years, disease duration – 12.6±6.9 years) and 30 with OV axSpA (16 men and 14 women, mean age – 42.9±9.7 years, disease duration – 16.30±8.3 years). All patients underwent a standard rheumatological examination. The diagnosis of comorbid diseases was confirmed using ICD-10 codes. The Cumulative Illness Rating Scale (CIRS), Charlson comorbidity index (CCI) and the weighted version of Functional Comorbidity Index (w-FCI) were used to assess comorbidity.Results and discussion. Comparative analysis of the two groups revealed that axPsA patients were older than OV axSpA patients (p &lt;0.05). Occurrence of back pain before the age of 40 was observed in 60% of axPsA cases, compared to 86.7% in OV axSpA (p&lt;0.05). The limitation of spinal and hip mobility was less severe in axPSA than in OV axSpA. The median side flexion was 12.3 [10; 15] and 9.5 [8; 11] cm, the Schober test was 4.2 [3; 5] and 3.0 [2; 4] cm and intermalleolar distance was 95.9 [86; 102] and 83.0 [75; 100] cm, respectively (p&lt;0.05). Patients with axPsA were more likely to have peripheral arthritis compared to patients with OV axSpA: 27 (90%) and 11 (36.7%) cases, respectively (p&lt;0.05) and higher laboratory indices of activity: median ESR, 31.9 [10; 38] and 20.4 [5; 14] mm/h, and CRP, 20.5 [2.8; 20.7] and 13.6 [0.9; 12.0] mg/L, respectively (p&lt;0.05). In the axPsA and OV axSpA groups, circulatory system diseases were found in 50 and 50% of patients, metabolic disorders in 76.6 and 76.6%, and gastrointestinal diseases in 46.7 and 70 %. Obesity was more common in axPsA than in OV axSpA – in 40 and 16.7% of patients, respectively (p&lt;0.05).Conclusion. A high frequency of comorbidities, mainly cardiovascular and metabolic diseases, was found in both groups. These data should be considered in the choice of therapy and optimization of existing treatment algorithms.

Preemptive caudal anesthesia on back pain after lumbar discectomy: a randomized and controlled study

Preemptive caudal anesthesia on back pain after lumbar discectomy: a randomized and controlled study

A Local Heating Profile to Manage Lower Back Pain in an Automotive Seat: A Pilot Study.

Lower back pain (LBP) is one of the most prevalent health losses in adults worldwide. Historically, heat has been successfully used for treating pain and relieving tight muscles. Given the effective contact with the occupant's back and proximity to the heat source, coupled with increasing commute times, automotive seats offer an opportunity to intervene. Fifteen adults (nine female) who experienced acute, subacute, and chronic lower back pain were recruited to examine the effectiveness of heat delivered to the lower back in providing temporary pain relief. Participants sat in a car seat for 38 min on two days, which included a 5-min baseline followed by a 33-min intervention; control, or localized. For the control condition, participants sat for 33 min without any thermal devices on, while the localized condition heated and maintained the seat surface temperature of the lower seat back area to ~45 °C. Over the 33-min control condition, the back skin temperature increased by ~1-2 °C and did not impact the subjective LBP. Heating the lower back for 33 min to ~39 °C reduced the subjective LBP by 10%. We demonstrated that lower back pain can be alleviated from an automotive seat providing heat to the lower back within normal commute times in those with lower back pain.

Relationship of the Iliac Crest Height with Subsidence After Oblique Lateral Interbody Fusion at L4-5: A Quantitative and Categorical Analysis.

Background: This study aimed to evaluate the impact of iliac crest height on clinical and radiological outcomes following oblique lateral interbody fusion (OLIF) at the L4-5 level. Methods: Data of patients who underwent single-level OLIF at the L4-5 level for degenerative spinal stenosis were retrospectively analyzed. The patients were categorized into three groups based on their iliac crest height measured relative to the L4 and L5 pedicles. Categorical and quantitative analyses, including univariate and multivariate logistic regressions, were performed to identify subsidence predictors. Clinical outcomes, including visual analog scale scores for back and leg pain, were assessed over a minimum 2-year follow-up. Results: No significant differences in cage obliquity were observed across the iliac crest height groups (axial angles, p = 0.39; coronal angles, p = 0.79). However, subsidence was significantly more common in patients with higher iliac crest heights, particularly at crest level III, where the subsidence rate reached 43% (p = 0.01). Subsidence was predominantly associated with damage to the L5 endplate, which occurred in 83% of subsidence cases at crest level III. A cutoff value of 12 mm for iliac crest height, above which the risk of subsidence significantly increased, was identified (AUC = 0.688, p = 0.042). Conclusions: Iliac crest height is a critical factor for predicting subsidence following OLIF at the L4-5 level. Surgeons should consider alternative strategies and meticulous preoperative planning in patients with an iliac crest height ≥ 12 mm to reduce the risk of adverse outcomes. Further studies are needed to validate these findings and to explore their long-term implications.

Outcome of posterior short segment fixation with implanting pedicle screw at the fractured level for treatment of thoracolumbar fracture

IntroductionThoracolumbar fractures make up majority of the spinal fractures. Various techniques including long, short, mono and short segment screw fixation have been used to achieve stability. There are still few studies describing the results of short segment fixation with intermediate screw fixation in fractured vertebrae, despite the fact that all have adequate efficacy and stability. Materials and methods41 patients were studied and evaluated preoperatively, at discharge and at 2, 6, 12, 24 weeks and 1 year follow-up clinically using Greenough and Fraser Low Back Pain Score, the American Spinal Injury Association (ASIA) grading, four-point scale questionnaire for patient's satisfaction, sagittal index (SI) of injured vertebra and Cobb's angle. ResultsThe patient's mean age was 36.9 ± 11.7 years, majority (90.2 %) with lumbar (L1-L3) segment involvement. All the patients significantly improved neurologically immediately after surgery (p < 0.001) however the improvement was not significant at final follow up (p = 0.3) as compared to the preoperative ASIA grade (Kendall's tau-b test). Low back pain decreased significantly on subsequent follow-up as measured by Visual Analogue Scale (VAS) score (p < 0.001). The Low Back Pain Scale of Greenough and Fraser calculated at immediate post-operation and at 1 year follow up in comparison to pre-operation status showed a statistically significant improvement (p < 0.001). Sagittal index (SI) estimated at 6, 12, 24 weeks and 1 year follow-up in comparison to preoperative SI was higher and statistically significant (p < 0.001). Mean Cobb's angle significantly decreased during follow-up at 6, 12, 24 weeks and 1 year compared to preoperative angle (p < 0.001). Four Point Scale Questionnaire assessed at 1 year follow-up showed majority (82.9 %) were very satisfied with the outcome. ConclusionPosterior short segment with intermediate screw fixation in fractured vertebra is a feasible and stable treatment method for traumatic single thoracolumbar fracture with respect to the functional outcome, patient satisfaction and preservation of motion segment.

Intrathecal anti-PD-1 treatment in metastatic melanoma patients with leptomeningeal disease (LMD): real-world data and evidence.

Leptomeningeal disease (LMD) is a severe complication of melanoma with a very poor prognosis. Despite improved treatment strategies and prolonged survival, the incidence of LMD has increased over the past decade. This real-world study aims to evaluate the efficacy and safety of intrathecal anti-PD-1 treatment in melanoma patients with LMD. Melanoma patients with LMD diagnosed by magnetic resonance imaging (MRI) and/or cerebrospinal fluid (CSF) cytology were treated with intrathecal infusions of nivolumab 20mg once every 2 weeks (n = 5) or pembrolizumab 20mg once every 3 weeks (n = 3), alongside systemic therapy. Patients received a median of 5.5 treatment cycles (range 2-9). Efficacy and safety analyses were performed on all treated patients. From June 2022 to February 2023, eight patients were treated, including four with cutaneous melanoma, two with acral melanoma, and two with primary leptomeningeal melanoma. All patients exhibited linear or small nodular enhancement of the leptomeninges on MRI. Four patients had concurrent parenchymal brain metastases. Tumor cells were identified in six patients by CSF cytology, and two patients underwent leptomeningeal biopsy for pathological diagnosis. According to the RANO-LM criteria, five patients responded to treatment with symptom improvement and reduction or disappearance of linear enhancement on MRI, while three patients developed progressive disease. With a median follow-up of 20.7 weeks (range 8.1-45.3 weeks), the median OS and median intracranial progression-free survival (IPFS) for intrathecal anti-PD-1 treatment were 21.1 and 16.1 weeks, respectively. All treatment-related adverse events were grade 1-2, including headache (grade 1, n = 1; grade 2, n = 2) and low back pain (grade 1, n = 1). In this real-world study, intrathecal anti-PD-1 treatment demonstrated potential clinical benefits and was well tolerated in metastatic melanoma patients with LMD.