Cause Of Back Pain Research Articles

Is Sacralization Associated with occurrence of Back pain - A Cross Sectional Study.

Background: The sacralization of the lumbar vertebra could be one of the cause for back pain. Though the relationship between Lumbosacral Transitional Vertebrae and low back pain was described a century before several contrast findings were also noted in the literature. Hence this study was conducted to assess the impact of sacralization on low back pain. Methods: This retrospective cross-sectional investigation, which used lumbo-sacral X-rays taken at Sri Muthukumaran Medical College Hospital and Research Institute, was carried out in the orthopaedics department. The study contained 514 lumbrosacral X-rays in total. The Institutional Ethics Committee provided its ethical approval. Descriptive statistics, Chi square test was employed in SPSS version 19 to examine the relationship between sacralization and back discomfort. Results: Prevalence of sacralisation was 10.1% with predominant complete sacralisation. Strong association was noted between sacralisation and lower back pain however sacralisation was not associated with age, gender and BMI. Conclusion: As there is a association noted between sacralisation and back pain, early identification of LSTV could help in early lifestyle changes and routine exercise, which can help prevent additional issues including disc degeneration of the vertebrae above the LSTV.

Calcific Discitis Seems to be a Common Incidental Finding in Adults.

Calcific discitis seems to be a rare cause of back pain in adults. Imaging shows a calcification of the nucleus pulposus with extension through the endplates on computed tomography. This can be accompanied by bone marrow edema on magnetic resonance imaging. In a retrospective review of 150 patients, 4 cases of calcific discitis were found (2.8%). None of the patients reported about back pain. Therefore, it seems that symptomatic cases of calcific discitis are a rare occurrence in contrast to the quite frequent incidental finding of asymptomatic cases on imaging. Knowledge of the various imaging appearances of calcific discitis is necessary for radiologists, because especially in acute cases with substantial bone marrow edema, this benign entity may be confused with infectious spondylodiscitis or malignancy.

Postoperative spinal cord infarction on a gravid woman with suspected IV drug use: a case report

BackgroundBack pain is common in the gravid population and spinal cord infarction (SCI) or chronic osteomyelitis are exceptionally rare underlying causes of back pain in this population. No case report to date has described this unexpected adverse event in a gravid woman with suspected history of IV drug use (IVDU). This diagnosis could potentially become more common with increasing rates of IVDU, and increased education could result in sooner recognition.CaseA 38 year old G9P0171 at 24 weeks gestation with a complex past medical history, and a suspected history of IVDU, presented repeatedly with back pain. Following cesarean delivery at 36w2d, she developed signs and symptoms of an anterior spinal artery syndrome (ASAS) and had evidence of chronic osteomyelitis at T9-T10 on imaging. This required emergent decompressive laminectomy and ultimately resulted in paraplegia.ConclusionThis case highlights the difficulties in recognizing all SCI risk factors pre-operatively and the importance of investigating back pain in pregnant patients with a suspected history of IVDU. We believe this patient’s chronic infection put her at an increased risk for SCI that was possibly compounded by the anatomical changes from its chronicity, possibly occurring in combination with several other precipitating causes of hypoperfusion. We hope this case report highlights the modern necessity to include a history, or suspected history, of IVDU as a red flag to initiate imaging in pregnant patients with acute, persistent, or unresolved back pain.

Assessment of early functional outcome of lumbar discectomy in Soba and Future hospitals, Khartoum, Sudan 2021.

Herniated lumbar disc is one of the common causes of back pain. Discectomy provides rapid relief of back pain and radicular pain. Few studies have been done in our setting to look for the outcome of discectomy. The purpose of this study was to assess the outcome of discectomy. This prospective cross-sectional hospital-based study was carried out on Soba Teaching Hospital and Future hospitals in Khartoum, Sudan. Sixty-one patients with lumbar discectomy were included in this study, collected data through a direct interviewing questionnaire and took some information from patients' files. Then collected data were analyzed using the statistical package for social science (SPSS) 24. In sixty-one patients with lumbar discectomy of them, 24(39.3%) were within the age group 31-45 years old, 21(34.4%) were within the age group 46-50 years old, and 10(16.4%) were within age group 51-65years old. Results showed a male-to-female ratio of 1.5:1. The most common presenting symptoms were right Leg pain or numbness in 14(23%) patients. In the majority, 33(54.1%) of patients, the duration of symptoms was 6-12 months, 46(75.4%) underwent discectomy only, and 15(24.6%) underwent discectomy with fusion. Preoperatively, the majority of 30(49.1%) patients had a complete disability, 26(42.6%) had a severe disability, and 5(8.2%) had a moderate disability. In contrast, postoperatively, the majority, 35(57.4%) of patients, had mild disability, 24(39.3%) had no disability, and only 2(3.3%) had moderate disability (P value<.001). Moreover, there was a statistically significant association between the presence of co-morbidity and postoperative outcome (P value=.021). Discectomy is a gold stander procedure in the management of LDH. Patients showed excellent functional outcomes. The most common presenting symptoms were right leg pain or numbness. Patients postoperatively showed significant clinical improvement according to the mODI score.

Nerve Root Sedimentation Sign among Lumbar Canal Stenosis Patients Visiting the Department of Orthopaedics in a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Lumbar canal stenosis is a common cause of back pain and neurogenic claudication in the elderly population. Nerve root sedimentation sign-on Magnetic resonance imaging is a novel sign proposed for the diagnosis of lumbar canal stenosis. There is limited research so far. So, the aim of this study was to find out the prevalence of nerve root sedimentation signs in lumbar canal stenosis among patients visiting the Department of Orthopaedics in a tertiary care centre. This was a descriptive cross-sectional study conducted from 1 January 2020 to 31 July 2021 in the tertiary care centre, after receiving ethical approval from the Institutional ethical review board (Reference number: 299/(6-11)076/077). The anteroposterior diameter of the dural sac at the most stenotic level and nerve root sedimentation sign in magnetic resonance images were measured in patients with lumbar canal stenosis. Point estimate and 95% Confidence Interval were calculated. Among 40 patients enrolled, 34 (85%) (84.01-85.99, 95% Confidence Interval) patients had positive nerve root sedimentation sign. Out of 34 (85%) cases with positive sedimentation signs, 32 (94.12%) had severe lumbar stenosis and the remaining 2 (5.88%) had moderate lumbar stenosis. The prevalence of nerve root sedimentation signs is similar to the similar studies done in similar settings. Nerve root sedimentation signs on magnetic resonance imaging can be used as an objective sign for the diagnosis of severe lumbar canal stenosis. magnetic resonance imaging; prevalence; spinal stenosis.

Occupational risk factors for the development of disc herniation in physically demanding occupations: a rapid review

Introduction: Herniation, also known as prolapse, of the intervertebral discs is a common cause of back pain and sciatica. Risk factors include genetics, trauma, and repetitive activity arising from recreation or working in physically demanding occupations. Disc herniation can limit mobility and the ability to handle and move objects, reducing the capacity to work. The aim of this rapid review was to identify and review studies that reported occupational risk factors for the development of intervertebral disc herniation in physically demanding occupations.

The effectiveness of bone scintigraphy in the management of low back pain

BackgroundBack and low back pain have been reported as one of the leading causes of activity restriction. While degenerative changes in the spine are among the common causes of low back pain, zygapophyseal (facet) joint pain is seen as the most widely accepted cause of back pain. Standard imaging modalities may have low predictive value in detecting the source of back pain. Thanks to radionuclide bone scintigraphy, painful lesions can be distinguished from age-related changes, especially in patients with chronic low back pain. In this study, we aimed to retrospectively evaluate the clinical results of facet-induced low back pain, which was confirmed by bone scintigraphy, after facet injection treatment. MethodsWe completed a retrospective review of patients who underwent diagnostic radionuclide bone scintigraphy imaging for low back pain at our institution from 2019 to 2021. Scintigraphy imaging was often performed in conjunction with traditional diagnostic imaging. The patients underwent injection at the levels that were decided by the referring physician on the basis of the clinical symptoms, the physical examination findings, and findings on existing radiologic images, with performance of bone scanning. ResultsThe patients consisted of 24 (47.1 %) males and 27 (52.9 %) females with a mean age of 44.03 ± 9.26 years (range 34–67 years) at initial symptom onset. In the bone scintigraphy, increased radioactive uptake was detected in the facet joints of the lumbar region in 33 of 51 (64.7 %) patients. Statistically significant improvement was found in VAS-ODI and SF-36 scorings in 30 patients (90.1 %) after injection in patients with increased radioactive uptake. Statistically significant improvement was found in VAS-ODI and SF-36 scorings in 12 (66.6 %) patients who had no pathological findings with imaging modalities and were injected according to physical examination. When the two groups were compared with each other, the success rate in the group with increased radioactive uptake was found to be statistically significantly higher (p < 0.01) ConclusionsApplication of this technology may lead to more reliable diagnosis and treatment of painful facet arthropathy. Appropriate diagnostic tests and determination of spinal level localization will provide satisfactory results with correct patient selection

Proceedings of the 28th European Paediatric Rheumatology Congress (PReS 2022)

Proceedings of the 28th European Paediatric Rheumatology Congress (PReS 2022)

Minimally invasive surgical management of symptomatic lumbar disc herniation: can the endoscope replace the microscope?

BackgroundDegenerative lumbar spine pathologies such as spinal stenosis and disc herniation constitute the most common causes of back pain and radiculopathy. After the introduction of the operative microscope in the 1970s, microscopic discectomy has become the gold standard of treatment for herniated lumbar disc by many surgeons. A tubular endoscopic approach was first described in 1997 by Foley and Smith as a new minimally invasive technique alternative to open surgical techniques. The objective of this study is to evaluate the outcome and efficacy of microscopic discectomy and endoscopic discectomy for the management of herniated lumbar disc as regard the clinical results, operation time, intraoperative blood loss, and postoperative complications.ResultsThis is a retrospective study of 40 patients, with symptomatic lumbar disc herniation managed by the authors either by microscopic discectomy (MD) (n = 20) or by endoscopic discectomy (ED) (n = 20). Patients were followed up and postoperative data was recorded at 1, 6, 12 months after surgery. Clinical scoring systems included the Visual Analog Scale (VAS) for the preoperative and the postoperative low back ache (VAS-B) as well as preoperative and postoperative sciatic pain (VAS-S), in addition to the evaluation of the modified Japanese Orthopedic Association scale (mJOA) over the same time intervals. Significant postoperative improvement in clinical and functional outcome of the two groups was noted, including a statistically significant improvement in postoperative VAS-B and VAS-S as well as the mJOA scores in comparison to the preoperative data (p = 0.001). There was a statistically significant shorter operative time, less blood loss and less rate of operative complications recorded in the microscopic discectomy group as compared with endoscopic discectomy group in our study.ConclusionsOur study concluded that microscopic lumbar discectomy is as safe and effective as endoscopic lumbar discectomy for the management of symptomatic lumbar disc herniation with a low complication rate, less operative blood loss and operative time. Larger series and further studies would be yet considered with longer follow-up periods.

Design of a flexing organ-chip to model in situ loading of the intervertebral disc.

The leading cause of disability of all ages worldwide is severe lower back pain. To address this untreated epidemic, further investigation is needed into the leading cause of back pain, intervertebral disc degeneration. In particular, microphysiological systems modeling critical tissues in a degenerative disc, like the annulus fibrosus (AF), are needed to investigate the effects of complex multiaxial strains on AF cells. By replicating these mechanobiological effects unique to the AF that are not yet understood, we can advance therapies for early-stage degeneration at the cellular level. To this end, we designed, fabricated, and collected proof-of-concept data for a novel microphysiological device called the flexing annulus-on-a-chip (AoC). We used computational models and experimental measurements to characterize the device's ability to mimic complex physiologically relevant strains. As a result, these strains proved to be controllable, multi-directional, and uniformly distributed with magnitudes ranging from % to 12% in the axial, radial, and circumferential directions, which differ greatly from applied strains possible in uniaxial devices. Furthermore, after withstanding accelerated life testing (66 K cycles of 10% strain) and maintaining 2000 bovine AF cells without loading for more than three weeks the AoC proved capable of long-term cell culture. Additionally, after strain (3.5% strain for 75 cycles at 0.5 Hz) was applied to a monolayer of AF cells in the AoC, a population remained adhered to the channel with spread morphology. The AoC can also be tailored for other annular structures in the body such as cardiovascular vessels, lymphatic vessels, and the cervix.

Management of patients with subacute back pain: how to effectively prevent chronicity

A clinical observation of a patient with subacute nonspecific lower back pain and comorbid panic disorder is presented; it illustrates a modern approach to the management of this type of patients. Subacute back pain is the transition from acute to chronic pain. Clinically, the pain becomes constant, exhausting the patient and reducing his quality of life, and pathophysiologically, the pain transforms from nociceptive to dysfunctional. Chronicity of musculoskeletal pain does not occur in conditions of mental and social well-being, the patient necessarily has the so-called “yellow flags” – factors that contribute to central sensitization and chronic pain. In the presented clinical case, the most common “yellow flags” were identified – anxiety, misunderstanding about the causes of back pain, pain catastrophizing, restrictive “pain” behavior. These factors are often found among patients with subacute back pain. It is important to identify “yellow flags” timely and treat patient taking into account their correction. For the treatment of this category of patients, the prescription of pain therapy alone is not enough, an interdisciplinary approach is needed, which will include rational pharmacotherapy, psychological methods and kinesiotherapy. The patient underwent interdisciplinary treatment, including non-drug and drug therapies and in accordance with Russian and foreign clinical guidelines for the treatment of subacute nonspecific lower back pain and panic disorder. Non-drug treatment consisted of educational talks, recommendations for daily activities, cognitive behavioral therapy, and kinesiotherapy. These methods were aimed at forming the patient's correct ideas about his condition, at reducing the catastrophizing of pain and anxiety, and at increasing the patient's physical and social activity. It is known that many patients with pain syndromes have insufficient adherence to treatment and adherence to medical recommendations. Patient adherence to non-drug treatments was maintained through educational conversations and cognitive-behavioral therapy. Taking into account the previous multiple intake of non-steroidal anti-inflammatory drugs and in order to avoid the risk of side effects, drugs of this group were not included in the present pharmacotherapy plan. The patient was prescribed Alflutop as a pharmacotherapy. After 10 days of treatment, a marked relief of pain was observed, and after 3 weeks of treatment, back pain regressed, and anxiety significantly decreased. The patient has formed correct ideas about his condition, about his lifestyle. Follow-up of the patient for 12 months showed that there were no repeated episodes of back pain and panic attacks. The patient continued to regularly engage in kinesiotherapy and maintain an active lifestyle.

Posterior-only debridement, bone fusion, single-segment versus short-segment instrumentation for mono-segmental lumbar or lumbosacral pyogenic vertebral osteomyelitis: minimum five year follow-up outcomes

BackgroundPyogenic vertebral osteomyelitis (PVO), which is a potentially life-threatening condition and is associated with significant morbidity and mortality, is a cause of back pain that can lead to neurologic deficits if not diagnosed in time and effectively treated. The objective of this study is to compare the efficacy of posterior single-segment and short-segment fixation combined with one-stage posterior debridement and fusion for the treatment of mono-segmental lumbar or lumbosacral PVO.MethodsCharts of all patients with mono-segmental lumbar or lumbosacral PVO were treated by single-stage posterior debridement, bone graft fusion, and pedicle screw fixation from April 2012 to January 2016. All patients were divided into two groups: sinlge-segment fixation (Group A, n = 31) and short-segment fixation (Group B, n = 36). These patients were followed up for a minimum of five years. The clinical efficacy was evaluated and compared on average operation time, blood loss, visual analog scale (VAS), erythrocyte sedimentation rate (ESR), C-Reactive protein (CRP), neurological function recovery and local lordotic angle.ResultsAll 67 patients were completely cured during the follow-up. All patients had significant improvement of neurological condition and pain relief at the final follow-up. The VAS was 7.1 ± 0.7 in group A and 7.2 ± 0.6 in group B pre-operatively, which decreased to 2.1 ± 0.6 and 2.0 ± 0.7, respectively, at three months after surgery, then reduced to 0.4 ± 0.5 and 0.5 ± 0.5, respectively, at the final follow-up. ESR, CRP returned to normal limits in all patients 3 months after surgery. The mean blood loss and operation time in group A were less than that in group B (P < 0.05). The local lordotic angle in group A was increased from preoperative − 1.7 ± 7.9° to postoperative 5.8 ± 7.1°, with angle loss of 1.5 ± 0.8° at the final follow-up, respectively (P < 0.05). The local lordotic angle in group B was increased from preoperative − 1.6 ± 7.8° to postoperative 13.5 ± 6.2°, with angle loss of 1.3 ± 0.8° at the final follow-up, respectively (P < 0.05). In the mean postoperative local lordotic angle, there was significant difference between the two groups at the time of immediate postoperative period or the final follow-up (P < 0.05).ConclusionPosterior-only debridement, interbody graft using titanium mesh cage, posterior single-segment instrumentation and fusion represent a safe and effective treatment option for selected patients with mono-segmental lumbar and lumbosacral PVO. This approach may preserve more lumbar normal motor units with less blood loss and operation time when compared with that of short-segment fixation. But short-segment fixation was superior to the single-segment fixation in the correction of kyphosis.

A personalized approach to the management of patients with chronic nonspecific back pain

Back pain is one of the most common causes of a doctor visit and occupy the first place among all non-infectious diseases in terms of the number of years of life, lost due to persistent deterioration in health. Nonspecific (musculoskeletal) pain represents the most common cause of pain and can be caused by the intervertebral disc extrusion, the lesion of the facet joints, the sacroiliac joints pain (SJP), the myofascial syndrome. A comprehensive (interdisciplinary) approach to the treatment of chronic back pain is aimed not only at reducing pain, but also at increasing physical, social and domestic activity, improving the emotional state, and developing effective stereotypes of behavior. The personalized approach is based on the patient clarifying both anatomical causes of pain and social and psychological, including erroneous ideas about the causes of back pain and its forecast, depression, increased anxiety and insomnia. Kinesitherapy represents the most effective direction when conducting patients with chronic back pain and should be combined with avoiding excessive static and physical exertion. In addition to therapeutic exercises, regular walks are of great importance, the intensity and volume of which can gradually increase. Psychological methods of therapy, mainly cognitive-behavioral therapy (CBT), are effective for chronic nonspecific back pain, they also use in the presence of emotional disorders and insomnia. In case of damage to the facet joints, the SJP, combined osteoarthritis of the knee and hip joints for chronic back pain as additional therapy, combined drugs of chondroitin sulfate and glucosamine sulfate are used. Unfortunately, in our country, a personalized approach is rarely used, including the CBT, but its use can help many patients with chronic back pain.

Outcomes of minimally invasive spine decompression in lumbar spinal stenosis and intervertebral disc prolapse: A prospective study

Introduction: Lumbar spinal stenosis and intervertebral disc prolapse are the most common cause of back pain and sciatica. Both conditions are traditionally treated by a midline lumbar incision, after which the paraspinous muscles are elevated from the spinous processes and lamina and retracted laterally and extensively. Minimally invasive lumbar decompression is a procedure designed to debulk hypertrophied ligamentum flavum and removal of the herniated disc with a goal of relieving neural compression. Our study aimed to assess the outcome in terms of improvement in neurology, extent of pain relief in the postoperative period and complications in patients undergoing minimally invasive spine decompression.Methodology: The present study was conducted in a tertiary care hospital. A total of 16 patients who satisfied both the inclusion and exclusion criteria and gave informed consent were recruited for the study from January 2020 to March 2021. All patients underwent minimally invasive spine decompression by tubular retractors. Outcome measures used are Visual analog score for leg pain and back pain, Modified Oswestry Disability Index (MODI), Roland Morris Disability Questionnaire (RMDQ) and neurological examination preoperatively and postoperatively at 6 weeks, 3 months and 6 months.Results: Out of 16 patients, ten patients had intervertebral disc prolapse and six had lumbar spinal stenosis. L4L5 was the most common level seen in our patients. Mean pre-operative VAS score was 6.88 and 4.44 for leg pain and back pain, there was significant reduction at the end of 6 months. Mean preoperative MODI score was 66.38, preoperatively 13 patients (81%) had crippling back pain, 3 patients (18.75%) had severe disability. At the end of 6 months, all 16 patients had less than minimal disability. Mean preoperative roland morris disability score was 11.31+ 0.61. There was a significant mean improvement at 6 months postoperatively from the preoperative baseline score. Nine patients (43.8%) had a motor deficit of which 4 patients had a significant motor power improvement. Two patient had complications, one patient had CSF leak intraoperatively and the other patient developed a superficial wound infection.Conclusion: Minimally invasive spine surgery is an excellent surgical option in patients with lumbar spinal stenosis and prolapsed intervertebral disc. Patients who underwent minimally invasive spine decompression had satisfactory functional outcome in terms of pain relief, minimal hospital stay and early return to day to day activities.

Non-Hodgkin's Lymphoma and Spondylitis in Type-2 Diabetes Mellitus: A Rare Geriatric Case Report

Purpose- Type 2 diabetes mellitus is a metabolic condition characterized by organ failure. In patients with type 2 diabetes, maintaining tight glycaemic control requires timely adjustments and changes in therapy. In children and adolescents, spondylolysis is a common cause of back pain. Spondylitis is more common in men than in women, and it is caused by a congenital defect. T-cell Non-Hodgkin lymphomas are a rare cancer of the lymphatic system. NHL are lymphoid tumours caused by chromosomal translocations, infections, immunodeficiency states, environmental causes, or persistent inflammation.&#x0D; Methods- A 65 years old male patient admitted to the tertiary care hospital. Past medical history of patient includes he was suffering from lower back pain along with increased blood sugar level since1 month. Past medical history of patient was Type-2 diabetes mellitus since 3years, spondylitis since 6month along with newly detected Non-Hodgkin’s lymphoma. T-cell Non-Hodgkin lymphomas are a rare cancer of the lymphatic system. There are 9 different clinics pathologic peripheral T-cell NHLs recognized by the current WHO/EORTC classification.&#x0D; Result and Conclusion- Early diagnosis is important for effective and curative therapy management. Early investigations include MRI, Chest X-ray and Ultrasonography. MRI examination of the spine is particularly helpful to diagnose and treatment of this rare disease.&#x0D; Keywords- Oral Anti-Diabetic Drugs, Non-Hodgkin’s Lymphoma, Spondylitis, Diabetes mellitus, spondylolisthesis

Anatomical Topographical Investigation of the Medial Branch of the Dorsal Thoracic Branch of the Spinal Nerve in the Segments T10-T12.

The zygapophyseal joints represent one possible cause for back pain. Therefore, many interventions are targeting the denervation of the facet joints. The aim of this study is to describe the course of the medial branch of the dorsal branch of the spinal nerve and its articular branches to the zygapophyseal joints in the segments T10-T12. The medial branches in the thoracic segments T10-T12 were dissected in 20 Thiel embalmed cadavers. An Eschenbach magnifying glass (4.0× magnification) was used during dissection preserving the articular branches. The topography and the branching pattern of the medial branches was observed. The course of the nerves in the segments T10-T12 differed from each other because of the different osseous anatomy of each segment. The medial branch at the segment T10 crossed the tip of the transverse process in 28 of the 40 hemivertebral specimens. In the remaining cases it passed superior to the transverse process. At T11 the medial branch ran constantly through an osteofibrous canal. At the segment T12 the medial branches showed a similar course to the medial branches in the lumbar region. In many cases two articular branches, which arose from the medial branch were identified. The results of this study show a considerable anatomic variety at the segment T10. It also demonstrates that the transverse process is an important landmark to encounter the medial branch. Furthermore, the possibility of a double innervation of the facet joints should always be considered.

Ultrasonography in the diagnosis of lumbar disc herniation in young adult

The aim: to assess the value of ultrasonography in the diagnosis of a lumbar herniation disc in young adults.&#x0D; Material and methods: 27 patients aged 17-21 years (8 girls, 19 boys) were included in our study. During the examination by a neurologist, all patients reported pain in the lower back. The results of the ultrasound investigation were compared with MRI. Ultrasonography (USG) was conducted on a Philips HD 11XE device using a convection transducer in the frequency range 2-5 MHz; MRI - General Electric, Signa HDI, 1.5T.&#x0D; Results: at the L3-L4 segment, hernia was diagnosed in 2 (7.4±5.0 %) cases, at the L4-L5 segment - in 14 (51.9±9.6 %) cases, and at the L5-S1 segment - in 11 (40.7±9.5 %) cases, respectively. The hernia at the segments of L5-S1 and L4-L5 was diagnosed significantly (P&lt;0.001) more often than at the segment of L3-L4. Median hernia was diagnosed in 12 (44.4±9.6 %) cases, paramedian - in 11 (40.7±9.5 %) cases and posterolateral - in 4 ( 14.8±6.8 %) cases, respectively. The median and paramedian hernia was diagnosed significantly (P&lt;0.05) more than the posterolateral. In ultrasound, only in one case, a posterolateral hernia was interpreted as paramedian&#x0D; Conclusions: 1) The lumbar hernia are localized at the segments of L5-S1 and L4-L5 significantly (P&lt;0.001) more often than at the other segments; 2) Sciatica is significantly more common in posterolateral localization of lumbar disc herniation; 3) The ultrasonography couldbe used to find out the causes of back pain in young adult

THE SPATIOTEMPORAL PROTEOMIC LANDSCAPE OF HUMAN INTERVERTEBRAL DISCS REVEALS AGING AND DEGENERATION DYNAMICS

Purpose: The intervertebral disc (IVD) is a spinal joint comprised of three main structures; the nucleus pulposus, annulus fibrosus and cartilage endplate. Intervertebral disc degeneration (IDD) is a progressive condition and a major cause of back pain. It primarily affects the nucleus pulposus associated with other structural changes, altering the biomechanics. These alterations are deeply connected to its extracellular matrix (ECM) composition. The human disc is matrix-rich embedded with few cells that are responsible for maintaining homeostasis, yet, cell numbers continually decline with aging/degeneration.

A Case Report on Prolapse Lumbar Intervertebral Disease (PLID) Treatment through Acupuncture Procedure

Lumbar disc disease is drying out of the spongy interior matrix of an intervertebral disc in the spine. Lumbar disc disease to encompass several different causes of back pain or sciatica term use by many physicians and back pain researchers. It is thought that about one-third of all back pain lumbar disc disease causes. Pain, loss of muscle strength, and loss of touch sensation may occur if this herniation causes the compression of the most proximal part of the nerve closely neighboring the intervertebral disc material. Pain usually is in the distribution of the nerve compressed, down the back of the leg, side of the calf, and inside of the foot which call sciatica. Most commonly, the nerve root between the fourth and fifth lumbar vertebrae or between the fifth lumbar vertebra and first sacral segment have impinged. Adults frequently experience back discomfort and sciatica. These result in a significant reduction in working hours, as well as financial losses for both individuals and the country. To treat these patients, a thorough examination is required. Inadequate treatment, whether medical or surgical, can have serious consequences, make the suffering worse. This case study was initiated in Suo Xi Hospital Limited,Shantinagar, Dhaka. A 43 years old female patient was visited in the clinic complaining of low back discomfort that has been spreading down her left leg for the past two months. The diagnosis was confirmed by MR and CT scan. The results of the follow-up study were excellent. The left leg showed signs of healing after the third day of acupuncture. The patient's lower back pain, which had been spreading down his left leg, was no longer present. Acupuncture can confirmative promote functional recovery for patients with PLID.

Preliminary results in comparison of caudal epidural injection of hyaluronidase versus hypertonic saline in managing lumbosacral canal stenosis: A randomized clinical trial

Background: Lumbosacral spinal stenosis (LSS) is one of the most common causes of back pain and disability. Its treatment varies from conservative and medical to surgical treatment, and the indications for its optimal management are not obviously defined. Epidural steroid injection is commonly used for pain relief in LSS. This study aims to compare the adjuvant efficacy of caudal epidural injection (CEI) of hyaluronidase with steroid versus hypertonic saline with steroid in patients with LSS. Methods: This clinical trial was done in a prospective, randomized, double-blind approach; it was conducted among 30 patients aged between 45 – 75 years who suffered from low back and leg pain in recent 6 months due to LSS. The patients were randomly allocated to two groups. Group A included 15 patients who received fluoroscopically guided CEI containing steroid, local anesthetic, and hyaluronidase, and Group B consisted of 15 patients who received fluoroscopically guided CEI containing steroid, local anesthetic, and hypertonic saline. The outcome measures included the Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and Quebec Back Pain Disability Scale (QBPDS), which were obtained from patients before the CEI as a baseline and after the second, fourth, and eighth weeks. Results: Before injection, there were no statistically significant differences between the two studied groups, neither in demographic characteristics nor in VAS, ODI, and QBPDS parameters. After injection, the mean of ODI and QBPDS improved from the baseline to the 2nd, 4th, and the 8th weeks in both groups (p &lt; 0.001) without any superiority between the two groups (p &gt; 0.05). However, there was a significant improvement of the mean VAS score through the second and fourth weeks in Group A (p = 0.032, 0.050). VAS score in the eighth week was equal without any superiority in both groups (p &gt; 0.05). Additionally, the mean social life status was significantly improved in group A in the 4th and 8th weeks after the intervention. Conclusions: In short-term follow-up, Caudal epidural injection of hyaluronidase, as well as hypertonic saline, seems to be effective in the management of LSS without any superiority in both materials. However, in the 2nd and 4th weeks after the procedure, better improvement of means VAS score was observed in the hyaluronidase group.