Back Pain Research Articles

Isolation and tracing of matrix-producing notochordal and chondrocyte cells using ACAN-2A-mScarlet reporter human iPSC lines.

The development of human induced pluripotent stem cell (iPSC)-based regenerative therapies is challenged by the lack of specific cell markers to isolate differentiated cell types and improve differentiation protocols. This issue is particularly critical for notochordal-like cells and chondrocytes, which are crucial in treating back pain and osteoarthritis, respectively. Both cell types produce abundant proteoglycan aggrecan (ACAN), crucial for the extracellular matrix. We generated two human iPSC lines containing an ACAN-2A-mScarlet reporter. The reporter cell lines were validated using CRISPR-mediated transactivation and functionally validated during notochord and cartilage differentiation. The ability to isolate differentiated cell populations producing ACAN enables their enrichment even in the absence of specific cell markers and allows for comprehensive studies and protocol refinement. ACAN's prevalence in various tissues (e.g., cardiac and cerebral) underscores the reporter's versatility as a valuable tool for tracking matrix protein production in diverse cell types, benefiting developmental biology, matrix pathophysiology, and regenerative medicine.

Morphological Changes in the Lumbar and Abdominal Muscles in Individuals with Sacralization

Although sacralization is one of the most common congenital anomalies of the spine, its effect on surrounding muscles is still not well known. This study was conducted to determine the size of the lumbar and abdominal muscles of the individuals with sacralization and to compare with the control group. Eighty-five participants with sacralization phenomena and fifty-six asymptomatic participants were included in this study. Sacralization was classified according to the Castellvi classification. The cross-sectional area of the multifidus lumborum, erector spinae and rectus abdominis muscles, and the section thicknesses of external abdominal oblique, internal abdominal oblique and transversus abdominis muscles were measured bilaterally on axial computed tomography images at the L1-2 and L4-5 levels. ANCOVA revealed that there is no any significant group*side interaction effect regarding muscles sizes in terms of two groups in L1-L2 and L4-L5. In addition, ANCOVA revealed a both side effect [(p=.020; η2p=.038)] and group*side interaction effect [(p=.010; η2p=.049)] regarding length of the L5 transverse process (p˃.05). Regardless of low back pain, muscle sizes are not associated with the sacralization phenomenon.

Overview of the Incidence of Post-Sectio Caesaria Back Pain with Spinal Anesthesia: A Literature Review

Post-cesarean back pain with spinal anesthesia is one of the most common complications and can affect the patient's quality of life. Although spinal anesthesia is a safe and commonly used option in surgical procedures, the risk of back pain remains, especially if the anesthesia technique is not optimal. This study aims to provide an overview of the incidence of post-cesarean section back pain with spinal anesthesia based on a literature review over the past 10 years. This study is a literature review that reviews 10 scientific journals published in the last 10 years. The focus of this study includes the prevalence of back pain, risk factors, anesthesia techniques, and post-cesarean section back pain management. The results of the review showed that the prevalence of post-cesarean back pain ranged from 30% to 50%, with the main risk factors being age, body mass index, and anesthesia techniques. The use of smaller atraumatic needles and careful anesthesia techniques can reduce the incidence of back pain. Back pain is generally temporary, but in some patients it can develop into chronic pain. Post-cesarean section back pain with spinal anesthesia can be prevented with proper anesthesia techniques and good pain management. A multidisciplinary approach is needed to reduce the prevalence of chronic pain and improve the patient's quality of life.

The interplay of stress and work-related musculoskeletal disorders in dental practitioners.

Prevalence of work-related musculoskeletal disorders (WRMSDs) among general dental practitioners and orthodontists is approximated to range between 64% and 93%. Etiology of WRMSDs in the mentally and physically demanding occupation remains unclear, for which reason the aim of the study was to clarify the interplay of physical, psychological, and mental factors on WRMSDs. Of 94 orthodontists and 187 general dental practitioners (mean age = 35 years) questioned using an online survey, 84% reported persisting tension or pain in the back, neck, or shoulders. While 71% of females were employed (29% self-employed), only 39% of male participants were employed. Cluster analysis was used to characterize dental practitioners according to their movement profile and the moderating effect of stress on certain WRMSDs. Three movement profiles of general dental practitioners and orthodontists were significantly predictive of WRMSD. The minority could be characterized as healthy (n = 45), whereas twice as many reported nearly twice as much pain (n = 90). Stress proved to be a strong, significant moderator of WRMSDs in relation to sex, employment status, and body mass index. The prevalence of WRMSDs found was alarming. Given the feminization of dentistry, and that being female, stressed, and an employee (rather than self-employed) is a significant predictor of WRMSDs, this represents a danger to the German health system.

Perceptions of Senior Citizens Regarding the Social Media Impact on Relationship between Parents and Teenagers: A Sociological Case Study in Dera Ghazi Khan

The utilization of social media can have both advantageous and detrimental effects on families, regardless of whether they are in their household or traveling. Elderly individuals in households often observe the impact of social media on their interactions with adults, experiencing a combination of concern and fascination. They express apprehension about the potential harm to family connections caused by the various risks linked with teenagers' use of social media, including cyberbullying, harassment, and fraud. The study aims to understand the sociological implications of social media on family dynamics with objective of, (i) to find out the socioeconomic characteristics of the study participants; (ii) to explore the main cause the social media platforms impact on the relationship between parents and teenagers; (iii) to explore the negative consequences of social media sites on the activities of teenagers; and (iv) how to overcome the negative effect of social media. For this study, a sample of 160 study participants (senior citizens) selected through multistage sampling technique. At first stage 1 Tehsil will be selected randomly, at second stage 4 union councils selected randomly from each tehsil, at third stage 2 villages selected from each union council randomly, at fourth stage 20 study participants selected from each village through convenient sampling technique. Majority more than eighty percent (80.7%) of the teenagers due to excessive usage of social media apps make them aggressive. Majority more than eighty-two percent (82.5%) of the teenagers face depression due social loneliness. Majority more than ninety-one percent (91.9%) of the senior citizens’ availability of internet making them addictive of social media app. Majority more than ninety-two percent (92.5%) of the teenagers after the use of social media app they feel headache, back pain and eyesight problems. Majority more than seventy-one percent (71.9%) of the senior citizens said that usage of social media apps teenagers faced mood swings. Strain relationship between parent’s teenagers was associated with teenager isolation. The time for parents was associated with the feeling of pleasant with social media apps. Habitual of social media app usage was associated with depression in teenagers.

Spinal hydatid disease-A case report: An uncommon differential diagnosis in LMICs

Background and Importance: With a 0.2–1% incidence, spinal hydatid disease is a very uncommon diagnosis. While it is uncommon in affluent nations, it should be taken into account when making a differential diagnosis for spinal cord compression syndrome, particularly in regions where it is prevalent. Case Presentation: We report a case of hydatid illness of the spine. A 52-year-old man presented with lower extremity discomfort and spastic paraparesis, trouble urinating, and back pain and edema. He had at the level of the 12th thoracic to third lumbar vertebrae (Th12-L3) with paraspinal extension. The patient was treated with four months of antiparasitic therapy and two surgical resections performed by general surgeons. Histological analysis showed pieces of fibrous tissue exhibiting granulomatous inflammation; however, no evidence of acid-resistant bacteria or PAS-positive chitin membrane was found. The existence of bacteria following therapy has not been confirmed by the parasitological investigation of the lesions. Clinical discussion: Primary spinal hydrodatidosis is a rare condition that affects about 0.2–1% of the population. Conclusion: Due to rarity of this disease, early discovery and timely treatment are critical, and this diagnosis should be considered when generating a differential diagnosis for spinal cord compression syndrome.

Non-surgical spinal cord infarction: case series & long-term follow-up of functional outcome

IntroductionSpinal cord infarction is a rare but often devastating disorder. The pathogenesis of most non-surgical cases involves atherothrombosis and treatment with anticoagulation and antiplatelet agents may be indicated. Functional recovery in most cases is poor. We describe five cases of spinal cord infarction and provide details on their functional outcomes after long-term (>10 years) follow-up.Case presentationA 28-year-old female presented at 16 weeks gestation with chest and back pain and paraesthesia in her fingers. Magnetic resonance imaging on admission revealed a spinal cord lesion extending from C5-T8. She was treated with anticoagulation and rehabilitation. Six years following presentation she was able to return to work. A 42-year-old male experiencing central chest pain and leg weakness was initially diagnosed as having acute coronary syndrome. Following discharge, he was re-admitted with urinary retention and leg weakness. Magnetic resonance imaging revealed a spinal cord lesion extending from T4 to T7. He was treated with anticoagulation, and eight months following presentation he regained full muscle strength but required intermittent self-catherisation. Three further cases are described.DiscussionThe aetiology of non-surgical spinal cord infarction is not always evident, but is commonly associated with atherothrombosis. There are often delays in making a diagnosis, but early recognition and prompt treatment of spinal cord infarction is essential. Long-term functional outcomes are often poor and typically reflect the severity of initial presentation. This case series is unique as it has one of the longest follow-up periods described in the literature.

Social media users’ perspectives of spinal cord stimulation: an analysis of data sourced from social media

ObjectivesTo identify Reddit users’ viewpoints and inquiries about spinal cord stimulation (SCS) for chronic back pain using Reddit databases.MethodsWe performed a qualitative analysis of public, anonymous threads and comments from...

Enhancing Equity in Clinical Research: A Multifaceted Proposal for Spondyloarthritis.

Clinical research advances medical knowledge and improves healthcare outcomes. However, disparities in research participation hinder progress. The Unmet Research Needs in Spondyloarthritis Conference IV highlighted critical insights and strategies to enhance equity in clinical research. Talks focused on engaging underrepresented communities and addressing disparities in rheumatic diseases, particularly spondyloarthritis (SpA), to ensure research results are generalizable and inclusive. Disparities in SpA management, such as greater back pain severity among Black and Hispanic Americans and sex-based differences in pain management, emphasize the need for equitable research. Dr. Elizabeth Ferucci discussed the racial disparities in rheumatologic care, highlighting the importance of early access to rheumatologists and culturally informed primary care to improve outcomes. Dr. Hani El-Gabalawy's talk on engaging Indigenous communities stressed the importance of community consent and reciprocal benefits. Dr. Sarfaraz Hasni's presentation on mitigating disparities in research participation underscored the need for inclusive practices and strategies to promote diverse representation. Finally, Dr. Edith Williams emphasized institutional approaches to fostering equity, including diverse recruitment practices and institutional review board alignment with diversity priorities. Strategies to enhance equity in clinical research include community engagement, addressing logistical barriers to participation, and ensuring diverse research teams. These approaches can dismantle barriers for underrepresented communities, making research more accessible and reflective of the broader population. The SpA research community must commit to creating structures that foster inclusivity, ensuring medical advancements benefit all populations, especially historically underrepresented groups. The principles and strategies proposed serve as a roadmap for achieving equity in SpA research.

A randomized trial on three different minimally invasive decompression techniques for lumbar spinal stenosis. Five years follow-up from the NORDSTEN-SST.

The short-term clinical outcome for midline-preserving posterior decompression techniques was comparable. The aim of this study was to evaluate long-term clinical results after three different midline-preserving posterior decompression techniques. In the NORDSTEN spinal stenosis trial (NORDSTEN-SST) 437 patients were randomized to three different midline-retaining posterior decompression techniques: Unilateral laminotomy with crossover (UL), bilateral laminotomy (BL) and spinous process osteotomy (SPO). Primary outcome was the mean change in Oswestry disability index (ODI) score at five-years follow-up. Secondary outcomes were the proportion of patients classified as success, mean change in EQ-5D, ZCQ-score, NRS-score for leg and low back pain, a seven-point Global Perceived Effect (GPE) Scale and proportion of subsequential spinal surgery. The number of patients that completed follow-up data after five years was 358 (82%): In the UL, BL and SPO group the numbers were 122, 119 and 117, respectively. Mean age at baseline was 66.7 (SD 8.2) years, mean BMI was 27.8 (SD 4.1), and 172/358 (48%) were female. In the UL group the mean change was -18.2 (95% CI -21.0 -5.4), in the BL group it was -19.0 (95% CI -21.9-16.1) and in the SPO it was -18.6 (95% CI -21.6-15.7) (p = 0.917). No significant differences in the secondary outcomes between the three surgical groups were found, also the subsequent spinal surgery rates were similar. There were no significant differences in patient reported outcomes and subsequent spinal surgery rates after the three different decompression techniques at five-year follow-up.

Exploring temporal congruence in motor imagery and movement execution in non-specific chronic low back pain

Chronic non-specific low back pain (NSCLBP) is linked to sensorimotor dysfunctions and altered motor planning, likely due to neuroplastic changes. Motor imagery (MI) and movement execution share neural pathways, but the relationship between imagined and executed movements in NSCLBP patients remains underexplored. This study aimed to assess the temporal congruence between imagined and executed movements in NSCLBP sufferers, with secondary goals of investigating group differences in movement chronometry, psychological well-being, and disability, as well as possible correlations among these factors. Fifty-six participants, including 28 NSCLBP patients and 28 asymptomatic subjects (AS), performed lumbar flexion and Timed Up and Go (TUG) tasks. NSCLBP patients showed significant temporal incongruence in both tasks, executing movements more slowly than imagined, whereas AS displayed incongruence only in the TUG task. NSCLBP patients also took longer to imagine and execute lumbar flexion movements compared to AS, with correlations observed between execution delays, higher disability, and greater fear of movement. The findings highlight a lack of temporal congruence in NSCLBP patients, especially in lumbar flexion, emphasizing the complex relationship between chronic pain, motor ability, and psychological factors. These results suggest that integrated treatment approaches addressing cognitive and emotional aspects are crucial for managing NSCLBP.

Clinical indications associated with new opioid use for pain management in the United Kingdom: using national primary care data.

Prescription opioids for noncancer pain in the United Kingdom have increased over the past 2 decades, alongside associated harms. Policies addressing opioid prescribing must be tailored to individual patient needs with specific disease systems. The aim of this study was to evaluate clinical conditions associated with new opioid initiation in noncancer pain using nationally representative UK data. Primary care electronic health records from January 1, 2006, to September 31, 2021, were used from the Clinical Research Practice Datalink to identify incident opioid prescriptions. Patient histories were reviewed using code lists for opioid-related conditions with a 5-year look-back for chronic conditions and a 1-year look-back for surgical indications before opioid initiation. In total, 3,030,077 new opioid use episodes in 2,027,402 patients were identified, with 61% being women, 77% aged 45 years and older, and 48% from the highest deprivation quintile. Ten systems associated with opioid initiation were identified, which were not mutually exclusive, as patients could have opioids prescribed for multiple indications. The most common were musculoskeletal (80.8%), respiratory (57.6%), infections (30.4%), trauma/injury (20.4%), neurology (19.9%), and postsurgical indications (5.5%). Osteoarthritis (60.7%) and low back pain (41.0%) were the most frequent musculoskeletal conditions. Orthopedic surgeries accounted for 41.2% of all postsurgical indications. This is the first study in the United Kingdom evaluating large-scale national data to assess indications associated with opioid initiation. Nearly 3 quarters of new opioid prescriptions for noncancer pain were in patients with musculoskeletal conditions, often for conditions with limited evidence for opioid efficacy. These findings could inform targeted interventions and future policies to support nonpharmacological interventions in the most common conditions where opioid harms outweigh benefits.

Predictors of time to achieve clinically significant improvements following lateral lumbar interbody fusion

BackgroundAs lateral lumbar interbody fusions (LLIF) are increasingly performed, our understanding of postoperative clinical trajectories is important in informing preoperative patient expectations. While minimum clinically important difference (MCID) rates are widely utilized in spine surgery literature, there is less published on how long it takes for patients to achieve MCID following LLIF. ObjectiveTo evaluate the length of time it takes for patients to report MCID achievement for back pain, leg pain, disability, and physical function and evaluate predictors of time to achieve MCID. MethodsPatients undergoing elective LLIF by the senior author with baseline and postoperative patient-reported outcomes (PROs) recorded were retrospectively identified. Data on potential predictors of time to MCID achievement were gathered including demographics, comorbidities, diagnostic information, and baseline PROs. MCID achievement rates for Oswestry Disability Index (ODI), Visual Analog Scale-Back (VAS-Back), VAS-Leg, and Patient-Reported Outcome Measurement Information System-Physical Function (PROMIS-PF) were calculated at six-, twelve, 6 month- 1 year- and 2-year postoperative timepoints. A Kaplan-Meier survival analysis was conducted to determine the proportion of patients achieving MCID at each time point. A multivariate Cox regression determined predictors of time to MCID achievement. ResultsOne hundred-five patients were included in the analysis. The mean time to achieve MCID for PROMIS-PF was 44.7 weeks, for VAS-Back was 38.5 weeks, for VAS-Leg was 36.7 weeks, and for ODI was 38.3 weeks. Worse baseline VAS-Back significantly predicted earlier MCID achievement for VAS-Back (HR: 1.55), while diabetes was predictive of later MCID achievement (HR: 0.21). Higher body mass index and worse preoperative ODI predicted earlier MCID achievement for ODI (HR: 1.04–1.08), and higher VAS-Leg score and two-level fusion were predictive of later MCID achievement for ODI, (HR:0.26–0.81). Worse preoperative VAS-Leg, isthmic spondylolisthesis, and three-level fusion were predictors of earlier achievement of MCID for VAS-Leg (HR: 1.27–6.47). Herniated nucleus pulposus and foraminal stenosis were early predictors (HR: 2.92–3.23) and workers’ compensation was a late predictor of MCID attainment for PROMIS-PF (HR: 0.13). ConclusionSelect demographic variables, comorbidities, spinal pathology, and preoperative PROs influenced the time it took for patients to report clinically significant improvements in pain, disability, and physical function scores. These findings can be used to prognosticate outcomes for patients undergoing LLIF and inform patient expectations of postoperative recovery.

Risk Factors for Developing Occupational Back Pain in Electronics Industry Workers: A Cross-Sectional Study

Back pain is an occupation-related problem among workforces. This cross-sectional study aimed to identify the prevalence of back pain and the risk factors of occupational back pain among workers in the electronics industry. In total, 354 electronics workers in Thailand participated in the study. Data were collected using the Musculoskeletal Disorders Severity and Frequency Questionnaire, the Job Content Questionnaire, and ergonomics risk assessment via the Rapid Upper Limb Assessment (RULA). Risk factors of back pain were identified by multiple logistic regression analysis, providing adjusted odds ratios (ORadj) and 95% confidence intervals (95% CI). The study found that most workers were operators (92.09%) and had repetitive work (83.62%). A high ergonomics risk was observed in workers who stood during work (68.49%) and operated machines (71.70%). The 1-month prevalence of developing back pain was 20.62% and the significant factors correlated with back pain were low levels of job control and decision-making (ORadj = 2.26; 95% CI [1.26 ,4.05]), lack of exercise (ORadj = 8.30; 95% CI [1.35, 24.28]), repetitive work (ORadj = 2.94; 95% CI [1.19, 7.29]), and high ergonomic risk level (ORadj = 2.81; 95% CI [1.16, 5.07]). These findings suggest that measures should be implemented by empowering electronics workers to make decisions and control their jobs, as well as promoting health through muscle-stretching exercise, to support back pain prevention.

Vertebral Body Tethering for Thoracolumbar Curvatures in Adolescent Idiopathic Scoliosis: Radiographic and Clinical Outcomes at 2–6-Year Follow-Up

Background: The gold standard treatment for adolescent idiopathic scoliosis (AIS) is posterior spinal fusion (PSF). However, long-term consequences of PSF can include reduced spinal flexibility, back pain, and intervertebral disc degeneration. Vertebral body tethering (VBT) is a non-fusion alternative that preserves motion. We investigated the outcomes of VBT for the treatment of thoracolumbar (TL) major AIS in the largest single-surgeon series with a minimum 2-year follow-up (FU). Methods: We performed a retrospective single-center review. Inclusion criteria were AIS, Lenke 5/6 curvature, and skeletally immature Variables were compared using Student’s t-tests, Wilcoxon rank sum tests, Chi-square, and Fisher’s exact tests. Results: A total of 37 consecutive patients, age 14.1 ± 1.6 years, 86.5% F, 35.9 ± 11.5-month FU, were examined. Overall, 27 patients (73%) had Lenke 5 and 10 (27%) had Lenke 6 curvatures. Instrumentation of the TL curve alone was performed in 59.5%, and thoracic (T) and TL in 40.5% of patients. Overall, 45.9% of patients had two tethers placed in the TL spine; no patients had double tethers placed at the main thoracic curves. The TL (51 ± 8° to 20 ± 11°; p < 0.0001) and T (37 ± 13° to 17 ± 10°; p < 0.0001) curvatures improved from baseline to the latest FU. Overall, 89% of patients achieved major Cobb < 35°; the three patients who did not experienced at least one cord breakage or required PSF. T5-T12 kyphosis increased (p = 0.0401) and lumbar lordosis was maintained (p = 0.9236). Both the TL inclinometer (16 ± 4º to 4 ± 2°; p < 0.0001) and T (6 ± 4° to 4 ± 3°; p = 0.0036) measurements improved. There was a 49% tether breakage rate as follows: 60% for single-cord TL constructs and 35% for double cords (p = 0.0991). There was an 8.1% re-operation rate as follows: one conversion to T PSF and revision of the TL tether; one release of the T tether and revision of the TL tether; one screw revision for radiculopathy. One patient was re-admitted for poor pain control. Conclusions: Patients with TL major curvature treated with VBT experienced a high rate of clinically successful outcomes with maintenance of lumbar lordosis and relatively low complication rates at the latest FU.

The impact of contextual effects in exercise therapy for low back pain: a systematic review and meta-analysis

BackgroundLow back pain is the leading cause of global disability for which exercise therapy is a widely recommended treatment. Research indicates that contextual factors may also influence treatment outcomes in low back pain. Examples include the patient-therapist relationship and other treatment-related circumstances that affect patient expectations. By focusing on the specific treatment effect, clinical trials often ignore the effect of contextual factors, thereby contributing to the so-called efficacy paradox. This means that treatment effects observed in clinical practice are often greater than those reported in clinical trials.This systematic review aims to investigate the proportion of improvement in pain and disability that can be attributed to contextual effects in the outcome of exercise therapy for patients with low back pain.MethodsA meta-analysis was conducted. PubMed, Embase, and the Cochrane database were searched for eligible articles reporting randomized controlled trials that compared exercise therapy to placebo interventions. Risk of bias was assessed with the Revised Cochrane Risk of Bias Tool. Outcomes of interest were pain and disability. Meta-analysis was carried out to calculate the proportion attributable to contextual effects for both pain and disability. The body of evidence was assessed using the GRADE methodology.ResultsEight studies met the inclusion criteria and were included in the meta-analysis. Five studies were rated as having a moderate risk of bias and two studies had a low risk of bias. Proportion attributable to contextual effects was 0.60 (95% CI 0.40–0.89) for pain and 0.69 (95% CI 0.48–1.00) for disability. Certainty of the evidence as assessed with the GRADE methodology was low.ConclusionsA large extent of pain and disability improvement after exercise therapy in low back pain is attributable to contextual effects although this conclusion is based on low certainty evidence.

Platelet Rich Plasma in the Management of Recurrent Lumbar Disc Surgery; A Study of Ten Cases

Low back pain (LBP) is a very common entity, now regarded as the first cause of disability worldwide. Intervertebral disc (IVD) degeneration leads to posterior rupture annulus fibrosus (AF) with extrusion of Central Nucleus pulposus (NP) through the injured area which has little potential to repair as it has no blood supply and causes mechanical pressure and inflammatory changes in the nerve root causing LBP. Autologous platelet rich plasma (PRP) contain concentrate blood that contain a natural concentration of autologous growth factors and cytokines and currently widely used in the clinical setting for tissue regeneration and repair. PRP had great potential to stimulate cell proliferation and metabolic activity of IVD effectively restoring structural change, improving matrix integrity, IVD regeneration, reducing discogenic back pain. Our Study of 10 cases, where repeat or re-exploration surgery (after primary PLID Surgery, fenestration and discectomy) was done, where removal of recurrent disc 5, release of epidural fibrosis and perineural scarring 4 and surgical debridement for discitis 1 was done. In addition, PRP was given in the disc space & around the nerve root which provides lots of growth factor, cytokines which helps in disc regeneration and prevent adhesion & fibrosis. These dual actions enhance symptomatic recovery of all cases. Large scale studies may be required to confirm the clinical evidence of PRP for the treatment of discogenic LBP Bang. J Neurosurgery 2024; 13(2): 70-74

Prevalence and association of musculoskeletal disorders with various risk factors among older Indian adults: Insights from a nationally representative survey.

Globally, Musculoskeletal disorders (MSDs) are the biggest contributor (17%) to years lived with disability. For offering diagnosis and appropriate health interventions options along with follow-up care, it is pertinent to have a thorough awareness of its associated risk factors. The study aims to assess the prevalence and association between MSDs and risk factors among the Indian older adults above 45 years. Prevalence of MSDs among 28,436 participants was estimated using nationally representative survey on older Indian adults. Spatial distribution maps were created to display the magnitude of MSD prevalence at Indian sub-national level. Association between presence of MSDs and associated risk factors (such as occupation, employment duration, physical activity, BMI, diabetes, hypertension, tobacco usage, and alcohol consumption) was explored through Multivariate logistic regression. P-value <0.05 was considered as statistically significant. MSD was prevalent in over half of participants (53.5 (52.9-54.1)%), with more among females and in those aged >60 years (60.4 (59.3-61.4)%). Overall, joint pain (41.9 (41.3-41.4)%) was more common than back pain (32.6 (32.0-33.1)%). Prevalence was highest in Manipur (81.1 (77.9-83.9)%) and lowest in West Bengal (33.1 (30.7-35.5)%). MSD presence was positively associated with certain occupational groups, pre-obesity (BMI 25-29.9 Kg/m2), currently hypertensive, vigorous physical activity among overall population. Tobacco usage was positively associated, while alcohol consumption was linked to a lower occurrence of MSDs for 45-60 years age group. Customised policy interventions can be developed for specific age category of older Indian adults and musculoskeletal health can be improved by addressing modifiable risk factors such as physical inactivity, tobacco usage, avoiding workplace risks in occupations requiring manual labour as revealed by this study.

Efficacy of Epidural Steroid in Controlling Pain After Unilateral Biportal Endoscopic Discectomy for Single-Level Lumbar Disc Herniation: A Randomized, Double-Blind, Placebo-Controlled Trial.

The effects of epidural steroid (ES) administration following open or minimally invasive surgery lumbar discectomy have been extensively studied. However, no research has investigated the impact of steroids following the unilateral biportal technique endoscopic lumbar discectomy (UBE-D) for lumbar disc herniation. This study aims to evaluate the efficacy of ES administration in controlling postoperative pain and disability scores following UBE-D for single-level lumbar disc herniation. This double-blind, randomized, placebo-controlled trial was conducted between June 2021 and June 2023. Eighty-two patients were assessed, and 60 were eligible and randomized to receive either ES (n = 30) or saline (placebo; n = 30) after UBE-D. The Outcome measures included visual analog scale scores for pain, Oswestry Disability Index scores, morphine consumption over 24 hours, serum C-reactive protein levels, and the occurrence of complications over a 6-month follow-up period. The baseline characteristics were comparable between the 2 groups, with no significant differences observed. Analysis of visual analog scale scores for back and leg pain, as well as Oswestry Disability Index scores, at various postoperative time points (6 hours, 12 hours, 24 hours, 2 weeks, 6 weeks, 3 months, and 6 months), showed no statistically significant differences between the ES and placebo groups (P values ranged from 0.47-0.94). Additionally, no significant differences were found in morphine consumption within the first 24 hours postoperatively (P = 0.85), length of hospital stay (P = 0.36), or C-reactive protein levels at 24 hours and 3 weeks postoperatively (P values ranged from 0.54-0.79) between the 2 groups. Importantly, no postoperative or steroid-related complications were reported in either group within the 6-month follow-up period. ES administration after UBE-D did not significantly reduce postoperative pain, disability scores, or morphine consumption compared with placebo. The findings suggest that routine use of ESs in this context may not provide additional benefits. Clinicians should reconsider the use of epidural steroids as part of standard postoperative management after UBE-D, as the lack of significant improvement in patient outcomes indicates that alternative pain management strategies may be more effective.

Association between Pre-operative Vitamin-D level and Shortterm Clinical Outcomes Regarding Pain &amp; Disability following PLID surgery

Background: Low back pain (LBP) is a common problem affecting 70% of the population in the developed countries and prevalence is also increasing in the developing countries. There were strong associations between vitamin D deficiency and LBP. According to the latest report in Bangladesh 86% (eighty-six percent) people had hypovitaminosis- D. A high prevalence of vitamin D deficiency is seen in patients with degenerative diseases of the spine. Considering the hypovitaminosis D led to musculoskeletal issues we want to examine the level of vitamin D in patients before PLID surgery and observe its impact 01 month postoperatively regarding pain &amp; disability outcomes by Visual Analogue Scale (VAS) &amp; Oswestry Disability Index (ODI). Objectives: The objective of this study was to evaluate an association between preoperative Vitamin-D level and short-term outcome regarding pain &amp; disability following PLID surgery. Materials and Methods: This cross-sectional observational study will be conducted in the Department of Neurosurgery, Bangabandhu Sheikh Mujib Medical University. Patient’s data will be collected in questionnaire/data collection sheet. All the patient will be evaluated by serum Vitamin-D level preoperatively. Patient will be clinically assessed by VAS (Visual Analogue Scale) score and ODI (Oswestry Disability Score) preoperatively and 01 month postoperatively. Then our aim is to determine a relationship between pre-operative Vitamin-D level and mean difference between pre and post-operative VAS &amp; ODI Score. Statistical analysis: Data was processed and analyzed by using computer software SPSS (Statistical Package for Social Sciences) version 22. Appropriate statistical test for data analysis (Unpaired T-test) was done. Statistical significance was set at pvalue &lt;0.05. Results: In this study population, the mean age was 42.84 ± 10.14 years ranging from 31 to 78 years. Out of 38 patients 17 (45%) patients had hypovitaminosis-D and 19 (55%) patient had normal vitamin-D level. 15 (39.5%), 11 (28.9%), 10 (26.3%) and 2 (5.3%) patients were service holder, housewife, Businessman and other (retired) respectively. T-test &amp; Chi square test showed positive association between preoperative vitamin-D level and post-operative clinical outcome regarding pain and disability, with a significant p-value of p = &lt;0.05. Conclusion: Our study has showed an association between Pre-operative Vitamin-D level and post-operative clinical outcome regarding pain &amp; disability, that is, insufficient Vitamin-D level leads to decrease alleviation of symptoms following PLID surgery. Bang. J Neurosurgery 2024; 13(2): 75-85