Chronic Discogenic Low Back Pain Research Articles

Prognostic Factors Affecting Therapeutic Efficacy of Intradiscal Steroid Injection in Patients with Chronic Discogenic Low Back Pain

Prognostic Factors Affecting Therapeutic Efficacy of Intradiscal Steroid Injection in Patients with Chronic Discogenic Low Back Pain

Safety and Feasibility of Intradiscal Administration of Matrilin-3-Primed Adipose-Derived Mesenchymal Stromal Cell Spheroids for Chronic Discogenic Low Back Pain: Phase 1 Clinical Trial

Functionally enhanced mesenchymal stromal cells participate in the repair of intervertebral disc. This study aimed to assess the safety and tolerability of intradiscal administration of matrilin-3-primed adipose-derived stromal cell (ASC) spheroids with hyaluronic acid (HA) in patients with chronic discogenic low back pain (LBP). In this single-arm, open-label phase I clinical trial, eight patients with chronic discogenic LBP were observed over 6 months. Each patient underwent a one-time intradiscal injection of 1 mL of 6.0 × 106 cells/disc combined with HA under real-time fluoroscopic guidance. Safety and feasibility were gauged using Visual Analogue Scale (VAS) pain and Oswestry Disability Index (ODI) scores and magnetic resonance imaging. All participants remained in the trial, with no reported adverse events linked to the procedure or stem cells. A successful outcome-marked by a minimum 2-point improvement in the VAS pain score and a 10-point improvement in ODI score from the start were observed in six participants. Although the modified Pfirrmann grade remained consistent across all participants, radiological improvements were evident in four patients. Specifically, two patients exhibited reduced high-intensity zones while another two demonstrated decreased disc protrusion. In conclusion, the intradiscal application of matrilin-3-primed ASC spheroids with HA is a safe and feasible treatment option for chronic discogenic LBP.

Efficacy of stepped care treatment for chronic discogenic low back pain patients with Modic I and II changes

ObjectiveThis study investigated whether patients with Modic changes (MC) of types I, I/II, and II would respond to an anti-inflammatory-based, stepped care treatment with three treatment steps: first, oral administration of NSAIDs, 2 × 200 mg celecoxib daily for two weeks; second, an intradiscal steroid injection (ID) with dexamethasone and cefazolin; and third, oral treatment with antibiotics (AB), 3 × 1 g amoxicillin daily for 100 days. DesignThis was an observational clinical study based on analyses of categorical data of patient-reported outcome measurements. SubjectsSubjects were consecutive patients with chronic low back pain (CLBP), diagnosed by assessment of anamnestic signs of inflammation; a pain score ≥6 on the Numeric Pain Rating Scale (NPRS); a mechanical assessment; MC I, I/II, or II based on MRI; and lack of response to conservative treatment. MethodsFrom January 1, 2015, to December 31, 2021, 833 eligible patients were selected for the stepped care treatment. A total of 332 patients completed requested follow-up questionnaires at baseline and 12 months (optional at 3 and 6 months). Primary outcomes were pain (at least 50 % pain relief) and/or a minimum of 40 % improvement in functionality as measured by the Roland Morris Disability Questionnaire (RMDQ) or the Oswestry Disability Questionnaire (ODI). Secondary outcome measures were use of pain medication and return to work. ResultsAt 1 year of follow-up, 179 (53.6 %) of 332 patients reported improvement according to the responder criteria. Of the 138 patients that had received only NSAIDs, 88 (63.8 %) had improved. In addition, 50 (56.8 %) of the 183 patients that had received ID had improved, and 41 (38.7 %) of the 106 patients treated with AB had improved. None of the patients reported complications. 12.0 % of patients using AB stopped preterm due to undesirable side effects. ConclusionTreatment with a stepped care model for inflammatory pain produced clinically relevant, positive reported outcomes on pain and/or function. Our stepped care model appears to be a useful, safe, and cost-saving treatment option that is easily reproducible. Further studies, including randomized controlled trials and analyses of subgroups, may help to develop a more patient-tailored approach and further avoidance of less-effective treatments and costs.

The clinical efficacy of ozone combined with steroid in the treatment of discogenic low back pain: a randomized, double-blinded clinical study.

This randomized double-blinded clinical study is to investigate the clinical efficacy of per-paravertebral disk ozone injection combined with steroids in the treatment of patients with chronic discogenic low back pain (CDLBP). Group A (N = 60) received a per-paravertebral injection of a steroid mixture of 10 mL with pure oxygen 20 mL, while group B (N = 60) received a per-paravertebral injection of a steroid mixture of 10 mL combined with ozone 20 mL (30 μg/mL). Injections were administered once a week for 3 weeks, with a follow-up of 6 months. Clinical outcomes were assessed at week 1, month 3, and month 6 with the help of Visual Analog Scale (VAS) scores and Macnab efficacy evaluation. The VAS score of both group A (1.65 vs. 6.87, p = 0.000) and group B (1.25 vs. 6.85, p = 0.000) at week 1 was significantly reduced compared to baseline. The effect was sustained at the 3- and 6-month follow-up periods (p < 0.05). Group B had significantly lower VAS scores at month 3 (1.53 vs. 3.82, p = 0.000) and month 6 (2.80 vs. 5.05, p = 0.000) compared to group A, respectively. Based on Macnab criteria, 95 and 96.7% of patients in groups A and B had good rates "excellent plus good" at week 1, respectively. Good rates were significantly higher in group B at month 3 (91.7 vs. 78.3%, p = 0.041) and month 6 (85.0 vs. 68.3%, p = 0.031) compared to group A, respectively. No serious adverse events were noted in both groups. Per-paravertebral injection of steroid and ozone combination resulted in better relief of CDLBP compared to pure oxygen plus steroid. ChiCTR2100044434 https://www.chictr.org.cn/showproj.html?proj=121571.

Magnetic resonance spectroscopy (MRS) identification of chemically painful lumbar discs leads to improved 6-, 12-, and 24-month outcomes for discogenic low back pain surgeries.

MRS was shown to reliably quantify relative levels of degenerative pain biomarkers, differentiating painful versus non-painful discs in patients with chronic discogenic low back pain (DLBP), and this correlates with surgical success rates. We now report results based on more patients and longer follow-up. Disc MRS was performed in DLBP patients who subsequently received lumbar surgery. Custom post-processing (NOCISCAN-LS®; Aclarion Inc.) calculated disc-specific NOCISCORES® that reflect relative differences in degenerative pain biomarkers for diagnosing chemically painful discs. Outcomes in 78 patients were evaluated using Oswestry Disability Index (ODI) scores. Surgical success (≥ 15-point ODI improvement) was compared between surgeries that were "Concordant" (Group C) versus "Discordant" (Group D) with NOCISCORE-based diagnosis for painful discs. Success rates were higher for Group C versus Group D: 6months (88% vs. 62%; p = 0.01), 12months (91% vs. 56%; p < 0.001), and 24months (85% vs. 63%; p = 0.07). Success rates for Group C surgeries were also higher than Group D surgeries in a variety of sub-group comparisons. Group C had a greater reduction in ODI from pre-operative to follow-up than Group D [absolute change (% change), (p)]: 6months: - 35 (- 61%) versus - 23 (- 39%), (p < 0.05);12months: - 39 (- 69%) versus - 22 (- 39%), (p < 0.01); and 24months: - 38 (- 66%) versus - 26 (- 48%), (p < 0.05). More successful, sustained outcomes were obtained when surgically treating chemically painful discs identified by NOCISCAN-LS post-processed disc MRS exams. Results suggest that NOCISCAN-LS provides a valuable new diagnostic tool to help clinicians better select treatment levels.

Clinical Presentation and Categorisation of Chronic Low Back Pain: A Cross-sectional Analysis of 1000 Outpatients in Eastern India

Introduction: Low back pain is one of the most common presenting symptom among patients seeking medical help, accounting for approximately 85% of the cases. It affects individuals of all age groups and genders. Predominantly back pain is non specific, lacking identifiable patho-anatomy, while a lesser-known type, specific low back pain, demonstrates identifiable aetiology and pathology. This poses a challenge for physicians, as they must not only determine the underlying cause but also formulate categorical treatments for Chronic Low Back Pain (CLBP). Aim: To assess the prevalence of different types of CLBP based on clinical examination, past history, age, and gender in the overall population of the study. Materials and Methods: A cross-sectional study was conducted at Kalinga Institute of Medical Sciences (KIMS), Bhubaneswar, Odisha, India, from August 2019 to July 2021. A total of 1,640 patients were examined in the orthopedics outpatient department, of which 1,000 patients aged between 20 and 60 years, with back pain lasting three months, were included in the study. All patients underwent a detailed clinical evaluation, including history and physical examination. The final type of CLBP was determined based on the predominant symptom. Data analysis was performed using Microsoft Excel software. Results: The male-to-female ratio was 1.23:1, and the average age was 43.1 years. The most common type of CLBP was neuropathic (n=473, 47.3%), followed by discogenic CLBP (n=255, 25.5%). The least common type was coccydynia (n=4, 0.4%). Facetogenic CLBP had the highest average age of presentation (57.3 years), while postural CLBP had the lowest average age (29.6 years). Conclusion: Neuropathic CLBP was the most common type, followed by discogenic CLBP, with sacroiliitis and coccydynia being less common. Detailed clinical evaluation aids in classifying different types of CLBP, which can help avoid unnecessary investigations, except for the neuropathic type and, to some extent, instability CLBP.

Oxygen-Ozone Discolysis for the Treatment of Non-Radicular Discogenic Chronic Low Back Pain: A Prospective Clinical Trial

Oxygen-Ozone Discolysis for the Treatment of Non-Radicular Discogenic Chronic Low Back Pain: A Prospective Clinical Trial

Low Back Pain, Disability, and Quality of Life One Year following Intradiscal Injection of Autologous Bone Marrow Aspirate Concentrate.

Degenerative disc disease is a common cause of chronic low back pain. Surgical intervention is an invasive treatment associated with high costs. There is growing interest in regenerative medicine as a less invasive but direct disc treatment for chronic discogenic low back pain. To evaluate clinical improvement of primary discogenic low back pain with intradiscal injection of autologous bone marrow aspirate concentrate (BMAC). Study Design. Prospective cohort study. Setting. Single, multiphysician center. Patients. 32 adult patients undergoing intradiscal injection of autologous BMAC for the treatment of primary discogenic low back pain. Interventions. Intradiscal injection of autologous BMAC. Main Outcome Measures. Primary outcome measure is visual analog back pain scale (VAS back pain). Secondary outcome measures include ODI, VAS leg pain, and EQ-5D-5L scores. Outcomes were compared from baseline to 1 year. Thirty-two patients (56.3% male) with a mean age of 45.9 years were enrolled, giving 92 treated levels. Mean VAS back and leg pain scores improved from 5.4 to 3.0 (p < 0.001) and 2.8 to 1.3 (p = 0.005), respectively. Mean ODI scores decreased from 33.5 to 21.1 (p < 0.001), and EQ-5D-5L scores improved from 0.69 to 0.78 (p = 0.001). Using established MCID values, 59.4% had clinically significant improvement in VAS back pain, 43.8% in VAS leg pain, and 56.3% in ODI scores. Intradiscal injection of autologous BMAC significantly improved low back pain, disability, and quality of life at one year. This study suggests that intradiscal BMAC has the potential to be an effective nonsurgical treatment for chronic discogenic low back pain.

A prospective study of BurstDR™ spinal cord stimulation for non-operated discogenic low back pain.

Chronic discogenic low back pain (CD-LBP) is caused by degeneration of the disc due to trauma to the annulus or by unprovoked degeneration, resulting in chronic pain. Spinal cord stimulation (SCS) employing the BurstDR™ waveform has been shown to be an effective treatment in a variety of chronic pain conditions. The aim of this prospective case study was to determine the effect of BurstDR™ SCS on pain relief, disability, and patient satisfaction in a population with CD-LBP. Seventeen subjects with CD-LBP received a SCS trial with BurstDR™ stimulation. Patients with >50% pain relief after a trial period of 2 weeks were permanently implanted (n=15). Patients then rated LBP and leg pain using the numeric rating scale (NRS), Oswestry disability index (ODI), patient global impression of change (PGIC), EQ-5D quality of life, and painDETECT for neuropathic pain at baseline following trial, 3, 6, and 12 months after permanent implantation. Treatment with BurstDR™ SCS resulted in significant reduction of LBP as the NRS was reduced from 71.7 ± 7.3 at baseline to 42.5 ± 18.1 at 12 months. Average pain relief at 12 months was 42.5%. In patients with leg pain (n=8), pain was significantly reduced from 66.9 ± 8.2 to 11.7 ± 10.4 at 12 months. PainDETECT scores for neuropathic pain significantly reduced from 18.9 ± 4.8 at baseline, and 14.8 ± 3.2 at 12 months. Baseline ODI score significantly reduced from 41.2 ± 12.8 to 25.8 ± 8.6 at 12 months. PGIC scores remained low from 2.6 ± 1.6 at 3months, 2.5 ± 1.0 at 6months, and 2.5 ± 1.3 at 12 months. EQ-5D-5L rates remained constant from baseline 56.10 ± 23.9 to 68.6 ± 12.9 at 12 months. BurstDR™ SCS resulted in significant reduction of back pain, leg pain, and quality of life in patients with CD-LBP and decreased the level of disability and generated positive patient satisfaction scores.

Target-oriented Percutaneous Lumbar Annuloplasty in Ambulatory Spine Center: Proctorship Description of Technique

Objective: To describe an alternative technique of annuloplasty for treatment of chronic discogenic back pain in an ambulatory setting.Method: A retrospective review of all patients presenting with chronic discogenic low back pain and managed by target-oriented thermal annuloplasty at our institute from May 2015 to June 2019 was performed. The procedure is carried out under local anaesthesia in prone position. The principle of the technique relies on dividing the posterior annulus into nine equal segments on AP-view of the C-arm. The trajectory is through the Kambin’s triangle in a horizontal trajectory as much as possible to target the posterior part of the disc annulus. Each of the nine segments is treated with radio-frequency probe to produce disc alterations required to relieve the pain.Results: A total of 9 patients were treated by this method with an average follow-up of 28.1±11.4 months. The average VAS improved from 4.1±1.2 to 2.5±0.4 at final follow-up. The ODI improved from 42±6.7 to 19.98±5.6. None of the patients had any complications. The patient satisfaction rate was 82%, the rate of return to daily life was 100% and recommendation rate to others was 100%.Conclusion: Target-oriented lumbar percutaneous nine point annuloplasty may be considered as a viable option for chronic discogenic back pain patients with relatively well-maintained disc heights. A successful outcome depends upon proper patient selection and correct trajectory.

“Back Rx, a personalized mobile phone application for discogenic chronic low back pain: a prospective pilot study”

BackgroundIntervertebral disc pathology is the most common identifiable cause of chronic lower back pain (CLBP). There are limited conservative alternatives to treat discogenic axial CLBP. Back Rx is a mobile application (app) developed to treat patients with this condition, following the Back Rx exercise program, assisted by a virtual coach.MethodsPatients 18 to 65 years of age, with axial CLBP (more than 3 months), and evidence of lumbar disc pathology by magnetic resonance imaging (MRI) were enrolled to the study. Patients’ symptomatology was prospectively evaluated at baseline and after 3 months of using the Back Rx app. The main outcome of the study was back pain evaluated using the visual analog scale (VAS) for pain. Secondary outcomes were the patient's functionality, the weekly pain medication intake, the patients’ adherence to the app, and the patients´ satisfaction rate.ResultsSeventy-five patients with CLBP were enrolled in the study. All patients had a statistically significant improvement from baseline to final follow-up in the average VAS scores, and the functionality evaluations. Average VAS scores decreased from 5.17 ± 2.1 at baseline to 3.8 ± 2.6 at final follow-up (P = 0.016). Patients showed a significant decrease in the number of pain medications taken during a week (P = 0.001). Overall compliance with the app was 52%, and 65% of the patients rated the overall experience as good or excellent.ConclusionThe Back Rx app decreased pain and increased function in patients with discogenic axial CLBP compared to their baseline status. Further measures are needed to increase patients' compliance with the app and the Back Rx program.Trial registrationRetrospectively registered in 2/2/2017 NCT03040310 (ClinicalTrials.gov).

PO134 / #801 DEVELOPMENT OF AN ANIMAL MODEL OF DISCOGENIC LOW BACK PAIN FOR USE IN NEUROMODULATION STUDIES: E-POSTER VIEWING

In patients with chronic discogenic low back pain (CDLBP), the intervertebral disc degenerates. Subsequent development of inflammation and nerve ingrowth causes chronic pain 1–3. For CDLBP patients, conventional pain medication is often not sufficient. Neuromodulation has shown to be an effective method for reducing pain4. To test novel stimulation parameters, appropriate animal models for DLBP compatible with neuromodulation must be developed. Here, we investigate the applicability of a CDLBP animal model for studying the effectivity and mechanisms of neuromodulation5.

P64. Intradiscal injection of autologous bone marrow aspirate concentrate improves low back pain at one year

<h3>BACKGROUND CONTEXT</h3> Chronic low back pain is one of the leading causes of disability and poor quality of life in the US and worldwide. A common cause of chronic low back pain is degenerative disc disease. Current nonsurgical treatments for degenerative disc disease-associated low back pain are typically effective. However, for patients who fail these treatments, surgical fusion is often used as last line treatment. Surgical treatment is associated with higher health care expenditures and a more invasive procedure. As such, there is growing interest in the field of regenerative medicine and stem cell therapy as a less invasive treatment for low back pain. <h3>PURPOSE</h3> The purpose of this study was to investigate the effect of autologous bone marrow aspirate concentrate (BMAC) on patients with symptomatic lumbar degenereative disc disease at one year. <h3>STUDY DESIGN/SETTING</h3> Single institution prospective cohort study. <h3>PATIENT SAMPLE</h3> A total of 32 adult patients. <h3>OUTCOME MEASURES</h3> Mean ODI, EQ-5D-5L, VAS back pain, and VAS leg pain scores. <h3>METHODS</h3> A total of 32 consecutive patients over the age of 18 years diagnosed with discogenic low back pain clinically or by discography who underwent injection of autologous intradiscal BMAC at a single multi surgeon orthopedic spine center were included in this study. Active smokers and patients who had pain generators other than purely discogenic pain were excluded. For primary analysis, patients completed baseline and 1 year post-injection ODI, VAS back, VAS leg, and EQ-5D-5L questionnaires; their scores were compared over time. Preprocedural lumbar MRIs were reviewed for Modic changes and assigned a Pfirrmann grade. Thirteen postprocedural MRIs were available and reviewed using the same parameters. <h3>RESULTS</h3> Thirty-two patients (56.3% male) with a mean age of 45.9 (range 19-65) underwent BMAC injection between 1 and 6 levels completed 1 year follow up. Mean VAS back and leg scores improved from 54.0 to 30.4 (p < 0.001) and 27.9 to 13.3 (p=0.005), respectively. Mean ODI scores decreased from 33.5 to 21.1 (p < 0.001), and EQ-5D-5L scores improved from 0.69 to 0.78 (p=0.001). Using established minimum clinically important difference values, 59.4% of patients saw a clinically significant improvement in VAS back pain, 43.8% in VAS leg pain, and 56.3% in ODI scores. On pre-procedural MRIs, 62.5% of patients had a Modic score of 1 or 2 and 93.8% had a Pfirrmann grade of 3 or higher. Postprocedural MRIs were available for 13 patients, and 61.5% had no measurable change in Pfirrmann grade. Three patients worsened by one Pfirrmann grade and one improved by 1 grade. <h3>CONCLUSIONS</h3> Intradiscal injection of autologous BMAC was shown to significantly improve pain and quality of life at one year. Additionally, this study meets 88% of recently published AAOS reporting standards for studies relating to mesenchymal stem cells. The results of this study suggest that intradiscal injection of autologous BMAC has the potential to be an effective non-surgical treatment for chronic discogenic low back pain. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

A High Body Mass Index and the Vacuum Phenomenon Upregulate Pain-Related Molecules in Human Degenerated Intervertebral Discs.

Animal studies suggest that pain-related-molecule upregulation in degenerated intervertebral discs (IVDs) potentially leads to low back pain (LBP). We hypothesized that IVD mechanical stress and axial loading contribute to discogenic LBP’s pathomechanism. This study aimed to elucidate the relationships among the clinical findings, radiographical findings, and pain-related-molecule expression in human degenerated IVDs. We harvested degenerated-IVD samples from 35 patients during spinal interbody fusion surgery. Pain-related molecules including tumor necrosis factor alpha (TNF-alpha), interleukin (IL)-6, calcitonin gene-related peptide (CGRP), microsomal prostaglandin E synthase-1 (mPGES1), and nerve growth factor (NGF) were determined. We also recorded preoperative clinical findings including body mass index (BMI), Oswestry Disability Index (ODI), and radiographical findings including the vacuum phenomenon (VP) and spinal instability. Furthermore, we compared pain-related-molecule expression between the VP (−) and (+) groups. BMI was significantly correlated with the ODI, CGRP, and mPGES-1 levels. In the VP (+) group, mPGES-1 levels were significantly higher than in the VP (−) group. Additionally, CGRP and mPGES-1 were significantly correlated. Axial loading and mechanical stress correlated with CGRP and mPGES-1 expression and not with inflammatory cytokine or NGF expression. Therefore, axial loading and mechanical stress upregulate CGRP and mPGES-1 in human degenerated IVDs, potentially leading to chronic discogenic LBP.

439 A Colloidal Polymethyl-Methacrylate (PMMA) Microsphere-Based Treatment for Patients with Symptomatic Discogenic Disease: A Safety and Feasibility Clinical Trial

INTRODUCTION: Low Back Pain (LBP) is a global healthcare issue, and first line therapy for patients with LBP include physical therapy, oral pain relievers, and steroid injections. If unsuccessful, surgical procedures are indicated. Non-surgical second-line treatments for LBP are warranted, and one example is DiscSeal, a colloidal form of viscous gel composed of polymethyl-methacrylate microspheres and aqueous buffered sodium hyaluronate. METHODS: Six participants were enrolled. The study population comprised of males/females between the ages of 18 and 70, diagnosed with chronic LBP of six months or more prior to enrollment determined to be predominantly caused by discogenic disease of the lumbar spine who failed at least six weeks of conservative management. Participants completed visits at 7, 14, 42, 90, and 180 days. RESULTS: The mean age of participants was 38.8 ± 10.0 years. The mean DiscSeal volume administered was 1.62 ± 0.35 mL with a range between 1.1-2.0 mL. The mean procedure time was 10.8 minutes. Mean LBP visual analog scale (VAS) percentage changes from baseline were -27.0% at 90 days and -42.3% at 180 days, with 50.0% of participants maintaining LBP VAS scores &lt;4 at 90- and 180-days post treatment with DiscSeal. Similarly, mean leg pain VAS percentage changes from baseline were -47.0% at 90 days and -36.6% at 180 days. Overall, participants' average improvement, assessed by Patient Rating Overall Health Status, was 55.2% at 90 days and 67.8% at 180 days. CONCLUSION: The results from this first-in-man trial suggest a favorable safety and efficacy profile for the continued study of DiscSeal. Future studies evaluating DiscSeal as a minimally invasive therapy for chronic discogenic LBP are warranted.

The Viable Disc Tissue Allograft Supplementation (VAST) Randomized Controlled Trial in Patients with Chronic Discogenic Low Back Pain: Correlating Age with Clinical Outcome

The Viable Disc Tissue Allograft Supplementation (VAST) Randomized Controlled Trial in Patients with Chronic Discogenic Low Back Pain: Correlating Age with Clinical Outcome

Non randomised trial of GRAVITY system therapy effectiveness in chronic, low intensity low back disc disease

Abstract Study aim: Chronic low back pain (CLBP) is a therapeutically challenging pain syndrome. Physical exercises are the most common therapy used in CLBP treatment. The aim of the study was to verify if GRAVITY system exercise can be effective in the therapy of chronic discogenic low back pain. The GRAVITY system exercise aims at strengthening full body muscles using the trainee’s own body weight only. Material and methods: The study was registered at ClinicalTrials.gov Identifier: NCT04765293. We used TREND statement. The study populations were 50 patients with CLBP. The study population (group I) consisted of 25 patients who had GRAVITY system exercise. The clinical control group were 25 patients who received standard treatment in an outpatient clinic of National Health Fund. Before the start of the training, the patients’ had their muscle strength responsible for stabilizing the lumbar segment measured. We also measured patients’ Oswestry Disability Index (ODI) prior to and after the therapy cycle. The therapy was conducted twice a week for 40 minutes over the period of 4 weeks. The clinical control group were 25 patients who received treatment from the National Health Fund and had only standardised physical therapy (laser, ultrasound, cryotherapy and magnetic therapy) sessions for two weeks. Results. We found statistically significant reduction in pain and disability in the study population after the treatment, but muscle strength did not increase significantly. Conclusions: 1. GRAVITY system exercise might efficient in pain and disability reduction. Muscle strength did not increase after therapy. 2. Pain and disability had positive correlation with female sex, decreased physical activity and sedentary work.

Effect of age on outcomes after allogeneic disc tissue supplementation in patients with chronic discogenic low back pain in the VAST trial.

Aim:To explore the effects of viable allogeneic disc tissue supplementation in younger patients with discogenic chronic low back pain (CLBP). Patients & methods: VAST was a randomized placebo-controlled trial of disc allograft supplementation in 218 patients with discogenic CLBP. We conducted a post hoc analysis of change from baseline to 12months in Oswestry Disability Index (ODI) and visual analog scale for pain intensity scores stratified by patient age. Results: Patients aged <42years receiving allograft experienced greater improvement in ODI (p=0.042) and a higher ODI response rate (≥10-, ≥15- and ≥20-point reductions in ODI) than those receiving saline (p=0.001, p=0.002 and p=0.021, respectively). Conclusion: Young patients with discogenic CLBP may have significant functional improvement following nonsurgical disc allograft supplementation.

Machine learning-augmented objective functional testing in the degenerative spine: quantifying impairment using patient-specific five-repetition sit-to-stand assessment.

What is considered "abnormal" in clinical testing is typically defined by simple thresholds derived from normative data. For instance, when testing using the five-repetition sit-to-stand (5R-STS) test, the upper limit of normal (ULN) from a population of spine-healthy volunteers (10.5 seconds) is used to identify objective functional impairment (OFI), but this fails to consider different properties of individuals (e.g., taller and shorter, older and younger). Therefore, the authors developed a personalized testing strategy to quantify patient-specific OFI using machine learning. Patients with disc herniation, spinal stenosis, spondylolisthesis, or discogenic chronic low-back pain and a population of spine-healthy volunteers, from two prospective studies, were included. A machine learning model was trained on normative data to predict personalized "expected" test times and their confidence intervals and ULNs (99th percentiles) based on simple demographics. OFI was defined as a test time greater than the personalized ULN. OFI was categorized into types 1 to 3 based on a clustering algorithm. A web app was developed to deploy the model clinically. Overall, 288 patients and 129 spine-healthy individuals were included. The model predicted "expected" test times with a mean absolute error of 1.18 (95% CI 1.13-1.21) seconds and R2 of 0.37 (95% CI 0.34-0.41). Based on the implemented personalized testing strategy, 191 patients (66.3%) exhibited OFI. Type 1, 2, and 3 impairments were seen in 64 (33.5%), 91 (47.6%), and 36 (18.8%) patients, respectively. Increasing detected levels of OFI were associated with statistically significant increases in subjective functional impairment, extreme anxiety and depression symptoms, being bedridden, extreme pain or discomfort, inability to carry out activities of daily living, and a limited ability to work. In the era of "precision medicine," simple population-based thresholds may eventually not be adequate to monitor quality and safety in neurosurgery. Individualized assessment integrating machine learning techniques provides more detailed and objective clinical assessment. The personalized testing strategy demonstrated concurrent validity with quality-of-life measures, and the freely accessible web app (https://neurosurgery.shinyapps.io/5RSTS/) enabled clinical application.

Епідуральне введення кортикостероїдів у лікуванні хронічного дискогенного болю в нижній частині спини

Актуальність. Біль у нижній частині спини залишається однією з найпоширеніших проблем хребетного стовпа та хронічних больових синдромів взагалі. Вона є частою причиною втрати працездатності, а витрати на неї вражають значністю сум. На сьогодні існують три напрямки лікування дискогенного болю — фізіотерапевтичний, медикаментозний і хірургічний. Інтервенційне лікування дискогенного болю шляхом уведення лікарських препаратів у епідуральний простір однаковою мірою можна віднести як до малоінвазивної хірургії, так і до активної таргетной терапії. Мета дослідження — вивчити динаміку больового синдрому в пацієнтів, які страждають від хронічного дискогенного болю в нижній частині спини, при використанні в їх лікуванні епідуральних стероїдних ін’єкцій. Матеріали та методи. У ретроспективне дослідження включено 74 пацієнти віком від 25 до 83 років (середній вік — 53,86 ± 14,27 року), пролікованих із 2015 по 2017 рік у клініці «Нейромед» м. Києва та Ужгородському обласному центрі нейрохірургії та неврології. У всіх досліджуваних після комплексного обстеження діагностовано терапевтично-резистентний хронічний дискогенний біль у нижній частині спини. Нами застосовувалося інтерламінарне та трансфорамінальне введення кортико­стероїдів під радіологічним контролем С-дуги. Всього було виконано 35 (47 %) трансфорамінальних епідуральних ін’єкцій, або блокад, і 39 інтерламінарних епідуральних блокад. За локалізацією проведені маніпуляції було розподілено наступним чином: на рівні L5-S1 — 36 (48 %), на рівні L4-L5 — 17 (23 %), на рівні L3-L4 — 12 (16 %) і на рівні L2-L3 — 9 (12 %). Больовий синдром оцінювався за 10-бальною візуально-аналоговою шкалою (ВАШ) перед маніпуляцією, через 7 і 30 днів після її проведення. Результати. Ускладнень не зареєстровано. Абсолютно всі пацієнти відзначали зниження больового синдрому. Більшість пацієнтів до маніпуляції характеризували свій біль як «дуже сильний, на межі з нестерпним» (7,01 ± 0,86 за ВАШ), а через тиждень після процедури більшість вже описували больові відчуття як «легкі, часом помірні» (3,68 ± 0,87 за ВАШ). Така тенденція зберігалася і через місяць після маніпуляції (1,98 ± 1,01 за ВАШ). Висновки. Епідуральне уведення кортикостероїдів є безпечним і ефективним способом лікування хронічного болю в нижній частині спини. Ця інтервенційна методика дозволяє істотно знизити інтенсивність страждання.