Complain Of Low Back Pain Research Articles

Diffuse metastatic disease of the lumbo-sacral spine mimicking a lumbar disc herniation

This report presents the case of a 39-year-old woman complaining of low back pain with radiation into the right leg and foot. She had been consulting her general practitioner (GP) for 14 months. He had diagnosed a herniated nucleus pulposus at L5/S1 and had prescribed analgesic medication. This report describes how diffuse metastatic disease of the pelvis and lumbo-sacral spine can mimic more common presentations of low back pain with radiating leg pain. The symptoms, pathology and radiographic changes associated with spinal metastases and the role of special imaging in the diagnoses of metastatic disease are discussed.

Poster 91: Tumor infiltration of the piriformis muscle resulting in piriformis syndrome: a case report

Setting: Tertiary care hospital. Patient: A 53-year-old female with high-grade, non-Hodgkin’s lymphoma. Case Description: The patient was admitted to the rehabilitation unit after a complicated hospital course. She complained of persistent right buttock pain associated with pain and numbness radiating down her right posterolateral leg to her lateral foot. She did not complain of low back pain, left lower-extremity symptoms, or bowel or bladder dysfunction. Her pain was accentuated with adduction, internal rotation, and flexion of her right lower limb. She demonstrated tenderness, increased pain, and worsening of symptoms with palpation over the right piriformis muscle. Neurologic exam revealed intact strength with normal tone, however, light touch was abnormal in the right L5-S1 dermatomes. Magnetic resonance imaging revealed an extensive pelvic tumor involving the cervix and adnexal regions extending to the margins of the right piriformis muscle. Assessment/Results: Tumor infiltration throughout the pelvis involving the right piriformis muscle likely resulted in right buttock and lower-extremity pain and parathesias. Discussion: A literature search revealed no other cases of tumor infiltration causing piriformis syndrome. The most common etiology of piriformis syndrome is local trauma resulting in muscle spasm, inflammation, and hypertrophy. As a result, the sciatic nerve is compressed either between the piriformis muscle belly and the bony pelvis or between 2 inflamed fascicles. In this case report, it is probable that compression of the sciatic nerve resulted from direct compression by the tumor or as a result of secondary inflammation within the muscle belly. Furthermore, the tumor infiltration may have caused irritation of the piriformis resulting in muscle spasms and thus compression of the sciatic nerve as it pierced the muscle. Conclusion: Tumor infiltration of the piriformis muscle is a rare cause of piriformis syndrome.

腰椎椎間板ヘルニアにおける腰痛の意義

Lumbar disk hernia (LDH) is a typical desease which causes low back pain (LBP). We analysed LBP in 45 operated cases with L4/5 LDH except for cases of relapse, spondylolysis, and pondylolisthesis between March 1999 and March 2001. 29 patients were treated by microscopic Love operation, 12 patients by laminoplasty and microscopic herniotomy, 4 patients by posterior lumbar interbody fusion (PLIF). 31 patients (68.9%) had LBP as a primary symptom of LDH, and only 3 patients (6.7%) continued to complain of LBP until preoperation. LBP with LDH changed to lower extremity pain. Patients who continue to complain of LBP should undergo fusion if LBP is caused by discography.

Risk factors for the development of low back pain in adolescence.

A previous history and earlier onset of low back pain are associated with chronic low back pain in adults, implying that prevention in adolescence may have a positive impact in adulthood. The study objectives were to determine the incidence of low back pain in a cohort of adolescents and to ascertain risk factors. A cohort of 502 high school students in Montreal, Canada, was evaluated during 1995-1996 at three separate times, 6 months apart. The outcome was low back pain occurrence at a frequency of at least once a week in the previous 6 months. Of the 377 adolescents who did not complain of low back pain at the initial evaluation, 65 developed low back pain over the year (cumulative incidence, 17 percent). Risk factors associated with development of low back pain were high growth (odds ratio = 3.09; 95 percent confidence interval (CI): 1.53, 6.01), smoking (odds ratio = 2.20; 95% CI: 1.38, 3.50), tight quadriceps femoris (odds ratio = 1.02; 95% CI: 1.00, 1.05), tight hamstrings (odds ratio = 1.04; 95% CI: 1.01, 1.06), and working during the school year (odds ratio = 1.33; 95% CI: 1.03, 1.71). Modifying such risk factors as smoking and poor leg flexibility may potentially serve to prevent the development of low back pain in adolescents.

Leg Swelling during Continuous Standing and Sitting Work without Restricting Leg Movement

Leg Swelling during Continuous Standing and Sitting Work without Restricting Leg Movement: Akihiko Seo, et al. Department of Public Health, Hiroshima University School of Medicine—To clarify the dynamics of leg swelling during standing and sitting work without restricting leg movement, lower leg swelling and subjective complaints were measured during work under three working conditions: Straight standing, buttock chair sitting and ordinary chair sitting. Twelve subjects (eight males and four females) were assigned jigsaw puzzles as a task for an hour. The lower leg swelling and subjective complaints were recorded every two minutes. The lower leg swelling was measured by the bioelectrical impedance method. The results were as follows: (1) The lower leg swelling increased during the work under all working conditions. The swelling was least for straight standing and greatest for ordinary chair sitting. The mean and standard deviations for leg swelling after one hour's work were 5.8±3.9% for straight standing, 8.2±4.7% for buttock chair sitting and 9.7 + 7.5% for ordinary chair sitting. (2) The subjective complaints also increased during work. Complaining of lower leg dullness was least for ordinary chair sitting and greatest for straight standing. The relation to the leg swelling was reversed. Complaining of low back pain was more common for buttock chair sitting than for other working postures. It is reasonable that prolonged standing is more likely to cause leg swelling than sitting because of high hydrostatic pressure. This theory has been supported by studies on motionless standing and sitting. Our results obtained without restricting leg movement, however, showed a reversed relation. It was considered that leg swelling factors such as low muscle activity and lymph pumps, low interstitial pressure brought on by low muscle activity, and the seat pressure during prolonged sitting may be dominant in the sitting posture although the hydrostatic pressure was low compared with the standing posture.

A fused pelvic kidney.

A case of fused pelvic kidney is reported. The patient was a 55-year-old Japanese male complaining of low back pain for one year.Urological examination revealed a fused pelvic kidney which was later confirmed by exploratory laparotomy. Radiological examination, especially the “series renal arteriography” was indispensable for the diagnosis of the case.The literature on fused pelvic kidney is reviewed and discussed.

Intraspinal lesions masquerading as protruded lumbar intervertebral disks.

For about every 25 operations performed for protruded lumbar intervertebral disk at the Mayo Clinic, one operation is performed for spinal cord tumor that is so situated that, at some time during its course, it could simulate a protruded lumbar intervertebral disk. One of our cases illustrates this statement especially well. A man, 41, a white collar worker, came to the Mayo Clinic in 1940 complaining of low back pain, with extension along the left sciatic nerve. His symptoms had been present intermittently for the previous three years. Examination revealed slight limitation of forward bending, Laségue's sign of sciatica on the left, diminution of the quadriceps reflex in the left leg, and slight weakness of the left leg. Simple roentgenographic examination of the thoracic and lumbosacral portion of the spinal column showed nothing abnormal. A provisional diagnosis of protruded intervertebral lumbar disk was made and intraspinal investigation was recommended. The