Complaint Of Low Back Pain Research Articles

Case of Unusual Abscess Localization in Lumbar Pott’s Disease

In Pott’s disease, cold abscesses usually sit and spread along the psoas muscle. This case concerned a 60 years old man who came to us with bilateral lomboradicular pain and a swelling of inguinal area and the anterior part of the left thigh. We found a 2 years long lasting story of low back pain complaint. Physical examination showed good general health status, stiffness of lumber spine, a left psoitis and no neurological deficit. CT scan going downward from the lumbar spine to the pelvic region and femoral limb with coronal reconstruction demonstrated a huge disco-vertebral destruction of L2-L3 with translation, and bilateral paramedian psoas abscess migrating subfascially toward Scarpa triangle and cleaving anteriorly mainly muscles of the left thigh. After 12 months medical treatment, the evolution has been favorable with clinical cure. The localization of the cold abscess in the left thigh anterior muscles compatment is uncommon. It is why we report this case.

Association Between Heel-Height and Low Back Pain in Sales Promotion Girls

Background: The Prevalence of LBP in Indonesia continues to increase, while the exact cause cannot be identified. The facts show that most of LBP is caused by occupational health problems rather than organic diseases, which one of them is the habit of wearing high-heeled shoes. Besides having an aesthetic function, high-heeled shoes also give negative effects on health. Objective: To evaluate the association between the usage and duration of high heels with LBP, as well as evaluating disability due to LBP in female salesperson Methods: The study used analytic observational study with cross-sectional design that includes 123 sales promotion girls in one of department stores, Cengkareng, West Jakarta which was carried out from November to December 2015. The data was collected through the interview which includes characteristics of the subjects, complaint history of low back pain (LBP), measurement of heel heights, and anthropometry data. The intensity of pain is assessed by Visual Analogue Scale, whilst the degree of disability is assessed by using Oswestry Low Back Pain Disability Questionnaire. Data analysis is performed by using Fisher’s test with a significance level p<0.05 software SPSS for Windows version 21. Results: The majority of 20 to 25-year-old sales promotion girls with a normal nutritional status wear 5-7 cm-high-heeled shoes for more than one year. About 68% of them complain of low back pain (LBP), where 11% of subjects were obtained with suspected disability due to LBP complaint. The heel heights is not correlated with LPB complaints, but the working period of sales promotion girls is (p=0.000). Conclusion: There is no correlation between high heel shoes with low back pain. There is a relationship between the working period with low back pain.

Bel ve sırt ağrısı olan hastada muhtemel faktör: D vi̇tami̇ni̇ eksi̇kli̇ği̇

Aim: Vitamin D is associated with many musculoskeletal system functions and its deficiency is a common health problem in the world. Lowback and back pain arealso an important health problems in terms of low quality of life, cost of labor loss, diagnosis and treatment approaches. The aim of this study was to investigate the deficiency of vitamin D in patients with complaints of lowback or back pain. Methods: The outpatients between 18-45 years of age, whose vitamin D levelsaremeasured in 2015, were scanned through the hospital information system. Serum 25-(OH) D levels below 20 ng/mL wereconsidered as vitamin D deficiency, 20 ng / mL and above were normal. Patients were divided into two groups according to the presence of pain. The patients who were with lowback or back pain were treated as group 1, and patients who did not complain pain as group 2. Group 1 and group 2 were compared in terms of the presence of vitamin D deficiency. In the analysis of the data, descriptive statistics, mean and standard deviation for continuous variables, and number and percentage for categorical data were used. Chi-square test was used for comparisons. Significance was assessed at a 95% safety interval and p <0.05 was considered as significant. Results: Vitamin D levels were measured in 28,148 of the patients between the ages of 18 and 45 who applied to our hospital during the study period. Vitamin D deficiency was 84.5% in group 1 patients whereas it was 75.7% in group 2 patients. A statistically significant difference was found in patients with lowback or back pains, with a higher incidence of vitamin D deficiency compared to the other group (p = 0.001). Conclusion: Vitamin D deficiency is often asymptomatic and may cause bone and muscle pain. In our study, we frequently observed deficiency of vitamin D in patients with lumbar or back pain. In this context, the level of vitamin D should be evaluated during the approach to lowback and back pain.

Magnetic resonance imaging findings in patients with low backache

Introduction: Low backache is commonly experienced by adults at some time during their lives. Though it is caused by degenerative changes, spinal stenosis, neoplasm, infection and trauma, lumbar disc degeneration is the most commonly diagnosed abnormalities associated. As Magnetic Resonance Imaging (MRI) is non invasive imaging technique with excellent spatial and contrast resolution, it has become the investigation of choice in evaluation of patients with low back pain. This study was designed to determine the patterns of degenerative disc disease on MRI in patients with low backache.Methods: A retrospective hospital based study was done by reviewing MRI report of 202 patients who underwent MRI of lumbar spine for complaint of chronic low back pain, radicular pain, neurogenic claudication or various other symptoms and signs suggestive of lumbar degenerative disc disease from January 2014 till June 2014. The patients having MRI findings of acute spinal infection, recent trauma, tumors, spinal dysraphism and metabolic conditions were excluded from the study.Results: Out of the 202 patients included in the study, 116 patients (57.4%) were male and 86 patients (42.6%) were female. The mean age of the study population was 44.26 ±15.61 (13-83) years. Multiple contiguous level disc disease was the most common type of involvement which was noted in 109 (54%) patients. Grade 4 lumbar disc degeneration (graded as per classification given by Pfirrmann et al) was noted in 65.3% (132) cases followed by Grade 2 in 25.2%(51) cases and Grade 1in 5.5% (11) cases. The most common involvement was observed at L4-L5 level (76.7%) and L5-S1 levels (55.9%) followed by L3-L4 (30.6%) in decreasing order of frequency. The most common category was disc bulge note in 46.5% (94) of cases. Nerve root compression was observed in 56% (114) of the total cases. Nerve root compromise was also noted most frequently compressing L5 nerve (28.23% of cases). Annular tear was observed in 14.4% (29) of cases and among them 20% (6) of cases had torn at two intervertebral discs. It is most frequently noted involving L4-L5 intervertebral disc (72.5% of cases), followed by L5-S1 (24.2% of cases).Conclusion: Disc generation is most common at L4-L5 level with multiple contiguous involvement of grade 4. Annular tear though not common can occur and is also common at L4-L5 level.Journal of Society of Surgeons of Nepal, 2015; 18 (2)

WORK POSTURE RELATIONS WITH MUSCULOSKELETAL DISORDERS IN DUMP TRUCK OPERATOR AT PT HARMONI PANCA MAIN

Improper work posture may affect waist and back pain as well as disruption of the muscularkeletal system. The results of estimates published by NIOSH show that the cost of compensation for musculoskeletal complaints has reached 13 billion dollars annually. This study aims to determine the relationship of work posture with lumbar pain and severity of Muskuloskeletal Disorder at Dump Truck Operators Production Part at PT Harmoni Panca Utama Site East Kalimatan. This research is an analytic survey research with cross sectional design. The population of this research is the dump truck operator in the production section of PT Harmoni Panca Utama Site East Kalimantan totaling 150 people. The number of samples is determined by Purposive Sampling Technique. The instruments used in this study were questionnaires, Nordic Body Map Questioner questionnaires, Video Record and Work Posture Images, a low back pain complaint questionnaire. The data analysis technique used is Spearman rank associative test. Characteristics of respondents in the form: age, employment and BMI have no relationship with the severity of musculoskeletal disorders. The result of spearman rank test analysis between work posture and severity of musculoskeletal disturbance was obtained on peaceful site (p = 0.47) and site singlurus (p = 0.43). Keywords: Work posture, Low back pain, Musculoskeletal

The Relationship Between Sacral Slope and Symptomatic Isthmic Spondylolysis in a Cohort of High School Athletes: A Retrospective Analysis

BackgroundSpondylolysis with and without anterolisthesis is the most common cause of structural back pain in children and adolescents, but few predictive factors have been confirmed. An association between abnormal sacropelvic orientation and both spondylolysis and spondylolisthesis has been supported in the literature. Sacral slope and other sacropelvic measurements are easily accessible variables that could aid clinicians in assessing active adolescents with low back pain, particularly when the diagnosis of spondylolysis is suspected. ObjectiveTo examine the relationship between sacral slope and symptomatic spondylolysis in a cohort of active adolescents. DesignCase-control retrospective study. SettingAcademic outpatient physiatry practice. PatientsSeventy-four patients of primarily adolescent age (between 12 and 22 years old) with a chief complaint of low back pain and presence of lateral radiographs of the lumbar spine were enrolled. Cases (n = 37) were defined as subjects with evidence of spondylolysis on both radiograph and magnetic resonance imaging of the lumbar spine. Controls (n = 37) were defined as subjects without spondylolysis. MethodsUsing a single sagittal radiograph, taken with the patient standing, a fellowship-trained interventional spine physiatrist measured the sacral slope of each subject (angle between the superior plate of S1 and a horizontal reference on sagittal imaging of the lumbosacral spine). Ages and genders were collected from medical records. Main Outcome MeasurementsThe primary outcome was mean sacral slope. Mean sacral slope of cases was compared with mean sacral slope of controls with the Student t-test. ResultsAges ranged from 12 to 22 for both groups, with no significant differences in age between the groups (cases: 16.8 ± 2.3 years; controls: 17.7 ± 2.7 years). The patients with spondylolysis (cases) consisted of 29 male and 8 female patients, whereas those without spondylolysis (controls) consisted of 15 male and 21 female patients (gender details for 1 patient were not available). The mean sacral slope among cases was 42.4°, whereas the mean sacral slope among controls was 37.4°. The difference achieved significance (P = .014). ConclusionsThe interdependence of positional parameters, such as sacral slope, with anatomic parameters, such as pelvic incidence, can affect lumbar lordosis and therefore upright positioning and loading of the spine. Sacral slope may be an important variable for clinicians to consider when caring for young athletes with low back pain, particularly when the index of suspicion for spondylolysis is high. Level of EvidenceIV

Chiropractic Management for US Female Veterans With Low Back Pain: A Retrospective Study of Clinical Outcomes

ObjectiveThe purpose of this study was to determine if female US veterans had clinically significant improvement in low back pain after chiropractic management. MethodsThis is a retrospective chart review of 70 courses of care for female veterans with a chief complaint of low back pain who received chiropractic management through the VA Western New York Healthcare System in Buffalo, New York. A paired t test was used to compare baseline and discharge outcomes for the Back Bournemouth Questionnaire. The minimum clinically important difference was set as a 30% improvement in the outcome measure from baseline to discharge. ResultsThe average patient was 44.8 years old, overweight (body mass index 29.1 kg/m2), and white (86%). The mean number of chiropractic treatments was 7.9. Statistical significance was found for the Back Bournemouth Questionnaire outcomes. The mean raw score improvement was 12.4 points (P < .001), representing a 27.3% change from baseline with 47% of courses of care meeting or exceeding the minimum clinically important difference. ConclusionFor our sample of female veterans with low back pain, clinical outcomes from baseline to discharge improved under chiropractic care. Although further research is warranted, chiropractic care may be of value in contributing to the pain management needs of this unique patient population.

Comprehensive Treatment Strategy for Chronic Low Back Pain in a Patient with Bilateral Transfemoral Amputations Integrating Changes in Prosthetic Socket Design

ABSTRACT Introduction Wounded service members with amputations undergo a complex rehabilitation regimen that can often become complicated by skin breakdown, heterotopic ossification (HO), and pain of the residual limb, contralateral limb, or low back. These complications can impact prosthetic socket fit, decreasing one's functional independence, and potentially negatively impact quality of life. The purpose of this report is to present a case involving the treatment of HO along with prosthetic socket modifications, with the intention to address low back pain (LBP), in a patient with bilateral transfemoral amputations. Materials and Methods The patient experienced traumatic bilateral amputations as a result of an improvised explosive device blast. He was initially fit with ischial containment sockets to provide stability and enhance early mobility. He became a community ambulator but was experiencing LBP and issues with HO. After extensive HO resection, a multidisciplinary discussion took place to determine the best way to diminish LBP by improving spinopelvic alignment while restoring function. It was decided to refit the patient with subischial containment sockets. Subjective questionnaires and three-dimensional gait analysis were used to quantify results. Results After HO resection and prosthetic socket modifications, the patient's complaints of LBP decreased, along with subjective improvements in the Oswestry Disability Index and Short Musculoskeletal Functional Assessment. During upright standing, anterior pelvic tilt decreased from 27.6° to 18.1°. During walking, excursion of the trunk relative to the pelvis decreased in all planes after changing prosthetic socket design to subischial and completing 6 months of rehabilitation: from 24.0° to 17.6° in the frontal plane, 12.4° to 7.8° in the sagittal plane, and 23.1° to 19.1° in the transverse plane. Conclusions A multidisciplinary team approach to the care of patients with bilateral transfemoral amputations can help to improve functional outcomes. For this patient with nonradicular, mechanical LBP, a subischial prosthetic socket design that minimized intrusion on the pelvis had a significant influence on static and dynamic sagittal spinopelvic alignment and overall outcomes. In the end, contributions by orthopedic and plastic surgeons, pain management strategies by a physical medicine and rehabilitation physician, rehabilitation by a physical therapist, and prosthetic modifications all played a role in reduction of this patient's LBP. Among the numerous interventions provided to this patient, including surgical revisions, prosthetic socket design, prosthetic alignment, and physical therapy, it is hypothesized that the change in prosthetic socket design from ischial containment to subischial had a significant, long-lasting impact on LBP and function.

Effect of personal risk factors on the prevalence rate of musculoskeletal disorders among workers of an Iranian rubber factory.

Musculoskeletal Disorders (MSDs) are among the most common occupational disorders in many countries and have an increasing trend. The present study was conducted in order to determine the prevalence rate of MSDs in different body regions and the effect of personal factors on the prevalence rate of MSDs among rubber industry workers. This analytical and cross-sectional study was performed on 206 workers of an Iranian rubber factory in 2014. The samples were randomly selected. Data were gathered by means of personal information form, the Nordic Musculoskeletal Questionnaire (NMQ) and the Rapid Entire Body Assessment (REBA). The results were analyzed using SPSS16; by descriptive and analytical statistics. The mean age and work history of subjects were 34.54±6.36 and 12.34±6.28 years, respectively. The highest prevalence rate of MSDs in the last twelve-months was related to the lower back region with a prevalence rate of 62.1%. Based on logistic regression, a significant correlation was found between MSDs and the final REBA score so that for a one-unit increase in score, the risk or complaint of neck and low back pain increased by 48.5% and 37.1%, respectively. Many rubber factory workers experience MSDs especially in the lower back region as a consequence of occupational risk factors. Therefore, detecting the occupational risk factors, work position standards and following ergonomic interventions are highly recommended.

EFFECTIVENESS OF CHIROPRACTIC ADJUSTMENT IN LUMBAR PAIN IN CROSSFIT PRACTITIONERS

ABSTRACT Objective: To evaluate the efficacy of acute chiropractic adjustment in individuals who practice CrossFit with regard to complaints of low back pain and the joint range of motion in this region. Methods: A randomized clinical trial comprised of CrossFit practitioners from a box in Novo Hamburgo-RS, of both sexes and aged 18 to 40 years who had low back pain at the time of the study. The following tools were used: Semi-structured Anamnesis Questionnaire, Visual Analog Scale, McGill Pain Questionnaire, and SF-36 Quality of Life Questionnaire. Individuals in the control group answered the questionnaires before and after CrossFit training. The chiropractic group performed the same procedure, plus pre-training chiropractic adjustment and joint range of motion (ROM) before and after lumbar adjustment. Results: There was a significant increase in pain in the control group, and a significant decrease in pain in the chiropractic group, including one day after the chiropractic adjustment. In the chiropractic group, the joint ranges of motion had a significant increase in flexion and extension of the lumbar spine after chiropractic adjustment. Conclusion: The chiropractic group achieved a significant improvement in pain level and joint range of motion, suggesting that acute chiropractic adjustment was effective in reducing low back pain.

Faktor Risiko Manual Handling dengan Keluhan Nyeri Punggung Bawah Pembuat Batu Bata

During done manual work handling for objects work hard, it will cause risk of injury or cause musculoskeletal systems. Risk assessment manual work handling with the methods indicators key-Leitmerkmal Method (LMM) intended to know the relationship between time, burden, attitudes of the body, and working conditions manual handling with complaints of the lower back pain at all stages making bricks perceived maker bricks. The kind of research used is surveyed such data is cross sectional. The data taken by lower back pain questionnaire assisted examination physically by nurses and checklist Key-LMM. Analysis relations use the spearman. The results of research acquired at variable time manual handling based frequency raised or operation the transfer of on stage excavation raw materials, the formation and drying bricks there are relations with complaints of low back pain with p value each are 0,039, 0,047, 0,038 while on the variables of working conditions manual handling in stage excavation raw materials obtained p value of 0,028 with so it can be said there was a correlation between working conditions manual handling with complaints low back pain. A variable load manual handling and attitudes of the body manual handling do not relate in significant to lower back pain all stages making bricks. Conclusion researchers that the variable time manual handling relate in significant with complaints lower back pain in stage excavation raw materials, the formation and drying bricks, while the phase processing raw materials that there was no correlation, in a variable load manual handling and attitudes of the body manual handling all these stage there was no correlation with complaints lower back pain, while variable working conditions manual handling only in stage excavation the raw materials there are relations with complaints lower back pain in the third stage other there was no correlation.

Osteitis CondensansIlii - A Rare Presentation

We presented a case of 45 years old unmarried woman who complaints of chronic low back pain and diagnosed as a case of Osteitis CondensansIlii (OCI). We are discussing this rare presentation of OCI to increase awareness among the specialty and primary care physicians, as it may be confused with other conditions like- Ankylosing Spondylitis (AS) and inflammatory arthritis. It also prevents misdiagnosis and extensive investigations that not only increase anxiety but are of little benefit.Medicine Today 2016 Vol.28(2): 89-91

Implementation of ergonomic programs to reduce sick leave due to low back pain among nickel mining operators

Whole body vibration (WBV) has been recognized as a main risk factor for low back pain (LBP) in coal mining activities. Heavy equipment operators in nickel mining may be exposed to a higher LBP risk due to the land condition of the overburden overlying nickel deposits, which is less stable than that of coal deposits. This report summarizes the efforts of a nickel company in managing LBP complaints among mining operators. The programs included risk assessment and mitigation, musculoskeletal complaint management, LBP training, and macroergonomic intervention. These programs were integrated into the occupational health management system of the company. Within a 3-year period, a decrease in LBP-related sick leave was reported. The present report shows how ergonomic programs may help to manage LBP and could be extended to other musculoskeletal cases.

Correlation of Body Composition and Low Back Pain Severity in a Cross-Section of US Veterans

ObjectiveBack pain is more prevalent in the obese, but whether back pain severity is directly correlated to obesity in veterans is unknown. We sought to determine if there was a correlation between body composition and low back pain severity in a sample of veterans. The hypothesis was that veterans with higher body mass index values would report higher low back pain severity scores. MethodsThis study was a retrospective chart review of 1768 veterans presenting to a Veterans Affairs chiropractic clinic with a chief complaint of low back pain between January 1, 2009 and December 31, 2014. Spearman’s rho was used to test for correlation between body composition as measured by body mass index and low back pain severity as measured by the Back Bournemouth Questionnaire. ResultsOn average, the sample was predominantly male (91%), older than 50, and overweight (36.5%) or obese (48.9%). There was no correlation between body mass index and Back Bournemouth Questionnaire scores, r = .088, p < .001. ConclusionsThe majority of veterans with low back pain in this sample were either overweight or obese. There was no correlation between body composition and low back pain severity in this sample of veterans.

MP31: The contrarian effect: how does a Choosing Wisely focused knowledge translation initiative affect emergency physician practice in a high awareness-low investigation environment?

Introduction: We previously reported that a targeted knowledge translation (KT) intervention was associated with a trend towards increased awareness and knowledge of the Choosing Wisely Canada (CWC) emergency medicine (EM) recommendations. We wished to assess if the intervention changed physician practice, specifically looking at the imperative “do not order lumbar XRs for non-traumatic low back pain unless red flags exist”. Methods: A departmental KT initiative was implemented in April 2016 and consisted of a 1-hour seminar reviewing the CWC-EM recommendations, access to a video cast, departmental posters, and a before and after awareness survey. The effectiveness of our intervention was assessed by analyzing the frequency of lumbar XR imaging conducted for low back pain before and after the introduction of our intervention at a tertiary teaching hospital emergency department. All patient visits for the complaint of low back pain were included. The rates of XR imaging from June 2014 to September 2014 for the pre-intervention period and June 2016 to September 2016 for the post-intervention period were collected and analyzed using Fisher exact tests. A sample size of 683 was required to detect a 5% change with an alpha of 0.05 and a power of 80%. Results: Baseline characteristics of patients were similar for the pre- and post-intervention periods. There was a total of 781 patient visits for low back pain in June to September 2014 and 672 in June to September 2016. The XR imaging rate for low back pain increased from 12% (95% CI 9.9-14.5) to 16.2% (95% CI 13.6-19.2) following the intervention (p=0.023). Conclusion: We previously demonstrated a trend towards increased awareness and knowledge of the CWC EM recommendations following a knowledge translation initiative. Baseline XR imaging rates for low back pain were lower than what has been reported. We observed that our intervention was associated with an increased frequency of imaging for low back pain. This may be due to a contrarian effect. We feel this calls into question the role of knowledge translation initiatives where physician practice already closely adheres to pre-established recommendations.

Lumbar muscle structure and function in chronic versus recurrent low back pain: a cross-sectional study

Background ContextHeterogeneity exists within the low back pain (LBP) population. Some patients recover after every pain episode, whereas others suffer daily from LBP complaints. Until now, studies rarely make a distinction between recurrent low back pain (RLBP) and chronic low back pain (CLBP), although both are characterized by a different clinical picture. Clinical experiences also indicate that heterogeneity exists within the CLBP population. Muscle degeneration, like atrophy, fat infiltration, alterations in muscle fiber type, and altered muscle activity, compromises proper biomechanics and motion of the spinal units in LBP patients. The amount of alterations in muscle structure and muscle function of the paraspinal muscles might be related to the recurrence or chronicity of LBP. PurposeThe aim of this experimental study is to evaluate differences in muscle structure (cross-sectional area and lean muscle fat index) and muscle activity of the multifidus (MF) and erector spinae (ES) during trunk extension, in patients with RLBP, non-continuous CLBP, and continuous CLBP. Study Design and SettingThis cross-sectional study took place in the university hospital of Ghent, Belgium. Muscle structure characteristics and muscle activity were assessed by magnetic resonance imaging (MRI). Patient SampleFifty-five adults with non-specific LBP (24 RLBP in remission, 15 non-continuous CLBP, 16 continuous CLBP) participated in this study. Outcome MeasuresTotal cross-sectional area, muscle cross-sectional area, fat cross-sectional area, lean muscle fat index, T2-rest and T2-shift were assessed. MethodsA T1-weighted Dixon MRI scan was used to evaluate spinal muscle cross-sectional area and fat infiltration in the lumbar MF and ES. Muscle functional MRI was used to evaluate the muscle activity of the lumbar MF and ES during a lumbar extension exercise. Before and after the exercise, a pain assessment was performed. This study was supported by grants from the Special Research Fund of Ghent University (DEF12/AOP/022) without potential conflict of interest-associated biases in the text of the paper. ResultsFat cross-sectional area and lean muscle fat index were significantly higher in MF and ES in continuous CLBP compared with non-continuous CLBP and RLBP (p<.05). No differencesbetween groups were found for total cross-sectional area and muscle cross-sectional area in MF or ES (p>.05). Also, no significant differences between groups for T2-rest were established. T2-shift, however, was significantly lower in MF and ES in RLBP compared with, respectively, non-continuous CLBP and continuous CLBP (p<.05). ConclusionsThese results indicate a higher amount of fat infiltration in the lumbar muscles, in the absence of clear atrophy, in continuous CLBP compared with RLBP. A lower metabolic activity of the lumbar muscles was seen in RLBP replicating a relative lower intensity in contractions performed by the lumbar muscles in RLBP compared with non-continuous and continuous CLBP. In conclusion, RLBP differs from continuous CLBP for both muscle structure and muscle function, whereas non-continuous CLBP seems comparable with RLBP for lumbar muscle structure and with continuous CLBP for lumbar muscle function. These results underline the differences in muscle structure and muscle function between different LBP populations.

Effects of manual therapy and exercise targeting the hips in patients with low-back pain-A randomized controlled trial.

The benefits of providing manual therapy and exercise targeting the hips in individuals with mechanical low-back pain (LBP) are not well established. The objective in this study is to determine whether a formal prescriptive treatment protocol for the hips improves outcomes in patients with a primary complaint of mechanical LBP. Eighty-four (84) subjects (50 males, 46.1±16.2years) were randomized to 1 of 2 groups: pragmatic treatment of the lumbar spine only (LBP) (n=39) or pragmatic treatment of the lumbar spine and prescriptive treatment of bilateral hips (LBP+HIP) (n=45). Pragmatic treatment of the lumbar spine was based upon published clinical guidelines. Prescriptive treatment of the hips involved the use of 3 hip exercises targeting the gluteal musculature and 3 mobilization techniques targeting the hips. Subjects were assessed at baseline, 2weeks, and at discharge with the following measures: Modified Oswestry Disability Index, Numeric Pain Rating Scale, a global rating of change (GRoC) score, the patient acceptable symptom state (PASS), and patient satisfaction. At 2weeks, significant differences between groups differences were found in GRoC and patient satisfaction (P<.05) favoring the LBP+HIP group. At discharge, there were significant differences on the Modified Oswestry Disability Index, numeric pain rating scale, GRoC, and patient satisfaction favoring the LBP+HIP group (P<.05). Effect sizes were small to medium. Our findings suggest that a prescriptive treatment of the hips may be of clinical value to individuals presenting with the primary complaint of mechanical LBP.

Mobile Schwannoma of the Cauda Equina for Which Intraoperative Myelography Was Useful in Locating

We report on a case of a mobile schwannoma of the cauda equina. The patient was a 24-year-old woman who visited our hospital with the chief complaints of low back pain and numbness of the right leg. A tumor was noted from the L2 midbody level to the L3 upper endplate on preoperative MRI and myelogram. During the surgery, a right L2 hemilaminectomy was performed, and the dura was incised, but no tumor was founded in the surgical field, and this was noted as a missing tumor. Intraoperative myelography showed that the tumor had moved to the adjacent vertebra on the caudal side. Myelography applied again to the caudal side of the mobile tumor. Then, the tumor had moved upward, and could be excised without an additional laminectomy.

A case of disseminated carcinomatosis of the bone marrow of primary pancreatic tail cancer with chief complaints of low back pain

A case of disseminated carcinomatosis of the bone marrow of primary pancreatic tail cancer with chief complaints of low back pain

Giant Cell Tumor in a Patient with Osteopetrosis: A Case Report

Introduction: Osteopetrosis, a rare disorder due to osteoclast dysfunction, which causes bone resorption dysfunction. These patients have brittle bones prone to osteomyelitis. Case presentation: A 14-years male referred with complaint of chronic low back pain. He was treated with analgesics but with no pain relief, thus imaging was requested and a mass at the site of left body and pedicle of L5 was detected. The patient underwent tumor resection. The mass was diagnosed as giant cell tumor (GCT). Conclusion: Due to the association of osteoclast dysfunction with both GCT and osteopetrosis, patients with osteopetrosis may be at higher risk of GCT.