Complaints Of Back Pain Research Articles

Spinal Canal Measurements at the Level of Lower Three Lumbar Vertebrae by 128-Slice CT Scanner in Bangladeshi Population

Background & objective : The knowledge of normal diameter of lumbar spinal canal is very important for diagnosing lumbar spinal canal stenosis and also for performing spinal surgeries at the lumbar level by Neurosurgeons and Orthopedicians. However, it varies widely among ethnic groups and between sexes in the same ethnic group. The present study was conducted to describe the morphometry of lumbar vertebrae at the level of L3-L5.
 Methods: This descriptive cross-sectional study was conducted on 302 patients (aged 20-60 years) at Ibrahim Cardiac Hospital & Research Institute between July 2019 to December, 2020 who underwent diagnostic CT scans for abdominal or genitourinary complaints without any known vertebral column pathology or complaints of low back pain or other abnormalities attributable to lumbar spine. Patients having sciatic pain with or without pain in the back, having past history of back surgery and patients with osteophytes or developmental anomalies, trauma or vertebral fracture and known case of lordosis, scoliosis or kyphosis or other abnormalities in lumbar vertebrae were also excluded. A CT scan was performed using 128-slice multi-detector CT with unenhanced CT images from the level of diaphragm to pubic symphysis so that the area from D12 to S1 vertebra be covered (field of view). Sections 3-mm thick with reconstruction up to 1 mm were analyzed and different parameters of the spinal canal and vertebral body were measured in sagittal and transverse sections. The images were reconstructed in true axial, coronal, and sagittal planes. The canal-body ratio (CBR) was determined by dividing the sagittal diameter of the spinal canal by the sagittal diameter of the vertebral body.
 Result: The findings of the present study demonstrate that nearly two-thirds (65.5%) of the subjects were early middle-aged or middle-aged with mean age of the subjects being 43 years. A male predominance was observed in the series with male to female ratio being 4:1. The study revealed that all the dimensions of the canal and the body in transverse and sagittal sections were observed to increase from level L3 to L5, while the canal body ratio was decreased slightly from L3-L5. The males have significantly wider vertebral body at all levels (L3-L5) of lumbar vertebrae compared to their female counterparts. Vertebral body diameter in sagittal section at L3 was significantly greater in males than those in females; however, they were not different between sexes at L4 and L5 levels. Canal-body ratio (CBR) was fairly comparable between males and females at L3 and L4, but it was greater in males than that in females at L5. No significant difference was observed between L3 & L4 and L4 & L5 in the same individuals in terms of CBR.
 Conclusion: The study concluded that there are significant variations in some of the lumbar spinal canal dimensions and vertebral body measurements (including CBR) from L3-L5 between males and females. Although there was no significant difference between L3 and L4 in the same individuals in terms of CBR, there was reasonable difference between L4 and L5 lumbar vertebrae. The findings are of much significance in the investigation of vertebral column pathology in the context of our population.
 Ibrahim Card Med J 2021; 11 (1): 8-13

Comparison Between Dry Needling And Laser Combination Of Core Stability Exercise To Decrease Myogenic Low Back Pain Complaints

Background: While performing daily activities, the incidence of myogenic low back pain (LBP) is experienced by many people. Physiotherapy technology in the form of dry needling and laser after both have received core stability exercise has not been widely applied in physiotherapy measures to reduce pain in complaints of myogenic low back pain. Therefore, further research is needed to compare the effectiveness of dry needling and laser with a combination of core stability exercises on low back pain myogenic complaints. 
 Methods: Experimental study design with two groups of pre-test and post-test designs. The research was conducted in 2021 at Sunafa physiotherapy practice, Colomadu, Karanganyar. Subjects with myogenic low back pain complaints who met the study criteria. Analysis of the research data obtained, the data is not normally distributed, therefore tested with a non-parametric test, namely the Wilcoxon test and Mann-Whitney test.
 Results: Has the effect of dry needling with core stability exercise on pain reduction in myogenic low back pain complaints (p = 0,000), has the effect of a laser with core stability exercise on pain reduction pain in myogenic low back pain complaints (p = 0,000), there is a different effect between dry needling and core stability exercise and laser with core stability exercise to reduce pain in myogenic low back pain complaints (p = 0.002), dry needling with core stability exercise was more effective than laser with core stability exercise in reducing pain in myogenic low back pain complaints with a mean difference of 8.94 mm more significant in the group I.
 Conclusion: Dry needling is more effective than laser after both have undergone core stability exercise to relieve pain with myogenic low back pain complaints equations. So dry needling is preferable to laser in the treatment of myogenic low back pain.

Unilateral fixation utilizing minimally invasive surgery (MIS) system for lumbosacral metastasis in a patient with stage 4 renal cell carcinoma.

Introduction and importanceTo summarize the clinical manifestations and treatment of a patient with lumbar metastases from renal cell carcinoma who underwent unilateral fixation of lumbosacral spine utilizing minimally invasive surgery systems.Case presentationA 71-year-old woman presented to a local hospital with complaints of low back pain. Computed tomography (CT) at the hospital revealed metastases to the lung, occipital bone, right ribs and fifth lumbar vertebrae from a primary left renal cancer. A lumbar Magnetic resonance imaging (MRI) performed at local clinic revealed an enlarged metastatic tumor invading the right body, transverse process and pedicle of fifth lumbar vertebra. Transmyofascial insertion of pedicle screws and connection with rod utilizing minimally invasive surgery (MIS) systems were made on the left L4.5.S1 vertebrae under fluoroscopy. The operating time was 36 min, the intraoperative blood loss was 30 g and fluoroscopic time was 56 s. Postoperative course was uneventful. She could walk with a single cane on the twenty postoperative days but passed away of systemic metastasis approximately10 months after the spinal fixation. An x-ray taken just before death showed no spinal instrumentation failure.DiscussionSurgery for spinal metastasis from hypervascular tumor may result in profuse intraoperative bleeding that is difficult to control. It might be preferable to operate with MIS if patients with spinal metastases are candidate for either MIS or conventional methods. It has been reported that unilateral fixation could be as effective as bilateral fixation in up to two-segment lumbar spinal fusion.ConclusionUnilateral fixation utilizing MIS systems may be effective in cases whom placing an instrumentation on the side with tumor extending posteriorly may cause massive bleeding.

A case involving laparoscopic decortication of a large simple renal cyst using conventional monopolar device.

Introduction and importanceSimple renal cysts are common in adults, but most of them are asymptomatic. Usually, percutaneous puncture is an initial treatment, but laparoscopic decortication may be effective for recurrent simple renal cyst. Herein, we report a case in which a large symptomatic simple renal cyst was treated with laparoscopic decortication using conventional monopolar device.Case presentationA 34-year-old female visited our hospital with chief complaints of back pain and abdominal fullness. Computed tomography showed a right simple renal cyst (diameter: 140 mm). We performed percutaneous drainage with sclerotherapy, but the cyst recurred a month later. Thus, we carried out laparoscopic decortication. We opened the cyst wall via a retroperitoneal approach and trimmed it using monopolar scissors. The operation time was 124 min. The patient's postoperative course was uneventful, and no complications were observed. Following surgery, the patient was asymptomatic.Clinical discussionIn our case, we performed operation using a conventional monopolar device without sealing devices. It has been reported that the use of sealing devices can make laparoscopic surgery safer and reduce the operation time, but we herein report that laparoscopic decortication with a conventional monopolar device is an effective and safe treatment option for symptomatic simple renal cysts and that more expensive energy sources are not required.ConclusionWe successfully performed laparoscopic decortication of a large symptomatic simple renal cyst. This operation is minimally invasive and safe.

Ventral Cervical Intradural Extramedullary Neuroenteric Cyst and its Operative Procedure; A Rare Case Report with Literature Review

Background:Neuroenteric cysts are rare non-neoplastic lesions arising from a failure of dissolution of the transient neuroenteric canal between the foregut and the notochord. They are most frequently seen in the intraduralextramedullary space in the lower cervical and upper thoracic spine. Case description:A 5 yrs old boy presented to us with the complaints of neck and upper back pain and weakness of all four limbs. MRI scan shows an intraduralextramedullary cystic lesion at C6-T1 with significant compression over cord. After patient’s preparation a Posterior approach was used to remove the cysts. Post-operative course was un-eventful. Histological results were consistent with neuroenteric cysts. MRI image of 3 months follow-up shows no residual cysts and the boy has no further complaints. Conclusion:Neuroenteric cyst (NC) is a rare lesion usual location at lower cervical and upper dorsal area and should be considered among differential diagnoses. Complete excision is the treatment of choice. In most instances a dorsal surgical approach will be satisfactory. Bang. J Neurosurgery 2021; 11(1): 54-57

Frequency of orthopedic manifestations in COVID-19 patients

ObjectivesThe effects of the novel coronavirus on the musculoskeletal system have been reported with wide variability. The purpose of this study was to determine the prevalence of musculoskeletal symptoms and if these correlated with other patient characteristics. MethodsThis was a retrospective review of 685 admitted patients who were found to be positive for COVID-19 during their admission. Based on a standard COVID-19 questionnaire, we recorded complaints of new onset myalgias, joint pain, back pain, and muscle weakness and performed a chart review for all existing comorbidities. Statistical analyses were performed to determine the association between various comorbidities and orthopedic manifestations of COVID-19 patients. ResultsOf the 685 patients who tested positive for COVID-19, 186 patients presented with at least one orthopedic manifestation (27.1%). Patients that experienced orthopedic manifestations were significantly younger at 53.7 years of age compared to 58.1 years of age (p = 0.003) with a significantly higher BMI (body mass index) at 32.6 versus 30.0 (p = 0.022). Patients that had diabetes or were obese had significantly higher rates of orthopedic manifestations while those that had heart or lung disease had significantly fewer. ConclusionObese and diabetic patients had significantly higher rates of orthopedic symptoms during COVID-19 infection. Further studies need to be carried out in these populations to determine if these comorbidities during infection have an effect on the musculoskeletal system in the perioperative setting and after recovery from infection.

A Case Of Diphenhydramine With Alcohol Induced Rhabdomyolysis

Rhabdomyolysis is muscle necrosis and the release of intracellular muscle components into circulation. Approximately 26,000 cases of rhabdomyolysis are reported annually in the United States. The severity varies greatly from asymptomatic individuals to individuals with life-threatening muscle enzyme elevations along with severe electrolyte abnormalities, acute other organ damage, and compartment syndrome. The mortality rates are as high as 59% in critically ill patients. There are multiple causes of rhabdomyolysis that can be classified as traumatic or non-traumatic. The traumatic cases are usually evident at presentation however, in a non-traumatic setting, the presentation may be misleading. In this specific case report, we discuss a case of rhabdomyolysis with shock liver and acute kidney injury in a 23-year-old male that presented with complaints of back pain and blood in his urine following the recreational use of alcohol and diphenhydramine. Given the frequent use and easy accessibility of both alcohol and diphenhydramine (DPH), it is crucial to be aware of the potential risk of rhabdomyolysis as early recognition and treatment can prevent life-threatening complications.

10 kHz Spinal Cord Stimulation for the Treatment of Non-Surgical Refractory Back Pain: A Case Report.

Back pain is one of the most common healthcare burdens in the United States and is the number one cause of disability worldwide. Treatment options for back pain usually emphasizes conservative modalities such as reassurance, education, physical therapy, cognitive behavioral therapy, medication management, and interventional pain procedures. Spinal cord stimulation (SCS) is a minimally invasive and reversible therapy used to treat various pain syndromes. The primary indications for SCS therapy are failed back surgery syndrome and complex regional pain syndrome. However, recent advances in therapy have expanded the use of SCS for a variety of chronic pain conditions including nonsurgical back pain and radiculopathy. We present the case of a patient with low back and lumbar radicular pain complaints that were not responsive to traditional conservative and interventional options who was successfully treated with 10 kHz spinal cord stimulation.

Endoscopic Approach at Two Non-Sequential Levels in Lumbar Discitis

We report a case of spondylodiscitis in two non-sequential segments of the lumbar spine that was unresponsive to antibiotic treatment instituted and guided by results of blood and urine cultures.A 70-year-old female was admitted to our hospital with complaints of adynamia, low fever, and severe lower back pain that caused difficulty in mobilizing the lower limbs. Spinal tomography and magnetic resonance imaging (MRI) of the lumbar spine suggested L2L3 and L5S1 spondylodiscitis. After an initial period of improvement, the patient’s condition began to deteriorate again four weeks after initiating the antibiotic therapy. We then opted for surgical treatment through a full-endoscopic transforaminal route, with the aim of collecting intervertebral discs material and performing debridement. After the procedure, the patient experienced immediate relief from the pain and was able to stand and walk without assistance. Cultures from disc fragments showed different bacterial species than that found in the first examination.The endoscopic approach allowed less tissue damage, debridement of the disc, collection of multiple fragments, thereby facilitating the best antibiotic therapy, and shortening the duration of hospital stay.

Relationship between Increased Sitting Time and Neck, Back and Shoulder Arch Pain During the Covid-19 Quarantine

Background. Coronavirus disease (Covid-19) originating in Wuhan, China in December 2019 spread worldwide rapidly. To avoid direct contact, quarantine was implemented globally, which changed employees’ work habits, leading to longer sedentary times and increased complaints of neck, back and shoulder arch pain.
 Aim. To analyse the association of increased sitting time during quarantine with neck, back and shoulder arch pain.
 Methods. The survey involved 180 respondents, 136 women (76.0%) and 43 men (24.0%), who participated in a questionnaire survey conducted in social networks. The questionnaire consisted of closed-ended questions. Statistical analysis was performed using the Spearman correlation coefficient to determine the relationship between sitting time and neck, back, and shoulder arch pain.
 Results. It was found that the time spent at the computer or TV screen during the quarantine and before quarantine differed statistically significantly (p <0.005). Respondents (40.8%) indicated that they spent 1–2 hours in front of the TV or computer screen, before the quarantine, and during the quarantine most respondents (57.0%) stated that they spent more than 5 hours. More than half of the respondents (56.4%) said that their well-being had recently deteriorated. Prolonged sitting time was mentioned by the majority of respondents (63.2%) as the main cause of deteriorating health. Respondents rated their pain before quarantine at 3.25 ± 1.92 points and during quarantine at 5.84 ± 2.12 points.
 Conclusions. Respondents’ time spent at the computer or TV screens more than doubled during the pandemic, with the vast majority complaining of back, neck and shoulder pain. There was a direct relationship between back, shoulder arch and neck pain and sitting time.
 Keywords: pain, sitting time, quarantine, lack of physical activity.

Effleurage Massage With Lavender (Lavandula Lamiaceae) Essential Oil Aromatherapy Reduces Pregnant Women's Lower Back Pain

Pregnant women are a high-risk group because they experience physical and psychological changes, one of which is often complaints of lower back pain (LBP) in the third trimester. This can be due to changes in positioning, walking too often, using high heels, or lifting heavy weights. Effleurage massage is a complementary therapy to reduce LBP. The combination with lavender essential oil aromatherapy may reduce LPB more optimally. The purpose of this study was to identify the impact of a combination of effleurage massage with lavender essential oil aromatherapy on LBP in pregnant women. The research used a quasi-experimental pretest-posttest design with a control group. The sample consisted of 16 third-trimester pregnant women for each group (intervention and control), recruited through the purposive sampling. This research was conducted in the area of the Padangsari Health Center, Semarang City in February-March 2021. The Numerical Rating Scale (NRS) of pain was used. The intervention provided was a combination of effleurage massage with lavender essential oil aromatherapy four times a month for 15-20 minutes per session. Data were analyzed using the Wilcoxon test and independent t test. The results showed that the combination of effleurage massage with lavender essential oil aromatherapy led to a significant decrease in LBP in pregnant women (p < 0.001). This therapy can be carried out by the family as needed because it is easy, does not cause side effects, and basic ingredients are available in the market. Nurses can accompany pregnant women and their families in the non-pharmacological management of LBP integrated with maternal health programs in primary health care facilities.
 Keywords: aromatherapy lavender essential oil, effleurage massage, lower back pain, pregnant women

Mycotic abdominal aortic aneurysm caused by Borrelia afzelii: a case report

BackgroundInflammatory aneurysms and mycotic aneurysms make up a minority of abdominal aortic aneurysms. Mainly autoimmune mechanisms are proposed in the pathogenesis of inflammatory aneurysms, and it is not routine to check for infectious agents as disease culprits.Case presentationA 58-year-old European male with complaints of abdominal and back pain for 8 weeks was admitted after a semi-urgent computed tomography scan revealed an 85 mm inflammatory abdominal aortic aneurysm. The patient had normal vital signs, slightly elevated inflammatory markers, and mild anemia on admission. Clinical examination revealed a tender pulsating mass in his abdomen. His clinical condition was interpreted as impending rupture and urgent repair of the aneurysm was deemed necessary. Due to the patient’s relatively young age and aneurysm neck morphology, open aortic repair was preferred. Preoperatively, the aneurysm appeared inflamed, with fibrous wall thickening and perianeurysmal adhesions. Aneurysm wall biopsies were sent to histopathological and microbiological diagnostics. Routine cultures were negative, but 16S rRNA gene real-time polymerase chain reaction was positive and Borrelia afzelii was identified by DNA sequencing of the polymerase chain reaction product. B. afzelii was also identified by sequencing the polymerase chain reaction product of a Borrelia-specific groEL target. Immunoglobulin G and M anti-Borrelia antibodies were present on serological analysis. Histopathological analysis displayed loss of normal aortic wall structure and diffuse infiltration of lymphocytes and plasma cells. The patient had an uneventful recovery and was discharged after 1 week to a regional rehabilitation facility. Though the patient fares clinically well and inflammatory markers had normalized, antimicrobial treatment with doxycycline continues at 3 months follow-up due to remaining radiologic signs of inflammation.ConclusionsBorrelia infection in the setting of acute aortic pathology is a rare entity. To our knowledge, this is the first case report to demonstrate a mycotic abdominal aortic aneurysm as a rare manifestation of Lyme disease. Aortic wall biopsies and real-time polymerase chain reaction analysis of the specimen were essential for accurate diagnosis. This finding may contribute to the understanding of the etiology of inflammatory aneurysmal disease and abdominal aneurysms in general.

Low back pain: Based on Age, Working Period and Work Posture

Low back pain is one of the health risks for workers. Age, years of work and work posture that are not ergonomic are associated with complaints of low back pain. This study aims to determine the relationship between age, work period, and work posture on complaints of low back pain in rice mill workers. This study used an analytical observational study, with a cross sectional approach. Samples were taken of 50 respondents using total sampling. Research instrument with a questionnaire to determine data on age, years of service and assessment of complaints of low back pain. The RULA checklist method for measuring body posture. The data analysis technique used the Pearson test and multiple linear regression. The results showed that there was a significant relationship between age, years of service and work posture with complaints of low back pain with a p value 0.05. The conclusion of this study is that there is a relationship between age, years of service and work posture with complaints of low back pain.

Transcutaneous Electrical Nerve Stimulation Uptake in Lowering Low Back Pain

Background: Low Back Pain (LBP) is a generalized pain from the second lumbar vertebra to the sacroiliac joint, and is generally a lifelong health disorder. LBP is often the cause of people feeling a decrease in ability in daily functional activities. Patients often complain of symptoms of pain, muscle spasms and impaired function. One of the interventions that can be used to reduce LBP is therapy using transcutaneous electrical nerve stimulation (TENS). TENS is a device used to relieve pain by stimulating nerves through electrodes transcutaneously. TENS is one of the modalities that can improve neuromuscular function or reduce pain and is very useful for patients with complaints of low back pain who experience pain and muscle weakness around the pelvis, trunk, and lower legs. LBP patient. Subject and Method : This study was a meta-analysis with the following PICO, population: low back pain patients. Intervention: administration of TENS. Comparison: not given TENS. Result: decreased pain. The articles used in this study were obtained from three databases, namely Google Scholar, Pubmed, and Science Direct. Keywords to search for articles “transcutaneous electrical nerve stimulation” OR “TENS” AND “reduction pain” OR “pain relief” AND “low back pain”. The articles included are full-text English with a randomized control trial study design from 2007 to 2022. Article selection was carried out using PRISMA flow diagrams. Articles were analyzed using the Review Manager 5.3 . application. Results : A total of 12 case studies from continental Europe, America and Asia were selected for systematic review and meta-analysis. It was found that giving TENS -0.67 times reduced pain in complaints of low back pain compared to not given TENS significantly (SMD = -0.67; 95% CI = -1.03 to -0.32; p = 0.002). Conclusion: Transcutaneous Electrical Nerve Stimulation reduces pain in low back pain patients. Keywords: Transcutaneous Electrical Nerve Stimulation, reduction pain, low back pain Correspondence: Husna Arwa Salsabil, Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta 57126, Central Java, Indonesia. Mobile: +6289611006503. Email: husna0105­@gmail.com. Indonesian Journal of Medicine (2022), 07(01): 9-18 https://doi.org/10.26911/theijmed.2022.07.01.02

Lumbar Multifidus Muscle Fatty Atrophy and Lumbar Disc Degeneration: Are they Associated in Middle Aged Patients with Low Backache?

Introduction: Low backache being one of the most common problems faced in the society mainly due to sedentary lifestyle and reduced physical activity which inturn leads to overweight, obesity and atrophy of paraspinal muscles. Disc prolapse is one of the most common causes of low backache. Hence, knowing the aetiological factors and treatment of the same at an early stage is beneficial. Aim: To determine the association between the grades of lumbar disc degeneration with degree of fatty infiltration of lumbar multifidus muscle in middle aged patients with low backache using Magnetic Resonance Imaging (MRI). Materials and Methods: A prospective observational study was conducted from April 2020 to February 2021 in Kempegowda Institute of Medical Sciences, Bengaluru, Karnataka, India, with a study population of 201 middle aged patients who complaints of low back pain for more than three months. All patients who met the inclusion and exclusion criteria underwent plain MRI for Lumbosacral (LS) spine with 16 channel 1.5 tesla strength MR machine. Lumbar intervertebral disc degeneration was graded according to the Pfirrmann classification using T2 sequence in the sagittal plane. For the evaluation of the degree of fatty infiltration of lumbar multifidus muscle, axial T2-weighted slices were used to detect the cross-sectional area of the right and left lumbar multifidus muscle involvement. Chi-square test was used to find the association between varying grades of disc degeneration and severity of fat infiltration at Lumbar (L)4-L5 and L5-Sacral (S) 1 regions. Results: There was significant association between the grade of lumbar disc degeneration and the degree of atrophy of multifidus muscle with p-value <0.001 in middle aged patients with low backache. There was significant relation with fatty muscle infiltration with a p-value of <0.001 in L4-L5 and 0.03 in L5-S1 disc spaces. Most of the patients had grade III intervertebral disc degeneration in both L4/L5 and L5/S1. Conclusion: Lumbar multifidus muscle atrophy is common in grade 3 Pfirrmann classification of lumbar disc degeneration at both L4/L5 and L5/S1 levels.

Avascular necrosis of the femoral head following an occult femoral neck stress fracture

Introduction. Osteonecrosis (ON) of the femoral head (FH) ? (ONFH) is an intractable disease that causes progressive femoral head collapse, severe pain, and gait disturbance. We report a case of avascular necrosis of the femoral head following an occult femoral neck (FN) stress fracture. Case report. A 55-year-old woman presented to our department with a chief complaint of low back pain that radiated into the left anterolateral thigh over the period of two months. Her left anterolateral thigh became progressively more painful over the past two weeks. No abnormal findings indicative of ONFH or an occult fracture of the FN were detected by X-ray or computed tomography, but an occult insufficiency fracture of the left FN was identified on magnetic resonance imaging (MRI). The diagnosis of FN stress fracture was delayed, resulting in femoral head necrosis. The fracture was treated with total hip arthroplasty, and the resected FH was subjected to histopathology (HP). Based on the HP findings, the final diagnosis of this case was ONFH with an occult fracture of the left FN. Clinical symptoms were relieved postoperatively. Conclusion. An early MRI examination is recommended in patients presenting with a suspected stress fracture of the FN to avoid FH necrosis due to a delayed diagnosis.

Alteração postural, dor lombar e a resistência dos músculos do tronco em jovens universitárias

Abstract Introduction: Low back pain, the most prevalent musculoskeletal disorder, is common in individuals with postural changes and has a high incidence in university students. Trunk muscle instability and weakness can contribute to the presence of low back pain. However, no research has investigated the relationship between low back pain in conjunction with postural changes and the resistance of the trunk stabilizing muscles. Objective: To analyze the correlation between postural alterations and muscular resistance of the trunk of women with and without low back pain. Methods: Forty university women were recruited and divided into a group with low back pain (n = 20; 20.85 ± 1.69 years) and a group without low back pain (n = 20; 20.05 ± 2.54 years). On the first day, the postural assessment was carried out by photogrammetry with Kinovea software. On the second day, the resistance tests of the trunk flexor and extensor muscles, lateral and ventral plank, bridge, and lumbar traction were performed through the traction dynamometer. Pearson's correlation test was applied to verify the relationship between the analyzed variables, Student's T test was used for comparison between groups, and a significance level of p < 0.05 was adopted. Results: There was no correlation between the variables related to postural changes and muscle resistance tests (p > 0.05). There was a difference between the groups only for the bridge exercise test (p = 0.04) and vertical alignment of the head, left lateral view (p = 0.041), and right lateral view (p = 0.034). Conclusion: This study did not show a direct and significant relationship between postural changes in young university students with and without complaints of low back pain and resistance of the trunk-stabilizing muscles.

Intraocular complications after caudal epidural steroid injection for discogenic lumbar pain with radiculopathy

Background: Epidural steroid injection is a common intervention for symptomatic lumbar disc herniation. It is safe, but not absolutely free from complications. Visual complications and adverse intraocular events are sparse in the literature. This study is done to determine any intraocular complication after caudal epidural steroid injection for discogenic low back pain and radiculopathy. Materials and Methods: It was a prospective study, conducted from April 2018 to December 2019 by the orthopedics and ophthalmology departments of our institute. A total of 31 patients were recruited based on inclusion/exclusion criteria. All the patients presented to this institute with complaints of low back pain and sciatica were investigated. After proper diagnosis, the decision was made for caudal epidural steroid injection as per the standard principles of orthopedic surgery. Eye evaluations (intraocular pressure [IOP], visual acuity, and ocular examination) were done 1 day before, and 2–4 h, 1 week, and 2 weeks after epidural injection. The differences in eye evaluation values between time points were determined and discussed. Results: A total of 31 patients were recruited for this study, out of which the majority of the patients (27 patients) were between 41 and 60 years of age, and males (22 patients) outnumbered females (nine patients). Most of the patients (17 patients) had prolapsed IV disc of L5-S1. IOP was found to be raised after the intervention of epidural steroid injection which gradually came down to a preinjection level within 2 weeks. There was no change in visual acuity and no other intraocular complications, like hemorrhages. Conclusion: Epidural steroid injection for discogenic low backache (LBA) with radiculopathy did not adversely affect IOP, and neither had any ocular complication (in an ophthalmologically normal set of patients). A prudent approach should always be implemented.

Применение комплексных лекарственных препаратов для лечения пациентов с болью в спине

Purpose of the study: to assess the dynamics of pain indicators and various characteristics of the quality of life in patients with back pain when using a one-course treatment complex with the use of Clodifen Neuro. Materials and methods. The study included men and women aged 44 to 52 years with complaints of lower back pain caused by exacerbation of chronic dorsalgia. The main group included 30 patients (14 men and 16 women). The control group consisted of 24 patients (12 men and 12 women). The groups were comparable in terms of the severity of symptoms and the length of the disease. All patients received muscle relaxants and gastroprotectors of the corresponding pharmacological groups, patients in the main group received Clodifen Neuro 1 capsule twice a day for 2 weeks, patients in the control group received diclofenac tablets (enteric form) 50 mg twice a day. The effectiveness of therapy was assessed using the VAS scale and the Oswestry questionnaire. Assessment of the condition of patients in both groups was carried out before the start of the study, after the end of treatment (after 14 days) and 2 months after the end of therapy. Results. The study of the effectiveness of the use of Clodifen Neuro showed that in patients with chronic back pain, the drug favored a decrease in pain syndrome, an increase in the mobility of the spine, and the functional potential of patients. Conclusion. Treatment with Clodifen Neuro for 14 days (1 capsule orally 2 times a day) as a part of complex therapy contributed to a steady reduction in pain in the study group of patients with chronic back pain. The analgesic effect persisted for 2 months after the end of therapy. Clodifen Neuro can be recommended as a polytropic agent in the complex therapy of chronic back pain.

Bone marrow metastasis from testicular seminoma in a patient with concomitant follicular non-Hodgkin lymphoma: A case report

Introduction. Seminomas are the most common testicular tumors. Initial therapy includes orchiectomy with resection of local lymph nodes, followed by adjuvant radiotherapy. Testicular tumors usually metastasize to retroperitoneal and mediastinal lymph nodes, lungs, liver, spleen, gastrointestinal tract, and adrenal glands. Bone metastases from testicular tumors are very rare, while seminoma metastasis to the bone marrow is a curiosity, without any references in the scientific literature. Case Report. A 66-year-old patient, previously treated for follicular non-Hodgkin lymphoma, was admitted due to complaints of malaise, abdominal and back pain, and hepatosplenomegaly. After examination and radiologically verified enlarged retroperitoneal lymph nodes, the patient was referred to a hematologist. Based on the patient?s medical history, a relapse of lymphoma was suspected, and bone marrow biopsy was performed. The hematoxylin-eosin staining of the biopsy sample showed diffuse large cell infiltrates with bright cytoplasm, polygonal nuclei and prominent nucleoli. By immunohistochemical staining, the cells showed positivity for cluster of differentiation 10, cluster of differentiation 117, octamer binding transcription factor 3/4, placental alkaline phosphatase, and cytokeratin 8/18, after which the diagnosis of seminoma metastasis to the bone marrow was made. Shortly after the histopathological diagnosis was made, the patient died. Conclusion. A seminoma is a testicular tumor with a favorable prognosis. Due to suppression of hematopoiesis, bone marrow metastases generally lead to the worst prognosis. The outcome of our patient highlights the importance of timely diagnosis and therapy, which would increase the chances of survival.