Etiology Of Low Back Pain Research Articles

Unveiling the role of CXCL8/CXCR2 in intervertebral disc degeneration: A path to promising therapeutic strategies

BackgroundIntervertebral disc degeneration(IVDD) is the primary etiology of low back pain and radicular pain. Recent studies have found that chemokines play a role in IVDD, but the underlying mechanism is largely unclear. MethodsBioinformatics analysis was employed to screen CXCL8 as the target gene. The expression levels of CXCL8 and CXCR2 were quantified using RT-qPCR, western blot(WB), immunohistochemistry(IHC), and enzyme-linked immuno-sorbent assay(ELISA). In the IVDD mouse model, X-ray images, Safranin O-fast green staining(SO-FG), IHC, and WB were conducted to assess the therapeutic effects of CXCL8 on IVDD. Reactive oxygen species (ROS) production, apoptosis of nucleus pulposus cells (NPCs), and the involvement of the NF-κB pathway were evaluated through WB, flow cytometry, immunofluorescence(IF), and Tunnel assay. ResultsIn our study, we observed that CXCL8 emerged as one of the chemokines that were up-regulated in IVDD. The mitigation of extracellular matrix degradation (ECM) and the severity of IVDD were significantly achieved by neutralizing CXCL8 or its receptor CXCR2(SB225002, CXCR2 antagonist). The release of CXCL8 from infiltrated macrophages within intervertebral discs (IVDs) was predominantly observed upon stimulation. CXCL8 exerted its effects on NPCs by inducing apoptosis and ECM degradation through the activation of CXCR2. Specifically, the formation of the CXCL8/CXCR2 complex triggered the NF-κB signaling pathway, resulting in an abnormal increase in intracellular ROS levels and ultimately contributing to the development of IVDD. ConclusionOur findings suggest that macrophage-derived CXCL8 and subsequent CXCR2 signaling play crucial roles in mediating inflammation, oxidative stress, and apoptosis in IVDD. Targeting the CXCL8/CXCR2 axis may offer promising therapeutic strategies to ameliorate IVDD. The translational potential of this articleThis study indicates that CXCL8 can effectively exacerbate the excessive apoptosis and oxidative stress of NPCs through activating the NF-κB pathway. This study may provide new potential targets for preventing and reversing IVDD.

Exercise for patients with low back pain

Background: Low back pain (LBP) is a common symptom that imposes a significant socioeconomic burden. Appropriate exercises that enhance the recovery of anatomical structures using biomechanical methods and improve lumbar stability are recommended for patients with LBP. Therefore, clinicians should prescribe appropriate exercises to alleviate LBP, improve function, and prevent recurrence.Current Concepts: Individualized and structured multimodal exercises (strengthening, aerobic, core stability exercises, and stretching) under the supervision of healthcare professionals are recommended for patients with LBP. It is preferable to focus on isometric trunk muscle exercises for strengthening, and strengthening the large muscles (back and gluteal muscles) attached to the thoracolumbar fascia is recommended rather than exercises that involve repeated extension and flexion of the trunk muscles. Individualized aerobic and core stability exercises are recommended, and stretching exercises focusing on extension movements are preferred. It is also important to educate patients regarding the etiology of LBP, harmful postures for LBP, and methods to maintain lumbar lordosis in daily life.Discussion and Conclusion: An appropriate exercise prescription can contribute to better clinical outcomes in patients with LBP. Although exercise is important for recovery and prevention of recurrence, inappropriate exercise can potentially exacerbate LBP; therefore, careful consideration is required.

Outcomes of dynamic lumbar fixation in young patients with minimal lumbar instability

Background Data: Lumbar instability is considered an essential aetiology of low back pain (LBP) which is always accompanied by considerable disability. The term ‘instability’ remains poorly defined. But it is most broadly explained by any change of the normal mechanism of spinal motion which leads to pain and/or neurological impairment. It was reported that ‘Segmental instability can be defined as a pathological reaction to the applied loads, characterized by motion in motion segments more than normal constraints. The dynamic system can stabilize an unstable segment adequately but permits more mobility in the fixed levels than the conventional fixation systems. Study design: prospective, consecutive study Patients and Methods: This study was conducted in Mansoura University hospitals over one year (starting from September 2019 till August 2020) Twenty patients who presented with back pain fulfilled our criteria and were included in this study and underwent surgery for lumbar fixation using a hybrid performance system with dynamic coupler. The history of all patients was taken and they were subjected to clinical examination and preoperative full radiological examination. Visual Analogue Scale (VAS) was used to evaluate POP. Regular follow-up visits were arranged for our cases 6 weeks, three months and 6 months postoperative. Results: This study included 20 patients (7 males and 13 females). The ages of the studied patients ranged from 20 to 33 years. 9 patients presented with L4- 5 affection, 8 patients with L3- 4 affection and three patients with L2-3 affection. The mean basal VAS score was 5.45 (range=4-6) while the mean six months VAS score was 0.40 (range=0-1) with a statistically significant difference from the basal VAS score (p ? 0.001). Also, the results show that post-operative QoL scale scores was significantly higher (p? 0.001) compared with pre-operative QoL scale scores (Physical function (54.30 vs. 67.10), limitations due to physical health (55.55 vs. 67.90)). Conclusion: The current study suggested that Dynamic lumbar fixation provides favourable and stable clinical mid-term results in patients suffering from a degenerative lumbar spinal disease (DLSD) and can be a considerable alternative to fusion surgery in these patients.

Compare the Effects of Bowen Technique and Muscle Energy Technique on Hamstrings Tightness in Patients with Chronic Low Back Pain

Background: Chronic low back pain (CLBP) is a prevalent condition affecting a significant portion of the global population, leading to decreased quality of life and increased healthcare utilization. Previous research has identified manual therapies, such as the Muscle Energy Technique (MET) and the Bowen Technique, as potential interventions for reducing pain and improving functional outcomes in patients with CLBP. These techniques focus on reducing muscular tightness and improving flexibility, which are often implicated in the etiology of low back pain. Objective: The aim of this study was to compare the effects of the MET and the Bowen Technique on hamstring tightness and pain reduction in patients with CLBP. Methods: This randomized controlled trial included 62 participants with CLBP, who were divided into two groups to receive either the MET or the Bowen Technique. The interventions were administered over an 8-week period, with sessions occurring three times per week. Outcome measures included hamstring flexibility (measured by the Active Knee Extension Test), pain intensity (measured by the Visual Analogue Scale), and functional disability (measured by the Oswestry Disability Index). Data were analyzed using repeated measures ANOVA and independent t-tests. Results: Both groups showed significant improvements in all measured outcomes. Participants in the MET group demonstrated a greater reduction in pain intensity from baseline to 8 weeks (5.5161±1.20750 to 1.4839±1.15097, P<0.000) compared to the Bowen Technique group (7.2258±0.88354 to 0.2581±0.51431, P<0.000). Similarly, hamstring flexibility and functional disability scores improved significantly in both groups, with the MET group showing slightly more substantial improvements in functional disability. Conclusion: The study concluded that both the MET and the Bowen Technique are effective interventions for reducing pain and improving hamstring flexibility in patients with CLBP. However, the MET showed a slight advantage in improving functional disability outcomes.

Serum 25-Hydroxyvitamin D Status and Vitamin D Supplements Use Are Not Associated with Low Back Pain in the Large UK Biobank Cohort.

Longitudinal studies assessing the association of vitamin D deficiency, defined by serum 25-hydroxyvitamin D levels < 30 nmol/L, and vitamin D supplement (VDS) use with low back pain (LBP) are sparse. This investigation assessed the cross-sectional and longitudinal association of vitamin D status and VDS use with LBP among 135,934 participants from the UK Biobank cohort. Approximately 21.6% of the participants had vitamin D deficiency, while only 4% regularly took VDS. In the month before study enrollment, 3.8% of the population reported experiencing LBP. An additional 3.3% of the population were diagnosed with LBP by their general practitioners for the first time during a median follow-up of 8.5 years. Vitamin D deficiency and VDS use were cross-sectionally associated with LBP in age- and sex-adjusted models, but these associations were not evident in comprehensively adjusted models. In longitudinal analyses, both vitamin D deficiency and VDS use were not associated with LBP in any model after correction for multiple testing. In conclusion, not unexpectedly due to the fact that LBP is multifactorial, our findings provide no evidence for the role of the vitamin D status in the etiology of LBP.

Retraction: Abdominal Aortic Aneurysm: An Overlooked Etiology of Low Back Pain.

[This retracts the article DOI: 10.7759/cureus.18587.].

Roles of Chemokines in Intervertebral Disk Degeneration.

Intervertebral disc degeneration is the primary etiology of low back pain and radicular pain. This review examines the roles of crucial chemokines in different stages of degenerative disc disease, along with interventions targeting chemokine function to mitigate disc degeneration. The release of chemokines from degenerated discs facilitates the infiltration and activation of immune cells, thereby intensifying the inflammatory cascade response. The migration of immune cells into the venous lumen is concomitant with the emergence of microvascular tissue and nerve fibers. Furthermore, the presence of neurogenic factors secreted by disc cells and immune cells stimulates the activation of pain-related cation channels in the dorsal root ganglion, potentially exacerbating discogenic and neurogenic pain and intensifying the degenerative cascade response mediated by chemokines. Gaining a deeper comprehension of the functions of chemokines and immune cells in these processes involving catabolism, angiogenesis, and injury detection could offer novel therapeutic avenues for managing symptomatic disc disease.

Low Back Pain in Resident Doctors with Standardized Training in China: A Cross-Sectional Study.

Low back pain (LBP) is a prevalent occupational disease with high morbidity among healthcare workers. Since the implementation of standardized residency training in China in 2015, the training intensity has significantly increased, which may lead to a higher incidence of LBP. However, epidemiological studies on LBP among resident doctors with standardized training remain scarce. To investigate the prevalence and associated factors of LBP among resident doctors with standardized training in a tertiary hospital in China. A cross-sectional study was conducted using self-administered questionnaires to collect information on demographics, lifestyle factors, work-related factors, and LBP from 345 resident doctors. Descriptive statistics were used to analyze the prevalence of LBP. Logistic regression analysis was performed to identify factors associated with LBP. Among 345 participants, the 1-year prevalence of LBP was 75.9%. Multivariable analysis revealed that physical exercise, weekly working hours, and prolonged sitting were independent risk factors for LBP. The prevalence of LBP among resident doctors was high. Promoting physical exercise, controlling working hours, and improving sitting posture may help prevent LBP. The study was limited by its cross-sectional design and self-reported data. Future studies should use longitudinal designs, objective measures, and larger and more representative samples to further explore the epidemiology and etiology of LBP among resident doctors with standardized training.

Age-Related Changes in the Temperature of the Lumbar Spine Measured by Passive Microwave Radiometry (MWR)

A study was conducted to determine the age dependence of the temperature of the low back in the region of the five lumbar vertebrae by using passive microwave radiometry (MWR). The rationale for the study is that the infrared brightness on which the temperature measurement is based will be dependent upon blood circulation and thus on metabolic, vascular, and other regulatory factors. The brightness and infrared temperatures were determined in five zones above each of the medial, left, and right lateral projections of the vertebrae. A total of 115 healthy subjects were recruited, aged between 18 and 84 years. No significant differences in infrared temperature were detected. As predicted, brightness temperature increased until 25 years old and then gradually decreased. In subjects over 70 years of age, compared with those aged 60–70 years, there is a significant increase in brightness temperature at the level of 3–5 lumbar vertebrae by 0.3–0.7 °C. This is interpreted as indicating that individuals who have lived to an advanced age successfully maintain metabolic and regenerative processes. The benchmark data that has been obtained can be usefully employed in future studies of the aetiology of low back pain. In particular, the prospect exists for the technology to be used to provide a non-invasive biomarker to evaluate the effectiveness of antiaging therapies.

Fatty infiltration of the erector spinae at the upper lumbar spine could be a landmark for low back pain.

Intervertebral disc degeneration (IVDD), Modic changes, and fatty infiltration in the paraspinal muscles are possible causes of low back pain (LBP). Multifidus has been the most commonly blamed paraspinal muscle in the etiology of LBP. However, it contributes to 20% of the extensor moment on the lumbar spine. In the present study, we aimed to identify whether patients with LBP and asymptomatic subjects differed in terms of intervertebral discs, end-plates, and fatty infiltration in their paraspinal muscles. Consecutive women and men, who visited the spine outpatient clinics with chronic LBP and had lumbar spine MRI for their LBP without leg pain were included. Asymptomatic subjects without LBP/leg pain for the last year were recruited. Modic changes, IVDD, and fatty infiltration in the paraspinal muscles were evaluated on lumbar spine magnetic resonance imagings of the patients with LBP and age-, gender- and BMI-matched asymptomatic controls. Low back pain was closely associated with fatty infiltration in the paraspinal muscles at all lumbar levels whereas it had association with severe IVDD and Modic changes at lower lumbar levels. Multifidus at the lower lumbar levels was the fattiest paraspinal muscle in both asymptomatic subjects and patients with LBP. Patients with LBP had severe fatty infiltration in the erector spinae at the upper lumbar levels. Severe IVDD and Modic changes were more common at lower lumbar levels in patients with LBP. Both asymptomatic subjects and those with LBP had fatty multifidus at lower lumbar levels, whereas those with LBP had fatty infiltration in the erector spinae at upper lumbar levels. We suggest that fatty infiltration could have started in the multifidus. The erector spinae had greater contribution to the lumbar extension compared to the multifidus. Thus, LBP could develop when the quality of the erector spinae at the upper lumbar levels impairs due to fatty infiltration.

Treatment of Low Back Pain Elicited by Middle Cluneal Neuralgia: Case Report and Literature Review of Interventional Treatments

BACKGROUND: Cluneal neuralgia is increasingly becoming recognized as an etiology of low back pain. The majority of the literature on cluneal nerve interventions describes modalities targeting the superior cluneal nerves with little emphasis on the middle cluneal nerves. CASE REPORT: A 21-year-old woman with a medical history of congenital myelomeningocele with tethered cord at L5-S1, status post 3 decompressive releases, presented to the clinic with chronic low back pain and associated sacroiliac paresthesia. Over 11 months, she underwent 7 ultrasound-guided bilateral middle cluneal nerve blocks, without corticosteroid, resulting in significant, immediate pain relief sustained for 4 to 6 weeks. CONCLUSIONS: A nerve block with local anesthetic has proven to be therapeutic for middle cluneal neuralgia, but with varying long-term efficacy. The use of radiofrequency ablation, peripheral nerve stimulation, regenerative medicine, and alcohol neurolysis have shown promise as long-term therapeutic options and as a substitute for invasive surgical release. KEY WORDS: Alcohol neurolysis, cluneal nerve block, middle cluneal neuralgia, peripheral nerve stimulation, prolotherapy, radiofrequency ablation, tethered cord

Acupuncture for patients with Maigne's syndrome: A case series.

Diagnosing the precise etiology of low back pain (LBP) is crucial for facilitating speedy recovery in patients. Maigne's syndrome (MS), commonly referred to as thoracolumbar junction syndrome, is a condition characterized by pain resulting from nerve entrapment, yet its underlying mechanisms remain poorly understood. This study presents a series of six case reports wherein patients diagnosed with MS received acupuncture treatment. Six individuals with LBP were included in the study, and all were diagnosed with MS. The diagnosis was confirmed in all six patients through pinch-roll and thoracic vertebrae compression tests, indicating the presence of thoracolumbar junction syndrome. Acupuncture treatment was administered to all patients, primarily targeting the T11-L2 facet joints, with additional acupoints selected based on the specific nerve entrapment of MS including the superior cluneal, subcostal, and iliohypogastric nerves. Following acupuncture therapy, all patients reported improvements in their LBP symptoms, while four patients also exhibited amelioration in their thoracic vertebrae compression test results. These findings underscore the significance of promptly diagnosing the underlying cause of LBP and suggest that acupuncture may be an effective approach in alleviating MS-related pain.

P.147 Exploring the bacterial hypothesis of low back pain: a prospective cohort study

Background: Occult bacterial infection is a proposed etiology of low back pain (LBP). However, a causative link between LBP and bacteria remains unconfirmed. Herein, we determined the incidence of occult discitis in patients receiving surgery for LDH. Methods: Study Design: prospective cohort study. Inclusion criteria: consecutive adult patients undergoing discectomy for symptomatic LDH. Exclusion criteria: prior epidural steroid use, prior spinal surgery, and antibiotic use within 2 weeks of surgery. Tissue samples: Four nuclear tissue and ligamentum flavum (control) samples were obtained per patient using stringent aseptic protocol. Samples underwent 16S-PCR and culturing. Results: Eighty-one patients were enrolled (mean age 43.3±13.3 years). All (100%) of tissue samples were negative by 16S PCR and no virulent species were detected. Nuclear and ligament cultures were both negative in 51 (62.9%) cases. Cultures were positive for nuclear tissue only, ligament only, or both in 14.8%, 12.3%, and 9.9% of cases, respectively. Fifteen of 20 (75%) disc positive samples grew a single colony of an indolent species. Conclusions: The findings of this prospective cohort study of consecutive patients receiving surgery for LDH do not support the theory of occult discitis. All samples were 16S-PCR negative, and most cultures were negative or grew a single colony suggestive of contamination.

Superior Cluneal Nerve Schwannoma as a Cause of Intractable Ipsilateral Low Back Pain: A Case Report

BACKGROUND: Superior cluneal nerve (SCN) entrapment is an infrequent, yet commonly missed etiology of low back pain (LBP). The SCN is prone to entrapment as it travels through the iliocostalis muscle and exits thoracolumbar fascia via an osseofibrous tunnel as it courses over the iliac crest. CASE REPORT: A patient with chronic LBP exhibited new provocative sacroiliac joint testing not responsive to injections. Subsequent pelvis magnetic resonance imaging revealed a peripheral nerve sheath tumor of the right SCN. Although she exhibited an excellent response to therapeutic nerve blocks, her silicone allergy excluded her from peripheral nerve stimulation as a treatment option. She underwent SCN neurolysis and tumor resection by the neurosurgery department resulting in symptom resolution. CONCLUSION: Interventional pain physicians should consider SCN entrapment when diagnosing intractable LBP. In the event of rare etiologies of SCN entrapment, such as neurogenic tumors, a multidisciplinary patient-centered care approach should be sought for symptom management. KEY WORDS: Superior cluneal nerve, pain management, chronic pain, nerve block, schwannoma

The lumbar spinal endplate lesions grades and association with lumbar disc disorders, and lumbar bone mineral density in a middle-young general Chinese population

BackgroundLumbar vertebral endplates lesions (LEPLs), one of the etiologies of low back pain (LBP), are one of the most prevalent causes of health-care costs. Despite progressively becoming the focus in recent years, almost all studies have concentrated on symptomatic patients rather than general populations. As a result, our study was designed to determine the prevalence and distribution patterns of LEPLs in a middle-young general population, as well as their associations with lumbar disc herniation (LDH), lumbar disc degeneration (LDD), and lumbar vertebral volumetric bone mineral density (vBMD).MethodsSeven hundred fifty-four participants aged 20–60 years were recruited from the subjects enrolled in a 10-year longitudinal study of degeneration of the spine and knee being conducted at the Beijing Jishuitan Hospital and 4 of them were excluded due to the missing of MRIs. In this observational study, a lumbar quantitative computed tomography (QCT) and MRI scan were performed among participants within 48 h. T2-weighted sagittal lumbar MRI images for all included subjects were identified for LEPLs by two independent observers based on morphological and local characteristics. Lumbar vertebral vBMD was measured with QCT. The age, BMI, waistline, hipline, lumbar vBMD, LDD, and LDH were measured to investigate their associations with LEPLs.ResultsThe prevalence of LEPLs was higher among the male subjects. 80% of endplates were recognition as no lesions with a substantial disparity between female (75.6%) and male subjects (83.4%) (p < 0.001). The most common lesions were “wavy/irregular” and “notched”, and “fracture” is most involved in L3-4 inferior endplate both in two genders. LEPLs were found to be associated with LDH (≥ 2 levels: OR = 6.859, P < 0.001; 1 level: OR = 2.328, P = 0.002 in men. OR = 5.004, P < 0.001; OR = 1.805, P = 0.014 in women) reference for non-LDH, and hipline in men (OR = 1.123, P < 0.001).ConclusionsLEPLs are the common findings on lumbar MRIs in general population, particularly in men. The presence of these lesions and advance from slightly to severely could be mainly attributed to LDH and men’s higher hipline.

Motor corticospinal excitability abnormalities differ between distinct chronic low back pain syndromes

ObjectivesIt is not known whether cortical plastic changes reported in low-back pain (LBP) are present in all etiologies of LBP. Here we report on the assessment of patients with three LBP conditions: non-specific-LBP (ns-LBP), failed back surgery syndrome (FBSS), and sciatica (Sc). MethodsPatients underwent a standardized assessment of clinical pain, conditioned pain modulation (CPM), and measures of motor evoked potential (MEPs)-based motor corticospinal excitability (CE) by transcranial magnetic stimulation, including short interval intracortical inhibition (SICI), and intracortical facilitation (ICF). Comparisons were also made with normative data from sex- and age-matched healthy volunteers. Results60 patients (42 women, 55.1±9.1 years old) with LBP were included (20 in each group). Pain intensity was higher in patients with neuropathic pain [FBSS (6.8±1.3), and Sc (6.4±1.4)] than in those with ns-LBP (4.7±1.0, P<0.001). The same was shown for pain interference (5.9±2.0, 5.9±1.8, 3.2±1.9, P<0.001), disability (16.4±3.3, 16.3±4.3, 10.4±4.3, P<0.001), and catastrophism (31.1±12.3, 33.0±10.4, 17.4±10.7, P<0.001) scores for FBSS, Sc, and ns-LBP groups, respectively. Patients with neuropathic pain (FBSS, Sc) had lower CPM (-14.8±1.9, -14.1±16.7, respectively) compared to ns-LBP (-25.4±16.6; P<0.02). 80.0% of the FBSS group had defective ICF compared to the other two groups (52.5% for ns-LBP, P=0.025 and 52.5% for Sc, P=0.046). MEPs (140%-rest motor threshold) were low in 50.0% of patients in the FBSS group compared to 20.0% of ns-LBP (P=0.018) and 15.0% of Sc (P=0.001) groups. Higher MEPs were correlated with mood scores (r=0.489), and with lower neuropathic pain symptom scores(r=-0.415) in FBSS. ConclusionsDifferent types of LBP were associated with different clinical, CPM and CE profiles, which were not uniquely related to the presence of neuropathic pain. These results highlight the need to further characterize patients with LBP in psychophysics and cortical neurophysiology studies.

MR Imaging Radiomics Analysis Based on Lumbar Soft Tissue to Evaluate Lumbar Fascia Changes in Patients with Low Back Pain

Clinicians must precisely pinpoint the etiology of low back pain as the number of people suffering from it increases to provide targeted care. The purpose of this paper was to use MR imaging radiomics based on lumbar soft tissue to analyze changes in the lumbar fascia of patients with low back pain. We retrospectively analyzed the lumbar MRI of 197 patients with low back pain. Patients were randomly assigned to either the training (n=138) or validation (n=59) cohorts. Multivariate logistic regression analysis was used to create radiomics model and combined nomogram model and their predictive performance were evaluated using receiver operating characteristic curves. Seven radiomics features based on lumbar soft tissue MRI images were established, which performed well in distinguishing between low back pain patients with fascial changes and normal individuals demonstrated an excellent ability to identify differences, with an Area Under Curve (AUC) of 0.92 (95% CI, 0.88-0.96) in the training cohort and 0.84 (95% CI, 0.73-0.96) in the validation cohort, which performed better than the clinical model significantly only. The nomogram based on clinical features and radiomics features of MR images had a good predictive ability to differentiate fascial alterations in patients with low back pain from normal subjects. It had the potential to be used as a decision support tool to assist clinicians in determining the etiology of patients with lower back pain and managing patients promptly, particularly in the early stage of the fasciitis when significant abnormalities on imaging were difficult to detect.

Investigation of Vitamin D Levels and the Effects of Being an Agricultural Worker on Etiology and Night Pain in Children and Adolescents With Chronic Low Back Pain.

Chronic low back pain in children is a condition that should be investigated. In this study, we examined the effects of agricultural work on imaging results, risk factors, night pain, and vitamin D levels in children and adolescents with chronic low back pain. The study included 133 patients who presented to the Physical Medicine and Rehabilitation and Neurosurgery outpatient clinics with low back pain that had lasted more than three months. The patients were evaluated based on the duration of their low back pain, the presence of night pain, a family history of low back pain, their employment status, local or radicular pain, and their body mass index (BMI). A physical examination was carried out to look into the etiologies of low back pain. Appropriate imaging, such as x-ray radiography, magnetic resonance imaging (MRI), and computed tomography (CT), was performed for the patients. Blood samples were collected from patients to assess inflammatory pathologies and vitamin D levels. The 133 patients in the study ranged in age from seven to 16 years, with a mean age of 14.3 + 1.9 years. Further, 60.2% (n = 80) of the cases were male, while 39.8% (n = 53) were female. Imaging revealed findings in 59.4% of the patients. In 97.7% of the participants, D hypovitaminosis was detected. There was no significant relationship between the patients' imaging findings and vitamin D deficiency, family history, BMI, and employment status (p = 0.441, 0.147, 0.082, 0.605). The relationship between family history, employment status, and night pain was statistically significant (p < 0.001). There was no statistically significant relationship between night pain and vitamin D deficiency (p = 0.667). Mechanical strain due to agricultural work and family history was found to be associated with night pain in patients with chronic low back pain in our study. The most important finding of this study is that night pain, which is considered a red flag, can occur in both inflammatory pathologies and situations causing mechanical low back pain, and risk factors should be thoroughly investigated. Studies with patients who have sufficient vitamin D will help to clarify the relationship between chronic low back pain and vitamin D.

Effects of age, gender and modifiable risk factors on low back pain

Low back pain increases with age and causes a burden of serious socio-economic adverse outcomes. Gender, age, vitamin D insufficiency, and obesity are some of the factors that are considered accountable for the etiology of low back pain, however, conflicting results are present in the literature regarding their effects on low back pain. In this study, we aimed to evaluate the effect of pain duration, pain intensity, gender, and preventable risk factors including vitamin D and body mass index (BMI), on low back pain. File registration data of 274 patients (211 females, 63 males) were included in this retrospective study. Age, gender, pain intensity, BMI, and vitamin D levels were recorded. Patients aged 60 and over were considered as the geriatric group. We observed that higher Visual Analogue Scale (VAS) scores were significantly associated with increased BMI (p=0.007) and advanced age (p=0.049). Duration of pain was positively correlated with, age (p&lt;0.001) and BMI (p=0.02). There was no significant relation between VAS scores and vitamin D levels. The duration of the disease was longer in women than men (p=0.038), but no significant difference was observed for VAS scores between genders. When the study group was divided into geriatric and non-geriatric groups, disease duration was higher in the geriatric group (p&lt;0.001), but no significant difference was observed between VAS scores. BMI, which is among the modifiable risk factors, is closely related to low back pain. The increase in both BMI and VAS scores, especially with advancing age, indicates that overweight older individuals are at high risk for low back pain.

Coluna Degenerativa – Novas Evidências

Low back pain is a frequent complaint in the general population, that may also affect veteran athletes. Understanding the etiology of low back pain is essential for a correct therapeutic orientation, which should include behavioral changes and a rehabilitation program. In some cases, it may be necessary to associate pharmacological therapy, minimally invasive procedures, or even surgical interventions. Minimally invasive procedures include a variety of techniques and procedures that have demonstrated low to moderate degrees of evidence in pain management. As they are not risk free and have a limited duration of action, they should be reserved for cases refractory to conservative treatment.