Left Lower Back Pain Research Articles

Ureteral polypoid endometriosis causing hydroureteronephrosis

A 44-year-old Japanese woman presented with a left low back pain. Abdominal ultrasonography revealed the left hydroureteronephrosis. She had the past history of endometriosis interna 3 years before. Retrograde pyelography showed the defect in the ureter, and on ureteroscopy, a polypoid mass was identified. Biopsy specimen from the ureteral mass showed endometrioid epithelia and edematous endometrial stroma, immunohistochemically positive for progesterone receptor (PgR), estrogen receptor (ER), and CD 10. For the lesion (endometrioma), partial resection of the ureter and ureteroneocystostomy with Boari flap were performed. The resected specimen showed a 2-cm polypoid mass. Histologically, the lesion was ureteral endometriosis. The postoperative course was uneventful, the patient showed no evidence of local recurrence after the initial resection and continues to be under close follow up. Urinary tract involvement of endometriosis is uncommon. Endometriosis should be included in the differential diagnosis of ureteral strictures in sexually active young females.

Range of Motion of Hip Joints of Male University Kendo Practitioners with Lower Back Pain

[Purpose] Kendo practitioners often suffer from left low back pain. The present study was undertaken to analyze the features of range of motion (ROM) of the hip joint of kendo practitioners and their relation to prevention of lower back pain. [Subjects and Methods] The study involved 37 male university kendo practitioners: 26 kendo practitioners having a history of lower back pain, 11 kendo practitioners having no history of lower back pain. In accordance with the method of ROM measurement set forth by the Japanese Orthopaedic Association, the same examiner measured hip joint ROM during passive flexion/extension and internal/external rotation. [Results] In the low back pain group, no laterality was noted in the ROM of the external rotation. However, ROM of the internal rotation was significantly smaller on the left side than on the right side. The range of rotation was significantly smaller on the left side than on the right side. [Conclusion] The ROM of hip rotation on the left side was significantly diminished (less than 90 degrees) only in the low back pain group, and the laterality in ROM of left hip rotation was significantly greater in the low back pain group than in the non-low back pain group (p<0.05). These findings suggest that small ROM of left hip rotation is a factor responsible for the onset of lower back pain.

Low Back Pain in a Teenage Baseball Player

HISTORY: A 17 y/o male high-school athlete originally experienced low back pain while pitching during a varsity baseball game. He has chronic low back and left leg pain since his injury almost two years ago. Previously treated conservatively with combination of physical therapy, trigger point injections, medications and interlaminar & transforaminal epidural steroid injections. A surgical consultation recommended discectomy. Returns to our practice for continued conservative management. Reports Axial back pain with radiation into the posterior aspect of the left lower leg. Pain ranged from 5/10 to 10/10. Worse at night. Denies any numbness, weakness or parasthesias. No Bowel or bladder incontinence.He continues to compete with pain. PHYSICAL EXAM: Height: 6.0 Weight: 170 BMI: 23.1 Neuro: Neural Tension-Mild positive left slump and SLR. Negative femoral stretch. Sensation-Grossly intact & symmetric to light touch. Muscle Tone-Normal, without clonus. No significant atrophy. Strength- Normal & symmetric in both lower extremities Reflexes- Normal & symmetric Patellar, Achilles and Medial Hamstrings MSK: Palpation-Segmental tenderness lower lumbosacral spine. Mild paraspinal spasm & tenderness. Nontender bilateral PSIS, greater trochanters, iliotibial band & Piriformis. Spine ROM: Grossly intact, end range pain. Stork test negative. Bilateral hamstring tightness. DIFFERENTIAL DIAGNOSIS Left Lumbar radiculopathy Chronic mechanical low back pain Sacroiliac Dysfunction Piriformis Syndrome TEST AND RESULTS Lumbar MRI 7/8/2007: L5-S1 left paracentral herniation, with mass effect, left S1 nerve. No central canal stenosis. Severe left neural foramen stenosis Minimal change from 2005 study. FINAL WORKING DIAGNOSIS Herniated disc at L5-S1 causing a chronic left S1 radiculopathy. TREATMENT and OUTCOME Left L5 and S1 transforaminal epidural steroid injection. Initiate Physical Therapy Consider discography prior to percutaneous disc procedure or surgical considerations. Consider Electrodiagnostic testing to evaluate for radiculopathy Treatment is on-going. Our interest, is to explore the effectiveness of minimally invasive and non-operative options for the adolescent athlete with chronic pain secondary to a herniated lumbar disc.

Flank Pain - Football

HISTORY: A 16 year-old junior high school football wide receiver presents to the training room with left flank and low back pain. During practice he was involved in a tackle where he sustained a blow to his left flank, just below his protective padding. He is unsure if he was hit by helmet or elbow. He had immediate sharp pain on his left but was able to stand and walk to the sidelines. He waited 10 minutes, and when the pain did not abate he went to the training room. He notes that he has increased pain with flexion and lateral bending away from and toward the affected side. Running and deep breathing do not increase his pain. He does not feel dizzy or nauseated. His pain is 5 out of 10 and he does not want to return to practice today. PHYSICAL EXAMINATION: Examination in the training room reveals an overall healthy adolescent male who is in moderate discomfort and holding his left side. Inspection of his left flank shows no bruising or swelling. He has diffuse, mild tenderness to the soft tissue overlying his posterior left flank. He has no point tenderness over his ribs. He has no tenderness over his vertebrae. He does have CVA tenderness on his left flank. His abdomen is benign with normal bowel sounds, and is non-tender without guarding or rebound. DIFFERENTIAL DIAGNOSIS: Renal contusion Rib fracture Soft tissue contusion Abdominal injury SECOND DAY EVALUATION: Patient was held out of practice. The following day he is evaluated and complains of ongoing left flank pain. He also has noted new onset left shoulder pain, worse with lying down, and some new pain in his left lower quadrant along. He denies any blood in his urine. Physical examination reveals an abdomen with tenderness in the left upper and lower quadrants. Bowel sounds are positive. No masses. No hepato-splenomegally are appreciated. No guarding or rebound is present. He continues to have CVA tenderness. TEST AND RESULTS: Abdominal CT scan: splenic laceration of 0.9 cm subcapsular hematoma of less than 10% of spleen surface area FINAL DIAGNOSIS: Splenic laceration - Grade I TREATMENT/OUTCOMES: Overnight inpatient observation Restricted from activity for 2 weeks Non-contact for 2 months Cleared for full play if CT scan shows resolution of laceration

Cauda Equina Syndrome Caused by Primary Lumbosacral and Pelvic Hydatid Cyst: A Case Report

Hydatid disease occurs in humans as a result of faeco-oral contamination and spinal echinococcosis is rare even in areas where echinococcosis is endemic. Hydatid cyst primarily occurs in the liver and lungs. Bone involvement constitutes only 0.5-2% of all hydatidoses. About half of the bone involvement occurs in vertebrae. The thoracic spine is the most common site of the spinal hydatidosis. Primary hydatid cysts of the lumbar and sacral spinal canal are very rare. We present a 31-year-old man with cauda equina syndrome caused by a primary hydatid cyst of the lumbosacral and pelvic areas. He had been admitted to hospital with left foot and low back pain three years ago. Magnetic resonance imaging revealed an intraspinal hydatid cyst extending from L2 to S2. The cyst had been totally removed. He was symptom-free for three years. After three years, he presented with acute cauda equina syndrome. His neurological examination revealed total plegia of dorsal flexion of the left foot and perianal hypoaesthesia. MRI showed lumbosacral and pelvic hydatidosis again. After total removal of the cyst, his neurological status revealed immediately relief. Hydatid cyst is an important health problem in some countries including Turkey. Bone involvement is seen in only 0.5-2% of cases. Furthermore sacral and lumber vertebral involvement is extremely rare. We presented a case with a spinal hydatid cyst which classified as a combination of intraspinal extradural, vertebral and paravertebral forms according to the Braitwate and Lees classification. Surgical excision and additional medical treatment is still the most effective treatment. Cysts located intraspinally have a tendency to rupture spontaneously. For this reason the high recurrence rate (30- 40%) is still a major problem in management.

Epidural Fibrosis Following Percutaneous Disc Decompression with Coblation Technology

Complications reported from percutaneous disc decompression (PDD) include discitis, anaphylaxis (with chemonucleolysis), instability, increased back pain, and reherniation. To the best of our knowledge, there is no report of epidural fibrosis occurring with any of the many types of PDD. To document a case of epidural fibrosis following PDD with coblation technology (Nucleoplasty), a previously unreported complication of this procedure. Case report. Details are presented on a 46-year-old man's history, diagnostic test results, treatments, and progression of his symptoms. Following PDD with coblation technology at L5-S1, the patient noticed improvement in his left lower extremity radicular symptoms and low back pain. He continued to improve over the following week to near complete relief. He resumed his normal activities. Three months post treatment, he experienced a recurrence of his radicular pain with a diminished left Achilles reflex. A subsequent MRI showed improvement of the previous left paracentral protrusion at L5-S1 along with a new contrast enhancing soft tissue mass. This mass, consistent with epidural fibrosis, was located in the left antero-lateral spinal canal and encased the left S1 nerve root. On the patient's next follow-up visit, he reported spontaneous resolution in his symptoms. He had stopped all pain medications and returned to his usual activities. This case is the first reported occurrence of epidural fibrosis following percutaneous lumbar disc decompression.

An Infrequent Presentation of SAPHO Syndrome

We describe a case of SAPHO (synovitis, acne, pustulosis, hyperostosis and osteitis) with an unusual presentation in a 14 year-old girl with low grade fever which lasts 8 months, left low back pain and elevated erythrocyte sedimentation rates and protein C-reactive with chronic anaemia. A radiograhy of the lower limbs showed a lytic image with osteitis and hyperostose in the right fibula, as a casual finding. This information, in addition to the acne, pustulosis, sternoclavicular arthritis and the studies got from the magnetic resonance image (MR) of spine, pointed out the diagnosis of SAPHO.

Pulmonary Embolization of Acrylic Cement During Vertebroplasty

A 79-year-old man with a history of diastolic left ventricular dysfunction, atrial fibrillation, and low back pain underwent vertebroplasty. The procedure was uneventful except for the development of low-grade fever 1 day after the procedure. The patient denied any cough, dyspnea, or chest pain. Initial physical examination revealed that he was not in respiratory distress. His temperature was 38.3°C, respiratory rate was 20/min, blood pressure was …

A Case of Idiopathic Avascular Necrosis of Both Femoral Heads

The patient is a male of 52 year old and holds managerial position. He suddenly devloped left leg pain and low back pain seven years ago, which were followed by similar pain on his right leg and visited this hospital one year later. On X-ray examination, his right femoral head showed an image of spotty sclerosis and his left femoral head showed a punched-out image of sclerosis and spurs in its inside. As time went by, his symptoms were aggravated, and deformities of femoral heads and bone sclerosis progressed. However, owing to conservative treatment, his clinical symptoms have been alleviated and he walks quite normally now, but with a moderate limitation on internal rotation of hip joints. On X-ray, defor mities of both femoral heads are moderate, but bone sclerosis appears to have become less conspicuous and to be remedied. It would be necessary to follow up this case for an extended period of time.