Osteopathic manipulative treatment, pain neuroscience education and clinical hypnosis as pain management interventions in chronic low back pain: a randomized sham-controlled feasibility pilot trial.

Effects of TDCS and TENS on chronic low back pain: A randomized controlled clinical trial.

Nonspecific chronic low back pain (NSCLBP) is a prevalent musculoskeletal disorder often aggravated by prolonged sitting. Previous studies have linked trunk muscle activity and posture to pain development, but their findings were inconsistent. Furthermore, previous studies did not use a backrest, so the study conditions did not reflect real-life conditions. The present study investigated the relationship between pain intensity, pelvic and trunk alignment, and lumbar muscle activity during sofa sitting in individuals with and without NSCLBP. Eighteen participants with NSCLBP and 19 healthy controls sat on a standard sofa for 30min. Pelvic and trunk angles were measured using a markerless motion capture system, and lumbar longissimus and multifidus muscle activity was recorded via surface electromyography. Pain intensity was assessed using a numerical rating scale. Both groups showed significant posterior pelvic tilt and trunk extend after 30min (Pelvis: mean difference [MD]: -1.64°, 95% CI: -2.64 to -0.64; P = 0.002, Trunk: MD: -3.70°, 95% CI: -6.02 to -1.37; P = 0.003). Numerical rating scale (NRS) scores increased significantly over time (MD: 1.62, 95% CI: 1.13 to 2.12; P < 0.001). No significant changes were observed in lumbar muscle activity and trunk flexion angle relative to the pelvis. In the NSCLBP group, worsening pain correlated with increased posterior pelvic tilt (r = - 0.694, P = 0.001). Prolonged sofa sitting exacerbates low back pain in patients with NSCLBP, primarily associated with posterior pelvic tilt rather than lumbar muscle activity. Postural guidance encouraging anterior pelvic tilt may help reduce pain during prolonged sitting in daily life.

Chronic low back pain (CLBP) is a major cause of disability worldwide and is strongly associated with anxiety, depression, and somatization. This study assessed the prevalence of these psychopathologies and their relationship with pain severity in Pakistani CLBP patients. To determine the prevalence of anxiety, depression, and somatization and evaluate their predictive value for pain severity in CLBP. A cross-sectional study was conducted from April to October 2024 at Jinnah Postgraduate Medical Center, Karachi. Fifty-eight CLBP patients and 58healthy controls completed PHQ-9, GAD-7, and PHQ-15 questionnaires. Statistical analyses included Chi-square, Mann-Whitney U, and ordinal logistic regression. CLBP patients showed significantly higher rates of anxiety (86.2%), depression (86.2%), and somatization (96.5%) than controls (p < 0.001). Depression was the only significant predictor of pain severity (β = -1.957, p = 0.009, OR = 0.141, 95% CI: 0.033-0.607), unexpectedly associating higher depression with lower reported pain severity. Anxiety and somatization were not significant predictors. Psychological distress is highly prevalent in CLBP, supporting its biopsychosocial nature. The inverse relationship between depression and pain severity warrants further investigation, while routine psychological screening and multidisciplinary care remain essential.

Manual therapy is recommended for the management of low back pain (LBP). However, there are gaps in our knowledge about how individuals understand and view the role of manual therapy in the management of their LBP. Beliefs about manual therapy may influence behaviors and clinical outcomes. This study aimed to develop an in-depth understanding of the beliefs about manual therapy held by a group of individuals experiencing LBP. Twenty-one participants with a history of LBP and varied experience of manual therapy participated in semi-structured interviews. The interviews were transcribed verbatim, and the dataset was analyzed using reflexive thematic analysis. A patient and public involvement group contributed to the design of the study. Five themes were generated: (1) Manual therapy as movement. Manual therapy is predominantly believed to be a transient mechanical treatment aimed at addressing restriction in the back. (2) Self-management and manual therapy go 'hand in hand'. Self-management was seen as a fundamental and complementary element of manual therapy. (3) Helping me manage or trying to 'fix' my back. The participants who believed that manual therapy was an appropriate long-term treatment felt that it could help manage their LBP rather than provide a permanent 'fix'. (4) All or nothing: the value of the therapeutic alliance. Beliefs about the importance of the therapeutic alliance with a manual therapist varied considerably, with some participants being dismissive of its value. (5) In safe hands? Most participants had no concerns about the safety of manual therapy, conditional on their trust in the manual therapist. However, some participants expressed significant concerns about safety. Participants' beliefs about their LBP and the role of manual therapy were shaped by a predominantly mechanical model. However, participants with greater experience of manual therapy often perceived the therapeutic alliance as beneficial for managing their LBP and addressing psychosocial factors. Manual therapists should be aware of unhelpful beliefs held by LBP patients that can potentially influence behaviors and outcomes. In addition, patients' beliefs about the risks and benefits of treatment should be explored to facilitate shared decision making around the use of manual therapy.

Introduction and importance: Systemic lupus erythematosus (SLE) and ankylosing spondylitis (AS) are common autoimmune disorders presented in a Rheumatology Clinic. However, their co-existence in the same patient is extremely rare. This case denotes the rare occurrence of such including the diagnostic dilemma and possible therapeutic options of the condition. Case presentation: A 54-year-old woman, a known case of SLE under immunomodulator and glucocorticoid therapy, presented to the clinic with persistent low back pain for 1 year. History and physical examination hinted toward the diagnosis of axial spondyloarthritis which was later confirmed by magnetic resonance imaging of hip with bilateral sacroiliac joint thereby refuting differentials of avascular necrosis of hip, osteoporotic vertebral fractures as the possible causes for low back pain. Patient was treated with sulfasalazine for AS along with hydroxychloroquine, prednisolone, and mycophenolate for SLE. Patient reported improvement in lower back pain and increased range of motion of hip joint as well as examination revealed only mild sacroiliac joint tenderness on 3 months follow-up. Clinical discussion: Co-existence of SLE and axial spondyloarthritis is uncommon and often presents as a diagnostic dilemma for the clinicians. Imaging is required to rule out common differential diagnoses. Conventional therapy in form of sulfasalazine can provide relief. Conclusion: This case highlights the rare occurrence of SLE and AS in the same patient and raises awareness to consider axial spondyloarthritis as differential for low back pain in patients of SLE. This case also advocates for the use of conventional drug modifying anti-rheumatic drugs such as sulfasalazine in treating axial spondyloarthritis and urges the readers for further research.

This study aimed to characterize long-term labor market participation from five years before to five years after assessment at departments of occupational medicine among patients referred with low-back pain (LBP) and to compare these patterns with those in a matched general working population. Secondary objectives were to assess subgroup differences and time to return to work. In this nationwide register-based cohort study, we included Danish residents aged 18-60 years referred for assessment (N=8256) and matched comparators (1:5 on sex, age, and calendar year; N=41 280). Using weekly register data, we calculated the prevalence of different labor market states before and after assessment as well as propensity score-weighted prevalence differences and ratios, and we performed stratified analyses. We estimated the five-year cumulative incidence of return to work among individuals on temporary public benefits using the Aalen-Johansen estimator. At assessment, 37% of patients were working versus 83% of comparators. Five years post-assessment, 40% of patients were working and 32% received permanent health-related public benefits. We observed substantial heterogeneity, with larger deficits in work participation in several subgroups. Among patients on temporary public benefits at assessment, the five-year cumulative incidence of return to work was 42%, with no increase in overall work prevalence. LBP patients had persistently poorer labor market participation than matched comparators, with declines already evident one year before assessment. Prognosis was particularly poor among older patients, those with weaker labor market participation at assessment, and those with comorbidities. These findings highlight the need for early identification and timely intervention and referral.

Acute low back pain (LBP) represents the leading cause of disability in the United States and affects up to 80% of adults. Clinical practice guidelines for the U.S. Military Health System (MHS) advise against certain modalities for the diagnosis and treatment of LBP because of inefficient or detrimental results. This study examines acute LBP practice patterns among providers within the MHS during the COVID-19 pandemic. We conducted an open retrospective study using electronic medical records from the MHS Data Repository between the fiscal years 2018 and 2022, divided into pre-pandemic, early-pandemic, and late-pandemic. We identified the first instance of LBP treatment by provider type and personnel category. Targeted practices were computed tomography, magnetic resonance imaging, X-ray, and prescription medications. Binomial logistic regression was used to calculate odds ratios by provider type. A total of 621,834 eligible LBP patients were identified. Over the course of the study period, all provider types observed an increasing likelihood of utilizing diagnostic imaging and a decreasing likelihood of administering prescription nonsteroidal anti-inflammatory drugs for LBP. Nurse practitioners (1.09, OR; 1.07-1.11, 95% CI) and physician assistants (1.24, OR; 1.22-1.26, 95% CI) were significantly more likely to utilize diagnostic imaging for LBP cases in comparison to physicians. Furthermore, nurse practitioners (1.13, OR; 1.12-1.15, 95% CI) and physician assistants (1.32, OR; 1.30-1.33, 95% CI) were more likely to prescribe nonsteroidal anti-inflammatory drugs compared to physicians. When assessing personnel categories, both contractor (1.13, OR; 1.11-1.15, 95% CI) and civilian (1.06, OR; 1.05-1.08, 95% CI) personnel displayed a greater likelihood of administering targeted practices for LBP compared to active duty providers. Differing treatment practices for acute LBP necessitate further clinical guideline adherence to promote consistent treatment among all providers, particularly given that nurse practitioners and physician assistants become an increasingly integral component of the MHS. Further investigation is needed to refine acute LBP management practices and minimize low-value care services within the MHS.

Background: Chronic nonspecific low back pain (CNLBP) with lumbar hyperlordosis leads to pain, dysfunction, and poor quality of life. Virtual reality (VR)-based training may enhance exercise engagement and outcomes. This study compared VR-based pelvic rocking training with conventional pelvic rocking training exercises. Methods: A triple-blind randomized controlled trial enrolled 100 participants with CNLBP and hyperlordosis, who were randomly allocated into two groups: the group, which performed pelvic rocking exercises using the TBed VR system (TbG), and the conventional group (CG), which performed the same exercises without VR. Both groups completed three sessions per week for eight weeks. Primary outcomes included pain (Numerical Pain Rating Scale, NPRS), lumbar lordotic angle (LLA), lumbar range of motion (ROM), and functional disability (Oswestry Disability Index, ODI). Secondary outcomes were patient satisfaction and commitment to exercise sessions. Assessments were conducted at baseline, immediately post-intervention, and after a one-month follow-up. Results: Both groups showed significant improvements in all outcome measures post-treatment (p < 0.016). Furthermore, some outcomes—specifically pain, LLA, and extension ROM—continued to improve during the follow-up period. The TbG demonstrated significantly greater reductions in pain, greater ROM improvements, greater functional gains, and higher levels of satisfaction and commitment than the CG (p < 0.05). These between-group differences persisted at the one-month follow-up, particularly for pain and ROM, which remained statistically significantly better in the TbG. Moreover, all between-group differences demonstrated medium to high clinical effects (d ≥ 0.3). Conclusions: Pelvic rocking exercises using the TBed VR system were superior to conventional exercises in terms of pain, ROM, and function at the immediate and intermediate time points. Using TBed led to better patient satisfaction and higher exercise commitment.

Nonspecific low back pain (NLBP) is a high-incidence condition in clinical orthopedics, rehabilitation, and acupuncture departments, accounting for 90%-95% of all low back pain patients, with an unclear etiology. After excluding specific spinal diseases and radicular pain, it is characterized by pain in the lumbar and sacroiliac regions as the core manifestation. Some patients may develop a chronic course, accompanied by lumbar stiffness and limited mobility, severely affecting daily work and quality of life [1]. According to relevant data, the annual prevalence of NLBP in China is 20.88%-29.88% [2]. The lifetime prevalence of NLBP is 40%-70%; the proportion of middle-aged patients seeking medical attention is higher than that of younger patients [3]. Current research proves that clinical treatment primarily uses exercise therapy as the main rehabilitation method [4-6]. Acupuncture therapies: local acupuncture, fire needle, electroacupuncture, etc., mostly focus on local lumbar and back acupoints. Although they can relieve pain by dredging local meridians, their intervention is insufficient for low back pain caused by abnormal central nervous system regulation and overall mechanical imbalance. The guideline clinical construction process and experience summarization are slow, and the progress of diagnostic scale research needs further exploration [7]. NLBP affects patients’ physical and mental health, quality of life, and social activities, so exploring safer, more effective, economical, and convenient treatment methods for this disease is a focus of discussion in the medical field. Although the term “nonspecific low back pain” is not directly recorded in ancient medical texts, it belongs to the categories of “low back pain” and “bi syndrome”. Analyzing the current research status of modern medicine on the TCM disease differentiation distribution of NLBP and the patient volume in our hospital’s outpatient department, the study includes patients who meet the TCM disease differentiation of “low back pain” after excluding factors [8]. The bone-reaching needle technique is a characteristic TCM applicable technology proposed by Dr. Zou Dehui, which is a new type of acupuncture technique with “needle tip reaching the bone” or “needle body touching the bone” as the core operation.

A 28-year-old male presented with chronic low back pain persisting for two years following a civilian gunshot injury, with retained shrapnel fragments in the L2 vertebra. Despite multiple outpatient evaluations and extensive pharmacological treatments, including nonsteroidal anti-inflammatory drugs, gabapentinoids, antidepressants, and opioids, his pain remained inadequately controlled. Due to the presence of retained spinal foreign bodies, epidural interventions were avoided. As an alternative approach, an ultrasound-guided erector spinae plane block (ESPB) was performed at the T12 level. The patient experienced immediate and significant pain relief, with sustained improvement in pain scores, mobility, and quality of life. During a one-year follow-up period, no complications or recurrence of symptoms were observed, and the patient did not require additional analgesic interventions. This case highlights ESPB as a safe and effective option for managing chronic post-traumatic low back pain in patients with retained spinal fragments, particularly when conventional interventional techniques are contraindicated.

Chronic back pain is a debilitating condition that significantly diminishes a patient's quality of life and imposes a substantial economic burden, driven by ongoing health care costs and lost workdays. This trial aimed to assess the efficacy and safety of an externally powered neuromodulation system targeting the proximal peripheral nerves at the T9 dermatome for chronic back pain refractory to surgery or standard treatment by comparing sub-threshold active stimulation therapy to sham. This is a prospective, multicenter, double-blinded, randomized controlled trial. Adhering to the highest standards of methodological quality control, the 38 patients who completed the study had been randomized in a 1:1 ratio to receive either subthreshold active stimulation or sham stimulation using the same Freedom® (Curonix LLC) Peripheral Nerve Stimulator System. This is a randomized controlled trial conducted at 2 independent clinical sites representing distinct secondary and tertiary clinical settings. Both the patients and the assessors were fully blinded. All patients were implanted with 2 4-electrode neurostimulators over the proximal peripheral nerves at the T9 level, in a single-stage direct to permanent procedure. The primary endpoint assessed the difference (at least 50% overall relief or a return to 30 mm or less on the Visual Analog Scale) between subthreshold stimulation and sham stimulation. Patients who received the sham treatment were unblinded and were then given the active treatment throughout the different visits if they reported a lack of response. A per-protocol analysis was conducted at the one-month visit. Patients were followed for 36 months. Thirty-eight (active: n = 19; sham: n = 19) patients completed the one-month primary endpoint. Superiority for the primary endpoint was confirmed for the active stimulation arm with a responder rate of 63% compared to the sham arm with only a 16% responder rate (P = 0.007). In addition, the active stimulation patients programmed with subthreshold frequencies experienced statistically and clinically significant improvements in Visual Analog Scale scores, the Oswestry Disability Index. the European Quality of Life Survey, the EuroQOL-5 Dimension Questionnaire, and the Patient Global Impression of Change compared to the sham group. Pain relief, improved functionality, and patient satisfaction were consistently reported throughout the study and were sustained through the 36-month follow-up. While the study was rigorously designed and executed, residual confounding cannot be entirely excluded. This trial showed statistically or clinically significant reductions in low back pain in patients with both Persistent Spinal Pain Syndrome Type 1 (chronic back pain without prior spine surgery) and Persistent Spinal Pain Syndrome Type 2 (chronic pain post spinal surgery), using neurostimulators applied to the proximal peripheral nerves at T9 using subthreshold high-frequency stimulation.

Low back pain (LBP) is common, yet many individuals maintain normal activities of daily living despite chronic symptoms and structural changes evident on imaging. We hypothesized that functional resilience, defined as preserved functional capacity despite pain and age‑typical degenerative changes, represents a meaningful clinical phenotype, and that function‑centered outcome measures would better discriminate disability status than structural imaging features. This study analyzed 347 participants reporting LBP from the Wakayama Spine Study (N=866). Maintained function was defined a priori as Oswestry Disability Index (ODI) ≤20%. We compared those with maintained function (n=220, 63.4%) to those with impairment (n=127) across demographics, lifestyle, metabolic components, physical performance (grip strength, gait speed), and lumbar magnetic resonance imaging (MRI) findings. Multivariable logistic regression among participants with LBP, including age, sex, obesity, metabolic factors, pain intensity, physical performance, and MRI phenotypes, was used to identify independent predictors of functional resilience. Functional resilience was common: 63.0% of LBP participants had ODI ≤20%. Resilient individuals were younger (65.0±11.9 years vs. 74.6±10.9 years, p<0.001) with superior physical performance. In multivariable models, male sex predicted maintained function (odds ratio [OR], 1.76; 95% confidence interval [CI], 1.03-3.00; p<0.05), while obesity (body mass index ≥25 kg/m2) was associated with reduced odds of resilience (OR, 0.50; 95% CI, 0.30-0.84; p<0.01). Standard MRI features, including disc degeneration, Modic changes, and Schmorl nodes, were not independently associated with functional status after adjustment, despite disc degeneration being highly prevalent even among resilient participants (95.4%). These data confirm that functional resilience is common in LBP and is not negated by the presence of structural MRI abnormalities. Among LBP patients, male sex and absence of obesity are independent predictors of maintained function, whereas standard MRI features do not independently predict functional status after age adjustment. Function-centered metrics (ODI, gait speed, grip strength) better discriminate functional status than structural imaging findings.

Introduction: Non-specific Chronic Low Back Pain (NSCLBP) is a prevalent musculoskeletal condition affecting daily functioning and causing socioeconomic burden worldwide. Altered activation of the deep trunk muscles, particularly transversus abdominis and multifidus, is considered important in symptom recurrence. Aim: To evaluate if lumbar Stabilisation Exercise (SE) program improves pain, disability and kinesiophobia compared to conventional physiotherapy in NSCLBP. Materials and Methods: The present prospective interventional study was conducted at Jorhat Medical College and Hospital, Assam, India, for one year from October 2023 to October 2024. A total of 268 adults (18-65 years) with NSCLBP were randomly assigned to two groups (group A and group B), 134 participants in each group. Group A received a lumbar SEs with conventional treatment, while group B received only conventional physiotherapy {Motor Control Exercises (MCE) and Neuro Muscular Electrical Stimulation (NMES)}. Pain, disability, and kinesiophobia were measured using the Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), and Tampa Scale for Kinesiophobia (TSK), respectively. Outcomes were analysed using Statistical Package for Social Sciences (SPSS) version 26. Group differences were analysed using independent t-tests for parametric data. p&lt;0.05 was considered as significant. Results: The mean age in group A was 42.2±9.2 years and in group B was 44.3±7.9 years. Group A had 97 females and 37 males while group B had 101 females and 33 males (p=0.320). Group A’s pre-post score improvement was as follows: VAS (5.55±1.23 to 2.02±1.179), TAMPA (42.07±4.500 to 31.33±1.249) and ODI (24.19±6.31 to 11.16±3.84) (p&lt;0.001**). Group B's pre-post scores also showed a noticeable improvement; VAS (5.63±1.19 to 3.40±1.04), TAMPA (42.23±4.403 to 36.28±1.983), ODI (24.61±6.141 to 17.48±2.658) (p&lt;0.001**). Both groups improved, but group A showed greater reductions in all measures (p&lt;0.001**) demonstrating better outcomes. Conclusion: Lumbar SE program combined with conventional physiotherapy significantly improves pain, disability, and kinesiophobia in NSCLBP compared to conventional physiotherapy alone, advocating deep trunk muscle activation. Future studies with long-term follow-up are recommended in this study

Brain mechanisms of pain anticipation in chronic low back pain: Insights into phenotypical responses to mind-body therapy.

Background: Pain is one of the main causes of poor quality of life in patients with Parkinson's disease. According to research, the percentage of Parkinson's patients with back pain is 37.1% and the VAS (Visual Analog Scale) pain score is 5.65. The Quality Control Circle method can be used to analyze possible causes of low back pain in patients with Parkinson's in a multi-directional manner to achieve an integrated treatment outcome. Approach: We aimed to use the Quality Control Circle (QCC) method to improve low back pain in patients with Parkinson's disease, with an expectation of a 1.37 point decrease in VAS as reaching a clinically important difference. 6 patients with Parkinson's disease who had low back pain were referred from the Parkinson and Movement Disorder Holistic Treatment Center of the National Taiwan University Hospital Hsin Chu Branch. The Cause &amp; Effect Analysis Diagram was used to analyze the influencing factors of the theme, and the four components of chronic postural problems, slow movement, low patient motivation and nutritional imbalance were used for the analysis of the important factors. The four dimensions were analyzed into more specific factors and surveyed by patients through questionnaires, and the three highest scored items (tilted posture, poor balance, and limited exercise) were selected by the patients as the three key factors for improvement of this QCC. Based on the brainstorming of the three key factors, 10 programs were developed and evaluated by the circle members. Depending on the scores, four countermeasures were selected as the central concept of this QCC (core training, balance training, group exercise class and exercise series) . Countermeasure 1: Utilize core training to improve poor posture caused by tilting posture. Countermeasure 2: Use balance training to improve slow movement caused by poor balance. Countermeasure 3: Use group exercise class training to improve the slowness of movement caused by little exercise. Countermeasure 4: Improve the slowness of movement caused by less movement by utilizing the exercise series program. Improvement activities were designed for the above four main strategies, and the implementation, evaluation and review of the effectiveness of each strategy were carried out smoothly. Results: After the circle members implemented core training, balance training, group exercise classes, and exercise series program, the VAS of low back pain was reduced from 5.6 to 3.3, a decrease of 2.3 points exceeding the target set, and the patient's tilted posture, poor balance, and lack of exercise also improved significantly. This integrated strategy led to good results, therefore relevant strategies are now included in the patient's regular treatment process. Implications: The QCC method was able to analyze factors to reduce the low back pain of patients with Parkinson's disease, and through the implementation of the targeted strategies, low back pain decreased in patients with Parkinson's disease, and at the same time improved the patient's tilted posture, poor balance, and lack of exercise, which resulted in significant implementation results.

Background: Chronic low back pain (CLBP) is a leading cause of global disability. While pregabalin is a common off-label treatment for CLBP, there is a significant gap in the literature regarding the demographic and clinical characteristics of the patient population receiving this medication, particularly in tertiary care settings in developing countries. This study aimed to describe the profile of these patients and observe changes in their pain over time. Methods: This was a cross-sectional study conducted at BIRDEM General Hospital in Dhaka from April to September 2024, involving 129 patients prescribed pregabalin for CLBP. Demographic, socio-economic, and clinical data were collected. The Visual Analog Scale (VAS) was used to measure self-reported pain intensity at baseline, and again at 6- and 12-week follow-up visits. The change in VAS scores was analyzed using a paired t-test by SPSS software (version 25.0) and then presented in tables and charts. Results: The study population had a mean (± SD) age of 52.3 ± 11.5 years and was predominantly female (61.2%). Common comorbidities included hypertension (38.0%), diabetes mellitus (29.5%), and ischemic heart disease (24.8%). The mean (± SD) duration of CLBP was 21.3 ± 9.8 months. Mean (± SD) VAS scores showed a progressive and statistically significant reduction from baseline (7.8 ± 1.1) to the 6-week (5.5 ± 1.4) and 12-week (4.2 ± 1.5) follow-up visits (p &lt; 0.05). Conclusion: The findings characterize a complex and highly symptomatic patient cohort receiving pregabalin for CLBP. The significant reduction in pain intensity observed over a 12-week period is a promising real-world observation. J Shaheed Suhrawardy Med Coll 2024; 16(2): 87-91

This study aims to investigate the efficacy of a simple and effective two-dimensional integrated navigation-guided spinal endoscopic interbody fusion surgery for the treatment of lumbar spondylolisthesis. A retrospective analysis was conducted on the clinical data of patients with lumbar spondylolisthesis treated with or without navigation. Postoperative clinical data were collected, and pain levels were assessed using the Visual Analog Scale (VAS), while functional improvement was evaluated using the Oswestry Disability Index (ODI). At the final follow-up, x-ray imaging was used to measure disc height (DH), slip percentage (SP), lumbar lordosis (LL), and slip angle (SA) at the surgical segment. Interbody fusion status was assessed based on the Bridwell grading criteria. ULIF surgery for lumbar spondylolisthesis with navigation assistance yields favorable early outcomes, including reduced surgery duration, fewer fluoroscopy instances, lower intraoperative blood loss, and less postoperative drainage volume (P < 0.05). Patients in the navigation group also show greater early postoperative improvements in low back pain (P < 0.05). No significant differences were observed between the two groups in other evaluation indicators (P > 0.05). Compared with the non-navigation group, the ULIF procedure guided by the two-dimensional integrated navigation system-which is simple and effective-can provide better early relief of low back pain in patients with lumbar spondylolisthesis, while also shortening operative time, reducing the number of fluoroscopy instances, minimizing intraoperative blood loss, and decreasing postoperative drainage volume. This surgical approach demonstrates great potential for widespread clinical application.

Background: Ac Lumbo-sacral transitional vertebra (LSTV) represents a common congenital anomaly at the lumbo-sacral junction, often associated with altered biomechanics, early degeneration and chronic low back pain (CLBP). Despite its clinical significance, regional data from South Kashmir remain limited. Objective: To determine the prevalence and types of LSTV among chronic low back pain patients in South Kashmir, using radiological evaluation (X-ray and MRI), and to assess associated degenerative changes and radiculopathy. Methods: This hospital-based cross-sectional study included patients aged 16–80 years presenting with chronic low back pain at MMABM Hospital, GMC Anantnag in South Kashmir, from June 2024 to May 2025. All subjects underwent lumbo-sacral spine imaging—either X-ray, MRI, or both. LSTV was identified and classified according to Castellvi’s classification1. Degenerative changes, adjacent segment disc pathology, and nerve root involvement were assessed. Data were analyzed for prevalence, laterality, and radiological correlations. Results: Of 208 patients evaluated, 35% (n=73) demonstrated LSTV on radiology. The most frequent subtype was Castellvi Type II (40%), followed by Type I (30%). Unilateral LSTV cases exhibited more severe degenerative changes and earlier disc space narrowing than bilateral types. Adjacent segment disc degeneration was observed in a majority of LSTV patients (70%), particularly at the L4–L5 level. Radiculopathy was present in a substantial proportion of cases with LSTV, frequently corresponding to foraminal stenosis or nerve root compression above the transitional level. Conclusion: LSTV is a frequent finding among chronic low back pain patients in South Kashmir, with a prevalence of approximately 35%. Unilateral variants are associated with more pronounced degeneration and radicular symptoms. Recognition of this variant on X-ray and MRI is vital for accurate diagnosis, classification, and management of low back pain

Background Chronic back pain is a common adult musculoskeletal disorder globally, causing lumbar dysfunction, sleep issues, and psychological anxiety. Yet current single-treatment plans have many limitations. Objective This study aimed to evaluate the efficacy of extracorporeal shock wave-based combined therapy for chronic back pain, analyze its impact on pain and lumbar function, and provide clinical evidence for multimodal treatment. Method This retrospective controlled study (September 2023–September 2025) enrolled 200 chronic low back pain (CLBP) patients from the Hospital, divided into two groups ( n = 100 each). The combined group received extracorporeal shock wave + core stability training + anti-inflammatory drugs, whereas the control group received exercise + anti-inflammatory drugs. The main indicators include Visual Analog Scale (VAS) (pain) and Oswestry Disability Index (ODI) (lumbar function), and the secondary indicators include Short Form 36 (SF-36) (quality of life), Berg Balance Scale (BBS) (posture control), Hospital Anxiety and Depression Scale (HADS) and Pittsburgh Sleep Quality Index (PSQI) (anxiety and sleep), serum IL-6, and TNF-α. Data were collected pretreatment and 4 and 12 weeks posttreatment, and a 12-week recurrence rate was recorded. Result No significant variations were observed in the baseline data of the two patient groups ( P &gt; 0.05). Following 4 and 12 weeks of treatment, two key differences emerged: First, the combined group had significantly lower values in VAS/ODI/HADS/PSQI scores and serum inflammatory factors (IL-6, TNF-α) than those of the control group ( P &lt; 0.05); second, the combined group's SF-36 and BBS scores were significantly higher than those of the control group ( P &lt; 0.05). Additionally, after 12 weeks of follow-up, the pain recurrence rate in the combined therapy group was significantly lower than that in the control group ( P &lt; 0.05). Conclusion The combination of extracorporeal shock wave therapy, core stability training, and anti-inflammatory drugs significantly alleviates pain, improves lumbar function/quality of life, reduces inflammation, and lowers long-term pain recurrence in CLBP treatment.