Relief Of Low Back Pain Research Articles

Lumbar transforaminal epidural block for treatment of low back pain with radicular pain

To evaluate the efficacy of lumbar transforaminal epidural block (LTEB) for treatment of low back pain with radicular pain. We retrospectively analyzed the clinical data of 78 patients with low back pain and radicular pain admitted to the Department of Orthopedics of Beijing Chuiyangliu Hospital from March, 2017 to April, 2019. Thirty-three of the patients received treatment with LTEB (LTEB group), and 45 received comprehensive conservative treatment including traction, massage, acupuncture and physiotherapy (control group). The demographic and clinical data of the two groups were compared. The patients were followed up for 3 to 24 months, and numerical rating scale (NRS) and Oswestry disability index (ODI) scores of the patients were evaluated before the treatment and at 2 weeks, 1 month and 3 months after discharge to assess the efficacy of the treatment. The mean operation time of LTEB was 25.7 7.5 min (15-45 min). After the operation, 5 patients developed weakness of the lower limbs but all recovered within 24-72 h. The patients receiving LTEB all showed significantly decreased NRS scores for low back and radicular pain and ODI scores after the operation (P=0.001). At 2 weeks after the operation, the patients receiving LTEB showed significant relief of low back pain as compared with the patients in the control group (t=2.224, P=0.034), and the difference in NRS scores for low back pain between the two groups tended to diminish over time (F=1.743, P=0.183). Treatment with LTEB resulted in obvious relief of radicular pain and significant reduction of the ODI score of the patients (P < 0.001), and such improvements became more obvious over time after LTEB (P < 0.01). As a minimally invasive approach, LTEB is effective for treatment of low back pain with radicular pain and can produce good short-term effects of pain relief and functional improvement.

A Pilot Study of Full-Endoscopic Annulus Fibrosus Suture Following Lumbar Discectomy: Technique Notes and One-Year Follow-Up

Background: An annulus fissure or defect will inevitably be left on the posterior annulus fibrosus after almost all kinds of lumbar discectomy, which may lead to unsatisfying postoperative pain relief and recurrence of the disc herniation. Objective: The objective of this research is to introduce the technique of full-endoscopic annulus fibrosus suture following lumbar discectomy through the transforaminal or interlaminar approach, and to analyze the clinical outcome of full-endoscopic lumbar discectomy and annulus fibrosus suture. Study Design: This study used a prospective cohort design. Setting: The research was conducted in a hospital and outpatient surgery center. Methods: A total of 50 patients with noncontained lumbar disc herniation treated with full-endoscopic lumbar discectomy and annulus fibrosus suture were treated in our department between January 2018 and November 2018. Full-endoscopic single-stitch suture via the transforaminal approach (Group T) or double-stitch suture via the interlaminar approach (Group I) was selected according to the level of lesion. Lumbar magnetic resonance imaging (MRI) was reexamined on the second day and 3 months after operation to evaluate the completeness of the discectomy and the adequacy of nerve decompression. Patients were followed up on the second day, 3 months, 6 months, and one year after operation to evaluate the relief of low back pain and leg pain, using a visual analog scale (VAS, 100-point scale). At 3 months, 6 months, and one year after operation, the patients were followed up for recovery of lumbar spine function, using the Oswestry Disability Index (ODI). At the one-year follow-up, the MacNab score was used to evaluate the clinical outcome, and the recovery of nerve root function (sensation, muscle strength, and reflex) was recorded. Results: All operations were successfully completed, including 27 cases in Group T and 23 cases in Group I. There were no surgical complications and no recurrence of lumbar disc herniation. Lumbar MRI reexaminations of all patients showed that the herniated disc was completely removed and the nerves were fully decompressed. Postoperative low back pain and leg pain were significantly relieved, and the ODI score was significantly improved (P &lt; .01) in both groups. At the one-year follow-up, the excellent and good rates as measured by the MacNab score were 92.6% in Group T and 91.3% in Group I with no significant difference between the 2 groups (P &gt; .05). The impaired sensation and muscle strength in the low extremities of evolved nerve root of the 2 groups of patients recovered significantly at the oneyear follow-up (P &lt; .01), but the tendon reflex did not recover significantly (P &gt; .05). Limitations: This is an observational cohort study with relatively small sample sizes and short-term follow-up. Conclusions: Full-endoscopic lumbar discectomy and annulus fibrosus suture through either the transforaminal or interlaminar approach are safe and effective minimally invasive spinal surgery techniques that can reduce the recurrence rate of lumbar disc herniation after full-endoscopic lumbar discectomy. Keywords: Annulus fibrosus suture; full-endoscope; lumbar disc herniation; lumbar discectomy; minimally invasive spinal surgery

Analysis of the technical key points and clinical effect of full-endoscopic lumbar annulus fibrosus suture

To introduce the technical key points of lumbar annulus fibrosus suture under full-endoscope and analyze the clinical efficacy of full-endoscopic lumbar discectomy and annulus fibrosus suture. A total of 50 patients with non contained lumbar disc herniation treated with full-endoscopic lumbar discectomy and annulus fibrosus suture in our department between January 2018 and November 2018 were included. Full-endoscopic single-stitch suture through transforaminal approach or double-stitch suture through interlaminar approach was selected according to lesion level. The lumbar MRI and CT were reexamined on the second day and 3 months after surgery to evaluate the completeness of the discectomy and the adequacy of nerve decompression respectively. The patients were followed up on the second day, 3 months, 6 months, and 1 year after surgery for pain relief using visual analogue scale (VAS, 100 -point scale). The patients were followed up at 3 months, 6 months, and 1 year postoperatively for the recovery of lumbar spine function using Oswestry Disability Index(ODI). At the 1-year follow-up, the Macnab standard of lumbar spine function was evaluated, and the recovery of nerve root function (sensory, muscular and reflex) was recorded. All operations were successfully completed, of which 27 patients were treated with transforaminal approach(including 8 cases of L3, 4 and 19 cases of L4, 5), and 23 patients(including 11 cases of L4, 5 and 12 cases of L5S1) with interlaminar approach. The average operation time was 43.2 minutes. There were no surgical complications and no recurrence of lumbar disc herniation. Postoperative lumbar MRI and CT examinations of all patients showed that the herniated disc was completely removed and the nerveswere fully decompressed. All patients had significant relief of low back pain and lower extremity radiation pain, and the ODI score improved significantly(P<0.01). At 1 year postoperative follow up, 17 patients got an excellent result, 29 good and 4 fair according to Macnab evaluation system. On the first year after surgery, the sense of damaged nerve roots and muscle strength were significantly restored (P<0.01), but tendon reflexes were not significantly restored (P>0.05). Full-endoscopic lumbar discectomy and annulus fibrosus suture are safe and effective techniques for minimally invasive spinal surgery, which can reduce the recurrence rate of lumbar disc herniation after full endoscopic lumbar discectomy.

Effectiveness of Short-Segment Fixation versus Long-Segment Fixation for Degenerative Scoliosis with Cobb Angle 20°~40°: A Retrospective Observational Study.

BackgroundThere remains a great deal of controversy regarding the selection of long-segment fixation and short-segment fixation, especially for degenerative scoliosis (DS) patients with Cobb angle 20°~40°. The purpose of this study was to investigate the effects of different fixation levels in DS patients with Cobb angle 20°~40°.Material/MethodsWe enrolled 96 DS patients, divided into a long-segment fixation group (>3 segments) and a short-segment fixation group (≤3 segments). The visual analogue scale (VAS) and Oswestry disability index (ODI) were used to evaluate the clinical outcomes. The spinal-pelvic parameters and complications were also collected and analyzed.ResultsThe short-segment fixation group had the advantages of less blood loss, shorter operation time and shorter fluoroscopy time (P<0.05). The 2 groups achieved similar effects in leg pain (VAS) and ODI after operation (P>0.05); however, there was a better relief of low back pain in the long-segment fixation group (P<0.05). The changes of Cobb angle, sagittal vertical axis (SVA), lumbar lordosis (LL), pelvic tilt (PT) and sacral slope (SS) in the long-segment fixation group were more obvious than that in the short-segment fixation group at the final follow-up (P<0.05). The prevalence of complications in the long-segment fixation group was significantly higher than in the short-segment fixation group (P<0.01).ConclusionsShort-segment fixation has less surgical trauma and fewer complications, whereas long-segment fixation has more advantages in improving spine-pelvis parameters and relieving low back pain.

Surgical Management of Degenerative Lumbar Scoliosis Associated With Spinal Stenosis: Does the PI-LL Matter?

Retrospective observational cohort study. To compare the benefits of long and short fusion treatments, and to identify factors potentially aiding surgeons' decision making about the surgical management of degenerative lumbar scoliosis associated with spinal stenosis (DLSS). The comparative effectiveness of long and short segment fusion for the treatment of DLSS remains controversial. Fifty-three patients with symptomatic DLSS managed by posterior-only fusion surgery were enrolled in this study. Twenty patients underwent short fusion (fewer than two segments), and 33 patients had more than three segments fused. The radiological outcomes were assessed by radiography. Health-related quality of life data, including visual analog scale (VAS) and Oswestry Disability Index (ODI) scores, were collected at all preoperative and follow-up visits. The short and long fusion groups showed significant differences in the change in the Cobb angle (4.2° vs. 11.2°), lumbar lordosis (3.9° vs. 11.5°), and pelvic incidence minus the lumbar lordosis angle (PI - LL; 3.2° vs. 11.2°). Both the short and long fusion achieved significant changes in low back pain and leg pain. Patients with PI -LLs > 10° had more relief of low back pain after long fusion (VAS 4.0 ± 2.0) than after short fusion (VAS 2.6 ± 1.7). Patients with PI - LLs > 10° showed significantly improved walking ability after long fusion (ODI 1.0 ± 0.8). The improvement in standing ability after short fusion was greater when PI - LL ≤ 10°(ODI 0.9 ± 0.6). Long segment fusion can relieve low back pain better and improve walking ability when PI-LL is mismatched, whereas short segment fusion is more advantageous in improving standing ability in cases of more balanced sagittal spinopelvic alignment. 3.

Association Between Opioid Use and Patient-Reported Outcomes in a Randomized Trial Evaluating Basivertebral Nerve Ablation for the Relief of Chronic Low Back Pain

Chronic low back pain (CLBP) is a primary indication for opioid therapy. To evaluate the hypothesis that CLBP patients reporting reduced opioid use have superior functional outcomes following basivertebral nerve (BVN) radiofrequency ablation. This post hoc analysis from a sham-controlled trial examined short-acting opioid use from baseline through 1 yr. Opioid use was stratified into 3 groups by two blinded external reviewers. Two-sample t-tests were used to compare Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) measurements between those patients who increased or decreased their opioid usage compared to baseline. Actively treated patients with decreased opioid use at 12 mo had a mean ODI improvement of 24.9±16.0 (n=27) compared to 7.3±9.8 (n=18) for patients reporting increased opioid use (P<.001). In the sham arm, the improvements in ODI were 17.4±16.1 (n=19) and 1.2±14.3 (n=5; P=.053) for the patients reporting decreased vs increased opioid usage, respectively. Actively treated patients reporting decreased opioid use had a mean improvement in VAS of 3.3±2.5 (n=27) compared to 0.6±1.8 (n=18) for patients reporting increased opioid use (P<.001). In the sham arm, the improvements in VAS were 2.5±2.6 (n=19) and 1.4±1.9 (n=5; P=.374) for patients reporting decreased vs increased opioid use, respectively. Subjects undergoing BVN ablation who decreased opioid use had greater improvement in ODI and VAS scores compared with those reporting increased opioid usage. There is an association between functional benefit from BVN ablation and reduced opioid use.

Sacral Insufficiency Fractures: a Review of Risk Factors, Clinical Presentation, and Management.

Sacral insufficiency fractures (SIF) are a common and often underdiagnosed source of low back pain. In patients with SIF, there is both a compromised sacroiliac joint and weakened sacrum, resulting in decreased resistance to torsional stress, leading to fracture. While conservative medical management is a safe option, minimally invasive intervention may provide improved short and long-term relief of low back pain in patients presenting with SIF. This comprehensive review is undertaken to provide an update to the current understanding of SIF with description of risk factors, clinical presentation, and management. Sacroplasty is a minimally invasive procedure in which polymethylmethacrylate (PMMA) cement is inserted into bone to improve its structural integrity and alleviate symptoms. Balloon sacroplasty (BSP) has also been successful in alleviating pain with minimal cement leakage in SIF patients. Various other interventional techniques, including navigation-assisted screw fixation have been used to address SIF and have shown improvement in pain with minimal side effects. This review included various modalities of treatments available to manage SIF. This review shows that in comparison with nonsurgical management, sacroplasty has been shown to have greater pain reduction and improved mobility.

International Society for the Advancement of Spine Surgery Guideline-Intraosseous Ablation of the Basivertebral Nerve for the Relief of Chronic Low Back Pain.

This International Society for the Advancement of Spine Surgery guideline is generated to respond to growing requests for background, supporting literature and evidence, and proper coding for intraosseous ablation of the basivertebral nerve for chronic low back pain.

Evaluation of epidural injection of steroid methyl prednisolone, linocaine and normal saline through the lumber epidural route in the management of low back pain

Background: Epidural injections have been used for decades for treatment of low back pain. The use of extradural medication to relieve back-ache has been studied in recent years and encouraging results have been published. The present study deals with the epidural injection of steroid methyl prednisolone, lignocaine and normal saline combination in the management of low back pain. Method: The present prospective study was conducted on 50 patients with low back pain form Karnataka Institute of Medical Sciences Hospital, Hubli were selected. All the patients were admitted and referred from the orthopedic department of the Karnataka Institute of Medical Sciences, Hubli to the Pain Clinic of our Anesthesiology Department, after they failed to improve with two weeks of conservative therapy such as bed rest, skin traction and non-steroidal anti-inflammatory drugs. Out of 50 patients 36 were males and 14 were females (n=50). Study was explained to the patients and the informed consent was obtained from all the patients. Result: The pain relief was assessed by VAS and the score was excellent in 23.91%, good in 47.82%, satisfactory in 15.22 and poor in 13.42%. There was a very mild fall of 10 mmHg of BP below pre-operative value in 5 patients and two patients complained of headache. Other than these no complications have been encountered. Conclusion: Epidural injection of corticosteroids methyl prednisolone and local anaesthetic lignocaine is an excellent technique for the relief of chronic low back-ache. The side effects are few compared to surgical management. The success rate is high in comparison with other conservative methods. So it can be safely recommended for the relief of low back pain where conservative methods have failed to relieve the pain before embarking on surgical procedure (laminectomy).

Long-Term Effect of Peripheral Nerve Field Stimulation as Add-On Therapy to Spinal Cord Stimulation to Treat Low Back Pain in Failed Back Surgery Syndrome Patients: A 12-Month Follow-Up of a Randomized Controlled Study

Different approaches in neuromodulation have been used to treat chronic low back pain in failed back surgery syndrome (FBSS) patients. We previously randomized 52 FBSS patients to be treated with spinal cord stimulation (SCS) and additional peripheral nerve field stimulation (PNFS) or SCS alone. At three months, we found a significant reduction of back pain in the PNFS-SCS group compared to the SCS group. In the subsequent open phase part of the study, all patients received optimal SCS and PNFS simultaneously. Here, we present the 12-month follow-up data on back and leg pain. Data regarding back and leg pain, function, quality of life, patient satisfaction, anxiety and depression, and use of medication were collected by analyzing patients' questionnaires at 12 months and compared with data collected at baseline. Data were analyzed using multilevel regression models. A combined group of 50 subjects completed the 12-month follow-up. Back pain, measured on a 100-mm visual analog scale (VAS), significantly decreased over this period by 30.0 mm (95% CI: [-37.7/-22.4]; p < 0.001), while leg pain decreased by 43.7 mm (95% CI: [-51.5/-36.2]; p < 0.001). We observed statistically significant improvement in almost all secondary outcome measurements. At 12-month follow-up, PNFS in addition to SCS continues to provide a statistically significant and clinically relevant relief of low back pain in FBSS patients in whom SCS alone is effective for relief of leg pain only.

Enfermagem e a prática avançada da acupuntura para alívio da lombalgia gestacional

Resumo Objetivo Avaliar os efeitos da prática de acupuntura realizada no alívio da dor lombar em gestantes que se encontram no segundo e terceiro trimestre de gravidez, bem como na execução das atividades diárias. Métodos Estudo quase experimental, antes e depois, realizado com 56 gestantes com idade gestacional entre 14 e 37 semanas e queixa referida de dor lombar. Foram realizadas seis sessões de acupuntura, duas vezes por semana, com 30 minutos, cada uma, com a aplicação de pontos sistêmicos e auriculares. Para avaliação da dor utilizou-se a Escala Analógica Visual. Foram calculadas frequência absoluta e relativa para variáveis categóricas e média e desvio padrão para variáveis numéricas. Os testes utilizados para associação foram o Wilcoxon, para medidas pareadas, e teste de McNemar. Resultados Encontrou-se redução significante (p&lt;0,05) dos escores do índice de dor. A média da dor diminuiu na avaliação da segunda (4,92), quarta (3,24) e sexta (1,00) sessão. Algumas mulheres tiveram sua dor cessada antes de completar as seis sessões e houve melhora nas atividades prejudicadas pela dor. Conclusão A acupuntura proporcionou efeitos favoráveis à saúde das participantes, pois houve redução na dor logo a partir da segunda sessão. Acredita-se que os enfermeiros possam rever a qualidade da assistência às gestantes, a partir do conhecimento de técnicas que contribuem a um cuidado integral, pois a enfermagem tem na sua essência o processo de cuidado holístico do cliente, visando suas necessidades, contribuindo para que suas ações, enquanto profissionais de Medicina Tradicional Chinesa, sejam realizadas de maneira qualificada, eficiente e humanizada.

Genetic Contribution in Low Back Pain: A Prospective Genetic Association Study.

Chronic pain is one of the most common reasons individuals seek medical attention. It is a major issue because of the wide interindividual variability in the analgesic response. This might be partly explained by the presence of variants in genes encoding molecules involved in pharmacodynamics and pharmacokinetics. The aim was to analyze opioid effectiveness in chronic low back pain (CLBP) relief after opioid titration, unveiling the impact of pharmacogenetics. The study included 231 opioid-naïve patients from the Spine Unit; age 63±14years, 64% female, body mass index 29±6kg/m2 , visual analog scale pain intensity score 73±16mm. Clinical data were collected at baseline, 3months after opioid titration, and after 2 to 4years of follow-up concerning pain (intensity and relief), quality of life, disability, comorbidities, and drug prescription (opioid dose, rotations, and adverse events). The genotype influence of OPRM1, COMT, UGT2B7, ABCB1, KCNJ6, and CYP3A5*3A in analgesic response was analyzed by reverse-transcription polymerase chain reaction genotyping. Patients with the COMT G472A-AA genotype (rs4680) and KCNJ6 A1032G-A allele (rs2070995) CLBP responded differently to opioid titration, with higher pain intensity requiring higher dosing. Furthermore, GG- genotypes of A118G (OPRM1, rs1799971) and A854G (UGT2B7, rs776746) influenced the neuropathic component. After opioid titration, CLBP intensity, neuropathic component, low back pain disability, anxiety, and depression significantly decreased, while quality of life improved. Single-nucleotide polymorphisms in genes involved in pain transmission and opioid metabolism might predispose to exaggerated sensitivity and differences in the opioid analgesic effect in patients with CLBP. We encourage clinical trials for their clinical application in chronic pain management.

The importance of interspinous spacers in the treatment of lumbar spinal stenosis

In the treatment of lumbar spinal stenosis, interspinous spacers can be used in atissue and time sparing technique. Relief of low back pain might be achieved by stress reduction of facet joints and limitation of segmental mobility. Presentation of dynamic stabilization by means of an interspinous spacer with and without decompression and to compare it with the outcome of decompression and fusion. As part of aPubMed search, randomized controlled trials (RCTs) and non-RCTs from high-quality controlled clinical trials were selected and contrasted with our own experience. The current literature was evaluated, which assesses interspinous spacers with and without decompression in comparison with the "gold standard", the microsurgical interlaminar decompression. Published data indicate that the use of interspinous spacers with or without decompression for the treatment of lumbar spinal stenosis is not less effective than stand-alone decompression. The reoperation rate can only be proven for implants without decompression on the basis of Level Istudies. However, as alink between decompression alone and fusion, it cannot yet provide ascientifically clear solution.

The Clinical Significance of L5 Incidence in Patients with High Pelvic Incidence: A Case Report

Objective: To present a case of sagittal malalignment with high pelvic incidence and its surgical management. Summary of Background Data: Though rare, patients with high pelvic incidence (PI) around 90° without spondylolisthesis or spondylolysis often show sagittal malalignment with low back pain. However, little has been reported about the treatment of such cases. Methods: We report a case of a 15-year-old female complaining of severe difficulty in maintaining an upright position and gait disturbance due to back pain. Radiographs showed high PI of 88° and L5 incidence (L5I) of 67° combined with hyperlordosis of lumbar segments. A lower Lordosis Distribution Index (LDI; percentage of lordosis on segments L4–S1 in entire lumbar lordosis of L1-S1) was detected despite the high overall lumbar lordosis. The patient was surgically treated by two-stage combined posterior and anterior short fusion from the sacrum. Results: The surgical strategy was planned with attention to L5I instead of PI. L5I decreased to 49° and sagittal alignment of the whole spine—including cervical, thoracic, and lumbar spine—improved without any complications. Activity of daily living (ADL）improved preoperatively with relief of low back pain. Conclusions: Improvement of L5I by performing short fusion from L4 to S1 may be a strategy for patients with high PI complaining of low back pain due to sagittal malalignment.

Experimental methodology for quantitative assessment of heat-wrap thermal transient behavior

Among the numerous thermotherapy methods, heat wraps have been largely used over the last 2 decades as a self-administered practice for pain relief. Therefore, understanding their performance has become instrumental within the healthcare industry. However, the majority of the available studies have been focused on in vivo clinical performance, whereas a standardized, quantitative approach to evaluate and compare the various heat-wrap types against each other is lacking. An experimental methodology is proposed to carry out a comparative assessment between heat wraps in terms of their transient thermal behavior. A simple setup was developed to measure wrap/substrate interface temperature trend. The approach was validated by a preliminary infrared-thermography assessment and statistical analysis on the extensive dataset acquired on commercial heat-wrap types for low-back and neck pain relief. The heat-release trend was found to be qualitatively similar over all the investigated types, consisting of rapid growth, stationary phase, decay and end of the reactions. A set of parameters is also proposed to summarize heat-wrap thermal performance.

Effects of Ho:YAG Laser Ablation on Postoperative Low Back Pain and Functional Status After Transforaminal Endoscopic Lumbar Discectomy: Minimum of 2-Year Follow-Up

To evaluate effects of holmium:yttrium-aluminum-garnet (Ho:YAG) laser ablation on postoperative low back pain and improving functional status in patients with lumbar disc herniation undergoing transforaminal endoscopic lumbar discectomy (TELD). The study enrolled 220 patients with lumbar disc herniation who underwent TELD or TELD with Ho:YAG laser from August 2015 to September 2016. Parameters including operative time, hospitalization, complications, and recurrence were recorded. Clinical outcomes were assessed according to visual analog scale for back pain and leg pain, Oswestry Disability Index for functional status, and modified MacNab criteria for patient satisfaction. Minimal 2-year follow-up was completed by 186 patients: 76 patients who underwent TELD and 110 patients who underwent TELD with Ho:YAG laser. In the group undergoing TELD, clinical outcomes of back pain and functional status exhibited a V-shaped upward trend after surgery; there were no statistically significant differences in visual analog scale for back pain and Oswestry Disability Index scores at final follow-up compared with preoperatively (P > 0.05). In the group undergoing TELD with Ho:YAG laser, postoperative visual analog scale for back pain and Oswestry Disability Index scores significantly improved compared with preoperatively (P < 0.05) exhibiting relatively consistent improvement after surgery. The only laser-related complication was a burning sensation in the ipsilateral lower limb during the thermal procedure in 2 cases. Performing Ho:YAG laser ablation with TELD prolonged low back pain relief and improved functional outcome during 2-year follow-up compared with TELD alone in patients with symptomatic lumbar disc herniation.

Acute effect of non-specific low back pain relief with quick combined simple exercise: preliminary examination for a male worker in manufacturing industry

Acute effect of non-specific low back pain relief with quick combined simple exercise: preliminary examination for a male worker in manufacturing industry

03:00 PM Abstract No. 199 Two-year outcomes of patients treated with BVN ablation for the relief of chronic low back pain: results of the SMART trial

Thirty percent of Americans have low back pain (LBP) at any given time, leading to approximately 50 million physician visits in the U.S. annually. Chronic low back pain (CLBP) can be difficult to diagnose and treat using either non-surgical therapies or surgical interventions. Antonacci et al. proposed that some pain previously ascribed to the disc actually emanates from the vertebral endplate nociceptors which communicate to the CNS through the basivertebral nerve (BVN).1 The purpose of the present study is to report the 2-year clinical outcomes for CLBP patients treated with radiofrequency (RF) ablation of the BVN in a randomized controlled trial (RCT) that previously reported 1-year follow-up. A total of 147 patients were treated with RF Ablation of the BVN in an RCT designed to demonstrate safety and efficacy as part of a Food and Drug Administration-Investigational Device Exemption (FDA-IDE) trial. Evaluations, including patient self-assessments, physical and neurological examinations, and safety assessments, were performed at two and six weeks, and three, six, twelve, eighteen, and twenty-four months postoperatively. Clinical improvements in ODI, VAS, and SF-36 PCS were statistically significant compared to baseline at all follow-up time points through 2 years. The mean percent improvements in ODI and VAS compared to baseline at 2 years were 53.7% and 52.9%, respectively. Responder rates for ODI and VAS were also maintained through 2 years with patients showing clinically meaningful improvements in both: ODI ≥ 10-point improvement in 76.4% of patients and ODI ≥ 20-point improvement in 57.5%; VAS ≥ 1.5 cm improvement in 70.2% of patients. Patients treated with RF ablation of the BVN for CLBP exhibited sustained clinical benefits in ODI and VAS and maintained high responder rates at 2 years following treatment. BVN ablation appears to be a durable, minimally invasive treatment for the relief of CLBP.

Intracutaneous sterile water versus intramuscular tramadol injection in relief of low back pain in labour

Intracutaneous sterile water versus intramuscular tramadol injection in relief of low back pain in labour

Erector spinae plane block for low back pain in failed back surgery syndrome: a case report

BackgroundPatients with failed back surgery syndrome (FBSS) experience chronic back pain following spinal surgery, and effective treatment is difficult because of multiple contributing factors.Case presentationHere we report a case involving a 72-year-old woman who experienced recurrent low back pain after undergoing two back surgeries. She was treated with erector spinae plane (ESP) block, which affected the dorsal rami of the spinal nerves from T12 to L5. Pain relief lasted for approximately 10 h after the initial block, and successful low back pain relief was achieved after a total of three trials.ConclusionsESP block, which is an easy and safe procedure, can be used to treat FBSS-associated low back pain.