Lumbar Backache Research Articles

PMON85 Co-occurrence of Carotid Body Tumor, Meningioma and Schwannoma in a Symptomatic Patient, Incidental Findings Vs Genetic Syndrome: A Case Report

Abstract Carotid body tumors, also known as chemodectomas/paraganglionomas; are rare neuroendocrine tumors that arise from parasympathetic ganglionic cells. They are usually benign with incidence of malignancy is <10%. In majority of cases, tumors are asymptomatic and found incidentally on clinical exam or radiological imagining. Their association with other non-neuroendocrine tumors as seen in present case; has not been well documented in literature. Case presentation 43 y/o female with PMH of GERD, obesity, asthma and anxiety disorder who came to endocrine clinic for left middle thyroid lobe nodule(0.9×0.6×0.6cm) evaluation; incidentally noted to have a multilobulated heterogeneous hypo echoic and iso-echoic mildly vascularized solid nodular mass (3.46×1.83×1.93 cm) in the left carotid bifurcation area; splaying the common and the internal carotid arteries on US. Review of systems was positive for left sided neck pain, intermittent palpitations, headaches, anxiety, and sleep disturbances. Clinical exam was remarkable for thyromegaly and a palpable non-tender 3cm left neck mass with no cervical lymphadenopathy. Initial labs were notable for mild elevation of chromogranin A (108.4 ng/ml) with normal levels of TSH, free T3, free T4, plasma metanephrines and 24-hour urinary metanephrines. Considering patient's persistent symptoms; plasma catecholamines levels were done and were negative. MRI soft tissue neck confirmed 2.8 cm lobular mass suggestive of paraganglioma. Metastatic work up was negative. Patient was referred for genetic testing considering young age and to rule out hereditary disorders. Interim, patient presented to the ED with complain of sudden onset lumbar backache without sphincteric involvement; neurological exam was unrevealing but on MRI lumbar spine found to have a 5.7×4.8×4cm lobulated well-circumscribed homogeneous soft tissue mass suggestive of schwannoma. Cervical and thoracic spine imaging was unremarkable. MRI brain showed a 1.1cm enhancing mass in right Meckel cave suggestive of meningioma. PET-DOTATATE scan was performed that revealed left neck mass as intensely avid, Right petrous apex mass as moderately avid and lumbar mass as not avid at all, consistent with the diagnosis of paraganglionoma, meningioma and schwannoma respectively. No evidence of DOTATATE avid nodal/ distant metastatic disease was found. Initially a hereditary etiology was suspected but genetic testing including (VHL, NF1/2, SDHD, SDHB) came back negative. Case was discussed with multidisciplinary teams; Neurosurgery service recommends conservative management of both meningioma and schwannoma at the moment considering benign course. Regarding paraganglioma, as tumor is non-secretory on repeated work up; sympathetic blockade is not warranted and patient is scheduled for pre-op embolization and surgical resection by Head and Neck surgery. Conclusion Paraganglionomas are generally benign non-secretory tumors that usually occur with other neuroendocrine tumors both as hereditary syndromes and sporadic cases. But their association with non-neuroendocrine tumors is mere incidental or has a genetic causation; is still unclear and warrants further research. Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.

PMON85 Co-occurrence of Carotid Body Tumor, Meningioma and Schwannoma in a Symptomatic Patient, Incidental Findings Vs Genetic Syndrome; a case report.

Abstract Carotid body tumors, also known as chemodectomas/paraganglionomas; are rare neuroendocrine tumors that arise from parasympathetic ganglionic cells. They are usually benign with incidence of malignancy is <10%. In majority of cases, tumors are asymptomatic and found incidentally on clinical exam or radiological imagining. Their association with other non-neuroendocrine tumors as seen in present case; has not been well documented in literature. Case presentation 43 y/o female with PMH of GERD, obesity, asthma and anxiety disorder who came to endocrine clinic for left middle thyroid lobe nodule(0.9×0.6×0.6cm) evaluation; incidentally noted to have a multilobulated heterogeneous hypo echoic and iso-echoic mildly vascularized solid nodular mass (3.46×1.83×1.93 cm) in the left carotid bifurcation area; splaying the common and the internal carotid arteries on US. Review of systems was positive for left sided neck pain, intermittent palpitations, headaches, anxiety, and sleep disturbances. Clinical exam was remarkable for thyromegaly and a palpable non-tender 3cm left neck mass with no cervical lymphadenopathy. Initial labs were notable for mild elevation of chromogranin A (108.4 ng/ml) with normal levels of TSH, free T3, free T4, plasma metanephrines and 24-hour urinary metanephrines. Considering patient's persistent symptoms; plasma catecholamines levels were done and were negative. MRI soft tissue neck confirmed 2.8 cm lobular mass suggestive of paraganglioma. Metastatic work up was negative. Patient was referred for genetic testing considering young age and to rule out hereditary disorders. Interim, patient presented to the ED with complain of sudden onset lumbar backache without sphincteric involvement; neurological exam was unrevealing but on MRI lumbar spine found to have a 5.7×4.8×4cm lobulated well-circumscribed homogeneous soft tissue mass suggestive of schwannoma. Cervical and thoracic spine imaging was unremarkable. MRI brain showed a 1.1cm enhancing mass in right Meckel cave suggestive of meningioma.PET-DOTATATE scan was performed that revealed left neck mass as intensely avid, Right petrous apex mass as moderately avid and lumbar mass as not avid at all, consistent with the diagnosis of paraganglionoma, meningioma and schwannoma respectively. No evidence of DOTATATE avid nodal/ distant metastatic disease was found. Initially a hereditary etiology was suspected but genetic testing including (VHL, NF1/2, SDHD, SDHB) came back negative. Case was discussed with multidisciplinary teams; Neurosurgery service recommends conservative management of both meningioma and schwannoma at the moment considering benign course. Regarding paraganglioma, as tumor is non-secretory on repeated work up; sympathetic blockade is not warranted and patient is scheduled for pre-op embolization and surgical resection by Head and Neck surgery. Conclusion Paraganglionomas are generally benign non-secretory tumors that usually occur with other neuroendocrine tumors both as hereditary syndromes and sporadic cases. But their association with non-neuroendocrine tumors is mere incidental or has a genetic causation; is still unclear and warrants further research. Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.

High grade isthmic spondylolisthesis – A case series illustrating three different operative instrumented fusion techniques

Adult isthmic spondylolisthesis most commonly occurs at the L5-S1 level. In adults a high-grade slip degree is rare comprising less than 1% of cases. Progressive axial lumbar backache characterizes the early stage of the disease which over time commonly complicates with the development of a super-imposed L5 radiculopathy. These are difficult cases to manage and the attending spinal surgeon must have an understanding of several different surgical options. These options include conservative treatment in those who are mildly symptomatic, decompression alone with its inherent tendency to facilitate further slip, decompression and fusion without instrumentation, decompression and fusion with instrumentation, and if so the extent of the construct both cranially and caudally. Another important consideration is whether, or not, reduction is necessary or whether fusion in situ will suffice. Regarding the surgical approach some surgeons regard an anterior approach, to perform an anterior release, as necessary if reduction is to be achieved. Others consider nerve root decompression and posterior spinal fusion in situ as the technique of choice. Others advocate a combined anterior and posterior surgical approach.We report a case series of three adult female patients with high grade isthmic spondylolisthesis complicated by L5 nerve root compression. Each patient was successfully managed with a different instrumented fusion technique. Our case series serves to highlight several of the specific surgical nuances pertaining to the management of high-grade isthmic spondylolisthesis and as such is valuable to the attending spinal surgeon who may infrequently encounter patient with the high-grade form of this disease.

A minimally invasive open surgical approach for piriformis syndrome. A case report and literature review

Piriformis syndrome is being increasingly recognized as a distinct clinical entity which is now thought to account for as many as 6–8% of cases of lumbar backache and sciatica. Gender distribution notes a strong female predominate with a female to male ratio of 6:1.4. The disease is noted to occur as a primary form as well as a secondary form with a wide differential diagnosis. Diagnosing the problem as the cause of a patient’s pain is difficult and the standard clinical tests have a low sensitivity. MRI evaluation is problematic due to thickness assessment alone being of limited value. Ultrasonography has shown promise and demonstrated superiority to MRI evaluation due to its ability to assess cross sectional area and inflammatory changes in the sciatic nerve. Management necessitates a conservative 6-week trial of non-steroidal anti-inflammatory medication, muscle relaxants, physical therapy and steroid injections. Most patients respond to this conservative regimen within 1–3 weeks however for enduring relief adherence to a stretching exercise program cannot be over-emphasised. Surgery is considered a last line resort and the standard approach utilizes a 12 cm incision placed posterior to the greater trochanter through which division of the piriformis tendon and a neurolysis of the sciatic nerve from the piriformis muscle belly is achieved. We report an adult female patient with piriformis syndrome who failed a 6-week trial of conservative measures. She was taken to the operating room and through a minimally invasive open surgical approach utilizing a 6 cm skin incision posterior to the greater trochanter the surgical objectives were achieved. There were no complications and at her 6-week follow-up appointment she was pain free. We recommend a minimally invasive open approach, through a 6 cm skin incision placed posterior to the greater trochanter, as adequate to achieve the surgical objectives in the surgical management of this disease.

Subacute pulmonary embolism in a hemodialysis patient, successfully treated with surgical thrombectomy.

A 53-year-old woman was admitted to our hospital with a 1-month history of gradually progressive resting dyspnea and lumbar backache. For the preceding 6years, she had received regular hemodialysis for end-stage renal disease caused by autosomal dominant polycystic kidney disease and had taken tamoxifen for 3years as post-operative chemotherapy for breast cancer. Before admission, the patient's symptoms had been attributed to volume overload, based on right thoracic fluid and leg edema. However, despite volume correction by dialysis therapy, her symptoms had not improved. The patient was transferred to our hospital, where she was diagnosed with subacute pulmonary embolism (PE). Emergent pulmonary thrombectomy was performed using cardio-pulmonary bypass. The patient was discharged from our hospital on post-operative day 23. Recent reports have shown that hemodialysis patients have a relatively higher risk of PE compared with the general population. Our case had additional risk factors for PE: female sex, decreased protein C level, tamoxifen use, and autosomal dominant polycystic kidney disease. These factors may have had a synergistic effect on the onset of PE.

Ureterosciatic hernia successfully treated by ureteral stent placement

A 76-year-old woman with history of cholecystectomy, hysterectomy, and vesicourethral suspension presented with acute lumbar backache and discomfort in the lower abdomen and severe nausea, with frequent vomiting, but without any associated fever. Physical examination revealed knocking tenderness at the left costal-vertebral angle. The patient's serum white blood cell count was 14,900/mm(3) and the results of other laboratory tests, including urinalysis, were normal. Non-enhanced computed tomography revealed left hydroureteronephrosis and obstruction of the distal left ureter with herniation into the sciatic foramen. A left ureteral stent was inserted with a double-J stent. The stent was removed after 2 months and thereafter the patient did not experience any recurrence.

Prevention of ureteral damage by using ureteral illuminating catheter during laparoscopic surgery

It has been reported that the incidence of ureteral injury during laparoscopic surgery is higher than during laparotomy. Accordingly, we investigated the usefulness and safety of ureteral illuminating catheters during gynecological surgery. Two patients underwent laparoscopic assisted vaginal hysterectomy and laparoscopic hysterectomy with the use of ureteral illuminating catheters. After introduction of the laparoscope, the catheters were clearly seen within the ureters through the pelvic peritoneum, facilitating dissection of the ureters and control of periureteric bleeding. Regarding the complications of ureteral illuminating catheters, lumbar backache was noted postoperatively in one patient, but it resolved after one day. No other complications were found. This method can be applied for training in laparoscopy at teaching hospitals, as well as in technically challenging cases where identification of the ureters is likely to be difficult, e.g. patients with severe pelvic adhesions, severe endometriosis, and malignant tumours. To assess the safety of ureteral illuminating catheters, we will investigate more cases in the future.

Mesothelial Cyst of the Kidney. A Rare Case Report of this Neoformation on the Left Kidney

The authors are hereby presenting a rare case of neoformation developing on the left kidney in a 80-year-old patient affected by left lumbar backache. The neoformation appears doubtful in nature, on ultrasonography, CT scan and MRI. The lesion is roundish and contiguous at the kidney convex edge; due to its clinical aspects, it requires a surgical management and is, therefore, easily excised. The histopathologic examination confirms it is a mesothelial cyst. The case is presented for its absolute rarity and for the preoperative diagnostic doubts it may generate.

Successful surgical treatment for infective endocarditis during pregnancy

We herein describe the case of a 31-year-old woman. In the 27th week of pregnancy, the patient was hospitalized because of fever and a lumbar backache. In the 29th week of pregnancy, she developed embolic symptom in her left lower limb. A cardiac murmur was detected, and a significant regurgitation of the mitral valve, along with a mobile vegetation at the posterior leaflet of the mitral valve, was detected by cardiac ultrasound examination, thus resulting in a diagnosis of infective endocarditis. At the time of diagnosis, the fetus was estimated to weigh 1400 g, and it was delivered by cesarian section, with a mitral valve repair being performed 4 days later. The mother did well and was discharged from the hospital after remission on the 30th hospital day. The infant was admitted to the NICU and was discharged from the hospital with good development and no complications at the age of 59 days, weighing 3066 g. Cardiac surgery under extracorporeal circulation in pregnant women is rare, and it is believed to have a high mortality rate for both the mothers and fetuses. On the other hand, the survival rate of low birth weight infants has improved as a consequence of progress in neonatal care. We herein report a case of mitral valve repair in the second trimester with a good outcome for both the mother and the infant.

Ossifying luteinized thecoma of the ovary

A 51-year-old woman presented with lumbar backache leading to the preoperative diagnosis of a right solid adnexal mass with calcification on computed tomographic scan. Histological examination revealed a right ovarian luteinized thecoma characterized by extensive calcification and metaplastic ossification. Osteoblasts and osteoclasts surrounded the surface of the heterotopic bone. Haversian canals were occasionally identified in the bony trabeculae. Ossifying ovarian neoplasms are extremely rare and this case is the first to demonstrate the osseous metaplasia in ovarian luteinized thecoma.

The Effectiveness Of Flexible and Rigid Supports in Patients with Lumbar Backache

Background: Supports are frequently prescribed to patients with backache. We have assessed the effectiveness of a rigid lumbar corset and a semi-flexible thoraco-lumbar vest in 27 men and 52 women for whom surgery was inappropriate. In the women, the two corsets were also compared with a lingerie ‘all-in-one’ from a high street store.Findings: None of the corsets improved either the patients’ pain (Dallas rating), or disability (Roland and Morris score). Investigators’ ratings of physical impairment were also similar before and after corset use. The majority of patients with spinal stenosis felt worse when wearing a corset of any type and minimal benefit was seen in elderly patients with osteoporosis. The sequence of issue was irrelevant to the results. Forty-four per cent of women said they preferred the high street store’s lingerie garment to the more rigid supports available on prescription.Conclusion: The results from this study suggest that in chronic back pain nothing is gained by wearing a support.

Anthropometric variability, equipment usability and musculoskeletal pain in a group of nurses in the Western Cape

This study examined the anthropometry and anthropometric fit of a group of nurses in Western Cape private hospitals. Anthropometric variables were measured using a sample of nurses and a correlation matrix generated. All nurses were given a questionnaire concerned with operational problems in the work environment and musculoskeletal pain. The nurses reported numerous problems in the working environment, including lumbar backache, inadequate space and equipment that caused bodily discomfort. There were consistent, statistically significant associations between the frequency of occurrence of these problems and the anthropometric data indicating that the problems were caused or amplified by body size variability and were not simply general usability problems which would affect all nurses irrespective of their body dimensions.

Home dampness, moulds and their influence on respiratory infections and symptoms in adults in Finland.

The aim of this study was to analyse the prevalence of mouldy homes and their association with respiratory symptoms and diseases in a subarctic climate. A questionnaire was mailed to a random sample of 2,000 males and females, aged 25-64 yrs, living in the county of Kuopio, Finland. A total of 1,521 (76%) responded and 1,460 were selected for the final analysis. The prevalence of homes with visible mould was 4%; with the odour of mould 5%; with damp spots, visible mould or the odour of mould 15%; and with moisture/ water damage, damp spots, visible mould or the odour of mould 23%. The number of reports of bronchitis, common cold, atopy, allergic rhinitis, rhinitis, fever and chills, hoarseness, fatigue, difficulties in concentration, lumbar backache and stomach ache were strongly associated with living in a damp home. Bronchitis, hoarseness and difficulties in concentration had the strongest associations, with adjusted odds ratios (95% confidence limits) of: 2.04 (1.49-2.78), 2.23 (1.37-3.63) and 2.17 (1.35-3.50), respectively. After controlling for a possible reporting bias by excluding those subjects reporting lumbar backache and recurrent stomach pain, eye irritation and tiredness remained significant. In conclusion, living in a home with mould problems may increase the risk of respiratory infections and symptoms in adults.

Injection péridurale accidentelle de chlorure de sodium hypertonique

Twenty ml of 20 % hypertonic saline were accidentally injected into the epidural space of a 53-year-old man with lumbar backache and sciatica. This resulted in severe thoracolumbar pain, which disappeared after he received by the same route 20 ml of 1 % lidocaine and 40 ml distilled water. Three months later, the sciatica had almost all disappeared ; there remained no motor deficit. A literature survey helped to explain the signs described. Further cases of accidental epidural injections of other drugs are discussed.

Douleurs rachidiennes après anesthésie péridurale

A 24-year-old female patient underwent a minor orthopaedic procedure under epidural anaesthesia. She had a past history of lumbar backache. The epidural anaesthetic was carried out with the patient sitting. However, she had an acute vagal reaction, with loss of consciousness and forward headfall. Thirty-six hours later, the patient complained of severe pains diffusing all over her vertebral column, together with sciatica and paravertebral muscle contraction which did not respond to drug treatment. An epidural abscess or haematoma was ruled out. The pain finally disappeared after a few days of wearing a cervical collar, taking anti-inflammatory drugs, and a few vertebral manipulations. The back pain was probably due to a posterior articular joint syndrome, worsened by the forward headfall. In view of the past history, an epidural anaesthetic should probably have been best avoided.

Histopathology of intestinal inflammation related to reactive arthritis.

This study has identified a group of patients with inflammatory chronic, or relapsing acute arthritis who even in the absence of gastrointestinal symptoms have histological evidence of ileocolitis. At colonoscopy simultaneous biopsies of the terminal ileum and colon were taken from 108 patients with reactive arthritis (n = 55) or ankylosing spondylitis (n = 53), 47 patients with other rheumatic diseases and 19 control patients suffering from colonic polyps, adenocarcinoma, or chronic constipation. All control patients and all but one patient with rheumatoid arthritis, juvenile chronic arthritis, systemic lupus erythematosus, lumbar back ache, and psoriatic arthritis did not have histological evidence of acute or chronic inflammatory bowel disease. In contrast, in 30 of 35 (56.6%) patients with ankylosing spondylitis, and in 37 of 55 (67%) patients with reactive arthritis, regardless of HLA B27 phenotype, there was histological evidence of inflammatory bowel disease with features either of acute enterocolitis, or early Crohn's disease. Only 18 of 67 (27%) of the patients with histological gut inflammation, however, had intestinal symptoms.

Subacute Staphylococcal Meningitis Secondary to Postpartum Endometritis

A woman with Staphylococcus aureus meningitis following postpartum endometritis presented with lumbar backache and fever of several weeks' duration. Thick, green exudate was aspirated at lumbar puncture hours before death. Histologic examination demonstrated subacute inflammation of the meninges and chronic inflammation of the endometrium. Although rare, postpartum endometritis followed by low back pain and fever should alter the physician to the possibility of serious infection involving the central nervous system. Diagnosis and treatment at this early stage would be expected to decrease mortality.

THE DIAGNOSIS AND EARLY TREATMENT OF ACUTE BACKACHE

Backache is a common condition: almost everyone has suffered from it in some degree at one time or another. Over the last four years I have kept a record of the cases of lumbar backache seen in general practice. The number of patients presenting with lumbar backache in that time was 210, that is, approximately one new patient each week. Of these 210 cases, 131 (60%) were referred for physiotherapy, and I believe that the majority of these were substantially helped by physiotherapy. In 100 patients, 138 episodes of backache have been fully analysed and will be considered in this discussion. The average age of the group was 43.8 years, the oldest 81 and the youngest 13. 64% were males and 36% females.

Lumbosacral junction; roentgenographic comparison of patients with and without backaches.

Chronic lumbar backache continues to be a source of difficulty, both to the patient and to the physician called on for treatment. There is hardly a person who has not, at some time, experienced low backache. The vast majority of the backaches are transitory and will subside with little or no treatment. There are, however, many instances in which these bothersome backaches become chronic and tax the ingenuity and resourcefulness of the physician. In order to determine the relationship between the roentgenographic findings and chronic lumbar backache, a study was made comparing 100 patients with backache and an equal number of persons not bothered by backache. The group of persons with chronic backache included the first hundred who applied for treatment at the New York Orthopedic Dispensary and Hospital in the year chosen for study. They were not screened except that those persons with obvious pathological changes, such as herniation

Pelvic flexion cast in treatment of chronic lumbar backache

Pelvic flexion cast in treatment of chronic lumbar backache