Lumbar Pain Research Articles

Spinal hydatid disease: A case report

Introduction: The parasitic tapeworm Echinococcus granulosus causes cystic echinococcosis, also known as hydatidosis. It is a serious medical condition that can show up in a lot of different ways. Although spinal involvement occurs in about 45% of bone echinococcosis cases, it represents only 0.5–4% of all echinococcosis cases. The disease can spread to the spine through hematogenous dissemination, direct invasion, or cerebrospinal fluid seeding from ruptured cysts. While the liver and lungs are the most commonly affected organs, spinal involvement can lead to severe complications, including radiculopathy, motor deficits, and paraparesis. Imaging, such as computed tomography (CT) and (MRI), typically makes the diagnosis by revealing cystic and osteolytic lesions. Case Report: The patient is a 51-year-old male from the Kakheti region (a region in Georgia) who presented with progressive generalized weakness, nausea, vomiting, and lumbar pain. He had a history of spinal echinococcosis, diagnosed 15 years ago, but was unable to complete antiprotozoal treatment due to intolerance to albendazole. Over the years, his condition deteriorated, leading to lower paraplegia and urinary incontinence, necessitating a suprapubic cystostomy. Imaging revealed extensive septated cystic lesions in Th4-S1, which spread to the ribs and subcutaneous tissues. Despite neurosurgical intervention to reduce the cyst burden, the infestation persisted. Multiple hospitalizations were required for complications, such as urinary tract infections and pneumonia. Joint supervision managed the patient’s condition, but he continued to experience spherocyte discharge from numerous fistulas. Conclusion: This case underscores the severe and chronic nature of spinal echinococcal infection, particularly when complete antiprotozoal treatment is not feasible. The patient did not experience severe neurological complications despite the extensive disease burden and the development of multiple vertebral-cutaneous fistulas, possibly due to the continuous drainage of spherocytes. This unusual clinical course highlights the importance of comprehensive management and the potential impact of innovative approaches on managing complex parasitic infections.

Severe atypical iliac wing fracture associated with long-term bisphosphonate use.

Bisphosphonate use is associated with atypical non-traumatic fractures, which are most commonly seen in the femur. We report a 63-year-old postmenopausal woman who presented acutely with progressively worsening lumbar pain radiating to her left hip for 10days. There was no antecedent trauma. On examination, the patient could not bear weight on her left leg due to the severity of the pain. Radiography and computed tomography of the pelvis demonstrated an iliac wing fracture which was treated conservatively. The patient had a significant past medical history of breast cancer and intense bisphosphonate use for several years which was discontinued 3years previously. No discrete bone lesion was seen at the fracture site on computed tomography, and there was no evidence of metastatic disease elsewhere. A dual-energy X-ray absorptiometry scan showed the lowest bone mineral density T-score of - 1.2. A diagnosis of an atypical fracture related to long-term bisphosphonate therapy was made. To the best of our knowledge, this is the first reported case of an isolated iliac wing fracture associated with long-term bisphosphonate therapy in the literature. Whilst the incidence of such fractures is exceedingly rare, it is an important differential in patients with atypical fractures on long-term bisphosphonates.

Surgical Outcomes in Patients Exhibiting Muscular Weakness Postadolescence Due to Tight Filum Terminale.

Tight filum terminale is a neurological condition marked by various symptoms, including muscle weakness. There is a notable lack of literature addressing muscle weakness, particularly in cases emerging during adolescence and beyond. The diagnosis is challenging due to a lack of radiological abnormalities, and the literature on its treatment, especially untethering, in adults is limited. This study aims to evaluate the effectiveness of untethering in improving muscle weakness and other symptoms in postadolescent patients diagnosed with tight filum terminale. A retrospective analysis was conducted on seven postadolescent patients diagnosed with tight filum terminale and presenting muscle weakness who underwent untethering at our institution between January 2018 and August 2022. Patients were monitored for muscle strength improvement, lumbar and lower extremity pain, and bowel and bladder dysfunction (BBD) after untethering. Muscle weakness improved in all cases after untethering, with a mean duration of 9.1 weeks for the improvement. Patients unable to walk independently regained mobility in an average of 22.3 weeks. Lumbar and lower limb pain improved in all cases within an average of 8.1 weeks, while BBD improved in six of the seven cases within an average of 1.9 weeks. Our findings suggest that untethering is an effective surgical intervention for postadolescent patients diagnosed with tight filum terminale and presenting muscle weakness.

Pain Management in Patients With Lumbar Pain Syndrome Through Combined Physical and Kinetic Therapies

The aim of this study is to highlight the importance of associating various means of electrotherapy and kinesiotherapy in patients with low back pain. The study included 30 patients, diagnosed with low back pain syndrome, who underwent a complex treatment of physical therapy and kinesiotherapy associated with drug treatment. A questionnaire based on a series of standard questions, marked with 0-5 points, ranging from no pain and reduced functionality to intense pain and functional impairment, was used to quantify the intensity of pain and limitation of functionality due to pain. Data centralization, analysis, and comparison allowed us to identify the dynamic evolution of the monitored parameters so that after the application of associated therapies we found that if at the beginning of the treatment the majority of patients 70% (21 cases) were in severity class I established on the basis of the scores obtained by the patients in the questionnaire applied, at the end of the treatment only 13.3% (4 cases) remained in severity class I. In conclusion, the use of electrotherapy ensures the rapid achievement of optimal local conditions in the affected structures, removing the algesic component and thus preparing them for the kinetic program, thus creating a perfect symbiosis between the two methods of recovery of patients with low back pain syndrome.

The effects of connective tissue massage and classical massage on pain, lumbar mobility, function, disability, and well-being in chronic low back pain: A three-arm randomized controlled trial

BackgroundChronic low back pain (CLBP) is a common musculoskeletal disorder. Effect of massage in the management of CLBP has been documented, but it is not clear which massage regimen is more effective. This study was carried out to compare the effect of connective tissue massage and classical massage on pain, lumbar mobility, function, disability, and well-being among patients with CLBP. MethodsThe study included 30 participants who were randomly assigned to one of three intervention groups: the connective tissue massage group (CTMG; n = 10), the classical massage group (CMG; n = 10), and a standard physiotherapy/control group (CG; n = 10). The interventions were administered three times a week for four consecutive weeks. Assessments were conducted at baseline and at the end of the fourth week. Pain severity (Visual Analog Scale), lumbar mobility (Modified Schober Test), function (Back Pain Functional Scale), disability (Roland Morris Disability Questionnaire), and well-being (Short Form-36/SF-36) was evaluated. ResultsAll groups exhibited improvements in pain, lumbar mobility, function, and disability after 4 weeks (p < 0.05). The CMG showed enhancements in physical function, bodily pain, role physical, and role emotional subgroups of SF-36. The CTMG demonstrated improvements in all subgroups of SF-36 except general health (p < 0.05), while the CG only improved in the physical function subgroup (p < 0.05). A 2-way repeated measures ANOVA revealed a significant group-time interaction for MST (p = 0.04), Bodily Pain (p = 0.025) and Role Physical (p = 0.015). ConclusionsThe findings obtained from this study showed that CTMG was superior to CMG and CG in increasing lumbar mobility, and both massage applications were superior to the CG in increasing the well-being.

The role of the greater trochanter pain syndrome in lumbar degenerative disc disease surgery.

Greater trochanter pain syndrome (GTPS) is highly discussed during spine surgeons, accompanies lumbar pain and complicates differential diagnosis. The aim is to raise awareness among physicians and demonstrate the lumbar spine degenerative diseases (LSDD) association with GTPS. A retro-prospective analysis enrolled 172 patients with LSDD with GTPS signs. Group I - retrospective (n = 112), group II - prospective (n = 60). Patients of group II with the confirmed diagnosis clinically and by the ultrasound recieved a GCS injection (Betamethasone 2mg\ml + 5mg\ml - 1.0). Also the VAS, X-ray and SPSS Statistics package were used. 112 patients in group I, 89 (79.5%) had increased pain in the hip early postOp to 7.8 points by VAS. All patients required trigger point injections of GCS and 68 (77%) received a repeat injection. 76 from 112 patients were tracked for long-term results, and recurrence of GTPS was detected in five people who treated conservatively for threemonths without dynamics. They were identified GTPS by ultrasound. During the injection, 39 from 43 (90%) patients noted pain reduction to 2.1 by VAS, but symptoms of radiculopathy or spinal stenosis persisted. Two patients (5%) did not note any changes. Two patients (5%) noted complete pain regression and refused the surgery. Timely detection of GTPS among spinal surgeons influences tactics and, in some cases, allows one to avoid unnecessary surgical interventions. In turn, ignoring the symptoms of GTPS in the preoperative period can lead to pain intensification in the greater trochanter after surgery for degenerative diseases of the spine.

Comparative analysis of two different physiotherapy intervention programs in individuals experiencing chronic lower back pain

Background and objectives. Physiotherapy programs in individuals experiencing chronic lower back pain (CLBP) aim to improve function, disabilities from worsening. As per clinical practice guidelines, many methods are applied, such as the McKenzie method, therapeutic exercises, transcutaneous electrical nerve stimulation (TENS), traction, thermotherapy etc. The effectiveness of these methods is supported by a wide range of evidence and studies, making them some of the most diverse and well-established approaches. These physiotherapeutic treatments are combined every day. Therefore, the aim of this research is to provide a comparative investigation on two different physiotherapy programs containing a combination of these treatment modalities in individuals with CLBP. Materials and methods. This research involved 60 patients who were separated into two groups. Group I received the McKenzie treatment method, passive modalities, lumbar traction, and a walking program. Group II received therapeutic exercises, passive modalities, lumbar traction, and a walking program. Both groups underwent treatment for six weeks. Subjects were tested using research instruments at the beginning, at the end of three weeks, and at the end of six weeks of treatment. The evaluation instruments used were the visual analog scale, Finger-to-Floor test, the Oswestry Low Back Pain Disability Questionnaire, and the Rosenberg self-esteem scale. Results. Pain intensity, functional disability, lumbar flexibility, and self-confidence showed greater improvement after six weeks of treatment in both programs (p &lt;0.0001), without any significant statistical difference among the groups (p &gt;0.05). Conclusions. The data obtained from both groups support the effectiveness of both treatment programs and suggest that they can be considered as options for viable programs treatment for patients with CLBP.

Postural and Lumbopelvic Control: Crucial Factors in the Functionality of Patients with Low Back Pain-A Descriptive Cross-Sectional Study.

Background: Low back pain (LBP) is one of the most prevalent musculoskeletal disorders in adults worldwide. Alterations in postural and lumbopelvic control and functionality appear to be determining factors in its resolution. Methods: A cross-sectional study was performed. Patients with LBP were enrolled. Lumbar pain; postural control (PC), total area of the center of pressure (TACOP), and the velocity of the center of pressure (VCOP); lumbopelvic control (LPC); and functionality were evaluated. Statistical tests were implemented to determine differences between sex and age and correlation models among the variables. Results: Thirty adult patients with LBP were analyzed. A strong relationship was found between pain and functionality [r = 0.64; p < 0.001]. A moderate relationship was found between pain and TACOP [r = 0.395; p = 0.031]. A moderate relationship was observed between TACOP and functionality [0.413; p = 0.023] and between LPC and TACOP [r = 0.416; p = 0.001]. Conclusions: This study demonstrates the significant impact of LBP on postural control, lumbopelvic control, and functionality. These results highlight the importance of addressing postural and lumbopelvic control in LBP treatment. No significant differences based on gender and age were found, but all clinical variables differed significantly between the LBP and control groups, underscoring the unique impairments associated with LBP.

Clinical therapeutic effect of self-prescribed Sanhanchushi Tongbi on lumbar disc herniation

BACKGROUND Lumbar disc herniation (LDH) commonly occurs during spinal surgery; LDH is on the increase in younger patients and is classified as "paralysis" and "back pain.” Sanhanchushi Tongbi (SPST) is a customized prescription. It disperses cold, relieves pain, removes cold from the meridians and viscera, and treats neuropathic pain. However, few studies have investigated its mechanism of pain relief. AIM To observe the clinical therapeutic effects on LDH treated with self-prescribed SPST. METHODS A total of 211 patients with LDH syndrome were divided into two groups: 107 patients in the control group were treated with conventional massage combined with traction, and 104 patients in the observation group were treated with a combination of the control regimen and self-prescribed oral SPST. The patients were treated for 4 wk. Indices of traditional Chinese medicine (TCM) syndrome score and serum inflammatory factor levels were measured. RESULTS After therapy, the TCM syndrome score in the observation group was significantly lower than that in the control group (P &lt; 0.05). The main symptoms, clinical signs, daily activities, and Japanese Orthopedic Association scores in the observation group were significantly higher than those in the control group after therapy (P &lt; 0.05). The levels of tumor necrosis factor-α, interleukin-6, and C-reactive protein were lower in the observation group than in the control group (P &lt; 0.05). In the observation group, superoxide dismutase levels were significantly higher, whereas malondialdehyde levels were significantly lower, compared with the control group (P &lt; 0.05). The overall efficacy rate in the observation group was 96.15%, which was substantially higher than that in the control group (88.79%; P &lt; 0.05). CONCLUSION Self-prescribed SPST can reduce the levels of inflammatory and pain-causing factors as well as lumbar pain in patients with LDH.

Back pain in adolescent idiopathic scoliosis: frequency and risk factors

PurposeAlthough back pain is commonly reported in patients with adolescent idiopathic scoliosis (AIS), factors that influence the presence and severity of back pain in AIS, including curve-specific variables, have not been well studied. This study aims to describe the prevalence and severity of back pain in AIS patients and determine the extent to which patient characteristics, including curve-specific factors, are associated with a higher risk of back pain in AIS.MethodsThe study was a retrospective medical records review of adolescents (aged 10–17 years) diagnosed with AIS between 01/01/2018 and 12/31/2021 at an academic tertiary children’s hospital. Patients with previous spine surgery were excluded. Variables collected included demographics (age, sex, race, insurance), Lenke classification, major coronal curve, back pain-related information, Risser stage, vitamin D levels, post-diagnosis brace utilization, physical therapy or chiropractic treatment, and surgery.ResultsA total of 891 AIS patients were included in the analysis. The sample was predominantly female (73.3%) and insured by Medicaid (57.8) with a mean age of 12.8 years. The mean major coronal curve was 26.3 degrees. Most patients had Lenke type 1 (47%) and type 5 (41%) curves. Nearly half of patients reported back pain (48.5%) with average pain severity in the low-to-moderate range (4.7) on FACES pain scale (0–10). Among those who reported back pain, 63.2% specified a location with the majority reporting pain in the lumbar region (56%) and, less commonly, in the thoracic (39%) and scapular (8%) regions. Lumbar pain was associated with significantly higher pain intensity (p = 0.033). Additionally, the location of pain reported was associated with location of major coronal curve (p < 0.0001). No association was observed between pain presence and vitamin D deficiency (p = 0.571, n = 175), major coronal curve magnitude (p = 0.999), Lenke curve type (p = 0.577), and sex (p = 0.069). Older patients, those insured by Medicaid, and those with higher Risser scores were more likely to report pain scores (p = 0.001 for all).ConclusionNearly half (48%) of newly diagnosed AIS patients experience back pain which is higher than the prevalence of 33% seen in the general adolescent population. Pain was more prevalent among patients over the age of 13, with heavier body weight, and those insured by Medicaid. Pain was most commonly reported in the lumbar region, especially among patients with lumbar curves. This information can be helpful in counseling AIS patients, though further investigations are needed, especially to determine the underlying causes of back pain in AIS and to elucidate the discrepancy in pain between patients with Medicaid and commercial insurance.Level of evidence.Prognostic Study Level II.

Clinical Outcomes of Percutaneous Endoscopic Transforaminal Discectomy for the Treatment of Disc Herniation: A 3-Year Retrospective Study.

Percutaneous endoscopic transforaminal discectomy (PELD) is a new minimally invasive spine surgery for patients with lumbar disc herniation (LDH). Based on the 3-year follow-up data, the effect of PELD on the clinical outcomes of patients with LDH through a retrospective cohort study was analyzed in this article, so as to provide guidance for clinical selection of surgical options. The clinical data of 150 patients with LDH admitted to our hospital from January 2019 to October 2020 were retrospectively analyzed. According to the surgical methods recorded in the medical record system, the patients were divided into the open lumbar microdiscectomy (OLM) group (n = 50) and the PELD group (n = 100). The surgical and postoperative recovery indicators of the two groups were compared after matching. These included incision length, intraoperative blood loss, operation time, postoperative ambulation time and hospital stays, recovery rate, short-term complication rate, Lumbar visual analogue scale (VAS) score, and Oswestry Disability Index (ODI) score. Compared with the OLM group, the PELD group had shorter incision length, shorter operation time, shorter postoperative ambulation time, shorter hospital stays, less intraoperative blood loss, lower short-term complication rate, lower lumbar pain and dysfunction scores at 3 months, 6 months, and 1 year after operation, higher short-term excellent-and-good recovery rate, and higher quality-of-life scores at 3 years after operation (p < 0.05). Compared with OLM, PELD in the treatment of LDH patients can reduce the operation time, blood loss, and length of hospital stays, suggesting a short-term postoperative recovery effect. Compared with OLM, PELD can also reduce the incidence of short-term complications, enhance the effect of pain control and improvement of dysfunction in the medium term, and improve the long-term quality of life.

Diagnosis and multidisciplinary management of a large primary retroperitoneal hydatid cyst: report of a sporadic case

BackgroundHydatid cysts, a parasite caused by infestation with Echinococcosis granulose, are rarely found in isolation in the retroperitoneum. Diagnosis is based on clinical and paraclinical criteria, and the symptoms are often aspecific. In large, symptomatic forms, surgical excision is the mainstay of treatment. However, a multidisciplinary approach, including infectious diseases specialists, can improve results and reduce the risk of recurrence.Case presentationWe report the case of a 38-year-old woman presenting with a large primary retroperitoneal hydatid cyst. After 13 years of asymptomatic evolution, she developed lumbar pain and a sensation of heaviness. The diagnosis was confirmed by a battery of biological and radiological tests. Due to the size of the cyst, open surgery was performed. Follow-up revealed no clinical complaints or recurrences.ConclusionConsidered a rare condition, hydatid cyst requires special attention when evaluating lumbar masses or cystic masses, particularly in endemic areas. In addition to surgery, it is essential to take into account the risk of contamination of other sites during surgery. Collaboration with specialists in infectious diseases is therefore essential.

Clinical Outcomes of the Transforaminal Lumbar Interbody Fusion Technique Among Patients With Low Back Pain Showing Type 1 Modic Changes on MRI.

Introduction The unilateral transforaminal lumbar interbody fusion (TLIF) signifies a different surgical method, circumventing both the anterior method and the method via the spinal canal. Due to the shortage of literature available for clinical outcomes and consequences post-TLIF, we undertook the current study to assess the TLIF technique's clinical outcomes among patients with low back pain showing type 1 Modic changes on MRI. Material and methods A cross-sectional study was conducted between January 2019 and March 2021. All patients included in the study had Modic type 1 change and disabling lowback pain as the main complaint and/or leg pain. Data were collected on age, body mass index (BMI), gender, and other risk factors like diabetes mellitus, steroid use, and smoking. Pain intensity was evaluated using a visual analog scale (VAS) before and after surgery. A radiographic evaluation was also performed. Preand post-operative pain scores and differences in disc height were assessed using the Wilcoxon rank sum test. A p-value of less than 0.05 was considered significant. Results The mean length of stay in the hospital was 4.3±1.61. The mean pre-operative lower back pain score was 8.78±0.79. The mean post-operative score was substantially lowered to 0.83±0.7. There was a significant difference between pre- and post-operative lumbar pain (p-value < 0.001). There was a significant increase in mean disc height from pre-operative (7.14 mm) to post-operative (11.02 mm) and also at one year (10.21 mm) with a p-value of <0.001. Of the patients,82.14% did not have any complications, and 3.57% each had either delayed wound healing without any infection or transient post-operative radiculopathy that improved in six weeks. Conclusion TLIF procedure can be considered safeto provide anterior and posterior column support by adopting a unilateral posterior approach. The outcomes were favorable in terms of no prolonged length of stay, less blood loss, no mortality, reduction in the severity of pain, and improvement in disc height. However, the appropriate selection of patients for this technique is pivotal for the success of the procedure.

Elbow bursitis, spondylodiscitis and meningitis due to streptococcus agalactiae: A case report

We present the case of a woman who consulted the Emergency Department for lumbar pain for 15 days, with fever in the previous 72 hours and confusion on the day she consulted.

One spinal manipulation session reduces local pain sensitivity but does not affect postural stability in individuals with chronic low back pain: a randomised, placebo-controlled trial

BackgroundClinical practice guidelines recommend spinal manipulation for patients with low back pain. However, the effects of spinal manipulation have contradictory findings compared to placebo intervention. Therefore, this study investigated the immediate effects of lumbar spinal manipulation on pressure pain threshold (PPT) and postural stability in people with chronic low back pain (cLBP). Second, we investigated the immediate effect of lumbar spinal manipulation on pain intensity and the interference of the participant beliefs about which treatment was received in the PPT, postural stability, and pain intensity.MethodsA two-arm, randomised, placebo-controlled, double-blind trial was performed. Eighty participants with nonspecific cLPB and a minimum score of 3 on the Numeric Pain Rating Scale received one session of lumbar spinal manipulation (n = 40) or simulated lumbar spinal manipulation (n = 40). Primary outcomes were local and remote PPTs and postural stability. Secondary outcomes were pain intensity and participant’s perceived treatment allocation. Between-group mean differences and their 95% confidence intervals (CIs) estimated the treatment effect. One-way analysis of covariance (ANCOVA) was performed to assess whether beliefs about which treatment was received influenced the outcomes.ResultsParticipants had a mean (SD) age of 34.9 (10.5) years, and 50 (62.5%) were women. Right L5 [between-group mean difference = 0.55 (95%CI 0.19 to 0.90)], left L5 [between-group mean difference = 0.45 (95%CI 0.13 to 0.76)], right L1 [between-group mean difference = 0.41 (95%CI 0.05 to 0.78)], left L1 [between-group mean difference = 0.57 (95%CI 0.15 to 0.99)], left DT [between-group mean difference = 0.35 (95%CI 0.04 to 0.65)], and right LE [between-group mean difference = 0.34 (95%CI 0.08 to 0.60)] showed superior treatment effect in the spinal manipulation group than sham. Neither intervention altered postural stability. Self-reported pain intensity showed clinically significant decreases in both groups after the intervention. A higher proportion of participants in the spinal manipulation group achieved more than two points of pain relief (spinal manipulation = 90%; sham = 60%). The participants’ perceived treatment allocation did not affect the outcomes.ConclusionOne spinal manipulation session reduces lumbar pain sensitivity but does not affect postural stability compared to a sham session in individuals with cLPB. Self-reported pain intensity lowered in both groups and a higher proportion of participants in the spinal manipulation group reached clinically significant pain relief. The participant’s belief in receiving the manipulation did not appear to have influenced the outcomes since the adjusted model revealed similar findings.

Role of End Plate Changes and Paraspinal Muscle Pathology in Lower Back Pain: A Narrative Review.

Degenerative changes of the lumbar intervertebral disc are the most significant causes of enduring lower back pain. The possibility of the diagnosis is limited in people with this low back pain. Therefore, it is essential to identify the relevant back pain subgroups. The paraspinal muscles, that is, the muscles that attach to the spine, are necessary for the proper functioning of the spine and the body; insufficiency can result in back pain. Lower back pain disorders are strongly associated with altered function or structure of these paraspinal muscles, especially fibrosis and fatty infiltration. Modic changes are the bone marrow changes of the end plate in the vertebral body seen on MRI. These are strongly related to degeneration of the disc and are common in individuals with back pain symptoms. Articles were selected from Google Scholar using the terms 'Modic changes,' 'end plate changes,' 'paraspinal muscles,' and 'lower back pain. ' This article compiled different studies aiming to enhance the comprehension of biochemical processes resulting in the development of lumbar pain. Search using the keywords 'Modic changes,'' end plate changes lower back pain,' 'paraspinal muscles lower back pain,' and 'Modic changes lower back pain' on Google Scholar yielded 33000, 41000, 49400, and 17,800 results, and 958, 118, 890 and 560 results on Pubmed respectively.

Effect of three-volt moxibustion with helium-neon laser irradiation on quality of care in patients with lumbar radiculopathy spondylosis.

Lumbar radiculopathy spondylosis is a relatively common orthopedic disease with a high incidence rate. It most commonly occurs in the lumbar 4-5 and lumbar 5-sacral 1 vertebrae, which account for approximately 95% of cases. It mostly occurs in people aged 30-50 years old and greatly affects their quality of life. To determine the effect of triple-voltage acupuncture combined with helium-neon laser irradiation on the quality of care and improvement of symptoms in patients with lumbar radiculopathy spondylolisthesis. In this study, we selected 120 patients with lumbar radiculopathy spondylosis who were treated at our hospital between June 2019 to June 2020. The patients were divided into control and observation groups according to the random number table method, with 60 patients in each group. Patients in the observation group were treated with three-volt moxibustion combined with helium-neon laser irradiation, and those in the control group were treated with lumbar traction. After 1 month of treatment, the lumbar pain scores, lumbar spine motor functions, clinical treatment effects, and nursing satisfaction of the two groups were compared. The results showed that acupuncture combined with laser irradiation significantly improved the patients' clinical symptoms, i.e., reduced their low back pain, significantly lower numerical rating scale pain scores in the observation group than in the control group, and better lumbar spine motility than in the control group, compared to lumbar traction. In addition, they were cared for. The treatment effectiveness rate of the observation group was 95.5%, which was significantly higher than that of the control group (81.67%). Satisfaction with care was higher than 90 points in both groups, but the difference was not statistically significant. Our study provides a clinical rationale for the future treatment of patients with lumbar spine disease. However, further extensive research is needed for validation.

Progress of researches on mechanisms of acupuncture therapy in the treatment of lumbar disc herniation.

Lumbar intervertebral disc herniation (LDH) is a common and frequently-occurring disease, which usually causes lumbar and leg pain. Studies have shown that acupuncture can improve the symptoms of LDH patients. In the present paper, we summarize the progress of researches on the mechanisms of acupuncture underlying improvement of symptoms of LDH in recent 10 years from 1) delaying the intervertibral disc degeneration (by down-regulating the expressions of matrix metalloproteinase ［MMP］-3 and MMP-4, up-regulating the expressions of diosaccharides and polyglycoprotein, inhibiting apoptosis and promoting mitochondrial autophagy of nucleus pulposus cells, etc.), 2) maintaining spinal column stability (by relieving rachiasmus and improving lumbar flexor and extensor muscle strength, lowering the degree of polyfidus edema and fat infiltration, and restoring the biomechanics of the spine), 3) regulating inflammation (by inhibiting the production of proinflammatory factors and increasing the production of anti-inflammatory factors, etc.), 4) regulating immune response (by promoting the activity of T cells and other immune cells, lowering serum levels of MMP-3, transforming growth factor-β1 and prostaglandin E2, raising serum levels of IgA, IgG and IgM to improve immune function ), 5) modulating neural structure and function (by promoting myelin regeneration of sciatic nerve fibers, and reducing the edema of Schwann cells' cytoplasm and mitochondria, and improving neural ultrastructure, and sensory and motor functions of peripheral nerves, etc.), 6) relieving lumbar pain (by down-regulating expression of Ca2+/calmodulin-dependent protein kinase and activation of lumbar spinal cord glial cells, blocking nociceptive signal conduction, regulating the levels of pain-related factors, etc.), and 7) improving local microcirculation. These results may provide scientific evidence for acupuncture treatment of LDH.

#99 Clinical characteristics and outcomes of PTLD after kidney transplant: a single center experience

Abstract Background and Aims Post-Transplant Lymphoproliferative Disorder (PTLD) is a serious and potentially fatal complication of immunosuppression in kidney transplantation. Given the rarity of this entity, a high index of suspicion is necessary. We aimed to review the incidence, clinical presentation, histological subtypes, treatment, patient and graft survival of PTLD in kidney transplant patients in our unit. Methods Observational retrospective study, including adults diagnosed with PTLD between 1998 and 2023 in a Kidney Transplantation Center. Results Of 1390 kidney transplant recipients, 4 (0.3%) developed PTLD with a mean age of 52 ± 12.5 years. All cases were late-onset, occurring one year after transplantation with a median time from transplantation to diagnosis of 16.7 ± 7.3 years (range: 5-22 years). Of these, none had EBV donor/recipient mismatch. Two patients had prior rejection episodes (one patient, acute T cell-mediated rejection and the other patient, acute T cell-mediated rejection and active antibody mediated rejection). Clinical presentation was variable. Non-specific constitutional symptoms such as fever, fatigue and night sweats were present in all patients. Organ-specific symptoms were also present: lumbar pain in one patient with bone involvement, and delirium and lethargy in two patients with central nervous system involvement. Laboratory analyses revealed an increase in serum LDH in all patients. The primary sites of involvement were central nervous system (50%), lymph nodes (25%) and bone (25%). At PTLD diagnosis, immunosuppression included: tacrolimus (100%), mycophenolate mofetil (75%), low-dose of steroids (50%) and everolimus (25%). Regarding histologic classification, 75% were monomorphic and 25% polymorphic. In the monomorphic group, all patients had Diffuse Large B Cell Lymphoma (CD20 positive). In the polymorphic group, the patient had a Mixed Cellularity Classic Hodgkin Lymphoma (CD20 negative). Immunosuppression therapy was reduced in all patients with discontinuation of mycophenolate mofetil and tacrolimus. In the patient who was taking everolimus, the dose was increased due to the potential clinical antitumor effects of mTOR inhibition. Additional therapies included, rituximab in monotherapy or in combination with chemotherapy (R-CHOP) in the monomorphic group. Palliative measures were selected for one patient of this group due to advanced disease. The patient with Mixed Cellularity Classic Hodgkin Lymphoma (CD20 negative) did chemotherapy with ABVD. None of the patients underwent surgery or radiation therapy. Two patients needed dialysis. Three patients died in the first four weeks after PTLD diagnosis, all due to infectious complications. Patient survival was 25% one year after diagnosis. Conclusions Although the incidence of PTLD was low following kidney transplantation, its impact was significant in kidney graft and overall patient survival. Given the poor prognosis, new therapies combining high efficacy and low toxicity are an urgent unmet medical need in this field.

#1061 Brucella infection in a patient with renal cystic disease and renal imaging changes before and after treatment: a case report

Abstract Background and Aims Brucellosis can affect nearly all systems. Genitourinary involvement is uncommon in patients with brucellosis, accounting for approximately 10% of cases. We diagnosed a rare case of renal cysts with brucellosis and reported renal imaging changes before and after treatment. Method A 38-year-old man was admitted to our hospital in September 2021 with complaints of elevated serum creatinine, proteinuria for more than 2 months, and intermittent fever for 2 weeks. In July 2020, the patient experienced fatigue, and a rash on all four extremities. He denied experiencing low back pain or joint swelling. Urine analysis revealed the following: BLD (+), Pro (+), 24-hour urine protein (24 h UP) 0.7 g; blood: Cr 11.88 mg/dL, UA 77.51 mg/dL, ALP 217 IU/L, and GGT 227 IU/L. MRI revealed multiple small punctate areas with short T1 signals in both kidneys and splenomegaly. Soon, he experienced persistent afternoon fever with a maximum temperature of 39.0°C, along with night sweats and left lumbar pain. There were no symptoms of cough, expectoration, or urinary tract irritation. The patient had diabetes mellitus and diabetic retinopathy. He has lived in the Inner Mongolia Autonomous Region. He denied having any contact with raw milk or mice. His father and sister had kidney disease and diabetes. In September 2021, the patient was admitted to our hospital. Urinalysis revealed BLD (-), Pro 0.3 g/L, and 24 hUP 1.39 g; blood: HGB 117 g/L, ALP 227 U/L, GGT 221 U/L, Cr 2.56 mg/dL, UA 88.79 mg/dL, and K 3.2 mEq/L. The infection indicators were as follows: the standard tube agglutination test (+) (Fig. 1), Brucella (+) in blood culture, a positive qualitative test for blood cryptococcal antigen and qualitative positive results for 6 Cryptococcus neoformans sequences in bronchoalveolar lavage fluid using next-generation sequencing. Ultrasound showed multiple cysts in both kidneys. It also showed uneven echogenicity in the left testis and visible lymph nodes in the left neck, bilateral axillae and groin. CT revealed cavitary nodules and ground-glass opacities in the right middle lobe, as well as splenomegaly. MRI revealed renal cysts (Fig. 2a, b, c) and abscesses (Fig. 2e, f, g). The patient was diagnosed with stage 3 chronic kidney disease (CKD), pulmonary cryptococcosis, and brucellosis associated with renal abscess, left orchitis, splenomegaly, multiple lymphadenopathies, rash, and hyperuricemia. Doxycycline, rifampicin, and fluconazole were administered. He had no fever, his low back pain had disappeared, and his rash were relieved. Results A reexamination after 2 months revealed the following: the urinalysis results revealed a BLD (-), Pro(-), and 24 hUP 0.15 g; blood: GGT 107 IU/L; ALP 72 IU/L; Cr 1.89 mg/dL; UA 0.22 mg/dL; and K 4.0 mEq/L. Ultrasound revealed a decrease in the size of the spleen. MRI revealed the liquefaction of renal abscesses. Brucella therapy has been found to be effective. Conclusion The patient was a young man who was infected with both Brucella and Cryptococcus. Although his hometown was in an area affected by an epidemic, his current residence was not affected. Namely, he was immunocompromised, which was associated with diabetes. After receiving anti-Brucella treatment, his symptoms disappeared, the renal abscess liquefied, but creatinine decreased to levels similar to those at onset without a decreasing trend. These findings suggest that the patient had underlying CKD that was not associated with Brucellosis. We believe that the CKD was diabetes and renal cysts. He had hyperuricemia, hypomagnesaemia, unexplained asymptomatic abnormal liver function, and mild proteinuria. Imaging indicated the presence of renal cysts. In addition to having diabetes, he had a family history of kidney disease and diabetes. We diagnosed the patient with CKD and as having autosomal dominant tubulointerstitial disease (ADTKD) associated with the HNF1B pathogenic gene mutation. This gene mutation is also rare in ADTKD patients. Genetic testing revealed that the causative genes include NM001303448. Potential causative genes included NM000128. The mutated genes mentioned above are not typical causative genes for HNF1B or other types of ADTKD.