Recurrent Back Pain Research Articles

Is Redo Vertebroplasty an Effective Treatment on the Same Vertebra?

Redo vertebroplasty is rarely reported. Previous studies on redo vertebroplasty included a small number of patients and lacked radiographic analysis. The purpose of this study was to assess the radiographic outcomes (restoration of vertebral body) and clinical outcomes (pain relief) in patients with recurrent or unrelieved pain after vertebroplasty with a minimum follow-up duration of 12months. The records of 22 patients (23 cases), who underwent redo vertebroplasty between March 2001 and February 2014, were analyzed. Vertebral height loss (VHL) and wedge angle (WA) were measured before and after redo vertebroplasty. Subjective back pain was assessed via the numeric rating scale (NRS) score. VHL after the initial vertebroplasty was 18.7%. Preoperative and final VHL of redo vertebroplasty were 32.3 and 18.3%, respectively. WA after initial vertebroplasty was 9.5°. Preoperative and final WA of redo vertebroplasty was 13.9° and 9°, respectively. Changes of VHL and WA values at each time point were significant (p<0.01). The change of NRS pain score at each time point, including the period between post-initial vertebroplasty and final follow-up, was statistically significant (p<0.01); 18 patients (82%) showed marked pain relief and 4 patients (18%) showed partial pain relief. Redo vertebroplasty seems to be an effective way to achieve pain relief and vertebral body height restorations without major complications in patients with unrelieved or recurrent back pain after vertebroplasty. Level 4, case series.

스텝박스 걷기 및 요부안정화 운동이 만성요통환자의 기능적 움직임, 심부근 단면적, 건강체력에 미치는 영향

The purpose of this study is to compare and analyze the effects of lumbar stabilization and step box walking-lumbar stabilization combined exercises on functional movement, cross-sectional area of deep muscle and health fitness in patients with chronic low back pain. Fifty six patients with chronic low back pain were classified into lumbar stabilization exercise group (LSEG, n=20), step box walking-lumbar stabilization combined exercise group (SEG, n=25) and control group (CG, n=7). Subjects participated in a 50 minutes exercise program twice a week for a total of 12 weeks. Functional movement screen (FMS), cross sectional area of deep muscles and health related fitness were measured and compared before and after exercise intervention. Repeated measures analysis of variance was used to compare the effects of the two exercise programs over time. One-way ANOVA and post-hoc test (LSD) were also used when the interaction effect between groups was significant. In results, first, functional movement was significantly improved by participating in exercise program, but there was no difference in functional movement according to exercise program type. Second, the cross sectional area of deep muscle was significantly improved by participating in exercise program. Lumbar stabilization exercise group was more effective than step box walking-lumbar stabilization combined exercise in the multifidus and erector spinae cross-sections. Third, the health fitness was significantly improved by participating in the exercise program, but there was no difference in health fitness according to the type of exercise program. These results indicate that lumbar stabilization exercise and step box walking-lumbar stabilization combined exercise for chronic low back pain can be an effective exercise program to lower the risk of recurrence of back pain, improve independence in daily life and health fitness. These positive effects also indicate that both exercise programs could reduce the secondary health risks caused by chronic low back pain and could be utilized as basic scientific data for exercise prescription in low back pain patients as well.

CHRONIC ELECTRICAL STIMULATION OF THE SPINAL CORD IN THE TREATMENT OF FAILED BACK SURGERY SYNDROME

The paper presents a literature review on failed back surgery syndrome (FBSS). According to statistics, the proportion of cases of back pain recurrence after lumbar spine surgery ranges from 15 to 50 %. There are many causes of the FBSS development, the most common of these are misdiagnosis and incorrect selection of candidates for surgery. In accordance with international clinical protocols, FBSS is an indication for chronic epidural spinal cord stimulation (SCS) in case of conservative treatment failure, absence of direct unconditioned indications for reoperation, and neurogenic pain. High efficiency and economic feasibility of the given method is proved in multiple studies including in well-organized evidence-based researches. The wide international experience allows making assertions about long-term and stable analgesic effect of chronic electric stimulation of the spinal cord. It must be remembered that delaying a decision on application of the SCS method leads to poor results in catamnesis. In advanced cases, a care to such patients becomes simply impossible due to the centralization of pain syndromes.

Transforaminal lumbar interbody fusion in recurrent disc herniation

Background Recurrent back and/or leg pain after primary lumbar discectomy is not uncommon. Some spine surgeons believe that fusion is necessary for treating disc reherniation. As repeated discectomy requires the removal of more disc material and posterior elements, such as lamina or facet joint, further invasion at the same surgical level can increase the risk of segmental instability. Patients and methods A total of 20 patients (12 men, eight women) with recurrent lumbar disc herniation were treated via transforaminal lumber interbody fusion. The mean age at the time of operation was 46.6 years (30–62 years). The primary procedures included discectomy with unilateral hemilaminectomy in nine and discectomy with bilateral laminectomy in 11 patients. The time from the primary surgery to that of recurrence averaged 10.6 months (range, 6–18 months). The levels of recurrent disc herniation were nine cases at L4–L5 (six ipsilateral and three contralateral) and 11 at L5–S1 (seven ipsilateral and four contralateral). Results The mean follow-up period was 22.8 months (18–30 months). The mean duration of the operation was 161.75 min (130–190–min), mean intraoperative blood loss was 325 ml (250–500), and mean duration of hospital stay was 4.15 days (3–7 days). At a minimum of 12 months of follow-up, all cases appeared to have solid fusions. Conclusion Transforaminal lumbar interbody fusion technique is an effective procedure with satisfactory clinical results for the treatment of recurrent lumbar disc herniation. The approach achieves a biomechanically stable spine, as it restores the segmental lordosis and has low complication rates.

SAPHO syndrome preceded by chronic recurrent back pain for seven years before the appearance of a skin lesion: a case report

SAPHO syndrome preceded by chronic recurrent back pain for seven years before the appearance of a skin lesion: a case report

Comparison of Decompression With and Without Fusion for Patients With Synovial Facet Cysts.

This is a retrospective study. To compare (1) recurrence of radiculopathy and (2) back pain after decompression with and without fusion for patients with a symptomatic synovial cyst. Previous work described favorable outcomes following cyst excision with and without fusion. Because of the association of facet cysts with spinal instability it is hypothesized that a decompression with fusion will lead to better outcomes. However, previous studies present contradicting results. We included 314 consecutive patients that underwent operative treatment for a facet cyst between 2003 and 2013 at 2 tertiary spine referral centers: 224 (71%) underwent decompression without fusion (35% spondylolisthesis), 90 (29%) underwent decompression with fusion (63% spondylolisthesis). Baseline data were compared between the groups. Bivariate log-rank analysis was used to compare outcomes between groups, followed by multivariable Cox regression analysis accounting for differences in baseline characteristics. Patients undergoing decompression with fusion presented with a higher incidence of back pain (P=0.004) and spondylolisthesis (P<0.001), had more often bilateral decompressions (P<0.001), more facetectomies (P<0.001), and more levels of decompression (P=0.004) than those who underwent decompression alone. We found a difference in recurrence of radiculopathy (no fusion: 25% vs. fusion: 9.4%, P=0.029) in bivariate analysis. However, this difference did not hold when accounting for confounders (hazard ratio, 0.50, 95% confidence interval, 0.19-1.31, P=0.16). There was no difference in recurrence of back pain in bivariate (no fusion: 29% vs. fusion: 22%, P=0.51) and multivariable analysis (hazard ratio 0.51, 95% confidence interval, 0.23-1.14, P=0.10). We found, with the numbers evaluated, no difference in recurrence of radiculopathy or back pain between patients undergoing decompression with or without fusion after accounting for confounders. The decision for fusion should be considered in light of the extent of decompression and the existence of other pathology. Level III-therapeutic study.

Predictors of Daily Pain Medication Use in Individuals with Recurrent Back Pain.

A key component to chronic pain management regimens is the use of analgesic medications. Psychological factors, such as mood states, may also affect the use of pain medications for individuals with chronic pain, but few observational studies have examined how these factors may predict pain medication use at the daily level. Daily assessments from 104 individuals with back pain were used to examine fluctuations in daily pain intensity, mood, sleep quality, and physical activity as predictors of the likelihood of pain medication (opioid and non-opioid) use and levels of medication use on the same day. Pain intensity and mood ratings significantly predicted whether participants used pain medication on the same day, while only pain intensity predicted whether participants used more medication than usual. Further, current opioid users were more likely to increase the amount of their medication use on days of higher pain. This article identifies fluctuations in daily pain intensity and mood as salient predictors of daily pain medication use in individuals with recurrent back pain. The current study is among the first to highlight both pain and mood states as predictors of daily pain medication use in individuals with back pain, though future studies may expand on these findings through the use of higher-resolution daily medication use variables.

Intraoperative biomechanics of lumbar pedicle screw loosening following successful arthrodesis.

These data indicate that pedicle screws can loosen significantly in patients with recurrent back pain and warrant further research into methods to reduce the incidence of screw loosening and to understand the risks and potential benefits of instrumentation removal. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2673-2681, 2017.

Low Back Injury - Football

HISTORY: A 23 year old division I football player presented for recurrent back pain after two separate injuries at practice. He has a prior history of left sided low back pain and spasm which responded well to mobilization treatments. However, during a power lifting session he felt increased pain with radiation down the left leg with extension maneuvers. At a subsequent practice, he rotated to grab a ball and noted significant right sided low back pain. PHYSICAL EXAMINATION: Full flexion, extension, sidebending, and rotation at waist Bilateral lumbar paravertebrals are tight and TTP, worse on left. Left SI region TTP. Spinous processes are non-tender. Full sensation in bilateral LE L2-S1 dermatomes 5/5 strength in bilateral LE L3-S1 myotomes 2+ patellar and achilles reflexes bilaterally. No clonus. SLR equivocal left, negative right. Slump test positive left, negative right. Stork test with mild discomfort left, negative right. DIFFERENTIAL DIAGNOSIS: 1. Lumbar radiculopathy 2. Lumbar paraspinal strain 3. Spondylolysis 4. Spondylolisthesis 5. Degenerative disc disease TEST AND RESULTS: XR L-spine, AP/Lat/Flexion/Extension views: Negative MRI L-spine: 1. Stress fracture with nondisplaced fracture of anterior pedicle on left and pars interarticularis on right of L4. Early stress injury without fracture at the pedicle and pars interarticularis of L5. 2. Left paracentral protrusion compressing left S1 nerve root at L5-S1. CT scan L-spine: Bilateral posterior element fractures at L4 vertebral body level, involving right lamina and pars interarticularis and left pedicle. No evidence of spondylolisthesis. FINAL WORKING DIAGNOSIS: Left L4 pedicle fracture. Right L4 pars fracture. Bilateral L5 pars and pedicle stress reactions. L5-S1 disc protrusion with left S1 nerve root compression. TREATMENT AND OUTCOMES: 1. L4-L5 and L5-S1 transforaminal epidural steroid injections: Complete resolution of leg pain. 2. Restricted from practice, weight lifting, and extension activities for 4 weeks with LSO brace. 3. Returned to running at 4 weeks, progressed to non-contact drills without pain. 4. Progressed to full contact practice and game play at 8 weeks without pain. 5. Plan for surgical fixation with screws at end of season with 3 to 6 month recovery. 6. If any setbacks, will be withheld from football and plan for earlier surgery.

Management for failed back surgery syndrome: three-in-one procedure versus percutaneous spinal fixation alone

Objectives: To evaluate the short-term outcome of a 3-in-1 procedure including percutaneous facet radiofrequency, percutaneous spinal fixation and steroid with hyaluronidase enzyme injection versus percutaneous spinal fixation alone for cases with failed back surgery syndrome (FBSS).Patients and methods: The study included 50 patients who had had previous spinal surgery since a mean duration of 39.7 ± 8.5 months and developed recurrent back pain since a mean duration of 10 ± 2.1 months. Patients were randomly allocated into two groups; group A underwent percutaneous spinal fixation only and group B underwent the 3-in-1 procedure. Outcome was evaluated at the end of six months postoperatively (PO) using a pain numeric rating scale (NRS), the Oswestry Disability Index (ODI) and Odom’s criteria for evaluation of surgical outcome with evaluation of patients’ satisfaction by outcome.Results: All patients showed progressive decrease of NRS pain and ODI scores compared with preoperative scores. However, patients...

Predicting the occurrence of headache and back pain in young adults by biopsychological characteristics assessed at childhood or adolescence.

The aim of the current study was to identify predictors of recurrent headache and back pain in young adults (aged 18–27 years) from data assessed in childhood or adolescence, i.e., 9 years before the final survey. Our interest was whether psychological characteristics contribute to the risk of pain prevalence in adult age when controlling for already empirically supported risk factors such as parental pain, pediatric pain and sex. The study was part of a five-wave epidemiological investigation of >5000 families with children aged between 7 and 14 years when addressed first. In a multiple hierarchical regression analysis, the abovementioned three variables (Block-I variables) were entered first followed by five psychological trait variables (Block-II variables: internalizing, anxiety sensitivity, somatosensory amplification, catastrophizing and dysfunctional stress coping) to find out the extent of model improvement. The multivariable hierarchical regression analysis confirmed the hypothesis that the Block-I variables significantly enhance the risk of future pain at young adult age. None of the psychological variables did so. Thus, the hypothesis of a significant surplus predictive effect was not confirmed. The amount of total explained variance differed strongly between headache and back pain. In particular, a valid prediction of back pain was not possible. When analyzed separately in simple regression analysis, psychological variables turned out to be significant predictors, however, of very low effect size. The inclusion of Block-I variables in the model clearly reduced the impact of the psychological variables. This risk profile is discussed in the context of the different trajectories of headache and back pain from childhood to adult age, which were proposed by various studies. We propose that a biopsychological characteristic denoted as emotional negativity, especially regarding self-reference, might be a common factor behind all selected variables. Risk research in recurrent pain is a field where much more multidisciplinary research is needed before progress can be expected.

Utility of 18F sodium fluoride PET/CT imaging in the evaluation of postoperative pain following surgical spine fusion.

A retrospective case review of patients who underwent 18F sodium fluoride PET/CT imaging of the spine with postoperative pain following vertebral fusion. To determine the benefit of 18F sodium fluoride PET/CT imaging in the diagnosis of persistent pain in the postoperative spine. The diagnosis of pain generators in the postoperative spine has proven to be a diagnostic challenge. The conventional radiologic evaluation of persistent pain after spine surgery with the use of plain radiographs, MRI, and CT can often fall short of diagnosis in the complex patient. 18F sodium fluoride PET/CT imaging is an alternative tool to accurately identify a patient's source of pain in the difficult patient. This retrospective study looked at 25 adult patients who had undergone 18F sodium fluoride PET/CT imaging. All patients had persistent or recurrent back pain over the course of a 15-month period after having undergone spinal fusion surgery. All patients had inconclusive dedicated MRI. The clinical accuracy of PET/CT in identifying the pain generator and contribution to altering the decision making process was compared to the use of CT scan alone. Of the 25 patients studied, 17 patients had increased uptake on the 18F sodium fluoride PET/CT fusion images. There was a high-level correlation of radiotracer uptake to the patients' pain generator. Overall 88% of the studies were considered beneficial with either PET/CT altering the clinical diagnosis and treatment plan of the patient or confirming unnecessary surgery. 18F sodium fluoride PET/CT proves to be a useful tool in the diagnosis of complex spine pathology of the postoperative patients. In varied cases, a high correlation of metabolic activity to the source of the patient's pain was observed.

Xanthogranulomatous pyelonephritis presenting as a type IV renal cyst.

A 20-year-old woman presented to our outpatient clinic with a 5-week history of recurrent right lumbar back pain. Contrast-enhanced computed tomography scan showed a Bosniak class IV renal cyst. She was treated with radical nephrectomy. Histopathology revealed xanthogranulomatous pyelonephritis.

A novel bilateral lower extremity mirror therapy intervention for individuals with stroke.

Despite improvements made in stroke rehabilitation, motor impairment and gait deficits persist at discharge. New interventions are needed. Mirror therapy has promise as one element of a rehabilitation program. The primary objectives were to 1) describe a bilateral, lower extremity mirror therapy (LE-MT) device and training protocol and 2) investigate the feasibility of LE-MT. A LE-MT device was constructed to train bilateral LE movements for 30 min, 3 times/week for 4 weeks, as an adjunct to physiotherapy in three individuals post-stroke. Sessions were digitally recorded and reviewed to extract feasibility measures; repetitions, rests and session duration. Pre and post measures of gait and motor impairment were taken. Two participants completed 100% of the sessions and a third completed 83% due to a recurrence of pre-existing back pain. Repetitions increased and session duration was maintained. Number of rests decreased for two participants and increased for one participant. Participants reported fatigue and mild muscle soreness but also that the intervention was tolerable. Positive gait changes included increased velocity and decreased variability. LE motor impairment also improved. A bilateral LE-MT adjunct intervention for stroke is feasible and may have positive effects. A history of low back pain should be a precaution.

Lumbar support and nonspecific low back pain: Evidence for daily practice

We aimed to evaluate the place of lumbar support in the management of nonspecific low back pain. We conducted a systematic review with the following databases: Pubmed, Cochrane Library, Science Direct and Pedro. The search strategy used the keywords low back pain; lumbar orthosis; lumbar belt; back support; lumbar support; lumbar brace. To be included, studies needed to have one or more keywords selected. The search was limited to French and English articles. The major exclusion criterion was studies included rigid orthotics of the trunk. High Authority of health statement was used to check the quality of reporting. Data were also analyzed according to stages of the disease (acute, subacute, and chronic) and in prevention (primary and secondary). We included 28 studies. Quality assessment was heterogeneous. The systematic review showed no official recommendations for lumbar support prescription among the general population. Lumbar support was effective on function, pain, and relative time intervals for dispensing medication with subacute low back pain. It was also effective with probability of low back pain recurrence in secondary prevention. Orthosis’ benefits were not highlighted probably due to the lack of observance, which was a limiting factor. It is a bias because observance was not systematically studied in the literature. To our knowledge, there is no meta-analysis because evaluation criteria are heterogeneous. To date, there is no proof to prescribe lumbar support in the management of low back pain general population. An individual prescription would be discussed for subacute low back pain or in secondary prevention. Further studies with a higher quality assessment are necessary in order to identify phenotypes of patients’ responders to lumbar support. The function would be preferred as a main assessment criterion.

Effects of Volitional Spine Stabilization and Lower-Extremity Fatigue on the Knee and Ankle During Landing Performance in a Population With Recurrent Low Back Pain

Recurrent lower back pain (rLBP) and neuromuscular fatigue are independently thought to increase the risk of lower extremity (LE) injury. Volitional preemptive abdominal contraction (VPAC) is thought to improve lumbar spine and pelvis control in individuals with rLBP. The effects of VPAC on fatigued landing performance in individuals with rLBP are unknown. To determine the effects of VPAC and LE fatigue on landing performance in a rLBP population. Cross-sectional pretest-posttest cohort control design. A clinical biomechanics laboratory. 32 rLBP (age 21.2 ± 2.7 y) but without current symptoms and 33 healthy (age 20.9 ± 2.3 y) subjects. (i) Volitional preemptive abdominal contraction using abdominal bracing and (ii) fatigue using submaximal free-weight squat protocol with 15% body weight until task failure was achieved. Knee and ankle angles, moments, electromyographic measurements from semitendinosus and vastus medialis muscles, and ground reaction force (GRF) were collected during 0.30 m drop-jump landings. The VPAC resulted in significantly earlier muscle onsets across all muscles with and without fatigue in both groups (mean ± SD, 0.063 ± 0.016 s earlier; P ≤ .001). Fatigue significantly delayed semitendinosus muscle onsets (0.033 ± 0.024 s later; P ≤ .001), decreased GRF (P ≤ .001), and altered landing kinematics in a variety of ways. The rLBP group exhibited delayed semitendinosus and vastus medialis muscle onsets (0.031 ± 0.028 s later; P ≤ .001) and 1.8° less knee flexion at initial contact (P ≤ .008). The VPAC decreases some of the detrimental effects of fatigue on landing biomechanics and thus may reduce LE injury risk in a rLBP population.

CIDP presenting as recurrent severe back pain without weakness or sensory loss

A 71-year-old woman presented with severe back pain, limb weakness and cranial nerve dysfunction associated with high cerebrospinal fluid (CSF) protein; we diagnosed Guillain-Barré syndrome and her symptoms completely resolved...

Infiltrative low-grade fibromyxoid sarcoma of the thoracic spine

A 25-year-old man presented with a 1-year history of recurrent thoracic back pain. Physical examination revealed a mild hypoesthesia of both lower extremities. Computed tomography scan showed an expansile lytic lesion involving the vertebral bodies as well as the posterior elements at the T1– T3 levels (Fig. 1, Left), which was confirmed to be extending into the right ribs on axial computed tomography image (Fig. 1, Right). Magnetic resonance imaging revealed a large multiloculated lesion measuring 13×10.8×4.7 cm, with high vascularization within the paraspinal soft tissues at the level of T1–T3 accompanied with associated intraspinal extension (Fig. 2). Complete resection of the mass lesion was performed by a posterior approach with instrumentation. Postoperative period was uneventful. Pathologic examination and immunohistochemical staining confirmed the diagnosis of lowgrade fibromyxoid sarcoma. Low-grade fibromyxoid sarcoma is a rare mesenchymal malignancy with a deceptively bland histologic appearance but showing potential for late recurrence and metastasis [1,2]. Low-grade fibromyxoid sarcoma occurs most commonly in the deep soft tissues of proximal extremities, and also in the inguinal area, neck, or chest wall [2,3]. Spinal involvement with low-grade fibromyxoid sarcoma has rarely been reported [3,4].

Conservative care with or without manipulative therapy in the management of back and neck pain in Danish children aged 9-15. Study protocol for a randomized controlled trial.

BackgroundComplaints in the musculoskeletal system often start early in life and back and neck pain in children are well-established predictors for similar problems in adulthood. Despite lack of evidence of effectiveness, manipulative therapy is one of the most commonly used treatment modalities for back and neck pain in children.The primary objective of this study is to evaluate the effectiveness of manipulative therapy when added to an approach consisting of manual soft tissue treatment, exercises and advice as needed, in children aged 9–15 complaining of back and neck pain.MethodThe project is nested in the Childhood Health, Activity and Motor Performance School Study, which includes around 1200 children aged 9–15, who were all invited to participate in this randomized controlled trial in case they experienced back and/or neck pain during the two year inclusion period. Parents received text messages (SMS) on a weekly basis inquiring about the child’s musculoskeletal pain. If pain was reported, the child was evaluated for inclusion into the trial and, if eligible, randomized into one of two intervention groups:Pragmatic advice, manual soft tissue treatment and exercisesThe above plus manipulative therapyBy the end of data collection 237 children were included in the study. The primary outcome measure is number of recurrences of back and neck pain during the follow-up period (3–27 months). Secondary outcome measures are average duration of complaint time for each episode, total duration of complaint time, global perceived effect after two weeks, and change in pain intensity after 2 weeks. Baseline information includes quality of life, expectations to treatment, expectations to future course, age, gender, social class and physical education at school.DiscussionFor most common non-traumatic musculoskeletal complaints no standardized and evidence based treatment strategy exists. We want to evaluate the effectiveness of manipulative therapy in addition to an approach consisting of manual soft tissue treatment, exercises and advice as needed, in children aged 9–15 complaining of back and neck pain.To our knowledge this is the first large scale randomized controlled trial investigating the effectiveness of commonly used treatments for back and neck pain in children.Trial registrationClinicalTrials NCT01504698Electronic supplementary materialThe online version of this article (doi:10.1186/s12998-016-0086-y) contains supplementary material, which is available to authorized users.

Recurrent back pain of unknown etiology - suspect an urological origin

Ureteropelvic junction (UPJ) obstruction poses a diagnostic challenge when the patient arrives at the emergency department with severe recurrent back pain without previous record of this condition. Extrinsic factors including crossing vessels or intrinsic factors such as adynamic segment of proximal ureter can cause UPJ obstruction. We report a case of a 16 year-old female patient with ureteropelvic junction syndrome occurring at adolescence, caused by two accessory vessels. She was submitted to a laparoscopic dismembered pyeloplasty with favorable outcome.