Relief Of Back Pain Research Articles

Clinical Efficacy of Percutaneous Kyphoplasty at the Hyperextension Position for the Treatment of Osteoporotic Kümmell Disease.

Percutaneous kyphoplasty might be effective for osteoporotic Kümmell disease. To investigate the clinical efficacy of percutaneous kyphoplasty in hyperextension for osteoporotic Kümmell disease. Retrospective study. A retrospective analysis was carried out on data from downstream balloon kyphoplasty treatments in hyperextension for 18 patients with osteoporotic Kümmell disease. All cases were single-segment disease affecting T5 (1 case), T7 (1 case), T8 (2 cases), T11 (6 cases), T12 (4 cases), L1 (2 cases), L2 (1 case), or L4 (1 case). Dual-energy x-ray absorptiometry bone mineral density values ranged from -2.8 to -5.8 SD. The sagittal Cobb angle of the involved segment was measured before and after the operation and the final follow-up also included a visual analog pain score (VAS) and the Oswestry Disability Index (ODI) after comprehensive efficacy assessment. All patients were followed up for 12-36 months, with an average of 15.8 months. Patients showed lower back pain relief and improvement in daily life activities. The kyphosis Cobb angle improved from 32.60±3.82 degrees before surgery to 7.60±1.68 degrees after surgery, and VAS and ODI scores significantly improved from 8.7±0.96 points and 88.6±3.76% to 2.6±0.32 points and 28.6±2.67%, respectively. The last follow-up for the kyphosis Cobb angle yielded a value of 9.60±2.06 degrees, and VAS and ODI averaged 2.2±0.26 points and 26.4±2.46%, respectively. Compared with 2 days postoperatively, the differences were not statistically significant. Intervertebral cement leakage occurred in 1 case, but no symptom was observed and no treatment was performed. Percutaneous balloon kyphoplasty in the hyperextension position is an effective method for osteoporosis in Kümmell disease.

Anterior versus Posterior Approach in Surgical Treatment of Tuberculous Spondylodiscitis of Thoracic and Lumbar Spine

Introduction The aim of this study is to compare the clinical, radiological and functional outcome of anterior versus posterior surgical debridement and fixation in patients with thoracic and lumbar tuberculous spondylodiscitis. Material and Methods A total number of 42 patients with tuberculous spondylodiscitis of the thoracic and lumbar spine treated surgically were included in this study. Twenty patients (group A) underwent anterior debridement, decompression and instrumentation by anterior approach. Twenty two patients (group B) were operated by posterolateral (extracavitary) decompression and posterior instrumentation. Operative parameters, clinical, radiographic and functional results for the two groups were analyzed and compared. Results The average follow up period was 15 months (range, 12 to 24) in both groups. The average operative time, blood loss and blood transfusion of anterior group were significantly less than the posterior one. There was significant better back pain relief, kyphotic angle correction and less angle loss in the posterior group than anterior. There was no significant difference between the 2 groups regarding neurological recovery, functional outcome and fusion rate. Conclusions Both anterolateral and posterolateral approaches are sufficient for achieving the goals of surgical treatment of thoracic and lumbar pott's disease but posterolateral approach allows significant better kyphotic angle correction, less angle loss, better improvement in back pain but unfortunately more operative time and blood loss.

Radiographic Restoration of Sagittal Spinopelvic Alignment After Posterior Lumbar Interbody Fusion in Degenerative Spondylolisthesis

A retrospective study. This study was aimed to analyze the changes in spinopelvic parameters after surgical correction of degenerative spondylolisthesis and to determine which deformity is most responsible for changes in sagittal spinopelvic alignment. The basic deformities of degenerative spondylolisthesis are forward slippage of the vertebral body, segmental kyphotic angle, and loss of disk height. Correction of those deformities during surgery will subsequently affect the spinopelvic parameters. A few studies have reported the changes of sagittal spinopelvic alignment after surgical treatment of isthmic spondylolisthesis. However, there appears to be relatively little information regarding degenerative spondylolisthesis. Fifty-three patients with L4-L5 degenerative spondylolisthesis were included. All patients underwent posterior lumbar interbody fusion and posterior instrumentation. Back pain, as the clinical outcome, was evaluated by visual analogue scale (VAS). The preoperative and postoperative spinopelvic parameters, including sacral slope (SS), pelvic tilt (PT), lumbar lordosis (LL), and L1 axis S1 distance were measured, and then the correlations between spinopelvic parameters and local deformity parameters such as slip degree, slip angle (SA), and height of the intervertebral disk were evaluated. After surgical correction of local deformity, all spinopelvic parameters changed subsequently: PT and L1 axis S1 distance had a decrease, SS and LL had an increase. VAS score decreased from 6.1±2.3 before surgery to 2.4±1.7 at the final follow-up assessment. Patients with VAS score changes ≥3 showed significantly higher SS and LL, and lower PT compared with those with VAS score changes <3. Among deformity parameters, restoration of the SA revealed significant correlation with improvement of LL (r=0.32, P=0.02), increase of SS (r=0.29, P=0.03), and decrease of PT (r=-0.29, P=0.03). Surgical correction of degenerative spondylolisthesis with posterior lumbar interbody fusion and posterior instrumentation resulted in relief of back pain, which may be associated with improvement of sagittal spinopelvic alignment. Surgeons should consider deformity parameters, especially the SA, in the surgical treatment of degenerative spondylolisthesis.

Effects of intracutaneous injections of sterile water in patients with acute low back pain: a randomized, controlled, clinical trial.

Intracutaneous sterile water injection (ISWI) is used for relief of low back pain during labor, acute attacks of urolithiasis, chronic neck and shoulder pain following whiplash injuries, and chronic myofascial pain syndrome. We conducted a randomized, double-blinded, placebo-controlled trial to evaluate the effect of ISWI for relief of acute low back pain (aLBP). A total of 68 patients (41 females and 27 males) between 18 and 55 years old experiencing aLBP with moderate to severe pain (scores ≥5 on an 11-point visual analogue scale [VAS]) were recruited and randomly assigned to receive either ISWIs (n=34) or intracutaneous isotonic saline injections (placebo treatment; n=34). The primary outcome was improvement in pain intensity using the VAS at 10, 45, and 90 min and 1 day after treatment. The secondary outcome was functional improvement, which was assessed using the Patient-Specific Functional Scale (PSFS) 1 day after treatment. The mean VAS score was significantly lower in the ISWI group than in the control group at 10, 45, and 90 min, and 1 day after injection (P<0.05, t-test). The mean increment in PSFS score of the ISWI group was 2.9±2.2 1 day after treatment, while that in the control group was 0.9±2.2. Our study showed that ISWI was effective for relieving pain and improving function in aLBP patients at short-term follow-up. ISWI might be an alternative treatment for aLBP patients, especially in areas where medications are not available, as well as in specific patients (e.g., those who are pregnant or have asthma), who are unable to receive medications or other forms of analgesia because of side effects.

Overview: the role of Propionibacterium acnes in nonpyogenic intervertebral discs

Propionibacterium acnes (P. acnes), an important opportunistic anaerobic Gram-positive bacterium, causes bone and joint infections, discitis and spondylodiscitis. Accumulated evidence suggested that this microbe can colonise inside intervertebral discs without causing symptoms of discitis. Epidemiological investigation shows that the prevalence ranges from 13% to 44%. Furthermore, colonisation by P. acnes inside nonpyogenic intervertebral discs is thought to be one pathogen causing sciatica, Modic changes and nonspecific low back pain. Specially, patients can attain significant relief of low back pain, amelioration of Modic changes and alleviation of sciatica after antibiotic therapy, indicating the role of P. acnes in these pathological changes. However, until now, there were hypotheses only to explain problems such as how P. acnes access intervertebral discs and what the exact pathological mechanism it employs during its latent infection period. In addition, research regarding diagnostic procedures and treatment strategies were also rare. Overall, the prevalence and possible pathological role that P. acnes plays inside nonpyogenic intervertebral discs is summarised in this paper.

Adding an Opioid or Muscle Relaxant to an NSAID Provides No Additional Pain Relief for Acute Back Pain

Adding an Opioid or Muscle Relaxant to an NSAID Provides No Additional Pain Relief for Acute Back Pain

Minimally Invasive Spinal Stabilization Using Fluoroscopic-Guided Percutaneous Screws as a Form of Palliative Surgery in Patients with Spinal Metastasis.

Study DesignProspective cohort study.PurposeTo report the outcome of 50 patients with spinal metastases treated with minimally invasive stabilization (MISt) using fluoroscopic guided percutaneous pedicle screws with/without minimally invasive decompression.Overview of LiteratureThe advent of minimally invasive percutaneous pedicle screw stabilization system has revolutionized the treatment of spinal metastasis.MethodsBetween 2008 and 2013, 50 cases of spinal metastasis with pathological fracture(s) with/without neurology deficit were treated by MISt at our institution. The patients were assessed by Tomita score, pain score, operation time, blood loss, neurological recovery, time to ambulation and survival.ResultsThe mean Tomita score was 6.3±2.4. Thirty seven patients (74.0%) required minimally invasive decompression in addition to MISt. The mean operating time was 2.3±0.5 hours for MISt alone and 3.4±1.2 hours for MISt with decompression. Mean blood loss for MISt alone and MISt with decompression was 0.4±0.2 L and 1.7±0.9 L, respectively. MISt provided a statistically significant reduction in visual analog scale pain score with mean preoperative score of 7.9±1.4 that was significantly decreased to 2.5±1.2 postoperatively (p=0.000). For patients with neurological deficit, 70% displayed improvement of one Frankel grade and 5% had an improvement of 2 Frankel grades. No patient was bed-ridden postoperatively, with the average time to ambulation of 3.4±1.8 days. The mean overall survival time was 11.3 months (range, 2–51 months). Those with a Tomita score <8 survived significantly longer than those a Tomita score ≥8 with a mean survival of 14.1±12.5 months and 6.8±4.9 months, respectively (p=0.019). There were no surgical complications, except one case of implant failure.ConclusionsMISt is an acceptable treatment option for spinal metastatic patients, providing good relief of instability back pain with no major complications.

Functional Outcome of Lumbar Discectomy by Fenestration Technique in Lumbar Disc Prolapse - Return to Work and Relief of Pain.

Low back pain affects every population and is one of world's foremost debilitating conditions. Clinically significant sciatica due to lumbar disc prolapse occurs in 4-6% of population. Fenestration discectomy as a surgical procedure is less time consuming, with lesser blood loss, lesser post-operative complications and does not compromise with stability of spine when compared to laminectomy. Present study was conducted to determine extent of functional recovery i.e. pain relief and return to work in patients with lumbar disc prolapse treated by fenestration technique. From October 2010 to March 2012, 50 patients with signs and symptoms of prolapsed lumbar intervertebral disc who failed to respond to conservative treatment were operated for discectomy by fenestration technique and studied prospectively. Functional outcome was evaluated by 'Back Pain Functional Score (BPFS)' of Strafford et al., PROLO rating scale to determine preoperative functional and economical status and outcome at final follow up after 6 months. In order to identify physical signs from non organic signs Wadell's score system was used. Result of surgery was evaluated with help of McNab's criteria. In our study, according to Back Pain Functional Scale by Strafford et al., and PROLO scale, good results were found in 42 (84%) cases, fair result in 8 cases (16%) and none with poor results at follow up of six months. According to PROLO economical and functional scale, 84% cases were able to join their previous occupation at end of six months and 76% cases had complete pain relief. In our study, correlation of age and duration of symptoms to functional outcome was statistically significant (p=0.089 & p = 0.098+ respectively) showing more good results among patients with age less than 30 years and patients having duration of symptoms less than 6 months. Functional outcome of fenestration technique in terms of return to work and complete back and leg pain relief at end of six months had been satisfactory in our study. Moreover, old age, long duration of symptoms and presence multiple psychological issues are negative predictors of functional outcome.

Decompression without Fusion for Low-Grade Degenerative Spondylolisthesis.

Study DesignRetrospective series.PurposeAssess results of decompression-only surgery for low-grade degenerative spondylolisthesis with consideration of instability.Overview of LiteratureThere is no consensus on whether fusion or decompression-only surgery leads to better outcomes for patients with low-grade degenerative spondylolisthesis. Current trends support fusion but many studies are flawed due to over-generalization without consideration of radiological instability and their variable presentations and natural history.MethodsPatients with surgically treated degenerative spondylolisthesis from 1990–2013 were included. Clinical and radiological instability measures were included. Any residual or recurrence of symptoms, revision surgery performed and functional outcome scores including the numerical global rate of change scale, visual analogue scale, and modified Barthel index were measured. Follow-up periods for patients were divided into short-term (<5 years), mid-term (5–10 years) and long-term (>10 years).ResultsA total of 64 patients were recruited. Mechanical low back pain was noted in 48 patients and most (85.4%) had relief of back pain postoperatively. Radiological instability was noted in 4 subjects by flexion-extension radiographs and 12 subjects with prone traction radiographs by increased disc height and reduction of olisthesis and slip angle. From the results of the short-term, mid-term and long-term follow-up, reoperation only occurred within the first 5-year follow-up period. All functional scores improved from preoperative to postoperative 1-year follow-up.ConclusionsDecompression-only for low-grade degenerative spondylolisthesis has good long-term results despite instability. Further higher-level studies should be performed on this patient group with radiological instability to suggest the superior surgical option.

A randomized placebo-controlled pilot study of the efficacy and safety of D-cycloserine in people with chronic back pain.

BackgroundFew effective pharmacological treatment options exist for chronic back pain, the leading cause of disability in the US, and all are associated with significant adverse effects.ObjectiveTo determine the efficacy and safety of D-cycloserine, a partial agonist to the N-methyl-D-aspartate receptor, in the treatment of chronic low back pain.MethodsA total of 41 participants with chronic back pain who met all inclusion and exclusion criteria were enrolled in a double-blind, placebo-controlled randomized pilot trial of D-cycloserine. Treatment was administered orally for six weeks at escalating daily doses of 100 mg, 200 mg, and 400 mg, each for two weeks. The primary outcome measure was back pain intensity using the Numeric Rating Scale (0–10). Secondary measures were back pain-related questionnaires: McGill Pain Questionnaire short form, painDETECT, PANAS, and BDI. The pre-specified analysis was a two-way repeated measures analysis of variance.ResultsA treatment difference was observed between groups treated with D-cycloserine and placebo at six weeks of 1.05 ± 3.1 units on the Numeric Rating Scale, with an effect size of 0.4 and p = 0.14. This trend of better chronic back pain relief with D-cycloserine was also observed in the secondary measures. No safety issues were seen.ConclusionThe difference in mean pain between the D-cycloserine and placebo groups did not reach statistical significance. However, a clinically meaningful effect size in the magnitude of pain relief was observed with a consistent pattern across multiple outcome measures with good safety, supporting further research into the effectiveness of D-cycloserine for chronic back pain.

Large, well-designed trials are needed to test the effectiveness of herbal medicines for the symptomatic relief of low back pain

Large, well-designed trials are needed to test the effectiveness of herbal medicines for the symptomatic relief of low back pain

Single intradiscal injection of the interleukin-6 receptor antibody tocilizumab provides short-term relief of discogenic low back pain; prospective comparative cohort study

BackgroundInflammatory cytokines, such as interleukin-6 and tumor necrosis factor-α, are gaining attention as important etiologic factors associated with discogenic low back pain. We conducted a prospective cohort study to evaluate the efficacy and safety of intradiscal injection of the interleukin-6 receptor antibody tocilizumab in patients with discogenic low back pain. MethodsThirty-two consecutive patients were intradiscally injected with 2 mL of 0.5% bupivacaine (control group). Another 31 consecutive patients were intradiscally injected with 40 mg tocilizumab and 1–2 mL of 0.5% bupivacaine (tocilizumab group) at the same time. Prior to treatment, the vertebral origin of low back pain was confirmed in all patients based on pain provocation during discography and pain relief with 1 mL of 1% xylocaine. Numeric rating scale and Oswestry disability index scores were used to evaluate pain level before and after treatment between the 2 groups. The association between pain relief with tocilizumab and intervertebral disc degeneration grade was also determined. ResultsAt the end of the study (8 weeks after treatment), 30 patients in each group were evaluable. In the tocilizumab group, numeric rating scale and Oswestry disability index scores improved significantly at 2 and 4 weeks after treatment, respectively. Intervertebral disc degeneration was not associated with improvement of numeric rating scale score in the tocilizumab group. Local infection (i.e., discitis) was observed in 1 patient in the tocilizumab group. ConclusionsThe results demonstrate the clinical relevance of interleukin-6 in discogenic low back pain. Intradiscal tocilizumab injection was shown to exert a short-term analgesic effect in patients with discogenic low back pain. Further research is required to determine the long-term effects of intradiscal tocilizumab therapy in patients with discogenic low back pain.

Comparison of Clinical and Radiological Improvement Between the Modified Trephine and High-speed Drill as Main Osteotomy Instrument in Pedicle Subtraction Osteotomy.

High-speed drill is the main osteotomy instrument in pedicle subtraction osteotomy (PSO) currently. Considering the long duration of surgery, the large amount of blood loss, and the high incidence of neurovascular injury, the osteotomy procedure is challenging. Use of trephine for the osteotomy displays high efficiency by shortening surgery time and reducing blood loss in anterior cervical corpectomy and fusion. However, the potential risk of neurological injury is high. We modified the trephine by adding locking instrument, when the serrated top of the trephine reaches the tip of the probe; the locking instrument on the probe restricts the trephine and improves security during the osteotomy procedure.The aim of this study was to compare the clinical and radiological improvement between the modified trephine and high-speed drill as main osteotomy instrument in PSO.From February 2009 to 2013, 50 patients with severe thoracolumbar kyphotic deformity caused by old compressive vertebrae were prospectively reviewed. All patients were randomly assigned to the experimental group (27 patients received PSO with modified trephine) and the control group (23 patients received PSO with high-speed drill). The clinical records were reviewed and compared for surgical time, operative blood loss, functional improvement (Oswestry Disability Index), and pain relief (visual analog scale). The radiological records were reviewed and compared for correction of kyphotic deformity postoperatively and correction loss at 2-year follow-up.All patients successfully finished the PSO procedure, and got satisfactory kyphotic deformity correction and overall function improvement. The surgery time was shorter in the experimental group than that in the control group (132.7 ± 12.6 vs 141.7 ± 16.7 min; P = 0.03). No significant difference was found in blood loss (882.9 ± 98.9 mL vs 902.2 ± 84.9 mL; P = 0.47) or correction of the kyphotic angle (33.4 ± 3.4° vs 32.1 ± 2.5°, P = 0.13) postoperatively between the 2 groups. At 24-month follow-up, no difference was discovered in loss of the correction (4.9 ± 1.6° vs 4.5 ± 1.6°; P = 0.42), change of Oswestry Disability Index (49.4 ± 6.2% vs 48.2 ± 4.2%; P = 0.44), or in back pain relief (6.2 ± 1.4 vs 6.4 ± 1.2 min; P = 0.51) between the 2 groups. No internal fixation related complication occurred and bony fusion was detected in lateral X-ray in all patients. In the control group, 2 patients had transient nerve root deficit, 14 patients at 3-month follow-up and 3 patients at 2-year follow-up experienced graft donor site morbidity, and pain killer medicine was always required.In conclusion, the modified trephine obviously shortens surgery time, and prevents graft donor site morbidity when compared to a high-speed drill. The learning curve for using the modified trephine in PSO procedure is short.

Prevalence, Patterns, and Predictors of Yoga Use: Results of a U.S. Nationally Representative Survey.

The purpose of this study was to investigate the prevalence, patterns, and predictors of yoga use in the U.S. general population. Using cross-sectional data from the 2012 National Health Interview Survey Family Core, Sample Adult Core, and Adult Complementary and Alternative Medicine questionnaires (N=34,525), weighted frequencies for lifetime and 12-month prevalence of yoga use and patterns of yoga practice were analyzed. Using logistic regression analyses, sociodemographic predictors of lifetime yoga use were analyzed. Analyses were conducted in 2015. Lifetime and 12-month prevalence of yoga use were 13.2% and 8.9%, respectively. Compared with nonpractitioners, lifetime yoga practitioners were more likely female, younger, non-Hispanic white, college educated, higher earners, living in the West, and of better health status. Among those who had practiced in the past 12 months, 51.2% attended yoga classes, 89.9% used breathing exercises, and 54.9% used meditation. Yoga was practiced for general wellness or disease prevention (78.4%), to improve energy (66.1%), or to improve immune function (49.7%). Back pain (19.7%), stress (6.4%), and arthritis (6.4%) were the main specific health problems for which people practiced yoga. About 31 million U.S. adults have ever used yoga, and about 21 million practiced yoga in the past 12 months. Disease prevention and back pain relief were the most important health reasons for yoga practice. Yoga practice is associated with age, gender, ethnicity, SES, and health status.

Role of high temperature denervation in pain relief during percutaneous kyphoplasty

Objective To determine the effect of high temperature denervation in back pain relief during percutaneous kyphoplasty (PKP) for vertebral osteoporotic fracture. Methods Fifty-six patients undergone PKP for single vertebral osteoporotic fracture were randomly divided into cooling group and normal group with 28 patients per group according to whether the temperature reducing measures were provided during the polymerization process of polymethyl methacrylate (PMMA). Data recorded were operation time, amount of PMMA injected into each vertebral body, visual analogue scale (VAS), Oswestry disability index (ODI), and anterior vertebral height. Results All the data revealed no significant differences between cooling and normal groups: operation time [ (45.6±7.3)minvs (43.6±5.8)min], PMMA injected into each vertebral body [ (2.8±0.3)ml vs (2.7±0.4)ml], VAS [(3.8±0.7)points vs (3.2±0.7)points], ODI [(36.6±8.2)points vs (30.4±6.0)points] and height restoration of anterior vertebral body [(85.3±6.1)%vs (83.9±7.3)%] (P>0.05). Conclusion High temperature denervation contributes a little to the relief of back pain during PKP, as may be due to the vertebral augmentation and stabilization. Key words: Spinal fractures; Osteoporosis; Polymethacrylic acids; Percutaneous kyphoplasty

Bilateral Portal Percutaneous Endoscopic Debridement and Lavage for Lumbar Pyogenic Spondylitis.

Common management approaches for spinal infections include conservative administration of antibiotics and aggressive surgical debridement. Minimally invasive endoscopic treatment has been reported and is gaining widespread attention because of its simplicity and effectiveness. This study retrospectively evaluated the clinical outcomes of bilateral portal percutaneous endoscopic debridement and lavage with dilute povidone-iodine solution in the treatment of patients with lumbar pyogenic spondylitis. From January 2007 to December 2011, a total of 22 patients diagnosed with single-level lumbar pyogenic spondylitis underwent bilateral portal percutaneous endoscopic debridement and lavage with dilute povidone-iodine solution at the authors' institution. Clinical outcomes were assessed by careful physical examination, visual analog scale pain score, modified MacNab criteria functional score, regular serologic testing, and imaging studies to determine whether percutaneous endoscopic debridement and lavage treatment was successful or if surgical intervention was required. Causative bacteria were identified in 19 (86.4%) of 22 biopsy specimens. Eighteen patients had satisfactory relief of back pain and uneventful recovery after this treatment. The success rate was 81.8% (18 of 22). Both visual analog scale and modified MacNab criteria scores improved significantly in successfully treated patients. No major surgical complications were noted, except for 3 patients who had residual or subsequent paresthesia in the affected lumbar segment. Percutaneous endoscopic debridement and lavage is a minimally invasive procedure that can yield a higher bacterial diagnosis, relieve back pain, and help to eradicate lumbar pyogenic spondylitis. It is an effective alternative treatment for patients with spinal infection before extensive open surgery.

Application of improved prone position pillow in preoperative postural training of patients with percutaneous kyphoplasty

Objective To explore the clinical effect of modified prone position pillow in preoperative postural training of patients with percutaneous kyphoplasty. Methods A total of 100 cases of patients with vertebral compression fractures were randomly divided into experimental group and control groups. Experimental group of 50 cases did preoperative postural training with modified prone position pillows,while 50 cases of the control group used traditional ordinary pillows. the comfort of patients when training, the effect of intraoperative tolerance and postoperative lower back pain relief were compared between two groups. Results In the experimental group preoperative postural training comfort was superior to the control group(P<0.01);better tolerance, shortened surgical time and pain relief of the two groups were statistically significant(P<0.05). Conclusions The modified prone position pillow was simple making,easy to operate can be applied as a nursing routine in the preoperative postural training of percutaneous kyphoplasty. Key words: Modified prone position pillow; Vertebral compression fracture; Postural training; Nursing

Effect of subcutaneous sterile water injection at the lumbosacral region on labour back pain

Objective: This study aimed to evaluate the effect of subcutaneous sterile water injection at the lumbosacral region on labour back pain. Methods: A quasi-experimental, pre/post test design was utilized to carry out this trial at the Labour and Delivery room, Mansoura University Hospital, Egypt. Sixty three primiparous in spontaneous active labour, indicated a low back pain ≥ 7 on numeric pain rating scale, and expected to have spontaneous vaginal delivery were included in this study as a one study group. Participants had received 4 subcutaneous sterile water injections of 0.1 ml at the lumbosacral region for once. Using three tools data were collected; the 1st was a structured interviewing questionnaire schedule to assess the participants basic characteristics, the 2nd was the numeric pain rating scale to evaluate the baseline pain intensity changes at ten minutes, one, two and three hours post injection, while the 3rd tool was the 5-points Likert scale for mother’s satisfaction with the pain relief. Results: The baseline pain score was 8 ± 0.8. It was reduced by 2.5, 3.5, 4.5, and 5 points at 10 minutes, one, two, and three hours post injection respectively. Strong satisfaction with the used method for pain relief was reported by 87.3% of the mothers, while only 3.2% were dissatisfied. Conclusions: It can be concluded that subcutaneous sterile water injection is an effective labour back pain relief method. This leading the investigators to recommend; raising the awareness of the labour and delivery nurses about this method in order to implement it in practice.

Superior outcomes of decompression with an interlaminar dynamic device versus decompression alone in patients with lumbar spinal stenosis and back pain: a cross registry study.

Surgical decompression for lumbar spinal stenosis (LSS) has been associated with poorer outcomes in patients with pronounced low back pain (LBP) as compared to patients with predominant leg pain. This cross registry study assessed potential benefits of the interlaminar coflex® device as an add-on to bony decompression alone. Patients with lumbar decompression plus coflex® (SWISSspine registry) were compared with decompressed controls (Spine Tango registry). Inclusion criteria were LSS and a preoperative back pain level of ≥5 points. 1:1 propensity score-based matching was performed. Outcome measures were back and leg pain relief, COMI score improvement, patient satisfaction, complication, and revision rates. 50 matched pairs without residual significant differences but age were created. At the 7-9 months follow-up interval the coflex® group had higher back (p=0.014) and leg pain relief (p<0.001) and COMI score improvement (p=0.029) than the decompression group. Patient satisfaction was 90% in both groups. No revision was documented in the coflex® and one in the decompression group (2.0%). In the short-term, lumbar decompression with coflex® compared with decompression alone in patients with LSS and pronounced LBP at baseline is a safe and effective treatment option that appears beneficial regarding clinical and functional outcomes. However, residual confounding of non-measured covariables may have partially influenced our findings. Also, despite careful inclusion and exclusion of cases the cross registry approach introduces a potential for selection bias that we could not totally control for and that makes additional studies necessary.

Assessment of manual load carrying and health status of women farm workers of district Sonipat (Haryana), India

In present study an assessment of manual load carrying and health status of women farm workers of Thana Kalan village, Kharkhoda tehsil in Sonipat district of Haryana was conducted. A total of forty women farm workers between 25-40 years age were selected with at least five year load carrying experience, involved in farm work, with no history of chronic disease and willingness to participate in the study. The women farm workers carried water, fodder, cow dung on daily basis and seed, fertilizer and other farm inputs and farm produce on seasonal basis. It was observed that preferable mode of load carrying was head. The quantum of load varied between 20-40 kg. Assessment of health status revealed that musculoskeletal disorder was prevalent in all the age groups. Musculoskeletal disorder namely lower back pain was observed in 87.5 per cent women workers, neck pain in 72.5 per cent women workers followed by knee (32.5%) and foot pain (25 %). The pain severity was mild in most of the women farm workers and nobody was bed ridden for back pain due to load carrying. The younger age women (25-30 years) preferred traditional way of oil massage and rest for relief from back pain and neck pain after load carrying, while older women (31-40 years) had to take rest for back pain relief. The issue of occupational health disorder associated with manual load carrying by women farm worker has to receive attention to reduce the potential health risk.