Relief Of Low Back Pain Research Articles

Efficacy of iodized oil in emergency ultraselective arterial embolization for fatal massive hemorrhage due to renal angiomyolipoma: a single-center retrospective cohort study.

In recent years, the area of minimally invasive, targeted therapy for kidney tumors has seen considerable advancement; however, little progress has been made in the evaluation of renal angiomyolipoma (RAML). We aimed to investigate the efficacy of emergency ultraselective arterial embolization for the treatment of fatal massive bleeding caused by RAML. At The First Hospital of Jilin University, a retrospective study was conducted between January 1, 2019 and March 1, 2024. The enrolled patients were those experiencing intense flank pain with a ruptured RAML and hemorrhage as confirmed through computed tomography (CT) and magnetic resonance imaging (MRI) in the emergency department. We performed renal arteriography and vascular ultraselective embolization in patients with ruptured and bleeding RAML. Patient information, including age, sex, tumor size, embolic material, several blood laboratory parameters, and postembolization syndrome (PES) occurrence, was retrospectively analyzed. PES was defined as the occurrence of fever, pain, nausea, or vomiting. This study ultimately enrolled 27 patients. After emergency embolization, 27 patients had 100% stable red blood cells and hemoglobin, and 7 patients had a single lesion and underwent surgical resection after the bleeding was stabilized. After emergency embolization, 22 patients experienced relief of low back pain as compared to pretreatment conditions, and the rate of lower back pain relief was 81.48%. Significantly higher creatinine and urea nitrogen levels were observed in three patients prior to the operation, and these levels reverted to their original state after renal function protection therapy. Despite varying levels of PES, all of the patients' symptoms returned to their normal levels following symptomatic treatment, with no significant impact on their quality of life or recovery period. Emergency ultraselective arterial embolization for the treatment of bleeding in fatal RAML is safe, rapid, and effective and has few complications. The use of iodized oil can not only serve an embolic function but also provide a tracer effect in subsequent reexamination.

Slit3 by PTH-Induced Osteoblast Secretion Repels Sensory Innervation in Spine Porous Endplates to Relieve Low Back Pain.

During aging, the spine undergoes degenerative changes, particularly with vertebral endplate bone expansion and sclerosis, that is associated with nonspecific low back pain (LBP). We reported that parathyroid hormone (PTH) treatment could reduce vertebral endplate sclerosis and improve pain behaviors in aging, SM/J and young lumbar spine instability (LSI) mice. Aberrant innervation noted in the vertebral body and endplate during spinal degeneration was reduced with PTH treatment in aging and LSI mice as quantified by PGP9.5 + and CGRP + nerve fibers, as well as CGRP expression in dorsal root ganglia (DRG). The neuronal repulsion factor Slit3 significantly increased in response to PTH treatment mediated by transcriptional factor FoxA2. PTH type1 receptor (PPR) and Slit3 deletion in osteoblasts prevented PTH-reduction of endplate porosity and improvement in behavior tests, whereas PPR deletion in chondrocytes continued to respond to PTH. Altogether, PTH stimulates Slit3 to repel sensory nerve innervation and provides symptomatic relief of LBP associated with spinal degeneration.

Integrative rehabilitation in the treatment of lumbosacral muscle strain in elite trampoline athletes: a pilot study.

Lumbosacral muscle strain (LMS) is common in Chinese elite trampoline athletes. Advanced lumbar muscle activation is necessary for postural control before upper extremity voluntary movements, called anticipatory postural adjustment to reduce internal postural interference (IPI). The potential of delayed lumbar muscle activation has been reported in patients with non-specific LBP (NLBP) in response to IPI. However, it remains unknown whether this effect exists in elite trampoline athletes. There is also limited literature reporting the rehabilitation of LMS in this population. This study first aimed to explore whether elite trampoline athletes with LMS experience delayed activation of lumbar muscles under IPI. The secondary aim was to preliminarily evaluate an integrative rehabilitation program's effectiveness. Ten elite trampoline athletes with LMS were recruited and received 10 sessions of integrative rehabilitation, including extracorporeal shock wave therapy, acupuncture, Tui-na, and spine function exercises. At baseline and after all sessions, the relative activation time of the lumbar muscles under IPI in a modified rapid arm-rise test was used as a primary outcome measure. The secondary measures included a visual analog scale (VAS) and a questionnaire to assess low back pain (LBP) and athletic training performance. The relative activation time of the lumbar muscles under IPI was delayed at baseline, but significantly decreased after the intervention (P < 0.05). The VAS was significantly decreased after the intervention (P < 0.05). There was no significant correlation between the difference in VAS and in activation time of the lumbar muscles before and after the intervention (P > 0.05). Elite trampoline athletes with LMS had delayed activation in their lumbar muscles under IPI. Integrative rehabilitation was effective in LBP relief and neuromuscular control of the lumbar muscles, and impacted positively on training performance. Future studies with a larger sample size, a control group, and long-term follow-ups are needed to further examine the efficacy of integrative rehabilitation in elite trampoline athletes with LMS. Additionally, the application of this approach in athletes with LMS or LBP in other sports, particularly those involving IPI, should be explored.

The Role of Intra-Articular Injection of Autologous Platelet Rich Plasma versus Corticosteroids in Treatment of Synovitis in Lumbar Facet Joint Disease

Abstract Background Low back pain (LBP) is an extremely common health problem and lumbar facet joint (FJ) disease is one of its main causes. Intra-articular injection of FJ is one of the vital therapeutic methods for FJ disease. Corticosteroids (CS) are the most commonly used injected drugs; however, previous studies have indicated that it has limited ability in long-term relief of LBP. Aim of the Work to compare the efficacy of intra-articular injection of platelet rich plasma (PRP) versus CS in improving MRI detected synovitis in correlation to clinical complaints of the patients with lumbar FJ syndrome. Patients and Methods Thirty patients with lumbar FJ syndrome divided into two equal groups: Group ‘I’ injected with PRP and Group ‘II’ with CS. The patients were comparatively assessed pre and post the intervention according to; number of tender lumbar FJs on palpation, maximum active lumbar extension range of motion, LBP visual analogue score (VAS), functional disability questionnaires - Roland Morris disability questionnaire (RMQ) and Oswestry disability index (ODI) - and MRI lumbar FJ detected synovitis and their grading. Results Both study groups showed statistical significant improvement in all mentioned parameters at 3 month follow up, there was no statistically significant difference between the results of both groups, however, PRP injected joints showed better performance regarding MRI synovitis grade in all lumbar FJ levels as compared to those injected with CS. Conclusion Both PRP and CS injections were determined to be effective in improvement of MRI detected FJ synovitis concurrently with improving clinical parameters, pain and functional activities of the patients at 3 months follow-up. However, PRP showed superior effect in improving MRI detected synovitis grade, therefore may be a better treatment option for longer duration efficacy and fewer side effects. TRN NCT04860531- 1/3/2021

Enhanced relief of low back pain following surgical repair of a ventral hernia: A case report

The effectiveness of core muscle strengthening in treating Low Back Pain (LBP) is well-established. The laxity or defect of the important portion of core muscle groups, transverse abdominis muscle, as seen in ventral hernia could be a contributing factor for core weakness and instability and thereafter results in LBP. The contribution of ventral hernia to LBP is scantily documented. Ventral hernias can be easily missed if a thorough physical exam is not performed. A 50-year-old male patient presented to the clinic with a 10- year history of LBP; a physical exam revealed a previously undiscovered ventral hernia. He reported a reduction in LBP and improvement in back support after his ventral hernia repair surgery. This case report highlights the importance of a thorough assessment and treatment of the underlying connection between ventral hernia and chronic LBP.

Preoperative Adjacent Facet Joint Osteoarthritis Is Associated with the Incidence of Adjacent Segment Degeneration and Low Back Pain after Lumbar Interbody Fusion.

A retrospective cohort study. To analyze the association between preoperative adjacent facet joint osteoarthritis (FJOA) and outcomes of lumbar interbody fusion (LIF). Whether preoperative adjacent FJOA is associated with the incidence of radiological adjacent segment degeneration (RASD) and low back pain (LBP) relief after lumbar fusion remains unknown. The study included patients who underwent LIF. The demographic characteristics and radiographic and surgical data were collected and evaluated. The included patients were divided into control group and FJOA group based on the preoperative adjacent facet joint Pathria grade. Preoperative and last follow-up LBP Visual Analog Scale (VAS) score, leg pain (LP) VAS, Oswestry Disability Index (ODI) and RASD were evaluated and compared. The improvement rates in VAS and ODI were calculated and compared between the two groups. Logistic regression was used to analyze the risk factors of LBP relief and incidence of RASD. In total, 197 patients (control group, 86; FJOA group, 111) were included, and the median follow-up was 46 months. The VAS and ODI in both groups significantly improved after surgery. At the last follow-up, the FJOA group had higher VAS and lower VAS improvement rates of LBP than the control group (p<0.05). However, no significant difference in the LP VAS and ODI was found between the two groups. The incidence of RASD in the FJOA group was significantly higher than that in the control group (48.6% vs. 30.2%, p=0.034). Multivariate logistic regression analysis showed that preoperative adjacent FJOA was significantly associated with LBP relief (odds ratio [OR], 0.691; 95% confidence interval [CI], 0.498-0.958) and the postoperative incidence of RASD (OR, 1.406; 95% CI, 1.020-1.939). The preoperative FJOA in the adjacent segments was significantly associated with LBP following LIF. Patients with preoperative FJOA were more likely to have RASD following lumbar fusion surgery.

Comparison of safety and efficacy of posterior lumbar interbody fusion (PLIF) and modified transforaminal lumbar interbody fusion (M-TLIF) in the treatment of single-segment lumbar degenerative diseases

ObjectiveTo compare modified transforaminal lumbar interbody fusion (M-TLIF) with posterior lumbar interbody fusion (PLIF) in the treatment of single-segment lumbar degenerative disorders in order to assess its safety and effectiveness.MethodsFrom January 2016 to January 2021, 74 patients who received single-segment M-TLIF were examined. A total of 74 patients having single-segment PLIF during the same time period were included in a retrospective controlled study using the same inclusion and exclusion criteria. The two groups were compared in terms of the fusion rate, the Oswestry disability index (ODI), the visual analogue scale of low back pain (VAS), the perioperative condition, the postoperative complications, and the postoperative neighbouring segment degeneration.ResultsAll patients had surgery satisfactorily and were monitored for at least a year afterwards. The baseline values for the two groups did not significantly differ. The interbody fusion rate between PLIF (98.65%) and M-TLIF (97.30%) was not significantly different. In the follow-up, the M-TLIF group's VAS score for low back and leg pain was lower than that of the PLIF group. The ODI score of the M-TLIF group was lower than that of the PLIF group at 7 days and 3 months following surgery. Both groups' post-op VAS and ODI scores for low back and leg pain were much lower than those from before the procedure. In M-TLIF group, the operation time, drainage tube extraction time, postoperative bed rest time and hospital stay time were shorter, and the amount of intraoperative blood loss was less. Compared with those before operation, the height of intervertebral space and intervertebral foramen were significantly increased in both groups during postoperative follow-up (P < 0.05). The postoperative complications and adjacent segment degeneration of M-TLIF were significantly lower than those of PLIF.ConclusionsM-TLIF is a safe and effective treatment for lumbar degenerative disorders, with a high fusion rate and no significant difference between M-TLIF and PLIF. M-TLIF's efficacy and safety are comparable to that of PLIF, particularly in terms of early relief of low back pain and improvement in quality of life following surgery. Therefore, M-TLIF technology can be popularized and applied in clinic.

Literature Review: Efektivitas Elastic Therapeutic Taping (Ett) Terhadap Pengurangan Skala Nyeri Punggung Bawah Pada Kehamilan Trimester Iii

One of the physiological changes in pregnant women in the third trimester is the gradual musculoskeletal changes associated with the occurrence of low back pain due to increased body weight and changes in body posture. One of the new technologies in physical therapy is the use of elastic therapeutic bandages. This literature review aims to determine the effectiveness of elastic therapeutic taping (ett) against LBP in the third trimester of pregnancy. Of the 11 studies reviewed by the authors, it was shown that ETT support for low back pain relief was usually installed in the lumbar region 5 (L5) and sacrum (S1) with a band pattern I. ETT can be done 2 times a week and the ETT is replaced 3 days every 3 weeks for best results. optimally with a duration of 24-72 hours. ETT can reduce pain scores more significantly when combined with other therapies such as Paracetamol plus ETT, TENS plus ETT, ETT with oblique pelvic exercises, back exercises with ETT. The conclusion is that ETT can relieve low back pain and have a very real effect in reducing low back pain intensity in the last trimester of pregnancy.

The Mckenzie Methodwith Interferential Therapy on Acute Low Back Pain (Sciatica) Patients: A Randomised Controlled Clinical Trial

Purpose: To investigate the effect of McKenzie method withInterferential therapy (IFT)when compare to IFTalone on acute low back pain (Sciatica) patients in terms of relieving pain, increasing lumbar extension range of motion and speed of walking.Methods: Randomised controlled clinical trial,fifty seven patients were screened; forty sciatica patients agedfrom 30 to 60 years with no recent injury were selected through the special tests, after randomisation, the experimental group (n-15) was treated with the McKenzie method andInterferential therapy whereas control group (n-15) was treated with the Interferential therapy alone. The primary outcome was the relief of low back pain and increasing the lumbar extension range of motion. The secondary outcome was the speed of walking by measuring the stride length and cadence for 10 meters.Result: The study aimed to compare the pain, lumbar extension range of motion (ROM), stride length, and cadence of two different teams before and after physiotherapy. The experimental team had an average pain score of 7.70 VAS, a lumbar extension range of motion of -3.70 degrees, a stride length of 56.70 cms, and a cadence of 115.35 steps. In post-physiotherapy, the team had an average pain score of 2.20 VAS, a lumbar extension range of motion of 24.85 degrees, a stride length of 58.65 cms, and a cadence of 113.15 steps. The mean difference in pain, ROM, stride length, and cadence was statistically significant. The results suggest that physiotherapy can be a valuable tool for improving pain management and reducing back pain.Conclusion: McKenzie method with Interferential therapy showed greater relief of low back pain, increased lumbar extension range of motion, increased speed of walking in terms of step length and cadence than IFT alone.

LITERATURE REVIEW: EFEKTIVITAS ELASTIC THERAPEUTIC TAPING (ETT) TERHADAP PENGURANGAN SKALA NYERI PUNGGUNG BAWAH PADA KEHAMILAN TRIMESTER III

One of the physiological changes in pregnant women in the third trimester is the gradual musculoskeletal changes associated with the occurrence of low back pain due to increased body weight and changes in body posture. One of the new technologies in physical therapy is the use of elastic therapeutic bandages. This literature review aims to determine the effectiveness of elastic therapeutic taping (ett) against LBP in the third trimester of pregnancy. Of the 11 studies reviewed by the authors, it was shown that ETT support for low back pain relief was usually installed in the lumbar region 5 (L5) and sacrum (S1) with a band pattern I. ETT can be done 2 times a week and the ETT is replaced 3 days every 3 weeks for best results. optimally with a duration of 24-72 hours. ETT can reduce pain scores more significantly when combined with other therapies such as Paracetamol plus ETT, TENS plus ETT, ETT with oblique pelvic exercises, back exercises with ETT. The conclusion is that ETT can relieve low back pain and have a very real effect in reducing low back pain intensity in the last trimester of pregnancy.

Comparison of the Low Back Pain Relief and Spread Level After Upper and Lower Lumbar Erector Spinae Plane Block

BACKGROUND: The erector spinae plane block (ESPB), which was introduced to manage the thoracic pain, is an ultrasound-guided technique that is relatively easy, less invasive, and safer. In spite of its technical ease and safety of ESPB, few studies have explored the analgesic efficacy and the exact spread level of injected local anesthetics. OBJECTIVES: The purpose of this study is to compare the analgesic efficacy and spread level of the upper and lower lumbar ESPBs . STUDY DESIGN: Prospective, randomized design. SETTING: The pain clinic of a tertiary university hospital. METHODS: This study included 84 patients with low back pain with or without leg pain who received lumbar ESPB at L2 (L2 ESPB group) or L4 (L4 ESPB group) using 10 mL of 0.2% ropivacaine mixed with 10 mL of the contrast medium. After finishing 20 mL of the local anesthetic mixture injection, a fluoroscopic examination was performed to evaluate the spread level. Analgesic efficacy was assessed using an 11-point Numeric Rating Scale (NRS-11) and a Back Pain Functional Scale. RESULTS: The number of patients who showed excellent-to-moderate low back pain relief was 35 (83.3%) and 36 (78.5%) in the L2 and L4 ESPB groups, respectively. Significant reductions in pain on the NRS-11 and improvements in disability were found in both groups. The total number of vertebral segments to which the anesthetic drugs spread was significantly higher in the L2 ESPB group than in the L4 ESPB group (2.7 ± 0.5 vs 2.0 ± 0.2, P = 0.002). LIMITATIONS: The analgesic efficacy of lumbar ESPB was evaluated with only short-term outcomes. CONCLUSIONS: Both the L2 and L4 ESPB groups demonstrated a significant reduction in low back pain and improvement in disability. The L2 ESPB group demonstrated a significantly increased spread level compared to the L4 ESPB group. KEY WORDS: Erector spinae plane block, spread level, low back pain, analgesic efficacy

Results From a Prospective, Clinical Study (US-nPower) Evaluating a Miniature Spinal Cord Stimulator for the Management of Chronic, Intractable Pain

BACKGROUND: Chronic, intractable, neuropathic pain is readily treatable with spinal cord stimulation (SCS). Technological advancements, including device miniaturization, are advancing the field of neuromodulation. OBJECTIVES: We report here the results of an SCS clinical trial to treat chronic, low back and leg pain, with a micro-implantable pulse generator (micro-IPG). STUDY DESIGN: This was a single-arm, prospective, multicenter, postmarket, observational study. SETTING: Patients were recruited from 15 US-based comprehensive pain centers. METHODS: This open-label clinical trial was designed to evaluate the performance of the Nalu™ Neurostimulation System (Nalu Medical, Inc., Carlsbad, CA) in the treatment of low back and leg pain. Patients, who provided informed consent and were successfully screened for study entry, were implanted with temporary trial leads. Patients went on to receive a permanent implant of the leads and micro-IPG if they demonstrated a &gt;= 50% reduction in pain during the temporary trial period. Patient-reported outcomes (PROs), such as pain scores, functional disability, mood, patient impression of change, comfort, therapy use profile, and device ease of use, were captured. RESULTS: At baseline, the average pain Visual Analog Scale (VAS) score was 72.1 ± 17.9 in the leg and 78.0 ± 15.4 in the low back. At 90 days following permanent implant (end of study), pain scores improved by 76% (VAS 18.5 ± 18.8) in the leg and 75% (VAS 19.7 ± 20.8) in the low back. Eighty-six percent of both leg pain and low back pain patients demonstrated a &gt;= 50% reduction in pain at 90 days following implant. The comfort of the external wearable (Therapy Disc and Adhesive Clip) was rated 1.16 ± 1.53, on average, at 90 days on an 11-point rating scale (0 = very comfortable, 10 = very uncomfortable). All PROs demonstrated statistically significant symptomatic improvement at 90 days following implant of the micro-IPG. LIMITATIONS: Limitations of this study include the lack of long-term results (beyond 90 days) and a relatively small sample size of 35 patients who were part of the analysis; additionally, there was no control arm or randomization as this was a single-arm study, without a comparator, designed to document the efficacy and safety of the device. Therefore, no direct comparisons to other SCS systems were possible. CONCLUSIONS: This clinical study demonstrated profound leg and low back pain relief in terms of overall pain reduction, as well as the proportion of therapy responders. The study patients reported the wearable aspects of the system to be very comfortable. KEY WORDS: Spinal cord stimulation, chronic pain, radiculopathy, micro-IPG, battery-free, persistent spinal pain syndrome, failed back surgery syndrome, low back pain, leg pain

Clinical Observation, Management and Function Of low back pain Relief Therapies (COMFORT): A cluster randomised controlled trial protocol

IntroductionLow back pain (LBP) is commonly treated with opioid analgesics despite evidence that these medicines provide minimal or no benefit for LBP and have an established profile of harms. International...

Clinical efficacy of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in the treatment of II° lumbar isthmic spondylolisthesis: A retrospective cohort study.

Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) is not suitable for high-grade isthmic spondylolisthesis, whether MIS-TLIF can treat II° lumbar isthmic spondylolisthesis (IS) is still controversial. This retrospective cohort study compared the clinical efficacy of MIS-TLIF and open transforaminal lumbar interbody fusion (OPEN-TLIF) in the treatment of II° lumbar IS. From January 2017 to January 2023, 101 patients with II° lumbar IS were diagnosed in our hospital and underwent surgical treatment, of which 53 received MIS-TLIF surgery and 48 received OPEN-TLIF surgery. The operation time, blood loss and surgical complications were compared between the 2 groups. The pain, function, reduction rate and fusion rate of the patients were evaluated during follow-up. The amount of intraoperative blood loss, postoperative drainage, and postoperative hospital stay in the MIS-TLIF group were significantly lower than those in the OPEN-TLIF group were (P < .01). In the MIS-TLIF group, there were 1 case of dural sac injury and 3 cases of lower limb paralysis. The complication rate of MIS-TLIF was lower than the OPEN-TLIF group (P = .032). In the visual analog scale score of low back pain, the MIS-TLIF group was lower than the OPEN-TLIF group after operation and at the last follow-up. There were no significant differences in postoperative leg pain score, slippage rate, and fusion rate between the 2 groups. Compared with OPEN-TLIF, MIS-TLIF has the advantages of better low back pain relief, less trauma, less bleeding and faster recovery, and is worthy of clinical promotion.

Clinical efficacy of midline lumbar interbody fusion arthrodesis with neuronavigation-guided cortical bone trajectory screws in the treatment of degenerative lumbar spondylolisthesis:a prospective randomized controlled trial

Introduction. Currently, the standard treatment of degenerative spondylolisthesis involves pedicle screw fixation to enhance the success of intervertebral fusion. The traditional pedicle screw techniques require extensive lateral muscle dissection, resulting in significantly increased surgical-related morbidity. To address some of these shortcomings, the Midline Lumbar Interbody Fusion (MIDLIF®) technique has recently been developed. It involves the combination of the cortical bone trajectory screw fixation of the spine with intervertebral cage placement to achieve a solid interbody fusion. So far, the clinical efficacy of the MIDLIF technique in the treatment of low-grade degenerative spondylolisthesis is still unknown. All existing publications are studies with a low level of relevance or scientific evidence. Materials and methods. A prospective randomized controlled trial was conducted between 2017 and 2022. The study analyzed the clinical and radiological effectiveness of the MIDLIF arthrodesis technique compared to the traditional lumbar interbody fusion techniques, used exclusively in the treatment of degenerative lumbar spondylolisthesis. Results. The study enrolled 112 eligible patients with degenerative low-grade spondylolisthesis, randomly assigned into two groups. At 1 year post-operatively, MIDLIF provided a significantly better improvement in postoperative relief of low back pain and radiating pain, as well as a significantly better functional recovery. Additionally, MIDLIF resulted in lower surgical morbidity compared to traditional fusion techniques. Conclusions. The success rate of MIDLIF arthrodesis is similar to that associated with traditional fusion techniques. At the same time, MIDLIF offers all the specific benefits of a minimally invasive approach, such as less postoperative pain, faster functional recovery, less bleeding, and fewer blood transfusions. Thus, MIDLIF might be a good alternative to the traditional intervertebral fusion techniques in the treatment of degenerative low-grade spondylolisthesis.

Comparing the efficacy and complications of unilateral biportal endoscopic fusion versus minimally invasive fusion for lumbar degenerative diseases: a systematic review and mate-analysis.

Unilateral biportal endoscopic (UBE) has been gradually applied in clinical practice. UBE has two channels, with good visual field and operating space, and has achieved good results in the treatment of lumbar spine diseases. Some scholars combine UBE with vertebral body fusion to replace traditional open fusion surgery and minimally invasive fusion surgery. The efficacy of biportal endoscopic transforaminal lumbar interbody fusion (BE-TLIF) is still controversial. In this systematic review and meta-analysis, BE-TLIF and minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) are compared in the efficacy and complicationsof lumbar degenerative diseases. PubMed, Cochrane Library, Web of Science and China National Knowledge Infrastructure (CNKI) were used to search literatures related to BE-TLIF before January 2023, to identify relevant studies, and systematically review all literatures. Evaluation indicators mainly include operation time, hospital stay, estimated blood loss, visual analog scale (VAS), Oswestry Disability Index (ODI), and Macnab. A total of 9 studies were included in this study; a total of 637 patients were collected, and 710 vertebral bodies were treated. Nine studies showed that there was no significant difference in VAS score, ODI, fusion rate, and complication rate between BE-TLIF and MI-TLIF at the final follow-up after surgery. This study suggests that BE-TLIF is a safe and effective surgical approach. BE-TLIF surgery has similar good efficacy to MI-TLIF in the treatment of lumbar degenerative diseases. And compared with MI-TLIF, it has the advantages of early postoperative relief of low-back pain, shorter hospital stay, and faster functional recovery. However, high-quality prospective studies are needed to validate this conclusion.

Systemically Acting Diclofenac Sodium Patch for Control of Low Back Pain: A Randomized, Double-Blind, Placebo-Controlled Study in Japan.

Nonsteroidal antiinflammatory drugs (NSAIDs) are commonly used for pain disorders such as low back pain and exist in multiple formulations; however, no systemically acting transdermal formulations are available for low back pain. Transdermal formulations can be safely administered even to patients with trouble swallowing or at risk of aspiration, and without regard to the effect of food on drug absorption. Unlike locally acting formulations, systemically acting transdermal formulations need not be applied at the target site, so dosing is simple and the burden is not on one area of the skin. A patch with the systemically acting NSAID diclofenac sodium is approved in Japan for treatment of cancer-related pain, and we hypothesized that it would be useful for controlling low back pain. This randomized, double-blind, placebo-controlled study aimed to evaluate the efficacy and safety of diclofenac sodium patch in Japanese patients with low back pain. Eligible patients were randomized to receive diclofenac sodium patch 75mg or 150mg or placebo once daily for 2weeks. The primary endpoint was pain intensity assessed on a visual analog scale (VAS). Primary analysis of the primary endpoint showed that both doses of the diclofenac sodium patch (150mg and 75mg) were superior to placebo in terms of absolute change from baseline in mean 3-day VAS score after 2weeks' treatment; the mean difference between the active and placebo treatments in this variable was -5.67 [95% confidence interval (CI) -9.34 to -2.00] mm in the 150mg group and -5.68 (95% CI -9.34 to -2.01) mm in the 75mg group. Most adverse events were mild. No serious adverse events occurred. In Japanese patients, diclofenac sodium patch is effective for the relief of low back pain and is well tolerated. JPRN number, JPRN-JapicCTI-205134.

Surgical management of isthmic spondylolisthesis: A comparative study of postoperative outcomes between ALIF and TLIF

IntroductionCircumferential fusion by the anterior (ALIF) or transforaminal (TLIF) approach combined with posterior instrumentation is currently used for the surgical treatment of low-grade isthmic spondylolisthesis. But few studies have compared the clinical and radiological outcomes of various interbody fusion techniques. The objective of this study was to compare the clinical and radiological results at 2 years postoperative of two fusion techniques–TLIF versus ALIF plus posterior instrumentation–for low-grade isthmic spondylolisthesis in adults. Materials and methodsThis was an observational multicenter study done at nine French healthcare facilities specialized in spine surgery. The inclusion criteria were minimum age of 18 years, grade 1–3 isthmic spondylolisthesis, ALIF+posterior fixation (ALIF+PS) or TLIF, minimum follow-up of 2 years. Clinical and radiological evaluations were done preoperatively and at 2 years of follow-up. A lumbar CT scan was done at 1 year postoperative to evaluate fusion. ResultsThe cohort consisted of 89 patients (50 women, 39 men) with a mean age of 47.7±12.3 (18–79) years. The patients in the ALIF groups (n=71) had a significantly longer hospital stay than those in the TLIF group (n=18): 5.7 days versus 4.6 days (p=.04). However, their medical leave from work was significantly shorter: 31.0 weeks versus 40.7 (p=.003). Lumbar pain VAS diminished faster in the ALIF groups, with a significantly larger drop than the TLIF group in the first 3 months postoperative. Only the increase in lumbar disc lordosis was larger in the ALIF group: 11.7°±12.0° versus 6.0°±11.7° (p=.036). There was a significant correlation between the increase in global lordosis and reduction in lumbar VAS at 2 years postoperative (ρ=−0.3295; p=.021). ConclusionALIF+PS provides a faster relief of postoperative low back pain than TLIF but there are no significant clinical differences between techniques at 2 years of follow-up. Despite better restoration of disc lordosis in the ALIF+PS group, there was no difference in the restoration of global lordosis. Level of evidenceIII; multicenter comparative study.

Innovative seated vertical lumbar traction allows simultaneous computer work while inducing spinal height changes similar to supine lying.

Lumbar intervertebral disc height loss has been associated with spinal height change (SHC) and low back pain (LBP), including stenosis. Non-invasive methods to improve disc height loss require forms of lying down, which are unconducive to computer work. Intermittent vertical traction (VT) integrated with seated computer work may provide ergonomic alternatives for increasing SHC to promote LBP relief. The primary aim was to develop and introduce a safe VT prototype and dosage to induce and measure SHC. Prototype comfort and LBP ratings were exploratory secondary aims. Forty-one participants were stadiometry-measured for pre- and post-intervention SHC from seated VT at 35% body weight removed, supine lying (SL), and sitting at a computer (SIT) without VT. Pain ratings were recorded for those self-reporting LBP. VT prototype evaluations were compiled from a 3-question, 7-point Likert-style survey. SHC increased by 3.9 ± 3.4 mm in VT, 1.7 ± 3.4 mm in SIT, and 4.3 ± 3.1 mm in SL (P< 0.000). Post hoc findings were significant between VT and SIT (P< 0.000), and SL and SIT (P< 0.000). VT and SL LBP ratings both decreased, but not SIT. Intermittent seated VT is a promising alternative for postural relief during seated computer work, producing SHC similar to lying down without compromising workflow.

A RCT Comparing Traditional and DTMTM SCS for Chronic Back and Leg Pain: Sub-Analysis of Profound Back Pain Responders at 12 months

DTMTM SCS is a programming approach where electrical signals are multiplexed spatially and temporally. We report data from a RCT comparing the effectiveness of DTM SCS to traditional SCS for low back pain (LBP) relief. At the 12-month follow-up, a high number of subjects experience profound LBP relief (≥ 80%) with DTM SCS. A sub-analysis of profound LBP responders was conducted.