Severe Back Pain Research Articles

IMPACT OF MCKENZIE METHOD WITH CONVENTIONAL THERAPY ON LUMBAR RADICULOPATHY: A CASE REPORT

Lower back pain is a prevalent and incapacitating global disorder, often attributed to factors such as prolonged standing, excess weight, and heavy lifting. Radiculopathy, a condition leading to lower back pain radiating to the lower extremities, is a common manifestation. This case study focuses on a 46-year-old businesswoman presenting with specific lower back discomfort and pain in her left lower extremity during certain movements. She reported experiencing severe lower back pain a month ago after an 8-hour standing period, with a Numeric Pain Rating Scale (NPRS) score of 8 and an Oswestry Disability Index score of 29, indicating a significant impact on her overall life. The McKenzie method, a prescribed exercise approach for spine management, was employed for diagnosis and treatment. This case study illustrates the clinical presentation, causes, diagnosis, radiological assessment, and management of lumbar radiculopathy using the McKenzie technique and Transcutaneous Electrical Nerve Stimulation (TENS). The study spanned three weeks with three sessions per week, including reassessment after each week. The findings suggest that the McKenzie technique combined with TENS had a substantial positive impact in alleviating lumbar radiculopathy. Keywords: Lumbar radiculopathy, McKenzie, TENS, low back pain, lumbar spine

Three cases of diagnostic delay of type A acute aortic dissection

BackgroundDiagnostic delay (DD) can be lethal when patients with type A acute aortic dissection (TAAAD). We report 3 cases of DD associated with TAAAD.Case presentationCase 1 is a female in her sixties presenting with severe back pain. A CT scan was taken, and TAAAD with a thrombosed false lumen was suspected by the radiology technician. He did not successfully transfer his concern to the physicians and the patient was sent home. The next day, she was transferred to another hospital with a recurrence of the symptom, and the diagnosis of TAAAD was made with a CT scan there. Case 2 was an 87-year-old female who was transferred to our hospital because of a loss of consciousness and bruises on the forehead. CT scan was taken and the displaced intimal flap in her aortic arch was overlooked by the part-time physician almost at the end of his shift. The diagnosis of TAAAD was made by the radiologist. Case 3 was the 44-year-old male who did not have health insurance and experienced severe back pain a few days before the visit to our clinic. On that day, he went to the nearby hospital’s emergency room, and only pain medication was prescribed. A few days later, a CT scan was taken at our hospital to investigate the cause of pyuria and the diagnosis of TAAAD was made.ConclusionDD may be common and multifactorial in our practice. Physicians need to take every step to improve diagnostic accuracy.

Rare Case of Wide Spread Fungal Spinal Osteomyelitis with Severe Back Pain under Conservative Treatment. Case Report and Review of the Literature

Rare Case of Wide Spread Fungal Spinal Osteomyelitis with Severe Back Pain under Conservative Treatment. Case Report and Review of the Literature

Altered central pain processing in patients with degenerative lumbar diseases and its association with low physical activity levels after lumbar spinal surgeries: a retrospective cohort analysis.

To investigate the occurrence of altered central pain modulation in patients with degenerative lumbar diseases (DLDs) and to analyze its association with physical activity (PA) 3years after lumbar decompression and fusion. Preoperative assessments of pressure pain thresholds (PPTs), temporal summation (TS), conditioned pain modulation (CPM) and pain were, respectively, recorded in 304 patients. These patients further underwent International Physical Activity Questionnaire (IPAQ) and both pain-related and psychological assessments 3years post-operation. Preoperatively, the patients had lower PPTs in both local pain and pain-free areas and lower CPM and higher TS in pain-free areas than healthy subjects (P < 0.05). Postoperatively, 53.9% (164/304) patients showed PA below healthy-related thresholds (< 600 MET min/w). Low PA group showed a greater postoperative weight gain and bone loss and a higher postoperative prevalence of both moderate anxiety and marginal depression than high PA group (P < 0.05). All covariates with differences between the high and low PA groups were subjected to multivariate logistic regression, and long preoperative disease duration, low preoperative PPT in pain-free area, high preoperative TS, revision surgery, severe postoperative low back pain and significant postoperative pain catastrophizing thought were independently associated with low postoperative PA (P < 0.05). This study supports the existence of central sensitization (CS) caused by abnormal central pain modulation in DLDs. Pre-existing CS in these patients may be associated with low PA after lumbar surgeries, and this low-activity lifestyle may predispose patients to multiple adverse health outcomes. Preoperative dynamic quantitative sensory testing may provide information for the identification of at-risk patients.

Pediatrics severe low back pain by disc herniation: an uncommon entity

BackgroundCommon severe back pain due to disc herniation is rare in the paediatric population which involves children under eighteen years of age. Paediatric lumbar disc herniation (LDH) cannot be considered the same disease as in adults, as it has potentially different natural and clinical backgrounds. The treatment of pediatric LDH is the other particularity of this condition. Indeed, in children, delaying surgery for a conservative treatment is justified. We report 3 cases treated in 8 years.Case presentationThree patients, two of whom were 14 years of age and one 17 years of age, were admitted for L5 or S1 lumbosciatica. A CT scan showed a lumbar disc herniation L5S1 associated with bi-isthmic lysis (and a transitional abnormality in 1 case or spina bifida occulta in 1 other case). The last patient had an magnetic resonance imaging (MRI) that showed a herniated L4L5 disc. The diagnosis of low back pain disc herniation was retained in two patients and that of disabling low back disc in one patient. Percutaneous discolysis in the two hyperalgesic cases and epidural corticosteroid infiltration in the disabling case were effective on lumbosciatica.ConclusionPaediatric common lomw back pain caused by a disc herniation with a hyperalgic or disabling character posed a therapeutic problem which were solved by the invasive approaches that must be given priority nowadays with children.

Comparison of CT-Guided needle biopsy versus percutaneous endoscopic debridement and drainage in pathogen identification and pain outcomes for spondylodiscitis patients: A systematic review and literature review

IntroductionSpondylodiscitis (SD) is an infection of the intervertebral disc with involvement of the adjacent vertebral bodies. Diagnostic tests with CT-guided biopsy only provide a positive yield in 14%–48% of cases. Percutaneous endoscopic debridement and drainage (PEDD) has recently shown promise in the treatment of spondylodiscitis. Research questionThe purpose of this study is to determine differences in pathogen identification and clinical outcomes for PEDD versus CT-guided needle biopsy in SD patients. Materials and methodsWe conducted a systematic review of the literature using PRISMA guidelines to determine differences in positive microbiology results, perioperative complications, pain control, and long-term clinical outcomes for PEDD vs. CT-guided needle biopsy in SD patients. Results1078 studies were evaluated, 87 of which underwent full review. 15 studies met the inclusion and exclusion criteria, including 7 PEDD, 7 CT-guided biopsy, and 1 CT-guided biopsy vs. PEDD article, for a total of 192 PEDD patients and 604 CT-guided biopsy patients. We found 36.59% of CT-guided biopsy patients had positive microbiology results, compared to 84.38% of PEDD patients. No major perioperative complications occurred as a result of the PEDD procedure. Of the five PEDD studies that reported pain outcomes, greater than 80% of patients experienced relief after intervention. Discussion and conclusionThese results suggest that PEDD may improve pathogen identification while simultaneously reducing pain compared to CT-guided needle biopsy in SD. Although current treatment guidelines recommend CT-guided biopsy, in patients with severe back pain and suspected SD, PEDD can be considered an alternative intervention.

In situ forming, mechanically resilient hydrogels prepared from 4a-[PEG-b-PTMC-Ac] and thiolated chondroitin sulfate for nucleus pulposus cell delivery.

Intervertebral disk degeneration (IVDD) is a common condition that causes severe back pain and affects patients' mobility and life quality considerably. IVDD originates within the central region of the disk called the nucleus pulposus (NP). Removing the damaged tissue and replacing it with NP cells (NPCs) delivered within an in situ forming hydrogel is a promising treatment approach. Herein we describe a hydrogel formulation based on 4-arm [poly(ethylene glycol)-b-poly(trimethylene carbonate)-acrylate] (4a[PEG-b-PTMC-Ac]) crosslinked with thiolated chondroitin sulfate via Michael-type reaction for this purpose. A library of hydrogels based on 15 kDa 4a-[PEG] with PTMC blocks of varying molecular weight were prepared and characterized. The instantaneous moduli of the hydrogels were adjustable from 24 to 150 kPa depending on the length of the PTMC block and the polymer volume fraction. The influence of each of these parameters was effectively explained using both scaling or mean field theories of polyelectrolyte hydrogels. The hydrogels were resistant to cyclic compressive loading and degraded gradually over 70 days in vitro. A hydrogel formulation with an instantaneous modulus at the high end of the range of values reported for human NP tissue was chosen to assess the ability of these hydrogels for delivering NPCs. The prepolymer solution was injectable and formed a hydrogel within 30 minutes at 37 °C. Bovine NPCs were encapsulated within this hydrogel with high viability and proliferated throughout a 28 day, hypoxic culture period. The encapsulated NPCs formed clusters and deposited collagen type II but no collagen type I within the hydrogels. Despite an initial gradual decrease, a steady-state modulus was reached at the end of the 28 day culture period that was within the range reported for healthy human NP tissue. This in situ forming hydrogel formulation is a promising approach and with further development could be a viable clinical treatment for IVDD.

Spondylodiscitis after sacral colpopexy: diagnose early to treat earlier.

Spondylodiscitis following sacral colpopexy for Pelvic Organ Prolapse (POP) represents a rare complication with severe consequences. Authors performed a literature search, from 2000 to 2022, to set a narrative review of literature. Spondylodiscitis is an uncommon but dangerous side effect of a routine surgical treatment that needs to be identified and treated right away to prevent worsening clinical consequences. Suboptimal dissection of the sacral promontory and/or site infection are associated with spondylodiscitis. When spondylodiscitis is suspected, advanced imaging methods should be used, and surgical excision shouldn't be put off after a failed course of treatment. Authors presented a case-video of a 68-year-old woman who reported severe lower back pain 7 weeks after surgery, in which sacral spondylodiscitis was diagnosed and laparoscopically treated. In this case, a laparoscopic tack and mesh removal from promontory was carried out following the patient's continued lower back pain and the antibiotic therapy's incomplete radiological remission of spondylodiscitis. The patient's radiological findings and symptoms completely resolved two weeks following the procedure.

Bilateral adrenal infarction and insufficiency associated with antiphospholipid syndrome and surgery: a case report

BackgroundAntiphospholipid syndrome causes systemic arterial and venous thromboses due to the presence of antiphospholipid antibodies. Adrenal insufficiency is a rare complication of antiphospholipid syndrome that may result in fatal outcomes if left untreated. Therefore, we report adrenal insufficiency as a rare complication of bilateral adrenal infarction associated with antiphospholipid syndrome and trauma surgery.Case presentationA 64-year-old male patient underwent surgery for a left traumatic hemothorax. He concurrently had antiphospholipid syndrome and was receiving warfarin. Postoperatively, the patient complained of severe lumbar back pain despite resuming anticoagulation therapy, and he experienced paralytic ileus and shock. Abdominal contrast-enhanced computed tomography revealed adrenal swelling and increased surrounding retroperitoneal adipose tissue density. Diffusion-weighted abdominal magnetic resonance imaging showed high-intensity areas in the bilateral adrenal glands. Cortisol and adrenocorticotropic hormone levels were 3.30 μg/dL and 185.1 pg/dL, respectively. Subsequently, the patient was diagnosed with bilateral adrenal infarction and acute adrenal insufficiency, and hydrocortisone was immediately administered. Adrenal insufficiency improved gradually, and the patient was discharged after initiating steroid replacement therapy.ConclusionsThe timing of postoperative anticoagulant therapy initiation remains controversial. Therefore, adrenal insufficiency due to adrenal infarction should be monitored while anticoagulant therapy is discontinued in patients with antiphospholipid syndrome.

CVID With Unusual Peripheral Mononeuropathy and Associated IL-7 Receptor Mutation.

Common variable immunodeficiency (CVID) is the most common symptomatic primary immunodeficiency. It is characterized by hypogammaglobulinemia and can present with a broad range of symptoms including recurrent bacterial infections, autoimmunity, and malignancy. Rarely, it has been implicated with peripheral neuropathy. We present a case of CVID with peripheral neuropathy and a pathogenic heterozygous variant of IL-7 receptor gene. The patient is a 38-year-old female with a history of recurrent infections since childhood including pneumonia and sinus infections status post tonsillectomy and sinus surgery. She subsequently developed severe left leg and lower back pain that progressed to left foot drop and decreased sensation over the left leg. She was found to have severe hypogammaglobulinemia and poor polysaccharide and protein response, thus meeting criteria for CVID. Mononeuropathy is a rare finding in CVID. Genetic panel was performed and was significant for a single pathogenic variant in IL-7 receptor. Disruptions in the IL-7 and IL-7 receptor signaling pathway have been associated with autoimmunity such as rheumatoid arthritis and multiple sclerosis. Further investigation is indicated to determine the clinical significance of this variant.

Epitheloid Haemangioma of Spine - A Rare Case Report and Review of Literature

Introduction: Epitheloid hemangioma (EH) of spine is a rare vascular disease. Haemangiomas are tumours typically composed of thin walled blood vessels, of which EH is an infrequent variation. The exact incidence of EH is not known. EH, though is considered to be benign disease it can be locally aggressive. EH most commonly affects the integumentary system. IT most commonly involves liver, lungs and bones. Here we report a 25 years old male with complete work up for EH including clinical data, MRI spine, surgical, histopathological information and adjuvant radiation therapy following surgical management. In addition to the case report, we reviewed literature on EH of bones. Case Report: A 25 years old male came to our emergency department with complaints of severe lower back pain. He also complained of difficulty in walking for the past 3 months. MRI Lumbosacral (LS) with whole spine screening was done 1 month back and it showed Multifocal vertebral lesions involving D4, D5, D6 vertebra predominantly in posterior elements, expansion of the transverse processes and involvement of costochondral junction, left 5th rib with extensive soft tissue component indenting on the pleura. He was seen by Neurosurgery team at our hospital and was planned for surgical decompression and stabilisation of D4-D6 vertebrae. He underwent D3 to D6 laminectomy and stabilization under general anaesthesia. Final histopathology along with IHC correlation was suggestive of Epitheloid Hemangioma. Case was discussed in our hospital multidisciplinary tumor board and was planned for adjuvant radiotherapy (RT). Then he received adjuvant radiotherapy total dose (TD) 45 Gray (Gy) to D3-D6 region. Post treatment 6 months, his power is improved and is near normal. Conclusion: To summarize our case appears as a typical features of EH like young male patient, lytic lesions with sclerotic rim, IHC confirmation

Role of Trigger Point Injection in the Management of Proximal Tensor Fascia Lata Myofascial Trigger Point in a Stage 4 Breast Cancer Patient

Pain is a common and devastating complaint in cancer patients. The etiology of pain in these patients is numerous and proper assessment is needed for treatment. Myofascial pain syndrome (MPS) is a common but often neglected cause of pain. Cancer patients are at risk of developing MPS. An accurate and early clinical diagnosis along with appropriate intervention is required to address this cause of pain in order to decrease the sufferings of these patients. Here, we report a patient of metastatic breast carcinoma with severe lower back and lower limb pain, significantly relieved with Minimally invasive pain and spine interventions (MIPSI) of the trigger point in the tensor fascia lata, which is often a missed cause of pain in this subgroup of the patient.

A Paradoxal Reaction from Intravenous Immunoglobulin

Introduction: Intravenous immunoglobulin (IVIG) is among the commonly used agents for many autoimmune conditions, such as chronic inflammatory demyelinating polyneuropathy (CIDP), a progressive neurologic disorder that is characterized by weakness and sensory loss. While rare, adverse effects stemming from IVIG have been noted, these usually occur during or right after the infusion. Hematopoietic adverse events leading to anemia have been documented but are extremely rare. Two cases of IVIG-associated thrombocytopenia have been reported. We present a case of IVIG-induced thrombocytopenia in a patient with CIDP. Case Presentation: A 73-year-old female presented with severe back pain, absent reflexes, worsening sensory loss, and proximal and distal weakness resulting from her CIDP. She received 1000 mg of IV methylprednisolone and 2 grams per kilogram of IVIG (Gamunex) to manage her presenting symptoms. Patient symptoms improved and was subsequently discharged from the hospital. Following the treatment regiment in the hospital she had 2 subsequent infusions of IVIG in the outpatient setting, scheduled 2 weeks apart. On follow up, her platelet count dropped from 333,000 noted at time of hospital discharge to 35,000, 9 days after her second outpatient infusion of IVIG. No known antiplatelet antibodies were found; a formal thrombocytopenic workup for underlying causes was negative. Her count was restored once IVIG was withheld. No other treatment was implemented, and no other changes were made. Discussion: In a retrospective study of patients receiving IVIG, headache and fatigue were the most common adverse reactions. Less frequently, observed events were back pain and changes in blood pressure (mostly tachycardia). Serious complications such as anaphylaxis, infection or cardiac infarction have been noted. Hematological effects such as Coombs negative hypochromic anemia, autoimmune pure red cell aplasia, acute hemolysis, thrombosis, and embolism were stated to be extremely rare. These side effects generally occurred within 6 h after the start of the infusion, and lowering the infusion rate led to an improvement in the symptoms. However, rare late-onset adverse effects (LAe) have been described, none of which describe thrombocytopenia as a possibility. The temporal association between IVIG administration and the rapid decline in this patient's platelet count suggested a possible link. A comprehensive workup excluded common causes of cytopenia, such as viral infections (hepatitis B&amp;C) and nutritional deficiencies (folic acid and copper). The exact mechanism underlying IVIG-induced thrombocytopenia remains unclear. Proposed mechanisms include immune-mediated destruction of platelets or drug-dependent antibody formation. Prompt recognition and appropriate management are crucial to prevent complications associated with severe thrombocytopenia. Our case highlights the significance of monitoring platelet counts in individuals receiving IVIG. Physicians and other providers should know the potential risk of IVIG-induced thrombocytopenia and promptly evaluate any unexplained platelet count decline after infusion. Further research is needed better to understand this rare complication's pathogenesis and risk factors. Heightened vigilance and early intervention can ensure optimal outcomes for IVIG therapy patients. While our patient had no complications from the developed thrombocytopenia, subsequent infusions will be needed for her inevitable CIDP flares. Closer observation and frequent lab draws will be needed to mitigate any future IVIG-associated thrombocytopenia.

Contextual factors in persistent severe back pain: A longitudinal analysis among German employees.

Chronic back pain in employees compromises participation in social and daily activities, as well as work. To examine the severity of back pain after 2 years and identify factors predicting stagnation at this level of pain. Data were derived from a prospective cohort study with randomized sampling of insurants in the German Pension Insurance using a questionnaire at baseline and follow-up after 2 years. The sample consisted of middle-aged employees (45-59 years) with strong limitations due to back pain (Chronic Pain Grade III or IV), who had not applied for disability pension and did not use medical rehabilitation in the previous 4 years before baseline. Stepwise multivariable logistic regression models with backwards selection were used to identify relevant contextual factors in the stagnation of severe back pain. Of 1208 persons with severe back pain at baseline, 48% had stagnated at that pain level after 2 years. Predictors of persistent severe back pain were older age, poorer general health, more additional disabling conditions, more depressive symptoms, caregiving burden, less pain-related self-efficacy and more fear avoidance beliefs. In a high-risk subgroup with several co-existing conditions, this analysis highlights (mental) health, social and personal (contextual) factors associated with long-term unfavourable back pain progression. Back pain is a condition that often has a chronic or recurrent course, threatening participation in many areas of life. In this study it was found that the unfavourable condition of severe back pain can remain stable for long periods of time in a significant proportion of sufferers. Contextual factors (self-efficacy, fear-avoidance beliefs, caregiving burden) as well as additional health problems should be considered when identifying persons with stagnating pain courses.

AN AYURVEDIC MANAGEMENT OF GRIDHRASI (SCIATICA): A CASE STUDY

Gridhrasi is one of the eighty Nanatmaja Vata Vyadhies described by Acharya Charaka. Clinically, it is distin-guished by acute hip or lower back pain that extends from the buttock to the back of one thigh and leg. One of the most prevalent issues in society today is severe low back pain that radiates to the toes of either one or both lower limbs. The sciatica nerve (L4, L5, S1, S2, S3), a sizable nerve stretching from the lower back and down the back of each leg, causes discomfort along its length. The diseased person moves like a vulture when they walk. Acharya Charaka, Bruhad Nighantu Ratnakar, and Bharat Bhaishajya Ratnakar explain the Gridhrasihar taila for managing Gridhrasi. Two forms of Gridhrasi, Vataja and Vata-Kaphaja, have been mentioned in classical Ayurvedic literature. Ac-cording to Ayurveda, Gridhrasi is one of the illnesses brought on by the vitiation of Vata, which is one of the fundamentals doshas in the body and is in charge of its movement and functionality. Gridhrasi can occasionally be brought on by both Vata and Kapha vitiation (Vata Kaphaja). Only conservative treatments provide tempo-rary pain relief or surgical interventions that have negative effects. The recurrence of sciatica pain after surgery is widespread. Ayurveda management provides no recurrenceable cure for Gridhrasi. In this case study, a 46-year-old female patient suffering from Gridhrasi was treated with Ayurvedic Chikitsa for 45 days in Kayachikitsa IPD and OPD of the Post Graduate Institute of Ayurveda, Jodhpur. Treatment is given: Vishwadi Guggulu 2 tablets (each 500mg) given twice daily with lukewarm water and Kati Basti with Gridhrasihar tail for 15 days.

SPINAL TUMORS-03 MALIGNANT PHYLLODES TUMOR OF THE BREAST WITH METASTASIS TO THE THORACIC SPINE: A CASE REPORT

Abstract Malignant phyllodes tumors (MPT) of the breast are rare, and spinal metastasis from these tumors is even rarer. We present a case report of a 37-year-old female with a breast mass, who was diagnosed with malignant MPT after incisional biopsy. The patient underwent a right partial mastectomy, and negative margins were reported. However, two weeks later, the patient presented to the emergency department with severe back pain, paresthesia, and lower limb weakness. Neurosurgery consultation led to a diagnosis of T4 pathological fracture, spinal tumor and spinal cord compression, likely due to metastasis from the breast mass. Chest abdomen and pelvis CT revealed no other lesion except the T4 compression fracture. The patient underwent cord decompression tumor resection, and transpedicular fixation of T3-T5 with T4 vertebroplasty. Histopathological analysis confirmed that it was a metastasis from phyllodes tumor. Our case report highlights the importance of early detection and management of MPT, as well as the need for close follow-up and monitoring of patients with a history of breast masses it also highlights the importance of considering malignant phyllodes tumors as a differential diagnosis for breast masses and the potential for metastasis to the spine.

Catastrophic Complications Following Spinal Deformity Surgery in a Patient with Myotonic Dystrophy

Myotonic dystrophy (MD) is a genetic disorder that causes progressive muscle weakness and atrophy, often leading to spinal deformities and decreased quality of life. While the surgical correction of spinal deformities is not absolutely contraindicated in MD patients, a comprehensive pre-anesthetic evaluation is crucial, particularly considering cardiovascular and respiratory health. We present a case of a 50-year-old woman with MD who underwent spinal deformity surgery to correct kyphosis and alleviate severe back pain. Despite the absence of significant events during surgery and preoperative risk factors, the patient experienced postoperative respiratory failure, hypotension, aggravated weakness, and mental deterioration in the intensive care unit. The patient received long-term ventilator support during hospitalization for respiratory muscle weakness. She demonstrated significant improvements in strength, mobility, and respiratory function with multidisciplinary support and rehabilitation, achieving functional independence within 6 months postoperatively. The authors discuss the possible etiological mechanisms underlying these complications and highlight the need for preoperative evaluations and multidisciplinary care for patients with MD.

Management of Complete Aortic Dissection in a 65-Year-Old Male: A Case Report

Background: Aortic dissection is a life-threatening condition characterized by a tear in the aortic wall that separates its layers. Complete aortic dissection involves both the ascending and descending aorta, necessitating prompt diagnosis and intervention. We present a case report of a 65-year-old male with a complete aortic dissection and discuss the challenges and management strategies employed in his treatment. Case Presentation: A 75-year-old male with a history of hypertension presented to the emergency department with sudden-onset severe chest and back pain. Physical examination revealed unequal blood pressure readings in both arms, suggesting aortic involvement. Urgent computed tomography angiography (CTA) and TTE confirmed the diagnosis of a complete aortic dissection extending from the aortic root to the iliac arteries. The patient was promptly transferred to the operating room for surgical intervention. Discussion: The management of complete aortic dissection requires a multidisciplinary approach involving cardiovascular surgeons, interventional radiologists, and anesthesiologists. In this case, emergency surgery was performed to address the life-threatening condition. Aortic root replacement and ascending aorta repair were performed, followed by stent graft placement in the descending aorta to exclude the false lumen. Postoperative care involved close monitoring for potential complications such as renal dysfunction, paraplegia, and cardiac ischemia. Conclusion: Prompt diagnosis and appropriate surgical intervention are crucial in the management of complete aortic dissection. Collaboration among healthcare professionals is essential for optimizing patient outcomes. Further studies are warranted to assess long-term outcomes and identify strategies for preventing complications in patients with complete aortic dissection.

Self-reported low back pain intensity and interferences among three-wheel drivers in Southwest of Ethiopia: A Community-Based Cross-sectional Study

Introduction: Low back pain is one of the most reported conditions among vehicle drivers. However, there is a paucity of information about low back pain experiences among three-wheel drivers in Ethiopia. This study aimed to determine the low back pain experience among three-wheel drivers in Ethiopia Jimma City, Southwest Ethiopia. Methods: A Community-based cross-sectional study was conducted from March 1-25, 2020 among 396 samples. Computer generated simple random sampling method was employed to get the required sample. An interviewer-administered questionnaire was used to collect the data. The data was checked for completeness, coded, cleaned and entered into Epi-data version 3.1 and exported to SPSS version 23 for analysis. Data was analyzed using mean and standard deviations for continuous and proportions for categorical variables. Binary and multivariable logistic regression was used to see an association between dependent and independent variables. P-value &lt;0.05 at 95% CI was declared statistically significant. Results: Of 396 study participants, 26.26% of them had low back pain at any time among which, 73.1% reported pain in the last 24 hours. Regarding pain intensity in 24 hours, the mean ± standard deviation of worst pain was 5.3 ± 2.5. The independent variables significantly associated with low back pain along with their adjusted odds ratio (95% confidence interval) were: age 3.45 (1.98, 6.03), educational status: 1.96 (1.07, 3.59), physical exercise: 0.52 (0.31, 0.86) drinking alcohol: 2.32 (1.22, 4.39) and working hours: 0.32 (0.13, 0.83). Conclusion: The three-wheel drivers experienced moderate to severe low back pain and moderate to severe functional and emotional interferences. More than half of the participants reported the worst pain experience within 24 hours. Age, educational status, physical exercise, drinking alcohol and working hours were significantly associated with low back pain.

Partial arch replacement of type A aortic dissection after thoracic endovascular aortic repair for type B dissection

BackgroundStent graft-induced new entry (SINE), defined as the stent graft-induced formation of a new entry point for blood to enter an area, is increasingly being observed after thoracic endovascular aortic repair (TEVAR) for Stanford type B aortic dissection worldwide. We herein describe a case of Stanford type A aortic dissection due to proximal SINE after TEVAR for Stanford type B dissection.Case presentationThis case involved a 58-year-old man with type A aortic dissection due to SINE. Six years previously, he had developed severe back pain and was diagnosed with type B aortic dissection after computed tomography examination. Because the primary entry was positioned at the descending aorta, we conducted TEVAR for exclusion of the entry with a GORE TAG conformable thoracic aortic graft. He was thereafter followed by our hospital. Six years later, he developed jaw pain and was examined at another hospital. He was transferred to our hospital because of the possibility of type A dissection. Computed tomography revealed type A aortic dissection with proximal site SINE. Emergency partial arch replacement was conducted, and he was discharged on postoperative day 27. Because the entry was at the lesser curve of the arch, we excluded the entry and conducted partial arch replacement.ConclusionsIn this case, proximal SINE occurred 6 years after TEVAR. Because SINE may occur even in the long term after TEVAR, careful follow-up is necessary.