Severe Low Back Pain Research Articles

CEMENT LEAKAGE FOLLOWING PERCUTANEOUS VERTEBRAL AUGMENTATION: CASE REPORT

Background: Percutaneous vertebroplasty (PV) has become an important minimally invasive surgical technique for vertebral compression fractures. However, indications for PV in these cases due to trauma had many rivals and unclearly. These complications, especially cement leakage still common, has many severe consequent. Object and method research: A 60-years-old man, who underwent vertebroplasty in low medical level. He had complete paralised of two leg, urine retention, and severe low back pain. We examined clinical signs, imaging, find and compared with literatures. Case presentation and discussion: We present a case, 60-years-old man, had labor accident, after that he could returned to state of normality. At the second day, he went to local hospital, had diagnosis: compression fractures of L1-L2. He underwent percutaneous vertebroplasty of L1-2 under local anesthesia. Post-operative, he had complete paralised of two leg, urine retention, and severe low back pain. He had exmined again, MRI and took second surgery to removed part of cement leakage. After the second surgery, radiological showed they had complete removed cement leakage, but the patient’s recovery was uneventful and stable. The patient was hospitalized at our instituation after 03 day with complaints of severe low back pain, urine retention and complete paralised of two leg. Conclusion: This is basic technique, widely and rewarding; also has many severe incident, complications. Consequently, we suggest that this technique have to perform in right indications, in the modern medical centre and fully trained surgeon.

Restorative Neurostimulation for Chronic Mechanical Low Back Pain: Results from a Prospective Multi-centre Longitudinal Cohort.

IntroductionLow back pain impacts most people throughout the course of their lives and contributes significantly to the global burden of disease. In some patients, symptoms resolve with little intervention, while others are amenable to surgical intervention, some cases are intractable to current care paradigms. Restorative neurostimulation is an emerging therapy for chronic mechanical low back pain.MethodsWe conducted a prospective post-market follow-up of 42 patients treated for longstanding chronic mechanical low back pain with restorative neurostimulation. Patients were followed up at 45, 90, and 180 days and 1 and 2 years following activation of the device. Pain, disability, and health-related quality of life were recorded.ResultsAmong the 37 patients completing 2-year follow-up, numerical rating scale (NRS) pain scores improved from 7.0 ± 0.2 to 3.5 ± 0.3 (p < 0.001), Oswestry Disability Index (ODI) scores improved from 46.2 ± 2.2 to 29.2 ± 3.1 (p < 0.001), and health-related quality of life (measured by the EuroQol 5-Dimension 5-Level questionnaire—EQ-5D-5L) improved from 0.426 ± 0.035 to 0.675 ± 0.030 (p < 0.001). Additionally, 57% of patients experienced a greater than 50% reduction in pain, and 51% of patients benefited by a greater than 15-point reduction in ODI, both substantial improvements.ConclusionThis real-world sample of patients shows that restorative neurostimulation can provide substantial and durable benefit to a cohort of patients that have traditionally had few reliable treatment options. Our findings support the continued used of this therapy in well-selected patients.Trial RegistrationClinicalTrials.gov Identifier: NCT01985230.

Association of intrinsic factors with non-contact low back pain among fast bowlers aged between 15-19 years in division 1 boys’ schools in Colombo

Background: Cricket fast bowlers are identified as the players with a higher risk of injury due to their susceptibility to develop low back pain (LBP). Aims and Objective: This study aims to investigate how intrinsic factors associate with LBP among fast bowlers aged between 15-19 years in Colombo division 1 boys’ schools in Sri Lanka. Materials and Methods: A descriptive cross-sectional study was conducted with one hundred and two (102) fast bowlers who were prospectively monitored over the competition period of 2019 cricket season and the demographic data, severity of LBP, general characteristics and intrinsic factors related data were recorded. Results: Thirty-seven (43.5%) of the subjects were presented with LBP. Reduction of quadriceps strength of dominant side, hamstring strength of non-dominant side and increased ankle dorsiflexion of non-dominant side were found to be significantly associated with non-contact LBP (P&lt;0.05). There were significant differences for the quadriceps strength of dominant side and hamstring strength and ankle dorsiflexion of non-dominant side between the fast bowlers with and without LBP. Conclusion: The results concluded that reduced quadriceps muscle strength of dominant side, reduced hamstring muscle strength and higher ankle dorsiflexion of non-dominant side have an important role in predisposing a fast bowler to have an increase in non-contact LBP.

Incidence of and risk factors for spondylolisthesis, scoliosis, and vertebral fracture in rheumatoid arthritis.

Although lumbar lesions such as spondylolisthesis, scoliosis, and vertebral fracture are not specific to rheumatoid arthritis (RA), the prevalence is high in RA patients. However, no longitudinal study has evaluated lumbar lesions in RA. This study aimed to investigate the incidence of and risk factors for lumbar lesions in RA by a prospective longitudinal cohort study. The study cohort comprised 110 patients with RA from the 'analysis of factors for RA spinal disorders (AFFORD)' study who completed the secondary survey at a single orthopaedic outpatient RA clinic. Radiological examination included standing radiographs and magnetic resonance imaging (MRI) of the lumbar spine. New development of spondylolisthesis, scoliosis, and vertebral fracture were assessed between baseline and secondary survey. The incidences of spondylolisthesis, scoliosis, and vertebral fracture were 42%, 16%, and 12%, respectively, during a mean follow-up of 7years. The independent risk factor for de novo scoliosis was poor control of RA (adjusted odds ratio [aOR] 4.81, p = 0.011), while the independent risk factors for new vertebral fracture was use of glucocorticoid at secondary survey (aOR 14.87, p = 0.012). Patients with de novo scoliosis exhibited more severe low back pain and lower quality of life than those without. The incidence of scoliosis was related in patients with poor control of RA, while new vertebral fracture was more common in patients with use of glucocorticoid. Control of disease activity might be important in preventing radiological lumbar disorders in RA.

Association of Lumbar MRI Findings with Current and Future Back Pain in a Population-based Cohort Study.

Population-based cohort study. We examined associations between common lumbar degenerative changes observed on magnetic resonance imaging (MRI) and present or future low back pain (LBP). The association between lumbar MRI degenerative findings and LBP is unclear. Longitudinal studies are sparse. Participants (n = 3369) from a population-based cohort study were imaged at study entry, with LBP status measured at baseline and 6-year follow-up. MRI scans were reported on for the presence of a range of MRI findings. LBP status was measured on a 0 to 10 scale. Regression models were used to estimate the cross-sectional and longitudinal associations between individual and multiple MRI findings and LBP severity. Separate longitudinal analyses were conducted for participants with and without baseline pain. MRI findings were present in persons with and without back pain at baseline. Higher proportions were found in older age groups. 76.4% of participants had a least one MRI finding and 8.3% had five or more different MRI findings. Cross-sectionally, most MRI findings were slightly more common in those with LBP and pain severity was slightly higher in those with MRI findings (ranging from 0.06 for high intensity zone to 0.83 for spondylolisthesis). In the longitudinal analyses, we found most MRI findings were not associated with future LBP-severity regardless of the presence or absence of baseline pain. Compared to zero MRI findings, having multiple MRI findings (five or more) was associated with mildly greater pain-severity at baseline (0.84; 0.50-1.17) and greater increase in pain-severity over 6 years in those pain free at baseline (1.21; 0.04-2.37), but not in those with baseline pain (-0.30; -0.99 to 0.38). Our study shows that the MRI degenerative findings we examined, individually or in combination, do not have clinically important associations with LBP, with almost all effects less than one unit on a 0 to 10 pain scale.Level of Evidence: 3.

Tapentadolprolonged release in patients with chronic low back pain: real-world data from the German Pain eRegistry.

Aim: Comparison of tapentadolprolonged release (PR) with other oral WHO-III PR opioid analgesics (morphine, oxycodone±naloxone, hydromorphone) in routine medical care of chronic low back pain. Patients & methods: Noninterventional, retrospective 12-week study usinganonymized clinical practice data from the German Pain eRegistry. Six effectiveness, tolerability, and safety criteria were aggregated in a primary composite end point (treatment responder). Propensity scoring matched 2331 datasets per treatment cohort. Results: All six single criteria showed significantly better outcomes for tapentadol PR (all parameters p<0.001). There were significantly more treatment responders under tapentadol PR (65.7 vs 14.2%; p<0.001). Conclusion: Tapentadol PR showed significantly better effectiveness and tolerability in severe chronic low back pain unsuccessfully treated with WHO-I/II analgesics compared with the other oral WHO-III PR opioids investigated.

ANALGESIC EFFICACY OF TRAMADOL/ ACETAMINOPHEN COMBINATION WITH DICLOFENAC SODIUM IN MODERATE TO SEVERE LOW BACK PAIN

This prospective randomized cohort study was conducted in two parallel groups to compare the analgesic effects in conventional use of oral Diclofenac tablet, 50 mg tablet three times daily or 75 mg tablet twice daily (DIC group) with oral combination of Tramadol 37.5 mg and Acetaminophen (Paracetamol) 325 mg (T-APAP group) one tablet twice daily. The number of patients n= 150 in each group. Study data of total 300 patients of age 20 - 60 years, with moderate to severe Low back pain (LBP) was collected from the public and two private setup OPDs in Karachi, Pakistan. Patient demographic data of gender, age, BMI and socioeconomic status were collected. Numeric Pain Rating Scale (NPRS) was used to measure pain intensity and overall pain intensity at the baseline 0, 1st, 2nd, 3rd and 4th week of the treatment. The results indicated that the incidence of Low back pain (LBP) is highest 41.0 % (n = 123) in 30-39 years age group. According to Body Mass Index (BMI) classification most of the patients 63.6 % (n = 191) patients are overweight. In socioeconomic classification 47.3 % (n = 142) are from lower socioeconomic status. The duration of perceived pain was found to be shorter with 58.6 % (n = 88) recovery within one week of the treatment in the T-APAP Group, compared to 35.3 % (n = 53) recovery in DIC group (p&lt; 0.05). Oral combination of Tramadol plus Paracetamol is found to be more effective than the use of oral Diclofenac alone. 79.4 % Overall Pain Relief with 5.8 scores of Overall Pain Relief (p&lt; 0.05) were observed in the T-APAP Group. It is concluded that the oral combination of Tramadol 37.5 mg and Acetaminophen (Paracetamol) 325 mg is more effective analgesic than oral use of Diclofenac sodium alone in moderate to severe LBP.

The treatment of chronic low back pain using annuloplasty with percutaneous endoscopic discectomy

Abstract Introduction: Percutaneous endoscopic discectomy (PED) is often used to treat patients with chronic discogenic low back pain (LBP) (DLBP). In this technique, after selective discectomy of the degenerated disc, the posterior annulus fibrosus and tear site are modulated by thermal annuloplasty (TA) using a bipolar radiofrequency coagulator (PED/TA). PED/TA has been shown to be effective for treating DLBP. Patient Concerns: The patient was a 40-year-old man who visited our hospital with complaints of chronic LBP (CLBP) and buttock pain, left-sided sciatica, and sensory disturbance affecting his left thigh. Diagnoses and interventions: He was diagnosed as having discogenic LBP with a high intensity zone in the L4–5 disc, so discography was performed combined with steroid and lidocaine injection at the affected site. He recovered from LBP with 80% effective rate. He again reported concordant LBP with leg pain and numbness, which was treated effectively by intradiscal injection. However, the pain gradually recurred, so we decided to perform PED/TA. Outcomes: After PED, the high intensity zone site was ablated with a coagulator. Following surgery, the patient's severe LBP in the seated position resolved, his leg pain and sensory disturbance improved, and has experienced no difficulties in carrying out activities of daily living. Conclusions: This case suggests that PED/TA is potentially advantageous for treating DLBP, CLBP and severe sitting intolerance. Also, PED/TA may allow lumbar interbody fusion to be avoided in patients with CLBP and severe sitting intolerance.

Minimally invasive anteroposterior combined surgery using lateral lumbar interbody fusion without corpectomy for treatment of lumbar spinal canal stenosis associated with osteoporotic vertebral collapse.

Various reconstructive surgical procedures have been described for lumbar spinal canal stenosis (LSCS) with osteoporotic vertebral collapse (OVC); however, the optimal surgery remains controversial. In this study, the authors aimed to report the clinical and radiographic outcomes of their novel, less invasive, short-segment anteroposterior combined surgery (APCS) that utilized oblique lateral interbody fusion (OLIF) and posterior fusion without corpectomy to achieve decompression and reconstruction of anterior support in patients with LSCS-OVC. In this retrospective study, 20 patients with LSCS-OVC (mean age 79.6 years) underwent APCS and received follow-up for a mean of 38.6 months. All patients were unable to walk without support owing to severe low-back and leg pain. Cleft formations in the fractured vertebrae were identified on CT. APCS was performed on the basis of a novel classification of OVC into three types. In type A fractures with a collapsed rostral endplate, combined monosegment OLIF and posterior spinal fusion (PSF) were performed between the collapsed and rostral adjacent vertebrae. In type B fractures with a collapsed caudal endplate, combined monosegment OLIF and PSF were performed between the collapsed and caudal adjacent vertebrae. In type C fractures with severe collapse of both the rostral and caudal endplates, bisegment OLIF and PSF were performed between the rostral and caudal adjacent vertebrae, and pedicle screws were also inserted into the collapsed vertebra. Preoperative and postoperative clinical and radiographical status were reviewed. The mean number of fusion segments was 1.6. Walking ability improved in all patients, and the mean Japanese Orthopaedic Association score for recovery rate was 65.7%. At 1 year postoperatively, the mean preoperative Oswestry Disability Index of 65.6% had significantly improved to 21.1%. The mean local lordotic angle, which was -5.9° preoperatively, was corrected to 10.5° with surgery and was maintained at 7.7° at the final follow-up. The mean corrective angle was 16.4°, and the mean correction loss was 2.8°. The authors have proposed using minimally invasive, short-segment APCS with OLIF, tailored to the morphology of the collapsed vertebra, to treat LSCS-OVC. APCS achieves neural decompression, reconstruction of anterior support, and correction of local alignment.

Comparative Effectiveness of Collaborative Treatment with Korean and Western Medicine for Low Back Pain: A Prospective Cohort Study.

In Korea, low back pain is the ailment that is most frequently treated using collaborative care regimens that include aspects of Western and traditional Korean medicine. As part of a national pilot project on the collaboration between Western and Korean medicine, we aimed to investigate the clinical effectiveness of collaborative treatment and compare it with treatment methods that involved only Korean or Western Medicine practices for patients with low back pain. This nationwide, multicenter, prospective, observational, and comparative study spanned 8 weeks, during which patients with low back pain were evaluated at three time points (at baseline, 4 weeks, and 8 weeks). The primary outcome was low back pain-related disability measured by the Oswestry Disability Index, while the secondary outcomes included severity of low back pain (as on a numeric rating scale) and quality of life (as per a 5-level EuroQol-5 dimensions questionnaire). We analyzed 150 patients (including 129 per-protocol cases) and found that the Oswestry Disability Index and 5-level EuroQol-5 dimensions showed statistically significant differences over time between the collaborative treatment group and the sole treatment group after adjusting for sex, income level, and age. Conversely, the numeric rating and EuroQol-visual analog scales showed no significant between-group differences over time. Based on our findings, we believe that collaborative treatment that includes parallelly administered aspects of Western and Korean medicine can benefit patients with low back pain by facilitating functional improvements and lead to a better quality of life.

Expected impact of lockdown measures due to COVID-19 on disabling conditions: a modelling study of chronic low back pain.

PurposeThe COVID-19 pandemic and the containment measures such as social distancing, mobility restrictions and quarantine have significantly impacted the delivery of healthcare services, with possible negative effects on low back pain patients. In this study, we used an innovative agent-based model to quantify the effects of COVID-19 on the prevalence and severity of low back pain in the general population.MethodsEpidemiological data were used to simulate the low back pain evolution in a population of 300,000 agents. Reduced access to treatment due to the containment measures was simulated with a probabilistic approach, in which 500 random scenarios (differing in: length of the lockdown, probability of having access to treatment, time before the resumption of treatment, duration of the effects of the treatment after its interruption) were simulated.ResultsThe lockdown may increase the mean pain score higher than 1/10 points for patients suffering from acute low back pain, up to 4–5/10 points for specific individuals. The lockdown also affected the length of pain episodes, possibly impacting chronicity and disability. All the variables describing the random scenarios had a relevant impact in determining both the increase of pain intensity in the population and the length of the effects of the lockdown.Conclusions“Optimal lockdown parameters” which minimize the impact on low back pain while preserving the effects on infection spread and mortality could not be identified. Policies favouring a prompt resumption of treatments after the lockdown may be effective in shortening the duration of its negative effects.

English

BACKGROUND Scoliotic spine puts undue strain on the back musculature which may lead to the production of myofascial pain syndrome (MPS). The purpose of this study was to find out the association of myofascial pain of iliopsoas and quadratus lumborum in scoliotic patients and to look for any correlation between the degree of deformity (Cobb’s angle) and severity of myofascial pain. METHODS A total of 60 patients of low back pain with spinal deformity were enrolled in the study. The severity of the spinal deformity and pain was calculated with Cobb’s angle and visual analogue scale (VAS) pain scale (0 - 100) respectively. Patients with iliopsoas and quadratus myofascial pain underwent trigger point therapy along with regimen of stretching exercises. VAS scores were recorded at 0 - hour, 2 - hour, 2 - weeks, 1 month and 3 months after the procedure. RESULTS Forty-four patients out of 60 had myofascial pain of iliopsoas or quadratus lumborum or both. 15, 31 and 12 patients had Cobb’s angle of 10 - 20, 21 - 30 and 31 - 40 degree, respectively. Trigger point injections were performed in 38 patients. The pre-procedure median VAS score was 70, at 0 hour 45, at 2 hour 40, at 2 weeks 30, at 1 month 30 and at 3 months 30. A significant reduction (P &lt; 0.001) in VAS score was observed till 3 months. CONCLUSIONS The myofascial pain of iliopsoas and quadratus lumborum is an important source of low back pain in patients with scoliosis. There is no correlation between the degree of scoliosis and severity of low back pain. KEYWORDS Scoliosis, Kyphoscoliosis, Thoraco-Lumbar Spinal Deformity, Myofascial Pain, Iliopsoas, Psoas Major, Quadratus Lumborum, Low Back Pain

Fatigue severity among adults with chronic low back pain: relations to opioid use and hazardous alcohol use

ABSTRACT Background : Chronic low back pain is the second leading cause of disability in the United States and is related to greater risk of opioid misuse. Research suggests that severe fatigue may be a relevant factor for better understanding the greater rates of opioid and misuse among adults with chronic low back pain. Therefore, the current study sought to examine differences in opioid misuse, risk for opioid use disorder, and hazardous alcohol use in two different groups: one group with clinically significant fatigue, and one group without clinically significant fatigue. Methods : Participants were recruited utilizing a validated online survey management system that yielded 1,681 adults (70.0% female, 81.1% White, Mage = 44.5 years, SD = 11.88) with current mild to severe chronic low back pain. One-way analysis of covariance (ANCOVA) models were conducted to examine group differences. Results : Among adults with chronic low back pain, those with clinically significant fatigue reported significantly greater opioid misuse and risk for opioid use disorder compared to those without clinically significant fatigue. These results were evident after controlling for pain severity and interference. The results for hazardous alcohol use were not significantly different between groups. Conclusions : Clinically significant fatigue is a distinguishing characteristic among adults with chronic low back pain in terms of opioid misuse and risk for opioid use disorder. Potential clinical implications of such findings suggest that it may be important for clinicians to assess fatigue levels to better manage opioid misuse potential among adults with chronic low back pain.

The Effect of Zinc Oxide Scallop-Shell Powder and Complications After Coronary Angiography

Introduction: Coronary angiography is often associated with complications such as hemorrhage and hematoma that should be considered and be minimized. Objective: This study aimed to determine the effect of Zinc oxide scallop-shell powder as a topical hemostatic agent (composed mainly of calcium) on complications after coronary angiography. These complications include hemostasis time, low back pain, hemorrhage, hematoma, the necessity of sandbags, and patient ambulation. Materials and Methods: The current research was a blind, parallel, randomized clinical trial done on 150 patients under coronary angiography. They were randomly divided into three equal groups of A (control), B (case 1), and C (case 2). In group A, hemostasis was done with manual compression, use of ChitoHem powder, putting sandbag for 4-6 h in a supine position, and getting out of bed after 24 h. In group B, instead of ChitoHem powder, we used Zinc oxide scallop-shell powder. In group C, hemostasis was done with manual compression, Zinc oxide scallop-shell powder, putting sandbag for 1 h in a supine position, and getting out of bed after 2 h. The duration of hemostasis, bleeding, and hematoma after hemostasis and the severity of low back pain were investigated at 8 point intervals during 24 h. Data analysis was done using descriptive statistics indicators and Kolmogorov-Smirnov, ANOVA, Chi Square, Fisher exact test and Kruskal-Wallis tests. Results: The mean ±SD ages of groups of A, B, and C were 60.08 ±11.32, 60.22 ±10.30, and 61.69 (10.61), respectively, which was not statistically different. Furthermore, there was no significant difference between these three groups regarding their demographic information. There were statistically significant differences between groups about the amount of low back pain at the second, third, and fourth hours after angiography (P= 0.001). There was a significant difference in the amount of bleeding between the three groups (P=0.017). The difference in time of hemostasis in the three groups was not statistically significant. Conclusion: The Zinc oxide scallop-shell powder reduces catheter site bleeding after coronary angiography and bed rest time and ultimately the severity of low back pain. Performing a similar study is recommended.

The Effect of Social Isolation During the COVID-19 Pandemic on Patients with Chronic Low Back Pain Who Underwent a Spine Intervention

The COVID-19 infection poses a serious threat to global health for millions of people. In addition to therapeutic treatment methods, preventive measures are also important in controlling the pandemic. As a result, billions of people are quarantined in their homes to prevent the spread of coronavirus. However, social isolation may result in immobility, which can lead to musculoskeletal problems and an increased level of pain, depending on the weakness of the muscles. To examine the effect of social isolation during the recent COVID-19 pandemic on patients with chronic low back pain. A total of 145 patients who underwent a spine intervention within the past year were enrolled in this prospective and cross-sectional study. The study was performed in the interventional pain unit of a tertiary rehabilitation center in Turkey. Patient data were obtained by telephone interview and included information pertaining to demographics, pain history, an assessment of pain, analgesic use, activity levels, and an evaluation of stress and sleep habits. Additionally, the International Physical Activity Questionnaire (IPAQ) was used to evaluate patient activity levels. It was detected that social isolation has increased the intensity of low back pain experienced by patients during the COVID-19 pandemic. We also found that patients who benefited from spinal injections administered in the prepandemic period experience less severe low back pain (P = 0.000) and took fewer analgesics (P = 0.000) during the pandemic. The findings of our study revealed that there was a significant reverse correlation between IPAQ walking scores and the prepandemic Visual Analog Scale (VAS) scores (P = 0.015, r = -0.201) and the pandemic VAS scores (P = 0.000, r = -0.313).By contrast, the level of benefit from injections decreased (P < 0.05) and the duration of spinal intervention was shortened in patients with high IPAQ sitting scores (P < 0.05). The limitations of the study are the small number of patients and the fact that our results are based on patients' self-reported data. Social isolation has had an increasing effect on low back pain during the COVID-19 pandemic. The results of our study showed a significant relationship between activity level and pain intensity. We also found that patients who have benefited from spinal injections administered in the prepandemic period experience less severe low back pain during the pandemic.

Three-dimensional reconstruction of intervertebral disc based on magnetic resonance imaging in patients with acute low back pain.

The aim of the study is to evaluate the morphology of the intervertebral discs visible in the magnetic resonance image in patients with sudden severe low back pain (with or without radiation of pain to the lower limb). The second goal of the study is to perform a digital three-plane reconstruction of the intervertebral disc and to compare this technique with a standard magnetic resonance imaging test. Twenty-five patients, mean age 35.5 years, all with acute low back pain, were examined. We compared the 3D MR models with standard MRI scans by measuring seven MRI parameters. In patients with sudden, severe low back pain, with clinical symptoms suggesting an etiology within the intervertebral disc, changes in a standard MRI are found consisting of the presence of a hernia / protrusion of the intervertebral disc and lowering the height of the intervertebral disc - with lowering the disc height occurs to a greater extent in the rear section. The 3D reconstruction is a reliable 3D representation of the intervertebral disc and adjacent vertebral bodies.

Prevalence of Lower Back Pain Among Doctors Working in Jinnah Hospital, Lahore

Doctors are health practitioners responsible for the patients’ overall health and well-being. They are at a remarkably high risk of developing a variety of occupational health conditions as a result of their workplace setting and workload. Among the many conditions of musculoskeletal issues, lower back pain (LBP) is the most prevalent. To determine the prevalence of LBP among doctors. A questionnaire was given to doctors that sought information regarding their social and demographic characteristics, job history, pattern of symptoms, frequency and severity of LBP and factors predisposing to LBP. A total of 97 doctors participated in the study. The prevalence of LBP among doctors was 51.55%. Its prevalence was higher in female doctors as compared to male doctors. Health education regarding appropriate sitting posture and correct lifting techniques can be introduced to reduce the burden of LBP among the affected population.

Effect of central sensitization inventory on the number of painful sites and pain severity in a Japanese regional population cohort

BackgroundTo investigate the association between the central sensitization inventory (CSI), a screening tool for central sensitization, and the number of painful sites and the severity of pain in locomotive organs in an epidemiological study in the elderly. MethodsA total of 379 individuals who underwent musculoskeletal disease screening were enrolled in this study. The CSI was used to assess symptoms of central sensitization. The number and location of painful sites and the severity of pain were evaluated using pain mapping and a numerical rating scale (NRS) at 37 sites. We investigated the association between the number of painful sites and CSI score, and the association between the severity of low back pain or knee pain and CSI score. ResultsThere was a positive correlation between CSI score and the number of painful sites. The CSI score was significantly higher in those with significant low back pain than in those without pain, and the high-CSI group tended to have a greater number of painful sites. Comparison of CSI scores between participants with low back pain alone and those with low back pain and posterior lower leg pain showed that the latter group had a significantly higher CSI score than the former group. The CSI score in participants with radiographic evidence of knee osteoarthritis was significantly higher in those with knee pain than in those without pain. ConclusionsThe results of this study suggest that participants with significant low back pain and a higher number of painful sites are more susceptible to the influence of central sensitization. In addition, CSI score was higher in participants with low back pain and posterior lower leg pain than in those with low back pain alone, suggesting that the spread of pain may be due to central sensitization.

Functional outcomes following surgical treatment in patient with primary degenerative adult scoliosis

IntroductionPrimary adult degenerative scoliosis is one of the adult scoliosis group that presents in adult patient without history of scoliosis during childhood or adolescence. This condition may be asymptomatic, mild low back pain, radiculopathy symptoms, or may be causing severe low back pain and major neurological symptoms including weakness and numbness of the lower extremities which can affect the patient quality of life. Case presentationIn this study, we presented seven cases of primary degenerative adult scoliosis that was treated either with decompression alone, decompression with short segment fusion and deformity correction, and decompression with long segment fusion and deformity correction. The parameters measured in this study were lumbar regional angle, Cobb angle, and pelvic parameters. The functional status of the patient was measured using Oswestry Disability Index (ODI). DiscussionThe main purpose for surgical treatment in primary degenerative adult scoliosis depends on the clinical presentation and also the patient's expectations .From the study, we found that all patient underwent surgery had improvement of functional status that measured with ODI score. The mean of pre operative ODI score was 49.70 (± 13.61 SD) (severe disability) and for post operative was 21.8 (± 13.40 SD) (moderate disability). Surgery decompressed the neural element and stabilize the spine. ConclusionSurgery treatment in patients with degenerative adult scoliosis was shown to have better functional outcomes regardless of the technique used. Further study with bigger sample with corresponding statistical analytic is mandatory.

P0001. Minimally invasive transthoracic extra-pleural rib sparing XLIF approach to anterior thoracic spine to address giant thoracic disc herniation: A case report and review of literature

Minimally invasive surgery is receiving considerable attention as a technique for reducing the complications of adult spinal deformity (ASD) surgery. For this technique, a new lateral osteotomy plays an important role to release fused vertebrae. We describe herein a novel navigated lateral osteotomy technique not requiring C-arm fluoroscopy to correct adult spinal deformities.A 68-year-old woman with symptomatic ASD and a 4-year history of severe low back pain affecting daily life was referred to our hospital. Surgery was performed without C-arm fluoroscopy. A navigated osteotome was used to release the fused L1/2 mass. The patient was successfully treated with surgery, and low back pain was well controlled. In terms of clinical outcomes, Oswestry Disability Index improved from 64%–19% and Visual Analog Scale score for low back pain improved from 74 mm–19 mm on final follow-up at 2 years.This novel navigated lateral osteotomy for ASD is a useful technique that enables minimally invasive surgery for fixed deformity. With this new technique, surgeons and operating room staff can avoid adverse effects of intraoperative radiation.