Severe Back Pain Research Articles

Health Care Costs After Lumbar Fusion and Disk Replacement for Diskogenic Pain.

Lumbar fusion is the most common surgical intervention for chronic or severe low back pain. However, lumbar disk replacement (LDR) may be appropriate for certain patients. The objective of this study was to describe the postoperative management costs associated with both lumbar fusion and LDR in the 2-year period after surgery. An observational cohort study was conducted using the Merative MarketScan databases. Patients who underwent lumbar fusion or LDR between January 1, 2017, and December 31, 2017, were identified and included in the study. The primary outcome was the cost of payments for physical therapy, pain medication, injections, and bladder management in the 2-year period after surgery. A total of 1660 patients (mean age, 50.1±10.6 years; lumbar fusion, 99%; LDR, 1%) were included in the study. The mean total cost of postoperative interventions identified was $2832±$5461 per patient, with no differences found between patients for identified interventions. The mean 30-day episode-of-care cost was $65,777±$40,869 and was similar (P=.894) between the two groups of patients. The main driver of cost was physical therapy for both groups of patients (lumbar fusion, 53.7%; LDR, 64.9%). Patients who underwent lumbar fusion and LDR had similar postoperative management costs. The shorter recovery periods associated with LDR may not necessarily translate into reduced long-term health care expenditure. [Orthopedics. 202x;4x(x):xx-xx.].

P-10 CUSHING'S SYNDROME WITH ATYPICAL ADRENAL MASS AND ELEVATED 17-HYDROXYPROGESTERONE: A DIAGNOSTIC CHALLENGE

Abstract Introduction Adrenal tumors can be challenging to diagnose, especially when they present with unusual biochemical profiles and unclear pathological findings. This case focuses on the management complexities of a patient with a heterogeneous adrenal mass, significantly elevated 17-hydroxyprogesterone levels, and Cushing's syndrome. The diagnostic uncertainty highlights the need for careful follow-up and further research into such adrenal tumors. Clinical Case A 63-year-old male with a 10-year history of hypertension presented with sudden severe back pain and dyspnea. He was diagnosed with a Type 3 aortic dissection, treated in the ICU, and later referred to endocrinology for secondary hypertension evaluation, where hypokalemia was noted. Investigations revealed normal 24-hour urinary metanephrines (metanephrine: 142 µg, normetanephrine: 367 µg), and an aldosterone/renin ratio of 8 while on multiple antihypertensive medications. His BMI was 24.6. Endocrine evaluation showed a 1 mg dexamethasone suppression test result of 19.6 µg/dL, suppressed basal ACTH and DHEAS, midnight cortisol levels of 21 µg/dL and 27 µg/dL, and an increased 24-hour urinary free cortisol level of 1069 µg. The 17-hydroxyprogesterone levels were 26 ng/mL and 18 ng/mL. A CT scan revealed a 47x40 mm heterogeneous lesion in the left adrenal gland. PET-CT and DOTATATE-PET scans showed mild to moderate FDG uptake, suggesting a possible, though unlikely, pheochromocytoma. The patient underwent a left adrenalectomy due to suspected Cushing's syndrome and potential adrenal malignancy. Pathology revealed a 6 cm lesion with no atypia, mitosis, or lymphovascular invasion, but the tumor was deemed neoplastic due to the disrupted excision capsule. Postoperatively, the patient's Cushing's symptoms improved, and follow-up tests showed reduced cortisol and 17-hydroxyprogesterone levels. He was diagnosed with adrenal insufficiency and started on prednisolone therapy. Conclusion This case underscores the diagnostic challenges of adrenal tumors with atypical biochemical presentations. The significant postoperative reduction in 17-hydroxyprogesterone and resolution of Cushing's syndrome suggests functional activity of the adrenal mass. However, the indeterminate pathology raises concerns about malignancy and emphasizes the need for close long-term monitoring. The lack of definitive pathological criteria to distinguish benign from malignant adrenal tumors highlights a critical gap in current diagnostic methods, reinforcing the importance of integrating clinical, biochemical, and pathological data for management decisions.

Clinical and radiological outcomes of lumbar endoscopic decompression for treating lumbar spinal stenosis and degenerative lumbar scoliosis: a retrospective study at mean 4.4 years follow-up.

To assess the clinical and radiological outcomes of lumbar endoscopic decompression for the treatment of lumbar spinal stenosis (LSS) with concurrent degenerative lumbar scoliosis (DLS). This study retrospectively reviewed 97 patients with LSS and DLS who underwent lumbar endoscopic decompression between 2016 and 2021. The average follow-up duration was 52.9 months. Another 97 LSS patients without DLS were selected as the control group. The pre- and postoperative visual analog score (VAS) and the Oswestry disability index (ODI) were recorded and analyzed to compare clinical outcomes. Radiological findings, such as coronal balance and intervertebral disc height, have also been reported. Both groups' mean VAS scores for back pain, leg pain, and ODI were significantly improved two weeks after surgery and at the final follow-up (p < 0.001). There was no significant difference in the prevalence of surgical complications or patient satisfaction rates. However, patients in the DLS group reported more severe back pain at the final follow-up than those in the LSS group (p = 0.039). Radiological follow-up revealed no significant deterioration in coronal imbalance or loss of disc height in either group. Lumbar endoscopic decompression can be a safe and effective surgical technique for treating LSS with DLS, particularly in elderly patients with poor general conditions.

Ayurvedic Management of Sciatica with Medicated Enema and Bloodletting: A Case Report

Background: The most common condition that restricts movement is low back pain, which is particularly common in the most productive years of life. Sciatica syndrome accounts for 40% of patients’ severe lower back pain. Psychological strain places excessive strain on the spinal column and is a major contributing factor to the development of sciatica and lower back pain. Purpose: The illness indicated in Ayurveda has symptoms and signs similar to “Sciatica” in modern, contemporary medicine. In clinical practice, Gridhrasi (Sciatica), the conditions stated in Ayurveda are comparable to those treated in contemporary medicine. Methods: A 38-year-old female patient suffering from the above ailments, having pain in the lumbar region radiating pain to the left leg, tingling sensation in both legs, difficulty in walking, irregular sleep, and limping gait, was admitted to an Ayurvedic hospital. Her treatment comprised external and internal, consisting of Snehan with Vishgarbha Taila, Kati Basti with Mahamasadi Taila, and Kala Basti with Panchtiktaksheer (medicated enema). Results: These treatments had a very favorable outcome, it was discovered. Following therapy, there was a significant improvement in walking time, lower extremity motions, and pain alleviation. Conclusion: This method of treating Sciatica may be helpful in clinical settings and future research.

Keyhole decompression surgery for holospinal epidural abscess: a novel approach for spinal stability preservation.

Spinal epidural abscesses are rare yet serious conditions, often necessitating emergency surgical intervention. Holospinal epidural abscesses (HEA) extending from the cervical to the lumbosacral spine are even rarer and present significant challenges in management. This report aims to describe a case of HEA with both ventrally-located cervical and dorsally-located thoracolumbar epidural abscesses treated with a combination of anterior keyhole decompression and posterior skip decompression surgeries. A 73-year-old woman with diabetes and hypertension presented with severe neck and back pain, fever, and a marked increase in leukocytes (29980/µL) and C-reactive protein (CRP; 24.26mg/dL) levels. Magnetic resonance imaging revealed epidural abscesses extending from the cervical to lumbar spine, confirming the diagnosis of HEA. At the cervical lesion, spinal cord was compressed by ventrally-located epidural abscess. Due to the patient's poor general condition, conservative treatment was initially pursued, followed by surgical intervention targeting the most severely compressed spinal segments. Managing ventrally-located epidural abscesses poses greater challenges. In this patient, a novel anterior keyhole decompression surgery was employed to evacuate the ventrally-located cervical epidural abscess while preserving intervertebral discs and endplates. Posterior skip decompression surgery was performed, successfully reducing thoracolumbar epidural abscesses. Subsequently, anterior keyhole decompression was performed to evacuate ventrally-located epidural abscess, preserving intervertebral discs and endplates. Postoperatively, the patient's symptoms improved, and leukocyte count and CRP gradually normalized. Follow-up imaging showed resolution of the abscesses and bone remodeling within the keyhole without evidence of spinal instability and postoperative kyphosis. Management of HEA poses significant challenges, particularly in cases with ventrally-located cervical epidural abscesses. Our case highlights the efficacy of a combined surgical approach involving anterior keyhole decompression and posterior skip decompression in achieving abscess drainage and preserving spinal stability. This novel technique offers advantages over existing methods by preserving intervertebral motion and minimizing the risk of postoperative kyphosis. Further studies are warranted to validate the long-term outcomes and generalizability of this approach.

Differences in anxiety, depression and pain experience among adults with chronic low back pain as a function of nicotine product use.

The landscape of nicotine use in the United States (US) has continued to evolve, with electronic cigarette use (hereafter e-cigarette) becoming more evident in recent years. Patterns of dual nicotine use, or using combustible nicotine in conjunction with e-cigarettes, may increase dependence on nicotine, continued exposure to toxins, and corresponding health risks. One of the most prevalent health problems related to nicotine use is the experience of chronic pain. Past work has established a bidirectional relationship between nicotine use and pain, such that pain motivates nicotine use and nicotine use contributes to pain. However, no work has explored differences in negative mood and pain experience as a product of nicotine use type among adults with chronic low back pain. The current cross-sectional study examined whether dual cigarette/e-cigarette use was associated with greater anxiety, depression, and pain experience among a sample of adult nicotine users (cigarettes and/or e-cigarettes) with self-reported mild to severe chronic low back pain (N = 1034, 66.0% female, Mage= 44.47 years, SD = 11.63). Results indicated that, compared to exclusive combustible nicotine users, dual cigarette/e-cigarette users had statistically significantly higher anxiety, depression, and pain disability scores, beyond the effects of age, sex, education, and use of opioid medications for pain. No significant group differences emerged as a function of exclusive e-cigarette use. The current findings highlight that dual cigarette/e-cigarette use may serve to mark a subpopulation of persons with chronic low back pain who present more complicated clinical features that require comprehensive care.

The influence of rurality on self-reported physical therapy utilization among patients with severe chronic back pain in the United States.

To examine the association of rurality and physical therapy utilization among a nationally representative sample of individuals with severe chronic back pain. This study utilized a publicly available dataset from the 2019 National Health Information Survey (Adult Sample). Individuals with severe chronic back pain were identified based on survey items examining respondents' pain frequency and location. Physical therapy utilization was identified based on survey questions asking about pain management strategies utilized over the previous 3 months. Rurality was classified as large central metro, large fringe metro, medium and small metro, and nonmetropolitan/rural, based on the county of residence. Regression was used to examine the association between rurality and physical therapy utilization, while controlling for relevant covariates. National estimates were calculated using provided weighting variables. We identified 2925 individuals (weighted=20,468,134) meeting the criteria for severe chronic back pain. We observed that individuals with severe chronic back pain living in nonmetropolitan/rural areas had 34% lower odds of (weighted OR: 0.66, 95% CI: 0.47, 0.92) utilizing physical therapy compared to individuals living in large central metropolitan areas. We did not observe significant differences in the odds of utilizing physical therapy among individuals living in large fringe metropolitan areas or medium-small metropolitan areas. Individuals living in rural parts of the United States have lower odds of using physical therapy for management of their severe chronic back pain. Additional research is needed to examine the factors that contribute to these differences and improve access to care.

Pengaruh Massage Endorphine terhadap Penurunan Nyeri Punggung pada Ibu Hamil Trimester III di Wilayah Kerja Puskesmas Kuta Baro Aceh Besar

From the results of a survey in the Kuta Baro Aceh Besar Health Center Work Area, there were 15 pregnant women and as many as 9 women who complained of severe back pain which was felt due to increasing gestational age, on average pregnant women were entering the third trimester or were approaching HPL (Day Estimated Birth). Meanwhile, 6 other pregnant women said they also felt pain but could still overcome it by lying down or reducing activity. The aim of the research is to determine the effect of endorphine massage on reducing back pain in pregnant women in the third trimester in the work area of the Kuta Baro Health Center, Aceh Besar. This research uses the Pre-Experiment method. The sample in this study used purposive sampling, namely the researcher determined 15 respondents to be used as samples. The results of the research are that there is an effect of endorphine massage on reducing back pain in pregnant women in the third trimester in the work area of the Kuta Baro Aceh Besar Health Center with a value of p = 0.000. Researchers hope that respondents can use it as a reference or guideline in dealing with back pain experienced in the third trimester.

The value of semiquantitative analysis of [99mTc]MDP SPECT/CT in localizing responsible lesions for suspected fresh osteoporotic vertebral compression fractures in patients with contraindications to MRI.

The aim of this study was to evaluate the effectiveness of single-photon emission computed tomography/computed tomography (SPECT/CT) in detecting and localizing the causative vertebra in cases of suspected fresh osteoporotic vertebral compression fractures (OVCFs) in patients with contraindications to MRI. A total of 21 patients with severe back pain with 31 suspected OVCF segments and contraindications to MRI were initially identified through radiographs and the back pain-inducing test (BPIT). The responsible vertebral bodies were determined using [99mTc]MDP SPECT/CT before percutaneous vertebroplasty (PVP). Clinical outcomes and radiographic parameters, including basic demographics, injury duration, focal kyphosis (FK), loss of vertebral height (LVH), and relative intensity values (RIVs) for target and nontarget segments in the SPECT/CT were measured. SPECT/CT identified 14 old and 26 fresh OVCFs. Of these, 18 patients with 26 fresh OVCF segments underwent PVP, and achieved satisfactory outcomes. Significant differences were observed in the RIV, FK, and LVH values between the fresh and old OCVF groups (all p < 0.05). RIVs showed a significant negative correlation with injury duration (r = -0.57, p < 0.05), and a positive correlation with LVH (r = 0.43, p < 0.05). Multiple linear regression analysis confirmed that injury duration was an independent predictor of RIVs (p < 0.05). SPECT/CT is useful for detecting and differentiating fresh fractures from old fractures in patients having OVCF who cannot undergo MRI after BPIT validation, allowing these patients to achieve excellent clinical outcomes following PVP. The RIV serves as a valuable parameter for assessing the duration of fresh versus old OVCFs. ChiCTR, ChiCTR 2300077570. Retrospectively registered, http://www.chictr.org.cn/showproj.html?proj=206192.

REDISCOVERING RELIEF: A CASE REPORT ON EFFECTIVELY MANAGING SCIATICA WITH AYURVEDIC APPROACHES.

Gridhrasi is a common condition characterized by sequential pain that starts from the (buttock region) of Sphik Pradesh and radiates down to the foot. It can be correlated with Sciatica, radiating pain from the back to the lower limb with paraesthesia. The present case report is of a 43-year-old male patient, unable to walk due to se-vere back pain radiating to his left ankle. As per the previous MRI report, the patient had an established case of prolapse of the intervertebral disc (PIVD) with radiculopathy and took treatment at a private allopathic hospital, and they advised him to have surgery. The patient and his attendant refused surgery and came to our hospital. The patient was treated with Siravedha and oral medications. After improvement, the patient was maintained on back strengthening exercises. Visual Analogue Scale (VAS) score, comfortable walking distance, Straight Leg Raise (SLR) test, and % relief reported by the patient were used as assessment criteria. The patient was relieved from all symptoms with a follow-up period of 1 year. This case report shows that Siravedha and Ayurvedic oral management is very effective in Gridhrasi (PIVD with Radiculopathy). Hence, this treatment can be minimally cost-effective as a day-care procedure and protects the patient from surgical intervention.

Spinal Epidural Empyema in a Male Cat

Background: A 6-year-old, male neutered, domestic short hair cat presented to the hospital with shifting leg lameness and gait abnormalities. There was a weak response to deep pain in the physical examination and no reaction to the sensory response test. The cat had a strong pain response during thoracolumbar palpation. It was confirmed that the substance was compressing the spinal cord at the thirteenth thoracic vertebrae and the first lumbar vertebrae and hyperintense changes were observed in the surrounding soft tissue. Methods: Six months later, the patient presented to the hospital again due to severe lameness and back pain. Magnetic resonance imaging (MRI) showed that more than 70% of the substances that were compressing the spinal were the contents of an epidural abscess. The patient underwent decompression with hemilaminectomy and routine suturing. Result: Nine days after surgery, there were no abnormalities in urination, defecation, or movement. This is a rare case of epidural empyema in a cat. The clinical symptoms, diagnosis and surgical intervention were described six months after the cat was diagnosed as having a spinal abscess.

Clinical efficacy and biomechanical analysis of a novel hollow pedicle screw combined with kyphoplasty for the treatment of Kümmell disease.

Vertebral augmentation is the preferred treatment for Kümmell disease (KD), but there exists a risk of cement displacement resulting in severe back pain and exacerbation of kyphosis. The study aimed to investigate the efficacy and safety of a novel hollow pedicle screw combined with kyphoplasty (HPS-KP) for treating KD, effectively preventing postoperative bone cement displacement. The prospective study included 50 KD patients with no neurological deficit detected during clinical and radiological evaluation who underwent HPS-KP (n = 25) and PKP (n = 25) surgeries. The visual analogue scale (VAS) score, Oswestry dysfunction index (ODI), anterior vertebral height (AVH), wedge-shape affected vertebral Cobb angle (WCA), bisegmental Cobb angle (BCA), and complications were evaluated and compared in both groups. Besides, a finite element (FE) model of T11-L2 was constructed. The stress distributions, maximum von Mises stresses of vertebrae and bone cement, and maximum displacement of bone cement were compared and analyzed. The VAS and ODI scores at 3 days, 3 and 6 months, and 1 year after surgery significantly improved in both groups (p < 0.05). The AVH, BCA, and WCA significantly improved initially after the surgery in both groups (p < 0.05). The displacement of M2 was larger than other models, especially in flexion, right bending, and left and right rotation, while that of M6 was the lowest under all conditions. HPS-KP was a safe and effective treatment for KD, effectively relieving pain, restoring vertebral height, and correcting local kyphosis, and it had better biomechanical stability and safety than ordinary single PKP and PKP combined with pediculoplasty in avoiding cement loosening and displacement.

Body Composition and Incident High-Intensity Back Pain and/or High Disability: A 10-Year Prospective Population-Based Male Cohort.

Back pain poses a significant global burden, within which individuals with more severe symptoms consume higher healthcare expenses than those with lesser back pain. Whether measures of body composition predict high-intensity back pain and/or high-disability in population-based cohorts is unknown. This study aimed to examine the association between body composition at baseline and their change in the prior 5 years (between 2001-2005 and 2006-2010) and incident high-intensity back pain and/or high-disability in long-term follow-up, 10 years later (2016-2021) in a population-based cohort of men. This study examined men with no or low-intensity back pain and disability (Graded Chronic Pain Scale) at back pain study baseline (2006-2010) within the Geelong Osteoporosis Study. Those developing high-intensity pain and/or high disability at follow-up (2016-2021) were identified. Weight, body mass index (BMI), abdominal circumferences, fat mass and lean mass (dual energy X-ray absorptiometry) were assessed prebaseline (2001-2005) and at baseline. The association of body composition at baseline and change in body composition from prebaseline to baseline with incident high-intensity pain and/or high disability at follow-up were examined using multivariable logistic regression. Of 695 participants with no or low-intensity pain and disability at baseline, 441 (62.3%) completed follow-up with a mean age of 54.3 ± 14.1 years: 37 (8.3%) developed high-intensity pain and/or high-disability, 33 (7.5%) developed high-intensity pain and 14 (3.2%) high disability. No measures of body composition at baseline were associated with incident high-intensity pain and/or high disability at follow-up in the whole population. In subgroup analysis, among men aged over 60 years, but not younger, higher lean mass was associated with decreased likelihood of high-intensity pain and/or high-disability (odds ratio [OR] 0.86, 95% confidence interval [CI] 0.76, 0.97, interaction p < 0.001). In the whole population, examination of the relationship between change in measures of body composition between prebaseline and baseline, only a one unit increase in BMI, equivalent to 3.1-kg weight gain, was associated with increased incident high disability (OR 1.63, 95% CI 1.06, 2.51). In a population-based sample, without severe back pain and disability, in older men aged ≥60 years, higher lean mass was protective of incident high-intensity pain and/or high disability. An increase in BMI, over 5 years, equivalent to 3.1-kg weight gain, was associated with incident back pain related high disability 10 years later. These results demonstrate another detrimental consequence of weight gain and highlight the importance of maintaining muscle mass in older men.

Urinary calculi successfully expelled in a patient through traditional Chinese exercise: A case report.

Urinary calculi are hard mineral deposits that typically require medication or surgery, such as lithotripsy. This case report presents traditional Chinese exercises (TCEs) as a potential alternative for stone expulsion. A 41-year-old male with no history of urinary tract stones, experienced sudden severe lower back and abdominal pain accompanied by nausea and vomiting. Computed tomography scan revealed a small calculus at the distal end of the left ureter (within the bladder wall), approximately 2 mm in size, with mild hydronephrosis in the ureter and renal pelvis. The patient was initially prescribed medication for pain relief and was advised to engage in TCEs. Follow-up computed tomography scan after the exercise regimen showed complete expulsion and disappearance of the urinary calculi. The patient reported significant improvement in physical and mental health with no recurrence of calculi observed in subsequent checkups. This case suggests that TCEs may facilitate the expulsion of small urinary calculi, offering a noninvasive treatment option. Further research is needed to confirm the therapeutic effects of TCEs on urinary calculi and to explore its potential mechanisms.

Clay-Shoveler Fracture in a Golfer: A Rare Sports Injury Case Report

Clay-shoveler's fracture is a relatively rare stress-type avulsion fracture of the lower cervical or upper thoracic spinous processes, most commonly occurring at C7 and T1. The term of this injury comes from its historical association with manual laborers who lifted and threw big objects, as well as with scooping huge loads of clay in the early 20th centuryThe case report describes A 29 year old male experienced severe back pain after playing golf. at the time of the golf swing, the golf swing did not hit the ball but hit the ground. the patient experienced radiculopathy pain to both hands. A "pop" sound was audible in the spine at the moment of the hitting fault, and there was no paralysis in the lower limbs.The primary method for managing a clay-shoveler fracture is conservative. In most cases, traction of the rhomboid and trapezius muscles on the spinous process leads to nonunion. In rare cases if the pain persists, surgically removing the bone fragment may be a possibility.

Predicting persistent back pain causing severe interference with daily activities among community-dwelling older adults: the OPAL cohort study

BackgroundMany older adults experience disabling back and leg pain. This study aimed to identify factors associated with back pain causing severe interference with daily activities over 2 years.MethodsParticipants were 2,109 community-dwelling adults (aged 65–100 years; mean age 74.2 (SD 6.3)) enrolled in a prospective cohort study who reported back pain at baseline and provided back pain data at 2 years follow-up. Baseline data included demographics, socio-economic factors, back pain presentation and age-associated adverse health states (e.g. frailty, falls, walking confidence). At 2 years follow-up, we asked if they were currently experiencing back pain and if so, asked participants to rate how much their back pain interfered with their daily activities on a scale of 0–10. Severe back pain interference was defined by a rating of 7 or more. The association between baseline factors and severe back pain interference at two years was assessed using logistic regression models.ResultsAt two years, 77% of participants (1,611/2,109) still reported back pain, 25% (544/2,083) also reported leg pain and 14% (227/1,611) reported severe back pain interference with activities. Improvements in symptoms were observed over the two years follow-up in 880/2,109 participants (41.7%), 41.2% (869/2,109) of participants report no change and worsening symptoms was reported by 17.1% (360/2109) of participants. After adjusting for back pain troublesomeness at baseline, factors associated with reporting severe interference were adequacy of income (careful with money [OR 1.91; 95% CI 1.19–3.06]; prefer not to say [OR 2.22; 95% CI 1.11–4.43]), low endorsement of exercise in later life (OR 1.18; 95% CI 1.02–1.37), neurogenic claudication symptoms (OR 1.68 (95% CI 1.15–2.46)], multisite pain (OR 1.13; 95% CI 1.02–1.24) and low walking confidence (OR 1.15; 95% CI 1.08–1.22).ConclusionAfter adjusting for baseline pain severity, we identified five factors that were associated with severe pain limitation at two years follow-up among a cohort of community dwelling older people reporting back and leg pain. These included other pain characteristics, walking confidence and attitude to activity in later life. We also identified a socioeconomic factor (perceived adequacy of income). Future research should focus on whether identifying individuals using these risk factors in order to intervene improves back pain outcomes for older people.

Expandable Intravertebral Titanium Implants for Thoracolumbar Burst Fractures Without Neurological Deficits

Objective: A thoracolumbar burst fracture (TLBF) is defined as the failure of the anterior and middle columns of the vertebra due to high-energy trauma, such as motor vehicle collisions and falls from heights. Debate has continued for decades regarding the standard treatment, especially for TLBFs without neurological deficits (TLBF-WONDs). The aim of this study was to understand the role of expandable intravertebral titanium implants (EITIs) in treating TLBF-WONDs.Methods: We included patients aged 18–65 years who presented at our hospital Emergency Department with severe back pain (visual analogue scale [VAS] score ≥ 8), were neurologically intact, were diagnosed with TLBF-WOND by either computed tomography or magnetic resonance imaging, underwent percutaneous bilateral transpedicular EITI implantation, and were followed-up for ≥12 months. Radiological and clinical outcomes were analyzed.Results: Thirty patients satisfied the study inclusion criteria, including 9 men and 21 women, with an average age of 48.2 years. Thirteen A3 and 17 A4 burst fractures were included. The mean duration of hospitalization was 3.3 days. The mean follow-up period was 4.4 years. All patients exhibited significant improvements in radiographical (anterior, middle, and posterior vertebral heights); vertebral kyphotic angle (p&lt;0.001); and functional outcomes (VAS and Oswestry Disability Index scores, p&lt;0.001). One case of cement leakage into the paraspinal muscle was observed; however, no major complications occurred.Conclusion: Percutaneous bilateral transpedicular EITI placement with cement augmentation under local anesthesia may be an effective strategy for the treatment of high-energy traumatic TLBFs with neurological integrity.

Prevalence of Acute Low Back Pain after Cesarean Delivery in Health Care Centers

Background: Low back pain is the common problem faced by mothers after cesarean delivery under spinal anesthesia. Application of spinal anesthesia leads to severe acute and chronic low back pain post-delivery. Physiotherapy plays an important role during and after pregnancy as it helps in reducing the incidence of low back pain and others musculoskeletal pain post-delivery. The aim of the study was to determine the prevalence of acute low back pain after cesarean section and to assess the percentage of population aware about antenatal and postnatal physiotherapy and percentages had taken the treatment in Heath care centers. Materials and methods: Study population comprised of 162 caesarean delivery females out of which 104 were selected of age between 19 to 35 having acute low back pain in postnatal cesarean ward of Heath care centers. Population was chosen through convenient sampling. Data collection tools were modified questionnaire. The data collected was analyzed through SPSS software Version 29.0.2.0(20). Prevalence and awareness were measured through descriptive statistics. Result: 64.1% postpartum caesarean section females had low back pain under spinal anesthesia.18.2% had mild pain,34.6% had moderate pain,30.7% had severe pain and 16.4% had very severe pain. Only18.3% were aware of antenatal and postnatal physiotherapy out of which only 6.7% had taken treatment.81.7% were unaware and 93.3% had not taken physiotherapy treatment. Low back pain is dependent upon Occupation and daily activity of the patient, awareness about antenatal and postnatal treatment is dependent upon educational level and patient age is seen as an associative factor for the patient dependency. Conclusion: Majority of postpartum caesarean delivery females complained of acute low back pain and very less had taken physiotherapy treatment during and after delivery. The majority were unaware about the antenatal and postnatal physiotherapy as they were not recommended by the gynecologist doctors. KEYWORDS: Acute back pain, Caesarean delivery, Spinal anesthesia, Antenatal, Postnatal, Physiotherapy, Awareness.

A case of consecutive four-level lumbar spondylolysis and spondylolisthesis

This rare and unusual case is about a 54-year-old female, who has pars fractures involving consecutive four-level bilateral spondylolysis and spondylolisthesis. Due to the increasing intensity with lumbar instability, the patient had severe low back pain. For diagnosis, dynamic X-ray, magnetic resonance, 3D tomography were performed, and bilateral L2-3-4-5 pars fracture and L3-4 spondylolisthesis were observed. This case was treated surgically byspinal canal decompression at L3-4, L4-5 and L5-S1, posterior lumbar interbody fusion at L4–5 and L5–S1, and pedicle screw fixation at L2–S1. The lower back pain disappeared after the surgery.

Spinal subarachnoid hematoma involving a thoracic ventral dural defect: illustrative case.

Spinal subarachnoid hematoma of unknown origin is rare. Superficial siderosis has been associated with chronic bleeding from spinal dural defects; however, the relationship between these defects and spinal subarachnoid hematoma remains unclear. A 32-year-old woman presenting with severe back pain and leg weakness exhibited an extensive thoracic spinal hematoma with spinal cord compression on magnetic resonance imaging. Emergency surgery was performed, which revealed a ventral subarachnoid hematoma that was evacuated. A ventral dural defect at the hematoma site and venous bleeding from the surrounding area were observed. Hemostasis was achieved and the defect closed. After surgery, her neurological symptoms quickly resolved. Postoperative spinal angiography showed no vascular lesions. Like superficial siderosis, ventral spinal subarachnoid hematoma can be caused by a spinal dural defect. https://thejns.org/doi/10.3171/CASE24435.