Spinal Pain Research Articles

Steroid response in a rare case of vertebrae butterfly with spinal cord compression caused by chronic subdural hematoma

IntroductionSpinal subdural hematoma (SSH) is a rare entity. Clinical symptoms include motor, sensory and/or autonomic dysfunction due to compression of the spinal cord. There is no standard consensus in the management of SSH. Here, we report a rare case of SSH of sudden onset following trauma, successfully treated with conservative therapy.AimThis case highlights butterfly vertebrae as an incidental imaging finding before SSH diagnosis.Case studyA 30-year-old female presented with weakness in the lower extremities after trauma, accompanied by paresthesia, urinary retention, and impaired defecating function. The thermoregulatory sweat exam revealed sudomotor dysfunction. Multiple slice computed tomography (MSCT) examination of the whole spine revealed wedge deformity of vertebral corpus (VC) L4 on the right lateral side, and VC L5 butterfly vertebrae. Spine magnetic resonance imaging (MRI) revealed an extramedullary intradural lesion at the T7 to T10 level suggestive of subdural hematoma.Results and discussionThe administration of methylprednisolone pulse therapy, combined with physical rehabilitation, led to a rapid and significant improvement in the patient's motor function. The absence of the spinal pain possibly indicated that there was no more extension of the hematoma; motor recovery, even if slight, should be a predictor of successful conservative therapy, and physical rehabilitation.ConclusionsSSH is an uncommon condition, with varying clinical presentation, and progression. This case report highlights significant improvement following conservative steroid treatment of a SSH. It also highlights a unique incidental finding of butterfly vertebra in a patient with paraparesis following trauma.

Endoscopic and microsurgical decompression for central lumbar spinal stenosis

Objective. To perform comparative analysis of the results of endoscopic and microsurgical decompression for lumbar spinal stenosis.Material and Methods. Design: Retrospective monocentric intra-cohort comparison of two groups of patients. The study included 99 patients aged 51–88 years with clinically significant lumbar spinal stenosis manifested by neurogenic intermittent claudication syndrome. Endoscopic decompression was performed in 51 patients, and microsurgical decompression – in 48 patients. To objectify and standardize clinical symptoms, walking distance in meters, pain syndrome and quality of life were assessed before and after surgery using standard scales and questionnaires (VAS, ODI). On the first day after surgery, back and lower limb pain were assessed, and during the observation period back and lower limb pain, quality of life and walking distance were assessed. Functional lumbar radiography was performed to exclude instability of the spinal motion segment. Using MRI, the cross-sectional area of the dural sac at the level of stenosis was measured before and after surgery. Clinical efficacy was assessed using the MCID (Minimal Clinical Important Difference) criterion. The results of the operation were followed-up for 12 months after the operation.Results. Blood loss in the endoscopic intervention group was less than in the microsurgical group. Pain in the lumbar spine and in the lower extremities decreased, and the cross-sectional area of the dural sac increased. In the first days after surgery, patients after endoscopic decompression had less severe back and lower extremity pain than patients after microsurgical decompression due to less soft tissue trauma. Pain syndrome in back 10–12 months after surgery was without statistically significant difference between the groups. Patients after endoscopic decompression had statistically significantly better quality of life according to ODI, lesser pain in the lower extremities according to VAS and longer walking distance than those in the microsurgical decompression group. Surgical treatment in both groups turned out to be effective, which is confirmed by MCID. The time of endoscopic intervention is significantly longer than that of microsurgical intervention. The length of the incision during endoscopic decompression is shorter than that of microsurgical decompression.Conclusion. A comparative analysis of the results of endoscopic and microsurgical decompression for degenerative central lumbar stenosis showed comparable effectiveness of both methods, including an increase in the spinal canal dimension and ensuring regression of clinical symptoms. The results of the comparison do not allow making a sufficiently substantiated judgment on the advantages of one of the methods, which dictates the need for further research.

Pharmacology of spinal interventions: review of agents used in spine pain procedures.

Spine procedures are commonly performed to diagnose and treat various spinal conditions, ranging from degenerative disc disease to vertebral fractures. These procedures often involve the use of pharmaceutical agents to enhance the efficacy of the intervention and improve patient outcomes. This review provides an overview of the pharmaceuticals commonly utilized in spine procedures, including corticosteroids, anesthetics, antibiotics, radiographic contrast, neurolytic agents, and materials used in kyphoplasty and vertebroplasty. This review summarizes the utilization of these pharmaceutical agents in spine procedures in an effort to optimize patient outcomes. Understanding the pharmacological properties and appropriate uses of these pharmaceuticals is essential for interventionalist and healthcare providers involved in the care of patients undergoing spinal interventions.

Causal impacts of smoking on pain conditions and the mediating pathways: a mendelian randomization study.

Smoking is a risk factor for multiple diseases. We performed mendelian randomization (MR) analyses to investigate the causal association of smoking initiation on pain conditions and the potential mediating pathways. Genetic associated with smoking initiation at the genome-wide significance level were selected as instrumental variables. Genetic associations with 10 pain conditions were derived from the FinnGen and UK Biobank study. Multivariable MR analysis was conducted to explore the mediation effects of depression, insomnia and sedentary behavior. A series of sensitivity analyses were conducted to assess the stability of our research findings. Genetic liability to smoking initiation was associated with an increased risk of angina pectoris, dorsalgia, low back pain, pain in limb, pain in joint, pain in thoracic spine and sciatica in both FinnGen and UK Biobank study. These causal associations were largely mediated by major depression (2.9- 39.5%), sedentary behavior (13.0- 31.2%), insomnia (10.3- 33.1%) and combination of all three mediators (30.2- 65.3%). The effects of smoking on outcomes were partly attenuated after adjusting for depression, sedentary behavior and insomnia respectively, and the direct effect of smoking initiation on pain was diminished toward null after adjusting for combined three mediators. These results were robust to sensitivity analyses. Our findings illustrated the causal effect of smoking and a broad range of pain conditions, and major depression, sedentary behavior and insomnia mediate many of these associations.

Reliability of the Revised Neurophysiology of Pain Questionnaire-Turkish in patients with neck pain: a cross-validation study

Background & Objectives: The Neurophysiology of Pain Questionnaire (NPQ) measures the level of knowledge of patients and healthcare professionals regarding the neurophysiology of pain. The revised Turkish (Tr) version has low reliability for patients with chronic spinal pain. In this study, we investigated the reliability of the Revised NPQ-Tr in patients with neck pain. Methodology: The Revised NPQ-Tr was administered to 219 participants suffering from neck pain for at least 3 months, who were between the ages of 25 and 60 y and native Turkish speakers. Correct responses were awarded one point, while undecided or incorrectly marked responses were awarded 0 points. In order to analyse the validity of the test, the high-scoring and low-scoring groups were compared. Using the percentage of correct responses in the high and low scoring groups, we calculated the difficulty of the item (P-value) and the discrimination power of the item (r). Results: Responses to the questionnaire were highly correlated. Items 1 and 2 had high discrimination power (r > 0.40), and items 3 and 5 had very good item quality (0.30 < r < 0.39). Among the items ranked between 1-7 and 9-12 in terms of difficulty of the item and discrimination power, only item 8 was found to be a difficult yet discriminating item (P < 0.60). According to Cronbach's alpha (0.81) and Kuder-Richardson-20 (0.81) coefficients, the questionnaire had a high internal consistency and reliability, and a split-half correlation coefficient (0.802) determined its internal consistency and reliability. Conclusion: We conclude that the Neurophysiology of Pain Questionnaire-Turkish can be used on neck pain, and it is reliable and highly valid. Keywords: Chronic Pain, neck pain, pain knowledge, pain education, pain beliefs, Turkish language, reliability, validity. Citation: Yasarer O, Sari Z, Copuroglu OB, Eker TA, Aydogdu O. Reliability of the Revised Neurophysiology of Pain Questionnaire-Turkish in patients with neck pain: a cross-validation study. Anaesth. pain intensive care 2024;28(5):859−865; DOI: 10.35975/apic.v28i5.2552 Received: August 04, 2024; Reviewed: August 14, 2024; Accepted: August 17, 2024

Spine Pain.

Spine pain is one of the most common presenting concerns in health care settings. This article reviews clinical strategies for evaluating and managing patients with spine pain. Minimally invasive interventional procedures, virtual reality, predictive analytics, neuromodulation, and other evolving technologies are significantly impacting the management of spine pain. Advances in modern pain science have also led to effective skills and treatment strategies, including patient interviews and queries for insight regarding pain, education, and cognitive restructuring, and adjusting the timing of examination (after reeducation) and examination techniques to encourage the experience of movement in the absence of assumed tissue damage. An evolving understanding of the influence of patient-centric thoughts, framing, emotional status, and cognitive restructuring's influence on the brain's response to perceived threat are important aspects of spine pain management. The correlation of clinical presentations with structural abnormalities is necessary but insufficient to evaluate and manage spine pain. Modern pain science acknowledges pain as a subjective experience but recognizes a critical distinction between tissue damage, nociception, and the experience of pain. What and how we communicate with patients, as well as evolving neuromodulation technologies, augment conventional approaches.

The effect of alcohol consumption on clinical outcomes and structural damage in patients with axial spondyloarthritis: A systematic literature review and meta-analysis

ObjectiveTo systematically review the effects of alcohol consumption (AC) on disease-specific outcomes in axial spondyloarthritis (axSpA). MethodsA systematic review of observational studies on axSpA and AC was conducted. Multiple electronic databases were searched for keywords. Two investigators reviewed articles to assess for inclusion eligibility. The Joanna Briggs Institute Critical Appraisal checklist was employed to evaluate the risk of bias. Standardized mean differences (SMD) were used to synthesize the data and I2 was used to ascertain heterogeneity. Spinal pain, disease activity as measured by Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Ankylosing Spondylitis Disease Activity Score (ASDAS), and spinal radiographic progression based on the modified Stokes Ankylosing Spondylitis Spinal Score (mSASSS) were examined as outcomes. ResultsSearch strategy identified 703 records; 13 articles were assessed for eligibility. Five studies (n=3858) were included. Compared to non-consumers, axSpA patients who consumed alcohol had lower BASDAI (SMD: −0.19, 95% CI: −0.37 to −0.02, I2=72.5%) and lower spinal pain (SMD: −0.17, 95% CI: −0.24 to −0.09, I2=0%). No significant difference was found for ASDAS (SMD: −0.19, 95% CI: −0.39 to 0.00, I2=36%). One cohort study on the spinal radiographic progression indicated greater radiographic progression among consumers (SMD: 0.35, 95% CI: 0.08 to 0.62). ConclusionAC appears to be associated with lower disease activity and spinal pain. However, these findings may reflect confounding by sex and smoking. Further longitudinal cohort studies with standardized measures for AC are warranted to assess the direction of alcohol's effect on structural damage progression.

ID: 344560 Spinal cord stimulation as a dual-purpose treatment for Spinal Cord Injury, Pain and Functional Restoration

ID: 344560 Spinal cord stimulation as a dual-purpose treatment for Spinal Cord Injury, Pain and Functional Restoration

ID: 337285 Comparing 10kHz Spinal Cord Stimulation Efficacy in Persistent Spinal Pain with versus without Previous Surgery

ID: 337285 Comparing 10kHz Spinal Cord Stimulation Efficacy in Persistent Spinal Pain with versus without Previous Surgery

Spinal Cord Stimulation with Implantation of Surgical Leads is a Sufficient Salvage Therapy for Patients Suffering from Persistent Spinal Pain Syndrome—A Retrospective Single-center Experience

ObjectivePersistent spinal pain syndrome (PSPS) poses a significant medical challenge, often leading to diminished quality of life for affected individuals. In response to this clinical dilemma, Spinal Cord Stimulation (SCS) has emerged as a promising intervention aimed at improving the functional outcomes and overall well-being of patients suffering from these debilitating syndrome. In case a therapy with percutaneous lead fails, e.g. due to a dislocation, surgical lead can be used as a stable alternative. This is resulting in a more invasive procedure and does not allow for intraoperative monitoring. The aim of the study is to investigate the efficacy and safety of the use of surgical leads, as there have been only a few case series published so far. MethodsWe included PSPS patients that gave consent to a SCS therapy and were treated with Surgical Leads. Outcome scores concerning the quality of life (SF-36), pain related disability (Oswestry disability index [ODI]), sleeping quality (Pittsburgh Sleep Quality Index [PSQI]), and pain intensity (NRS) were obtained prior surgery and at outpatient visits after permanent implantation. ResultsIn this study, 36 patients were implanted with a Surgical Lead SCS system. One patient developed a new neurological deficit characterized by left-sided leg paresis attributable to postoperative hemorrhage, and another patient experienced a wound infection. These complications contributed to an overall morbidity rate of 5.6%. In overall 5 patients (20.8%) the electrodes were explanted within the first month. Follow-up data of 24 subjects with a median time of 21 [15-47] months were available. The mean pain intensity at rest and in motion was reduced. Further pain depending disability improved from a median ODIpreop=38 [30-57]% to ODIfollow-up =21 [9-35]% (p<0.01). Additionally the Sleeping Quality and the Quality of Life improved concerning the physical (Median PCS preop=22.5 [20.4-30.4] vs. PCSfollow-up = 41.8 [35.2-47.0], p < 0.01).) and mental (Median MCSpreop=45.4 [31.1-55.5] vs. MCSfollow-up=58.1 [47.6-59.8], p=0.018). component. ConclusionSCS with surgical leads is a safe secondary technique to treat PSPS, where treatment with percutaneous leads fail. The results show a promising long-term effect concerning pain intensity and functional outcome.

Human-Robot Interaction and Social Robot: The Emerging Field of Healthcare Robotics and Current and Future Perspectives for Spinal Care.

Recent advances in robotics technology and artificial intelligence (AI) have sparked increased interest in humanoid robots that resemble humans and social robots capable of interacting socially. Alongside this trend, a new field of robot research called human-robot interaction (HRI) is gaining prominence. The aim of this review paper is to introduce the fundamental concepts of HRI and social robots, examine their current applications in the medical field, and discuss the current and future prospects of HRI and social robots in spinal care. HRI is an interdisciplinary field where robotics, AI, social sciences, design, and various disciplines collaborate organically to develop robots that successfully interact with humans as the ultimate goal. While social robots are not yet widely deployed in clinical environments, ongoing HRI research encompasses various areas such as nursing and caregiving support, social and emotional assistance, rehabilitation and cognitive enhancement for the elderly, medical information provision and education, as well as patient monitoring and data collection. Although still in its early stages, research related to spinal care includes studies on robotic support for rehabilitation exercises, assistance in gait training, and questionnaire-based assessments for spinal pain. Future applications of social robots in spinal care will require diverse HRI research efforts and active involvement from spinal specialists.

Guselkumab in Biologic-Naïve Patients with Active Psoriatic Arthritis in Russia: A Post Hoc Analysis of the DISCOVER-1 and -2 Randomized Clinical Trials.

There are limited data on the use of advanced therapies to treat psoriatic arthritis (PsA) in Russia. Guselkumab, an interleukin (IL)-23p19-subunit inhibitor, demonstrated efficacy in patients with PsA in the phase3 DISCOVER-1 and -2, and COSMOS trials. This analysis evaluated the efficacy and safety of guselkumab in patients with PsA in Russia. This posthoc analysis of DISCOVER-1 and -2 included 1002 biologic-naïve patients with active PsA from Russia (n = 317) and the rest of the world (RoW; n = 685). Patients received guselkumab 100mg every 4weeks (Q4W), or at week0 and 4 then Q8W, or placebo then guselkumab Q4W at week24 (Russian: n = 119, 88, and 110, respectively; RoW: n = 216, 246, and 223, respectively). Outcomes through week52 were pooled (DISCOVER-1 and -2); outcomes from week52 to 100 represent DISCOVER-2 only. In patients from Russia, ≥ 20% improvement in the American College of Rheumatology (ACR20) criteria response rates were higher with guselkumab vs. placebo at week24, increased through week52, and were consistent across all guselkumab-treated groups at week100. Similar trends were generally observed for ACR50, ≥ 90% improvement in Psoriasis Area and Severity Index (PASI90), achievement of Disease Activity in Psoriatic Arthritis (DAPSA) low disease activity/remission and minimal disease activity, enthesitis and dactylitis resolution, ≥ 0.35 improvement in Health Assessment Questionnaire-Disability Index (HAQ-DI) score, improvement in patient-reported pain, and measures in patients with axial PsA (including Bath Ankylosing Spondylitis Disease Activity Index [BASDAI], Ankylosing Spondylitis Disease Activity Score [ASDAS], and patient-reported spinal pain). Efficacy responses were similar between patients from Russia and the RoW across all endpoints and timepoints. The safety profile of guselkumab in patients from Russia was consistent with previous findings. This analysis demonstrated that the safety and efficacy profiles of guselkumab across all PsA domains and patient-reported outcomes in patients from Russia were similar to those in patients from the RoW. NCT03162796 and NCT03158285.

Conotoxins: emerging analgesics for neck and spinal surgery pain management

Conotoxins, peptides derived from the venom of marine cone snails, have emerged as promising analgesics for managing pain associated with neck and spinal surgery. These toxins target specific neurotransmitter receptors and ion channels in the nervous system, offering an alternative to traditional opioids with potentially fewer side effects. By interacting with receptors such as nicotinic acetylcholine and voltage-gated sodium and calcium channels, conotoxins disrupt pain signal transmission and induce muscle relaxation, providing effective pain relief. Research into conotoxins is ongoing, with the goal of developing novel, safer analgesics that mitigate the risks of opioid addiction. This exploration not only holds promise for surgical pain management but also advances our understanding of venom pharmacology and its therapeutic applications.

Heterogeneity of synaptic NMDA receptor responses within individual lamina I pain-processing neurons across sex in rats and humans.

Excitatory glutamatergic NMDA receptors (NMDARs) are key regulators of spinal pain processing, and yet the biophysical properties of NMDARs in dorsal horn nociceptive neurons remain poorly understood. Despite the clinical implications, it is unknown whether the molecular and functional properties of synaptic NMDAR responses are conserved between males and females or translate from rodents to humans. To address these translational gaps, we systematically compared individual and averaged excitatory synaptic responses from lamina I pain-processing neurons of adult Sprague-Dawley rats and human organ donors, including both sexes. By combining patch-clamp recordings of outward miniature excitatory postsynaptic currents with non-biased data analyses, we uncovered a wide range of decay constants of excitatory synaptic events within individual lamina I neurons. Decay constants of synaptic responses were distributed in a continuum from 1-20ms to greater than 1000ms, suggesting that individual lamina I neurons contain AMPA receptor (AMPAR)-only as well as GluN2A-, GluN2B- and GluN2D-NMDAR-dominated synaptic events. This intraneuronal heterogeneity in AMPAR- and NMDAR-mediated decay kinetics was observed across sex and species. However, we discovered an increased relative contribution of GluN2A-dominated NMDAR responses at human lamina I synapses compared with rodent synapses, suggesting a species difference relevant to NMDAR subunit-targeting therapeutic approaches. The conserved heterogeneity in decay rates of excitatory synaptic events within individual lamina I pain-processing neurons may enable synapse-specific forms of plasticity and sensory integration within dorsal horn nociceptive networks. KEY POINTS: Synaptic NMDA receptors (NMDARs) in spinal dorsal horn nociceptive neurons are key regulators of pain processing, but it is unknown whether their functional properties are conserved between males and females or translate from rodents to humans. In this study, we compared individual excitatory synaptic responses from lamina I pain-processing neurons of male and female adult Sprague-Dawley rats and human organ donors. Individual lamina I neurons from male and female rats and humans contain AMPA receptor-only as well as GluN2A, GluN2B- and GluN2D-NMDAR-dominated synaptic events. This may enable synapse-specific forms of plasticity and sensory integration within dorsal horn nociceptive networks. Human lamina I synapses have an increased relative contribution of GluN2A-dominated NMDAR responses compared with rodent synapses. These results uncover a species difference relevant to NMDAR subunit-targeting therapeutic approaches.

Severity of lumbar spinal stenosis does not impact responsiveness to exercise-based rehabilitation.

Spine pain is a prevalent and costly condition affecting up to 85% of individuals throughout their lifetime, and spinal stenosis is one of the most debilitating sources of spine pain. Although conservative management is the first line of treatment for spinal stenosis, severe cases often are directly referred to surgical intervention due to the belief that conservative strategies delay necessary treatment. However, there are no studies supporting the premise that individuals with more severe stenosis respond poorly to conservative management. The purpose of this study was to compare improvements in pain, disability, strength, medication usage, and patient goals in response to an exercise-based physical therapy program across 1,806 individuals with mild, moderate, or severe lumbar spine stenosis. Participants demonstrated significant improvements in all variables of interest (p<0.001), and 11.5% of participants reported cessation of narcotic use with treatment. There were no significant differences in treatment response across mild, moderate, or severe stenosis groups for any outcome (p>0.546). Exercise-based rehabilitation is as beneficial in the short term for individuals presenting for nonoperative care with severe stenosis compared to their milder counterparts. Future research is needed to evaluate long term durability and cost effectiveness of rehabilitation in this patient population.

Efficacy of Laser Therapy in Patient Self-Assessment for Cervical and Lumbar Spine Pain Syndromes – Original Study

Introduction: Laser therapy, or Light Amplification by Stimulated Emission of Radiation (LASER), is a relatively popular method used in rehabilitation for various patient conditions. Purpose: To evaluate the effectiveness of laser therapy in treating pain syndromes of the cervical and lumbar spine. Material: The study included 108 patients, consisting of 72 women (67%) and 36 men (33%) diagnosed with chronic pain syndromes in the cervical and lumbar spine regions. The average patient age was 64.4 years. Method: A proprietary questionnaire survey Results: According to 44.4% of respondents, the effects of laser therapy are moderate, while 28.7% reported significant improvement. The study showed that for 50% of patients, the pain relief was substantial, for 37% it was minimal, and for only 9.3% there was no noticeable improvement. Among the participants, 70.8% of women and 75% of men considered laser therapy to be an effective treatment. Notably, 100 respondents expressed a willingness to undergo laser therapy again in the future. Conclusions: The data indicates that laser therapy is an effective treatment for spinal pain syndromes, often resulting in significant symptom relief. However, the concern is the short duration of pain relief after therapy, with symptoms commonly recurring within a few months to a year. The willingness of 100 respondents to undergo future laser therapy underscores the positive perception of this rehabilitation method among patients.

Efficacy and Outcomes of Selective Nerve Root Blocks in Diagnosis: A Systematic Review

Background: Selective nerve root blocks or transforaminal epidural injections are commonly utilized for both diagnosing and treating various spinal disorders, such as radiculopathy or nerve compression. However, there is currently no clear consensus on their role as a diagnostic tool. The effectiveness of these injections in accurately diagnosing the underlying cause of spinal pain remains uncertain, as studies show mixed results regarding their diagnostic reliability. While these injections can provide temporary pain relief and may help identify the specific nerve root involved, their long-term diagnostic value is still a topic of debate. A systematic review of clinical studies was conducted to evaluate the accuracy of selective nerve root injections for diagnosing spinal pain. Methodological quality was assessed using the PRISMA guidelines. Studies were categorized based on the strength of evidence into five levels: problem identification, literature searching, data review and evaluation, data synthesis and analysis or data presentation. Studies were categorized based on the strength of evidence into five levels: conclusive, strong, moderate, limited, or indeterminate. The review included an extensive literature search across multiple databases such as PubMed, Google Scholar and EMBASE. There is limited evidence regarding the effectiveness of selective nerve root injections as a diagnostic tool for spinal pain. Although the research is insufficient to provide stronger support, the existing literature suggests that selective nerve root injections can be useful in diagnosing uncertain cases of radicular pain. Moderate evidence supports their use in preoperative evaluations, particularly when imaging studies are negative or inconclusive. While the positive predictive value of these injections is low, they are valuable for their negative predictive value, meaning they are more effective in ruling out conditions than in confirming them.

Views and perspectives toward implementing the Global Spine Care Initiative (GSCI) model of care, and related spine care program by the people in Cross Lake, Northern Manitoba, Canada: a qualitative study using the Theoretical Domain Framework (TDF)

BackgroundBack pain is very common and a leading cause of disability worldwide. Due to health care system inequalities, Indigenous communities have a disproportionately higher prevalence of injury and acute and chronic diseases compared to the general Canadian population. Indigenous communities, particularly in northern Canada, have limited access to evidence-based spine care. Strategies established in collaboration with Indigenous peoples are needed to address unmet healthcare needs, including spine care (chiropractic and movement program) services. This study aimed to understand the views and perspectives of Cross Lake community leaders and clinicians working at Cross Lake Nursing Station (CLNS) in northern Manitoba regarding the implementation of the Global Spine Care Initiative (GSCI) model of spine care (MoC) and related implementation strategies.MethodA qualitative exploratory design using an interpretivist paradigm was used. Twenty community partners were invited to participate in semi-structured interviews underpinned by the Theoretical Domains Framework (TDF) adapted to capture pertinent information. Data were analyzed deductively and inductively, and the interpretation of findings were explored in consultation with community members and partners.ResultsCommunity leaders (n = 9) and physicians, nurses, and allied health workers (n = 11) emphasized: 1) the importance of contextualizing the MoC (triaging and care pathway) and proposed new services through in-person community engagement; 2) the need and desire for local non-pharmacological spine care approaches; and 3) streamlining patient triage and CLNS workflow. Recommendations for the streamlining included reducing managerial/administrative duties, educating new incoming clinicians, incorporating follow-up appointments for spine pain patients, and establishing an electronic medical record system along with a patient portal. Suggestions regarding how to sustain the new spine care services included providing transportation, protecting allocated clinic space, resolving insurance coverage discrepancies, addressing misconceptions about chiropractic care, instilling the value of physical activity for self-care and pain relief, and a short-term (30-day) incentivised movement program which considers a variety of movement options and offers a social component after each session.ConclusionCommunity partners were favorable to the inclusion of a refined GSCI MoC. Adapting the TDF to unique Indigenous needs may help understand how best to implement the MoC in communities with similar needs.

Management of mild Cervical Spondylotic Myelopathy

Introduction: Most of the elderly individuals with cervical spondylotic myelopathy (CSM) suffer from a progressive, and irreversible spinal cord dysfunction and pain. The incidence is rising in tandem with the ageing population. Due to its debilitating effects on a person's physical, mental, and social aspects, it is quickly becoming a public health issue. Therefore, the primary objective is to diagnose the condition in its milder form, prevent its progression, and treat the symptoms aggressively. This article discusses the management of mild CSM, including our experiences, difficulties, current state of knowledge, and potential future developments. Methodology: From the patients presenting with neck pain in the OPD, those with mild CSM according to modified Japanese Orthopedic Association (mJOA) scoring system were selected. Their disabilities were studies with commonly used scoring systems like Nurick grading, Neck Disability Index (NDI), and quality of life with SF-36v2. Only the degenerative cases were included, and other pathologies were excluded. Classical cervical disc prolapse with radiculopathy was also not included. Conservative management was initiated in all these patients and followed up for the improvement or deterioration. Results: With the above selection criteria, 235 patients with mild CSM were included in the studies. There were 186 males and 49 females with ages ranging from 42 to 78 years. The clinical profiles were studied. The major signs and symptoms were neck pain, disturbed dexterity of hands, imbalance on walking and exaggerated reflexes. The impairments were stratified and found that the average mJOA score was 16.2, Nurick score was 2.8 and NDI was 33.6. The quality of life was judged using SF-36v2 and was 39.7. The patients were monitored for three, six, twelve, and twenty-four months with conservative care. The follow up was very poor and only 46 out of the total 235 patients could be followed up to two years. Thus the result obtained could not derive any significant information. The symptoms like pain significantly reduced and there was improvement in overall scores including the quality of life. There were no case of deterioration during the conservative treatment. Thus, there was no discernible advancement that called for surgery. Conclusion: Mild CSM is a common, under diagnosed and usually ignored entity which affects big portion of elderly population. It specifically impacts the mental and social aspects that impairs one's quality of life, as well as the functional and emotional aspects. They are initially being treated conservatively and closely monitored for signs of worsening and advancement. Most of the patients respond to conservative treatment but those having risk factors for progression and bad prognosis, should remain vigilant of any features of deterioration. The treatment plan must be timely modified if a patient's clinical condition deteriorates preventing life-long sufferings.

Clinical Phenotype of HLA B*44 Patients in a Rheumatology Outpatient Clinic Favors Peripheral Arthropathies.

Objective: The genetic background of HLA-B*27 in spondyloarthritis is known, and the search for another gene with similar role is ongoing. We wanted to investigate clinical presentations of HLA-B*44 patients in rheumatology practice. Methods: A cross-sectional retrospective study of 303 HLA-B*44 adult patients from the outpatient rheumatology clinic from 5/2018-5/2024. Clinical phenotype, confirmed or excluded rheumatic diagnosis, therapy used, and data on HLA A, B, and DR alleles inherited with B*44 were analyzed. Results: A female predominance of 2.79:1 was noted. A total of 150 [49.5%] patients were referred due to peripheral joint pain, 77 [25.4%] due to combined spine and peripheral joint pain or spine alone (57 [18.8%]). A total of 19 [6.3%] patients had no symptoms of the musculoskeletal system. Statistically significant peripheral joint affection was proved in females but not in males (p = 0.04). A total of 121 [40%] patients from B*44 group had established rheumatic disease, with the rest being excluded or under observation. The most common working diagnoses were polyarthritis (32 [10.5%]) and mono-oligoarthritis (14 [4.6%]). A second allele in addition to HLA B*44 showed a similar frequency to the general population. Patients with HLA B*44/44 and B*27/44 genotypes were at the most risk for having definitive rheumatic disease (>60%). Conventional synthetic disease-modifying anti-rheumatic drugs (DMARDs) were used in 38.6% of patients, non-steroidal anti-inflammatory drugs were used in 31.6% of patients, biologic DMARDs were used in 8.9% of patients, and corticosteroids were used in 7.3% of patients. Conclusions: The most common presentation in HLA-B*44 patients is peripheral joint affection. Most patients with HLA-B*27/44 and B*44/44 genotypes had definitive rheumatic disease. B*44 homozygosity or B*27/44 might be risk factors for arthritis development.