Sudden-onset Low Back Pain Research Articles

Abstract #1403692: Discrepancy Between Dual-Energy X-ray Absorptiometry and Quantitative Computed Tomography in Analyzing Bone Mineral Density in a Patient with Primary Hyperparathyroidism, Fractures and Degenerative Joint Disease - A Case Report and Review of Literature

Primary hyperparathyroidism is associated with lower bone mineral density (BMD). Dual-energy x-ray absorptiometry (DXA) is the gold standard to measure BMD and a T-score of less than -2.5 is an indication for parathyroidectomy. However, DXA has limitations in skeletal evaluation of patients with primary hyperparathyroidism and degenerative joint disease (DJD). The use of quantitative computed tomography (QCT) should be considered for these patients to accurately assess their BMD to guide proper management. 87-year-old female with a past medical history of primary hyperparathyroidism and DJD. She has a previous history of two left femoral fractures and underwent surgical repair. She was not considered for parathyroidectomy based on her age, serum calcium, and absence of renal and skeletal indications for surgery given that her BMD only reveals osteopenia. Patient experienced sudden-onset low back pain and MRI of the spine revealed L1 compression fracture and diffuse DJD. QCT showed severe osteoporosis with BMD of 21.8 mg/c (T-score equivalent of -5.64) while her DXA only showed osteopenia on the lumbar spine and right femoral neck with T-score of -1.4 and -2.3, respectively. Based on the history of vertebral fracture and QCT result, patient was referred for parathyroidectomy. Osteoporosis is a degenerative disease of the bone characterized by low BMD which predisposes patients to low-impact, fragility fractures. Regular assessment of BMD in patients with primary hyperparathyroidism is beneficial to evaluate the need for parathyroidectomy. While current guidelines suggest the use of DXA to assess BMD, it does not always reflect the accurate state of the bones. From the review of the literature, the difference of T-scores between DXA and QCT is due to an artifact from arthritic changes and degenerative disease. DXA evaluates cortical bone and findings can be influenced by degenerative changes and facet joint hypertrophy, which is strongly associated with the overestimation of the BMD. QCT, on the other hand, evaluates trabecular and cortical bone separately and is not affected by arthrosic changes and vascular calcifications. Clinicians should be aware of the discrepancy and should consider QCT instead of DXA for screening and diagnosing of osteoporosis in patients with primary hyperparathyroidism, DJD and history of fractures. If the skeletal assessment was done by QCT and not DXA, parathyroidectomy could have been done earlier preventing her vertebral fracture. Therefore, we suggest adding the option to perform QCT instead of DXA for the skeletal assessment of patients with asymptomatic hyperparathyroidism who has DJD.

The curtain tieback: Typical aspect of tumoral and infectious epiduritis

A 71-year-old woman with multiple myeloma complaining of sudden onset low back pain, associated with functional impotence of both lower limbs. The clinical examination found paraparesis of the lower limbs. An MRI was performed 72 hours after onset of symptoms.

Devastating Cause of Low Back Pain: A Case of Spinal Cord and Vertebral Body Infarction

A 62-year-old male presented with sudden onset low back pain and bilateral lower limb weakness while playing Mahjong continuously for an hour. There was no history of trauma. He was a chronic smoker with hypertension and hypercholesterolemia but was not on any regular medication. He had no known family history of neurological or autoimmune disease.

Poster 42 Baclofen Dose Escalation Study: Using Clinical Tolerance and Pharmacokinetics to Predict Dosing Recommendations for IV Baclofen

PM&RVolume 7, Issue 9S p. S105-S105 Friday Poster Presentation Poster 42 Baclofen Dose Escalation Study: Using Clinical Tolerance and Pharmacokinetics to Predict Dosing Recommendations for IV Baclofen Robert L. Kriel MD, Robert L. Kriel MD University of Minnesota, Minneapolis, MN, United StatesSearch for more papers by this authorNatalie Schmitz, Natalie Schmitz University of Minnesota, Minneapolis, MN, United StatesSearch for more papers by this authorLisa D. Coles PhD, Lisa D. Coles PhD University of Minnesota, Minneapolis, MN, United StatesSearch for more papers by this authorLinda E. Krach MD, Linda E. Krach MD University of Minnesota, Minneapolis, MN, United StatesSearch for more papers by this authorJames C. Cloyd PharmD, James C. Cloyd PharmD University of Minnesota, Minneapolis, MN, United StatesSearch for more papers by this author Robert L. Kriel MD, Robert L. Kriel MD University of Minnesota, Minneapolis, MN, United StatesSearch for more papers by this authorNatalie Schmitz, Natalie Schmitz University of Minnesota, Minneapolis, MN, United StatesSearch for more papers by this authorLisa D. Coles PhD, Lisa D. Coles PhD University of Minnesota, Minneapolis, MN, United StatesSearch for more papers by this authorLinda E. Krach MD, Linda E. Krach MD University of Minnesota, Minneapolis, MN, United StatesSearch for more papers by this authorJames C. Cloyd PharmD, James C. Cloyd PharmD University of Minnesota, Minneapolis, MN, United StatesSearch for more papers by this author First published: 08 September 2015 https://doi.org/10.1016/j.pmrj.2015.06.083Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume7, Issue9SSeptember 2015Pages S105-S105 RelatedInformation

Triggers for an episode of sudden onset low back pain: study protocol

BackgroundMost research on risk factors for low back pain has focused on long term exposures rather than factors immediately preceding the onset of low back pain. The aim of this study is to quantify the transient increase in risk of a sudden episode of low back pain associated with acute exposure to a range of common physical and psychological factors.Methods/designThis study uses a case-crossover design. One thousand adults with a sudden onset of low back pain presenting to primary care clinicians will be recruited. Basic demographic and clinical information including exposure to putative triggers will be collected using a questionnaire. These triggers include exposure to hazardous manual tasks, physical activity, a slip/trip or fall, consumption of alcohol, sexual activity, being distracted, and being fatigued or tired. Exposures in the case window (0-2 hours from the time when participants first notice their back pain) will be compared to exposures in two control time-windows (one 24-26 hours and another 48-50 hours before the case window).DiscussionThe completion of this study will provide the first-research based estimates of the increase in risk of a sudden episode of acute low back pain associated with transient exposure to a range of common factors thought to trigger low back pain.