Thoracic Spine Pain Research Articles

Ostéoporose gravidique: À propos d'un cas

Introduction Pregnancy-associated osteoporosis is a rare disorder and its pathophysiology remains unknown. Exegisis We report a case of pregnancy-associated osteoporosis in a 27-year-old primiparous patient, revealed by acute lumbar pain and a right costal pain during the last month of pregnancy. The standard radiographs showed multiple vertebral compression fracture and a 10th rib fracture. The diagnosis of osteoporosis was established by osteodensitometry. Diagnostic work-up excluded a secondary osteoporosis, and the outcome was favourable with an increase of bone mineral density after 2 years of treatment with calcium, vitamin D and alendronate 10 mg/j. Conclusion Although rare, diagnosis of pregnancy-associated osteoporosis should be suspected when thoracic or lumbar spine pain occur during pregnancy or in the post-partum period as it can lead to vertebral or peripheral fractures.

A 44-Year-Old Woman With Polyarthritis, Fever, and Hilar Adenopathy

A 44-year-old white woman presented with an 8-week history of increasing bilateral (right more than left) ankle pain with progressive periarticular edema and inflammation. The right wrist and both elbows were additively and mildly involved. She had intermittent fever with no clear pattern, malaise, mild thoracic spine pain, and intermittent limb muscle aches. Dry cough was present 4 days before hospital admission. The patient was treated with nonsteroidal antiinflammatory drugs and morphine at another hospital for 4 days before being transferred to our institution for management of asymmetric large-joint polyarthritis of unclear etiology.

Vertebroplasty in the Treatment of Spine Disease

We report our experience in the treatment of thoracic and lumbosacral spinal pain due to vertebral bone fractures. This pathology can be related to osteoporosis but also to metastatic disease and less frequently vertebral haemangioma. From April 2001 through December 2004 we treated 238 patients for a total of 455 vertebral bodies. 175 patients had osteoporosis, 70 had metastasis and 13 had vertebral haemangioma. Sacroplasty was performed in six patients to obtain a cement filling of sacral metastasis. The procedures were mostly performed under fluoroscopy and only in cases of metastasis or sacroplasty was CT/fluoroscopy guidance preferred for optimal filling of the area of osteolysis. We evaluated the results at six and 18 months follow-up and analysed the incidence of new vertebral fractures, vascular and disk leakage and the incidence of major and minor complications. Biopsy was performed only in doubtful cases. We obtained different results considering the etiology of the disease. We obtained a 92% success rate at six months follow-up and 89% success at 18 months follow-up in osteoporosis, a 77% and 72% success rate at six and 18 months follow-up in metastastic patients, and no change at six and 18 months follow-up in patients with vertebral haemangioma in which the success rate was of 95%. We noted extravertebral leakage in 41% of vertebral bodies of which 31% were treated at the level of the vascular space and only 10% at the level of the disk space, and symptomatic in only two cases (acute compressive radiculitis, medically treated and resolved within a month). Six patients presented new fractures in the adjacent vertebral body and 30% had a partial recovery in the height of the vertebral body with kyphosis curve reduction. Vertebroplasty is a good technique to obtain spine pain relief and has a low incidence of side effects. Good quality equipment is important to obtain these results.

Multidrug-resistant tuberculous spondylodiscitis: need for aggressive management and drug susceptibility testing of Mycobacterium tuberculosis isolates

A 49-year-old woman complaining of thoracic spine pain for 18 months was admitted to the hospital for evaluation. Magnetic resonance imaging of the thoracic spine showed spondylodiscitis of the T8-T9 intervertebral disk. Computed tomography scan-guided fine needle aspiration of the affected area was performed but it did not reveal the cause of the disease. Because of continuing symptoms and lack of diagnosis the patient underwent a vertebrectomy and substitution of the eighth thoracic vertebra with Moss titanium cylinder filled-up with auto-bone grafts. Culture of the extracted bone grew Mycobacterium tuberculosis, which was resistant to isoniazid and rifampin. Persistent and even invasive diagnostic work up is needed for the proper and prompt management of patients with spondylodiscitis.

Management of acute musculoskeletal pain

AbstractThe pain and disability associated with musculoskeletal conditions represent a significant and increasing health burden worldwide. Musculoskeletal conditions of acute onset and short duration occur commonly, affect all age groups, and are usually idiopathic. Successful management of acute pain is paramount if chronic pain conditions are to be avoided.This article focuses on interventions for five areas of acute musculoskeletal pain (acute low back pain, acute thoracic spinal pain, acute neck pain, acute shoulder pain and anterior knee pain). It summarizes the results of a multidisciplinary evidence review recently conducted by the Australian Acute Musculoskeletal Pain Guidelines Group.

Prevalence of facet joint pain in chronic spinal pain of cervical, thoracic, and lumbar regions.

BackgroundFacet joints are a clinically important source of chronic cervical, thoracic, and lumbar spine pain. The purpose of this study was to systematically evaluate the prevalence of facet joint pain by spinal region in patients with chronic spine pain referred to an interventional pain management practice.MethodsFive hundred consecutive patients with chronic, non-specific spine pain were evaluated. The prevalence of facet joint pain was determined using controlled comparative local anesthetic blocks (1% lidocaine or 1% lidocaine followed by 0.25% bupivacaine), in accordance with the criteria established by the International Association for the Study of Pain (IASP). The study was performed in the United States in a non-university based ambulatory interventional pain management setting.ResultsThe prevalence of facet joint pain in patients with chronic cervical spine pain was 55% 5(95% CI, 49% – 61%), with thoracic spine pain was 42% (95% CI, 30% – 53%), and in with lumbar spine pain was 31% (95% CI, 27% – 36%). The false-positive rate with single blocks with lidocaine was 63% (95% CI, 54% – 72%) in the cervical spine, 55% (95% CI, 39% – 78%) in the thoracic spine, and 27% (95% CI, 22% – 32%) in the lumbar spine.ConclusionThis study demonstrated that in an interventional pain management setting, facet joints are clinically important spinal pain generators in a significant proportion of patients with chronic spinal pain. Because these patients typically have failed conservative management, including physical therapy, chiropractic treatment and analgesics, they may benefit from specific interventions designed to manage facet joint pain.

Chiropractic Care of a Geriatric Patient with an Acute Fracture-Subluxation of the Eighth Thoracic Vertebra

Objective To describe the chiropractic care of a geriatric patient with complaints of midthoracic and low back pain. Clinical Features A 74-year-old woman sought chiropractic care with complaints of thoracic spinal pain following a fall. Palpation findings included hypertonicity and tenderness along with painful muscle spasms in the paraspinal musculature of the thoracolumbar spine. Limited range of thoracolumbar motion was found on extension and lateral flexion, most notably on right lateral flexion, with pain. Radiographic examination revealed a compression fracture at T8, in addition to spinographic listings. Signs of sprain injury were also detected at T8. Intervention and Outcome The patient was cared for with contact-specific, high-velocity, low-amplitude adjustments to sites of vertebral subluxations and at the T8 fracture-subluxation. The patient's response to care was positive. Conclusion This case report describes the clinical features, care, and results of 1 geriatric patient with a thoracic compression fracture-subluxation treated with specific chiropractic procedures. The patient had an apparent decrease in pain as a result of the treatment. Due to the inherent limitations of a case report, it is inappropriate to generalize this outcome.

Evaluation of the Prevalence of Facet Joint Pain in Chronic Thoracic Pain

The role of zygapophysial (facet) joints in chronic thoracic pain has received very little attention with only a few publications discussing these joints as sources of pain. In contrast, facet joints have been implicated as responsible for chronic pain in a significant proportion of patients with chronic neck and low back pain. However, thoracic spinal pain, though less common, has been reported to be as disabling as neck and low back pain. This study was designed to evaluate all the consecutive patients presenting with thoracic pain and undergoing diagnostic medial branch blocks during 2001. All the patients failed conservative management with physical therapy, chiropractic therapy and drug therapy. All patients underwent diagnostic facet joint nerve blocks using lidocaine 1%, initially followed by bupivacaine 0.5% on separate occasions. Results showed that 46 patients underwent single blocks with lidocaine and 36 of these patients, or 78%, were positive for facet joint pain, reporting a definite response. Confirmatory blocks with bupivacaine were performed in all patients who were lidocaine-positive, with 61%, or 48% of the total sample of the lidocaine-positive group, reporting a definite response with improvement in their pain. Thus, comparative local anesthetic blocks showed the prevalence of facet joint pain to be 48%, with single blocks carrying a false-positive rate of 58%.

The effect of soft tissue deloading tape on thoracic spine pressure pain thresholds in asymptomatic subjects

The application of tape to deload soft tissue is used in the management of thoracic spine pain. A reported clinical feature of this treatment is reduced tenderness of the spine during postero-anterior mobilizations. A randomized, single blind, placebo controlled, repeated measures design study was employed to investigate the effects of deloading tape on pressure pain threshold measurements at the level of the T7 spinous process in an asymptomatic group of 24 subjects. Pressure pain thresholds were assessed prior to and following the application of deloading tape, placebo sham tape and no-tape control conditions. All subjects received all three conditions in a randomized order on three separate days. Differences between the pre- and post-measurements were used as indicators of change in a subject's pressure pain threshold. No significant change in pressure pain threshold measurements was found between conditions. In summary, this study demonstrated that deloading tape applied to the level of the T7 spinous process did not significantly change pressure pain threshold measurements in asymptomatic subjects, raising the possibility that any pain relieving effect may well be conditional upon pain being present.

Spinal manipulation superior to placebo in treating mechanical thoracic spine pain

Spinal manipulation superior to placebo in treating mechanical thoracic spine pain

Acute respiratory distress syndrome: Clinical recognition and preventive management in chiropractic acute care practice

<h2>Abstract</h2> <b>Objective:</b> To present clinical information relevant to acute respiratory distress syndrome (ARDS) and its appearance in chiropractic acute care practice. <b>Data Sources:</b> The National Library of Medicine MEDLINE database was used, along with the bibliographies of selected articles and textbooks commonly found in chiropractic college libraries and bookstores. <b>Study Selection:</b> Clinical studies from the English literature were selected if they pertained to incidence, clinical relevancy, or the association of ARDS with commonly-seen diagnoses in chiropractic neuromusculoskeletal or orthopedic practice. <b>Data Extraction:</b> All relevant studies identified by the search were evaluated based on information pertinent to chiropractic management of acute care patients. <b>Results:</b> ARDS is a pulmonary distress syndrome with a high mortality rate. Recognizable indications for the possible development of ARDS include chest pain, head injury, and thoracic spine pain with or without trauma. Clinical evaluation, radiographic findings, and laboratory findings are presented to assist practitioners in identifying this disease process of multiple etiology. A study of the basic pathophysiologic processes that occur in the formation of ARDS is presented to help practitioners gain clinical appreciation. Strategies for preventing respiratory distress in chiropractic patients are also presented and include use of the postural position and the clinical maxim of "slow, deep breathing despite pain" to lessen incident rates of subjects at risk. <b>Conclusion:</b> Although ARDS may not be prevalent in chiropractic practice, it is important for physicians to be aware of the clinical basics (including its pathophysiology), its medical significance, and the preventive strategies that may be used to minimize its occurrence. This basic understanding will further advance knowledge of this disease complex.

Acute respiratory distress syndrome: Clinical recognition and preventive management in chiropractic acute care practice

Objective: To present clinical information relevant to acute respiratory distress syndrome (ARDS) and its appearance in chiropractic acute care practice. Data Sources: The National Library of Medicine MEDLINE database was used, along with the bibliographies of selected articles and textbooks commonly found in chiropractic college libraries and bookstores. Study Selection: Clinical studies from the English literature were selected if they pertained to incidence, clinical relevancy, or the association of ARDS with commonly-seen diagnoses in chiropractic neuromusculoskeletal or orthopedic practice. Data Extraction: All relevant studies identified by the search were evaluated based on information pertinent to chiropractic management of acute care patients. Results: ARDS is a pulmonary distress syndrome with a high mortality rate. Recognizable indications for the possible development of ARDS include chest pain, head injury, and thoracic spine pain with or without trauma. Clinical evaluation, radiographic findings, and laboratory findings are presented to assist practitioners in identifying this disease process of multiple etiology. A study of the basic pathophysiologic processes that occur in the formation of ARDS is presented to help practitioners gain clinical appreciation. Strategies for preventing respiratory distress in chiropractic patients are also presented and include use of the postural position and the clinical maxim of “slow, deep breathing despite pain” to lessen incident rates of subjects at risk. Conclusion: Although ARDS may not be prevalent in chiropractic practice, it is important for physicians to be aware of the clinical basics (including its pathophysiology), its medical significance, and the preventive strategies that may be used to minimize its occurrence. This basic understanding will further advance knowledge of this disease complex.

Effectiveness of spinal manipulative therapy in the treatment of mechanical thoracic spine pain: A pilot randomized clinical trial

Background: To date, no substantiated studies have been performed to investigate the efficacy of spinal manipulative therapy on thoracic spinal syndromes. Objective: To investigate the effectiveness of spinal manipulative therapy in the treatment of mechanical thoracic spine pain. Study Design: A single-blind, randomized, comparative, controlled pilot study. Setting: Technikon Natal Chiropractic Clinic in Durban, South Africa. Participants: Thirty subjects selected from the general population (from 16 to 60 years old) were randomly divided into two different treatment groups of 15 each. Methods: The objective measurements collected were the thoracic spine ranges of motion with the BROM II goniometer and pain threshold with an algometer. The subjective information required completion of the Oswestry Back Pain Disability Index, short-form McGill Pain Questionnaire, and Numerical Pain Rating Scale-101 Questionnaire by the patient. These 3 forms and objective measurements were collected before the first and final treatment and again at the 1-month follow-up consultation. The data gathered were then statistically analyzed with use of a 95% confidence level. The nonparametric Mann-Whitney U test and the Wilcoxon signed-rank test were used to compare intergroup and intragroup data, respectively. This was conducted at the α =.05 level of confidence. Further assessment of the data was conducted by use of power analysis. Interventions: The treatment group received thoracic spinal manipulation. The placebo group received nonfunctional ultrasound application only. The research project was carried out so that both groups received 6 treatments over a period of 2 to 3 weeks. A 1-month follow-up appointment was scheduled after the final treatment to assess the relative long-term benefits of the two different treatments. Results: Statistically significant results (P ≤.025) were noted for the percentage of pain experienced (Numerical Pain Rating Scale) and for right and left lateral flexion during intergroup comparison after the final treatment. The final treatment results were maintained at the 1-month follow-up consultation; however, there were no further statistically significant results. It was noted that the power was weak, so the probability of committing type II error (falsely accepting the null hypothesis) for the other measurements was high. The intragroup analysis showed statistically significant improvements in the group that received spinal manipulative therapy in both subjective and objective measurements between the first to final treatment and the first treatment to the 1-month follow-up consultation. The placebo group analysis showed a statistically significant improvement in sensory pain only (subjective measurement) between the first treatment and the final treatment. Conclusions: This pilot study suggests that spinal manipulative therapy has greater benefits than placebo treatment. The sample size was small, therefore the findings of this trial study should not be considered conclusive but rather should be used as a foundation for planning future studies. In further studies a larger sample size will be necessary to identify subtle changes in measurement parameters and to add to the validity of the results. (J Manipulative Physiol Ther 2001;24:394-401)

Thoracolumbar Pain among Fighter Pilots

High +Gz forces place high stress on the spinal column, and fighter pilots flying high-performance fighter aircraft frequently] report work-related thoracic and lumbar spine pain. The aim of this study was to determine whether +Gz exposure causes work-related thoracolumbar spine pain among fighter pilots. A questionnaire was used to establish the occurrence of thoracic and lumbar spine pain during the preceding 12 months and during duties over the whole working career among 320 fighter pilots and 283 nonflying controls matched for age and sex. Thirty-two percent of the pilots and 19% of the controls had experienced pain in the thoracic spine during the preceding 12 months (odds ratio [OR] = 2.3; 95% confidence interval [CI] = 1.5-3.5; p = 0.002 for the pilots). Among the pilots, the OR increased up to 6.1 (95% CI = 1.6-23.1; p = 0.0007) with the number of +Gz flight hours. There was no difference between the groups with regard to lumbar pain during the preceding 12 months, but over their whole working careers fighter pilots (58%) had experienced lumbar pain during their duties more often than controls (48%) (OR = 1.8; 95% CI = 1.3-2.6; p = 0.002). The greater the number of +Gz flight hours, the greater the occurrence of lumbar spine pain when on duty (OR = 26.9; 95% CI = 6.2-116; p = 0.0001 for the most experienced fighter pilots). The same was not true with regard to the number of +Gz flight hours and lumbar pain during the preceding 12 months. Age had no effect on pain in the thoracic or lumbar spine. Fighter pilots flying high-performance aircraft have more work-related thoracic and lumbar spine pain than controls of the same age and sex. The difference is explained by the pilots' exposure to +Gz forces.

Physician-applied contact pressure and table force response during unilateral thoracic manipulation

Objective: To measure the applied loading to human subjects during the reinforced unilateral thoracic manipulation. Design: Biomechanical descriptive study. Setting: The National College of Chiropractic Clinical Biomechanical Laboratory in Lombard, Illinois. Subjects: Seven men, ages 24 to 47, with no positive responses regarding muscle relaxants or thoracic spinal fractures, surgeries, or pain. Main Outcome Measures: We measured the contact pressure distribution at the physician-subject contact region and extracted three biomechanical parameters. From the measured timedependent support force magnitudes, we extracted five additional biomechanical parameters. Results: In the application of the reinforced unilateral manipulative treatment, the physician establishes contact and applies a near-static preload force of 250 to 350 N. The dynamic portion of the typical thrust is preceded by a 22% decrease in force magnitude, and the peak thrust magnitude is linearly related to the preload force magnitude. We estimate that the peak contact pressure beneath the chiropractor's pisiform can exceed 1000 kPa, with the highest pressures transmitted over areas as small as 3.6 cm 2, depending on manipulative style. Conclusions: This work represents the first attempt at performing simultaneous measurements of the physician-applied loading and table force response and measuring the contact pressure distribution at the physician-patient contact region during chiropractic manipulation. This type of work will lead to a better understanding of the relationship between the dynamic physician-applied normal forces and the resulting load response at the table and gives us additional outcome parameters to quantify manipulative technique. (J Manipulative Physiol Ther 1999;22:269–79)

Thoracic scoliosis and restricted neck motion: a new syndrome? A report of six cases.

The cases of six adolescent males with a mild thoracic scoliosis of unknown etiology and a marked limitation of neck flexion are reported. All six complained of mild thoracic spine pain and were 13-17 years old at the onset of their symptoms. In addition to the thoracic scoliosis, all were found to have a marked limitation of neck flexion. They were unable to touch their chest wall with their chin. None had a positive family history of scoliosis. Radiological examination revealed a thoracic scoliosis of 10 degrees-40 degrees, no abnormalities were detected on cervical spine plain radiographs. Extensive investigations, including MRI of the entire spine, failed to disclose the cause of the spinal deformity or the mechanism causing the limitation of neck motion. Apart from the limited cervical flexion and mild pain, this condition was found to be benign and the spine deformity to be mild or moderate in nature and with limited progression. Review of the literature failed to identify similar cases.

Percutaneous facet denervation in chronic thoracic spinal pain.

In 40 patients with chronic thoracic spinal pain of more than 12 months duration which failed to respond to conservative treatment and with a previous evaluation by specialists, mainly neurologists and orthopaedic surgeons, the diagnosis of facet syndrome was made. This diagnosis was based on clinical criteria and a transient positive response to a prognostic blockade of the medial branch of the dorsal ramus of the thoracic spinal nerve. They were selected to undergo percutaneous radiofrequency denervation of the facet joints. The short and long-term results of 51 percutaneous thoracic facet denervations in 40 patients are described. After 2 months, 19 patients (47.5%) were pain-free, 14 patients (35%) had more than 50% pain-relief, and 7 patients (17.5%) had no relief. After a follow-up of 18-54 (average 31) months in 36 cases (3 patients had died because of malignancy, and 1 had undergone a spinal fusion), 16 patients (44%) were pain-free, 14 patients (39%) had more than 50% pain-relief and in 6 cases (17%) the result was poor. Adverse effects consisted of postoperative pain in 5 patients (12.5%). When conservative treatment fails, percutaneous thoracic facet denervation can be a safe and beneficial therapy in chronic thoracic spinal pain originating from the facet joints.

Spontaneous regression of intervertebral disc calcifications in a child

This article presents the case of a boy who complained of cervical and thoracic spine pain for the first time at the age of nine. Plain films of cervical and thoracic spine showed calcifications of intervertebral disc C4-C5, C5-C6, C6-C7 and D3-D4. The symptoms disappeared after conservative therapy. Plain films taken 16 months later showed spontaneous disappearance of all disc calcifications. This spontaneous regression of intervertebral disc calcifications in childhood has also been described in other cases reported in the medical literature. Except for the rare cases when disc calcifications are associated with disc herniation, the discovery of disc calcifications on a plain X-ray of a child corresponds to a benign abnormality.

Lumbar and Thoracic Spine Pain in the Athlete: Radiographic Evaluation

A comprehensive but basic and updated systematic radiographic approach to various pain-producing thoracolumbar diseases is presented. The advantages and limitations of available diagnostic modalities are discussed in relation to the clinically considered etiologies.