Traction Therapy Research Articles

Effectiveness of Transforaminal Epidural Steroid Injection and Lumbar Traction in Lumbar Radiculopathy Due to Intervertebral Disc Herniation: A Comparative Study

Background: Lumbar radiculopathy, commonly caused by intervertebral disc herniation, leads to severe pain and disability. Various non-surgical treatments, including Transforaminal Epidural Steroid Injection (TESI) and lumbar traction, are employed to alleviate pain and improve functionality. Objective: The study aimed to compare the effectiveness of TESI and lumbar traction in managing lumbar radiculopathy. Methods: This study was designed as a prospective, randomized, comparative trial conducted over 12 months at a tertiary care center, involving 100 patients diagnosed with lumbar radiculopathy due to intervertebral disc herniation (IDH). Eligible patients, aged 18 to 65 years with MRI-confirmed disc herniation causing radiculopathy, were randomly assigned to either the TESI group (n=50) or the lumbar traction group (n=50). Exclusion criteria included patients with prior lumbar surgery, spinal infections, or tumors. The TESI group received a single transforaminal epidural steroid injection under fluoroscopic guidance, while the lumbar traction group underwent mechanical traction therapy for 30 minutes per session, three times a week for six weeks. Outcome measures included pain intensity, assessed using the Visual Analog Scale (VAS) at baseline, two weeks, and six months post-intervention, functional outcome using the Oswestry Disability Index (ODI) at the same time points, and patient satisfaction using a five-point Likert scale at six months. Statistical analyses were conducted using SPSS software, with significance set at p-values <0.05. Results: The results of this study demonstrated that both the TESI and lumbar traction groups experienced significant improvements in pain and functional outcomes; however, the TESI group showed more pronounced results. In terms of pain reduction, the TESI group’s mean VAS score decreased from 7.5 at baseline to 3.2 at two weeks and 2.8 at six months, while the lumbar traction group saw a decrease from 7.6 to 5.1 at two ........

Intralesional and topical treatments for Peyronie's disease: a narrative review of current knowledge.

Peyronie's disease (PD) presents a multifaceted challenge in contemporary urological practice, marked by penile deformity, pain, and the potential for erectile dysfunction. We meticulously explored the existing literature of intralesional/topical interventions, aiming to provide clinicians with a nuanced understanding of available options for comprehensive PD management. To conduct this review, we performed a systematic search using the PubMed, Scopus, and ScienceDirect databases, including the keywords of combination of the "Peyronie's disease/plastic induration of the penis (PIP) and intralesional/topical treatments". The study selection was based on adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, resulting in the inclusion of 16 articles. We delve into the effectiveness and safety profiles of collagenase Clostridium histolyticum (CCH), interferon, platelet-rich plasma (PRP), hyaluronic acid, botulinum toxin, stem cell, extracorporeal shock wave therapy (ESWT), and traction therapy, assessing their impact on penile curvature, length improvement, and patient-reported symptoms and outcomes. The best options evaluated are intralesional injections of CCH and penile traction devices, alone or in combination. Despite PD remains a challenge for urologists, the objective of this review is to contribute to the evolving landscape of PD management, fostering informed decision-making, and personalized care for individuals grappling with this challenging condition.

Clinical outcomes of gradual reduction of late-detected developmental dysplasia of the hip using ultrasound-guided flexion abduction continuous traction: a midterm follow up study.

Reducing the avascular necrosis (AVN) rate in infants treated for developmental dysplasia of the hip (DDH) is important. We previously reported the clinical outcomes of gradual reduction via ultrasound-guided flexion abduction continuous traction (FACT-R), which achieved a 99% reduction with an AVN rate of 1.0% in infants <12 months. Here, we investigated the clinical outcomes of late-detected DDH after FACT-R. Infants ≥12 months who were treated with FACT-R for DDH from January 1995 to 2007 and followed up for 6 years were enrolled. Treatment comprised continuous traction, a hip-spica cast, and an abduction brace. The rates of reduction, redislocation, AVN, and secondary osteotomy surgery were evaluated. In the study patients (n = 26, hips 30), the mean age at the time of traction therapy was 23 months (range: 13-44) and the mean follow-up was 12.5 years (range: 6-16.4). Female gender and the left side were predominant. The rates of reduction, redislocation, and AVN were 100%, 0%, and 0%, respectively. However, 25 hips (83%) required secondary osteotomy surgery, including Salter innominate osteotomy in 21 hips, Salter innominate osteotomy combined with femoral osteotomy in 3 hips, and triple pelvic osteotomy in 1 hip. They had a larger acetabular index after FACT-R (P = 0.04) and a longer duration of FACT-R (P = 0.05). All hips were successfully reduced, with no redislocation or AVN. However, most hips required a secondary osteotomy surgery because of residual dysplasia. Careful follow-up and informed consent for secondary osteotomy surgery is thus essential.

Acute Phase Peyronie's Disease: Where Do We Stand?

Peyronie's disease (PD) is a common benign condition characterized by superficial fibrosis and scar formation at the tunica albuginea of the penis, eventually leading to penile curvature. It is believed that penile micro-traumas during intercourse and subsequent activation of inflammatory processes constitute the pathogenetic basis of the disease. Routinely, PD is divided into acute and chronic phases, with pain during erection or flaccid state being the hallmark of the former. Surgical intervention should be avoided during the acute phase, as the risk of recurrence or progression of penile deformity during this stage might affect the optimal outcomes of the procedure. During this stage, many conservative treatment options have been suggested, including oral, topical, and intralesional therapies, extracorporeal shock wave therapy (ESWT), and penile traction therapy (PTT). Currently, the optimal treatment consists of a combined treatment strategy with phosphodiesterase type 5 inhibitors (PDE5Is), ESWT for pain management, PTT, and intralesional therapies. Large, well-designed randomized controlled trials (RCTs) are necessary to further elucidate the most efficient treatment option for acute phase PD.

Balance chiropractic therapy for cervical spondylotic radiculopathy: A randomized controlled trial

ObjectiveTo assess the clinical effectiveness of the balance chiropractic therapy (BCT) compared with traction therapy (TT) for patients with cervical spondylotic radiculopathy. MethodsSubjects were enrolled from four hospitals. Eligible patients will be randomized to one of the two arms: the treatment group and the control group. In the treatment group, patients received the BCT for 20 days, while patients in the control group received TT. Patients visited the physician at 1- and 3-month follow-up. The primary outcome was pain severity measured with a Visual Analog Scale (VAS). Secondary outcomes included cervical curvature measured using the Borden method, a composite of functional status measured by the Neck Disability Index (NDI), patient health status (evaluated by the SF-36 health survey) and adverse events (AEs) as reported in the trial. ResultsOf the 240 randomly assigned patients, 120 participants were assigned to the BCT and 120 to the TT. 231 (96.3 %) provided follow-up data at 1 and 3 months. There were no significant differences in baseline data between the two groups (P > 0.05), indicating good comparability. According to the results, after BCT and TT treatment, the pain VAS score, cervical curvature, NDI scores and SF-36 scores of two groups was significantly improved (P < 0.05). Furthermore, at 20 days of treatment and 1 and 3 months of follow-up, the participants in the BCT group showed superior treatment outcomes on both primary and secondary measures. ConclusionThe BCT may be a novel strategy for the treatment of the cervical spondylotic radiculopathy. Trial registrationClinical Trials.gov Identifier: NCT02705131. Registered on March 10, 2016, https://clinicaltrials.gov/study/NCT02705131?cond=NCT02705131&rank=1&tab=table.

도수치료의 키 성장 효과에 대한 실증연구

The necessity of this study can be summarized as follows: Previous research on height growth has mainly presented results from medical approaches. However, individuals seeking height growth through medical interventions such as medication or surgery entail significant risks, time, and costs. Through empirical research utilizing chiropractic therapy in this study, it has been validated that such risks can be avoided, and consequently, the effectiveness is substantial. Furthermore, physical therapists can provide therapeutic tips essential for height growth treatment. To validate this, the summary of the research method is as follows: It is crncial to determine whether the increase in height is due to chiropractic therapy or if chiropractic therapy aids in height growth. Additionally, the sustainability of the results needs verification. Therefore, results observing the sustainability of height growth at least three months later will be provided. The tool utilized is a machine called BestRack, which is used to determine if there is a positive effect on height growth even in the short term (one month). BestRack is a tool where the individual lies on a bed and stands upside down, mainly used for traction therapy. However, prior to traction therapy, relaxation, stimulation, and chiropractic techniques were applied to students to ensure flexibility. In other words, both height growth therapy (flexibility enhancement) and BestRack (traction) were simultaneously applied to measure changes in height before and after. However, the limitation of the one-month measurement period assumes that most chiropractic therapy patients do not require long-term treatment. Despite this short-te1m validation of height growth effects, objective results will be provided by measuring whether continuous growth or cessation of growth occurs after three months. The research results indicated an increase in height ranging from l .6cm to 2.0cm. Particularly, individuals with shorter heights prior to the study showed more significant height growth, while those with taller heights did not exhibit significant growth. In chiropractic therapy, height increased by a minimum of +0.45cm to +9.55cm, while using BestRack resulted in height growth ranging from +o.74cm to +9.25cm. Furthermore, it was confirmed that most paiiicipants either maintained the height gained or experienced an additional growth of up to an average of 1 cm after three months.

Optimization of traction parameters for lumbar scoliosis

BackgroundScoliosis is a high incidence disease that endangers the physical and mental health of adolescents. Traction therapy, as a conservative treatment plan, is helpful to improve the recovery speed of patients by studying the influence of different traction factors on the therapeutic effect.MethodsBased on the thin layer CT data of the lumbar spine of a 16-year-old patient with scoliosis, Mimics21.0 was used to extract the 3D digital model, and Geomagic Wrap2021 was used to perform the smooth surface. After that, SolidWorks was used to manually construct the structures, such as the intervertebral disc, and Ansys17.0 was used to add constraints, ligaments, and other features. Three-factor ANOVA was carried out after an orthogonal experiment that considered traction mode, traction angle, and traction force was finished.Results① A three-dimensional biomechanical model of lumbar scoliosis was created. ② The model’s correctness was confirmed by comparing it to the corpse and other finite element models, as well as by verifying it under a range of working settings. ③ Traction force (P = 0.000), traction angle (P = 0.000), the interaction between traction force and traction angle (P = 0.000), and the interaction between traction mode and traction angle (P = 0.045) were all significant. ④ The interaction between traction force and traction angle has the most significant effect on Cobb, and traction with a certain angle is better than traditional axial traction. ⑤ Traction mode is not significant, but the interaction between traction mode and traction angle is significant.ConclusionsA certain angle of traction can aid in improving outcomes and the traction force can be suitably decreased in the clinical formulation of the traction plan. The uniformity of correcting effect is more favorable when higher fixation techniques like positive suspension or traction bed traction are used, as opposed to overhanging traction.

Conservative treatment of Peyronie's disease: a guide.

To review the literature on the topic, to suggest a common line of treatment applicable across a wide community of specialists, and to contribute in maintaining the high level of interest in this disease. A comprehensive and exhaustive review of the literature was performed, identifying hundreds of articles on the topic. Peyronie's disease is a condition that has been recognized, studied, and treated for centuries; despite this, if one excludes surgery in cases in which the deformity is stable, no clear treatment (or line of treatment) is available for complete relief of signs and symptoms. Treatment options were divided into local, oral, and injection therapy, and a wide variety of drugs, remedies, and options were identified. Low-intensity extracorporeal shock wave therapy, vacuum therapy, penile traction therapy, phosphodiesterase type 5 inhibitors, hyaluronic acid, and collagenase of Clostridium histolyticum may be recommended only in specific contexts. Further studies on individual options or potential combinations are required.

A contemporary systematic review of penile lengthening procedures with penile prosthesis.

Penile prosthetic devices are the standard treatment for erectile dysfunction (ED) after failure of maximum medical therapy and conservative options. Several penile lengthening procedures (PLPs) can be performed concurrently with penile prosthesis (PP) insertion in patients with severe ED, penile shortening, and/or Peyronie's disease to help combat negative emotional and psychological concerns from penile length loss with penile prosthetic device placement. An extensive, systematic literature review of the various pre-, intra-, and post-operative techniques that can be applied to preserve, restore or enhance penile length at the time of penile prosthetic implantation. Numerous pre-operative and post-operative inflation protocols exists with vacuum erection devices and penile traction therapy. Intraoperative surgical techniques include cavernosal sparing and channeling without dilatation, subcoronal incision with circumferential penile degloving and grafting, the sliding technique, the modified sliding technique, the multiple-slit technique, the tunical expansion procedure (TEP), modified TEP, and the auxetic expansion procedure. These approaches can be meaningful to restore and/or preserve length for patients undergoing PP insertion. PLPs can be performed by surgeons who have extensive penile reconstruction experience and have been trained to do these procedures, as there is significant risk to the patient and limitations to what can be expected. Each patient must be counseled in detail about the risks and benefits of these procedures and have their expectations managed as the average postoperative penile length recovery is around 3 cm and can range from 0-4.0 cm. Future research is needed to identify the appropriate candidate for each approach, and how much length gain the patient can expect.

The Efficacy of Manual Nerve Mobilization Combined with Traction Therapy in the Treatment of Nerve Root Cervical Spondylosis

Objective: This study aimed to evaluate the therapeutic effect of the manual nerve mobilization technique combined with traction therapy on nerve root cervical spondylosis and to investigate its effect on symptomatic improvement and functional recovery of patients. Methods: 101 patients diagnosed with nerve root cervical spondylosis were selected and randomly divided into two groups. The control group received conventional medication and physical therapy, while the observation group was treated with manual nerve mobilization combined with traction therapy. The manual nerve mobilization technique uses a delicate and gentle technique to reduce pain and inflammation by loosening the soft tissues around the compressed nerve roots. Traction therapy was used to relieve pressure on the cervical discs pull on the nerve roots, and restore the normal physiologic curvature of the cervical spine. All patients were assessed for pain scores and neck mobility before and after treatment. Results: At the end of the treatment, the pain scores of the patients in the observation group were significantly reduced and neck mobility was significantly improved, with a significant difference compared with the control group (P &lt; 0.001). No serious adverse events occurred in the patients of the observation group after the completion of treatment. Conclusion: Manual nerve mobilization combined with traction therapy has good efficacy in the treatment of nerve root cervical spondylosis. This therapy can effectively reduce patients’ pain and improve neck motor function. Therefore, the promotion and application of this therapy in rehabilitation therapy will play a positive role in the recovery of patients with radiculopathy.

Potential of Cytokines in the Management of Intervertebral Disc Degeneration

The illness known as intervertebral disc degeneration (IDD) is characterized by discomfort in the intervertebral discs. The IDD is made up of the annulus fibrosus (AF) and nucleus pulposus (NP), which function as a joint and cushion for the spine. IDD can develop with ageing, which can cause the NP to herniate and cause pain. IDD patients experience detrimental effects on their quality of life and mental health in addition to their physical health. It also poses a critical economic burden on society as a whole. Imaging techniques used for the diagnosis are disc herniation, X-ray plain film, CT, and MRI are discussed as imaging modalities, with MRI being particularly useful for diagnosing disc herniation. Treatment approaches range from conservative methods to surgical intervention, related to the type of IDD. Nonsteroidal anti-inflammatory medications, rest, traction therapy, and physical therapy are examples of non-surgical therapies. Options for surgery include conventional open surgery, microsurgical lumbar discectomy, minimally invasive IVD removal surgery, and artificial IVD replacement surgery. Many studies are focused on the role of cytokines to explain the cause of IDD. And these cytokines can be classified as cell cycle inhibitor, proinflammatory factor and growth factor. The article highlights cell cycle inhibitors (p16INK4a and p53), proinflammatory factors (IL-1β and TNF-α), and growth factor (TGF-β) involvement in IDD. However, currently, there are no cytokine-based treatments available for IDD in clinical practice. Future research could focus on developing new treatment or prevention targets for IL-1β or TNF-α.

(016) A Global Survey of Sexual Dysfunction Management among Urologists and Sexual Medicine Experts

Abstract Introduction Understanding and addressing sexual dysfunction is of paramount importance to enhance the overall well-being and quality of life of individuals worldwide. While significant progress has been made in the field of sexual medicine, variability in practice patterns among healthcare professionals remains a potential barrier to optimal patient care. To bridge this knowledge gap and identify the prevailing trends in sexual dysfunction management, we conducted an international survey targeting urologists specializing in Andrology, Sexual Medicine, and related fields. Objective This international survey aimed to assess male and female sexual dysfunction management practices among sexual medicine physicians across to globe to identify variability in practice patterns. Methods A survey was distributed globally to urologists specializing in Andrology, Sexual Medicine, and related fields who are members of International Society for Sexual Medicine (ISSM) or affiliated regional societies (SMSNA, ESSM, MESSM, APSSM, SASSM, SLAMS, ISSWSH, SIU). Demographic information (age, gender, specialty, and practice setting) and treatment approaches for male and female sexual dysfunction were collected. Respondents also reported the percentage of their practice dedicated to sexual dysfunction and whether treatments were covered by health insurance. Results A total of 200/3000 practitioners participated, with 101 (50.7%) identifying as urologists. The majority were male (72.9%) and worked in private practice or community hospitals (32.7%) or a mixture of both (34.2%). Male sexual dysfunction was treated by 71.4% of respondents, with 25.7% dedicating 75–100% of their practice to it. Female sexual dysfunction was treated by 36.9% of respondents, with 64% dedicating 0–25% of their practice to it. Health insurance covered 25–49% of their care for 41.2% of respondents, predominantly provided by private companies (45.9%). The most common treatments for erectile dysfunction were oral medications (86.5%), injections (61.7%), and inflatable penile prostheses (45.1). For Peyronie's disease, oral therapies (59.1%) and penile traction therapy (34.4%) were most frequently offered, while surgical treatment for Peyronie's disease was offered by 58.2% of respondents, with penile prostheses being the primary choice (79.7%). Regarding female sexual dysfunction, 58.4% of respondents offered treatments for genitourinary syndrome of menopause/atrophic vaginitis, with vaginal estrogen being the most common choice (50%). For dyspareunia due to vaginismus/hypertonic pelvic floor dysfunction, 50.3% of respondents offered treatment, with pelvic floor exercise/physiotherapy being the most recommended (66%). Conclusions This study provides valuable insights for healthcare professionals, policymakers, and researchers regarding the current landscape of sexual dysfunction management. The results underscore the importance of continuous efforts to develop comprehensive and individualized approaches, ensuring that both male and female patients receive effective and accessible care for their sexual health concerns. By addressing issues related to insurance coverage and fostering interdisciplinary collaboration, the medical community can collectively work towards improving sexual well-being and quality of life for patients worldwide. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Advisory board and speaker for Coloplast; consultant for Cynosure; advisory board and speaker for Halozyme; intellectual property with Masimo; advisory board for Promescent; consultant for Sprout; advisory board for Xialla.

(399) Reducing Out-of-Pocket Expenses for Peyronie’s Disease Therapy with a Novel Penile Traction Device

Abstract Introduction Penile traction therapy (PTT) has gained popularity as a nonsurgical approach to penile lengthening and curvature correction in those with Peyronie's disease (PD). PD is an acquired fibrotic plaque that develops within the tunica albuginea and causes penile curvature, which can have significant physical and mental health consequences. Due to the sensitive nature of this disease presentation and the large number of unidentified or misdiagnosed people, current prevalence estimations in the US are around 11%. PD therapies aim to correct penile curvature while also addressing erectile dysfunction and pain. Common PD therapies include oral medications, intralesional penile injections, surgery, and stretching techniques. When deciding which therapies to pursue, disease severity, costs, compliance, and patient access to facilities and trained providers must be considered. Of these therapies, PTT with a penile traction device (PTD), although uncovered by insurance, has proven to be one of the most cost-effective PD treatments. While an effective treatment in some men, PTDs cost hundreds of dollars out-of-pocket. Objective Our project aims to address the financial and practicality concerns of penile traction therapy by creating an affordable and comfortable PTD. Methods Our PTD offers precise, dial-adjustable tensioning and penile holding systems with contoured penile holding plates lined with silicone cushions for improved grip and comfort. Our PTD is 3D-printed using polylactic acid (PLA) and medical-grade silicone. To assess our efforts in improving comfort, we measured holding capacity under tension at increasing amounts of penile clamping. We compared our silicone-lined clamp to an all-plastic clamp: this test served as a surrogate for comfort. By improving its grip on the penis, patients can secure their penis with minimal clamping force, thereby improving comfort. Results Our literature search revealed that the average cost for PTDs recommended by urologists for patients with PD was approximately $883. Our PTD currently costs $6.38 to manufacture and assemble. We found a statistically significant (p=0.000276) increase in the tension-holding capacity of the silicone-lined clamp compared to that of the all-plastic clamp. This demonstrates that our silicone-lined clamp may exert less clamping force on the penis, thereby providing patients with the same stretching and a more comfortable grip. Conclusions Future directions include exploring urologists' perception of PTT for PD and their PTD recommendation patterns, refining our current PTD model, and clinically testing our device compared to those currently available. Disclosure No.

(363) A Global Survey of Sexual Dysfunction Management Among Urologists and Sexual Medicine Experts

Abstract Introduction Understanding and addressing sexual dysfunction is of paramount importance to enhance the overall well-being and quality of life of individuals worldwide. While significant progress has been made in the field of sexual medicine, variability in practice patterns among healthcare professionals remains a potential barrier to optimal patient care. To bridge this knowledge gap and identify the prevailing trends in sexual dysfunction management, we conducted an international survey targeting urologists specializing in Andrology, Sexual Medicine, and related fields. Objective This international survey aimed to assess male and female sexual dysfunction management practices among sexual medicine physicians across to globe to identify variability in practice patterns. Methods A survey was distributed globally to urologists specializing in Andrology, Sexual Medicine, and related fields who are members of International Society for Sexual Medicine (ISSM) or affiliated regional societies (SMSNA, ESSM, MESSM, APSSM, SASSM, SLAMS, ISSWSH, SIU). Demographic information (age, gender, specialty, and practice setting) and treatment approaches for male and female sexual dysfunction were collected. Respondents also reported the percentage of their practice dedicated to sexual dysfunction and whether treatments were covered by health insurance. Results A total of 200/3000 practitioners participated, with 101 (50.7%) identifying as urologists. The majority were male (72.9%) and worked in private practice or community hospitals (32.7%) or a mixture of both (34.2%). Male sexual dysfunction was treated by 71.4% of respondents, with 25.7% dedicating 75-100% of their practice to it. Female sexual dysfunction was treated by 36.9% of respondents, with 64% dedicating 0-25% of their practice to it. Health insurance covered 25-49% of their care for 41.2% of respondents, predominantly provided by private companies (45.9%). The most common treatments for erectile dysfunction were oral medications (86.5%), injections (61.7%), and inflatable penile prostheses (45.1). For Peyronie's disease, oral therapies (59.1%) and penile traction therapy (34.4%) were most frequently offered, while surgical treatment for Peyronie's disease was offered by 58.2% of respondents, with penile prostheses being the primary choice (79.7%). Regarding female sexual dysfunction, 58.4% of respondents offered treatments for genitourinary syndrome of menopause/atrophic vaginitis, with vaginal estrogen being the most common choice (50%). For dyspareunia due to vaginismus/hypertonic pelvic floor dysfunction, 50.3% of respondents offered treatment, with pelvic floor exercise/physiotherapy being the most recommended (66%). Conclusions This study provides valuable insights for healthcare professionals, policymakers, and researchers regarding the current landscape of sexual dysfunction management. The results underscore the importance of continuous efforts to develop comprehensive and individualized approaches, ensuring that both male and female patients receive effective and accessible care for their sexual health concerns. By addressing issues related to insurance coverage and fostering interdisciplinary collaboration, the medical community can collectively work towards improving sexual well-being and quality of life for patients worldwide. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Advisory board and speaker for Coloplast; consultant for Cynosure; advisory board and speaker for Halozyme; intellectual property with Masimo; advisory board for Promescent; consultant for Sprout; advisory board for Xialla.

(395) Safety and Efficacy of Collagenase Clostridium Histolyticum in Peyronie's Disease Men with Ventral Curvatures

Abstract Introduction Limited data are available on the efficacy of collagenase clostridium histolyticum (CCH) on Peyronie’s disease (PD) in men with ventral curvatures. Our team previously published a limited series of outcomes of 25 men with ventral curvatures who underwent CCH. Given the paucity of data available, we sought to provide an updated series of outcomes in this important cohort. Objective To report outcomes of men undergoing CCH injections for PD based on initial direction of curvature, including absolute and percent improvement in curvature, adverse events (AE), and other subjective outcomes. Methods A prospective registry has been maintained of all men undergoing CCH injections since 2014. All men underwent curvature assessments and subjective questioning at the time of initial evaluation and prior to each subsequent series of injections. The method of injection and subsequent protocol have changed in a stepwise fashion since 2014 and currently include injecting 0.9 mg (diluted to 0.8 mL) on back-to-back days, injecting into the point of max curve with an erection on day 1, performing in-office modeling on day 2, utilizing Restorex traction beginning on day 2, and wrapping for 4-8 days depending on results. To review outcomes, clinicopathologic data were abstracted from the registry including relevant history, exam, and data obtained at the time of penile ultrasound and curvature assessment. Outcomes are reported using a “Most Recent” definition (most recent data point used, regardless if the patient continues or finished treatment) and “Completed 8 or Satisfied” (only included if the patient indicated that they were done with treatment or had finished the full 8 injections). Results A total of 560 patients (mean age 57 years) were identified from March 2014 through Feb 2023 and comprise our study cohort. Overall, 85 men had a ventral component to their curvature and 475 non-ventral. Baseline demographics and clinical factors were similar between groups, with the exception of penile length (ventral 14.0 cm, non-ventral 12.0 cm, p&amp;lt;0.0001), Psych and Physical subdomain of the Peyronie’s Disease Questionnaire (10 vs 12, p=0.03), and prior treatment with CCH (3% vs 16%, p=0.03). Following treatment, men in the ventral cohort exhibited possibly greater improvements in curvature (Most Recent Definition: -25 degrees vs -24, p=0.08; 45% vs 34%, p=0.03; Completed 8 or Satisfied Definition: -35 vs -25, p&amp;lt;0.05, 48% vs 38%, p=0.11). However, all other outcomes were similar between cohorts, including differences in subdomains of the IIEF and PDQ, use of traction therapy, and adverse events including ecchymoses, hematomas, and popping sensations. Importantly, no urethral complications were experienced in the ventral group. Conclusions Men with ventral PD may be effectively treated with CCH with similar AEs compared to other directions. Ventral curvatures are likely associated with greater overall curvature improvements compared to other directions. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Endo - Matt Ziegelmann.

Acetabular Fracture; its Management and Early Functional Outcome

Aim: To evaluate the functional results of open reduction and rigid internal fixation with Reconstruction plates and screws in acetabular fractures Methods: This prospective case series study was carried out on 47 consecutive patients, of either gender and age ranging from 18 to 60 years, who presented with an acetabular fracture within a month of injury at the Orthopedic and Trauma Department of the Medical Teaching Institute Lady Reading Hospital (LRH) in Peshawar, Pakistan, from January 2018 to September 2023. Excluded from the research were patients receiving traction therapy with a trochanteric pin for an open fracture. A non-probabilistic sequential sampling method was applied. Clinical grading followed D'aubigne and Postel's guidelines, with Matta's modifications. We measured range of motion, pain, and gait. Results: There were 47 patients in total, ages ranging from 20 to 60, with an average age of 37.52. there were 31 males (66.0%) and 16 females (33%). In 19(40.4%) patients, 5(10.6%) patients have physical violence and 23(48.9%) of the patients, the cause of injury was a road traffic collision. Our study shows that of the patients, 29(61.7%) were involved on the right side and 18(38.3%) on the left. In five (10.6%) of the instances, there was plate loosing. It is shown that 24(51.1%) cases, excellent outcomes were attained, in 15(31.9%) case good, 5(10.6%) cases fair, 3(6.4%) cases poor outcome were attained. Conclusion: According to Matta Grading, all acetabular fractures, including those involving osteoporotic bone, respond excellently to rather well to open reduction and internal fixation using a 3.5-millimeter reconstruction plate and screws. Keywords: Acetabulam, Fracture, Internal fixation, Open Reduction, Rigid Fixation.

Sanogenetic mechanisms of cyclic local traction therapy in the treatment of neurological manifestations of degenerative diseases in the spine. (Literature review)

New information on the results of scientific research may change the understanding of the etiology and pathogenesis of diseases, which makes adjustments in treatment approaches. Cyclic local traction therapywas created in USA by the group of scientists for NASA (Axiom Worldwide, Tampa, FL) and approved by FDA in 2003. The year 2023 is the 20th anniversary of its successful application in practical medicine. Evaluating the effectiveness of the method, it has been shown that after undergoing treatment in patients with chronic back pain, the height of the intervertebral discs increases, pain syndrome and frequency of taking pain medications decreases, daily activity and duration of walking without pain increases. It is assumed that the treatment effect was achieved due to the «vacuum» effect, which could contribute to the regeneration of the intervertebral disc. It is also known about the possibility of intervertebral disc herniation reduction after a course of traction therapy and it was believed that this was ensured by «retraction» of the hernia back into the intervertebral space under the influence of the longitudinal ligament. However, fundamental studies of the past century and the present indicate the presence of other mechanisms affecting the structures of the vertebral motor segment, especially the processes occurring inside the intervertebral disc and contributing to the regression of the intervertebral disc herniation.

Traction treatment, underwater traction therapy, weight bath cabin

Thermal waters are important and multifunctional natural resources for renewable energy, recreation, health-tourism and their use in balneotherapy is particularly well known. Many degenerative spine diseases can be successfully treated with traction treatments. As a result of traction, the height of the discs adjusts, the disc protrusions retract, and canals of the nerve roots expand. Compared to dry traction treatment, underwater traction treatment has many advantages. Due to the effect of warm water, we do not have to count on muscle protection. Thanks to the buoyant force, a very careful traction can be achieved. Thanks to this, this treatment can be considered the safest and most effective traction treatment. With our innovative weight bath cabin, you can carry out an individualized, safe and successful weight bath treatment. In our weight bath cabin, we can effectively combine traction treatment and medicinal water treatment.

Влияние эффективной тракционной терапии на аппарате Robospine на качество жизни пациентов с дорсопатией

Pain in the lower back is a serious problem for the patient’s quality of life. Scientific studies confirm the importance of this problem and emphasize the need for a timely and comprehensive approach to its treatment. The aim is to conduct a study of hardware spinal traction, also known as spinal traction, on the quality of life of patients with lumbalgia. Methods: SF-36 questionnaires were used to study the quality of life before and after the spinal traction course on the Robospine device. According to the results obtained against the background of therapy, the quality of life of patients with this pathology significantly improves, it is established that the quality of life of patients in all samples improves. In all groups, a significant improvement in the physical component of health according to SF-36 was found, with a predominance of improvement in men than in women. According to the results of the analysis, it can be concluded that the effect on the general health of traction therapy in men is higher than in women. Also, the intensity of pain significantly decreased in men, against the general group and women. And physical functioning significantly improves in the general group after treatment, the advantage in improving the condition in women. It is recommended to use this technique for the treatment of patients with pain in the lower back.

In search of biomarkers for low back pain: can traction therapy effectiveness be prognosed by surface electromyography or blood parameters?

Background: Lumbar traction therapy is a common method to reduce low back pain (LBP) but is not always effective. The search for biomarkers that would prognose the effectiveness of LBP management is one priority for improving patients' quality of life. Objectives: 1) To determine the phenotype of patients benefiting most from lumbar traction therapy. 2) To correlate systemic and electromyographic biomarkers with pain and pain-related disability. Methods: Data on muscle bioelectrical activity (surface electromyography [SEMG]) in the flexion-extension task, the concentrations of twelve systemic biochemical factors, LBP intensity (Visual Analog Scale), the Oswestry Disability Index, and the Roland-Morris Disability Questionnaire (RMDQ) were collected before and 72h after 20 sessions of lumbar traction therapy. Patients were divided into responders and nonresponders based on the criterion of a 50% reduction in maximal pain. Results: The responders had lower maximal muscle bioactivity in the extension phase on the left side (p < 0.01) and higher flexion-extension ratios on both sides of the body in the SEMG (left: p < 0.05; right: p < 0.01), and higher adipsin, interleukin-2, interleukin-4, and interleukin-10 concentrations (p < 0.05) than nonresponders. Patients with higher interleukin-4 concentrations before therapy achieved greater reductions in maximal pain in the sitting position, bioelectrical muscle activity in flexion, and flexion-relaxation ratio on the left side of the body. Changes in adipsin and interleukin-4 concentrations correlated with changes in LBP intensity (r = 0.68; r = -0.77). Changes in stem cell growth factor and interleukin-17A correlated with changes in RMDQ (R = 0.53) and bioelectrical muscle activity in extension (left: R = -0.67; right: R = -0.76), respectively. Conclusion: Responders to traction therapy had SEMG indices of less favorable muscle activity in the flexion-extension task and elevated indices of inflammation before the study. For the first time, interleukin-4 was indicated as a potential biomarker for prognosing post-therapy changes in pain intensity and muscle activity.