Clinical anatomy of the lumbar sinuvertebral nerve with regard to discogenic low back pain and review of literature

Abstract Purpose Lumbar discogenic diffuse pain is still not understood. Authors describe the sinuvertebral nerve (SVN) as one possible cause. Body-donor studies are rare and controversial. Therefore, the aim was to revisit the origin, course and distribution in a body-donor study. Methods Six lumbar blocks (3 female, 3 male) aged between 59 and 94 years were dissected. After removal of the back muscles, lamina, dura mater and cauda equina, the anterior vertebral venous plexus, spinal artery and SVN were exposed and evaluated. Results 43 nerves out of 48 levels could be evaluated. The origin of the SVN was constituted by two roots: a somatic and a sympathetic branch arising from the rami communicantes. In 4/48 intervertebral canals studied (8.3%), we found two SVN at the same level. In 35/48 cases, one SVN was found. In 9/48 cases, no SVN was found. The SVN had a recurrent course below the inferior vertebral notch; in the vertebral canal it showed different patterns: ascending branch (31/43, 72.1%), common branch diverging into two branches (10/43, 23.3%), double ascending branch (1/43, 2.3%) finalizing two levels above and a descending branch (1/43, 2.3%). In 12/43 cases (27.9%) the SVN had ipsilateral connections with another SVN. The distribution ended in the middle of the vertebral body supplying adjacent structures. Conclusion A thorough understanding of the anatomy of the SVN might lead to significant benefits in therapy of discogenic low back pain. We suggest blocking the SVN at the level of the inferior vertebral notch of two adjacent segments. Level of evidence I Diagnostic: individual cross-sectional studies with consistently applied reference standard and blinding

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COMPARISON BETWEEN START BACK SCREENING TOOL AND DRAM FOR DETECTION OF PSYCHOSOCIAL FACTORS IN LOW BACK PAIN

Coluna/Columna ◽

10.1590/s1808-185120212004239030 ◽

2021 ◽

Vol 20 (4) ◽

pp. 268-271

Author(s):

Carlos Tucci ◽

Alex Oliveira de Araujo ◽

Raphael Martus Marcon ◽

Alexandre Fogaça Cristante ◽

Tarcísio Eloy Pessoa de Barros Filho

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Screening Tool ◽

Cross Sectional Study ◽

Low Back ◽

Level Of Evidence ◽

Cross Sectional ◽

Start Back Screening Tool ◽

Number Of Patients ◽

Medium Risk

ABSTRACT Objective: To correlate the results of the STarT Back Screening Tool and DRAM questionnaires, applied simultaneously, in a population with low back pain. Methods: Comparative cross-sectional study with 84 participants with low back pain assessed by both STarT Back Screening Tool (SBST) and DRAM questionnaires. The degree of correlation between the two questionnaires was analyzed through the evaluation of individualized data and using the Spearman correlation coefficient. Results: According to the DRAM, 19% of the patients were classified as “normal”, 32.1% as “at risk” and 48.8% as “distressed”. According to SBST, 59.5% of patients were classified as “low risk”, 31% as “medium risk” and 9.5% as “high risk”. Applying the Spearman's coefficient to evaluate the degree of correlation between the two questionnaires, a value of 0.4 was obtained. This shows that there is a positive, but weak, correlation (p <0.001) between the two questionnaires. Conclusion: There is a positive correlation between the two questionnaires, but the DRAM showed a greater tendency to classify patients with some degree of psychological distress when compared to the SBST. Both questionnaires are effective in identifying these factors, but the data suggest that the DRAM may be more effective as a screening tool in patients with low back pain, in view of the higher number of patients identified. Level of evidence III; Diagnostic test study.

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PREVALENCE OF LOW BACK PAIN AND EVALUATION OF RISK FACTORS IN HOSPITALIZED PATIENTS

Coluna/Columna ◽

10.1590/s1808-185120212003235589 ◽

2021 ◽

Vol 20 (3) ◽

pp. 207-211

Author(s):

JOÃO PEDRO DE SALLES NETTO ◽

FERNANDA ANDREA MINUTTI NAVARRO ◽

RODRIGO YUITI NAKAO ◽

MAXWEL DE MENEZES SANTOS ◽

LUIZ CLÁUDIO LACERDA RODRIGUES

Keyword(s):

Risk Factors ◽

Low Back Pain ◽

Back Pain ◽

Teaching Hospital ◽

Sleep Disturbances ◽

Hospital Environment ◽

Low Back ◽

Level Of Evidence ◽

Cross Sectional ◽

Average Pain

ABSTRACT Objective To determine the prevalence of low back pain and to establish a correlation with risk factors for the development of low back pain in a teaching hospital in the East Zone of São Paulo. Method This is a cross-sectional, observational, analytical study, in which 90 patients from the teaching hospital wards were evaluated. Internationally validated instruments were used to assess clinical, epidemiological and behavioral aspects. Results The prevalence rate obtained was 57.73%, which is considered high compared to the rates in studies conducted outside of the hospital environment. There was predominance in the female sex, at 30.13% (SSD 5.32%). Sleep disturbances, measured indirectly through hours of sleep and the average pain score (p = 0.007), seem to act as a risk factor. The instruments for checking pain seem to be more effective when used together, with an association being observed between the Oswestry questionnaire (ODI) and the visual analog scale (VAS) for pain (p = 0.000). Conclusions There is a prevalence of low back pain among institutionalized individuals, especially those who are hospitalized, compared to rates observed outside the hospital environment. Level of evidence IV; Cross-sectional observational.

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Systematic Review of the Effectiveness of Thermal Annular Procedures in Treating Discogenic Low Back Pain

January 2018 - Pain Physician ◽

10.36076/ppj.2009/12/207 ◽

2009 ◽

Vol 1;12 (1;1) ◽

pp. 207-232 ◽

Cited By ~ 1

Author(s):

Standiford Helm II

Keyword(s):

Systematic Review ◽

Low Back Pain ◽

Back Pain ◽

Outcome Measures ◽

Observational Studies ◽

Low Back ◽

Level Of Evidence ◽

Level Ii ◽

Discogenic Low Back Pain ◽

One Year

Background: Chronic discogenic low back pain is a common problem with significant personal and societal costs. Thermal annular procedures (TAPs) have been developed in an effort to provide a minimally invasive treatment for this disorder. Multiple techniques utilized are intradiscal electrothermal therapy (IDET), radiofrequency annuloplasty, and intradiscal biacuplasty (IDB). However, these treatments continue to be controversial, coupled with a paucity of evidence. Study Design: A systematic review of the literature evaluating the efficacy or effectiveness of TAPs. Objective: To determine the effectiveness of TAPs in reducing low back pain in patients with intradiscal disorders. Methods: A comprehensive evaluation of the literature relating to TAPs was performed. The literature was evaluated according to Cochrane Review criteria for randomized controlled trials (RCTs) and according to the Agency for Healthcare Research and Quality (AHRQ) criteria for observational studies. The level of evidence was classified as Level I, II, or III based on the quality of evidence developed by the U.S. Preventive Services Task Force (USPSTF). Pain relief was the primary outcome measure. Other outcome measures were functional improvement, improvement of psychological status, and return to work. Data sources included relevant literature of the English language identified through searches of PubMed, EMBASE, the Cochrane Library, and the Database of Reviews of Effectiveness (DARE). Outcome Measures: Short-term effectiveness was defined as one-year or less and long-term effectiveness was defined as greater than one-year. Results: Systematic review of IDET identified 2 RCTs and 16 observational studies with an indicated evidence of Level II-2. Systematic review of radiofrequency annuloplasty identified no RCTs but 2 observational studies with an uncertain evidence of Level II-3. Systematic review of IDB identified one pilot study. The level of evidence is lacking with Level III. Limitations: The limitations of this review include paucity of the literature and lack of evidence with internal validity and generalizability. Conclusion: IDET offers functionally significant relief in approximately one-half of appropriately chosen chronic discogenic low back pain patients. There is minimal evidence supporting the use of radiofrequency annuloplasty and IDB. Key words: Chronic low back pain, degenerative disc disease, internal disc disruption, intervertebral disc, thermal annular procedures, intradiscal electrothermal therapy, radiofrequency ablation, intradiscal biacuplasty, radiofrequency annuloplasty

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The effect of posterior lumbar dynamic fixation and intervertebral fusion on paraspinal muscles

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04943-w ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Geng-Xiong Lin ◽

Yan-Ming Ma ◽

Yong-Chun Xiao ◽

Dian Xiang ◽

Jian-Xian Luo ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Internal Fixation ◽

Fatty Infiltration ◽

Operation Time ◽

Low Back ◽

Paraspinal Muscles ◽

Cross Sectional ◽

Vas Score ◽

Adjacent Segments

Abstract Background The aim of this study was to analyze the effect of unilateral K-rod dynamic internal fixation on paraspinal muscles for lumbar degenerative diseases. Methods This study retrospectively collected 52 patients who underwent lumbar surgery with the K-rod group or PLIF. The operation time, intraoperative blood loss, postoperative drainage volume, postoperative exercise time were compared in the two groups. The visual analog scale (VAS) score and the oswestry dysfunction index (ODI) were employed to evaluate the clinical outcomes. The functional cross-sectional area (FCSA) of the paraspinal muscles and paraspinal muscles fat infiltration were measured to assess on the paraspinal muscles. Results As compared with the PLIF group, the operation time, the postoperative time in the field, and the average postoperative hospital stay in the K-rod internal fixation group were significantly shortened. At the last follow-up, both the groups showed significant improvement in the VAS score and ODI. The FCSA atrophy of the upper and lower adjacent segments (UAS and LAS) of the K-rod internal group was significantly less than that of the PLIF group. The extent of increase in the fatty infiltration of the paraspinal muscles in the K-rod group was significantly lesser than that in the PLIF group. The postoperative low back pain of the two groups of patients was significantly positively correlated with the FCSA atrophy. Conclusions As compared to PLIF, the posterior lumbar unilateral K-rod dynamic internal fixation showed significantly lesser paraspinal muscle atrophy and fatty infiltration, which were significantly positively correlated with postoperative low back pain.

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LOW BACK PAIN IN MEDICAL STUDENTS: PREVALENCE AND RELATED FACTORS

Coluna/Columna ◽

10.1590/s1808-185120212003244850 ◽

2021 ◽

Vol 20 (3) ◽

pp. 197-200

Author(s):

NATASSJA BOSZCZOWSKI ◽

RUAN CARLO RODRIGUES PINTO ◽

FRANCISCO ALVES DE ARAÚJO JUNIOR

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Medical Students ◽

Lumbar Pain ◽

Low Back ◽

Level Of Evidence ◽

Related Factors ◽

Disability Score ◽

Cross Sectional ◽

Informed Consent Form

ABSTRACT Objective To identify the prevalence of low back pain and related factors among graduate medical students, and to measure the level of disability that this pain can cause in these students. Methods Data were collected virtually, through Google Forms. After signing an Informed Consent Form (ICF), the participants responded to a sociodemographic survey, and those who reported having low back pain responded to the Oswestry Disability Index. The data analysis was conducted in three stages, through the R Core Team 2020 statistic program, open-source and free software. The Chi-square Test and Fisher’s Exact Test were used in the second and third stages. Results The study was composed of 200 participants, of whom 58% reported lumbar pain. Of those with pain, 94% had minimum scores on the disability scale. None of the variables showed a relevant connection, though BMI, sex, and use of Alcohol were notable for achieving p-values of around 0.05 or higher. Conclusion The prevalence of lumbar pain among the medical students was 58%, and no specific risk factors were identified. Furthermore, 94% of the students who reported lumbar pain had a minimum disability score and 6% a moderate score. None of the participants presented severe or greater disability. Level of evidence II; A descriptive cross-sectional study with a quantitative approach.

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The Effect of Posterior Lumbar Dynamic Fixation and Intervertebral Fusion on Paraspinal Muscles

10.21203/rs.3.rs-800229/v1 ◽

2021 ◽

Author(s):

Geng-Xiong Lin ◽

Yan-Ming Ma ◽

Rong-Sheng Wang ◽

Dian Xiang ◽

Jian-xian Luo ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Internal Fixation ◽

Fatty Infiltration ◽

Operation Time ◽

Low Back ◽

Paraspinal Muscles ◽

Cross Sectional ◽

Vas Score ◽

Adjacent Segments

Abstract Background: The aim of this study was to analyze the effect of unilateral K-rod dynamic internal fixation on paraspinal muscles for lumbar degenerative diseases. Methods: This study retrospectively collected 52 patients who underwent lumbar surgery with the K-rod group or PLIF. The operation time, intraoperative blood loss, postoperative drainage volume, postoperative exercise time were compared in the two groups. The visual analog scale (VAS) score and the oswestry dysfunction index (ODI) were employed to evaluate the clinical outcomes. The functional cross-sectional area (FCSA) of the paraspinal muscles and paraspinal muscles fat infiltration were measured to assess on the paraspinal muscles. Results: As compared with the PLIF group, the operation time, the postoperative time in the field, and the average postoperative hospital stay in the K-rod internal fixation group were significantly shortened. At the last follow-up, both the groups showed significant improvement in the VAS score and ODI. The FCSA atrophy of the upper and lower adjacent segments (UAS and LAS) of the K-rod internal group was significantly less than that of the PLIF group. The extent of increase in the fatty infiltration of the paraspinal muscles in the K-rod group was significantly lesser than that in the PLIF group. The postoperative low back pain of the two groups of patients was significantly positively correlated with the FCSA atrophy.Conclusions: As compared to PLIF, the posterior lumbar unilateral K-rod dynamic internal fixation showed significantly lesser paraspinal muscle atrophy and fatty infiltration, which were significantly positively correlated with postoperative low back pain.

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