Poster 242 Chronic Low Back Pain in a 25-Year-Old Woman Due to Right L4 Transverse Process Articulation With the Sacrum: A Case Report

Abstract Objective: This article aims to provide more insight into the presentation, diagnosis, and treatment of Bertolotti's syndrome, which is a rare spinal disorder that is very difficult to recognize and diagnose correctly. The syndrome was first described by Bertolotti in 1917 and affects approximately 4 to 8% of the population. It is characterized by an enlarged transverse process at the most caudal lumbar vertebra with a pseudoarticulation of the transverse process and the sacral ala. It tends to present with low back pain and may be confused with facet and sacroiliac joint disease. Methods: In this case report, we describe a 40-year-old man who presented with low back pain and was eventually diagnosed with Bertolotti's syndrome. The correct diagnosis was made based on imaging studies which included computed tomographic scans, plain x-rays, and magnetic resonance imaging scans. The patient experienced temporary relief when the abnormal pseudoarticulation was injected with a cocktail consisting of lidocaine and steroids. In order to minimize the trauma associated with surgical treatment, a minimally invasive approach was chosen to resect the anomalous transverse process with the accompanying pseudoarticulation. Results: The patient did well postoperatively and had 97% resolution of his pain at 6 months after surgery. Conclusion: As with conventional surgical approaches, a complete knowledge of anatomy is required for minimally invasive spine surgery. This case is an example of the expanding utility of minimally invasive approaches in treating spinal disorders.

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Atraumatic Bilateral Lumbar Pedicle Fractures in a Patient with Back Pain and History of Long- Term Bisphosphonate Therapy: A Case Report

Pain Management Case Reports ◽

10.36076/pmcr.2020/4/97 ◽

2020 ◽

pp. 97-102

Author(s):

Alec L. Meleger

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Case Report ◽

Lumbar Spine ◽

Conservative Management ◽

Chronic Low Back Pain ◽

Bisphosphonate Therapy ◽

Low Back ◽

History Of ◽

Lumbar Pedicle

of atypical femoral fractures is a known complication of chronic bisphosphonate therapy; however, the finding of atraumatic lumbar pedicle fractures without a prior history of spinal surgery or contralateral spondylolysis is rare. While a few cases of osteoporotic pedicle fractures associated with adjacent vertebral compression fractures have been reported, only a single case of isolated atraumatic bilateral pedicle fractures has been published in a patient who had been on chronic risedronate therapy of 10-year duration. Case Report: The present case report illustrates a 63-year-old man who developed isolated atraumatic bilateral lumbar pedicle fractures after 3 years and 5 months on alendronate treatment. The patient’s past medical history had been significant for osteoporosis with a lumbar spine T-score of -2.7. At the time of initial diagnosis, a comprehensive work-up for secondary causes of osteoporosis proved to be negative; this was followed by initiation of bisphosphonate treatment with 70 mg of alendronate once per week. Ten months after starting bisphosphonate therapy, he underwent magnetic resonance imaging (MRI) of the lumbar spine for low back pain that had not responded to conservative management, with imaging not revealing any evidence of pedicle fractures or pedicle stress reaction. He was again seen in the spine clinic, for atraumatic exacerbation of his chronic low back pain with concurrent right lower extremity radiation, 6 months after stopping bisphosphonate therapy. Since the patient failed to respond to conservative management over the ensuing 6 months, a repeat MRI was obtained, which showed new acute/subacute bilateral L5 pedicle fractures. Conclusion: An isolated atraumatic lumbar pedicle fracture may be an additional type of atypical fracture associated with chronic bisphosphonate therapy in an osteoporotic patient. Key words: Chronic low back pain, bisphosphonate, alendronate, pedicle fracture Pain Medicine

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Is single-point acupuncture effective in treating acute low back pain? A case report

10.22541/au.163645355.53355481/v1 ◽

2021 ◽

Author(s):

Sagun Tiwari ◽

Namrata Sapkota

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Case Report ◽

Adverse Events ◽

Chronic Low Back Pain ◽

Single Point ◽

Low Back ◽

Acute Low Back Pain ◽

Short Time

Acupuncture is often used for acute and chronic low back pain; however, its efficacy is controversial, primarily for acute low back pain (ALBP). Our case study suggests that single acupuncture could relieve ALBP within a short time without any adverse events.

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A case report of a thalamic stroke associated with sudden disappearance of severe chronic low back pain

Scandinavian Journal of Pain ◽

10.1515/sjpain-2017-0169 ◽

2018 ◽

Vol 18 (1) ◽

pp. 121-124 ◽

Cited By ~ 1

Author(s):

Harsha Shanthanna

Keyword(s):

Central Nervous System ◽

Chronic Pain ◽

Nervous System ◽

Low Back Pain ◽

Back Pain ◽

Case Report ◽

Chronic Low Back Pain ◽

Low Back ◽

Chronic Pain Condition ◽

The Central Nervous System

Abstract Background: Chronic pain conditions are associated with neuroplasticity within the central nervous system. In most patients the maladaptive consequence of neuroplasticity supports prolonged course of chronic pain, despite the absence of a commensurate etiology. From a pain neuromatrix perspective it can involve three different circuits within the central nervous system; the classical sensory pathway, the limbic system pathway, and the associative pathways involving the parietal cortical connections. Although this can be conceptualized as a fluid system composed of several interacting networks, it can be broadly separated into a nociceptive specific network of spino-thalamic neurons and second order neurons beyond thalamus that are not nociceptor specific. Thalamus acts as an important relay station that conveys nociceptive signaling to higher centres. Neuroplastic changes can potentially involve any parts within this neuromatrix. It is very uncommon to observe the sudden disappearance of such a chronic pain condition. Methods and results: In this case report, the author describes the clinical course of a patient with severe chronic low back pain (CLBP), whose pain suddenly disappeared after a stroke involving his left thalamus. Although extremely rare, existing case reports of such disappearance of pain with a secondary stroke in patients suffering from central post stroke pain (CPSP) are reviewed. The author further postulates hypotheses that could potentially explain this phenomenon based on the existing knowledge. Conclusions and implications: Although extremely rare and unpredictable, a thalamic stroke involving areas that are involved in chronic pain signaling can potentially lead to disappearence of an existing chronic pain condition. This is the first case report of such sudden disappearence of CLBP with well established nociceptive pathology supported by clinical and imaging findings. This unique case report could potentially generate ideas for future research and clinical treatment in the field of neuromodulation and brain stimulation.

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