Poster 112: Spinal Dorsal Rami Injection and Radiofrequency Neuroablation for Low Back Pain Related to Thoraco-Lumbar Vertebral Compression Fracture

Abstract Background: PVP (Percutaneous vertebroplasty) has been used to treat patients with OVCFs, however, we found that some patients did not significantly relieve back pain after surgery. The purpose of this paper is to explore the possible risk factors for residual low back pain after PVP and to Method: A retrospective study was conducted on 1120 patients hospitalized for osteoporotic vertebral compression fracture (OVCF) and treated with PVP between from July 2014 to June 2020 at our hospital. Baseline, clinical and surgical data were collected to analyze the factors associated with residual low back pain after PVP.Results: A total of 61 patients complained of residual low back pain, and the prevalence was 5.4%. Among the observed indices included, there were significant differences in preoperative thoracolumbar fascia injury (TFI) and a liquefaction signal on magnetic resonance imaging (MRI) of the affected vertebrae; the number of responsible vertebrae and the distribution of bone cement were different between the two groups (P<0.05). Multivariate analysis revealed that preoperative TFI (OR=5.378, 95% CI: 1.713-16.888, P=0.004), a liquefaction signal on MRI of the affected vertebrae (OR=6.111, 95% CI：1.898-19.673, P=0.002), the number of responsible vertebrae (OR=0.098, 95% CI: 0.039-0.249, P=0.004), and the distribution of bone cement (OR=0.253, 95% CI: 0.079-0.810, P=0.021) were risk factors for residual low back pain after PVP.Conclusion: TFI, a liquefaction signal on MRI of the affected vertebrae, the number of responsible vertebrae and the distribution pattern of bone cement could be risk factors for residual low back pain after PVP.

Download Full-text

MRI Findings of Non-Degenerative Pathoanatomical Changes in Low Back Pain

Nepal Journal of Neuroscience ◽

10.3126/njn.v12i2.15894 ◽

2016 ◽

Vol 12 (2) ◽

pp. 59-62 ◽

Cited By ~ 1

Author(s):

Dan B Karki ◽

Om B Panta ◽

Ghanshyam Gurung

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Multimodality Imaging ◽

Compression Fracture ◽

Degenerative Changes ◽

Lumbosacral Spine ◽

Low Back ◽

Neoplastic Lesion ◽

Lower Lumbar ◽

Meningeal Cysts

Non-degenerative pathoanatomical changes are far less common than degenerative changes but benefi ts most from imaging assessment. This study aimed to evaluate the non-degenerative pathoanatomical changes in patients undergoing MRI for low back pain.The study was a retrospective study conducted for the duration of 3 years in a multimodality-imaging center. All patients undergoing MRI of lumbosacral spine with complains of low back pain with or without radiculopathy were assessed for morphological changes and other abnormal fi ndings. After excluding patients with degenerative changes, non-degenerative pathologies were evaluated. Data was entered in predesigned proforma and analysis was done with SPSS 21.0.There were 183 patients who met the inclusion criteria and were included in the study. The mean age of the patients was 51.23 ±16.86 years. Compression fracture of the vertebra was the most common non-degenerative changes accounting for 34% cases followed by spinal meningeal cysts (26%) and infection (14%). Fractures were more common in upper lumbar level as compared to lower lumbar levels. Meningeal cysts were noted to involve the sacral spinal canal more frequently followed by lower lumbar levels. Infective lesions were equally distributed throughout the lumbar spine. Hemangioma was common lesion involving 16% of cases. Lumbosacral transitional vertebra was seen in 7(3.8%) patients.The common non-degenerative pathoanatomical changes associated with low back pain were traumatic lesion, infection, neoplastic lesion and lumbosacral transitional vertebra.Nepal Journal of Neuroscience 12:59-62, 2015

Download Full-text

The Anatomy of the Lateral Branches of the Sacral Dorsal Rami: Implications for Radiofrequency Ablation

January 2018 - Pain Physician ◽

10.36076/ppj.2014/17/459 ◽

2014 ◽

Vol 5;17 (5;9) ◽

pp. 459-464

Author(s):

Joseph Fortin

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Radiofrequency Ablation ◽

Sacroiliac Joint ◽

Low Back ◽

Sacral Foramina ◽

Dorsal Rami ◽

Lateral Branches ◽

The Right ◽

Segmental Innervation

Background: The sacroiliac joint (SIJ) is a major source of pain in patients with chronic low back pain. Radiofrequency ablation (RFA) of the lateral branches of the dorsal sacral rami that supply the joint is a treatment option gaining considerable attention. However, the position of the lateral branches (commonly targeted with RFA) is variable and the segmental innervation to the SIJ is not well understood. Objectives: Our objective was to clarify the lateral branches’ innervation of the SIJ and their specific locations in relation to the dorsal sacral foramina, which are the standard RFA landmark. Methods: Dissections and photography of the L5 to S4 sacral dorsal rami were performed on 12 hemipelves from 9 donated cadaveric specimens. Results: There was a broad range of exit points from the dorsal sacral foramina: ranging from 12:00 – 6:00 position on the right side and 6:00 – 12:00 on the left positions. Nine of 12 of the hemipelves showed anastomosing branches from L5 dorsal rami to the S1 lateral plexus. Limitations: The limitations of this study include the use of a posterior approach to the pelvic dissection only, thus discounting any possible nerve contribution to the anterior aspect of the SIJ, as well as the possible destruction of some L5 or sacral dorsal rami branches with the removal of the ligaments and muscles of the low back. Conclusion: Widespread variability of lateral branch exit points from the dorsal sacral foramen and possible contributions from L5 dorsal rami and superior gluteal nerve were disclosed by the current study. Hence, SIJ RFA treatment approaches need to incorporate techniques which address the diverse SIJ innervation. Key words: Sacroiliac joint pain, radiofrequency ablation, dorsal sacral rami, low back pain

Download Full-text

Design Implementation and Analysis of a Universal Lumbosacral Support Device to Prevent Low Back Pain in Motorized Two-Wheeler Riders

2017 Design of Medical Devices Conference ◽

10.1115/dmd2017-3442 ◽

2017 ◽

Author(s):

Krishna Pedaprolu ◽

Satyam Rajput ◽

Sharmila Nageswaran

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Lower Back Pain ◽

Chronic Low Back Pain ◽

Compression Fracture ◽

The Body ◽

Low Back ◽

Persistent Symptoms ◽

Acute Low Back Pain ◽

Lower Back

According to National Institute of Neurological Disorders and Stroke (NINDS), a division of National Institutes of Health (NIH), about 80% adults suffer from low back pain at some point in time and about 2 out of 10 people who are affected by acute low back pain develop chronic low back pain with persistent symptoms at one year [1]. Though in some cases, treatment does relieve chronic low back pain, but in other cases, pain persists despite treatment. Mostly, the lower back pain is of mechanical nature, i.e., disruption in the way the components of the back (the spine, muscle, intervertebral discs, and nerves) fit together and move. The causes of lower back pain can be imputed to various conditions such as sprains and strains, osteoarthritis, herniated discs, whiplash, compression fracture, scoliosis, stenosis, inflammation of joints, osteoporosis. It not only causes pain, but also severs the economy of a nation. It is a major contributor to missed workdays [1]. Research indicates that the total indirect costs due to back pain accrue to more than $100 billion annually [2]. Not many people can afford traveling by car or taxi to office, especially in developing countries and in cities with high traffic, where people prefer to travel by two-wheelers for their access to work and other amenities. However, people with lumbar problems are recommended not to use two-wheelers as the movement of the body on uneven roads or while braking/accelerating may increase the pain and discomfort. This reduces the productivity of not only the individual and the firm but also the productivity of the country as a whole.

Download Full-text

Patient with Lumbar Spondylosis and Diskogenic Pain

10.2310/pm.15016 ◽

2016 ◽

Author(s):

Jianguo Cheng

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Clinical Manifestations ◽

Compression Fracture ◽

Treatment Modalities ◽

Low Grade ◽

Type I ◽

Low Back ◽

Positive Effects ◽

Modic Type

Diskogenic low back pain (LBP), defined as pain that originates from a damaged vertebral disk, is a common cause of LBP. It is characterized by a three-phase cascade of degeneration marked by dysfunction, instability, and stabilization. A distinct pathologic characteristic of the disks from patients with diskogenic LBP has been found to be the formation of the zones of vascularized granulation tissue, with extensive innervation extending from the outer layer of the annulus fibrosus into the nucleus pulposus along a torn fissure. In addition, there appears to be an association between microbial infection and symptomatic disk degeneration. Low-virulence microorganisms, in particular Propionibacterium acnes, might be causing a chronic low-grade infection in the lower intervertebral disks in some patients. The diagnosis of diskogenic pain is primarily based on clinical manifestations, physical examinations, imaging studies, and provocative diskography. Diskogenic pain should be differentiated from other axial back pain conditions, such as facet arthropathy, sacroiliac joint pain, myofascial strain and pain, vertebral compression fracture, and other, less common conditions. Treatment options should be tailored to individual needs. Early and gradual physical and behavioral therapies are encouraged. Pharmacologic therapy, composed primarily of analgesics, nonsteroidal antiinflammatory drugs, muscle relaxants, and antidepressants, may have modest positive effects. A subset of patients with Modic type I changes in magnetic resonance imaging may benefit antibiotic therapy directed at the infected disks by P. acnes and other low-virulence microorganisms. There is evidence that supports the use of epidural steroid injections and intradiskal injections (methylene blue, ozone, steroids) for diskogenic pain. Additional options include intradiskal biacuplasty, gray ramus communicans nerve blocks/radiofrequency ablation, and intradiskal stem cell injections for disk repair/regeneration, all of which have gained support in clinical trials. These treatment modalities have shown promise to provide equal or even better outcomes compared with surgical spinal fusion or total disk replacement with an artificial disk. This review contains 2 figures and 149 references. Keywords: collagen, diskogenic low back pain (LBP), herniation, intervertebral disk, spondylosis

Download Full-text

Low back pain as an initial symptom of pregnancy‐associated breast cancer: a case report

BMC Women s Health ◽

10.1186/s12905-021-01298-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Shunya Sugai ◽

Eiko Sakata ◽

Takumi Kurabayashi

Keyword(s):

Breast Cancer ◽

Low Back Pain ◽

Back Pain ◽

Spinal Metastases ◽

Compression Fracture ◽

Whole Body ◽

Initial Symptom ◽

Low Back ◽

Second Trimester ◽

Pregnancy And Postpartum

Abstract Background Low back pain during pregnancy and postpartum is common and might not arouse clinical interest. Pregnancy-associated breast cancer is often found as a breast mass, but its diagnosis is difficult during pregnancy and postpartum. As more women delay their first pregnancies, its incidence may increase in the future. Case presentation The patient was a 30-year-old gravida 3, para 3. She had low back pain from the second trimester of her previous two pregnancies, which improved spontaneously after delivery. In her third pregnancy, she again developed low back pain in the second trimester. Her delivery was normal. However, her low back pain continued for up to 7 months postpartum and then worsened sharply. A whole-body scan revealed a compression fracture due to multiple spinal metastases of breast cancer. As she had not complained about her breasts, they had not been closely examined. Conclusions This case shows the importance of considering bone metastases from breast cancer in the differential diagnosis of patients with low back pain during pregnancy and postpartum.

Download Full-text

Effects of Electro-Acupuncture and Acupotomy Dissolution on mRNA Expression of Center Pro-Opiomelanocortin Detected by In Situ Hybridization in Rats with Non-Specific Low Back Pain

Galen Medical Journal ◽

10.31661/gmj.v5i4.710 ◽

2016 ◽

Vol 5 (4) ◽

pp. 194-99

Author(s):

Shapour Badiee Aval ◽

Ali Khorsand ◽

Seyed Javad Mojtabavi ◽

Shima Rezaei Deloei ◽

Guo Chang Qin

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Mrna Expression ◽

Dorsal Horn ◽

Spinal Dorsal Horn ◽

Low Back ◽

Model Group ◽

Peripheral Tissues ◽

Spinal Dorsal ◽

Pomc Mrna

Background: Pro-opiomelanocortin (POMC) mainly exists in the pituitary gland, hypothalamus, and peripheral tissues and can relieve pain through its degradation product β-endorphin. Its mRNA expression quantity represents the level of gene expression of endorphin system. We aimed to determine the effects of electro-acupuncture and acupotomy dissolution on the mRNA expression of center POMC in rats with non-specific low back pain.Materials and Methods: This study was performed on 42 Sprague-Dawley rats in four groups of normal, model, electro-acupuncture, and acupotomy. The normal group did not receive any intervention, while non-specific low back pain was established in other groups. Then, the model group did not receive any treatment, electro-acupuncture and acupotomy groups were treated with electro-acupuncture therapy and acupotomy, respectively. Microscopic images of the slices, prepared from spinal dorsal horn and hypothalamus, were analyzed to evaluate the mRNA expression of center POMC. Results: Under light microscopy examination, the positive POMC mRNA cells of electro-acupuncture and acupotomy groups increased more than the model group, while its expression in the hypothalamus and spinal dorsal horn was less than the model group, but the difference was not significant (P<0.01). Conclusion: Electro-acupuncture and acupotomy could reduce POMC mRNA expression in spinal cord and increase it in the hypothalamus of rats with non-specific low back pain.[GMJ.2016;5(4):194-99]

Download Full-text

Bertolotti Syndrome

10.2310/pm.15017 ◽

2016 ◽

Author(s):

Jiang Wu ◽

Jianguo Cheng

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Compression Fracture ◽

Lumbar Vertebra ◽

Transverse Process ◽

Lumbosacral Spine ◽

Medial Branch ◽

Low Back ◽

Transitional Vertebra ◽

Lumbosacral Transitional Vertebra

Bertolotti syndrome is caused by a lumbosacral transitional vertebra, a congenital variation of the most caudal lumbar vertebra, characterized by an enlarged transverse process that articulates or fuses with the sacrum, ilium, or both. This syndrome accounts for 4.6 to 7% of cases of low back pain in adults and for more than 11% of patients with low back pain who are under 30 years old. The primary effect of lumbosacral transitional vertebra is reduced and asymmetrical motion between the transitional vertebra and the sacrum, resulting in early arthritic changes at pseudoarticulation; the secondary effect is the progressively compensatory modifications in the biomechanics of the mobile vertebral segments superior to the transitional vertebra related to restriction in rotation and bending motion at the lumbosacral articulation. Bertolotti syndrome should be considered in the differential diagnosis of low back pain. Clinical findings include low back pain in the midline or paramedian area that is reproduced with palpation along the base of the lumbosacral spine and near the posterosuperior iliac spine and aggravated by forward flexion, excessive extension, or lateralization of the back to the same side of the mega-apophysis. A plain x-ray is diagnostic; the extension-flexion lumbosacral radiographs in anteroposterior, lateral, and oblique views demonstrate lumbosacral transitional vertebra, with an enlarged unilateral or bilateral transverse process of the most distal lumbar vertebra, abnormally articulating with the ala of the sacrum and degenerative changes of the pseudarthrosis. Other imaging studies, such as computed tomography and magnetic resonance imaging of the lumbosacral spine and selective radiculography of the spinal nerve, could provide additional detailed anatomic information. Major differential diagnoses of Bertolotti syndrome include sacroiliac joint pain, myofascial pain, lumbar facet pain, lumbar disk herniation, compression fracture, and Baastrup disease/interspinous bursitis. These conditions are not mutually exclusive and, in fact, often coexist. A course of conservative management, including activity modification, medication management with nonsteroidal antiinflammatory drugs, muscle relaxants, and rehabilitative physical therapy, should be offered initially. Due to the multifactorial etiology of low back pain in patients with Bertolotti syndrome, procedures such as diagnostic intrapseudoarticular block for arthritis, medial branch block for facet arthropathy, diskography for diskogenic pain, and selective nerve roots block for radiculopathy can potentially help identify the primary and secondary origins of the pain. Surgical treatment of Bertolotti syndrome was only slightly better than conservative treatment and should only be used in very selective patients with disk pathology. To achieve long-term improvement by any of these therapeutic options, a continuing physical rehabilitation program is often needed. Key words: Bertolotti syndrome, intrapseudoarticular block, transitional lumbosacral vertebra, transverse process

Download Full-text