The Limitation of Endoscopic Surgery Using the Full Endoscopic Discectomy System for the Treatment of Destructive Stage Pyogenic Spondylodiscitis: A Case Series

Introduction. Conservative therapy, including appropriate antibiotics and bracing, is usually adequate for most patients with pyogenic spondylodiscitis. If conservative treatment fails, surgical intervention is needed. However, major spinal surgery comprising anterior debridement and accompanying bone grafting with or without additional instrumentation is often related to undesired postoperative complications. In recent years, with minimally invasive surgery, the diagnostic and therapeutic value of endoscopic lavage and drainage has been proven. This study reports a case series of patients who required open revision surgery after treatment with endoscopic surgery using the full endoscopic discectomy system (FED), indicating the surgical limitations of endoscopic surgery for pyogenic spondylodiscitis. Methods. We retrospectively investigated the medical records of 4 patients who underwent open debridement and anterior reconstruction with posterior instrumentation following endoscopic surgery for their advanced lumbar infectious spondylitis. They had been receiving conservative treatment with antibiotics for 12–15 days. They also had various comorbidities, including kidney disease, heart failure, and diabetes. Numerical rating scale pain response, perioperative imaging studies, and C-reactive protein (CRP) levels were determined, and causative bacteria were identified. Primarily, the bone destruction stage was classified using computed tomography with reference to Griffiths’ scheme. Results. All patients had severe back pain before surgery with no relief of the pain after FED. Increased pain, including radicular pain after FED, was noted in one case. Causative pathogens from biopsy specimens were identified in 3 (75%) of the 4 cases. In preoperative radiological evaluation, all cases were classified as destructive stage in Griffiths’ scheme. The CRP levels of all the patients decreased slightly after endoscopic surgery. Relapse of spinal infection after revision surgery was not noted in any patient during the follow-up period. Conclusion. The surgical treatment of destructive-stage spondylitis with FED alone can increase low back pain due to aggressive debridement.

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NUMERICAL RATING SCALE AS A PREDICTOR OF AN UNDERLYING PATHOLOGY IN PEDIATRIC BACK PAIN USING MAGNETIC RESONANCE IMAGE AS DIAGNOSTIC TOOL

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121s00043 ◽

2021 ◽

Vol 9 (7_suppl3) ◽

pp. 2325967121S0004

Author(s):

Eduardo A. Lindsay ◽

Gerardo Olivella ◽

Manuel Rodríguez ◽

Edwin Burgos-Rossy ◽

Natalia Torres-Acevedo ◽

...

Keyword(s):

Back Pain ◽

Magnetic Resonance Image ◽

Rating Scale ◽

Chronic Back Pain ◽

Numerical Rating Scale ◽

Children And Adolescent ◽

Constant Pain ◽

Neurological Exam ◽

Numerical Rating ◽

Underlying Pathology

Background & Objectives: Recently, constant and night pain has been discarded as adequate clinical markers to predict the presence of an underlying pathology in pediatric back pain. The pain intensity has been recognized as an important domain in the pain assessment. Numerical Rating Scale (NRS) is one of the most common validated tools to assess pediatric pain intensity in children above 8 years of age. The aim of this study is to assess NRS as a predictor of underlying pathologies found by magnetic resonance image (MRI) in pediatric back pain. We hypothesize that a higher NRS score is associated with a high sensitivity, specificity and likelihood ratio to identify the present of organic pathology in pediatric chronic back pain. Methodology: After obtaining Institutional Review Board approval, a retrospective electronical medical record review was conducted. All pediatric patients who reported back pain lasting > 4 weeks between 2009 to 2018 were enrolled in the study. As per regular protocol, a pediatric orthopedic surgeon evaluated all patients who presented with back pain. After a non-diagnostic history, physical examination and spinal x-ray; spine MRI was order. Pain was graded with the use of NRS from 0 to 10. Patients were divided in two groups: NRS (1-5) & NRS (6-10). Variables such as gender, age, pain frequency, night pain, neurological exam, and the presence of an underlying pathology were compared between both groups. Patients that presented with injury due to trauma, previous diagnosis of back pain or cervical pain were excluded. Results: A total of 467 patients were evaluated in the study. Mean age of subjects was 15 years; 69% being female. An underlying pathology was identified in 131/315 (41.6%) patients with NRS (6-10), and 55/152 (36.2%) patients with NRS (1-5) (P=0.27). Patients with NRS (6-10) had two times more probability of suffering constant pain (P<0.03) and three times more likely of having an abnormal neurological examination (P<0.05). See table 1. Conclusion: Evaluation and treatment of children and adolescent with chronic back pain is challenging. Our study shows a strong association between NRS high (6-10) and constant pain and/or abnormal neurological exam. However, the use of NRS of (6-10) was not found as adequate predictor for the presence of an underlying organic pathology in children and adolescent patients. Therefore, physicians should not rely only high NRS score to recommend advance imaging study to assess chronic back pain in children and adolescent patients. Summary [Table: see text]

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The efficacy of transcatheter arterial embolization for knee pain on patients with knee osteoarthritis: A case series

Journal of Back and Musculoskeletal Rehabilitation ◽

10.3233/bmr-210043 ◽

2021 ◽

pp. 1-6

Author(s):

Kun Yung Kim ◽

Gi-Wook Kim

Keyword(s):

Conservative Treatment ◽

Knee Osteoarthritis ◽

Knee Pain ◽

Transcatheter Arterial Embolization ◽

Rating Scale ◽

Case Series ◽

Arterial Embolization ◽

Numeric Rating Scale ◽

Knee Oa ◽

Before And After

BACKGROUND: Knee osteoarthritis (OA) is accompanied by inflammation and angiogenesis. Modifying angiogenesis through transcatheter arterial embolization (TAE) can be a potential treatment for knee OA. OBJECTIVE: We subjected five OA knees in three patients to TAE and report the results of our post-treatment observations. CASE DESCRIPTION: Three patients that had experienced knee pain for a minimum of one year prior to the study, and whose pain had persisted despite conservative treatment, were included in this study. Patients more often chose conservative treatment over surgical treatment. Pain and functional scales were evaluated before, immediately, and 1 month after TAE using the Numeric Rating Scale (NRS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). TAE was performed by an experienced interventional radiologist. The average values of NRS evaluated before and after 5 TAEs were 5.2 before TAE, 3 immediately after TAE, and 3.6 after 1 month of TAE, and the average values of WOMAC were 52, 38.4, and 36.4, respectively. There were no major adverse effects. CONCLUSION: The examined cases support the conclusion that TAE is an effective treatment for patients with knee OA. Substantial pain relief and WOMAC improvement were observed both immediately and one month after TAE.

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Association of Serum Serotonin and Pain in Patients with Chronic Low Back Pain before and after Spinal Surgery

Pain Research and Treatment ◽

10.1155/2018/4901242 ◽

2018 ◽

Vol 2018 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Afshin Farhanchi ◽

Behrouz Karkhanei ◽

Negar Amani ◽

Mashhood Aghajanloo ◽

Elham Khanlarzadeh ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Chronic Low Back Pain ◽

Rating Scale ◽

Numerical Rating Scale ◽

Low Back ◽

Significant Difference ◽

Before And After ◽

Postoperative Serum ◽

Serum Serotonin

Introduction. In this study we are aiming to evaluate the changes of serum serotonin and its association with pain in patients suffering from chronic low back pain before and after lumbar discectomy surgery. Patients and Methods. A prospective study was performed on the patients referring to the outpatient clinic in Besat hospital, Hamadan University of Medical Sciences, Hamadan, Iran, during 2016. A 2 mL fasting blood sample was collected from each patient at preoperative day 1 and postoperative day 14 and they were measured for level of serum serotonin. Besides, all patients were asked for severity of their low back pain in preoperative day 1 and postoperative day 14 and scored their pain from zero to ten using a Numerical Rating Scale. Results. Forty patients with the mean age of 47 ± 13 yrs/old (range 25–77) including 15 (37.5%) males were enrolled into the study. The overall mean score of preoperative pain was significantly decreased from 7.4 ± 2.18 (range 4–10) to the postoperative pain score 3.87 ± 2.92 (range 0–10) (P < .001). The overall levels of pre- and postoperative serum serotonin were 3.37 ± 1.27 (range 1.1–6.4) and 3.58 ± 1.32 (range .94–7.1) ng/mL, respectively, with no significant difference (P = .09). The levels of pre- and postoperative serum serotonin were significantly higher in males and patients older than 50 yrs/old compared to the females and patients younger than 50 yrs/old, respectively (P = .03 and .005, respectively). A significant inverse correlation between the postoperative levels of pain and serum serotonin was observed (r = -.36 and P = .02). Conclusion. A negative medium strength linear relationship may exist between the postoperative serum serotonin and low back pain.

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Comparison of post-spinal back pain after midline versus paramedian approaches for urologic surgeries

Ain-Shams Journal of Anesthesiology ◽

10.1186/s42077-020-00088-5 ◽

2020 ◽

Vol 12 (1) ◽

Author(s):

Payman Dadkhah ◽

Masoud Hashemi ◽

Babak Gharaei ◽

Mohammad Hassan Bigdeli ◽

Ali Solhpour

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Spinal Anesthesia ◽

Rating Scale ◽

Numerical Rating Scale ◽

Spinous Process ◽

Lithotomy Position ◽

Significant Variable ◽

Low Back ◽

Increased Risk

Abstract Introduction Low back pain after spinal anesthesia is of concern in lithotomy position. During our study, low back pain in both midline and paramedian approaches after spinal anesthesia in lithotomy position was compared. Material and methods Spinal anesthesia was performed by two approaches of midline and paramedian by an expert. The midline at middle line and paramedian at 1 cm inferior and 1 cm lateral to the spinous process performed with the needle type of Quincke 25G. The severity of back pain in patients was measured with numerical rating scale method by an anesthesiology assistant 24 and 72 h and a week after surgery. Results A total of 139 patients were studied. After 24 h, back pain in the midline group was 21% and in the paramedian group was 25.4%, respectively. There were no significant differences between them. In the first 24 h, the only significant variable was the number of tries. In patients with ≥ 2 times of tries for performing spinal anesthesia, multivariate analysis of patients showed back pain to be 4.7 times more common compared to single try (OR 4.70, CI 1.79–10.18; p = 0.001). Conclusion There were no significant differences between the two methods of midline and paramedian approaches after spinal anesthesia in the incidence of back pain. However, two or more times of tries compared with one time try had increased risk of low back pain.

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EUS-Guided Versus Percutaneous Celiac Neurolysis for the Management of Intractable Pain Due to Unresectable Pancreatic Cancer: A Randomized Clinical Trial

Journal of Clinical Medicine ◽

10.3390/jcm9061666 ◽

2020 ◽

Vol 9 (6) ◽

pp. 1666

Author(s):

Won Jae Yoon ◽

Yul Oh ◽

Changhoon Yoo ◽

Sunguk Jang ◽

Seong-Sik Cho ◽

...

Keyword(s):

Pancreatic Cancer ◽

Abdominal Pain ◽

Back Pain ◽

Cancer Patients ◽

Rating Scale ◽

Numerical Rating Scale ◽

Intractable Pain ◽

Point Reduction ◽

Pain Scores ◽

Numerical Rating

Although endoscopic ultrasound-guided celiac neurolysis (EUS-CN) and percutaneous celiac neurolysis (PCN) are utilized to manage intractable pain in pancreatic cancer patients, no direct comparison has been made between the two methods. We compared the efficacy and safety of EUS-CN and PCN in managing intractable pain in such patients. Sixty pancreatic cancer patients with intractable pain were randomly assigned to EUS-CN (n = 30) or PCN (n = 30). The primary outcomes were pain reduction in numerical rating scale (NRS) and opioid requirement reduction. Secondary outcomes were: successful pain response (NRS decrease ≥50% or ≥3-point reduction from baseline); quality of life; patient satisfaction; adverse events; and survival rate at 3 months postintervention. Both groups reported sustained decreases in pain scores up to 3 months postintervention (mean reductions in abdominal pain: 0.9 (95% confidence interval (CI): −0.8 to 4.2) and 1.7 (95% CI: −0.3 to 2.1); back pain: 1.3 (95% CI: −0.9 to 3.4) and 2.5 (95% CI: −0.2 to 5.2) in EUS-CN, and PCN groups, respectively). The differences in mean pain scores between the two groups at baseline and 3 months were −0.5 (p = 0.46) and −1.4 (p = 0.11) for abdominal pain and 0.1 (p = 0.85) and −0.9 (p = 0.31) for back pain in favor of PCN. No significant differences were noted in opioid requirement reduction and other outcomes. EUS-CN and PCN were similarly effective and safe in managing intractable pain in pancreatic cancer patients. Either methods may be used depending on the resources and expertise of each institution.

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The Use of a Dynamic Elastomeric Fabric Orthosis in Supporting the Management of Athletic Pelvic and Groin Injury

Journal of Sport Rehabilitation ◽

10.1123/jsr.2014-0266 ◽

2016 ◽

Vol 25 (2) ◽

pp. 101-110 ◽

Cited By ~ 4

Author(s):

Leanne Sawle ◽

Jennifer Freeman ◽

Jonathan Marsden

Keyword(s):

Outcome Measures ◽

Rating Scale ◽

Numerical Rating Scale ◽

Preliminary Investigation ◽

Case Series ◽

Baseline Period ◽

Numerical Rating ◽

Straight Leg Raise ◽

Type Of Injury ◽

Groin Injury

Context:Athletic pelvic and groin injuries are a common yet challenging problem. Pelvic belts have been successfully used to reduce pain and improve function but are not a practical solution for athletes. Therefore, there is scope to explore the use of a more dynamic intervention developed to aid in the management of this type of injury.Objectives:To undertake a preliminary investigation into the effectiveness of a dynamic elastomeric fabric orthosis (DEFO) in supporting the management of athletic pelvic and groin injury.Design:A case series with an AB design. Daily assessments were undertaken over 15 days; the onset of intervention was randomized with a minimum baseline period of 6 d. Follow-up assessment was undertaken after 1 mo.Settings:Community and university.Participants:8 athletes presenting with pelvic or groin injury confirmed through clinical screening.Intervention:A bespoke DEFO.Main Outcome Measures:Force produced on bilateral resisted hip adduction and self-scored pain (using a numerical rating scale of 0–10) at rest and during an active straight-leg raise and a broad jump.Results:In 7 cases a significant improvement was observed on at least 1 measure (2-SD method, celeration line, and/or the point of nonoverlapping data). The remaining case showed minimal symptoms during testing.

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Percutaneous drainage and continuous irrigation in patients with severe pyogenic spondylitis, abscess formation, and marked bone destruction

Journal of Neurosurgery Spine ◽

10.3171/spi.2006.4.5.374 ◽

2006 ◽

Vol 4 (5) ◽

pp. 374-379 ◽

Cited By ~ 30

Author(s):

Naoyoshi Hanaoka ◽

Yoshiteru Kawasaki ◽

Toshinori Sakai ◽

Taro Nakamura ◽

Kazuhisa Nanamori ◽

...

Keyword(s):

Back Pain ◽

Conservative Treatment ◽

Percutaneous Drainage ◽

General Health ◽

Open Surgery ◽

Bone Destruction ◽

Abscess Formation ◽

Continuous Irrigation ◽

Pyogenic Spondylitis ◽

The Mean

Object The use of percutaneous suction aspiration has recently become viewed as an effective management strategy for pyogenic spondylitis unresponsive to conservative treatment. What remains unclear is whether it can be effective for severe pyogenic spondylitis in which abscess formation or marked bone destruction is present. The authors undertook a study to clarify answers to this question. Methods The authors evaluated clinical and radiographic/neuroimaging data obtained in five patients with severe pyogenic spondylitis, extensive abscesses, and marked bone destruction. These patients had undergone percutaneous drainage and continuous irrigation because open surgery was considered contraindicated in light of their poor general health. The mean period during which continuous irrigation was applied was 9 days (range 7–11 days), and the mean period during which the drainage tube was in place was 19 days (range 13–38 days). All patients suffered from back pain, which was relieved by the percutaneous technique in four patients after a mean of 8 days. The abscesses and inflammation resolved in all patients. Progressive osseous destruction was not observed, and open surgery was performed in only one patient in whom back pain persisted as a result of spinal instability. Conclusions After an unsuccessful course of conservative treatment, severe pyogenic spondylitis with abscess formation or marked bone destruction was successfully treated using percutaneous drainage and continuous irrigation. Based on their results, the authors believe that this procedure can be used in patients with severe pyogenic spondylitis that was unresponsive to conservative treatment, particularly in those whose general health is poor.

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Association between intermittent low-back pain and superior cluneal nerve entrapment neuropathy

Journal of Neurosurgery Spine ◽

10.3171/2015.1.spine14173 ◽

2016 ◽

Vol 24 (2) ◽

pp. 263-267 ◽

Cited By ~ 5

Author(s):

Yasuhiro Chiba ◽

Toyohiko Isu ◽

Kyongsong Kim ◽

Naotaka Iwamoto ◽

Daijiro Morimoto ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Rating Scale ◽

Numerical Rating Scale ◽

Symptom Relief ◽

Japanese Orthopaedic Association ◽

Entrapment Neuropathy ◽

Low Back ◽

Lumbar Extension

OBJECT Superior cluneal nerve (SCN) entrapment neuropathy (SCNEN) is a cause of low-back pain (LBP) that can be misdiagnosed as a lumbar spine disorder. The clinical features and etiology of LBP remain poorly understood. In this study, 5 patients with intermittent LBP due to SCNEN who had previously received conservative treatment underwent surgery. The findings are reported and the etiology of LBP is discussed to determine whether it is attributable to SCNEN. METHODS Intermittent LBP is defined as a clinical condition in which pain is induced by standing or walking but is absent at rest. Between April 2012 and March 2013, 5 patients in this study who had intermittent LBP due to SCNEN underwent surgery. The patients included 3 men and 2 women, with a mean age of 66 years. The affected side was unilateral in 2 patients and bilateral in 3 (total sites, 8). The interval from symptom onset to treatment averaged 51.4 months; the mean postoperative follow-up period was 17.6 months. The clinical outcomes were assessed using the numerical rating scale (NRS) for LBP, the Japanese Orthopaedic Association (JOA) scale, and the Roland-Morris Disability Questionnaire (RDQ) preoperatively and at the last follow-up; these data were analyzed statistically. RESULTS None of the 5 patients reported LBP at rest. Intermittent LBP involving the iliac crest and buttocks was induced by standing or walking an average of 136 m. In 2 patients with unilateral involvement, LBP was improved only by SCN block. Surgeries were performed on 6 sites in 5 patients because the SCN block was only transiently effective. Patients’ SCNs penetrated the orifice of the thoracolumbar fascia. SCN kinking at the orifice was exacerbated at the lumbar-extension provocation posture, and radiating pain increased upon manual intraoperative compression of the SCN in this posture. After releasing the SCN surgically, disappearance of the pain was intraoperatively confirmed by manual compression of the SCN with the patients in the lumbar-extension posture. Surgery was effective in all 5 patients, and all clinical outcome scores indicated significant improvement (p < 0.05). CONCLUSIONS To the authors’ knowledge, this is the first report of patients with intermittent LBP due to SCNEN. Clinical and surgical evidence presented suggests that their LBP was exacerbated by lumbar extension and that symptom relief was obtained by SCN block or surgical release of the SCN entrapment. These results suggest that SCNEN should be considered as a causal factor in patients for whom walking elicits LBP.

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Single vertebral manipulative therapy (Kitchener’s Technique): a new technique for treatment of acute and subacute spinal root compression

Journal of Neurology & Stroke ◽

10.15406/jnsk.2021.11.00451 ◽

2021 ◽

Vol 11 (2) ◽

pp. 31-35

Author(s):

Nabil Kitchener

Keyword(s):

Back Pain ◽

Physical Functioning ◽

Rating Scale ◽

Numerical Rating Scale ◽

Roland Morris Disability Questionnaire ◽

Spinal Root ◽

Functional Scale ◽

Manipulative Therapy ◽

Numerical Rating ◽

Disability Questionnaire

Introduction: Spinal Root Compression Syndromes (SRCS) are common, costly, and significant cause of long-term sick leave and work loss. There is No consensus on the best approach. One intervention often used is manipulative therapy. Objective: The aim of this study was to determine if Single Vertebral Manipulative Therapy (Kitchener’s Technique) (SVMT) is effective in alleviating pain levels and regaining physical functioning in comparison to standard medical care (SMC), among 18-55-year-old active working personnel. Methods: Prospective, longitudinal, 2-arm controlled study comparing SMC plus SVMT (32 patients) with only SMC (21 patients). The primary outcome measures were changes in root-related pain on the numerical rating scale and physical functioning at 6 weeks on the Roland-Morris Disability Questionnaire and back pain functional scale (BPFS). Results: Mean Roland-Morris Disability Questionnaire scores decreased in both groups during the course of the study, but adjusted mean scores were significantly better in the SMC plus SVMT group than in the SMC group at both week 2 (P<0.001) and week 6 (P=0.001). Mean numerical rating scale pain scores were also significantly better in the group that received SVMT. Adjusted mean back pain functional scale scores were significantly higher (improved) in the SMC plus SVMT group than in the SMC group at both week 2 (P<0.001) and week 6 (P=0.001). Conclusion: Results suggest that SVMT in conjunction with SMC offers a significant advantage for decreasing pain and improving physical functioning when compared with only SMC, for patients aged 18-55 years with SRCS.

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Association between telecommuting environment and low back pain among Japanese telecommuting workers: A cross-sectional study

10.1101/2021.07.15.21260610 ◽

2021 ◽

Author(s):

Ryutaro Matsugaki ◽

Keiji Muramatsu ◽

Seiichiro Tateishi ◽

Tomohisa Nagata ◽

Mayumi Tsuji ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Rating Scale ◽

Numerical Rating Scale ◽

Cross Sectional Study ◽

Mixed Effects ◽

Low Back ◽

Sectional Study ◽

Cross Sectional ◽

Numerical Rating

Objectives: We evaluated the relationship between telecommuting environment and low back pain (LBP) among desk-based workers in Japan. Methods: This cross-sectional study included 3,663 desk-based, telecommuting workers. LBP was assessed using a 0 to 10 numerical rating scale. The telecommuting environment was evaluated using subjective questions. Mixed-effects logistic regression analysis was used. Results: Mixed-effects logistic model results revealed that not having a place or room to concentrate on work, desk not well-lit enough for work, not having enough space on the desk to work, not having enough legroom, and not having comfortable temperature and humidity conditions in the workspace were significantly associated with higher odds of LBP. Conclusions: Our findings suggest that telecommuting environment is associated with the prevalence of LBP.

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