scholarly journals Unexplained back pain and sciatica: the added value of upright dynamic MRI of the lumbar spine in cases of clinical/radiological mismatch

2021 ◽  
Vol 52 (1) ◽  
Author(s):  
Heba Ibrahim ◽  
Khaled Diab
Keyword(s):  
Back Pain ◽  
Lumbar Spine ◽  
Ligamentum Flavum ◽  
Imaging Modality ◽  
Weight Bearing ◽  
Dynamic Mri ◽  
Daily Practice ◽  
Clinical Situation ◽  
Added Value ◽  
Disc Protrusion

Abstract Background Degenerative disease of the lumbar spine is one of the most prevalent pathologies worldwide, and MRI is the gold standard imaging modality that helps to assess soft tissue and bony abnormalities and elicit causes of neural compression. It is not uncommon in the daily practice to have patients presenting with neurological symptoms during standing or walking while MRI fails to detect lesion that explains their clinical picture. The aim of this study was to detect changes that appear on dynamic weight-bearing MRI of the lumbar spine that was hidden on conventional supine MRI and to correlate them with the clinical situation. Methodology Ninety patients with back pain were enrolled in the study, they did conventional and dynamic MRI of the lumbar spine. We compared findings in both modalities as regard alignment, ligamentum flavum buckling, foraminal narrowing and neural compression. Results Dynamic MRI showed neural compression in 87% of patients in comparison to supine MRI, ligamentum flavum buckling was reported in 80%, neural foraminal narrowing was seen in 24%, exaggeration of the lumbar lordoisis in 10% and exaggeration of the already existing disc protrusion was documented in 60% of the included patients. Conclusions Upright dynamic MRI has added to supine MRI in problem solving cases with clinical radiological mismatch. The results indicated changes in the spine alignment, neural compression and spinal canal stenosis. Since the examination is non-invasive, it could be used in the preoperative planning of patients with degenerative lumbar spine disease.

scholarly journals Patient-Reported Outcome-Based Quality Indicators in Dutch Primary Care Physical Therapy for Patients With Nonspecific Low Back Pain: A Cohort Study

2021 ◽  
Author(s):  
Arie C Verburg ◽  
Simone A van Dulmen ◽  
Henri Kiers ◽  
Maria W G Nijhuis-van der Sanden ◽  
Philip J van der Wees
Keyword(s):  
Quality Improvement ◽  
Back Pain ◽  
Physical Therapy ◽  
Quality Indicators ◽  
Physical Therapists ◽  
Daily Practice ◽  
Patient Reported Outcome ◽  
Added Value ◽  
Core Set ◽  
Patient Reported

Abstract Objective The purpose of this study was to define and select a core set of outcome-based quality indicators, accepted by stakeholders on usability and perceived added value as a quality improvement tool, and to formulate recommendations for the next implementation step. Methods In phase 1, we defined 15 potential quality indicators for patient-reported outcome measures (PROMs) and associated domains, namely the Numeric Pain Rating Scale (NPRS) for pain intensity, the Patient Specific Functioning Scale (PSFS) for physical activity, the Quebec Back Pain Disability Scale (QBPDS) for physical functioning, and the Global Perceived Effect - Dutch Version (GPE-DV) for perceived effect. We described their comparability and discriminatory characteristics using cohort data. In phase 2, a core set of quality indicators was selected based on consensus among stakeholders in focus group meetings. Results In total, 65,815 completed treatment episodes for patients with nonspecific low back pain (NSLBP) were provided by 1009 physical therapists from 219 physical therapist practices. The discriminability between physical therapists of all potential 15 quality indicators was adequate with intraclass correlation coefficients between 0.08 and 0.30. Stakeholders selected a final core set of 6 quality indicators: 2 process indicators (the routine measurement of NPRS and the PSFS) and 4 outcome indicators (pretreatment and posttreatment change scores for the NPRS, PSFS, QBPDS, and the minimal clinically important difference of the GPE-DV). Conclusion This study described and selected a core set of outcome-based quality indicators for physical therapy in patients with NSLBP. The set was accepted by stakeholders for having added value for daily practice in physical therapy primary care and was found useful for quality improvement initiatives. Further studies need to focus on improvement of using the core set of outcome-based quality indicators as a quality monitoring and evaluation instrument. Impact Patient-reported outcome-based quality indicators developed from routinely collected clinical data are promising for use in quality improvement in daily practice.

Severe low back pain with mild leg symptoms due to lumbar spine stenosis

2021 ◽  
pp. 1-4
Author(s):  
Ryo Kanematsu ◽  
Junya Hanakita ◽  
Toshiyuki Takahashi ◽  
Manabu Minami ◽  
Kazuhiro Miyasaka ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Lumbar Spine ◽  
Low Back

scholarly journals THU0492 MAGNETIC RESONANCE IMAGING OF THE SACROILIAC JOINTS IN PATIENTS WITH HYPERMOBILITY: A RETROSPECTIVE COHORT STUDY

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 482.4-483
Author(s):  
A. Jones ◽  
C. Ciurtin ◽  
H. Kazkaz ◽  
M. Hall-Craggs
Keyword(s):  
Magnetic Resonance Imaging ◽  
Bone Marrow ◽  
Back Pain ◽  
Lumbar Spine ◽  
Magnetic Resonance ◽  
Bone Marrow Oedema ◽  
Resonance Imaging ◽  
Sacroiliac Joints ◽  
Fatty Change ◽  
Subchondral Sclerosis

Background:The incidence of inflammatory and structural lesions on magnetic resonance imaging of sacroiliac joints (MRI SIJs) in patients with hypermobility related disorders has not been fully investigated. Hypermobile patients are more susceptible to pelvic instability and biomechanical stress of the SIJs, leading to MRI SIJ changes similar to those occurring in spondyloarthritis (SpA). Patients with hypermobility and suspected SpA pose a unique challenge owing to the high prevalence of back pain in the hypermobility cohort and the absence of spinal restriction on clinical examination.Objectives:In this study, we aim to investigate the incidence of MRI SIJ lesions in patients with hypermobility.Methods:We performed a retrospective study of all patients with a confirmed diagnosis of hypermobility related disorders (including hypermobility syndrome, hypermobility spectrum disorders and Ehlers-Danlos Syndromes) referred for an MRI lumbar spine and SIJ between 2011 and 2019 to investigate long-standing back pain. MRIs were examined by a musculoskeletal (MSK) radiologist with more than 25 years of experience, who was blinded to the clinical outcome of the patients. MRI SIJs were assessed for the presence of bone marrow oedema, subchondral sclerosis, erosion, fatty change, enthesitis, ankylosis, joint fluid and capsulitis.Results:51 patients with confirmed hypermobility related disorders were referred for MRI SIJ and lumbar spine between 2011 and 2019. 3 patients demonstrated clinical features in keeping with a diagnosis of SpA and were excluded from the study. 15/48 (31.3%) of patients with hypermobility and back pain (but no clinical picture of SpA) were found to have inflammatory and/or structural lesions on MRI SIJ. The most frequent lesions were small foci of bone marrow oedema (16.6%) followed by subchondral sclerosis (12.5%) and fatty change (10.4%). The incidence of erosions was 4.2%.Conclusion:There is a relatively high incidence of inflammatory and structural lesions on MRI SIJ of patients with hypermobility. The presence of hypermobility should be taken into consideration when interpreting MRI changes in patients with suspected SpA. Further research into long-term outcomes of MRI SIJs in patients with hypermobility and back pain is required to establish the clinical significance of these findings.Disclosure of Interests: :Alexis Jones: None declared, Coziana Ciurtin Grant/research support from: Pfizer, Consultant of: Roche, Modern Biosciences, Hanadi Kazkaz: None declared, Margaret Hall-Craggs: None declared

scholarly journals Hodgkin lymphoma presenting as alcohol-induced back pain

2019 ◽  
Vol 12 (11) ◽  
pp. e228440
Author(s):  
Lucy Ma ◽  
Sanskriti Varma ◽  
Ashwini Niranjan-Azadi
Keyword(s):  
Back Pain ◽  
Lumbar Spine ◽  
Hodgkin Lymphoma ◽  
Anterior Chest Wall ◽  
Marrow Transplant ◽  
Radiographic Evaluation ◽  
Anterior Mediastinal Mass ◽  
Left Lower Extremity ◽  
Stage Ivb ◽  
The Right

A 32-year-old Chinese man without significant medical history presented with a 2-month history of worsening lumbosacral back pain radiating to the groin and left lower extremity. He also described a shooting pain in the sciatic nerve distribution that began with and was exacerbated by alcohol consumption, a rare but known symptom of Hodgkin lymphoma (HL). On exam, an anterior chest wall mass was noted. Radiographic evaluation of an anterior mediastinal mass showed osseous erosion into the manubrium. MRI of the lumbar spine showed diffuse osseous disease of the lower thoracic and lumbar spine with extension into the right sacroiliac joint and S2 neural foramen without vertebral body collapse or stenosis. Tissue biopsy revealed nodular sclerosis HL, stage IVB IPS2. The patient was primary refractory to ABVD (adriamycin, bleomycin, vinblastine, dacarbazine) therapy. Salvage ICE (ifosfamide, carboplatin, etoposide) chemotherapy was used and then followed by non-myeloablative haploidentical bone marrow transplant was performed on 5 March 2019.

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