Thoracolumbar Fascia Enthesopathy as a Cause of Low Back Pain: A Retrospective and Follow-up Study

2021 ◽  
Author(s):  
Ouidade A. Tabesh ◽  
Roba Ghossan ◽  
Soha H Zebouni ◽  
Rafic Faddoul ◽  
Michel Revel ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Iliac Crest ◽  
Pain Syndrome ◽  
Clinical Findings ◽  
Complete Relief ◽  
Low Back ◽  
Thoracolumbar Fascia ◽  
The Mean

Abstract Aim. To evaluate ultrasonography findings of Thoracolumbar Fascia (TLF) enthesis in patients with low back pain (LBP) due to iliac crest pain syndrome (ICPS). Method. The ultrasonographic and clinical findings of 60 patients with LBP due to ICPS were compared to those of 30 healthy volunteers with no LBP. Thickness of the TLF was measured with ultrasound (US) at its insertion on the iliac crest. Results. Forty-eight women and 12 men with a mean age of 42.1±11.3 years were diagnosed with ICPS. In patients, the mean thickness of the TLF was 2.51±0.70mm in affected sides compared to 1.81±0.44mm in the contralateral unaffected sides. The mean thickness difference of 0.82mm between the affected and non-affected sides was statistically significant (95%CI, 0.64-0.99, P<0.0001). In volunteers, the mean thickness of the TLF was 1.6±0.2mm. The mean thickness difference of 0.89mm between the affected sides of patients and volunteers was statistically significant (95%CI, 0.73-1.06, P<0.0001). Forty-two patients who didn’t improve with conservative therapy, received injections of methylprednisolone acetate and 1% lidocaine around the TLF enthesis. All patients reported complete relief of their LBP within 20 minutes of the injections thanks to the lidocaine anesthetic effect. Fifty-six (93.3%) patients were reached by phone for a long-term follow-up. Among them, 33 (58.9%) patients experienced a sustained complete pain relief after a mean follow-up of 45±19.3 months (range, 3-74 months). Conclusion. our findings suggest that TLF enthesopathy is a potential cause of nonspecific LBP that can be diagnosed using US.

scholarly journals Intradiscal Injection of Autologous Platelet-Rich Plasma Releasate to Treat Discogenic Low Back Pain: A Preliminary Clinical Trial

2017 ◽  
Vol 11 (3) ◽  
pp. 380-389 ◽  
Author(s):  
Koji Akeda ◽  
Kohshi Ohishi ◽  
Koichi Masuda ◽  
Won C. Bae ◽  
Norihiko Takegami ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Platelet Rich Plasma ◽  
Low Back ◽  
Discogenic Low Back Pain ◽  
Intradiscal Injection ◽  
Autologous Platelet Rich Plasma ◽  
The Mean ◽  
Autologous Platelet

<sec><title>Study Design</title><p>Preliminary clinical trial.</p></sec><sec><title>Purpose</title><p>To determine the safety and initial efficacy of intradiscal injection of autologous platelet-rich plasma (PRP) releasate in patients with discogenic low back pain.</p></sec><sec><title>Overview of Literature</title><p>PRP, which is comprised of autologous growth factors and cytokines, has been widely used in the clinical setting for tissue regeneration and repair. PRP has been shown <italic>in vitro</italic> and <italic>in vivo</italic> to potentially stimulate intervertebral disc matrix metabolism.</p></sec><sec><title>Methods</title><p>Inclusion criteria for this study included chronic low back pain without leg pain for more than 3 months; one or more lumbar discs (L3/L4 to L5/S1) with evidence of degeneration, as indicated via magnetic resonance imaging (MRI); and at least one symptomatic disc, confirmed using standardized provocative discography. PRP releasate, isolated from clotted PRP, was injected into the center of the nucleus pulposus. Outcome measures included the use of a visual analog scale (VAS) and the Roland-Morris Disability Questionnaire (RDQ), as well as X-ray and MRI (T2-quantification).</p></sec><sec><title>Results</title><p>Data were analyzed from 14 patients (8 men and 6 women; mean age, 33.8 years). The average follow-up period was 10 months. Following treatment, no patient experienced adverse events or significant narrowing of disc height. The mean pain scores before treatment (VAS, 7.5±1.3; RDQ, 12.6±4.1) were significantly decreased at one month, and this was generally sustained throughout the observation period (6 months after treatment: VAS, 3.2±2.4, RDQ; 3.6±4.5 and 12 months: VAS, 2.9±2.8; RDQ, 2.8±3.9; <italic>p</italic>&lt;0.01, respectively). The mean T2 values did not significantly change after treatment.</p></sec><sec><title>Conclusions</title><p>We demonstrated that intradiscal injection of autologous PRP releasate in patients with low back pain was safe, with no adverse events observed during follow-up. Future randomized controlled clinical studies should be performed to systematically evaluate the effects of this therapy.</p></sec>

scholarly journals Thoracolumbar Fascia Enthesopathy as a Cause of Low Back Pain: A Retrospective and Follow-up Study

2021 ◽  
Vol 03 (03) ◽  
Author(s):  
Ouidade A Tabesh ◽  
Roba Ghossan ◽  
Soha H Zebouni ◽  
Rafic Faddoul ◽  
Michel Revel ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Low Back ◽  
Thoracolumbar Fascia ◽  
Follow Up Study

scholarly journals Transforaminal Epiduroscopic Basivertebral Nerve Laser Ablation for Chronic Low Back Pain Associated with Modic Changes: A Preliminary Open-Label Study

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Hyeun Sung Kim ◽  
Nitin Adsul ◽  
Farid Yudoyono ◽  
Byapak Paudel ◽  
Ki Joon Kim ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Laser Ablation ◽  
Chronic Low Back Pain ◽  
Modic Changes ◽  
Type I ◽  
Low Back ◽  
Vas Score ◽  
The Mean

Background. Chronic low back pain (CLBP) arising from degenerative disc disease continues to be a challenging clinical and diagnostic problem whether treated with nonsurgical, pain intervention, or motion-preserving stabilization and arthrodesis. Methods. Fourteen patients with CLBP, greater than 6 months, unresponsive to at least 4 months of conservative care were enrolled. All patients were treated successfully following screening using MRI findings of Modic type I or II changes and positive confirmatory provocative discography to determine the affected levels. All patients underwent ablation of the basivertebral nerve (BVN) using 1414 nm Nd:YAG laser-assisted energy guided in a transforaminal epiduroscopic approach. Macnab’s criteria and visual analog scale (VAS) score were collected retrospectively at each follow-up interval. Results. The mean age was 46 ± 9.95 years. The mean symptoms duration was 21.21 ± 21.87 months. The mean follow-up was 15.3 ± 2.67 months. The preoperative VAS score of 7.79 ± 0.97 changed to 1.92 ± 1.38, postoperatively (P<0.01). As per Macnab’s criteria, seven patients (50%) had excellent, six patients (42.85%) had good, and one patient (7.14%) had fair outcomes. Conclusion. The transforaminal epiduroscopic basivertebral nerve laser ablation (TEBLA) appears to be a promising option in carefully selected patients with CLBP associated with the Modic changes.

scholarly journals Efficacy of a multidimensional versus usual care physiotherapy on pain and electroencephalography (EEG) spectrum in chronic nonspecific low back pain: study protocol for a randomized controlled trial

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Sanaz Bemani ◽  
Shohreh Noorizadeh Dehkordi ◽  
Javad Sarrafzadeh ◽  
Saeed Talebian ◽  
Reza Salehi ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Low Back Pain ◽  
Back Pain ◽  
Usual Care ◽  
Chronic Low Back Pain ◽  
Controlled Trial ◽  
Clinical Findings ◽  
Low Back ◽  
Randomized Controlled

Abstract Background Non-specific chronic low back pain (NSCLBP) is a major public health and global socioeconomic burden associated with a complex interplay of biopsychosocial factors. Despite scientific signs of progress, treatment of NSCLBP often tends to stick to a biomechanical model, without targeting psychological and social factors. To enhance the clinical efficacy of usual physiotherapy for NSCLBP, the development of clinical strategies is to be pursued. This study aims to assess the effectiveness of multidimensional physiotherapy based on a biopsychosocial approach compared to usual care physiotherapy, on clinical findings and electroencephalography spectrum in non-specific chronic low back pain. Methods This study is a triple-blind, two-arm (1:1) randomized controlled trial with a 4 months follow-up. Seventy NSCLBP patients will be randomly allocated to either the experimental (multidimensional physiotherapy) or the active control group (usual physiotherapy); each group will receive 6 weeks of physiotherapy. The main outcome is pain and secondary outcomes are brain function, quality of life, disability, lumbar flexion range of motion, and psychosocial correlates. Assessment will be performed at baseline, post-treatment, and at 1 and 4 months follow-up. Discussion Findings may provide evidence on the effectiveness of multidimensional physiotherapy on clinical findings and brain characteristics and might provide evidence towards showing the role of brain and biopsychosocial factors on chronic pain. Trial registration ClinicalTrials.gov NCT04270422, Registered on 17 February 2020, IRCT Identifier: IRCT20140810018754N11

Employment status five years after a randomised controlled trial comparing multidisciplinary and brief intervention in employees on sick leave due to low back pain

2017 ◽  
Vol 46 (3) ◽  
pp. 383-388 ◽  
Author(s):  
Pernille Pedersen ◽  
Claus Vinther Nielsen ◽  
Ole Kudsk Jensen ◽  
Chris Jensen ◽  
Merete Labriola
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Sick Leave ◽  
Brief Intervention ◽  
Employment Status ◽  
Work Participation ◽  
Low Back ◽  
Multidisciplinary Intervention ◽  
The Mean

Aims: To evaluate differences in employment status, during a five-year follow-up period in patients on sick leave due to low back pain who had participated in a trial comparing a brief and a multidisciplinary intervention. Methods: From 2004 to 2008, 535 patients were referred to the Spine Centre at the Regional Hospital in Silkeborg if they had been on sick leave for 3–16 weeks due to low back pain. All patients underwent a clinical examination by a rehabilitation physician and a physiotherapist, and were randomised to either the brief intervention or the multidisciplinary intervention. The outcome was employment status from randomisation to five years of follow-up and was measured by the mean number of weeks in four different groups of employment status (sequence analysis) and a fraction of the number of weeks working (work participation score) that were accumulated over the years. Results: A total of 231 patients were randomised to the brief intervention and 233 patients to the multidisciplinary intervention. No statistically significant differences in the mean weeks spent within the different employment statuses were found between the two intervention groups. After five years of follow-up, participants in the multidisciplinary intervention had a 19% higher risk of not having a work participation score above 75% compared to participants in the brief intervention. Conclusions: After five years of follow-up no differences in employment status were found between participants in the brief and the multidisciplinary intervention.

scholarly journals Practical measurement of changes in leg length discrepancy after a myofascial release on the thoracolumbar fascia in patients with acute low back pain. A pilot study.

2021 ◽  
Author(s):  
Andreas Brandl
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Low Back ◽  
Leg Length ◽  
Thoracolumbar Fascia ◽  
Myofascial Release ◽  
Acute Low Back Pain ◽  
Length Discrepancy ◽  
Practical Measurement

Background: A relationship between leg length discrepancy (LLD), pelvic obliquity and acute low back pain (aLBP) is discussed in recent work. Myofascial release (MFR) techniques are probably one approach to tread aLBP. It is proposed to use anamnestic LLD survey in aLBP patients. The aim of this study is to evaluate a practical measurement of LLD and the feasibility of MFR in the setting of a randomized control trial (RCT).Methodology: In 12 subjects (7 female, 5 male) with aLBP and a LLD greater than 3 mm, a MFR technique was performed on the thoracolumbar fascia. At baseline, post-intervention and follow-up, LLD was measured with a cross-line laser, pain with the visual analogue scale (VAS) and finger floor distance (FFD). Patients completed a survey after follow-up to assess their acceptance of the study procedure. The therapist evaluated the methods in terms of practicability.Results: The cost on time and resources for the LLD measurement and the MFR treatment was low. The participants voted with medium to high acceptance for the study procedure. The LLD decreased by 5.00 mm after treatment and by 4 mm to follow-up. The minimum detectable changes were exceeded in 7 out of 12 cases after intervention and in 2 of 9 cases at follow-up. The VAS showed a reduction in pain of 17.50 mm to follow-up but not after treatment. The FFD revealed no clinically relevant differences.Conclusion: Measurement of LLD is applicable in daily practice in a manual therapy setting, but it cannot be assumed to be a valid method for an RCT. Valid methods such as video raster stereography are therefore recommended. A comprehen-sive RCT with an MFR arm to investigate the impact of this intervention on leg length is feasible.

PERCUTANEOUS EPIDURAL NEUROPLASTY (PEN) USING COMBINATION OF HYALURONIDASE AND HYPERTONIC SALINE (NaCl 3%) IN TREATING FAILED BACK SURGERY SYNDROME

2018 ◽  
Vol 1 (1) ◽  
pp. 1
Author(s):  
Wawan Mulyawan ◽  
Yudi Yuwono Wiwoho ◽  
Syaiful Ichwan
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Hypertonic Saline ◽  
Failed Back Surgery Syndrome ◽  
Favourable Outcome ◽  
Lumbar Spine Surgery ◽  
Low Back ◽  
Failed Back Surgery ◽  
Scale Scores

Background: Following surgical treatments for low back pain, lower extremity pain or neurologic symptoms would last or recur, this is defined as failed sack surgery syndrome (FBSS). FBSS usually occurs in 5-40% of these surgical patients. The most common cause is an epidural scar adhesion. Percutaneous epidural neuroplasty is the non-mechanical treatment for this condition. Previously, the use of hyaluronidase and hypertonic saline separately is commonly used for epidurolysis but the combination of hyaluronidase and hypertonic saline 3% has not been explored.Objective: To investigate the two-year outcomes of percutaneous epidural neuroplasty using a combination of hyaluronidase and hypertonic saline 3% in patients with FBSS.Methods: Twelve patients who experience low back pain, with or without radiculopathy, who have underwent lumbar spine surgery previously were assigned to the study. Parameters, such as the visual analogue scale scores for the back (VAS-B) and legs (VAS-L), and the Oswestry disability index (ODI), were recorded and compared between pretreatment, 1 week, 1 month, 3 months, 1 year and 2 years follow-up.Results: For all 12 patients, the postoperative VAS-B, VAS-L, and ODI were significantly different from the preoperative values in all follow-up periods: 1 month, 3 months, 1 year, and 2 years.Conclusion: Based off this study group, percutaneous epidural neuroplasty using a combination of hyaluronidase and hypertonic saline 3% has a favourable outcome in the 2 years follow-up

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