Risk factors for progression of juvenile-onset non-radiographic axial spondyloarthritis to juvenile-onset ankylosing spondylitis: a nested case–control study

ObjectiveTo evaluate the clinical characteristics of juvenile-onset non-radiographic axial spondyloarthritis (nr-axSpA) and to investigate risk factors associated with progression to juvenile-onset ankylosing spondylitis (JoAS).MethodsA nested case–control study was conducted using the retrospectively collected data of 106 patients with juvenile-onset nr-axSpA (age at disease onset, <16 years) in the Clinical characteristic and Outcome in Chinese Axial Spondyloarthritis study cohort. Baseline demographic and clinical characteristics and prognosis were reviewed. Logistic regression analyses were performed to investigate risk factors associated with progression to JoAS.ResultsOverall, 58.5% of patients with juvenile-onset nr-axSpA presented with peripheral symptoms at disease onset. In 82.1% of these patients, axial with peripheral involvement occurred during the disease course. The rate of disease onset at >12 years and disease duration of ≤10 years were significantly higher in those with progression to JoAS than in those without progression to JoAS (83.0% vs 52.8%, p=0.001; 92.5% vs 56.6%, p<0.001, respectively). Multivariable logistic regression analysis revealed that inflammatory back pain (IBP) (OR 13.359 (95% CI 2.549 to 70.013)), buttock pain (OR 10.171 (95% CI 2.197 to 47.085)), enthesitis (OR 7.113 (95% CI 1.670 to 30.305)), elevated baseline C reactive protein (CRP) levels (OR 7.295 (95% CI 1.984 to 26.820)) and sacroiliac joint-MRI (SIJ-MRI) positivity (OR 53.821 (95% CI 9.705 to 298.475)) were significantly associated with progression to JoAS.ConclusionPeripheral involvement was prevalent in juvenile-onset nr-axSpA. IBP, buttock pain, enthesitis, elevated baseline CRP levels and SIJ-MRI positivity in patients with the disease are associated with higher risk of progression to JoAS.

Analysis of curative effect: percutaneous transforaminal endoscopic discectomy for lumbar disc herniation with buttock pain as the main symptom

Background . Lumbar disc herniation (LDH) is a common disease in spinal surgery which often causes acute radicular pain. However, LDH with buttock pain (BP) as the main clinical symptom is rare. Herein, we retrospectively evaluated the efficacy and safety of percutaneous transforaminal endoscopic discectomy (PTED) in the treatment of LDH with the buttock as the primary clinical symptom. Methods . Totally 12 patients have LDH (L4-5) with BP who underwent PTED from January 2019 to June 2020 were enrolled. All patients performed magnetic resonance imaging (MRI) and computed tomography (CT) preoperatively, 1 week postoperatively, and at follow-up. The pain relieve were evaluated by the Visual analog scale (VAS), the functional recovery was assessed by Oswestry disability index (ODI) and Roland-Morris questionnaire (RMQ). Parameters were evaluated preoperatively, immediately after surgery, 1 month, 3 months and 6 months after surgery, respectively. Moreover, the lumbar function was determined by modified MacNab criteria. Results . Pain relieve was found in 11 patients postoperatively. The VAS, ODI and RMQ scores were improved significantly at the latest follow up visit compared to preoperative (P < 0.05). One patient suffered from LDH recurrence one month after operation and received revision surgery, then achieved satisfied effect. Two patients experienced residual BP after operation and obtained good clinical outcomes by conservative treatment. No other surgical complications were found during follow up period. The average length of follow-up was 6.68 ± 0.67 months. Conclusion. PTED is a safe and efficacious method in treating LDH with BP.

Sacral Tuberculosis: Never Ignore Buttock Pain

A last few decade, case of infection with Mycobacterium tuberculosis (TB) is increasing. TB infection of other than pulmonary is quite challenging to diagnose due to non-specific signs and symptoms (Wellons III et al., 2004). Spine being the commonest site of skeletal TB which account approximately 50% from reported cases (Tuli, 2002). Spinal TB can be associated with pulmonary infection, however in less than 1% of cases, it occurs in the absence of pulmonary involvement (Davidson & Horowitz, 1970; Gorse, Pais, Kusske, & Cesario, 1983; Omari, Robertson, Nelson, & Chiu, 1989; Rezai, Lee, Cooper, Errico, & Koslow, 1995). TB infection involving the lumbosacral junction is uncommon, only 2 to 3% from all cases of spinal TB (Ahmadi, Bajaj, Destian, Segall, & Zee, 1993; Dayras, Lorilloux, Hugonet, & Benichou, 1985; MANSBERG, ROWE, & WALKER, 1991; Pun et al., 1990; Rajasekaran et al., 1998). Isolated sacral TB is rare entity, The patient usually presented with lower back pain with or without neurological involvement (Patankar et al., 2000). Here we presented a case of sacral TB which not associated with neurological impairment.

Aggressive angiomyxoma of the ischioanal fossa in a post-menopausal woman

Aggressive angiomyxoma is a rare mesenchymal tumour, primarily arising in the soft tissue of the pelvis and perineum in women of reproductive age. There is a paucity of evidence on optimal management because of the rarity of these tumours, but the consensus has been for surgical excision. We present the case of a 65-year-old woman who was admitted with left-sided buttock pain and initially diagnosed with a perianal abscess. She underwent examination under anaesthesia rectum with surgical excision of the lesion, subsequent histopathological and immunochemical analysis was suggestive of aggressive angiomyxoma. To complement our case report, we also present a literature review focusing on aggressive angiomyxoma in the ischioanal fossa (also known as the ischiorectal fossa) with only eight cases of primary aggressive angiomyxoma involving the ischioanal fossa documented to date. The primary aims of this case report and literature review are to familiarise clinicians with the clinical, histopathological and immunochemical features of these tumours, and to increase appreciation that despite the rarity of aggressive angiomyxoma, it might be considered in the differential diagnosis of ischioanal lesions.

Covid-19 Potentially Caused By A Corticosteroid Injection: A Case Report

This is a case regarding a 50-year-old female from Maryland, USA, with no pertinent past medical history, presenting with a 1 year history of low back pain, elicited by an exercise-related injury. During this time, she had low back and right buttock pain without radiation or neurological signs. The patient tried and failed conservative measures including OTC medications, oral steroids, and Physical Therapy. Based on the discussion between the physician and the patient, a decision was made to proceed with bilateral L3-S1 lumbar facet joint corticosteroid injections on September 21st, 2020, as she was very low risk for COVID-19. 6 days post-procedure, on September 27th, the patient began developing COVID-like symptoms, including fatigue, DOE and anosmia. She later had a positive COVID-19 test on October 1st, 2020. Contact tracing for the patient did not reveal any recent contacts who had COVID-19, and her contacts tested negative for the virus. An in-depth literature review was conducted regarding the nature of this case. While there were many articles with recommendations on steroid injections for pain interventions, there were no cases found directly linking COVID-19 as caused by such an intervention. It is proposed that, while this may not be the first case of its kind, this may certainly be the first case published in the literature, which can open the door for further investigation

Case Report: When Shingles Disrupts Bladder Function

Varicella Zoster (shingles) virus is a double stranded DNA in the Herpesviridae family that can present as both chicken pox and as shingles. The virus enters through the respiratory system, replicating in the nasopharynx, and causes a viremia upon primary infection. Varicella Zoster spreads to other organs and often lies dormant in the dorsal root ganglion. Reactivation of the virus is more common in older or immunocompromised patients and often presents as a painful vesicular rash in a unilateral dermatomal distribution with possible concurrent radiculopathy. A rare complication of herpes zoster is urinary dysfunction. We report a case of a 42-year-old patient diagnosed with herpes zoster whose primary complaint was left buttock pain and a maculovesicular rash in the S2-S4 dermatomal distribution. She was prescribed Valacyclovir and began to experience urinary retention two days after starting the medication.

Combined Wireless Spinal Cord Stimulation, Dorsal Root Ganglion Stimulation, and Peripheral Nerve Stimulation for Treating Low Back Pain

Background: Neuromodulation has undergone significant advances over the past decade, particularly when the DRG and PNS modalities evolved to target conditions that are hard to cover by conventional SCS. The availability of a variety of stimulation modalities allows for a customized approach. Case Presentation: A 49-year-old man presented with low back and buttock pain. The patient had a history of chronic lower back pain, L4/L5 and L5/S1 facet hypertrophy, a 3-mm left paracentral and foraminal disc protrusion minimally involving the left S1 nerve root, and right low back/buttock/hip pain after previous surgical removal of an episacroiliac lipoma on the right sacroiliac joint. Despite multiple therapies such as oral opioids, anticonvulsants, and physical therapy, the patient continued to experience right lower back and buttock pain. Conclusion: The patient’s pain scores decreased from a baseline score of 8 out of 10 without medication to a 1 out of 10 without medication. The wireless SCS and PNS significantly reduced pain scores for this patient suffering from lower back, buttock, and hip pain. Key words: Dorsal root ganglion, low back pain, peripheral nerve stimulation, spinal cord stimulation