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Back pain lifetime incidence is 60%–70%, while 12%–20% of older women have vertebral fractures (VFs), often with back pain. We aimed to provide objective evidence, currently lacking, regarding whether back pain and VFs affect physical activity (PA). We recruited 69 women with recent back pain (age 74.5 ± 5.4 years). Low- (0.5 < g < 1.0), medium- (1.0 ≤ g < 1.5), and high-impact (g ≥ 1.5) PA and walking time were measured (100 Hz for 7 days, hip-worn accelerometer). Linear mixed-effects models assessed associations between self-reported pain and PA, and group differences (VFs from spine radiographs/no-VF) in PA. Higher daily pain was associated with reduced low (β = −0.12, 95% confidence interval, [−0.22, −0.03], p =.013) and medium-impact PA (β = −0.11, 95% confidence interval, [−0.21, −0.01], p =.041), but not high-impact PA or walking time (p >.11). VFs were not associated with PA (all p >.2). Higher daily pain levels but not VFs were associated with reduced low- and medium-impact PA, which could increase sarcopenia and falls risk in older women with back pain. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to investigate the influence of multifidus muscle fat infiltration on clinical outcomes in lumbar disc herniation (LDH) undergoing percutaneous endoscopic lumbar discectomy (PELD). Methods: A retrospective analysis was conducted on 224 patients who underwent lateral PELD, with complete one-year follow-up data. Patients were divided into two groups based on preoperative MRI evaluation of L4 multifidus muscle fat infiltration: a mild group (< 25%) and a severe group (≥ 25%). Baseline characteristics and postoperative outcomes were recorded and compared. Results: At the final follow-up, significant improvements in VAS scores for back and leg pain, ODI scores, and EQ-5D scores were observed in both groups. There were no statistically significant differences in preoperative VAS scores for back and leg pain, ODI scores, and EQ-5D scores between the two groups. However, significant differences were found in VAS scores for back pain, ODI scores, and EQ-5D scores at 3, 6, and 12 months postoperatively (P < 0.05), while no significant difference was noted in VAS scores for leg pain during follow-up. The total recurrence rate was 6.7% (15 out of 224 cases), with 12 cases in the severe group and 3 cases in the mild group, showing a statistically significant difference (P < 0.05). Conclusion: The effectiveness of postoperative PELD in patients with LDH is impacted by severe multifidus muscle fat infiltration. Multifidus muscle fat infiltration represents a risk factor for recurrent LDH after PELD. [ABSTRACT FROM AUTHOR]

The case of Lumbar spinal stenosis (LSS) combined with tophi due to gout is rarely reported. In the course of our clinic work, we encountered a young male patient who was diagnosed with a history of gout for 5 years and was targeted as LSS combined with gouty tophi, and we would like to share this case. In addition, in order to further investigate the deep mechanism of LSS associated with gout, we obtained the intersecting genes of the two diseases based on a machine learning approach by obtaining the dataset GSE113212 related to LSS from the Gene Expression Omnibus (GEO) database, and the genes related to gout from the human gene database. We found that TGFB1, PPARG, and SAMRCC1 may be important biomarkers for treating of both diseases. From a clinical perspective, clinicians should be vigilant about the possibility of gouty lumbar spinal stenosis with tophi in young patients presenting with back pain, hyperuricemia, and elevated inflammatory markers. A combined surgical and pharmacological treatment plan has a favorable prognosis. Investigating the mechanisms of action of core genes may provide new insights for treatment, ultimately leading to the development of comprehensive and personalized diagnostic and therapeutic strategies. [ABSTRACT FROM AUTHOR]

Background/objective: Low back pain (LBP) is the leading cause of disability worldwide, resulting in enormous socio-economic and personal consequences. Sensory profiles during the acute back pain stage will predict central sensitization symptoms in the chronic pain stage, as central sensitization is the main mechanism behind nociplastic pain and pain chronicity. Therefore, our objective was to establish overall and sex-specific sensory profile cut-off points that distinguish symptoms of central sensitization at 12 weeks, using a retrospective prognostic cohort study design. Methods: Two hundred and seventeen patients with acute LBP (<6 weeks) were assessed using Receiver Operator Characteristic analyses. Measurements were taken at baseline using the Adolescent/Adult Sensory Profile and follow-up by the Central Sensitization Inventory at 12 weeks, based on the established Central Sensitization Inventory cut-off points for the overall population at ≥30 and ≥40, female patients at ≥33, and male patients at ≥25. Results: In female patients, a Sensory Sensitive cut-off point of ≥30.5 significantly distinguished central sensitization symptoms at 12 weeks, resulting in the following values: Area Under the Curve = 0.81 (95% CI = 0.73; 0.89), sensitivity = 0.89, specificity = 0.63, prevalence = 0.36, positive predictive value = 0.56, negative predictive value = 0.80, and Youden's index = 0.52. Conclusions: The Sensory Sensitive profile distinguishes female patients with acute LBP with and without central sensitization symptoms at 12 weeks. This cut-off point may be useful in identifying individual sensory preferences and addressing maladaptive behavioral responses to sensory stimulation in clinical practice to prevent chronicity. [ABSTRACT FROM AUTHOR]

Background and aims: Previous studies in lumbar spine surgery have mainly studied functioning and pain by comparing average scores from Patient Reported Outcome Measures (PROMs) at different time points. Less is known about these changes in different subgroups. It is self-evident that, while most patients may demonstrate trajectories of these changes close to the average one, some groups may follow more or less different trends. Also, it is unclear which preoperative factors may affect the probability of being classified into groups with different development trajectories of surgical outcome. The objective of this study was to identify groups exhibiting distinct trajectories within the broader cohort of patients undergoing lumbar spine surgery and to determine whether certain factors may be associated with a probability of being classified into a particular group. Methods: This was a register-based study of 1,451 patients undergoing lumbar spine surgery. The group-based trajectory analysis was used separately for leg pain, for back pain, and for functioning. The probability of group membership was calculated based on sex, age, leg and back pain duration before surgery, and obesity. Results: Two kinds of group-based trajectories were identified for each of three-factor variables: a long-term and a short-term improvement group. Sex and age were not associated with being classified into short-term improvement groups, but obesity was associated for all three-factor variables with relative risk ratios (RRR) varying from 1.26 (95% CI 1.02 to 1.56) to 1.45 (95% CI 1.10 to 1.90). Preoperative leg and back pain duration was significantly associated solely with back pain severity with an RRR of 1.28 (95% CI 1.01 to 1.61). Conclusions: The results of this study suggest that most of the patients may experience pain relief and improved functioning within three months after lumbar surgery, and this effect may last, at least, for two years. Higher BMI and worse preoperative pain and disability were associated with the inferior outcome of surgery. When considering surgery, planning pre- and postoperative rehabilitation, or forecasting the use of pain medications, a higher probability of worse outcome could be expected for overweight and initially more painful patients with higher level of disability. [ABSTRACT FROM AUTHOR]

Background/Objectives: Low back pain is one of the most prevalent pathologies. Several studies relate its chronification to certain psycho-emotional characteristics, such as self-efficacy or the patient's lack of confidence in the ability to move. Determine the reliability and validity of the OPTIMAL-confidence scale in people with chronic low back pain and describe the confidence in the movement capacity of this population. Methods: Design: A validation study was designed to evaluate the psychometric properties of the OPTIMAL-Confidence Questionnaire in a population with chronic low back pain. A descriptive observational study in a population with chronic low back pain and a healthy population was designed to describe the confidence in the movement capacity of the population with chronic low back pain. Settings: Health centers of primary care from a region of northwestern Spain. Participants: The final sample was 122 patients diagnosed with chronic low back pain. The sampling was completed with 30 additional healthy subjects. Instruments: OPTIMAL-confidence questionnaire, Numerical Pain Rating Scale, Chronic Pain Self-efficacy Scale, and ad hoc questionnaire to collect socio-demographic and clinical variables. Results: Cronbach's alpha for the OPTIMAL-confidence questionnaire was 0.91. The association of OPTIMAL-confidence with the self-efficacy, pain intensity, and movement ability scales was moderate and significant (p < 0.001). Regarding the low back pain population, significant differences were observed in confidence levels according to age and the need for walking aids (p < 0.009). The OPTIMAL-confidence questionnaire also showed significant discrimination between the low back pain group and the no back pain group (p < 0.001). The confidence interval was 95%. Conclusions: The population with low back pain shows less confidence in their ability to perform movements, compared to the general population. OPTIMAL is an instrument that can discriminate between patients who present chronic low back pain and those who do not. [ABSTRACT FROM AUTHOR]

Copyright of Retos: Nuevas Perspectivas de Educación Física, Deporte y Recreación is the property of Federacion Espanola de Asociaciones de Docentes de Educacion Fisica and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective. To assess the effect of bimekizumab on pain, morning stiffness, and fatigue in patients with nonradiographic and radiographic axial spondyloarthritis (axSpA) in the phase III BE MOBILE studies (ClinicalTrials.gov: NCT03928704 and NCT03928743). Methods. Patients were randomized to bimekizumab 160 mg or placebo every 4 weeks; and all patients received bimekizumab from week 16. Patients reported spinal pain, peripheral pain, morning stiffness, and fatigue to week 52. Total and nocturnal spinal pain were each assessed on a 0-10 numerical rating scale (NRS). Individual Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) items (0-10--point NRS) assessed peripheral arthritis pain (question [Q] 3), enthesitis pain/discomfort (Q4), morning stiffness (mean of Q5 and Q6), and fatigue (Q1). Functional Assessment of Chronic Illness Therapy Fatigue subscale score (FACIT-Fatigue) is also reported. Results. At week 16, bimekizumab-treated patients reported lower mean nocturnal spinal pain, total spinal pain, and BASDAI scores (nominal except for nocturnal spinal pain; all P ≤ 0.001), as well as higher FACIT-Fatigue scores (nominal P < 0.05) vs placebo, indicating improved symptom levels. Improvements continued to week 52 in continuous bimekizumab-treated patients and in placebo-bimekizumab switchers. A higher proportion of bimekizumab- vs placebo-randomized patients achieved increasingly stringent thresholds for low spinal and peripheral pain at week 16; this was sustained or improved at week 52. Results were similar for morning stiffness and fatigue. At week 52, over half of patients were considered FACIT-Fatigue responders (≥ 8-point increase in score). Conclusion. Bimekizumab treatment led to rapid improvements in levels of pain and morning stiffness. Substantial improvements were seen in all domains across the full disease spectrum of axSpA and continued to week 52. [ABSTRACT FROM AUTHOR]

Study Design: Review article. Objectives: A review of literature on the epidemiology, natural course, pathobiology and clinical implications of vertebral endplate changes. Methods: A literature search was performed using the Cochrane Database of Systematic Reviews, EMBASE, and PubMed. Studies published over the last 10 years were analysed. The searches were performed using Medical Subject Headings terms, and the subheadings used were "Vertebral endplate changes", "Modic changes", "Disc Endplate Bone Marrow complex". Results: The disc, endplate (EP), and bone marrow region of the spine constitute a unified morphological and functional unit, with isolated degeneration of any one structure being uncommon. Disc degeneration causes endplate defects, which result in direct communication and a constant cross-talk between the disc and the vertebral body. This may result in a persistent inflammatory state of the vertebral bone marrow, serving as a major pain generator. This review article focuses on vertebral endplate changes and how the current understanding has progressed from the Modic classification to the Disc Endplate Bone Marrow complex classification. It provides a clear portrayal of the natural course of these alterations and their clinical implications in low back pain. Conclusions: In light of the heightened interest and current prominence of vertebral endplate changes within the spine community, we must progress beyond the Modic changes to achieve a comprehensive understanding. The DEBM complex classification will play a major part in disc degeneration research and clinical care, representing a considerable advancement in our understanding of the vertebral endplate changes over the classical Modic changes. [ABSTRACT FROM AUTHOR]

Background: In this study, we expand the supportive evidence for total disc arthroplasty (TDA) with results up to 21 years in a large patient cohort who received a semiconstrained ball-and-socket lumbar prosthesis. The objectives of the study were to compare the results for 1 versus 2-level surgeries and to evaluate whether prior surgery at the index level(s) impacts clinical outcomes. Methods: From 1999 to 2013, 1,187 patients with chronic lumbar degenerative disc disease (DDD) underwent lumbar TDA, of whom 772 underwent a 1-level procedure and 415 underwent a 2-level procedure. A total of 373 (31.4%) of the 1,187 patients had prior index-level surgery. Patients were evaluated preoperatively; at 3, 6, 12, 18, and 24 months postoperatively; and yearly thereafter. The follow-up duration ranged from 7 to 21 years (mean, 11 years and 8 months). Collected data included radiographic, neurological, and physical assessments, as well as self-evaluations using the Oswestry Disability Index (ODI) and visual analog scale (VAS) for back and leg pain. Perioperative data points, complication rates, and reoperation or revision rates were also assessed. Patients were divided into 4 groups: 1-level TDA with no prior surgery at the index level, 1-level TDA with prior surgery, 2-level TDA with no prior surgery, and 2-level TDA with prior surgery. Results: All groups showed dramatic reduction in the ODI at 3 months postoperatively and maintained these scores over time. Although VAS pain did not diminish to its final level as rapidly for patients with prior surgery, there was no significant difference between the groups in terms of pain reduction at 24 months postoperatively. Of 1,187 patients, 49 (4.13%) required either a new surgery at another level or revision or reoperation at the index level. Rates were too low in all groups to compare them statistically. Total TDA revision and adjacent-level surgery rates over 7 to 21 years were very low (0.67% and 1.85%, respectively). Conclusions: This study demonstrates the robust long-term clinical success of 1 and 2-level lumbar TDA as assessed at 7 to 21 years postoperatively in one of the largest evaluated cohorts of patients with TDA. Patients had dramatic and maintained reductions in disability and pain scores over time and low rates of index-level revision or reoperation and adjacent-level surgery relative to published long-term fusion data. Additionally, patients who underwent 1-level lumbar TDA and those who underwent 2-level TDA demonstrated equivalent improvement, as did patients with prior surgery at the index level and those with no prior surgery. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Purpose: There is paucity of guidelines with inadequate data available about the extent and prevention of bone and joint disease in beta-thalassemic patients in Indian population. This study aims to determine bone and joint involvement in beta-thalassemic patients. It evaluates serum biochemical parameters of bone formation and resorption and correlates with the symptomatology in these patients. The study also determines their daily physical activity and find a correlation if any with bone mineral density. Methods: The study was carried out on 40 regularly transfused beta thalassemic patients between 5 and 18 years of age under regular follow-up at our centre from June 2012 to June 2014. All patients were interviewed as per a well-structured proforma for symptoms relating to bone and joint disease as described by the patient/parents in past 1 year and physical activity by QAPACE questionnaire. Venous blood samples were drawn under aseptic conditions and used for estimation of biochemical parameters (calcium, phosphorus, alkaline phosphatase, vitamin D, parathyroid hormone and serum ferritin). Enrolled subjects were scanned for bone mineral density (BMD) at femur neck, trochanter and Ward's angle using dual-energy X-ray absorptiometry. Results: A total of 40 patients were enrolled in the study (Male:Female = 80:20). Half the patients (n = 20) had symptoms pertaining to bone and joint disease. The most common symptom was leg pain (42.50%), followed by backache (22.50%). Asymptomatic patients had greater mean serum vitamin D as compared to the symptomatic patients (22.2 vs 15.08 ng/ml) (p = 0.225). Five patients were detected to have osteopenia, all above 10 years of age. The mean BMD in symptomatic patients at femur neck, trochanter and ward's angle was 0.781, 0.639 and 0.735 g/cm2, respectively, as compared to 0.754, 0.635 and 0.722 g/cm2 in asymptomatic patients. The difference was not statistically significant. Patients with low BMD had lower mean pre-transfusion Hb (< 9 g/dl) (p = 0.01). Eighty percent of osteopenic patients had sedentary lifestyle as compared to 44% of patients with normal BMD. Bone mineral density did not have any correlation with vitamin D levels, serum ferritin and type of chelation therapy. Conclusion: Pre-transfusion hemoglobin of more than 9 gm/dL has a protective role in maintaining good bone health and bone mineral density. Engaging thalassemia patients in physical activity has a positive effect on bone mineral density. Low vitamin D levels contribute to symptoms of bone and joint involvement in thalassemia and the same needs to be determined and supplemented. [ABSTRACT FROM AUTHOR]

Background: Stroke ranks as the second leading cause of death worldwide. Meanwhile, headaches are considered the second leading cause of disability, and they often occur as a stroke complication. However, insufficient attention has been given to the treatment and rehabilitation of headaches among stroke patients, and the research on the epidemiology and risk factors of headaches in stroke patients in China is limited. Therefore, in this study, China Health and Retirement Longitudinal Study (CHARLS) data were utilized for a cross-sectional analysis to estimate the prevalence of headaches in stroke patients and identify the associated risk factors. Method: This study utilized data, which included those of participants aged 45 and above from 28 provinces across China, from the nationally representative CHARLS 2018 database. A total of 876 stroke patients and 17,469 nonstroke patients were considered in this work. Stroke diagnosis and headache status were determined based on self-reported questionnaire responses. Cross-sectional analysis determined the prevalence of headaches in patients with strokes and those without through quantification of individuals diagnosed with headaches. Categorical variables were presented as percentages and counts, and univariate and multivariate logistic regression models were used to calculate the odds ratios (OR) for the risk factors associated with headaches in stroke patients. Results: In the 2018 data, 328 individuals with stroke-related headaches were screened and compared with 4,249 individuals without the condition. Overall, a cross-sectional survey revealed that the headache prevalence among stroke patients reached 37.44% (95% confidence interval (CI): 34.23%-40.74%), which was higher than the overall headache prevalence among nonstroke patients 24.32% (95% CI: 23.69%-24.97%). Headaches were considerably more common in women (45.95%; 95% CI: 41.31%-50.58%) than in men (26.70%; 95% CI: 24.44%-32.97%; gender difference, p < 0.001). According to multifactorial logistic regression analysis, the risk factors for stroke-related headaches included being female (OR: 1.45, 95% CI: 1.02–2.07), residency in Central (2.50, 1.37–4.54), Eastern (1.87, 1.07–3.27), and Northwest China (2.49, 1.06–5.84), Very poor self-health (4.06, 1.90–8.68), diabetes (1.85, 1.11–3.07), shoulder pain (4.01, 2.77–5.81), back pain (2.01, 1.32–3.05), and chest pain (2.51, 1.55–4.06). Conclusion: Enhancement of self-awareness of health, effective management of diabetes, and minimization of the physical discomfort in the shoulders, back, and chest may contribute to the decreased occurrence of headaches. Therefore, targeted prevention and treatment of headaches are necessary. [ABSTRACT FROM AUTHOR]

Spinal implant infections are a serious complications of instrumented spinal fusion surgeries, carrying high morbidity and complex management challenges. Early postoperative infections may manifest with wound-healing issues, back pain, and fevers. Magnetic resonance imaging (MRI) is the preferred imaging modality, but can be limited by metal artifacts. For cases with stable implants, surgical debridement with implant retention combined with at least 12 weeks of antibiotics is currently considered appropriate treatment. Staphylococcal infections are ideally treated with biofilm-active antibiotics. Suppressive antibiotic therapy can be considered when surgical debridement has been delayed or is incomplete, and for those who are poor surgical candidates for another surgery. Chronic infections may present insidiously with implant failure or pseudarthrosis; implant removal or revision is generally pursued. As current guidance is heavily based on the periprosthetic joint infection literature and low-level studies on spinal implant infections, further research on optimizing diagnostic and treatment approaches is needed. [ABSTRACT FROM AUTHOR]

Copyright of Nishinihon Journal of Urology is the property of West Japan Urological Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Today, musculoskeletal pain is frequently seen in the working population. Analgesic drugs are frequently used in the treatment of this chronic pain. However, analgesic drug treatment causes various side effects. Mesotherapy is an application method that aims to heal by injecting a small amount of medication under the skin. In this method, less medication is used compared to systemic treatment and a similar effect is achieved. Although mesotherapy has a wide range of uses, it does not yet have a standard protocol. For these reasons, every study conducted in the field of mesotherapy is quite valuable. It was aimed to contribute to the literature by evaluating the mesotherapy results of three sisters from the same family who applied to our center with various pain complaints. The pain of the sisters, aged 44, 47 and 50, was evaluated with the Visual Analog Scale (VAS) before and after mesotherapy. The pain levels, which were 10/10, 8/10 and 10/10, decreased to 7/10, 4/10 and 3/10 after three sessions of mesotherapy, respectively. In addition, all of them reported an increase in their quality of life. The decrease in pain in these patients with similar genetic and sociodemographic characteristics, consistent with previous studies, can be interpreted as significant. [ABSTRACT FROM AUTHOR]

The purpose of this systematic review and meta-analysis is to evaluate the safety and efficacy of anti-inflammatory-impregnated gelatin sponges in spine surgeries. Gelatin sponges are increasingly used as delivery vehicles for anti-inflammatory and analgesic drugs during spine surgeries. However, concerns about their safety and efficacy persist. A comprehensive literature search was conducted to identify original research articles investigating the use of anti-inflammatory-impregnated gelatin sponges in spine surgeries from 2006 to 2024. Case reports, case series, animal studies, cadaveric studies, and abstract-only articles were excluded. The risk of bias was assessed using Cochrane Risk of Bias 2.0 (Cochrane, UK) for randomized controlled trials (RCTs) and the Newcastle Ottawa Scale (NOS) for observational studies. Meta-analysis was performed using Cochrane Review Manager Web. Thirteen studies (six RCTs, six cohort studies, and one case-control study) were included. Pooled analysis revealed a significant decrease in Visual Analog Scale (VAS) score for back pain (mean difference [MD], −0.62; 95% confidence intervals [CI], −0.78 to −0.46; p<0.00001), VAS score for leg pain (MD, −0.60; 95% CI, −0.87 to −0.34; p<0.00001), and length of hospital stay (MD, −0.99; 95% CI, −1.68 to −0.31; p=0.0004). Additionally, there was a significant increase in the Japanese Orthopedic Association score (MD, 0.98; 95% CI, 0.00 to 1.96; p=0.05). However, no significant difference was observed in the disability index (MD, −0.59; 95% CI, −1.88 to −0.70; p=0.37). The use of anti-inflammatory-impregnated gelatin sponges during spine surgeries decreases postoperative back pain and leg pain, reduces length of stay, and improves neurological function. Larger, prospective, randomized trials are required to obtain more robust evidence. [ABSTRACT FROM AUTHOR]

Purpose: The Core Outcome Measures Index (COMI) is a short, multidimensional instrument translated into several languages that covers five domains recommended in the assessment of outcome in patients with low-back and neck pain. The purpose of this study was to cross-culturally adapt the COMI from English to Czech language and to test the face and construct validity and reproducibility of its results in patients with low-back and neck pain. Methods: Participants (n = 125) were included from primary and secondary care. The participants reported moderate pain and disability levels. All participants filled in the COMI forms before and after surgery. Descriptive statistics, Wilcoxon paired test, Crombach's alpha, principal component analysis and information entropy calculation were used. Results: The instrument was successfully forward and back-translated. It can be seen that the questionnaire applied as part of our intervention study produces answers with a sufficient degree of variability and with a satisfactory degree of representation of extreme values. It can be also seen that the questionnaire can diagnose an objectively occurring change associated with the surgeon within the intervention procedure. Our other findings support the idea of ​​a possible reduction in the number of questions that measure the same latent variable. Our investigations also showed that it is possible to reduce the range of the point scale of the perception of pain to 5 degrees of intensity and thus unify the range with the other questions. Conclusion: The Czech COMI shows acceptable properties and is thus suitable to use as a short instrument for measuring important domains in patients with low-back and neck pain. [ABSTRACT FROM AUTHOR]

Background: Osteoporotic vertebral compression fracture (OVCF) is a common consequence of osteoporosis and can significantly impact the quality of life for affected individuals. Despite treatment options such as vertebroplasty and kyphoplasty, many patients continue to experience residual back pain (RBP) even after the fracture has healed. The incidence of RBP after OVCF treatment varies among studies, and there is a need for further research to understand the risk factors associated with RBP. Methods: A systematic review and meta-analysis were conducted following the PRISMA guidelines. Electronic databases were searched, and relevant studies were selected based on inclusion and exclusion criteria. Data extraction and quality assessment were performed independently by two authors. Statistical analysis included single-proportion meta-analyses and pooling of odds ratios (OR) using the inverse-variance method, to calculate the overall incidences of RBP and cement leakage and identify risk factors associated with RBP. Results: A total of 19 studies were included in the analysis. The overall incidences of RBP and cement leakage were found to be 16% and 18%, respectively. Several risk factors were identified, including gender, bone mineral density, depression, baseline visual analog scale (VAS) score, intravertebral vacuum cleft, number of fractured segments, cement distribution, history of vertebral fracture, thoracolumbar fascial injury, and fracture non-union. Conclusions: This study provides potential value within the scope of the incidence and risk factors of RBP following treatment of OVCFs. The identified risk factors can help clinicians identify high-risk patients and tailor appropriate interventions. Future research should focus on standardizing the definition of RBP and patient selection criteria to improve the accuracy of estimates and facilitate better management strategies for OVCF patients. [ABSTRACT FROM AUTHOR]

Objective: To compare the effectiveness of endometriosis excision alone to excision plus hysterectomy, with and without bilateral oophorectomy, for endometriosis‐related symptoms. Design: Multicentre prospective cohort. Setting: Eighty‐six specialist endometriosis centres. Population: Women undergoing rectovaginal endometriosis surgery between 2009 and 2021. Methods: We performed multivariable regression with random effects for patient and centre, controlling for age, BMI, smoking, laparoscopic versus open approach and type of bowel surgery performed, with sensitivity analysis for loss to follow‐up. Main Outcome Measures: Pain scores, bowel symptoms and quality‐of‐life measures. Results: Compared to endometriosis excision alone, women undergoing hysterectomy with conservation of ovaries had greater improvement in non‐cyclical pain (MD: 1.41/10, 95% CI: 1.03–1.78, p < 0.001), dyspareunia (MD: 1.12/10, 95% CI: 0.71–1.53, p < 0.001), back pain (MD: 1.29/10, 95% CI: 0.92–1.67, p < 0.001) and quality‐of‐life scores (MD: 8.77/100, 95% CI: 5.79–11.75, p < 0.001) at 24 months post‐operatively. Women undergoing hysterectomy with bilateral oophorectomy also had greater improvement in non‐cyclical pelvic pain (MD: 2.22/10, 95% CI: 1.80–2.63, p < 0.001), dyspareunia (MD: 1.05/10, 95% CI: 0.59–1.52, p < 0.001), back pain (MD: 1.18/10, 95% CI: 0.77–1.59, p < 0.001) and quality of life (MD: 12.41/100, 95% CI: 9.07–15.74, p < 0.001) at 24 months compared to endometriosis excision alone. Compared to hysterectomy with ovarian conservation, hysterectomy with bilateral oophorectomy was associated with greater improvement in non‐cyclical pelvic pain (MD: 0.81/10, 95% CI: 0.32–1.30, p = 0.001) at 24 months and quality of life (MD: 3.74/100, 95% CI: 0.56–6.92, p = 0.021) at 12 months, although this result was sensitive to loss to follow‐up. Conclusions: Patients who undergo endometriosis excision plus hysterectomy experience greater improvement in pain and quality of life compared to those who have endometriosis excision alone. There are additional benefits of bilateral oophorectomy with hysterectomy, although its value is less clear due to loss of follow‐up. [ABSTRACT FROM AUTHOR]

Objective: Describe trends in health care utilization, demographic characteristics and patient pathways among patients with musculoskeletal disorders (MSD) in Norway. Design: Register-based cohort study. Settings: Data were obtained from two Norwegian National registries; the Norwegian Control and Payment of Health Reimbursements Database (KUHR) and the Norwegian Patient Registry (NPR). Subjects: Patients with MSD according to ICPC-2 and ICD-10 during 2014–2017. Main outcome measures: Patient pathways from the first contact and the following two years, described in a Sankey Diagram for all MSD patients and three common diagnoses: spine pain, osteoarthritis (OA) and fibromyalgia (FM). Result: About 26% of the Norwegian population consulted PHC annually while 7% were treated in SHC. Mean age was 47 and 53 years in PHC and SHC, respectively. The proportion of women increased by age. Spine pain was the most common diagnosis; 33% and 22% in PHC and SHC, respectively. Over 90% visited a GP first, 50% of them were treated by PT and/or in SHC during follow-up. Patients visiting the PT first were less likely to be treated in SHC. OA patients were most likely to be treated by more than one health care professional (>70%). Conclusion: One third of the Norwegian population consulted health care services due to MSD annually between 2014–2017. GP was the most consulted health care professional. Among MSD patients with long-term use of health care services, 50% were treated by a PT and/or in SHC in addition to a GP. [ABSTRACT FROM AUTHOR]

Copyright of Zagazig University Medical Journal is the property of Association of Arab Universities and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aim of the study: To compare clinical findings with MRI findings and evaluate the role of physical examination in the diagnosis, localization of the level, site, size, and type of lumbosacral disc herniation. Materials and methods: A prospective study of 104 patients with low back pain and/or sciatica was conducted et al.-Kindy Teaching Hospital between January to December 2022. All Participants were evaluated via history, clinical examination, and MRI. One hundred patients had a disc herniation in the lumbosacral region, which was confirmed by MRI assessment after clinical presentation and physical examination. The data were collected and analyzed by the chi-square test. Results: Most of the patients (84%) experienced pain in the lower back that radiated to the lower limb or limbs, and nearly half of the patients experienced paresthesia (48%). Sixty-six percent of the patients had a scoliotic list; limitation of lumbar spine movements was common in 96%, and a decrease in the straight leg raising test (SLR) was detected in 98%. Cross SLR "Well test" was positive in 64% of patients. The femoral nerve stretch test was positive in 40% of patients. Sixty-four percent were presented with neurological deficits, 42% with affected L5 nerve roots, 22% with affected S1 nerve roots, and no patients with L4 affected. Twenty-two percent showed a positive SLR test with an angle between 41 and 70°. Conclusion: Proper correlation between clinical and MRI will help determine the lesion's level, horizontal location, herniation type, and herniated disc size in the lumbosacral region and achieve a more accurate diagnosis. [ABSTRACT FROM AUTHOR]

BACKGROUND: Work-related disability is caused commonly due to musculoskeletal disorders (MSD) in dentistry. Prolonged static awkward and repetitive postures cause MSD in dentists. The study was executed to confirm the development of MSD in various body regions as they have to work in a small oral cavity to perform crucial dental procedures with precision and concentration. OBJECTIVE: To assess the occurrence of the MSD in several body regions of dentists and to carry out postural study thereby helping them improve posture. METHODS: Dentists were assessed for their current working postures with various MSD symptoms and its effects. The questionnaire was devised to get musculoskeletal health data from dentists. The postural load was investigated using Rapid Upper Limb Assessment (RULA). Various risk factors contributing to MSD symptoms were identified after data were statistically analysed using IBM SPSS version 27. RESULTS: According to the current study neck, shoulder, lower back, upper back, wrist hand, elbow, hip, thigh, knee, and ankle were the most affected anatomical regions. Average RULA score for the current study was found to be 6.75 which indicated a need of change of posture while performing dental procedures. There is statistical correlation between gender, Body Mass Index (BMI), uncomfortable positions, stretching, use of ergonomic saddle chair, hand dominance and MSD. There is no statistical correlation between years of experience and MSD. CONCLUSION: Current workstation (Dental Chair) requires immediate improvements as evident from the postural load analysis, thus immediate implementation of intervention program is required. [ABSTRACT FROM AUTHOR]

BACKGROUND: In India's fast-growing economy, the construction sector offers significant developments with huge employment opportunities but poses risks due to poor working environments and uncomfortable postures. Traditional methods, such as manual material handling, can lead to health hazards and musculoskeletal disorders such as overexertion, low back pain, etc. OBJECTIVE: The purpose of this study was to analyze the working postures of unorganized employees engaged in residential buildings using Ergofellow software and to recommend changes in their unsafe working postures. METHODS: Participants' working positions were video recorded and the postures were analyzed using Rapid Upper Limb Assessment (RULA), Rapid Entire Body Assessment (REBA) and Ovako Working Posture Analysis (OWAS). Paired sample t-tests were used to analyze significant differences between the RULA and REBA scores after the ergonomic interventions were implemented. RESULTS: From the analysis of RULA, REBA and OWAS, the working postures showed a high risk of potential injury and required an immediate change in employees' working postures. The RULA and REBA scores were subsequently lower after the ergonomic interventions, which were based on ergonomic and safety principles. The paired sample t-tests with p-values of less than 0.05 demonstrated decreased risks after ergonomic interventions. CONCLUSION: Working postures of the construction workers exposed to musculoskeletal disorders were examined and the ergonomic interventions were implemented. According to the recommendations, working positions were changed, and employee well-being was enhanced by reduced operational risks. [ABSTRACT FROM AUTHOR]

Objective: To describe the full-endoscopic lumbar foraminoplasty with midline skin incision (FEFM) and lateral recess decompression procedure and to report its clinical outcomes at the 1-year follow-up. Methods: Consecutive patients with lumbar foraminal and/or lateral recess stenosis who underwent FEFM procedures were retrospectively reviewed. Clinical outcomes were evaluated with a visual analogue scale (VAS) of back and leg pain and Oswestry Disability Index (ODI) up to 1 year postoperatively. The complications and recurrence rate were also recorded. Results: A total of 30 cases (51 levels) were included (L3–4, 6 cases [11.8%]; L4–5, 23 [45.1%]; L5–S1, 22 cases [43.1%]). VAS scores collected at preoperative, postoperative day 1, 3 months, 6 months, and 1 year were 9.16, 1.7, 1.36, 1.3, and 1.43, respectively. The ODI scores collected at preoperative, postoperative 3 months, 6 months, and 1 year were 46.63, 11.5, 10.66, and 10.46, respectively (p<0.05). The mean operation time was 88.7 minutes (range, 45–152 minutes). The length of hospital stay was 1.21 days (range, 1–3 days). No immediate complications were identified, and no patients experienced a recurrence of symptoms requiring revision surgery. Conclusion: FEFM is an effective procedure for treating foraminal and/or lateral recess stenosis. It demonstrates the capability to decompress both bilateral foraminal and lateral recess stenosis through a single-entry point. [ABSTRACT FROM AUTHOR]

Background: Flatfoot deformity is a common condition in children and teenagers that may increase the risk of knee, hip, and back pain. Most of the insoles suggested to treat flatfoot symptoms are not designed to adapt to foot temperature during walking, and they are either too soft to provide support or hard enough to be uncomfortable. Purpose: This study aims to develop an advanced solution to diagnose and treat flexible flatfoot (FFT) using infrared thermography measurements and a hybrid insole reinforced by nitinol (NiTiCu) smart-memory-alloy wires (SMAWs), this super-elastic alloy can return back to its pre-deformed shape when heated, which helps to reduce the local high-temperature points caused by the uneven pressure of FFT. This approach achieves a more uniform thermal distribution across the foot, which makes the hybrid insole more comfortable. Methods: The study involved 16 subjects, divided into two groups of eight flat-footed and eight normal. The procedure includes two parts, namely, designing a prototype insole with SMAW properties based on thermography measurement by using SolidWorks, and evaluating this design using Ansys. Second, a hybrid insole reinforced with SMAWs is customized for flatfoot subjects. The thermography measurement differences between the medial and lateral sides of the metatarsophalangeal line are compared for the normal and flatfoot groups before and after wearing the suggested design. Results: The results show that our approach safely diagnosed FFT and significantly improved the thermal distribution in FFT subjects by more than 80% after wearing the suggested design. A paired t-test reported significant (p-value > 0.001) thermal decreases in the high-temperature points after using the SMAW insole, which was closely approximated to the normal subjects. Conclusions: the SMAW-reinforced insole is comfortable and suitable for treating FFT deformity, and infrared thermography is an effective tool to evaluate FFT deformity. [ABSTRACT FROM AUTHOR]

Ibuprofen, a commonly used over-the-counter medication, is widely recognized for its effective pain relief properties but is also associated with various adverse effects, including rare ocular and neurological manifestations. We report a case of a 27-year-old male who experienced transient vertical diplopia following a standard ibuprofen dosage for back pain. Symptoms resolved promptly upon discontinuation of the drug, with normal findings on extensive clinical and laboratory evaluations. The clinical presentation, suggestive of skew deviation, implies central toxicity. This case underscores the potential for diplopia associated with NSAIDs like ibuprofen to be underdiagnosed and offers valuable insights into the central toxicity of ibuprofen. Further research is warranted to elucidate the underlying mechanisms and optimize patient care in similar scenarios. [ABSTRACT FROM AUTHOR]

Introduction Degenerative spondylolisthesis (DS) is usually seen at lumbo-sacral region. Lumbarization of S1 is seen in less than 2% of the population and to have spondylolisthesis in this segment is even rarer. The purpose is to report a rare case of DS at S1-S2 level. Case Report A 52-year-old male, a farmer by profession, presented to Neurosurgery outpatient department with complaint of low back ache for 4 years, which was insidious and progressive. The pain radiated to both lower limbs with more on right than left side. Radiological evaluation with anteroposterior and lateral roentgenogram of lumbo-sacral spine revealed anterolisthesis of S1-S2 (Meyerding's grade 2). Magnetic resonance imaging reported S1-S2 disk bulge with bilateral foraminal stenosis. The patient underwent S1 laminectomy along with S1-S2 discectomy with bilateral S1 and S2 pedicle screws and rod fixation with transforaminal lumbar interbody fusion. Result Postoperative recovery was good with improvement in back pain along with power on postoperative day 1. Conclusion The prevalence of lumbarization is less than 2% and getting spondylolisthesis in this segment is even rarer. As this is one of the first of its kind of case, further case series or longitudinal studies of such cases may help understand better the pathomechanics related to spondylolisthesis at this level. [ABSTRACT FROM AUTHOR]

Summary: Background: Recent studies have described techniques to acquire ultrasound measurements of the cross‐sectional area of the multifidus muscle to investigate back pain in horses and monitor the response to rehabilitation. These techniques have been extrapolated from human research but have not been clinically validated in the horse. Objective: The objective of the study was to investigate whether measuring the cross‐sectional area of the multifidus muscle in horses using ultrasound is a repeatable technique. Study design: Cross‐sectional. Methods: Ultrasound images of the articular process view and interspinous view of the multifidus muscle were acquired at T15, T18, L2 and L5 on the left and right sides. Three images were acquired at each location and each image was measured three times to give an average cross‐sectional area. Study 1 investigated the repeatability of acquiring images in a single session, and then on two separate days. Study 2 compared measurements of images acquired with a console (Philips EpiQ) and a portable (MyLab™Alpha) ultrasound machine. Study 3 investigated the repeatability of measuring the cross‐sectional area using external software, OsiriX. Intraclass correlation coefficients (ICC) were calculated for each study. Results: Repeatability varied from good to excellent for images taken in a single session. The repeatability for measuring the images using external software was good to excellent. There was poor‐to‐moderate repeatability for images taken on two different days and poor‐to‐good repeatability when using the two different machines. Main limitations: Population size, study population limited to a single breed, only one operator. Conclusions: The measurement of the multifidus muscle in horses has poor repeatability and may have limited application. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To summarize the effectiveness of eHealth interventions for improving pain, physical disability, psychological factors, and the quality of life for people with spine pain. DESIGN: Overview of systematic reviews. LITERATURE SEARCH: CINAHL, Embase, PubMed, and SPORTDiscus e-databases were searched. STUDY SELECTION CRITERIA: Systematic reviews with meta-analysis of randomized clinical trials evaluating any type of eHealth were included. DATA SYNTHESIS: AMSTAR 2 was used to assess the methodological quality of included reviews. The degree of overlap between reviews was calculated. RESULTS: Sixteen systematic reviews were included. Of them, 13 reviews were exclusively focused on back pain or low back pain. Exercise and psychological interventions were the primary contents of eHealth interventions. In general, eHealth interventions based on physical exercise may improve the quality of life of people with low back pain. eHealth interventions based on cognitive behavioral therapy may reduce pain catastrophizing and fear-avoidance beliefs for physical activity for people with low back pain. eHealth interventions based on multidisciplinary approaches including physical exercise may reduce low back pain. Few systematic reviews used the GRADE system to evaluate the certainty of evidence, and few specified the content of eHealth interventions. CONCLUSION: eHealth interventions may improve the quality of life, pain catastrophizing, and fear-avoidance beliefs for people with low back pain. It is unclear, based on available systematic reviews, how clinicians should deliver eHealth interventions for people with spine pain (eg, neck pain or low back pain). [ABSTRACT FROM AUTHOR]

Background: "Spinal ganglioneuroma" is a rare entity of neuroblastic tumors, frequent among children, that has been sparsely reported in articles involving both the pediatric and adult populations. These tumors mostly arise from the sympathetic ganglia located in the paravertebral region, near the intervertebral foramina of the spine. This makes their extension into the spinal canal possible but quite rare, in a dumbbell fashion, producing radicular or medullary symptoms. We provide an extensive review of the pediatric cases found in the literature; while reporting a challenging case we have recently got to treat at the CHRU de Brabois in Nancy, France. Methods: We searched PubMed's database for articles and abstracts related to "spinal ganglioneuromas," from inception until June 1, 2024. We combined every case among patients under 18 years of age and divided them between the different spinal areas. We excluded those that originated from outside of the spine. We particularly focused our attention on the thoraco-lumbar region, which involved our case report, since the surgical management is completely different from other regions of the spine. Results: As per June 1, 2024, 21 patients aged between 3 and 17 years were identified with "spinal ganglioneuromas," with a predominance of females (81%). The thoracic region of the spine seems to be the area of predilection for these tumors (42.85%), although some have been found in the cervical (9.5%), cervico-thoracic (4.76%), thoraco-lumbar (19.04%), lumbar (19.04%), and sacral (4.76%) regions. Discussion: Our specific case included long-date abdominal pain and recent progressive paraparesis as the main symptoms, with radiological manifestations of renal atrophy and hydronephrosis, due to the compression and complete displacement of the kidney, as well as scoliosis. To our knowledge, this combination of symptoms has never been seen with spinal ganglioneuromas before in the pediatric population, given the gigantic size of the tumor, and its significant extension to both the spinal canal and the retroperitoneal space, which is quite uncommon. Conclusion: Spinal ganglioneuromas are very rare, benign lesions, that should be included in the differential diagnosis of dumbbell tumors that can cause in the pediatric population, alongside neurological symptoms in the limbs and back pain, thoracic, abdominal, and even urinary symptoms. [ABSTRACT FROM AUTHOR]

Brucellosis is a zoonotic disease frequently observed in regions where animal husbandry is intensive in Eastern and Southeast Anatolia. The most common transmission route is raw milk and unpasteurized dairy products. The condition can affect many organs and systems in the body, and clinical findings can vary depending on the location. This condition should be considered in the differential diagnosis of acute joint pain due to unknown causes. Early diagnosis of Brucella septic arthritis in endemic regions is important to prevent serious complications. Here, clinical, laboratory, and imaging data of five healthy patients with acute joint involvement who visited the outpatient clinic were presented with the support of visuals and literature. [ABSTRACT FROM AUTHOR]

Back pain is an occupation-related problem among workforces. This cross-sectional study aimed to identify the prevalence of back pain and the risk factors of occupational back pain among workers in the electronics industry. In total, 354 electronics workers in Thailand participated in the study. Data were collected using the Musculoskeletal Disorders Severity and Frequency Questionnaire, the Job Content Questionnaire, and ergonomics risk assessment via the Rapid Upper Limb Assessment (RULA). Risk factors of back pain were identified by multiple logistic regression analysis, providing adjusted odds ratios (ORadj) and 95% confidence intervals (95% CI). The study found that most workers were operators (92.09%) and had repetitive work (83.62%). A high ergonomics risk was observed in workers who stood during work (68.49%) and operated machines (71.70%). The 1-month prevalence of developing back pain was 20.62% and the significant factors correlated with back pain were low levels of job control and decision-making (ORadj = 2.26; 95% CI [1.26, 4.05]), lack of exercise (ORadj = 8.30; 95% CI [1.35, 24.28]), repetitive work (ORadj = 2.94; 95% CI [1.19, 7.29]), and high ergonomic risk level (ORadj = 2.81; 95% CI [1.16, 5.07]). These findings suggest that measures should be implemented by empowering electronics workers to make decisions and control their jobs, as well as promoting health through muscle-stretching exercise, to support back pain prevention. [ABSTRACT FROM AUTHOR]

Background: Culture-negative vertebral osteomyelitis presents a significant diagnostic challenge. Neisseria sicca (N. sicca) is a typically benign commensal organism of the upper respiratory tract that rarely causes invasive infections, warranting cautious interpretation if isolated in a single positive culture. This case study details a 62-year-old male diagnosed with vertebral osteomyelitis caused by N. sicca, examining diagnostic challenges, treatment, and outcomes. Methods: We conducted a comprehensive search on MEDLINE using the keywords "Neisseria sicca", "osteomyelitis", and "diskitis". An additional search excluding N. gonorrhea and N. meningitidis was also performed, revealing a total of four cases of N. sicca osteomyelitis in the literature. Results: A 62-year-old male with a history of hypertension, type 2 diabetes, atrial fibrillation, and previous L5-S1 spinal fusion presented with fever and back pain in May 2023. Initial imaging revealed T8-T9 vertebral osteomyelitis. Despite a six-week course of IV daptomycin, his symptoms worsened, prompting further evaluation. A CT-guided biopsy with comprehensive testing, including histopathology and microbial cultures, initially identified N. sicca. Due to its rarity, additional biopsies were conducted, confirming the infection. IV ceftriaxone was initiated, leading to significant pain improvement, and a subsequent MRI showed near resolution. The patient transitioned to oral cefuroxime, with follow-up confirming complete infection resolution by December 2023. Conclusions: This case underscores the importance of a structured diagnostic approach in culture-negative vertebral osteomyelitis to differentiate between commensal contamination and true infection. Repeated positive cultures of N. sicca from a sterile site confirmed its role as the causative agent. Early identification and targeted antibiotic therapy are critical to improving outcomes in rare cases of N. sicca vertebral osteomyelitis. [ABSTRACT FROM AUTHOR]

Non-specific low back pain (NLBP) is prevalent among patients with rheumatic conditions. Digital health applications (DiGAs) provide reimbursed, personalized home treatment for patients, promising to overcome limitations of traditional healthcare systems. However, the adoption and effectiveness of back pain-specific DiGAs in rheumatology are not well understood. This study aims to explore the experiences and perspectives of a diverse group of rheumatology stakeholders regarding the use of DiGAs for back pain management. Qualitative interviews and a focus group discussion were conducted with a wide range of stakeholders including rheumatic patients, rheumatologists, nurses and DiGA producers. The data were analysed using qualitative content analysis. The study included 15 interviews (10 rheumatic patients, 4 rheumatologists, 1 DiGA producer) and 1 focus group with mixed participants (n = 12). Most stakeholders valued the instant access to personalized and effective back pain treatment provided by DiGAs. Patients appreciated the flexibility and ease of use of DiGAs which can be used anywhere and anytime. Concerns were raised about insufficient guidance regarding correct execution of exercises, which was seen as potentially dangerous and unsettling for patients. Healthcare professionals (HCPs) highlighted barriers, such as the lack of reimbursement, time constraints, and inadequate DiGA-specific education as barriers to prescribing DiGAs. Additionally, poor patient onboarding often led to delays, increased skepticism, and premature discontinuation of therapy. Stakeholders emphasized the challenges of current care driven by a shortage of HCPs and generally supported usage of back pain DiGAs. Various barriers and solution approaches were identified to enhance the performance, usability, and implementation of DiGAs in rheumatology. [ABSTRACT FROM AUTHOR]

This analysis was part of the Pain and Smoking Study (PASS), a randomized trial of a cognitive behavioral intervention (CBI) for Veterans with chronic pain who smoke. The objective of this study was to examine factors associated with participation in the walking component of the intervention. Demographics and clinical characteristics were obtained at baseline. Completion of two or more CBI counseling sessions was required to be included in analyses. Average daily step counts obtained via pedometer in the prior week were recorded in up to three telephone counseling sessions. Participants were then categorized as "sedentary" (≤ 4999 daily steps) or "not sedentary" (≥ 5000 daily steps). Multivariable logistic regression was used to model variance in activity categorization. Overall, 91.0% of participants were men, 70.5% were white, mean age was 58.4 years, mean BMI was 28.6, median pack years was 20.5, and 43.8% were depressed. Veterans reported moderate pain intensity (4.9/10) and pain interference (5.4/10). Pain locations included: lower extremity (67.4%), back (53.4%) and upper extremity (28.1%). Median daily steps were 2491 [IQR: 1720–3550] (sedentary) (n = 65), 7307 [IQR: 5952–8533] (not sedentary) (n = 24), and 3196 [IQR: 2237–5067] (overall) (n = 89). Veterans with older age (odds ratio (OR): 1.10, 95% confidence interval (CI): 1.04, 1.17) and presence of LE pain (OR: 5.98, 95% CI: 1.82, 19.65) had increased odds of being "sedentary." Integrated smoking cessation and chronic pain self-management interventions that include a walking component may need to consider the impact of age and pain location on participation. Trial registration: The trial is registered at www.ClinicalTrials.gov (NCT02971137). First posted on November 22, 2016. [ABSTRACT FROM AUTHOR]

Objectives: Prevalence of irregular menstrual cycle ranges from 81.7% to 96.3%. Recent research suggested that homeopathy is one of the most popular choices for women with various gynecological disorders. This trial was aimed at differentiating individualized homeopathic medicinal products (IHMPs) from identical-looking placebos in the treatment of menstrual irregularities in early reproductive women. Design: Double-blind, randomized (1:1), two parallel arms, placebo-controlled trial. Setting: D. N. De Homoeopathic Medical College & Hospital, Kolkata, West Bengal, India. Subjects: Ninety-two females with menstrual irregularities. Interventions: Group verum (n = 46; IHMPs plus concomitant care) versus group control (n = 46; placebos plus concomitant care). Outcome Measures: Primary—The proportion of early reproductive females in whom menstrual irregularities can be corrected for consecutive three cycles; Secondary—Menstrual Distress Questionnaire (MDQ) total score; all of them were measured at baseline and every month, up to 4 months. Results: Intention-to-treat sample (n = 92) was analyzed. Group differences were examined by chi-squared tests with categorical outcomes, two-way repeated measure analysis of variance accounting for the time–effect interactions, and unpaired t-tests comparing the mean estimates obtained individually every month. The level of significance was set at p < 0.05 two-tailed. After 4 months of intervention, the group difference in the primary outcome was nonsignificant statistically—IHMPs: 22/46 v/s placebo: 24/46, chi-square (Yates corrected) = 0.043, p = 0.835. The improvement observed in the MDQ total score (F1,90 = 0.054, p = 0.816) and subscales scores were higher in the IHMPs group than in placebos, however statistically nonsignificant in most of the occasions, except for the behavioral change subscale (F1,90 = 0.029, p < 0.001). Pulsatilla nigricans was the most frequently prescribed medicine. Kent's Repertory and Zandvoort's Complete Repertory were the most frequently used repertories. No harm or serious adverse events were reported from either group. Conclusions: The analysis failed to demonstrate clearly that IHMPs were effective beyond placebos in all but one of the outcomes. More appropriate outcome measures may be sought for future trials. Clinical Trial Registration Number: CTRI/2022/04/041659. [ABSTRACT FROM AUTHOR]

Babesiosis is a parasitic tick‐borne infectious disease that is well elucidated in medical literature and known to be endemic to the Midwest and northeast United States. However, like other infectious diseases, its epidemiology is subject to change. This case report documents two cases with clinical presentations that deviate from what is expected in typical cases of Babesiosis. Two patients presented to a safety‐net hospital in Newark, NJ, during the summer of 2022 with nonspecific symptoms. The first patient had a history of polysubstance use disorder and presented with bilateral leg pain, drowsiness, exertional dyspnea, back pain, and chest pain. The second patient had recently returned from a trip to Guatemala and presented with subjective fevers, generalized myalgias, malaise, headaches, and chills. Both patients underwent similar workups yielding a diagnosis of Babesiosis. Of note, neither patient had recently spent time in wooded areas. Ultimately, both patients were treated for Babesiosis with resolution of their presenting symptoms. These two cases suggest that the epidemiology of Babesiosis is changing and provide a clinical workflow for diagnosing and managing this disease in a modern healthcare setting. [ABSTRACT FROM AUTHOR]

Over 60% of women with endometriosis experience abdominopelvic pain and broader pain manifestations, including chronic back pain, fibromyalgia, chronic fatigue, vulvodynia, and migraine. Although the imbalance of proinflammatory mediators, including the complement component C5a, is associated with endometriosis-related pain, the mechanisms causing widespread pain and the C5a role remain unclear. Female mice and women with endometriosis exhibit increased plasma C5a levels and pain. We hypothesize the Schwann cells involvement in endometriotic pain. Here, we show that silencing the C5a receptor (C5aR1) in Schwann cells blocks the C5a-induced activation of the NLRP1 inflammasome and subsequent release of interleukin-1β (IL-1β). Macrophages, recruited to sciatic/trigeminal nerves by IL-1β from Schwann cells, increase oxidative stress, which activates the proalgesic TRPA1 pathway, resulting in widespread pain. These findings reveal a pathway involving Schwann cell C5aR1, NLRP1/IL-1β activation, macrophage recruitment, oxidative stress, and TRPA1 engagement, contributing to pain in a mouse model of endometriosis. Endometriosis affects over 60% of women, leading to widespread pain. Here, the authors show that blocking C5a receptor (C5aR1) in Schwann cells reduces pain by inhibiting pathways that trigger inflammation, oxidative stress, and nerve sensitivity, revealing a potential therapeutic target in endometriosis pain management. [ABSTRACT FROM AUTHOR]

Background: Musculoskeletal pain is a global health concern affecting both sexes. However, recent insights highlighted significant sex differences in its occurrence and experience, which are influenced by various factors. The present study sought to examine sex differences in musculoskeletal pain and, subsequently, explore the factors associated with its occurrence, separately for both adult males and females belonging to the Santal indigenous community. Methods: The present cross-sectional study was conducted in a Santal indigenous community inhabiting Purba Bardhaman District, West Bengal, India. It comprised 278 adult individuals, including 112 males and 166 females. Data on socio-demographic, lifestyle, anthropometric, reproductive (only for females), and pain-related variables were collected using appropriate tools and protocols. Results: Females exhibited a significantly higher incidence of musculoskeletal pain, with nearly half experiencing chronic pain, particularly back pain. Pain intensity and interference of pain were notably higher in females compared to males. Males were less inclined to use treatment for their pain. Hierarchical binary logistic regression revealed that for males, involvement in white-collar jobs showed an inverse association, while engaging in vigorous physical activities demonstrated a positive link with the incidence of musculoskeletal pain. In females, advanced age and a higher number of childbirths were associated with a greater likelihood of experiencing musculoskeletal pain. Conclusion: The study reveals significant sex disparities in musculoskeletal pain concerning its prevalence, severity, interference, and treatment-seeking behavior. Additionally, marked differences were observed in the risk factors contributing to musculoskeletal pain between the sexes. These findings underscore the importance for public health researchers to tailor interventions addressing sex-specific risk factors and experiences, aiming to enhance overall musculoskeletal health and reduce pain-related interference. [ABSTRACT FROM AUTHOR]

Background: We currently lack clear definitions for structural and symptomatic spinal osteoarthritis (OA). To define spinal OA and create diagnostic criteria for this condition, it is necessary to determine the relationship between clinical signs and symptoms of back pain and radiographic features of OA. Notably, recent studies suggest a defining sign of spinal OA could be a limited or painful spinal range of motion (ROM). Therefore, our objective was to assess the association between restricted or painful active spinal ROM, and multilevel structural features of lumbar disc degeneration (LDD) (i.e., disc space narrowing, osteophytes) on radiographs. Methods: We used the baseline data from the'Back Complaints in Older Adults' (BACE) study. The association between a limited or painful active spinal ROM, and multilevel disc space narrowing or osteophytes was assessed using multivariable logistic regression adjusted for age, mean pain intensity in the previous week, sex, BMI, and the Fear Avoidance Belief Questionnaire score. Primary analyses were performed on imputed datasets. Results: We included 675 patients with a mean age of 66.52 years (SD 7.69). Limited latero-flexion (fingertip that at best reached halfway up the upper leg) was associated with increased odds of having multilevel osteophytes (OR 1.85; 95% CI: 1.13 to 3.01). However, a limited or painful ROM in other directions (i.e., rotation, ante-flexion) was not associated with multilevel osteophytes, and a limited or painful active ROM in any direction was found to have no association with multilevel disc space narrowing. Conclusions: Our study indicates that a restricted ROM in latero-flexion could potentially be a defining sign in future definitions of symptomatic spinal OA. However, since our results partially differ from previous studies, further research is needed to explore the association between active ROM and LDD. [ABSTRACT FROM AUTHOR]

Background: Worldwide, the cesarean section (c-section) rate is rising. Globally, regional anesthesia in the form of spinal anesthesia (SA) is considered the first choice in uncomplicated c-section cases for safe maternal and neonatal outcomes. This study aimed to ascertain knowledge, acceptance, and fears of SA among patients scheduled for c-section in a tertiary care hospital. Methods: This cross-sectional study was performed in the Anesthesia Department, Hamdard University Hospital, Karachi, from April to September 2023. Knowledge was assessed using a self-designed questionnaire with a total of 7 questions. Data was entered in SPSS version 26 to perform statistical analysis. Results: A total of 303 females were enrolled, with a mean age of 26.5 ± 4.5 years and a median gestational age of 37 (IQR = 36–37) weeks. 93.7% of women agreed to receive SA. 63% heard the term regional anesthesia before, 12.2% heard about general anesthesia, and 17.5% heard about SA. 23.4% of participants scored 7 out of 7, 39.9% had a score of 6 out of 7, and 36.6% had a score of ≤ 5. Among 129 (42.6%) females having fear, the commonest fear was limiting lower limb functions post-surgery (93.8%), followed by post-operative vaginal pain (91.5%), intra-operative pain (80.6%), post-operative backache (76.7%), having visuals of surgery (72.9%), back injury (56.6%), headache (46.5%), nausea/vomiting (31%), and being nude (24%). Conclusion: The present study analyzed that although the majority of female agreed to receive spinal anesthesia, they had a fear of it. Knowledge of spinal anesthesia was not remarkable among the study population. Proper education regarding anesthesia should be given to patients to overcome fears related to spinal anesthesia. Clinical trial number: Not applicable. [ABSTRACT FROM AUTHOR]

Over the course of the physical activity transition, machines have largely replaced skeletal muscle as the source of work for locomotion and other forms of occupational physical activity in industrial environments. To better characterize this transition and its effect on back muscles and the spine, we tested to what extent typical occupational activities of rural subsistence farmers demand higher magnitudes and increased variability of back muscle activity and spinal loading compared to occupational activities of urban office workers in Rwanda, and whether these differences were associated with back muscle endurance, the dominant risk factor for back pain. Using electromyography, inertial measurement units, and OpenSim musculoskeletal modeling, we measured back muscle activity and spinal loading continuously while participants performed occupational activities for one hour. We measured back muscle endurance using electromyography median frequency analysis. During occupational work, subsistence farmers activate their back muscles and load their spines at 390% higher magnitudes and with 193% greater variability than office workers. Partial correlations accounting for body mass show magnitude and variability response variables are positively associated with back muscle endurance (R = 0.39–0.90 [P < 0.001–0.210] and R = 0.54–0.72 [P = 0.007–0.071], respectively). Body mass is negatively correlated with back muscle endurance (R = -0.60, P = 0.031), suggesting higher back muscle endurance may be also partly attributable to having lower body mass. Because higher back muscle endurance is a major factor that prevents back pain, these results reinforce evidence that under-activating back muscles and under-loading spines at work increases vulnerability to back pain and may be an evolutionary mismatch. As sedentary occupations become more common, there is a need to study the extent to which occupational and leisure time physical activities that increase back muscle endurance helps prevent back pain. [ABSTRACT FROM AUTHOR]

Objective The objective was to examine the associations of number and type of chronic conditions with the use of rehabilitation services among older adults with bothersome back pain. Methods We conducted a cohort study using the National Health and Aging Trends Study, a longitudinal survey of Medicare beneficiaries ≥65 years. We included community-dwelling older adults with bothersome back pain in 2015. We assessed 12 self-reported chronic conditions, including arthritis, depression, and anxiety. We used 2016 data to ascertain self-reported use of any rehabilitation services in the prior year. We used weighted, logistic regression to examine the association of conditions with rehabilitation use. Results The sample size was 2443. A majority were age ≥75 years (59%); female (62%); and White, non-Hispanic (71%). The median number of chronic conditions was 3 (interquartile range, 2–4). Arthritis was the most common chronic condition (73%); 14% had anxiety; and 16% had depression. For every additional chronic condition, adjusted odds of any rehabilitation use increased 21% (Odds Ratio = 1.21, 95% CI = 1.11–1.31). Those with ≥4 chronic conditions had 2.13 times higher odds (95% CI = 1.36–3.34) of any rehabilitation use in the next year versus those with 0–1 condition. Participants with arthritis had 1.96 times higher odds (95% CI = 1.41–2.72) of any rehabilitation use versus those without arthritis. Anxiety and depression were not significantly associated with rehabilitation use. Conclusions Among older adults with back pain, a greater number of chronic conditions and arthritis were associated with higher use of rehabilitation services. Those with anxiety or depression had no difference in their use of rehabilitation care versus those without these conditions. Impact This pattern suggests appropriate use of rehabilitation for patients with back pain and multiple chronic conditions based on greater need, but there may be potential underuse for those with back pain and psychological conditions. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the effect of baseline back pain severity on PROMIS mental health outcomes following minimally invasive lumbar decompression (LD). Methods: Patients undergoing elective, primary, single-level LD were retrospectively reviewed from a prospective single spine surgeon registry. Perioperative characteristics, demographics, and the following patient-reported outcomes (PROs) were extracted: Oswestry Disability Index (ODI)/Patient-Health Questionnaire-9 /PROMIS-Physical Function/Anxiety/Pain Interference/Sleep Disturbance (PROMIS-PF/A/PI/SD). Two cohorts were created: preoperative VAS-B < 7 and VAS-B ≥ 7. Change in PROs (ΔPROs) from baseline to six weeks/final follow-up were determined. Average patient follow-up was 13.4 ± 8.8 months. Minimal clinically important difference (MCID) achievement rates were calculated and compared through multivariable logistic regression. Postoperative scores and ΔPROs, were compared with multivariable linear regression while all other data was compared between groups with inferential statistics. Results: Altogether, 347 patients were included, with 190 in the VAS-B < 7 group. VAS-B ≥ 7 reported worse outcomes preoperatively (p ≤ 0.013, all). At six weeks, VAS-B ≥ 7 reported worse VAS-B (p = 0.017), with no other significant differences. At final follow-up, patients with worse VAS-B reported worse ODI (p = 0.040) and VAS-B while all other PROs were similar (p ≥ 0.078, all). VAS-B ≥ 7 experienced greater 6-week improvements in VAS-B/ODI/PROMIS-PI/PROMIS-SD (p ≤ 0.009, all), greater VAS-B/ODI/PROMIS-SD improvement by final follow-up (p ≤ 0.009, all) and greater MCID achievement in ODI/VAS-B (p ≤ 0.027). Conclusion: Patients with worse baseline back pain report inferior baseline scores that converge with those with milder preoperative back pain by 6 weeks after LD and reported greater 6-week improvements in disability, pain interference, and sleep disturbance by 6 weeks, and greater improvements in disability and sleep disturbance by final follow-up. [ABSTRACT FROM AUTHOR]

Introduction: SH is considered to be the most common benign tumor within the human spine. 1–2% of SH get symptomatic with back pain in most cases. Less often, ingrowth of vessels into the spinal canal is seen. In these cases, more invasive surgical treatment is required. Recurrence of SH following surgical treatment is a very rare condition. Methods: We present the results of a retrospective chart review, with description of the clinical course of 12 patients with spinal canal invading SH without recurrence and of 5 patients with a recurrent SH. Results: Recurrence was diagnosed 70 months (mean value) after the first procedure. All patients with a recurrent SH had received an incomplete tumor resection as a first treatment. The distribution of gender, age at the diagnosis, levels involved by the tumor, and initial symptoms were comparable in the group of patients with and without recurrence. The patients with recurrent SH were treated with preoperative embolization and en bloc resection or complete piecemeal resection of the affected vertebra. For stabilization, a combined, circumferential fixation was used consisting in a TSM cage filled by bone graft and posterior pedicle screw rod instrumentation in all patients. We followed these patients until 09/ 2023, mean FU 122 months (range 72–184 months). At this time, we found no evidence of tumor recurrence, good clinical conditions in all patients, no signs of implant failure or pseudarthrosis. Discussion: Thus, radical excision, sufficient stabilization and fusion is considered to be an adequate treatment concept for recurrent SH. Key points: SH is usually benign, but sometimes a more aggressive behavior with spinal canal encroachment can be seen. For these, a wide variety of surgical and combined treatment options is available. Local recurrence or regrowth of SH following surgery is rare if the lesion is located within the vertebral body without spinal canal invasion. Patients with SH invading the spinal canal, initially treated with less radical treatment options, should be followed closely via MRI after initial treatment to detect possible local regrowth. In the presence of a local recurrence of SH preoperative embolization, radical removal of the affected level– not necessarily as en bloc procedure – and sufficient stabilization/ fusion may be a promising procedure to avoid tumor re –recurrence. [ABSTRACT FROM AUTHOR]

Background/Objectives: Musculoskeletal pain is one of the leading causes of years lived with disability worldwide and has a negative impact on daily life and quality of life. Methods: The purpose of this study was to analyze the electrical characteristics of back pain by measuring and calculating bioelectrical impedance variables (R, Z, PA) in 85 subjects (45 in the Healthy group and 40 in the LBP group). Additionally, impedance measurements were conducted on 20 subjects (10 in the Young group and 10 in the Older group) to assess the impact of aging. Results: Bioelectrical impedance parameter values were higher in cases of back pain, and correlation analysis showed that there was a statistically significant difference between the Healthy and LBP groups (p < 0.05). A positive correlation was found between impedance parameters and pain related indices (ODI, RMDQ, VAS) (mean R, Z, PA: 0.68, 0.54, 0.75), with BMI positively correlating only with PA (0.493). Diagnostic accuracy for detecting back pain exceeded 95% (R, Z, PA: 0.984, 0.984, 0.963). Conclusions: Results indicated that aging did not significantly affect impedance values. The bioelectrical impedance measurement device used in this study, with its simultaneous diagnostic and therapeutic capabilities, proved useful for real-time pain diagnosis and treatment monitoring, highlighting its potential clinical utility. [ABSTRACT FROM AUTHOR]