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Objective : 1) to determine the proportion of sport specialization among female figure skaters, 2) to compare proportion of low back injuries between specialized female figure skaters and non-specialized female figure skaters, and 3) to identify an independent risk factor(s) for low back injuries in female figure skaters. Methods : A cross-sectional questionnaire study was used. Young female figure skaters were asked questions related to sport specialization and any history of low back injuries. The primary outcome variables were status of sport specialization, weekly training hours, and low back injury. Descriptive statistics, t-test, chi-square analyses, and binary logistic regressions were used. Results : Responses from 132 female figure skaters (mean age: 16.3 ± 2.7 years, age range: 8-22 years) were analyzed. Sixty-two percent (82/132) of figure skaters were specialized. Specialized female figure skaters spent more time in training (11.3 ± 6.5 hours/week) than non-specialized skaters (7.6 ± 4.9 hours/week, p = 0.001). No statistical differences were found in proportion of low back injury history between specialized (25.6%) and non-specialized female figure skaters (24.0%, p = 0.836). Chronological age was also identified as an independent risk factor for low back injuries in female figure skaters (aOR: 1.24, 95%CI: 1.00, 1.54, p = 0.048). Conclusions : The majority of female figure skaters in this cohort were specialized. An association between chronological age and low back injuries, found in the current study, may be a result of cumulative effects of participating in figure skating over time.

Background: Mortality tends to be higher among people who do not work than among workers, but the impact of work-related disability on mortality has not been well studied., Methods: The vital status through 2015 was ascertained for 14 219 workers with an accepted workers' compensation claim in West Virginia for a low back injury in 1998 or 1999. Mortality among the cohort compared with the West Virginia general population was assessed using standard life table techniques. Associations of mortality and disability-related factors within the cohort were evaluated using Cox proportional hazards regression., Results: Compared to the general population, mortality from accidental poisoning was significantly elevated among the overall cohort and lost-time claimants. Most deaths from accidental poisoning in the cohort were due to drug overdoses involving opioids. Mortality from intentional self-harm was also significantly elevated among lost-time claimants. In internal analyses, overall mortality and mortality from cancer, heart disease, intentional self-harm, and drug overdoses involving opioids was significantly associated with lost time. Overall mortality and mortality from drug overdoses involving opioids were also significantly associated with amount of lost time, permanent partial disability, and percent permanent disability. Heart disease mortality was also significantly associated with the amount of lost time., Conclusions: The results suggest that disability itself may impact mortality risks. If confirmed, these results reinforce the importance of return to work and other efforts to reduce disability., (© 2019 Wiley Periodicals, Inc.)

When searching for evidence-based answers about treating athletes with low back injury/pain, there are some difficulties. The first is defining who is an athlete. The second problem is that the lifetime prevalence of low back pain in the general population in our country approaches 100. Last, most studies published only deal with a narrow population of athletes, often performing very different types of physical activity. We searched the literature for studies that specifically evaluated athletes longitudinally. This article reviews the demographics, diagnostic challenges, history and physical examination, imaging choices, treatment, and controversies encountered when treating this population., Competing Interests: Disclosure The authors have nothing to disclose., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Objectives: To examine and compare whether dispensing of prescription opioids, non-steroidal anti-inflammatory drugs (NSAIDs) and skeletal muscle relaxants (SMRs) within 8 weeks after a work-related low back pain (LBP) injury is associated with work disability., Methods: A historical cohort study of 55 571 workers' compensation claimants with LBP claims in British Columbia from 1998 to 2009 was conducted using linked compensation, dispensing and healthcare data. Four exposures were constructed to estimate the effect on receipt of benefits and days on benefits 1 year after injury: drug class(es) dispensed, days' supply, strength of opioids dispensed and average daily morphine-equivalent dose., Results: Compared with claimants receiving NSAIDs and/or SMRs, the incidence rate ratio (IRR) of days on benefits was 1.09 (95% CI 1.04 to 1.14) for claimants dispensed opioids only and 1.26 (95% CI 1.22 to 1.30) for claimants dispensed opioids with NSAIDs and/or SMRs. Compared with weak opioids only, the IRR for claimants dispensed strong opioids only or strong and weak opioids combined was 1.21 (95% CI 1.12 to 1.30) and 1.29 (95% CI 1.20 to 1.39), respectively. The incident rate of days on benefits associated with each 7-day increase in days supplied of opioids, NSAIDs and SMRs was 10%, 4% and 3%, respectively. Similar results were seen for receipt of benefits, though effect sizes were larger., Conclusions: Findings suggest provision of early opioids leads to prolonged work disability compared with NSAIDs and SMRs, though longer supplies of all drug classes are also associated with work disability. Residual confounding likely partially explains the findings. Research is needed that accounts for prescriber, system and workplace factors., Competing Interests: Competing interests: AF developed the Opioid Manager, a point-of-care tool that distils information from the Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain. This app, available on iTunes for US$9.99, is owned by the University Health Network and all revenues are used to invest in the continued maintenance of the app itself. MK receives infrastructure funding from WorkSafeBC (the provincial workers’ compensation system in British Columbia, Canada) via a formal research agreement between the University of British Columbia and WorkSafeBC. The Institute for Work and Health receives infrastructure support from Ontario’s Ministry of Labour. However, neither WorkSafeBC nor the Ministry of Labour in Ontario influenced the conduct of this study., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: Compare prescription dispensing before and after a work-related low back injury., Methods: Descriptive analyses were used to describe opioid, nonsteroidal anti-inflammatory drug (NSAID), and skeletal muscle relaxant (SMR) dispensing 1 year pre- and post-injury among 97,124 workers in British Columbia with new workers' compensation low back claims from 1998 to 2009., Results: Before injury, 19.7%, 21.2%, and 6.3% were dispensed opioids, NSAIDs, and SMRs, respectively, increasing to 39.0%, 50.2%, and 28.4% after. Median time to first post-injury prescription was less than a week. Dispensing was stable pre-injury, followed by a sharp increase within 8 weeks post-injury. Dispensing dropped thereafter, but remained elevated nearly a year post-injury, an increase attributable to less than 2% of claimants., Conclusion: These drug classes are commonly dispensed, particularly shortly after injury and dispensing is of short duration for most, though a small subgroup receives prolonged courses.

Blunt trauma rarely causes renal pedicle dissection. Clinical signs are minimal and inconsistently reported. The diagnosis is based on computed tomographic angiography; arteriography is still useful when revascularization is considered. We report here a case of traumatic dissection with thrombosis of a juxta-aortic renal pedicle monitored in the intensive care unit. An endovascular procedure could not be proposed because of the juxta-aortic localization., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)

Purpose: This population-based cohort study investigated the association between a lifetime history of a low back injury in a motor vehicle collision (MVC) and future troublesome low back pain. Participants with a history of a low back injury in a motor vehicle collision who had recovered (no or mild low back pain) were compared to those without a history of injury. Current evidence from two cross-sectional and one prospective study suggests that individuals with a history of a low back injury in a MVC are more likely to experience future LBP. There is a need to test this association prospectively in population-based cohorts with adequate control of known confounders., Methods: We formed a cohort of 789 randomly sampled Saskatchewan adults with no or mild LBP. At baseline, participants were asked if they had ever injured their low back in a MVC. Six and 12 months later, participants were asked about the presence of troublesome LBP (grade II-IV) on the Chronic Pain Grade Questionnaire. Multivariable Cox proportional hazards regression analysis was used to estimate the association while controlling for known confounders., Results: The follow-up rate was 74.8% (590/789) at 6 months and 64.5% (509/789) at 12 months. There was a positive crude association between a history of low back injury in a MVC and the development of troublesome LBP over a 12-month period (HRR = 2.76; 95% CI 1.42-5.39). Controlling for arthritis reduced this association (HRR = 2.25; 95% CI 1.11-4.56). Adding confounders that may be on the casual pathway (baseline LBP, depression and HRQoL) to the multivariable model further reduced the association (HRR = 2.20; 95% CI 1.04-4.68)., Conclusion: Our analysis suggests that a history of low back injury in a MVC is a risk factor for developing future troublesome LBP. The consequences of a low back injury in a MVC can predispose individuals to experience recurrent episodes of low back pain.

Background: Neurological deficits noted immediately after childbirth are usually various obstetric neuropathies, but prospective studies are limited. The main study aim was to quantify and describe immediate postpartum neurological deficits of the lower extremity, including the buttocks., Methods: A prospective observational study of postpartum women delivering in a single maternity hospital during three months of 2016. Among 1147 eligible women, 1019 were screened for symptoms of lower extremity numbness or weakness within eight to 32hours of delivery. Consent to undergo a detailed neurological evaluation was sought from those reporting symptoms. Risk factors were identified using logistic regression., Results: Thirty five women (3.4%) reported symptoms, 27 entered the study and 23 (2.0%) had objective signs of a neurological deficit. The most common injuries were mild lumbosacral plexopathies and cluneal nerve compression. Most deficits were sensory, half of these also having a motor deficit that did not impact functionally. Based on analysis of 22 cases involving a likely intrapartum deficit, no association was found with parity, body weight, duration of labour, mode of delivery or neuraxial block. A past history of a neurological condition or a back injury was associated with odds ratios of 7.98 and 4.82 respectively. There were no neurological deficits that were clinically concerning or that were likely a complication of a neuraxial block., Conclusion: Transient neurological complications after labour and delivery are infrequent, mainly sensory involving multiple lumbosacral nerve roots or specific sacral cutaneous nerves, and they typically resolve within a short time., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Morel-Lavallee seroma (MLS) or post-traumatic pseudocyst is a soft tissue seroma developing due to closed degloving injury by a shearing force that causes separation of subcutaneous fatty layer from the deeper muscular fascia resulting in collection of fluid in the created space. Presentation is usually fluctuant swelling following history of injury. More frequently described in orthopaedic literature, it occurs more commonly over gluteal and trochanteric regions, knee and flanks with occurrence over back, thorax being a rare entity. Despite mimicking several other similar presenting conditions, diagnosis of MLS can be made by meticulous history and physical examination with classical findings on ultrasonography, CT scan and MRI. Treatment modality may vary from conservative management to open surgical debridement of the wound with percutaneous aspiration and sclerodhesis forming useful adjuncts to conservative management., (2016 BMJ Publishing Group Ltd.)

Background: Traffic collisions often result in a wide range of symptoms included in the umbrella term whiplash-associated disorders. Mid-back pain (MBP) is one of these symptoms. The incidence and prognosis of different traffic injuries and their related conditions (e.g. neck pain, low back pain, depression or others) has been investigated previously; however, knowledge about traffic collision-related MBP is lacking. The study objectives were to describe the incidence, course of recovery and prognosis of MBP after traffic collisions, in terms of global self-reported recovery., Methods: Longitudinal data from a population-based inception cohort of all traffic injuries occurring in Saskatchewan, Canada, during a 2-year period were used. Annual overall and age-sex-specific incidence rates were calculated, the course of recovery was described using the Kaplan-Meier technique, and associations between participant characteristics and time-to-self-reported recovery were explored in 3496 MBP cases using Cox proportional hazards models., Results: The yearly incidence rate was 236 per 100,000 population during the study period, and was highest in women and in young persons. The median time-to-first reported recovery was 101 days (95% CI: 99-104) and about 23% were still not recovered after 1 year. Participant's expectation for recovery, general health, extent of severely affecting comorbidities and having experienced a previous traffic injury were some of the prognostic factors identified., Conclusions: These findings show that MBP is common after traffic collisions, may result in a long recovery process and that a range of biopsychosocial factors are associated with recovery., (© 2015 The Authors. European Journal of Pain published by John Wiley & Sons Ltd on behalf of European Pain Federation - EFIC®.)

An 83-year-old woman with no significant medical history was transferred to our tertiary hospital after being hit by a car and presenting with haemorrhagic shock. Immediate fluid resuscitation was performed; physical, chest/pelvic X-ray and echographic examinations did not detect any major sources of bleeding. However, a contrast-enhanced CT scan revealed multiple regions of significant contrast extravasation in an extensive part of the subcutaneous tissue of the patient's lower back, which is an unusual source of bleeding. Transcatheter arterial embolisation of the lumbar and internal iliac arteries and their branches was carried out. In addition, haemostatic resuscitation was performed for damage control resuscitation, which successfully resolved the patient's haemorrhagic shock., (2015 BMJ Publishing Group Ltd.)

Current technique of airway management for impaled knife in the back includes putting the patient in lateral position and intubation. We present here a novel technique of anesthesia induction (intubation and central line insertion) in a patient with impaled knife in the back which is simple and easily reproducible. This technique can be used for single lung ventilation using double lumen tube or bronchial blocker also if desired.

Objective: The aim of this study was to investigate sex differences in predicting chronicity of low-back pain after acute trauma using cross-sectional areas of paraspinal (multifidus and erector spinae) and psoas muscles., Design: Between January 2006 and December 2010, a total of 54 patients were interviewed at least 6 mos after the trauma event. The subjects were classified into chronic low-back pain group and improved low-back pain group according to the presence of low-back pain for more than 6 mos. The cross-sectional area of the multifidus, erector spinae, and psoas muscles was measured at the level of the lower margin of the L3 and L5 vertebrae using magnetic resonance imaging., Results: The cross-sectional area of the multifidus and erector spinae muscles at L5 in the chronic low-back pain group was significantly smaller than that of the improved low-back pain group (P < 0.05) in the men. There were no significant differences in the other parameters between the groups in the men. There were no significant differences in any parameters in the women., Conclusions: In the men, the cross-sectional area of the multifidus and erector spinae muscles at the lower lumbar level can be considered to be prognostic factors for the chronic low-back pain after acute trauma. The authors thus suggest that strengthening of lumbar paraspinal muscles could be helpful for preventing chronicity of low-back pain.

Background and Context: The cricket pace bowling action consists of a complex sequence of forceful actions, involving practiced, particular movements of the lumbar spine. The nature and repetition of the pace bowling action is known to be associated with a high incidence of low back injuries., Purpose: This study aimed to establish whether lumbar proprioception (as measured by joint position sense) in the neutral lumbar spine position as well as lumbar positions corresponding to those at front foot placement and ball release positions of the cricket pace bowling action were related to previous injury and injury sustained during the cricket season under review. Injuries specifically sustained during the bowling action and those specific to the low back were explicitly investigated., Study Setting: Longitudinal study with participants tested at the start and monitored over the duration of a cricket season., Participant Sample: Seventeen male cricket pace bowlers between the ages of 18 and 26 years participated in this study., Outcome Measures: Physiological outcome measures were used. Lumbar position sense was established using electrogoniometry., Methods: Lumbar reposition error was measured in three positions (neutral lumbar spine, front foot placement, and ball release bowling positions). In each position, lumbar orientation was determined in the sagittal (flexion-extension) and coronal (left-right lateral flexion) planes. Wilcoxon matched-pairs ranks and Kruskal-Wallis tests were used to establish the relationship between variables., Results: Reposition error was associated with general injuries sustained in the past and during the cricket season under review, low back injuries, as well as injuries sustained during the bowling action (p<.05)., Conclusion: Lumbar position sense, as a measure of proprioception, was related to injury in general, injuries sustained during the bowling action, and, especially, low back injury sustained in the past. Low back injury prevention methods are particularly needed because of the high load nature of the pace bowling action. If the proprioception of the lumbar spine is improved in pace bowlers, their risk of lumbar injury can potentially be reduced., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Background: Lumbar disc degeneration (LDD) is a process that begins early in life, contributing to the development of low back pain. LDD is a consequence of a variety of factors, and its etiology remains poorly understood. Objectives to investigate occupational and genetic risk factors inducing lumbar disc degeneration, and to evaluate the possible association of genetic polymorphisms of matrix metalloproteinase 3 (MMP-3) and vitamin D receptor (VDR) with the severity of LDD in an Egyptian population., Subjects and Methods: A case control study involving 84 LDD and 60 controls was carried out. Five types of work related factors were investigated by questionnaire, complete neurological examination for all subjects and MRI for the cases. Polymerase chain reaction and restriction fragment length polymorphism methods were applied to detect polymorphisms in MMP-3 Promoter (-1,171 6A/5A) (rs 731236) and VDR-Apa (rs 35068180)., Results: We found that family history, back injury, smoking, high level of sitting, bending/twisting, physical workload, lifting, whole body vibration, mutant allele 5A of MMP-3 and mutant allele T of VDR were significantly associated with LDD (OR = 2.9, 3.1, 2.1, 11.1, 15.9, 11.7, 8.2, 12.6, 2.5 and 3.1 respectively, p < 0.05). Cases that carry allele 5A and/or allele T were associated with LDD severity., Conclusion: LDD is closely associated in occurrence and severity with occupational, environmental risk factors and susceptibility genes namely MMP-3, and VDR (ApaI). This study throws light on the importance of screening for early detection of susceptible individuals and disease prevention.

Background and Importance: Herniated intervertebral disc fragments rarely penetrate the thecal sac, and intracranial hypotension attributable to such penetrating fragments is even more unusual. We describe the first reported case of a cranial neuropathy due to intradural herniation of a disc fragment, in which intracranial hypotension from a resulting cerebrospinal fluid leak caused bilateral abducens palsies., Clinical Presentation: A 45-year-old man presented with a positional headache after having experienced a "popping" sensation in his back while lifting a heavy object. He also reported blurred vision and was noted to have lateral gaze palsies bilaterally. Magnetic resonance imaging (MRI) of the brain revealed bilateral subdural collections, abnormal pachymeningeal enhancement, and cerebellar tonsillar herniation, suggesting intracranial hypotension. T2-weighted MRI of the spine revealed extrusion of the T12-L1 disc and suggested the presence of a disc fragment in the intradural space, displacing the caudal nerve roots. A myelogram demonstrated a filling defect extending into the subarachnoid space adjacent to the disc herniation, consistent with a free disc fragment in the intradural space. A diagnosis of intracranial hypotension due to a cerebrospinal fluid leak resulting from an intradural herniated disc was made. The diagnosis was confirmed intraoperatively., Conclusion: Surgical removal of the herniated disc fragment and repair of the dural defect resulted in complete resolution of the cranial neuropathy. This rare etiology of a cranial neuropathy, arising from pathology in the thoracolumbar spine, illustrates the clinical teaching that the sixth cranial nerve is highly sensitive to deformation induced by intracranial hypotension.

Objective: The objective of this study was to compare the effect of customized foot orthotics in addition to usual care (UC) compared with UC alone for the treatment of patients with chronic low back pain after work-related injury., Methods: Sixty-two consecutive patients presenting with chronic (>3 months), nonspecific, low back pain following work-related low back injury were included in the study. A total of 30 patients in the UC group were given a 6-week exercise therapy program along with prescription analgesics. The intervention group, composed of 32 patients, received UC in addition to customized foot orthotics (orthotics group). All subjects completed the Oswestry Disability Index at the initiation of the study and at 8-week follow-up. Work disability, as defined by working at usual, preinjury job labor level, was recorded at baseline and 8-week follow-up., Results: A total of 28 subjects in the UC group and 32 in the orthotics group completed the study. The 2 groups were well matched in terms of age, sex distribution, and duration of low back pain as well as baseline Oswestry Disability Index score. At 8 weeks, both groups had improved. The orthotics group had a lower Oswestry Disability Index than the UC group (P < .01), with a smaller proportion of the orthotics group using any form of prescribed analgesics for back pain (P < .05)., Conclusions: The findings showed that patients in this study with chronic, nonspecific low back pain following work-related low back injury had greater improvement in short-term outcomes with orthotics and UC than with UC alone., (Copyright © 2013 National University of Health Sciences. Published by Mosby, Inc. All rights reserved.)

Study Design: Prospective population-based cohort study., Objective: To identify early predictors of lumbar spine surgery within 3 years after occupational back injury., Summary of Background Data: Back injuries are the most prevalent occupational injury in the United States. Few prospective studies have examined early predictors of spine surgery after work-related back injury., Methods: Using Disability Risk Identification Study Cohort (D-RISC) data, we examined the early predictors of lumbar spine surgery within 3 years among Washington State workers, with new workers compensation temporary total disability claims for back injuries. Baseline measures included worker-reported measures obtained approximately 3 weeks after claim submission. We used medical bill data to determine whether participants underwent surgery, covered by the claim, within 3 years. Baseline predictors (P < 0.10) of surgery in bivariate analyses were included in a multivariate logistic regression model predicting lumbar spine surgery. The area under the receiver operating characteristic curve of the model was used to determine the model's ability to identify correctly workers who underwent surgery., Results: In the D-RISC sample of 1885 workers, 174 (9.2%) had a lumbar spine surgery within 3 years. Baseline variables associated with surgery (P < 0.05) in the multivariate model included higher Roland-Morris Disability Questionnaire scores, greater injury severity, and surgeon as first provider seen for the injury. Reduced odds of surgery were observed for those younger than 35 years, females, Hispanics, and those whose first provider was a chiropractor. Approximately 42.7% of workers who first saw a surgeon had surgery, in contrast to only 1.5% of those who saw a chiropractor. The area under the receiver operating characteristic curve of the multivariate model was 0.93 (95% confidence interval, 0.92-0.95), indicating excellent ability to discriminate between workers who would versus would not have surgery., Conclusion: Baseline variables in multiple domains predicted lumbar spine surgery. There was a very strong association between surgery and first provider seen for the injury even after adjustment for other important variables.

Objective: To examine the incidence of clinically significant weight gain 1 year after occupational back injury, and risk factors for that gain., Methods: A cohort of Washington State workers with wage-replacement benefits for back injuries completed baseline and 1-year follow-up telephone interviews. We obtained additional measures from claims and medical records., Results: Among 1263 workers, 174 (13.8%) reported clinically significant weight gain (≥7%) 1 year after occupational back injury. Women and workers who had more than 180 days on wage replacement at 1 year were twice as likely (adjusted odds ratio = 2.17, 95% confidence interval = 1.54 to 3.07; adjusted odds ratio = 2.40, 95% confidence interval = 1.63 to 3.53, respectively; both P < 0.001) to have clinically significant weight gain., Conclusions: Women and workers on wage replacement for more than 180 days may be susceptible to clinically significant weight gain after occupational back injury.

Study Design: Prospective population-based cohort study., Objective: To identify early predictors of self-reported occupational back reinjury within 1 year after work-related back injury., Summary of Background Data: Back injuries are the costliest and most prevalent disabling occupational injuries in the United States. A substantial proportion of workers with back injuries have reinjuries after returning to work, yet there are few studies of risk factors for occupational back reinjuries., Methods: We aimed to identify the incidence and early (in the claim) predictors of self-reported back reinjury by approximately 1 year after the index injury among Washington State workers with new work disability claims for back injuries. The Washington Workers' Compensation Disability Risk Identification Study Cohort provided a large, population-based sample with information on variables in 7 domains: sociodemographic, employment-related, pain and function, clinical status, health care, health behavior, and psychological. We conducted telephone interviews with workers 3 weeks and 1 year after submission of a time-loss claim for the injury. We first identified predictors (P < 0.10) of self-reported reinjury within 1 year in bivariate analyses. Those variables were then included in a multivariate logistic regression model predicting occupational back reinjury., Results: A total of 290 (25.8%) of 1123 (70.0% response rate) workers who completed the 1-year follow-up interview and had returned to work reported having reinjured their back at work. Baseline variables significantly associated with reinjury (P < 0.05) in the multivariate model included male sex, constant whole-body vibration at work, previous similar injury, 4 or more previous claims of any type, possessing health insurance, and high fear-avoidance scores. Baseline obesity was associated with reduced odds of reinjury. No other employment-related or psychological variables were significant., Conclusion: One-fourth of the workers who received work disability compensation for a back injury self-reported reinjury after returning to work. Baseline variables in multiple domains predicted occupational back reinjury. Increased knowledge of early risk factors for reinjury may help to lead to interventions, such as efforts to reduce fear avoidance and graded activity to promote recovery, effective in lowering the risk of reinjury.

Our objective was to investigate the incidence of musculoskeletal injuries sustained by elite level curling athletes during international competition. This study was conducted during the 2008 World Men's Curling Championships. All registered athletes and the tournament medical team were given report forms for documenting injuries that occurred during the tournament. Report form information included demographics, area injured, types of injuries sustained, and curling-specific aggravating conditions. During the competition five injuries were reported, resulting in an injury rate of .07 injuries per game. Only one reported injury resulted in missed competition (.014 injuries per game). All reported injuries involved increased pain during curling-specific activities. At the elite international competitive level, injury incidence in curling was found to be low. Future exploration over the course of a season may be beneficial to identify risk factors and to assist with formulating training strategies to decrease injury risk.

Background: High prevalence and high costs in the treatment of spine injuries make a cost study necessary. The objective of this paper is to analyze, from the economic point of view, the behavior of traumatic and non-traumatic spinal pathologies in relation to hospital stay., Methods: Analysis of economic cost per hospital stay (January 2000 to May 2010)., Results: 4,173 cases studied, 45% women and 55% men, predominantly elderly and a mean age of 48.9, standard deviation 16.8 years, with a notable increase in hospital expenses in prevalence and peak months: January, February and April; and a decrease in July, October and December. Total expenses for hospital stay were estimated as $85,565,288.00. Traumatic entities consumed $40,404,477.00, and degenerative $21,866,815.00. The months of highest spending were: April, $11,072,683.00, December, $8,423,773.00 and February $8,154,152.00; whereas July showed the lowest spending: $4,874,261.00. Inflation up to July 2011 remained at 3.55% on average, down 2.98 percentage points from 2008 figures., Discussion: there is a clear increase in spending connected with spine condition treatment at hospitals, in particular those resulting from traumatic events. The definition of risk groups for preventive measures is also reflected in the spending records. Spending on hospital treatment of spinal conditions of the elderly reflects an increment in degenerative conditions., Conclusion: It is necessary to plan a timely resource distribution by month and year in order to achieve a better and more efficient scheme for health services. The epidemiological basis for the reorientation of the current models is now clear.

We report a 52-year-old woman presenting with stab wounds on her back and upper extremities. A knife retained in her chest wall was not discovered in the emergency department. This case reminds us that an obvious foreign body can be missed even after obtaining a detailed history, complete physical examination and plain film. Particularly, a retained foreign body increases the risk of infection and may cause further internal organ injury. We suggest that patients undergo computed tomography (CT) scanning whenever a penetrating wound cannot be explored adequately or the trauma surgeons are unable to perform detailed examinations on the injured patients. The CT images could delineate the course and severity of the penetrating injury, and decrease the risk of a retained foreign body.

Study Design: A population-based, prospective cohort study., Objective: To evaluate the association of early imaging and health and disability status 1 year following acute low back injury, among a population-based sample of Washington State workers' compensation claimants., Summary of Background Data: Use of early diagnostic magnetic resonance imaging (MRI) for low back pain (LBP) contributes to increasing health care costs but may not lead to better outcomes than delayed imaging. In the worker's compensation system, LBP is common and costly. This research examines the association between early MRI among workers with LBP and health outcomes (pain intensity, Roland disability score, and 36-Item Short Form Health Survey scores) and disability status 1 year after injury., Methods: This nonrandomized prospective cohort study of Washington State workers' compensation claimants with nonspecific LBP used administrative claims and interview data. Multivariable regression methods were used to estimate change in health outcome scores, the relative risk of disability at 1 year, and the rate of recovery 1 year after injury., Results: Of 1226 participants, 18.6% received early MRI. Most (77.9%) had mild/major sprains and 22.1% had radiculopathy. Participants with early MRI differed significantly at baseline in pain, function, and psychosocial variables. After adjusting for covariates, early imaging was not associated with substantial differences in 1-year health outcomes for sprains or radiculopathy. For workers with mild/major sprain, early imaging was associated with a 2-fold increase in the likelihood of work disability benefits at 1 year (adjusted relative risk: 2.03, 95% confidence interval: 1.33-3.11). Early imaging was not associated with an increased risk of long-term disability for workers with radiculopathy (adjusted relative risk: 1.31, 95% confidence interval: 0.84-2.05). For both groups, early MRI was associated with longer disability duration (P < 0.001)., Conclusion: Among workers with LBP, early MRI is not associated with better health outcomes and is associated with increased likelihood of disability and its duration. These associations warrant further testing in a randomized controlled trial. Our findings suggest that adherence to evidence-based guidelines is an important factor in ensuring that workers receive the highest quality care for occupational injuries.

Background: This study aimed at assessing factors associated to the duration of sickness absence after a back injury in the Belgian working population, with a special emphasis on cultural factors., Methods: The data were retrieved from the Belgian Fund for Work Accidents database over a 3-year period (2001-2003). The population source involved all Belgian workers under a job contract in the private sector registered as compensated cases for an accident that occurred at the workplace (n = 558,276). From that database, all back injury cases involving a complete data set and registered during the first 6 months of each year (n = 11,262) were selected and eight factors (gender, age, seniority in the current job, job category, accident regional location, enterprise size, sector of activity, and accident circumstances) were analyzed in relation to the outcome variable, sick leave duration recorded as ordered time intervals between 0 and 183-366 days., Results: Sick leave duration was strongly associated in a multivariate model to age (≥40 years: OR = 2.18), blue-collar job (1.55), work in building industry (1.32), and enterprise size (>100: 0.85), and to a less extent to seniority (>10y: 0.88), and circumstance of accident (falls: 1.26). Injuries occurring in the French-speaking part of the country were associated to a longer sick leave (1.07; P = 0.034)., Conclusions: This study shows that besides well-known risk factors, subtle cultural language-linked factors and/or regional differences in economic climate may significantly influence the length of disability period after a back injury., (Copyright © 2012 Wiley Periodicals, Inc.)

Buttock (gluteal) pain is commonly experienced by athletes of all ages and activity levels. Evaluation of buttock pain can be challenging because the differential diagnoses are extensive. Symptoms may originate from the pelvis or hip or be referred from the lumbosacral spine or neurovascular structures. Few articles in the literature are dedicated to the primary complaint of buttock pain. The purpose of this article is to provide a clinical algorithm to assist the sports clinician in reaching an accurate diagnosis and initiating the appropriate treatment.

Traumatic lumbar hernia (TLH) is a rare presentation. Traditionally, these have been repaired via an open approach. Recurrence can be a problem due to the often limited tissue available for mesh fixation at the inferior aspect of the hernia defect. We report the successful use of bone suture anchors placed in the iliac crest during transperitoneal laparoscopy for mesh fixation to repair a recurrent TLH. This technique may be particularly useful after previous failed attempts at open TLH repair.

We present the case of a male patient with post traumatic retroperitoneal fibrosis whose main clinical expression was low-back pain. Diagnosis was established using CAT-scan and MRI, which revealed a large mass of soft tissue that almost entirely enveloped the abdominal aorta. Treatment with 40 mg of prednisone every 24 hours was established. This dose was reduced gradually, and progressive remission of clinical signs and symptoms was achieved, with a significant improvement of subsequent imaging-test results. Treatment was continued for one year. Two and a half years later the patient remains symptom-free, with no recurrence of his condition.

This report describes a case of Brown-Sequard syndrome in a man who presented to the ED after a stabbing to the left scapula region. The incidental finding of pneumocephalus found on CT scan during workup lead to cervical MRI that revealed the spinal cord pathology associated with Brown-Sequard syndrome., (© 2011 The Authors. EMA © 2011 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.)

A 56-year-old man presented with a very rare case of mobile schwannoma of the cauda equina incarcerated following caudal migration after trauma, manifesting as attack of severe back pain and bilateral sciatica which developed just after a fall. Magnetic resonance imaging demonstrated a large intradural tumor at the L4-5 level with redundant nerve roots below that. Two days before the surgery, his pain unexpectedly lessened without additional treatment. Computed tomography showed that the tumor had migrated cranially and was now located at the L3-4 level. These findings suggest that the severe symptoms were caused by incarceration of a mobile tumor at the L4-5 level following the trauma. The tumor was successfully removed using minimally invasive procedures with guidance provided by the intraoperative myelography. The patient was relieved from pain postoperatively. The histological diagnosis was schwannoma. This case suggests that intraoperative myelography is a useful method for guiding the removal of mobile tumors.

Objectives: The objectives for presenting these medico-legal forensic case reports are the following: 1) detail three cases where chronic opioid analgesic therapy (COAT) was alleged to cause iatrogenic addiction and/or re-addiction; 2) detail the plaintiff's and defendant's medical experts' opinions on these allegations; and 3) through analyzing these cases, develop some recommendations for future prevention of such allegations during COAT., Methods: Case Reports., Results: Medico-legal issues surrounding the allegation of iatrogenic addiction were identified in each case., Conclusions: Before starting COAT, physicians should obtain and document patient informed consent for the risk of addiction/re-addiction with COAT treatment. Patients with a history of addictions pre-COAT should be placed on adherence monitoring immediately on beginning COAT., (Wiley Periodicals, Inc.)

Background: Knowledge on long-term consequences of injury on health is vital when injury prevention policies and emergency care are planned. However, few studies have described lasting health consequences associated with injury. This study analyses the relationship between injury and self-assessed health up to 10 years after the injury., Methods: The study makes use of a public health research database linking health interview survey information with data from national health registries. Using this database, the health of a group of Danish patients with injury events during 1995 to 2005 was compared with a noninjured group up to 10 years after the injury. The association between self-assessed general health and self-reported depression and injury-related factors were estimated using logistic regression analysis., Results: When patients with injuries compared with noninjured, the odds ratios of poor self-assessed general health and self-reported depression were 1.83 (confidence level, 1.53-2.19) and 1.33 (confidence level, 1.14-1.54), respectively. Although decreasing with time, the effect of injury on general health was significant up to 10 years after the injury. The injury type was significantly related to health, and in particular, patients with back, head, and neck injuries reporting poor general health. No gender differences were found in the effect of injury on self-assessed health., Conclusions: Injuries have lasting consequences for physical and mental health up to 10 years after the injury event, in particular, for people sustaining head, neck, and back injuries. Sustaining an injury has the same effect on general health in men and women.

Opioid addiction and abuse are growing problems in the United States, particularly in Appalachian areas, which has led to a major social health problem costing millions of dollars in lost wages, medical care and lost productivity. In some patients with chronic moderate to severe pain, opioids are indicated and can be successfully used with proper monitoring. In this report, we present a case where the use of spinal cord stimulation (SCS) led to an elimination of opioids, a return to work, and to productive function. We also review the literature on the use of SCS to reduce opioid use and improve function based on objective criteria.

The Range of Motion (ROM) is a popular measurement used in the determination of disability for low back pain subjects in spite of serious objections to its clinical usefulness. It is proposed to consider a different index called the Range of Normality (RON) which is defined to be the portion of the ROM that an injured subject is able to do quasi-normally. This permits a direct assessment of the return to work parameters and the restrictions that ought to be placed on activities. It also allows follow up since the RON is expected to fill up the ROM as the injured subject recovers from his injury.

Objectives: Little is known about the risks of injury to dogs participating in the relatively new sport of canine agility. The purpose of this study was to identify the factors that put the participating dog at risk as well as determine the anatomical sites that were most commonly injured., Methods: A retrospective survey using a paper and web-based data collection instrument was used to evaluate dogs participating in the sport of canine agility., Results: Of the 1627 dogs included in the study, 33% were injured, and of those 58% were injured in competition. Most injuries occurred on dry outdoor surfaces. Border Collies were the most commonly injured, and injuries were in excess of what would be expected from their exposure. For all dogs, soft tissue injuries were most common. The shoulders and backs of dogs were most commonly injured. Dogs were most commonly injured by contact with an obstacle. The A-frame, dogwalk and bar jump obstacles were responsible for nearly two-thirds of injuries that resulted from contact with the obstacle., Conclusions: Border Collies are at higher risk for injury than would be expected from their exposure. The A-frame, dogwalk and bar jump obstacles put the shoulders and backs of dogs at risk., Clinical Relevance: For the first time, this study gives us insight into injuries occurring in dogs participating in canine agility. This will help direct prospective studies that evaluate the safety of individual obstacles, direct rule changes and enable practitioners to understand the risks of the sport.

Study Design: Prospective population-based cohort study., Objective: To identify early predictors of chronic work disability after work-related back injury., Summary of Background Data: Identification of early predictors of prolonged disability after back injury could increase understanding concerning the development of chronic, disabling pain, and aid in secondary prevention. Few studies have examined predictors across multiple domains in a large, population-based sample., Methods: Workers (N = 1885) were interviewed 3 weeks (average) after submitting a lost work-time claim for a back injury. Sociodemographic, employment-related, pain and function, clinical, health care, administrative/legal, health behavior, and psychological domain variables were assessed via worker interviews, medical records, and administrative databases. Logistic regression analyses identified early predictors of work disability compensation 1 year after claim submission., Results: Significant baseline predictors of 1-year work disability in the final multidomain model were injury severity (rated from medical records), specialty of the first health care provider seen for the injury (obtained from administrative data), and worker-reported physical disability (Roland-Morris disability questionnaire), number of pain sites, "very hectic" job, no offer of a job accommodation (e.g., light duty), and previous injury involving a month or more off work. The model showed excellent ability to discriminate between workers who were/were not disabled at 1 year (area under the receiver operating characteristic curve = 0.88, 95% CI = 0.86-0.90)., Conclusion: Among workers with new lost work-time back injury claims, risk factors for chronic disability include radiculopathy, substantial functional disability, and to a lesser extent, more widespread pain and previous injury with extended time off work. The roles of employers and health care providers also seem important, supporting the need to incorporate factors external to the worker in models of the development of chronic disability and in disability prevention efforts.

The objective of this study was to examine the influence of variations in contextual features of a physically demanding lifting task on the judgments of others' pain. Healthy undergraduates (n=98) were asked to estimate the pain experience of chronic pain patients who were filmed while lifting canisters at different distances from their body. Of interest was whether contextual information (i.e., lifting posture) contributed to pain estimates beyond the variance accounted for by pain behavior. Results indicated that the judgments of others' pain varied significantly as a function of the contextual features of the pain-eliciting task; observers estimated significantly more pain when watching patients lifting canisters positioned further away from the body than canisters closest from the body. Canister position contributed significant unique variance to the prediction of pain estimates even after controlling for observers' use of pain behavior as a basis of pain estimates. Correlational analyses revealed that greater use of the contextual features when judging others' pain was related to a lower discrepancy (higher accuracy) between estimated and self-reported pain ratings. Results also indicated that observers' level of catastrophizing was associated with more accurate pain estimates. The results of a regression analysis further showed that observers' level of catastrophizing contributed to the prediction of the accuracy of pain estimates over and above the variance accounted for by the utilisation of contextual features. Discussion addresses the processes that might underlie the utilisation of contextual features of a pain-eliciting task when estimating others' pain.

Persistent vegetative state (PVS) is described as one of the complications of brain damage in the current forensic science literatures. PVS unrelated to brain damage, however, is not uncommon in daily forensic practice. Currently, only "Assessment for Body Impairment of the Injured in Road Traffic Accident" designates PVS as one of its items under the section of "Brain, Spinal Cord, and Nerves Injury." Therefore, it is difficult to assess the damage and disability in PVS, especially PVS due to non-brain damage. Based on a case of PVS caused by chest injury in combination with relevant literature review, this paper provides a summary on the general information, etiology, pathogenesis, clinical manifestation, diagnosis and differential diagnosis of PVS, as well as a guideline for its forensic assessment.

Background: Little is known about the role of prior occupational low back injury in future episodes of low back pain and disability in the general population. We conducted a study to determine if a lifetime history of work-related low back injury is associated with prevalent severity-graded low back pain, depressive symptoms, or both, in the general population., Methods: We used data from the Saskatchewan Health and Back Pain Survey - a population-based cross-sectional survey mailed to a random, stratified sample of 2,184 Saskatchewan adults 20 to 69 years of age in 1995. Information on the main independent variable was gathered by asking respondents whether they had ever injured their low back at work. Our outcomes, the 6-month period prevalence of severity-graded low back pain and depressive symptoms during the past week, were measured with valid and reliable questionnaires. The associations between prior work-related low back injury and our outcomes were estimated through multinomial and binary multivariable logistic regression with adjustment for age, gender, and other important covariates., Results: Fifty-five percent of the eligible population participated. Of the 1,086 participants who responded to the question about the main independent variable, 38.0% reported a history of work-related low back injury. A history of work-related low back injury was positively associated with low intensity/low disability low back pain (OR, 3.66; 95%CI, 2.48-5.42), with high intensity/low disability low back pain (OR, 4.03; 95%CI, 2.41-6.76), and with high disability low back pain (OR, 6.76; 95%CI, 3.80-12.01). No association was found between a history of work-related low back injury and depression (OR, 0.85; 95%CI, 0.55-1.30)., Conclusion: Our analysis shows an association between past occupational low back injury and increasing severity of prevalent low back pain, but not depression. These results suggest that past work-related low back injury may be an important risk factor for future episodes of low back pain and disability in the general population.