- Significant cephalad lead migration with use of externally powered spinal cord stimulator. [Journal Article]
- BCBMJ Case Rep 2018 Sep 21; 2018
- Spinal cord stimulation has been an effective therapy for treatment of chronic low back pain over the last four decades. Over the years, there have been significant technological advances in the neur...
Spinal cord stimulation has been an effective therapy for treatment of chronic low back pain over the last four decades. Over the years, there have been significant technological advances in the neuromodulation devices. Externally powered neuromodulation devices, that do not require an internal pulse generator (IPG) implantation, have recently been approved for treatment of chronic pain and the data on potential pitfalls and unforeseen complications with these devices is minimal. Here, we report a case of a 60-year-old woman with chronic back pain who underwent the implantation of one of such devices and developed complication that required neurosurgical intervention. The epidural stimulator leads in the patient migrated cranially to the T2 level that required extensive neurosurgical exploration. We believe this is the first reported case of such significant cranial epidural lead migration with the use of neurostimulation devices and demands more research into the safety of externally powered neurostimulation devices.
- Vertebral fracture after removing pedicle screws used for posterior lumbar interbody fusion: A case report. [Journal Article]
- JCJ Clin Neurosci 2018 Sep 19
- It is uncommon to remove pedicle screws after posterolateral lumbar interbody fusion (PLIF), and there are a few case reports of vertebral fracture involving holes remaining after screw removal. We r...
It is uncommon to remove pedicle screws after posterolateral lumbar interbody fusion (PLIF), and there are a few case reports of vertebral fracture involving holes remaining after screw removal. We report a case of the vertebral fracture after removing pedicle screws instrumented for PLIF. A 66-year-old woman with osteopenia, who underwent PLIF at L4-S1 10 years earlier, underwent PLIF at L3-L4 to correct adjacent-segment degeneration. We removed L5 and S1 pedicle screws, and inserted L3 pedicle screws. After surgery, she presented with severe progressive low back pain. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed an L5 body fracture involving the pedicle screw holes. Revision surgery, including posterolateral fusion from L3 to S2 alar iliac and L5 vertebroplasty, was performed. One year after the revision surgery, the patient remained pain-free and returned to normal activity. Possible reasons for instrumented vertebral body fracture after pedicle screw removal are decrease of vertebral mass, increased mechanical stress caused by PLIF at the adjacent segment, stress-shielding-related osteopenia, and spinal imbalance. Vertebral body fractures associated with spinal implant removal are rare, but possible, especially in elderly patients with osteopenia and osteoporosis.
- Compensatory strategy between trunk-hip kinematics and reaction time following slip perturbation between subjects with and without chronic low back pain. [Journal Article]
- JEJ Electromyogr Kinesiol 2018 Sep 15; 43:68-74
- Compensatory trunk and hip motions following slip perturbations may compromise the control of lumbopelvic movement. However, it is unclear how postural integration of the trunk and hips can be transf...
Compensatory trunk and hip motions following slip perturbations may compromise the control of lumbopelvic movement. However, it is unclear how postural integration of the trunk and hips can be transferred to treadmill-induced slip perturbations in subjects with chronic low back pain (LBP). The purpose of this study was to investigate trunk reaction times and three-dimensional trunk-hip angle changes following a slip perturbation (duration: 0.12 sec, velocity: 1.37 m/sec, displacement: 8.22 cm) with a handheld task between subjects with and without chronic LBP. There were 23 subjects with LBP and 33 control subjects who participated in the study. The trunk reaction time was not significantly different between groups. However, the three-dimensional trunk-hip angle changes were significantly different following the perturbation. There were significant interactions between the body regions and three-dimensional angles between groups. There was a negative correlation between reaction time and trunk flexion in the LBP group. Overall, the LBP group demonstrated significantly reduced trunk flexion, which might be associated with reduced adaptability or a possible fear of avoidance strategy. Clinicians need to consider compensatory strategies to improve trunk flexibility following slip perturbations in subjects with chronic LBP. Mini abstract: Trunk reaction time and three-dimensional trunk-hip motions were compared between subjects with and without chronic low back pain (LBP). The control group demonstrated greater trunk flexion; however, the LBP group reduced trunk flexion to protect against further injuries following the novelty of the slip perturbation.
- The type and pain provoking nature of exercise prescribed for low back pain: A survey of Australian health professionals. [Journal Article]
- MSMusculoskelet Sci Pract 2018 Sep 17; 38:37-45
- CONCLUSIONS: Several exercises are prescribed for LBP, irrespective of pain mechanism or duration, with more clinicians prescribing strengthening exercise for chronic than acute LBP. Most clinicians prescribed exercise into pain for acute and chronic LBP, irrespective of the exercise. Further research should determine which exercises are beneficial based on pain mechanism and duration, and whether exercise into pain should be prescribed for LBP.
- The burden of musculoskeletal disorders in Mexico at national and state level, 1990-2016: estimates from the global burden of disease study 2016. [Journal Article]
- OIOsteoporos Int 2018 Sep 21
- CONCLUSIONS: MSK conditions are an important cause of premature mortality and disability. Researcher engagement and cross-sectorial actions to address the burden of MSK disorders are essential.
- Virtual Special Issue on low back pain. [Editorial]
- JPJ Physiother 2018 Sep 18
- O'Sullivan PB, Caneiro JP, O'Keeffe M, et al. Cognitive functional therapy: an integrated behavioral approach for the targeted management of disabling low back pain. Phys Ther. 2018;98:408-423. [Journal Article]
- PTPhys Ther 2018 Oct 01; 98(10):903
- Whole-Body Vibration and Trunk Posture During Operation of Agricultural Machinery. [Journal Article]
- AWAnn Work Expo Health 2018 Sep 20
- Exposure to whole-body vibration (WBV) is common among agricultural workers and is associated with musculoskeletal health outcomes such as low back pain. Little is known, however, about the character...
Exposure to whole-body vibration (WBV) is common among agricultural workers and is associated with musculoskeletal health outcomes such as low back pain. Little is known, however, about the characteristics of exposure experienced during actual production practices. We measured WBV levels during agricultural machinery use among a sample of farmers (n = 55) performing routine agricultural activities and explored machinery attributes that may explain WBV summary measures. We also measured trunk posture to provide additional information about physical exposures during machinery operation. Measurements were made on-farm and during actual work conditions of a sample of agricultural machines (n = 112), including tractors, combines, heavy utility vehicles, and all-terrain vehicles (ATVs). Results indicated the presence of high levels of vibration (median frequency-weighted root-mean-square acceleration of approximately 0.8 m s-2) with time signatures that include high-amplitude mechanical shocks (median crest factor of nearly 23). Compared to other machinery types, combines exhibited the lowest WBV levels and among the most favorable trunk postures. Substantial variability was observed in both the WBV and trunk posture summary measures, suggesting for future studies that alternative sampling strategies are needed to fully capture temporal patterns of machinery use.
- Prevalence of Back Pain in Secondary School Students in an Urban Population: Cross-sectional Study. [Journal Article]
- CCureus 2018 Jul 14; 10(7):e2983
- Introduction The prevalence of low back pain (LBP) among secondary school students is increasing. The magnitude of the problem is not well quantified. Evidence shows LBP in adolescents can be a signi...
Introduction The prevalence of low back pain (LBP) among secondary school students is increasing. The magnitude of the problem is not well quantified. Evidence shows LBP in adolescents can be a significant risk factor for back pain in adulthood. The present study aimed to determine the lifetime prevalence of LBP among secondary school students from schools of an urban metropolitan city and the prevalence of LBP in the presence of associated factors. Methods This cross-sectional analytical study was done using a validated semi-structured questionnaire (N = 555; response rate, 85.3%). Secondary school students between the age of 12 and 15 years from three randomly selected urban secondary schools of Mumbai, India were recruited for the study. Results We analyzed the data for prevalence and odds ratios (OR), and we conducted a univariate analysis to determine the significance of LBP prevalence. We found the lifetime prevalence of LBP was high (32.9%). The prevalence of LBP was highly significant (p < .0001) among girls (confidence interval [CI]: 1.5 to 3.2; OR: 2.2), those who felt their school satchel was heavy (CI: 1.7 to 3.5; OR: 2.4) and those who watched television (TV; CI: 0.03 to 0.28; OR: 0.09). Conclusion We noted a high prevalence of LBP among adolescents. LBP had a significantly high prevalence among girls and in the presence of factors like a heavy school satchel and watching TV. LBP in adolescence is a significant risk factor in developing back pain in adulthood, and our findings highlight the need for awareness of LBP among stakeholders like educationists, policymakers, medical professionals and parents given the possible detrimental effects on adolescent children.
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- Assessment of variability in traction interventions for patients with low back pain: a systematic review. [Review]
- CMChiropr Man Therap 2018; 26:35
- CONCLUSIONS: There is wide variability in the type of traction, traction parameters and patient characteristics found among the RCTs of lumbar traction. The variability may call into question the conclusion that lumbar traction has little no or value on clinical outcomes. Also, this variability emphasizes the need for targeted delivery methods of traction that match appropriate dosages with specific subgroups of patients with LBP.