Brucellar spondylodiscitis frequently poses diagnostic challenges due to its atypical early clinical manifestations, which may mimic degenerative spinal diseases. This report described a 42-year-old male patient who initially presented with severe low back pain and acute cauda equina syndrome and was preoperatively diagnosed with lumbar disc herniation. Emergency lumbar decompression was performed; however, the patient later developed fever and systemic symptoms. Repeated serological testing confirmed brucellosis. The early clinical, laboratory, and imaging features were nonspecific, and initial inflammatory markers and bacterial cultures were negative. Empirical levofloxacin may have masked inflammatory responses. This case highlights the importance of maintaining high index of suspicion for brucellar spondylodiscitis in endemic regions, even in the absence of systemic signs of infection. Repeat serologic testing, careful radiological evaluation, and attention to epidemiological exposure are critical for early and accurate diagnosis.

BACKGROUND Myofascial pain syndrome (MPS) is a common cause of chronic low back pain with trigger points in the muscles and fascia. This study compared outcomes after radial extracorporeal shock wave therapy (rESWT) plus physical therapy versus infrared therapy plus physical therapy among patients with myofascial low back pain. MATERIAL AND METHODS Overall, 112 patients were randomly assigned to the experimental group (n=56) or control group (n=56). For 6 weeks, the experimental group received physical therapy combined with rESWT (2000 pulses, 2.0-2.5 bar, twice weekly), whereas the control group received physical therapy combined with infrared therapy (15 minutes per session, twice weekly). Primary outcomes were pain intensity (Numerical Rating Scale [NRS]), functional disability (Oswestry Disability Index [ODI]), and patient-reported improvement (Patient Global Impression of Change [PGIC]). RESULTS The rESWT group showed greater improvements than the control group in pain (ΔNRS: 0.68±0.81 vs 0.13±0.66, P<0.001, Cohen's d=0.747), disability (ΔODI: 5.29±5.71 vs 0.84±5.49, P<0.0001, Cohen's d=0.793), and patient-reported improvement (PGIC: 2.82±1.53 vs 4.07±1.36, P<0.0001, Cohen's d=0.865). Within-group analysis revealed significant improvements in the rESWT group (NRS and ODI, both P<0.01) but not the control group (both P>0.05). CONCLUSIONS Compared with infrared therapy plus physical therapy, rESWT plus physical therapy yielded greater improvements in pain and disability. These findings support use of rESWT for the management of chronic low back MPS.

Musculoskeletal pain presents a major global public health burden as it is a highly prevalent and disabling health condition. Non-pharmacologic treatments such as therapeutic exercise and dry needling are increasingly utilized in current practice although uncertainty remains regarding their comparative and combined effectiveness. This study aimed to systematically review contemporary evidence regarding the effectiveness of dry needling and exercise, alone and in combination, for the management of musculoskeletal pain. A systematic search adherent to PRISMA guidelines was conducted of PubMed, Web of Science, and Scopus databases for relevant studies from 2000-2023. After screening 642 records, 22 studies comprising a total of 1585 participants were analyzed. Seventeen studies (73.9%) found that dry needling provided no additional benefits over exercise alone for the reduction of musculoskeletal pain. Three studies demonstrated no improvements with either intervention alone. However, three studies showed greater improvements when dry needling was combined with exercise in knee osteoarthritis, trapezius myofascial pain, and low back pain. The most frequently utilized dry needling technique involved rapid in-and-out needling for 25 seconds to 15 minutes with 12-15 insertions per muscle, delivered over at least five weeks (twice weekly). Current evidence supports dry needling plus exercise as efficacious for musculoskeletal pain, although dry needling offers no additional benefit versus exercise alone. The heterogeneity of methods underscores the need for further high-quality comparative effectiveness trials across diverse populations and pain conditions to identify optimal protocols.