News Category: Lumbar Spine

The use of circumferential (CF) fusion is better than posterolateral fusion (PLF) in lumbar spinal fusion, say researchers of a recent study. Although many people experience chronic lower back pain, there has been little agreement on the best method of treatment until a recent study demonstrated the effectiveness of a particular spinal fusions technique.

The authors of this study set out to evaluate the posterolateral approach, from the sides and back, in order to determine the cost per quality-adjusted-life-year (QALY) compared with that of CF fusion, a more invasive surgery. Discovering the cost-effectiveness of two procedures allows doctors to analyze the difference between the procedures and helps in decision-making within certain budget constraints.

The researchers enrolled 148 patients, between the ages of 20 and 65 years (average 46), who had severe chronic low back pain and leg pain, from an instability in the back that required repair through surgery. All patients were examined through clinical and neurological examinations, as well as by x-ray, computed tomography scanning (CT scan) with myelography, or magnetic resonance imaging (MRI). Long-term follow up was done by mail; 125 patients were available to complete the study.

To perform the economic evaluation, the researchers used the EuroQol instrument EQ-5D. They report that to calculate the QALY, the patient’s health state is assigned a certain value. All costs between January 1 of the year of the initial surgery to a fixed study endpoint of January 1, 2004, were recorded and discounted at an annual rate of three percent. Healthcare services used (initial surgery, repeat surgeries, repeat hospitalization, and clinic visits) were all recorded, as were visits with general physicians, specialists, physiotherapists, psychologists, and chiropractors. Prescribed medications, as well as over-the-counter medications were recorded. Finally, patient disability and absenteeism due to inability to work were also tracked.

During the surgery, eight patients who underwent the PLF experienced complications, as did 13 patients in the CF group. At two-year follow-up, 16 in the PLF group needed repeat surgeries, while five in the CF group also required repeat surgeries. Measurements for disability and pain were done with the Oswestry Disability Index, the Short-form 36, and a pain scale. After two years, the researchers found that the fusion rate was better in the patients who had undergone the CF approach than the patients who underwent the PLF. This was noted with both physical and psychosocial functional ability.

Regarding costs, the CF approach appeared to be more cost effective than the PLF. Although the cost of the CF surgery was a bit higher than the PLF (US$12,070 vs. US$11,990), the follow-up care was less expensive, particularly because of the repeat surgeries. The biggest difference was in the post-operative clinic visits because of back pain. In terms of societal cost, patients in the PLF group did not return to work as often as did the patients in the CF group. Interestingly, the CF patients did have more reported absences from work than did the PLF group, but the PLF group had a poorer return to work rate. At the same time, patients in the CF group reported a significantly better quality-of-life than did those in the PLF group.

The authors’ goal was to assess if their hypothesis of CF fusion being more economical than PLF, despite the added cost of the initial surgery with the CL fusion. They concluded that the CF procedure was both less expensive and more effective. They caution, however, that this information might not necessarily be transferred to other parts of the world, or even to other parts of the country in terms of actual numbers.

Given the large number of people who have had or have back pain in their lifetime, it is surprising that only 15 per cent of the time back pain has been specifically diagnosed in the past. This means that the great majority of back pain was termed non-specific. This also means that treatments were not targeted to specific parts of the spine.

Facet joints, discs, ligaments, nerve roots, and muscles can all be a source of back pain. Some can be eliminated as a source of pain given a patient’s symptoms, physical examination, or imaging such as Xray or MRI.

More recently, doctors, with the help of injections that numb certain parts of the spine, can make a specific or positive diagnosis in up to 85 per cent of patients.

Studies have shown that facet joints, the small joints in the spine, may be the source of neck, midback (thoracic), and low back pain 25 to 40 per cent of the time.

Diagnosing the facet joints as the source of pain requires performing a sympathetic nerve block using a numbing agent such as lidocaine. This is done using an xray technique called fluoroscopy to insure the medication goes where it is intended. The lidocaine is used to block the nerve to the targeted facet joint(s). The authors chose to perform blocks at a minimum of two levels to block a single joint. Target joints were identified by the pain pattern, local or paramedian tenderness over the area of the facet joint, and reproduction of pain with deep pressure.

The authors of this study considered a positive response when at least an 80 per cent reduction in pain with ability to perform previously painful movements was achieved. A verbal numeric pain rating scale was used. Pain relief had to last for two hours when lidocaine was used. Because of the known high incidence of false positive results with just one set of injections, the authors repeated the injection with a longer acting numbing agent, bupivacaine. If this decreases pain by 80 per cent for three hours or longer and allows improvement in function, then a positive response was diagnosed. Any other response was considered a negative outcome.

The authors found that 42 to 45 per cent of the time just one set of facet nerve blocks was not accurate in making a positive diagnosis in the neck, the thoracic or lumbar spine. The authors felt that given the high false positive results with single blocks, a second set of blocks should be done after an initial positive response to ensure proper diagnosis and treatment.

Direct repair of pars defects with wire and bone grafting has been widely used for single level spondylolysis. This study is a retrospective study over 12-51 months post-operatively using the same technique for multiple level pars defects and spondylolysis. One of the authers was the surgeon who performed the direct repair with bone grafting procedure on seven patients. Direct repair vs. posterolateral fusion was chosen because of its advantage in terms of maintaining mobility at the segments and less risk of developing adjacent disc degeneration and transitional syndrome.

The seven subjects ranged in age from 19-37 years. All were limited in activities of daily living. They underwent conservative care for at least six months which included bedrest, analgesics, lumbar bracing, and activity restriction. All had participated in sports and none had any significant medical comorbidities.

Following the direct repair with wire and bone grafting, patients were on bedrest for two days. They were then allowed mobility in a lumbar corset for six months. The lumbar corset was replaced with a lumbar support and then they were allowed to resume sports. Assessment of surgical outcomes focused on activities of daily living (ADL) and pain, and healing of the pars defects. The Japanese Orthopaedic Association (JOA) scores were used to assess pain and ADL. A maximum score is 29. Radiographs or CT was used to evaluate healing of the pars defects. The mean JOA improved from 21.29 before surgery to 27.86 after surgery with a recovery rate of 85.21 percent. Healing of all defects was observed in four cases, three out of four defects in two cases, and no healing of four defects in one case. Overall healing of the pars defects was 81.25 percent. Subjects that did not have complete healing of the pars defects, returned to sports activity too soon, or stopped wearing the corset too soon post-operatively. All of the wires had been broken due to non-healing pars defects. The authors conclude that post-operative treatment with a corset is very important for pars healing without wire breakage.

The authors also concluded that in general, conservative care such as bracing, analgesics, and physical therapy did not allow patients to return to previous level of activity and sports. Surgical intervention using a direct repair with wire fixation and bone grafting of the pars defects, even at multiple levels yeilded preferred outcomes particularly in those who desire to return to sports.

Studies show that psychosocial distress is linked with chronic low back pain (CLBP). People who are depressed, anxious, or stressed are at greater risk for CLBP. Fear, uncertainty, anger, and hostility are other ways distress is expressed.

Researchers are trying to find ways to measure psychosocial distress. They want to be able to predict disability among patients with CLBP. There are many tools already available for assessing distress. Each one seems to measure different aspects of distress. There isn’t one all-purpose instrument to measure distress in this group of patients.

In this study, the Symptom Checklist-90 (SCL-90) and the Roland Morris Disability (RMDQ) are given to CLBP patients before treatment. The SCL-90 is a self-report inventory of psychosocial distress. Eight categories of psychosocial distress are examined.

The RMDQ measures self-reported disability caused by LBP. Physical functions such as walking, bending, sitting, lying down, and sleep are included. Physical activities and self-care are also reported.

The goal was to measure the strength of the relationship between distress and disability using these two tools. Is it necessary to use both questionnaires? Is one a better measure of disability than the other?

The results show that when using these two tools, a weak relationship between psychosocial distress and disability was seen in patients with CLBP. Other studies using the same two tests but doing so separately show a stronger relationship. It’s unclear why this difference occurred. Perhaps it’s because this study combined the use of SCL-90 and RMDQ.

The authors suggest further studies using other combinations of instruments are needed. Finding the best group of tools to identify the impact of psychosocial distress on self-reported disability is needed. Accurate assessment tools can help reduce disability and guide treatment for patients with CLBP.

It is well-known that disc protrusion can cause back pain that travels down the leg. This condition is called lumbar radiculopathy. It is more commonly referred to as sciatica.

When conservative care fails to relieve symptoms, surgery may be the next step. About 80 per cent of the patients treated surgically for lumbar radiculopathy get good results. But what about the other 20 per cent? Why don’t they get a positive outcome?

In this study, researchers use a group of tests to predict success. If it could be possible to predict who won’t be helped by surgery, then patients in that 20 per cent group could be spared the procedure.

All patients in the study had failed at least six weeks of conservative care. Imaging studies showed they all had signs and symptoms from pressure on a single spinal nerve. The pressure was caused by a bone spur, disc herniation, or cyst.

Everyone filled out a survey before surgery and then each time they were seen in follow-up after surgery. There were six assessment tools that asked questions about general health, psychologic distress, and emotional factors. All six questionnaires are discussed in detail. These included two parts of the McGill Pain Questionnaire, the Visual Analogue Scale, two parts of the Prolo Scale, and the Ransford Pain Drawing Score.

The authors knew from previous studies that psychosocial issues affect treatment outcomes. They were surprised by the strength and magnitude of their negative effects on surgical results.

Using these tools, it was easier to predict failure than improvement with treatment. The McGill and Ransford tools were the most helpful. Negative predictive factors included sciatica accompanied by joint pain in the legs. Psychiatric factors or personal injury or compensation claims were also predictors of a negative outcome.

The authors conclude that patients should not be denied surgery based on these factors. But surgeons may want to change what they tell patients, referring physicians, and other third party payers. For example, predictions of success are very conservative. And if surgery fails in the presence of these factors, then revision surgery is not advised.

Many people suffer from low back pain (LBP) that has no known cause or pathology. Studies show that psychosocial factors may play a key role in such cases. Guidelines for back care for those patients is to keep active and avoid bed rest or passive treatments.

But many health care workers (HCWs) don’t give back pain patients this advice. It’s possible that HCWs’ attitudes and beliefs influence their practices in this area. Some studies have been done to survey HCWs’ attitudes and beliefs.

In this study, researchers conducted a systematic review of tools used to measure HCWs’ attitudes and beliefs about back pain. Out of 5,269 references, they found 12 papers that met their criteria. The five tools that were used in these studies are the Attitudes to Back Pain Scale for musculoskeletal practitioners (ABS.mp), Fear Avoidance Beliefs Questionnaire (FABQ) adapted for HCWs, Fear Avoidance Tool, Health Care Providers’ Pain and Impairment Relationship Scale (HC-PAIRS), and Pain Attitudes and Beliefs Scale for Physiotherapists (PABS.PT).

Each survey tool was examined closely. The reviewers assessed the reliability and validity of each tool. They checked to see if it could be filled out by the HCW without help (self-administration). And they looked to see if the survey could be changed to meet language and cultural differences among HCWs.

Based on their critical review, the authors put together a table to give a summary of each of the five tools. They reported that the study of HCWs attitudes and beliefs about LBP is very new. A good tool is needed but before developing something new, it seems wise to check out what has already been done. That’s the purpose of this review.

They suggest further study is needed using these five tests with different groups of HCWs and in different settings. Reliability and validity of each test must be proven. And researchers need to see if any of these tools can be used to measure change in attitudes or beliefs after training or education takes place.

Severe back and/or leg pain after spinal surgery is referred to as failed back surgery syndrome (FBSS). This type of neuropathic (nerve) pain doesn’t respond to pain relievers or conventional treatment.

Decreased quality of life and disability is common with FBSS. The cost of treatment is three times the amount for back pain patients who don’t have neuropathic pain. In this study, the use of spinal cord stimulation (SCS) in addition to conventional medical management (CMM) is compared with just CMM.

Two groups of patients with neuropathic pain were followed for 12 months. The SCS group had a neurostimulation device implanted. The CMM group received medications for pain relief and to reduce inflammation. Some patients tried nerve blocks and epidural injections. Physical therapy, chiropractic care, and psychologic help were also included.

Success of treatment was defined as 50 per cent improvement in leg pain after six months. Other outcome measures included improved back pain, increased function, and decreased usage of drugs. Measures of patient satisfaction and improved quality of life were also recorded.

Patients with the SCS had much better results than the CMM group. Pain relief and decreased use of analgesic drugs was significantly improved in the SCS group. Rates of return to work were the same between the two groups.

The authors concluded that SCS provides pain relief and improves quality of life and function in patients with neuropathic pain from FBSS. In the SCS group 48 per cent met the goal of pain reduction by 50 per cent. This compares favorably to the nine per cent reported in the CMM group.

Standing AP and lateral X-rays are often ordered when back and/or leg pain doesn’t go away. The value of X-rays in diagnosing low back pain (LBP) has been questioned in the past. In this study, researchers reviewed the use of flexion-extension (F/E) X-rays for patients with LBP.

FE X-rays are taken with the patient bedning forward or extending backward as far as possible while in the standing position. This allows for a better idea of how the spine looks in a functional position. This type of X-ray is called a dynamic radiograph.

Dynamic F/E X-rays may be taken to look for spinal instability. But should every patient with LBP have this type of X-ray at the initial (first) exam? According to the results of this study, the answer is No.

A series of X-rays were taken and reviewed by three experts. The series included AP, lateral, and dynamic F/E radiographs. The panel included a musculoskeletal radiologist, a spine surgeon, and an orthopedic resident. The films were also measured and analyzed using digital measuring tools and computer software.

Only two patients out of 342 had findings on the dynamic F/E X-ray that weren’t seen in standard X-rays. And neither one of those patients needed surgery. The authors suggest dynamic radiographs of the lumbar spine are only justified in surgical patients. They are not advised for routine screening of LBP.

Lumbar arthroplasties, or disc replacements in the back, have shown promising results for patients with back injuries that did not respond to other treatments. One manufacturer began producing a second type of prosthesis, the ProDisc II after having success with the ProDisc I.

The authors of this study looked back at the results of patients who had undergone disc replacement with either product and compared their outcomes in order to determine if one was better than the other. To be included in the study, the patients could not have had a spinal fusion (joining of the discs).

The average age of the 38 males and 21 females in the study group was 39 years. There were 27 patients in the ProDisc I group and 32 in the ProDisc II group. Patients were evaluated before surgery, at six weeks, three months, six months, one year, 18 months, and two years after surgery. The patients were assessed using the Oswestry Disability Index (ODI), the Short Form Health survey (SF-36), and the Visual Analog Scale (VAS) for pain. Of the patients available at two-year follow up, there were 25 one-level patients (out of 27) and 29 two-level patients (out of 32).

The arthroplasties in the one-level group were performed at L5-S1 in 17 patients and at L4-L5 in the remaining patients. In the two-level group, 29 patients received arthroplasty at L4-L5 and L5-S1, and three at L3-L4 and L4-L5.

Prior to surgery, most of the patients had complaints of back pain for less than one year. Seventy percent also complained of leg pain. The surgical procedures in the one-level group resulted in one complication during surgery (a tear in the ileac vein, which was repaired immediately). Two patients continued to have pain and inflammation at the nerve roots (radiculopathy) and required pain medication through an epidural, fluid administered directly into the spine. One more patient continued to have radiculopathy and had further surgery three months after the arthroplasty. In the two-level group, there were no complications during surgery. Four patients experienced six problems total after the surgery. Two patients had blood clots (thrombosis and a left foot drop, which fully resolved. The third patient had further surgery a year later and the fourth patient had a vertebral fracture at L5; the implant was removed and the spine was fused at that section.

When the patients in the one-level group were evaluated for pain, their VAS score was an average of 71.7 before surgery, dropping to 45.2 at six weeks after surgery, and dropping more to 38.2 at two years. In the two-level group, VAS average score dropped from 75.5 before surgery to 43.4 at six weeks and 47.9 at two years. The ODI, which measures disability, in the one-level group dropped from 63.3 before surgery to 39 at two years after surgery. In the two-level group, the drop went from 63.2 before surgery to 45.7 at two years after surgery. Finally, the SF-36 evaluation, examining the physical ability by rising numbers, in the one-level group rose from 30.9 before surgery to 38.1 at three months after surgery, dropping to 36.4 at one year, and rising again to 39.1 at two years after surgery. In the two-level group, the score rose from 30.9 before surgery to 38.1 at three months after surgery, stayed at 38.6 at one year, and then rose to 39.0 at two years after surgery.

The authors write that they were not able to find any major differences between the two ProDisc replacements.

Disc degeneration in the cervical spine that requires surgical intervention is historically treated by removing debris and/or performing an anterior cervical discectomy and fusion (ACDF), removal of the disc and fusion of the bones. Although this has been fairly effective, the treatment affects the patients’ range of motion and often needs further surgery in neighboring discs. Current statistics identify the rate as 2.9 percent every year, with 25.6 percent of patients requiring repeat surgery within 10 years of the first surgery.

Researchers have also found that another complication, pseudoarthritis, which affects the local tendons and ligaments, also occurs frequently. One previous study has shown that the pseudoarthritis rate is related to the number of discs fused (levels). As well, the bone for the fusion is harvested by the surgeon from the patient’s iliac crest (the edge of the hip bone), and this results in complications (pain, infection, nerve pain in the thigh, and bone fracture) in between one percent and 25 percent of the patients.

The authors of this study investigated the use of a replacement disc, the BRYAN Cervical Disc Prosthesis, compared with the standard ACDF treatment in 115 patients (32 men) at 3 centers. Fifty-six patients received the implant and 59 the fusion. The average age of the patients was 42 years for the replacement and 46 for the fusion.

In order to evaluate the patients’ ability to function and levels of pain, the researchers used the Neck Disability Index (NDI), the Arm Pain Score (VAS), Neck Pain Score (also VAS), and the Short form 36 (SF-36). The patients were assessed before surgery and again at six weeks, three months, six months, 12 months, and 24 months after surgery. X-rays were also done for visual assessment.

When reviewing the findings, the researchers found the prosthesis performed favorably compared with the ACDF. The physical component, measured by the SF-36 was, on average, 56 in the prosthesis group and 59 in the control group, before surgery. This remained at 56 and 59, respectively, at six weeks, but began to drop, indicating improvement, to 54 and 57 (respectively) at three months and 36 and 35 at 24 months. In the mental component, the numbers were similar. Before surgery, the NDI scores for pain in the prosthesis group were rated, on average, at 56, the control group at 59. The pain scores improved steadily, dropping to 54 and 57 (respectively) at three months and 36 and 35 at 24 months. Finally, the neck pain scores, before surgery, were on average 56 in the prosthesis group and 58 in the control group, dropping to 49 and 54, respectively, at six months, and 36 and 35 at 24 months.

Some patients did experience complications during the follow-up period. Three patients in the prosthesis group and four in the control group needed further surgery. In the control group, one required a fusion, another a revision ACDF that was followed by another surgery for fusion, and two more required further ACDF for neighboring levels that had begun to deteriorate. In the prosthesis group, the three required ACDF for neighboring levels.

The authors write that their findings were similar to previous study findings, although there were differences in the study itself. For example, one previous study did not have a control group. They concluded that the BRYAN Cervical disc prosthesis compares favorably with ACDF.

The cause of most low back pain (LBP) remains unknown. Without a way to categorize LBP patients based on pathology, health care providers use two other approaches to classification. The first is treatment-based classification (TBC). The second is impairment-based.

The TBC system places acute LBP patients into one of four treatment groups. Each group has a set of exercises to perform. This direction-specific program includes flexion or extension, mobilization or manipulation, core training, and traction.

In this study, physical therapists use rehabilitative ultrasound imaging (RUSI) to assess deep muscle function in patients with LBP. RUSI is the use of US by rehabilitative specialists for biofeedback and to measure muscle performance. RUSI can be used to assess deep muscle function.

The goal was to measure the amount of change in muscle thickness in the lumbar multifidus (LM) and transverse abdominis (TrA) muscles. These two muscles are deep spinal stabilizers. Muscle thickness was measured for the TrA while actively pulling the stomach in toward the spine. The same measurements were taken for the LM during an arm lifting activity.

A second aim of the study was to see if changes in muscle thickness are different for patients with LBP based on how long they had painful symptoms. Measurements were compared between two groups. The first group had LBP and were referred to physical therapy for treatment. The second (control) group had no history of LBP and no current symptoms of back pain.

The authors reported that muscle thickness change of both muscles was different between the patient and control groups. There was no difference in muscle thickness among the patients in the four TBC-treatment groups. In other words, all back pain patients had changes in the thickness of the deep spinal stabilizers. Subcategories of patients with LBP had the same changes.

Differences in muscle thickness were also observed based on duration of symptoms. The results of this study point to the need for further RUSI research. Studies are needed to show if muscles thickness change can be reversed with treatment. And if so, which treatment works the best?

In this case report, physical therapists measure the response of a single muscle to treatment using spinal manipulation for low back pain (LBP). The patient was a 33-year old man who had a long history of LBP and leg pain.

A special noninvasive method was used to measure function of the lumbar multifidus (LM) muscle before and after spinal manipulation. The LM is a deep spinal muscle. It goes from the base of the skull down to the sacrum. The LM provides stability and stiffness to the spine. This helps reduce wear and tear on the joints.

Rehabilitative ultrasound imaging (RUSI) allows the therapist to assess thickness and function of soft tissues such as muscles. Imaging of the LM at the L45 and L5-S1 levels was done before and right after spinal manipulation. RUSI was repeated one day later.

Measuring a change in muscle thickness is a way to assess muscle activation. In this case, the first measurement (before manipulation) showed poor activation of the LM.

Thickness and function of the muscle increased after spinal manipulation. Improvements were seen right away and continued for the first 24-hours. The greatest change occurred at the L4-5 level. The patient reported decreased stiffness and greater ease during movement.

It appears that spinal manipulation may affect LM muscle function.
The authors conclude that RUSI can be used to measure changes in LM muscle size before and after treatment. Changes can be observed and measured during the follow-up period. Differences in muscle thickness may be a good measure of muscle performance and can be used to assess outcomes of treatment.

Advancing technology has provided a new research tool for rehab specialists. It’s called rehabilitative ultrasound imaging (RUSI). This type of ultrasound can be used to assess muscle contraction and function.

The examiner is able to view on a monitor or screen when selected muscles are activated. The thickness of the muscle can be measured to show muscle performance. This tool can be used as a way to give patients feedback when retraining muscles.

In this article, physical therapists studying rehabilitation and movement offer a review of RUSI. They discuss motor learning and motor performance in patients with low back pain (LBP). The use of RUSI as feedback to enhance both is a key topic. A summary is provided of studies done so far using RUSI to activate the deep muscles of the spine.

Motor learning refers to the process of improving the smoothness and accuracy of movements. Motor performance is the execution of a specific skill or movement. Studies show that improving both functions is important in the rehab of patients with LBP.

RUSI has been used to help patients selectively contract the lumbar multifidus (LM) and the transverse abdominis (TrA) muscles. These two deep trunk muscles are part of the core-training program used to stabilize the spine. Results of RUSI studies show that such a program can decrease LBP and reduce the recurrence rate of LBP.

Future studies are needed to find out the best timing, frequency, and schedule during feedback programs. There are many factors to consider when using RUSI to teach motor control and improve motor performance.

For example, is it better to give feedback while the patient is attempting to contract the muscle? Should feedback be given throughout the muscle contraction? Should feedback be used for every muscle contraction? When should the feedback be stopped?

The timing and optimal intervals for feedback for patients with LBP have yet to be determined. And from the first batch of studies done, it looks like some groups of LBP patients benefit more than others. More study is needed to identify when RUSI should be used with LBP.

Heat is a common modality to use for low back pain (LBP). But how well does it work? How long does it last? If low-level heat reduces pain and promotes relaxation, how does it do this?

In this study, the effect of continuous low-level heatwrap therapy on the nervous system is measured. Specifically, the effect of heat on mental alertness and central nervous system arousal is measured.

Two groups of people participated in the study. All patients had acute low back pain. The pain was rated between one and five on a scale from zero (no pain) to 10 (most pain). The control group was not treated with heat. Instead they took an antiinflammatory drug when needed.

The treatment group received the same medication. They were also treated with a heatwrap. The heatwrap was placed like a belt around the belly with heat delivered to the low back area. Each patient in the treatment group wore the heatwrap daily for at least four hours.

Using EEG measurements, the effect of the heatwrap on stress was assessed. EEG measures the electrical activity in the brain. Higher EEG frequencies occur with increased states of arousal and vice versa. Each subject was given a timed computer test of math and word problem solving.

Other tests and measures used to assess the outcome of the heatwrap therapy included sleep, self-reported levels of stress at home and at work, and relaxation. The need for naps, time to fall asleep, and quality of sleep were examined.

The results of this study showed that heatwrap therapy reduced pain and improved sleep after the first day. Patients in the treatment group were better able to tolerate the pain they did have. They reported taking fewer daytime naps and an increased ability to concentrate on daily tasks.

At the same time, EEG activity changed to a lower frequency, which means there was a decrease in central nervous system arousal. Heatwrap therapy for LBP decreases muscle tension and promotes relaxation. Less pain means less anxiety and stress. Further study is needed to understand the exact nerve pathways that lead to this therapeutic effect.

Back pain affects millions of people around the world each year. Finding the right treatment is a challenge because the cause of low back pain (LBP) is not always the same. When one treatment is applied to everyone, the risk of treatment failure or symptoms getting worse increases.

In this study, researchers from Australia compile and summarize the opinions of 20 medical and physical therapy experts. The goal was to identify indicators that LBP is coming from the lumbar zygapophyseal joints (LZJ). Facet joint is another name for the LZJ.

These joints are located on either side of the spine. All spinal movements such as forward or side bending, straightening or extending, and twisting or rotation occur at the facet joints. LBP can come from these joints. But knowing when the pain is generated by the joints isn’t always so easy.

The Delphi technique was used to survey this group of experts. This method collects the opinions of experts on specific questions or issues. It allows for free discussion of opinions without bias or influence.

The request given to the group was to list the indicators that are diagnostic of LZJ pain. Then the indicators were ranked in order of importance. After three rounds, consensus was reached. This means the majority of the group agreed on the most common indicators of LBP from the LZJ.

The following are signs of facet joint pain agreed upon by the panel.

Studies show that back pain sufferers go on to develop chronic pain and disability when fear-avoidance beliefs (FABs) are present. FAB refers to the idea that the patient believes activity will cause another injury and more pain. This is a negative interpretation of painful symptoms that is often in error.

In this study, researchers from France surveyed 709 doctors (general practitioners or GPs) treating patients with low back pain (LBP). The questions asked were to assess the physicians’ understanding of FABs. They also surveyed 2727 patients with acute LBP to measure pain and beliefs about pain.

They found that FABs were common early on in the episode of LBP (after five days). And they observed that patients being treated by GPs who had high FABs themselves were more likely to develop chronic pain and decreased function. This study also showed that an increase in FABs is linked with higher levels of disability.

Questions on the FAB survey are divided into two sections: physical activity and work scores. The results of this study showed that patients with fears about physical activity aren’t involved in sports. But since they weren’t involved in sports before the back pain started, it’s possible that FABs were present before they ever had back pain.

The authors conclude that patient and physician education about back pain is needed to reduce FABs. This type of education may reduce the risk of chronic disability that can occur in some patients. Since these beliefs are present either before the episode of LBP or shortly after the LBP begins, education must begin early as well. Altering physicians’ FABs is equally important.

The normal spine has three natural curves when viewed from the side. The cervical (neck or upper spine) is in a curved position called lordosis. Lordosis means it’s an inward curve.

The thoracic spine (middle back) curves outward. The outward curve of the thoracic spine is called kyphosis. The lumbar spine (low back) is also in a position of lordosis.

In this study, surgeons from Korea measure the effect on the spine of surgical correction for flat back syndrome. Flat back syndrome is also called lumbar degenerative kyphosis. It is the loss of the natural lordosis of the low back.

This condition is common among middle-aged women in Asian countries. It is most likely the result of sleeping, working, and eating in a flexed or crouched position.

The authors present the case example of one patient who was treated with surgery for the flat back syndrome. There were a total of 28 patients in the study who had spinal fusion to restore lumbar lordosis.

X-rays were used before and after surgery for all patients to measure the results of surgical treatment. Various spinal curves, slopes, and angles were used as measures of the results. Pain and function were also evaluated.

The authors report a significant difference in spinal curves after the corrective procedure. Restoring lumbar lordosis brought about a spontaneous correction of the thoracic curve.

It appears that the lower lumbar curve (L4 – S1) has an important role in the alignment and balance of the entire spine. Patients with flat back syndrome can benefit from surgery to correct this problem.

In Finland, researchers have been conducting various studies on 300 pairs of male twins. Using the data collected, scientists can look for genetic causes of health-related issues.

In this study, the genetic influence on back pain was analyzed. Is back pain determined by genetic traits? Or are there environmental factors that influence who develops low back pain (LBP)?

Lumbar MRIs were done on all subjects. The presence and amount of disc degeneration was determined from the MRIs. Each man was interviewed in depth about his lifetime history of back pain. Questions were asked to identify possible risk factors for LBP. Risk factors could be environmental or behavioral.

The results of this study showed that both genetics and environmental factors have a major role in narrowing of the disc height. The presence of genetic factors contributes to both disc degeneration and back pain.

After analyzing all the data, the authors concluded that genetic factors influence disc narrowing. Disc narrowing was the main factor in disc degeneration. Disc degeneration may be one pathway through which genes influence back pain.

Back pain in older adults is a common problem. In fact, up to half of all adults over the age of 65 report some type of body pain. Pain of any kind can decrease function and threaten the independence of seniors.

But with other illnesses, problems sleeping, and difficulty with mobility, it can be difficult to tell how much back pain contributes to disability in older adults. That’s the focus of this study from the University of Pittsburgh.

Two groups of older adults were compared. All were mentally aware and alert. One group had moderate pain for at least three months. The second (control) group was pain-free. Each person was assessed thoroughly. Twenty-two measures of physical and mental health were collected.

The two groups were equal in terms of age, gender, and education. In comparing the two groups, the researchers found major differences in function. Eight of the 22 measures could explain the differences between the two groups. These included self-reported function, mood, and body mass index (BMI).

Other significant measures were severity of disc disease and ability to repeatedly rotate the trunk or reach forward without losing balance. All of these results show that older adults with chronic low back pain have decreased function compared with those who are pain-free.

The authors conclude that doctors can use these eight specific measures to assess older adults for loss of function caused by low back pain. Some of the tasks (repetitive trunk rotation, reaching forward) are simple to do and easy to test.

The Geriatric Depression Screen (GDS) was a good tool for assessing the effects of back pain on psychosocial function. Depression can be very disabling. With early diagnosis treatment can prevent decline in function and independence.

Orthopedic surgeons are aware of the hip-spine syndrome but no one has ever studied it. The hip-spine syndrome refers to low back pain (LBP) that occurs as a result of hip osteoarthritis (OA). This is the first study to show the positive effect of hip replacement on low back pain.

The authors set out to see if reducing hip pain and improving hip function would change back pain. Patients with severe hip OA who were scheduled to have a total hip replacement were included in the study. All patients in the study also had at least moderate LBP.

Everyone was followed for a minimum of two years. After two years, patients were still reporting continued improvement in pain levels and function of the hip. Improvement in LBP did not change from what was experienced by the end of three months after hip replacement. But relief from back pain was maintained at the two-year follow-up.

This study documented improvement in back pain and function after hip replacement. The results validate the theory that hip-spine syndrome is a real condition.

The exact cause remains unknown. Change in posture because of pain may be a factor. The authors were unable to show that it was from a true change in the spinal or sacral alignment. Future studies may be able to identify the link between these two sets of symptoms.