STUDY DESIGN: Retrospective study. PURPOSE: To determine whether low-dose tramadol plus non-steroidal anti-inflammatory drug combination therapy could prevent the transition of acute low back pain to chronic low back pain. OVERVIEW OF LITERATURE: Inadequately treated early low back pain transitions to chronic low back pain occur in approximately 30% of affected individuals. The administration of non-steroidal anti-inflammatory drugs is effective for treatment of low back pain in the early stages. However, the treatment of low back pain that is resistant to non-steroidal anti-inflammatory drugs is challenging. METHODS: Patients who presented with acute low back pain at our hospital were considered for inclusion in this study. After the diagnosis of acute low back pain, non-steroidal anti-inflammatory drug administration was started. Forty patients with a visual analog scale score of >5 for low back pain 1 month after treatment were finally enrolled. The first 20 patients were included in a non-steroidal anti-inflammatory drug group, and they continued non-steroidal anti-inflammatory drug therapy for 1 month. The next 20 patients were included in a combination group, and they received low-dose tramadol plus non-steroidal anti-inflammatory drug combination therapy for 1 month. The incidence of adverse events and the improvement in the visual analog scale score at 2 months after the start of treatment were analyzed. RESULTS: No adverse events were observed in the non-steroidal anti-inflammatory drug group. In the combination group, administration was discontinued in 2 patients (10%) due to adverse events immediately following the start of tramadol administration. At 2 months, the improvement in the visual analog scale score was greater in the combination group than in the non-steroidal anti-inflammatory drug group (p<0.001). CONCLUSIONS: Low-dose tramadol plus non-steroidal anti-inflammatory drug combination therapy might decrease the incidence of adverse events and prevent the transition of acute low back pain to chronic low back pain.
Anti-Inflammatory Agents, Non-Steroidal ; Diagnosis ; Drug Therapy ; Humans ; Incidence ; Low Back Pain* ; Retrospective Studies ; Spine ; Tramadol* ; Visual Analog Scale

We report a case of a 31-year-old woman with glioblastoma multiforme (GBM) in the pineal region with associated leptomeningeal dissemination and lumbar metastasis. The patient presented with severe headache and vomiting. Magnetic resonance imaging (MRI) of the brain showed a heterogeneously enhanced tumor in the pineal region with obstructive hydrocephalus. After an urgent ventricular-peritoneal shunt, she was treated by subtotal resection and chemotherapy concomitant with radiotherapy. Two months after surgery, MRI showed no changes in the residual tumor but leptomeningeal dissemination surrounding the brainstem. One month later, she exhibited severe lumbago and bilateral leg pain. Thoracico-lumbar MRI showed drop like metastasis in the lumbar region. Finally she died five months after the initial diagnosis. Neurosurgeons should pay attention to GBM in the pineal region, not only as an important differential diagnosis among the pineal tumors, but due to the aggressive features of leptomeningeal dissemination and spinal metastasis.
Adult ; Brain ; Brain Stem ; Diagnosis ; Diagnosis, Differential ; Drug Therapy ; Female ; Glioblastoma* ; Headache ; Humans ; Hydrocephalus ; Leg ; Low Back Pain ; Lumbosacral Region ; Magnetic Resonance Imaging ; Neoplasm Metastasis* ; Neoplasm, Residual ; Pinealoma ; Radiotherapy ; Vomiting

OBJECTIVETo evaluate the preliminary curative effect of interspinous injections for the diagnosis and treatment of back pain caused by lumbar kissing spine (Baastrup's disease) under fluoroscopically guiding.

METHODSFrom November 2011 to March 2013,17 patients with back pain caused by Baastrup's disease were treated with fluoroscopically-guided interspinous injections, including 7 males and 10 females with an average age of 49.6 years old ranging from 40 to 71 years old; the duration of the disease ranged from 2 to 5 years with a mean of 3.7 years. The visual analogue scale (VAS) and the lumbar segments range of motion (ROM) was analyzed at pre-operation, 2 days, 3 months and final followed-up after operation, the effects were evaluated with modified Macnab standard.

RESULTSAll patients were follow-up from 6 to 10 months with an average of 7.6 months. The pre-operative VAS was 6.41 +/- 0.94, the postoperative VAS at different time points improved significantly comparing with pre-operation,and the differences were statistically significant (P < 0.01). There was no significant difference in VAS at different time points after operation (P > 0.05). The ROM of operated segment and adjacent segment was (4.88 +/- 0.86) degrees and (6.82 +/- 0.73) degrees respectively at pre-operation. The postoperative operated segment ROM at different time points improved significantly comparing with pre-operation, and the differences were statistically significant (P < 0.05). Compared with pre-operation, there was no significant difference in adjacent segment ROM at different time points after operation (P > 0.05). According to modified Macnab, the result was excellent in 6 cases, good in 7 cases, fair in 3 cases and poor in 1 case.

CONCLUSIONFluoroscopically-guided interspinous injections is an effective method for the diagnosis and treatment of Baastrup's disease. The method has advantages of simple operation, minimal invasion and safety, satisfactory short-term and medium-term therapeutic effect; it can also effectively lessen the pain of lumbar and back.

Adult ; Aged ; Anesthetics, Local ; administration & dosage ; Female ; Humans ; Low Back Pain ; diagnosis ; diagnostic imaging ; drug therapy ; Lumbar Vertebrae ; diagnostic imaging ; drug effects ; Male ; Middle Aged ; Nerve Block ; Spinal Diseases ; diagnosis ; diagnostic imaging ; drug therapy ; Tomography, X-Ray Computed

In many circumstances, causing sites of low back pain (LBP) cannot be determined only by anatomical imaging. Combined functional and morphological imaging such as bone scan with single-photon emission computed tomography/computed tomography (SPECT/CT) may be helpful in identifying active lesions. The purpose of this study was to evaluate the usefulness of bone SPECT/CT in localizing the pain site and the treatment of chronic LBP. One hundred seventy-five patients suffering from chronic LBP who underwent SPECT/CT were included, retrospectively. All of the patients received multiple general treatments according to the symptoms, and some of them underwent additional target-specific treatment based on SPECT/CT. Numerical rating scale (NRS) pain score was used to assess the pain intensity. Of 175 patients, 127 showed good response to the given therapies, while the rest did not. Overall, 79.4% of patients with definite active lesions showed good response. Patients with mild active or no lesions on SPECT/CT had relatively lower response rate of 63.0%. Good response was observed by the treatment with the guidance of active lesions identified on SPECT/CT. SPECT/CT could be useful in identifying active lesions in patients with chronic LBP and guiding the clinicians to use adequate treatment.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Chronic Pain/*diagnosis/*therapy ; Female ; Humans ; Low Back Pain/*diagnosis/*therapy ; Lumbar Vertebrae/radiography/radionuclide imaging ; Male ; Middle Aged ; Multimodal Imaging/methods ; Pain Measurement/*methods ; Reproducibility of Results ; Retrospective Studies ; Sensitivity and Specificity ; Tomography, Emission-Computed, Single-Photon/*methods ; Tomography, X-Ray Computed/*methods ; Treatment Outcome ; Young Adult

A Solitary Fibrous Tumor (Sft) Is A Rare Neoplasm Originated From The Pleura, But They Can Occur In A Variety Of Extrathoracic Regions. Although Many Cases Of Primary Sft Have Been Reported, There Are Extremely Rare Repots To Date Of A Malignant Sft In The Spine Or Skull. A 54-year-woman Visited Our Hospital Due To Low Back Pain And Both Leg Radiating Pain. Several Imaging Studies Including Magnetic Resonance Imaging And Computed Tomography Revealed Expansive Enhanced Lesions In The Occipital Bone, T8, S1-2, And Ilium, With Neural Tissue Compression. We Performed Surgical Resection Of The Tumor In Each Site, And Postoperative Radiosurgery And Chemotherapy Were Performed. However, After Six Months, Tumors Were Recurred And Metastasized In Multiple Regions Including Whole Spine And Lung. The Authors Report Here The First Case Of Patient With Malignant Sft Of Tandem Lesions In The Various Bony Structures, Including Skull, Thoracic Spine, And Sacral Spine, With A Rapid Recurrence And Metastasis. Although Malignant Sft Is Extremely Rare, It Should Be Considered In The Differential Diagnosis And Carful Follow-up Is Needed.
Diagnosis, Differential ; Drug Therapy ; Follow-Up Studies ; Humans ; Ilium ; Leg ; Low Back Pain ; Lung ; Magnetic Resonance Imaging ; Neoplasm Metastasis ; Occipital Bone ; Pleura ; Radiosurgery ; Recurrence ; Skull* ; Solitary Fibrous Tumors* ; Spine*

BACKGROUND: Selective lumbar nerve root block (SNRB) is generally accepted as an effective treatment method for back pain with sciatica. However, it requires devices producing radioactive materials such as C-arm fluoroscopy. This study evaluated the usefulness of the longitudinal view of transverse process and needles for medial branch block as landmarks under ultrasonography. METHODS: We performed selective nerve root block for 96 nerve roots in 61 patients under the guidance of ultrasound. A curved probe was used to identify the facet joints and transverse processes. Identifying the lumbar nerve roots under the skin surface and ultrasound landmarks, the cephalad and caudal medial branch blocks were undertaken under the transverse view of sonogram first. A needle for nerve root block was inserted between the two transverse processes under longitudinal view, while estimating the depth with the needle for medial branch block. We then injected 1.0 mL of contrast medium and checked the distribution of the nerve root with C-arm fluoroscopy to evaluate the accuracy. The visual analog scale (VAS) was used to access the clinical results. RESULTS: Seven SNRBs were performed for the L2 nerve root, 15 for L3, 49 for L4, and 25 for L5, respectively. Eighty-six SNRBs (89.5%) showed successful positioning of the needles. We failed in the following cases: 1 case for the L2 nerve root; 2 for L3; 3 for L4; and 4 for L5. The failed needles were positioned at wrong leveled segments in 4 cases and inappropriate place in 6 cases. VAS was improved from 7.6 +/- 0.6 to 3.5 +/- 1.3 after the procedure. CONCLUSIONS: For SNRB in lumbar spine, the transverse processes under longitudinal view as the ultrasound landmark and the needles of medial branch block to the facet joint can be a promising guidance.
Adult ; Aged ; Aged, 80 and over ; Chronic Disease ; Female ; Humans ; Low Back Pain/etiology/*therapy ; Lumbar Vertebrae/anatomy & histology/*ultrasonography ; Male ; Middle Aged ; Nerve Block/*methods ; Sciatica/etiology/*therapy ; Spinal Stenosis/complications/*diagnosis ; Zygapophyseal Joint/anatomy & histology/ultrasonography

The literatures of clinical research on acupuncture treatment of low back pain included in foreign SCI journals as well as the domestic core journals in the recent 10 years were collected in this article to discuss the divergence of views domestically and abroad. The result showed that acute and chronic back pain and low back pain were generally set as the targets of research abroad. While, diseases with western diagnosis such as lumbar disc herniation was often set as the study target by domestic researchers. It indicats that divergence existed in understanding and study methods between Chinese and foreign research fellows. Thus, comparison should be carried out so as to learn from the strong points of each other and close the gap.
Acupuncture Therapy ; Biomedical Research ; Humans ; Low Back Pain ; diagnosis ; therapy ; Moxibustion ; Periodicals as Topic ; Thinking

A giant vertebral notochordal rest is a newly described, benign entity that is easily confused with a vertebral chordoma. As microscopic notochordal rests are rarely found in adult autopsies, the finding of a macroscopic vertebral lesion is a new entity with only seven previously presented cases. We report here radiological findings, including diffusion weighted images, of a patient with a giant notochordal remnant confined to the L5 vertebra, with an emphasis on its distinction from a chordoma.
Chordoma/*diagnosis ; Diagnosis, Differential ; Diffusion Magnetic Resonance Imaging/methods ; Female ; Humans ; Low Back Pain/etiology ; Lumbar Vertebrae/pathology/radiography ; Magnetic Resonance Imaging/*methods ; Middle Aged ; Notochord/*pathology/radiography ; Physical Therapy Modalities ; Spinal Neoplasms/*diagnosis/therapy ; Tomography, X-Ray Computed

OBJECTIVETo explore the diagnostic value of lumbar disc imagery applied for patients with discogenic lumbodynias and the outcome of lumbar fusion and the significance of the imagery technique in choosing the joints and sections for fusion.

METHODSThe lumbar imagery technique was applied for 35 patients who suffered from discogenic lumbodynias, involving 74 discs. All the cases got MRI and CT scanning. The results of the imagery and MRI were observed and induced pains were recorded. According to the imagery results, 20 out of the 35 patients received lumbar fusion and were followed up.

RESULTSAmong 35 patients, the induced pains occurred at 22 discs in 20 patients (57.1%). All the 22 segments in 20 patients with positive reaction were given lumbar fusion. The follow-up time was 10 months to 2 years with an average of 15 months. Based on the renewed MacNab standard, the results were excellent in 13 cases,good in 4 cases, fair in 2 cases, bad in 1 case. Fifteen patients with negative reaction were given conservative treatment and pains disappeared completely in 5 patients, disappeared nearly in 7 patients, no changes or became worse in 3 patients. Six patients including 9 lumbar discs neighboring the fusion segments who were found no changes in MRI scan and no induced pains in lumbar discography, were not given fusion treatment. Meantime, 1 patient was given fusion treatment because his neighboring symptom-free discs getting more deteriorative resulted in the happen of serious symptoms.

CONCLUSIONLumbar imagery technique has its unique value in the diagnosis and selective treatment of lumbar-disc-related pains. Lumbar fusion of the intervertebral space causing pains can eliminate the suffering of patients. It is appropriate to select those deteriorating discs with symptoms in deciding the fusion segments.

Adult ; Female ; Humans ; Intervertebral Disc ; diagnostic imaging ; Low Back Pain ; diagnosis ; therapy ; Lumbar Vertebrae ; diagnostic imaging ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Radiography

There are currently no initial guides for the diagnosis of somatic referred pain of lumbar zygapophyseal joint (LZJ) or sacroiliac joint (SIJ). We developed a classification system of LZJ and SIJ pain, the "pain distribution pattern template (PDPT)" depending on the pain distribution patterns from a pool of 200 patients whose spinal pain source was confirmed. We prospectively applied the PDPT to determine its contribution to clinical decision-making for 419 patients whose pain was presumed to arise from the LZJs (259 patients) or SIJs (160 patients). Forty-nine percent (128/259) of LZJ and 46% (74/160) of SIJ arthopathies diagnosed by PDPT were confirmed by nerve blocks. Diagnostic reliabilities were significantly higher in Type A and C patterns in LZJ and Type C in SIJ arthropathies, 64%, 80%, and 68.4%, respectively. For both LZJ and SIJ arthropathies, favorable outcome after radiofrequency (RF) neurotomies was similar to the rate of positive responses to diagnostic blocks in Type A to Type D, whereas the outcome was unpredictable in those with undetermined type (Type E). Considering the paucity of currently available diagnostic methods for LZJ and SIJ arthropathies, PDPT is useful in clinical decision- making as well as in predicting the treatment outcome.
Adult ; Aged ; Decision Making ; Female ; Humans ; Joint Diseases/*diagnosis/therapy ; Low Back Pain/*diagnosis/therapy ; Magnetic Resonance Imaging ; Male ; Middle Aged ; *Pain Measurement ; *Sacroiliac Joint ; Treatment Outcome ; *Zygapophyseal Joint