Discogenic Axial Back Pain: Is There a Role for Nucleoplasty?

STUDY DESIGN: A prospective observational study. PURPOSE: To evaluate the role of nucleoplasty in the management of discogenic axial back pain; to determine the influence of concordant pain during provocative discography, annular tear and loss of disc height on the outcome of nucleoplasty. OVERVIEW OF LITERATURE: The role of nucleoplasty in the management of radicular leg pain due to disc herniation is known. However, the data regarding its role in the management of discogenic axial back pain is scarce. METHODS: A prospective evaluation of 30 patients with discogenic axial back pain undergoing nucleoplasty was performed. Pain, functional disability and quality of life were assessed using the 100 mm visual analogue scale (VAS), Oswestry Disability Index (ODI) and Short Form-36 (SF-36), respectively. RESULTS: The mean reduction in VAS was 31.03 and 29.03; mean reduction in ODI was 24.53 and 20.60; and mean increment in SF-36 was 13.58 and 12.30, at 6 months and at 12 months, respectively. The differences were statistically significant (p <0.05). Concordant pain during provocative discography, annular tear and loss of disc height did not affect a clinically significant improvement in any of the three outcomes (p =0.882, 0.213, and 0.170; respectively). CONCLUSIONS: Nucleoplasty produced statistically significant improvements in pain, functional disability and quality of life in patients with discogenic low back pain at 6 months and at 12 months. Concordant pain during provocative discography, annular tear and loss of disc height did not influence any of the outcomes after nucleoplasty in patients with discogenic axial back pain.

Juvenile Spondyloarthritis with Microscopic Colitis.

We report an adolescent girl with long standing spondyloarthritis and chronic diarrhea. Colonoscopy and biopsy revealed microscopic colitis. All serology and HLA-B27 were negative. This case is reported for its rarity and the need to evaluate gut in chronic arthritis to achieve clinical remission.

Bioterrorism - “My Role as a Dentist”.

Bioterrorism is the intentional use of micro-organisms and toxins to produce disease and death in humans, livestock and crops, their attraction in war and for use in terrorist attacks is attributed to various unique features. Biological weapons can be disseminated by aerosol sprays, explosives or food and water contamination. They can strike suddenly without any warning and inflict considerable mortality and morbidity that can continue for a long period, such attacks may create high level of panic, environment contamination and extreme pressures on emergency health services. Accurate and substantial information given to the public by credible public health and medical experts can do much to allay their fears and encourage their cooperation and participation in constructive, organized community response efforts. The dental profession could potentially play a significant role in the emergency response to a major bioterrorism attack.