Comparison of Lumbopelvic Motions During Hip Medial Rotation Depending on Sex Differences and Chronic Lower Back Pain

PURPOSE: Hip rotation testing is important in the evaluation of chronic back pain. The purpose of this study was to investigate hip and lumbopelvic movement during hip medial rotation (HMR) in individuals with chronic lower back pain (CLBP). METHODS: This study targeted 112 subjects in total: 28 healthy males and 28 healthy females, and 27 males with CLBP and 29 females with CLBP. Motion-capture device was used to measure the hip medial rotation angle (HMRA), lumbopelvic rotation angle (LPRA), and the rotation angle of the hip when lumbopelvic rotation starts during hip medial rotation. RESULTS: When evaluating the healthy males and females using the hip medial rotation test (HMRT), healthy males showed a smaller HMRA than did healthy females (p<0.05). When evaluating the healthy males and the males with CLBP using the HMRT, males with CLBP showed a smaller HMRA and more lumbopelvic movements than did healthy males (p<0.05) in addition, their lumbopelvic movements occurred earlier during HMR (p<0.05). Finally, when evaluating the males and the females with CLBP using the HMRT, males with CLBP showed a smaller HMRA and more lumbopelvic movements (p<0.05), and their lumbopelvic movements occurred earlier during HMR (p<0.05). CONCLUSION: The HMRT is an important test for the evaluation of males, and especially males with CLBP, as they often experience an increased LPRA and decreased HMRA, with lumbopelvic movement occurring earlier during HMR when compared to other groups.

Efficacy and Safety of Different Aceclofenac Treatments for Chronic Lower Back Pain: Prospective, Randomized, Single Center, Open-Label Clinical Trials

PURPOSE: Nonsteroidal anti-inflammatory drugs are a mainstay for medical treatment of chronic lower back pain (CLBP). Increased dose intervals for medication have been associated with increased patient adherence to prescriptions. The purpose of this clinical trial was to compare the efficacy and safety of a once daily dose of aceclofenac controlled release (CR) and a twice daily dose of aceclofenac for CLBP management. MATERIALS AND METHODS: A prospective, randomized, single center, open-label clinical trial was performed to compare the efficacy and safety of aceclofenac CR (200 mg once daily) to aceclofenac dose (100 mg twice daily). Fifty patients in each group were enrolled for the study. The primary end point was Visual Analogue Scale (VAS) change at baseline to that at 2 weeks after medication and safety profiles. Also, change in quality of life measured by EuroQoL 5D (EQ-5D) and Oswestry Disability Index (ODI) functional score for the lumbar spine were also assessed. RESULTS: Within groups at pre- and post-treatment, there were significant VAS reductions for aceclofenac CR and aceclofenac (p=0.028). EQ-5D increased significantly in both groups (p=0.037). ODI scores decreased significantly in both groups (p=0.012). However, there were no significant differences between aceclofenac CR and aceclofenac at pre- and post-treatment. Patients with aceclofenac CR showed significant increases in heartburn and indigestion and adverse gastrointestinal effects, compared to aceclofenac. CONCLUSION: In patients with CLBP, aceclofenac CR and aceclofenac demonstrated significant symptomatic pain relief, improvement in quality of life and functional scores. Aceclofenac CR slightly increased gastrointestinal adverse effects, such as heartburn and indigestion.

Quiste de Tarlov bilateral, presentación de un caso / Tarlov cyst bilateral, case report

Los quistes de Tarlov, son crecimientos quísticos benignos sub diagnosticados y no reportándose ningún caso en Bolivia. Son clasificados como quistes meníngeos tipo II, infrecuentes (incidencia estimada de 4,6% - 9%), de características benignas, en su mayoría localizados en región sacra. Asintomáticos, en su gran mayoría diagnosticados de manera incidental. Se presenta el caso de una paciente con dolor crónico de tipo radicular en fosa iliaca izquierda sin mejoría ni explicación del mismo. Se le realizó tomografía computarizada y resonancia magnética por las cuales se llegó al diagnóstico. Posteriormente se da tratamiento conservador sintomatológico con mejoría evidente de las misma. No requiriendo tratamiento quirúrgico.

Tarlov cyst is a benign cystic growth usually underdiagnosed. No case has been reported so far in Bolivia. Classified as a Type II meningeal cysts, rare (estimated incidence of 4,6% - 9%), of benign characteristics, most commonly located in the sacral region. Asymptomatic and diagnosed incidentally most of the times. The patient comes with a chief complaint of chronic radicular back pain in the left iliac fossa with no improvement or explanation thereof. The patient underwent CT and MRI leading us to the diagnosis. The patient is managed with conservative treatment targeting the symptoms, with notorious improvement not requiring surgical treatment.

Caudal Epidural Steroid Injections for the Treatment of Chronic Lower Back Pain

BACGROUND: The purpose of this study was to evaluate the efficacy of caudal epidural steroid injection with local anesthetic for chronic lower back pain patients. METHODS: The 152 patients with lower back pain were selected for the study. The patients were treated with the caudal injections of steroid (triamcinolone acetate 40 mg) and local anesthetics (1% lidocaine 17 ml). The efficacy of caudal injections was assessed with the visual analogue scale (VAS) before procedure and at 8 weeks following procedure. RESULTS: The VAS scores of 'Before procedure' group and '8 weeks after procedure' group were 62 23 and 31 15, respectively. The caudal steroid injections provided effectiveness in treating various lower back pain diseases except postlaminectomy syndrome. CONCLUSION: We consider that caudal epidural injections of steroid and local anesthetics are effective for patients with chronic lower back pain in the short term.

Clinical Comparison between Decompression and Posterior Lumbar Interbody Fusion in Chronic Lower Back Pain Involving Degenerative Disc Disease and Spinal Stenosis

Between January 1992 and December 1995, 23 patients with chronic lower back pain involving lumbar disc degeneration and spinal stenosis underwent decompression and posterior lumbar interbody fusion. Two groups of patients were studied, and clinical symptoms, neurological signs and clinical results were compared. With regard to mechanical back pain and clinical results, posterior lumbar interbody fusion was superior to decompression, but as regards leg pain and neurologic signs, the two groups were similar. Posterior lumbar interbody fusion was of considerable benefit to patients with chronic lower back pain.