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Objective:To explore MRI T 2-mapping and blood oxygenation level dependent (BOLD) to evaluate the functional changes of paraspinal muscle in rats with discogenic low back pain (DLBP) after swimming. Methods:Totally 54 female 1-month-old SD rats were selected, which were divided into 3 groups by random number table method, sham operation (Sham) group, DLBP non-swimming group and DLBP swimming group, with 18 rats in each group. Under the guidance of X-ray fluoroscopy, the L4/5 and L5/6 intervertebral discs of the rats in the DLBP non-swimming group and DLBP swimming group were punctured by the posterior approach, and establishment of DLBP rat model by destroying nucleus pulposus, and only paraspinal muscles at the same level were punctured in the Sham group. After modeling, the DLBP swimming group received swimming exercise intervention for 5 consecutive days (30 min/d), while the DLBP non-swimming group and Sham group did not receive any rehabilitation exercise intervention. Each group was divided into 3 time point subgroups on average, the T 2-mapping and BOLD sequences were scanned at 30, 90 and 180 days after modeling to obtain the T 2 value, R 2* value of the paraspinal muscles, and the paraspinal muscles at the modeling level were taken for immunofluorescence staining, and the fluorescence intensity of myosin heavy chain (MYH)1 (type Ⅱ muscle fiber) and MYH7 (type I muscle fiber) was analyzed. One-way analysis of variance was used for comparison among the 3 groups, and the Bonferroni method was used for multiple comparisons, and Pearson correlation coefficient was used to evaluate the correlation between quantitative MRI parameters T 2 value, R 2* value and MYH1, MYH7 immunofluorescence intensity of rat paraspinal muscles at 180 days after modeling. Results:At 30 days after modeling, there was no significant difference in T 2 value and R 2* value among the 3 groups (all P>0.05). At 90 days after modeling, the T 2 value of the DLBP swimming group was higher than that of the DLBP non-swimming group, and the T 2 value of the DLBP non-swimming group was lower than that of the Sham group (all P<0.05), and there was no significant difference in the R 2* value among the 3 groups ( P>0.05). At 180 days after modeling, the T 2 value of the DLBP swimming group was higher than that of the DLBP non-swimming group, and the R 2* value was lower than that of the DLBP non-swimming group; the T 2 value of the DLBP non-swimming group was lower than that of the Sham group, and the R 2* value was higher than that of the Sham group (all P<0.05). At 30 and 90 days after modeling, there was no significant difference in the expressions of MYH1 and MYH7 among the 3 groups (all P>0.05). At 180 days after modeling, the expression of MYH1 decreased and the expression of MYH7 increased in the DLBP swimming group compared with the DLBP non-swimming group; the expression of MYH1 increased and the expression of MYH7 decreased in the DLBP non-swimming group compared with the Sham group (all P<0.05). At 180 days after modeling, the T 2 value had a moderate negative correlation with the fluorescence intensity of MYH1 ( r=-0.511, P=0.043), and a moderate positive correlation with the fluorescence intensity of MYH7 ( r=0.564, P=0.023); R 2* value was moderate positive correlated with the fluorescence intensity of MYH1 ( r=0.625, P=0.010), and moderate negative correlated with the fluorescence intensity of MYH7 ( r=-0.653, P=0.006). Conclusions:Swimming exercise can improve the reduction of water content and perfusion in the paraspinal muscles of DLBP rats, and reduce the transformation of muscle fibers from type Ⅰ to type Ⅱ, the changes of T 2 and R 2* value can reflect the transformation of paraspinal muscle fiber types to a certain extent.
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Objective:To evaluate of modified Shentong Zhuyutang combined with celecoxib capsules in the treatment of acute discogenic low back pain due to wind-cold and stasis obstruction sydrome. Method:One hundred and forty eligible patients were randomly divided into control group （70 cases） and observation group （70 cases）. Patients in both groups took the celecoxib capsules orally， 200 mg/time. On this basis， patients in the control group were further treated with Tongluo Huoxue capsule orally， 6 capsules/time， 3 times/day， while those in the observation group received the modified Shentong Zhuyutang， 1 bag/day， for three weeks. The short-form McGillpain questionnaire （SF-MPQ）， including pain rating index （PRI）， present pain intensity （PPI）， and visual analog scale （VAS）， Oswestry disability index （ODI）， wind-cold obstruction and stasis syndrome， and abilities of daily living （ADL） scoring and the Schober's test were conducted before and after treatment. The tumor necrosis factor-<italic>α</italic> （TNF-<italic>α</italic>）， interleukin-1<italic>β</italic> （IL-1<italic>β</italic>）， IL-6， thromboxane B<sub>2</sub> （TXB<sub>2</sub>）， and 6-keto prostaglandin F<sub>1</sub><italic><sub>α</sub></italic> （6-keto-PGF<sub>1</sub><italic><sub>α</sub></italic>） levels before and after treatment were measured， followed by the safety evaluation. Result:The PRI， VAS， and PPI scores in SF-MPQ of the observation group were reduced in contrast to those in the control group （<italic>P</italic><0.01）. The wind-cold and stasis obstruction syndrome and ODI scores in the observation group also declined as compared with those of the control group （<italic>P</italic><0.01）， while the ADL and Schober's test scores were elevated （<italic>P</italic><0.01）. The TNF-<italic>α</italic>， IL-1<italic>β</italic>， IL-6， and TXB<sub>2</sub> levels in the observation group were lower than those in the control group （<italic>P</italic><0.01）， whereas the 6-keto-PGF<sub>1</sub><italic><sub>α</sub></italic> was higher （<italic>P</italic><0.01）. The excellent and good rate of the observation group was （51/63） 80.95%， significantly better than （39/63） 61.90% of the control group （<italic>χ</italic><sup>2</sup>＝5.601， <italic>P</italic><0.05）. No adverse reactions occurred after the intake of Chinese medicinal prescriptions. Conclusion:The modified Shentong Zhuyutang combined with celecoxib capsules is efficient and safe in inhibiting inflammation， easing back pain， enhancing lumbar spine mobility， and improving the ADL of patients with acute DLBP of wind-cold obstruction syndrome.
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Discogenic low back pain (DLBP) is a common clinical degenerative disease of lumbar intervertebral disc, and its incidence rate is as high as 39%. The DLBP has become one of the major public health problems in the world. After the onset of DLBP, the patient's mental health, quality of life and work are seriously affected. At present, the diagnosis and treatment of DLBP are clinical problems and controversies, and the pathogenesis of DLBP is still not fully understood. The clinical manifestations of DLBP are atypical and lack specificity. In recent years, DLBP has received extensive attention from researchers, and a large number of studies have been conducted on clinical diagnosis and treatment methods and pathogenesis. In this paper, the research progress in the treatment of DLBP treatment methods reported in the literature was reviewed, in order to provide help for the selection of clinical treatment methods.
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This is a case report of the provocative discographic findings before and after focal selective coagulation of the major annular fissure using intradiscal navigable catheter. A 46-year-old woman had a 30-month history of axial low back pain and magnetic resonance imaging findings suspicious for painful L4/5 disc. The provocative discography confirmed painful disc before coagulation. The final electrode tip position in the coagulation procedure was at the largest fissure within the outer annular margin identified through the discography. Six months after the successful coagulation therapy, inadvertently performed discography resulted in decreased pressure rise over time. Neither evoked pain nor change in the integrity of outer annulus as compared with the previous results was reported. Such an interventional method has not been reported previously, and the analytic results suggest that it may be possible to relocate the pressure of the entire nucleus pulposus only by focal selective coagulation of the fissure.
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Female , Humans , Middle Aged , Catheters , Electrodes , Low Back Pain , Magnetic Resonance Imaging , MethodsABSTRACT
Objective To observe the clinical effect of manipulation combined with McKenzie technique on discogenic low back pain. Methods 80 patients were randomly divided into control group (n=39, 1 case was lost) and observation group (n=40). The patients in obser-vation group received manipulation and McKenzie technique, while the control group received manipulation only. All the patients were eval-uated with Oswestry Disability Index (ODI), Visual Analogous Scale (VAS) and Self-rating Depression Scale (SDS) before and 3 weeks af-ter treatment. Results The scores of ODI, VAS and SDS decreased after treatment in both groups (P0.05). Conclusion Manipulation combined with McKenzie technique is more effective on discogenic low back pain.
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10.3969/j.issn.2095-4344.2013.26.015
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OBJECTIVE: To evaluate the efficacy of intradiscal methylene blue (MB) injection in patients with chronic discogenic low back pain. METHOD: Twenty patients with discogenic low back pain (4 males, 16 females; mean age 45.6 years) refractory to conservative management were recruited. All subjects underwent MB injection in target lumbar intervertebral discs confirmed by provocative discography. The clinical outcome was assessed by visual analog scale (VAS) and Oswestry disability index (ODI) at baseline and 1, 3, 6 and 12 months after treatment. Successful outcome was described as minimum of 2 points reduction in pain intensity compared with the baseline. RESULTS: VAS and ODI significantly decreased after one injection. The average VAS and ODI were reduced significantly from 5.1 and 38.0 at baseline to 3.2 and 27.4 at 3 months after injection (p<0.05). However, the mean score of VAS at 12 month follow-up was 4.5 and we could not observe any difference between 12 months after injection and pretreatment. Eleven of twenty patients (55%) reported successful outcomes after intradiscal MB injection at 3 month follow up and the average VAS was reduced by 3.3+/-1.1 (p<0.05). At the time of 12 month follow up, pain had relapsed in 6 patients who have had satisfactory effect at 3 month follow up. Successful outcome was maintained in only 5 patients (20%) for 1 year. CONCLUSION: The intradiscal MB injection is a short-term effective minimally invasive treatment indicated for discogenic back pain but it may lose its effectiveness long-term.
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Humans , Male , Back Pain , Follow-Up Studies , Intervertebral Disc , Low Back Pain , Methylene Blue , Prospective StudiesABSTRACT
Objective To explore the curative effect of the traditional Chinese medicine"SHU JI FANG"in treating lumbar discogenic low back Pain(DLBP).Methods 156 cases were divided into three groups by random with 52 cases in each group.A treatment group was treated by traditional Chinese medicine"SHU JI FANG".A control group 1 was treated by Bextra;A control group 2 was treated bv Chinese traditional medicine Zuogui pill.Results The difiererlce of cure rate and the excellent rate between the treatment group and the control group I did not show significance by X2 check,with P＞0.05;while the difference between the treatment Group and the Control group 2 showed significance by X2 check with P＜0.05.Conclusion I"SHU JI FANG"is effective in treating discogenic low back pain.
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Objective To study the short-term outcome of transforaminal posterolateral endoscopic discectomy and radiofrequency annuloplasty in patients with discogenic low back pain. Methods A total of 25 patients with discogenic low back pain,who were diagnosed by provocative discography,received transforaminal posterolateral endoscopic discectomy and radiofrequency annuloplasty in our hospital. The VAS scores determined before and 6 months after the operation were compared in the patients. Their MacNab scores were also evaluated at 6 months postoperation. Results After the surgery,2 patients who had ruptured intervertebral discs (L5-S1) developed sunburn syndrome,and then was relieved by pulsed electrical stimulation for one week. The patients were followed up for 6-10 months,during which no other postoperative complications occurred. The mean VAS score of this series decreased significantly after the treatment,and kept being reduced in 6 months [preoperation:6.24?0.97,1,3,6 months after the operation:0(0~2); Kruskal-Wallis rank-sum test,H=61.680,P=0.000]. Four patients showed lower limbs pain before the treatment and were relieved after the surgery. The evaluation of MacNab score showed excellent in 11 pateints,good in 12,and fair in 2,suggesting an effective rate of 92.0%(23/25). Conclusions Transforaminal posterolateral endoscopic discectomy plus radiofrequency annuloplasty is effective for discogenic low back pain in a short term.