Spinopelvic Parameters as Risk Factors of Nonspecific Low Back Pain: A Case-Control Study.

Background: The effect of spinopelvic alignment on low back pain (LBP) incidence has been studied in many investigations. However, the interrelation between spinopelvic parameters and LBP is poorly understood. In particular, it is unknown whether particular patterns of spinopelvic parameters render nonspecific LBP. In this study, we aimed to evaluate the role of spinopelvic parameters as risk factors of nonspecific LBP. Methods: In this case-control study, spinopelvic parameters, including lumbar lordosis (LL), sacral slope (SS), pelvic tilt (PT), and pelvic incidence (PI), were compared between 148 patients with nonspecific LBP and 148 healthy controls. Demographic characteristics of the patients, such as age, gender, occupation, smoking, diabetes mellitus, and body mass index (BMI), were recorded as confounders. Spinopelvic parameters were assessed using radiographic findings in 2 groups. The analysis was done once as univariate (Kolmogorov-Smirnov test) and once as multivariate (multivariate logistic regression) analysis. Results: Univariate analysis showed that female gender, higher BMI, smoking, and blue-collar jobs were associated with a higher risk of nonspecific LBP. LL, SS, and PI, but not PT, were all greater in LPB patients in the univariate analysis regarding the spinopelvic parameters. Multivariate analysis showed female gender (odds ratio adjusted (ORAdj) = 4.26 [95% CI, 2.11-9.58]; P = 0.001) and LL (ORAdj = 1.58; [95% CI, 1.18-3.22]; P = 0.026) were predictable risk factors for Nonspecific LBP. Conclusion: Spinopelvic parameters, particularly LL, could be considered as risk factors of nonspecific LBP so that a more significant LL might indicate a greater risk of LBP. However, the role of other parameters in this association could not be neglected.

Validation and reliability of the Persian version of the Zurich Claudication Questionnaire in patients with lumbar spinal stenosis.

Background: One of the applicable tools introduced as a specific tool for assessing claudication in patients with lumbar spinal stenosis is the Zurich Claudication Questionnaire (ZCQ). This questionnaire has been validated in different populations of patients. The present study aimed to determine the validation status of the Persian version of ZCQ. Methods: After professional translation of the ZCQ by native English translators, it was executed twice before surgery with 1 day interval on 45 Iranian patients with spinal stenosis. The reliability was assessed by determining the Chronbach's Alpha coefficient as well as intraclass correlation coefficient (ICC). To assess the concurrent validity, the correlation across the 3 domains of the questionnaire was calculated by the Pearson's correlation test and the content validity was determined using a panel of experts. Results: To assess test-retest reliability, the ICC for ZCQ for symptom severity, functional disability, and satisfaction domains were 0.80, 0.82, and 0.78, indicating acceptable reliability. Regarding internal consistency, Cronbach's alpha coefficients for the Persian version of ZCQ for the 3 above domains were shown to be 0.96, 0.92, and 0.90 respectively. On the subject of content validity, the 3 questionnaire's domains were marked as relevant with the content validity indices of 0.88, 0.82, and 0.80 respectively. Concerning concurrent validity, all 3 domains of the Persian ZCQ correlated strongly with 1 another. Conclusions: The ZCQ questionnaire with the same original structure is completely functional and reliable in the Iranian patient community.

Direct epidural metastasis of breast cancer mimicking a large lumbar disc sequestrum: A case report and review of literature.

We report a case of cauda equina syndrome (CES) caused by an epidural metastasis of breast cancer, which oddly mimicked a large disc sequestrum leading to misdiagnosis. To our knowledge, it is the first report of a metastatic epidural breast cancer lesion mimicking a disc sequestrum.

Missed C5 vertebral brown tumor causing spinal cord compression and myelopathy: A case report and literature review.

We aim to report a patient with vertebral brown tumor in the context of a primary hyperparathyroidism presented by shoulder pain. This is the first report of C5 brown tumor involvement in a primary hyperparathyroid patient and emphasizes the consideration of cervical vertebral evaluation in patients with persistent shoulder pain.

Metastatic L1 root compression presenting as an inguinal pain: A case report.

As the spine is the third most common place for metastatic involvement, spinal examination is essential in patients with a known history of cancer, even in those with no related complains (ie. Backpain).

Outcome of Posterior-Only Approach for Severe Rigid Scoliosis: A Retrospective Report.

BACKGROUND: The management of severe scoliosis may lead to significant complications, and adequate mobilization is a key step to achieve maximal correction, usually requiring extensive approaches. There is still no consensus on the management of these severe and rigid curves. In this study we evaluated the clinical and radiologic outcome of a posterior-only approach with multilevel asymmetric Ponte osteotomy with a minimum of 2 years' follow-up. METHODS: In this retrospective study, 23 patients with severe and rigid adolescent idiopathic scoliosis who underwent surgery with a single-staged posterior-only approach were included. The surgical procedures in these patients were excision of posterior ligaments and spinous process, partial laminectomy in caudal part of lamina, excision of the ligamentum flavum, facetectomies, and multilevel asymmetric posterior column osteotomies (Ponte) followed by instrumented fusion. Clinical records-including demographic data; operating time; hospitalization time; blood loss; number of segments instrumented, fused, and osteotomized; functional improvement; follow-up duration; and complications-were recorded. RESULTS: The mean preoperative Cobb angle of major curve in coronal plan was 97.5° (range, 82°-131°) with the mean flexibility of 21.4° (range, 10°-25°) on bending radiography. The mean immediate postoperative Cobb angle of major curve was 34.8° (range, 17°-61°), showing a 64.2% correction. The mean preoperative coronal and sagittal imbalances of 3.8 and 4.2 cm were improved to 1.0 and 1.3 cm at postoperative measurements, respectively. A mean of 6.1 (range, 5-9) vertebral segments were osteotomized. We experienced no major complications. CONCLUSIONS: We found that a posterior-only procedure in patients with severe and rigid adolescent idiopathic scoliosis could provide correction rate, coronal and sagittal balance, and clinical outcomes comparable with other procedures. Using this technique can eliminate the need for the anterior release, with the associated complications related to anterior surgery, in the treatment of severe rigid scoliosis.

Translation, Cross-cultural Adaptation and Validation of the Farsi Version of NIH Task Force's Recommended Multidimensional Minimal Dataset for Research on Chronic Low Back Pain.

STUDY DESIGN: Translation and cultural adaptation of the National Institutes of Health (NIH) Task Force's minimal dataset. OBJECTIVE: The purpose of this study was to evaluate validity and reliability of the Farsi version of NIH Task Force's recommended multidimensional minimal dataset for research on chronic low back pain (CLBP). SUMMARY OF BACKGROUND DATA: Considering the high treatment cost of CLBP and its increasing prevalence, NIH Pain Consortium developed research standards (including recommendations for definitions, a minimum dataset, and outcomes' report) for studies regarding CLBP. Application of these recommendations could standardize research and improve comparability of different studies in CLBP. METHODS: This study has three phases: translation of dataset into Farsi and its cultural adaptation, assessment of pre-final version of dataset's comprehensibility via a pilot study, and investigation of the reliability and validity of final version of translated dataset. Subjects were 250 patients with CLBP. Test-retest reliability, content validity, and convergent validity (correlations among different dimensions of dataset and Farsi versions of Oswestry Disability Index, Roland Morris Disability Questionnaire, Fear-Avoidance Belief Questionnaire, and Beck Depression Inventory-II) were assessed. RESULTS: The Farsi version demonstrated good/excellent convergent validity (the correlation coefficient between impact dimension and ODI was r = 0.75 [P < 0.001], between impact dimension and Roland-Morris Disability Questionnaire was r = 0.80 [P < 0.001], and between psychological dimension and BDI was r = 0.62 [P < 0.001]). The test-retest reliability was also strong (intraclass correlation coefficient value ranged between 0.70 and 0.95) and the internal consistency was good/excellent (Chronbach's alpha coefficients' value for two main dimensions including impact dimension and psychological dimension were 0.91 and 0.82 [P < 0.001], respectively). In addition, its face validity and content validity were acceptable. CONCLUSION: The Farsi version of minimal dataset for research on CLBP is a reliable and valid instrument for data gathering in patients with CLBP. This minimum dataset can be a step toward standardization of research regarding CLBP. LEVEL OF EVIDENCE: 3.

Epidural Anesthesia Combined with Light General Anesthesia for a Juvenile with Charcot-Marie-Tooth Disease Undergoing Corrective Spine Surgery: A Case Report.

General anesthesia (GA) is associated with serious concerns in advanced cases of Charcot-Marie-Tooth (CMT). Despite several benefits of applying regional anesthesia (RA), recommendation for RA is controversial in CMT due to insufficient supporting documents and trials. We report combined epidural/general anesthesia for a 12-year-old boy with CMT disease undergoing major spine corrective surgery. This manuscript is presented not only to evaluate the costs and benefits of RA, but also to highlight the safety of neuraxial anesthesia and emphasis on the broad potential role of RA to reduce risks of GA in CMT patients.

Neglected Alkaptonuric Patient Presenting with Steppage Gait.

Even though intervertebral disc degeneration can be found in the natural course of alkaptonuria, detection of the disease by black disc color change in a patient without any other presentation of alkaptonuria is an exceptionally rare condition. We have reported a very rare case of alkaptonuria presented with low back pain and steppage gait in a 51-year-old male with a complaint of chronic low-back pain and steppage gait who was operated on for prolapsed lumbar disc herniation. Intraoperatively his lumbar disk was discovered to be black. The alkaptonuria diagnosis was considered after histopathological examination of the black disc material and elevated urinary concentration of homogentisic acid confirmed the diagnosis. To our knowledge, this presentation has not been reported previously in literature.

Low Back Pain in Athletes.

CONTEXT: Low Back Pain (LBP) in athletes is common and has a broad spectrum of differential diagnoses that must be taken in to account when a clinician approaches the patient with LBP. The physicians should take into account spinal and extra spinal causes of low back pain in athletes. EVIDENCE ACQUISTION: A literature review was performed for the years 1951 through 2013. Keywords used were Low Back Pain and Athletes. We searched MEDLINE, EMBASE, OVID, PUBMED, the Cochrane Library, ELSEVIER, and the references of reviewed articles, for English-language of Low Back Pain in Athletes. RESULTS: The two most common causes of LBP arising from spine in athletes are degenerative disc disease and spondylolysis with or without listhesis. Although most athletes, respond well to conservative treatment, surgical treatment is indicated when conservative treatment failes. CONCLUSIONS: The major concern in athletes with LBP is return to play and previous level of their activity after treatment. There is insufficient evidence regarding this issue in literature to define the optimal time of return to play following treatment.

Muscle relaxant or prone position, which one unfastened the entrapped epidural catheter?

Some nonsurgical steps have been introduced to remove an entrapped catheter. But occasionally, the majority of them fail, and we are forced to extract the catheter through an invasive procedure. This article depicts our team's experience on the issue. When we found that the inserted epidural catheter was entrapped, we performed all recommended noninvasive maneuvers to release the catheter, but no progress was achieved. Therefore, after obtaining informed consent, we induced anesthesia and changed her to a prone position to explore her back. The intact catheter was removed easily in this stage. The authors believe, in this process, it would have been better if they had tried pulling the catheter in a prone position as a preliminary step. Furthermore, pulling the catheter in a prone position after injecting a muscle relaxant appeared to be more effective and saved the patient from the scheduled surgery.

Contribution of surgery in solitary plasmacytoma of spine; a case report.

Solitary plasmacytoma of bone is a rare malignant tumor mostly involving the axial skeleton. The tumor occurs in middle- aged or elderly people (mean age: 55 years) and has a high risk of progression to multiple myeloma. Radiotherapy is the preferred treatment for this disease. We report a case of recurrent solitary plasmacytoma of the fourth lumbar vertebra in a 35-year-old male. The patient suffered from intractable pain due to a pathologic fracture and instability. We performed two-stage posterior and anterior surgical procedures on him. Our method was useful for immediate pain relief and early return to activity, spinal decompression and biomechanical stabilization of the involved vertebra. Afterward, the patient underwent radiotherapy as the adjuvant therapy. The patient is asymptomatic without any recurrence after a one-year follow up. We recommend surgery as an appropriate option for patients with intractable pain as a result of pathologic fracture, vertebral instability, neurological compromise, failure of radiotherapy or a combination of these disorders.

Brown tumor of lumbar spine in chronic renal failure: a case report.

Brown tumors may occur secondary to hyperparathyroidism in patients with chronic renal failure (CKD). They are increasingly rare because hyperparathyroidism in now diagnosed and treated at an early stage. We report 67-year-old man who had been on hemodialysis for CRF for over 3 years, who presented with back pain over the thoracolumbar junction from 2 years ago and because of pain he could not stand or walk in the last 3 months before surgery. Ambulation was regained after surgical decompression and stabilization. In conclusion, when brown tumor arises in the spine, surgery may be needed to preserve neurologic function.

Open reduction and posterior instrumentation of type 3 high transverse sacral fracture-dislocation: technical note.

The authors describe an open reduction and fixation through a posterior approach of Roy-Camille Type 3 transverse sacral fractures. This technique involves posterior staged reduction of the fracture applying distraction forces to restore the height, followed by posterior translation to restore sagittal alignment. Tips and pearls of this procedure, described for the first time in the literature, are also discussed in this report.

Comparison of designed slippers splints with the splints available on the market in the treatment of hallux valgus.

Hallux valgus or the lateral deviation of the great toe is a complex disease. If it is not treated, it will cause the deviation of other toes. Hallux valgus is three times more common in females and may cause uncomfortable deformity of the foot, problems in putting on unsuitable and narrow toe box shoes, and pain on the medial side of the first metatarsophalangeal joint; therefore, patients seek medical services. Untreated hallux valgus may cause the hammer toe deformity of the second toe. In this cohort study, 30 patients referring to the Orthopedic Clinic of Shohada Ashayer Hospital of Khorramabad, Iran, with a complaint of hallux valgus were randomly divided into two groups. The splints designed by the researches (slippers splints) were given to the case group, and the splints on the market including night splints and interdigital pads were given to the control group. The patients were followed every three months for a year and every time the weight bearing anteroposterior radiography of both feet were taken and hallux valgus and inter-metatarsal angles were measured. The data was analyzed by the SPSS software using repeated measure tests. In the case group that used the designed splints regularly, hallux valgus angles decreased more dramatically than in the control group (P<0.001). This study showed that, despite controversies over the nonoperative treatment of hallux valgus, if hallux valgus angle in patient is mild to moderate, the splint can be used as a nonoperative treatment.