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BACKGROUND: Lumbar facet arthritis is one of the main causes of low back pain. At present, MRI is mainly used for preliminary diagnosis, and there is still a certain probability of missed diagnosis and misdiagnosis. Therefore, MR T2* mapping imaging technology is expected to become an important means of quantitative detection of cartilage damage in lumbar facet arthritis. OBJECTIVE: To investigate the application value of MR T2* mapping imaging technique in quantitative analysis of cartilage damage and degeneration of lumbar facet joint. METHODS: A total of 110 outpatient or inpatient patients with low back pain in Fourth Affiliated Hospital of Nanjing Medical University from April 2020 to March 2022 were collected and set as case group. At the same time, 80 asymptomatic volunteers were recruited as the control group. T2* mapping transectal images and T2WI images were obtained by 3.0T MR Scanning for the facet joints of all included subjects L1-S1. Weishaupt grading and T2* value measurement were performed for all facet joint cartilage, and the data were collected for parallel statistical analysis. The comparison of T2* values of facet joint cartilage between different articular Weishaupt grades was performed by one-way analysis of variance. RESULTS AND CONCLUSION: (1) Statistical analysis found that the T2* value of lumbar facet joint cartilage in the case group (17.6±1.5) ms was significantly lower than that in the control group (21.4±1.3) ms (P < 0.05). (2) In the case group, with the hierarchical increase of lumbar facet joint Weishaupt, the T2* value of facet joint cartilage also showed a gradual decreasing trend, and the difference was statistically significant (P < 0.05). (3) It is concluded that T2* mapping can better display the early pathological changes of lumbar facet joint cartilage injury, and T2* value of lumbar facet joint cartilage can quantitatively evaluate the degree of lumbar facet joint cartilage injury. T2* mapping imaging technique can provide a good theoretical basis for the imaging diagnosis of the early cartilage injury induced by lumbar facet arthritis and has important clinical application value. [ABSTRACT FROM AUTHOR]

Introduction: Lumbar facet joint degeneration is a source of chronic low back pain, with an incidence of 15% to 45% among patients with low back pain. Pain arising from the lumbar facet joints is a common cause of axial back pain in adults. Radiofrequency ablation (RF) of the medial branches of the spinal dorsal rami has been used as a treatment option. Various therapeutic techniques in the treatment of facet-related pain have been described in the literature, including intraarticular lumbar facet joint steroid injections and radiofrequency denervation. Aim and Objective: To provide evidence based clinical practice guidelines for comparison of fluoroscopic guided facet joint radiofrequency ablation of medial branch and facet joint steroid injection for low back pain. Material and Methods: This was a prospective non-randomized study carried out in the Department of Anaesthesia at Maharaja Institute of Medical Sciences for a period of 1 year i.e, April 2023 to April 2024 on patients who were admitted from casualty and outpatient’s department with a diagnosis of chronic low back pain. All patients were assigned to LFJ intraarticular steroid infiltrations or RF denervation. All of the enrolled patients were suffering from LFJ-related pain at the L3/L4–L5/S1. Results: In the present study, there were 65 patients screened out of which 8 patients drop out. There were 57 patients of low back pain in which the mean age of Group A patients was (62.26 ± 11.56) years and Group B patients was(55.75±10.25)years. It was observed that Males were more commonly affected than females. Duration of back pain of Group A patients was (1.72±0.85) years while that of Group B patients was (2.26±0.92) years. Vas scoring before procedure was found to be not significant. But vas scoring at 6 months after procedure was found to be very highly significant. Rolland Morris questionnaire before procedure in both the groups was found to be insignificant. But at 6 months after procedure between both groups was found to be highly significant. Conclusion : Intraarticular steroid infiltration or radiofrequency denervation appear to be a managing option for chronic function-limiting low back pain of facet origin with favourable short- and midterm results in terms of pain relief and function improvement, but improvements were similar in both groups. [ABSTRACT FROM AUTHOR]

Lower back pain is a common occurrence among mine workers due to the nature of their work. Globally, workplace (occupational) and ergonomic risk factors have been reported to influence the prevalence of lower back pain among workers. This study aimed to determine ergonomic risk factors associated with lower back pain and associated risk factors (workplace and ergonomics) among mineworkers in a nickel mine in Zimbabwe. A cross-sectional study design was employed, and participants were randomly selected to complete a questionnaire that included the Dutch Musculoskeletal Questionnaire (DMQ). A total of 420 mine workers were interviewed, with the majority being male (n = 259, 61.7%) and aged between 31 and 44 years old (n = 159, 37.9%). The study found that the prevalence of lower back pain was 41.43% (n = 174). Several risk factors were found to be associated with lower back pain, including working overtime (AOR = 1.13, p < 0.01; 95% CI: 0.07–0.22), performing repetitive tasks (AOR = 8.06, p < 0.01; 95% CI: 4.67–13.93), bending (AOR = 7.77, p < 0.01; 95% CI: 3.97–15.22), and twisting (AOR = 3.32, p < 0.01; 95% CI: 1.83–6.03). Based on these findings, it is recommended that an ergonomic risk assessment and prevention program be implemented, which should include educational awareness about lower back pain and its prevention among mine workers. [ABSTRACT FROM AUTHOR]

Lower back pain (LBP) is a widely prevalent global health issue, affecting over half a billion people and remaining the leading cause of years lived with disability (YLDs). LBP significantly impacts healthcare systems, with substantial costs related to surgical procedures and lost workdays. Vertebrogenic back pain (VBP), characterized by specific clinical symptoms and associated with Modic changes (MC) in vertebral endplates, best seen on MRI, is a significant subset of LBP. This paper explores the pathophysiology, diagnosis, and current reports and studies focusing on VBP and the role of basivertebral nerve (BVN) ablation as a therapeutic intervention. Multiple studies, including randomized controlled trials (RCTs) and meta-analyses, demonstrate the efficacy of BVN ablation in reducing pain and improving function in patients with chronic LBP associated with MC. [ABSTRACT FROM AUTHOR]

Background: Minimally invasive surgical techniques for sacroiliac joint (SIJ) fixation have the potential to reduce risk and improve patient outcomes, but evidence remains limited. This interim analysis presents initial findings from an ongoing prospective study evaluating the safety and efficacy of the Catamaran System. Methods: The primary endpoint of success at 6 months was defined as a ≥20 mm improvement in SIJ pain (Visual Analog Scale, VAS), no neurologic worsening, absence of device-related serious adverse events (SAEs), and no surgical reintervention. Secondary endpoints included 6 month evaluation of the Oswestry Disability Index (ODI), patient satisfaction, and 12 month radiographic CT fusion, performed by an indpendent radiologist. Results: Thirty-three consecutive patients (mean age: 58.9 years; %-females: 76%; Body Mass Index: 30.5) were treated across six U.S. clinical sites. At the primary endpoint of 6 months, 80% of patients met the criteria for success, with no device-related SAEs and no surgical reintervention reported. VASSIJ-Pain significantly decreased from preoperative levels (mean: 80.9 mm) to 6 months postoperatively (31.1 mm; p < 0.001). Mean ODI scores also showed a significant improvement from preoperative values (51.9%) to 6 months postoperatively (29.6%, p < 0.01). Patients reported high satisfaction rates throughout all follow-ups, with 93.3% of patients being satisfied at 6 months. Conclusion: In patients diagnosed with chronic SIJ pain, minimally invasive inferior-posterior delivery of the Catamaran implant was safe and effective in relieving pain and reducing disability. [ABSTRACT FROM AUTHOR]

Background: Sometimes during breastfeeding women adopt positions that may cause problems with musculoskeletal system, resulting in back pain. The aim of this study was to determine the prevalence of lower back, upper back and neck pain in breastfeeding women and how this may be related to the act of breastfeeding. Methods: An online survey within Poland was conducted among 395 breastfeeding women who were 1 to 48 months postpartum and were divided into two groups; "no back pain" and "back pain present". The measurement tools used included an original questionnaire, the International Physical Activity Questionnaire (IPAQ), a Numerical Pain Rating Scale (0–10), and the Roland-Morris Disability Questionnaire. Pearson's chi-squared tests, Mann-Whitney U tests, Student's t-tests, and Kruskal-Wallis ANOVA tests were used to compare the groups. Results: It was found that 84% of breastfeeding mothers suffered from back pain at least once a month. Pain was experienced at least once a week in the cervical, thoracic and lumbosacral regions in 48%, 36%, and 66% of the women, respectively. A dysfunctional state was present in 27.6% of breastfeeding mothers who suffered from back pain. Mothers experiencing back pain spent significantly more time on single breastfeeding episodes (p < 0.05) and had an increased total time breastfeeding per day (p < 0.01) compared to mothers with no back pain. Neck pain was significantly less intense in mothers preferring to breastfeed in a lying position as compared to mothers preferring a sitting position in a chair or an armchair (p < 0.05). Conclusions: This survey of Polish breastfeeding mothers revealed a very high prevalence of lower back, upper back and neck pain. The amount of time spent on breastfeeding and the choice of body position for breastfeeding were important factors differentiating the prevalence and intensity of the pain. It is recommended that breastfeeding mothers do not extend the single-feeding time in the adopted position beyond the required time. It is of utmost importance to choose a breastfeeding position in which all parts of the mother's body are supported. To prevent neck pain, lying and semi-lying positions with head support are recommended. [ABSTRACT FROM AUTHOR]

Various nutritional supplements are available over the counter, yet few have been investigated in randomized controlled trials. The rationale for using the specific mix of nutritional substances including collagen type II, hyaluronic acid, n-acetyl-glucosamine, bamboo extract, L-lysine, and vitamin C is the assumption that combining naturally occurring ingredients of the intervertebral disc would maintain spine function. This double-blinded, placebo-controlled randomized trial aimed to evaluate the efficacy of a nutraceutical supplement mix in the management of lumbar osteochondrosis. Fifty patients were randomly assigned to either the supplement or placebo group in a 1:1 ratio. Patient-Reported Outcome Measures (PROMs) included the Oswestry Disability Index (ODI), the visual analogue scale for pain (pVAS), short form-12 (SF-12) physical and mental component summary subscale scores (PCS and MCS, respectively), and global physical activity questionnaire (GPAQ). Magnetic resonance imaging (MRI) was used to evaluate degenerative changes of intervertebral discs (IVD) including Pfirrmann grades as well as three-dimensional (3D) volume measurements. Data were collected at baseline and after the 3-month intervention. None of the PROMs were significantly different between the supplement and placebo groups. Disc degeneration according to Pfirrmann classifications remained stable during the 3-month intervention in both groups. Despite no significance regarding the distribution of Pfirrmann grade changes (improvement, no change, worsening; p = 0.259), in the supplement group, one patient achieved a three-grade improvement, and worsening of Pfirrmann grades were only detected in the placebo group (9.1%). Furthermore, in-depth evaluations of MRIs showed significantly higher 3D-measured volume changes (increase) in the supplement (+740.3 ± 796.1 mm3) compared to lower 3D-measured volume changes (decrease) in the placebo group (−417.2 ± 875.0 mm3; p < 0.001). In conclusion, this multi-nutrient supplement might not only stabilize the progression of lumbar osteochondrosis, but it might also potentially even increase IVD volumes as detected on MRIs. [ABSTRACT FROM AUTHOR]

Objectives: This project aimed to promote running as the best treatment for lower back pain (LBP) in an outpatient setting. Introduction: LBP is one of the most prevalent conditions worldwide. Sixty-two percent of all Germans experience episodes of non-specific back pain at least once a year, with one-fifth developing chronic conditions. Intervertebral disc (IVD) degeneration is a natural process, contributing to periods of acute LBP. However, the scientific literature and guidelines partially overlook the significance of water management in IVD. This implementation project sought to address this gap by educating patients about this process. Running and/or walking were chosen as general approaches for treatment rather than specific disease-related approaches. Methods: This implementation project was conducted in an outpatient physiotherapy clinic in Brandenburg, Germany, utilizing the JBI Evidence Implementation Framework. An evidence-informed clinical audit and feedback strategy was used to measure compliance with ten audit criteria. Five physiotherapists and 20 patients took part in the audits. Results: At baseline, only 20% of participating physiotherapists screened for yellow flags regarding psychological issues. However, after project implementation, this criterion scored 100% compliance. Some patients performed exercises independently, but confusion persisted regarding the choice of beneficial exercises. Patients continued running, but those who took a break due to pain expressed uncertainty about resuming. Conclusions: The project highlighted the effectiveness of collaborative efforts between patients and therapists to address the issue. The project team's conviction in action and solution strategies serves as the foundation for this collaboration. This implementation strategy provided "running" patients with the confidence to either resume or reintegrate running after an extended break. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to investigate the effect of osteoporosis (OP) on the outcomes of facet medial branch radiofrequency thermocoagulation (RFT). Materials and Methods: Thirty-six patients with chronic lower back pain due to lumbar facet joint syndrome (LFJS) who underwent facet medial branch RFT were retrospectively reviewed. The patients were divided into two groups: Group I (without OP, n=19) and group II (with OP, n=16). Pre-intervention and post-intervention evaluations of the patients were assessed at 1, 6, and 12th months by visual analog scale (VAS). Results: In both groups, VAS scores 1st, 6th, and 12th months after intervention were lower than those at baseline (p=0.001). There were no significant difference between the groups in terms of VAS score improvement. Conclusion: Lumbar facet medial branch RFT is an effective and safe treatment method in both the short and long-term in patients with LFJS. OP therapy had no effect on RFT treatment results. [ABSTRACT FROM AUTHOR]

Avascular necrosis (AVN) is linked to considerable morbidity, resulting in severe pain and functional impairment. Herein, for the first time, we reported an 18-year-old patient with Crohn's disease during the remission phase under Azathioprine therapy who presented with articular pain. Although no underlying risk factors, the patient was diagnosed with severe AVN of the bilateral femoral head and both knees simultaneously following pain in involved areas. This case highlights the importance of demand multidisciplinary approach to chronic disease. Moreover, clinicians should be aware of articular manifestations in IBD patients to diagnose and treat these conditions as soon as possible. Patients should be evaluated for their psychologic, gastrointestinal, and extra-gastrointestinal comorbidities during each follow-up visit. [ABSTRACT FROM AUTHOR]

Lower back pain is prevalent in equestrian athletes, but its prevalence and associated factors are unknown in the Portuguese equestrian population. A questionnaire regarding lower back pain and possible associated factors was answered by 347 respondents. Of the respondents, 214 (61.7%) stated having experienced lower back pain in the past 12 months and therefore completed the Roland Morris disability questionnaire. Among the latter, 63.1% stated that lower back pain impaired their performance. The probability of suffering from lower back pain was higher in individuals with higher weekly riding workloads, who reported equestrianism as their main occupation, and who performed daily stable duties. Considering a Roland Morris disability score of 4 as the cut-off value for dysfunction, this sample had an average score of 5.39 ± 4.42. Individuals who stated equestrianism was their main occupation showed a significantly higher risk (OR = 1.759, p = 0.041) of exhibiting a score ≥ 4 than those who stated equestrianism as a hobby. Age (p = 0.029), body mass index (p = 0.047), and daily performance of stable duties (p = 0.030) were also associated with a higher Roland Morris disability score. Further research is needed to understand the full impacts of lower back pain in Portuguese equestrian athletes. [ABSTRACT FROM AUTHOR]

Abstract Background Sometimes during breastfeeding women adopt positions that may cause problems with musculoskeletal system, resulting in back pain. The aim of this study was to determine the prevalence of lower back, upper back and neck pain in breastfeeding women and how this may be related to the act of breastfeeding. Methods An online survey within Poland was conducted among 395 breastfeeding women who were 1 to 48 months postpartum and were divided into two groups; “no back pain” and “back pain present”. The measurement tools used included an original questionnaire, the International Physical Activity Questionnaire (IPAQ), a Numerical Pain Rating Scale (0–10), and the Roland-Morris Disability Questionnaire. Pearson’s chi-squared tests, Mann-Whitney U tests, Student’s t-tests, and Kruskal-Wallis ANOVA tests were used to compare the groups. Results It was found that 84% of breastfeeding mothers suffered from back pain at least once a month. Pain was experienced at least once a week in the cervical, thoracic and lumbosacral regions in 48%, 36%, and 66% of the women, respectively. A dysfunctional state was present in 27.6% of breastfeeding mothers who suffered from back pain. Mothers experiencing back pain spent significantly more time on single breastfeeding episodes (p

Objective: The aim of this study was to investigate the effect of osteoporosis (OP) on the outcomes of facet medial branch radiofrequency thermocoagulation (RFT). Materials and Methods: Thirty-six patients with chronic lower back pain due to lumbar facet joint syndrome (LFJS) who underwent facet medial branch RFT were retrospectively reviewed. The patients were divided into two groups: Group I (without OP, n=19) and group II (with OP, n=16). Pre-intervention and post-intervention evaluations of the patients were assessed at 1, 6, and 12th months by visual analog scale (VAS). Results: In both groups, VAS scores 1st, 6th, and 12th months after intervention were lower than those at baseline (p=0.001). There were no significant difference between the groups in terms of VAS score improvement. Conclusion: Lumbar facet medial branch RFT is an effective and safe treatment method in both the short and long-term in patients with LFJS. OP therapy had no effect on RFT treatment results.

OBJECTIVES: To evaluate whether combining fast acquisitions with deep-learning reconstruction can provide diagnostically useful images and quantitative assessment comparable to standard-of-care acquisitions for lumbar spine magnetic resonance imaging (MRI). METHODS: Eighteen patients were imaged with both standard protocol and fast protocol using reduced signal averages, each protocol including sagittal fat-suppressed T2-weighted, sagittal T1-weighted, and axial T2-weighted 2D fast spin-echo sequences. Fast-acquisition data was additionally reconstructed using vendor-supplied deep-learning reconstruction with three different noise reduction factors. For qualitative analysis, standard images as well as fast images with and without deep-learning reconstruction were graded by three radiologists on five different categories. For quantitative analysis, convolutional neural networks were applied to sagittal T1-weighted images to segment intervertebral discs and vertebral bodies, and disc heights and vertebral body volumes were derived. RESULTS: Based on noninferiority testing on qualitative scores, fast images without deep-learning reconstruction were inferior to standard images for most categories. However, deep-learning reconstruction improved the average scores, and noninferiority was observed over 24 out of 45 comparisons (all with sagittal T2-weighted images while 4/5 comparisons with sagittal T1-weighted and axial T2-weighted images). Interobserver variability increased with 50 and 75% noise reduction factors. Deep-learning reconstructed fast images with 50% and 75% noise reduction factors had comparable disc heights and vertebral body volumes to standard images (r2≥ 0.86 for disc heights and r2≥ 0.98 for vertebral body volumes). CONCLUSIONS: This study demonstrated that deep-learning-reconstructed fast-acquisition images have the potential to provide noninferior image quality and comparable quantitative assessment to standard clinical images.

Purpose: The aim was to evaluate the efficacy of ultrasound‐guided erector spinae plane (ESP) block and compare with the conventional physical therapy in chronic low back pain (LBP). Materials and Methods: This prospective case‐controlled study included patients with chronic LBP. Their clinical and demographic data were obtained, and they were divided into two groups for conventional physical therapy and ESP blocks. Prior to treatment, on the first day, the second week, and the third month, the Oswestry Disability Index (ODI) and visual analog scale (VAS) pain score were evaluated. Results: The study included 43 patients, 21 in the ESP block group and 22 in the conventional physical therapy group. The VAS in movement was higher in the ESP block group at baseline (p = 0.047). On the first day after the treatments, the ESP block group showed lower resting (p < 0.001) and movement (p = 0.001) VAS values than the conventional physical therapy group. At the end of 3 months, both groups had improved VAS and ODI scores (all p < 0.001). Conclusion: US‐guided ESP block might be considered a successful, safe, and technically simple alternative treatment in patients with chronic LBP to control pain and reduce the cost of physical therapy and lost workdays. [ABSTRACT FROM AUTHOR]

Lower back pain (LBP) is a musculoskeletal condition that affects millions of people worldwide and significantly limits their mobility and daily activities. Appropriate ergonomics and exercise are crucial preventive measures that play a vital role in managing and reducing the risk of LBP. Individuals with LBP often exhibit spinal anomalies, which can serve as valuable indicators for early diagnosis. We propose an advanced machine learning methodology for LBP detection that incorporates data balancing and bootstrapping techniques. Leveraging the features associated with spinal anomalies, our method offers a promising approach for the early detection of LBP. Our study utilizes a standard dataset comprising 310 patient records, including spinal anomaly features. We propose an ensemble method called the random forest gradient boosting XGBoost Ensemble (RGXE), which integrates the combined power of the random forest, gradient boosting, and XGBoost methods for LBP detection. Experimental results demonstrate that the proposed ensemble method, RGXE Voting, outperforms state-of-the-art methods, achieving a high accuracy of 0.99. We fine-tuned each method and validated its performance using k-fold cross-validation in addition to determining the computational complexity of the methods. This innovative research holds significant potential to revolutionize the early detection of LBP, thereby improving the quality of life. [ABSTRACT FROM AUTHOR]

Introduction and purpose Non-specific and specific lower back pain syndrome is one of the leading causes of musculoskeletal disability and affects more than half of the population worldwide. The aim of this paper is to confront the problem of lumbar pain, possible diagnostic options, conservative and surgical opportunities with long term satisfactory rate. State of knowledge The paper reviews literature on lower back pain syndrome, sciatica, radiculopathy and lumbar disc herniation in regards to detection of the problem, classifying it and possible methods of resolvent. The WHO defines lower back pain as one of the leading causes of musculoskeletal dysfunction and it focuses on reducing the occurrence by programs like WHO Rehabilitation 2030 Initiative, UN Decade of Healthy Ageing and others. The paper also focuses on nonsurgical options of treatment. Material and method A review of the literature available in the "PubMed" and Google Schoolar was conducted. We focused on differential diagnosis depending on clinical presentation and possible treatment methods depending on symptoms, pathogenesis of the disorder and available procedures. Summary Our review managed to present the current state of development, possible differential diagnosis, prevalence of neural compressions, sciatica and radiculopathy in different diagnostic options. By receiving multiple studies we confront varied opinions of specialists regarding the approach to lower back pain syndrome and favorable forms of care. Additionally we came to the conclusion that the difference of patients' long term satisfactory rate in regards to nonoperative and operative treatment is not significant, and flattens over the years. [ABSTRACT FROM AUTHOR]

BACKGROUND: Rowing-related low back disorders may occur from inconsistent technique, high trunk flexion and training volumes, overactivation of paraspinal muscles, and fatigue. OBJECTIVE: To examine if kinesiology tape (KT) affixed to the trunk dorsum affects muscular co-activation and neuromuscular control to limit dangerous rowing movements and associated injuries. METHODS: Participants (n = 18) completed two 2000 m rowing trials under BASELINE and KT conditions. KT was applied to the skin superficial to the paraspinals bilaterally with 60% pre-strain. Participants were instructed to minimize any sensation of tension. Whole body kinematics were obtained using inertial measurement units (IMUs), and surface electromyograms (EMGs) were recorded from trunk and lower extremity. Changes in joint range-of-motion (ROM) and co-activation indices (CAIs) were analyzed for shoulder, lumbar, hip, and knee. RESULTS: Responding participants (n = 5) were identified by reduced maximum lumbar flexion during the KT condition. As expected, significant differences occurred in maximum and minimum lumbar flexion/extension between responders and non-responders to KT. Additionally, there was significant reduction in mean trunk muscle co-activation in both those who did and did not respond to KT through reductions in maximum lumbar flexion. CONCLUSION: KT can be an effective at reducing mean trunk co-activation during a rowing trial in the flexed catch position. Variable responses suggest that further work is necessary to optimize the efficacy of sensory cues derived from KT during rowing movements. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Spinal subdural hematoma is uncommon but may become more prevalent with increasing anticoagulant use. Early diagnosis from symptoms like lower back pain and leg paralysis is crucial for timely intervention. [ABSTRACT FROM AUTHOR]

OBJECTIVE: We applied natural language processing and inference methods to extract social determinants of health (SDoH) information from clinical notes of patients with chronic low back pain (cLBP) to enhance future analyses of the associations between SDoH disparities and cLBP outcomes. MATERIALS AND METHODS: Clinical notes for patients with cLBP were annotated for 7 SDoH domains, as well as depression, anxiety, and pain scores, resulting in 626 notes with at least one annotated entity for 364 patients. We used a 2-tier taxonomy with these 10 first-level classes (domains) and 52 second-level classes. We developed and validated named entity recognition (NER) systems based on both rule-based and machine learning approaches and validated an entailment model. RESULTS: Annotators achieved a high interrater agreement (Cohens kappa of 95.3% at document level). A rule-based system (cTAKES), RoBERTa NER, and a hybrid model (combining rules and logistic regression) achieved performance of F1 = 47.1%, 84.4%, and 80.3%, respectively, for first-level classes. DISCUSSION: While the hybrid model had a lower F1 performance, it matched or outperformed RoBERTa NER model in terms of recall and had lower computational requirements. Applying an untuned RoBERTa entailment model, we detected many challenging wordings missed by NER systems. Still, the entailment model may be sensitive to hypothesis wording. CONCLUSION: This study developed a corpus of annotated clinical notes covering a broad spectrum of SDoH classes. This corpus provides a basis for training machine learning models and serves as a benchmark for predictive models for NER for SDoH and knowledge extraction from clinical texts.

Back pain is the single leading cause of disability worldwide. Despite the prevalence and morbidity of lower back pain, we still lack a gold-standard treatment that restores the physiological function of degenerated intervertebral discs. Recently, stem cells have emerged as a promising strategy for regenerative therapy for degenerative disc disease. In this study, we review the etiology, pathogenesis, and developing treatment strategies for disc degeneration in low back pain with a focus on regenerative stem cell therapies. A systematic search of PubMed/MEDLINE/Embase/Clinical Trials.gov databases was conducted for all human subject abstracts or studies. There was a total of 10 abstracts and 11 clinical studies (1 RCT) that met the inclusion criteria. The molecular mechanism, approach, and progress of the different stem cell strategies in all studies are discussed, including allogenic bone marrow, allogenic discogenic cells, autologous bone marrow, adipose mesenchymal stem cells (MSCs), human umbilical cord MSC, adult juvenile chondrocytes, autologous disc derived chondrocytes, and withdrawn studies. Clinical success with animal model studies is promising; however, the clinical outcomes of stem cell regenerative therapy remain poorly understood. In this systematic review, we found no evidence to support its use in humans. Further studies on efficacy, safety, and optimal patient selection will establish whether this becomes a viable, non-invasive therapeutic option for back pain.

BackgroundThere is an urgent need to confirm biomarkers reflecting the pathogenesis and targeted drugs of lower back pain or/and sciatica in clinical practice. This study aimed to conduct a two sample bidirectional Mendelian randomization (MR) analysis to explore the causal link between 486 serum metabolites and lower back pain or/and sciatica.MethodsAll data come from two public shared databases of European ancestry and single nucleotide polymorphisms (SNPs) for lower back pain or/and sciatica acted as instrumental variables. The traditional inverse variance weighting (IVW) method, weighted-median method, MR-Egger methodand other methods were used to estimate causality. The horizontal pleiotropy, heterogeneities were also verified through the MR-Egger intercept test, Cochran's Q test, MR-PRESSO test and the leave-one-out sensitivity analysis. Reverse MR analysis was employed to evaluate the direct impact of metabolites on lower back pain or/and sciatica. Additionally, we conducted the colocalization analysis to reflect the causality deeply. Furthermore, metabolic pathway analysis was performed.Results28 metabolites (18 known metabolites, 1 identified metabolites and 9 unknown metabolites) relevant to the risk of sciatica or/and lower back pain after using genetic variants as probes at PIVW

Xinyong Chen,1,2,&ast; Zhe Chen,3,&ast; Gongchang Ma,2 Jianjun Sha,2 Shan Zhao,2 Zuoqing Liu,2 Nong Chen,2 Huilin Yang1 1Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, 215000, People’s Republic of China; 2Department of Orthopedics, Qingpu Branch of Zhongshan Hospital Affiliated to Fudan University, Shanghai, 200025, People’s Republic of China; 3Department of Orthopedics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Nong Chen, Department of Orthopedics, Qingpu Branch of Zhongshan Hospital Affiliated to Fudan University, Shanghai, 200025, People’s Republic of China, Email chennong1975@126.com Huilin Yang, Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, 215000, People’s Republic of China, Email orthdoctor@126.comBackground: Dorsal root ganglia (DRGs) contain sensory neurons that innervate intervertebral discs (IVDs) and may play a critical role in mediating low-back pain (LBP), but the potential pathophysiological mechanism needs to be clarified.Methods: A discogenic LBP model in rats was established by penetration of a lumbar IVD. The severity of LBP was evaluated through behavioral analysis, and the gene and protein expression levels of pro-algesic peptide substance P (SP) and calcitonin gene–related peptide (CGRP) in DRGs were quantified. The level of reactive oxygen species (ROS) in bilateral lumbar DRGs was also quantified using dihydroethidium staining. Subsequently, hydrogen peroxide solution or N-acetyl-L-cysteine was injected into DRGs to evaluate the change in LBP, and gene and protein expression levels of transient receptor potential vanilloid-1 (TRPV1) in DRGs were analyzed. Finally, an inhibitor or activator of TRPV1 was injected into DRGs to observe the change in LBP.Results: The rats had remarkable LBP after disc puncture, manifesting as mechanical and cold allodynia and increased expression of the pro-algesic peptides SP and CGRP in DRGs. Furthermore, there was significant overexpression of ROS in bilateral lumbar DRGs, while manipulation of the level of ROS in DRGs attenuated or aggravated LBP in rats. In addition, excessive ROS in DRGs stimulated upregulation of TRPV1 in DRGs. Finally, activation or inhibition of TRPV1 in DRGs resulted in a significant increase or decrease of discogenic LBP, respectively, suggesting that ROS-induced TRPV1 has a strong correlation with discogenic LBP.Conclusion: Increased ROS in DRGs play a primary pathological role in puncture-induced discogenic LBP, and excessive ROS–induced upregulation of TRPV1 in DRGs may be the underlying pathophysiological mechanism to cause nerve sensitization and discogenic LBP. Therapeutic targeting of ROS or TRPV1 in DRGs may provide a promising method for the treatment of discogenic LBP.Keywords: lower back pain, reactive oxygen species, dorsal root ganglion, transient receptor potential vanilloid-1, substance p, calcitonin gene related peptide, intervertebral disc

Background. Globally, the LBP prevalence among the general population varies from 15-45%. Work-related LBP is estimated to cause 818,000 disability-adjusted life years lost (DALYs) annually. Aim of study. To determine the prevalence and factors associated with LBP among Iraqi Healthcare workers. Methodology. This is a cross-sectional study that included 220 participants and was conducted at Baghdad during the period from 5/7/2023 to 25/11/2023. Lower back pain was assessed using an Arabic version of the Standardized Nordic Musculoskeletal Questionnaire (NMQ). Results. The life, annual, and weekly prevalence of LBP were 92.7%, 90.9%, and 58.2%, respectively. A statistically significant associated was detected between weekly prevalence of LBP and each of female gender, long working hours, BMI, and occupation. Conclusion. LBP is a highly prevalent condition among Iraqi HCWs and it caused considerable reduction to the quality of life and work performance. Risk factors for weekly prevalence were female gender, longer working hours, obesity, and working as a dentist.

Lumbar facet interventions, including facet joint injections, medial nerve blocks, and radiofrequency ablation (RFA), are prevalent treatments for low back pain (LBP). Despite their widespread use, debates persist regarding various aspects of these procedures. The 2024 Consensus Working Group on Lumbar Facet Interventions, composed of practicing pain physicians from both China and the United States, conducted an extensive review of the literature on the use of lumbar facet interventions in chronic pain management. Following the U.S. Preventive Services Task Force grading guidelines, this consensus provides an evidence-based, patient-centered guideline tailored for pain physicians at all expertise levels for the management of chronic lower spinal pain. The guideline offers detailed recommendations on the identification of facetogenic pain, criteria for patient selection, the application of lumbar facet blocks and RFA techniques, and strategies for the prevention and management of intervention-related complications.

Abstract Introduction Persistent low back pain (LBP) is the leading cause of disability worldwide, and therapeutic exercise is recommended as a first-line treatment in international guidelines. The effects of exercise on clinical outcomes of pain and physical function are small to moderate, despite broader impacts on cardiovascular systems, biological health, mood, and emotional well-being. Therapeutic exercise prescription is defined as exercise that is prescribed by a clinician for a health-related treatment. It is unknown how therapeutic exercise prescription creates effects on outcomes of importance. Realist reviews explore how underlying mechanisms (M) may be active in the context (C) of certain situations, settings, or populations to create an intended or unintended outcome (O). Our objective is to explore and understand the mechanisms by which therapeutic exercise prescription changes outcomes for people with persistent LBP. Methods We will develop initial programme theories based on preliminary data from a previous systematic review and consensus workshop. These theories will be modified with input from a steering group (experts), a stakeholder group (people with lived experience of exercise for persistent LBP and clinicians), and a scoping search of the published literature. An information specialist will design and undertake an iterative search strategy. These will be used to create CMO configurations, which will be refined and tested using the literature. The realist review will be reported following RAMESES guidance. Discussion Realist reviews are uncommon in LBP research to date, yet those offer an opportunity to contrast with traditional methods of randomised controlled trials and systematic reviews and provide additional information regarding the contexts and mechanisms that may trigger certain outcomes. This can aid our understanding of the contextual features that may influence exercise prescription, such as for whom they are most effective, in what setting, how they are implemented and why. This realist synthesis will enhance our understanding of therapeutic exercise prescription to improve adherence and engagement and ultimately will provide clinically relevant recommendations regarding exercise prescription for those with persistent LBP. Systematic review registration The review has been registered with PROSPERO (CRD42017072023).

Introduction: The lumbar erector spinae plane block is one of the interventional procedures for chronic low back pain. This study aimed to compare the efficacy of lumbar erector spinae plane block for chronic axial low back pain due to disc protrusion/bulging in geriatric and younger patients and to evaluate clinical, demographic, and radiological characteristics that may be associated with treatment success. Materials and Method: The clinical and demographic data of patients who underwent ultrasound-guided lumbar erector spinae plane block for chronic axial low back pain between November 2022 and July 2023 were retrospectively evaluated. Patients were divided into two groups, =65 and <65 years of age, and treatment efficacy at the third month after the procedure was evaluated and compared. Results: A total of 147 patients (75 patients aged <65 years and 72 patients aged =65 years) were included in the analysis, and a successful treatment response (at least 50% pain relief) was achieved in 44.4% of geriatric patients and 62.6% of younger patients (p=0.027). In addition BMI, comorbidity, opioid use, and lumbar paraspinal fatty infiltration were significantly higher in geriatric patients than in younger patients (p<0.05). Conclusion: The results of this study demonstrate that lumbar erector spinae plane block for chronic axial low back pain provides significantly less pain relief in geriatric patients than in younger patients at three-month follow-up. [ABSTRACT FROM AUTHOR]

Given there are no known studies which have examined multiple lower extremity muscles between different ankle positions during bridging activities, the objective was to assess how employing two different ankle positions (PF versus DF) while performing five common bridging exercises (three bipedal and two unipedal) used in rehabilitation and athletic performance affect core and select lower extremity muscle EMG recruitment. Twenty healthy subjects performed a 5 s isometric hold during five two- and one-leg bridge exercises: (1) on right leg with left knee to chest (1LB-LFlex); (2) on right leg with left knee extended (1LB-LExt); (3) standard two-leg bridge (2LB); (4) two-leg bridge with resistance band around knees (2LB-ABD); and (5) two-leg bridge with ball between knees (2LB-ADD). Surface electromyographic (EMG) data were collected using a Noraxon Telemyo Direct Transmission System from fourteen muscles: (1) three superficial quadriceps (VM, VL, and RF); (2) three hip abductors (TFL, GMED, and GMAX); (3) medial hamstrings (ST) and lateral hamstrings (BF); (4) hip adductors (ADD); (5) erector spinae (ES); (6) latissimus dorsi (LATS); (7) upper rectus abdominis (RA); and (8) external oblique (EO) and internal oblique (IO). EMG data were normalized by maximum voluntary isometric contractions (MVICs). A paired t-test (p < 0.01) was used to assess differences in normalized mean EMG activities between DF and PF for each exercise. EMG activities were significantly greater in DF than PF for the (a) VM, VL, and RF during 1LB-LFlex; (b) ADD during 1LB-LFlex, 1LB-LExt; (c) EO during 1LB-LFlex; and (d) IO during 1LB-LFex. In contrast, EMG activities were significantly greater in PF than DF for ST and BF during all five bridge exercises. Bridging with PF (feet flat) was most effective in recruiting the hamstrings, while bridging with DF (feet up) was most effective in recruiting the quadriceps, hip adductors, and internal and external obliques. [ABSTRACT FROM AUTHOR]

To explore the main risk factors for the occurrence of low back pain (LBP) and provide a theoretical basis for future prevention and intervention of LBP. Methods Using stratified cluster sampling, LBP patients treated in 11 hospitals nationwide were selected as the case group (n = 394), and patients with other diseases or healthy individuals from the same hospitals were selected as the control group (n = 413) from December 2021 to December 2022. Data on general personal information, occupational factors, lifestyle, and socio -psychological factors were collected through electronic questionnaires. R-language statistical software was used to analyze the data. Multifactorial logistic regression analysis was employed to explore the influencing factors of LBP, and multiplicative and additive interaction models were used to analyze the interaction effects of occupational and lifestyle factors. Results The average age of the case group was (47.65 ± 11.24) years; the control group's average age was (46.54 ± 11.31) years. Multifactorial logistic regression analysis showed that compared to those who were underweight, did not engage in repetitive work, did not use mobile phones during commuting, and were dissatisfied with their salary, those who were overweight or obese, engaged in repetitive work, used mobile phones during commuting, and were satisfied with their salary had an increased risk of LBP ranging from 1.759 to 3.713 times (P < 0.05). Compared to those with an educational level of primary school or below and administrative personnel, those with higher educational levels and professional technicians, office workers, military personnel, and equipment operators had a lower risk of LBP ranging from 0.144 to 0.571 times (P < 0.05). Interaction analysis showed a multiplicative interaction between repetitive work and mobile phone use during commuting (OR = 3.743, 95%CI: 2.181 - 6.424). Conclusions The occurrence of LBP was related to multiple individual, occupational, and lifestyle factors, and there may be a cumulative effect of work and lifestyle factors on the occurrence of LBP. Employers should take reasonable preventive measures to reduce the risk of LBP and ensure the occupational health of workers. [ABSTRACT FROM AUTHOR]

Lower back pain (LBP) describes pain of indeterminate duration between the lower edge of the ribs and the buttocks. LBP hinders movement, quality of life, and mental well-being, and limits work activities and engagement with family and friends. LBP represents a public health problem, and most workers are expected to experience LBP symptoms throughout their working lives. The study's main objective was to characterize LBP in the hospitality population of the province of León, Spain, determining the risk factors. A pilot study with a cross-sectional observational design was developed following the guidelines of Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) for 150 Spanish hotel workers. Sociodemographic and lifestyle, occupational, and clinical data related to LBP were obtained through surveys. The annual prevalence of LBP in this study was 87.1% which was higher in women. A significant relationship (p < 0.05) was obtained between sex, income, smoking, sleep quality, and all labor variables with LBP. In addition, the Fear Avoidance Beliefs Questionnaire (FABQ) results revealed that 49% of the participants had a score > 14. Also, 83.3% of patients with >6 annual LBP crises suffered from sciatica. Once the results were known, preventive intervention would be needed to reduce these main risk factors for LBP for hospitality workers. [ABSTRACT FROM AUTHOR]

Introduction: Persistent low back pain (LBP) is the leading cause of disability worldwide, and therapeutic exercise is recommended as a first-line treatment in international guidelines. The effects of exercise on clinical outcomes of pain and physical function are small to moderate, despite broader impacts on cardiovascular systems, biological health, mood, and emotional well-being. Therapeutic exercise prescription is defined as exercise that is prescribed by a clinician for a health-related treatment. It is unknown how therapeutic exercise prescription creates effects on outcomes of importance. Realist reviews explore how underlying mechanisms (M) may be active in the context (C) of certain situations, settings, or populations to create an intended or unintended outcome (O). Our objective is to explore and understand the mechanisms by which therapeutic exercise prescription changes outcomes for people with persistent LBP. Methods: We will develop initial programme theories based on preliminary data from a previous systematic review and consensus workshop. These theories will be modified with input from a steering group (experts), a stakeholder group (people with lived experience of exercise for persistent LBP and clinicians), and a scoping search of the published literature. An information specialist will design and undertake an iterative search strategy. These will be used to create CMO configurations, which will be refined and tested using the literature. The realist review will be reported following RAMESES guidance. Discussion: Realist reviews are uncommon in LBP research to date, yet those offer an opportunity to contrast with traditional methods of randomised controlled trials and systematic reviews and provide additional information regarding the contexts and mechanisms that may trigger certain outcomes. This can aid our understanding of the contextual features that may influence exercise prescription, such as for whom they are most effective, in what setting, how they are implemented and why. This realist synthesis will enhance our understanding of therapeutic exercise prescription to improve adherence and engagement and ultimately will provide clinically relevant recommendations regarding exercise prescription for those with persistent LBP. Systematic review registration: The review has been registered with PROSPERO (CRD42017072023). [ABSTRACT FROM AUTHOR]

Abdominal aortic calcification (AAC) is hypothesized to lead to ischemic pain of the lower back. This retrospective study aims to identify the relationship between AAC and lower back pain (LBP) in patients with degenerative lumbar spondylolisthesis. Lower back pain was assessed preoperatively and 2 years after surgery using the numeric analogue scale. Abdominal aortic calcification was assessed according to the Kauppila classification and was grouped into no, moderate, and severe. A multivariable regression, adjusted for age, sex, body mass index, hypertension, and smoking status, was used to assess the association between AAC and preoperative/postoperative LBP as well as change in LBP after surgery. A total of 262 patients were included in the final analysis. The multivariable logistic regression demonstrated an increased odds ratio (OR) for preoperative LBP$4 numeric analogue scale (OR5 9.49, 95% confidence interval [CI]: 2.71-40.59, P,0.001) and postoperative LBP$4 (OR51.72, 95% CI: 0.92-3.21, P50.008) in patients with severe AAC compared with patients with no AAC. Both moderate and severe AAC were associated with reduced improvement in LBP after surgery (moderate AAC: OR50.44, 95% CI: 0.22-0.85, P50.016; severe AAC: OR50.41, 95% CI: 0.2-0.82, P 5 0.012). This study demonstrates an independent association between AAC and LBP and reduced improvement after surgery. Evaluation of AAC could play a role in patient education and might be considered part of the differential diagnosis for LBP, although further prospective studies are needed. [ABSTRACT FROM AUTHOR]

Introduction: Chronic low back pain presents a significant challenge in healthcare, affecting numerous individuals globally. Despite the availability of various treatment options, optimal management remains elusive. This study aims to explore different treatment strategies for chronic low back pain, including exercise, pharmacological interventions, and emerging techniques in neural management. Aim of the Study: The aim of this study is to provide healthcare professionals with comprehensive insights into managing chronic low back pain. By examining the effectiveness and potential side effects of different treatment modalities, the study seeks to enhance clinicians' understanding and decision-making in pain management. Brief Summary: Through a thorough review of literature and evidence-based analysis, this study discusses the role of exercise, medications, and neural management techniques in managing chronic low back pain. It evaluates the efficacy, safety, and potential benefits of each approach, offering valuable guidance for healthcare professionals in optimizing patient care. Conclusion: This study underscores the importance of adopting a multidisciplinary approach to managing chronic low back pain. By incorporating a range of treatment modalities, including exercise, pharmacological interventions, and emerging techniques, healthcare professionals can deliver personalized and effective care to patients. Enhanced knowledge and understanding of these strategies empower clinicians to address the complex challenges associated with chronic low back pain and improve patient outcomes.