Pregnancy-related low back pain in women in Turkey: Prevalence and risk factors

Objectives: To investigate the prevalence of pregnancy-related low back pain (PRLBP) in women in Turkey, identify the factors associated with PRLBP and predict the risk of PRLBP. Materials and methods: This cross-sectional study included a total of 1500 pregnant women admitted to a prenatal care clinic in a secondary care hospital in Turkey between August 2011 and September 2014. All participants were asked to complete a survey questionnaire. The pregnant women who reported recurrent or continuous pain in the lumbar spine or pelvis for more than 1 week were offered a clinical examination for PRLBP by the spine physiatrist. The main outcome measure was the presence of PRLBP. We collected data on sociodemographic factors, previous obstetric history, daily habits, history of LBP, and functional disability scores as assessed by the Oswestry Disability Index (ODI). Results: The mean age of the 1500 women was 26.5 +/- 5.5 years. The prevalence of PRLBP was 53.9%, mostly in the third trimester. Women with PRLBP in the third trimester were more disabled than those in the first and second trimesters (mean ODI 40.0 +/- 16.7 vs. 34.9 +/- 19.2 and 37.4 +/- 15.3, respectively). Risk factors of PRLBP were history of LBP, PRLBP, and menstruation-related LBP as well as no housework assistance (OR = 5.394, 95% CI: 3.128-9.300, P < 0.001; 3.692, 2.745-4.964, P < 0.001; 2.141, 1.563-2.932, P < 0.001; 1.300, 1.029-1.64, P = 0.028, respectively). Conclusion: This cross-sectional study is the largest study of PRLBP in the literature and showed that about 1 in 2 women have PRLBP in any stage of pregnancy. History of LBP related and unrelated to previous pregnancy and menstruation are strong risk factors for PRLBP. Receiving no housework assistance is another risk factor. (C) 2017 Elsevier Masson SAS. All rights reserved

Use of fluoroscopic-guided transsacral block for the treatment of iatrogenic post-injection sciatic neuropathy: Report of three cases

Post-injection sciatic neuropathy (PISN) from an inadvertent intramuscular injection in the gluteal region is a type of iatrogenic sciatic nerve injury. Patients with neuropathic pain following PISN frequently experience disability leading to restrictions in daily activities and pain, which may be resistant to conventional treatments and physiotherapy in some cases. To date, minimal invasive procedures for neuropathic pain have been performed with various medications at the site of lesion. Herein, we report three adult male cases with PISN-associated neuropathic pain who were resistant to conservative management and were treated with fluoroscopy-guided transsacral block

Do informative leaflets affect pre-procedural anxiety and immediate pain after transforaminal epidural steroid injections? A prospective randomized controlled study

Objectives: The aim of this study was to evaluate the effect of an informative leaflet provided to patients before a lumbar transforaminal epidural steroid injection (TFESI) on the level of immediate pain and pre-procedural anxiety. Methods: A total of 166 patients were randomized into 2 groups: a group that received an explanatory leaflet (LG) and a control group. Both groups were given verbal information, while the LG was also given an illustrated leaflet describing the injection process. All of the patients were evaluated with the Hospital Anxiety and Depression Scale before the TFESI. The numerical rating scale and the Oswestry Disability Index (ODI) were used to assess disability and pain before and after the TFESI. Major complications that occurred before and during the procedure were recorded and analyzed. Results: The patient characteristics were similar in both groups (age, body mass index, depression level, pre-procedural pain, and ODI). The anxiety level was also similar in both groups (p>0.05). When both groups were evaluated at the first hour after the procedure, the numerical rating scale level of pain intensity was also similar (p>0.05). No major complication was observed in either group. Conclusion: The detailed leaflet did not affect the patients' pre-procedural anxiety or acute post-procedural pain level. However, the importance of informed consent and comprehensive information should not be overlooked

The effect of spinopelvic parameters on transforaminal epidural steroid injection treatment success in lumbar disc herniation

Background Spinopelvic parameters (SPP) is closely associated with diseases such as lumbar disc herniation (LDH), disc degeneration and spondylolisthesis. Although there exist many known clinical and radiological factors affecting the success of the transforaminal epidural steroid injection (TFESI) treatment, the effect of SPP has not yet been investigated. This study aims to examine the effects of SPP on treatment success in patients who undergo TFESI because of lumbar disc herniation and to investigate the correlation among multifidus cross-sectional area (MFCSA). Methods This was a prospective, observational study. Patients with low back and/or leg pain, unilateral nerve root compression were applied TFESI. Outcome measures included the numerical rating scale (NRS), Oswestry Disability Index (ODI) and Beck Depression Inventory (BDI). The patients were evaluated at the first hour, third week and third month. The SPP and MFCSA measurements were made on direct radiographs and MRIs. Results A total of 58 patients, 24 women and 34 men, with an average age of 42.0 +/- 9.5 were included. NRS, ODI and BDI scores improved significantly up to three months follow-up (P < .001). Moderately positive correlations were found between leg NRS and PT/PI scores immediately after treatment (r: 0.307 and r: 0.334) and a weak positive correlation was found between BDI and PT at third week (r: 0.269). The MFCSA/vertebral sectional area (VSA) and MFCSA/total multifidus cross-sectional area (TMFCSA) of the affected side was found to be significantly low (P < .001). Conclusions Subjects with high PI and PT reported less improvement in leg pain immediately after treatment and patients with high PT had fewer BDI improvements. MFCSA had no correlations with SPPs in patients who underwent TFESI

Does obesity have an impact on the radiation exposure_x000D_ during lumbosacral transforaminal epidural steroid_x000D_ injections? Retrospective study

Aim: To find out whether obesity or injection level have an impact on the amount of radiation exposure during fluoroscopy-guidedlumbosacral transforaminal epidural steroid injections (TFESIs).Material and Methods: Patients aged 19-65 years who underwent lumbosacral transforaminal epidural steroid injection wereretrospectively reviewed. Eighty-three patients with a mean age of 42.7±13.2 (19-65) years with signs and symptoms of unilaterallumbar radicular pain due to single level disc herniation were included. Subjects were categorized as normal weighted (18.5≤bodymass index (BMI) ≤ 24.9), overweighed (25≤BMI0.05). The radiation dosages andprocedure durations between the two different injection levels (L5 and S1) were not found to be statistically significant (>0.05).Conclusion: Obesity is associated with increased radiation exposure independent of procedure duration and the injection level

Does facet tropism negatively affect the response to transforaminal epidural steroid injections? A prospective clinical study

ObjectiveTo examine the impact of the presence of facet tropism on the results of transforaminal epidural steroid injection for unilateral radicular pain induced by lumbar disc herniation.Materials and MethodsWe included 112 patients diagnosed with unilateral, single-level lumbar disc herniation-induced radicular pain. Injection was planned at relevant levels. The patients were assessed using the Numerical Rating Scale, the Modified Oswestry Disability Index, and the Beck Depression Inventory before the injection and at hour 1, week 3, and month 3 after the injection. Presence of facet tropism was assessed by measuring the facet angles in the L3-4, L4-5, and L5-S1 segments of lumbar MRI T2 sequence axial section.ResultsA significant decrease in the Numerical Rating Scale and an increase in the Modified Oswestry Disability Index scores were detected at all follow-ups in groups comprising 39 patients with and 61 without facet tropism (p<0.05). On comparison, improvement in clinical parameters at week 3 and month 3 in the group without facet tropism was greater (p<0.05). As treatment success is considered to be a 50% reduction in the Numerical Rating Scale scores, 55.2% of the patients attained treatment success at month 3. Further, although the treatment success rate in the group with facet tropism was 34.2%, it was 69% in that without facet tropism (p<0.05).ConclusionFacet tropism correlates with less success of transforaminal epidural steroid injection; therefore, facet tropism may be a worthwhile measurement in a discussion with patients of the benefits of the procedure

Proximal femur diaphysis osteoid osteoma mimicking lumbar radiculopathy

Osteoid osteoma is a benign bone tumor that commonly arises from the metaphyseal and diaphyseal regions of long bones. Pain is often the first symptom, and it can mimic many diseases. Herein, we report a 36-year-old male patient who presented with complaints of lower back pain radiating to the right extremity for a year. In the patient\"s history, physical therapy, platelet-rich plasma, pregabalin, and duloxetine were used, with the only benefit from indomethacin. An X-ray of the femur was requested, and the diagnosis of osteoid osteoma was confirmed by magnetic resonance imaging. Osteoid osteoma should be kept in mind as a differential diagnosis of persistent pain despite treatment

The influence of coccygeal dynamic patterns on ganglion impar block treatment results in chronic coccygodynia

Objective: Ganglion impar block (GIB) can be performed in patients with chronic coccygodynia who do not respond to conservative treatments. We investigated the effect of coccygeal dynamic patterns on the treatment outcome in patients with chronic coccygodynia treated with GIB. Materials and methods: We retrospectively analyzed the data for patients diagnosed with chronic coccygodynia who underwent GIB only once by a transsacrococcygeal method under fluoroscopy guidance in our Pain Medicine Clinic. Patients were assessed with standard and dynamic coccyx radiographs and classified according to coccygeal mobility. Pain scores were assessed with a numerical rating scale (NRS) before and after the intervention (at 1 hour and 4, 12 and 24 weeks). A 50% or more reduction in the NRS score was accepted as significant pain relief. Results: Of the 37 patients included in the study, 14 had normal coccyx (Group I) and 23 had immobile coccyx (Group II) based on the radiological evaluation. The NRS scores were significantly reduced in both groups on each follow-up visit but there was no significant difference between the two groups in terms of pre- and post-intervention NRS scores. Significant pain relief was achieved in 42.9% and 61.9% of patients in Group I and II at the last examination, respectively. Conclusion: GIB administered by transsacrococcygeal method in patients with chronic coccygodynia is a safe and alternative treatment approach with reduced pain scores and low complication rates. In patients with chronic coccygodynia, having a normal or immobile coccyx does not appear to affect treatment outcomes

Is fluoroscopy-guided percutaneous rupture of facet cyst an alternative to surgery? A case report

Lumbar intraspinal synovial cysts (LISCs) are rare cause of the lumbosacral radicular syndrome. Fluoroscopy-guided percutaneous cyst rupture (PCR) is an option in the treatment. This report introduces long-term symptom relief after fluoroscopy-guided PCR of LISC. A 73-year-old patient presented with low back pain radiating to right leg. L5 radiculopathy was suspected by physical examination; however, an intraspinal cystic mass was visualized through imaging studies. The patient reported immediate pain relief after fluoroscopy-guided PCR, which sustained for one year. In conclusion, fluoroscopy-guided PCR appears to be a safe and effective treatment option and should be considered before surgery in patients with LISCs