Occupation-based demographic, clinical, and psychological presentation of spine pain: A retrospective analysis of 71,727 patients from urban India.

BACKGROUND: Although many studies have investigated the physical and ergonomic risks of spine pain in specific occupation groups, the literature is lacking on occupation-based clinical and psychological presentation in patients with spine pain. OBJECTIVE: To analyze occupation-based variation in demographic, clinical, and psychological presentation in patients with spine pain. METHODS: This retrospective study analyzed the clinical data of 71727 patients with spine pain visiting a chain of spine rehabilitation clinics. Demographic and clinical variables such as gender, age, affected site, symptom duration, clinical symptoms and presentation, pain intensity, disability, and STarT Back Screening Tool (SBT) risk were compared between 9 occupational groups. RESULTS: The service and sales workers (44%) and students (43.5%) groups had the highest percentage of patients who presented with central spine pain; military personnel had the highest percentage of patients who presented with unilateral radicular pain (51.5%); and the retired or unemployed group had the highest percentage of patients who presented with severe myotomal loss (grade≤3) (6%). Homemakers had significantly higher pain intensity and disability (p < 0.001) and had the highest percentage of patients who presented with severe pain (47%), severe and crippled disability (59.5%), and medium to high risk (59%) with SBT when compared to other occupational groups. CONCLUSION: Patients with spine pain showed variation in demographic, clinical, and psychological presentation based on their occupation. The findings of this study can be the basis for identifying risk factors for spine pain and helping plan preventive and treatment measures based on their occupation.

Successful treatment of quadriparesis from radiation myelopathy with bevacizumab in a patient with metastatic breast cancer.

Radiation myelopathy (RM) is rare condition defined as injury to the spinal cord by ionising radiation. Due to improved survival in patients with advanced malignancies, there is a renewed interest in recognition and treatment of RM. There are very few reports on treatment of RM. A 64-year-old woman with metastatic oestrogen receptor, progesterone receptor weakly positive and human epidermal growth factor 2 negative breast, stereotactic radiosurgeries to brain metastases and a history of reradiation to the cervical spinal cord presented with neck pain, arm weakness, hyperreflexia and gait ataxia. RM was suspected and the patient was started on high dose corticosteroid therapy. However, the patient's condition deteriorated and she developed quadriparesis. A timely treatment with an antivascular endothelial growth factor antibody, bevacizumab reversed her neurological deficits and preserved her walking ability. Our case illustrates a prompt diagnosis and successful treatment of RM with bevacizumab.