Association of Back Pain with All-Cause and Cause-Specific Mortality Among Older Women: a Cohort Study.

BACKGROUND: The impact of back pain on disability in older women is well-understood, but the influence of back pain on mortality is unclear. OBJECTIVE: To examine whether back pain was associated with all-cause and cause-specific mortality in older women and mediation of this association by disability. DESIGN: Prospective cohort study. SETTING: The Study of Osteoporotic Fractures. PARTICIPANTS: Women aged 65 or older. MEASUREMENT: Our primary outcome, time to death, was assessed using all-cause and cause-specific adjusted Cox models. We used a four-category back pain exposure (no back pain, non-persistent, infrequent persistent, or frequent persistent back pain) that combined back pain frequency and persistence across baseline (1986-1988) and first follow-up (1989-1990) interviews. Disability measures (limitations of instrumental activities of daily living [IADL], slow chair stand time, and slow walking speed) from 1991 were considered a priori potential mediators. RESULTS: Of 8321 women (mean age 71.5, SD = 5.1), 4975 (56%) died over a median follow-up of 14.1 years. A higher proportion of women with frequent persistent back pain died (65.8%) than those with no back pain (53.5%). In the fully adjusted model, women with frequent persistent back pain had higher hazard of all-cause (hazard ratio [HR] = 1.24 [95% CI, 1.11-1.39]), cardiovascular (HR = 1.34 [CI, 1.12-1.62]), and cancer (HR = 1.33, [CI 1.03-1.71]) mortality. No association with mortality was observed for other back pain categories. In mediation analyses, IADL limitations explained 47% of the effect of persistent frequent back pain on all-cause mortality, slow chair stand time, and walking speed, explained 27% and 24% (all significant, p < 0.001), respectively. LIMITATIONS: Only white women were included. CONCLUSION: Frequent persistent back pain was associated with increased mortality in older women. Much of this association was mediated by disability.

PNET spine: morbid and mortal, but ignored till late.

Spinal primitive neuroectodermal tumor (PNET) is rare. We present clinical, radiologic profile and treatment outcome of 15 spinal PNET patients from June 2003 to March 2010 treated with chemoradiotherapy. Median duration of backache was 6.5 months; all had features of myelopathy and/or radiculopathy; 5/15 (33.3%) patients were diagnosed initially as spinal tuberculosis. The event-free survival (EFS) was 24.73% at a median follow-up of 22 months. Complete functional recovery to treatment significantly predicted better EFS; 4 patients discontinued treatment because of poor functional recovery. It is important to recognize spinal PNET early to prevent permanent neurological damage, which in turn would improve compliance, quality of life, and perhaps EFS.

Spontaneous pyogenic spinal epidural abscess.

AIM: Spontaneous pyogenic spinal epidural abscess (SEA) is a rare condition but might be devastating and fatal. Traditional treatment is surgical decompression and antibiotics. A retrospective study was designed to assess the eff ect of clinical findings and treatment methods on the outcome. MATERIAL AND METHODS: 14 patients were reviewed (10 male, 4 female, mean age 59.14). Six dorsal, seven ventral and one dorsal with ventral SEA were observed. SEA found in thoracal (5), lumbar (4), cervical (3) regions. One patient showed both cervical and thoracal and one patient showed cervical, thoracal and lumbar involvement. All patients received minimum 3 weeks of I.V., followed by minimum 3 weeks of oral antibiotics. All patients complained of spinal pain. Ten patients presented with fever. Neurological deficit was observed in 9 cases. RESULTS: A total of 22 interventions was performed. Instrumentation was applied in 5 cases. Full recovery was achieved in 7 patients, significant improvement was observed in 5 patients. The neurological findings did not change in one patient. One mortality and one morbidity were observed. CONCLUSION: Spontaneous SEA is a rare disease but might result in catastrophic neurological deficits and fatal even with prompt treatment. Therefore, one should always keep SEA in mind if a patient presents with fever, vague and spinal pain.

[Surgical treatment and prognosis factors in spinal metastases of breast cancer]. / Chirurgische Behandlung und Prognosefaktoren von Wirbelsäulenmetastasen bei Mamma-Karzinom.

AIM: The aim of this study was the evaluation of surgical therapy results and prognosis factors in patients with spinal metastases of breast cancer. METHODS: 55 patients with spinal metastases of breast cancer who were treated surgically were retrospectively evaluated. In 11 patients the cervical, in 27 patients the thoracic and in 17 patients the lumbar spine was affected. RESULTS: Postoperatively, 45 patients (81.8 %) described a reduction in pain and 5 patients (50 %) reported a neurological improvement. Perioperative complications appeared in 27 patients (49.1 %), 2 patients died. For the entire group, the mean postoperative survival was 27.2 +/- 28.6 months and the median survival 16.2 months. In patients with solitary metastasis the univariate analysis did not show a significantly longer postoperative survival than in patients with additional visceral metastases (p = 0.0659), but patients with solitary metastasis showed a significantly longer survival than those with multiple osseous and/or visceral metastases (p = 0.0325). In the univariate analysis, the classification of the primary tumour, the duration of symptoms, the localisation of the metastases, the patient's age and the kind of surgical procedure (posterior stabilising instrumentation versus combined posterior-anterior treatment with intralesional resection of the affected vertebra and vertebral body replacement) did not show a significant influence on the postoperative survival. The multivariate analysis did not show a significant prognostic influence for the potentially prognostic factors, however, solitary and multiple metastasis showed the highest statistical influence for the prognosis (p = 0.1187), followed by the classification of the primary tumour (p = 0.1243). CONCLUSION: Pain reduction and neurological improvement can be reached by a stabilisation of the diseased spinal region. Patients with spinal metastases due to breast cancer showed a relatively long postoperative median and mean survival. Therefore, the preoperative evaluation of extent of the disease and the therapy concept should be individually adapted. The surgical procedure (posterior stabilising instrumentation versus combined posterior-anterior approach with vertebrectomy and vertebral body replacement) does not significantly influence the survival.