Analysis of musculoskeletal disorders-associated disability in Mexico from 1990 to 2021.

BACKGROUND: Musculoskeletal disorders (MSD) affect 1.71 billion people worldwide and are the leading cause of disability. OBJECTIVE: To analyze the years lived with disability (YLD) attributed to MSD in Mexico between 1990 and 2021. MATERIAL AND METHODS: With estimates from the Global Burden of Disease 2021 study, the YLDs due to MSD and their six categories were analyzed, including osteoarthritis, rheumatoid arthritis, gout, neck pain, low back pain, as well as other MSDs. Patterns and trends in the number, crude rate, and YLD age-standardized rate were evaluated at the national and state levels, as well as by age group and gender. RESULTS: MSDs were the main cause of YLDs in Mexico between 1990 and 2021, with an increase of 57.3%, going from 1,458.4 to 2,293.7 per 100,000 population. Low back pain (840.6 YLD) showed the highest rate in 2021, while osteoarthritis had the largest increase. MSDs increased with age and, and except for gout, affected women more often. CONCLUSIONS: From 1990 to 2021, MSDs were the main cause of YLDs in Mexico, with a higher impact on adults and women. MSDs can appear early in life, hence the need for continuous interventions in order to preserve quality of life.

ANTECEDENTES: Los trastornos musculoesqueléticos (TME) afectan a 1710 millones de personas en todo el mundo y es la principal causa de discapacidad. OBJETIVO: Analizar los años vividos con discapacidad (AVD) por TME en México entre 1990 y 2021. MATERIAL Y MÉTODOS: Con las estimaciones del estudio de la Carga Global de la Enfermedad 2021 se analizaron los AVD por TME y sus seis categorías: osteoartritis, artritis reumatoide, gota, dolor cervical, lumbalgia y otros TME. Se evaluaron patrones y tendencias del número, tasa cruda y tasa estandarizada por edad de los AVD a nivel nacional, estatal, por grupos de edad y sexo. RESULTADOS: Los TME constituyeron la principal causa de AVD en México entre 1990 y 2021, con un incremento de 57.3 %; pasaron de 1458.4 a 2293.7 por 100 000 habitantes. La lumbalgia (840.6 AVD) destacó con la mayor tasa en 2021 y la osteoartritis, con el mayor incremento. Los TME se incrementaron con la edad y, con excepción de la gota, afectaron más a las mujeres. CONCLUSIONES: De 1990 a 2021, los TME constituyeron la principal causa de AVD en México, con mayor impacto en adultos y mujeres. Los TME se evidencian desde edades tempranas, de ahí la necesidad de intervenciones continuas para preservar la calidad de vida.

[Clinical-demographic factors associated with fear-avoidance in subjects with non-specific chronic low back pain in Primary Care: secondary analysis of intervention study]. / Factores clínico-demográficos asociados al miedo-evitación en sujetos con lumbalgia crónica inespecífica en atención primaria: análisis secundario de estudio de intervención.

OBJECTIVE: To describe some sociodemographics and clinical characteristics of subjects with Non-specific Chronic Low Back Pain (NCLBP) in Primary Care, as well as to investigate their association with Fear-Avoidance (FA). DESIGN: Cross-sectional. Secondary analysis of an intervention study. LOCATION: Basic Health Areas in Costa del Sol Health District (Málaga, Spain). PARTICIPANTS: An analysis was performed on 147 subjects with NCLBP from a previous intervention study database in Primary Care Physiotherapy (PCP). Characteristics: age 18-65; understanding of the Spanish language; absence of cognitive disorders, fibromyalgia or dorsolumbar surgery, and to be able to perform physical exercise. MAIN MEASUREMENTS: The main variable was FA level (FABQ and the FABQ-PA and FABQ-W) sub-scales. Clinical variables included: pain (NRPS-11), disability (RMQ), evolution, previous treatments and diagnostic imaging. The sociodemographic variables included: gender, age, educational level, and employment status. RESULTS: Just over half (51.7%) of the subjects had high FA on the FABQ-PA sub-scale. Sick leave (SL) [ß=24.45 (P=.009*); ß=13.03 (P=.016*); ß=14.04 (P=.011*) for FABQ, FABQ-PA and FABQ-W, respectively]; primary studies level [ß=15.09 (P=.01*); ß=9.73 (P=.01*) for FABQ and FABQ-PA], and disability [ß=1.45 (P<.001); ß=0.61 (P<.001); ß=0.68 (P<.001) for FABQ, FABQ-PA and FABQ-W, respectively] were associated with FA when they were modeled by multivariate regression. CONCLUSIONS: Some sociodemographic and clinical features of the NCLBP population are presented. Imaging tests (81.63%) and previous passive treatments (55.78%) could reflect problems of adherence to recommendations of CPGs. Sick leave, primary studies level, and disability were associated with FA. The findings should be interpreted in the light of possible limitations. Some suggestions for clinical practice are provided.

[Non-randomised trial of an educational intervention based on cognitive-behavioural principles for patients with chronic low back pain attended in Primary Care Physiotherapy]. / Ensayo no aleatorizado de una intervención educativa basada en principios cognitivo-conductuales para pacientes con lumbalgia crónica inespecífica atendidos en fisioterapia de atención primaria.

OBJECTIVE: To assess the influence of an educational intervention in reducing «fear-avoidance¼ (FA) and «pain catastrophising¼ (CAT) in a population with unspecific chronic low back pain (UCLBP), attending physiotherapy in Primary Health Care. A pragmatic quasi-experimental study was conducted in Health Centres of a Costa del Sol Health District. DESIGN: Quasi-experimental study. SETTING: Primary Health Care physiotherapy Back Schools in Health Centres of a Costa del Sol Health District. PARTICIPANTS: The selection criteria were: UCLBP; 18-65years; understanding of the Spanish language; absence of parallel educational interventions; absence of red flags; not showing cognitive impairment or fibromyalgia; absence of thoracic-lumbar surgery, and exercise tolerance. INTERVENTIONS: The control group received the usual Back Schools program. The experimental group also received a written document for home reading, plus the subsequent sharing, clarifying doubts, and beliefs and goals restructuring during the development of the sessions. Both interventions lasted about 280minutes (7 sessions×40min). RESULTS: The main variables included FA and CAT. Pain and disability were also assessed. Some «demographic¼ and «related disorder¼ variables were considered in the analysis. Statistically significant differences were observed in the experimental group versus control, in the variation of FA -14 (-25.5; 0) vs -4 (-13; 0) (P=.009), and CAT -9 (-18; -4) vs -4,5 (-8.25; 0) (P=.000), were observed. Also differences in disability (P=.046), but not in pain (P=.280). CONCLUSIONS: These results should be considered in light of possible limits imposed by the study. Its pragmatic nature would allow a potential transfer to usual care.

Degenerative disease of the lumbar spine. / Patología degenerativa en la columna lumbar.

In the last 25 years, scientific research has brought about drastic changes in the concept of low back pain and its management. Most imaging findings, including degenerative changes, reflect anatomic peculiarities or the normal aging process and turn out to be clinically irrelevant; imaging tests have proven useful only when systemic disease is suspected or when surgery is indicated for persistent spinal cord or nerve root compression. The radiologic report should indicate the key points of nerve compression, bypassing inconsequential findings. Many treatments have proven inefficacious, and some have proven counterproductive, but they continue to be prescribed because patients want them and there are financial incentives for doing them. Following the guidelines that have proven effective for clinical management improves clinical outcomes, reduces iatrogenic complications, and decreases unjustified and wasteful healthcare expenditures.

[Design of an educational tool for Primary Care patients with chronic non-specific low back pain]. / Diseño de un instrumento educativo para pacientes con lumbalgia crónica inespecífica atendidos en Atención Primaria.

Current scientific evidence on the management of chronic non-specific low back pain highlights the benefits of physical exercise. This goal is frequently undermined due to lack of education of the subjects on the multifactorial, benign, and non-specific nature of low back pain, which can lead to a chronic disease with genuine psychosocial risk factors. Its influence may not only interfere with individual decision to adopt more adaptive coping behaviors, but also with the endogenous mechanisms of pain neuromodulation. Thus, the educational strategies and control of these factors have become important objectives to be incorporated into the management of the disorder and research guidelines. This paper presents the theoretical models and the scientific basis on which it has based the design of an educational tool for patients with chronic non-specific low back pain treated in Primary Care physiotherapy. Structure, content and objectives are also presented.

A modified Delphi survey on the signs and symptoms of low back pain: indicators for an interventional management approach.

BACKGROUND: Low back pain (LBP) symptoms and signs are nonspecific. If required, diagnostic blocks may find the source of pain, but indicators of suspect diagnosis must be defined to identify anatomical targets. OBJECTIVE: To reach a consensus from an expert panel on the indicators for the most common causes of LBP. MATERIAL AND METHODS: A 3-round (2 telematic and 1 face-to-face) modified Delphi survey with a questionnaire on 78 evidence-based indicators of 7 LBP etiologies was completed by 23 experts. RESULTS: 98.7% of the questionnaire was consensuated. The most accepted indicators were for zygapophysial joint pain, painful ipsilateral paravertebral palpation, worsening with trunk extension, paravertebral musculature spasm on the affected articulation, and referred pain above the knee, without radicular pattern. For sacroiliac joint pain, unilateral pain when seating, with at least 3 described provoking tests: Approximation; gapping; Patrick's; Gaenslen's; thigh thrust; Fortin finger; and Gillet's tests. For discogenic pain, midline pain that may be provoked by pressure on the spinal processes at the affected level; for quadratus lumborum muscle, painful palpation on both the L1 level paravertebral region, referred to iliac crest, and the iliac crest, referred to greater trochanter. For iliopsoas muscle, pain elicited by thigh flexion, referred to buttock, inguinal region, and anterior thigh. For pyramidal muscle, pain while sitting on the affected side and positive Freiberg's test. For radicular pain, paresthesias and positive Lassègue's test at 60°. CONCLUSION: Seventy-seven diagnostic suspect indicators of LBP conditions were consensuated. These may facilitate conservative or interventional pain management decision-making.

[Translated article] Frequency of use of discography findings for the diagnosis of low back pain of discogenic origin. Systematic review of the literature.

INTRODUCTION: There are different techniques and interpretations of discography findings to determine it positive for the diagnosis of discogenic pain. This study aims to evaluate the frequency of use of discography findings for the diagnosis of low back pain of discogenic origin. MATERIAL AND METHODS: A systematic review of the literature of the last 17 years was performed in MEDLINE and BIREME. A total of 625 articles were identified, 555 were excluded for duplicates, title and abstract. We obtained 70 full texts of which 36 were included in the analysis after excluding 34 for not meeting the inclusion criteria. RESULTS: Among the criteria in discography to determine it as positive, 8 studies used only the pain response to the procedure, 28 studies used more than one criterion during discography to consider it as positive, the evaluation of at least one adjacent intervertebral disc with a negative result was necessary in 26 studies to consider a discography as positive. Five studies formally expressed the use of the technique described by SIS/IASP to determine a discography as positive. CONCLUSIONS: Pain in response to contrast medium injection, assessed with the visual analogue pain scale ≥6, was the most used criterion in the studies included in this review. Although there are already criteria to determine a discography as positive, the use of different techniques and interpretations of discography findings to determine a positive discography for low back pain of discogenic origin persists.

Psychosocial factors associated with disability in patients with non-specific chronic low back pain: A cross-sectional study.

INTRODUCTION AND OBJECTIVES: Chronic low back pain is the main cause of disability worldwide, generating high costs for society. To evaluate the prevalence of disability in patients with non-specific chronic low back pain and associated factors, including the impacts of low back pain and psychosocial factors linked to kinesiophobia, catastrophism, anxiety, and depression. PATIENTS: A cross-sectional study was carried out with 108 adult individuals who had non-specific chronic low back pain. The patients answered previously validated questionnaires, namely the Brief Pain Inventory, the Roland-Morris Disability Questionnaire, the Pain Catastrophizing Scale, the Tampa Kinesiophobia Scale, and the Hospital Anxiety and Depression Scale. RESULTS: The prevalence of disability observed was 65.7%, with the mean disability score being 15.7±5.3 points in the Roland-Morris Disability Questionnaire. Although pain intensity and other domains of the Brief Pain Inventory, like anxiety, depression, and severe kinesiophobia were significant in the bivariate analyses, they were not associated with disability in the multivariate analysis. Only catastrophic thoughts (prevalence ratio [PR]=1.19; 95% confidence interval [CI]: 1.07-1.32), and the 'walking' domain (PR=1.08; 95% CI: 1.03-1.14) remained statistically associated with disability. CONCLUSION: Pain catastrophization and impact on gait were associated with disability in individuals with non-specific chronic low back pain. Motor control thoughts and behaviors during functional activities were considered to be relevant aspects for the better assessment and treatment of these patients.

[Treatment of patients with chronic nonspecific lumbalgia with various pain triggers]. / Lechenie patsientok s khronicheskoi nespetsificheskoi lyumbalgiei, svyazannoi s razlichnymi bolevymi triggerami.

OBJECTIVE: To evaluate the effectiveness of complex therapy in patients with chronic nonspecific lumbalgia associated with various pain triggers. MATERIAL AND METHODS: There were 121 patients with chronic nonspecific lumbalgia (average duration of pain 8.0±5.0 months) aged 22 to 59 years (average age 42.1±10.5). The lesion of the facet joints (24.8%), sacroiliac joint (23.2%), muscles (16.5%) or their combined lesion (35.5%) was established as pain triggers of lumbalgia. The patients underwent complex therapy, including medications, kinesiotherapy and cognitive therapy. Before and after the course of therapy (on average 3 weeks), a digital rating scale for pain assessment, the Oswestry Disability Index and the Hospital Anxiety and Depression Scale (HADS) were used. RESULTS: After treatment, there was a significant (p<0.01) decrease in pain (6.1±1.1 to 1.13±0.37 points, p<0.01), disability (40.09±3.56 to 22.15±13.20%), anxiety (8.98±0.50 to 6.46±0.34 points) and depression (8.72±0.17 to 6.02±0.26 points). A significant improvement in the condition was found in all pain triggers of chronic lumbalgia. The duration of chronic lumbalgia, the severity of life limitations on the Oswestry Disability Index and anxiety on HADS were the reliable predictors of the low effectiveness of complex therapy. CONCLUSION: Complex therapy, including medications, kinesiotherapy and cognitive therapy, is effective for various pain triggers of chronic lumbalgia.

Frequency of use of discography findings for the diagnosis of low back pain of discogenic origin. Systematic review of the literature. / Frecuencia de uso de los hallazgos de la discografía para el diagnóstico del dolor lumbar de origen discogénico. Revisión sistemática de la literatura.

INTRODUCTION: There are different techniques and interpretations of discography findings to determine it positive for the diagnosis of discogenic pain. This study aims to evaluate the frequency of use of discography findings for the diagnosis of low back pain of discogenic origin. MATERIAL AND METHODS: A systematic review of the literature of the last 17 years was performed in MEDLINE and BIREME. A total of 625 articles were identified, 555 were excluded for duplicates, title and abstract. We obtained 70 full texts of which 36 were included in the analysis after excluding 34 for not meeting the inclusion criteria. RESULTS: Among the criteria in discography to determine it as positive, 8 studies used only the pain response to the procedure, 28 studies used more than one criterion during discography to consider it as positive, the evaluation of at least one adjacent intervertebral disc with a negative result was necessary in 26 studies to consider a discography as positive. Five studies formally expressed the use of the technique described by SIS/IASP to determine a discography as positive. CONCLUSIONS: Pain in response to contrast medium injection, assessed with the visual analog pain scale≥6, was the most used criterion in the studies included in this review. Although there are already criteria to determine a discography as positive, the use of different techniques and interpretations of discography findings to determine a positive discography for low back pain of discogenic origin persists.

Diagnostic accuracy of lumbar CT and MRI in the evaluation of chronic low back pain without red flag symptoms.

BACKGROUND: Low back pain (LBP) is one of the most frequent reasons for medical consultation. Most of the patients will have nonspecific LBP, which usually are self-limited episodes. It is unclear which of the diagnostic imaging pathways is most effective and costeffective and how the imaging impacts on patient treatment. Imaging techniques are usually indicated if symptoms remain after 6 weeks. Magnetic resonance imaging (MRI) is the diagnostic imaging examination of choice in lumbar spine evaluation of low back pain; however, availability of MRI is limited. OBJECTIVES: To evaluate the diagnostic accuracy of computed tomography (CT) with MRI (as standard of reference) in the evaluation of chronic low back pain (LBP) without red flags symptoms. To compare the results obtained by two radiologists with different grades of experience. MATERIALS AND METHODS: Patients with chronic low back pain without red flags symptoms were retrospectively reviewed by two observers with different level of experience. Patients included had undergone a lumbar or abdominal CT and an MRI within a year. Once the radiological information was collected, it was then statistically reviewed. The aim of the statistical analysis is to identify the equivalence between both diagnostic techniques. To this end, sensitivity, specificity and validity index were calculated. In addition, intra and inter-observer reliability were measured by Cohen's kappa values and also using the McNemar test. RESULTS: 340 lumbar levels were evaluated from 68 adult patients with chronic low back pain or sciatica. 63.2% of them were women, with an average age of 60.3 years (SD 14.7). CT shows high values of sensitivity and specificity (>80%) in most of the items evaluated, but sensitivity was low for the evaluation of density of the disc (40%) and for the detection of disc herniation (55%). Moreover, agreement between MRI and CT in most of these items was substantial or almost perfect (Cohen's kappa-coefficient > 0'8), excluding Modic changes (kappa = 0.497), degenerative changes (kappa0.688), signal of the disc (kappa = 0.327) and disc herniation (kappa = 0.639). Finally, agreement between both observers is mostly high (kappa > 0.8). Foraminal stenosis, canal stenosis and the grade of the canal stenosis were overdiagnosed by the inexperienced observer in the evaluation of CT images. CONCLUSIONS AND SIGNIFICANCE: CT is as sensitive as lumbar MRI in the evaluation of most of the items analysed, excluding Modic changes, degenerative changes, signal of the disc and disc herniation. In addition, these results are obtained regardless the experience of the radiologist. The rising use of diagnostic medical imaging and the improvement of image quality brings the opportunity of making a second look of abdominal CT in search of causes of LBP. Thereby, inappropriate medical imaging could be avoided (2). In addition, it would allow to reduce MRI waiting list and prioritize other patients with more severe pathology than LBP.

[Low back pain and abdominal aortic aneurysm: Red flags]. / Dolor lumbar y aneurisma de aorta abdominal: red flags.

Approximately 70% of adults will experience low back pain at some point in their life. Most of the cases cannot be identified a cause, being nonspecific pains. The clinical guidelines on the management of low back pain indicate suspecting the presence of serious processes by means of the so-called red flags. Abdominal aortic aneurysm in 91% of cases is accompanied by low back pain, hence its importance of including it as a differential diagnosis. We present the case of a 75-year-old man with low back pain, without improvement with conservative treatment, referred to a rehabilitation consultation 3months after the onset of symptoms, and in the event of warning signs, imaging studies are requested that show abdominal aortic aneurysm and mass right kidney. We must bear in mind the red flags in patients with low back pain, and thus avoid outcomes that can put their lives at risk.

Influence of comorbidities on pain intensity in patients with chronic low back pain. / Influencia de las comorbilidades en la intensidad del dolor en los pacientes con lumbalgia crónica.

OBJECTIVES: Chronic pain is a complex process that can vary depending on factors such as time evolution, mood, or even previous experiences. Our objective is to describe patient's characteristics from those who were referred with a diagnosis of low back pain in their first Pain Unit (PU) visit, and identify those factors that may interfere with their pain perception. METHODS: Inferential analysis was carried out from data recorded in the PU database of the Hospital de la Santa Creu y Sant Pau in Barcelona, from November 2012 to November 2018. The average pain intensity during the last 24 hours (EVN24) was quantified using data from the BPI (Brief Pain Inventory) questionnaire. Using multiple linear regression, the independent predictive factors related to pain intensity (EVN24) were assessed. RESULTS: Mood disorders (Degree of depresión acording HAD_D level) was the variable with the highest impact in pain perception. Using binary logistic regression for multivariate analysis, a model of variables related to pain intensity (EVN24) was obtained (R = 0.354, P < 0.001). CONCLUSIONS: The specialized treatment of low back pain in PUs must take into account the patient's profile and especially the affective disorders and associated comorbidities since they predict a greater intensity of pain. Consequently, the associated comorbidity not only affects the greater intensity of pain, but the physical characteristics that accompany the patient throughout the process can influence or even compromise treatment.

Effect of Home Exercise Training in Patients with Nonspecific Low-Back Pain: A Systematic Review and Meta-Analysis.

BACKGROUND: Exercise therapy is recommended to treat non-specific low back pain (LBP). Home-based exercises are promising way to mitigate the lack of availability of exercise centers. In this paper, we conducted a systemic review and meta-analysis on the effects of home-based exercise on pain and functional limitation in LBP. METHOD: PubMed, Cochrane, Embase and ScienceDirect were searched until April 20th, 2021. In order to be selected, studies needed to report the pain and functional limitation of patients before and after home-based exercise or after exercise both in a center and at-home. Random-effect meta-analyses and meta-regressions were conducted. RESULTS: We included 33 studies and 9588 patients. We found that pain intensity decreased in the exclusive home exercise group (Effect size = -0.89. 95% CI -0.99 to -0.80) and in the group which conducted exercise both at-home and at another setting (-0.73. -0.86 to -0.59). Similarly, functional limitation also decreased in both groups (-0.75. -0.91 to -0.60, and -0.70, -0.92 to -0.48, respectively). Relaxation and postural exercise seemed to be ineffective in decreasing pain intensity, whereas trunk, pelvic or leg stretching decreased pain intensity. Yoga improved functional limitation. Supervised training was the most effective method to improve pain intensity. Insufficient data precluded robust conclusions around the duration and frequency of the sessions and program. CONCLUSION: Home-based exercise training improved pain intensity and functional limitation parameters in LBP.

Epidural Blood Patch Performed Immediately After Dural Puncture and Epidural Drug Administration.

The epidural blood patch (EBP) is a solution for persistent headaches following an accidental dural puncture. We report three cases where EBP was performed immediately after dural puncture combined with drug administration for lumbago. To the best of our knowledge, no similar cases have been reported in the literature. The patients provided their informed consent, and all standard protocols were followed. At the moment of the dural puncture, all the patients manifested severe headaches, nausea, vomiting, and profuse sweating. A second epidural puncture was performed at a higher intervertebral space, followed by drug administration and 20 mL of autologous blood. All the patients improved gradually, while their headaches vanished after 30-35 minutes. The patients were kept in for monitoring and released the following day with specific instructions and daily phone contact for a week without any complications. Their lumbago symptoms regressed. The possibility of pneumocephalus was excluded because of the patients' symptomatology. The risk of high or total spinal anesthesia due to local anesthetic leakage subarachnoidally was countered with close monitoring of the patients. EBP complications include failure, postdural-puncture headache worsening by an accidental additional dural tear(s), back pain, and infection. All patients were instructed to report any symptoms immediately. EBP executed immediately after dural puncture seems to relieve headache fast and does not appear to impede epidural analgesia.

[Copeman nodules, a frequent but little known cause of low back pain; case report]. / Nódulos de Copeman, una causa frecuente pero poco conocida de dolor lumbar: presentación de un caso.

Copeman nodules or episacral lipomas are a very prevalent entity in the general population. They consist of subfascial fat herniations at the episacral region, through weakened areas of the overlying thoracodorsal fascia. They are usually bilateral and symmetric. Only in rare cases they are the cause of clinical manifestations. We present the case of a 63-year-old woman who presents with lumbar pain refractory to conventional treatments. Ultrasound examination suggests the diagnosis of Copeman nodules. The treatment of the patient is approached from a multidisciplinary perspective, finally deciding to operate the patient. After the intervention, the symptoms remitted shortly, allowing the patient to continue a normal life without discomfort or analgesic treatment.

Plain lumbosacral X-rays for low back pain: Findings correlate with clinical presentation in primary care settings.

BACKGROUND: Low back pain (LBP) is a common disabling condition frequently seen and managed in primary care. LBP is considered to be the most common health problem for which general practitioners order an imaging test. OBJECTIVE: To correlate radiological findings of plain lumbosacral X-rays with the initial clinical presentation of patients with back pain. MATERIALS AND METHODS: This is a descriptive cross-sectional retrospective chart review study, conducted for 384 adult patients, with back pain who had plain lumbosacral X-rays, at three primary healthcare centers at King Abdul-Aziz Medical City (KAMC) in Riyadh, Saudi Arabia, in the period from 1 Jan 2017 to 31 Dec 2018. RESULTS: The majority of cases had either normal lumbosacral X-rays (32.8%) or incidental findings that were nonspecific. The most abnormal findings were degenerative changes such as spondylosis (osteophytosis) and narrowing of the intervertebral foraminal space (45.3%). The vast majority of cases of chronic back pain was associated with abnormal findings on a plain lumbosacral X-ray, which constituted most cases with abnormal findings among subjects. CONCLUSION: Lumbosacral X-ray findings in the vast majority of cases do not correlate with clinical presentation and do not justify routinely ordering imaging studies for nonspecific back pain in a primary care setting.

Development of a calculator to establish indications to refer patients with lumbar degenerative disease for spinal surgery consultation. / Desarrollo de una calculadora para establecer indicación de derivación a consulta de cirugía del raquis en patología degenerativa lumbar.

BACKGROUND AND AIM: Low-back pain remains a common pathological entity in the Western population. We have found no data in the literature that assess whether, with correct physical examination and evaluation of simple x-rays of the spine, it is possible to diagnose patients who are highly likely to be candidates for lumbar spine surgery and thus reduce the care burden and resource consumption that this disorder entails. The aim of the study was to develop a user-friendly calculator that allows only patients who are strong candidates for surgical treatment to be referred for spinal surgery consultation. MATERIAL AND METHOD: An observational and retrospective study that included all adult patients from the healthcare area of Talavera de la Reina (Toledo, Spain) with a clinical and/or radiological diagnosis of degenerative lumbar spine disease referred by other specialists over one calendar year to the spinal surgery unit to assess whether surgery was indicated after unsuccessful conservative treatment. All the patients were assessed under the same protocol with a follow-up of 6years, at the end of which we performed a check of those who had undergone lumber spine surgery. RESULTS: A total of 201 patients were studied and at the end of the 6-year follow-up, a total of 77 patients had been operated. Concordance of 70% was found between the indication for surgical treatment and the treatment received at the end of the follow-up. Therefore a logistic regression was performed in an attempt to predict the patients that could be referred to the spinal surgery units and from that a calculator was generated, which included the plain x-ray variable as an essential item, and which showed as statistically significant (P<.05): age, Waddell's non-organic signs, Lasegue's sign and plain x-ray assessment. Once this tool had been obtained, the likelihood of undergoing surgery was calculated for all patients who were proposed surgical treatment, obtaining results above 62% as the cut-off point when using the calculator. CONCLUSIONS: The use of the calculator predicts the possibility of being a candidate for surgical treatment with 70% reliability. Therefore, patients with a result in the calculator of above 62% should be referred for spinal surgery consultation for assessment by a specialist.

Motor Control Stabilisation Exercise for Patients with Non-Specific Low Back Pain: A Prospective Meta-Analysis with Multilevel Meta-Regressions on Intervention Effects.

Low-to-moderate quality meta-analytic evidence shows that motor control stabilisation exercise (MCE) is an effective treatment of non-specific low back pain. A possible approach to overcome the weaknesses of traditional meta-analyses would be that of a prospective meta-analyses. The aim of the present analysis was to generate high-quality evidence to support the view that motor control stabilisation exercises (MCE) lead to a reduction in pain intensity and disability in non-specific low back pain patients when compared to a control group. In this prospective meta-analysis and sensitivity multilevel meta-regression within the MiSpEx-Network, 18 randomized controlled study arms were included. Participants with non-specific low back pain were allocated to an intervention (individualized MCE, 12 weeks) or a control group (no additive exercise intervention). From each study site/arm, outcomes at baseline, 3 weeks, 12 weeks, and 6 months were pooled. The outcomes were current pain (NRS or VAS, 11 points scale), characteristic pain intensity, and subjective disability. A random effects meta-analysis model for continuous outcomes to display standardized mean differences between intervention and control was performed, followed by sensitivity multilevel meta-regressions. Overall, 2391 patients were randomized; 1976 (3 weeks, short-term), 1740 (12 weeks, intermediate), and 1560 (6 months, sustainability) participants were included in the meta-analyses. In the short-term, intermediate and sustainability, moderate-to-high quality evidence indicated that MCE has a larger effect on current pain (SMD = -0.15, -0.15, -0.19), pain intensity (SMD = -0.19, -0.26, -0.26) and disability (SMD = -0.15, -0.27, -0.25) compared with no exercise intervention. Low-quality evidence suggested that those patients with comparably intermediate current pain and older patients may profit the most from MCE. Motor control stabilisation exercise is an effective treatment for non-specific low back pain. Sub-clinical intermediate pain and middle-aged patients may profit the most from this intervention.

Abandoned techniques in spine surgery. / Técnicas abandonadas en cirugía de columna.

In spine surgery, certain surgical techniques and devices are currently in marked decline or have been completely abandoned. Although used in thousands of patients, such treatments failed to demonstrate durable and sound effectiveness, and sometimes associate inacceptable morbidity. Chemopapain injections, percutaneous discectomy, laser discectomy or antiadhesion gels are examples of abandoned therapies. Some other techniques are in frank decline like implantation of interspinous devices or lumbar disc prosthesis. In general, a technique is abandoned due to inefficacy, excessive associated morbidity, substituted by another more efficacious and less aggressive technique, end of commercialization, or usage prohibition. In the last decades, a great commercial pressure plus an increasing social demand have managed to convince many spine surgeons to indicate treatments not sufficiently supported by scientific evidence nor consolidated over time, many of which are eventually abandoned.