Low Back Pain Pathogenesis and Treatment

Evaluation and Management of Lower Back Pain in Oncological Patients (Pathogenesis) Part 2

PET/CT FDG-PET/CT studies in oncology utilize labeled glucose with the tracer fluorine-18 (F-18) fluorodeoxyglucose (FDG), in combination with MDCT, to provide the benefits of metabolic and anatomic imaging in a single study. FDG is a glucose analog that is taken up by glucose-using cells and phosphorylated by hexokinase in the mitochondria. Increased tumor [18F]-FDG uptake […]

Pharmacotherapy for Chronic Low Back Pain (Conservative Treatment) Part 1

Introduction Chronic low back pain is a common, debilitating, and costly health problem (Centers for Disease Control and Prevention, 2001; Collins et al., 2005; Mapel et al., 2004; Vogt et al., 2005). The prevalence of chronic low back pain is higher in women and in whites versus blacks (Andersson, 1999; Mapel et al., 2004). Although […]

Pharmacotherapy for Chronic Low Back Pain (Conservative Treatment) Part 2

Summary of efficacy data Flexible titration allows for successful titration in the majority of opioid-treated patients. The availability of formulations administered twice daily, daily, every 3 days, or once weekly allows for individualized treatment of patients to optimize treatment compliance. Studies of long-acting oxymorphone, oxycodone, morphine, hydromorphone, fentanyl, and buprenorphine confirm the analgesic efficacy in […]

Application of Radiofrequency in Low Back Pain Treatment (Conservative Treatment) Part 1

Introduction Chronic low back pain (LBP) has become a main cause of absenteeism and disability in industrialized societies and is a major health problem with enormous economic and costs (Andersson, 1999). As many as 80% of adults experience at least one episode of LBP during their lifetime. Only 5% of patients suffering from chronic LBP […]

Application of Radiofrequency in Low Back Pain Treatment (Conservative Treatment) Part 2

Low back pain from facet joint arthritis or degeneration (anatomy and biomechanics, clinical presentation and physical examination, diagnostic imaging) Anatomy and pathogenesis of facet joints pain Each vertebra has two sets of facet joints. One pair faces upward (superior articular facet) and one downward (inferior articular facet). The joint surfaces are coated with cartilage allowing […]

Application of Radiofrequency in Low Back Pain Treatment (Conservative Treatment) Part 3

Radiofrequency in medial branch block for facet joint pain The patient is placed in prone position on the radiolucent table. The anatomical landmarks of the spinal structures reflected on the skin are marked under fluoroscopic guidance including midline and facet joints and transverse processes. The skin is then sterilized in the standard fashion. Local anesthesia […]

Nonfusion Techniques for Degenerative Lumbar Diseases Treatment (Low Back Pain) (Surgical Treatment) Part 1

Introduction Conservative treatment is the "gold standard" treatment for low back pain, in spine degenerative conditions. However, in cases where there is a failure in conservative measures, surgical treatment becomes an option (Roh et al, 2005). These procedures traditionally included decompression of spinal elements, correction of deformity and arthrodesis of the diseased spinal segment but, […]

Nonfusion Techniques for Degenerative Lumbar Diseases Treatment (Low Back Pain) (Surgical Treatment) Part 2

Total disc arthroplasty Overview Lumbar fusion has been developed for several decades and became the standard surgical treatment for symptomatic lumbar degenerative disc disease (DDD). Disc arthroplasty devices have been designed in an attempt to replace functionally the intervertebral discs, as opposed to the gold standard method (fusion) which could not achieve that (Fekete et […]

Posterior Dynamic Stabilization: The Interspinous Spacer (Low Back Pain) (Surgical Treatment)

Introduction Neurogenic claudication was first related to lumbar stenosis (Verbiest H, 1954). Since, decompressive surgery was indicated in patients who failed to respond to conservative therapy. It is followed by posterior fusion in cases where the motion segment showed instability or in case where a secondary instability is expected to develop after surgery. However, while […]

Development and Clinical Evaluation of Bioactive Implant for Interbody Fusion in the Treatment of Degenerative Lumbar Spine Disease (Low Back Pain) (Surgical Treatment) Part 1

Introduction Due to new information about the pathophysiology and biomechanics of degenerative lumbar spine disease, the surgical treatment of this disease has undergone a significant increase over the past forty years. Novel diagnostic approaches and the development of new materials provided the impetus to produce new types of instrumentation, and these instruments have led to […]

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