Intervention Effect of Exercise Training Program Using Deep Learning-based Motion Analysis System on Patients with Low Back Pain

To observe the clinical efficacy of long snake moxibustion and Ashi-point moxibustion in the treatment of cold-dampness type chronic non-specific low back pain (CNLBP) patients. A total of 120 cold-dampness type CNLBP patients who signed the informed consent were randomly and equally divided into control, long snake moxibustion and Ashi-point moxibustion groups. Ginger-separated moxibustion was applied to the region between Dazhui (GV14) and Yaoshu (GV2) for patients of the long-snake moxibustion group, or to the tenderness spot of the waist for patients of the Ashi-point moxibustion group. The treatment was conducted for 40 min each time, once every other day for a total of 8 sessions. Patients of the control group did not receive any intervention. The visual analogue scale (VAS) was used to assess low back pain severity. The Oswestry Disability Index (ODI) was employed to assess ten aspects of patients' daily-life activities (pain intensity, personal care, lif-ting, walking, sitting, standing, sleeping, sex life, social life, and traveling). The cold-damp syndrome scores (pain property, symptoms, ranges of motion, waist palpation, tongue and pulse condition) were achieved by consulting the textbook "Differential Diagnostics of Traditional Chinese Medicine Syndromes". The Hospital Anxiety and Depression Scale (HADS, a self-made assessment instrument) was used to assess the patients' severity of emotional disorder.The plasma cortisol level was detected by ELISA. Before treatment, there were no significant differences among the three groups in the levels of all the indexes (P>0.05). After moxibustion, the VAS scores during rest and movement, ODI score, cold-damp syndrome score and anxiety score in both long snake moxibustion and Ashi-point moxibustion groups, and the HADS depression score and plasma cortisol content in the long snake moxibustion group were significantly reduced compared with their own pre-treatment (P<0.05). The difference values between pre and post-treatment of VAS scores during rest and movement, ODI score, cold-damp syndrome score, anxiety score, depression score and cortisol content were obviously higher in the long snake moxibustion and Ashi-point moxibustion groups than those in the control group. The difference values between pre- and post-treatment of VAS scores during rest and movement, ODI score, cold-damp syndrome score, anxiety score, depression score and cortisol content were obviously higher in the long snake moxibustion group than in the Ashi-point group (P<0.05). Both ginger-separated long snake moxibustion and Ashi-point moxibustion can relieve low back pain, daily-life activities, cold-damp syndrome, negative emotions, and reducing cortisol level in cold-dampness type CNLBP patients，and the therapeutic efficacy of long snake moxibustion is obviously better.

The quantitative assessment of individual muscle and fascial stiffness in patients with low back pain remains a challenge. This study aimed to compare the stiffness of the thoracolumbar fascia (TLF), erector spinae (ES), and multifidus (MF) in patients with and without chronic non-specific low back pain (CNLBP) using shear wave elastography (SWE). It also sought to explore the relationship between muscle and fascial stiffness and the levels of pain and dysfunction in patients with CNLBP. In this cross-sectional study, 30 patients with CNLBP (age 27.40 ± 4.57 years, 19 males, 11 females, BMI 22.96 ± 2.55kg/m2) and 32 healthy controls (age 27.94 ± 4.94 years, 15 males, 17 females, BMI 22.52 ± 2.26kg/m2) were enrolled. Stiffness of the TLF, ES, and MF was measured using SWE, and Young's modulus values were recorded. The numeric rating scale (NRS) for quantifying pain intensity and the Oswestry Disability Index (ODI) scores were recorded for the case group to examine their correlations with the resilience index. The CNLBP group exhibited significantly higher shear modulus values at the L4-5 bilateral TLF (left: p = 0.014, d = 0.64; right: p = 0.002, d = 0.86), ES (left: p = 0.013, d = 0.66; right: p = 0.027, d = 0.58), and MF (left: p = 0.009, d = 0.69; right: p = 0.002, d = 0.85) compared to the control group. Comparable findings were observed for the right ES (p = 0.026, d = 0.59) and left MF (p = 0.020, η 2 = 0.09) at L1-2. Strong correlations were observed between the shear modulus of the bilateral TLF (left: r = 0.57, p = 0.001; right: r = 0.65, p < 0.001) at L4-5 and the NRS scores. Moderate correlations were noted between the shear modulus of the ES (left: r = 0.42, p = 0.022; right: r = 0.48, p = 0.007) and MF (left: r = 0.50, p = 0.005; right: r = 0.42, p = 0.023) at L4-5 and the NRS scores. Additionally, the shear modulus of the MF (r = 0.50, p = 0.005) on the left side of L1-2 showed similar correlations. Strong correlations were observed between the shear modulus of the bilateral TLF (left: r = 0.60, p < 0.001; right: r = 0.58, p < 0.001) at L4-5 and the ODI scores. Moderate correlations were observed between the shear modulus of the right TLF (r = 0.43, p = 0.017), ES (r = 0.38, p = 0.037), and MF (r = 0.44, p = 0.015) at L1-2, as well as the bilateral MF (left: r = 0.46, p = 0.011; right: r = 0.45, p = 0.012) at L4-5, and the ODI scores. No significant correlations were found at other measurement sites. In patients with CNLBP, the stiffness of the lumbar fascia and muscles is generally higher than in individuals without LBP. However, this increase is not uniform across all lumbar regions, with the most significant changes observed in the L4-5 segments. In addition, higher stiffness may be associated with pain and dysfunction, primarily manifested in the TLF.

<bold>Objective</bold> To observe the effects of a novel transcranial direct current stimulation (tDCS) device known as "Halo Sport" on pain and mood in patients with non-specific chronic low back pain (NSCLBP), by specifically targeting the bilateral primary motor cortex (M1 region). <bold>Methods</bold> Forty-two patients with NSCLBP who were treated in the Rehabilitation Medicine Department of Wuxi People's Hospital Affiliated to Nanjing Medical University from July 2023 to March 2024 were recruited. According to the random number table method, the patients were divided into control group and experimental group, with 21 patients in each group. During the course of treatment, one patient withdrew in each group and 20 patients were included in both groups. The experimental group received treatment using the new "Halo Sport" tDCS at 2.0 mA for 20 minutes with bilateral M1 anodes, followed by 45-minute exercise treatment, including 5 minutes of stretching exercises, 20 minutes of core training exercises, and 20 minutes of aerobic training exercises. The control group received sham tDCS in combination with exercise therapy. The treatment period for both groups was three days a week for four weeks. Before and after 4 weeks of treatment, the numerical rating scale (NRS) was used to evaluate pain intensity, the oswestry disability index (ODI) was used to evaluate lumbar dysfunction degree, while the pain catastrophizing scale (PCS), self-rating anxiety scale (SAS) and self-rating depression scale (SDS) were used to assess related negative emotions. <bold>Results</bold> 1) Pain intensity: After treatment, the NRS scores in the experimental and control groups significantly decreased compared with those at the baseline (<italic>P</italic>&lt;0.05). The difference of NRS score in the experimental group was significantly higher than that in the control group (<italic>P</italic>&lt;0.05). 2) Lumbar dysfunction degree: After treatment, ODI scores of the experimental and control groups significantly decreased compared with those at the baseline (<italic>P</italic>&lt;0.05). However, the difference of ODI scores between the two groups was not statistically significant (<italic>P</italic>&gt;0.05). 3) Negative emotions: After treatment, both groups showed a significant decrease in PCS, SDS and SAS scores compared to the baseline (<italic>P</italic>&lt;0.05), while the difference of PCS, SDS and SAS scores between the two groups was not statistically significant (<italic>P</italic>&gt;0.05). <bold>Conclusion</bold> Bilateral M1 area anodal tDCS with the Halo Sport device can significantly reduce pain in patients with NSCLBP. Whether combined with tDCS or not, exercise therapy can improve lumbar spine dysfunction and alleviate negative emotions in NSCLBP patients.

In this prospective study, we used the random number table method to equally divide 141 patients with chronic nonspecific low back pain (CNLBP) who met the inclusion criteria into 3 groups. One group who received massage manipulation therapy was recorded as the manipulation group (n = 47), one other group who received core strength training therapy was recorded as the training group (n = 47), and the other group who received massage manipulation combined with core strength training was recorded as the combination group (n = 47). All the patients were treated for 1w as the course of treatment, with the treatment conducted for 5 d/w for 4 w and 12 w of follow-up. The efficacies of the 3 groups were evaluated after treatment, and the visual analog scale (VAS) scores, Oswestry disability index (ODI) scores, and waist dynamic and static muscle endurance before and after treatment of the 3 groups were compared, and the long-term efficacies of the 3 groups were evaluated combined with the VAS scores at 6 w and 12 w after treatment. Our result was that, after treatment, the total effective rate of the combination group (95.74%) is significantly better than that of the manipulation group (80.85%) and the training group (78.72%) (P < 0.05). After treatment, the VAS and ODI scores of the 3 groups significantly decreased, and the waist dynamic endurance and static muscle endurance significantly increased, and the condition of the combination group was significantly improved compared with that of the manipulation group and the training group (P < 0.05). At 6w and 12w after treatment, the VAS scores of the manipulation group and training group were increased compared with those at the end of treatment (P < 0.05), there was no significant change in the combination group (P < 0.05), and the VAS scores of the combination group at 6 w and 12 w after treatment were lower than those of the manipulation group and training group at the same time point (P < 0.05). This suggests that the synergistic effect of massage manipulation combined with core strength training in the treatment of CNLBP can effectively alleviate patients' pain and waist dysfunction, enhance dynamic and static muscle endurance, and have significant short-term and long-term effects, which are worthy of promotion.

BackgroundPedicle screw invasion of the proximal articular process will cause local articular process degeneration and acceleration, which is an important factor affecting adjacent segment degeneration. Although lumbar spondylolisthesis is a risk factor for screw invasion of the proximal joint, there is no clear conclusion regarding the two different types of spondylolisthesis. Therefore, the purpose of this study was to explore the influence of pedicle screw placement on proximal facet invasion in the treatment of degenerative spondylolisthesis and isthmic spondylolisthesis.MethodsIn total, 468 cases of lumbar spondylolisthesis treated by decompression and fusion in our hospital from January 2017 to January 2020 were included in this retrospective study. Among them, 238 cases were degenerative spondylolisthesis (group A), and 230 cases were isthmic spondylolisthesis (group B). Sex, age, body mass index, bone mineral density, preoperative visual analog scale (VAS) and Oswestry Disability Index (ODI) scores, postoperative VAS and ODI scores at 1 month and 3 months, and angle of the proximal facet joint at the last follow-up were recorded and compared between the two groups. The degree of pedicle screw invasion of the proximal facet joint was graded and compared by the SEO grading method.ResultsThere were no significant differences in sex, age, body mass index, bone mineral density, preoperative VAS and ODI scores, or proximal facet joint angle between the two groups (P > 0.05). There was no significant difference in VAS and ODI scores between the two groups at 1 month and 3 months after the operation (P > 0.05). The VAS score of group A at the last follow-up was 1 (1,2). The VAS score of group B at the last follow-up was 3 (1,3). The ODI score of group A at the last follow-up was 6(4,26). The ODI score of group B at the last follow-up was 15(8,36). The VAS and ODI scores of the two groups at the last follow-up were significantly different (P < 0.05). According to the SEO grading method, the invasion of the proximal articular process by pedicle screw placement in group A involved 320 cases in grade 0, 128 cases in grade I and 28 cases in grade II. In group B, there were 116 cases in grade 0, 248 cases in grade I and 96 cases in grade II, with a significant difference (P < 0.01).ConclusionIn summary, a certain number of cases involving screws invading the proximal facet joint occurred in the two different types of lumbar spondylolisthesis, but the number in the isthmic spondylolisthesis group was significantly higher than that in the degenerative spondylolisthesis group, which caused more trauma to the proximal facet joint and significantly affected the patient prognosis.

ObjectiveTo detect the influences of postoperative out-of-bed activity restriction on recurrence rate, low back and leg pain, functional rehabilitation after percutaneous endoscopic lumbar discectomy (PELD).MethodsIn this research, 213 patients with lumbar intervertebral disc herniation (LDH) who underwent PELD were divided into the out-of-bed activity restriction group and out-of-bed activity non-restriction group. The visual analog scale (VAS) and Oswestry disability index (ODI) scores were used to evaluate postoperative clinical efficacy at 1 and 3 months after the operation, and to count the recurrence rates. All of these operations were performed between August 2017 and July 2020, and they were followed in the outpatient department for 12 months at least.ResultsBoth of the groups showed significantly lower VAS and higher ODI scores at 1 month and 3 months post-operation, respectively, when compared with pre-operation. At 1 month after the operation, the restriction group performed lower VAS scores of low back pain compared with the non-restriction group, but this advantage disappeared at 3months post-operation. However, there was no statistical difference in the VAS scores of leg pain and ODI scores between the two groups, neither at 1 nor 3 months after the surgery. The recurrence rate is significantly lower in the restriction group than in the non-restriction group at a 12-month follow-up after the surgery.ConclusionOut-of-bed activity restriction in the early postoperative period of PELD could reduce LDH recurrence effectively, and it may relieve the low back pain to some extent. It has no benefit in the recovery of leg pain and functional rehabilitation.

ObjectiveTo compare the effectiveness and practicality of pedicle screw fixation via the Quadrant retractor and Buck's technique in the treatment of adolescent spondylolysis.MethodsA total of 31 patients who underwent pedicle screw fixation or Buck's technique at our hospital from 2012 to 2017 were selected for this retrospective study. The patients were divided into a pedicle screw group (16 patients) and a Buck's technique group (15 patients) according to surgical procedure. Age, sex, disease duration, involved segments, preoperative Oswestry disability index (ODI) scores, visual analogue scale (VAS) scores for low back pain (LBP), intraoperative blood loss, incision length, operative time and length of hospital stay were documented. ODI scores, VAS scores for LBP and fusion rates at 1 month, 6 months, 1 year and 3 years postoperatively were used to evaluate surgical outcomes.ResultsThe average follow‐up period was 32.75 ± 11.99 months in the pedicle screw group and 31.02 ± 9.64 months in the Buck's technique group. No significant differences in demographic data and perioperative data were found between the two groups (P > 0.05). The ODI scores and VAS scores for LBP in both groups were significantly improved at 3 years postoperatively compared with the values before surgery (ODI%: 45.74 ± 2.47 vs 10.99 ± 3.00; 45.29 ± 6.94 vs 15.73 ± 6.89. VAS: 5.94 ± 0.68 vs 1.50 ± 0.52; 6.13 ± 0.74 vs 2.13 ± 0.92, P < 0.05). The ODI scores of the patients in the pedicle screw group at 1 month to 3 years postoperatively were lower than those of the patients in the Buck's technique group (P < 0.05). Moreover, the VAS scores for LBP of the patients in the pedicle screw group at 6 months and 3 years postoperatively were lower than those of the patients in the Buck's technique group (P < 0.05). No significant difference in the VAS scores for LBP was found between the two groups at 1 month postoperatively (3.88 ± 0.50 vs 4.20 ± 0.56, P = 0.10). Three years postoperatively, good fusion of the pars interarticularis was achieved in all patients in the pedicle screw group, but four patients in the Buck's technique group did not achieve good fusion (P = 0.02).ConclusionBoth pedicle screw fixation and Buck's technique can achieve good outcomes in the treatment of adolescent spondylolysis. Pedicle screw fixation via the Quadrant retractor for the treatment of spondylolysis is associated with more satisfactory effects in terms of LBP relief and fusion results.

Feng spinal mobilization (FSM) is one of the most widely practiced techniques in traditional Chinese osteopathy, especially in China. However, whether this FSM technique is more effective than the Maitland posteroanterior mobilization (MM), which is widely used all over the world, is still unknown. The purpose of this study was to retrospectively analyze and compare the efficacy of these 2 treatments in patients with chronic nonspecific low back pain (CNLBP) as to provide a basis for the clinical treatment of chronic low back pain. A total of 83 patients, including 43 patients in the FSM group and 40 in the MM group, were enrolled in this cohort study. FSM or MM was performed on patients 3 times during a period of 2 weeks. Changes in the subjective and objective measurements were measured before and after the third treatment. The subjective symptoms recorded included the visual analogue scale (VAS), Oswestry disability index, and Patient Health Questionnaire-9. The objective symptoms, including the lumbar range of motion (ROM), and straight leg raise (SLR) height were also checked for any changes. The VAS scores were reassessed at the 1-year follow-up visit. The results showed that 2 weeks of FSM treatment significantly improved CNLBP patients modified Schober test (P < .05), extension ROM (P < .01), and SLR height (P < .05) while MM treatment did not. Both treatments significantly decreased the values of VAS, Oswestry disability index, and Patient Health Questionnaire-9 (P < .01). Compared to the MM treatment, the FSM treatment showed a much more significant improvement in VAS score (P < .01), range of motion of extension (P < .01), and SLR of both sides (P < .05). At the 1-year follow-up, VAS scores in both groups decreased significantly compared to pretreatments; however, there was no significant difference between the 2 groups. Our data suggested that the FSM treatment can provide better efficacy than MM in CNLBP patients, improving the VAS scores, lumbar extension ROM, and SLR height in a shorter time.

Low back pain is one of the most common health problems that affects daily living activities of most people at some time in their lifetime. Non-specific chronic low back pain (NS-CLBP) can be seen in 85-95% of the population. Although it is known that disability and lower limb muscle strength are affected in patients with NS-CLBP, no study investigated the relationship between these variables. The aim of this study was to identify association between disability and lower limb muscle strength in these patients. 79 patients with NS-CLBP were enrolled. The strength of knee extensor and ankle dorsiflexor muscles were measured using a hand-held dynamometer. The disability was assessed using Oswestry Disability Index. Spearman correlation analysis revealed that there were negative significant correlations between Oswestry Disability Index score and right knee extensor muscle strength, left knee extensor muscle strength and left ankle dorsiflexor muscle strength (r=-0.290, p=0.009; r=-0.408, p

Objective The present study investigated the clinical efficacy of percutaneous kyphoplasty (PKP) combined with calcitriol and calcium in the treatment of traumatic nonosteoporotic vertebral compression fractures (TNVCFs). Methods The patients were equally divided into a control group and a treatment group by a random number table. The patients in the control group underwent PKP surgery, and the patients in the treatment group received calcitriol and calcium on the basis of PKP surgery. The visual analog scale (VAS) pain scores, Oswestry Disability Index (ODI) scores, the height of the anterior edge of the vertebral body, Cobb's angle, and the level of the bone mineral density of the two groups of TNVCF patients before surgery were recorded and compared, one and six months after surgery. Results Thirty-six inpatients with TNVCFs admitted to the trauma center of the First Affiliated Hospital of Soochow University from January 2019 to January 2020 were recruited. There were no significant differences in the VAS and ODI scores, the height of the anterior edge of the injured vertebral body, Cobb's angle, and bone mineral density between the two groups before surgery (P > 0.05). The VAS scores, ODI scores, the height of the anterior edge of the injured vertebral body, and Cobb's angle of the two groups of patients after surgery were significantly better than those before surgery. One and six months after surgery, the VAS and ODI scores, the height of the anterior edge of the injured vertebral body, Cobb's angle, and the bone mineral density of the patients in the treatment group improved significantly compared to those in the control group (P < 0.05). Conclusions PKP combined with calcitriol and calcium medications could significantly relieve pain, alleviate the loss of compressed vertebral height and kyphosis, and improve the spinal function and the life quality of the TNVCF patients.

OBJECTIVE This study aimed to evaluate the clinical outcomes of percutaneous endoscopic transforaminal discectomy (PETD), microendoscopic discectomy (MED), and microdiscectomy (MD) for treatment of symptomatic lumbar disc herniation (LDH). METHODS One hundred ninety-two patients with symptomatic LDH at L3-4 and L4-5 were included in this study. The mean (± SD) age of patients was 34.2 ± 2.6 years (range 18-62 years). The patients were divided into groups as follows: group A was treated with PETD and included 60 patients (31 men and 29 women) with a mean age of 36.2 years; group B was treated with MED and included 63 patients (32 men and 31 women) with a mean age of 33.1 years; and group C was treated with MD and included 69 patients (36 men and 33 women) with a mean age of 34.0 years. The Japanese Orthopaedic Association (JOA) scale for low-back pain (LBP), Oswestry Disability Index (ODI), creatine phosphokinase activity 3 days after surgery, and visual analog scale (VAS) scores for LBP and leg pain were used for evaluation of clinical results. RESULTS There were no significant differences in mean preoperative JOA score, ODI score, and VAS scores for LBP and leg pain among groups A, B, and C. Incision length, duration of the operation, blood loss, creatine phosphokinase, length of hospital stay, and postoperative incision pain according to the VAS were best in the PETD group (p < 0.05). The number of seconds of intraoperative fluoroscopy was highest in the PETD group (p < 0.05), whereas there was no difference between the MED and MD groups. Three cases from the MED group and 2 cases from the MD group had an intraoperative durotomy. No CSF leakage was observed after surgery. One case from the MED group and 3 cases from the MD group had incision infections. There were no neurological deficits related to the surgeries in any of the groups. Fifty-five (91.6%), 59 (93.7%), and 62 patients (89.9%) had at least 2 years of follow-up in groups A, B, and C, respectively. At the last follow-up, JOA scores, VAS scores of LBP and leg pain, and ODI scores were significantly better than preoperative correlates in all groups. There were no differences among the 3 groups in JOA scores, JOA recovery rate, ODI scores, and VAS scores for leg pain. The VAS score for LBP was best in the PETD group (p < 0.05). No lumbar instability was observed in any group. Three cases (5.5%) in the PETD group had recurrent LDH, and 2 recurrent cases (3.4%) were confirmed in the MED group. CONCLUSIONS PETD, MED, and MD were all reliable techniques for the treatment of symptomatic LDH. With a restricted indication, PETD can result in rapid recovery and better clinical results after at least 2 years of follow-up.

Chronic non-specific low back pain is a musculoskeletal disorder that has a significant tendency to spread among working-age people throughout their lives worldwide. Lower back pain is the leading cause of disability worldwide among people of working age and is a significant social and economic burden on the healthcare system. In patients with chronic low back pain, assessment of functional impairment is of important clinical significance, as it allows for evaluation of the complexity of the course, the effectiveness of treatment, and the prognosis for the disease. To assess the degree of functional impairment in patients with chronic non-specific low back pain depending on the dominant type of pain. A retrospective single-center pilot study was conducted and included patients with chronic non-specific low back pain who underwent rehabilitation in the rehabilitation department of the Bogomolets National Medical University. All participants were divided into three groups depending on the dominant type of pain: with a predominance of nociplastic pain, with a predominance of neuropathic pain, and with a predominance of nociceptive pain. The subjects underwent an assessment of socio-demographic and anthropometric indicators, pain status, and functional impairment using the Oswestry Disability Index (ODI) questionnaire, and subjective assessment of stress level (PSS-10). Among 102 subjects with chronic non-specific low back pain, 63% were women and 37% were men of working age, with a mean age of 39.0±12.3 and 40.4±10.5 years, respectively. Among the subjects, nociceptive pain was dominant in 53.9% (CI 44.1-63.6%), nociplastic pain was present in 22.5% (CI 14.9-31.2%), 15.7% (CI 9.2-23.4%) had neuropathic pain, and in 7.8% (CI 3.4-13.9%) of the subjects, the dominant type of pain could not be determined. In the group of patients with a dominant nociplastic type of pain, the ODI dysfunction index was 27.2±14.0%, which corresponds to moderate dysfunction. In the group with a dominant neuropathic type of pain, this indicator was 22.0±12.1%, which also indicates moderate impairment. Among patients with nociceptive type of pain, the ODI indicator corresponded to minimal impairment, 13.6±10.7%, the difference was significant compared to the group of patients with dominant nociplastic and neuropathic pain, respectively (p&lt;0.001, p=0.009). Most patients with chronic non-specific low back pain with a dominant nociplastic type of pain have moderate functional impairment. In this group of patients, low back pain most significantly limits functioning during sitting, standing, social and sexual life, and traveling. Most patients with nociceptive and neuropathic type of pain have minimal functional impairment.

Background : Transcutaneous Electrical Nerve Stimulation (TENS) is often used to treat Low-Back Pain (LBP). However, its effectiveness is controversial in non-specific chronic LBP (CLBP). The study aimed to determine TENS’ efficacy in treating non-specific CLBP when added to Non-Steroidal Anti- Inflammatory Drugs (NSAIDs) and Activities of Daily Living (ADL). Materials and methods: This randomized controlled clinical trial was conducted in the Department of Physical Medicine and Rehabilitation of Chittagong Medical College Hospital, Chattogram, over six months from January 2019 to June 2019. Ninety patients suffering from LBP for more than six weeks were enrolled and randomized into Group A, and Group B. Patients in both groups were treated with NSAID+ADL. TENS was added to the patients of Group B. Subjective pain intensity score, Visual Analogue Scale (VAS) Tenderness index, Disability due to pain, Spinal mobility index and Oswestry Disability Index was the outcome parameters assessed at baseline and after eight weeks of intervention. Results: Ten patients were lost to follow-up (Five from each group) giving an effective sample of 80 (40 in each group). Both the groups were similar at enrollment in terms of the demographic, clinical and laboratory parameters. In Group A and B, the VAS score at baseline was 7.06±0.81 and 7.11±0.83, respectively. At eight weeks, the VAS score was 6.55±0.77 and 6.11±0.75, respectively, in Group A and B. Reduction of VAS scores was significant in both groups without any statistical differences. Similarly, Disability due to pain and Oswestry Disability Index scores reduced significantly from baseline to eight weeks after treatment in both groups, without statistically significant differences. Conclusion: The study ascertained no additional benefit of TENS in patients of non specific CLBP when added to NSAID and ADL. IAHS Medical Journal Vol 5(1), June 2022; 82-86

To explore the surgical treatment strategy of the vertebral "shell" after thoracolumbar fracture, and provide clinical reference for the intervention and treatment of "shell". Between June 2015 and January 2017, 53 patients with high risk of vertebral "shell" after thoracolumbar fracture surgery were enrolled in a prospective study according to the selection criteria. All patients were randomly divided into two groups according to the order of treatment, 27 cases in the treatment group were treated with short-segment fixation combined with vertebral reconstruction, 26 cases in the control group were treated with short-segment fixation. There was no significant difference in gender, age, injury cause, Denis classification, fracture segment, the degree of injured vertebra compression, bone mineral density, and American Spinal Cord Injury Association (ASIA) classification between the two groups ( P>0.05). The degree of injured vertebra compression, visual analogue scale (VAS) score, and Oswestry disability index (ODI) score at preoperation, immediate after operation, and last follow-up were calculated and compared between the two groups. The "shell" phenomenon and surgery complications were observed at the same time. All patients were followed up 12-18 months with an average of 14.4 months. There were 5 cases of "shell" phenomenon in the treatment group and 4 cases of nonunion at last follow-up, 23 cases of "shell" phenomenon in the control group and 19 cases of nonunion at last follow-up; there was a significant difference between the two groups ( P<0.05). In the treatment group, 1 case had incision fat liquefaction and 4 cases had bone cement leakage; in the control group, 2 cases had screw loosening and 1 case had unilateral connecting rod rupture; there was no significant difference in the incidence of complications between the two groups ( χ2=0.504, P=0.478). The degree of injured vertebra compression, VAS score, and ODI score were significantly improved in both groups at immediate after operation and last follow-up ( P<0.05). There was no significant difference in the degree of injured vertebra compression between the two groups at immediate after operation ( P>0.05), but which was significantly higher in the control group than that in the treatment group at last follow-up ( P<0.05). Except that the ODI score of the control group was significantly higher than that of the treatment group at last follow-up ( P<0.05), there was no significant difference in VAS score and ODI score between the two groups at the other time points ( P>0.05). The treatment of thoracolumbar fracture with short-segment fixation combined with injured vertebral reconstruction can effectively prevent the "shell" phenomenon, which is conducive to maintaining the height of injured vertebral and improving the long-term function. The effectiveness is satisfactory.

ObjectiveThe objective of the present study was to evaluate the safety and efficacy of percutaneous transforaminal endoscopic discectomy (PTED) and open fenestration discectomy (OFD) in the treatment of lumbar disc herniation (LDH).MethodsPatients in our hospital with LDH who received PTED (n = 71) and OFD (n = 39) from 2013 to 2014 were retrospectively studied. Patient information, including age, gender, visual analogue scale (VAS) score for low back pain and leg pain, body weight, height, Oswestry disability index (ODI), Japanese Orthopedic Association (JOA), and recurrence, was collected. The patients in the two groups were followed up for an average of 63 months after surgery.ResultsA total of 136 patients completed the operation and 110 patients were followed up completely. There was no significant difference in baseline data between the two groups (P > 0.05). The postoperative low back pain, leg pain, ODI, and JOA of the two groups were better than those preoperatively (P < 0.05). One week after surgery, the recovery of PTED patients was better than that of OFD. The ODI score of the PTED group was lower than that of the OFD group (10 [8, 12] vs 14 [11, 16]; P < 0.05), the waist VAS score of the PTED group was lower than that of the OFD group (2 [2, 3] vs 3 [2, 4]; P < 0.05), the leg VAS score of the PTED group was lower than that of the OFD group (1 [0,1] vs 1 [1, 2]; P < 0.05), while the JOA score of the PTED group was higher than that of OFD group [19(16, 20) vs 12(10, 17); P < 0.05]. There were no significant differences in ODI, JOA, waist and leg VAS scores between the two groups at 1 month after surgery and at subsequent follow‐up (P > 0.05). At the end of the follow up, 89.7% (35/39) of patients in the OFD group had excellent improvement in the JOA score, and 88.7% (63/71) of patients in the PTED group had an excellent improvement. There was no significant difference between the two (P > 0.05). There was also no significant difference in the recurrence rate between the two groups [(5/71) vs (3/39); P > 0.05]. [Correction added on 05 March 2021, after first online publication: “3/29” was amended to “3/39” in the preceding sentence.]ConclusionBoth PTED and OFD can achieve good mid‐term efficacy in the treatment of LDH but PTED has certain advantages, including the small incision, a shorter hospital stay, and quicker, earlier recovery. However, prospective randomized controlled studies with a larger sample size are needed.