Footballer’s knee . . . and other stories

Occupational hazards of professional footballersThe prevalence of knee pain and radiographic evidence of osteoarthritis is two to three times higher among retired professional footballers than in the...

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Orofacial pain

What you need to knowOrofacial pain is not a hallmark feature of rhinosinusitis and affects only 10% of patients with rhinosinusitisConsider alternative diagnoses such as migraine, midfacial segment...

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Pain management after bone reconstruction surgery using an analgesic bone cement: a functional non-invasive in vivo study using gait analysis

Postoperative pain following bone reconstruction is one of the most frequent undesirable complications, especially in bone iliac crest graft procedures 15,24,28,36,42,54. This pain significantly disrupts patient recovery by reducing their mobility, delaying their functional recovery, increasing their hospital stay and decreasing their quality of life and autonomy 37,53. Furthermore, recent data suggest that chronic pain could induce changes at the immune system level, by modifying immune cell gene expression 29.

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Pathobiology of Christianson Syndrome: Linking Disrupted Endosomal-Lysosomal Function with Intellectual Disability and Sensory Impairments

Flesh-eating bacteria thrive on pain

Flesh-eating bacteria thrive on pain

Flesh-eating bacteria thrive on pain, Published online: 10 May 2018; doi:10.1038/d41586-018-05137-6

Microbes weaken host’s immune response by triggering pain neurons.

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Quality of Life and Slip Progression in Degenerative Spondylolisthesis Treated Nonoperatively

Study Design. A prospective cohort study of consecutive patients. Objective. Determination of the quality of life (QoL) and prevalence of slip progression in patients with degenerative lumbar spondylolisthesis managed nonoperatively. Summary of Background Data. Lumbar spinal stenosis secondary to degenerative lumbar spondylolisthesis is a common radiographic diagnosis associated with chronic back pain and radicular symptoms. There is limited evidence as to the clinical course in terms of validated QoL measures, and the extent of slip progression in patients with this condition treated nonoperatively. Methods. Validated disease-specific and generic QoL metrics including SF12 physical and mental scores [SF12-physical component summary (PCS) and SF12-mental component summary (MCS)], Oswestry Disability Index (ODI), and numeric scales for back and leg pain as well as radiographic assessment of slip extent were evaluated at initial consultation (baseline) and at a minimum of 5 years after the baseline assessment. Slip progression was defined by a >5% increase in slip percentage. Results. Thirty-nine of 160 (24.4%) patients elected to switch to operative management, despite no slip progression on preoperative radiographs. Seventy spondylolisthetic levels in 66 participants were assessed after a minimum of 5 years of nonoperative management. Twenty-one participants (31.8%) had slip progression. SF12-PCS, ODI, and leg pain improved similarly in both groups (P < 0.05). SF12-MCS did not change significantly in either group. Back pain improved only in the nonprogressing group. Conclusion. The majority of cases of low-grade spondylolisthesis do not progress over 5 years with nonoperative management. Regardless of whether there was progression or not, the mean PCS, ODI, and leg pain improved from baseline, although symptoms remained and a significant number elected to switch to surgical management before 5 years. Back pain improved with nonoperative treatment only in those without progression. Level of Evidence: 2

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Cartilage Endplate Thickness Variation Measured by Ultrashort Echo-Time MRI Is Associated With Adjacent Disc Degeneration

Study Design. A magnetic resonance imaging study of human cadaver spines. Objective. To investigate associations between cartilage endplate (CEP) thickness and disc degeneration. Summary of Background Data. Damage to the CEP is associated with spinal injury and back pain. However, CEP morphology and its association with disc degeneration have not been well characterized. Methods. Ten lumbar motion segments with varying degrees of disc degeneration were harvested from six cadaveric spines and scanned with magnetic resonance imaging in the sagittal plane using a T2-weighted two-dimensional (2D) sequence, a three-dimensional (3D) ultrashort echo-time (UTE) imaging sequence, and a 3D T1ρ mapping sequence. CEP thicknesses were calculated from 3D UTE image data using a custom, automated algorithm, and these values were validated against histology measurements. Pfirrmann grades and T1ρ values in the disc were assessed and correlated with CEP thickness. Results. The mean CEP thickness calculated from UTE images was 0.74 ± 0.04 mm. Statistical comparisons between histology and UTE-derived measurements of CEP thickness showed significant agreement, with the mean difference not significantly different from zero (P = 0.32). Within-disc variation of T1ρ (standard deviation) was significantly lower for Pfirrmann grade 4 than Pfirrmann grade 3 (P < 0.05). Within-disc variation of T1ρ and adjacent CEP thickness heterogeneity (coefficient of variation) had a significant negative correlation (r = −0.65, P = 0.04). The standard deviation of T1ρand the mean CEP thickness showed a moderate positive correlation (r = 0.40, P = 0.26). Conclusion. This study demonstrates that quantitative measurements of CEP thickness measured from UTE magnetic resonance imaging are associated with disc degeneration. Our results suggest that variability in CEP thickness and T1ρ, rather than their mean values, may serve as valuable diagnostic markers for disc degeneration. Level of Evidence: N/A

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