Articles: back-pain.
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Study Design. Systematic Review. Objective. ⋯ StrongSummary Statement. Oblique corpectomy is an option in selected cases of CSM. It should not be considered a first line treatment strategy due to the relatively high morbidity associated with this procedure.
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Study Design. Basic pain study using osteoporotic rodent models. Objective. ⋯ Sustained upregulation of CGRP in DRG neurons was observed following compression of the Co5 vertebra, and Co5 compression caused significant increase in CGRP production in DRG neurons, while a greater level of ATF-3 upregulation was observed in DRGs in OVX rats following dynamic vertebral compression 8 weeks after surgery, implying potential neuropathic pain. Conclusion: There was sustained upregulation of CGRP and ATF3 in DRGs in osteoporotic model rats compared with controls, and levels were further enhanced by dynamic vertebral compression. These findings imply that dynamic compression stress on vertebrae can exacerbate osteoporotic pain by inducing both inflammatory and neuropathic pain mediators.
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The differential diagnosis of back pain in children and adolescents is wide. The prevalence of low back pain is increasing with age and after puberty is similar to what is known from the adult population, but in smaller children a structural cause for the pain is more common. Careful history taking and physical examination will help with the decision of when to perform further investigations. This article lists the most common differential diagnoses of back pain in children.
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Nerve growth factor (NGF) is a key regulator of nociceptive pain and thus appears to be an interesting target molecule for an innovative class of analgesic medication. We set out to review the principles of neurogenic inflammation and results of anti-NGF regimens in animal studies as well as clinical trials with patients with back pain and osteoarthritis (OA). ⋯ Anti-NGF agents either alone or in combination with non-steroidal anti-inflammatory agents (NSAIDs) were more efficacious for the treatment of pain in a number of trials of knee and hip pain compared to NSAIDs alone. However, adverse effects that included rapidly progressive OA and joint replacement were more common in patients treated with anti-NGF and NSAIDs than either treatment alone. Anti-NGF treatment related neurologic symptoms including paresthesias, and potentially other types of adverse effects were usually transient but warrant additional investigation.
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Next to conventional x-ray examinations, modern imaging modalities as computed tomography (CT) and magnetic resonance imaging (MRI) play an important role in the assessment of back pain. Guidelines and recommendations should be helpful for the - not always simple - indication for imaging for back pain. However, the latter have to be individually adapted regarding clinical symptoms and appearance for every patient. Choosing the adequate imaging modality depends on several criteria, as the suspected- and differential diagnosis, the acuteness, age of patient and the temporal availability of the examination.