The Role of Diagnostic Injections in Spinal Disorders: A Narrative Review

Neck and back pain is increasingly prevalent, and has increased exponentially in recent years. As more resources are dedicated to the diagnosis of pain conditions, it is increasingly important that the diagnostic techniques used are as precise and accurate as possible. Traditional diagnostic methods rely heavily upon patient history and physical examination to determine the most appropriate treatments and/or imaging studies. Though traditional means of diagnosis remain a necessity, in many cases, correlation with positive or negative responses to injections may further enhance diagnostic specificity, and improve outcomes by preventing unnecessary treatments or surgeries. This narrative review aims to present the most recent literature describing the diagnostic validity of precision injections, as well as their impact on surgical planning and outcomes. Diagnostic injections are discussed in terms of facet arthropathy, lumbar radiculopathy, discogenic pain and discography, and sacroiliac joint dysfunction. There is a growing body of evidence supporting the use of diagnostic local anesthetic injections or nerve blocks to aid in diagnosis. Spinal injections add valuable objective information that can potentially improve diagnostic precision, guide treatment strategies, and aid in patient selection for invasive surgical interventions.

Spinal Injections

Spinal pain is a common complaint and cause of disability in the United States, affecting most individuals at some point in their lives. The complex anatomy of the spine leads to multiple potential and coexisting etiologies for pain, and the differentiation of these sources can present a diagnostic challenge. Image-guided spinal injections can provide both diagnostic information identifying pain location as well as prolonged therapeutic relief as an alternative to medical management. Anesthetic and corticosteroid medications can be administered within the epidural space through transforaminal or interlaminar approaches, blocking various sensory nerves, or directly within the facet joints. Proceduralists must be aware of associated patient considerations, techniques, and potential complications to perform the procedures safely. We discuss image-guided spinal injection techniques, based on best practices and our experiences.

The Effect of Social Isolation During the COVID-19 Pandemic on Patients with Chronic Low Back Pain Who Underwent a Spine Intervention

BACKGROUND: The COVID-19 infection poses a serious threat to global health for millions of people. In addition to therapeutic treatment methods, preventive measures are also important in controlling the pandemic. As a result, billions of people are quarantined in their homes to prevent the spread of coronavirus. However, social isolation may result in immobility, which can lead to musculoskeletal problems and an increased level of pain, depending on the weakness of the muscles. OBJECTIVES: To examine the effect of social isolation during the recent COVID-19 pandemic on patients with chronic low back pain. STUDY DESIGN: A total of 145 patients who underwent a spine intervention within the past year were enrolled in this prospective and cross-sectional study. SETTING: The study was performed in the interventional pain unit of a tertiary rehabilitation center in Turkey. METHODS: Patient data were obtained by telephone interview and included information pertaining to demographics, pain history, an assessment of pain, analgesic use, activity levels, and an evaluation of stress and sleep habits. Additionally, the International Physical Activity Questionnaire (IPAQ) was used to evaluate patient activity levels. RESULTS: It was detected that social isolation has increased the intensity of low back pain experienced by patients during the COVID-19 pandemic. We also found that patients who benefited from spinal injections administered in the prepandemic period experience less severe low back pain (P = 0.000) and took fewer analgesics (P = 0.000) during the pandemic. The findings of our study revealed that there was a significant reverse correlation between IPAQ walking scores and the prepandemic Visual Analog Scale (VAS) scores (P = 0.015, r = -0.201) and the pandemic VAS scores (P = 0.000, r = -0.313).By contrast, the level of benefit from injections decreased (P < 0.05) and the duration of spinal intervention was shortened in patients with high IPAQ sitting scores (P < 0.05). LIMITATIONS: The limitations of the study are the small number of patients and the fact that our results are based on patients’ self-reported data. CONCLUSIONS: Social isolation has had an increasing effect on low back pain during the COVID-19 pandemic. The results of our study showed a significant relationship between activity level and pain intensity. We also found that patients who have benefited from spinal injections administered in the prepandemic period experience less severe low back pain during the pandemic. KEY WORDS: COVID-19, spine intervention, physical activity, low back pain, social isolation

Variations in anthropometry and physical characteristics of staff with low back pain working in tertiary hospital

<p class="abstract"><strong>Background:</strong> Several links were searched to know the variations in anthropometry and physical characteristics of staff with low back pain (LBP) working in tertiary hospital. Controversy exists between the association of these characteristics with LBP. The study was conducted to understand the relation between physical characteristics and LBP in the south Indian population.</p><p class="abstract"><strong>Methods:</strong> Ethical approval was obtained from the institutional health research ethical committee. A survey was conducted using a proforma and it was circulated among the staff and doctors in the tertiary care hospital. The validated questionnaires were framed to collect all the physical characteristics and anthropometry of the respondents and history of LBP. The distribution of the parameters are calculated either as mean±two standard deviation, or as count and percentage. The tests used for comparison is the t test and for association is the chi square (𝛘2) test. A p value less than or equal to 0.5 is considered as statistically significant. The data was analysed using the microsoft excel and the minitab (17) software.<strong></strong></p><p class="abstract"><strong>Results:</strong> The study showed significant positive association of back pain with increase in weight of the subjects, history of back trauma, spinal injections and lifting heavy weights (p value&lt;0.01). There was no significant association of LBA with variables like history of menstrual irregularities and mode of transport.</p><p class="abstract"><strong>Conclusions:</strong> There is a positive association between LBP with anthropometric features like weight of the patient and also physical characteristics like history of back trauma, spinal injections and lifting heavy weights.</p>

Clinical research

This chapter explains some of the research activities which are currently in place. It describes the global research platform called ENROLL-HD. It also describes the process of undertaking a clinical trial. The current clinical trials are focusing on lowering the amount of huntingtin in the cells of the brain especially the caudate and putamen nuclei. The plan is to interfere with the chemical message between the gene and the protein-making machinery of the cell. These drugs are called anti-sense oligonucleotides (ASOs). It is not known if these treatments will result in an alteration of the natural history of Huntington’s disease (HD) but there is hope because the treatment does not rely upon an understanding of the abnormal function of the abnormal huntingtin protein. Currently, the treatments are developed by spinal injections but a future development will be to have drugs which do not have have to be given by spinal injection. This work is contrasted with ideas of gene editing. Brief mention is made to understand genetic factors other than the length of the CAG repeat which influence the age of onset because such an understanding can lead to new avenues for drug treatments.