Study DesignCross-sectional study.PurposeTo evaluate the prevalence and various risk factors for low back pain (LBP) in young adults in India.Overview of LiteratureLBP is an emerging problem in adolescents, with an incidence that is the highest in the third decade of life worldwide. Various risk factors such as obesity, smoking, family history, stress, and exercise have been described in the literature. This study was conducted because of paucity of data in the Indian literature.MethodsA total of 1,355 (741 males and 641 females) young Indian Administrative Service aspirants and medical postgraduate aspirants aged 18–35 years were enrolled in the study. The subjects completed a detailed, semi-structured questionnaire that gathered data regarding their sociodemographic profile and factors considered to be risk factors for LBP. Anthropometric measurements, including height and weight, were measured and body mass index was calculated.ResultsMost subjects (90.6%) were aged 20–29 years (mean, 24.49; range, 18–35 years). Results indicated that the following factors were associated with LBP in young adults: marital status, previous history of spine problems, strenuous exercise, job satisfaction, monotony, stress, daily number of studying hours, and family history of spine problems (p<0.05). However, age, sex, smoking, alcoholism, coffee intake, mode and duration of travel, diet, frequency of weightlifting, wearing heels, studying posture, and frequency and type of sports activities were not associated with LBP.ConclusionsThe study identified various modifiable and non-modifiable risk factors that precipitated LBP in young adult Indians. Identifying these risk factors at an early stage will prevent LBP progression to a chronic disease state, thereby improving an individual's quality of life and increasing productivity.

IntroductionIntraoperative neuromonitoring (IONM) has become a standard of care in spinal deformity surgeries to minimize the incidence of new onset neurological deficit. Stagnara wake up test and ankle clonus test are the oldest techniques described for spinal cord monitoring, but they cannot be solely relied upon as a neuromonitoring modality. Somatosensory evoked potentials monitor only dorsal tracts and give high false positive and negative alerts. Transcranial motor evoked potentials (TcMEPs) monitor the more useful motor pathways. The purpose of our study was to report the safety, efficacy, limitations of TcMEPs in spine deformity surgeries, and the role of a checklist.Study designRetrospective review of all spinal deformity surgeries performed with TcMEPs from 2011 to 2015.Materials and methodsAll patients were subjected to IONM by TcMEPs during the spinal deformity surgery. Patients were included in the study only if complete operative reports and neuromonitoring data and postoperative neurological data were available for review. An alert was defined as 80% or more decrement in the motor evoked potential amplitude, or increase in threshold of 100 V or more from baseline. The systemic and surgical causes of IONM alerts and the postoperative neurological status were recorded.ResultsIn total, 61 patients underwent surgery for spinal deformities with TcMEPs. The average age was 12.6 years (6–36 years) and male:female ratio was 1:1.3. Diagnoses included idiopathic scoliosis (n = 35), congenital scoliosis (n = 13), congenital kyphosis (n = 7), congenital kyphoscoliosis (n = 4), post-infectious kyphosis (n = 1), and post-traumatic kyphosis (n = 1). The average kyphosis was 72° (45°–101°) and the average scoliosis was 84° (62°–128°). There were in total 33 alerts in 22 patients (36%). The most common causes were hypotension (n = 7), drug induced (n = 5), deformity correction (n = 5), osteotomies (n = 3), tachycardia (n = 1), screw placement (n = 2), and electrodes disconnection (n = 1). Reversal of the inciting event cause resulted in complete reversal of the alert in 90% of the times. Three patients showed persistent alerts, out of whom one had a positive wake up test and woke up with neurodeficit, which recovered over few weeks, while the other patients showed persistent alerts but woke up without any deficit. Sensitivity and specificity of TcMEP in deformity correction surgery were 100 and 96.6%, respectively, in our study.ConclusionIONM alerts are frequent during spinal deformity surgery. In our study, more than 50% of the alerts were associated with anesthetic management. IONM with TcMEPs is a safe and effective monitoring technique and wake up test still remains a valuable tool in cases of a persistent alert.

STUDY DESIGN.: Prospective, computer aided pedicle morphometric data measurements obtained from computed tomography (CT) scan of lower thoracic (T9-T12) and lumber vertebrae in a large group of Indian population. OBJECTIVES.: Measurement on CT scan of the surgically relevant parameters of transverse pedicle isthmus width, transverse pedicle angle, and depth to anterior cortex along the midline axis and the pedicle axis by Computer software aid in a large sample of Indian population. To compare the results with those of similar studies of Western and Indian population in literature by other methods and to deduce safety parameters for pedicular screw placements in these areas. SUMMARY OF BACKGROUND DATA.: Although differences have been reported in literature between various ethnic groups, most studies reported are for white populations and Indian studies are few. The Indian studies have had small sample size, and been done on patients with preexisting spinal disorder or cadavers and by manual data measurements. To the authors' knowledge, the present study is the largest published for patients from the Indian subcontinent and only using computer software aided measurements. METHODS.: CT scans of the lower thoracic and lumbosacral spine of patients free from spinal disorders from the Indian subcontinent were reviewed. We analyzed a total of 450 vertebrae in 50 consecutive patients. Parameters recorded were transverse pedicle isthmus width, transverse pedicle angle, and depth to anterior cortex along the midline axis and the pedicle axis with help of computer software. RESULTS.: The mean transverse pedicle isthmus width was least at the T9 level (5.65 mm). Majority of pedicles at thoracic level had diameter over 5 mm T9 (94%), T10 (100%), T11 (96%), T12 (100%). At lumber all had diameters over 7 mm with wide range at upper levels. The mean transverse pedicle angle faced laterally at thoracic vertebrae with exception of T9. In lumber area, all were medially directed with maximum at L5 and least at L1. The depth to the anterior cortex was more along the pedicle axis at all levels except T11 and T12. CONCLUSION.: Significant differences exist between the pedicles of Indian and white populations. It is suggested that preoperative software-based morphometric data should be collected if possible for preoperative planning of pedicle implant placement and sizes to avoid inadvertent complications. Further, data from study can be used as a guide for implant size, intraoperative placement trajectory at lower thoracic and lumber vertebrae pedicles.

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