Costs of back pain in Germany

Wenig, Christina M.; Schmidt, Carsten Oliver; Kohlmann, Thomas; Schweikert, Bernd

doi:10.1016/j.ejpain.2008.04.005

Cited by 373 publications

(248 citation statements)

References 27 publications

(59 reference statements)

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“…Such symptoms are all too common and account for the majority of health consultations worldwide (23)(24)(25). In fact, the global socioeconomic burden of back pain alone is staggering, underlining the urgency to understand its etiology in an effort to best devise preventative and therapeutic measures to combat its occurrence and effects (26)(27)(28).…”

mentioning

confidence: 99%

Intervertebral disc degeneration: New insights based on “skipped” level disc pathology

Cheung¹,

Samartzis²,

Karppinen³

et al. 2010

Arthritis & Rheumatism

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Objective. Typically, age and abnormal physical loading ("wear and tear") have been associated with the development of intervertebral disc degeneration. In the past decade, various additional etiologic factors for disc degeneration have been sporadically reported in the literature; however, many investigators continue to place tremendous emphasis on the effects of age and biomechanics associated with disc degeneration. The aim of this study was to provide additional insight into the notion that age and biomechanics are key factors in the development of disc degeneration. To this end, we addressed the prevalence of and risk factors associated with a unique pattern of disc degeneration of the lumbar spine, "skipped" level (nonconsecutive) disc degeneration (SLDD).Methods. As part of a large genetics-based study in southern Chinese individuals (n ‫؍‬ 1,989), a crosssectional analysis was performed in subjects exhibiting disc degeneration in >2 levels (n ‫؍‬ 838) who were then categorized as having SLDD (n ‫؍‬ 174) or non-SLDD (contiguous, multilevel; n ‫؍‬ 664). Various radiographic parameters were assessed based on T2-weighted magnetic resonance imaging (MRI). Subject demographics were assessed, and univariate and multivariate logistic regression analyses were performed.Results. Overall, 8.7% of the whole population (n ‫؍‬ 1,989) had SLDD, while it was present in 20.8% of subjects with multilevel disc degeneration (n ‫؍‬ 838). SLDD was more prevalent in male subjects (adjusted odds ratio [OR] 1.48, 95% confidence interval [95% CI] 1.04-2.10, P ‫؍‬ 0.028). SLDD was significantly associated with the presence of Schmorl's nodes (adjusted OR 2.72, 95% CI 1.78-4.15, P < 0.001), which also presented in levels with no disc degeneration. A history of disc bulge/extrusion (P ‫؍‬ 0.004) and/or a history of back injury (P ‫؍‬ 0.010) was significantly associated with non-SLDD, and a greater degree of overall severity of disc degeneration was also associated with non-SLDD. Other demographic and MRI findings did not significantly differ between groups.Conclusion. To our knowledge, this report is the first to describe the prevalence and risk factors associated with SLDD. Our study challenges the paradigm that age and biomechanics are the key factors associated with the development of disc degeneration. Although age and biomechanical factors may play a role in the manifestation of disc degeneration, our novel findings of SLDD patterns provide further awareness of and support for the notion that additional etiologic factors may play a role in the development of disc degeneration. Such factors warrant further investigation to shed light on the cause of disc degeneration.

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mentioning

confidence: 99%

Intervertebral disc degeneration: New insights based on “skipped” level disc pathology

Cheung¹,

Samartzis²,

Karppinen³

et al. 2010

Arthritis & Rheumatism

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“…Disabling Chronic Low Back Pain (CLBP) impairs quality of life (QoL), impacts healthcare systems and burdens societies worldwide 1, 2, 3. For the majority of people suffering from CLBP, it is difficult to identify abnormalities in specific spinal structures as the cause of their symptoms 4, 5 and they are often referred to as having Non‐Specific Low Back Pain (NSLBP), although some reports advocate the use of precision diagnostic blocks in an attempt to circumvent this 6.…”

Section: Introductionmentioning

confidence: 99%

New Therapy for Refractory Chronic Mechanical Low Back Pain—Restorative Neurostimulation to Activate the Lumbar Multifidus: One Year Results of a Prospective Multicenter Clinical Trial

Deckers

Smedt

Mitchell³

et al. 2018

Neuromodulation: Technology at the Neural Interface

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ObjectivesThe purpose of the international multicenter prospective single arm clinical trial was to evaluate restorative neurostimulation eliciting episodic contraction of the lumbar multifidus for treatment of chronic mechanical low back pain (CMLBP) in patients who have failed conventional therapy and are not candidates for surgery or spinal cord stimulation (SCS).Materials and MethodsFifty‐three subjects were implanted with a neurostimulator (ReActiv8, Mainstay Medical Limited, Dublin, Ireland). Leads were positioned bilaterally with electrodes close to the medial branch of the L2 dorsal ramus nerve. The primary outcome measure was low back pain evaluated on a 10‐Point Numerical Rating Scale (NRS). Responders were defined as subjects with an improvement of at least the Minimal Clinically Important Difference (MCID) of ≥2‐point in low back pain NRS without a clinically meaningful increase in LBP medications at 90 days. Secondary outcome measures included Oswestry Disability Index (ODI) and Quality of Life (QoL; EQ‐5D).ResultsFor 53 subjects with an average duration of CLBP of 14 years and average NRS of 7 and for whom no other therapies had provided satisfactory pain relief, the responder rate was 58%. The percentage of subjects at 90 days, six months, and one year with ≥MCID improvement in single day NRS was 63%, 61%, and 57%, respectively. Percentage of subjects with ≥MCID improvement in ODI was 52%, 57%, and 60% while those with ≥MCID improvement in EQ‐5D was 88%, 82%, and 81%. There were no unanticipated adverse events (AEs) or serious AEs related to the device, procedure, or therapy. The initial surgical approach led to a risk of lead fracture, which was mitigated by a modification to the surgical approach.ConclusionsElectrical stimulation to elicit episodic lumbar multifidus contraction is a new treatment option for CMLBP. Results demonstrate clinically important, statistically significant, and lasting improvement in pain, disability, and QoL.

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“…The one year and lifetime prevalence was approximately 60-70% and more than 80%, respectively [1] . In a study from Korea the prevalence of disc herniation, annular fissure and disc degeneration in asymptomatic subjects were 81.4%, 76.1%, and 75.8% respectively [2] .…”

Section: Introductionmentioning

confidence: 99%

Prevalence of lumbar disc herniation and disc degeneration in asymptomatic Indian subjects: An MRI based study

Kuppuswamy¹,

George²,

Chemmanam³

2017

Int. J. Orthop. Sci.

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Background: India is a country with a huge human resource been utilised for labour and also is a country of diversity in culture and religions. Thus we have numerous activities which involve bending and twisting of the spine. Therefore we expect more disc degeneration and disc herniation compared to the western world. Indian health care system has traditional medicine and modern medicine. Both systems has easy access to Magnetic Resonance Imaging (MRI) which in fact will display both physiological and pathological changes. This may miss-lead a less experienced health worker and can also create a bad mental impact on an otherwise normal individual. Aim: Analyse the prevalence of lumbar disc degeneration and herniation in asymptomatic Indian subjects using MRI Materials and Methods: this was an observational study where we selected subjects without any low back related symptoms and signs and allowed them to undergo lumbar spine screening using a 0.2 tesla machine. Results: We had 76 subjects with a mean age of 43.7 and studied 380 discs in 4 different age groups. Among disc herniation 273 discs (71.8%) were normal and 107 discs (28.2%) had pathological changes in the form of bulge 68(17.8%), protrusions 30(7.8%) and extrusions 9(2%). None of the subjects had sequestration. Among disc degeneration 256(67.3%) were Grade 1& 2 and 124 (32.7%) were Grade 3, 4&5. In the 76 subjects 37% had disc herniation and 33% had grade 3, 4 and 5 degeneration. Conclusion: The high prevalence of disc degeneration and disc herniation in MRI of normal subjects, emphasize the value of clinical history and clinical evaluation before starting precious treatment.Keywords: disc degeneration, herniation, MRI, asymptomatic subjects Introduction According to literature, the prevalence of lumbar pain at one time point was approximately 30-40% in Germany. The one year and lifetime prevalence was approximately 60-70% and more than 80%, respectively

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Costs of back pain in Germany

Cited by 373 publications

References 27 publications

Intervertebral disc degeneration: New insights based on “skipped” level disc pathology

Intervertebral disc degeneration: New insights based on “skipped” level disc pathology

New Therapy for Refractory Chronic Mechanical Low Back Pain—Restorative Neurostimulation to Activate the Lumbar Multifidus: One Year Results of a Prospective Multicenter Clinical Trial

Prevalence of lumbar disc herniation and disc degeneration in asymptomatic Indian subjects: An MRI based study

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