Purpose of the study and background. The preliminary study aimed to establish clinical and research expert opinion with regards to the key components of an assessment of a person with Mechanical Low Back Pain (MLBP). We aimed to identify the key subjective questions and objective tests which would be helpful for clinicians to develop the most appropriate self-management exercise programme. This is the first part of the study to develop the ‘Back-to-Fit’ digital tool offering personalised self-management exercise solutions for people with MLBP. Summary of the methods. A Bristol online survey which included a questionnaire with a series of open and closed questions was developed using the literature and was distributed among clinicians/researchers with a background in the clinical management of MLBP. The questionnaire included 6 demographic questions followed by sections related to subjective questions and objective tests of the MLBP assessment. 71 participants responded to the survey. Results. In the subjective assessment component, ≥80% level of agreement was obtained for 17 of 26 proposed subjective questions and 05 of the 21 suggested objective tests. Two more questions and two objective tests to be included in the assessment had been suggested by the partcipants. Conclusion. These expert agreements on questions and opinions provides an indication of the key subjective and objective components to be included in a self-assessment tool in a personalised self-management platform for MLBP. Further testing with a multiple round Delphi study in a large sample of experts is now required to obtain consensus for the above findings. Conflicts of interest: No conflicts of interest. Sources of funding: Biomechanics and Bioengineering Research Centre Versus Arthritis, Cardiff University, UK

Background

Low back pain (LBP) is widespread in all populations and is a worldwide health problem, which poses substantial challenges for clinical management. Individuals with LBP may reduce their symptoms by implementing self-managed at-home interventions. The theoretical design of the LumbaCurve™ promotes the principles of a passive gravity-assisted traction (PGAT) stretch of the lumbar and sacral region in order to reduce LBP. This study aimed to assess the clinical effectiveness of the LumbaCurve™ in the management of LBP when compared to a control group of standardised care.

Background and purpose of the study. Axial Spondyloarthritis (axSpA) is commonly mistaken as chronic mechanical back pain. Delayed diagnosis averages 5- 8 years with impacts on effective and timely management, outcomes and quality of life. NICE Guidance (2017) highlights the importance of the recognition and referral of suspected axial spondyloarthritis. This study investigated the occurrence of physiotherapy care prior to diagnosis of axSpA within physiotherapy outpatient settings. Methods and results. A retrospective review was performed of all patients diagnosed with axSpA who had received physiotherapy care prior to their diagnosis from 1990–2016. Three or more episodes of care prior to diagnosis was taken as unrecognised axSpA. Information was obtained on diagnostic codes, number of episodes of care and contacts per episode from nine outpatient physiotherapy services. Analysis showed that 263 people (17–69 years) diagnosed with axSpAs had received physiotherapy care prior to diagnosis. Within this population, 103 (44%) had received ≥3 episodes of care. Number of contacts within each episode ranged from 3 (47 people) to 58 (1 person) [median=11 contacts-10 people]. Average time from initial physiotherapy episode to date of diagnosis was 6.4 years (range=0.3–12.8 years, median=8.8 years). The most common assigned diagnostic code was back pain (49.6%), followed by shoulder (11.1%), knee (8.5%), neck (7.7%), ankle/foot (4.3%), tendonitis (4.2%), joint pain (3.4%), osteoarthritis (3.4%) and sacroiliac joint (2%). Conclusion. Findings illustrate the extent of unrecognised axial spondyloarthritis referred to and missed in musculoskeletal physiotherapy practice. It is essential to improve screening and recognition of inflammatory back pain and possible axSpA in musculoskeletal assessments, supported by rheumatology referral guidance. No conflicts of interest. No funding obtained

Aims

To identify the incidence and risk factors for five-year same-site recurrent disc herniation (sRDH) after primary single-level lumbar discectomy. Secondary outcome was the incidence and risk factors for five-year sRDH reoperation.

Purposes of the study and background. Characteristics of muscle activity, represented by surface electromyography (EMG), have shown differences between patients with low back pain and healthy adults; how they relate to functional/clinical scales remains unclear. The purpose of the current study was to examine the correlation between frequency characteristics of EMG and patients' self-rated score of disability using continuous wavelet transform (CWT) analysis. Methods and Results. Fifteen patients with chronic mechanical low back pain (LBP) and 10 healthy adults were recruited. Patients completed the Roland-Morris Disability Questionnaire (RMDQ) and bilateral EMG activity was obtained from erector spinae at vertebral level L4 and T12. Subjects performed 3 brief maximal voluntary contractions (MVCs) of the back extensors and the torque was measured using a dynamometer. CWT was applied to the EMG signals of each muscle in a 200ms window centred around the peak torque obtained during the MVCs. The ratio (low/high frequencies) of the energy, the peak energy, and the frequency of the peak energy were calculated for each muscle and then averaged and correlated with the individual's RMDQ score. Patients had significantly lower peak power than the controls (p=0.04). Additionally, RMDQ positively correlated to the average ratio of energy (rho=0.71; p=0.01), meaning higher disability corresponded to a dominant distribution of energy in the lower-frequencies; but negatively correlated to the average frequency of peak energy (rho=-0.61; p=0.035), meaning lower frequency of peak energy corresponded to higher levels of disability. Conclusion. The current findings support anatomical evidence of changes in muscle fibre composition of back muscles in subjects with chronic LBP. Conflicts of interest: No conflicts of interest. Sources of funding: No funding obtained

Aims

To determine the effectiveness of prone traction radiographs in predicting postoperative slip distance, slip angle, changes in disc height, and lordosis after surgery for degenerative spondylolisthesis of the lumbar spine.

Aim. To evaluate the level of health resource utilisation by patients after lumbar total disc replacement (TDR) for mechanical low back pain. Method. At our centre, 35 patients underwent TDR and were followed prospectively from surgery. All surgery was performed by the senior author. Patients were followed routinely in clinic at yearly intervals. In addition, the patients and their GPs were contacted via telephone. Information gathered included ODI and VAS, satisfaction with surgery and return to work. We specifically established whether the patients continued to seek healthcare, for persistent back symptoms, from professionals (both NHS and private) including their GP, pain clinic, physiotherapist, acupuncturist, chiropractor or another spinal surgeon, and had any further interventions. Results. We have complete dataset on 30 out of 35 patients and are the subject of this study. There were 13 men, with a mean age of 37.7 years (range 28-45 years), and 17 women with a mean age of 49.8 years (range 27-62 years). Surgery was single level in 26 and two levels in 6 cases. Patients were satisfied with the outcome of surgery in 21 cases (70%), not satisfied in 7. Two cases had implant failures. 25 patients were working pre-operatively and 26 were working postoperatively. Eighteen patients required no further healthcare input. Five had had pain clinic reviews, six had seen their GPs (1-6 visits) and one another spinal surgeon (after late liner extrusion). Seven had facet injections and two had epidurals. One patient underwent posterior fusion for implant migration. Conclusion. In our series TDR is successful in 70% and 60% of the entire cohort needed no further healthcare input. After successful TDR there is almost no ongoing use of health resources

This review of the literature presents the current understanding of Scheuermann’s kyphosis and investigates the controversies concerning conservative and surgical treatment. There is considerable debate regarding the pathogenesis, natural history and treatment of this condition. A benign prognosis with settling of symptoms and stabilisation of the deformity at skeletal maturity is expected in most patients. Observation and programmes of exercise are appropriate for mild, flexible, non-progressive deformities. Bracing is indicated for a moderate deformity which spans several levels and retains flexibility in motivated patients who have significant remaining spinal growth.

The loss of some correction after the completion of bracing with recurrent anterior vertebral wedging has been reported in approximately one-third of patients. Surgical correction with instrumented spinal fusion is indicated for a severe kyphosis which carries a risk of progression beyond the end of growth causing cosmetic deformity, back pain and neurological complications. There is no consensus on the effectiveness of different techniques and types of instrumentation. Techniques include posterior-only and combined anteroposterior spinal fusion with or without posterior osteotomies across the apex of the deformity. Current instrumented techniques include hybrid and all-pedicle screw constructs.