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BackPage Online, February 2016

doi: 10.1097/01.BACK.0000480370.32612.64
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Recognizing Hip Pathology in the Evaluation of Low Back Pain

Healthcare professionals evaluating lumbar, pelvic, and/or leg pain often have to determine whether symptoms originate from the lumbar spine, the hip, or both. It is no easy task.

They often rely on history, physical testing and/or imaging to make these decisions. However, none of these methods offers a guaranteed crystal ball. These decisions often involve an uncomfortable level of guesswork.

A new study explores the uncertainty regarding the relationship between hip pain and radiographic evidence of hip osteoarthritis. Chan Kim, MD, and colleagues looked at evidence from two major cohort studies on hip pain and osteoarthritis.

Their results will likely confound the expectations of many healthcare providers. “Hip pain was not present in many hips with radiographic osteoarthritis, and many hips with pain did not show radiographic hip osteoarthritis. Most older participants with a high suspicion for clinical hip osteoarthritis (groin or anterior pain and/or painful internal rotation) did not have radiographic hip osteoarthritis, suggesting that in many cases, hip osteoarthritis might be missed if diagnosticians relied solely on hip radiographs. Here is the entire study:

http://www.bmj.com/content/351/bmj.h5983.long.

Chronic Back Pain Research in a Country Torn Apart By War

The vast majority of evidence on low back pain comes from relatively affluent and orderly developed nations. And researchers are having to play “catch up” to see if patterns of back pain observed in modern industrialized societies also apply in other countries. There is starting to be a trickle of both epidemiologic and clinical studies from less developed countries. And this research movement needs encouragement.

Syrian researchers performed a study of the roots of chronic back pain in 2011 and 2012—as observed among patients in a neurology clinic. They found some intriguing patterns and associations, including hints of a congenital pattern of chronic back pain, variable rates of back pain among women and men, and variable associations with degrees of overweight. They found no association between work-related loading and low back pain.

The entire study from the Avicenna Journal of Medicine can be found at the web address below. This is apparently the first study of its type performed in Syria. And, tragically, it may be the last for a long, long time. Shortly after this study was completed, Syria was enveloped in a vicious and destructive civil war that continues today. One hopes this line of research can continue in the future—in a happier and more peaceful time for this large Middle Eastern nation. See:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4637947/?report=classic.

U.S. Not the Only Country to Have Rising Spine Surgery Rates

The United States is not the only country to experience rising spine surgery rates over the past two decades. Neurosurgeon Vinothan Sivasubramanian and colleagues used a publicly available database to study growth in hospital admissions and surgical procedures for degenerative lumbar spine disease in England from 1999 through 2013.

The new study found substantial growth in both hospital admissions and surgical procedures for lumbar disease. The rate of admissions rose from 127.09 to 216.14 per 100,000 and there was comparable growth in the rate of surgical procedures.

The increase was most marked in the oldest age groups with a 1.9 and 2.33-fold increase in admissions for patients aged 60–74 and ≥75 years, respectively, and a 2.8-fold increase in procedures for those aged ≥60 years.

These data suggest there will be an increasing demand for surgical and nonsurgical spine specialists in England—and a growing need to treat a large population of older patients with significant comorbidities. Here is the entire study from BMJ Open:

http://bmjopen.bmj.com/content/5/12/e009011.long.

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