BACKGROUND:Surgical intervention for lumbar spinal stenosis (LSS) is common and associated with high rates of postoperative side effects or complications. Prehabilitation programs aim to reduce postoperative complications and enhance outcomes. However, the clinical effectiveness of prehabilitation programs for patients undergoing LSS surgery has yet to be fully investigated. A key part of this investigation is to gain insight into how to design these programs through an iterative process that includes feedback from patients' experiences. OBJECTIVE:To explore patients' experiences with a novel prehabilitation program: Pre-Operative Spinal Education for Lumbar Spinal Stenosis (POSE-LSS). DESIGN:Individual structured telephone interviews with pragmatic qualitative analysis. SETTING:Academic medical center. PARTICIPANTS:Patients (n = 10) who underwent lumbar spinal stenosis surgery and completed the POSE-LSS program prior to their surgery were included (six women; four men, mean age: 62.3 years). INTERVENTIONS:POSE-LSS is a novel multimodal, education-focused, time-efficient prehabilitation program for patients undergoing LSS surgery. Participants received the following: (1) educational booklet and video, (2) in-person physical therapy (PT) session, and (3) telemedicine visit with a physiatrist. OUTCOME MEASURES:One-on-one structured interviews to understand patients' experiences with a LSS prehabilitation program. RESULTS:Participants in this qualitative study described a favorable, unique, and feasible experience associated with participation in the POSE-LSS program. Three main themes were developed from these interviews about POSE-LSS: (1) it helped patients to better prepare for their surgery and improved postoperative expectations, (2) it addressed modifiable psychological factors associated with the surgical intervention, and (3) it fits into a larger support system necessary to meet patients' needs. CONCLUSIONS:The perspectives gained from this qualitative study can inform improved design and evaluation of LSS prehabilitation programs.

BACKGROUND CONTEXT:Spine surgery, like all major surgeries, carries the risk of adverse events and delayed recovery. Prehabilitation programs may mitigate negative prognostic factors to reduce complications and promote faster recovery postoperatively following spine surgery. There is no international consensus or recommendations regarding prehabilitation components in spine surgery. PURPOSE:This study aims to establish international consensus on important modalities of prehabilitation before spine surgery for patients appropriate for prehabilitation using a modified nominal group technique (NGT). STUDY DESIGN/SETTING:A modified NGT. PATIENT SAMPLE:This study used a modified NGT to establish consensus among 50 participants during the International Forum for Back and Neck Pain (ILBP Forum) 2023 and International Society for the Study of the Lumbar Spine (ISSLS) 2024 conference. OUTCOME MEASURES:The rank for each theme and component was computed as the mean of the ranking. We expressed the dispersion in ranking as a measure of consensus. METHODS:During the workshops participants consisting of clinicians and researchers ranked themes and components of a prehabilitation intervention for patients scheduled for spine surgery. The rank for each theme and component was calculated as the mean rank, the dispersion in rankings was used as a measure of consensus. RESULTS:Five main prehabilitation themes were identified and ranked from most to least important by the participants: education (consensus=0.65), psychological prehabilitation (consensus=0.56), physical prehabilitation (consensus=0.37), multidisciplinary prehabilitation (consensus=0.54) and lifestyle factors (consensus=0.53). Within themes, different prehabilitation components were identified and ranked by priority. CONCLUSIONS:The 5 themes identified by this NGT consensus process (education, psychological prehabilitation, physical prehabilitation, multidisciplinary prehabilitation and lifestyle factors) can help inform the design of innovative prehabilitation interventions for optimizing recovery from spine surgery.

Background Physicians, allied health clinicians, scientists, and industry partners’ use of social media has grown exponentially, permeating across all levels of healthcare delivery and practice. Spine care professionals can interact with both professional and patient audiences across social media platforms. Methods This article aims to narratively outline social media best practices for the spine care professional. Results Thirty-two social media best practice statements are presented to help guide spine care professionals. The best practice statements are thematically organized: (1) Compliance and Confidentiality, (2) Professionalism, (3) Security and Access, and (4) Spine Care. Conclusions Social media represents a broadcasting platform for communication between clinicians and patients alike, presenting with it numerous advantages and challenges. As spine care professionals we must learn how to engage in its utilization in both educational and professional-social environments.

INTRODUCTION:Lumbar spinal stenosis (LSS) is a leading cause of chronic musculoskeletal pain among older adults. A common and costly intervention for the treatment of LSS is lumbar decompression with or without fusion (LSS surgery), which has mixed outcomes among patients. Prehabilitation is a strategy designed to optimize the consistency of positive surgical outcomes and promote patient self-efficacy, while attempting to mitigate postoperative complications. No efforts have investigated the prehabilitation strategies specifically for patients undergoing LSS surgery. OBJECTIVE:To determine the feasibility of delivery and acceptability by participants of a novel prehabilitation intervention for patients undergoing LSS surgery. DESIGN:Feasibility study. SETTING:Outpatient orthopedic clinic at an academic medical center. PARTICIPANTS:Patients at least 50 years of age, who were scheduled for LSS surgery between October 2020 and October 2021. INTERVENTION:PreOperative Spinal Education for Lumbar Spinal Stenosis (POSE-LSS), is a novel multimodal, education-focused, time-efficient prehabilitation program for patients undergoing LSS surgery. Participants received the following: (1) Educational booklet and video; (2) In-person physical therapy (PT) session; and (3) Telemedicine visit with a physiatrist. MAIN OUTCOME MEASURE(S):The primary outcomes of interest were feasibility and acceptability of intervention by participants. Key potential surgical outcomes were length of stay and discharge disposition. RESULTS:POSE-LSS was completed by all eligible participants enrolled (n = 15) indicating feasibility and acceptability. Potential effectiveness measures including length of stay and discharge disposition were positively associated with the POSE-LSS intervention. CONCLUSIONS:This study demonstrates that a novel prehabilitation intervention is feasible, acceptable, and appears positively associated with important short-term measures of postoperative recovery that may impact the trajectory of patient care following LSS surgery.

We aimed to identify and describe the current interventions used in preoperative programs ("prehabilitation") for spine surgery. Knowledge gaps in approaches, feasibility, timing, patient experience, clinical outcomes, and health care costs were explored while describing their potential benefits on physical and psychological outcomes. An electronic search was conducted from January 2004 to February 2022 in Ovid Medline, Embase, EBSCO CINAHL, the Cochrane Database of Systematic Reviews, and PEDro to identify studies in English evaluating adults enrolled in prehabilitation before undergoing elective spine surgeries. Studies were uploaded into DistillerSR for systematic screening after removing duplicates. Four reviewers screened nested references for inclusion based on titles and abstracts, followed by their full-text review. Two reviewers subsequently extracted data and summarized the results. The results were reported using Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines. Studies were rated for quality using National Health and Medical Research Council criteria. Out of 18,879 potential studies, a total of 23 studies (0.12%) met the eligibility criteria and were included in this scoping review. The prehabilitation programs included general education (n = 6, 26%), exercise (n = 6, 26%), cognitive behavioral therapy (n = 3, 13%), pain neuroscience education (n = 3, 13%), health behavior counseling (n = 3, 13%), and mindfulness (n = 2, 9%). Additional studies are needed to identify optimal patient characteristics, intervention dosage, and whether multimodal approaches using a combination of physical and psychological strategies lead to more favorable outcomes. Although studies on prehabilitation for spine surgery are limited, they seem to demonstrate that prehabilitation programs are feasible, reduce medical expenditures, and improve patients' postoperative pain, disability, self-efficacy, psychological behaviors, and satisfaction with surgical outcomes. The available literature suggests there is an opportunity to improve patient experience, clinical outcomes and reduce medical costs with the use of prehabilitation in spine surgery.

Globally, low back pain (LBP) is the leading cause of years lived with disability. LBP is usually benign yet is often interpreted as an ominous sign of disease. Prior research has demonstrated many populations have misinformed beliefs about the nature, etiology, and prognosis of LBP, with the primary source being healthcare professionals (HCP). There is a gap in knowledge about LBP beliefs in the North American (NA) population. Current beliefs must be identified to inform future educational interventions. We conducted a cross-sectional online qualitative survey to assess NA population beliefs about LBP. Participants were recruited via social media advertisements targeting individuals over age 18 with English speaking and reading comprehension. We used an inductive content analysis approach to develop categories based on participants’ responses to 3 open-ended questions about the presumed cause of their low back pain, its persistence, and the source of these beliefs. 62 participants (51 women, 7 men) were included, mean age of 47.6 years, 33 located in U.S.A. and 29 in Canada. Participants presumed causes of LBP fell into three categories: physical (biology, biomechanics, prior injury), psychological, unknown. Similar themes were generated regarding reported reasons for the recurrence or persistence of LBP, with the addition of a single category, environmental. Participants' primary source of beliefs was HCP (n = 34, 55%) with secondary sources of family (n = 12, 19%) and internet (n = 12, 19%). Many participants reported multiple causes for LBP, however, these were mostly focused on the physical body, with minimal consideration of psychological and sociological influences.[PASD1] Our study findings align with prior research from other regions in the world, further demonstrating a need for updating clinical education and public messaging about LBP. Funding provided by Faculty Research Fund at Bridgewater College. Globally, low back pain (LBP) is the leading cause of years lived with disability. LBP is usually benign yet is often interpreted as an ominous sign of disease. Prior research has demonstrated many populations have misinformed beliefs about the nature, etiology, and prognosis of LBP, with the primary source being healthcare professionals (HCP). There is a gap in knowledge about LBP beliefs in the North American (NA) population. Current beliefs must be identified to inform future educational interventions. We conducted a cross-sectional online qualitative survey to assess NA population beliefs about LBP. Participants were recruited via social media advertisements targeting individuals over age 18 with English speaking and reading comprehension. We used an inductive content analysis approach to develop categories based on participants’ responses to 3 open-ended questions about the presumed cause of their low back pain, its persistence, and the source of these beliefs. 62 participants (51 women, 7 men) were included, mean age of 47.6 years, 33 located in U.S.A. and 29 in Canada. Participants presumed causes of LBP fell into three categories: physical (biology, biomechanics, prior injury), psychological, unknown. Similar themes were generated regarding reported reasons for the recurrence or persistence of LBP, with the addition of a single category, environmental. Participants' primary source of beliefs was HCP (n = 34, 55%) with secondary sources of family (n = 12, 19%) and internet (n = 12, 19%). Many participants reported multiple causes for LBP, however, these were mostly focused on the physical body, with minimal consideration of psychological and sociological influences.[PASD1] Our study findings align with prior research from other regions in the world, further demonstrating a need for updating clinical education and public messaging about LBP. Funding provided by Faculty Research Fund at Bridgewater College.

Background: Prior research has demonstrated that people across different populations hold beliefs about low back pain (LBP) that are inconsistent with current evidence. Qualitative research is needed to explore current LBP beliefs in Northern America (NA). Objectives: We conducted a primarily qualitative cross-sectional online survey to assess LBP beliefs in a NA population (USA and Canada). Methods: Participants were recruited online using social media advertisements targeting individuals in NA over the age of 18 with English speaking and reading comprehension. Participants answered questions regarding the cause of LBP, reasons for reoccurrence or persistence of LBP, and sources of these beliefs. Responses were analyzed using conventional (inductive) content analysis. Results/findings: 62 participants were included with a mean age of 47.6 years. Most participants reported multiple causes for LBP as well as its persistence and reoccurrence, however, these were biomedically focused with minimal to no regard for psychological or environmental influences. The primary cited source of participants' beliefs was healthcare professionals. Conclusions: Our findings align with prior research from other regions, demonstrating a need for updating clinical education and public messaging about the biopsychosocial nature of LBP.

ABSTRACT Purpose We sought to assess the relationship between physical activity (PA) and pain within the available sample, with secondary aims to assess prevalence of pain, PA levels, health care seeking behaviors, and impact of pain on daily activities and work. Methods We conducted an epidemiological cross-sectional observational study utilizing National Health Interview Survey data from 2020. We examined the self-reported adherence to current PA guidelines and the prevalence of pain. We hypothesized those dealing with pain were less likely to meet PA guidelines. The PA levels, pain prevalence, frequency, and intensity were assessed via the survey and relationships explored via modeling. Results Of 31,568, 46% were men and 53.99% women with mean age of 52.27 yr (±17.31 yr). There were 12,429 (39.37%) participants that reported pain on some days, 2761 (8.75%) on most days, and 4661 (14.76%) every day. The odds of engaging in PA decreased in a stepwise fashion based on frequency and intensity of pain reporting when compared with no pain. Importantly, PA is a significant correlate affecting pain reporting, with individuals engaging in PA (strength and aerobic) demonstrating two times lower odds of reporting pain when compared with those not meeting the PA guidelines. Conclusions There is a significant correlation between meeting PA guidelines and pain. Meeting both criteria of PA guidelines resulted in lower odds of reporting pain. In addition, the odds of participating in PA decreased based on pain frequency reporting. These are important findings for clinicians, highlighting the need for assessing PA not only for those dealing with pain but also as a potential risk factor for minimizing development of chronic pain.

Objective:Summarize the therapeutic pain-reducing effects of GnRF for refractory post-TKA knee pain. A secondary objective was to summarize improvements in physical function after GnRF. Methods:A protocol was registered, and a database search conducted by an experienced librarian of all available studies in the English language up until November 3, 2021. Study inclusion criteria were randomized controlled trials (RCTs), prospective and retrospective longitudinal studies, cross-sectional studies, case series, case reports, studies involving adults ≥18 years of age, and studies written about the use of GnRF for the alleviation of chronic knee pain after receiving a TKA. The study quality and risk of bias was assessed using NHLBI Study Quality of Assessment Tools and Murad et al.'s Quality Assessment of Case Reports. Certainty in the evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation approach. Results:A total of 229 studies were screened, 11 met the inclusion criteria, and 265 patients underwent GnRF. Study designs included 1 double-blind pragmatic RCT, 5 retrospective cohort studies, 2 retrospective case series, and 3 case reports. The overall study quality assessment demonstrated three studies had "good", six "fair", and two "poor" quality. There have been positive responses to GnRF for post-TKA chronic knee pain in a range of 30-100% of patients. Conclusions:According to GRADE, there is limited evidence, associated with low certainty to support the use of GnRF to ameliorate chronic knee pain after TKA, largely due to inconsistency and risk of bias. The studies included in this review reported positive results in pain and disability, and relatively few adverse events.

OBJECTIVE:Lumbar spondylolysis occurs in 5%-8% of adults. This study aimed to report clinical and radiographic outcomes of direct pars repair in adults with lumbar spondylolysis.METHODS:We conducted a retrospective review of all patients treated for lumbar spondylolysis via open fracture reduction and direct pars repair with cannulated screws using a lag technique. Demographics, clinical presentation, perioperative and intraoperative imaging, and postoperative data were collected. We subsequently performed a systematic review to describe radiographic and clinical outcomes following direct pars repair.RESULTS:Three patients were identified (mean age 40.3 years; range, 21-72 years; 2 male). All patients had bilateral L5 pars fractures treated via open, direct repair with cannulated screws. There were no intraoperative complications. Length of stay was <24 hours for each patient. All patients reported back/radicular symptom relief and returned to full-time manual labor by latest follow-up. Noncontrast lumbar computed tomography performed 14-20 months postoperatively confirmed that all patients had good bilateral screw placement without fracture. Two patients (21 and 28 years old at surgery) had evidence of fusion across fracture sites, while 1 patient exhibited radiolucency around the screws and no progression of spondylolisthesis. Additionally, we reviewed 8210 articles and included 15 in a systematic review of direct pars repair. Fusion rates were 67%-100%, with improved average Oswestry Disability Index and visual analog scale back pain scores by latest follow-up.CONCLUSIONS:Lumbar spondylolysis treatment with open fracture reduction and direct pars repair with cannulated screws in adults is safe and may result in mechanical back/radicular pain relief, even in the absence of radiographic fusion.

Abstract This study evaluated the impact of a 4-wk mandatory neurology-physical medicine and rehabilitation advanced-core clerkship for fourth-year medical students. The combined clerkship encouraged an interdisciplinary and function-based approach to the management of common neurologic, musculoskeletal, and pain complaints. Seventy-three fourth-year medical students participated in the rotation over 1 yr. A survey assessing knowledge and skill set topics was conducted before and after the clerkship. Qualitative feedback regarding the rotation was provided by the students and analyzed. Significant gaps in knowledge and skill sets were identified before the clerkship and successfully addressed by combined teaching modalities. These data demonstrate that an integrated neurology-physical medicine and rehabilitation clerkship can improve students’ confidence in multiple domains. Integrating physical medicine and rehabilitation into core clerkships at other medical schools may provide an avenue to address curriculum gaps.

A 46-year-old woman underwent a cervical radiofrequency ablation (RFA) for chronic neck pain. Following the procedure, two areas surrounding the grounding pad in the lumbar region developed full thickness third-degree burns. Burn injuries following cervical RFA are rarely reported and are most often associated with cardiac and solid tumour RFA. Only one other case has been reported in literature with a similar outcome following a thoracic facet RFA. In our case, the lesion was directly from the ground pad and not from the radiofrequency electrode, which is more often the culprit. This is the first case reported in the literature of a full-thickness skin burn from a cervical RFA. Physicians should be aware of the potential for severe burns around the RF probe and ground pad as sequelae of RFA, and we caution the use of sedation during the procedure, as patients will unlikely be able to report any unusual sensation.

Historically, intervertebral disc degeneration has been the etiological target of chronic low back pain; however, disc degeneration is not necessarily directly associated with pain, and many other anatomical structures are potential etiologies. The vertebral endplates have been postulated to be a source of vertebral pain, where these endplates become particularly susceptible to increased expression of nociceptors and inflammatory proliferation carried by the basivertebral nerve (BVN), expressed on diagnostic imaging as Modic changes. This is useful diagnostic information that can help physicians to phenotype a subset of low back pain, which is known as vertebral pain, in order to directly target interventions, such as BVN ablation, to this significant pain generator. Therefore, this review describes the safety, efficacy, and the rationale behind the use of BVN ablation, a minimally invasive spinal intervention, for the treatment of vertebral pain. Our current literature review of available up-to-date publications utilizing BVN ablation in the treatment of vertebral pain suggests that there is limited, but moderate-quality evidence that this is an effective intervention for reduction of disability and improvement in function, at short- and long-term follow-up, in addition to limited moderate-quality evidence that BVN RFA is superior to conservative care for pain reduction, at least at 3-month follow-up. Our review concluded that there is a highly clinical and statistically significant treatment effect of BVN ablation for vertebral pain with clinically meaningful benefits in pain reduction, functional improvements, opioid dose reduction, and improved quality of life. There were no reported device-related patient deaths or serious AEs based on the available literature. BVN ablation is a safe, well-tolerated and clinically beneficial intervention for vertebral pain, when proper patient selection and surgical/procedural techniques are applied.

This chapter looks at the techniques for performing manipulation, traction, and massage and the medical literature to support their use. The manipulation section includes information on high velocity low amplitude (HVLA)/thrusting, muscle energy, myofascial release, counterstrain, and craniosacral techniques. There have been a large number of research projects completed on the use of manipulation, mostly with the HVLA form, but often they were done with small numbers, different outcome measures, or different frequency/length of treatment. However, spinal manipulation is an extremely common treatment provided to millions of Americans each year. Massage is most often performed with classic Swedish techniques including effleurage, petrissage, or tapotement, but may also be done with less commonly known techniques such as lymphatic drainage, Feldenkrais, Rolfing, acupressure, or others. There are a lot of small clinical studies for the use of massage in a large variety of musculoskeletal and other medical diagnoses, most of which show short-term beneficial effects but limited long-term changes in the treatment outcomes. The traction section focuses on the differences between utility and success of different cervical traction equipment with primary indication for use with cervical radiculopathies. In contrast, there is limited success with most types of lumbar traction, other than inversion traction, due to difficulties in maintaining the forces directed to the spine. All of the treatments in this chapter can be performed alone but will have more beneficial effects when combined with appropriate exercise regimen.

Patients undergoing pancreatic surgery are at risk of pancreatic exocrine insufficiency (PEI) and needing pancreatic enzyme replacement therapy (PERT).This study included 254 patients undergoing pancreatic surgery for oncologic indications. A13C mixed triglyceride breath test was performed immediately preoperative and postoperative. This test analyzes the pancreatic remnant lipase activity measuring 13CO2 in breath samples after a test meal with 1.3-distearyl-(13C-Carboxyl)octanol-glycerol. Cumulative percent dose recovery after 6 h of less than 23% confirms PEI. In addition, PEI was compared between pathology subgroups.In 197 patients undergoing pancreaticoduodenectomy, cPDR-6h decreased significantly from a median of 32.84% before to 15.80% after surgery (p < 0.0001). This decrease in exocrine function was significant in all pathology subgroups except in pancreatic neuroendocrine tumors. Exocrine function decreased most in pancreatic ductal adenocarcinoma (PDAC). In addition, the percentage of patients needing PERT because of PEI increased from 25.9% to 68.0% postoperative (p < 0.001). Overall, patients with an MPD diameter of more than 3 mm had a higher risk of developing postoperative PEI: 62.7% compared to 37.3% (p = 0.009), OR = 3.11.In contrast, the majority of the 57 patients undergoing a distal pancreatectomy did not experience any significant change in exocrine function.The vast majority of patients undergoing pancreaticoduodenectomy for oncologic indications experience a significant drop in exocrine function, are at high risk of developing pancreatic exocrine insufficiency and consequently need to be treated with pancreatic enzyme replacement therapy. Therefore, systematic screening for pancreatic exocrine insufficiency is needed after pancreaticoduodenectomy.