Back pain — is surgery really the only option?

Aim of the study: Low back pain can present with radicular pain caused by lumbosacral nerve root pathology. Neural mobilization (NM) is a treatment technique used to treat low back and radicular pain (LBRP). To evaluate the effectiveness of NM interventions in improving pain, disability, and function in adults with LBRP.

Results: NM may be an effective tool for short-term improvements in pain, function, and disability associated with LBRP. Additional high quality research is needed.

Aim of the study: To determine the efficacy of a specific exercise intervention in the treatment of patients with chronic low back pain and a radiologic diagnosis of spondylolysis or spondylolisthesis. A recent focus in the physiotherapy management of patients with back pain has been the specific training of muscles surrounding the spine (deep abdominal muscles and lumbar multifidus), considered to provide dynamic stability and fine control to the lumbar spine.

Results: After intervention, the specific exercise group showed a statistically significant reduction in pain intensity and functional disability levels, which was maintained at a 30-month follow-up. The control group showed no significant change in these parameters after intervention or at follow-up.

Aim of the study: The aim of the study determining whether or not Non-invasive Spinal Decompression Therapy (NSDT) was effective in resorption of herniation, increasing disc height in patients with lumbar disc herniation (LHNP).

Results: Both treatments had positive effect for improving pain, functional restoration and reduction in thickness of herniation. Although reduction of herniation size was higher in SG than CG, no significant differences were found between groups and any superiority to each other (p> 0.05). This study showed that patients with LHNP received physiotherapy had improvement based on clinical and radiologic evidence. NSDT can be used as assistive agent for other physiotherapy methods in treatment of lumbar disc herniation.

Aim of the study: Morel-Lavallée lesions (MLLs) are closed traumatic degloving injuries caused by separation of the subcutaneous tissue from the underlying fascia. Although most commonly described around the greater trochanter and pelvis, lumbar MLLs are rare and may be overlooked in patients presenting with post-traumatic low back pain.

Results: Interval ultrasound demonstrated only a minimal residual collection without drainable fluid, and aspiration was deferred. His symptoms progressively improved and completely resolved within four weeks. This case highlights lumbar MLL as an uncommon cause of severe post-traumatic low back pain despite reassuring osseous imaging. Early recognition and appropriate soft-tissue imaging can guide management, help avoid unnecessary invasive treatment, and allow selected small acute lesions to resolve successfully with conservative care.

Aim of the study: Pregnancy-associated low back and pelvic pain is a common musculoskeletal condition associated with substantial pain, impaired mobility, and functional limitation during pregnancy. Pharmacologic pain management is constrained by maternal and fetal safety considerations, increasing reliance on conservative musculoskeletal interventions.

Results: Six randomized controlled trials met inclusion criteria for qualitative synthesis, of which four studies involving 254 participants contributed directly extractable data for the primary quantitative meta-analyses. Conservative musculoskeletal interventions were associated with significant reductions in pain intensity (SMD -0.85, 95% CI -1.18 to -0.53; P < 0.001; I² = 34%) and functional disability (SMD -0.84, 95% CI -1.31 to -0.37; P < 0.001; I² = 66%). Subgroup analysis demonstrated numerically larger pain effects for device-assisted interventions, followed by acupuncture-based and manual or manipulative approaches, although subgroup differences were not statistically significant (P = 0.26). One trial was judged at high risk of bias, while the remaining studies were classified as having some concerns. Conservative musculoskeletal interventions were associated with improvements in pain intensity and functional disability among women with pregnancy-associated low back and pelvic pain.

Aim of the study: BACKGROUND The optimal treatment strategy for osteoporotic vertebral compression fractures (OVCFs) remains unclear. This single-center study aimed to compare outcomes of percutaneous vertebroplasty (PVP) and conservative management in 55 patients with OVCF.

Results: No significant difference in complications was observed between groups (P>0.05). CONCLUSIONS Both PVP and conservative treatment relieved pain and improved quality of life in patients with OVCF. PVP provided more rapid pain relief and functional recovery. Although conservative treatment resulted in slower improvement and longer duration of bed rest, long-term clinical outcomes and complication rates were similar between groups.

Aim of the study: While conservative management often improves lumbar disc herniation (LDH) symptoms and promotes spontaneous resorption over time, the clinical value of extracorporeal shock wave therapy (ESWT) in accelerating this process remains underexplored.

Aim of the study: Sacroiliac joint (SIJ) pain is an important source of chronic axial low back and buttock pain. Initial treatment commonly includes activity modification, physical therapy, nonsteroidal anti-inflammatory drugs (NSAIDs), and other nonopioid medications. Interventional treatment options may include corticosteroid injections, radiofrequency ablation, and, in selected refractory cases, SIJ fusion.

Results: PRP injection was associated with sustained improvement in pain in two patients with refractory SIJ pain after failure of multiple conventional treatments. These cases provide additional real-world clinical observations supporting further investigation of PRP as a potential nonsurgical option for carefully selected patients with persistent SIJ pain.