Journal of Neurology and Neurorehabilitation Research

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Mysteries of Spinal pain and pain distribution

Joint Event on 3rd International Conference on Spine and Spine Disorders & International Conference on Addiction Research and Therapy
November 26-27, 2018 | Dubai, UAE

Raman V Kalyan, A Hamilton, P Nolan, E Cooke, N Eames, M Crone and D Marsh

Royal National Orthopaedic Hospital, UK Royal Victoria Hospital, UK

Scientific Tracks Abstracts : J Neurol Neurorehabil Res


Objectives: To analyze the pain distribution in the acute and chronic phase following Thoraco-lumbar fractures. Study design: Prospective observational study

Subjects: 39 patients with fractures between T11 and L2, with no neurological deficit, were treated conservatively. Strict inclusion and exclusion criteria were applied. All had X-rays and MR imaging (whole spine) at post-injury and one-year followup. Outcome measures & Methods: The patients documented their pain distribution using pain drawing, along with 10 other domains of pain and functional outcomes for a period over 12 months. The pain distribution was analyzed. The association of distal pain distribution to other associated injury, resultant kyphosis, pre-existing or increase in disc degeneration at the lower non-injured disc levels – were analyzed and reviewed

Results: The most common site of the pain distribution in both the acute (90%) and chronic phase (97%) was distal to the fracture (regions - iliac crest, lumbosacral junction and buttock). Factors mentioned above that could be related to distal pain distribution did not show any significant correlation (P>0.5) with different domains of pain outcome.

Conclusions: Some of the commonly believed reasons for distal pain distribution like resultant Kyphosis and associated disc/ facet pathologies were not supported by our study findings. The distal pain distribution corresponds to the scelerotomal referred pain mapping, which could be the probable explanation. Thoraco-lumbar pathologies could be the source of pain in patients complaining of low back symptoms. Distal pain distribution of spine pathologies should not be attributed as functional.


Raman V Kalyan is a Consultant Spine Surgeon from UK working in North East England. His busy practice covers a wide spectrum of both Adult and Paediatric Spine Pathologies. He is an Honorary Consultant in James Cook University Hospital, UK. From 1992 to 2000, he has gained extensive experience from working in numerous renowned spinal centres in UK, Europe and India. He started his training in Spinal Surgery in the famous institution Christian Medical College Hospital in India in 1992. In Europe, he got specialized training in Spinal Surgery by attaining the prestigious fellowship in France (under Prof J Dubousset, 1998) and Germany (Prof. J. Harms, 1997). In UK, he undertook further spinal training and fellowships under eminent surgeons in Edinburgh (Mr M Mc Master), Belfast and London (Stanmore Hospital). He obtained his dual accreditation (clinical and academic) in Trauma and Orthopaedics, by undertaking the Northern Ireland and Stanmore rotations. In 1996, he was elected for the TNOA travelling fellowship to visit few distinguished spinal surgeons. He was awarded the MD degree in Belfast for his research work in Spinal fractures and has won prizes for his research work. As a Clinical lecturer in UCL University London (2008 - 2009), he gained experience in conducting courses and teaching programmes. His research interests focus on Spinal Pain, Less invasive management of Spinal Pathologies, Spinal fractures and Spinal deformity. 


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