Background: Preliminary evidence suggests an association of hypovitaminosis D (hypo.D) with mechanical Low back ache (mLBA). Aim: This study was designed to 1. Explore the relationship of hypovitaminosis D with mLBA in the absence of other confounding factors 2. Formulate and validate an appropriate treatment protocol and 3. Explore the differences in outcomes with various oral formulations of vitamin D available in Indian market.Materials & methods: Three randomised groups of patients with mLBA and hypo.D between 18 and 45 years of age without any co morbid conditions were studied for the effectiveness of adjunctive vit.D supplementation of 6,00,000 IUs (60,000 IUs/day for ten consecutive days) in the form of granule or nano syrup or soft gel capsule for the treatment of mLBA. Review evaluation of pain, functional disability and vit.D was done at three weeks and an additional evaluation of vit.D was done at nine months. Evaluation with 3,00,000 IUs of vit.D (60,000 IUs/day for five consecutive days) was done with nano syrup in a different cohort. Results: High prevalence of hypo.D (96%) was noted in patients with mLBA. Significant improvement was noted after supplementation of vit.D. The subjects of nano syrup group have shown significantly better improvement compared to others (P < 0.000). Non obese and chronic patients have shown significantly better results than their peers. Though there was significant difference in vit.D before treatment, the difference of improvement between the genders, deficiency and insufficiency, in-door and out-door, smokers and non smoker subgroups was not significant. Seasonal variation in vit.D before and after the treatment was significant. Conclusion: Hypovitaminosis D can be a potential causative factor for mLBA in addition to the other known causes. Proper evaluation and adjunctive vit.D supplementation can effectively break the vicious cycle of low back ache with significant improvement in serum vit.D level, effective relief of pain and significant functional improvement without any adverse effects. Improvement in vit.D was not significantly related to its initial status and obese individuals have shown significantly lesser improvement. The results with nano syrup formulation were significantly better compared to others. Formulation based dosage adjustments assume significance in view of these results.

Background:Patients undergoing corrective surgery for scoliosis of spine are commonly ventilated in our institute after the operation. Postoperative mechanical ventilation (PMV) and subsequent prolongation of intensive care unit stay are associated with increase in medical expenditure and complications such as ventilator-associated pneumonia. Identification of factors which may contribute to PMV and their modification may help in allocation of resources effectively. The present study was performed to identify preoperative and intraoperative factors associated with early PMV after scoliosis surgery.Methods:One hundred and two consecutive patients who underwent operation for scoliosis correction between January 2006 to July 2011 were reviewed retrospectively. Patients requiring PMV included patients who were not extubated in the operating room and were continued on mechanical ventilation. Preoperative and intraoperative factors which were analysed included age, gender, weight, cardiorespiratory function, presence of kyphosis, number and level of vertebrae involved, surgical approach, whether thoracoplasty was done, duration of surgery, blood loss, fluids and blood transfused, hypothermia and use of antifibrinolytics.Results:The average age of the patients was 14.31±3.78 years with female preponderance (57.8%). Univariate analysis found that longer fusions of vertebrae (more than 8), blood loss, amount of crystalloids infused, blood transfused and hypothermia were significantly associated with PMV (P<0.05). Independent risk factors for PMV were longer fusion (Odds Ratio (OR), 1.290; 95% confidence interval (CI), 1.038-1.604) and hypothermia (OR, 0.096; 95% CI, 0.036-0.254; P<0.05).Conclusion:The authors identified that longer fusions and hypothermia were independent risk factors for early PMV. Implementation of measures to prevent hypothermia may result in decrease in PMV.

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Background: In lumbar radiculopathy there is compression or inflammation of a spinal nerve and it may be accompanied by numbness and tingling, muscle weakness or loss of spinal reflexes in one or both lower limbs. Conventional physiotherapy which includes back extension exercises has varying degree of success in pain and functional outcome in lumbar radiculopathy. Mulligan's spinal mobilization with limb movement (SMWLM) and Shacklock's neural tissue mobilization are few of the techniques employed in the management of lumbar radiculopathy. The purpose of the study was to find out whether spinal mobilization with leg movement as an adjunct to neural mobilization and conventional therapy could bring better outcome in patients when compared to conventional therapy or neural mobilization and conventional therapy. Methods: 90 patients were selected randomly with lumbar radiculopathy. Duration of the study was for six weeks. The study included 3 groups, control group received back extension exercises and hot pack, experimental group 1 received neural mobilisation and conventional physiotherapy and experimental group 2 received SMWLM along with neural mobilisation and conventional physiotherapy. The outcomes included NPRS, SLR using goniometry and MOLBPQ which were assessed at day 1 and 2, 4, 6 week. ANOVA was done for inter group analysis and paired t-test was done for intra group analysis. Results: All the groups showed significant difference (P -0.000 < 0.05) at 2, 4, 6 weeks of NPRS, MOLBPQ and SLR. The mean difference and paired t-test values of experimental group 2 was more when compared to experimental group 1 and control group at the end of 6 weeks. Conclusion: All the three groups showed improvement in pain, functional disability and straight leg raise (SLR). SMWLM as an adjunct to neural mobilization and conventional therapy showed significantly better outcomes in pain, functional disability and SLR when compared to conventional therapy or neural mobilization and conventional therapy.

Bisphosphonates may exacerbate callus hyperplasia, and may therefore have to be used with caution in patients with type V osteogenesis imperfecta.