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Spinal Condition &
Back Pain

What is it and types :

Lower back pain can be categorized into specific lower back pain and non-specific lower back pain based on the underlying causes.

 

Specific Lower Back Pain:

Definition: Specific lower back pain refers to pain that can be directly attributed to a specific underlying pathology or identifiable cause. This type of pain has a clear diagnosis that can be linked to a particular structure or condition

​

Non-Specific Lower Back Pain:

Definition: Non-specific lower back pain refers to pain in the lower back that cannot be attributed to a specific underlying condition or identifiable cause. It is the most common type of lower back pain and is usually related to the musculoskeletal system


Pain is a prevalent condition that affects millions globally. It can vary from a persistent, dull ache to a sudden, sharp discomfort.

 

Comprehensive Overview of Lower Back Pain


Lower back pain is a prevalent health issue that can be broadly classified into specific and non-specific categories. Understanding these classifications aids in accurate diagnosis and treatment.

Specific Lower Back Pain

Specific lower back pain refers to pain with a clear, identifiable cause. Common conditions include:

 

  1. Herniated Disc


Pathophysiology: A herniated disc occurs when the nucleus pulposus (the soft, gel-like centre of the intervertebral disc) protrudes through a tear or weakness in the annulus fibrosus (the disc’s tough outer layer). This herniation can compress nearby nerves, leading to pain and neurological symptoms. The condition is often caused by degenerative disc disease, trauma, or heavy lifting.

Clinical Significance: Herniated discs are significant because they can lead to nerve compression, causing radicular pain, weakness, and, in severe cases, loss of bladder or bowel control (cauda equina syndrome), which is a medical emergency.

Signs and Symptoms:

  • Radicular pain: Often described as sharp or burning, radiating down the leg (sciatica) or arm.

  • Numbness and tingling: In the affected nerve’s distribution.

  • Weakness: In the muscles served by the affected nerves.

  • Red Flags: Loss of bladder or bowel control (indicative of cauda equina syndrome).


-Management:

  • Conservative: Physiotherapy, NSAIDs, muscle relaxants, and epidural steroid injections.

  • Surgical: Microdiscectomy or laminectomy in cases of severe or persistent symptoms.

  • Osteopathy: Can help by improving mobility, reducing pain through manual therapy, and enhancing circulation around the affected disc.


Reference:

  • Fardon DF, Milette PC. Nomenclature and classification of lumbar disc pathology. Spine. 2001;26(5):E93-E113. doi:10.1097/00007632-200103010-00006.
     

Degenerative Disc Disease

Pathophysiology: Degenerative Disc Disease (DDD) involves the gradual dehydration and loss of disc height in intervertebral discs due to ageing or repetitive stress. This process reduces the discs' ability to cushion the vertebrae, leading to increased mechanical stress on the spine, inflammation, and sometimes disc herniation.

Clinical Significance: DDD is a common cause of chronic low back pain and can lead to other spinal conditions such as herniated discs, spinal stenosis, or spondylolisthesis.

Signs and Symptoms:

  • Chronic back pain: Typically worse with prolonged sitting or standing.

  • Pain relief with movement: Often feels better when lying down or after changing positions.

  • Radicular symptoms: Can develop if nerve roots are compressed.

  • Red Flags: Progressive neurological deficits, significant weight loss (suggestive of malignancy).


Management:

  • Conservative: Physiotherapy, pain management, and lifestyle changes.

  • Surgical: Spinal fusion surgery for severe cases.

  • Osteopathy: Can assist by enhancing spinal mobility, reducing pain, and strengthening the muscles supporting the spine.


Reference:

  • Chou R, Fu R, Carrino JA, Deyo RA. Imaging strategies for low-back pain: systematic review and meta-analysis. Lancet. 2009;373(9662):463-472. doi:10.1016/S0140-6736(09)60172-0.


Spinal Stenosis

Pathophysiology: Spinal stenosis is the narrowing of the spinal canal, typically due to degenerative changes such as disc herniation, osteophyte formation, or thickening of the ligamentum flavum. This narrowing can compress the spinal cord or nerve roots, leading to neurological symptoms.

Clinical Significance: The condition is significant because it can cause severe pain, numbness, and weakness in the extremities, and in advanced cases, can lead to significant disability.

Signs and Symptoms:

  • Neurogenic claudication: Pain, tingling, or weakness in the legs that worsens with walking and improves with sitting or leaning forward.

  • Back pain: Especially in the lower back, often relieved by rest.

  • Radiculopathy: Nerve root compression can cause radicular pain similar to that seen in herniated discs.

  • Red Flag: Bowel or bladder dysfunction, progressive weakness.


Management:

  • Conservative: Physiotherapy, NSAIDs, corticosteroid injections.

  • Surgical: Decompressive laminectomy in severe cases.

  • Osteopathy: Can help by improving posture, reducing muscle tension, and enhancing mobility to alleviate pressure on the spinal canal.


Reference:

  • Genevay S, Atlas SJ. Lumbar spinal stenosis. Best Pract Res Clin Rheumatol. 2010;24(2):253-265. doi:10.1016/j.berh.2009.11.001.


Spondylolisthesis

Pathophysiolog: Spondylolisthesis occurs when one vertebra slips forward over the one below it, often due to a defect or fracture in the pars interarticularis (isthmic spondylolisthesis) or due to degenerative changes (degenerative spondylolisthesis).

Clinical Significance: This condition can lead to mechanical back pain and, if severe, can compress nerve roots, causing radiculopathy.

Signs and Symptoms:

  • Lower back pain: Often worsens with standing or walking.

  • Radiculopathy: Pain radiating to the legs if nerve compression occurs.

  • Visible deformity: In severe cases, a "step-off" may be palpable.

  • Red Flags: Progressive neurological symptoms, bowel or bladder dysfunction.


Management:

  • Conservative: Physiotherapy, NSAIDs, bracing.

  • Surgical: Spinal fusion for cases with significant slippage or neurological impairment.

  • Osteopathy: Can assist by correcting postural issues, reducing pain, and improving the range of motion.


Reference:

  • Wiltse LL, Newman PH, Macnab I. Classification of spondylolisis and spondylolisthesis. Clin Orthop Relat Res. 1976;(117):23-29.


Retrolisthesis

Pathophysiology: Retrolisthesis is the backward displacement of one vertebra relative to the one below it. This condition often results from degenerative disc disease, trauma, or congenital defects, leading to instability and altered spinal mechanics.

Clinical Significance: Retrolisthesis can cause mechanical back pain and, if significant, may lead to nerve compression.

Signs and Symptoms:

  • Back pain: Worsens with movement, especially extension.

  • Radiculopathy: Pain, numbness, or weakness in the legs or arms if nerves are compressed.

  • Palpable deformity: In severe cases, the displaced vertebra may be felt.

  • Red Flags: Significant neurological deficits, changes in bladder or bowel function.


Management:

  • Conservative: Physiotherapy, NSAIDs, chiropractic care.

  • Surgical: Fusion surgery in cases of severe displacement.

  • Osteopathy: Helps by improving spinal alignment, reducing pain, and enhancing stability.


Reference:

  • Giles LG, Müller R. Chronic low back pain associated with the anterior or posterior displacement of the lumbar spine vertebrae. J Manipulative Physiol Ther. 1999;22(3):189-192.

 

​Mechanical Pain

Pathophysiology: Mechanical pain is typically due to dysfunction in the musculoskeletal system, such as poor posture, improper lifting techniques, or a sedentary lifestyle. It involves strain on the muscles, ligaments, and joints of the spine, leading to pain.

Clinical Significance: Mechanical pain is one of the most common causes of non-specific lower back pain and is usually not associated with serious underlying pathology.

Signs and Symptoms:


Osteoarthritis

Pathophysiology: Osteoarthritis of the spine involves the degeneration of the cartilage in the facet joints and the intervertebral discs, leading to joint space narrowing, osteophyte formation, and sometimes spinal stenosis. The condition is primarily driven by ageing, obesity, and mechanical stress.

Clinical Significance: Osteoarthritis is a leading cause of chronic pain and disability, particularly in older adults.

Signs and Symptoms:

  • Chronic back pain: Typically worse with activity and relieved by rest.

  • Stiffness: Particularly in the morning or after periods of inactivity.

  • Crepitus: A grating sensation or sound during movement.

  • Red Flags**: Significant functional impairment, sudden onset of neurological symptoms.


Management:

  • Conservative: Weight management, physiotherapy, NSAIDs, corticosteroid injections.

  • Surgical: Joint replacement or spinal fusion in severe cases.

  • Osteopathy: Can help manage pain, improve joint function, and enhance overall mobility.


Reference:

  • Hunter DJ, Felson DT. Osteoarthritis. BMJ. 2006;332(7542):639-642. doi:10.1136/bmj.332.7542.639.


Fractures

Pathophysiology: Spinal fractures can result from trauma (e.g., motor vehicle accidents, falls) or from conditions that weaken the bones, such as osteoporosis. Types of fractures include compression fractures, burst fractures, and transverse process fractures. Compression fractures often occur in the thoracic spine due to osteoporosis.

Clinical Significance:

Fractures can lead to significant pain, spinal instability, and in severe cases, neurological deficits due to spinal cord or nerve root compression.

Signs and Symptoms:

  • Acute back pain: Often severe and localised to the site of the fracture.

  • Deformity: Kyphosis or other spinal deformities may develop.

  • Neurological deficits: If the fracture compresses the spinal cord or nerves.

  • Red Flags: Sudden onset of severe pain following trauma, progressive neurological deficits.


Management:

  • Conservative: Bracing, pain management, and activity modification.

  • Surgical: Vertebroplasty, kyphoplasty, or spinal stabilisation in cases of instability.

  • Osteopathy: Supports recovery through gentle mobilisation, pain management, and rehabilitation exercises.


Reference:

  • Lindsay R, Burge RT. Epidemiology and burden of illness of osteoporosis. Med Clin North Am. 2006;90(4):519-534. doi:10.1016/j.mcna.2006.03.004.


Infections

Pathophysiology: Spinal infections can involve the intervertebral discs (discitis), vertebral bodies (osteomyelitis), or the epidural space (epidural abscess). These infections are often bacterial (e.g., Staphylococcus aureus) but can also be fungal or tuberculous. They typically occur due to haematogenous spread from other infection sites or following spinal surgery.

Clinical Significance:

Spinal infections are serious conditions that can lead to severe pain, spinal instability, and neurological deficits if not promptly treated.
 

Signs and Symptoms:

  • Severe back pain**: Often with a fever and night sweats.

  • Tenderness over the affected area**: On palpation.

  • Neurological deficits**: If the infection causes spinal cord or nerve root compression.

  • Red Flags: Rapidly worsening neurological symptoms, sepsis, severe pain unrelieved by rest.


Management:

  • Conservative: Long-term antibiotics or antifungal medications.

  • Surgical: Drainage of abscesses, debridement, or spinal stabilisation in cases of instability or failure of conservative management.

  • Osteopathy: May assist in pain management and supportive care but requires coordination with medical treatment


Reference:

  • Zimmerli W. Vertebral osteomyelitis. N Engl J Med. 2010;362(11):1022-1029. doi:10.1056/NEJMcp0910753.


Tumours

Pathophysiology: Spinal tumours can be primary (originating in the spine) or metastatic (spread from other parts of the body). They can affect the vertebrae, spinal cord, or surrounding tissues, leading to compression, bone destruction, and instability.

Clinical Significance:

Tumours in the spine are serious and often present with progressive pain, neurological deficits, and potentially life-threatening complications such as spinal cord compression.

Signs and Symptoms:

  • Persistent back pain: Often worse at night and not relieved by rest.

​Neurological symptoms:

  • Numbness, weakness, or paralysis depending on the tumour’s location.

  • Weight loss and malaise: Common in metastatic cases.

  • Red Flags: Rapid onset of neurological deficits, unexplained weight loss, severe pain unresponsive to treatment.


Management:

  • Conservative: Pain management, radiotherapy, chemotherapy.

  • Surgical: Resection of the tumour, spinal stabilisation.

  • Osteopathy: May provide supportive care in conjunction with oncological treatments, focusing on pain relief and mobility.


Reference:

  • Fourney DR, Gokaslan ZL. Spinal instability and deformity due to neoplastic conditions. Neurosurg Focus. 2003;14(1):e8. doi:10.3171/foc.2003.14.1.9.


Inflammatory Conditions

Pathophysiology: Inflammatory spine conditions include disorders such as Ankylosing Spondylitis, Rheumatoid Arthritis, and Psoriatic Arthritis. These autoimmune conditions lead to chronic inflammation of the spinal joints and ligaments, resulting in pain, stiffness, and, in some cases, fusion of the spine (ankylosis).

Clinical Significance: These conditions can cause significant disability if untreated, with the potential for severe spinal deformities and chronic pain.

 

Signs and Symptoms:

  • Morning stiffness: Lasting more than 30 minutes, improves with activity.

  • Back pain: Chronic and progressive, often worse at night.

  • Reduced range of motion**: Especially in ankylosing spondylitis.

  • Red Flags: Progressive spinal deformity, systemic symptoms such as fever, weight loss.


Management:

  • Conservative: NSAIDs, DMARDs (Disease-Modifying Antirheumatic Drugs), biologics.

  • Surgical: Spinal surgery for severe deformities or instability.

  • Osteopathy: Can help manage pain, improve mobility, and support overall treatment goals by enhancing the function of the musculoskeletal system.


Reference:

  • Braun J, Sieper J. Ankylosing spondylitis. Lancet. 2007;369(9570):1379-1390. doi:10.1016/S0140-6736(07)60635-7.


Disc Desiccation

Pathophysiology: Disc desiccation refers to the drying out of intervertebral discs, which leads to a reduction in disc height and elasticity. This condition is commonly associated with ageing and can contribute to other spinal pathologies such as disc herniation and degenerative disc disease.

Clinical Significance: Disc desiccation is a precursor to degenerative disc disease and can lead to chronic back pain and reduced spinal flexibility.

Signs and Symptoms:

  • Chronic back pain: Often dull and achy, worse with prolonged sitting or standing.

  • Stiffness: Reduced flexibility in the spine.

  • Radicular symptoms: If nerve roots are compressed by associated disc bulges or herniations.

  • Red Flags: Sudden onset of severe pain, neurological symptoms such as weakness or numbness.


Management:

  • Conservative: Physiotherapy, pain management, lifestyle modifications.

  • Surgical: Spinal fusion surgery in severe cases.

  • Osteopathy: Can support treatment by improving spinal mobility, reducing pain, and enhancing overall function.


Reference:

  • Luoma K, Riihimäki H, Luukkonen R, Raininko R, Viikari-Juntura E, Lamminen A. Low back pain in relation to lumbar disc degeneration. Spine (Phila Pa 1976). 2000;25(4):487-492. doi:10.1097/00007632-200002150-00016.


Bulging Disc and Annular Tear

Pathophysiology:
Bulging Disc: A bulging disc occurs when the nucleus pulposus pushes outwards against the annulus fibrosus, causing the disc to bulge but not rupture. It often results from degeneration due to ageing or repetitive strain.

 

Annular Tear: An annular tear involves a tear in the annulus fibrosus, which can allow the nucleus pulposus to herniate through the tear, potentially leading to nerve compression and radicular pain.

Clinical Significance:

  • Both conditions can lead to significant pain and neurological symptoms if they compress nearby nerve roots.


Signs and Symptoms:
Bulging Disc:

  • Localised back pain: Often worse with movement or prolonged sitting.

  • Radiculopathy: Pain radiating down the leg or arm if nerve roots are compressed.

Annular Tear:

  • Sharp, localised pain: Often sudden in onset, especially with twisting or lifting.

  • Radicular symptoms: If the tear leads to herniation and nerve compression.

  • Red Flags for  bougth : Progressive neurological symptoms, loss of bowel or bladder control (cauda equina syndrome).


Management:

  • Conservative: Physiotherapy, NSAIDs, epidural steroid injections.

  • Surgical: Discectomy or spinal fusion in severe cases.

  • Osteopathy: Can help by reducing pain, improving mobility, and supporting the healing process through manual therapy.


References:

Bulging Disc:

  • Roberts S, Evans H, Trivedi J, Menage J. Histology and pathology of the human intervertebral disc. J Bone Joint Surg Am. 2006;88(Suppl 2):10-14. doi:10.2106/JBJS.F.00019.

Annular Tear:

  • Vernon-Roberts B, Moore RJ, Fraser RD. The natural history of age-related disc degeneration: the pathology and sequelae of tears. Spine (Phila Pa 1976). 2007;32(25):2797-2804. doi:10.1097/BRS.0b013e31815b9eb0.


Schmorl's Nodes

Pathophysiology: Schmorl's nodes are vertical herniations of the nucleus pulposus into the vertebral body through defects in the

cartilaginous endplate. These nodes can develop due to weakened endplates, trauma, or degenerative changes. They are often associated with conditions like osteoporosis or degenerative disc disease.

Clinical Significance:

  • Schmorl's nodes are typically asymptomatic but can cause back pain if they lead to inflammation or microfractures in the vertebral body. Their presence may indicate underlying spinal pathology, such as degenerative disc disease.


Signs and Symptoms:

  • Asymptomatic: Often found incidentally on imaging.

  • Pain: If symptomatic, pain may be localised and exacerbated by movement.

  • Red Flags: Persistent or worsening pain, especially if associated with neurological symptoms.


Management:

  • Conservative: Often no treatment is required for asymptomatic nodes. Symptomatic cases are managed with physiotherapy, pain management, and treatment of underlying conditions like osteoporosis.

  • Osteopathy: Can help manage symptoms through gentle mobilisation, pain management techniques, and improving spinal health.


Reference:

  • Hilton RC, Ball J, Benn RT. Vertebral end-plate lesions (Schmorl's nodes) in the dorsolumbar spine. Ann Rheum Dis. 1976;35(2):127-132. doi:10.1136/ard.35.2.127.


Non-Specific Lower Back Pain

Non-specific lower back pain refers to pain without a clear or specific underlying cause. It is the most common type of lower back pain and includes:


Muscle Strain

Pathophysiology: Muscle strain occurs when muscle fibres are overstretched or torn, often due to sudden movements, heavy lifting, or overuse. This results in inflammation and localised pain.

Clinical Significance:

  • Muscle strains are a common cause of acute lower back pain but typically resolve with rest and conservative treatment.


Signs and Symptoms:

  • Localised pain: Typically worse with movement, particularly bending or twisting.

  • Muscle spasm: The affected muscle may feel tight or knotted.

  • Red Flags: Severe pain that does not improve with rest, pain radiating down the leg (indicating possible nerve involvement).


Management:

  • Conservative: Rest, ice/heat therapy, physiotherapy, NSAIDs.

  • Osteopathy: Supports recovery through techniques to reduce muscle tension, improve flexibility, and alleviate pain.


Reference:

  • Maher C, Underwood M, Buchbinder R. Non-specific low back pain. Lancet. 2017;389(10070):736-747. doi:10.1016/S0140-6736(16)30970-9.


Ligament Sprain
 

Pathophysiology: Ligament sprains occur when ligaments, the connective tissues that stabilise joints, are overstretched or torn. This can happen due to sudden movements, falls, or twisting injuries, leading to inflammation and joint instability.
 

Clinical Significance:

Ligament sprains can cause significant pain and instability in the spine, but they usually heal with appropriate treatment.

Signs and Symptoms:

  • Localised pain: Especially with movement or pressure on the affected area.

  • Swelling and bruising: May occur around the injured ligament.

  • Red Flags: Persistent instability or severe pain, indicating a more serious injury or associated fracture.

 

Management:
- Conservative**: Rest, ice, compression, elevation (RICE), physiotherapy.
- Osteopathy: Helps by improving joint stability, reducing pain, and supporting healing through manual therapy.

Reference**:

  • Borenstein DG. Epidemiology, etiology, diagnostic evaluation, and treatment of low back pain. Curr Opin Rheumatol. 2001;13(2):128-134. doi:10.1097/00002281-200103000-00005.

​

Mechanical Pain

Pathophysiology: Mechanical pain is typically due to dysfunction in the musculoskeletal system, such as poor posture, improper lifting techniques, or a sedentary lifestyle. It involves strain on the muscles, ligaments, and joints of the spine, leading to pain.

 

Clinical Significance:

  • Mechanical pain is one of the most common causes of non-specific lower back pain and is usually not associated with serious underlying pathology.

Signs and Symptoms

  • Pain: Often worse with specific movements, such as bending or lifting.

  • Stiffness: Especially after prolonged periods of inactivity.

  • Red Flags: Pain that does not improve with rest, severe or progressive symptoms suggesting underlying structural issues.


Management:

  • Conservative: Ergonomic adjustments, physiotherapy, exercise to strengthen the back.

  • Osteopathy: Focuses on correcting posture, improving mobility, and reducing pain through manual techniques.


Reference:

  • Airaksinen O, Brox JI, Cedraschi C, et al. Chapter 4. European guidelines for the management of chronic nonspecific low back pain. Eur Spine J. 2006;15(Suppl 2):S192-S300. doi:10.1007/s00586-006-1072-1.
     

Postural Stress

Pathophysiology: Postural stress occurs when sustained poor posture places excessive strain on the muscles, ligaments, and joints of the spine. Over time, this can lead to muscle imbalances, joint dysfunction, and chronic pain.
Clinical Significance: Postural stress is a common cause of chronic lower back pain and is typically reversible with appropriate interventions.

 

Signs and Symptoms:

  • Dull, aching pain: Usually worse at the end of the day or after prolonged sitting or standing.

  • Muscle tension: Particularly in the lower back, shoulders, and neck.

  • Red Flags: Persistent pain despite posture correction, suggesting possible underlying structural issues.

 

Management:

  • Conservative: Posture correction, ergonomic adjustments, physiotherapy.

  • Osteopathy: Helps by improving posture, relieving muscle tension, and enhancing spinal alignment.


Reference:

  • van Dieën JH, Cholewicki J, Radebold A. Trunk muscle recruitment patterns in patients with low back pain enhance the stability of the lumbar spine. Spine (Phila Pa 1976). 2003;28(8):834-841. doi:10.1097/01.BRS.0000051924.51147.69.

 

Overuse Injuries

​​

Pathophysiology: Overuse injuries occur due to repetitive stress or prolonged activities that strain the muscles, tendons, and ligaments of the spine. These injuries can lead to inflammation, microtears, and chronic pain.

 

Clinical Significance: Overuse injuries are common in athletes and individuals with repetitive job tasks. They can lead to chronic pain and functional limitations if not properly managed.

 

Signs and Symptoms:

  • Gradual onset of pain: Often associated with specific activities or movements.

  • Swelling and tenderness: Over the affected area.

  • Red Flags: Persistent pain despite rest, indicating possible structural damage.

 

Management:

  • Conservative: Activity modification, physiotherapy, rest, and anti-inflammatory treatments.

  • Osteopathy: Supports recovery by improving biomechanics, reducing inflammation, and promoting healing through manual therapy.

 

Reference: Reiman MP, Bolgla LA, Lorenz D. Hip function's influence on knee dysfunction: a proximal link to a distal problem. J Sport Rehabil. 2009;18(1):33-46. doi:10.1123/jsr.18.1.33.

​

Spondylolysis

 

​Pathophysiology: Spondylolysis is a stress fracture in the pars interarticularis, a small bony structure that connects the facet joints in the spine. It is often caused by repetitive hyperextension and rotation, commonly seen in athletes.

 

​Clinical Significance: Spondylolysis can lead to lower back pain and may progress to spondylolisthesis if the fracture causes vertebral slippage.

 

​Signs and Symptoms:

  • Localised lower back pain: Often worse with hyperextension or rotational movements.

  • Stiffness and decreased range of motion: Especially in activities involving spinal extension.

  • Red Flags: Progression to spondylolisthesis, leading to more severe symptoms including radiculopathy.

 

Management:

  • Conservative: Rest, bracing, physiotherapy.

  • Surgical: May be required if the condition progresses or does not improve with conservative management.

  • Osteopathy: Helps manage pain, improve spinal alignment, and enhance recovery through targeted manual therapy.

 

​Reference:

  • Standaert CJ, Herring SA. Spondylolysis: a critical review. Br J Sports Med. 2000;34(6):415-422. doi:10.1136/bjsm.34.6.415.

​Can Osteopathy Help?

Osteopathy can effectively relieve back pain through a holistic approach that targets the musculoskeletal system. By utilizing manual techniques like soft tissue manipulation, joint mobilization, and spinal adjustments, osteopaths decrease muscle tension, enhance circulation, and restore mobility.

Why Choose Cruz Osteopathy?

At Cruz Osteopathy, our osteopaths offer postural education and ergonomic advice to prevent strain, along with personalized exercise plans to strengthen supporting muscles. Our comprehensive approach addresses the symptoms and tackles the root causes of back pain, promoting long-term relief and overall well-being.

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