1
|
Fundaun J, Kolski M, Baskozos G, Dilley A, Sterling M, Schmid AB. Nerve pathology and neuropathic pain after whiplash injury: a systematic review and meta-analysis. Pain 2022; 163:e789-e811. [PMID: 35050963 PMCID: PMC7612893 DOI: 10.1097/j.pain.0000000000002509] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 09/29/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT There is no clear understanding of the mechanisms causing persistent pain in patients with whiplash-associated disorder (WAD). The aim of this systematic review was to assess the evidence for nerve pathology and neuropathic pain in patients with WAD. EMBASE, PubMed, CINAHL (EBSCO), and MEDLINE were searched from inception to September 1, 2020. Study quality and risk of bias were assessed using the Newcastle-Ottawa Quality Assessment Scales. Fifty-four studies reporting on 390,644 patients and 918 controls were included. Clinical questionnaires suggested symptoms of predominant neuropathic characteristic in 34% of patients (range 25%-75%). The mean prevalence of nerve pathology detected with neurological examination was 13% (0%-100%) and 32% (10%-100%) with electrodiagnostic testing. Patients independent of WAD severity (Quebec Task Force grades I-IV) demonstrated significantly impaired sensory detection thresholds of the index finger compared with controls, including mechanical (SMD 0.65 [0.30; 1.00] P < 0.005), current (SMD 0.82 [0.25; 1.39] P = 0.0165), cold (SMD -0.43 [-0.73; -0.13] P = 0.0204), and warm detection (SMD 0.84 [0.25; 1.42] P = 0.0200). Patients with WAD had significantly heightened nerve mechanosensitivity compared with controls on median nerve pressure pain thresholds (SMD -1.10 [-1.50; -0.70], P < 0.0001) and neurodynamic tests (SMD 1.68 [0.92; 2.44], P = 0.0004). Similar sensory dysfunction and nerve mechanosensitivity was seen in WAD grade II, which contradicts its traditional definition of absent nerve involvement. Our findings strongly suggest a subset of patients with WAD demonstrate signs of peripheral nerve pathology and neuropathic pain. Although there was heterogeneity among some studies, typical WAD classifications may need to be reconsidered and include detailed clinical assessments for nerve integrity.
Collapse
Affiliation(s)
- Joel Fundaun
- Nuffield Department of Clinical Neurosciences, The University of Oxford, Oxford, United Kingdom
| | - Melissa Kolski
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Feinberg School of Medicine, Chicago, IL, United States
- Musculoskeletal Outpatient Department, Shirley Ryan AbilityLab, Chicago, IL, United States
| | - Georgios Baskozos
- Nuffield Department of Clinical Neurosciences, The University of Oxford, Oxford, United Kingdom
| | - Andrew Dilley
- Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom
| | - Michele Sterling
- RECOVER Injury Research Centre, NHMRC Centre of Research Excellence in Recovery Following Road Traffic Injuries, The University of Queensland, Brisbane, Queensland, Australia
| | - Annina B Schmid
- Nuffield Department of Clinical Neurosciences, The University of Oxford, Oxford, United Kingdom
| |
Collapse
|
2
|
Schmid AB, Fundaun J, Tampin B. [Entrapment neuropathies: a contemporary approach to pathophysiology, clinical assessment, and management : German version]. Schmerz 2021; 35:419-433. [PMID: 34505948 DOI: 10.1007/s00482-021-00584-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2021] [Indexed: 10/20/2022]
Abstract
Entrapment neuropathies such as carpal tunnel syndrome, radiculopathies, or radicular pain are the most common peripheral neuropathies and also the most common cause for neuropathic pain. Despite their high prevalence, they often remain challenging to diagnose and manage in a clinical setting. Summarising the evidence from both preclinical and clinical studies, this review provides an update on the aetiology and pathophysiology of entrapment neuropathies. Potenzial mechanisms are put in perspective with clinical findings. The contemporary assessment is discussed and diagnostic pitfalls highlighted. The evidence for the noninvasive and surgical management of common entrapment neuropathies is summarised and future areas of research are identified.
Collapse
Affiliation(s)
- Annina B Schmid
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford University, West Wing Level 6, OX3 9DU, Oxford, Großbritannien.
| | - Joel Fundaun
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford University, West Wing Level 6, OX3 9DU, Oxford, Großbritannien.,High Country Physical Therapy, Laramie, WY, USA
| | - Brigitte Tampin
- Department of Physiotherapy, Sir Charles Gairdner Hospital, Perth, Westaustralien, Australien.,School of Physiotherapy and Exercise Science, Curtin University, Westaustralien, Australien.,Fakultät Wirtschafts- und Sozialwissenschaften, Hochschule Osnabrück, Osnabrück, Deutschland
| |
Collapse
|
3
|
Schmid AB, Fundaun J, Tampin B. Entrapment neuropathies: a contemporary approach to pathophysiology, clinical assessment, and management. Pain Rep 2020; 5:e829. [PMID: 32766466 PMCID: PMC7382548 DOI: 10.1097/pr9.0000000000000829] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 05/04/2020] [Accepted: 05/30/2020] [Indexed: 12/18/2022] Open
Abstract
Entrapment neuropathies such as carpal tunnel syndrome, radiculopathies, or radicular pain are the most common peripheral neuropathies and also the most common cause for neuropathic pain. Despite their high prevalence, they often remain challenging to diagnose and manage in a clinical setting. Summarising the evidence from both preclinical and clinical studies, this review provides an update on the aetiology and pathophysiology of entrapment neuropathies. Potential mechanisms are put in perspective with clinical findings. The contemporary assessment is discussed and diagnostic pitfalls highlighted. The evidence for the noninvasive and surgical management of common entrapment neuropathies is summarised and future areas of research are identified.
Collapse
Affiliation(s)
- Annina B. Schmid
- Nuffield Department of Clinical Neurosciences, Oxford University, Oxford, United Kingdom
| | - Joel Fundaun
- Nuffield Department of Clinical Neurosciences, Oxford University, Oxford, United Kingdom
- High Country Physical Therapy, Laramie, WY, USA
| | - Brigitte Tampin
- Department of Physiotherapy, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
- School of Physiotherapy and Exercise Science, Curtin University, Western Australia, Australia
- Faculty of Business Management and Social Sciences, Hochschule Osnabrück, University of Applied Sciences, Osnabrück, Germany
| |
Collapse
|
4
|
Quantitative sensory testing to evaluate and compare the results after epidural injection and simple discectomy, in patients with radiculopathy secondary to lumbar disc herniation. J Clin Monit Comput 2019; 34:1095-1104. [PMID: 31559523 DOI: 10.1007/s10877-019-00395-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 09/24/2019] [Indexed: 10/25/2022]
Abstract
The objective assessment of the radiculopathy secondary to lumbar disc herniation is essential to optimize treatment. The quantitative sensory test (QST) is a useful tool to evaluate somatosensory nerves. The aim of our study is quantifying by QST the alterations of patients treated by epidural injections (EI) or surgical lumbar decompression (LD). A prospective, cohort study has done in Hospital Universitario Rio Hortega, Valladolid, Spain, between January 2014 and December 2016.The study includes 74 patients (40 men) who underwent EI (50) or LD (24) with lumbar disc herniation and treated by EI or LD. Participants underwent a brief battery of QST at baseline and after 1, 3 and 6 months of follow-up. QST threshold were measured in three series of five warm and cold stimuli (cold detection threshold, warm detection threshold, cold pain threshold, heat pain threshold) bilateral. Additionally, pain assessment (Visual Analogue Scale) and neurological examination was performed. Thermal thresholds were analysed and compared. In the EI group, warm detection threshold (WDT) measurements were significantly lower after 3 and 6 months of follow-up (40.44 ± 3.42°C vs. 38.30 ± 3.73°C and 37.48 ± 4.58°C respectively, p = 0.031 and p = 0.043). LD group showed lower WDT measurements at 1, 3 and 6 months of follow up (40.20 ± 2.97°C vs., 37.98 ± 2.04°C, 37.43 ± 3.80°C and 36.55 ± 2.77°C respectively, p = 0.049, p = 0.032 and p = 0.024) and lower heat pain threshold (HPT) levels after 3 and 6 months of follow-up (48.75 ± 1.37°C vs. 43.26 ± 0.60°C and 42.06 ± 1.37°C respectively, p = 0.037 and p = 0.021). QST explorations were compared between both groups. At 1-month follow-up only the WDT parameter was different, higher in EI group (40.98 ± 4.04°C vs. 37.98 ± 2.04°C, p = 0.043). There were no differences in any parameter measured by QST after 3 and 6-months follow-up between both groups. Epidural injection should be considered the first-step of treatment.
Collapse
|
5
|
Tschugg A, Lener S, Hartmann S, Fink V, Neururer S, Wildauer M, Löscher WN, Thome C. Extraforaminal Lumbar Disk Herniations Lead To Neuroplastic Changes: a Study Using Quantitative Sensory Testing. Muscle Nerve 2018; 58:676-680. [DOI: 10.1002/mus.26184] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 05/24/2018] [Accepted: 05/24/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Anja Tschugg
- Department of Neurosurgery; Innsbruck Medical University; Anichstrasse 35, A-6020 Innsbruck Austria
| | - Sara Lener
- Department of Neurosurgery; Innsbruck Medical University; Anichstrasse 35, A-6020 Innsbruck Austria
| | - Sebastian Hartmann
- Department of Neurosurgery; Innsbruck Medical University; Anichstrasse 35, A-6020 Innsbruck Austria
| | - Valentin Fink
- Department of Neurosurgery; Innsbruck Medical University; Anichstrasse 35, A-6020 Innsbruck Austria
| | - Sabrina Neururer
- Department of Medical Statistics and Health Economics; Innsbruck Medical University; Innsbruck Austria
| | - Matthias Wildauer
- Department of Neuroradiology; Innsbruck Medical University; Innsbruck Austria
| | | | - Claudius Thome
- Department of Neurosurgery; Innsbruck Medical University; Anichstrasse 35, A-6020 Innsbruck Austria
| |
Collapse
|
6
|
Erbüyün SC, Ovalı GY, Özyurt B, Yentür EA. Lumbar Disc Herniation, the Association Between Quantitative Sensorial Test and Magnetic Resonance Imaging Findings. PAIN MEDICINE 2018; 19:1373-1381. [PMID: 29126222 DOI: 10.1093/pm/pnx236] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Quantitative sensorial tests (QST) are used for evaluating specific sensorial nerve function. In this study, QST and magnetic resonance imaging (MRI) findings are compared in lumbar disc herniation patients, and the accuracy of QST data was investigated. MATERIAL AND METHODS Sixty-four patients between 18 and 70 years of age suffering from radicular pain with positive Lasegue's test were included in this study. Specific criteria included complaints due to L5 discopathy. MRI findings were classified according to the Pfirmann grading system, and QST was applied to the L5 dermatoma of both symptomatic and nonsymptomatic legs of all patients. Vibration detection threshold, heat detection threshold, cold detection threshold, and heat pain detection threshold values were obtained, and MRI findings were classified according to the Pfirmann grading system. RESULTS When we compared the symptomatic and nonsymptomatic legs of participants, there were significant differences by means of all QST parameters (0 = 0.00). In a comparison of the QST and MRI Pfirmann grading systems, there is also a strong parallel statistical correlation between the Pfirmann grade and QST parameters (P < 0.05). CONCLUSIONS According to the results of our study, QST has an additive effect to MRI for nerve root compression evaluation in the clinical basis, which might enable more sensitive diagnosis and treatment protocol. QST can also be an alternative method for evaluation of nerve root compression in patients who have contraindications for MRI.
Collapse
Affiliation(s)
| | | | - Beyhan Özyurt
- Public Health, School of Medicine, Celal Bayar University, Manisa, Turkey
| | | |
Collapse
|
7
|
Thompson K, Moore S, Tang S, Wiet M, Purmessur D. The chondrodystrophic dog: A clinically relevant intermediate-sized animal model for the study of intervertebral disc-associated spinal pain. JOR Spine 2018; 1:e1011. [PMID: 29984354 PMCID: PMC6018624 DOI: 10.1002/jsp2.1011] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 02/23/2018] [Accepted: 02/23/2018] [Indexed: 12/16/2022] Open
Abstract
Low back pain (LBP) is the leading cause of disability worldwide, with an estimated 80% of the American population suffering from a painful back condition at some point during their lives. The most common cause of LBP is intervertebral disc (IVD) degeneration (IVDD), a condition that can be difficult to treat, either surgically or medically, with current available therapies. Thus, understanding the pathological mechanisms of IVDD and developing novel treatments are critical for improving outcome and quality of life in people living with LBP. While experimental animal models provide valuable mechanistic insight, each model has limitations that complicate translation to the clinical setting. This review focuses on the chondrodystrophic canine clinical model of IVDD as a promising model to assess IVD‐associated spinal pain and translational therapeutic strategies for LBP. The canine IVD, while smaller in size than human, goat, ovine, and bovine IVDs, is larger than most other small animal IVDD models and undergoes maturational changes similar to those of the human IVD. Furthermore, both dogs and humans develop painful IVDD as a spontaneous process, resulting in similar characteristic pathologies and clinical signs. Future exploration of the canine model as a model of IVD‐associated spinal pain and biological treatments using the canine clinical model will further demonstrate its translational capabilities with the added ethical benefit of treating an existing veterinary patient population with IVDD.
Collapse
Affiliation(s)
- Kelly Thompson
- Department of Veterinary Clinical Sciences The Ohio State University Columbus Ohio
| | - Sarah Moore
- Department of Veterinary Clinical Sciences The Ohio State University Columbus Ohio
| | - Shirley Tang
- Department of Biomedical Engineering, College of Engineering The Ohio State University Columbus Ohio
| | - Matthew Wiet
- Department of Biomedical Engineering, College of Engineering The Ohio State University Columbus Ohio
| | - Devina Purmessur
- Department of Biomedical Engineering, College of Engineering The Ohio State University Columbus Ohio.,Department of Orthopedics, College of Medicine The Ohio State University Columbus Ohio
| |
Collapse
|
8
|
Tschugg A, Löscher WN, Lener S, Hartmann S, Wildauer M, Neururer S, Thomé C. The value of quantitative sensory testing in spine research. Neurosurg Rev 2017; 40:411-418. [PMID: 27896457 PMCID: PMC5486464 DOI: 10.1007/s10143-016-0798-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 10/05/2016] [Accepted: 10/31/2016] [Indexed: 11/30/2022]
Abstract
The improvement of pain and functionality is the major goal of a surgical intervention. Thus, the purpose of the present prospective study was to evaluate whether subjective sensory deficits in patients with lumbar radiculopathy caused by a lumbar disc herniation are related to clinical status, using several outcome scores and the quantitative sensory testing (QST) pre- and 12 months postoperatively. We applied the QST in 52 patients with a single lumbar disc herniation treated by lumbar sequestrectomy pre- and 12 months postoperatively. Further evaluation included numeric rating scale (NRS) for leg, EuroQoL-5D (EQ-5D), Core Outcome Measure Index (COMI), Oswestry Disability Index (ODI), Beck Depression Inventory (BDI) and PaindDetect questionnaire (PD-Q). Patients were then categorized into two groups based on their subjective recovery of sensory function. The patients' self-assessment and QST were correlated with each other for the pre- and postoperative visit after 12 months. The two groups showed postoperative differences in mechanical and vibration detection threshold as well as in the postoperative PD-Q (p < 0.005). Multidimensional scores did not consistently match the QST parameters in patients with a lumbar disc herniation. Commonly used clinical scores in spine research show low or no correlation with QST. Nevertheless, mechanical thresholds seem to play an important role to detect and follow up a sensory deficit investigated by QST.
Collapse
Affiliation(s)
- Anja Tschugg
- Department of Neurosurgery, Medical University Innsbruck, Anichstr. 35, A-6020, Innsbruck, Austria.
| | - Wolfgang N Löscher
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Sara Lener
- Department of Neurosurgery, Medical University Innsbruck, Anichstr. 35, A-6020, Innsbruck, Austria
| | - Sebastian Hartmann
- Department of Neurosurgery, Medical University Innsbruck, Anichstr. 35, A-6020, Innsbruck, Austria
| | - Matthias Wildauer
- Department of Neuroradiology, Medical University Innsbruck, Innsbruck, Austria
| | - Sabrina Neururer
- Department of Medical Statistics, Informatics and Health Economics, Medical University Innsbruck, Innsbruck, Austria
| | - Claudius Thomé
- Department of Neurosurgery, Medical University Innsbruck, Anichstr. 35, A-6020, Innsbruck, Austria
| |
Collapse
|
9
|
Tschugg A, Löscher WN, Lener S, Wildauer M, Hartmann S, Neururer S, Thomé C. Gender differences after lumbar sequestrectomy: a prospective clinical trial using quantitative sensory testing. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2016; 26:857-864. [PMID: 28004244 DOI: 10.1007/s00586-016-4891-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 10/17/2016] [Accepted: 11/17/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND Quantitative sensory testing (QST) gained popularity to evaluate the time course of recovery in sensory dysfunction and the results of different treatment options. Concerning sex differences in lumbar spine surgery, female gender seems to play a major role as a negative prognostic factor in different spinal disorders. For this purpose, we hypothesised that there are also comparable differences in pain patterns in men and women after lumbar sequestrectomy using QST. METHODS We applied the QST protocol of the German Research Network on Neuropathic Pain in 53 patients (21 women and 32 men) with a single lumbar disc herniation confirmed on MRI treated by a lumbar sequestrectomy. Further evaluation included a detailed medical history, a physical examination, and various questionnaires: Beck-Depression-Inventory, Oswestry Disability Index, Core Outcome Measure Index, painDETECT-Questionnaire and EQ-5D thermometer. RESULTS Our analyses showed lower heat thresholds in females preoperatively, that adjusted to that of males 1 week postoperatively. Pressure pain thresholds were lower in women as well, but differed between genders throughout the study. Vibration perception deficits resolve earlier in female than in male patients. Both, women and men, had an excellent overall improvement, postoperatively. CONCLUSION Our results clearly revealed pre- and postoperative differences in pain perception between genders. These differences have to be taken into account in the evaluation of outcome between genders. Therefore, QST seems to be a good method to evaluate the time course of recovery after surgery.
Collapse
Affiliation(s)
- Anja Tschugg
- Departmen of Neurosurgery, Innsbruck Medical University, Anichstr. 35, 6020, Innsbruck, Austria.
| | - Wolfgang N Löscher
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Sara Lener
- Departmen of Neurosurgery, Innsbruck Medical University, Anichstr. 35, 6020, Innsbruck, Austria
| | - Matthias Wildauer
- Department of Neuroradiology, Innsbruck Medical University, Innsbruck, Austria
| | - Sebastian Hartmann
- Departmen of Neurosurgery, Innsbruck Medical University, Anichstr. 35, 6020, Innsbruck, Austria
| | - Sabrina Neururer
- Department of Medical Statistics and Health Economics, Innsbruck Medical University, Innsbruck, Austria
| | - Claudius Thomé
- Departmen of Neurosurgery, Innsbruck Medical University, Anichstr. 35, 6020, Innsbruck, Austria
| |
Collapse
|
10
|
Tschugg A, Löscher WN, Hartmann S, Neururer S, Wildauer M, Thomé C. Gender Influences Radicular Pain Perception in Patients with Lumbar Disc Herniation. J Womens Health (Larchmt) 2015; 24:771-6. [DOI: 10.1089/jwh.2014.5108] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Anja Tschugg
- Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria
| | | | - Sebastian Hartmann
- Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria
| | - Sabrina Neururer
- Department of Medical Statistics and Health Economics, Medical University Innsbruck, Innsbruck, Austria
| | - Matthias Wildauer
- Department of Neuroradiology, Medical University Innsbruck, Innsbruck, Austria
| | - Claudius Thomé
- Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria
| |
Collapse
|
11
|
Kreiner DS, Hwang SW, Easa JE, Resnick DK, Baisden JL, Bess S, Cho CH, DePalma MJ, Dougherty P, Fernand R, Ghiselli G, Hanna AS, Lamer T, Lisi AJ, Mazanec DJ, Meagher RJ, Nucci RC, Patel RD, Sembrano JN, Sharma AK, Summers JT, Taleghani CK, Tontz WL, Toton JF. An evidence-based clinical guideline for the diagnosis and treatment of lumbar disc herniation with radiculopathy. Spine J 2014; 14:180-91. [PMID: 24239490 DOI: 10.1016/j.spinee.2013.08.003] [Citation(s) in RCA: 322] [Impact Index Per Article: 32.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Accepted: 08/14/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The objective of the North American Spine Society's (NASS) Evidence-Based Clinical Guideline for the Diagnosis and Treatment of Lumbar Disc Herniation with Radiculopathy is to provide evidence-based recommendations to address key clinical questions surrounding the diagnosis and treatment of lumbar disc herniation with radiculopathy. The guideline is intended to reflect contemporary treatment concepts for symptomatic lumbar disc herniation with radiculopathy as reflected in the highest quality clinical literature available on this subject as of July 2011. The goals of the guideline recommendations are to assist in delivering optimum efficacious treatment and functional recovery from this spinal disorder. PURPOSE To provide an evidence-based educational tool to assist spine specialists in the diagnosis and treatment of lumbar disc herniation with radiculopathy. STUDY DESIGN Systematic review and evidence-based clinical guideline. METHODS This guideline is a product of the Lumbar Disc Herniation with Radiculopathy Work Group of NASS' Evidence-Based Guideline Development Committee. The work group consisted of multidisciplinary spine care specialists trained in the principles of evidence-based analysis. A literature search addressing each question and using a specific search protocol was performed on English-language references found in Medline, Embase (Drugs and Pharmacology), and four additional evidence-based databases to identify articles. The relevant literature was then independently rated using the NASS-adopted standardized levels of evidence. An evidentiary table was created for each of the questions. Final recommendations to answer each clinical question were developed via work group discussion, and grades were assigned to the recommendations using standardized grades of recommendation. In the absence of Level I to IV evidence, work group consensus statements have been developed using a modified nominal group technique, and these statements are clearly identified as such in the guideline. RESULTS Twenty-nine clinical questions were formulated and addressed, and the answers are summarized in this article. The respective recommendations were graded by strength of the supporting literature, which was stratified by levels of evidence. CONCLUSIONS The clinical guideline has been created using the techniques of evidence-based medicine and best available evidence to aid practitioners in the care of patients with symptomatic lumbar disc herniation with radiculopathy. The entire guideline document, including the evidentiary tables, suggestions for future research, and all the references, is available electronically on the NASS Web site at http://www.spine.org/Pages/PracticePolicy/ClinicalCare/ClinicalGuidlines/Default.aspx and will remain updated on a timely schedule.
Collapse
Affiliation(s)
- D Scott Kreiner
- Ahwatukee Sports and Spine, 4530 E. Muirwood Dr, Suite 110, Phoenix, AZ 85048-7693, USA.
| | - Steven W Hwang
- Department of Neurosurgery, Tufts Medical Center, 800 Washington St, Boston, MA 02111-1552, USA
| | - John E Easa
- The College of Human Medicine, Michigan State University, 12662 Riley St, Suite 120, Holland, MI 49424-8023, USA
| | - Daniel K Resnick
- Department Neurosurgery, University of Wisconsin Medical School, K4/834 Clinical Science Center, 600 Highland, Madison, WI 53792-0001, USA
| | - Jamie L Baisden
- Department of Neurosurgery, Medical College of Wisconsin, 9200 W. Wisconsin Ave., Milwaukee, WI 53226-3522, USA
| | - Shay Bess
- Rocky Mountain Scoliosis and Spine, 2055 High St, Suite 130, Denver, CO 80205-5504, USA
| | - Charles H Cho
- Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115-6110, USA
| | | | | | | | - Gary Ghiselli
- Denver Spine, 7800 E. Orchard Rd, Suite 100, Greenwood Village, CO 80111-2584, USA
| | | | - Tim Lamer
- Mayo Clinic Rochester, 200 1st St SW, Eisenberg 8G, Rochester, MN 55905-0001, USA
| | - Anthony J Lisi
- VACT Healthcare System, 950 Campbell Ave., Bldg 2, Floor 4, West Haven, CT 06516-2770, USA
| | - Daniel J Mazanec
- Cleveland Clinic Spine Institute, 9500 Euclid Ave., C21, Cleveland, OH 44195-0001, USA
| | | | | | - Rakesh D Patel
- University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI 48109-5000, USA
| | - Jonathan N Sembrano
- University of Minnesota, 2450 Riverside Ave. S., Suite R200, Minneapolis, MN 55454-1450, USA
| | - Anil K Sharma
- Spine and Pain Medicine, 2 Mockingbird Drive, Colts Neck, NJ 07722-2228, USA
| | - Jeffrey T Summers
- NewSouth NeuroSpine, 2470 Flowood Drive, Flowood, MS 39232-9019, USA
| | | | | | | | | |
Collapse
|
12
|
Neuropathic Pain Components Are Common in Patients With Painful Cervical Radiculopathy, but Not in Patients With Nonspecific Neck-Arm Pain. Clin J Pain 2013; 29:846-56. [DOI: 10.1097/ajp.0b013e318278d434] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
|
13
|
Rasche D, Ruppolt MA, Kress B, Unterberg A, Tronnier VM. Quantitative sensory testing in patients with chronic unilateral radicular neuropathic pain and active spinal cord stimulation. Neuromodulation 2013; 9:239-47. [PMID: 22151713 DOI: 10.1111/j.1525-1403.2006.00066.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Objectives. Spinal cord stimulation (SCS) is an effective treatment option for chronic radicular neuropathic pain syndromes. This prospective study was performed to examine the peripheral effects of SCS on sensation using quantitative sensory testing (QST). Materials and Methods. We measured two consecutive QST measurements for thermal, tactile-static, tactile-dynamic, vibratory, and pain sensation of the lower limbs in seven patients with chronic unilateral radicular neuropathic pain who underwent SCS implantation for their pain. Measurements were performed when SCS was turned off and once again during SCS and subsequent reduced pain levels. Results. Baseline QST demonstrated significantly increased thresholds for tactile and warm and cold detection in the pain area. With SCS active, a significant reduction of the cold and warm perception and mechanical detection thresholds was found on the painful side (p < 0.01). Although not significant (p > 0.01), altered sensory thresholds with active SCS also were found at the healthy side where no paresthesias were felt. Conclusion. SCS leads to bilateral subclinical effects even if the evoked paresthesias are only unilateral. Pain perception thresholds are not altered with therapeutic SCS.
Collapse
Affiliation(s)
- Dirk Rasche
- Department of Neurosurgery, University Hospital of Heidelberg, Heidelberg; Department of Neurology, Division of Neuroradiology, University Hospital of Heidelberg, Heidelberg; Department of Neurosurgery, University Hospital of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | | | | | | | | |
Collapse
|
14
|
Tampin B, Slater H, Hall T, Lee G, Briffa NK. Quantitative sensory testing somatosensory profiles in patients with cervical radiculopathy are distinct from those in patients with nonspecific neck-arm pain. Pain 2012; 153:2403-2414. [PMID: 22980746 DOI: 10.1016/j.pain.2012.08.007] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2011] [Revised: 08/09/2012] [Accepted: 08/10/2012] [Indexed: 01/22/2023]
Abstract
The aim of this study was to establish the somatosensory profiles of patients with cervical radiculopathy and patients with nonspecific neck-arm pain associated with heightened nerve mechanosensitivity (NSNAP). Sensory profiles were compared to healthy control (HC) subjects and a positive control group comprising patients with fibromyalgia (FM). Quantitative sensory testing (QST) of thermal and mechanical detection and pain thresholds, pain sensitivity and responsiveness to repetitive noxious mechanical stimulation was performed in the maximal pain area, the corresponding dermatome and foot of 23 patients with painful C6 or C7 cervical radiculopathy, 8 patients with NSNAP in a C6/7 dermatomal pain distribution, 31 HC and 22 patients with FM. For both neck-arm pain groups, all QST parameters were within the 95% confidence interval of HC data. Patients with cervical radiculopathy were characterised by localised loss of function (thermal, mechanical, vibration detection P<.009) in the maximal pain area and dermatome (thermal detection, vibration detection, pressure pain sensitivity P<.04), consistent with peripheral neuronal damage. Both neck-arm pain groups demonstrated increased cold sensitivity in their maximal pain area (P<.03) and the foot (P<.009), and this was also the dominant sensory characteristic in patients with NSNAP. Both neck-arm pain groups differed from patients with FM, the latter characterised by a widespread gain of function in most nociceptive parameters (thermal, pressure, mechanical pain sensitivity P<.027). Despite commonalities in pain characteristics between the 2 neck-arm pain groups, distinct sensory profiles were demonstrated for each group.
Collapse
Affiliation(s)
- Brigitte Tampin
- School of Physiotherapy, Curtin Health Innovation Research Institute, Curtin University, Perth, Western Australia, Australia Department of Physiotherapy, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia Department of Neurosurgery, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia Pain Medicine Unit, Fremantle Hospital and Health Service, Fremantle, Western Australia, Australia School of Surgery, University of Western Australia, Perth, Western Australia, Australia
| | | | | | | | | |
Collapse
|
15
|
Whiplash (Grade II) and Cervical Radiculopathy Share a Similar Sensory Presentation: An Investigation Using Quantitative Sensory Testing. Clin J Pain 2008; 24:595-603. [PMID: 18716498 DOI: 10.1097/ajp.0b013e31816ed4fc] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
16
|
Connell K, Guess MK, Bleustein CB, Powers K, Lazarou G, Mikhail M, Melman A. Effects of age, menopause, and comorbidities on neurological function of the female genitalia. Int J Impot Res 2004; 17:63-70. [PMID: 15164089 DOI: 10.1038/sj.ijir.3901230] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The aim of this study was to investigate the effects of age, menopause, and comorbidities on neurological function of the female genitalia using a noninvasive, validated technique. In all, 58 consecutive women were enrolled in the study. Biothesiometry was performed at five genital sites and one peripheral site with S2 dermatome distribution. Kruskal-Wallis one-way ANOVA on ranks was used to evaluate the relationship between age and vibratory sensation. Bivariate and regressional analyses were performed to evaluate the effects of age, menopause and comorbidities on genital sensation. The mean age was 44.6+14.8 y (range 20-78 y). Vibration thresholds increased with advancing age at all six sites. Multilinear regression analysis indicated that menopause and increasing age negatively affect sensation. History of herniated lumbar disc, vaginal delivery, and diabetes variably affected genital sensation. There is a significant increase in vibration thresholds (indicating worsening neurological function) in women as they age and undergo menopause. Biothesiometry is a technique for evaluating genital neurological function in women with coexisting morbidities.
Collapse
Affiliation(s)
- K Connell
- Department of Obstetrics and Gynecology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York, USA.
| | | | | | | | | | | | | |
Collapse
|