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Montaner-Cuello A, Caudevilla-Polo S, Rodríguez-Mena D, Ciuffreda G, Pardos-Aguilella P, Albarova-Corral I, Pérez-Rey J, Bueno-Gracia E. Comparison of Magnetic Resonance Imaging with Electrodiagnosis in the Evaluation of Clinical Suspicion of Lumbosacral Radiculopathy. Diagnostics (Basel) 2024; 14:1258. [PMID: 38928673 PMCID: PMC11202655 DOI: 10.3390/diagnostics14121258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 06/03/2024] [Accepted: 06/12/2024] [Indexed: 06/28/2024] Open
Abstract
(1) Background: The diagnosis of lumbosacral radiculopathy involves anamnesis, an assessment of sensitivity and strength, diagnostic imaging-usually magnetic resonance imaging (MRI)-and electrodiagnostic testing (EDX), typically electromyography (EMG), and electroneurography (ENG). MRI evaluates the structures supporting the spinal cord, while EDX evaluates root functionality. The present study aimed to analyze the concordance of MRI and EDX findings in patients with clinically suspected radiculopathy. Additionally, we investigated the comparison between these two reference tests and various clinical variables and questionnaires. (2) Methods: We designed a prospective epidemiological study of consecutive cases with an observational, descriptive, cross-sectional, and double-blind nature following the STROBE guidelines, encompassing 142 patients with clinical suspicion of lumbosacral radiculopathy. (3) Results: Of the sample, 58.5% tested positive for radiculopathy using EDX as the reference test, while 45.8% tested positive using MRI. The comparison between MRI and EDX in the diagnosis of radiculopathy in patients with clinical suspicion was not significant; the overall agreement was 40.8%. Only the years with symptoms were comparatively significant between the positive and negative radiculopathy groups as determined by EDX. (4) Conclusion: The comparison between lumbar radiculopathy diagnoses in patients with clinically suspected pathology using MRI and EDX as diagnostic modalities did not yield statistically significant findings. MRI and EDX are complementary tests assessing different aspects in patients with suspected radiculopathy; degeneration of the structures supporting the spinal cord does not necessarily imply root dysfunction.
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Affiliation(s)
- Alberto Montaner-Cuello
- Department of Physiatry and Nursing, Faculty of Health Sciences, University of Zaragoza, Calle Domingo Miral S/N, 50009 Zaragoza, Spain; (S.C.-P.); (G.C.); (P.P.-A.); (I.A.-C.); (E.B.-G.)
- PhysiUZerapy: Health Sciences Research Group, University of Zaragoza, Calle Domingo Miral S/N, 50009 Zaragoza, Spain; (D.R.-M.); (J.P.-R.)
| | - Santos Caudevilla-Polo
- Department of Physiatry and Nursing, Faculty of Health Sciences, University of Zaragoza, Calle Domingo Miral S/N, 50009 Zaragoza, Spain; (S.C.-P.); (G.C.); (P.P.-A.); (I.A.-C.); (E.B.-G.)
| | - Diego Rodríguez-Mena
- PhysiUZerapy: Health Sciences Research Group, University of Zaragoza, Calle Domingo Miral S/N, 50009 Zaragoza, Spain; (D.R.-M.); (J.P.-R.)
- Department of Neurophysiology, University Clinical Hospital “Lozano Blesa”, 50009 Zaragoza, Spain
| | - Gianluca Ciuffreda
- Department of Physiatry and Nursing, Faculty of Health Sciences, University of Zaragoza, Calle Domingo Miral S/N, 50009 Zaragoza, Spain; (S.C.-P.); (G.C.); (P.P.-A.); (I.A.-C.); (E.B.-G.)
| | - Pilar Pardos-Aguilella
- Department of Physiatry and Nursing, Faculty of Health Sciences, University of Zaragoza, Calle Domingo Miral S/N, 50009 Zaragoza, Spain; (S.C.-P.); (G.C.); (P.P.-A.); (I.A.-C.); (E.B.-G.)
- PhysiUZerapy: Health Sciences Research Group, University of Zaragoza, Calle Domingo Miral S/N, 50009 Zaragoza, Spain; (D.R.-M.); (J.P.-R.)
| | - Isabel Albarova-Corral
- Department of Physiatry and Nursing, Faculty of Health Sciences, University of Zaragoza, Calle Domingo Miral S/N, 50009 Zaragoza, Spain; (S.C.-P.); (G.C.); (P.P.-A.); (I.A.-C.); (E.B.-G.)
- PhysiUZerapy: Health Sciences Research Group, University of Zaragoza, Calle Domingo Miral S/N, 50009 Zaragoza, Spain; (D.R.-M.); (J.P.-R.)
| | - Jorge Pérez-Rey
- PhysiUZerapy: Health Sciences Research Group, University of Zaragoza, Calle Domingo Miral S/N, 50009 Zaragoza, Spain; (D.R.-M.); (J.P.-R.)
| | - Elena Bueno-Gracia
- Department of Physiatry and Nursing, Faculty of Health Sciences, University of Zaragoza, Calle Domingo Miral S/N, 50009 Zaragoza, Spain; (S.C.-P.); (G.C.); (P.P.-A.); (I.A.-C.); (E.B.-G.)
- PhysiUZerapy: Health Sciences Research Group, University of Zaragoza, Calle Domingo Miral S/N, 50009 Zaragoza, Spain; (D.R.-M.); (J.P.-R.)
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Studnicki R, Szymczyk P, Adamczewski T, Studzińska K, Hansdorfer-Korzon R, Silva AF, Kawczyński A. Manual traction is effective in alleviating lumbosacral spine pain: Evidence from a randomized controlled trial. Heliyon 2024; 10:e31013. [PMID: 38799754 PMCID: PMC11126845 DOI: 10.1016/j.heliyon.2024.e31013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 05/08/2024] [Accepted: 05/09/2024] [Indexed: 05/29/2024] Open
Abstract
Background Manual traction, a therapeutic technique frequently employed in healthcare, involves applying controlled pulling force by hand, usually to the spine, to stretch muscles and decompress joints, thereby alleviating pain. This method can be particularly beneficial for addressing lumbosacral spine pain exacerbated by radicular symptoms, characterized by pain radiating from the lower back due to compression or irritation of spinal nerves. Purpose This study aimed to compare the effects of manual traction against control group in alleviating the lumbosacral spine pain caused by radicular symptoms. Methods A randomized controlled study design was utilized with a sample of 60 patients experiencing lumbosacral spine pain, evenly distributed between an experimental group (n = 30; receiving manual traction) and a control group (n = 30). Patients underwent assessments before and after six treatment sessions, which included the Straight Leg Raise test, modified Bragard's test, Kernig's test, and the visual analogue scale for pain perception. Results Between-group significant differences were found at post-intervention, favoring the experimental group on SLR - Left (°) (p = 0.004; medium effect size), SLR - Right (°) (p = 0.004; medium effect size), Modified Bragard test - Left (°) (p = 0.024; small effect size), Modified Bragard test - Right (°) (p = 0.003; medium effect size), Kernig's Test - Left (°) (p = 0.013; medium effect size) and Kernig's Test - Right (°) (p = 0.010; medium effect size). Additionally, between-group significant differences were found at post-intervention, favoring the experimental group on VAS scores at SLR left (p < 0.001; medium effect size), and right (p < 0.001); medium effect size, Modified Bragard test left (p < 0.001; medium effect size) and right (p < 0.001; medium effect size) and at Kernig's Test left (p < 0.001; medium effect size) and right (p < 0.001; medium effect size). Conclusions In conclusion, manual traction is recommended as an effective approach for alleviating lumbosacral spine pain in patients experiencing symptoms resulting from irritation or compression of a spinal nerve root.
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Affiliation(s)
- Rafał Studnicki
- Sub-Faculty of Physiotherapy, Medical University of Gdańsk, Gdańsk, Poland
| | - Piotr Szymczyk
- Sub-Faculty of Physiotherapy, Medical University of Gdańsk, Gdańsk, Poland
| | - Tomasz Adamczewski
- Medical Rehabilitation Clinic, Chair of Rehabilitation, Faculty of Health Sciences, Medical University of Lódź, Łódź, Poland
| | | | | | - Ana Filipa Silva
- Escola Superior Desporto e Lazer, Instituto Politécnico de Viana do Castelo, Rua Escola Industrial e Comercial de Nun’Álvares, 4900-347 Viana do Castelo, Portugal
- Sport Physical Activity and Health Research & Innovation Center, Viana do Castelo, Portugal
| | - Adam Kawczyński
- Wrocław University of Health and Sport Sciences, Departament of Paralympic Games, Wrocław, Poland
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3
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Balint NT, Antohe BA, Uysal HS, Cristuță AM, Rață M. Relationship between Spinal Range of Motion and Functional Tests in University Students: The Role of Demographic Factors. Healthcare (Basel) 2024; 12:1029. [PMID: 38786439 PMCID: PMC11121651 DOI: 10.3390/healthcare12101029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Revised: 05/10/2024] [Accepted: 05/12/2024] [Indexed: 05/25/2024] Open
Abstract
Spinal disorders are some of the most prevalent health concerns, especially among students. Based on student demographics, this cross-sectional study evaluated the correlation between functional tests (FTs) and spinal range of motion (ROM). This study included 206 students (age = 19.85 ± 1.80 years) from the Vasile Alecsandri University of Bacău. Participants' assessments were conducted using the following tests: (i) Ott, (ii) Schober, (iii) Stibor, (iv) finger-to-floor distance, (v) lateral flexion of the cervical and lumbar spine, and (vi) flexion of the cervical spine. Correlation analyses were evaluated using the Spearman correlation coefficient analysis. The results indicated a very strong relationship between lateral flexion of the lumbar spine on the left (LFLSL) and right (LFLSR) for all departments (r = 0.85 to 0.97, p < 0.05). There was a stronger relationship between FT results and spinal ROM for physical-education-department students compared to students from other departments (n = 17, r = -0.38 to 0.93, p < 0.05). There was no statistically significant correlation between FTs and spinal ROM based on age (p > 0.05). The study results provide evidence of the primary risk factors that predispose students to postural deviations. Practitioners and physiotherapists can utilize these values as a reference for potential therapeutic interventions.
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Affiliation(s)
- Nela Tatiana Balint
- Faculty of Movement, Sports and Health Science, “Vasile Alecsandri” University of Bacău, 600115 Bacău, Romania; (N.T.B.); (M.R.)
| | - Bogdan Alexandru Antohe
- Faculty of Movement, Sports and Health Science, “Vasile Alecsandri” University of Bacău, 600115 Bacău, Romania; (N.T.B.); (M.R.)
| | - Huseyin Sahin Uysal
- Faculty of Sport Science, Burdur Mehmet Akif Ersoy University, 15500 Burdur, Turkey;
| | - Alina Mihaela Cristuță
- Faculty of Movement, Sports and Health Science, “Vasile Alecsandri” University of Bacău, 600115 Bacău, Romania; (N.T.B.); (M.R.)
| | - Marinela Rață
- Faculty of Movement, Sports and Health Science, “Vasile Alecsandri” University of Bacău, 600115 Bacău, Romania; (N.T.B.); (M.R.)
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Montaner-Cuello A, Bueno-Gracia E, Rodríguez-Mena D, Estébanez-de-Miguel E, Malo-Urriés M, Ciuffreda G, Caudevilla-Polo S. Is the Straight Leg Raise Suitable for the Diagnosis of Radiculopathy? Analysis of Diagnostic Accuracy in a Phase III Study. Healthcare (Basel) 2023; 11:3138. [PMID: 38132028 PMCID: PMC10742430 DOI: 10.3390/healthcare11243138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 12/04/2023] [Accepted: 12/07/2023] [Indexed: 12/23/2023] Open
Abstract
The straight leg raise test (SLR) has been proposed to detect increased nerve mechanosensitivity of the lower limbs in individuals with low back pain. However, its validity in the diagnosis of lumbosacral radiculopathy shows very variable results. The aim of this study was to analyse the diagnostic validity of the SLR including well-defined diagnostic criteria (a change in symptoms with the structural differentiation manoeuvre and the reproduction of the patient's symptoms during the test or the asymmetries in the range of motion or symptoms location between limbs) in a sample of participants in phase III with suspicion of lumbar radiculopathy using the electrodiagnostic studies (EDX) as the reference standard. A phase III diagnostic accuracy study was designed. In total, 142 individuals with suspected lumbosacral radiculopathy referred for EDX participated in the study. Each participant was tested with EDX and SLR. SLR was considered positive using three diagnostic criteria. The sensitivity of the SLR for Criterion 3 was 89.02% (CI 81.65-96.40), the specificity was 25.00% (CI 13.21-36.79), and the positive and negative likelihood ratios were 1.19 (CI 1.01-1.40) and 0.44 (0.21-0.94), respectively. SLR showed limited validity in the diagnosis of lumbosacral radiculopathy. The incorporation of more objective diagnostic criteria (asymmetry in range of motion or localisation of symptoms) improved the diagnostic validity but the imprecision of the confidence intervals limited the interpretation of the results.
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Affiliation(s)
| | - Elena Bueno-Gracia
- Physiatry and Nursery Department, Health Sciences Faculty, University of Zaragoza, 50009 Zaragoza, Spain; (A.M.-C.); (D.R.-M.); (E.E.-d.-M.); (M.M.-U.); (G.C.); (S.C.-P.)
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5
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Antohe BA, Uysal HŞ, Panaet AE, Iacob GS, Rață M. The Relationship between Magnetic Resonance Imaging and Functional Tests Assessment in Patients with Lumbar Disk Hernia. Healthcare (Basel) 2023; 11:2669. [PMID: 37830706 PMCID: PMC10572759 DOI: 10.3390/healthcare11192669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 09/22/2023] [Accepted: 09/29/2023] [Indexed: 10/14/2023] Open
Abstract
Although magnetic resonance imaging (MRI) findings are the gold standard for diagnosing herniated discs, there are many limitations to accessing MRI scanning devices in practice. This study aimed to evaluate the relationship between functional tests (the visual analog scale (VAS), the SLUMP test, the Sciatica Bothersomeness Index (SBI), the Oswestry Disability Index (ODI), and the LASEGUE test and MRI findings (LSA, IVDH L4-L5, IVDH L5-S1, DHS L4-L5, and DHS L5-S1) in patients diagnosed with disc herniation. Seventy-eight patients who met the inclusion criteria participated in the study. Radiologists and neurologists evaluated patients with disc herniation. After the disc hernia diagnosis, the patients were referred to a physical therapist for conservative management of the disk hernia. The physical therapists assessed the pain level and performed functional tests on patients. All statistical analyses were performed using R (Core Team) software. The correlation between the measured variables was conducted using the Pearson and Spearman tests. The study results indicated statistically significant correlations between DHS L4-L5 vertebral level and functional tests (VAS: r = 0.49, p = 0.00; SBI: r = 0.44, p = 0.00; ODI: r = 0.49, p = 0.00; LASEGUE: r = -0.48, p = 0.00; SLUMP: r = 0.50, p = 0.00). In conclusion, physiotherapists may prefer functional tests to diagnose the herniated disc, and these functional tests may contribute to performing evidence-based assessments.
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Affiliation(s)
- Bogdan-Alexandru Antohe
- Faculty of Movement, Sports and Health Science, “Vasile Alecsandri” University of Bacău, 600115 Bacău, Romania; (B.-A.A.); (A.-E.P.)
| | - Hüseyin Şahin Uysal
- Faculty of Sport Science, Burdur Mehmet Akif Ersoy University, 15500 Burdur, Turkey;
| | - Adelina-Elena Panaet
- Faculty of Movement, Sports and Health Science, “Vasile Alecsandri” University of Bacău, 600115 Bacău, Romania; (B.-A.A.); (A.-E.P.)
| | - George-Sebastian Iacob
- Faculty of Physical Education and Sports, “Alexandru Ioan Cuza” Univesity of Iasi, 700554 Iasi, Romania;
| | - Marinela Rață
- Faculty of Movement, Sports and Health Science, “Vasile Alecsandri” University of Bacău, 600115 Bacău, Romania; (B.-A.A.); (A.-E.P.)
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6
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Villagrán I, Rammsy F, Del Valle J, Gregorio de Las Heras S, Pozo L, García P, Torres G, Varas J, Mandrusiak A, Corvetto M, Fuentes-Cimma J. Remote, asynchronous training and feedback enables development of neurodynamic skills in physiotherapy students. BMC MEDICAL EDUCATION 2023; 23:267. [PMID: 37081551 PMCID: PMC10116106 DOI: 10.1186/s12909-023-04229-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 04/03/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND During the COVID-19 pandemic, face-to-face teaching and learning of physiotherapy practical skills was limited. Asynchronous, remote training has been effective in development of clinical skills in some health professions. This study aimed to determine the effect of remote, asynchronous training and feedback on development of neurodynamic skills in physiotherapy students. METHODS Longitudinal repeated measurements study, across four training sessions. Participants engaged in a remote training program for development of upper limb neurodynamic techniques. In this sequential training, participants viewed the online tutorial, practiced independently, and uploaded a video of their performance for formative assessment and feedback from a trained instructor via a checklist and rubric. RESULTS Intra-subject analyses of 60 third-year physiotherapy students showed that the target standard of performance, with no further significant change in scores, was attained following session 2 for the checklist and session 3 for the rubric. This shows that two sessions are required to learn the procedures, and three sessions yield further improvements in performance quality. CONCLUSION The remote, asynchronous training and feedback model proved to be an effective strategy for students' development of neurodynamic testing skills and forms a viable alternative to in-person training. This study contributes to the future of acquiring physiotherapy clinical competencies when distance or hybrid practice is required.
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Affiliation(s)
- Ignacio Villagrán
- Carrera de Kinesiología, Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Vicuña Mackenna 4860, Santiago, Chile
| | - Francisca Rammsy
- Carrera de Kinesiología, Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Vicuña Mackenna 4860, Santiago, Chile
| | - Javiera Del Valle
- Carrera de Kinesiología, Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Vicuña Mackenna 4860, Santiago, Chile
| | - Sofía Gregorio de Las Heras
- Carrera de Kinesiología, Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Vicuña Mackenna 4860, Santiago, Chile
| | - Liliana Pozo
- Carrera de Kinesiología, Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Vicuña Mackenna 4860, Santiago, Chile
| | - Patricio García
- Carrera de Kinesiología, Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Vicuña Mackenna 4860, Santiago, Chile
| | - Gustavo Torres
- Carrera de Kinesiología, Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Vicuña Mackenna 4860, Santiago, Chile
| | - Julián Varas
- Centro de Simulación y Cirugía experimental, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Allison Mandrusiak
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Marcia Corvetto
- Centro de Simulación y Cirugía experimental, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Javiera Fuentes-Cimma
- Carrera de Kinesiología, Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Vicuña Mackenna 4860, Santiago, Chile.
- School of Health Professions Education (SHE), Maastricht University, Maastricht, the Netherlands.
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7
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Fourré A, Monnier F, Ris L, Telliez F, Michielsen J, Roussel N, Hage R. Low-back related leg pain: is the nerve guilty? How to differentiate the underlying pain mechanism. J Man Manip Ther 2023; 31:57-63. [PMID: 35735104 PMCID: PMC10013353 DOI: 10.1080/10669817.2022.2092266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
Low back pain (LBP) that radiates to the leg is not always related to a lesion or a disease of the nervous system (neuropathic pain): it might be nociceptive (referred) pain. Unfortunately, patients with low-back related leg pain are often given a variety of diagnoses (e.g. 'sciatica'; 'radicular pain'; pseudoradicular pain"). This terminology causes confusion and challenges clinical reasoning. It is essential for clinicians to understand and recognize predominant pain mechanisms. This paper describes pain mechanisms related to low back-related leg pain and helps differentiate these mechanisms in practice using clinical based scenarios. We illustrate this by using two clinical scenarios including patients with the same symptoms in terms of pain localization (i.e. low-back related leg pain) but with different underlying pain mechanisms (i.e. nociceptive versus neuropathic pain).
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Affiliation(s)
- Antoine Fourré
- Department of Neurosciences, Research Institute for Health Sciences and Technology, University of Mons, Mons, Belgium.,Faculty of Medicine and Health Sciences, Rehabilitation Sciences and Physiotherapy (MOVANT), University of Antwerp, Antwerp, Belgium.,Traitement Formation Thérapie Manuelle (TFTM), Physiotherapy Center, Brussels, Belgium
| | - Félix Monnier
- Department of Neurosciences, Research Institute for Health Sciences and Technology, University of Mons, Mons, Belgium
| | - Laurence Ris
- Department of Neurosciences, Research Institute for Health Sciences and Technology, University of Mons, Mons, Belgium
| | - Frédéric Telliez
- Institut d'Ingénierie de la Santé-UFR de Médecine, Centre Universitaire de Recherche en Santé-Laboratoire Péritox, Université de Picardie Jules Verne, Amiens, France
| | - Jef Michielsen
- Faculty of Medicine and Health Sciences, Rehabilitation Sciences and Physiotherapy (MOVANT), University of Antwerp, Antwerp, Belgium.,Orthopedic Department, University Hospital, Antwerp, Belgium
| | - Nathalie Roussel
- Faculty of Medicine and Health Sciences, Rehabilitation Sciences and Physiotherapy (MOVANT), University of Antwerp, Antwerp, Belgium
| | - Renaud Hage
- Traitement Formation Thérapie Manuelle (TFTM), Physiotherapy Center, Brussels, Belgium.,Centre de Recherche et de Formation (CeREF), HELHa, Mons, Belgium
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Wu Y, Zhu T, Fu Z. Effects of Different Intervertebral Space Heights on Nerve Root Tension during Posterior Lumbar Interbody Fusion. Orthop Surg 2023; 15:1196-1202. [PMID: 36846938 PMCID: PMC10102308 DOI: 10.1111/os.13649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/29/2022] [Accepted: 12/08/2022] [Indexed: 03/01/2023] Open
Abstract
OBJECTIVE There is no effective standard method to evaluate whether the nerve root tension is restored during lumbar decompression surgery, which is an important indicator for the recovery of nerve function. This study aimed to investigate the feasibility of intraoperative nerve root tension measurement and to confirm the correlation between nerve root tension and intervertebral space height. METHODS A total of 54 consecutive patients (mean age, 54.3 years; range, 25-68 years) received posterior lumbar interbody fusion (PLIF) for lumbar disc herniation (LDH) with lumbar spinal stenosis and instability. The 110%, 120%, 130%, 140% height values of each lesion were calculated based on preoperative measurements of the intervertebral space height. The heights were intraoperatively expanded after the intervertebral disc was removed using the interbody fusion cage model. The tension value of nerve root was measured by pulling the nerve root for 5 mm with a self-made measuring device. The nerve root tension value was measured before decompression, after discectomy at 100%, 110%, 120%, 130%, and 140% of the height of each intervertebral space, and after placement of the cage during intraoperative nerve root tension monitoring. RESULTS The nerve root tension values at 100%, 110%, 120%, and 130% heights were significantly lower than those before decompression, and there was no statistical significance among the four groups. The nerve root tension value was significantly higher at 140% height and was statistically significant compared with that of 130% height. The nerve root tension value after cage placement was significantly lower than that before decompression (1.32 ± 0.22 N vs. 0.61 ± 0.17 N, p < 0.01), and the postoperative VAS score was also significantly improved (7.0 ± 2.24 vs. 0.8 ± 0.84, p < 0.01). The nerve root tension was positively correlated with the VAS score (F = 85.19, p < 0.01; F = 78.65, p < 0.01). CONCLUSION This study demonstrates that nerve root tonometry can perform instant noninvasive intraoperative nerve root tension measurement. There is a correlation between nerve root tension value and VAS score. We found that when the height of the intervertebral space was increased to 140% of the original height, the nerve root tension increased the risk of injury significantly.
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Affiliation(s)
- Yujie Wu
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tong Zhu
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhiyi Fu
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Achieving effective long-term therapeutic results in the treatment of chronic pain of musculoskeletal origin: the place of regenerative medicine. MANUELLE MEDIZIN 2023. [DOI: 10.1007/s00337-022-00934-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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10
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Kearns G, Bason J. Sensitization of Hoffmann's sign in response to a reverse Lhermitte's sign: a case report. J Man Manip Ther 2022; 30:357-364. [PMID: 35312464 PMCID: PMC9621270 DOI: 10.1080/10669817.2022.2056363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Neurologic clustering of findings is recommended with Cervical Spondylotic Myelopathy (CSM). Hoffmann's Sign and Reverse Lhermitte's Sign have been associated with CSM, which, however, have not been discussed as the only objective findings that may cause clinical uncertainty. CASE DESCRIPTION This case report describes how sensitizing Hoffmann's Sign following a Reverse Lhermitte's Sign guided reasoning, with a 66-year-old male presenting with a right lumbar radiculopathy diagnosis. Local lumbar symptoms and impairments were identified, however, a Reverse Lhermitte's Sign with cervical extension was the only finding that reproduced right lower extremity (LE) pain. Hoffmann's Sign, the only abnormal neurologic finding, became exaggerated when performed in cervical extension. Concern of an early presenting CSM accounting for right LE pain was considered. A neurosurgical consultation was initiated with concurrent guideline-based lumbar spine treatment and continued monitoring of neurologic status. OUTCOMES Seven weeks after evaluation, sudden worsening of right LE symptoms, hand numbness, ataxia, and grip weakness occurred. Cervical magnetic resonance imaging demonstrated C3-6 cord compression. A multi-level cervical decompression surgery was performed. DISCUSSION Using a sensitized Hoffmann's Sign-in response to a Reverse Lhermitte's Sign aided differential diagnosis of an early presenting CSM with reports of LE pain. The diagnostic utility of a sensitized Hoffmann's Sign is unknown.
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Affiliation(s)
- Gary Kearns
- Doctor of Physical Therapy (Dpt) Program, Department of Rehabilitation Sciences, School of Health Professions, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Jillian Bason
- Texas Tech University Health Sciences Center School of Medicine, Lubbock Campus: Texas Tech University Health Sciences Center School of Medicine,Lubbock, TX, USA
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Selective Nerve Root Block in Treatment of Lumbar Radiculopathy: A Narrative Review. SURGERIES 2022. [DOI: 10.3390/surgeries3030028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Selective Nerve Root Block (SNRB) is a precise local injection technique that can be utilised to target a particular inflamed nerve root causing lumbar radiculopathy for both diagnostic and therapeutic purposes. Usually, for SNRB to be therapeutic, a combination of a local anaesthetic agent and a steroid is injected under imaging guidance, whereas for diagnostic purposes, just the local anaesthetic agent is injected. While the ideal treatment strategy is to relieve the nerve root from its compressing pathology, local injection of steroids targeted at the affected nerve root can also be attempted to reduce inflammation and thus achieve pain relief. Although the general principle for administering an SNRB remains largely the same across the field, there are differences in techniques depending on the region and level of the spine that is targeted. Moreover, drug combinations utilised by clinicians vary based on preference. The proven benefits of SNRBs largely outweigh their risks, and the procedure is deemed safe and well tolerated in a majority of patients. In this narrative, we explore the existing literature and seek to provide a comprehensive understanding of SNRB as a treatment for lumbar radiculopathy, its indications, techniques, outcomes, and complications.
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