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Wang B, Sun Y, Zhang J, Meng H, Zhang H, Shan L. Ultrasound-guided versus fluoroscopy-guided lumbar selective nerve root block: a retrospective comparative study. Sci Rep 2024; 14:3235. [PMID: 38331978 PMCID: PMC10853516 DOI: 10.1038/s41598-024-53809-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 02/05/2024] [Indexed: 02/10/2024] Open
Abstract
The purpose of this study is to compare the accuracy and effectiveness of ultrasound-guided and fluoroscopy-guided lumbar selective nerve root block (SNRB), and to explore the feasibility of ultrasound-guided methods. This retrospective study included patients with lumbar radicular pain who underwent ultrasound-guided and fluoroscopy-guided selective nerve root block at Honghui Hospital Affiliated to Xi'an Jiaotong University from August 2020 to August 2022. Patients were divided into U-SNRB group and F-SNRB group according to ultrasound-guided or fluoroscopy-guided selective nerve root block. There were 43 patients in U-SNRB group and 20 patients in F-SNRB group. The pain visual analogue scale (VAS) scores, Japanese Orthopaedic Association (JOA) scores, related indexes and complications were recorded and compared between the two groups before, 30 min, 1 month and 6 months after block. To evaluate the feasibility, accuracy and effectiveness of ultrasound-guided selective nerve root block. There were no complications in the process of selective nerve root block in both groups. The operating time and the times of closing needle angle adjustment in U-SNRB group were better than those in F-SNRB group, and the difference was statistically significant (P < 0.05). The VAS score and JOA score of patients in the two groups were significantly improved 30 min after block, 1 month and 6 months after block, and the difference was statistically significant (P < 0.05). There was no significant difference between the two groups (P > 0.05). The accuracy of ultrasound-guided selective nerve root block and the degree of pain relief of patients were similar to those of fluoroscopy guidance, but the operation time and needle angle adjustment times were significantly less than that of fluoroscopy, and could effectively reduce radiation exposure. Therefore, it can be used as a better way to guide for choice.
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Affiliation(s)
- Bowen Wang
- Yan'an University, Yan'an, 716000, Shannxi, China
- The Spine Surgery Department of Honghui Hospital, Xi'an Jiaotong University, Xi'an, 710054, Shannxi, China
| | - Yang Sun
- The Spine Surgery Department of Honghui Hospital, Xi'an Jiaotong University, Xi'an, 710054, Shannxi, China
| | - Jitao Zhang
- The Spine Surgery Department of Honghui Hospital, Xi'an Jiaotong University, Xi'an, 710054, Shannxi, China
| | - Hailan Meng
- The Spine Surgery Department of Honghui Hospital, Xi'an Jiaotong University, Xi'an, 710054, Shannxi, China
| | - Hong Zhang
- The Ultrasound Department of Honghui Hospital, Xi'an Jiaotong University, Xi'an, 710054, Shannxi, China.
| | - Lequn Shan
- The Spine Surgery Department of Honghui Hospital, Xi'an Jiaotong University, Xi'an, 710054, Shannxi, China.
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Han S, Lee HD, Jang HD, Suh DH, Han K, Hong JY. Lumbar radiculopathy and fracture risk: A Korean nationwide population-based cohort study. Bone 2024; 179:116981. [PMID: 38008302 DOI: 10.1016/j.bone.2023.116981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 11/06/2023] [Accepted: 11/21/2023] [Indexed: 11/28/2023]
Abstract
INTRODUCTION Lumbar radiculopathy is a common disease with a high economic burden, and fractures in adults are a significant public health problem. However, studies of the relationship between lumbar radiculopathy and fractures are scarce. We investigated the fracture risk in patients with lumbar radiculopathy. METHODS This nationwide retrospective cohort study identified 815,101 patients with lumbar radiculopathy and randomly matched individuals without lumbar radiculopathy (1:1) who were included in the Korean National Health Insurance System in 2012. Cox proportional hazards regression analyses were performed to calculate the hazard ratio (HR) for fracture risk in patients with lumbar radiculopathy. RESULTS The study included 301,347 patients with lumbar radiculopathy and matched 289,618 individuals without lumbar radiculopathy. Compared to individuals without lumbar radiculopathy, patients with lumbar radiculopathy had a 27 % increased fracture risk (adjusted HR = 1.27, 95 % confidence interval = 1.24-1.31). The Kaplan-Meier plot showed a significantly higher fracture incidence in patients with lumbar radiculopathy than in individuals without lumbar radiculopathy at all times. CONCLUSION Lumbar radiculopathy is significantly associated with fracture risk.
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Affiliation(s)
- Sangsoo Han
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, 170 Jomaru-ro, Bucheon 14584, Republic of Korea
| | - Han-Dong Lee
- Department of Orthopaedic Surgery, Ajou University School of Medicine, Suwon 16499, Republic of Korea
| | - Hae-Dong Jang
- Department of Orthopaedic Surgery, Soonchunhyang University Bucheon Hospital, 170 Jomaru-ro, Bucheon 14584, Republic of Korea
| | - Dong Hun Suh
- Department of Orthopedics, Korea University Hospital, Ansan, 123, Jeokgeum-ro, Danwon-gu, Ansan-si, Gyeonggi-do 15355, Republic of Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, 369 Sangdo-ro, Dongjak-gu, Seoul 06978, Republic of Korea
| | - Jae-Young Hong
- Department of Orthopedics, Korea University Hospital, Ansan, 123, Jeokgeum-ro, Danwon-gu, Ansan-si, Gyeonggi-do 15355, Republic of Korea.
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Ryf C, Hofstetter L, Clack L, Hincapié CA. Involving patients and clinicians in the development of a randomised clinical trial protocol to assess spinal manual therapy versus nerve root injection for patients with lumbar radiculopathy: a patient and public involvement project to inform the SALuBRITY trial design. Res Involv Engagem 2024; 10:8. [PMID: 38229190 DOI: 10.1186/s40900-023-00536-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 12/22/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND Spinal manual therapy and corticosteroid nerve root injection are commonly used to treat patients with lumbar radiculopathy. The SALuBRITY trial-a two parallel group, double sham controlled, randomised clinical trial-is being developed to compare their effectiveness. By gathering patients' and clinicians' perspectives and involving them in discussions related to the trial research question and objectives, proposed trial recruitment processes, methods, and outcome measures, we aimed to improve the relevance and quality of the SALuBRITY trial. METHODS We involved patients with lived experience of lumbar radiculopathy (n = 5) and primary care clinicians (n = 4) with experience in the treatment of these patients. Involvement activities included an initial kick-off event to introduce the project, establishing a shared purpose statement, and empowering patient and clinician advisors for their involvement, followed by semi-structured group and individual interviews, and questionnaires to evaluate the experience throughout the project. RESULTS Both patient and clinician advisors endorsed the significance and relevance of the trial's objectives. Patients assessed the proposed trial methods as acceptable within the context of a trusting patient-clinician relationship. A trial recruitment and enrolment target time of up to five days was regarded as acceptable, although patients with chronic radiculopathy may need more time to consider their trial participation decision. All advisors reached consensus on the acceptability of a medication washout phase of 12- to 24-h before pain outcome measurement, with the inclusion of a rescue medication protocol. Both advisory groups preferred leg pain over back pain as the primary clinical outcome, with patient advisors advocating for personalized primary pain localization. Furthermore, patients requested expanding the pain, enjoyment, and general activity scale with peak pain intensity, rather than average pain alone. Patient and clinician advisors evaluated their engagement in clinical research as meaningful and impactful. CONCLUSION Patient and public involvement resulted in important and relevant considerations for the SALuBRITY trial, spanning all research phases. These findings hold promise for enhancing the trial's quality and relevance and improving its translation into clinical practice.
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Affiliation(s)
- Corina Ryf
- Department of Chiropractic Medicine, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- EBPI-UWZH Musculoskeletal Epidemiology Research Group, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Léonie Hofstetter
- EBPI-UWZH Musculoskeletal Epidemiology Research Group, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- Head of Musculoskeletal Epidemiology Research, Epidemiology, Biostatistics and Prevention Institute (EBPI) & University Spine Centre Zurich, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- University Spine Centre Zurich (UWZH), Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Lauren Clack
- Institute for Implementation Science in Health Care, University of Zurich, Zurich, Switzerland
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
| | - Cesar A Hincapié
- EBPI-UWZH Musculoskeletal Epidemiology Research Group, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
- Head of Musculoskeletal Epidemiology Research, Epidemiology, Biostatistics and Prevention Institute (EBPI) & University Spine Centre Zurich, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
- University Spine Centre Zurich (UWZH), Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
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Choi YC, Seo JH, Kim P. Clinical efficacy of nucleoplasty for uncontained lumbar disc herniation: a retrospective study. BMC Musculoskelet Disord 2024; 25:12. [PMID: 38166911 PMCID: PMC10759451 DOI: 10.1186/s12891-023-07120-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 12/14/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND There are insufficient in-depth studies on whether percutaneous lumbar nucleoplasty (PLN) is effective and safe for the treatment of uncontained lumbar disc herniation (ULDH). This study aimed to investigate the clinical efficacy of PLN on radiating leg pain caused by ULDH. METHODS Patients who underwent PLN for ULDH and met the inclusion criteria between June 2018 and July 2022 were included. Clinical outcomes were evaluated using the numeric rating scale (NRS) for radiating pain preoperatively; at 1 day, 1 week, and 1 month postoperatively; and at the last follow-up. Patient satisfaction was assessed using MacNab criteria. RESULTS Forty-one patients were enrolled. The mean age was 50.2 years (range 24-73 years). The mean and standard deviation of the preoperative NRS in 39 patients with radiating pain was 9.0 ± 1.2. The NRS scores at 1 day, 1 week, and 1 month postoperatively and at the last follow-up were 4.6 ± 3.2, 3.6 ± 3.3, 2.9 ± 3.2, and 1.4 ± 2.0, respectively, showing significant improvement (all, p < 0.001). The number of patients (percentage) with excellent or good satisfaction according to the MacNab criteria was 29 (70.7%). Major complications were not observed. Three patients underwent additional surgery after PLN because of persistent radiating pain. CONCLUSIONS PLN is a safe and feasible treatment option for ULDH. Treatment outcomes were favorable on average; however, the lack of consistency was a drawback.
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Affiliation(s)
- Yong Cheol Choi
- Department of Neurosurgery, College of Medicine, Chosun University, Gwangju, Korea
| | - Jong Hun Seo
- Department of Neurosurgery, College of Medicine, Chosun University, Gwangju, Korea
| | - Pius Kim
- Department of Neurosurgery, College of Medicine, Chosun University, Gwangju, Korea.
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Kojo S, Takahashi K, Tsubakino T, Hashimoto K, Aizawa T, Tanaka Y. Lumbar radiculopathy due to Bertolotti's syndrome: Alternative method to reveal the "hidden zone" - A report of two cases and review of literature. J Orthop Sci 2024; 29:366-369. [PMID: 35305864 DOI: 10.1016/j.jos.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/13/2022] [Accepted: 02/17/2022] [Indexed: 02/09/2023]
Affiliation(s)
- Shigeaki Kojo
- Department of Orthopaedic Surgery, Tohoku Central Hospital
| | - Kohei Takahashi
- Department of Orthopaedic Surgery, Tohoku Central Hospital; Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine
| | | | - Ko Hashimoto
- Department of Orthopaedic Surgery, Tohoku Central Hospital; Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine.
| | - Toshimi Aizawa
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine
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Su CY, Huang GS, Chang WC, Wang CC, Chen CW, Hsu YC. The Value of 18F-FDG PET/MRI in Detecting Lumbar Radiculopathy for Selective Percutaneous Endoscopic Discectomy: a Case Report. Nucl Med Mol Imaging 2023; 57:247-250. [PMID: 37720881 PMCID: PMC10504134 DOI: 10.1007/s13139-023-00797-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 03/09/2023] [Accepted: 03/16/2023] [Indexed: 03/31/2023] Open
Abstract
Magnetic resonance imaging (MRI) is the most popular imaging modality for investigating intervertebral disc herniation. However, it has a high chance for identifying incidental findings that are morphologically or structurally abnormal but not responsible for patients' symptoms. Although a previous study suggested that 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/magnetic resonance imaging (PET/MRI) may help identify neuroinflammation in lumbar radiculopathy, there is currently no direct evidence obtained from surgery. Here, we describe the case of a 32-year-old man with low back pain and right leg paresthesia for 7 months. MRI demonstrated disc herniation at the L3-L4, L4-L5 and L5-S1 levels, causing bilateral L5 and left S1 root compression. 18F-FDG PET/MRI demonstrated increased 18F-FDG uptake at the right L5 root, which was compatible with the patient's symptoms. Transforaminal percutaneous endoscopic lumbar discectomy (PELD) was performed. Intraoperative images revealed a swollen nerve root at the right L5 after removal of the herniated disc. After surgery, the patient experienced immediate pain relief and had no recurrence at the 6-month follow-up. When performing PELD in patients with multilevel radiculopathy identified on MRI, the use of 18F-FDG PET/MRI can help in accurate localization of the symptomatic roots and minimize surgical incision and soft-tissue injury.
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Affiliation(s)
- Chih-Ying Su
- Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec. 2, Cheng-kung Rd., Neihu Dist, 114 Taipei, Taiwan, Republic of China
- Department of Radiology, Taichung Armed Forces General Hospital, Taichung, Taiwan, Republic of China
| | - Guo-Shu Huang
- Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec. 2, Cheng-kung Rd., Neihu Dist, 114 Taipei, Taiwan, Republic of China
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Wei-Chou Chang
- Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec. 2, Cheng-kung Rd., Neihu Dist, 114 Taipei, Taiwan, Republic of China
| | - Chih-Chien Wang
- Department of Orthopedic, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Chun-Wen Chen
- Department of Radiology, Taichung Armed Forces General Hospital, Taichung, Taiwan, Republic of China
- Department of Medical Imaging and Radiological Sciences, Central Taiwan University of Science and Technology, Taichung City, Taiwan, Republic of China
- Department of Radiology, School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Yi-Chih Hsu
- Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec. 2, Cheng-kung Rd., Neihu Dist, 114 Taipei, Taiwan, Republic of China
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Thoomes E, Falla D, Cleland JA, Fernández-de-Las-Peñas C, Gallina A, de Graaf M. Conservative management for lumbar radiculopathy based on the stage of the disorder: a Delphi study. Disabil Rehabil 2023; 45:3539-3548. [PMID: 36205564 DOI: 10.1080/09638288.2022.2130448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 09/25/2022] [Indexed: 11/09/2022]
Abstract
PURPOSE Conservative management of lumbar radiculopathy (LR) is the first treatment option. To date, systematic reviews and clinical practice guidelines have not considered the most appropriate timing of management. This study aimed to establish consensus on effective conservative treatment modalities across different stages (i.e., acute, sub-acute, or chronic) of LR. MATERIALS AND METHODS Through an iterative multistage Delphi process, experts rated agreement with proposed treatment modalities across stages of LR and could suggest additional treatment modalities. The agreement was measured using a 5-point Likert scale. Descriptive statistics were used to measure agreement (median, interquartile ranges, and percentage of agreement). Consensus criteria were defined a priori for each round. RESULTS Fourteen panelists produced a consensus list of effective treatment modalities across stages of LR. Acute stage management should focus on providing patients with information about the condition including pain education, individualized physical activity, and directional preference exercises, supported with NSAIDs. In the sub-acute stage, strength training and neurodynamic mobilization could be added and transforaminal/epidural injections considered. In the chronic stage, spinal manipulative therapy, specific exercise, and function-specific physical training should be combined with individualized vocational, ergonomic and postural advice. CONCLUSIONS Experts agree effectiveness of interventions differs through the evolution of LR.IMPLICATIONS FOR REHABILITATIONTo date clinical guideline for conservative management of lumbar radiculopathy do not consider the evolution of the condition.Acute stage management of lumbar radiculopathy should focus on providing information about the condition and support individualized physical activity with pain medication.Sub-acute management should add neurodynamic mobilization to strength training, while transforaminal and/or epidural injections could be considered.Chronic stage management should consider spinal manipulative therapy and focus on restoring personalized functional capacity.
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Affiliation(s)
- Erik Thoomes
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, UK
- Research Department, Fysio-Experts, Hazerswoude, Netherlands
| | - Deborah Falla
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, UK
| | - Joshua A Cleland
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, Alcorcón, Spain
| | - Alessio Gallina
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, UK
| | - Marloes de Graaf
- Research Department, Fysio-Experts, Hazerswoude, Netherlands
- Department of Manual Therapy, Breederode University of Applied Science, Rotterdam, Netherlands
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Knezevic A, Kovacevic M, Jeremic-Knezevic M, Nikolasevic Z, Tomasevic-Todorovic S, Zivanovic Z, Spasojevic T, Garipi E, Vojnovic L, Popovic D, Neblett R. Patients with neuropathic pain from lumbosacral radiculopathy demonstrate similar pressure pain thresholds and conditioned pain modulation to those with fibromyalgia. Neurophysiol Clin 2023; 53:102841. [PMID: 36716611 DOI: 10.1016/j.neucli.2022.102841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 11/13/2022] [Accepted: 12/17/2022] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVE The purpose of the study was to evaluate pain thresholds, impairment of the endogenous pain modulatory system, and self-reported cognitive-emotional and central sensitization-related symptoms among three subject groups: a rarely studied patient cohort with neuropathic pain from lumbosacral radiculopathy (NPLSR), patients with fibromyalgia (FM) and healthy controls (HC). METHODS Patient-reported pain-related symptomology was evaluated with psychometricallyvalidated questionnaires. Pressure pain threshold (PPT), heat pain threshold (HPT), and cold pain threshold (CPT) were assessed in the low back and contralateral forearm. Conditioned pain modulation (CPM) was evaluated with a recently introduced methodology that accounts for a standard error of measurement. RESULTS Compared to the HC subjects, the FM and NPLSR subjects had significantly lower pain thresholds and more CPM impairment. No significant differences in PPT and CPM were observed between the FM and NPLSR groups. Significant group differences were found in self-reported symptoms of depression, anxiety, stress, and central sensitization. Self-reported symptom severity increased in a stair-step fashion, with the HC group scoring lowest and FM group scoring highest. CONCLUSION The NPLSR group manifested CPM dysfunction and pressure hyperalgesia at similar levels to the FM group, indicating that these two chronic pain syndromes, likely based on different pathophysiological mechanisms, in fact share some common pain processing features. However, though both patient groups demonstrated similarities in pain processing, self-reported cognitive-emotional and central sensitization-related symptom severity was significantly higher in the FM cohort, which distinguished them from the chronic NPLSR cohort.
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Affiliation(s)
- Aleksandar Knezevic
- Faculty of Medicine University of Novi Sad, Serbia; Medical Rehabilitation Clinic University Clinical Centre of Vojvodina, Serbia.
| | | | | | | | - Snezana Tomasevic-Todorovic
- Faculty of Medicine University of Novi Sad, Serbia; Medical Rehabilitation Clinic University Clinical Centre of Vojvodina, Serbia
| | - Zeljko Zivanovic
- Faculty of Medicine University of Novi Sad, Serbia; Neurology Clinic University Clinical Centre of Vojvodina, Serbia
| | - Tijana Spasojevic
- Faculty of Medicine University of Novi Sad, Serbia; Medical Rehabilitation Clinic University Clinical Centre of Vojvodina, Serbia
| | - Enis Garipi
- Faculty of Medicine University of Novi Sad, Serbia; Medical Rehabilitation Clinic University Clinical Centre of Vojvodina, Serbia
| | - Larisa Vojnovic
- Faculty of Medicine University of Novi Sad, Serbia; Medical Rehabilitation Clinic University Clinical Centre of Vojvodina, Serbia
| | - Dunja Popovic
- Faculty of Medicine University of Novi Sad, Serbia; Medical Rehabilitation Clinic University Clinical Centre of Vojvodina, Serbia
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Dewberry LS, Porche K, Koenig T, Allen KD, Otto KJ. High frequency alternating current neurostimulation decreases nocifensive behavior in a disc herniation model of lumbar radiculopathy. Bioelectron Med 2023; 9:15. [PMID: 37434246 DOI: 10.1186/s42234-023-00119-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 06/19/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND The purpose of this study was to evaluate if kilohertz frequency alternating current (KHFAC) stimulation of peripheral nerve could serve as a treatment for lumbar radiculopathy. Prior work shows that KHFAC stimulation can treat sciatica resulting from chronic sciatic nerve constriction. Here, we evaluate if KHFAC stimulation is also beneficial in a more physiologic model of low back pain which mimics nucleus pulposus (NP) impingement of a lumbar dorsal root ganglion (DRG). METHODS To mimic a lumbar radiculopathy, autologous tail NP was harvested and placed upon the right L5 nerve root and DRG. During the same surgery, a cuff electrode was implanted around the sciatic nerve with wires routed to a headcap for delivery of KHFAC stimulation. Male Lewis rats (3 mo., n = 18) were separated into 3 groups: NP injury + KHFAC stimulation (n = 7), NP injury + sham cuff (n = 6), and sham injury + sham cuff (n = 5). Prior to surgery and for 2 weeks following surgery, animal tactile sensitivity, gait, and static weight bearing were evaluated. RESULTS KHFAC stimulation of the sciatic nerve decreased behavioral evidence of pain and disability. Without KHFAC stimulation, injured animals had heightened tactile sensitivity compared to baseline (p < 0.05), with tactile allodynia reversed during KHFAC stimulation (p < 0.01). Midfoot flexion during locomotion was decreased after injury but improved with KHFAC stimulation (p < 0.05). Animals also placed more weight on their injured limb when KHFAC stimulation was applied (p < 0.05). Electrophysiology measurements at end point showed decreased, but not blocked, compound nerve action potentials with KHFAC stimulation (p < 0.05). CONCLUSIONS KHFAC stimulation decreases hypersensitivity but does not cause additional gait compensations. This supports the idea that KHFAC stimulation applied to a peripheral nerve may be able to treat chronic pain resulting from sciatic nerve root inflammation.
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Affiliation(s)
- Lauren Savannah Dewberry
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, 1275 Center Dr. JG56, P.O. Box 116131, Gainesville, FL, 32611, USA
| | - Ken Porche
- Lillian S Wells Department of Neurosurgery at the University of Florida, College of Medicine, 1505 SW Archer Road Gainesville, FL, 32608, Gainesville, USA
| | - Travis Koenig
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, 1275 Center Dr. JG56, P.O. Box 116131, Gainesville, FL, 32611, USA
| | - Kyle D Allen
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, 1275 Center Dr. JG56, P.O. Box 116131, Gainesville, FL, 32611, USA
- Pain Research & Intervention Center of Excellence, University of Florida, CTSI 2004 Mowry Road, Gainesville, FL, USA
- Department of Orthopedics and Sports Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Kevin J Otto
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, 1275 Center Dr. JG56, P.O. Box 116131, Gainesville, FL, 32611, USA.
- Department of Neuroscience, University of Florida, 1149 Newell Dr. L1-100, P.O. Box 100244, Gainesville, FL, USA.
- Department of Electrical and Computer Engineering, University of Florida, 968 Center Dr, Gainesville, FL, 32611, USA.
- Department of Chemical Engineering, University of Florida, 1030 Center Drive, P.O. Box 116005, Gainesville, FL, 32611, USA.
- Department of Materials Science and Engineering, University of Florida, 549 Gale Lemerand Dr, P.O. Box 116400, Gainesville, FL, 32611, USA.
- Department of Neurology, 1149 Newell Dr, P.O. Box 100236, Gainesville, FL, L3-10032610, USA.
- Nanoscience Institute for Medical and Engineering Technology (NIMET), University of Florida, 1041 Center Drive, Gainesville, FL, 32611, USA.
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Saraf A, Hussain A, Sandhu AS, Bishnoi S, Arora V. Transforaminal Injections of Platelet-Rich Plasma Compared with Steroid in Lumbar radiculopathy: A Prospective, Double-Blind Randomized Study. Indian J Orthop 2023; 57:1126-1133. [PMID: 37384009 PMCID: PMC10293530 DOI: 10.1007/s43465-023-00898-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 04/22/2023] [Indexed: 06/30/2023]
Abstract
Purpose To evaluate and compare the clinical efficacy of transforaminal steroid and platelet-rich plasma (PRP) injections in patients with discogenic lumbar radiculopathy. Methods 60 patients were randomized to be treated with single transforaminal injection of PRP (n = 29) or steroid (methylprednisolone acetate [n = 31]). Clinical assessment was done with Visual analogue scale (VAS), modified Oswestry low back pain disability index (MODI), and straight leg raise test (SLRT). Baseline assessment of outcomes was done followed by post-intervention evaluation at 1, 3, and 6 months. Both groups had similar baseline characteristics. Results There was a significant statistical improvement of VAS and MODI in both groups at follow-up (P < 0.05). In PRP group, minimal clinically important change (> 2 cm difference of mean for VAS and > 10-point change in MODI) for both outcome scores was achieved at all follow-up intervals (1, 3, 6 months), while as in steroid group, it was seen only at 1 and 3 months for both VAS and MODI. On intergroup comparison, better results were seen in steroid group at 1 month (P < 0.001 for both VAS and MODI), and in PRP group at 6 months (P < 0.001 for both VAS and MODI) with non-significant difference at 3 months (P = 0.605 for MODI and P = 0.612 for VAS). More than 90% tested SLRT negative in PRP group and 62% in steroid group at 6 months. No serious complications were seen. Conclusion Transforaminal injections of PRP and steroid improve short-term (up to 3 months) clinical outcome scores in discogenic lumbar radiculopathy, but clinically meaningful improvements sustaining for 6 months were provided by PRP only.
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Affiliation(s)
- Amit Saraf
- Department of Orthopaedics, Teerthanker Mahaveer Medical College and Research Centre, Delhi Road, 4th Floor, Hospital Building, NH 24, Bagadpur, Moradabad, Uttar Pradesh 244001 India
| | - Altaf Hussain
- Department of Orthopaedics, Teerthanker Mahaveer Medical College and Research Centre, Delhi Road, 4th Floor, Hospital Building, NH 24, Bagadpur, Moradabad, Uttar Pradesh 244001 India
| | - Angad Singh Sandhu
- Department of Orthopaedics, Teerthanker Mahaveer Medical College and Research Centre, Delhi Road, 4th Floor, Hospital Building, NH 24, Bagadpur, Moradabad, Uttar Pradesh 244001 India
| | - Sandeep Bishnoi
- Department of Orthopaedics, Teerthanker Mahaveer Medical College and Research Centre, Delhi Road, 4th Floor, Hospital Building, NH 24, Bagadpur, Moradabad, Uttar Pradesh 244001 India
| | - Vaneet Arora
- Department of Orthopaedics, Teerthanker Mahaveer Medical College and Research Centre, Delhi Road, 4th Floor, Hospital Building, NH 24, Bagadpur, Moradabad, Uttar Pradesh 244001 India
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11
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Zhao W, Guo G, Wang Q, Yang L. Ultrasound-guided transforaminal epidural injection with fluoroscopy confirmation for the treatment of unilateral lumbar radiculopathy: A randomized controlled non-inferiority study. Clin Neurol Neurosurg 2023; 231:107849. [PMID: 37385126 DOI: 10.1016/j.clineuro.2023.107849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 06/18/2023] [Accepted: 06/21/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND Ultrasound (US)-guided injections for chronic pain has multiple advantages over traditional radiologic method. The study was performed to exam the clinical outcomes of lumbar transforaminal epidural injection (LTFEI) between US and fluoroscopy (FL) guidance for lumbar radiculopathy (LRP). METHODS A total of 164 patients with LRP were randomly assigned into US and FL group to receive LTFEI in a 1:1 ratio. Pain relief and functional disability were assessed by numeric rating scale (NRS) and Modified Oswestry Disability Questionnaire (MODQ) scores before treatment, 1 month and 3 months post-intervention. Contrast spread pattern, fluoroscopic image number and complications were also recorded. The primary outcome was accurate rate of contrast dispersing into lumbar epidural space, and non-inferiority margin was predefined at -15 %. RESULTS The accuracy of LTFEI was 90.2 % and 91.5 % in US and FL group, and the lower limit of the 95 %CI of mean difference between two modalities (-4.9 % (95 %CI: -12.8 %, 3.1 %)) was above the non-inferiority margin. Procedure time in US group (531.90 ± 67.12 s) was shorter than FL group (904.20 ± 120.20 s) (p < 0.05), while radiation dosage in the US group was lower than in the FL group (3047.20 ± 569.53 vs. 8807.50 ± 1039.10 μGy m2, p < 0.001). Both groups didn't differ in pain reduction (F = 1.050, p = 0.306) and functional improvement (F = 0.103, p = 0.749) during follow-up period. No severe complications occurred in both groups. CONCLUSIONS US-guided LTFEI confirmed by FL was not inferior to conventional FL method in terms of accurate rate of lumbar epidural contrast dispersion. Effective pain relief and functional ability improvement were comparable between two modalities, and US technique had advantages of less radiation exposure and possible facilitation of avoiding critical vessels around intervertebral foramen.
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Affiliation(s)
- Wenxing Zhao
- Department of Pain Management, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing 100053, China
| | - Guili Guo
- Stroke Acute Care Center, Department of Pain Management, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, China
| | - Qi Wang
- Department of Pain Management, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing 100053, China
| | - Liqiang Yang
- Department of Pain Management, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing 100053, China.
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Amarasinghe P, Wadugodapitiya S, Weerasekara I. Biomechanical and clinical relationships between lower back pain and knee osteoarthritis: a systematic review. Syst Rev 2023; 12:28. [PMID: 36864486 PMCID: PMC9979420 DOI: 10.1186/s13643-022-02164-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 12/26/2022] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND Osteoarthritis (OA) and lower back pain (LBP) are most common health problems which lead to pain and disability. This study aimed to systematically review the evidence to find any relationship between knee osteoarthritis (KOA) and LBP or any potential causation. METHODS The databases of Scopus, MEDLINE, and Embase were searched from inception to 01 October 2022. Any study published in English assessing live humans over 18 years with KOA and LBP was eligible to be included. Studies were independently screened by two researchers. Data of the included studies were extracted based on the participants, outcomes related to knee and lumbar spine, reported association or causation between LBP and KOA, and study design. Data were narratively analyzed and presented as graphs and table. Methodology quality was assessed. RESULTS Of 9953 titles and abstracts, duplicates were removed, and 7552 were screened. Altogether, 88 full texts were screened, and 13 were eligible for the final inclusion. There were some biomechanical and clinical causations were observed for the concurrent presence of LBP and KOA. Biomechanically, high pelvic incidence is a risk factor for development of spondylolisthesis and KOA. Clinically, knee pain intensity was higher in KOA when presents with LBP. Less than 20% of studies have justified their sample size during the quality assessment. DISCUSSION Development and progression of KOA in patients with degenerative spondylolisthesis may be induced by significantly greater mismatches of lumbo-pelvic sagittal alignment. Elderly patients with degenerative lumbar spondylolisthesis and severe KOA reported a different pelvic morphology, increased sagittal malalignment with a lack of lumbar lordosis due to double-level listhesis, and greater knee flexion contracture than in patients with no to mild and moderate KOA. People with concurrent LBP and KOA have reported poor function with more disability. Both LBP and lumbar kyphosis indicate functional disability and knee symptoms in patients with KOA. CONCLUSIONS Different biomechanical and clinical causations were revealed for the concurrent existence of KOA and LBP. Therefore, careful assessment of both back and knee joints should be considered when treating KOA and vice versa. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42022238571.
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Affiliation(s)
- Piyumi Amarasinghe
- Department of Physiotherapy, Faculty of Allied Health Sciences, University of Peradeniya, Peradeniya, Sri Lanka. .,District General Hospital, Embilipitiya, Sri Lanka.
| | - Surangika Wadugodapitiya
- Department of Physiotherapy, Faculty of Allied Health Sciences, University of Peradeniya, Peradeniya, Sri Lanka
| | - Ishanka Weerasekara
- Department of Health and Functioning, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway.,School of Health Sciences, The University of Newcastle, Callaghan, NSW, Australia.,Faculty of Health and Medical Sciences, School of Allied Health Science and Practice, The University of Adelaide, Adelaide, SA, Australia
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13
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Dove L, Jones G, Kelsey LA, Cairns MC, Schmid AB. How effective are physiotherapy interventions in treating people with sciatica? A systematic review and meta-analysis. Eur Spine J 2023; 32:517-533. [PMID: 36580149 PMCID: PMC9925551 DOI: 10.1007/s00586-022-07356-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 07/20/2022] [Accepted: 08/16/2022] [Indexed: 12/30/2022]
Abstract
PURPOSE Physiotherapy interventions are prescribed as first-line treatment for people with sciatica; however, their effectiveness remains controversial. The purpose of this systematic review was to establish the short-, medium- and long-term effectiveness of physiotherapy interventions compared to control interventions for people with clinically diagnosed sciatica. METHODS This systematic review was registered on PROSPERO CRD42018103900. Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL (EBSCO), Embase, PEDro, PubMed, Scopus and grey literature were searched from inception to January 2021 without language restrictions. Inclusion criteria were randomised controlled trials evaluating physiotherapy interventions compared to a control intervention in people with clinical or imaging diagnosis of sciatica. Primary outcome measures were pain and disability. Study selection and data extraction were performed by two independent reviewers with consensus reached by discussion or third-party arbitration if required. Risk of bias was assessed independently by two reviewers using the Cochrane Risk of Bias tool with third-party consensus if required. Meta-analyses and sensitivity analyses were performed with random effects models using Revman v5.4. Subgroup analyses were undertaken to examine the effectiveness of physiotherapy interventions compared to minimal (e.g. advice only) or substantial control interventions (e.g. surgery). RESULTS Three thousand nine hundred and fifty eight records were identified, of which 18 trials were included, with a total number of 2699 participants. All trials had a high or unclear risk of bias. Meta-analysis of trials for the outcome of pain showed no difference in the short (SMD - 0.34 [95%CI - 1.05, 0.37] p = 0.34, I2 = 98%), medium (SMD 0.15 [95%CI - 0.09, 0.38], p = 0.22, I2 = 80%) or long term (SMD 0.09 [95%CI - 0.18, 0.36], p = 0.51, I2 = 82%). For disability there was no difference in the short (SMD - 0.00 [95%CI - 0.36, 0.35], p = 0.98, I2 = 92%, medium (SMD 0.25 [95%CI - 0.04, 0.55] p = 0.09, I2 = 87%), or long term (SMD 0.26 [95%CI - 0.16, 0.68] p = 0.22, I2 = 92%) between physiotherapy and control interventions. Subgroup analysis of studies comparing physiotherapy with minimal intervention favoured physiotherapy for pain at the long-term time points. Large confidence intervals and high heterogeneity indicate substantial uncertainly surrounding these estimates. Many trials evaluating physiotherapy intervention compared to substantial intervention did not use contemporary physiotherapy interventions. CONCLUSION Based on currently available, mostly high risk of bias and highly heterogeneous data, there is inadequate evidence to make clinical recommendations on the effectiveness of physiotherapy interventions for people with clinically diagnosed sciatica. Future studies should aim to reduce clinical heterogeneity and to use contemporary physiotherapy interventions.
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Affiliation(s)
- Lucy Dove
- grid.4991.50000 0004 1936 8948Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, The University of Oxford, West Wing Level 6, Oxford, OX3 9DU UK ,grid.410556.30000 0001 0440 1440Oxford Spine Service, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Gillian Jones
- grid.7628.b0000 0001 0726 8331Department of Sport, Health Sciences and Social Work, Oxford Brookes University, Oxford, UK
| | - Lee Anne Kelsey
- grid.451190.80000 0004 0573 576XOxford Health NHS Foundation Trust, Oxford, UK
| | - Melinda C. Cairns
- grid.5846.f0000 0001 2161 9644School of Health and Social Work, University of Hertfordshire, Hatfield, UK ,Physiocare Body Management, 6 Church St, Twyford, Reading, RG10 9DR UK
| | - Annina B. Schmid
- grid.4991.50000 0004 1936 8948Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, The University of Oxford, West Wing Level 6, Oxford, OX3 9DU UK
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14
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Gasser L, Lener S, Hartmann S, Löscher WN, Thomé C, Hofer A. Does preoperative opioid therapy in patients with a single lumbar disc herniation positively influence the postoperative outcome detected by quantitative sensory testing? Neurosurg Rev 2022; 45:2941-2949. [PMID: 35608709 PMCID: PMC9349102 DOI: 10.1007/s10143-022-01818-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 04/21/2022] [Accepted: 05/18/2022] [Indexed: 12/02/2022]
Abstract
The importance of the type of pain medication in spinal disease is an ongoing matter of debate. Recent guidelines recommend acetaminophen and NSAIDs as first-line medication for lumbar disc herniation. However, opioid pain medication is commonly used in patients with chronic pain, and therefore also in patients with sciatica. The aim of this study is to evaluate if opioids have an impact on the outcome in patients suffering from lumbar disc herniation. To assess this objectively quantitative sensory testing (QST) was applied. In total, 52 patients with a single lumbar disc herniation confirmed on magnetic resonance imaging (MRI) and treated by lumbar sequesterectomy were included in the trial. Patients were analysed according to their preoperative opioid intake: 35 patients who did not receive opioids (group NO) and 17 patients, who received opioids preoperatively (group O). Further evaluation included detailed medical history, physical examination, various questionnaires, and QST. No pre- and postoperative differences were detected in thermal or mechanical thresholds (p > 0.05). Wind-up ratio (WUR) differed significantly between groups 1 week postoperatively (p = 0.025). The NRS for low back pain was rated significantly higher in the non-opioid group (NO) after 1-week follow-up (p = 0.026). Radicular pain tended to be higher in the NO group after 12 months of follow-up (p = 0.023). Opioids seem to be a positive predictor for the postoperative pain outcome in early follow-up in patients undergoing lumbar sequesterectomy. Furthermore, patients presented with less radicular pain 1 year after surgery.
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Affiliation(s)
- Lea Gasser
- Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Sara Lener
- Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria.
| | - Sebastian Hartmann
- Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Wolfgang N Löscher
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Claudius Thomé
- Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Anja Hofer
- Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria
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15
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Kamp JPM, Bartlett J, Fahmy A, To K, Hossain R, Akula M. CT-guided vs. fluoroscopically guided transforaminal epidural steroid injections for lumbar radiculopathy: a comparison of efficacy, safety and cost. Arch Orthop Trauma Surg 2022; 143:2355-2361. [PMID: 35420357 PMCID: PMC10110633 DOI: 10.1007/s00402-022-04436-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 03/25/2022] [Indexed: 02/07/2023]
Abstract
INTRODUCTION There are no formal guidelines for whether CT-guided or fluoroscopy-guided TFESI should be undertaken for patients with symptoms of lumbar nerve root irritation and corresponding nerve impingement. Here, we sought to compare the efficacy, safety and cost of computer tomography (CT)-guided and fluoroscopically guided transforaminal epidural steroid injection (TFESI). MATERIALS AND METHODS All patients who underwent lumbar TFESI at our institution between June 2016 and June 2018 were identified. Six-week follow-up outcomes were categorised. The radiation doses and associated cost was retrieved from our institution's costing system. RESULTS One hundred and sixteen patients were included (CT-50; fluoroscopy-56). There were no complications. More patients were discharged 6 weeks after CT-guided lumbar TFESI when compared with fluoroscopically guided TFESI (CT-23, fluoroscopy-14 (P = 0.027)). There was no difference in the number of patients who were referred to surgery (P = 0.18), for further pain management (P = 0.45), or for further TFESI (P = 0.43). The effective radiation dose was significantly higher for CT-guided TFESI (CT-5.73 mSv (3.87 to 7.76); fluoroscopy-0.55 mSv (0.11 to 1.4) (P < 0.01)). The total cost for CT-guided lumbar TFESI was £237.50 (£235 to £337), over £800 less than under fluoroscopic guidance (£1052 (£892.80 to £1298.00), P < 0.01)). Removing cost associated with staff and theatre use (staffing, theatre, medical indemnity and overheads) revealed CT-guided lumbar TFESI to be less expensive than if the procedure was fluoroscopy-guided-CT-guided: £132.6 (130.8 to 197.5); fluoroscopy: £237.4 (£209.2 to £271.9) (P = 0.019). CONCLUSIONS CT-guided TFESI was associated with a higher discharge rate, a lower cost, but a ten times higher radiation dose when compared with fluoroscopically guided TFESI. Prospective studies are required to compare the efficacy of these procedures and to investigate how the radiation dose of CT-guided TFESI can be reduced without jeopardising efficacy or safety.
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Affiliation(s)
- Jozef P M Kamp
- Department of Trauma and Orthopaedics, Basildon and Thurrock University Hospital, Basildon, UK
| | - Jonathan Bartlett
- Department of Trauma and Orthopaedics, Rotorua Hospital, Rotorua, New Zealand
| | - Amr Fahmy
- Department of Trauma and Orthopaedics, Basildon and Thurrock University Hospital, Basildon, UK
| | - Kendrick To
- Division of Trauma and Orthopaedics, Department of Surgery, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK.
| | - Rumana Hossain
- Department of Trauma and Orthopaedics, Basildon and Thurrock University Hospital, Basildon, UK
| | - Maheswara Akula
- Department of Trauma and Orthopaedics, Basildon and Thurrock University Hospital, Basildon, UK
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Van Bogaert W, Putman K, Coppieters I, Goudman L, Nijs J, Moens M, Buyl R, Ickmans K, Huysmans E. Health-related quality of life deviations from population norms in patients with lumbar radiculopathy: associations with pain, pain cognitions, and endogenous nociceptive modulation. Qual Life Res 2021; 31:745-757. [PMID: 34342846 DOI: 10.1007/s11136-021-02964-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2021] [Indexed: 01/08/2023]
Abstract
PURPOSE The primary goal of this study was to compare the health-related quality of life (HRQoL) of people with lumbar radiculopathy to age- and sex-adjusted population norms. Additionally, it aimed to explore the associations between the HRQoL difference scores and measures related to pain cognitions, pain intensity, and endogenous nociceptive modulation. METHODS Using answers from the Short Form 36-item Health Survey and UK population norms, SF-6D difference scores were calculated. A one-sample t test was used to assess the SF-6D difference scores. Univariate and multivariate regression analyses were used to assess the associations between SF-6D difference scores and pain intensity [Visual Analogue Scale (VAS) for back and leg pain], pain cognitions [Pain Catastrophizing Scale (PCS), Tampa Scale for Kinesiophobia (TSK), Pain Vigilance and Awareness Questionnaire (PVAQ)], and correlates for endogenous nociceptive modulation using quantitative sensory testing. RESULTS One hundred and twenty people with lumbar radiculopathy scheduled for surgery were included in this study. The mean SF-6D difference score of - 0.26 [SD = 0.09] was found to be significantly less than 0 [95%CI: - 0.27 to - 0.24]. Univariate analyses showed a significant influence from PCS, TSK, and PVAQ on the SF-6D difference scores. The final multivariate regression model included PCS and PVAQ, with only PCS maintaining a statistically significant regression coefficient [b = - 0.002; 95% CI: - 0.004 to - 0.001]. CONCLUSION People diagnosed with lumbar radiculopathy report significantly lower HRQoL scores when compared with age- and sex-adjusted UK norm values. Even though all examined pain cognitions were found to have a significant association, pain catastrophizing showed the most significant relation to the SF-6D difference scores. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov Identifier No. NCT02630732. Date of registration: November 25, 2015.
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Affiliation(s)
- Wouter Van Bogaert
- Pain in Motion (PAIN) Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.
- Interuniversity Center for Health Economics Research (I-CHER), Department of Public Health (GEWE), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium.
- Department of Public Health (GEWE), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium.
- Research Foundation-Flanders (FWO), Brussels, Belgium.
| | - Koen Putman
- Interuniversity Center for Health Economics Research (I-CHER), Department of Public Health (GEWE), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Public Health (GEWE), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Iris Coppieters
- Pain in Motion (PAIN) Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine & Health Sciences, Ghent University, Ghent, Belgium
- Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium
| | - Lisa Goudman
- Pain in Motion (PAIN) Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Neurosurgery, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Jo Nijs
- Pain in Motion (PAIN) Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium
| | - Maarten Moens
- Department of Neurosurgery, Universitair Ziekenhuis Brussel, Brussels, Belgium
- Center for Neurosciences, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Ronald Buyl
- Department of Public Health (GEWE), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Biostatistics and Medical Informatics, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Kelly Ickmans
- Pain in Motion (PAIN) Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium
- Research Foundation-Flanders (FWO), Brussels, Belgium
| | - Eva Huysmans
- Pain in Motion (PAIN) Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Interuniversity Center for Health Economics Research (I-CHER), Department of Public Health (GEWE), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Public Health (GEWE), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium
- Research Foundation-Flanders (FWO), Brussels, Belgium
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Akdeniz Leblebicier M, Gündüz OH, Mansız Kaplan B, Erçalık T. Role of paraspinal mapping before transforaminal epidural injections for lumbar radiculopathy. Turk J Phys Med Rehabil 2021; 67:196-202. [PMID: 34396070 DOI: 10.5606/tftrd.2021.5042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 01/20/2020] [Indexed: 11/21/2022] Open
Abstract
Objectives This study aims to investigate whether electromyography (EMG) including paraspinal mapping (PM) and specific clinical findings before the injection have a predictive role on the results in patients undergoing unilateral transforaminal epidural steroid injection (TFESI). Patients and methods In this prospective study, a total of 46 patients (19 males, 17 females; mean age: 44.0±10.8 years; range, 23 to 60 years) with unilateral L5 root compression confirmed by physical examination, EMG and lumbar MRI between March 2013 and January 2014 were included. The patients underwent L5 TFESI. After the injection, they were examined at 1 h, three weeks, and three months. Results The clinical findings and presence of acute involvement on EMG were not predictive for TFESI results; however, the patients with lower scores for the L5 segment in PM benefited more from the injection, compared to patients with higher scores for the L5 segment in PM. Conclusion In patients with very clearly defined L5 radiculopathy, PM EMG can give us an idea about the effectiveness of L5 TFESI.
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Verheijen EJA, Bonke CA, Amorij EMJ, Vleggeert-Lankamp CLA. Epidural steroid compared to placebo injection in sciatica: a systematic review and meta-analysis. Eur Spine J 2021; 30:3255-3264. [PMID: 33974132 DOI: 10.1007/s00586-021-06854-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 04/18/2021] [Indexed: 01/08/2023]
Abstract
PURPOSE The purpose of this systematic review and meta-analysis was to determine whether epidural steroid injections (ESI) are superior to epidural or non-epidural placebo injections in sciatica patients. METHODS The PubMed, Embase, Cochrane Library, and Web of science databases were searched for trials comparing ESI to epidural or non-epidural placebo. Risk of bias was assessed using the Cochrane RoB 2 tool. The primary outcome measures were pooled using a random-effects model for 6-week, 3-month, and 6-month follow-up. Secondary outcomes were described qualitatively. Quality of evidence was graded using GRADE classification. RESULTS Seventeen out of 732 articles were included. ESI was superior compared to epidural placebo at 6 weeks (- 8.6 [- 13.4; - 3.9]) and 3 months (- 5.2 [- 10.1; - 0.2]) for leg pain and at 6 weeks for functional status (- 4.1 [- 6.5; - 1.6]), though the minimally clinical important difference (MCID) was not met. There was no difference in ESI and placebo for back pain, except for non-epidural placebo at 3 months (6.9 [1.3; 12.5]). Proportions of treatment success were not different. ESI reduced analgesic intake in some studies and complication rates are low. CONCLUSION The literature indicates that ESI induces larger improvements in pain and disability on the short term compared to epidural placebo, though evidence is of low to moderate quality and MCID is not met. Strong conclusions for longer follow-up or for comparisons with non-epidural placebo cannot be drawn due to general low quality of evidence and limited number of studies. Epidural injections can be considered a safe therapy.
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Affiliation(s)
- E J A Verheijen
- Department of Neurosurgery, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands. .,Department of Neurosurgery, Spaarne Gasthuis Hospital, Haarlem/Hoofddorp, The Netherlands.
| | - C A Bonke
- Department of Neurosurgery, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - E M J Amorij
- Department of Neurosurgery, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - C L A Vleggeert-Lankamp
- Department of Neurosurgery, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands.,Department of Neurosurgery, Spaarne Gasthuis Hospital, Haarlem/Hoofddorp, The Netherlands
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19
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Verheijen EJA, Munts AG, van Haagen OBHAM, de Vries D, Vleggeert-Lankamp CLA. The Outcome of Epidural Injections in Lumbar Radiculopathy Is Not Dependent on the Presence of Disc Herniation on Magnetic Resonance Imaging: Assessment of Short-Term and Long-Term Efficacy. World Neurosurg 2021; 148:e643-e649. [PMID: 33497827 DOI: 10.1016/j.wneu.2021.01.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 01/12/2021] [Accepted: 01/13/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Lumbar radiculopathy is a condition with major physical, social, and economic consequences. Despite its favorable prognosis, the burden can be significant. In this study, we aimed to determine the value of magnetic resonance imaging (MRI) and the efficacy of transforaminal epidural injections (TEIs) in patients with lumbar radiculopathy secondary to lumbar disc herniation (LDH) and other causes (non-LDH). METHODS Patients with lumbar radiculopathy were reviewed for radiologic diagnosis based on MRI. For patients receiving TEI therapy, response after 6-8 weeks (short-term) and 16 weeks (long-term), number of injections, subsequent surgery, and patient outcome were evaluated. Treatment response was assessed by patient-reported symptom relief and numeric rating scale pain scores. RESULTS Overall, 66% of MRI examinations showed a clinically relevant LDH. A total of 486 of 1824 patients received TEI, of whom one third did not show LDH. Of patients, 70% reported a short-term effect with significant pain reduction and 44% reported a long-term effect. No significant differences were observed between the LDH and non-LDH groups. Of patients, 59% required multiple injections and reported similar efficacy compared with patients treated with a single injection. CONCLUSIONS A considerable part of MRI examinations in patients with lumbar radiculopathy do not show a clinically relevant LDH. Regardless of the radiologic diagnosis, most patients treated with TEI benefit in both the short-term and the long-term after a single-injection or multiple-injection regime. Subsequent injections are advisable if the effect from the first injection is unsatisfactory or wears off. MRI examination before TEI therapy may be redundant, which allows for expedition of this treatment.
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Affiliation(s)
- Eduard J A Verheijen
- Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands.
| | | | | | - Dirk de Vries
- Department of Anaesthesiology, Spaarne Gasthuis, Haarlem, The Netherlands
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20
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Tokita K, Anetai H, Kojima R, Banneheka S, Aizawa Y, Naito M, Nakano T, Kageyama I, Kumaki K. Relationship of segmental variations in the human lumbar plexus to the length of the 12th rib. Ann Anat 2020; 233:151592. [PMID: 32898660 DOI: 10.1016/j.aanat.2020.151592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 08/07/2020] [Accepted: 08/16/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Evaluating segmental variations in the lumbar plexus is crucial for neurological diagnosis. In the present study, we examined the relationship between the segmental composition of the lumbar plexus and length of the 12th rib. PROCEDURES To evaluate segmental variations in the lumbar plexus, the furcal nerve (Nf) which forms the boundary between the lumbar and sacral plexus, was used as an index of plexus arrangement. MAIN FINDINGS Segmental variations in the Nf were classified into four groups on the basis of whether the Nf originated from the ventral rami of L3 and L4 (Nf L3 + L4 group), L4 (Nf L4 group), L4 and L5 (Nf L4 + L5 group), or L5 (Nf L5 group). The Nf L3 + L4 group was associated with short 12th rib, and groups Nf L4 + L5 and Nf L5 were associated with long 12th rib. These findings suggest that the segmental variations in the lumbar plexus are related to the length of the 12th rib. CONCLUSIONS Therefore, the segmental variations in the lumbar plexus can be evaluated non-invasively and easily by measuring the length of the 12th rib. This may contribute to the diagnosis and treatment of various lumbar radiculopathies.
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Affiliation(s)
- Kounosuke Tokita
- School of Physical Therapy, Faculty of Health and Medical Care, Saitama Medical University, Saitama, Japan; Department of Anatomy, School of Life Dentistry at Niigata, The Nippon Dental University, Niigata, Japan; Department of Anatomy, School of Medicine, Aichi Medical University, Aichi, Japan.
| | - Hidaka Anetai
- Department of Anatomy and Life Structure, School of Medicine, Juntendo University, Tokyo, Japan
| | - Ryuhei Kojima
- School of Physical Therapy, Faculty of Health and Medical Care, Saitama Medical University, Saitama, Japan
| | - Shyama Banneheka
- Department of Basic Sciences, University of Peradeniya, Kandy, Sri Lanka
| | - Yukio Aizawa
- Department of Anatomy, School of Life Dentistry at Niigata, The Nippon Dental University, Niigata, Japan
| | - Munekazu Naito
- Department of Anatomy, School of Medicine, Aichi Medical University, Aichi, Japan
| | - Takashi Nakano
- Department of Anatomy, School of Medicine, Aichi Medical University, Aichi, Japan
| | - Ikuo Kageyama
- Department of Anatomy, School of Life Dentistry at Niigata, The Nippon Dental University, Niigata, Japan
| | - Katsuji Kumaki
- Department of Anatomy, School of Life Dentistry at Niigata, The Nippon Dental University, Niigata, Japan
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21
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Kassem H, Urits I, Hasoon J, Kaye AD, Viswanath O. Tarlov cysts in a 49-year-old woman presenting with bilateral lower-extremity radiculopathy: A case report. Case Rep Womens Health 2020; 28:e00248. [PMID: 32874930 PMCID: PMC7451826 DOI: 10.1016/j.crwh.2020.e00248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 08/08/2020] [Accepted: 08/10/2020] [Indexed: 11/26/2022] Open
Abstract
Tarlov cysts are an uncommon and often incidentally noted source of low back pain in women. Because these cysts can be asymptomatic, they can be overlooked on radiological imaging. This case is of a 49-year-old woman who presented with a chronic history of low back pain and bilateral radiculopathy who on magnetic resonance imaging (MRI) was found to have multiple Tarlov cysts. This case illustrates the need for large observational studies to show the incidence of Tarlov cysts as a cause of low back pain in women.
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Affiliation(s)
- Hisham Kassem
- Department of Anesthesiology, Mount Sinai Medical Center, Miami Beach, FL, United States of America
| | - Ivan Urits
- Beth Israel Deaconess Medical Center, Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA, United States of America
| | - Jamal Hasoon
- Beth Israel Deaconess Medical Center, Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA, United States of America
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, LA, United States of America
| | - Omar Viswanath
- Department of Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, LA, United States of America.,Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ, United States of America.,Department of Anesthesiology, University of Arizona College of Medicine - Phoenix, Phoenix, AZ, United States of America.,Department of Anesthesiology, Creighton University School of Medicine, Omaha, NE, United States of America
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22
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Hassan O, Lewis CS, Aradhyula L, Hirshman BR, Pham MH. Engorged venous plexus mimicking adjacent segment disease: Case report and review of the literature. Surg Neurol Int 2020; 11:104. [PMID: 32494381 PMCID: PMC7265352 DOI: 10.25259/sni_166_2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 04/16/2020] [Indexed: 11/04/2022] Open
Abstract
Background An engorged venous plexus may mimic nerve compression from a herniated disk on the magnetic resonance (MR) studies as they both have similar signal intensities. During a laminectomy, if an engorged venous plexus is encountered instead of a disk herniation, there may be marked unanticipated bleeding. Case Description A 58-year-old female who had a prior anterior lumbar interbody fusion later returned with recurrent radiculopathy. Adjacent segment disease from a spinal disk herniation was suspected based on the surgical history, physical examination, and imaging (MRI) findings. Rather than a disk, an engorged venous plexuses (EVP) was encountered intraoperatively. Conclusion Here, we discussed our findings regarding a lumbar EVP rather than a herniated disk and reviewed the current literature. Although rare, a higher index of suspicion for these vascular malformations based on combined historical information and MRI studies should allow one to better detect and/or anticipate an EVP rather than a routine disk.
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Affiliation(s)
- Omron Hassan
- Department of Basic Sciences, School of Osteopathic Medicine, Touro University Nevada, Henderson, Nevada, United States
| | - Courtney S Lewis
- Department of Neurosurgery, University of California San Diego School of Medicine, San Diego, California, United States
| | - Likitha Aradhyula
- Department of Neurosurgery, University of California San Diego School of Medicine, San Diego, California, United States
| | - Brian R Hirshman
- Department of Neurosurgery, University of California San Diego School of Medicine, San Diego, California, United States
| | - Martin H Pham
- Department of Neurosurgery, University of California San Diego School of Medicine, San Diego, California, United States
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23
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Mataki K, Koda M, Shibao Y, Kumagai H, Nagashima K, Miura K, Noguchi H, Funayama T, Abe T, Yamazaki M. New methods for diagnosing lumbar foraminal stenosis using dynamic digital tomosynthesis radiculography. J Clin Neurosci 2020; 77:106-109. [PMID: 32387257 DOI: 10.1016/j.jocn.2020.05.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 05/01/2020] [Indexed: 10/24/2022]
Abstract
The symptoms of lumbar radiculopathy, in particular foraminal stenosis, often exacerbated when the patient is upright. However, it is difficult to detect the compression of nerve roots while the patient is upright using conventional MRI. In this study, we analyzed the compression of lumbar nerve roots using dynamic digital tomosynthesis radiculography (DTRG) in patients diagnosed with lumbar radiculopathy. And we determined the relationship between leg pain and nerve compression while the patients are either prone or upright. We evaluated 30 patients with unilateral leg pain diagnosed as lumbar radiculopathy by physical examination and MRI. The patients were divided in two groups, one with foraminal stenosis (17 patients) and the other with canal stenosis (13 patients), based on MRI findings. All patients underwent DTRG to determine the diameter of their nerve roots in the foramen while prone and upright. Pain while prone or upright was assessed using a 100-point visual analogue scale (VAS) questionnaire. The VAS for leg pain while upright was significantly higher in the foraminal stenosis group (58 ± 24.7) than it was in the canal stenosis group (19.6 ± 13.2; p = 0.0002)). The nerve root diameter while prone or upright was significantly smaller in the foraminal stenosis group (1.2 ± 0.2 mm) than it was in the canal stenosis group (0.2 ± 0.1 mm; p < 0.0001). DTRG has the potential to visualize nerve compression while the patient is upright to reveal the relevance of foraminal stenosis to clinical findings. DTRG is useful for diagnosis of lumbar foraminal stenosis.
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Affiliation(s)
- Kentaro Mataki
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan.
| | - Masao Koda
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Yosuke Shibao
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Hiroshi Kumagai
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Katsuya Nagashima
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Kousei Miura
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Hiroshi Noguchi
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Toru Funayama
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Tetsuya Abe
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan.
| | - Masashi Yamazaki
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan.
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24
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Sato T, Eguchi Y, Norimoto M, Inoue M, Enomoto K, Watanabe A, Sakai T, Yoneyama M, Aoki Y, Orita S, Narita M, Inage K, Shiga Y, Umimura T, Sato M, Suzuki M, Takaoka H, Mizuki N, Kim G, Hozumi T, Hirosawa N, Furuya T, Maki S, Nakamura J, Hagiwara S, Koda M, Akazawa T, Takahashi H, Takahashi K, Ohtori S. Diagnosis of lumbar radiculopathy using simultaneous MR neurography and apparent T2 mapping. J Clin Neurosci 2020; 78:339-346. [PMID: 32336629 DOI: 10.1016/j.jocn.2020.04.072] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 04/13/2020] [Indexed: 11/25/2022]
Abstract
We sought to assess the utility of simultaneous apparent T2 mapping and neurography with the nerve-sheath signal increased by inked rest-tissue rapid acquisition of relaxation-enhancement imaging (SHINKEI-Quant) for the quantitative evaluation of compressed nerves in patients with lumbar radiculopathy. Thirty-two patients with lumbar radiculopathy and 5 healthy subjects underwent simultaneous apparent T2 mapping and neurography with SHINKEI-Quant. Regions of interest (ROIs) were placed in the lumbar dorsal root ganglia (DRG) and the spinal nerves distal to the lumbar nerves bilaterally at L4-S1. The T2 relaxation times were measured on the affected and unaffected sides. The T2 ratio was calculated as the affected side/unaffected side. Pearson correlation coefficients were calculated to determine the correlation between the T2 relaxation times or T2 ratio and clinical symptoms. An ROC curve was used to examine the diagnostic accuracy and threshold of the T2 relaxation times and T2 ratio. We observed no significant differences in the T2 relaxation times between the nerve roots on the left and right at each spinal level in healthy subjects. In patients, lumbar neurography revealed swelling of the involved nerve, and prolonged T2 relaxation times compared with that of the contralateral nerve. The T2 ratio correlated with leg pain. The ROC analysis revealed that the T2 relaxation time threshold was 127 ms and the T2 ratio threshold was 1.07. To our knowledge, this is the first study to show the utility of SHINKEI-Quant for the quantitative evaluation of lumbar radiculopathy.
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Affiliation(s)
- Takashi Sato
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, 1-8-1 Inohana, Chuo-ku 260-0856, Japan.
| | - Yawara Eguchi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, 1-8-1 Inohana, Chuo-ku 260-0856, Japan; Department of Orthopaedic Surgery, Shimoshizu National Hospital, 934-5, Shikawatashi, Yotsukaido, Chiba 284-0003, Japan.
| | - Masaki Norimoto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, 1-8-1 Inohana, Chuo-ku 260-0856, Japan.
| | - Masahiro Inoue
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, 3-6-2 Okayamadai, Togane, Chiba 283-8686, Japan.
| | - Keigo Enomoto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, 1-8-1 Inohana, Chuo-ku 260-0856, Japan
| | - Atsuya Watanabe
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, 3-6-2 Okayamadai, Togane, Chiba 283-8686, Japan.
| | - Takayuki Sakai
- Department of Radiology, Eastern Chiba Medical Center, 3-6-2 Okayamadai, Togane, Chiba 283-8686, Japan; Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, 5-11-80 Kodatsuno, Kanazawa, Ishikawa 920-0942, Japan.
| | - Masami Yoneyama
- MR Clinical Science, Philips Japan, 2-13-37 Konan, Minato-ku, Tokyo 108-8507, Japan.
| | - Yasuchika Aoki
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, 3-6-2 Okayamadai, Togane, Chiba 283-8686, Japan.
| | - Sumihisa Orita
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, 1-8-1 Inohana, Chuo-ku 260-0856, Japan.
| | - Miyako Narita
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, 1-8-1 Inohana, Chuo-ku 260-0856, Japan.
| | - Kazuhide Inage
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, 1-8-1 Inohana, Chuo-ku 260-0856, Japan.
| | - Yasuhiro Shiga
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, 1-8-1 Inohana, Chuo-ku 260-0856, Japan.
| | - Tomotaka Umimura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, 1-8-1 Inohana, Chuo-ku 260-0856, Japan.
| | - Masashi Sato
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, 1-8-1 Inohana, Chuo-ku 260-0856, Japan.
| | - Masahiro Suzuki
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, 1-8-1 Inohana, Chuo-ku 260-0856, Japan.
| | - Hiromitsu Takaoka
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, 1-8-1 Inohana, Chuo-ku 260-0856, Japan.
| | - Norichika Mizuki
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, 1-8-1 Inohana, Chuo-ku 260-0856, Japan.
| | - Geundong Kim
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, 1-8-1 Inohana, Chuo-ku 260-0856, Japan.
| | - Takashi Hozumi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, 1-8-1 Inohana, Chuo-ku 260-0856, Japan.
| | - Naoya Hirosawa
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, 1-8-1 Inohana, Chuo-ku 260-0856, Japan.
| | - Takeo Furuya
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, 1-8-1 Inohana, Chuo-ku 260-0856, Japan.
| | - Satoshi Maki
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, 1-8-1 Inohana, Chuo-ku 260-0856, Japan.
| | - Junichi Nakamura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, 1-8-1 Inohana, Chuo-ku 260-0856, Japan.
| | - Shigeo Hagiwara
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, 1-8-1 Inohana, Chuo-ku 260-0856, Japan.
| | - Masao Koda
- Department of Orthopedic Surgery, University of Tsukuba, 1-1-1 Tennodai, Tsukuba-City, Ibaraki 305-8575, Japan.
| | - Tsutomu Akazawa
- Department of Orthopaedic Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511, Japan.
| | - Hiroshi Takahashi
- Department of Orthopaedic Surgery, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura, Chiba 285-8741, Japan.
| | - Kazuhisa Takahashi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, 1-8-1 Inohana, Chuo-ku 260-0856, Japan.
| | - Seiji Ohtori
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, 1-8-1 Inohana, Chuo-ku 260-0856, Japan.
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25
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Kashlan ON, Kim HS, Khalsa SSS, Ravindra S, Yong Z, Oh SW, Noh JH, Jang IT, Oh SH. Percutaneous Endoscopic Contralateral Lumbar Foraminal Decompression via an Interlaminar Approach: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2020; 18:E118-E119. [PMID: 31232437 DOI: 10.1093/ons/opz162] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 03/25/2019] [Indexed: 11/13/2022] Open
Abstract
Nerve root compression by foraminal pathology is challenging for a surgeon to decompress without violating the facet joint, which may necessitate a fusion procedure. One nonfusion approach to foraminal pathology is a combination intracanal approach for a laminotomy/foraminotomy followed by a paraspinal Wiltse approach for far lateral decompression. Unfortunately, even with the combination approach, it continues to be difficult to achieve adequate decompression without violating much of the facet joint overlying the nerve root. Spine endoscopy offers the ability to decompress the foraminal portion of the nerve without significant violation of the facet joint. We present a surgical video describing the technique for performing a percutaneous endoscopic contralateral L5-S1 foraminal decompression via an interlaminar approach, for a patient presenting with a left L5 radiculopathy due to L5-S1 foraminal stenosis. We explain the differences in the endoscopic channel docking point between ipsilateral and contralateral interlaminar approaches. The steps of an endoscopic foraminotomy are then described: dissect soft tissue and ligamentum flavum off the medial left S1 lamina and superior articulating process (SAP), undercut the superior articulating process of S1 and the inferior articulating process (IAP) of L5 with a drill, resect lateral ligamentum flavum off SAP and IAP exposing epidural fat, and finally dissect the left L5 nerve root and remove compressive lesions throughout its course in the lateral recess, foramen, and laterally. The presentation ends with an intraoperative photograph showing a decompressed L5 nerve root and postoperative imaging confirming this decompression. Appropriate patient consent was obtained.
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Affiliation(s)
| | - Hyeun Sung Kim
- Department of Neurosurgery, Nanoori Gangnam Hospital, Seoul, Republic of Korea
| | | | - Singh Ravindra
- Department of Neurosurgery, Nanoori Gangnam Hospital, Seoul, Republic of Korea
| | - Zhang Yong
- Department of Neurosurgery, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, P. R. China
| | - Seong Woon Oh
- Department of Neurosurgery, Nanoori Gangnam Hospital, Seoul, Republic of Korea
| | - Jeong Hoon Noh
- Department of Neurosurgery, Nanoori Gangnam Hospital, Seoul, Republic of Korea
| | - Il-Tae Jang
- Department of Neurosurgery, Nanoori Gangnam Hospital, Seoul, Republic of Korea
| | - Seong-Hoon Oh
- Department of Neurosurgery, Nanoori Incheon Hospital, Incheon, Republic of Korea
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26
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Ford JJ, Kaddour O, Page P, Richards MC, McMeeken JM, Hahne AJ. A multivariate prognostic model for pain and activity limitation in people undergoing lumbar discectomy. Br J Neurosurg 2020; 34:381-387. [PMID: 32216592 DOI: 10.1080/02688697.2020.1742288] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Purpose: The purpose of this study was to identify a multivariate predictive model for 6-month outcomes on overall pain, leg pain and activity limitation in patients undergoing lumbar discectomy. Identification of predictors of outcome for lumbar discectomy has the potential to assist identifying treatment targets, clinical decision making and disease understanding.Materials and methods: Prospective cohort design. Ninety-seven patients deemed by study surgeons to be suitable for lumbar discectomy completed a comprehensive clinical and radiological baseline assessment. At 6-months post surgery outcome measures of overall and leg pain (visual analogue scale) as well as activity limitation (Oswestry Disability Index) were completed. Univariate and multivariate analyses were conducted to determine the best multivariate predictive model of outcome.Results: In the multivariate model, presence of a compensation claim, longer duration of injury and presence of below knee pain and/or parasthesia were negative prognostic indicators for at least two of the outcomes. Peripheralization in response to mechanical loading strategies was a positive prognostic indicator for overall pain and leg pain. A range of other prognostic indicators for one outcome were also identified. The prognostic model explained up to 32% of the variance in outcome.Conclusions: An 11-factor prognostic model was identified from a range of clinically and radiologically assessed variables in accordance with a biopsychosocial model. The multivariate model has potential implications for researchers and practitioners in the field. Further high quality research is required to externally validate the prognostic model, evaluate effect of the identified prognostic factors on treatment effectiveness and explore potential mechanisms of effect.
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Affiliation(s)
- Jon J Ford
- College of Science, Health & Engineering, La Trobe University, Bundoora, Australia.,Advance Healthcare, Boronia, Australia
| | | | - Patrick Page
- Box Hill Radiology, Epworth Eastern Hospital, Box Hill, Australia
| | - Matthew C Richards
- College of Science, Health & Engineering, La Trobe University, Bundoora, Australia.,Advance Healthcare, Boronia, Australia
| | - Joan M McMeeken
- Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Parkville, Australia
| | - Andrew J Hahne
- College of Science, Health & Engineering, La Trobe University, Bundoora, Australia
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27
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Pennington Z, Swanson MA, Lubelski D, Mehta V, Alvin MD, Fuhrman H, Benzel EC, Mroz TE. Comparing the short-term cost-effectiveness of epidural steroid injections and medical management alone for discogenic lumbar radiculopathy. Clin Neurol Neurosurg 2020; 191:105675. [PMID: 31954364 DOI: 10.1016/j.clineuro.2020.105675] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 10/19/2019] [Accepted: 01/11/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Epidural steroid injections (ESIs) are a commonly used treatment strategy for low back pain and lumbar radiculopathy. However, their cost-effectiveness and ability to mediate long-term quality of life (QOL) improvements is debated. We sought to analyze the cost-effectiveness of lumbar epidural steroid injections (ESIs) compared to medical management alone for patients with lumbar radiculopathy and low back pain. PATIENTS AND METHODS QOL outcomes were prospectively collected at 3- and 6-months following initial consultation. Metrics included the EuroQol-5 Dimensions (EQ-5D) questionnaire, the Pain Disability Questionnaire (PDQ), the Patient Health Questionnaire (PHQ-9) and the Visual Analogue Scale (VAS). Cost estimations were based on Medicare national payment amounts, median income, and missed workdays. A cost-utility analysis was performed based upon cost estimations and a cost-effectiveness threshold of $100,000/Quality-adjusted life year (QALY). RESULTS One hundred forty-one patients met our inclusion/exclusion criteria; 89 received ESI and 52 were treated with medical management alone. Both cohorts showed improved EQ-5D scores at 3 months but were similar to one another: ESI (ΔEQ-5D = 0.06; p = 0.03) and medical-alone (ΔEQ-5D = 0.07; p = 0.03). No significant difference was seen between groups for total costs ($2,190 vs. $1,772; p = 0.18) or cost-utility ratios ($38,710/QALY vs. $27,313/QALY; p = 0.73). At both the 3-month and 6-month endpoints, absolute differences in cost-utility was driven by overall costs as opposed to QALY gains. Medical management alone was more cost effective at both points owing to lower expenditures, however these differences were not significant. No benefits were seen in either group on the EQ-5D or any of the patient reported outcomes at the 6-month time point. CONCLUSION ESIs were not cost-effective at either the 3-month or 6-month follow-up period. At 3 months, ESIs provide similar improvements in QOL outcomes relative to medical management and at similar costs. At 6 months, neither ESIs nor conservative management provide significant improvements in QOL outcomes.
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Ko S, Chae S, Choi W, Kwon J. Prolonged pain reducing effect of sodium hyaluronate-carboxymethyl cellulose solution in the selective nerve root block (SNRB) of lumbar radiculopathy: a prospective, double-blind, randomized controlled clinical trial. Spine J 2019; 19:578-586. [PMID: 30395961 DOI: 10.1016/j.spinee.2018.10.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 10/12/2018] [Accepted: 10/15/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND The pattern of linear graph schematized by visual analogue scale (VAS) score displaying pain worsening between 2 days and 2 weeks after selective nerve root block (SNRB) is called rebound pain. PURPOSE The purpose of this study was to determine if sodium hyaluronate and carboxymethyl cellulose solution (HA-CMC sol) injection could reduce the occurrence of rebound pain at 3 days to 2 weeks after SNRB in patients with radiculopathy compared with injection with corticosteroids and local anesthetics alone. STUDY DESIGN/SETTING Double blinded randomized controlled clinical trial. PATIENT SAMPLE A total of 44 patients (23 of 24 patients in the Guardix group and 21 of 24 patients in the control group) who finished the follow-up session were subjects of this study. OUTCOME MEASUREMENT Patients were asked to write down their average VAS pain scores daily for 12 weeks. Functional outcomes were assessed by Oswestry Disability Index, Roland Morris Disability Questionnaire , and Short Form-36. METHOD A cocktail of corticosteroids, 1% lidocaine, 0.5% Bupivacaine, and 1 mL of normal saline was used for the control group whereas a cocktail of corticosteroids, 1% lidocaine, 0.5% Bupivacaine, and 1 mL of HA-CMC solution was used for the G group. Study participants were randomized into one of two treatment regimens. They were followed up for 3 months. RESULTS VAS score at 2 weeks after the procedure was 4.19±1.32 in the control group, which was significantly (p<.05) higher than that (2.43±1.24) in the G group. VAS score at 6 weeks after the procedure was 4.00±1.23 in the control group and 3.22±1.45 in the G group, showing no significant (p=.077) difference between the two groups. There were no significant differences in functional outcomes at 6 or 12 weeks after the procedure. CONCLUSIONS Compared with conventional cocktail used for SNRB, addition of HA-CMC sol showed effective control of rebound pain at 3 days to 2 weeks after the procedure.
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Affiliation(s)
- Sangbong Ko
- Department of Orthopedic Surgery, College of Medicine, Daegu Catholic University, Daegu city, Korea
| | - Seungbum Chae
- Department of Orthopedic Surgery, College of Medicine, Daegu Catholic University, Daegu city, Korea
| | - Wonkee Choi
- Department of Orthopedic Surgery, College of Medicine, Daegu Catholic University, Daegu city, Korea
| | - Jaibum Kwon
- Department of Orthopedic Surgery, College of Medicine, Daegu Catholic University, Daegu city, Korea.
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Mataki K, Koda M, Shibao Y, Kumagai H, Nagashima K, Miura K, Noguchi H, Funayama T, Abe T, Yamazaki M. Successful visualization of dynamic change of lumbar nerve root compression with the patient in both upright and prone positions using dynamic digital tomosynthesis-radiculography in patients with lumbar foraminal stenosis: An initial report of three cases. J Clin Neurosci 2019; 62:256-9. [PMID: 30638782 DOI: 10.1016/j.jocn.2018.12.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 12/23/2018] [Indexed: 11/23/2022]
Abstract
The symptoms of lumbar foraminal stenosis are often exacerbated when the patient is upright. Lumbar pathological conditions related to clinical symptoms such as disc herniation, foraminal stenosis, and instability of the lumbar spine are often exacerbated when the patient is upright and hidden when the patient is supine. Lumbar radiculopathy is usually diagnosed by MRI. However, it is difficult to detect the compression of nerve roots while the patient is upright using conventional MRI when the patient is supine. Dynamic digital tomosynthesis radiculography (DTRG) while the patient is upright detects pathological changes of the lumbar nerve root while the patient is upright. We report cases of symptomatic lumbar foraminal stenosis which were diagnosed by using digital tomosynthesis radiculography with the patient in an upright position. Three patients with history of unilateral leg pain which was exacerbated when they were upright underwent selective nerve root block and DTRG in both prone and upright positions. All patients were relieved of the leg pain after selective nerve root block. DTRG with the patient in an upright position showed better exacerbation of nerve root compression than while the patient was prone in all cases. DTRG with the patient in prone and upright positions is useful to detect compression of nerve roots hidden while MRI is conducted with the patient supine. DTRG is helpful to diagnose lumbar foraminal stenosis which is exacerbated while the patient is upright.
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Lin JH, Chen CC. Current challenges in diagnosis of lumbar radiculopathy. World J Anesthesiol 2018; 7:20-23. [DOI: 10.5313/wja.v7.i3.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 08/23/2018] [Accepted: 10/13/2018] [Indexed: 02/06/2023] Open
Abstract
Lumbar radiculopathy (LR) is a term used to describe a pain syndrome caused by compression or irritation of nerve roots in the lower back. The surgery cost for LR increased by 23% annually during 1992-2003 in the developed country. Although it is one of most common complaints in clinical practice, the diagnosis for LR is still very challenging. Here we discuss the current tools of LR diagnosis and highlight the needs to develop new diagnosis tools for LR.
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Affiliation(s)
- Jiann-Her Lin
- Department of Neurosurgery, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Surgery, School of Medicine, Taipei Medical University, Taipei, Taiwan
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
| | - Chih-Cheng Chen
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
- Taiwan Mouse Clinic, National Comprehensive Mouse Phenotyping and Drug Testing Center, Academia Sinica, Taipei, Taiwan
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Wahlström J, Burström L, Johnson PW, Nilsson T, Järvholm B. Exposure to whole-body vibration and hospitalization due to lumbar disc herniation. Int Arch Occup Environ Health 2018; 91:689-694. [PMID: 29855719 PMCID: PMC6060752 DOI: 10.1007/s00420-018-1316-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Accepted: 05/22/2018] [Indexed: 11/28/2022]
Abstract
Objective The aim was to examine if exposure to whole-body vibration (WBV) increases the risk for hospitalization due to lumbar disc herniation. Methods The study basis is a cohort of 288,926 Swedish construction workers who participated in a national occupational health surveillance programme from 1971 until 1992. Job title, smoking habits, body weight, height and age were registered at the examinations. Assessment of WBV were made for each of the constituent occupations by constructing a job-exposure matrix (JEM). Exposure to WBV was graded on a scale from 0 to 5. In addition, the occurrence of hospitalization due to lumbar disc herniation from January 1st 1987 until December 31st 2010 was collected from a linkage with the Swedish Hospital Discharge Register. Poisson regressions were used to estimate relative risk with 95 percent confidence intervals (95% CI), adjusting for age, height, weight and smoking, using white-collar workers and foremen as a reference group. Results There was an increased risk for hospitalization due to lumbar disc herniation for workers in the construction industry exposed to medium to high WBV compared to white-collar workers and foremen 1.35 (1.12–1.63). When restricting the analyses to include workers 30–49 years of age at the time of the hospital admission the risk was 1.69 (95% CI 1.29–2.21). Conclusion This study further supports that occupational exposure to whole-body vibration increases the risk for hospitalization due to lumbar disc herniation. Electronic supplementary material The online version of this article (10.1007/s00420-018-1316-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jens Wahlström
- Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, 901 87, Umeå, Sweden.
| | - Lage Burström
- Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, 901 87, Umeå, Sweden
| | - Peter W Johnson
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, USA
| | - Tohr Nilsson
- Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, 901 87, Umeå, Sweden
| | - Bengt Järvholm
- Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, 901 87, Umeå, Sweden
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Kolu E, Buyukavci R, Akturk S, Eren F, Ersoy Y. Comparison of high-intensity laser therapy and combination of transcutaneous nerve stimulation and ultrasound treatment in patients with chronic lumbar radiculopathy: A randomized single-blind study. Pak J Med Sci 2018; 34:530-534. [PMID: 30034410 PMCID: PMC6041553 DOI: 10.12669/pjms.343.14345] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Objective: To compare the effects of high-intensity laser therapy (HILT) and a combination of transcutaneous nerve stimulation (TENS) with ultrasound (US) therapy on pain and functionality in patients with chronic lumbar radiculopathy. Methods: This prospective randomized comparative study was conducted in Department of physical medicine and rehabilitation, Turgut Ozal Medicine Center, Malatya, Turkey from April 2016 to September 2016. A total of 54 patients with chronic lumbar radiculopathy were enrolled in this study. The patients were randomly divided into two groups: Group 1 (n:27) received 10 sessions of a combination of hot pack, TENS, US and exercise, and Group 2 (n:27) received hot pack, HILT and exercise. The outcomes measured were low back with unilateral leg pain level measured by visual analog scale (VAS) and functionality measured with the Oswestry Disability Index (ODI) at the end of the therapy and four weeks later. p-value less than 0.05 considered statistically significant. Results: In two groups, VAS (low back with unilateral leg pain) and ODI scores showed significant changes. At the end of the 2 weeks intervention, participants in Group-1 showed a significantly greater decrease in pain than participants in Group-2. Statistically significant differences in pain variation and functionality (VAS and ODI) were observed four weeks after treatment sessions for participants in the TENS+US therapy group compared with participants in the HILT group. Conclusion: HILT and TENS+US combined with exercise were effective treatment modalities in decreasing the VAS and ODI scores. TENS+US combined with exercises were more effective than HILT combined with exercise.
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Affiliation(s)
- Emine Kolu
- Emine Kolu, Inonu University, Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Malatya, Turkey
| | - Raikan Buyukavci
- Raikan Buyukavci, Inonu University, Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Malatya, Turkey
| | - Semra Akturk
- Semra Akturk, Inonu University, Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Malatya, Turkey
| | - Fatma Eren
- Fatma Eren, Inonu University, Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Malatya, Turkey
| | - Yuksel Ersoy
- Yuksel Ersoy, Inonu University, Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Malatya, Turkey
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Tan LA, Benkli B, Tuchman A, Li XJ, Desai NN, Bottiglieri TS, Pavel J, Lenke LG, Lehman RA. High prevalence of greater trochanteric pain syndrome among patients presenting to spine clinic for evaluation of degenerative lumbar pathologies. J Clin Neurosci 2018; 53:89-91. [PMID: 29685405 DOI: 10.1016/j.jocn.2018.04.030] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 04/09/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Greater trochanteric pain syndrome (GTPS) is a relatively common diagnosis among the general population. OBJECTIVE We aim to determine the prevalence of GTPS among patients who presented to the spine clinic. METHODS Medical records of patients who were evaluated in the spine clinic were reviewed over a 12-month period (4/1/2016 to 3/31/2017). Patient demographics, presenting symptomatology, physical examination findings, presence or absence of GTPS, medical imaging findings, and interventions were recorded analyzed. Statistical analysis was performed using SPSS Statistics 23.0 (Chicago, IL). Statistical significance is defined as p < 0.05. RESULTS A total of 273 consecutive patients (145 women, 128 men) were evaluated for degenerative lumbar pathologies by a single spine surgeon over the study period. The average patient age was 61.9 years. Overall, there were 138/273 patients (50.5%) with GTPS (Group I), while 135/273 patients (49.5%) did not have GTPS (Group II). There were 73 patients in Group I received trochanteric injection for GTPS treatment and subsequently returned to clinic for follow-up, and there were 36/73 (49.3%) patients reporting improvement in their symptoms after trochanteric injection. There was a statistically significant predilection for presence of GTPS in the female gender (60% vs 32.8%, p = <0.01). There was no statistically significant difference in the prevalence of low back pain, buttock, thigh or groin pain between the two groups. CONCLUSION GTPS is a very common but often unrecognized or misdiagnosed condition. Accurate diagnosis and differentiation of GTPS from lumbar spinal pathologies are essential in avoiding potential unnecessary spinal procedures.
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Affiliation(s)
- Lee A Tan
- Department of Neurological Surgery, UCSF Medical Center, San Francisco, CA, United States
| | - Barlas Benkli
- The Spine Hospital, Columbia University Medical Center, New York, NY, United States
| | - Alexander Tuchman
- The Spine Hospital, Columbia University Medical Center, New York, NY, United States
| | - Xudong J Li
- Department of Orthopedic Surgery, University of Virginia, Charlottesville, VA, United States
| | - Natasha N Desai
- The Spine Hospital, Columbia University Medical Center, New York, NY, United States
| | - Thomas S Bottiglieri
- The Spine Hospital, Columbia University Medical Center, New York, NY, United States
| | - Jeffrey Pavel
- The Physical Medicine and Rehabilitation Center, Englewood, NJ, United States
| | - Lawrence G Lenke
- The Spine Hospital, Columbia University Medical Center, New York, NY, United States
| | - Ronald A Lehman
- The Spine Hospital, Columbia University Medical Center, New York, NY, United States.
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Abstract
PURPOSE OF REVIEW Recurrent lumbar disc herniation (RLDH) is the most common indication for reoperation after a lumbar discectomy. The purpose of this manuscript is to review the incidence, risk factors, and treatment for RLDH. RECENT FINDINGS Patients who require revision surgery for RLDH improved significantly compared to baseline; however, the magnitude of improvement is less than in primary discectomy patients. Treatment with either repeat discectomy or instrumented fusion has comparable clinical outcomes. Repeat discectomy patients, however, have shorter operative times and length of stay. Hospital charges are dramatically lower for repeat discectomy compared to instrumented fusion. The incidence of RLDH is somewhere between 5 and 18%. Risk factors include younger age, lack of a sensory or motor deficit, and a higher baseline Oswestry Disability Index (ODI) score. Available evidence suggests that some patients may respond to nonoperative interventions and avoid the need for reoperation. For those that fail a trial of conservative management or present with neurologic deficit, both repeat lumbar discectomy and instrumented fusion appear to effectively treat patients with similar complication rates and clinical outcomes.
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Affiliation(s)
- Randall J Hlubek
- Scripps Clinic, 10666 N. Torrey Pines Rd, La Jolla, CA, 92037, USA.,San Diego Center for Spinal Disorders, La Jolla, CA, USA.,Division of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ, USA
| | - Gregory M Mundis
- Scripps Clinic, 10666 N. Torrey Pines Rd, La Jolla, CA, 92037, USA. .,San Diego Center for Spinal Disorders, La Jolla, CA, USA.
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Genevay S, Courvoisier DS, Konstantinou K, Kovacs FM, Marty M, Rainville J, Norberg M, Kaux JF, Cha TD, Katz JN, Atlas SJ. Clinical classification criteria for radicular pain caused by lumbar disc herniation: the radicular pain caused by disc herniation (RAPIDH) criteria. Spine J 2017; 17:1464-1471. [PMID: 28483706 DOI: 10.1016/j.spinee.2017.05.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 03/09/2017] [Accepted: 05/02/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Classification criteria are recommended for diseases that lack specific biomarkers to improve homogeneity in clinical research studies. Because imaging evidence of lumbar disc herniations (LDHs) may not be associated with symptoms, clinical classification criteria based on patient symptoms and physical examination findings are required. PURPOSE This study aimed to produce clinical classification criteria to identify patients with radicular pain caused by LDH. STUDY DESIGN The study design was a two-stage process. Phase 1 included a Delphi process and Phase 2 included a cohort study. PATIENT SAMPLE The patient sample included outpatients recruited from spine clinics in five countries. OUTCOME MEASURES The outcome measures were items from history and physical examination. MATERIALS AND METHODS In Phase 1, 17 spine experts participated in a Delphi process to select symptoms and signs suggesting radicular pain caused by LDH. In Phase 2, 19 different clinical experts identified patients they confidently classified as presenting with (1) radicular pain caused by LDH, (2) neurogenic claudication (NC) caused by lumbar spinal stenosis, or (3) non-specific low back pain (NSLBP) with referred leg pain. Patients completed survey items and specialists documented examination signs. A score to predict radicular pain caused by LDH was developed based on the coefficients of the multivariate model. An unrestricted grant of less than US$15,000 was received from MSD: It was used to support the conception of the Delphi, data management, and statistical analysis. No fees were allocated to participating spine specialists. RESULTS Phase 1 generated a final list of 74 potential symptoms and signs. In Phase 2, 209 patients with pain caused by LDH (89), NC (63), or NSLBP (57) were included. Items predicting radicular pain caused by LDH (p<.05) were monoradicular leg pain distribution, patient-reported unilateral leg pain, positive straight leg raise test <60° (or femoral stretch test), unilateral motor weakness, and asymmetric ankle reflex. The score had an AUC of 0.91. An easy-to-use weighted set of criteria with similar psychometric characteristics is proposed (specificity 90.4%, sensitivity 70.6%). CONCLUSIONS Classification criteria for identifying patients with radicular pain caused by LDH are proposed. Their use could improve the homogeneity of patients enrolled in clinical research studies.
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Affiliation(s)
- Stéphane Genevay
- Division of Rheumatology, University Hospitals of Geneva, Geneva, Switzerland.
| | - Delphine S Courvoisier
- Division of Rheumatology, University Hospitals of Geneva, Geneva, Switzerland; Quality of Care Division, University Hospitals of Geneva, Geneva, Switzerland
| | - Kika Konstantinou
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Newcastle, United Kingdom
| | - Francisco M Kovacs
- Spanish Back Pain Research Network, Moncloa University Hospital, Madrid, Spain
| | - Marc Marty
- Department of Rheumatology, Henri-Mondor Hospital, Créteil, France
| | - James Rainville
- Physical Medicine and Rehabilitation, New England Baptist Hospital, Boston, MA, USA
| | - Michael Norberg
- Physical Medicine and Rehabilitation, University Hospital of Lausanne, Lausanne, Switzerland
| | - Jean-François Kaux
- Physical Medicine and Sport Traumatology Department, University and University Hospital of Liège, Belgium
| | - Thomas D Cha
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Jeffrey N Katz
- Department of Orthopaedic Surgery and Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA, USA
| | - Steven J Atlas
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
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Miller E, Sahrmann SA, Avers D. A Movement system impairment approach to evaluation and treatment of a person with lumbar radiculopathy: A case report. Physiother Theory Pract 2017; 33:245-253. [PMID: 28339334 DOI: 10.1080/09593985.2017.1282997] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND PURPOSE There are several systems of classification and treatment of patients with low back pain (LBP) based on assessment of the effect of lumbar postures and movements on symptoms. The efficacy of one of these systems, The Movement System Impairment (MSI) method, has not yet been demonstrated in the literature. The purpose of this case report is to describe the approach of the MSI method for an individual with lumbar radiculopathy. CASE DESCRIPTION A 79-year-old woman with a history of chronic LBP was referred to PT with a physician's diagnosis of sciatica. The patient was classified utilizing a standardized MSI evaluation. She was instructed to modify her daily postures and movements, as well as perform specific exercises to address these impairments. OUTCOMES Her Oswestry LBP disability score improved by over 30% and pain level per the NPRS improved by 3 out of 10 points. DISCUSSION Despite the challenges of advanced joint degeneration and neurological involvement, this approach of identifying and addressing specific movement impairments appeared helpful for this older individual.
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Affiliation(s)
| | - Shirley A Sahrmann
- b School of Medicine- Physical Therapy, Washington University , St Louis , MO , USA
| | - Dale Avers
- c Physical Therapy Education, College of Health Professions SUNY Upstate Medical University , Syracuse , NY , USA
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Tawa N, Rhoda A, Diener I. Accuracy of clinical neurological examination in diagnosing lumbo-sacral radiculopathy: a systematic literature review. BMC Musculoskelet Disord 2017; 18:93. [PMID: 28231784 PMCID: PMC5324296 DOI: 10.1186/s12891-016-1383-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 12/23/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lumbar radiculopathy remains a clinical challenge among primary care clinicians in both assessment and diagnosis. This often leads to misdiagnosis and inappropriate treatment of patients resulting in poor health outcomes, exacerbating this already debilitating condition. This review evaluated 12 primary diagnostic accuracy studies that specifically assessed the performance of various individual and grouped clinical neurological tests in detecting nerve root impingement, as established in the current literature. METHODS Eight electronic data bases were searched for relevant articles from inception until July 2016. All primary diagnostic studies which investigated the accuracy of clinical neurological test (s) in diagnosing lumbar radiculopathy among patients with low back and referred leg symptoms were screened for inclusion. Qualifying studies were retrieved and independently assessed for methodological quality using the 'Quality Assessment of Diagnostic tests Accuracy Studies' criteria. RESULTS A total of 12 studies which investigated standard components of clinical neurological examination of (sensory, motor, tendon reflex and neuro-dynamics) of the lumbo-sacral spine were included. The mean inter-observer agreement on quality assessment by two independent reviewers was fair (k = 0.3 - 0.7). The diagnostic performance of sensory testing using MR imaging as a reference standard demonstrated a sensitivity (confidence interval 95%) 0.61 (0.47-0.73) and a specificity of 0.63 (0.38-0.84). Motor tests sensitivity was poor to moderate, ranging from 0.13 (0.04-0.31) to 0.61 (0.36-0.83). Generally, the diagnostic performance of reflex testing was notably good with specificity ranging from (confidence interval 95%) 0.60 (0.51-0.69) to 0.93 (0.87-0.97) and sensitivity ranging from 0.14 (0.09-0.21) to 0.67 (0.21-0.94). Femoral nerve stretch test had a high sensitivity of (confidence interval 95%) 1.00 (0.40-1.00) and specificity of 0.83 (0.52-0.98) while SLR test recorded a mean sensitivity of 0.84 (0.72-0.92) and specificity of 0.78 (0.67-0.87). CONCLUSIONS There is a scarcity of studies on the diagnostic accuracy of clinical neurological examination testing. Furthermore there seem to be a disconnect among researchers regarding the diagnostic utility of lower limb neuro-dynamic tests which include the Straight Leg Raise and Femoral Nerve tests for sciatic and femoral nerve respectively. Whether these tests are able to detect the presence of disc herniation and subsequent nerve root compression or hyper-sensitivity of the sacral and femoral plexus due to mechanical irritation still remains debatable.
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Affiliation(s)
- Nassib Tawa
- Department of Rehabilitative Sciences, College of Health Sciences, Jomo Kenyatta University of Agriculture & Technology, P. O. Box 62 000 00200, Nairobi, Kenya. .,Division of Physiotherapy, Faculty of Medicine and Health Sciences, Stellenbosch University, Private Bag X1 7602, Matieland, South Africa.
| | - Anthea Rhoda
- Department of Physiotherapy, Faculty of Community and Health Sciences, University of the Western Cape, Private Bag X 17, 7535, Bellville, Republic of South Africa
| | - Ina Diener
- Department of Physiotherapy, Faculty of Community and Health Sciences, University of the Western Cape, Private Bag X 17, 7535, Bellville, Republic of South Africa
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Singh S, Kumar S, Chahal G, Verma R. Selective nerve root blocks vs. caudal epidural injection for single level prolapsed lumbar intervertebral disc - A prospective randomized study. J Clin Orthop Trauma 2017; 8:142-147. [PMID: 28720990 PMCID: PMC5498739 DOI: 10.1016/j.jcot.2016.02.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 02/02/2016] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Chronic lumbar radiculopathy has a lifetime prevalence of 5.3% in men and 3.7% in women. It usually resolves spontaneously, but up to 30% cases will have pronounced symptoms even after one year. AIMS A prospective randomized single-blind study was conducted to compare the efficacy of caudal epidural steroid injection and selective nerve root block in management of pain and disability in cases of lumbar disc herniation. METHODS Eighty patients with confirmed single-level lumbar disc herniation were equally divided in two groups: (a) caudal epidural and (b) selective nerve root block group, by a computer-generated random allocation method. The caudal group received three injections of steroid mixed with local anesthetics while selective nerve root block group received single injection of steroid mixed with local anesthetic agent. Patients were assessed for pain relief and reduction in disability. RESULTS In SNRB group, pain reduced by more than 50% up till 6 months, while in caudal group more than 50% reduction of pain was maintained till 1 year. The reduction in ODI in SNRB group was 52.8% till 3 months, 48.6% till 6 months, and 46.7% at 1 year, while in caudal group the improvement was 59.6%, 64.6%, 65.1%, and 65.4% at corresponding follow-up periods, respectively. CONCLUSIONS Caudal epidural block is an easy and safe method with better pain relief and improvement in functional disability than selective nerve root block. Selective nerve root block injection is technically more demanding and has to be given by a skilled anesthetist.
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Affiliation(s)
- Sudhir Singh
- Professor, Department of Orthopaedics, Era's Lucknow Medical College & Hospital, Lucknow, UP, India
- Corresponding author. Tel.: +91 8799544905.
| | - Sanjiv Kumar
- Associate Professor, Department of Orthopaedics, Era's Lucknow Medical College & Hospital, Lucknow, UP, India
| | - Gaurav Chahal
- Junior Resident, Department of Orthopaedics, Era's Lucknow Medical College & Hospital, Lucknow, UP, India
| | - Reetu Verma
- Associate Professor, Department of Anesthesia, King George Medical University, Lucknow, UP, India
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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. Eur Spine J 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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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Tschugg A, Lener S, Hartmann S, Neururer S, Wildauer M, Thomé C, Löscher WN. Improvement of sensory function after sequestrectomy for lumbar disc herniation: a prospective clinical study using quantitative sensory testing. Eur Spine J 2016; 25:3543-9. [PMID: 27637902 DOI: 10.1007/s00586-016-4770-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Revised: 08/08/2016] [Accepted: 09/03/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND Previous studies have investigated sensory recovery in patients with lumbar disc herniation using rather subjective methods. There have been no reports on changes of sensory function in patients suffering from a preoperative sensory deficit using quantitative sensory testing (QST). The aims of this prospective study were (1) to assess the recovery of preoperative sensory dysfunction after lumbar sequestrectomy and (2) to quantify the strength of relationship between a sensory deficit and the patient's quality of life. METHODS We applied the QST protocol of the German Research Network on Neuropathic Pain (DFNS) in fifty-two patients with a single lumbar disc herniation confirmed on MRI treated by lumbar sequestrectomy. Further evaluation included a detailed medical history, a physical examination, numeric rating scale for leg, EQ-5D questionnaire, and thermometer. RESULTS Disc surgery resulted in a significant reduction of leg pain and a significant gain of quality of life. Thermal, mechanical, and vibration perception thresholds showed an obvious side-to-side difference preoperatively (p < 0.005). An early recovery of mechanical and vibration perception thresholds was detected, whereas cold perception needed more than 6 months to recover (p < 0.05). Quality of life was independent from perception thresholds, but correlated significantly with pain reduction. CONCLUSION Our data clearly show that there is a subjective and quantifiable improvement in sensory dysfunction postoperatively. The current data suggest that a sensory dysfunction does not influence a patient's quality of life.
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Park BE. Surgical Treatment of Degenerative Lumbar Spine Disease in Rural Sub-Saharan Africa: A Retrospective Study of 450 Cases and Its Future Implications. World Neurosurg 2016; 87:417-21. [PMID: 26723284 DOI: 10.1016/j.wneu.2015.11.077] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 11/23/2015] [Accepted: 11/24/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Treatment for lumbar disc disease and spinal stenosis is the most common reason patients seek neurosurgical consultation in rural sub-Saharan Africa. Yet the misperception remains that lacking access to magnetic resonance imaging/computed tomography and a "spine surgeon," neither a definitive diagnosis can be made nor corrective treatment instituted. To combat such therapeutic nihilism, the author has supervised the on-site training of general surgeons in rural Kenya for the past 15 years with the intent of making spine surgery available for patients in outlying provincial areas. METHODS Using a simplified, cost-effective approach for both diagnosis (myelography) and treatment (hemilaminectomy/foraminotomy for radiculopathies; decompressive laminectomy for neurogenic claudication), this retrospective study of 450 patients was undertaken to 1) determine the efficacy of such an approach, and 2) the general surgeon's role in it. RESULTS Whether performed by the instructor alone (326 cases) or by the trainee under supervision (124), 92% of patients were satisfied with their surgical results. Equally noteworthy, perioperative morbidity (less than 2%) was essentially the same within the 2 groups. CONCLUSIONS Assuming experienced spine surgeons are willing to involve themselves in such hands-on training, the results of this study affirm that general surgeons can diagnose efficiently and then treat safely such degenerative spine conditions-thereby addressing this most prevalent of disease processes that has huge socioeconomic implications for rural sub-Saharan Africans.
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Affiliation(s)
- Bert E Park
- Department of Surgery/Neurosurgery Tenwek Hospital, Kenya Pan African Academy of Christian Surgeons, Bomet, Kenya.
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Saxena A, Neelakantan A, Jampana R, Sangra M. Melorheostosis causing lumbar radiculopathy: a case report and a review of the literature. Spine J 2013; 13:e27-9. [PMID: 23541445 DOI: 10.1016/j.spinee.2013.02.039] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2012] [Accepted: 02/18/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Melorheostosis is a rare sclerosing bone disorder with a predilection for the appendicular skeleton. Involvement of the spine is infrequent and largely asymptomatic. Surgical treatment for spinal involvement is therefore uncommon with only one reported case of lumbar fusion for painful lumbosacral melorheostosis. PURPOSE We report a case of lumbar melorheostosis causing disabling radiculopathy treated with nerve root decompression. CONCLUSIONS Melorheostosis of the lumbar spine causing radicular symptoms has not been reported before. Our message from the management of this particular patient is to consider surgical option in symptomatic individuals.
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Kim HK, Koh SH, Chung KJ. Solitary epidural lipoma with ipsilateral facet arthritis causing lumbar radiculopathy. Asian Spine J 2012; 6:203-6. [PMID: 22977701 DOI: 10.4184/asj.2012.6.3.203] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2011] [Revised: 04/26/2011] [Accepted: 04/27/2011] [Indexed: 11/08/2022] Open
Abstract
A 55-year-old obese man (body mass index, 31.6 kg/m2) presented radiating pain and motor weakness in the left leg. Magnetic resonance imaging showed an epidural mass posterior to the L5 vertebral body, which was isosignal to subcutaneous fat and it asymmetrically compressed the left side of the cauda equina and the exiting left L5 nerve root on the axial T1 weighted images. Severe arthritis of the left facet joint and edema of the bone marrow regarding the left pedicle were also found. As far as we know, there have been no reports concerning a solitary epidural lipoma combined with ipsilateral facet arthorsis causing lumbar radiculopathy. Solitary epidural lipoma with ipsilateral facet arthritis causing lumbar radiculopathy was removed after the failure of conservative treatment. After decompression, the neurologic deficit was relieved. At a 2 year follow-up, motor weakness had completely recovered and the patient was satisfied with the result. We recommend that a solitary epidural lipoma causing neurologic deficit should be excised at the time of diagnosis.
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Jeswani S, Drazin D, Shirzadi A, Fan X, Johnson JP. Endometriosis in the Lumbar Plexus Mimicking a Nerve Sheath Tumor. World J Oncol 2011; 2:314-318. [PMID: 29147269 PMCID: PMC5649718 DOI: 10.4021/wjon413w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2011] [Indexed: 11/03/2022] Open
Abstract
Endometriosis consists of ectopic endometrial tissue outside of the uterine cavity. It is typically benign. It may cause neurological symptoms if involving the central or peripheral nervous system. We present in this report a 46-year-old Caucasian female with progressively worsening lumbar pain with radiation to her left anterior thigh. MR imaging showed an enhancing mass in the L4 neural foramen, intrepreted as a nerve sheath tumor. At operation the nerve showed extrinsic and intrinsic abnormality, proven to be endometriosis. Postoperatively, the patient reported relief from her radiculopathy. We review the previous cases, discuss the pathogenesis and additional characteristics that highlight intraspinal endometriosis, although rare, should be considered as a potential cause of neurologic symptoms in women. Surgical resection is recommended in cases having severe or worsening neurologic symptoms or signs of cauda equina syndrome. Adjunctive treatment may be used in cases of residual or recurrent lesions.
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Affiliation(s)
- Sunil Jeswani
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles,CA USA
| | - Doniel Drazin
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles,CA USA
| | - Ali Shirzadi
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles,CA USA
| | - Xuemo Fan
- Department of Pathology, Cedars-Sinai Medical Center, Los Angeles, CA USA
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