1
|
Kilpikoski S, Suominen EN, Repo JP, Häkkinen AH, Kyrölä K, Kautiainen H, Ylinen J. Comparison of magnetic resonance imaging findings among sciatica patients classified as centralizers or non-centralizers. J Man Manip Ther 2023; 31:358-367. [PMID: 36756675 PMCID: PMC10566442 DOI: 10.1080/10669817.2023.2174555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 01/22/2023] [Indexed: 02/10/2023] Open
Abstract
OBJECTIVE To compare if the degenerative findings from MRI differ between the sciatica patients classified as centralizers (CEN) and non-centralizers (Non-CEN) according to the McKenzie Method of mechanical diagnosis and therapy. STUDY DESIGN A cross-sectional study. METHODS Patients (N = 100) referred to a spine clinic of a single tertiary hospital for specialist consultation for sciatica. The McKenzie-based assessment was performed by the mechanical diagnosis and therapy-trained physiotherapists. Clinical data and prevalence of lumbar MRI findings were compared between the groups. RESULTS There was no significant difference in leg pain intensity between the groups. The Non-CEN had significantly more intense back pain, mean 56 (SD 30) and were more disabled 44 (SD 15) compared to the CEN mean 41 (SD 25) and mean 31 (11), measured with a visual analogue scale (0-100), and the Oswestry Disability Index (0-100), respectively. The CEN had more severe degenerative findings on MRI than the Non-CEN: vertebral end-plate changes were 63% and 43%; mean Pfirrmann's disc degeneration lumbar summary score was 12.8, and 10.6; and severity score of total damage was 12.0 and 10.1, respectively. There were differences neither in disc contour changes nor nerve root stenosis on MRI. CONCLUSIONS Sciatica patients classified as non-centralizers had significantly more severe back pain, and were significantly more disabled than centralizers, who instead had more severe degenerative findings on MRI. Thus, classification to non-centralizers by the McKenzie method seems not predict higher incidence of degenerative findings on MRI compared to centralizers.
Collapse
Affiliation(s)
- Sinikka Kilpikoski
- Department of Physical and Rehabilitation Medicine, Centra’ Finland Health Care District Hospital, Jyvaskyla, Finland
| | | | - Jussi P Repo
- Department of Orthopaedics and Traumatology, Tampere University Hospital, Tampere, Finland
| | - Arja H Häkkinen
- Faculty of Health Sciences, Univeristy of Jyväskylä, Jyväskylä, Finland
| | - Kati Kyrölä
- Consultant Surgeon Orthopaedics and Traumatology, Docent. Chief Orthopaedic Surgeon, Hospital NOVA, Central Finland Health Care District, Jyvaskyla, Finland
| | - Hannu Kautiainen
- Primary Health Care Unit, Kuopio University Hospital, Helsinki, Finland
| | - Jari Ylinen
- Department of Physical and Rehabilitation Medicine, Centra’ Finland Health Care District Hospital, Jyvaskyla, Finland
| |
Collapse
|
2
|
Lin GX, Jhang SW, Chen CM. An Effectiveness Evaluation of Nucleo-Annuloplasty for Lumbar Discogenic Lesions Using Disc-FX: A Scoping Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1291. [PMID: 37512102 PMCID: PMC10383110 DOI: 10.3390/medicina59071291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 05/20/2023] [Accepted: 06/30/2023] [Indexed: 07/30/2023]
Abstract
Background and Objectives: Degenerative disk disease is a widespread chronic condition that causes diskogenic pain. Diskogenic pain can be treated with various therapy methods. Disc-FX is a revolutionary, minimally invasive, percutaneous nucleo-annuloplasty method that combines manual diskectomy with nuclear and annular remodeling using radiofrequency ablation to relieve diskogenic pain. In this study, the technical features, clinical outcomes, and complications of Disc-FX are summarized. Materials and Methods: A comprehensive literature review was performed. By exploring several databases, we collected studies on Disc-FX for treating diskogenic pain. The outcomes included perioperative data, clinical results, and complications. Results: In the 15 studies included, data from 570 patients were collected. L4-L5 was the most frequently operated level, and most cases underwent single-level procedures. The follow-up period for these patients ranged from 2 months to 24 months. One study reported a procedure time between 35 and 60 min, whereas the remaining studies reported a procedure time of less than 30 min. The mean visual analog scale score decreased from 7.22 preoperatively to 1.81 at the final follow-up. The mean numerical rating scale score decreased from 6.98 preoperatively to 3.9 at the final follow-up. The mean Japanese Orthopaedic Association score improved from 16.26 preoperatively to 25.88 in the final follow-up. The mean Oswestry Disability Index score decreased from 35.37 preoperatively to 14.66 at the final follow-up. The mean satisfaction rate (based on the Macnab criteria) was 87.6% (range, 78.4-95.2%). The total incidence of postoperative transient pain was 8.77% (50/570) after nucleo-annuloplasty using Disc-FX, and recurrence was 1.58% (9/570). Conclusions: According to our comprehensive evaluation, using percutaneous nucleo-annuloplasty for treating lumbar diskogenic diseases provided considerable pain alleviation and improved functional outcomes with fewer complications. Disc-FX is a safe and effective procedure that is a good treatment option for patients with diskogenic pain.
Collapse
Affiliation(s)
- Guang-Xun Lin
- Department of Orthopedics, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen 361000, China
- The School of Clinical Medicine, Fujian Medical University, Fuzhou 350122, China
| | - Shang-Wun Jhang
- Division of Neurosurgery, Department of Surgery, Changhua Christian Hospital, Changhua 500209, Taiwan
| | - Chien-Min Chen
- Division of Neurosurgery, Department of Surgery, Changhua Christian Hospital, Changhua 500209, Taiwan
- Department of Leisure Industry Management, National Chin-Yi University of Technology, Taichung 41170, Taiwan
| |
Collapse
|
3
|
Wu SK, Chen HY, You JY, Bau JG, Lin YC, Kuo LC. Outcomes of active cervical therapeutic exercise on dynamic intervertebral foramen changes in neck pain patients with disc herniation. BMC Musculoskelet Disord 2022; 23:728. [PMID: 35906546 PMCID: PMC9338473 DOI: 10.1186/s12891-022-05670-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 07/19/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To better understand biomechanical factors that affect intervertebral alignment throughout active therapeutic exercise, it is necessary to determine spinal kinematics when subjects perform spinal exercises. This study aims to investigate the outcomes of active cervical therapeutic exercise on intervertebral foramen changes in neck pain patients with disc herniation. METHODS Thirty diagnosed C4/5 and/or C5/6 disc-herniated patients receiving an 8-week cervical therapeutic exercise program were followed up with videofluoroscopic images. The dynamic changes in the foramen were computed at different timepoints, including the neutral position, end-range positions in cervical flexion-extension, protrusion-retraction, and lateral flexion movements. RESULTS The results showed that the active cervical flexion, retraction, and lateral flexion away from the affected side movements increased the area of the patients' intervertebral foramen; while the active extension, protrusion, and lateral flexion toward the affected side reduced the areas of intervertebral foramen before treatment. After the treatment, the active cervical flexion significantly increased the C2/3, C3/4, and C6/7 foramen area by 5.02-8.67% (p = 0.001 ~ 0.029), and the extension exercise significantly reduced the C2/3 and C4/5 area by 5.12-9.18% (p = 0.001 ~ 0.006) compared to the baseline. Active retraction movement significantly increased the foramen area from C2/3 to C6/7 by 3.82-8.66% (p = 0.002 ~ 0.036 with exception of C5/6). Active lateral flexion away from the affected side significantly increased the foramen by 3.71-6.78% (p = 0.007 ~ 0.046 with exception of C6/7). CONCLUSIONS The 8-week therapeutic exercises including repeated cervical retraction, extension, and lateral flexion movements to the lesion led to significant changes and improvements in intervertebral foramen areas of the patients with disc herniation. TRIAL REGISTRATION ISRCTN61539024.
Collapse
Affiliation(s)
- Shyi-Kuen Wu
- Department of Physical Therapy, HungKuang University, Taichung, Taiwan
| | - Han-Yu Chen
- Department of Physical Therapy, HungKuang University, Taichung, Taiwan
| | - Jia-Yuan You
- Department of Physical Therapy, I-Shou University, Kaohsiung, Taiwan
| | - Jian-Guo Bau
- Department of Biomedical Engineering, HungKuang University, Taichung, Taiwan
| | - Yu-Chen Lin
- Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Li-Chieh Kuo
- Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan. .,Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan.
| |
Collapse
|
4
|
Sousa Filho LF, Barbosa Santos MM, de Farias Neto JP, da Silva Junior WM. The addition of neurodynamic exercises to extension-oriented exercises among patients with chronic back-related leg pain: A study protocol. J Bodyw Mov Ther 2019; 23:473-478. [PMID: 31563358 DOI: 10.1016/j.jbmt.2018.10.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Revised: 06/25/2018] [Accepted: 08/25/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Patients with back-related leg pain exhibit nociceptive and neuropathic characteristics. Few studies have investigated the combination of interventions considering these characteristics. OBJECTIVES To investigate if the addition of neurodynamic exercises (EEN) to extension-oriented exercises (EE) promotes additional benefits in individuals with back-related leg pain and a directional preference. METHODS Patients will be randomized to either EE or EEN. Patients from both groups will receive 7 sessions over 3 weeks. Low back and leg pain, function, quality of life, disability, and global perceived effect will be evaluated at baseline, 3 weeks after randomization and 1-month follow-up. A linear mixed model will be used for outcomes analysis.
Collapse
Affiliation(s)
- Luis F Sousa Filho
- Master's Program in Physical Education, Universidade Federal de Sergipe, São Cristovão, Sergipe, Brazil.
| | - Marta M Barbosa Santos
- Department of Physiotherapy, Universidade Federal de Sergipe, São Cristovão, Sergipe, Brazil.
| | - Jader P de Farias Neto
- Department of Physiotherapy, Universidade Federal de Sergipe, São Cristovão, Sergipe, Brazil.
| | - Walderi M da Silva Junior
- Master's Program in Physical Education, Universidade Federal de Sergipe, São Cristovão, Sergipe, Brazil.
| |
Collapse
|
5
|
Consistency of commonly used orthopedic special tests of the shoulder when used with the McKenzie system of mechanical diagnosis and therapy. Musculoskelet Sci Pract 2018; 33:11-17. [PMID: 29059632 DOI: 10.1016/j.msksp.2017.10.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 09/25/2017] [Accepted: 10/04/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND Shoulder Orthopedic Special Tests (OSTs) are used to assist with diagnosis in shoulder disorders. Issues with reliability and validity exist, making their interpretation challenging. Exploring OST results on repeated testing within Mechanical Diagnosis and Therapy (MDT) shoulder classifications may offer insight into the poor performance of these tests. OBJECTIVES To investigate in patients with shoulder complaints, whether MDT classifications affect the agreement of OST results over the course of treatment. METHODS An international group of MDT clinicians recruited 105 patients with shoulder problems. Three commonly used OSTs (Empty Can, Hawkins-Kennedy, and Speed's tests) were utilized. Results of the OSTs were collected at sessions 1, 3, 5 and 8, or at discharge from an MDT classification-based treatment. The Kappa statistic was utilized to determine the agreement of the OST results over time for each of the MDT classifications. RESULTS The overall Kappa values for Empty Can, Hawkins-Kennedy and Speed's tests were 0.28 (SE = 0.07), 0.28 (SE = 0.07) and 0.29 (SE = 0.07), respectively. The highest level of agreement was for Articular Dysfunction for the Empty Can test (0.84, SE = 0.19). For shoulder Derangements, there was no agreement for any of the OSTs (P values > 0.05). CONCLUSION The lack of agreement when the OSTs were consecutively tested in the presence of the MDT Derangement classification contrasted with the other MDT classifications. The presence of Derangement was responsible for reducing the overall agreement of commonly used OSTs and may explain the poor consistency for OSTs.
Collapse
|
6
|
Schuller W, Ostelo RWJG, Rohrich DC, Apeldoorn AT, de Vet HCW. Physicians using spinal manipulative treatment in The Netherlands: a description of their characteristics and their patients. BMC Musculoskelet Disord 2017; 18:512. [PMID: 29207995 PMCID: PMC5718083 DOI: 10.1186/s12891-017-1863-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Accepted: 11/20/2017] [Indexed: 11/26/2022] Open
Abstract
Background Various health care professionals apply Spinal Manipulative Treatment (SMT) in daily practice. While the characteristics of chiropractors and manual therapists and the characteristics of their patient populations are well described, there is little research about physicians who use SMT techniques. A distinct group of physicians in The Netherlands has been trained in musculoskeletal (MSK) medicine, which includes the use of SMT. Our objective was to describe the characteristics of these physicians and their patient population. Methods All registered MSK physicians were approached with questionnaires and telephone interviews to collect data about their characteristics. Data about patient characteristics were extracted from a web-based register. In this register physicians recorded basic patient data (age, gender, the type and duration of the main complaint, concomitant complaints and the type of referral) at the first consultation. Patients were invited to fill in web-based questionnaires to provide baseline data about previous treatments and the severity of their main complaint. Functional impairment was measured with Patient Reported Outcome Measures (PROMs). Results Questionnaires were sent to 138 physicians of whom 90 responded (65%). Most physicians were trained in MSK medicine after a career in other medical specialities. They reported to combine their SMT treatment with a variety of diagnostic and treatment options part of which were only permissible for physicians, such as prescription medication and injections. The majority of patients presented with complaints of long duration (62.1% > 1 year), most frequently low back pain (48.1%) or neck pain (16.9%), with mean scores of 6.0 and 6.2, respectively, on a 0 to10 numerical rating scale (NRS) for pain intensity. Mean scores on all PROMs showed moderate impairment. Patients most frequently reported previous treatment by physical therapists (68.1%), manual therapists (37.7%) or chiropractors (17.0%). Conclusion Our study showed that MSK physicians in The Netherlands used an array of SMT techniques. They embedded their SMT techniques in a broad array of other diagnostic and treatment options, part of which were limited to medical doctors. Most patients consulted MSK physicians with spinal pain of long duration with moderate functional impairment.
Collapse
Affiliation(s)
- Wouter Schuller
- VU University Medical Center, Department of Epidemiology & Biostatistics and the Amsterdam Public Health Research Institute, P.O. box 7057, 1007 MB, Amsterdam, The Netherlands. .,Spine Clinic, Mahoniehout 10-12, 1507 ED, Zaandam, The Netherlands.
| | - Raymond W J G Ostelo
- VU University Medical Center, Department of Epidemiology & Biostatistics and the Amsterdam Public Health Research Institute, P.O. box 7057, 1007 MB, Amsterdam, The Netherlands.,Department of Health Science of the Faculty of Earth and Life Sciences and the Amsterdam Public Health Research Institute, P.O. box 7057, 1007 MB, Amsterdam, The Netherlands
| | - Daphne C Rohrich
- VU University Medical Center, Department of Epidemiology & Biostatistics and the Amsterdam Public Health Research Institute, P.O. box 7057, 1007 MB, Amsterdam, The Netherlands
| | - Adri T Apeldoorn
- Rehabilitation department, Noordwest Ziekenhuisgroep, Wilhelminalaan 12, 1815 JD, Alkmaar, The Netherlands
| | - Henrica C W de Vet
- VU University Medical Center, Department of Epidemiology & Biostatistics and the Amsterdam Public Health Research Institute, P.O. box 7057, 1007 MB, Amsterdam, The Netherlands
| |
Collapse
|
7
|
Tousignant-Laflamme Y, Longtin C, Brismée JM. How radiological findings can help or hinder patients' recovery in the rehabilitation management of patients with low back pain: what can clinicians do? J Man Manip Ther 2017; 25:63-65. [PMID: 28559664 DOI: 10.1080/10669817.2017.1309345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Yannick Tousignant-Laflamme
- Faculty of Medicine and Health Sciences, School of Rehabilitation, Université de Sherbrooke, Sherbrooke, Canada.,Research Center of the Centre hospitalier universitaire de Sherbrooke (CRCHUS), Sherbrooke, Canada
| | - Christian Longtin
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada
| | - Jean-Michel Brismée
- Doctor of Science Program in Physical Therapy, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| |
Collapse
|
8
|
Peterson S, Hodges C. Lumbar lateral shift in a patient with interspinous device implantation: a case report. J Man Manip Ther 2016; 24:215-22. [PMID: 27582621 PMCID: PMC4987148 DOI: 10.1179/2042618615y.0000000019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Lumbar lateral shift (LLS) is a common clinical observation but has rarely been described in a patient with a history of lumbar surgery. The purpose of the current case report was to describe the use of the McKenzie Method of Mechanical Diagnosis and Therapy (MDT) in the multi-modal treatment of a patient with an LLS and a history of multiple surgical procedures in the lumbar spine, including interspinous process device (IPD) implantation. CASE DESCRIPTION A 72-year-old female with chronic low back pain (LBP) and a surgical history in the lumbar spine was referred to physical therapy for radiating leg pain and presented with a right LLS. Her chief complaints included sitting for long periods, vacuuming and ascending stairs into her home. OUTCOMES The patient was treated during eight visits over 30 days. Treatment interventions included manual shift correction, self-correction and management, joint mobilisation below the level of IPD implantation ,neurophysiology education, and development of a home exercise programme. At discharge, her leg pain was resolved and all goals had been met. The patient reported maintenance of gains at 6-month follow-up. DISCUSSION Utilisation of the MDT approach, including LLS correction, produced positive outcomes in a complex patient with previous IPD implantation. Future research should investigate treatment and outcomes after invasive spinal procedures in similar patient populations to better inform clinical management. LEVEL OF EVIDENCE 4.
Collapse
Affiliation(s)
| | - Cheri Hodges
- Arizona School of Health Sciences, A. T. Still University, Mesa, AZ, USA
| |
Collapse
|
9
|
The Effectiveness of Mechanical Traction Among Subgroups of Patients With Low Back Pain and Leg Pain: A Randomized Trial. J Orthop Sports Phys Ther 2016; 46:144-54. [PMID: 26813755 DOI: 10.2519/jospt.2016.6238] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Randomized clinical trial. Background The recommended initial management strategy for patients with low back pain and signs of nerve root compression is conservative treatment, but there is little evidence to guide the most appropriate management strategy. Preliminary research suggests that a treatment protocol of mechanical traction and extension-oriented exercises may be effective, particularly in a specific subgroup of patients. OBJECTIVE To examine the effectiveness of mechanical traction in patients with lumbar nerve root compression and within a predefined subgroup. METHODS One hundred twenty patients with low back pain with nerve root compression were recruited from physical therapy clinics. Using predefined subgrouping criteria, patients were stratified at baseline and randomized to receive an extension-oriented treatment approach with or without the addition of mechanical traction. During a 6-week period, patients received up to 12 treatment visits. Primary outcomes of pain and disability were collected at 6 weeks, 6 months, and 1 year by assessors blinded to group allocation. Outcomes were examined using linear mixed-model analyses examining change over time by treatment and the interaction between treatment and subgrouping status. RESULTS The mean ± SD age of participants was 41.1 ± 11.3 years, median duration of symptoms was 62 days, and 57% were male. No significant differences in disability or pain outcomes were noted between treatment groups at any time point, nor was any interaction found between subgroup status and treatment. CONCLUSION Patients with lumbar nerve root compression presenting for physical therapy can expect significant changes in disability and pain over a 6-week treatment period. There is no evidence that mechanical lumbar traction in combination with an extension-oriented treatment is superior to extension-oriented exercises alone in the management of these patients or within a predefined subgroup of patients. The study protocol was registered with ClinicalTrials.gov (NCT00942227). Level of Evidence Therapy, level 2b.
Collapse
|
10
|
Abady AH, Rosedale R, Overend TJ, Chesworth BM, Rotondi MA. Inter-examiner reliability of diplomats in the mechanical diagnosis and therapy system in assessing patients with shoulder pain. J Man Manip Ther 2014; 22:199-205. [PMID: 25395828 DOI: 10.1179/2042618614y.0000000068] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVE To investigate the inter-examiner reliability of Mechanical Diagnosis and Therapy (MDT)-trained diplomats in classifying patients with shoulder disorders. The MDT system has demonstrated acceptable reliability when used in patients with spinal disorders; however, little is known about its utility when used for appendicular conditions. METHODS Fifty-four clinical scenarios were created by a group of 11 MDT diploma holders based on their clinical experience with patients with shoulder pain. The vignettes were made anonymous, and their clinical diagnoses sections were left blank. The vignettes were sent to a second group of six international McKenzie Institute diploma holders who were asked to classify each vignette according to the MDT categories for upper extremity. Inter-examiner agreement was evaluated with kappa statistics. RESULTS There was 'very good' agreement among the six MDT diplomats for classifying the McKenzie syndromes in patients with shoulder pain (kappa = 0.90, SE = 0.018). The raw overall level of multi-rater agreement among the six clinicians in classifying the vignettes was 96%. After accounting for the actual MDT category for each vignette, kappa and the raw overall level of agreement decreased negligibly (0.89 and 95%, respectively). DISCUSSION Using clinical vignettes, the McKenzie system of MDT has very good reliability in classifying patients with shoulder pain. As an alternative, future reliability studies could use real patients instead of written vignettes.
Collapse
Affiliation(s)
| | | | - Tom J Overend
- School of Physical Therapy, Western University, London, Canada
| | - Bert M Chesworth
- School of Physical Therapy, Western University, London, Canada ; Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Michael A Rotondi
- School of Kinesiology and Health Sciences, York University, Toronto, Canada
| |
Collapse
|
11
|
Tessitore E, Molliqaj G, Schatlo B, Schaller K. Clinical evaluation and surgical decision making for patients with lumbar discogenic pain and facet syndrome. Eur J Radiol 2014; 84:765-70. [PMID: 24801263 DOI: 10.1016/j.ejrad.2014.03.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Accepted: 03/11/2014] [Indexed: 12/11/2022]
Abstract
In industrialized countries, more than two thirds of the population suffers from low back pain (LBP) in their lifetime. LBP associated with lumbar disc herniation, stenosis, and instability is a well-known and documented entity. On the other hand, the lumbar discogenic pain and facet syndrome are difficult to be clearly identified, and they are not always detectable by imaging. This article describes the causes of these painful syndromes, which are typically without radicular component, explains the modern diagnostic procedures, and provides guidelines for surgical decision making.
Collapse
Affiliation(s)
- Enrico Tessitore
- Neurosurgical Unit, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Switzerland.
| | - Granit Molliqaj
- Neurosurgical Unit, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Switzerland.
| | - Bawarjan Schatlo
- Department of Neurosurgery, Georg-August University, University of Medicine Gottingen, 37075 Gottingen, Germany.
| | - Karl Schaller
- Neurosurgical Unit, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Switzerland.
| |
Collapse
|
12
|
Reiman MP, Manske RC. The assessment of function. Part II: clinical perspective of a javelin thrower with low back and groin pain. J Man Manip Ther 2013; 20:83-9. [PMID: 23633887 DOI: 10.1179/2042618611y.0000000018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Assessment of an individual's functional ability can be complex. This assessment should also be individualized and adaptable to changes in functional status. In the first article of this series, we operationally defined function, discussed the construct of function, examined the evidence as it relates to assessment methods of various aspects of function, and explored the multi-dimensional nature of the concept of function. In this case report, we aim to demonstrate the utilization of a multi-dimensional assessment method (functional performance testing) as it relates to a high-level athlete presenting with pain in the low back and groin. It is our intent to demonstrate how the clinician should continually adapt their assessment dependent on the current functional abilities of the patients.
Collapse
|
13
|
Wyss JF, Lutz GE, LaSalle EE. Re: is it time to rethink the typical course of low back pain? PM R 2012; 4:1024. [PMID: 23245667 DOI: 10.1016/j.pmrj.2012.09.1158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Accepted: 09/18/2012] [Indexed: 10/27/2022]
|
14
|
Desai MJ, Padmanabhan G, Simbasivan A, Kamanga-Sollo GG, Dharmappa A. Directional Preference Following Epidural Steroid Injection in Three Patients with Acute Cervical Radiculopathy. Pain Pract 2012; 13:559-65. [DOI: 10.1111/papr.12000] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Accepted: 08/19/2012] [Indexed: 11/28/2022]
Affiliation(s)
- Mehul J. Desai
- The George Washington University Medical Center; Washington; District of Columbia; U.S.A
| | - Girish Padmanabhan
- The George Washington University Medical Center; Washington; District of Columbia; U.S.A
| | - Ajai Simbasivan
- The George Washington University Medical Center; Washington; District of Columbia; U.S.A
| | | | - Ajay Dharmappa
- The George Washington University Medical Center; Washington; District of Columbia; U.S.A
| |
Collapse
|
15
|
Hebert JJ, Koppenhaver SL, Walker BF. Subgrouping patients with low back pain: a treatment-based approach to classification. Sports Health 2012; 3:534-42. [PMID: 23016055 PMCID: PMC3445227 DOI: 10.1177/1941738111415044] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Context: Low back pain (LBP) is a prevalent condition imposing a large socioeconomic burden. Despite intensive research aimed at the efficacy of various therapies for patients with LBP, most evidence has failed to identify a superior treatment approach. One proposed solution to this dilemma is to identify subgroups of patients with LBP and match them with targeted therapies. Among the subgrouping approaches, the system of treatment-based classification (TBC) is promoted as a means of increasing the effectiveness of conservative interventions for patients with LBP. Evidence acquisition: MEDLINE and PubMed databases were searched from 1985 through 2010, along with the references of selected articles. Results: TBC uses a standardized approach to categorize patients into 1 of 4 subgroups: spinal manipulation, stabilization exercise, end-range loading exercise, and traction. Although the TBC subgroups are in various stages of development, recent research lends support to the effectiveness of this approach. Conclusions: While additional research is required to better elucidate this method, the TBC approach enhances clinical decision making, as evidenced by the improved clinical outcomes experienced by patients with LBP.
Collapse
Affiliation(s)
- Jeffrey J. Hebert
- Faculty of Health Sciences, School of Chiropractic and Sports Science, Murdoch University, Murdoch, Western Australia
- Address correspondence to Jeffrey J. Hebert, DC, PhD, Murdoch University, Faculty of Health Sciences, School of Chiropractic and Sports Science, Murdoch, Western Australia 6150 (e-mail: )
| | - Shane L. Koppenhaver
- US Army-Baylor University Doctoral Program in Physical Therapy, San Antonio, Texas
| | - Bruce F. Walker
- US Army-Baylor University Doctoral Program in Physical Therapy, San Antonio, Texas
| |
Collapse
|
16
|
Padmanabhan G, Sambasivan A, Desai MJ. Three-step treadmill test and McKenzie mechanical diagnosis and therapy to establish directional preference in a patient with lumbar spinal stenosis: a case report. J Man Manip Ther 2012; 19:35-41. [PMID: 22294852 DOI: 10.1179/2042618610y.0000000002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2010] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Lumbar spinal stenosis (LSS) is defined as narrowing of the spinal canal. LSS is commonly treated conservatively, primarily with flexion-based exercises. We present a patient diagnosed with LSS, refractory to a flexion-based protocol who ultimately responded to an extension-based protocol following establishment of directional preference with three-step treadmill testing. DESCRIPTION A 64-year-old male was diagnosed with LSS with a 2-year history of bilateral neurogenic claudication unresponsive to flexion-based exercises. Initially, distinct directional preference or centralization was not demonstrated on repetitive movement testing. Ultimately, preference towards extension was established through a three-step treadmill test. An extension-based treatment plan was recommended, which provided significant relief despite focusing on exercises that are commonly avoided during traditional treatment for LSS. OUTCOMES He began to centralize pain to his lower back after 2 weeks and denied neurogenic claudication on repeat three-step treadmill test at 3 weeks. His drastic improvements in pain levels and functional status continued throughout four sessions. DISCUSSION Although the patient's initial diagnostic label may bias towards a spinal flexion protocol, further mechanical testing revealed an extension directional preference. The three-step treadmill test was crucial in establishing his directional preference and guiding his treatment. Treadmill testing may be useful in a subset of patients who do not demonstrate distinct directional preferences on mechanical testing.
Collapse
Affiliation(s)
- G Padmanabhan
- The GW Spine & Pain Center, The George Washington University Hospital, Washington DC
| | | | | |
Collapse
|
17
|
Simmerman SM, Sizer PS, Dedrick GS, Apte GG, Brismée JM. Immediate changes in spinal height and pain after aquatic vertical traction in patients with persistent low back symptoms: a crossover clinical trial. PM R 2011; 3:447-57. [PMID: 21570033 DOI: 10.1016/j.pmrj.2011.01.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Revised: 01/20/2011] [Accepted: 01/31/2011] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To investigate the effect of aquatic vertical traction on spinal height, pain intensity, and centralization response compared with a land-based supine flexion position for patients with low back pain and signs of nerve root compression. DESIGN Single-blind, repeated-measures crossover design. SETTING Outpatient physical therapy clinic. SUBJECTS Ninety-eight subjects were recruited using consecutive sampling, with 28 men and 32 women of a mean ± standard deviation (SD) age of 59.6 ± 11.6 years completing testing. INTERVENTION Each subject participated in 2 sessions that consisted of loaded walking for 15 minutes, followed by either 15 minutes of land-based supine position or 15 minutes of aquatic vertical traction. MEASUREMENTS Spinal height change, measured using a commercial stadiometer, was determined after completing loaded walking and after each intervention. RESULTS The mean ± SD height change of 4.99 ± 2.88 mm after aquatic vertical traction was similar to that of 4.21 ± 2.53 mm after the land-based supine flexion (P = .0969). Paired t-test indicated that both interventions resulted in significant increased height (P < .0001). Decreases in pain after aquatic intervention (2.7 ± 2.1 cm) were significantly greater than decreases after land intervention (1.7 ± 1.7 cm; P = .0034), and centralization of symptoms was more pronounced after aquatic vertical suspension compared with the supine land-based flexion condition (P < .0001). A significant correlation between height change and both pain reduction (r = 0.39; P = .001) and centralization (r = 0.29; P = .013) was observed for the aquatic intervention only. CONCLUSION Although both the aquatic and land interventions produced significant increases in overall spinal height, the aquatic intervention produced greater pain relief and centralization response in subjects with low back pain and signs of nerve root compression.
Collapse
|
18
|
Kongsted A, Leboeuf-Yde C. The Nordic back pain subpopulation program: can low back pain patterns be predicted from the first consultation with a chiropractor? A longitudinal pilot study. CHIROPRACTIC & OSTEOPATHY 2010; 18:8. [PMID: 20429887 PMCID: PMC2868855 DOI: 10.1186/1746-1340-18-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2010] [Accepted: 04/29/2010] [Indexed: 11/10/2022]
Abstract
BACKGROUND It is widely believed that non-specific low back pain (LBP) consists of a number of subgroups which should be identified in order to improve treatment effects. In order to identify subgroups, patient characteristics that relate to different outcomes are searched for. However, LBP is often fluctuating or recurring rather than clearly limited in time. Therefore it would be relevant to consider outcome after completed treatment from a longitudinal perspective (describing "course patterns") instead of defining it from an arbitrarily selected end-point. AIMS The objectives of this pilot study were to investigate the interobserver reliability of a diagnostic classification system and to evaluate whether diagnostic classes or other baseline characteristics are associated with the LBP course pattern over a period of 18 weeks. METHODS Patients visiting one of 7 chiropractors because of LBP were classified according to a diagnostic classification system, which includes end-range loading, SI-joint pain provocation tests, neurological examination and tests for muscle tenderness and abnormal nerve tension. In addition, age, gender, duration of pain and presence of leg pain were registered in the patient's file. By weekly SMS-messages on their mobile phones, patients were asked how many days they had LBP the preceding week, and these answers were transformed into pain course patterns and the total number of LBP days. RESULTS A total of 110 patients were included and 76 (69%) completed follow-up. Thirty-five patients were examined by two chiropractors. The agreement regarding diagnostic classes was 83% (95% CI: 70 - 96). The diagnostic classes were associated with the pain course patterns and number of LBP days. Patients with disc pain had the highest number of LBP days and patients with muscular pain reported the fewest (35 vs. 12 days, p < 0.01). Men had better outcome than women (17 vs. 29 days, p < 0.01) and patients without leg pain tended to have fewer LBP days than those with leg pain (21 vs.31 days, p = 0.06). Duration of LBP at the first visit was not associated with outcome. CONCLUSIONS The study indicated that there is a clinically meaningful relationship between diagnostic classes and the course of LBP. This should be evaluated in more depth.
Collapse
Affiliation(s)
- Alice Kongsted
- The Nordic Institute of Chiropractic and Clinical Biomechanics, Odense M, Denmark.
| | | |
Collapse
|
19
|
The prognostic value of symptom responses in the conservative management of spinal pain: a systematic review. Spine (Phila Pa 1976) 2009; 34:2686-99. [PMID: 19910773 DOI: 10.1097/brs.0b013e3181b43a41] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Systematic review. OBJECTIVE To investigate the prognostic value of clinically induced changes in spinal symptoms (i.e., symptom response) in the conservative management of spinal pain. SUMMARY OF BACKGROUND DATA Symptom response is used by clinicians to inform management decisions. Understanding the prognostic value of symptom response can aid in this decision-making process. METHODS A search of Ovid-Medline, Ovid-Embase, Ovid-Cinahl, Ovid-Amed, reference lists and citation tracking was performed. Methodologic quality was assessed independently by 2 raters. RESULTS We included 22 articles reporting 18 different cohorts. The evidence was limited and mainly involved low back pain. We found no association between most symptom responses and clinical outcomes. Only for changes in pain location and/or intensity with repeated spinal movement testing or as a response to treatment did the data provide support for use of symptom response to inform management. Further work is needed to confirm these findings. Limited evidence of an association with disability was found for the prone instability test in low back pain patients attending a stabilization program. The evidence for neurodynamic testing was conflicting for low back pain. The strength of identified associations and the extent of confounding between investigated prognostic factors remain uncertain. CONCLUSION Further investigation of symptom responses in spinal pain is needed before their use can be recommended.
Collapse
|
20
|
Zhang YG, Guo TM, Guo X, Wu SX. Clinical diagnosis for discogenic low back pain. Int J Biol Sci 2009; 5:647-58. [PMID: 19847321 PMCID: PMC2764347 DOI: 10.7150/ijbs.5.647] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2009] [Accepted: 10/09/2009] [Indexed: 11/06/2022] Open
Abstract
Discogenic lower back pain (DLBP) is the most common type of chronic lower back pain (LBP), accounting for 39% of cases, compared to 30% of cases due to disc herniation, and even lower prevalence rates for other causes, such as zygapophysial joint pain. Only a small proportion (approximately 20%) of LBP cases can be attributed with reasonable certainty to a pathologic or anatomical entity. Thus, diagnosing the cause of LBP represents the biggest challenge for doctors in this field. In this review, we summarize the process of obtaining a clinical diagnosis of DLBP and discuss the potential for serum-based diagnosis in the near future. The use of serum biomarkers to diagnose DLBP is likely to increase the ease of diagnosis as well as produce more accurate and reproducible results.
Collapse
Affiliation(s)
- Yin-gang Zhang
- Department of Orthopaedics, First Affiliated Hospital, Medical College of Xi'an Jiaotong University, Xi'an 710061, PR China.
| | | | | | | |
Collapse
|
21
|
Berthelot JM, Laslett M. Par quels signes cliniques s’assurer au mieux qu’une douleur est bien d’origine sacro-iliaque (sensu lato) ? ACTA ACUST UNITED AC 2009. [DOI: 10.1016/j.rhum.2009.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
22
|
Hebert J, Koppenhaver S, Fritz J, Parent E. Clinical Prediction for Success of Interventions for Managing Low Back Pain. Clin Sports Med 2008; 27:463-79, ix-x. [DOI: 10.1016/j.csm.2008.03.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
23
|
Centralization: prevalence and effect on treatment outcomes using a standardized operational definition and measurement method. J Orthop Sports Phys Ther 2008; 38:116-25. [PMID: 18383645 DOI: 10.2519/jospt.2008.2596] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Retrospective, observational cohort design. OBJECTIVES Purpose 1 was to determine the association between age, symptom chronicity, and prevalence of centralization in a sample of patients with nonserious cervical or lumbar spinal syndromes referred to a hospital-based outpatient rehabilitation clinic. Purpose 2 was to examine if classifying these patients at intake to centralization or noncentralization predicts functional status, pain intensity, and number of treatment visits at discharge from rehabilitation. Purpose 3 was to compare clinically meaningful changes in functional status and pain intensity between patients subgrouped by centralization and noncentralization. BACKGROUND Variations in operational definitions and measurements used to identify centralization affect patient classification, contribute to variation in reported prevalence rates, and influence treatment strategy and outcome interpretation. Investigating a standardized operational definition and measurement method for centralization may reduce practice and outcomes variation. METHODS AND MEASURES Adults (n=418) with cervical or low back syndromes (mean +/- SD age, 58 +/- 17 years; range, 19-91 years; 33% male; 76% lumbar symptoms; 53% chronic symptoms) were assessed. Therapists classified patients using a standardized operational definition and method for centralization during initial evaluation. Prevalence rates were calculated for centralization by age and acuity. Multivariate models were used to assess discharge functional status, pain intensity, and visits while controlling important variables. Percentage of patients subgrouped by centralization and noncentralization achieving minimal clinically important differences (MCID) in functional status and pain intensity was assessed. RESULTS Overall prevalence rate for centralization was 17%, but increased for patients who were younger and reported acute symptoms regardless of body part. For patients with lumbar syndromes, noncentralization was associated with lower discharge functional status and more pain, but not associated with number of visits compared to patients classified as centralization. For patients with cervical syndromes, noncentralization was associated with more pain but not associated with functional status or number of visits compared to patients classified as centralization. Pain pattern classification affected percentage of patients with lumbar and cervical impairment achieving MCID. CONCLUSION Results supported the clinical use of a standardized definition of centralization to facilitate patient classification and management and interpretation of outcomes.
Collapse
|