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Kanna RM, Prashasth BS, Shetty AP, Rajasekaran S. Foot pressure transfers are altered in lumbar radiculopathy but reversible after surgery: a prospective, Pedobarography study. Spine J 2024:S1529-9430(24)00309-7. [PMID: 38925299 DOI: 10.1016/j.spinee.2024.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 05/02/2024] [Accepted: 05/20/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND CONTEXT Patients with lower lumbar stenosis and disc herniation report disability in standing and ambulation, despite normal neurological examination. The L5 and S1 nerve roots support the entire motor and sensory function of the foot, and their radiculopathy can affect foot loading during standing and walking. This has not been quantified before. PURPOSE To quantify alterations in static and dynamic foot pressure transfers in patients with lower lumbar nerve root compression, and document any beneficial effects of surgical decompression. STUDY DESIGN Prospective, case-control study. PATIENT SAMPLE Cases-Patients with unilateral radiculopathy (L5/S1) with normal neurology (n=50); Controls - Healthy volunteers (n=50). METHODS The volunteers and patients underwent pedobarographic analysis during standing (static) and walking (dynamic), and fifteen (12 dynamic and three static) parameters were documented. The patient's preoperative values were compared with that of the healthy volunteers. All the 50 patients underwent surgical decompression, and clinical outcome measures (VAS/ODI at 3 months) were documented. Pedobarographic analysis was repeated in the postoperative period (48 hours) and 3-month follow-up and compared with the preoperative scores. RESULTS In healthy controls, the mean values of all 15 parameters were comparable between the right and the left side (p>.05). When compared to controls, the patients had significantly lower maximum foot loads (p=.01) and average foot loads (p=.05) on the affected side during walking indicating lesser load transmission, in the preoperative period. Within the affected foot, the load transfer was higher on the first metatarsal/ medial arch while significantly less on the lateral metatarsals (p=.04). The percentage load on whole foot and forefoot was significantly less on standing (p=.01). Significant improvements were noted in the post-operative period, especially in the maximum foot surface area (p=.01), maximum and average foot loads, and improved weight transfers on lateral arch and forefoot (p=.02). The load on whole foot increased significantly from 46.1%±5.5% (preoperative) to 48.1%±5.5% (postoperative) and 49.9%±3.3% at follow-up (p=.01). CONCLUSION This is the first study using Pedobarography to document altered foot pressure patterns during ambulation in patients with disc herniation and stenosis. Decreased load transfer, asymmetrical and unphysiological distribution of pressures on the affected foot were observed during weight bearing, which improved after surgical decompression.
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Affiliation(s)
- Rishi M Kanna
- Department of Orthopaedics and Spine Surgery, Ganga Hospital, Coimbatore, Tamil Nadu, India.
| | - B S Prashasth
- Department of Orthopaedics and Spine Surgery, Ganga Hospital, Coimbatore, Tamil Nadu, India
| | - Ajoy Prasad Shetty
- Department of Orthopaedics and Spine Surgery, Ganga Hospital, Coimbatore, Tamil Nadu, India
| | - S Rajasekaran
- Department of Orthopaedics and Spine Surgery, Ganga Hospital, Coimbatore, Tamil Nadu, India
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Montaner-Cuello A, Bueno-Gracia E, Rodríguez-Mena D, Estébanez-de-Miguel E, Malo-Urriés M, Ciuffreda G, Caudevilla-Polo S. Is the Straight Leg Raise Suitable for the Diagnosis of Radiculopathy? Analysis of Diagnostic Accuracy in a Phase III Study. Healthcare (Basel) 2023; 11:3138. [PMID: 38132028 PMCID: PMC10742430 DOI: 10.3390/healthcare11243138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 12/04/2023] [Accepted: 12/07/2023] [Indexed: 12/23/2023] Open
Abstract
The straight leg raise test (SLR) has been proposed to detect increased nerve mechanosensitivity of the lower limbs in individuals with low back pain. However, its validity in the diagnosis of lumbosacral radiculopathy shows very variable results. The aim of this study was to analyse the diagnostic validity of the SLR including well-defined diagnostic criteria (a change in symptoms with the structural differentiation manoeuvre and the reproduction of the patient's symptoms during the test or the asymmetries in the range of motion or symptoms location between limbs) in a sample of participants in phase III with suspicion of lumbar radiculopathy using the electrodiagnostic studies (EDX) as the reference standard. A phase III diagnostic accuracy study was designed. In total, 142 individuals with suspected lumbosacral radiculopathy referred for EDX participated in the study. Each participant was tested with EDX and SLR. SLR was considered positive using three diagnostic criteria. The sensitivity of the SLR for Criterion 3 was 89.02% (CI 81.65-96.40), the specificity was 25.00% (CI 13.21-36.79), and the positive and negative likelihood ratios were 1.19 (CI 1.01-1.40) and 0.44 (0.21-0.94), respectively. SLR showed limited validity in the diagnosis of lumbosacral radiculopathy. The incorporation of more objective diagnostic criteria (asymmetry in range of motion or localisation of symptoms) improved the diagnostic validity but the imprecision of the confidence intervals limited the interpretation of the results.
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Affiliation(s)
| | - Elena Bueno-Gracia
- Physiatry and Nursery Department, Health Sciences Faculty, University of Zaragoza, 50009 Zaragoza, Spain; (A.M.-C.); (D.R.-M.); (E.E.-d.-M.); (M.M.-U.); (G.C.); (S.C.-P.)
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Wang H, Wang Y, Li Y, Wang C, Qie S. A diagnostic model of nerve root compression localization in lower lumbar disc herniation based on random forest algorithm and surface electromyography. Front Hum Neurosci 2023; 17:1176001. [PMID: 37469999 PMCID: PMC10353737 DOI: 10.3389/fnhum.2023.1176001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 06/19/2023] [Indexed: 07/21/2023] Open
Abstract
Objective This study aimed to investigate the muscle activation of patients with lumbar disc herniation (LDH) during walking by surface electromyography (SEMG) and establish a diagnostic model based on SEMG parameters using random forest (RF) algorithm for localization diagnosis of compressed nerve root in LDH patients. Methods Fifty-eight patients with LDH and thirty healthy subjects were recruited. The SEMG of tibialis anterior (TA) and lateral gastrocnemius (LG) were collected bilaterally during walking. The peak root mean square (RMS-peak), RMS-peak time, mean power frequency (MPF), and median frequency (MF) were analyzed. A diagnostic model based on SEMG parameters using RF algorithm was established to locate compressed nerve root, and repeated reservation experiments were conducted for verification. The study evaluated the diagnostic efficiency of the model using accuracy, precision, recall rate, F1-score, Kappa value, and area under the receiver operating characteristic (ROC) curve. Results The results showed that delayed activation of TA and decreased activation of LG were observed in the L5 group, while decreased activation of LG and earlier activation of LG were observed in the S1 group. The RF model based on eight SEMG parameters showed an average accuracy of 84%, with an area under the ROC curve of 0.93. The RMS peak time of TA was identified as the most important SEMG parameter. Conclusion These findings suggest that the RF model can assist in the localization diagnosis of compressed nerve roots in LDH patients, and the SEMG parameters can provide further references for optimizing the diagnosis model in the future.
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Liu H, Li P, Yu D, Ma Z, An Y, Li S, Cai L. Analysis of the Nursing Effect of Anesthesia Care Integration Combined with Preventive Nursing on Older Patients with Lumbar Disc Herniation During the Perioperative Period. Risk Manag Healthc Policy 2023; 16:1001-1009. [PMID: 37323191 PMCID: PMC10263014 DOI: 10.2147/rmhp.s411885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 05/17/2023] [Indexed: 06/17/2023] Open
Abstract
Objective This study explored the nursing effect of anesthesia care integration combined with preventive nursing on older patients with perioperative lumbar disc herniation (LDH). Methods Clinical data of 100 older patients with LDH who were admitted to our hospital between May 2017 and May 2022 were used, and there were no patients who had not had surgery between January and May 2020 because of the COVID-19 pandemic. Based on the different nursing methods, the patients were divided into control and observation groups, with 50 cases each. The control group received anesthesia care integration, whereas the observation group received anesthesia care integration combined with preventive nursing. Lumbar spine function, pain score, anesthesia recovery assessment, and nursing effects were compared between the two groups. Results The scores of the anesthesia recovery assessment of the two groups were compared, and the vital signs of the observation group during recovery from anesthesia were significantly better than those of the control group (P<0.05). After nursing care, the Japanese Orthopaedic Association (JOA) score of the observation group was significantly higher than that of the control group; however, the numerical scale (NRS) score of the observation group was significantly lower than that of the control group (P<0.05). After nursing care, the physical comfort, emotional state, psychological support, self-care ability, and pain scores were higher in the observation group than in the control group; however, the NRS score of the observation group was significantly lower than that of the control group (P<0.05). Conclusion Anesthesia care integration combined with preventive nursing has a positive effect on older patients with perioperative LDH, and it significantly improves lumbar spine function, reduces pain, shortens recovery time, and benefits physical and mental health.
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Affiliation(s)
- Honghong Liu
- Department of Anesthesiology, Wuhan Fourth Hospital, Wuhan, 430033, People’s Republic of China
| | - Peng Li
- Department of Anesthesiology, Wuhan Fourth Hospital, Wuhan, 430033, People’s Republic of China
| | - Dan Yu
- Department of Anesthesiology, Wuhan Fourth Hospital, Wuhan, 430033, People’s Republic of China
| | - Zhongxi Ma
- Department of Spine Surgery, Wuhan Fourth Hospital, Wuhan, 430033, People’s Republic of China
| | - Yu An
- Department of Anesthesiology, Wuhan Fourth Hospital, Wuhan, 430033, People’s Republic of China
| | - Si Li
- Department of Anesthesiology, Wuhan Fourth Hospital, Wuhan, 430033, People’s Republic of China
| | - Lin Cai
- Department of Anesthesiology, Wuhan Fourth Hospital, Wuhan, 430033, People’s Republic of China
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Mathieu J, Pasquier M, Descarreaux M, Marchand AA. Diagnosis Value of Patient Evaluation Components Applicable in Primary Care Settings for the Diagnosis of Low Back Pain: A Scoping Review of Systematic Reviews. J Clin Med 2023; 12:jcm12103581. [PMID: 37240687 DOI: 10.3390/jcm12103581] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 05/16/2023] [Accepted: 05/20/2023] [Indexed: 05/28/2023] Open
Abstract
Low back pain ranks as the leading cause of years lived with disability worldwide. Although best practice guidelines share a consistent diagnostic approach for the evaluation of patients with low back pain, confusion remains as to what extent patient history and physical examination findings can inform management strategies. The aim of this study was to summarize evidence investigating the diagnostic value of patient evaluation components applicable in primary care settings for the diagnosis of low back pain. To this end, peer-reviewed systematic reviews were searched in MEDLINE, CINAHL, PsycINFO and Cochrane databases from 1 January 2000 to 10 April 2023. Paired reviewers independently reviewed all citations and articles using a two-phase screening process and independently extracted the data. Of the 2077 articles identified, 27 met the inclusion criteria, focusing on the diagnosis of lumbar spinal stenosis, radicular syndrome, non- specific low back pain and specific low back pain. Most patient evaluation components lack diagnostic accuracy for the diagnosis of low back pain when considered in isolation. Further research is needed to develop evidence-based and standardized evaluation procedures, especially for primary care settings where evidence is still scarce.
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Affiliation(s)
- Janny Mathieu
- Department of Anatomy, Université du Québec à Trois-Rivières, 3351, Boul. des Forges, C.P. 500, Trois-Rivieres, QC G8Z 4M3, Canada
| | - Mégane Pasquier
- Institut Franco-Européen de Chiropraxie, 72 Chemin de la Flambère, 31300 Toulouse, France
| | - Martin Descarreaux
- Department of Human Kinetics, Université du Québec à Trois-Rivières, 3351, Boul. des Forges, C.P. 500, Trois-Rivières, QC G8Z 4M3, Canada
| | - Andrée-Anne Marchand
- Department of Chiropractic, Université du Québec à Trois-Rivières, 3351, Boul. des Forges, C.P. 500, Trois-Rivières, QC G8Z 4M3, Canada
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Joseph AM, Karas M, Joubran E, Jara Silva CE, Cordova S, Sinha M, Salam A, Leyva MM, Quinonez J, Ruxmohan S. Recent Advancements in Epidural Etanercept for Pain Management in Radiculopathy: A Literature Review. Cureus 2023; 15:e37672. [PMID: 37206531 PMCID: PMC10191459 DOI: 10.7759/cureus.37672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 04/16/2023] [Indexed: 05/21/2023] Open
Abstract
The most common etiology of low back and neck pain is associated with spinal cord pathologies. Regardless of origin, low back and neck pain are some of the most common causes of disability worldwide. Mechanical compression due to spinal cord diseases, such as degenerative disc disorders, can lead to radiculopathy, which manifests as numbness or tingling and can progress to loss of muscle function. Conservative management, such as physical therapy, has not been proven effective in treating radiculopathy, and surgical treatments have more risks than benefits for most patients. Epidural disease-modifying medications, such as Etanercept, have been recently explored due to their minimal invasiveness and direct effects on inhibiting tumor necrosis factor-α (TNF-α). Therefore, this literature review aims to evaluate epidural Etanercept's effect on radiculopathy caused by degenerative disc diseases. Epidural Etanercept has been shown to improve radiculopathy in patients with lumbar disc degeneration, spinal stenosis, and sciatica. Further research is needed to compare the effectiveness of Etanercept with commonly used treatments such as steroids and analgesia.
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Affiliation(s)
- Andrew M Joseph
- Department of Osteopathic Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Davie, USA
| | - Monica Karas
- Department of Osteopathic Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Davie, USA
| | - Ernesto Joubran
- Department of Osteopathic Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
| | - Cesar E Jara Silva
- Department of Osteopathic Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
| | - Steven Cordova
- Department of Neurology, Larkin Community Hospital, South Miami, USA
- College of Medicine, St. Matthew's University School of Medicine, Grand Cayman, CYM
| | - Mehul Sinha
- Department of Medicine, International Society for Chronic Illnesses, Vadodara, IND
- Department of Surgery, Kasturba Medical College, Mangalore, IND
| | - Abdus Salam
- Department of General Surgery, Khyber Teaching Hospital, Peshawar, PAK
| | - Melissa M Leyva
- Department of Osteopathic Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
| | - Jonathan Quinonez
- Department of Neurology/Osteopathic Neuromuscular Medicine, Larkin Community Hospital, Miami, USA
| | - Samir Ruxmohan
- Division of Neurocritical Care, UT Southwestern Medical Center, Dallas, USA
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Multi-echo in steady-state acquisition improves MRI image quality and lumbosacral radiculopathy diagnosis efficacy compared with T2 fast spin-echo sequence. Neuroradiology 2023; 65:969-977. [PMID: 36862186 DOI: 10.1007/s00234-023-03130-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 02/05/2023] [Indexed: 03/03/2023]
Abstract
PURPOSE This study compares the performance of a 4-min multi-echo in steady-state acquisition (MENSA) with a 6-min fast spin echo with variable flip angle (CUBE) protocol for the assessment of lumbosacral plexus nerve root lesions. METHODS Seventy-two subjects underwent MENSA and CUBE sequences on a 3.0-T MRI scanner. Two musculoskeletal radiologists independently assessed the images for quality and diagnostic capability. A qualitative assessment scoring system for image quality and quantitative nerve signal-to-noise ratio (SNR) and iliac vein and muscle contrast-to-noise ratios (CNR) was applied. Using surgical reports as the reference, sensitivity, specificity, accuracy, and area under the receiver operating characteristic curves (AUC) were evaluated. Intraclass correlation coefficients (ICC) and weighted kappa were used to calculate reliability. RESULTS MENSA image quality rating (3.679 ± 0.47) was higher than for CUBE images (3.038 ± 0.68), and MENSA showed higher mean nerve root SNR (36.935 ± 8.33 vs. 27.777 ± 7.41), iliac vein CNR (24.678 ± 6.63 vs. 5.210 ± 3.93), and muscle CNR (19.414 ± 6.07 vs. 13.531 ± 0.65) than CUBE (P < 0.05). Weighted kappa and ICC values indicated good reliability. Sensitivity, specificity, and accuracy of diagnosis based on MENSA images were 96.23%, 89.47%, and 94.44%, respectively, and AUC was 0.929, compared with 92.45%, 84.21%, 90.28%, and 0.883 for CUBE images. The two correlated ROC curves were not significantly different. Weighted kappa values for intraobserver (0.758) and interobserver (0.768-0.818) reliability were substantial to perfect. CONCLUSION A time-efficient 4-min MENSA protocol exhibits superior image quality and high vascular contrast with the potential to produce high-resolution lumbosacral nerve root images.
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Zale C, Mitsunaga K. Accuracy of Dermatomes in the Localization of Lumbar Disc Herniations for Pre-operative Planning: A Systematic Review. INTERDISCIPLINARY NEUROSURGERY 2023. [DOI: 10.1016/j.inat.2023.101728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
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Kaito T, Yamato Y. The Essence of Clinical Practice Guidelines for Lumbar Disc Herniation, 2021: 3. Diagnosis. Spine Surg Relat Res 2022; 6:325-328. [PMID: 36051681 PMCID: PMC9381081 DOI: 10.22603/ssrr.2022-0044] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 03/12/2022] [Indexed: 11/17/2022] Open
Affiliation(s)
- Takashi Kaito
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine
| | - Yu Yamato
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine
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Skorupska E, Dybek T, Rychlik M, Jokiel M, Zawadziński J, Dobrakowski P. Amplified Vasodilatation within the Referred Pain Zone of Trigger Points Is Characteristic of Gluteal Syndrome-A Type of Nociplastic Pain Mimicking Sciatica. J Clin Med 2021; 10:jcm10215146. [PMID: 34768666 PMCID: PMC8584656 DOI: 10.3390/jcm10215146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 10/20/2021] [Accepted: 10/26/2021] [Indexed: 11/16/2022] Open
Abstract
Gluteal syndrome (GS) mimicking sciatica is a new disease that has been recently recognized and included in the International Classification of Diseases, 11th Revision. The present study examines nociplastic pain involvement in GS and sciatica patients using a new Skorupska protocol (SP) test that provokes amplified vasodilatation in the area of expected muscle-referred pain. A positive test is confirmed if there is (i) a development of autonomic referred pain (AURP) and (ii) an increase in the delta of average temperature (Δ₸°) > 0.3 °C at the end of the stimulation and during the observation SP phases. Chronic GS (n = 20) and sciatica (n = 30) patients were examined. The SP test confirmed muscle-referred pain for (i) all GS patients with 90.6% positive thermograms (Δ₸° 0.6 ± 0.8 °C; maximum AURP 8.9 ± 13.6% (both p < 0.05)) and (ii) those sciatica (n = 8) patients who reported pain sensation during the test with 20.6% positive thermograms (Δ₸° 0.7 ± 0.7 °C; maximum AURP 15.1 ± 17.8% (both p < 0.05)). The remaining sciatica (n = 22) patients did not report pain during the test and presented a Δ₸° decrease and the AURP size below 1%. Conclusion: Amplified vasodilatation suggesting nociplastic pain involvement was confirmed for all GS and sciatica patients who reported painful sensations in the zone typical for gluteus minimus referred pain during the test.
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Affiliation(s)
- Elzbieta Skorupska
- Department of Physiotherapy, Poznan University of Medical Sciences, 61-701 Poznan, Poland; (M.J.); (J.Z.)
- Faculty of Physical Education and Physiotherapy, Opole University of Technology, 45-758 Opole, Poland;
- Correspondence:
| | - Tomasz Dybek
- Faculty of Physical Education and Physiotherapy, Opole University of Technology, 45-758 Opole, Poland;
| | - Michał Rychlik
- Department of Virtual Engineering, Poznan University of Technology, 60-965 Poznan, Poland;
| | - Marta Jokiel
- Department of Physiotherapy, Poznan University of Medical Sciences, 61-701 Poznan, Poland; (M.J.); (J.Z.)
- Department of Traumatology, Orthopedics and Hand Surgery, Poznan University of Medical Sciences, 60-761 Poznan, Poland
| | - Jarosław Zawadziński
- Department of Physiotherapy, Poznan University of Medical Sciences, 61-701 Poznan, Poland; (M.J.); (J.Z.)
| | - Paweł Dobrakowski
- Psychology Institute, Humanitas University in Sosnowiec, 41-200 Sosnowiec, Poland;
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Asada T, Koda M, Funayama T, Takahashi H, Noguchi H, Miura K, Mataki K, Yamazaki M. Imaging-Based Diagnosis of Epiconus Syndrome From the Distance of the Lesion to Where the Spinal Cord Terminates Not From the Disc Level: A Case Series. Cureus 2021; 13:e17708. [PMID: 34650882 PMCID: PMC8489802 DOI: 10.7759/cureus.17708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2021] [Indexed: 11/05/2022] Open
Abstract
Objective This study aimed to analyze the neurological symptoms caused by thoracolumbar lesions according to their distance from where the spinal cord terminates for a better description of epiconus syndrome. Methods We retrospectively reviewed cases of patients with neurological symptoms caused by a thoracolumbar lesion in a single institute. Neurological symptoms were analyzed according to the distance from the proximal end of the lesion to where the spinal cord terminates using MRI or CT myelograms. The symptoms were classified into epiconus syndrome, thoracic myelopathy, and conus medullaris syndrome. The distance was described regarding the length of a vertebral body (VB). Results We included 19 patients in this series. The spinal cord terminates were at the lower third of the L1 vertebra most frequently (32%) in the range of T12 to L2 vertebra. The border between thoracic myelopathy and epiconus syndrome was 2VB proximal from where the spinal cord terminates, and that between epiconus syndrome and conus medullaris syndrome was 1VB. Mean disease duration until symptoms changed was 2.4 months in epiconus syndrome, while it was 25 months in thoracic myelopathy, and 10.3 months in conus medullaris syndrome. Conclusion Epiconus syndrome is caused by lesion 1-2VB proximal to where the spinal cord terminates. This study may provide further helpful information for clinical practice in the treatment of epiconus syndrome.
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Affiliation(s)
- Tomoyuki Asada
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, JPN
| | - Masao Koda
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, JPN
| | - Toru Funayama
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, JPN
| | - Hiroshi Takahashi
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, JPN
| | - Hiroshi Noguchi
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, JPN
| | - Kousei Miura
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, JPN
| | - Kentaro Mataki
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, JPN
| | - Masashi Yamazaki
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, JPN
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Mourad F, Lopez G, Cataldi F, Maselli F, Pellicciari L, Salomon M, Kranenburg H, Kerry R, Taylor A, Hutting N. Assessing Cranial Nerves in Physical Therapy Practice: Findings from a Cross-Sectional Survey and Implication for Clinical Practice. Healthcare (Basel) 2021; 9:1262. [PMID: 34682942 PMCID: PMC8535196 DOI: 10.3390/healthcare9101262] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 09/14/2021] [Accepted: 09/17/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Serious pathologies of the neck can potentially result in cranial nerve palsy. Knowledge about cranial nerve examination (CNE) seems sparse, and its use is still unknown. We aim to investigate the knowledge, skills, and utilization of CNE of Italian physiotherapists. MATERIALS AND METHODS An online cross-sectional survey. RESULTS 396 completed the survey, reaching the required sample size. Although Italian physiotherapists consider CNE relevant (mean ± SD = 7.6/10 ± 2.0), over half of all responders (n = 229 (57.8%)) were not trained in the fundamentals and around a third did not use it in their daily practice (n = 138 (34.8%)). Additionally, participants were unconfident and insecure in conducting (n = 152 (38.4%) and n = 147 (37.1%)), interpreting (n = 140 (35.4%) and n = 164 (41.4%)), and managing the CNE (n = 141 (35.6%) and n = 154 (38.9%)). Possessing a musculoskeletal specialization was associated with an increased value attributed to clinical practice guidelines and reduced the lack of confidence in conducting, interpreting, and managing the CNE (respectively, n = 35 (25.5%), p = 0.0001; n = 32 (23.4%) p = 0.0002; n = 32 (23.4%) p = 0.0002). Working in a direct access setting significantly increased the considered relevance of guidelines and the concerns about arterial (p = 0.004) and other serious pathologies (p = 0.021). Pain and visual disturbances were considered the main indicators to CNE, demonstrating limited knowledge of signs and symptoms' indicating CNE. Participants considered specific training in CNE as relevant (mean ± SD = 7.6/10 = 2.1). CONCLUSIONS a substantial proportion of Italian physiotherapists are not schooled in the fundamentals of cranial nerve examination. Given the number of physiotherapists who work in first contact roles, this is a professional concern.
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Affiliation(s)
- Firas Mourad
- Department of Physiotherapy, LUNEX International University of Health, Exercise and Sports, 4671 Differdange, Luxembourg;
- Luxembourg Health & Sport Sciences Research Institute A.s.b.l., 50, Avenue du Parc des Sports, 4671 Differdange, Luxembourg
- Department of Clinical Science and Translation Medicine, Faculty of Medicine and Surgery, University of Rome Tor Vergata, 00133 Roma, Italy; (G.L.); (F.C.); (M.S.)
| | - Giovanni Lopez
- Department of Clinical Science and Translation Medicine, Faculty of Medicine and Surgery, University of Rome Tor Vergata, 00133 Roma, Italy; (G.L.); (F.C.); (M.S.)
- Department of Physiotherapy, Kinesis, 70126 Bari, Italy
| | - Fabio Cataldi
- Department of Clinical Science and Translation Medicine, Faculty of Medicine and Surgery, University of Rome Tor Vergata, 00133 Roma, Italy; (G.L.); (F.C.); (M.S.)
- Department of Physiotherapy, Manual Therapy Laboratory—MTLab, 70123 Bari, Italy
| | - Filippo Maselli
- Sovrintendenza Sanitaria Regionale Puglia INAIL, 70126 Bari, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal Infantile Sciences (DINOGMI), Campus of Savona, University of Genova, 16132 Savona, Italy
| | | | - Mattia Salomon
- Department of Clinical Science and Translation Medicine, Faculty of Medicine and Surgery, University of Rome Tor Vergata, 00133 Roma, Italy; (G.L.); (F.C.); (M.S.)
- Department of Physical Therapy, Centro Diagnostico e Polispecialistico CST S.r.l., 38121 Trento, Italy
| | - Hendrikus Kranenburg
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, 9714 CE Groningen, The Netherlands;
| | - Roger Kerry
- Division of Physiotherapy and Sport Rehabilitation, School of Health Sciences, Faculty of Medicine and Health Sciences, Nottingham University, Nottingham NG5 1PB, UK; (R.K.); (A.T.)
| | - Alan Taylor
- Division of Physiotherapy and Sport Rehabilitation, School of Health Sciences, Faculty of Medicine and Health Sciences, Nottingham University, Nottingham NG5 1PB, UK; (R.K.); (A.T.)
| | - Nathan Hutting
- Department of Occupation and Health, School of Organisation and Development, HAN University of Applied Sciences, 6503 GL Nijmegen, The Netherlands;
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Isolated Lumbar Extension Resistance Exercise in Limited Range of Motion for Patients with Lumbar Radiculopathy and Disk Herniation-Clinical Outcome and Influencing Factors. J Clin Med 2021; 10:jcm10112430. [PMID: 34070780 PMCID: PMC8198576 DOI: 10.3390/jcm10112430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 05/25/2021] [Accepted: 05/26/2021] [Indexed: 01/01/2023] Open
Abstract
(1) Background: Reconditioning of the paraspinal lumbar extensor muscles by isolated lumbar extension resistance exercises (ILEX) has shown good clinical results for patients with chronic unspecific low back pain. However, the clinical value and safety for patients with specific spine pathologies is unclear. In this study, clinical outcome and influencing factors were retrospectively analyzed for patients with lumbar disk herniation (LDH) and radiculopathy. (2) Methods: 189 consecutive patients (123 men and 66 women; mean age, 36 years) with clinically diagnosed LDH and relative indications for surgery started a 9-week rehabilitation program (2x/week) including ILEX in limited range of motion (ROM) adjusted to patients’ symptoms. Patients diagnosed with advanced levels of spine degeneration were excluded. Pain/radiculopathy (PR), influence on mental health (IOMH), satisfaction rates were measured via Numeric Rating Scales (NRS, 0–10), and overall clinical outcome was stated in % (100% = full recovery). Isometric extension strength was tested before and after the program. (3) Results: 168 patients (88.9%) completed the program. For 162 out of 168 patients (96.4%) there was a significant reduction of clinical symptoms, whereas 6 patients reported no changes in symptoms. Scores (mean) for symptom intensity decreased from 4.2 (±1.5) to 1.9 (±1.5) (p < 0.001), the impact on mental health decreased from 5.9 (±2.3) to 2.4 (±2.0) (p < 0.001). There was a (weak) correlation between lower scores for PR and IOMH before the study and better clinical outcomes; PR also weakly correlated with satisfaction. Other factors such as age, strength increase, level/location and number of LDH did not have a significant impact on the clinical results. (4) Conclusion: The results indicate that ILEX in limited ROM can be an effective treatment for the majority of patients with LDH. For patients with high pain levels, the results are less consistent, and surgery may be considered.
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Kuligowski T, Dȩbiec-Ba K A, Skrzek A. Mobilisation efficacy in young patients with different stages of degenerative disc disease. J Back Musculoskelet Rehabil 2021; 33:913-918. [PMID: 32568172 DOI: 10.3233/bmr-181219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Lumbar vertebrae carry the greatest load from the spinal column, often leading to several pathologies, including degenerative disc disease (DDD), potentially disturbing spinal movement patterns. Mobilisation increases hypomobile segment mobility, however there is little evidence on mobilisation in patients suffering from different types of DDD. OBJECTIVE To assess the efficacy of mobilisation in young patients with DDD, as diagnosed by MRI. METHODS Thirty patients (24-35 years) participated in this study, and were divided into two groups, based on progression levels of DDD diagnosed by MRI (protrusion-PRO/extrusion-EXT). Twenty sessions of sustained stretch mobilisation (grade III) were applied to both groups over four weeks. Numeric Rating Scale (NRS), Oswestry Disability Index (ODI), straight leg raise (SLR), passive lumbar extension (PLE) and lumbar range of motion (ROM) assessed outcome variables. Three trial stages were investigated: pre-therapy (1), post-therapy (2) and follow-up (3). RESULTS Age (p= 0.007) and NRS (p= 0.002) were significantly different before therapy. Patient outcomes were significantly improved for all parameters in both groups, except SLR which improved in the EXT group only (p= 0.043). CONCLUSIONS Applied treatments improved patient outcomes and were statistically significant in both groups, however, better outcomes were observed in the EXT group during follow-up. Mobilisation was a safe and effective procedure for the treatment of DDD.
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Differential diagnosis of endometriosis in patient with nonspecific low back pain: A case report. J Bodyw Mov Ther 2021; 27:227-232. [PMID: 34391238 DOI: 10.1016/j.jbmt.2021.02.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 02/23/2021] [Accepted: 02/28/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Endometriosis is one of the most widespread gynecological disorders and a very common condition amongst fertile women, thus it has to be considered one of the possible sources of lumbopelvic pain. Endometriosis is commonly related to low back pain (LBP) and therefore often mistaken for a musculoskeletal disorder. The purpose of this case report is to underline the primary role of clinical reasoning and assessment process, which led the physiotherapist to the differential diagnosis, considering endometriosis among the possible causes of low back pain. CASE PRESENTATION S.C, 45 years old, complained to physiotherapist of lumbar spine and left buttock pain, spreading to the hypogastric, inguinal and left pubic areas. The patient's past medical history included gynecological visceral disorders, regularly monitored. Functional evaluation and clinical tests revealed a disorder referred to the lumbar spine and sacroiliac region. Initial physical therapy management included education, manual therapy and therapeutic exercise. Nevertheless, after five treatment sessions, the symptoms remained unchanged, and therefore the patient was referred to a gynecologist for a consultation. The patient underwent a laparoscopy for endometriosis eradication and the intervention resulted in complete abolition of symptoms, enabling the patient to return to work and to do physical activities. CONCLUSIONS this case report highlights the importance of a thorough clinical assessment and the identification of relevant findings from patient's medical history to be carried out by the physiotherapist. Those are of crucial importance to make an appropriate differential diagnosis and to screen amongst the possible causes of lumbopelvic pain also visceral ones as endometriosis, which often manifests with associated symptoms such as nonspecific LBP.
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16
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Qie S, Li W, Li X, Chen X, Gong W, Xi J, Sun F, Yue S. Electromyography activities in patients with lower lumbar disc herniation. J Back Musculoskelet Rehabil 2020; 33:589-596. [PMID: 31658036 PMCID: PMC7458508 DOI: 10.3233/bmr-181308] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Lumbar disc herniation (LDH) can affect lower limb muscle function resulting in an abnormal gait. This study aims to use surface electromyography (SEMG) to evaluate patients with L4/L5 and L5/S1 LDH throughout muscle movement. METHODS Twenty L4/L5 LDH patients (L5 Group), twenty L5/S1 LDH patients (S1 Group), and twenty healthy controls (Healthy) were recruited for the study. SEMG of bilateral tibialis anterior (TA) and lateral gastrocnemius (LG) muscles of patients were recorded using the DELSYS Wireless EMG System (TrignoTM Wireless Systems, Delsys Inc., USA). Root-mean-square (RMS), mean power frequency (MPF), and median frequency (MF) were compared between bilateral limbs in each participant. RESULTS Reduced MPF and MF was found in TA measurements of the L5 Group and LG measurements of the S1 Group. The MPF and MF of the TA of symptomatic limbs of the L5 Group were reduced when compared to asymptomatic limbs (p= 0.006, p= 0.012, p< 0.05), and there were no significant differences in LG measurements (p> 0.05). The LG MPF and MF of the S1 Group in symptomatic limbs were reduced when compared to asymptomatic limbs (p= 0.006, p= 0.017, p< 0.05), and there were no significant differences in TA measurements (p> 0.05). Although there were no significant differences in RMS between bilateral limbs of the L5 and S1 Groups, we found some changes in RMS curves. First, compared to asymptomatic limbs of L4/L5LDH patients, β-peaks in the TA of symptomatic limbs appeared earlier. Second, two peaks in the LG of symptomatic limbs were found in L5/S1 LDH patients. CONCLUSION TA is affected in patients with LDH of L4/L5, and LG is affected in patients with LDH of L5/S1. As demonstrated, SEMG can identify LDH-related muscle dysfunction.
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Affiliation(s)
- Shuyan Qie
- Department of Physical Medicine and Rehabilitation, Qilu Hospital of Shandong University, Jinan, China
| | - Wei Li
- Department of Physical Medicine and Rehabilitation, Qilu Hospital of Shandong University, Jinan, China,Department of Rehabilitation, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Xiangrong Li
- Department of Respiratory Medicine, School Hospital of Peking University, Haidian District, Beijing, China
| | - Xuemei Chen
- Department of Health Management, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Weijun Gong
- Department of Neurological Rehabilitation, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Jianing Xi
- Department of Neurological Rehabilitation, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Fenglong Sun
- Department of Orthopedics, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Shouwei Yue
- Department of Physical Medicine and Rehabilitation, Qilu Hospital of Shandong University, Jinan, China,Corresponding author: Shouwei Yue, Department of Physical Medicine and Rehabilitation, Qilu Hospital of Shandong University, Jinan, Shandong, China. Tel.: +86 531 81309107; E-mail:
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Li S, Yi D, Luo Q, Jia D. Combination of Gluteal Trigger Points Dry Needling and Percutaneous Endoscopic Lumbar Discectomy for Complex Low Back-Related Leg Pain. J Pain Res 2020; 13:3125-3129. [PMID: 33262646 PMCID: PMC7700084 DOI: 10.2147/jpr.s279592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 10/23/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose Causes of low back-related leg pain (LBLP) can be complex and diverse. A detailed medical history, physical examination, laboratory tests, and imaging are necessary to accurately distinguish the pathomechanisms of LBLP and determine the most appropriate treatment. Case In this study, we report the first documented case in which the combination of dry needling (DN) and percutaneous endoscopic lumbar discectomy (PELD) was used for a patient with active myofascial trigger points (MTrPs) in the gluteus minimus muscle as well as L3-4 lumbar disc herniation (LDH). This 63-year-old woman complained of LBLP for 3 months. After careful examination and analysis, we determined this pain originated from two active MTrPs in the gluteal region and not LDH in L3-4. We first performed MTrPs DN, and the patient's LBLP was relieved completely. We then performed PELD at the L3-4 level for residual numbness on the medial and anterior aspect of the left lower limb. Finally, the patient received a satisfactory result. Conclusion The gluteal MTrPs test may be used as a routine examination for patients with LBLP, especially when clinical findings are discordant with imaging results.
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Affiliation(s)
- Shuiqing Li
- Department of Pain Medicine, Peking University Third Hospital, Beijing 100191, People's Republic of China
| | - Duan Yi
- Department of Pain Medicine, Peking University Third Hospital, Beijing 100191, People's Republic of China
| | - Qipeng Luo
- Department of Pain Medicine, Peking University Third Hospital, Beijing 100191, People's Republic of China
| | - Donglin Jia
- Department of Pain Medicine, Peking University Third Hospital, Beijing 100191, People's Republic of China
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18
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Šušteršič T, Milovanović V, Ranković V, Filipović N. A comparison of classifiers in biomedical signal processing as a decision support system in disc hernia diagnosis. Comput Biol Med 2020; 125:103978. [PMID: 32861048 DOI: 10.1016/j.compbiomed.2020.103978] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 08/15/2020] [Accepted: 08/16/2020] [Indexed: 11/17/2022]
Abstract
The aim of this research was to investigate the best methodology for disc hernia diagnosis using foot force measurements from the designed platform. Based on the subjective neurological examination that examines muscle weakness on the nerve endings of the skin area on feet and concludes about origins of nerve roots between spine discs, a platform for objective recordings of the aforementioned muscle weakness has been designed. The dataset included 33 patients with pre-diagnosed L4/L5 and L5/S1 disc hernia on the left or the right side, confirmed with the MRI scanning and neurological exam. We have implemented 5 different classifiers that were found to be the most suitable for smaller dataset and investigated the accuracy of classification depending on the normalization method, linearity/non-linearity of the algorithm, and dataset splitting variation (32-1, 31-2, 30-3, 29-4 patients for training and testing, respectively). The classifier is able to distinguish between four different diagnoses L4/L5 on the left side, L4/L5 on the right side, L5/S1 on the left side and L5/S1 on the right side, as well as to recognize healthy subjects (without disc herniation). The results show that non-linear algorithms achieved better accuracy in comparison to tested linear classifiers, suggesting the expected non-linear connection between the foot force values and the level of disc herniation. Two algorithms with highest accuracy turned out to be Decision Tree and Naïve Bayes, depending on the normalization method. The system is also able to record and recognize improvements in muscle weakness after surgical operation and physical therapy.
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Affiliation(s)
- Tijana Šušteršič
- Faculty of Engineering, University of Kragujevac, Sestre Janjić 6, 34000, Kragujevac, Serbia; Bioengineering Research and Development Center (BioIRC), Prvoslava Stojanovića 6, 34000, Kragujevac, Serbia.
| | - Vladimir Milovanović
- Faculty of Engineering, University of Kragujevac, Sestre Janjić 6, 34000, Kragujevac, Serbia.
| | - Vesna Ranković
- Faculty of Engineering, University of Kragujevac, Sestre Janjić 6, 34000, Kragujevac, Serbia.
| | - Nenad Filipović
- Faculty of Engineering, University of Kragujevac, Sestre Janjić 6, 34000, Kragujevac, Serbia; Bioengineering Research and Development Center (BioIRC), Prvoslava Stojanovića 6, 34000, Kragujevac, Serbia.
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Samolsky Dekel BG, Sorella MC, Vasarri A, Melotti RM. Reply to the Letter "Regarding Samolsky Dekel et al. Reliability of the Buttock Applied Strain Test to Diagnose Radicular Pain in Patients With Low Back Pain". Pain Pract 2020; 20:951-952. [PMID: 32677268 DOI: 10.1111/papr.12941] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 07/10/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Boaz Gedaliahu Samolsky Dekel
- Department of Medicine and Surgery Sciences, University of Bologna, Bologna, Italy.,Anesthesia and Pain Therapy Unit, Azienda Ospedaliera-Universitaria di Bologna Policlinico S. Orsola-Malpighi, Bologna, Italy.,Post Graduate School of Anaesthesia and Intensive Care, University of Bologna, Bologna, Italy
| | - Maria Cristina Sorella
- Department of Medicine and Surgery Sciences, University of Bologna, Bologna, Italy.,Anesthesia and Pain Therapy Unit, Azienda Ospedaliera-Universitaria di Bologna Policlinico S. Orsola-Malpighi, Bologna, Italy.,Post Graduate School of Anaesthesia and Intensive Care, University of Bologna, Bologna, Italy
| | - Alessio Vasarri
- Anesthesia and Pain Therapy Unit, Azienda Ospedaliera-Universitaria di Bologna Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - Rita Maria Melotti
- Department of Medicine and Surgery Sciences, University of Bologna, Bologna, Italy.,Anesthesia and Pain Therapy Unit, Azienda Ospedaliera-Universitaria di Bologna Policlinico S. Orsola-Malpighi, Bologna, Italy.,Post Graduate School of Anaesthesia and Intensive Care, University of Bologna, Bologna, Italy
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20
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Berthelot JM, Darrieutort-Laffite C, Arnolfo P, Glémarec J, Le Goff B, Maugars Y. Inadequacies of the Lasègue test, and how the Slump and Bowstring tests are useful for the diagnosis of sciatica. Joint Bone Spine 2020; 88:105030. [PMID: 32561431 DOI: 10.1016/j.jbspin.2020.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2020] [Indexed: 01/19/2023]
Abstract
Diagnosis of sciatica mainly relies on pain reproduction by stretching of the lumbar roots since neurological examination and medical history are usually not sufficient to guarantee diagnosis. The Lasègue test is the most popular method, which starts with the straight leg-raising test (SLR). However it is not perfect, and is not always well performed or interpreted. Passive ankle dorsiflexion at the end of the SLR (Bragard test) is more sensitive, but can also remain normal in some cases of sciatica. Other stretching tests can help to recognise lumbar root damage in patients with poorly defined pain in a lower extremity: firstly, the Christodoulides test, i.e. reproduction of L5 sciatic pain by a femoral stretch test; secondly, the Slump test, performed on a patient in a sitting position, by slowly extending their painful leg then passively bending their neck (or the opposite); and thirdly, the Bowstring test, which requires, at the end of the Lasègue test, once the knee has been slightly flexed, pressing on the course of the peroneal and/or tibial nerves in the popliteal fossea to try and reproduce the exact pain felt by the patient. The combination of all these tests takes less than 2minutes, and could improve both the sensitivity and specificity of the physical examination for the diagnosis of sciatica. This article is a review of the limitations of the Lasègue/SLR tests and of the efficacy of these other tests for stretching the lumbar roots.
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Affiliation(s)
- Jean-Marie Berthelot
- Service de rhumatologie, Hôtel-Dieu, CHU of Nantes, 44093, Nantes cedex 01, France.
| | | | - Paul Arnolfo
- Service de rhumatologie, Hôtel-Dieu, CHU of Nantes, 44093, Nantes cedex 01, France
| | - Joëlle Glémarec
- Service de rhumatologie, Hôtel-Dieu, CHU of Nantes, 44093, Nantes cedex 01, France
| | - Benoît Le Goff
- Service de rhumatologie, Hôtel-Dieu, CHU of Nantes, 44093, Nantes cedex 01, France
| | - Yves Maugars
- Service de rhumatologie, Hôtel-Dieu, CHU of Nantes, 44093, Nantes cedex 01, France
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21
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Guedes F, Brown RS, Lourenço Torrão-Júnior FJ, Siquara-de-Sousa AC, Pires Amorim RM. Nondiscogenic Sciatica: What Clinical Examination and Imaging Can Tell Us? World Neurosurg 2020; 134:e1053-e1061. [DOI: 10.1016/j.wneu.2019.11.083] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 11/13/2019] [Accepted: 11/14/2019] [Indexed: 10/25/2022]
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22
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O’Shea S, Jenkins TM. Limb girdle muscular dystrophy: a case report initially presenting to an outpatient musculoskeletal physiotherapy clinic with spinal pain and functional weakness. Arch Physiother 2019; 9:13. [PMID: 31807317 PMCID: PMC6857131 DOI: 10.1186/s40945-019-0066-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 10/29/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The term limb girdle muscular dystrophy (LGMD) describes a group of genetic muscular disorders that require specialist input from neurologically trained clinicians. The plethora of potential symptoms of this heterogenous group can result in patients presenting initially to musculoskeletal (MSK) physiotherapists. CASE PRESENTATION The following case report highlights the presentation of a 21 year old female attending with 2 years of spinal pain and an unusual pattern of weakness, namely when rising from a sitting position the hips were abducted and then internally rotated. Formal testing in clinic revealed no isolated weakness initially despite the odd functional movements. There were no neural limb pains and no upper or lower motor neuron concerns on testing. There were no other health concerns. Some gains were reported with recent physiotherapy strengthening exercises and these were persisted with but proved ineffective overall. The Biopsychosocial model was used judiciously to explore alternative pathologies and led to appropriate investigations, onward referral, diagnosis and appropriate management of LGMD. Extensive atrophy of the spinal muscles was evident on imaging which was not particularly identified within the physiotherapy testing process in the earlier stages. Creatine kinase levels were also significantly raised. CONCLUSIONS Being mindful of this novel presentation in musculoskeletal clinics may well aid future, similar cases to be identified. The case highlights the importance of looking at the functional impact as opposed to traditional testing methods especially in the early stages of such conditions.
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Affiliation(s)
- Simon O’Shea
- PhysioWorks, Sheffield Teaching Hospitals NHS Foundation Trust, Bochum Parkway, Sheffield, S8 8JR England
| | - Thomas M. Jenkins
- Department of Neurology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England
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Li P, Ning Y, Guo X, Wen Y, Cheng B, Ma M, Zhang L, Cheng S, Wang S, Zhang F. Integrating transcriptome-wide study and mRNA expression profiles yields novel insights into the biological mechanism of chondropathies. Arthritis Res Ther 2019; 21:194. [PMID: 31455417 PMCID: PMC6712880 DOI: 10.1186/s13075-019-1978-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 08/16/2019] [Indexed: 12/31/2022] Open
Abstract
Background Chondropathies are a group of cartilage diseases, which share some common pathogenetic features. The etiology of chondropathies is still largely obscure now. Methods A transcriptome-wide association study (TWAS) was performed using the UK Biobank genome-wide association study (GWAS) data of chondropathies (including 1314 chondropathy patients and 450,950 controls) with gene expression references of muscle skeleton (MS) and peripheral blood (YBL). The candidate genes identified by TWAS were further compared with three gene expression profiles of osteoarthritis (OA), cartilage tumor (CT), and spinal disc herniation (SDH), to confirm the functional relevance between the chondropathies and the candidate genes identified by TWAS. Functional mapping and annotation (FUMA) was used for the gene ontology enrichment analyses. Immunohistochemistry (IHC) was conducted to validate the accuracy of integrative analysis results. Results Integrating TWAS and mRNA expression profiles detected 84 candidate genes for knee OA, such as DDX20 (PTWAS YBL = 1.79 × 10− 3, fold change (FC) = 2.69), 10 candidate genes for CT, such as SRGN (PTWAS YBL = 1.46 × 10− 3, FC = 3.36), and 4 candidate genes for SDH, such as SUPV3L1 (PTWAS YBL = 3.59 × 10− 3, FC = 3.22). Gene set enrichment analysis detected 73 GO terms for knee OA, 3 GO terms for CT, and 1 GO term for SDH, such as mitochondrial protein complex (P = 7.31 × 10− 5) for knee OA, cytokine for CT (P = 1.13 × 10− 4), and ion binding for SDH (P = 3.55 × 10− 4). IHC confirmed that the protein expression level of DDX20 was significantly different between knee OA cartilage and healthy control cartilage (P = 0.0358). Conclusions Multiple candidate genes and GO terms were detected for chondropathies. Our findings may provide a novel insight in the molecular mechanisms of chondropathies. Electronic supplementary material The online version of this article (10.1186/s13075-019-1978-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ping Li
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, Key Laboratory of Environment and Genes Related to Diseases of Ministry of Education, Collaborative Innovation Center of Endemic Diseases and Health Promotion in Silk Road Region, School of Public Health, Health Science Center, Xi'an Jiaotong University, No.76 Yan Ta West Road, Xi'an, 710061, Shaanxi, People's Republic of China
| | - Yujie Ning
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, Key Laboratory of Environment and Genes Related to Diseases of Ministry of Education, Collaborative Innovation Center of Endemic Diseases and Health Promotion in Silk Road Region, School of Public Health, Health Science Center, Xi'an Jiaotong University, No.76 Yan Ta West Road, Xi'an, 710061, Shaanxi, People's Republic of China
| | - Xiong Guo
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, Key Laboratory of Environment and Genes Related to Diseases of Ministry of Education, Collaborative Innovation Center of Endemic Diseases and Health Promotion in Silk Road Region, School of Public Health, Health Science Center, Xi'an Jiaotong University, No.76 Yan Ta West Road, Xi'an, 710061, Shaanxi, People's Republic of China
| | - Yan Wen
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, Key Laboratory of Environment and Genes Related to Diseases of Ministry of Education, Collaborative Innovation Center of Endemic Diseases and Health Promotion in Silk Road Region, School of Public Health, Health Science Center, Xi'an Jiaotong University, No.76 Yan Ta West Road, Xi'an, 710061, Shaanxi, People's Republic of China
| | - Bolun Cheng
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, Key Laboratory of Environment and Genes Related to Diseases of Ministry of Education, Collaborative Innovation Center of Endemic Diseases and Health Promotion in Silk Road Region, School of Public Health, Health Science Center, Xi'an Jiaotong University, No.76 Yan Ta West Road, Xi'an, 710061, Shaanxi, People's Republic of China
| | - Mei Ma
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, Key Laboratory of Environment and Genes Related to Diseases of Ministry of Education, Collaborative Innovation Center of Endemic Diseases and Health Promotion in Silk Road Region, School of Public Health, Health Science Center, Xi'an Jiaotong University, No.76 Yan Ta West Road, Xi'an, 710061, Shaanxi, People's Republic of China
| | - Lu Zhang
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, Key Laboratory of Environment and Genes Related to Diseases of Ministry of Education, Collaborative Innovation Center of Endemic Diseases and Health Promotion in Silk Road Region, School of Public Health, Health Science Center, Xi'an Jiaotong University, No.76 Yan Ta West Road, Xi'an, 710061, Shaanxi, People's Republic of China
| | - Shiqiang Cheng
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, Key Laboratory of Environment and Genes Related to Diseases of Ministry of Education, Collaborative Innovation Center of Endemic Diseases and Health Promotion in Silk Road Region, School of Public Health, Health Science Center, Xi'an Jiaotong University, No.76 Yan Ta West Road, Xi'an, 710061, Shaanxi, People's Republic of China
| | - Sen Wang
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, Key Laboratory of Environment and Genes Related to Diseases of Ministry of Education, Collaborative Innovation Center of Endemic Diseases and Health Promotion in Silk Road Region, School of Public Health, Health Science Center, Xi'an Jiaotong University, No.76 Yan Ta West Road, Xi'an, 710061, Shaanxi, People's Republic of China
| | - Feng Zhang
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, Key Laboratory of Environment and Genes Related to Diseases of Ministry of Education, Collaborative Innovation Center of Endemic Diseases and Health Promotion in Silk Road Region, School of Public Health, Health Science Center, Xi'an Jiaotong University, No.76 Yan Ta West Road, Xi'an, 710061, Shaanxi, People's Republic of China.
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Wu W, Chen Y, Yu L, Li F, Guo W. Coronal and sagittal spinal alignment in lumbar disc herniation with scoliosis and trunk shift. J Orthop Surg Res 2019; 14:264. [PMID: 31451116 PMCID: PMC6710870 DOI: 10.1186/s13018-019-1300-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 07/30/2019] [Indexed: 12/03/2022] Open
Abstract
Background To investigate the incidence of scoliosis and trunk shift in patients with LDH (lumbar disc herniation) and analyze the differences in spinopelvic alignment among patients with or without trunk shift and non-symptom controls. Materials and methods All included subjects had standard upright antero-posterior and lateral radiographs of the whole spine taken. Evidence of disc herniation was confirmed by computed tomography or magnetic resonance imaging. The parameters measured included trunk shift and Cobb angle, TK (thoracic kyphosis), TLK (thoraco-lumbar junction kyphosis), LL (lumbar lordosis), PI (pelvic incidence), SS (sacral slope), PT (pelvic tilt) and SVA (sagittal vertical axis). Results Sixty-eight patients with LDH and 61 controls were included. There were significantly more male patients with trunk shift than the patients without trunk shift. Forty-two patients had curve magnitudes ranging from 5 to 38°. The trunk shift ranged from 0.5 to 7.3 cm. A total of 54.76% of patients had a disc herniation on the concave side of the main curve. Fifty percent of patients showed a trunk shift towards the opposite side of disc herniation. There were significant differences in spinopelvic parameters among groups. Significant correlations were also observed between several spinopelvic parameters in the three groups. However, the degrees of correlations among the spinopelvic parameters differed among the three groups. Conclusion Spinal sagittal morphology in LDH patients with trunk shift exhibits a more anterior shift of the C7 plumb line, less LL, and a more horizontal sacrum. Correlation analysis indicated a disharmonious spinopelvic interaction and a change in the compensatory model in patients with LDH.
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Affiliation(s)
- Weifei Wu
- Department of Orthopedics, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Ying Chen
- Department of Nephrology, The People's Hospital of Three Gorges University, the First People's Hospital of Yichang, Yichang, Hubei, China
| | - Ling Yu
- Department of Orthopedics, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Fei Li
- Department of Orthopedics, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Weichun Guo
- Department of Orthopedics, Renmin Hospital of Wuhan University, Wuhan, Hubei, China.
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Tawa N, Diener I, Louw Q, Rhoda A. Correlation of the self-reported Leeds assessment of neuropathic symptoms and signs score, clinical neurological examination and MR imaging in patients with lumbo-sacral radiculopathy. BMC Neurol 2019; 19:107. [PMID: 31146710 PMCID: PMC6542141 DOI: 10.1186/s12883-019-1333-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 05/13/2019] [Indexed: 11/16/2022] Open
Abstract
Background Lumbo-sacral radiculopathy (LSR) is a common musculoskeletal disorder for which patients seek medical care and referrals for advanced imaging. However, accurate diagnosis remains challenging. Neuropathic pain screening questionnaires, clinical neurological examination and magnetic resonance imaging (MRI) are used in the initial diagnosis. The utility of these tools in diagnosing LSR varies and their correlation has not been reported. Methods A cross-sectional, multicentre, blinded design was used in six physiotherapy departments in Kenya. Each participant was blindly examined by three independent clinicians using the Self-Reported Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) score, clinical neurological examination (CNE) and MRI. Spearman’s rank coefficient (r) was used to examine the correlation between the three tests. Linear regression and odds ratios were used to establish correlations between socio-demographic, clinical and diagnostic parameters. The diagnostic accuracy of individual or combined sets of CNE tests in diagnosing LSR, with reference to MRI, was determined using Receiver Operating Characteristics (ROC) curves. Results We enrolled 102 participants (44 males, 58 females; mean age: 44.7 years). Results indicated a significant positive correlation (r = 0.36, P = 0.01) between S-LANSS, CNE and MRI among patients with low back and radiating leg symptoms. Positive agreement existed between combined neuro-conduction tests (sensory, motor and reflex) and neuro-dynamic tests (NDT). The NDT component of CNE (Straight Leg Raise Test [SLRT] and Femoral Nerve Stretch Test [FNST]) was significantly associated (P = 0.05) with MRI: patients who had positive NDT results had higher odds (8.3) for positive nerve root compromise on MRI versus those who had negative NDT results. Conclusion This was the first study to investigate the correlation between S-LANSS, CNE and MRI in patients presenting with low back and radiating leg symptoms. Results indicated a significant positive correlation. The strongest correlations to MRI findings of LSR were firstly, NDT (SLRT and FNST); secondly, the S-LANSS score; and thirdly, the CNE components of motor power and deep tendon reflex. The clinical implication is that clinicians can confidently use the S-LANSS score and CNE to diagnose and make therapeutic decisions in LSR, when MRI is medically contra-indicated, unaffordable or unavailable. Electronic supplementary material The online version of this article (10.1186/s12883-019-1333-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nassib Tawa
- Department of Rehabilitation Sciences, College of Health Sciences, Jomo Kenyatta University of Agriculture and Technology, PO Box 62 000 00200, Nairobi, Kenya. .,Division of Physiotherapy, Faculty of Medicine and Health Sciences, Stellenbosch University, Private Bag X1, Matieland, 7602, South Africa.
| | - Ina Diener
- Department of Physiotherapy, Faculty of Community and Health Sciences, University of the Western Cape, Private Bag X17, Bellville, 7535, South Africa
| | - Quinette Louw
- Division of Physiotherapy, Faculty of Medicine and Health Sciences, Stellenbosch University, Private Bag X1, Matieland, 7602, South Africa
| | - Anthea Rhoda
- Department of Physiotherapy, Faculty of Community and Health Sciences, University of the Western Cape, Private Bag X17, Bellville, 7535, South Africa
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Lumbar Radicular Pain. Pain 2019. [DOI: 10.1007/978-3-319-99124-5_137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Stynes S, Konstantinou K, Ogollah R, Hay EM, Dunn KM. Clinical diagnostic model for sciatica developed in primary care patients with low back-related leg pain. PLoS One 2018; 13:e0191852. [PMID: 29621243 PMCID: PMC5886387 DOI: 10.1371/journal.pone.0191852] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 01/12/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Identification of sciatica may assist timely management but can be challenging in clinical practice. Diagnostic models to identify sciatica have mainly been developed in secondary care settings with conflicting reference standard selection. This study explores the challenges of reference standard selection and aims to ascertain which combination of clinical assessment items best identify sciatica in people seeking primary healthcare. METHODS Data on 394 low back-related leg pain consulters were analysed. Potential sciatica indicators were seven clinical assessment items. Two reference standards were used: (i) high confidence sciatica clinical diagnosis; (ii) high confidence sciatica clinical diagnosis with confirmatory magnetic resonance imaging findings. Multivariable logistic regression models were produced for both reference standards. A tool predicting sciatica diagnosis in low back-related leg pain was derived. Latent class modelling explored the validity of the reference standard. RESULTS Model (i) retained five items; model (ii) retained six items. Four items remained in both models: below knee pain, leg pain worse than back pain, positive neural tension tests and neurological deficit. Model (i) was well calibrated (p = 0.18), discrimination was area under the receiver operating characteristic curve (AUC) 0.95 (95% CI 0.93, 0.98). Model (ii) showed good discrimination (AUC 0.82; 0.78, 0.86) but poor calibration (p = 0.004). Bootstrapping revealed minimal overfitting in both models. Agreement between the two latent classes and clinical diagnosis groups defined by model (i) was substantial, and fair for model (ii). CONCLUSION Four clinical assessment items were common in both reference standard definitions of sciatica. A simple scoring tool for identifying sciatica was developed. These criteria could be used clinically and in research to improve accuracy of identification of this subgroup of back pain patients.
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Affiliation(s)
- Siobhán Stynes
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire, United Kingdom
- * E-mail:
| | - Kika Konstantinou
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire, United Kingdom
| | - Reuben Ogollah
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire, United Kingdom
| | - Elaine M. Hay
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire, United Kingdom
| | - Kate M. Dunn
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire, United Kingdom
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Accuracy of Clinical Tests in Detecting Disk Herniation and Nerve Root Compression in Subjects With Lumbar Radicular Symptoms. Arch Phys Med Rehabil 2018; 99:726-735. [DOI: 10.1016/j.apmr.2017.11.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Revised: 11/02/2017] [Accepted: 11/07/2017] [Indexed: 11/18/2022]
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Li W, Liu YC, Zheng CF, Miao J, Chen H, Quan HY, Yan SH, Zhang K. Diagnosis of Compressed Nerve Root in Lumbar Disc Herniation Patients by Surface Electromyography. Orthop Surg 2018; 10:47-55. [PMID: 29424098 DOI: 10.1111/os.12362] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 08/20/2017] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE To establish a logistic regression model using surface electromyography (SEMG) parameters for diagnosing the compressed nerve root at L5 or S1 level in patients with lumbar disc herniation (LDH). METHODS This study recruited 24 patients with L5 nerve root compression and 23 patients with S1 nerve root compression caused by LDH from May 2014 to May 2016. SEMG signals from the bilateral tibialis anterior and lateral gastrocnemius were measured. The root mean square (RMS), the RMS peak time, the mean power frequency (MPF), and the median frequency (MF) were analyzed. The accuracy, sensitivity, and specificity values were calculated separately. The areas under the curve (AUC) of the receiver-operating characteristic (ROC) curve and the kappa value were used to evaluate the accuracy of the SEMG diagnostic model. RESULTS The accuracy of the SEMG model ranged from 85.71% to 100%, with an average of 93.57%. The sensitivity, specificity, AUC, and kappa value of the logistic regression model were 0.98 ± 0.05, 0.92 ± 0.09, 0.95 ± 0.04 (P = 0.006), and 0.87 ± 0.11, respectively (P = 0.001). The final diagnostic model was: P=1-11+ey; y = 10.76 - (5.95 × TA_RMS Ratio) - (0.38 × TA_RMS Peak Time Ratio) - (5.44 × 44 × LG_RMS Peak Time Ratio). L5 nerve root compression is diagnosed when P < 0.5 and S1 nerve root compression when P ≥ 0.5. CONCLUSIONS The logistic regression model developed in this study showed high diagnostic accuracy in detecting the compressed nerve root (L5 and S1 ) in these patients with LDH.
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Affiliation(s)
- Wei Li
- School of Biomedical Engineering, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, China
| | - Yan-Cheng Liu
- Department of Spinal Surgery, Tianjin Hospital, Tianjin, China
| | - Chen-Fan Zheng
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, China
| | - Jun Miao
- Department of Spinal Surgery, Tianjin Hospital, Tianjin, China
| | - Hui Chen
- School of Biomedical Engineering, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, China
| | - Hai-Ying Quan
- School of Biomedical Engineering, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, China
| | - Song-Hua Yan
- School of Biomedical Engineering, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, China
| | - Kuan Zhang
- School of Biomedical Engineering, Capital Medical University, Beijing, China
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Muscle Atrophy Measurement as Assessment Method for Low Back Pain Patients. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1088:437-461. [PMID: 30390264 DOI: 10.1007/978-981-13-1435-3_20] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Low back pain is one of the most common pain disorders defined as pain, muscle tension, or stiffness localized below the costal margin and above the inferior gluteal folds, sometimes with accompanying leg pain. The meaning of the symptomatic atrophy of paraspinal muscles and some pelvic muscles has been proved. Nowadays, a need for new diagnostic tools for specific examination of low back pain patients is posited, and it has been proposed that magnetic resonance imaging assessment toward muscle atrophy may provide some additional information enabling the subclassification of that group of patients.
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Chiropractic care and risk for acute lumbar disc herniation: a population-based self-controlled case series study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2017; 27:1526-1537. [DOI: 10.1007/s00586-017-5325-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 09/04/2017] [Accepted: 10/02/2017] [Indexed: 01/31/2023]
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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] [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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Petersen T, Laslett M, Juhl C. Clinical classification in low back pain: best-evidence diagnostic rules based on systematic reviews. BMC Musculoskelet Disord 2017; 18:188. [PMID: 28499364 PMCID: PMC5429540 DOI: 10.1186/s12891-017-1549-6] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 05/05/2017] [Indexed: 12/13/2022] Open
Abstract
Background Clinical examination findings are used in primary care to give an initial diagnosis to patients with low back pain and related leg symptoms. The purpose of this study was to develop best evidence Clinical Diagnostic Rules (CDR] for the identification of the most common patho-anatomical disorders in the lumbar spine; i.e. intervertebral discs, sacroiliac joints, facet joints, bone, muscles, nerve roots, muscles, peripheral nerve tissue, and central nervous system sensitization. Methods A sensitive electronic search strategy using MEDLINE, EMBASE and CINAHL databases was combined with hand searching and citation tracking to identify eligible studies. Criteria for inclusion were: persons with low back pain with or without related leg symptoms, history or physical examination findings suitable for use in primary care, comparison with acceptable reference standards, and statistical reporting permitting calculation of diagnostic value. Quality assessments were made independently by two reviewers using the Quality Assessment of Diagnostic Accuracy Studies tool. Clinical examination findings that were investigated by at least two studies were included and results that met our predefined threshold of positive likelihood ratio ≥ 2 or negative likelihood ratio ≤ 0.5 were considered for the CDR. Results Sixty-four studies satisfied our eligible criteria. We were able to construct promising CDRs for symptomatic intervertebral disc, sacroiliac joint, spondylolisthesis, disc herniation with nerve root involvement, and spinal stenosis. Single clinical test appear not to be as useful as clusters of tests that are more closely in line with clinical decision making. Conclusions This is the first comprehensive systematic review of diagnostic accuracy studies that evaluate clinical examination findings for their ability to identify the most common patho-anatomical disorders in the lumbar spine. In some diagnostic categories we have sufficient evidence to recommend a CDR. In others, we have only preliminary evidence that needs testing in future studies. Most findings were tested in secondary or tertiary care. Thus, the accuracy of the findings in a primary care setting has yet to be confirmed. Electronic supplementary material The online version of this article (doi:10.1186/s12891-017-1549-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tom Petersen
- Back Center Copenhagen, Mimersgade 41, 2200, Copenhagen N, Denmark.
| | - Mark Laslett
- PhysioSouth Ltd, 7 Baltimore Green, Shirley, Christchurch, 8061, New Zealand.,Southern Musculoskeletal Seminars, Christchurch, New Zealand
| | - Carsten Juhl
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Department of Rehabilitation, University Hospital of Copenhagen, Herlev and Gentofte, Niels Andersen Vej 65, 2900, Hellerup, Denmark
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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] [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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Factors for Predicting Favorable Outcome of Percutaneous Epidural Adhesiolysis for Lumbar Disc Herniation. Pain Res Manag 2017; 2017:1494538. [PMID: 28246488 PMCID: PMC5299181 DOI: 10.1155/2017/1494538] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 12/11/2016] [Accepted: 01/10/2017] [Indexed: 11/17/2022]
Abstract
Background. Lower back pain is a common reason for disability and the most common cause is lumbar disc herniation. Percutaneous epidural adhesiolysis has been applied to relieve pain and increase the functional capacity of patients who present this condition. Objectives. In this study, we retrospectively evaluated the factors which predict the outcome of percutaneous epidural adhesiolysis in patients who were diagnosed with lumbar disc herniation. Methods. Electronic medical records of patients diagnosed with lumbar disc herniation who have received percutaneous epidural adhesiolysis treatment were reviewed. The primary outcome was the factors that were associated with substantial response of ≥4 points or ≥50% of pain relief in the numerical rating scale pain score 12 months after the treatment. Results. Multivariate logistic regression analysis demonstrated that the presence of high-intensity zone (HIZ) at magnetic resonance imaging was a predictor of substantial response to percutaneous epidural adhesiolysis for 12 months (P = 0.007). The presence of a condition involving the vertebral foramen was a predictor for unsuccessful response after 12 months (P = 0.02). Discussion and Conclusion. The presence of HIZ was a predictor of favorable long-term outcome after percutaneous epidural adhesiolysis for the treatment of lower back pain with radicular pain caused by lumbar disc herniation.
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Delgado-López PD, Rodríguez-Salazar A, Martín-Alonso J, Martín-Velasco V. [Lumbar disc herniation: Natural history, role of physical examination, timing of surgery, treatment options and conflicts of interests]. Neurocirugia (Astur) 2017; 28:124-134. [PMID: 28130015 DOI: 10.1016/j.neucir.2016.11.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 09/26/2016] [Accepted: 11/24/2016] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Indication for surgery in lumbar disc herniation (LDH) varies widely depending on the geographical area. DEVELOPMENT A literature review is presented on the natural history, role of physical examination, timing of surgery, evidence-based treatment, and conflicts of interests in LDH. Surgery is shown to provide significant faster relief of pain compared to conservative therapy, although the effect fades after a year. There is no treatment modality better than the rest in terms of pain control and neurological recovery, nor is there a surgical technique clearly superior to simple discectomy. The lack of sound scientific evidence on the surgical indication may contribute to its great geographical variability. CONCLUSIONS Since LDH has a favourable natural history, neuroimaging and surgery should not be considered until after a 6-week period. It is necessary to specify and respect the surgical indications for LDH, avoiding conflicts of interests.
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Skorupska E, Keczmer P, Łochowski RM, Tomal P, Rychlik M, Samborski W. Reliability of MR-Based Volumetric 3-D Analysis of Pelvic Muscles among Subjects with Low Back with Leg Pain and Healthy Volunteers. PLoS One 2016; 11:e0159587. [PMID: 27459688 PMCID: PMC4961367 DOI: 10.1371/journal.pone.0159587] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 07/06/2016] [Indexed: 01/21/2023] Open
Abstract
AIM Lately, the diagnostic value of magnetic resonance imaging, Lasègue sign and classic neurological signs have been considered not accurate enough to distinguish the radicular from non-radicular low back with leg pain (LBLP) and a calculation of the symptomatic side muscle volume has been indicated as a probable valuable marker. However, only the multifidus muscle volume has been calculated so far. The main objective of the study was to verify whether LBLP subjects presented symptomatic side pelvic muscle atrophy compared to healthy volunteers. The second aim was to assess the inter-rater reliability of 3-D manual method for segmenting and measuring the volume of the gluteus maximus, gluteus medius, gluteus minimus and piriformis muscles in both LBLP patients and healthy subjects. METHOD Two independent raters analyzed MR images of LBLP and healthy subjects towards muscle volume of four pelvic muscles, i.e. the piriformis, gluteus minimus, gluteus medius and gluteus maximus. For both sides, the MR images of the muscles without adipose tissue infiltration were manually segmented in 3-D medical images. RESULTS Symptomatic muscle atrophy was confirmed in only over 50% of LBLP subjects (gluteus maximus (p<0.001), gluteus minimus (p<0.01) and piriformis (p<0.05)). The ICC values indicated that the inter-rater reproducibility was greater than 0.90 for all measurements (LBLP and healthy subjects), except for the measurement of the right gluteus medius muscle in LBLP patients, which was equal to 0.848. CONCLUSION More than 50% of LBLP subjects presented symptomatic gluteus maximus, gluteus minimus and piriformis muscle atrophy. 3-D manual segmentation reliably measured muscle volume in all the measured pelvic muscles in both healthy and LBLP subjects. To answer the question of what kind of muscle atrophy is indicative of radicular or non-radicular pain further studies are required.
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Affiliation(s)
- Elżbieta Skorupska
- Department of Rheumatology and Rehabilitation, Poznan University of Medical Sciences, Poznan, Poland
| | - Przemysław Keczmer
- Department of Rheumatology and Rehabilitation, Poznan University of Medical Sciences, Poznan, Poland
| | - Rafał M. Łochowski
- Department of Mathematics and Mathematical Economics, Warsaw School of Economics, Warsaw, Poland
| | - Paulina Tomal
- Department of Rheumatology and Rehabilitation, Poznan University of Medical Sciences, Poznan, Poland
| | - Michał Rychlik
- Department of Virtual Engineering, Poznan University of Technology, Poznan, Poland
| | - Włodzimierz Samborski
- Department of Rheumatology and Rehabilitation, Poznan University of Medical Sciences, Poznan, Poland
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Abbott A. Evidence base and future research directions in the management of low back pain. World J Orthop 2016; 7:156-161. [PMID: 27004162 PMCID: PMC4794533 DOI: 10.5312/wjo.v7.i3.156] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 11/17/2015] [Accepted: 12/21/2015] [Indexed: 02/06/2023] Open
Abstract
Low back pain (LBP) is a prevalent and costly condition. Awareness of valid and reliable patient history taking, physical examination and clinical testing is important for diagnostic accuracy. Stratified care which targets treatment to patient subgroups based on key characteristics is reliant upon accurate diagnostics. Models of stratified care that can potentially improve treatment effects include prognostic risk profiling for persistent LBP, likely response to specific treatment based on clinical prediction models or suspected underlying causal mechanisms. The focus of this editorial is to highlight current research status and future directions for LBP diagnostics and stratified care.
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Ruiz-España S, Arana E, Moratal D. Semiautomatic computer-aided classification of degenerative lumbar spine disease in magnetic resonance imaging. Comput Biol Med 2015; 62:196-205. [DOI: 10.1016/j.compbiomed.2015.04.028] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 04/14/2015] [Accepted: 04/16/2015] [Indexed: 11/29/2022]
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Hartvigsen L, Kongsted A, Hestbaek L. Clinical examination findings as prognostic factors in low back pain: a systematic review of the literature. Chiropr Man Therap 2015; 23:13. [PMID: 25802737 PMCID: PMC4369880 DOI: 10.1186/s12998-015-0054-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 01/15/2015] [Indexed: 11/28/2022] Open
Abstract
Background There is a strong tradition of performing a clinical examination of low back pain (LBP) patients and this is generally recommended in guidelines. However, establishing a pathoanatomic diagnosis does not seem possible in most LBP patients and clinical tests may potentially be more relevant as prognostic factors. The aim of this review of the literature was to systematically assess the association between low-tech clinical tests commonly used in adult patients with acute, recurrent or chronic LBP and short- and long-term outcome. Methods MEDLINE, Embase, and MANTIS were searched from inception to June 2012. Prospective clinical studies of adult patients with LBP with or without leg pain and/or signs of nerve root involvement or spinal stenosis, receiving non-surgical or no treatment, which investigated the association between low-tech clinical tests and outcome were included. Study selection, data extraction and appraisal of study quality were performed independently by two reviewers. Results A total of 5,332 citations were retrieved and screened for eligibility, 342 articles were assessed as full text and 49 met the inclusion criteria. Due to clinical and statistical heterogeneity, qualitative synthesis rather than meta-analysis was performed. Associations between clinical tests and outcomes were often inconsistent between studies. In more than one third of the tests, there was no evidence of the tests being associated with outcome. Only two clinical tests demonstrated a consistent association with at least one of the outcomes: centralization and non-organic signs. Conclusions For most clinical tests in LBP there is not consistent evidence for an association with outcome. Centralization and non-organic signs are exceptions from that. None of the other clinical tests have been investigated in confirmatory studies and study quality is generally low. There is a need for hypothesis testing studies designed specifically to investigate the prognostic value of the clinical tests, and a need for standardization of the performance and interpretation of tests. Electronic supplementary material The online version of this article (doi:10.1186/s12998-015-0054-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lisbeth Hartvigsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Alice Kongsted
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark ; Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark
| | - Lise Hestbaek
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark ; Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark
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Johanning E. Whole-body vibration-related health disorders in occupational medicine--an international comparison. ERGONOMICS 2015; 58:1239-1252. [PMID: 25655650 DOI: 10.1080/00140139.2015.1005170] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
UNLABELLED Workers with whole-body vibration (WBV) exposure are likely to report non-specific health complaints. Health and safety providers may not recognise such occupational injuries and may be unfamiliar with appropriate exposure assessment and prevention. This is a review of clinical studies, medical evidence, differential diagnostic evaluation protocols, surveillance programmes, national and international standards, and interventions recommendations utilising PubMed and other online resources. In summary, several studies show a clear trend: with increasing duration and intensity of occupational WBV exposure, primarily musculoskeletal or neurological disorders of the spine occur. Other organ damage has also been reported. In some European Union countries, spinal injury caused by WBV is recognised as an occupational disease and may be compensable. The WBV-related injury diagnosis includes a review of the work history, exposure assessment and differential diagnostic evaluation. WBV health surveillance should assess health status of WBV-exposed workers and address preventive measures. PRACTITIONER SUMMARY Workers with whole-body vibration exposure report a variety of physical disorders. Health and safety providers may not recognise such injuries, or may be unfamiliar with exposure assessment and prevention. This review addresses health issues, exposure assessment and an international review of compensation criteria, trends and prevention efforts.
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Affiliation(s)
- Eckardt Johanning
- a Center for Family and Community Medicine , Columbia University , New York , NY , USA
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Analysis of the clinical picture in patients with osteoarthritis of the spine depending on the type and severity of lesions on magnetic resonance imaging. Reumatologia 2015; 53:186-91. [PMID: 27407246 PMCID: PMC4847293 DOI: 10.5114/reum.2015.53995] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 08/17/2015] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Spondyloarthritis is the most common pathological change in the spine. In a significant number of cases, it leads to compression of the nervous structures of the spinal canal, causing pain and neurological symptoms. Intervertebral disc pathology is a common cause of root deficits in neurological examination of all types of degenerative changes of the spine structures. Disc herniation is pathologically divided into 4 stages of herniated nucleus pulposus: 1) bulging, 2) protrusion, 3) extrusion, 4) sequestration. The aim of this study is to analyze the correlation between the type and severity of degenerative changes in the spine and the incidence of neurological deficits. MATERIAL AND METHODS The study included 100 patients: 74 men and 26 women aged 50.2 ±10.43 years with pain of the spine in the cervical and/or lumbosacral segments and with degenerative changes in the plain radiographs. The mean value of body mass index (BMI) was 27.8 ±3.95 kg/m(2). Each patient underwent neurological examinations and 1.5 T magnetic resonance imaging MRI of the cervical and/or lumbar spine. RESULTS Every patient was diagnosed with herniated nucleus pulposus affecting on average 4 ±2 segments of the spine. The most frequently observed degree of severity of disc herniation was the second (protrusion, 71.9% of all disc disease in 89 patients). Much less frequently found was the third degree (extrusion, 45 patients, 20.1% slipped disc), the first (bulging, 14 patients, 6.3% slipped disc), and least often only a small percentage of fourth degree (sequestration, 4 patients, 1.7% slipped disc). Neurological symptoms (deficits) were observed in 34 patients. They were accompanied by disc herniations in 23.7% of patients. In remaining patients with neurological deficits there was spinal stenosis. No correlation was observed between neurological deficits and stage 1 of disc herniation. CONCLUSIONS The incidence rate of neurological deficits is correlated with the degree of changes in the spine, as visualized by MRI.
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Ammer K. Diagnostische Genauigkeit der körperlichen Untersuchung bei Patienten mit vermuteter chronischer lumbaler Radikulopathie. MANUELLE MEDIZIN 2013. [DOI: 10.1007/s00337-013-1071-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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