1
|
Gupta A. Evolving Spinal Treatment Modalities: A Review of the Literature on Non-surgical Interferential Differential Dynamics (IDD) Therapy. Cureus 2024; 16:e59873. [PMID: 38854340 PMCID: PMC11157978 DOI: 10.7759/cureus.59873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2024] [Indexed: 06/11/2024] Open
Abstract
Low back pain is one of the most common ailments encountered by physicians and orthopedic surgeons. There are various modalities used to treat low back pain, including conservative management, and a few of them involve rest, medications, massage, bracing, acupuncture, and physical therapy. Though most of the patients improve with conservative management, the burden of this disease has been very high and caused a significant amount of economic loss. Therefore, in-depth knowledge of all conservative methods is essential for physicians managing low back pain. Furthermore, there can be many causes of low back pain. Some of the more common ones are mechanical back pain due to paraspinal muscles or facetal in origin, discogenic back pain, and sacroiliac joint dysfunction. Many patients, especially the older population, have the discogenic origin as the more common cause of back pain, and traction therapy has been used for its treatment for ages. In this review, we discuss non-surgical spinal decompression/traction therapy popularly known as interferential differential dynamics (IDD) therapy with its current standing and recent advancement.
Collapse
Affiliation(s)
- Anuj Gupta
- Orthopedics: Spine, Triveni Ortho and Spine Center, Delhi, IND
- Spine, Max Superspeciality Hospital, Delhi, IND
| |
Collapse
|
2
|
El Melhat AM, Youssef ASA, Zebdawi MR, Hafez MA, Khalil LH, Harrison DE. Non-Surgical Approaches to the Management of Lumbar Disc Herniation Associated with Radiculopathy: A Narrative Review. J Clin Med 2024; 13:974. [PMID: 38398287 PMCID: PMC10888666 DOI: 10.3390/jcm13040974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 01/30/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024] Open
Abstract
Lumbar disc herniation associated with radiculopathy (LDHR) is among the most frequent causes of spine-related disorders. This condition is triggered by irritation of the nerve root caused by a herniated disc. Many non-surgical and surgical approaches are available for managing this prevalent disorder. Non-surgical treatment approaches are considered the preferred initial management methods as they are proven to be efficient in reducing both pain and disability in the absence of any red flags. The methodology employed in this review involves an extensive exploration of recent clinical research, focusing on various non-surgical approaches for LDHR. By exploring the effectiveness and patient-related outcomes of various conservative approaches, including physical therapy modalities and alternative therapies, therapists gain valuable insights that can inform clinical decision-making, ultimately contributing to enhanced patient care and improved outcomes in the treatment of LDHR. The objective of this article is to introduce advanced and new treatment techniques, supplementing existing knowledge on various conservative treatments. It provides a comprehensive overview of the current therapeutic landscape, thereby suggesting pathways for future research to fill the gaps in knowledge. Specific to our detailed review, we identified the following interventions to yield moderate evidence (Level B) of effectiveness for the conservative treatment of LDHR: patient education and self-management, McKenzie method, mobilization and manipulation, exercise therapy, traction (short-term outcomes), neural mobilization, and epidural injections. Two interventions were identified to have weak evidence of effectiveness (Level C): traction for long-term outcomes and dry needling. Three interventions were identified to have conflicting or no evidence (Level D) of effectiveness: electro-diagnostic-based management, laser and ultrasound, and electrotherapy.
Collapse
Affiliation(s)
- Ahmed M. El Melhat
- Department of Physical Therapy for Musculoskeletal Disorders and Their Surgeries, Faculty of Physical Therapy, Cairo University, Cairo 12613, Egypt;
- Department of Physical Therapy, Faculty of Health Sciences, Beirut Arab University, Beirut P.O. Box 11-5020, Lebanon (M.R.Z.); (M.A.H.); (L.H.K.)
| | - Ahmed S. A. Youssef
- Basic Science Department, Faculty of Physical Therapy, Beni-Suef University, Beni-Suef 62521, Egypt;
| | - Moustafa R. Zebdawi
- Department of Physical Therapy, Faculty of Health Sciences, Beirut Arab University, Beirut P.O. Box 11-5020, Lebanon (M.R.Z.); (M.A.H.); (L.H.K.)
| | - Maya A. Hafez
- Department of Physical Therapy, Faculty of Health Sciences, Beirut Arab University, Beirut P.O. Box 11-5020, Lebanon (M.R.Z.); (M.A.H.); (L.H.K.)
| | - Lamia H. Khalil
- Department of Physical Therapy, Faculty of Health Sciences, Beirut Arab University, Beirut P.O. Box 11-5020, Lebanon (M.R.Z.); (M.A.H.); (L.H.K.)
| | | |
Collapse
|
3
|
Correlation between Pain Scores and Disc Height Changes after Discectomy in Patients with Lumbar Disc Herniation: A Systematic Review and Meta-Analysis. COMPUTATIONAL INTELLIGENCE AND NEUROSCIENCE 2022; 2022:2580004. [PMID: 36035825 PMCID: PMC9410963 DOI: 10.1155/2022/2580004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/20/2022] [Accepted: 06/23/2022] [Indexed: 11/25/2022]
Abstract
Background Surgery can reduce and improve lumbar disc herniation, but some patients still have pain after surgery, and the relationship between lumbar disc height and pain after surgery is still unclear. Objective The main objective is to investigate the relationship between lumbar disc height and postoperative pain. Methods We searched Pubmed, Web of Science, the Cochrane library, and Embase online for cohort studies or RCT studies on discectomy and assessed the quality of the included articles using the Newcastle-Ottawa Scale (NOS scale), with disc height (DH) and postoperative back pain as the main clinical outcome indicators, and the correlation coefficient between DH and back pain as the statistic to assess the pooled effect size. Results 10 kinds of literature were included in this study for quantitative analysis. A total of 589 patients participated in the study. The follow-up time was between 1 and 2.3 years. Meta-analysis showed that after surgery, the relief of back pain was statistically significant (MD = −2.57, 95% CI (−3.10,−2.04), Z = −9.570, P < 0.0001), the reduction of disc height was statistically significant (MD = −0.82, 95% CI (−1.11, −0.52), Z = −5.477, P < 0.0001), the combined value of correlation coefficient Fisher's Z value was 0.33, 95% CI (0.25,0.42), with statistical significance (P < 0.00001), suggesting that the degree of back pain after surgery showed a moderate positive correlation with disc height in the short term. Discussion. After discectomy, the degree of pain is relieved, the disc height is reduced, and low back pain in the short term and disc height showed a moderate positive correlation, but the long-term correlation remains to be studied in depth.
Collapse
|
4
|
Mariajoseph FP, Castle-Kirszbaum M, Kam J, Rogers M, Sher R, Daly C, Roadley J, Risbey P, Fryer K, Goldschlager T. Relationship between herniated intervertebral disc fragment weight and pain in lumbar microdiscectomy patients. J Clin Neurosci 2022; 102:75-79. [PMID: 35738184 DOI: 10.1016/j.jocn.2022.06.012] [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: 03/03/2022] [Revised: 06/14/2022] [Accepted: 06/16/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The relationship between lumbar disc herniation (LDH) size and the severity of preoperative pain and its impact on postoperative recovery is incompletely understood. This study was conducted to investigate the association between herniated disc fragment weight and pain before and after microdiscectomy. METHODS A consecutive series of patients from an ongoing randomised controlled trial (ACTRN12616001360404) were included in this study. Included patients were aged between 18 and 75, had a clinical diagnosis of radiculopathy, and MRI evidence of a concordant single-level lumbar disc herniation. All patients underwent standard microdiscectomy without aggressive discectomy or curettage of the endplates. Disc fragment weight was measured intraoperatively. RESULTS A total of 122 patients with a mean age of 49.5 ± 12.8 years, were included. The median weight of disc fragment was 0.545 g (95% CI 0.364 - 0.654 g). There was no relationship between disc weight and the duration of symptoms (p = 0.409) severity of preoperative leg pain (p = 0.070) or preoperative back pain (p = 0.884). Disc fragment weight was demonstrated to have no correlation with clinically significant postoperative leg pain improvement (p = 0.535) or back pain (p = 0.991). Additional LDH factors, including radiological percentage of canal compromise (p = 0.714), herniation classification (p = 0.462), and vertebral level (p = 0.788) were also shown to have no effect on leg pain outcomes. CONCLUSIONS Disc fragment weight had no effect on the severity of pain at presentation or after microdiscectomy. Patients benefit from surgery equally, regardless of the size of LDH.
Collapse
Affiliation(s)
- Frederick P Mariajoseph
- School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia.
| | | | - Jeremy Kam
- Department of Neurosurgery, Monash Health, Melbourne, Victoria, Australia
| | - Myron Rogers
- Department of Neurosurgery, Austin Hospital, Melbourne, Victoria, Australia; Department of Neurosurgery, Cabrini Hospital, Melbourne, Victoria, Australia
| | - Reece Sher
- Department of Neurosurgery, Austin Hospital, Melbourne, Victoria, Australia; Department of Surgery, Monash University, Melbourne, Victoria, Australia
| | - Chris Daly
- Department of Neurosurgery, Gold Coast University Hospital, Southport, Queensland, Australia; School of Medicine, Griffith University, Queensland, Australia
| | - Jack Roadley
- School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia; Department of Neurosurgery, Monash Health, Melbourne, Victoria, Australia
| | - Phillipa Risbey
- Department of Physiotherapy, Cabrini Hospital, Melbourne, Victoria, Australia
| | - Kylie Fryer
- Department of Neurosurgery, Monash Health, Melbourne, Victoria, Australia
| | - Tony Goldschlager
- Department of Neurosurgery, Monash Health, Melbourne, Victoria, Australia; Department of Surgery, Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
5
|
Amjad F, Mohseni-Bandpei MA, Gilani SA, Ahmad A, Hanif A. Effects of non-surgical decompression therapy in addition to routine physical therapy on pain, range of motion, endurance, functional disability and quality of life versus routine physical therapy alone in patients with lumbar radiculopathy; a randomized controlled trial. BMC Musculoskelet Disord 2022; 23:255. [PMID: 35296293 PMCID: PMC8924735 DOI: 10.1186/s12891-022-05196-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 03/08/2022] [Indexed: 01/16/2023] Open
Abstract
Background Lumbar radiculopathy is an extensively common complaint reported by patients of low back pain (LBP), resulting in several impairments. A comparatively novel technique, non-surgical spinal decompression (NSD), is introduced, which uses a sensitive computerized feedback mechanism and decompresses the spinal nerve roots through segmental distraction. The objective of this study was to determine the effects of NSD therapy in addition to routine physical therapy on pain, lumbar range of motion (ROM), functional disability, back muscle endurance (BME), and quality of life (QOL) in patients with lumbar radiculopathy. Methods A total of sixty patients with lumbar radiculopathy were randomly allocated into two groups, an experimental (n = 30) and a control (n = 30) group, through a computer-generated random number table. Baseline values were recorded before providing any treatment by using a visual analogue scale (VAS), Urdu version of Oswestry disability index (ODI-U), modified-modified Schober’s test (MMST), prone isometric chest raise test, and Short Form 36-Item Survey (SF-36) for measuring the pain at rest, functional disability, lumbar ROM, BME, and QOL, respectively. All patients received twelve treatment sessions over 4 weeks, and then all outcome measures were again recorded. Results By using the ANCOVA test, a statistically significant (p < 0.05) between-group improvement was observed in VAS, ODI-U, BME, lumbar ROM, role physical (RP), and bodily pain (BP) domains of SF-36, which was in favour of NSD therapy group. The between-group difference was 1.07 ± 0.32 cm (p < .001) for VAS, 5.65 ± 1.48 points (p < .001) for ODI-U, 13.93 ± 5.85 s (p = 0.002) for BME, 2.62 ± 0.27 cm (p < .001) for lumbar flexion, 0.96 ± 0.28 (p < .001) for lumbar extension, 5.77 ± 2.39 (p = 0.019) for RP and 6.33 ± 2.52 (p = 0.016) for BP domain of SF-36. For these outcomes, a medium to large effect size (d = 0.61–2.47, 95% CI: 0.09–3.14) was observed. Conclusion It was concluded that a combination of non-surgical spinal decompression therapy with routine physical therapy is more effective, statistically and clinically, than routine physical therapy alone in terms of improving pain, lumbar range of motion, back muscle endurance, functional disability, and physical role domain of quality of life, in patients with lumbar radiculopathy, following 4 weeks of treatment. Trial registration WHO Iranian registry of clinical trials (IRCT20190717044238N1) Dated: 23.12.2019.
Collapse
Affiliation(s)
- Fareeha Amjad
- University Institute of Physical Therapy, Faculty of Allied Health Sciences, The University of Lahore, Lahore, Pakistan.
| | - Mohammad A Mohseni-Bandpei
- University Institute of Physical Therapy, Faculty of Allied Health Sciences, The University of Lahore, Lahore, Pakistan.,Pediatric Neurorehabilitation Research Center, the University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | | | - Ashfaq Ahmad
- Department University Institute of Physical Therapy, Faculty of Allied Health Sciences, Lahore, Pakistan
| | - Asif Hanif
- University Institute of Physical Therapy, Faculty of Allied Health Sciences, The University of Lahore, Lahore, Pakistan
| |
Collapse
|
6
|
Lan X, Wang Z, Huang Y, Ni Y, He Y, Wang X, Wu C, Hu R, Han R, Guo G, Li Z, Zhang X, Zhang J, Liao Q, Huang D, Zhou H. Clinical and Radiological Comparisons of Percutaneous Low-Power Laser Discectomy and Low-Temperature Plasma Radiofrequency Ablation for Cervical Radiculopathy: A Prospective, Multicenter, Cohort Study. Front Surg 2022; 8:779480. [PMID: 35223967 PMCID: PMC8863912 DOI: 10.3389/fsurg.2021.779480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 12/30/2021] [Indexed: 12/02/2022] Open
Abstract
Background Minimally invasive techniques, such as percutaneous low-power laser discectomy (PLLD) and low-temperature plasma radiofrequency ablation (coblation) can be applied to treat degenerative cervical radiculopathy. However, less evidence supports the superiority of distinct minimally-invasive therapy. Our study aimed to evaluate the clinical and radiological characteristics of the PLLD and coblation for cervical radiculopathy. Methods This was a prospective, multicenter, cohort study (ChiCTR-ONC-17010356). The modified Macnab criteria was performed to assess the clinical improvement pre- and post-surgery. To evaluate the radiological effect, the Pfirrmann grading system and disk herniation index were applied with MRI. Results In this study, 28 patients were enrolled in the coblation group and 30 patients in the PLLD group. The mean good-excellent rate at 3-month follow-up was 82.1% for PLLD group, and 66.7% for coblation group, respectively (p = 0.179). The PLLD group achieved higher good-excellent rate 6 and 12 months after discharge (92.9 vs. 70.0%, p = 0.026). Radiological data revealed that PLLD but not coblation treatment achieved significant reduction of disk herniation index (p < 0.0001). Coblation treatment did not change the Pfirrmann grades of cervical radiculopathy patients (n = 18), and 7 out of 17 (41.2%) patients achieved improvement after PLLD therapy. None obvious adverse event was observed in this study. Conclusion Both PLLD and coblation are effective and safe option for patients with cervical radiculopathy. Better long-term clinical outcomes may be potentially associated with the improvement of disk degeneration after PLLD treatment.
Collapse
Affiliation(s)
- Xueqin Lan
- Department of Pain, Institute of Pain Medicine, The Third Xiangya Hospital, Central South University, Changsha, China
- Department of Anesthesiology, The Affiliated Changsha Central Hospital, University of South China, Changsha, China
| | - Ziyang Wang
- Department of Pain, Institute of Pain Medicine, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Yuzhao Huang
- Department of Orthopedics, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Yuncheng Ni
- Department of Pain, Institute of Pain Medicine, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Yunwu He
- Department of Pain, The Second Affiliated Hospital, University of South China, Hengyang, China
| | - Xiaofeng Wang
- Department of Pain, Hunan Aerospace Hospital, Changsha, China
| | - Chunsheng Wu
- Department of Pain, People's Hospital of Xiangxi Prefecture, Jishou University, Jishou, China
| | - Rong Hu
- Department of Pain, Institute of Pain Medicine, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Rui Han
- Department of Pain, Institute of Pain Medicine, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Gangwen Guo
- Department of Pain, Institute of Pain Medicine, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Zhenxing Li
- Department of Pain, Institute of Pain Medicine, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Xuan Zhang
- Department of Pain, Institute of Pain Medicine, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Jianping Zhang
- Department of Pain, Institute of Pain Medicine, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Qin Liao
- Department of Anesthesiology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Dong Huang
- Department of Pain, Institute of Pain Medicine, The Third Xiangya Hospital, Central South University, Changsha, China
- Hunan Key Laboratory of Brain Homeostasis, Central South University, Changsha, China
- *Correspondence: Dong Huang
| | - Haocheng Zhou
- Department of Pain, Institute of Pain Medicine, The Third Xiangya Hospital, Central South University, Changsha, China
- Hunan Key Laboratory of Brain Homeostasis, Central South University, Changsha, China
- Haocheng Zhou
| |
Collapse
|
7
|
Khanzadeh R, Mahdavinejad R, Borhani A. The Effect of Suspension and Conventional Core Stability Exercises on Characteristics of Intervertebral Disc and Chronic Pain in Office Staff Due to Lumbar Herniated Disc. THE ARCHIVES OF BONE AND JOINT SURGERY 2020; 8:445-453. [PMID: 32766406 PMCID: PMC7358225 DOI: 10.22038/abjs.2019.40758.2102] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 12/16/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND The purpose of this study was to identify the effects of eight weeks of conventional and suspension core stability exercises by use of the designed device on characteristic of intervertebral discs in low back pain. METHODS A total of 27 men with chronic low back (CLB) pain due to lumbar disc herniation in L4-L5 and L5-S1 regions were enrolled in this quasi-experimental study. After assessing the pain intensity using a visual analog scale (VAS) and determining the disc herniation index using MRI, each group of patients were asked to perform either conventional or suspension exercises for eight weeks, each week consisting of three training sessions. The pain intensity was assessed at the end of the first, second, third, fourth and eighth weeks and the disc hernia index was determined again at the end of the eight weeks of exercises. RESULTS The results indicated significant changes in the intensity of pain in both groups through the period of eight weeks of exercise with a remarkable pain relief. In relation to the structural characteristics of the intervertebral disc, data analysis did not reveal any significant change between the pre- and post-test. CONCLUSION Considering the beneficial effects of the stability exercises and specially suspension stability exercises with respect to pain alleviation and reduced use of sedatives and anti-inflammatory drugs, this method can be helpful at early stages of treatment for chronic pains.
Collapse
Affiliation(s)
- Reza Khanzadeh
- Department of Physical Education Faculty of Sports Sciences, Isfahan, Iran
| | - Reza Mahdavinejad
- Department of Physical Education Faculty of Sports Sciences, Isfahan, Iran
| | | |
Collapse
|
8
|
Jeong DK, Choi HH, Kang JI, Choi H. Effect of lumbar stabilization exercise on disc herniation index, sacral angle, and functional improvement in patients with lumbar disc herniation. J Phys Ther Sci 2017; 29:2121-2125. [PMID: 29643588 PMCID: PMC5890214 DOI: 10.1589/jpts.29.2121] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 09/20/2017] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study aimed to examine the effects of pelvic movements on the back
function of patients with lumbar disc herniation when lumbar stabilization exercise was
applied to the patients, suggest an intervention method that can be used in future
clinical therapies. [Subjects and Methods] Thirty patients with lumbar disc herniation
underwent the intervention 30 minutes per day, three times per week for 4 weeks. Of them,
15 patients were assigned to the balance center stabilization resistance exercise group
(experimental group I) and the other 15 were assigned to the three-dimensional
stabilization exercise group (experimental group II). Before the intervention, disc
herniation index was measured using magnetic resonance imaging, sacral angle was measured
using X-ray, and back function was measured using the KODI. Four weeks later, these three
factors were re-measured and analyzed. [Results] There was a significant pre- versus
post-intervention difference in disc herniation index, sacral angle, and KODI in
experimental group I and a significant difference in disc herniation index and KODI in
experimental group II, and each group of disc herniation index and sacral angle had a
significant difference. In experimental group I, each disc herniation index and sacral
angle had a negative correlation. [Conclusion] The lumbar stabilization exercise, which
controls balance using pelvic movements, improves mobility and stability of the sacroiliac
joint; therefore, it increases pelvic and back movements. These kinds of movements not
only improved proprioception sense, they also had positive effects on lumbar disc function
recovery.
Collapse
Affiliation(s)
- Dae-Keun Jeong
- Department of Physical Therapy, Sehan University: 1113 Noksaek-ro, Samho-eup, Yeongam-gun, Jeollanam-do, Republic of Korea
| | - Hyun-Ho Choi
- Department of Physical Therapy, Sehan University: 1113 Noksaek-ro, Samho-eup, Yeongam-gun, Jeollanam-do, Republic of Korea
| | - Jeong-Il Kang
- Department of Physical Therapy, Sehan University: 1113 Noksaek-ro, Samho-eup, Yeongam-gun, Jeollanam-do, Republic of Korea
| | - Hyun Choi
- Department of Physical Therapy, Mokpo Mirae Hospital, Republic of Korea
| |
Collapse
|