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Li J, Xing G, Lu P, Ding Y. Paravertebral Muscular Neurophysiological Function as an Independent Outcome Predictor of Recurring Herniation/Low Back Pain after Radiofrequency Ablation: A Prospective Follow-Up and Case-Control Study Based on Surface Electromyography. Orthop Surg 2024; 16:724-732. [PMID: 38183345 PMCID: PMC10925511 DOI: 10.1111/os.13981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 12/03/2023] [Accepted: 12/04/2023] [Indexed: 01/08/2024] Open
Abstract
OBJECTIVE Spinal endoscopy radiofrequency is a minimally invasive technique for lumbar disc herniation (LDH) and low back pain (LBP). However, recurring LDH/LBP following spinal endoscopy radiofrequency is a significant problem. Paravertebral musculature plays a crucial role in spine stability and motor function, and the purpose of the present study was to identify whether patients' baseline lumbar muscular electrophysiological function could be a predictor of recurring LDH/LBP. METHODS This was a prospective follow-up and case-control study focusing on elderly patients with LDH who were treated in our department between January 1, 2018, and October 31, 2021. The end of follow-up was recurring LBP, recurring LDH, death, missing to follow-up or 2 years postoperation. The surface electromyography test was performed before the endoscopy C-arm radiofrequency (ECRF) operation to detect the flexion-relaxation ratio (FRR) of the lumbar multifidus (FRRLM ) and the longissimus erector spinae (FRRES ), and the other baseline parameters included the general characteristics, the visual analogue scale, the Japanese Orthopaedic Association score, and the Oswestry Disability Index. Intergroup comparisons were performed by independent t-test and χ2 -test, and further binary logistic regression analysis was performed. RESULTS Fifty-four patients completed the 2-year follow-up and were retrospectively divided into a recurring LDH/LBP group (Group R) (n = 21) and a no recurring group (Group N) (n = 33) according to their clinical outcomes. FRRLM and FRRES in Group N were much higher than those in Group R (p < 0.001, p = 0.009). Logistic regression analysis showed that only the FRRLM (odds ratio [OR] = 0.123, p = 0.011) and FRRES (OR = 0.115, p = 0.036) were independent factors associated with the ECRF outcome. CONCLUSIONS Lumbar disc herniation patients' baseline FRRLM and FRRES are independent outcome predictors of recurring LDH/LBP after ECRF. For every unit increase in baseline FRRLM , the risk of recurring LDH/LBP is decreased by 87.7%, and for every unit increase in baseline FRRES , the risk of recurring LDH/LBP is decreased by 88.5%.
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Affiliation(s)
- Jian Li
- Department of OrthopaedicsChina Aerospace Science & Industry Corporation Hospital 731BeijingChina
- Department of OrthopaedicsThe Third Medical Center of PLA General HospitalBeijingChina
| | - Gengyan Xing
- Department of OrthopaedicsThe Third Medical Center of PLA General HospitalBeijingChina
| | - Pengfei Lu
- Department of OrthopaedicsThe People's Hospital of Changshou ChongqingChongqingChina
| | - Yi Ding
- Department of OrthopaedicsThe Third Medical Center of PLA General HospitalBeijingChina
- Rehabilitation Hospital Affiliated to National Research Center for Rehabilitation Technical AidsBeijingChina
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Ehrenbrusthoff K, Ryan CG, Martin DJ, Milnik V, Dinse HR, Grüneberg C. Low test–retest reliability of a protocol for assessing somatosensory cortex excitability generated from sensory nerves of the lower back. Front Hum Neurosci 2022; 16:898759. [PMID: 36082228 PMCID: PMC9445117 DOI: 10.3389/fnhum.2022.898759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 08/04/2022] [Indexed: 11/13/2022] Open
Abstract
In people with chronic low back pain (CLBP), maladaptive structural and functional changes on a cortical level have been identified. On a functional level, somatosensory cortical excitability has been shown to be reduced in chronic pain conditions, resulting in cortical disinhibition. The occurrence of structural and/or functional maladaptive cortical changes in people with CLBP could play a role in maintaining the pain. There is currently no measurement protocol for cortical excitability that employs stimulation directly to the lower back. We developed a protocol for the measurement of single pulse somatosensory evoked potential (SEP) waveforms and paired-pulse behavior (PPB) generated from sensory nerves of the lower back and quantified its test–retest reliability in a sample of 30 healthy individuals to gain insights into the normal variability of cortical responses, which could then be compared to results from people with CLBP. We investigated cortical excitability by measuring SEPs and PPB. PPB was defined as the ratio of the amplitude of the second cortical response (A2s) divided by the first cortical response (A1). A2s was determined by subtracting the response to single-pulse stimuli from the paired pulse stimuli response to account for linear superposition effects. The test–retest reliability of the protocol was very poor with no evidence of systematic bias but a high amount of random variability between sessions. There was no significant difference in the right side PPB for session 1 (Mean ratio A2s/A1 = 0.66, SD = 0.54) and session 2 (Mean ratio A2s/A1 = 0.94, SD = 1.56); mean session difference [(95% CI) = −0.44 (−1.23 to 0.34); t (22) = −1.17, p = 0.26]. The ICC3.1 (absolute agreement) for the outlier-removed right side PPB were 0.19 (95% CI: −0.84 to 0.66) and 0.43 for left side PPB (95% CI: −0.37 to 0.76). This finding potentially has wider implications for PPB protocols. If these findings were replicated in other groups and other nerves, it would question the validity of this measure more generally. However, these findings are restricted to healthy people and sensory nerves of the lower back and may not be generalizable.
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Affiliation(s)
- Katja Ehrenbrusthoff
- Department of Applied Health Sciences, Hochschule für Gesundheit, Bochum, Germany
- *Correspondence: Katja Ehrenbrusthoff,
| | - Cormac G. Ryan
- School of Health & Life Sciences, Teesside University, Middlesbrough, United Kingdom
| | - Denis J. Martin
- School of Health & Life Sciences, Teesside University, Middlesbrough, United Kingdom
| | | | - Hubert R. Dinse
- Department of Neurology, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil GmbH, Ruhr-University Bochum, Bochum, Germany
- Institute for Neuroinformatics, Neural Plasticity Lab, Ruhr-University of Bochum, Bochum, Germany
| | - Christian Grüneberg
- Department of Applied Health Sciences, Hochschule für Gesundheit, Bochum, Germany
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Han Q, Meng F, Chen M, Lu X, Zhao D, Wu D, Wang T, Qin R. Comparison Between PE-TLIF and MIS-TLIF in the Treatment of Middle-Aged and Elderly Patients with Single-Level Lumbar Disc Herniation. J Pain Res 2022; 15:1271-1282. [PMID: 35516460 PMCID: PMC9064176 DOI: 10.2147/jpr.s371635] [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] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 04/20/2022] [Indexed: 11/23/2022] Open
Abstract
Objective To evaluate the early clinical effect of percutaneous endoscopic transforaminal lumbar interbody fusion (PE-TLIF) and minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) surgery in the treatment of middle-aged and elderly patients with single-level lumbar disc herniation accompanied by lumbar instability. Methods From January 2019 to June 2020, a total of 82 consecutive patients were categorised into PE-TLIF group and MIS-TLIF group based on different surgical methods. The visual analog scale (VAS), Oswestry disability index (ODI), Japanese Orthopaedic Association (JOA) score, perioperative objective serological index, operation time, intraoperative blood loss, time to back to work or normal life, and Modified MacNab score were used as the evaluation indexes. The differences between the two groups were analyzed and the clinical effects were compared. Results The VAS back pain of PE-TLIF group was decreased compared to that of MIS-TLIF group in the postoperative 1 week and 1 month. The operative time in PE-TLIF group was obviously longer than that in MIS-TLIF group. The hospital stay was significantly shorter in PE-TLIF group than that in MIS-TLIF group. More intraoperative blood loss and postoperative drainage were recorded in MIS-TLIF group. Compared with MIS-TLIF, PE-TLIF surgery was associated with a shorter time to ambulation after surgery and a shorter time to back to work or normal life. Significant statistical differences were observed in IL-6, CRP, and CK on postoperative 3 days between the two groups. Conclusion For middle-aged and elderly patients, PE-TLIF and MIS-TLIF surgery both have obvious clinical efficacy and safety. However, with less intraoperative blood loss, shorter recovery time and less injury to the patients, people undergoing PE-TLIF surgery can return to work or normal life faster. It is speculated that PE-TLIF has a higher incidence of complications and recurrence rate than that MIS-TLIF. PE-TLIF may be a better choice for middle-aged and elderly patients with single-level lumbar disc herniation.
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Affiliation(s)
- Qi Han
- Department of Orthopedics, The First People's Hospital of Lianyungang Affiliated to Xuzhou Medical University, Lianyungang, Jiangsu, People's Republic of China
| | - Feifan Meng
- Department of Orthopedics, The First People's Hospital of Lianyungang Affiliated to Xuzhou Medical University, Lianyungang, Jiangsu, People's Republic of China
| | - Ming Chen
- Department of Orthopedics, The First People's Hospital of Lianyungang Affiliated to Xuzhou Medical University, Lianyungang, Jiangsu, People's Republic of China
| | - Xiangjun Lu
- Department of Orthopedics, The First People's Hospital of Lianyungang Affiliated to Xuzhou Medical University, Lianyungang, Jiangsu, People's Republic of China
| | - Deyuan Zhao
- Department of Orthopedics, The First People's Hospital of Lianyungang Affiliated to Xuzhou Medical University, Lianyungang, Jiangsu, People's Republic of China
| | - Dongze Wu
- Department of Orthopedics, The First People's Hospital of Lianyungang Affiliated to Xuzhou Medical University, Lianyungang, Jiangsu, People's Republic of China
| | - Tingting Wang
- Department of Dermatology, The First People's Hospital of Lianyungang Affiliated to Xuzhou Medical University, Lianyungang, Jiangsu, People's Republic of China
| | - Rujie Qin
- Department of Orthopedics, The First People's Hospital of Lianyungang Affiliated to Xuzhou Medical University, Lianyungang, Jiangsu, People's Republic of China
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Lenoir D, Willaert W, Coppieters I, Malfliet A, Ickmans K, Nijs J, Vonck K, Meeus M, Cagnie B. Electroencephalography During Nociceptive Stimulation in Chronic Pain Patients: A Systematic Review. PAIN MEDICINE 2021; 21:3413-3427. [PMID: 32488229 DOI: 10.1093/pm/pnaa131] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND With its high temporal resolution, electroencephalography (EEG), a technique that records electrical activity of cortical neuronal cells, is a potentially suitable technique to investigate human somatosensory processing. By using EEG, the processing of (nociceptive) stimuli can be investigated, along with the functionality of the nociceptive pathway. Therefore, it can be applied in chronic pain patients to objectify whether changes have occurred in nociceptive processing. Typically, so-called event-related potential (ERP) recordings are used, where EEG signals are recorded in response to specific stimuli and characterized by latency and amplitude. OBJECTIVE To summarize whether differences in somatosensory processing occur between chronic pain patients and healthy controls, measured with ERPs, and determine whether this response is related to the subjective pain intensity. DESIGN Systematic review. SETTING AND METHODS PubMed, Web of Science, and Embase were consulted, and 18 case-control studies were finally included. SUBJECTS The chronic pain patients suffered from tension-type headache, back pain, migraine, fibromyalgia, carpal tunnel syndrome, prostatitis, or complex regional pain syndrome. RESULTS Chronic neuropathic pain patients showed increased latencies of the N2 and P2 components, along with a decreased amplitude of the N2-P2 complex, which was also obtained in FM patients with small fiber dysfunction. The latter also showed a decreased amplitude of the N2-P3 and N1-P1 complex. For the other chronic pain patients, the latencies and the amplitudes of the ERP components did not seem to differ from healthy controls. One paper indicated that the N2-P3 peak-to-peak amplitude correlates with the subjective experience of the stimulus. CONCLUSIONS Differences in ERPs with healthy controls can mostly be found in chronic pain populations that suffer from neuropathic pain or where fiber dysfunction is present. In chronic pain populations with other etiological mechanisms, limited differences were found or agreed upon across studies.
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Affiliation(s)
- Dorine Lenoir
- Pain in Motion International Research Group.,Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Pain in Motion International Research Group, Vrije Universiteit Brussel, Brussel, Belgium.,Department of Physical Medicine and Physiotherapy, Universitair Ziekenhuis Brussel, Brussels, Belgium.,Research Foundation - Flanders (FWO), Brussels, Belgium
| | - Ward Willaert
- Pain in Motion International Research Group.,Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Pain in Motion International Research Group, Vrije Universiteit Brussel, Brussel, Belgium.,Department of Physical Medicine and Physiotherapy, Universitair Ziekenhuis Brussel, Brussels, Belgium.,Research Foundation - Flanders (FWO), Brussels, Belgium.,Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Iris Coppieters
- Pain in Motion International Research Group.,Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Pain in Motion International Research Group, Vrije Universiteit Brussel, Brussel, Belgium.,Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Anneleen Malfliet
- Pain in Motion International Research Group.,Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Pain in Motion International Research Group, Vrije Universiteit Brussel, Brussel, Belgium
| | - Kelly Ickmans
- Pain in Motion International Research Group.,Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Pain in Motion International Research Group, Vrije Universiteit Brussel, Brussel, Belgium.,Department of Physical Medicine and Physiotherapy, Universitair Ziekenhuis Brussel, Brussels, Belgium.,Research Foundation - Flanders (FWO), Brussels, Belgium
| | - Jo Nijs
- Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Pain in Motion International Research Group, Vrije Universiteit Brussel, Brussel, Belgium
| | - Kristl Vonck
- Department of Neurology, 4Brain, Ghent University Hospital, Ghent, Belgium
| | - Mira Meeus
- Pain in Motion International Research Group.,Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Department of Rehabilitation Sciences and Physiotherapy - MOVANT Research Group, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium
| | - Barbara Cagnie
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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The Effects of Filter's Class, Cutoff Frequencies, and Independent Component Analysis on the Amplitude of Somatosensory Evoked Potentials Recorded from Healthy Volunteers. SENSORS 2019; 19:s19112610. [PMID: 31181744 PMCID: PMC6603557 DOI: 10.3390/s19112610] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 05/14/2019] [Accepted: 06/04/2019] [Indexed: 12/15/2022]
Abstract
Objective: The aim of this study was to investigate the effects of different preprocessing parameters on the amplitude of median nerve somatosensory evoked potentials (SEPs). Methods: Different combinations of two classes of filters (Finite Impulse Response (FIR) and Infinite Impulse Response (IIR)), three cutoff frequency bands (0.5–1000 Hz, 3–1000 Hz, and 30–1000 Hz), and independent component analysis (ICA) were used to preprocess SEPs recorded from 17 healthy volunteers who participated in two sessions of 1000 stimulations of the right median nerve. N30 amplitude was calculated from frontally placed electrode (F3). Results: The epochs classified as artifacts from SEPs filtered with FIR compared to those filtered with IIR were 1% more using automatic and 140% more using semi-automatic methods (both p < 0.001). There were no differences in N30 amplitudes between FIR and IIR filtered SEPs. The N30 amplitude was significantly lower for SEPs filtered with 30–1000 Hz compared to the bandpass frequencies 0.5–1000 Hz and 3–1000 Hz. The N30 amplitude was significantly reduced when SEPs were cleaned with ICA compared to the SEPs from which non-brain components were not removed using ICA. Conclusion: This study suggests that the preprocessing of SEPs should be done carefully and the neuroscience community should come to a consensus regarding SEP preprocessing guidelines, as the preprocessing parameters can affect the outcomes that may influence the interpretations of results, replicability, and comparison of different studies.
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