1
|
Anttila S, Määttä J, Heikkala E, Arokoski J, Karppinen J, Oura P. Associations of socioeconomic and lifestyle characteristics, psychological symptoms, multimorbidity, and multisite pain with sciatica - a 15-year longitudinal study. Spine J 2024; 24:842-850. [PMID: 38211903 DOI: 10.1016/j.spinee.2023.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 12/03/2023] [Accepted: 12/27/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND CONTEXT Sciatica is defined as pain radiating from the low back to the leg, usually below the knee. It is a disabling condition that causes a major burden to health care and society. Previous evidence of the multifactorial etiology of sciatica comes mostly from cross-sectional studies. Larger, longitudinal studies with a multidimensional set of variables are needed. PURPOSE To examine how socioeconomic and lifestyle characteristics, psychological symptoms, multimorbidity, and multisite pain are associated with sciatica. STUDY DESIGN A longitudinal study of the Northern Finland Birth Cohort 1966. PATIENT SAMPLE In total 6,683 working-aged members of the Northern Finland Birth Cohort 1966. OUTCOME MEASURES Self-reported sciatic pain status over a 15-year study period. METHODS We conducted a 15-year longitudinal study from the age of 31 to 46. We used multivariable generalized estimation equations analysis to examine how socioeconomic characteristics (low education, unemployment, and living alone), lifestyle characteristics (overweight, obesity, current smoking, and physical inactivity), psychological symptoms (depression, anxiety), multimorbidity, and multisite pain were associated with sciatica. RESULTS At the age of 31, 21.1% of the study population reported sciatic pain and at the age of 46, 36.7%. Multisite pain was clearly the strongest factor associated with sciatica (odds ratio [OR] 2.61, 95% confidence interval [CI] 2.34‒2.92). In descending order of effect size, older age, low education, psychological symptoms, multimorbidity, overweight, obesity, physical inactivity and current smoking were positively associated with sciatica. Their ORs varied between 1.17 and 2.18. Living alone was negatively associated with sciatica (OR 0.81, 95% CI 0.72‒0.90). CONCLUSIONS Multisite pain had the strongest association with sciatica. The effect sizes of the other factors were clearly smaller. To our knowledge this is the first study to evaluate the association of multisite pain with sciatica. This finding may have considerable implications for clinical work treating patients with sciatica.
Collapse
Affiliation(s)
- Sanna Anttila
- Medical Research Center Oulu, Oulu University Hospital, University of Oulu, P.O. Box 8000, FI-90014, Oulu, Finland; Research Unit of Health Sciences and Technology, University of Oulu, P.O. Box 8000, FI-90014, Oulu, Finland.
| | - Juhani Määttä
- Medical Research Center Oulu, Oulu University Hospital, University of Oulu, P.O. Box 8000, FI-90014, Oulu, Finland; Research Unit of Health Sciences and Technology, University of Oulu, P.O. Box 8000, FI-90014, Oulu, Finland
| | - Eveliina Heikkala
- Medical Research Center Oulu, Oulu University Hospital, University of Oulu, P.O. Box 8000, FI-90014, Oulu, Finland; Research Unit of Population Health, University of Oulu, P.O. Box 8000, FI-90014, Oulu, Finland
| | - Jari Arokoski
- Department of Physical and Rehabilitation Medicine, Helsinki University Hospital, University of Helsinki, P.O. Box 4, FI-00014, Helsinki, Finland
| | - Jaro Karppinen
- Medical Research Center Oulu, Oulu University Hospital, University of Oulu, P.O. Box 8000, FI-90014, Oulu, Finland; Research Unit of Health Sciences and Technology, University of Oulu, P.O. Box 8000, FI-90014, Oulu, Finland; Finnish Institute of Occupational Health, FI-90032, Oulu, Finland; Rehabilitation Services of Wellbeing Services County of South Karelia, FI-53130, Lappeenranta, Finland
| | - Petteri Oura
- Medical Research Center Oulu, Oulu University Hospital, University of Oulu, P.O. Box 8000, FI-90014, Oulu, Finland; Research Unit of Health Sciences and Technology, University of Oulu, P.O. Box 8000, FI-90014, Oulu, Finland; Department of Forensic Medicine, University of Helsinki, P.O. Box 21, FI-00014, Helsinki, Finland; Forensic Medicine Unit, Finnish Institute for Health and Welfare, P.O. Box 30, FI-00271, Helsinki, Finland
| |
Collapse
|
2
|
Lin Y, Sahr M, Lan R, Nguyen J, Tan ET, Sneag DB. MRI findings correlate with difficult dissection during proximal hamstring repair and with postoperative sciatica. Skeletal Radiol 2024:10.1007/s00256-024-04668-6. [PMID: 38581584 DOI: 10.1007/s00256-024-04668-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 03/22/2024] [Accepted: 03/24/2024] [Indexed: 04/08/2024]
Abstract
OBJECTIVE This study examines the correlation between MRI findings and difficult dissection during proximal primary hamstring repair and postoperative sciatica. MATERIALS AND METHODS A total of 32 cases of surgically repaired hamstring tendon tears that underwent preoperative and postoperative MRI were divided into sciatica (n = 12) and control (n = 20) groups based on the presence or absence of postoperative sciatica. Cases were scored by two blinded musculoskeletal radiologists for imaging features associated with difficult surgical dissection and the development of subsequent sciatica. Intra- and interrater agreements, as well as correlation of MRI findings with symptoms (odds ratio, OR), were calculated. RESULTS On preoperative MRI, diffuse hamstring muscle edema pattern suggestive of active denervation (OR 9.4-13.6), and greater sciatic perineural scar circumference (OR 1.9-2) and length (OR 1.2-1.3) were significantly correlated with both difficult dissection and postoperative sciatica. Preoperatively, a greater number of tendons torn (OR 3.3), greater tear cross-sectional area (CSA, OR 1.03), and increased nerve T2-weighted signal (OR 3.2) and greater perineural scar thickness (OR 1.7) were also associated with difficult dissection, but not postoperative sciatica. On postoperative MRI, hamstring denervation, sciatic nerve tethering to the hamstring tendon, and development of perineural scar and greater perineural scar extent were all significantly correlated with postoperative sciatica. CONCLUSION Preoperative hamstring MRI demonstrates findings predictive of difficult sciatic nerve dissection; careful MRI evaluation of the nerve and for the presence and extent of perineural scar is important for preoperative planning. Preoperative and postoperative MRI both depict findings that correlate with postoperative sciatica.
Collapse
Affiliation(s)
- Yenpo Lin
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, 10021, USA
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Meghan Sahr
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, 10021, USA.
| | - Ranqing Lan
- Biostatistics Core Facility, Hospital for Special Surgery, New York, NY, USA
| | - Joe Nguyen
- Biostatistics Core Facility, Hospital for Special Surgery, New York, NY, USA
| | - Ek T Tan
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, 10021, USA
| | - Darryl B Sneag
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, 10021, USA
| |
Collapse
|
3
|
Willems SJ, Coppieters MW, Rooker S, Orzali L, Kittelson AJ, Ostelo RW, Kempen DHR, Scholten-Peeters GGM. The impact of being overweight or obese on 12 month clinical recovery in patients following lumbar microdiscectomy for radiculopathy. Spine J 2024; 24:625-633. [PMID: 37935285 DOI: 10.1016/j.spinee.2023.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 10/31/2023] [Accepted: 10/31/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND CONTEXT The proportion of patients who undergo lumbar microdiscectomy due to lumbar radiculopathy who are also overweight or obese is high. However, whether high body mass index (BMI) affects clinical outcomes is not well-studied. PURPOSE To investigate the difference in the clinical course between normal weight, overweight, and obese patients with radiculopathy who underwent lumbar microdiscectomy followed by physical therapy and to evaluate whether high BMI is associated with poor recovery. STUDY DESIGN/SETTING A prospective cohort study with a 12-month follow-up was conducted in a multidisciplinary clinic. PATIENT SAMPLE We included 583 patients (median [IQR] age: 45 [35-52] years; 41% female) with clinical signs and symptoms of lumbar radiculopathy, consistent with magnetic resonance imaging findings, who underwent microdiscectomy followed by postoperative physical therapy. OUTCOME MEASURES Outcomes were leg pain and back pain intensity measured with a visual analogue scale, disability measured with the Roland Morris Disability Questionnaire at 3 and 12-month follow-ups, and complications. METHODS Patients were classified as being normal weight (46.9%), overweight (38.4%), or obese (14.7%). A linear mixed-effects model was used to assess the difference in the clinical course of pain and disability between the three BMI categories. The association between BMI and outcomes was evaluated using univariable and multivariable logistic regression analyses. RESULTS All three patient groups experienced a significant improvement in leg pain, back pain, and disability over 3 and 12-month follow-up. Patients who were overweight, obese, or normal weight experienced comparable leg pain (p=.14) and disability (p=.06) over the clinical course (p=.14); however, obese patients experienced higher back pain (MD=-6.81 [95%CI: -13.50 to -0.14]; p=.03). The difference in back pain scores was not clinically relevant. CONCLUSIONS In the first year following lumbar microdiscectomy, patients demonstrated clinical improvements and complications that were unrelated to their preoperative BMI.
Collapse
Affiliation(s)
- Stijn J Willems
- Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, program Musculoskeletal Health, Van der Boechorststraat 9, 1081 BT, Amsterdam, The Netherlands
| | - Michel W Coppieters
- Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, program Musculoskeletal Health, Van der Boechorststraat 9, 1081 BT, Amsterdam, The Netherlands; Menzies Health Institute Queensland, Griffith University, Brisbane and Gold Coast, 170 Kessels Road, 4111 Brisbane, Australia; School of Health Sciences and Social Work, Griffith University, Brisbane and Gold Coast, 170 Kessels Road, 4111 Brisbane, Australia
| | - Servan Rooker
- Department of Neurosurgery, Kliniek ViaSana, Hoogveldeseweg 1, 5451AA Mill, The Netherlands; Department of Family Medicine and Population Health (FAMPOP), University of Antwerp, Campus Drie Eiken, R235, Universiteitsplein 1, 2610 Antwerp, Belgium
| | - Luca Orzali
- Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, program Musculoskeletal Health, Van der Boechorststraat 9, 1081 BT, Amsterdam, The Netherlands
| | - Andrew J Kittelson
- School of Physical Therapy and Rehabilitation Science, University of Montana, 32 Campus Drive, Missoula, MT 59812, USA; Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, 12631 East 17th Avenue, RM 1201G, Aurora, CO 90045, USA
| | - Raymond W Ostelo
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences research institute, Van der Boechorststraat 9, 1081 BT, Amsterdam, The Netherlands; Department of Epidemiology and Data Science, Amsterdam University Medical Center, Location VUmc, Amsterdam Movement Sciences, program Musculoskeletal Health, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Diederik H R Kempen
- Department of Orthopedic Surgery, Amsterdam University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands; Department of Orthopaedics, OLVG, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands
| | - Gwendolyne G M Scholten-Peeters
- Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, program Musculoskeletal Health, Van der Boechorststraat 9, 1081 BT, Amsterdam, The Netherlands.
| |
Collapse
|
4
|
Ter Meulen BC, Maas ET, van der Vegt R, Haumann J, Weinstein HC, Ostelo RWJG, van Dongen JM. Cost-effectiveness of Transforaminal epidural steroid injections for patients with ACUTE sciatica: a randomized controlled trial. BMC Musculoskelet Disord 2024; 25:247. [PMID: 38561748 PMCID: PMC10983727 DOI: 10.1186/s12891-024-07366-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 03/20/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Transforaminal epidural injections with steroids (TESI) are increasingly being used in patients sciatica. The STAR (steroids against radiculopathy)-trial aimed to evaluate the (cost-) effectiveness of TESI in patients with acute sciatica (< 8 weeks). This article contains the economic evaluation of the STAR-trial. METHODS Participants were randomized to one of three study arms: Usual Care (UC), that is oral pain medication with or without physiotherapy, n = 45); intervention group 1: UC and transforaminal epidural steroid injection (TESI) 1 ml of 0.5% Levobupivacaine and 1 ml of 40 mg/ml Methylprednisolone and intervention group 2: UC and transforaminal epidural injection (TEI) with 1 ml of 0,5% Levobupivacaine and 1 ml of 0.9% NaCl (n = 50). The primary effect measure was health-related quality of life. Secondary outcomes were pain, functioning, and recovery. Costs were measured from a societal perspective, meaning that all costs were included, irrespective of who paid or benefited. Missing data were imputed using multiple imputation, and bootstrapping was used to estimate statistical uncertainty. RESULTS None of the between-group differences in effects were statistically significant for any of the outcomes (QALY, back pain, leg pain, functioning, and global perceived effect) at the 26-weeks follow-up. The adjusted mean difference in total societal costs was €1718 (95% confidence interval [CI]: - 3020 to 6052) for comparison 1 (intervention group 1 versus usual care), €1640 (95%CI: - 3354 to 6106) for comparison 2 (intervention group 1 versus intervention group 2), and €770 (95%CI: - 3758 to 5702) for comparison 3 (intervention group 2 versus usual care). Except for the intervention costs, none of the aggregate and disaggregate cost differences were statistically significant. The maximum probability of all interventions being cost-effective compared to the control was low (< 0.7) for all effect measures. CONCLUSION These results suggest that adding TESI (or TEI) to usual care is not cost-effective compared to usual care in patients with acute sciatica (< 8 weeks) from a societal perspective in a Dutch healthcare setting. TRIAL REGISTRATION Dutch National trial register: NTR4457 (March, 6th, 2014).
Collapse
Affiliation(s)
- Bastiaan C Ter Meulen
- Department of Neurology at OLVG Teaching Hospital, Amsterdam, The Netherlands.
- Department of Epidemiology and Data Sciences, Amsterdam UMC, Vrije Universiteit, Amsterdam Movement Sciences Research Institute Musculoskeletal Health, De Boelelaan 1089a, 1081, HV, Amsterdam, The Netherlands.
| | - Esther T Maas
- Department of Epidemiology and Data Sciences, Amsterdam UMC, Vrije Universiteit, Amsterdam Movement Sciences Research Institute Musculoskeletal Health, De Boelelaan 1089a, 1081, HV, Amsterdam, The Netherlands
| | - Rien van der Vegt
- Department of Pain Medicine and Anesthesiology Zaans MC, Zaandam, The Netherlands
| | - Johan Haumann
- Department of Pain Medicine and Anesthesiology, OLVG, Amsterdam, The Netherlands
| | - Henry C Weinstein
- Department of Neurology at OLVG Teaching Hospital, Amsterdam, The Netherlands
| | - Raymond W J G Ostelo
- Department of Epidemiology and Data Sciences, Amsterdam UMC, Vrije Universiteit, Amsterdam Movement Sciences Research Institute Musculoskeletal Health, De Boelelaan 1089a, 1081, HV, Amsterdam, The Netherlands
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam and the Amsterdam Movement Sciences Research Institute, De Boelelaan 1085, 1081, HV, Amsterdam, The Netherlands
| | - Johanna M van Dongen
- Department of Epidemiology and Data Sciences, Amsterdam UMC, Vrije Universiteit, Amsterdam Movement Sciences Research Institute Musculoskeletal Health, De Boelelaan 1089a, 1081, HV, Amsterdam, The Netherlands
| |
Collapse
|
5
|
Veihelmann A, Beck F, Birkenmaier C. HADS and SOMS-2 brief score evaluation can prevent unnecessary minimal invasive spine interventions - a prospective blinded observational clinical trial. Arch Orthop Trauma Surg 2024; 144:1575-1584. [PMID: 38386066 DOI: 10.1007/s00402-024-05257-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 02/18/2024] [Indexed: 02/23/2024]
Abstract
INTRODUCTION To test the hypothesis, whether HADS/SOMS is practical in a spine surgery consultation setting and that patients with CLBP, but a high-risk of psychic comorbidities using above screenings will not improve after minimal-invasive spine interventions (MIS). METHODS n = 150 completed HADS and SOMS prior to the acquisition of history and examination. Primary outcome was improvement by numeric rating scale (NRS), Pain disability index (PDI) and oswestry disability index (ODI) at baseline and 6 months after intervention. In case of sciatica due to disc herniation epidural neurolysis, for facet or SI-joint-syndrome, radiofrequency and for discogenic pain intradiscal electrothermal therapy (IDET) was performed. RESULTS 6 months after interventions, pat. with a high-risk of anxiety or depression showed no clinically important improvements in NRS, PDI and ODI, whereas in the low-risk group all 3 parameters were significantly reduced. We found a statistically significant difference in the improvement of NRS (p < 0·05), PDI (p < 0·001), ODI (p < 0·001) between high- and low-risk HADS-anxiety and depression groups and in the improvement of NRS and PDI (p < 0·05) between high- and low-risk SOMS-2-subgroups. CONCLUSIONS In this group of CLBP patients, the easy-to-administer HADS/SOMS reliably predicted outcome after MIS due to the detection of somatoform comorbidities. Thus, 30 out of 150 patients were invasively treated without improvement. This is alarming not only because of unnecessary MIS being performed on these individuals, but also because it represents an inefficient allocation of increasingly limited healthcare funds. LEVEL OF EVIDENCE II.
Collapse
Affiliation(s)
- Andreas Veihelmann
- Department of Orthopaedics, Physical Medicine & Rehabilitation, Ludwig-Maximilians- University of Munich, Munich, Germany.
- Department for Spine Therapy, Sports Hospital Stuttgart, Stuttgart, Germany.
- SRH Health-center, Bad Herrenalb, Germany.
| | - Florian Beck
- Department of Orthopaedics, Physical Medicine & Rehabilitation, Ludwig-Maximilians- University of Munich, Munich, Germany
- Orthopaedie Centrum 30, Fellbach, Germany
| | - Christof Birkenmaier
- Department of Orthopaedics, Physical Medicine & Rehabilitation, Ludwig-Maximilians- University of Munich, Munich, Germany
| |
Collapse
|
6
|
Vaishya S, Pojskic M, Bedi MS, Oertel J, Sippl C, Robertson S, Zygourakis C. Cauda equina, conus medullaris and syndromes mimicking sciatic pain: WFNS spine committee recommendations. World Neurosurg X 2024; 22:100274. [PMID: 38496349 PMCID: PMC10943478 DOI: 10.1016/j.wnsx.2024.100274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 02/01/2024] [Indexed: 03/19/2024] Open
Abstract
Introduction Cauda equina syndrome (CES), conus medullaris syndrome (CMS), and sciatica-like syndromes or "sciatica mimics" (SM) may present as diagnostic and/or therapeutic dilemmas for the practicing spine surgeon. There is considerable controversy regarding the appropriate definition and diagnosis of these entities, as well as indications for and timing of surgery. Our goal is to formulate the most current, evidence-based recommendations for the definition, diagnosis, and management of CES, CMS, and SM syndromes. Methods We performed a systematic literature search in PubMed from 2012 to 2022 using the keywords "cauda equina syndrome", "conus medullaris syndrome", "sciatica", and "sciatica mimics". Standardized screening criteria yielded a total of 43 manuscripts, whose data was summarized and presented at two international consensus meetings of the World Federation of Neurosurgical Societies (WFNS) Spine Committee. Utilizing the Delphi method, we generated seven final consensus statements. Results and conclusion s: We provide standardized definitions of cauda equina, cauda equina syndrome, conus medullaris, and conus medullaris syndrome. We advocate for the use of the Lavy et al classification system to categorize different types of CES, and recommend urgent MRI in all patients with suspected CES (CESS), considering the low sensitivity of clinical examination in excluding CES. Surgical decompression for CES and CMS is recommended within 48 h, preferably within less than 24 h. There is no data regarding the role of steroids in acute CES or CMS. The treating physician should be cognizant of a variety of other pathologies that may mimic sciatica, including piriformis syndrome, and how to manage these.
Collapse
Affiliation(s)
- Sandeep Vaishya
- Department of Neurosurgery, Fortis Memorial Research Institute, Guragaon and Fortis Hospital Vasant Kunj, New Delhi, India
| | - Mirza Pojskic
- Department of Neurosurgery, University of Marburg, Germany
| | - Manbachan Singh Bedi
- Department of Neurosurgery, Fortis Memorial Research Institute, Guragaon and Fortis Hospital Vasant Kunj, New Delhi, India
| | - Joachim Oertel
- Department of Neurosurgery, Saarland University Medical Centre, Homburg, Germany
| | - Christoph Sippl
- Department of Neurosurgery, Saarland University Medical Centre, Homburg, Germany
| | - Scott Robertson
- Dept of Neurosurgery, Ochsner Medical Center Baton Rouge, USA
| | | |
Collapse
|
7
|
Fang M, Liu W, Wang Z, Li J, Hu S, Li Z, Chen W, Zhang N. Causal associations between gut microbiota with intervertebral disk degeneration, low back pain, and sciatica: a Mendelian randomization study. Eur Spine J 2024; 33:1424-1439. [PMID: 38285276 DOI: 10.1007/s00586-024-08131-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 11/30/2023] [Accepted: 01/03/2024] [Indexed: 01/30/2024]
Abstract
PURPOSE Although studies have suggested that gut microbiota may be associated with intervertebral disk disease, their causal relationship is unclear. This study aimed to investigate the causal relationship between the gut microbiota and its metabolic pathways with the risk of intervertebral disk degeneration (IVDD), low back pain (LBP), and sciatica. METHODS Genetic variation data for 211 gut microbiota taxa at the phylum to genus level were obtained from the MiBioGen consortium. Genetic variation data for 105 taxa at the species level and 205 metabolic pathways were obtained from the Dutch Microbiome Project. Genetic variation data for disease outcomes were obtained from the FinnGen consortium. The causal relationships between the gut microbiota and its metabolic pathways and the risk of IVDD, LBP, and sciatica were evaluated via Mendelian randomization (MR). The robustness of the results was assessed through sensitivity analysis. RESULTS Inverse variance weighting identified 46 taxa and 33 metabolic pathways that were causally related to IVDD, LBP, and sciatica. After correction by weighted median and MR-PRESSO, 15 taxa and nine pathways remained stable. After FDR correction, only the effect of the genus_Eubacterium coprostanoligenes group on IVDD remained stable. Sensitivity analyses showed no evidence of horizontal pleiotropy, heterogeneity, or reverse causation. CONCLUSION Some microbial taxa and their metabolic pathways are causally related to IVDD, LBP, and sciatica and may serve as potential intervention targets. This study provides new insights into the mechanisms of gut microbiota-mediated development of intervertebral disk disease.
Collapse
Affiliation(s)
- Miaojie Fang
- Department of Orthopedics Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Shangcheng District, 310009, Hangzhou, People's Republic of China
- Department of Orthopedics Surgery, International Institutes of Medicine, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, N1 Shangcheng Road, Yiwu, Zhejiang, People's Republic of China
- Orthopedics Research Institute of Zhejiang University, Hangzhou, Zhejiang, People's Republic of China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, Zhejiang, People's Republic of China
- Clinical Research Center of Motor System Disease of Zhejiang Province, Hangzhou, Zhejiang, People's Republic of China
| | - Wei Liu
- Department of Orthopedics Surgery, International Institutes of Medicine, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, N1 Shangcheng Road, Yiwu, Zhejiang, People's Republic of China
| | - Zhan Wang
- Department of Orthopedics Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Shangcheng District, 310009, Hangzhou, People's Republic of China
- Orthopedics Research Institute of Zhejiang University, Hangzhou, Zhejiang, People's Republic of China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, Zhejiang, People's Republic of China
- Clinical Research Center of Motor System Disease of Zhejiang Province, Hangzhou, Zhejiang, People's Republic of China
| | - Jun Li
- Department of Orthopedics Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Shangcheng District, 310009, Hangzhou, People's Republic of China
- Orthopedics Research Institute of Zhejiang University, Hangzhou, Zhejiang, People's Republic of China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, Zhejiang, People's Republic of China
- Clinical Research Center of Motor System Disease of Zhejiang Province, Hangzhou, Zhejiang, People's Republic of China
| | - Shaojun Hu
- Department of Orthopedics Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Shangcheng District, 310009, Hangzhou, People's Republic of China
- Orthopedics Research Institute of Zhejiang University, Hangzhou, Zhejiang, People's Republic of China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, Zhejiang, People's Republic of China
- Clinical Research Center of Motor System Disease of Zhejiang Province, Hangzhou, Zhejiang, People's Republic of China
| | - Zilong Li
- Department of Orthopedics Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Shangcheng District, 310009, Hangzhou, People's Republic of China
- Orthopedics Research Institute of Zhejiang University, Hangzhou, Zhejiang, People's Republic of China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, Zhejiang, People's Republic of China
- Clinical Research Center of Motor System Disease of Zhejiang Province, Hangzhou, Zhejiang, People's Republic of China
| | - Weishan Chen
- Department of Orthopedics Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Shangcheng District, 310009, Hangzhou, People's Republic of China.
- Orthopedics Research Institute of Zhejiang University, Hangzhou, Zhejiang, People's Republic of China.
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, Zhejiang, People's Republic of China.
- Clinical Research Center of Motor System Disease of Zhejiang Province, Hangzhou, Zhejiang, People's Republic of China.
| | - Ning Zhang
- Department of Orthopedics Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Shangcheng District, 310009, Hangzhou, People's Republic of China.
- Orthopedics Research Institute of Zhejiang University, Hangzhou, Zhejiang, People's Republic of China.
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, Zhejiang, People's Republic of China.
- Clinical Research Center of Motor System Disease of Zhejiang Province, Hangzhou, Zhejiang, People's Republic of China.
| |
Collapse
|
8
|
Zendeoui A, Gharbi MA, Nefiss M, Ezzine MH, Tborbi A, Bouzidi R. Primary extrahepatic hydatid cyst of the thigh, an unusual presentation of sciatica: A case report of a diagnostic challenge. Int J Surg Case Rep 2024; 117:109545. [PMID: 38518474 PMCID: PMC10973717 DOI: 10.1016/j.ijscr.2024.109545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 03/08/2024] [Accepted: 03/14/2024] [Indexed: 03/24/2024] Open
Abstract
INTRODUCTION Sciatica, a condition characterized by pain along the sciatic nerve distribution, is commonly associated with nerve compression or irritation. However, its etiology can vary, including rare non-spinal causes such as hydatid cysts. We present a case of hydatid cyst in the thigh causing sciatica-like symptoms, highlighting the diagnostic challenges and management approach. CASE PRESENTATION A 40-year-old patient with a history of pulmonary tuberculosis presented with persistent lumbosciatic pain despite conservative treatment. Physical examination revealed left sciatica without spinal abnormalities. MRI revealed a hydatid cyst in the thigh, causing nerve irritation. Surgical resection of the cyst was performed, achieving symptom resolution. DISCUSSION Hydatid cysts in skeletal muscles are rare, with atypical presentations complicating diagnosis. Localization in the thigh, particularly the biceps femoris muscle, is uncommon. Diagnostic modalities include imaging and serological tests, while treatment involves surgical excision and postoperative albendazole therapy. CONCLUSION Recognition of rare presentations like thigh hydatid cysts causing sciatica-like symptoms is crucial for timely diagnosis and management. This case emphasizes the importance of considering unusual etiologies in refractory sciatica cases and underscores the complexity of medical diagnosis. Increased awareness among healthcare providers can lead to improved patient outcomes and prevent diagnostic delays.
Collapse
Affiliation(s)
| | | | - Mouadh Nefiss
- Orthopaedic Department, Mongi Slim Hospital, Tunisia
| | | | - Anis Tborbi
- Orthopaedic Department, Mongi Slim Hospital, Tunisia
| | - Ramzi Bouzidi
- Orthopaedic Department, Mongi Slim Hospital, Tunisia
| |
Collapse
|
9
|
Qiu X, Luo X, Wu R. Atypical lipoma of the right piriformis muscle: a case report and review of the literature. J Med Case Rep 2024; 18:189. [PMID: 38555435 PMCID: PMC10981807 DOI: 10.1186/s13256-024-04507-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 03/13/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Piriformis muscle mass is rare, which is particular for intrapiriformis lipoma. Thus far, only 11 cases of piriformis muscle mass have been reported in the English literature. Herein, we encountered one patient with intrapiriformis lipoma who was initially misdiagnosed. CASE PRESENTATION The patient is a 50-year-old Chinese man. He complained of osphyalgia, right buttock pain, and radiating pain from the right buttock to the back of the right leg. Both ultrasound and magnetic resonance imaging demonstrated a cyst-like mass in the right piriformis muscle. Ultrasonography-guided aspiration was performed on this patient first, but failed. He was then recommended to undergo mass resection and neurolysis of sciatic nerve. Surprisingly, final histology revealed the diagnosis of intrapiriformis lipoma. The patient exhibited significant relief of symptoms 3 days post-surgery. CONCLUSION Diagnosis and differential diagnosis of radicular pain are potentially challenging but necessary. Atypical lipoma is prone to be misdiagnosed, especially in rare sites. It is notable for clinicians to be aware of the presence of intrapiriformis lipoma to avoid misdiagnosis and inappropriate treatment.
Collapse
Affiliation(s)
- Xiao Qiu
- Department of Ultrasound, Suining Central Hospital, 127 Desheng West Road, Suining, Sichuan, China
| | - Xiaoyong Luo
- Department of Ultrasound, Suining Central Hospital, 127 Desheng West Road, Suining, Sichuan, China
| | - Renmei Wu
- Department of Ultrasound, Suining Central Hospital, 127 Desheng West Road, Suining, Sichuan, China.
| |
Collapse
|
10
|
Lu KY, Tung WE, Chiang CJ, Hsieh YY, Chen CH, Lee MH, Yen MH, Lu PW, Wu LC. Sciatica caused by spinal epidural abscess as the initial clinical presentation of colon cancer: a rare case report and review of literature. BMC Infect Dis 2024; 24:293. [PMID: 38448866 PMCID: PMC10916147 DOI: 10.1186/s12879-024-09159-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 02/20/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Colorectal cancer is one of the most frequently diagnosed forms of cancer, and it is associated with several common symptoms and signs such as rectal bleeding, altered bowel habits, abdominal pain, anemia, and unintentional weight loss. Sciatica, a debilitating condition in which the patient experiences paresthesia and pain in the dermatome of associated lumbosacral nerve roots or sciatic nerve distribution, is not considered one of these. Here we present a case of colorectal cancer manifesting symptoms of sciatica alone. CASE PRESENTATION A 68-year-old male presented with progressive lower back pain radiating to his left thigh and calf over L5/S1 dermatome. Sciatica was suspected and initially underwent conservative treatment with analgesics. However, the symptoms progressed and MRI revealed an epidural abscess surprisingly. Surgical debridement was performed and pus culture isolated Streptococcus gallolyticus. Based on the strong association of S. gallolyticus with colorectal cancer, the presence of this pathogen prompted further tumor evaluation, even in the absence of the typical symptoms and signs. This investigation ultimately leads to the diagnosis of sigmoid adenocarcinoma. CONCLUSIONS Although rare, sciatica caused by S. gallolyticus infection of the spinal epidural space may serve as the initial presentation of colorectal cancer. Physicians should be aware of the strong association between S. gallolyticus and colorectal cancer. Based on what we currently know about the condition; a thorough systematic assessment of occult neoplasia for patients with S. gallolyticus infection is recommended.
Collapse
Affiliation(s)
- Kuan-Yu Lu
- Department of Orthopedics, Shuang Ho Hospital, Taipei Medical University, New Taipei City, 23561, Taiwan
| | - Wei-En Tung
- Department of Orthopedics, Shuang Ho Hospital, Taipei Medical University, New Taipei City, 23561, Taiwan
| | - Chang-Jung Chiang
- Department of Orthopedics, Shuang Ho Hospital, Taipei Medical University, New Taipei City, 23561, Taiwan
- Department of Orthopedic Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, 110, Taiwan
| | - Yueh-Ying Hsieh
- Department of Orthopedics, Shuang Ho Hospital, Taipei Medical University, New Taipei City, 23561, Taiwan
- Department of Orthopedic Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, 110, Taiwan
| | - Chia-Hsien Chen
- Department of Orthopedics, Shuang Ho Hospital, Taipei Medical University, New Taipei City, 23561, Taiwan
- School of Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei City, Taiwan
| | - Mei-Hui Lee
- Division of Infectious Diseases, Department of Internal Medicine, Shuang-Ho Hospital, Taipei Medical University, New Taipei City, 23561, Taiwan
| | - Min-Hsuan Yen
- Division of Colorectal Surgery, Department of Surgery, Shuang-Ho Hospital, Taipei Medical University, New Taipei City, 23561, Taiwan
| | - Po-Wen Lu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, 23561, Taiwan
- Graduate Institute of Biomedical Materials and Tissue Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei City, 110, Taiwan
| | - Lien-Chen Wu
- Department of Orthopedics, Shuang Ho Hospital, Taipei Medical University, New Taipei City, 23561, Taiwan.
- Department of Orthopedic Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, 110, Taiwan.
- Graduate Institute of Biomedical Materials and Tissue Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei City, 110, Taiwan.
| |
Collapse
|
11
|
Chen L, Jiang C, Xu Q, Jin J, A S, Wang X, Li X, Hu Y, Sun H, Lu X, Duan S, Gao Z, Wang W, Wang Y. Biphasic release of betamethasone from an injectable HA hydrogel implant for alleviating lumbar disc herniation induced sciatica. Acta Biomater 2024; 176:173-189. [PMID: 38244658 DOI: 10.1016/j.actbio.2024.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 12/17/2023] [Accepted: 01/11/2024] [Indexed: 01/22/2024]
Abstract
Epidural steroid injection (ESI) is a common therapeutic approach for managing sciatica caused by lumbar disc herniation (LDH). However, the short duration of therapeutic efficacy and the need for repeated injections pose challenges in LDH treatment. The development of a controlled delivery system capable of prolonging the effectiveness of ESI and reducing the frequency of injections, is highly significant in LDH clinical practice. In this study, we utilized a thiol-ene click chemistry to create a series of injectable hyaluronic acid (HA) based release systems loaded with diphasic betamethasone, including betamethasone dipropionate (BD) and betamethasone 21-phosphate disodium (BP) (BD/BP@HA). BD/BP@HA hydrogel implants demonstrated biocompatibility and biodegradability to matched neuronal tissues, avoiding artificial compression following injection. The sustained release of betamethasone from BD/BP@HA hydrogels effectively inhibited both acute and chronic neuroinflammation by suppressing the nuclear factor kappa-B (NF-κB) pathway. In a mouse model of LDH, the epidural administration of BD/BP@HA efficiently alleviated LDH-induced sciatica for at least 10 days by inhibiting the activation of macrophages and microglia in dorsal root ganglion and spinal dorsal horn, respectively. The newly developed HA hydrogels represent a valuable platform for achieving sustained drug release. Additionally, we provide a simple paradigm for fabricating BD/BP@HA for epidural injection, demonstrating greater and sustained efficiency in alleviating LDH-induced sciatica compared to traditional ESI and displaying potentials for clinical translation. This system has the potential to revolutionize drug delivery for co-delivery of both soluble and insoluble drugs, thereby making a significant impact in the pharmaceutical industry. STATEMENT OF SIGNIFICANCE: Lumbar disc herniation (LDH) is a common degenerative disorder leading to sciatica and spine surgery. Although epidural steroid injection (ESI) is routinely used to alleviate sciatica, the efficacy is short and repeated injections are required. There remains challenging to prolong the efficacy of ESI. Herein, an injectable hyaluronic acid (HA) hydrogel implant by crosslinking acrylated-modified HA (HA-A) with thiol-modified HA (HA-SH) was designed to achieve a biphasic release of betamethasone. The hydrogel showed biocompatibility and biodegradability to match neuronal tissues. Notably, compared to traditional ESI, the hydrogel better alleviated sciatica in vivo by synergistically inhibiting the neuroinflammation in central and peripheral nervous systems. We anticipate the injectable HA hydrogel implant has the potential for clinical translation in treating LDH-induced sciatica.
Collapse
Affiliation(s)
- Lunhao Chen
- Spine Lab, Department of Orthopedic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Chao Jiang
- Spine Lab, Department of Orthopedic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Qian Xu
- The Charles Institute of Dermatology, School of Medicine, University College Dublin, Dublin D04V1W8, Ireland; School of Pharmaceutical Science, Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
| | - Jiale Jin
- Spine Lab, Department of Orthopedic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Sigen A
- School of Medicine, Anhui University of Science and Technology, Huainan, China; The Charles Institute of Dermatology, School of Medicine, University College Dublin, Dublin D04V1W8, Ireland
| | - Xi Wang
- The Charles Institute of Dermatology, School of Medicine, University College Dublin, Dublin D04V1W8, Ireland
| | - Xiaolin Li
- The Charles Institute of Dermatology, School of Medicine, University College Dublin, Dublin D04V1W8, Ireland
| | - Yaling Hu
- Liangzhu Laboratory, Zhejiang University Medical Center, MOE Frontier Science Center for Brain Science and Brain-machine Integration, State Key Laboratory of Brain-machine Intelligence, Zhejiang University, Hangzhou 311121, China; NHC and CAMS Key Laboratory of Medical Neurobiology, Zhejiang University, Hangzhou 310058, China; Zhejiang Provincial Key Laboratory of Pancreatic Diseases, The First Affiliated Hospital, University School of Medicine, Hangzhou 310003, China
| | - Huankun Sun
- Zhejiang Provincial Key Laboratory of Pancreatic Diseases, The First Affiliated Hospital, University School of Medicine, Hangzhou 310003, China
| | - Xuan Lu
- Spine Lab, Department of Orthopedic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Shumin Duan
- Liangzhu Laboratory, Zhejiang University Medical Center, MOE Frontier Science Center for Brain Science and Brain-machine Integration, State Key Laboratory of Brain-machine Intelligence, Zhejiang University, Hangzhou 311121, China; NHC and CAMS Key Laboratory of Medical Neurobiology, Zhejiang University, Hangzhou 310058, China
| | - Zhihua Gao
- Liangzhu Laboratory, Zhejiang University Medical Center, MOE Frontier Science Center for Brain Science and Brain-machine Integration, State Key Laboratory of Brain-machine Intelligence, Zhejiang University, Hangzhou 311121, China; NHC and CAMS Key Laboratory of Medical Neurobiology, Zhejiang University, Hangzhou 310058, China.
| | - Wenxin Wang
- Research and Clinical Translation Center of Gene Medicine and Tissue Engineering, School of Public Health, Anhui University of Science and Technology, Huainan, China; School of Medicine, Anhui University of Science and Technology, Huainan, China; The Charles Institute of Dermatology, School of Medicine, University College Dublin, Dublin D04V1W8, Ireland.
| | - Yue Wang
- Spine Lab, Department of Orthopedic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.
| |
Collapse
|
12
|
Son BC. Importance of Sacrotuberous Ligament in Transgluteal Approach for Sciatic Nerve Entrapment in the Greater Sciatic Notch (Piriformis Syndrome). J Korean Neurosurg Soc 2024; 67:217-226. [PMID: 37752819 PMCID: PMC10924905 DOI: 10.3340/jkns.2023.0166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 09/17/2023] [Accepted: 09/25/2023] [Indexed: 09/28/2023] Open
Abstract
OBJECTIVE The efficacy of sciatic nerve decompression via transgluteal approach for entrapment of the sciatic nerve at the greater sciatic notch, called piriformis syndrome, and factors affecting the surgical outcome were analyzed. METHODS The outcome of pain reduction was analyzed in 81 patients with sciatic nerve entrapment who underwent decompression through a transgluteal approach. The patients were followed up for at least 6 months. The degree of pain reduction was analyzed using a numerical rating scale-11 (NRS-11) score and percent pain relief before and after last follow-up following surgery. Success was defined by at least 50% reduction in pain measured via NRS-11. To assess the degree of subjective satisfaction, a 10-point Likert scale was used. In addition, demographic characteristics, anatomical variations, and variations in surgical technique involving sacrotuberous ligamentectomy were analyzed as factors that affect the surgical outcome. RESULTS At a follow-up of 17.5±12.5 months, sciatic nerve decompression was successful in 50 of 81 patients (61.7%), and the pain relief rate was 43.9±34.17. Subjective improvement based on a 10-point Likert scale was 4.90±3.43. Among the factors that affect the surgical outcome, only additional division of the sacrotuberous ligament during piriformis muscle resection played a significant role. The success rate was higher in the scarotuberous ligementectomy group (79.4%) than in the non-resection group (42.6%), resulting in statistically significant difference based on average NRS-11 score, percent pain relief, and subjective improvement (p<0.05, independent t-test). CONCLUSION Sciatic nerve decompression is effective in pain relief in chronic sciatica due to sciatic nerve entrapment at the greater sciatic notch. Its effect was further enhanced by circumferential dissection of the sciatic nerve based on the compartment formed by the piriformis muscle and the sacrotuberous ligament in the greater sciatic notch.
Collapse
Affiliation(s)
- Byung-chul Son
- Department of Neurosurgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Catholic Neuroscience Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea
| |
Collapse
|
13
|
Feeley I, Shahin A, Feeley A, Wilby M, Goebel A, Bhojak M, Gupta M, Gulati S. Results from an expedited spinal nerve root block clinic at a UK tertiary neurosurgical centre. Surgeon 2024; 22:e41-e47. [PMID: 37914542 DOI: 10.1016/j.surge.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 09/26/2023] [Accepted: 10/10/2023] [Indexed: 11/03/2023]
Abstract
STUDY DESIGN Retrospective Observational Study. INTRODUCTION Lumbar radicular pain has a prevalence of 3-5%. Level 1 evidence has demonstrated equivalence between surgical and injection treatment. We assess the outcomes from a transforaminal epidural steroid injection clinic in a tertiary neuroscience referral centre. METHODS We performed an analysis of data from consecutive patients entered into a new internal referral database between August 2018 to May 2021. Radicular pain was classified as one of "first presentation" or "recurrence". Outcomes were obtained from follow up clinic letters and recorded in a binary manner of "positive result" or "negative result". Spinal pathology was documented from radiology reports and MRI images. RESULTS We analysed 208 patients referred to the clinic. Excluding those who improved to a point of not requiring treatment, and those who underwent surgical intervention, 119 patients undergoing injection were included, of which 14 were lost to follow-up. 68 % of patients had a positive result from injection. Subgroup analysis demonstrated good outcomes for both hyperacute (<6 weeks) and chronic (>12 months). Contained disk pathologies had better outcomes than uncontained. There was no difference in outcomes across grades of compression, but previous same level surgery was associated with poorer response rates. CONCLUSIONS There is a high rate of natural resolution of symptoms in patients with LSRP. In those where pain persists, TFESI is a valuable first line treatment modality. This study suggests the efficacy of TFESI is potentially independent of grade of stenosis and chronicity of symptoms. Contained disc pathologies respond better than uncontained.
Collapse
Affiliation(s)
- Iain Feeley
- Walton Centre Foundation Trust, Liverpool, United Kingdom; Royal College of Surgeons in Ireland, Dublin, Ireland.
| | - Ahmed Shahin
- Walton Centre Foundation Trust, Liverpool, United Kingdom
| | - Aoife Feeley
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Martin Wilby
- Walton Centre Foundation Trust, Liverpool, United Kingdom
| | - Andreas Goebel
- Walton Centre Foundation Trust, Liverpool, United Kingdom; Pain Research Institute, University of Liverpool, Liverpool, United Kingdom
| | - Maneesh Bhojak
- Walton Centre Foundation Trust, Liverpool, United Kingdom
| | - Manish Gupta
- Walton Centre Foundation Trust, Liverpool, United Kingdom
| | - Sumit Gulati
- Walton Centre Foundation Trust, Liverpool, United Kingdom
| |
Collapse
|
14
|
Han S, Lee HD, Jang HD, Suh DH, Han K, Hong JY. Lumbar radiculopathy and fracture risk: A Korean nationwide population-based cohort study. Bone 2024; 179:116981. [PMID: 38008302 DOI: 10.1016/j.bone.2023.116981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 11/06/2023] [Accepted: 11/21/2023] [Indexed: 11/28/2023]
Abstract
INTRODUCTION Lumbar radiculopathy is a common disease with a high economic burden, and fractures in adults are a significant public health problem. However, studies of the relationship between lumbar radiculopathy and fractures are scarce. We investigated the fracture risk in patients with lumbar radiculopathy. METHODS This nationwide retrospective cohort study identified 815,101 patients with lumbar radiculopathy and randomly matched individuals without lumbar radiculopathy (1:1) who were included in the Korean National Health Insurance System in 2012. Cox proportional hazards regression analyses were performed to calculate the hazard ratio (HR) for fracture risk in patients with lumbar radiculopathy. RESULTS The study included 301,347 patients with lumbar radiculopathy and matched 289,618 individuals without lumbar radiculopathy. Compared to individuals without lumbar radiculopathy, patients with lumbar radiculopathy had a 27 % increased fracture risk (adjusted HR = 1.27, 95 % confidence interval = 1.24-1.31). The Kaplan-Meier plot showed a significantly higher fracture incidence in patients with lumbar radiculopathy than in individuals without lumbar radiculopathy at all times. CONCLUSION Lumbar radiculopathy is significantly associated with fracture risk.
Collapse
Affiliation(s)
- Sangsoo Han
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, 170 Jomaru-ro, Bucheon 14584, Republic of Korea
| | - Han-Dong Lee
- Department of Orthopaedic Surgery, Ajou University School of Medicine, Suwon 16499, Republic of Korea
| | - Hae-Dong Jang
- Department of Orthopaedic Surgery, Soonchunhyang University Bucheon Hospital, 170 Jomaru-ro, Bucheon 14584, Republic of Korea
| | - Dong Hun Suh
- Department of Orthopedics, Korea University Hospital, Ansan, 123, Jeokgeum-ro, Danwon-gu, Ansan-si, Gyeonggi-do 15355, Republic of Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, 369 Sangdo-ro, Dongjak-gu, Seoul 06978, Republic of Korea
| | - Jae-Young Hong
- Department of Orthopedics, Korea University Hospital, Ansan, 123, Jeokgeum-ro, Danwon-gu, Ansan-si, Gyeonggi-do 15355, Republic of Korea.
| |
Collapse
|
15
|
Carlos AGJ, Silvia CV. Evaluation of the Usefulness of Ozone - O3 in the Treatment of Low Back Pain. Is it Really Something more than an Empirical Concept? Systematic Review of the Literature. World Neurosurg 2024; 182:e319-e333. [PMID: 38013111 DOI: 10.1016/j.wneu.2023.11.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 11/21/2023] [Accepted: 11/22/2023] [Indexed: 11/29/2023]
Abstract
OBJECTIVE Low back pain (LBP) is a common pathology, and its high prevalence has led to the emergence of alternative options that have gained popularity without objective epidemiological evaluations. This work seeks to clarify the utility of ozone in the treatment of LBP. METHODS A systematic literature search was conducted following the principles by PRISMA. The search included articles published up to June 2023. Each of the authors reviewed the abstract of the articles and applied the inclusion and exclusion criteria. RESULTS A total of 28 articles were selected: 18 prospective randomized clinical studies, 3 systematic reviews plus meta-analysis, and 6 retrospective case series studies. CONCLUSIONS The treatment of LBP is complex. Advancements have been made in recent years from biomechanical and pathophysiological perspectives, but ozone therapy is not considered a treatment option. Techniques that involve the use of ozone fall into the category of empirical options. International guidelines for LBP exclude ozone therapy. It is advisable to conduct further studies under strict parameters to better evaluate its outcomes.
Collapse
Affiliation(s)
- Acevedo-Gonzalez Juan Carlos
- Neurosurgeon Specializing in Functional Neurosurgery and Stereotaxy, Pain and Spasticity Management, Faculty of Medicine, Pontificia Javeriana University, San Ignacio Universitary Hospital, Bogotá, Colombia.
| | - Clavijo-Vega Silvia
- Department of Neurosurgery, Pontificia Javeriana University, Bogotá, Colombia
| |
Collapse
|
16
|
Ryf C, Hofstetter L, Clack L, Hincapié CA. Involving patients and clinicians in the development of a randomised clinical trial protocol to assess spinal manual therapy versus nerve root injection for patients with lumbar radiculopathy: a patient and public involvement project to inform the SALuBRITY trial design. Res Involv Engagem 2024; 10:8. [PMID: 38229190 DOI: 10.1186/s40900-023-00536-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 12/22/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND Spinal manual therapy and corticosteroid nerve root injection are commonly used to treat patients with lumbar radiculopathy. The SALuBRITY trial-a two parallel group, double sham controlled, randomised clinical trial-is being developed to compare their effectiveness. By gathering patients' and clinicians' perspectives and involving them in discussions related to the trial research question and objectives, proposed trial recruitment processes, methods, and outcome measures, we aimed to improve the relevance and quality of the SALuBRITY trial. METHODS We involved patients with lived experience of lumbar radiculopathy (n = 5) and primary care clinicians (n = 4) with experience in the treatment of these patients. Involvement activities included an initial kick-off event to introduce the project, establishing a shared purpose statement, and empowering patient and clinician advisors for their involvement, followed by semi-structured group and individual interviews, and questionnaires to evaluate the experience throughout the project. RESULTS Both patient and clinician advisors endorsed the significance and relevance of the trial's objectives. Patients assessed the proposed trial methods as acceptable within the context of a trusting patient-clinician relationship. A trial recruitment and enrolment target time of up to five days was regarded as acceptable, although patients with chronic radiculopathy may need more time to consider their trial participation decision. All advisors reached consensus on the acceptability of a medication washout phase of 12- to 24-h before pain outcome measurement, with the inclusion of a rescue medication protocol. Both advisory groups preferred leg pain over back pain as the primary clinical outcome, with patient advisors advocating for personalized primary pain localization. Furthermore, patients requested expanding the pain, enjoyment, and general activity scale with peak pain intensity, rather than average pain alone. Patient and clinician advisors evaluated their engagement in clinical research as meaningful and impactful. CONCLUSION Patient and public involvement resulted in important and relevant considerations for the SALuBRITY trial, spanning all research phases. These findings hold promise for enhancing the trial's quality and relevance and improving its translation into clinical practice.
Collapse
Affiliation(s)
- Corina Ryf
- Department of Chiropractic Medicine, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- EBPI-UWZH Musculoskeletal Epidemiology Research Group, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Léonie Hofstetter
- EBPI-UWZH Musculoskeletal Epidemiology Research Group, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- Head of Musculoskeletal Epidemiology Research, Epidemiology, Biostatistics and Prevention Institute (EBPI) & University Spine Centre Zurich, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- University Spine Centre Zurich (UWZH), Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Lauren Clack
- Institute for Implementation Science in Health Care, University of Zurich, Zurich, Switzerland
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
| | - Cesar A Hincapié
- EBPI-UWZH Musculoskeletal Epidemiology Research Group, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
- Head of Musculoskeletal Epidemiology Research, Epidemiology, Biostatistics and Prevention Institute (EBPI) & University Spine Centre Zurich, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
- University Spine Centre Zurich (UWZH), Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
| |
Collapse
|
17
|
Abstract
Piriformis syndrome is a condition that is proposed to result from compression of the sciatic nerve, either in whole or in part, in the deep gluteal space by the piriformis muscle. The prevalence of piriformis syndrome depends upon the diagnostic criteria being used and the population studied but is estimated by some to be 5%-6% in all cases of low back, buttock, and leg pain and up to 17% of patients with chronic low back pain. While the sciatic nerve may pierce the piriformis muscle in about 16% of healthy individuals, this frequency is no different in those with the syndrome; thus, the relationship to this anatomic finding is unclear. The most common symptoms are buttock pain, external tenderness over the greater sciatic notch, and aggravation of the pain through sitting. Many clinical signs are reported for piriformis syndrome, but the sensitivity and specificity are unclear, in part because of the lack of a uniformly accepted case definition. In the majority of cases in the literature, it appears that the diagnosis is more ascribed to a myofascial condition rather than a focal neuropathy. Electrodiagnostic studies can be useful to exclude other causes of symptoms, but there is no well-accepted test to confirm the presence of piriformis syndrome. Ultrasound imaging may show thickening of the piriformis muscle, but further research is required to confirm that this is correlated with the clinical diagnosis. Magnetic resonance imaging and neurography may hold promise in the future, but there are not yet sufficient data to support adopting these methods as a standard diagnostic tool. The initial treatment of piriformis syndrome is typically conservative management with the general rehabilitation principles similar to other soft tissue musculoskeletal conditions. Local anesthetic, botulinum toxin, and/or corticosteroid injections have been reported by some to be beneficial for diagnostic or treatment purposes. Surgical interventions have also been used with variable success.
Collapse
Affiliation(s)
- Julian K Lo
- Division of Physical Medicine and Rehabilitation, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
| | - Lawrence R Robinson
- Division of Physical Medicine and Rehabilitation, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
18
|
Håkansson J, Juhlin O, Hovannisyan A, Rosendahl J, Bogestål Y, Olmarker K. Changes in ion-channels in the dorsal root ganglion after exposure to autologous nucleus pulposus and TNF. A rat experimental study. J Orthop 2024; 47:23-27. [PMID: 38046450 PMCID: PMC10689205 DOI: 10.1016/j.jor.2023.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 11/03/2023] [Indexed: 12/05/2023] Open
Abstract
Purpose It is known that contact of nucleus pulposus with the dorsal root ganglion may induce changes in nerve conduction and pain behavior. It has also been suggested that the behavioristic changes are caused by changes in voltage-gated ion channels, which in turn have been upregulated by TNF. Such upregulations have previously been shown for NaV 1.8 and NaV 1.9. In this investigation, we expanded the number of studied ion channels after the application of nucleus pulposus or TNF. Methods Following removal of the left L4-5 fact joint, a disc puncture was performed and the dorsal root ganglion was exposed to nucleus pulposus (n = 5) and TNF (n = 5). Operated rats without disc puncture served as sham (n = 5) and 5 non-operated (naïve) rats were included. After 24 h, the DRGs were harvested and analyzed by quantitative PCR on validated pre-spotted primer plates displaying genes for 90 voltage-gated ion channels. Results It was evident that the changes in operated animals were separate from the naïve rats. It was also apparent that gene expression changes in rats with nucleus pulposus or TNF application showed similar trends and were also separated from sham-operated animals. Conclusion The application of nucleus pulposus and TNF onto the DRG in rats induces comparable changes in gene expression of several ion channels. Since the changes induced by TNF and NP are similar, one might also suspect that TNF mediates the NP-induced changes. However, such a mechanism needs further investigation.
Collapse
Affiliation(s)
- Joakim Håkansson
- RISE Research Institutes of Sweden, Unit of Biological Function, Division Materials and Production, Borås, Sweden
- Department of Laboratory Medicine, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden
- Department of Chemistry and Molecular Biology, University of Gothenburg, Gothenburg, Sweden
| | - Oskar Juhlin
- Musculoskeletal Research, Department of Medical Chemistry and Cell Biology, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Armen Hovannisyan
- Musculoskeletal Research, Department of Medical Chemistry and Cell Biology, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jennifer Rosendahl
- RISE Research Institutes of Sweden, Unit of Biological Function, Division Materials and Production, Borås, Sweden
| | - Yalda Bogestål
- RISE Research Institutes of Sweden, Unit of Biological Function, Division Materials and Production, Borås, Sweden
| | - Kjell Olmarker
- Musculoskeletal Research, Department of Medical Chemistry and Cell Biology, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
19
|
Zheng Y, Zhao J, Chang S, Zhuang Z, Waimei S, Li X, Chen Z, Jing B, Zhang D, Zhao G. β-Sitosterol Alleviates Neuropathic Pain by Affect Microglia Polarization through Inhibiting TLR4/NF-κB Signaling Pathway. J Neuroimmune Pharmacol 2023; 18:690-703. [PMID: 38041701 DOI: 10.1007/s11481-023-10091-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 10/17/2023] [Indexed: 12/03/2023]
Abstract
The etiology of neuropathic pain is mostly caused by mechanical deformation and neuroinflammation, of which neuroinflammation is the main cause of chronic neuropathic pain. Activation of the TLR4/NF-κB signaling pathway mediates elevated levels of inflammatory cytokines, and we clearly demonstrated by in vivo and in vitro Western blot experiments that β-sitosterol significantly inhibited the elevated Toll-like receptor 4 (TLR4) expression levels and nuclear factor-kappa B (NF-κB) activation associated with inflammatory responses. In cellular experiments, we clearly saw that both β-sitosterol and TLR4/NF-κB signaling pathway inhibitors could inhibit M1 proinflammatory phenotype expression and promote M2 anti-inflammatory phenotype expression in GMI-R1 microglia by flow cytometry and immunofluorescence assays. Therefore, we suggest that β-sitosterol can affect microglial polarization by inhibiting the TLR4/NF-κB signaling pathway thereby reducing neuroinflammation and thus alleviating neuropathic pain.
Collapse
Affiliation(s)
- Yachun Zheng
- College of Traditional Chinese Medicine, Jinan University, Tianhe District, West of Huangpu Road No. 601, Guangzhou, 510632, China
- Department of Acupuncture and Rehabilitation, GuangDong Second Traditional Chinese Medicine Hospital, Guangzhou, China
| | - Jiaji Zhao
- Chemistry & Chemical Engineering, Guangdong Pharmaceutical University, Guangzhou, China
| | - Shiquan Chang
- College of Traditional Chinese Medicine, Jinan University, Tianhe District, West of Huangpu Road No. 601, Guangzhou, 510632, China
| | - Zifeng Zhuang
- College of Traditional Chinese Medicine, Jinan University, Tianhe District, West of Huangpu Road No. 601, Guangzhou, 510632, China
| | - Si Waimei
- College of Traditional Chinese Medicine, Jinan University, Tianhe District, West of Huangpu Road No. 601, Guangzhou, 510632, China
| | - Xin Li
- College of Traditional Chinese Medicine, Jinan University, Tianhe District, West of Huangpu Road No. 601, Guangzhou, 510632, China
| | - Zenni Chen
- College of Traditional Chinese Medicine, Jinan University, Tianhe District, West of Huangpu Road No. 601, Guangzhou, 510632, China
| | - Bei Jing
- College of Traditional Chinese Medicine, Jinan University, Tianhe District, West of Huangpu Road No. 601, Guangzhou, 510632, China
| | - Di Zhang
- College of Traditional Chinese Medicine, Jinan University, Tianhe District, West of Huangpu Road No. 601, Guangzhou, 510632, China.
| | - Guoping Zhao
- College of Traditional Chinese Medicine, Jinan University, Tianhe District, West of Huangpu Road No. 601, Guangzhou, 510632, China.
| |
Collapse
|
20
|
Bejarano G, Csiernik B, Zadro JR, Ferreira GE. Compared to what? An analysis of comparators in trials informing the National Institute of Clinical Excellence (NICE) low back pain guideline. Braz J Phys Ther 2023; 27:100563. [PMID: 37980717 PMCID: PMC10692652 DOI: 10.1016/j.bjpt.2023.100563] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 10/04/2023] [Accepted: 11/05/2023] [Indexed: 11/21/2023] Open
Abstract
BACKGROUND Low back pain (LBP) is the leading cause of disability globally. Clinical practice guidelines (CPGs) have been developed in hopes of encouraging evidence-based care for LBP. However, poor quality of trials that underpin CPGs can lead to misleading recommendations for LBP. OBJECTIVES To categorize the comparator used in trials included in the National Institute of Clinical Excellence (NICE) LBP CPG and describe the proportion and association of suboptimal comparators with NICE recommendation. METHODS We conducted a cross-sectional analysis to describe the proportion of trials included in the NICE LBP CPG that used a suboptimal comparator. If comparators used an ineffective treatment, a treatment of unknown effectiveness, or no or minimal treatment then they were considered suboptimal. RESULTS We included 408 trials and analyzed 580 comparators used in the trials. 30.9% of the comparators used in the trials were suboptimal. Trials testing invasive treatments (32.4%) had the highest proportion of suboptimal comparators followed by non-surgical (32.3%) and pharmacological (19.0%) treatments. Trials using suboptimal treatments were less likely to have their treatment recommended (odds ratio: 0.68; 95% CI: 0.47, 0.98) for use by NICE. CONCLUSION There is a concerning proportion of suboptimal comparators used in LBP trials that may be misleading CPG recommendations, funding allocation decisions, and ultimately clinical practice. Efforts to increase the use of optimal comparators in LBP trials are urgently needed to better understand what treatments should be recommended.
Collapse
Affiliation(s)
| | - Ben Csiernik
- Ontario Tech University, Oshawa, Ontario, Canada
| | - Joshua R Zadro
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, New South Wales, Australia
| | - Giovanni E Ferreira
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, New South Wales, Australia
| |
Collapse
|
21
|
Gao Q, Yang H, Masood U, Zhou C, Cen Y, Song Y. Lumbar Disc Herniation with Contralateral Symptoms: A Case-Series of 11 Patients and Literature Review. Orthop Surg 2023; 15:2839-2847. [PMID: 37749774 PMCID: PMC10622262 DOI: 10.1111/os.13849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 07/02/2023] [Accepted: 07/07/2023] [Indexed: 09/27/2023] Open
Abstract
OBJECTIVE Lumbar disc herniation (LDH) is a common pathology that typically causes unilateral radiculopathy on the same side as herniation, while patients may occasionally present with contralateral symptoms. Owing to the rare incidence of LDH with contralateral symptoms, the pathological mechanism remains unclear and the optimal surgical strategy is a subject of debate. This study aimed to provide new insights into the pathological mechanism of contralateral symptoms and assess the efficacy of ipsilateral hemilaminectomy and discectomy surgery in this population. METHODS This study was a retrospective, single-center, clinical case series, including 11 LDH cases with exclusive contralateral symptoms. We searched for LDH cases that were presented at our institution between January 2011 and December 2020. Adult LDH Patients with contralateral radicular pains were included, while those with ipsilateral radiculopathy, lumbar stenosis, foraminal stenosis on the symptomatic side, multilevel disc herniations, scoliosis, and lumbar operation history were excluded. Visual Analog Scale (VAS), clinical features, radiographic images, and other data were collected from the study cohort of 11 cases for further analysis. We also reviewed LDH cases in English literature from 1978 to 2023 to analyze their clinical characteristics and treatment. RESULTS The incidence rate of LDH with contralateral symptoms in single-level LDH cases was 0.32%. The average age of our 11 cases was 49.3 years old, and five of them were female (45.5%). All individuals had single-level lateral LDH, with six cases (54.5%) located at L4-5 and five cases (45.5%) located at L5-S1. Upon admission, patients presented with lower back pain (seven cases, 63.6%), radicular pain (seven cases, 63.6%), hypoesthesia (seven cases, 63.6%), and muscle weakness (one case, 9.1%) on the contralateral side alone. Each case experienced ipsilateral hemilaminectomy and discectomy, and no lateral recess stenosis, hypertrophy of facets or ligaments, and sequestrated discs were found during surgery. All of them have good pain relief with two cases reporting no pain and nine cases reporting only mild pain at the last follow-up. CONCLUSIONS Based on the surgical findings of our 11 LDH cases with contralateral symptoms, we hypothesized that the contralateral symptoms might be produced when the nerve root on the contralateral symptomatic side was tightly pulled by the herniated disc via the dural mater. Ipsilateral hemilaminectomy and discectomy surgery effectively and efficiently relieve the symptoms without postoperative complications for these patients.
Collapse
Affiliation(s)
- Qingyang Gao
- Department of Plastic and Burn Surgery, West China HospitalSichuan UniversityChengduChina
| | - Huiliang Yang
- Department of Orthopedics, Orthopedic Research Institute, West China HospitalSichuan UniversityChengduChina
| | - Umar Masood
- Jacobs School of Medicine and Biomedical SciencesUniversity at Buffalo, The State University of New YorkBuffaloNew YorkUSA
| | - Chunguang Zhou
- Department of Orthopedics, Orthopedic Research Institute, West China HospitalSichuan UniversityChengduChina
| | - Ying Cen
- Department of Plastic and Burn Surgery, West China HospitalSichuan UniversityChengduChina
| | - Yueming Song
- Department of Orthopedics, Orthopedic Research Institute, West China HospitalSichuan UniversityChengduChina
| |
Collapse
|
22
|
Jinying W, Keming L, Hanqing T, Xuqing Z, Muccee F, Xuan L, Yalin L, Meiye S, Shumin Z, Selvaraj C, Safi SZ. Role and anti-inflammatory mechanisms of acupuncture and moxibustion therapy on pain relief through NOX-ROS-NLRP3 pathway in CCI rats models. Mol Biol Rep 2023; 50:9367-9378. [PMID: 37819498 DOI: 10.1007/s11033-023-08858-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 09/27/2023] [Indexed: 10/13/2023]
Abstract
OBJECTIVE To observe the effects of acupuncture and moxibustion therapy on pain relief in sciatica rats and to explore the mechanism of its anti-inflammatory effect. METHODS SPF grade 4-6-week-old Kunming rats were randomly divided into 5 groups including a blank group, sham-operated group, model group, acupuncture, and moxibustion (AnM) group, and positive group. A total of 10 rats were included in each group. The model group, the AnM group, and the positive group were prepared by ligating the left sciatic nerve. AnM group was used for acupuncture and moxibustion therapy intervention, and the positive group was rendered to quick-acting sciatica pills once a day for 7 days (3 courses of treatment). The blank group, sham-operated group, and model group were not treated. The changes in thermal and mechanical pain thresholds were observed before and after the operation, and the morphological changes of the dorsal horn of the spinal cord in the lumbosacral region of the rats in each group were observed by HE staining after the courses of treatment finished. The contents of IL-1β, IL-6, IL-18, and TNF-α were measured by ELISA and the expressions of NOX1, NOX2, NOX4, and NLRP3 genes were detected by RT-qPCR while the protein expressions of NOX1, NOX2, NOX4 and NLRP3 were analyzed by Western blotting. RESULTS The AnM and positive group showed a significant increase in thermal and mechanical pain thresholds after treatment, while there was no significant change in the model group. As compared to the control group, the contents of IL- 1β, IL-6, IL-18, and TNF-α, as well as the relative expressions of NOX1, NOX2, NOX4, and NLRP3 genes were significantly increased in the model group (P < 0.05 or P < 0.01). As compared to the model group, the contents of IL-1β, IL-6, IL-18, and TNF-α, as well as the relative expressions of NOX1, NOX2, NOX4, and NLRP3 genes significantly decreased in the AnM and positive groups (P < 0.05 or P < 0.01). The pathological changes of inflammatory infiltration of tissue cells in the dorsal horn of the lumbosacral spinal cord were slowed in the AnM group. CONCLUSION Acupuncture and moxibustion therapy have a positive effect on pain relief and anti-inflammatory effects in CCI sciatica rats, which may point to the regulation of NOX1, NOX2, NOX4, and NLRP3 expressions, and inhibition of ROS.
Collapse
Affiliation(s)
- Wang Jinying
- Youjiang Medical University for Nationalities, Baise, 533000, China
| | - Li Keming
- Youjiang Medical University for Nationalities, Baise, 533000, China
- Faculty of Medicine, Bioscience and Nursing, MAHSA University, 42610, Jenjarom, Selangor, Malaysia
| | - Tang Hanqing
- Youjiang Medical University for Nationalities, Baise, 533000, China.
| | - Zhang Xuqing
- Youjiang Medical University for Nationalities, Baise, 533000, China
| | - Fatima Muccee
- School of Biochemistry and Biotechnology, University of the Punjab, Lahore, Pakistan
| | - Luo Xuan
- Youjiang Medical University for Nationalities, Baise, 533000, China
| | - Liu Yalin
- Youjiang Medical University for Nationalities, Baise, 533000, China
| | - Song Meiye
- Youjiang Medical University for Nationalities, Baise, 533000, China
| | - Zhang Shumin
- Youjiang Medical University for Nationalities, Baise, 533000, China
| | - Chandrabose Selvaraj
- Laboratory for Artificial Intelligence and Molecular Modelling, Center for Global Health Research, Saveetha Medical College, Saveetha Institute of Medical and Technical Sciences (SIMATS), Thandalam, Chennai, Tamil Nadu, 600077, India
| | - Sher Zaman Safi
- Faculty of Medicine, Bioscience and Nursing, MAHSA University, 42610, Jenjarom, Selangor, Malaysia.
| |
Collapse
|
23
|
Zaina F, Côté P, Cancelliere C, Di Felice F, Donzelli S, Rauch A, Verville L, Negrini S, Nordin M. A Systematic Review of Clinical Practice Guidelines for Persons With Non-specific Low Back Pain With and Without Radiculopathy: Identification of Best Evidence for Rehabilitation to Develop the WHO's Package of Interventions for Rehabilitation. Arch Phys Med Rehabil 2023; 104:1913-1927. [PMID: 36963709 DOI: 10.1016/j.apmr.2023.02.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 01/13/2023] [Accepted: 02/28/2023] [Indexed: 03/26/2023]
Abstract
OBJECTIVE To Identify evidence-based rehabilitation interventions for persons with non-specific low back pain (LBP) with and without radiculopathy and to develop recommendations from high-quality clinical practice guidelines (CPGs) to inform the World Health Organization's (WHO) Package of Interventions for Rehabilitation (PIR). DATA SOURCE We searched MEDLINE, EMBASE, CINAHL, PsycINFO, National Health Services Economic Evaluation Database, Health Technology Assessment Database, PEDro, the Trip Database, the Index to Chiropractic Literature and the gray literature. STUDY SELECTION Eligible guidelines were (1) published between 2009 and 2019 in English, French, Italian, or Swedish; (2) included adults or children with non-specific LBP with or without radiculopathy; and (3) assessed the benefits of rehabilitation interventions on functioning. Pairs of independent reviewers assessed the quality of the CPGs using AGREE II. DATA SYNTHESIS We identified 4 high-quality CPGs. Recommended interventions included (1) education about recovery expectations, self-management strategies, and maintenance of usual activities; (2) multimodal approaches incorporating education, exercise, and spinal manipulation; (3) nonsteroidal anti-inflammatory drugs combined with education in the acute stage; and (4) intensive interdisciplinary rehabilitation that includes exercise and cognitive/behavioral interventions for persistent pain. We did not identify high-quality CPGs for people younger than 16 years of age. CONCLUSION We developed evidence-based recommendations from high-quality CPGs to inform the WHO PIR for people with LBP with and without radiculopathy. These recommendations emphasize the potential benefits of education, exercise, manual therapy, and cognitive/behavioral interventions.
Collapse
Affiliation(s)
- Fabio Zaina
- ISICO (Italian Scientific Spine Institute), Milan, Italy
| | - Pierre Côté
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada; Institute for Disability and Rehabilitation Research, Ontario Tech University, Oshawa, Ontario, Canada
| | - Carolina Cancelliere
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada; Institute for Disability and Rehabilitation Research, Ontario Tech University, Oshawa, Ontario, Canada
| | | | | | - Alexandra Rauch
- Sensory Functions, Disability and Rehabilitation Unit, Department for Noncommunicable Diseases, World Health Organization, Geneva, Switzerland
| | - Leslie Verville
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada; Institute for Disability and Rehabilitation Research, Ontario Tech University, Oshawa, Ontario, Canada
| | - Stefano Negrini
- Department of Biomedical, Surgical and Dental Sciences, University "La Statale", Milan, Italy; IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.
| | - Margareta Nordin
- Departments of Orthopedic Surgery and Environmental Medicine, NYU Grossman School of Medicine, Occupational and Industrial Orthopedic Center (OIOC), NYU Hospital for Joint Diseases, NYU Langone Health, New York University, New York, NY
| |
Collapse
|
24
|
Porceban GH, França Filho AF, Ueta RHS, Curto DD, Puertas EB, Tamaoki MJS. ACUTE RADIATING LOW BACK PAIN IMPACT ON ROUTINE AND FUNCTION OF THE BRAZILIAN POPULATION: A CROSS-SECTIONAL STUDY. Acta Ortop Bras 2023; 31:e266200. [PMID: 37876864 PMCID: PMC10592387 DOI: 10.1590/1413-785220233105e266200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 02/17/2023] [Indexed: 10/26/2023]
Abstract
Acute radiating low back pain is a frequently occurring clinical condition among the population, and it represents a significant portion of urgent care in public health services. Objective Consider the clinical characteristics, demographics, as well as the intensity of the pain, discomfort, and dysfunction of patients who show a clinical diagnosis that is compatible with acute radicular pain, new or reoccurring after an asymptomatic period. Methods Patients that display a clinical diagnosis that is compatible with acute sciatic nerve pain, with the beginning of it starting within three months, without previous history of a similar occurrence, were seen in an orthopedic health clinic from July 2020 to January 2021. Results A total of 42 patients were seen with a compatible diagnosis, which represents 1.4% of all medical visits. To the best of our knowledge, no studies have considered the clinical and demographic characteristics of patients with acute radicular pain in the Brazilian population. This study has found a mean value on the disfunction index that is greater than what is suggested by the current literature. Conclusion About 30% of individuals showed functional involvement that was considered crippling, which presented a stronger association with individuals with the presence of motor deficits, intensity of radiating pain, and professional inactivity. Level of Evidence IV, Cross-Sectional Study.
Collapse
Affiliation(s)
- Guilherme Henrique Porceban
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Ortopedia e Traumatologia, São Paulo, SP, Brazil
| | - Alexandre Felipe França Filho
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Ortopedia e Traumatologia, São Paulo, SP, Brazil
| | - Renato Hiroshi Salvioni Ueta
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Ortopedia e Traumatologia, São Paulo, SP, Brazil
| | - David Del Curto
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Ortopedia e Traumatologia, São Paulo, SP, Brazil
| | - Eduardo Barros Puertas
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Ortopedia e Traumatologia, São Paulo, SP, Brazil
| | - Marcel Jun Sugawara Tamaoki
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Ortopedia e Traumatologia, São Paulo, SP, Brazil
| |
Collapse
|
25
|
Kabeer AS, Osmani HT, Patel J, Robinson P, Ahmed N. The adult with low back pain: causes, diagnosis, imaging features and management. Br J Hosp Med (Lond) 2023; 84:1-9. [PMID: 37906065 DOI: 10.12968/hmed.2023.0063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
Low back pain is the leading cause of disability worldwide. This article highlights the importance of succinct history taking and a thorough clinical examination when managing a patient with lower back pain in hospital. Furthermore, it encourages the clinician to consider the pertinent causes of low back pain such as age-related degeneration, malignancy, trauma, infection and seronegative inflammatory spondyloarthropathies, and looks at the diagnosis, imaging features and key management options which are available in secondary care.
Collapse
Affiliation(s)
- Adnan S Kabeer
- Department of Radiology, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Humza T Osmani
- Department of Radiology, Addenbrooke's Hospital, Cambridge, UK
| | - Jugal Patel
- Department of Radiology, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Philip Robinson
- Department of Radiology, Musculoskeletal Centre, Chapel Allerton Hospital, Leeds Teaching Hospitals, Leeds, UK
| | - Naeem Ahmed
- Department of Radiology, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| |
Collapse
|
26
|
Martel Villagrán J, Martínez-Sánchez RT, Cebada-Chaparro E, Bueno Horcajadas AL, Pérez-Fernández E. Diagnostic accuracy of lumbar CT and MRI in the evaluation of chronic low back pain without red flag symptoms. Radiologia (Engl Ed) 2023; 65 Suppl 2:S59-S70. [PMID: 37858354 DOI: 10.1016/j.rxeng.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 02/01/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND Low back pain (LBP) is one of the most frequent reasons for medical consultation. Most of the patients will have nonspecific LBP, which usually are self-limited episodes. It is unclear which of the diagnostic imaging pathways is most effective and costeffective and how the imaging impacts on patient treatment. Imaging techniques are usually indicated if symptoms remain after 6 weeks. Magnetic resonance imaging (MRI) is the diagnostic imaging examination of choice in lumbar spine evaluation of low back pain; however, availability of MRI is limited. OBJECTIVES To evaluate the diagnostic accuracy of computed tomography (CT) with MRI (as standard of reference) in the evaluation of chronic low back pain (LBP) without red flags symptoms. To compare the results obtained by two radiologists with different grades of experience. MATERIALS AND METHODS Patients with chronic low back pain without red flags symptoms were retrospectively reviewed by two observers with different level of experience. Patients included had undergone a lumbar or abdominal CT and an MRI within a year. Once the radiological information was collected, it was then statistically reviewed. The aim of the statistical analysis is to identify the equivalence between both diagnostic techniques. To this end, sensitivity, specificity and validity index were calculated. In addition, intra and inter-observer reliability were measured by Cohen's kappa values and also using the McNemar test. RESULTS 340 lumbar levels were evaluated from 68 adult patients with chronic low back pain or sciatica. 63.2% of them were women, with an average age of 60.3 years (SD 14.7). CT shows high values of sensitivity and specificity (>80%) in most of the items evaluated, but sensitivity was low for the evaluation of density of the disc (40%) and for the detection of disc herniation (55%). Moreover, agreement between MRI and CT in most of these items was substantial or almost perfect (Cohen's kappa-coefficient > 0'8), excluding Modic changes (kappa = 0.497), degenerative changes (kappa0.688), signal of the disc (kappa = 0.327) and disc herniation (kappa = 0.639). Finally, agreement between both observers is mostly high (kappa > 0.8). Foraminal stenosis, canal stenosis and the grade of the canal stenosis were overdiagnosed by the inexperienced observer in the evaluation of CT images. CONCLUSIONS AND SIGNIFICANCE CT is as sensitive as lumbar MRI in the evaluation of most of the items analysed, excluding Modic changes, degenerative changes, signal of the disc and disc herniation. In addition, these results are obtained regardless the experience of the radiologist. The rising use of diagnostic medical imaging and the improvement of image quality brings the opportunity of making a second look of abdominal CT in search of causes of LBP. Thereby, inappropriate medical imaging could be avoided (2). In addition, it would allow to reduce MRI waiting list and prioritize other patients with more severe pathology than LBP.
Collapse
Affiliation(s)
- J Martel Villagrán
- Radiología musculoesquelética, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | | | - E Cebada-Chaparro
- Radiología musculoesquelética, Hospital Universitario de Cáceres, Cáceres, Spain
| | - A L Bueno Horcajadas
- Radiología musculoesquelética, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - E Pérez-Fernández
- Metodología de la Investigación, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| |
Collapse
|
27
|
Qazi SA, Qazi RA, Ahmed T, Rehman L, Javeed F, Aziz HF. The diagnostic accuracy of straight leg raise test in patients more than 60 years of age suffering lumbar disk herniation with low back pain and sciatica. J Neurosci Rural Pract 2023; 14:610-614. [PMID: 38059256 PMCID: PMC10696343 DOI: 10.25259/jnrp_97_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 09/09/2023] [Indexed: 12/08/2023] Open
Abstract
Objective To determine the diagnostic accuracy of the SLR test in elderly patients suffering from lumbar disk herniation with sciatica and low back pain, using magnetic resonance imaging (MRI) as the gold standard. Materials and Methods A cross-sectional study was conducted at Jinnah Postgraduate Medical Center and a total of 120 patients, above 60 years of age, with symptomatic lumbar disk herniation were enrolled. SLR test was performed and the results recorded. MRI of the lumbar spine was undertaken for confirmation of disk herniation. Results The sensitivity of the SLR test in patients 60 years and older is 33.3%. A decrease in the diagnostic accuracy of the SLR test with an increment in age was also noted. Conclusion It was found that with an increment in age, there is a steady decline in the diagnostic accuracy of SLR Test.
Collapse
Affiliation(s)
- Sana Akbar Qazi
- Department of Neurosurgery, Jinnah Postgraduate Medical Centre, Karachi, Pakistan
| | - Rabail Akbar Qazi
- Department of Neurosurgery, Jinnah Postgraduate Medical Centre, Karachi, Pakistan
| | - Tanweer Ahmed
- Department of Neurosurgery, Jinnah Postgraduate Medical Centre, Karachi, Pakistan
| | - Lal Rehman
- Department of Neurosurgery, Pakistan Institute of Medical Sciences, Islamabad, Pakistan
| | - Farrukh Javeed
- Department of Neurosurgery, Jinnah Postgraduate Medical Centre, Karachi, Pakistan
| | - Hafiza Fatima Aziz
- Department of Neurosurgery, Aga Khan University Hospital, Karachi, Pakistan
| |
Collapse
|
28
|
Lavari N, Ostadrahimi N, Rahimi R, Raei M, Abbassian A. The effect of a topical formulation from Lawsonia inermis L. (henna) on pain intensity in patients with chronic sciatica: A randomized double-blind clinical trial. J Ethnopharmacol 2023; 313:116519. [PMID: 37105368 DOI: 10.1016/j.jep.2023.116519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/23/2023] [Accepted: 04/17/2023] [Indexed: 05/22/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Chronic sciatica (CS) is a common condition of disability and pain. Lawsonia inermis L. (henna) is a medicinal plant that is commonly recommended in traditional Persian medicine textbooks for pain relief in patients with sciatica, particularly in the form of oil. AIM OF THE STUDY This research was designed to investigate the efficacy of a topical formulation from henna on pain intensity in patients with CS. METHODS AND MATERIALS In a randomized, double-blind clinical study, 81 patients were randomly allocated to three groups to receive the topical henna formulation (aqueous extract of henna in sesame oil), sesame oil, or placebo, three times daily, for four weeks. The patients were assessed by visual analog scale (VAS), 36-item short form health survey (SF-36), and Oswestry disability index (ODI). RESULTS There was a significant decrease in mean VAS in henna oil compared to sesame oil (p = 0.004) and placebo (p = 0.004). Significant improvements in total SF-36 scores were observed in henna oil and sesame oil compared to placebo (p = 0.011 and p = 0.025, respectively). Furthermore, ODI significantly decreased in henna oil compared to sesame oil (p < 0.001) and placebo (p = 0.005). CONCLUSION Henna oil seems to be an effective treatment to reduce pain intensity in patients with CS. Moreover, it improves quality of life and functional ability. Further randomized controlled trials with longer intervention periods are recommended to confirm this efficacy.
Collapse
Affiliation(s)
- Narges Lavari
- Department of Traditional Medicine, School of Persian Medicine, Tehran University of Medical Sciences, Tehran, Iran; Traditional Persian Medicine and Complementary Medicine (PerCoMed) Student Association, Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Nima Ostadrahimi
- Neurosurgery Department, Tehran University of Medical Sciences, Tehran, Iran.
| | - Roja Rahimi
- Department of Traditional Pharmacy, School of Persian Medicine, Tehran University of Medical Sciences, Tehran, Iran.
| | - Mehdi Raei
- Health Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran.
| | - Alireza Abbassian
- Department of Traditional Medicine, School of Persian Medicine, Tehran University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
29
|
Dewberry LS, Porche K, Koenig T, Allen KD, Otto KJ. High frequency alternating current neurostimulation decreases nocifensive behavior in a disc herniation model of lumbar radiculopathy. Bioelectron Med 2023; 9:15. [PMID: 37434246 DOI: 10.1186/s42234-023-00119-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 06/19/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND The purpose of this study was to evaluate if kilohertz frequency alternating current (KHFAC) stimulation of peripheral nerve could serve as a treatment for lumbar radiculopathy. Prior work shows that KHFAC stimulation can treat sciatica resulting from chronic sciatic nerve constriction. Here, we evaluate if KHFAC stimulation is also beneficial in a more physiologic model of low back pain which mimics nucleus pulposus (NP) impingement of a lumbar dorsal root ganglion (DRG). METHODS To mimic a lumbar radiculopathy, autologous tail NP was harvested and placed upon the right L5 nerve root and DRG. During the same surgery, a cuff electrode was implanted around the sciatic nerve with wires routed to a headcap for delivery of KHFAC stimulation. Male Lewis rats (3 mo., n = 18) were separated into 3 groups: NP injury + KHFAC stimulation (n = 7), NP injury + sham cuff (n = 6), and sham injury + sham cuff (n = 5). Prior to surgery and for 2 weeks following surgery, animal tactile sensitivity, gait, and static weight bearing were evaluated. RESULTS KHFAC stimulation of the sciatic nerve decreased behavioral evidence of pain and disability. Without KHFAC stimulation, injured animals had heightened tactile sensitivity compared to baseline (p < 0.05), with tactile allodynia reversed during KHFAC stimulation (p < 0.01). Midfoot flexion during locomotion was decreased after injury but improved with KHFAC stimulation (p < 0.05). Animals also placed more weight on their injured limb when KHFAC stimulation was applied (p < 0.05). Electrophysiology measurements at end point showed decreased, but not blocked, compound nerve action potentials with KHFAC stimulation (p < 0.05). CONCLUSIONS KHFAC stimulation decreases hypersensitivity but does not cause additional gait compensations. This supports the idea that KHFAC stimulation applied to a peripheral nerve may be able to treat chronic pain resulting from sciatic nerve root inflammation.
Collapse
Affiliation(s)
- Lauren Savannah Dewberry
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, 1275 Center Dr. JG56, P.O. Box 116131, Gainesville, FL, 32611, USA
| | - Ken Porche
- Lillian S Wells Department of Neurosurgery at the University of Florida, College of Medicine, 1505 SW Archer Road Gainesville, FL, 32608, Gainesville, USA
| | - Travis Koenig
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, 1275 Center Dr. JG56, P.O. Box 116131, Gainesville, FL, 32611, USA
| | - Kyle D Allen
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, 1275 Center Dr. JG56, P.O. Box 116131, Gainesville, FL, 32611, USA
- Pain Research & Intervention Center of Excellence, University of Florida, CTSI 2004 Mowry Road, Gainesville, FL, USA
- Department of Orthopedics and Sports Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Kevin J Otto
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, 1275 Center Dr. JG56, P.O. Box 116131, Gainesville, FL, 32611, USA.
- Department of Neuroscience, University of Florida, 1149 Newell Dr. L1-100, P.O. Box 100244, Gainesville, FL, USA.
- Department of Electrical and Computer Engineering, University of Florida, 968 Center Dr, Gainesville, FL, 32611, USA.
- Department of Chemical Engineering, University of Florida, 1030 Center Drive, P.O. Box 116005, Gainesville, FL, 32611, USA.
- Department of Materials Science and Engineering, University of Florida, 549 Gale Lemerand Dr, P.O. Box 116400, Gainesville, FL, 32611, USA.
- Department of Neurology, 1149 Newell Dr, P.O. Box 100236, Gainesville, FL, L3-10032610, USA.
- Nanoscience Institute for Medical and Engineering Technology (NIMET), University of Florida, 1041 Center Drive, Gainesville, FL, 32611, USA.
| |
Collapse
|
30
|
Huang HZ, Lyu LJ, Liu Z, Lyu ZZ, Huang YB, Wu HJ, Gao XF. [Intervention effect of Tuina pressing and kneading the Huantiao (GB30) acupoint on NF-κB p65 protein at spinal cord dorsal horn in sciatica rats]. Zhongguo Gu Shang 2023; 36:519-24. [PMID: 37366093 DOI: 10.12200/j.issn.1003-0034.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
OBJECTIVE To observe the analgesic effect of Tuina by pressing and kneading the Huantiao (GB30) acupoint on rats with chronic constriction injury (CCI) and to explore the analgesic mechanism of Tuina on sciatica rats. METHODS Thirty-two SPF male SD rats weighing 180 to 220 g were randomly divided into fore groups:blank group (without any treatment), sham group (only exposed without sciatic nerve ligating), model group (sciatic nerve ligating) and Tuina group (manual intervention after lsciatic nerve ligating). The CCI model was prepared by ligating the right sciatic nerve of the rats, on the third day of modeling, the rats in the Tuina group were given pressing and kneading the Huantiao (GB30) point for 14 days, and the changes of paw withdrawal threshold(PWT), paw withdrawal latency(PWL) were measured before and on the 1st, 3rd, 7th, 10th, 14th and 17th days after modeling. The changes of sciatic functional index(SFI) were measured before and on the 1st and 17th day after modeling. The morphological changes of the sciatic nerve were observed by hematoxylin-eosin(HE) staining;and the differences in NF-κB protein expression in the right dorsal horn of the spinal cord of rats were detected. RESULTS Following modeling, there was no significant difference in PWT, PWL and SFI between the blank group and the sham group (P>0.05), but the PWT, PWL and SFI of the model group and the Tuina group decreased significantly (P<0.01). After manual intervention, the pain threshold of rats in Tuina group increased. On the 8th day of manual intervention (the 10th day after modeling), PWT in Tuina group increased significantly compared with that in model group (P<0.01). On the 5th day of manual intervention (the 7th day after modeling), the PWL of the massage group was significantly higher than that of the model group (P<0.01). The pain threshold of rats in Tuina group continued to rise with the continuous manipulation intervention. After 14 days of manipulative intervention, the sciatic nerve function index of rats in the Tuina group increased significantly(P<0.01). Compared with the blank group and sham group, the myelinated nerve fibers of sciatic nerve in the model group were disordered and the density of axons and myelin sheath was uneven. Compared with the model group, the nerve fibers of rats in the Tuina group were gradually continuous and the axons and myelin sheath were more uniform than those in the model group. Compared with the blank group and sham group, the expression of NF-κB protein in the right spinal dorsal horn of the model group was significantly increased(P<0.01). Compared with the model group, the expression of NF-κB protein in the right spinal dorsal horn of rats in Tuina group decreased significantly(P<0.01). CONCLUSION Pressing and kneading the Huantiao (GB30) point restores nerve fiber alignment;and improves the PWT、PWL and SFI in the CCI model by decreasing NF-κB p65 protein expression in the spinal dorsal horn. There fore, Tuina demmstrates an analgesic effect and improves the gait of rats with sciatica.
Collapse
Affiliation(s)
- Hua-Zhi Huang
- The Third Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang, China; Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Hangzhou 310053, Zhejiang, China
| | - Li-Jiang Lyu
- The Third Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang, China; Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Hangzhou 310053, Zhejiang, China
| | - Zhen Liu
- The Third Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang, China; Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Hangzhou 310053, Zhejiang, China
| | - Zhi-Zhen Lyu
- The Third Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang, China; Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Hangzhou 310053, Zhejiang, China
| | - Yu-Bo Huang
- The Third Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang, China; Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Hangzhou 310053, Zhejiang, China
| | - Hong-Jiao Wu
- The Third Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang, China; Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Hangzhou 310053, Zhejiang, China
| | - Xiang-Fu Gao
- The First Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang, China
| |
Collapse
|
31
|
Pozarek G, Strömqvist B, Ekvall Hansson E, Ahlström G. Pain and function in patients with chronic low back pain and leg pain after Zhineng Qigong - a quasi-experimental feasibility study. BMC Musculoskelet Disord 2023; 24:480. [PMID: 37312140 DOI: 10.1186/s12891-023-06581-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 05/30/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Qigong includes training for body and mind, one method is Zhineng Qigong. Scientific literature on qigong for chronic low back pain (LBP) is sparse. This study aimed to investigate feasibility including evaluation of a Zhineng Qigong intervention for pain and other lumbar spine-related symptoms, disability, and health-related quality of life in patients with chronic LBP and/or leg pain. METHODS Prospective interventional feasibility study without control group. Fifty-two chronic pain patients (18-75 years) with LBP and/or leg pain (Visual Analogue Scale ≥ 30) were recruited from orthopaedic clinics (spinal stenosis, spondylolisthesis, or segmental pain) and primary healthcare (chronic LBP). Patients from orthopaedic clinics were 1-6 years postoperative after lumbar spine surgery or on lumbar surgery waiting list. Patients received a 12-week training intervention with European Zhineng Qigong. The intervention consisted of face-to-face group activities in non-healthcare setting (4 weekends and 2 evenings per week), and individual Zhineng Qigong training. Main health outcomes were self-reported in a 14-day pain diary, Oswestry Disability Index (ODI), Short Form 36 version 2 (SF-36v2), and EuroQol 5 Dimensions 5 Levels (EQ-5D-5L), once directly before and once directly after the intervention. RESULTS Recruitment rate was 11% and retention rate was 58%. Dropouts did not report higher pain (baseline), only 3 dropped out because of lumbar spine-related pain. Adherence was median 78 h group attendance (maximum 94 h) and 14 min daily individual training. Ability to collect outcomes was 100%. Thirty patients completed (mean 15 years symptom duration). Twenty-five had degenerative lumbar disorder, and 17 history of lumbar surgery. Results showed statistically significant (within-group) improvements in pain, ODI, all SF-36v2 scales, and EQ-5D-5L. CONCLUSIONS Despite low recruitment rate, recruitment was sufficient. A multicentre randomized controlled trial is proposed, with efforts to increase recruitment and retention rate. After this Zhineng Qigong intervention patients with chronic LBP and/or leg pain, also patients with considerable remaining LBP/sciatica after lumbar surgery, had significantly improved in pain and function. Results support involvement of postoperative patients in a future study. The results are promising, and this intervention needs to be further evaluated to provide the most reliable evidence. TRIAL REGISTRATION NCT04520334. Retrospectively registered 20/08/2020.
Collapse
Affiliation(s)
| | - Björn Strömqvist
- Departments of Clinical Sciences and Orthopaedics, Lund University, Skåne University Hospital, Lund, Sweden
| | | | - Gerd Ahlström
- Department of Health Sciences, Lund University, Lund, Sweden
| |
Collapse
|
32
|
da Silva ML, Fernandes AM, Silva VA, Galhardoni R, Felau V, de Araujo JO, Rosi J, Brock RS, Kubota GT, Teixeira MJ, Yeng LT, de Andrade DC. Motor corticospinal excitability abnormalities differ between distinct chronic low back pain syndromes. Neurophysiol Clin 2023; 53:102853. [PMID: 37018953 DOI: 10.1016/j.neucli.2023.102853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 02/26/2023] [Accepted: 02/26/2023] [Indexed: 04/05/2023] Open
Abstract
OBJECTIVES It is not known whether cortical plastic changes reported in low-back pain (LBP) are present in all etiologies of LBP. Here we report on the assessment of patients with three LBP conditions: non-specific-LBP (ns-LBP), failed back surgery syndrome (FBSS), and sciatica (Sc). METHODS Patients underwent a standardized assessment of clinical pain, conditioned pain modulation (CPM), and measures of motor evoked potential (MEPs)-based motor corticospinal excitability (CE) by transcranial magnetic stimulation, including short interval intracortical inhibition (SICI), and intracortical facilitation (ICF). Comparisons were also made with normative data from sex- and age-matched healthy volunteers. RESULTS 60 patients (42 women, 55.1±9.1 years old) with LBP were included (20 in each group). Pain intensity was higher in patients with neuropathic pain [FBSS (6.8±1.3), and Sc (6.4±1.4)] than in those with ns-LBP (4.7±1.0, P<0.001). The same was shown for pain interference (5.9±2.0, 5.9±1.8, 3.2±1.9, P<0.001), disability (16.4±3.3, 16.3±4.3, 10.4±4.3, P<0.001), and catastrophism (31.1±12.3, 33.0±10.4, 17.4±10.7, P<0.001) scores for FBSS, Sc, and ns-LBP groups, respectively. Patients with neuropathic pain (FBSS, Sc) had lower CPM (-14.8±1.9, -14.1±16.7, respectively) compared to ns-LBP (-25.4±16.6; P<0.02). 80.0% of the FBSS group had defective ICF compared to the other two groups (52.5% for ns-LBP, P=0.025 and 52.5% for Sc, P=0.046). MEPs (140%-rest motor threshold) were low in 50.0% of patients in the FBSS group compared to 20.0% of ns-LBP (P=0.018) and 15.0% of Sc (P=0.001) groups. Higher MEPs were correlated with mood scores (r=0.489), and with lower neuropathic pain symptom scores(r=-0.415) in FBSS. CONCLUSIONS Different types of LBP were associated with different clinical, CPM and CE profiles, which were not uniquely related to the presence of neuropathic pain. These results highlight the need to further characterize patients with LBP in psychophysics and cortical neurophysiology studies.
Collapse
Affiliation(s)
- Marcelo Luiz da Silva
- LIM-62, Pain Center, Department of Neurology, University of São Paulo, São Paulo, Brazil
| | - Ana Mércia Fernandes
- LIM-62, Pain Center, Department of Neurology, University of São Paulo, São Paulo, Brazil
| | - Valquíria A Silva
- LIM-62, Pain Center, Department of Neurology, University of São Paulo, São Paulo, Brazil
| | - Ricardo Galhardoni
- School of Medicine, University of City of São Paulo (UNICID), São Paulo, Brazil
| | - Valter Felau
- LIM-62, Pain Center, Department of Neurology, University of São Paulo, São Paulo, Brazil
| | - Joaci O de Araujo
- LIM-62, Pain Center, Department of Neurology, University of São Paulo, São Paulo, Brazil
| | - Jefferson Rosi
- LIM-62, Pain Center, Department of Neurology, University of São Paulo, São Paulo, Brazil
| | - Roger S Brock
- LIM-62, Pain Center, Department of Neurology, University of São Paulo, São Paulo, Brazil
| | - Gabriel T Kubota
- LIM-62, Pain Center, Department of Neurology, University of São Paulo, São Paulo, Brazil
| | - Manoel J Teixeira
- LIM-62, Pain Center, Department of Neurology, University of São Paulo, São Paulo, Brazil
| | - Lin T Yeng
- Pain Center, Institute of Orthopedics and Traumatology, University of São Paulo, São Paulo, Brazil
| | - Daniel Ciampi de Andrade
- LIM-62, Pain Center, Department of Neurology, University of São Paulo, São Paulo, Brazil; Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark.
| |
Collapse
|
33
|
Bindra V, Nori M, Reddy R, Reddy R, Satpathy G, Reddy CA. Sciatic nerve endometriosis - The correct approach matters: A case report. Case Rep Womens Health 2023; 38:e00515. [PMID: 37275569 PMCID: PMC10238457 DOI: 10.1016/j.crwh.2023.e00515] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 05/16/2023] [Accepted: 05/17/2023] [Indexed: 06/07/2023] Open
Abstract
Endometriosis is a chronic inflammatory condition affecting nearly 10-15% of women of reproductive age and most frequently occurs in the pelvis. Extrapelvic endometriosis leading to sacral neuropathy is rare. A 29-year old woman, para 1 (vaginal delivery 8 years previously), presented with worsening right hip and buttock pain radiating to the right leg, resulting in limping and other gait changes due to delayed diagnosis and treatment. A diagnosis of sciatic nerve endometriosis was made based on both clinical and imaging findings. The final diagnosis was confirmed on histopathological examination. Transgluteal excision of the sciatic nerve with concomitant laparoscopy for exploration of the pelvic part of the sciatic nerve and excision of the pelvic endometriosis were undertaken. The operating team included a gynaecologist, an orthopaedic surgeon and a neurosurgeon. Postoperative recovery was uneventful and physiotherapy was started. Pain and gait improved. Endometriosis of the sciatic nerve should be suspected if a patient complains of cyclical sciatica. Magnetic resonance remains the imaging modality of choice. This case report illustrates the benefit of a multidisciplinary approach.
Collapse
Affiliation(s)
- Vimee Bindra
- Endometriosis Centre, Apollo Health City, Hyderabad 500033, India
| | | | | | | | | | - C. Archana Reddy
- Endometriosis Centre, Apollo Health City, Hyderabad 500033, India
| |
Collapse
|
34
|
Lee JY, Oya A, Tsuji O, Umezu T, Kanaji A, Niki Y, Nakamura M, Matsumoto M. Occult proximal femoral fracture with radiating leg pain masquerading as sciatica: a case report. J Med Case Rep 2023; 17:216. [PMID: 37226262 DOI: 10.1186/s13256-023-03951-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 04/26/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Occult proximal femoral fractures do not appear as fracture lines in radiographs, causing misdiagnosis and delayed diagnosis unless additional imaging studies, such as computed tomography or magnetic resonance imaging, are performed. Here, we present a 51-year-old male with an occult proximal femoral fracture who experienced radiating unilateral leg pain that took 3 months to be diagnosed because his symptoms mimicked lumbar spine disease. CASE PRESENTATION A 51-year-old Japanese male experienced persistent lower back and left thigh pain after falling off a bicycle, and was referred to our hospital 3 months thereafter. Whole-spine computed tomography and magnetic resonance imaging revealed minute ossification of the ligamentum flavum at T5/6 without spinal nerve compression, but this did not explain his leg pain. Additional magnetic resonance imaging of the hip joint revealed a fresh left proximal femoral fracture without displacement. He underwent surgery for in situ fixation using a compression hip screw. Post-surgical pain relief was immediate. CONCLUSIONS Misdiagnosis of occult femoral fractures as lumbar spinal disease may occur if distally radiating referred pain is present. Hip joint disease should be considered as a differential diagnosis in cases of sciatica-like pain with an unknown spinal origin and no specific findings on spinal computed tomography or magnetic resonance imaging accounting for the leg pain, especially following trauma.
Collapse
Affiliation(s)
- Ji-Yeon Lee
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi,, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Akihito Oya
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi,, Shinjuku-Ku, Tokyo, 160-8582, Japan.
| | - Osahiko Tsuji
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi,, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Taro Umezu
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi,, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Arihiko Kanaji
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi,, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Yasuo Niki
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi,, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Masaya Nakamura
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi,, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Morio Matsumoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi,, Shinjuku-Ku, Tokyo, 160-8582, Japan
| |
Collapse
|
35
|
Nagington A, Foster NE, Snell K, Konstantinou K, Stynes S. Prognostic factors associated with outcome following an epidural steroid injection for disc-related sciatica: a systematic review and narrative synthesis. Eur Spine J 2023; 32:1029-1053. [PMID: 36680619 DOI: 10.1007/s00586-023-07528-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 11/28/2022] [Accepted: 01/07/2023] [Indexed: 01/22/2023]
Abstract
PURPOSE Clinical guidelines recommend epidural steroid injection (ESI) as a treatment option for severe disc-related sciatica, but there is considerable uncertainty about its effectiveness. Currently, we know very little about factors that might be associated with good or poor outcomes from ESI. The aim of this systematic review was to synthesise and appraise the evidence investigating prognostic factors associated with outcomes following ESI for patients with imaging confirmed disc-related sciatica. METHODS The search strategy involved the electronic databases Medline, Embase, CINAHL Plus, PsycINFO and reference lists of eligible studies. Selected papers were quality appraised independently by two reviewers using the Quality in Prognosis Studies tool. Between-study heterogeneity precluded statistical pooling of results. RESULTS 3094 citations were identified; 15 studies were eligible. Overall study quality was low with all judged to have moderate or high risk of bias. Forty-two prognostic factors were identified but were measured inconsistently. The most commonly assessed prognostic factors were related to pain and function (n = 10 studies), imaging features (n = 8 studies), patient socio-demographics (n = 7 studies), health and lifestyle (n = 6 studies), clinical assessment findings (n = 4 studies) and injection level (n = 4 studies). No prognostic factor was found to be consistently associated with outcomes following ESI. Most studies found no association or results that conflicted with other studies. CONCLUSIONS There is little, and low quality, evidence to guide practice in terms of factors that predict outcomes in patients following ESI for disc-related sciatica. The results can help inform some of the decisions about potential prognostic factors that should be assessed in future well-designed prospective cohort studies.
Collapse
Affiliation(s)
- Alan Nagington
- Midlands Partnership NHS Foundation Trust, Haywood Hospital, Stoke On Trent, Staffordshire, UK
| | - Nadine E Foster
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Staffordshire, UK.,Surgical Treatment and Rehabilitation Service (STARS), Education and Research Alliance, The University of Queensland and Metro North Hospital and Health Service, Herston, QLD, Australia
| | - Kym Snell
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Staffordshire, UK
| | - Kika Konstantinou
- Midlands Partnership NHS Foundation Trust, Haywood Hospital, Stoke On Trent, Staffordshire, UK.,Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Staffordshire, UK
| | - Siobhán Stynes
- Midlands Partnership NHS Foundation Trust, Haywood Hospital, Stoke On Trent, Staffordshire, UK. .,Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Staffordshire, UK.
| |
Collapse
|
36
|
Sharma S, Kaur H, Verma N, Adhya B. Looking beyond Piriformis Syndrome: Is It Really the Piriformis? Hip Pelvis 2023; 35:1-5. [PMID: 36937215 PMCID: PMC10020728 DOI: 10.5371/hp.2023.35.1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/29/2022] [Accepted: 11/09/2022] [Indexed: 03/21/2023] Open
Abstract
Piriformis syndrome is a common differential diagnosis related to sciatica. The following review provides a concise synopsis of the diagnosis, management, history, and alternatives to diagnosis of piriformis syndrome. A search of the literature for research articles related to piriformis syndrome and associated differential diagnosis of sciatica was conducted. A thorough review of the included articles found that the condition known as piriformis syndrome is over-diagnosed and that potential anatomic and biomechanical variations originating in the pelvic region might be related to the complaint of sciatica. The criteria for diagnosis are based on findings from both physical examination and radio imaging. Piriformis syndrome resembles a variety of clinical conditions; therefore, conduct of future studies should include development of a validated method for evaluation as well as clinical criteria for diagnosis of piriformis syndrome.
Collapse
Affiliation(s)
- Shivam Sharma
- Department of Physical and Rehabilitation Medicine, Physiotherapy Section, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Harmanpreet Kaur
- Department of Physical and Rehabilitation Medicine, Physiotherapy Section, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Nishank Verma
- Department of Physical and Rehabilitation Medicine, Physiotherapy Section, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Bibek Adhya
- Department of Physical and Rehabilitation Medicine, Physiotherapy Section, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
37
|
Silver D, Esener D, Rose G. Ultrasound guided transgluteal sciatic nerve hydrodissection for the treatment of acute sciatica in the emergency department. Am J Emerg Med 2023:S0735-6757(23)00095-5. [PMID: 36933988 DOI: 10.1016/j.ajem.2023.02.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 02/22/2023] [Accepted: 02/22/2023] [Indexed: 03/04/2023] Open
Abstract
Radicular pain due to sciatica is a common occurrence with a lifetime incidence of up to 40%. Typical approaches to treatment vary and may include topical and oral analgesics, such as opioids, acetaminophen, and non-steroidal anti-inflammatory drugs (NSAIDs); however, these medications may be contraindicated in some or result in untoward effects in others. The use of ultrasound-guided regional anesthesia is an important component of multimodal analgesia in the emergency department. Transgluteal sciatic nerve block has been described as an effective method to treat patients with sciatica but carries risk of injury and falls due to its resultant loss of motor function and potential for systemic toxicity when higher volumes are used. Ultrasound-guided peripheral nerve hydrodissection with D5W has been shown to be an effective treatment of various compressive neuropathies in the outpatient setting. Here we present 4 cases of patients who presented to the emergency department with severe acute sciatica and were treated successfully using an ultrasound guided transgluteal sciatic nerve hydrodissection (TSNH). This technique may offer a safe and effective approach to treating patients with sciatica, but more studies are needed to assess its utility on a larger scale.
Collapse
Affiliation(s)
- Drew Silver
- Department of Emergency Medicine, Kaiser Permanente San Diego, 4647 Zion Ave, San Diego, CA 92120, USA
| | - Dasia Esener
- Department of Emergency Medicine, Kaiser Permanente San Diego, 4647 Zion Ave, San Diego, CA 92120, USA
| | - Gabriel Rose
- Department of Emergency Medicine, Kaiser Permanente San Diego, 4647 Zion Ave, San Diego, CA 92120, USA.
| |
Collapse
|
38
|
Ding S, Du X, Fu C, Zhao X, Ge Y, Wang Y. Conservative Treatments for Lumbar Disc Herniation at L3-4 or L4-5 Were More Likely to Fail When Ipsilateral Foraminal Stenosis Was Present at the Caudally Adjacent Segment. World Neurosurg 2023; 170:e577-e583. [PMID: 36403932 DOI: 10.1016/j.wneu.2022.11.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 11/15/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Conservative treatments are important in lumbar disc herniation (LDH), but predictors for poor outcomes are unclear. METHODS Consecutive patients with unilateral single-level LDH at L3-4 or L4-5 were enrolled. Baseline clinical data were collected, and lumbar spine magnetic resonance imaging was evaluated. Foraminal stenosis was evaluated using Lee's approach and further categorized as absence (grade 0 and 1) or presence (grade 2 or 3). Each patient underwent conservative treatments (oral meloxicam and dexamethasone, corset, back extension exercise, physiotherapy, and manual therapy) for 6 weeks. Conservative treatments were defined as failed if a patient underwent surgery within 6 weeks or reported poor recovery at 6-week follow-up. Multivariate logistic regressions were used to examine the associations of failed conservative treatments with baseline characteristics and magnetic resonance imaging findings. RESULTS The study included 222 patients (mean age 45.5 ± 9.8 years). Of patients, 48 (21.6%) had concurrent ipsilateral foraminal stenosis at the caudal segment, and conservative treatments failed in 39 (17.6%). At baseline, patients with LDH and caudal foraminal stenosis were older (50.79 ± 6.14 years vs. 44.10 ± 10.13 years, P < 0.001), had greater leg pain (7.06 ± 1.17 vs. 6.39 ± 1.40, P = 0.003), and had a higher rate of positive straight leg raising test (54.2% vs. 33.3%, P = 0.008) than patients without caudal foraminal stenosis. In multivariate regression, failure of conservative treatments was associated with positive straight leg raising test (odds ratio 2.26, P = 0.046), and caudal foraminal stenosis (odds ratio 3.20, P = 0.007). CONCLUSIONS In the presence of caudal foraminal stenosis and positive SLR test, conservative treatments were more likely to fail in patients with LDH.
Collapse
Affiliation(s)
- Shuchen Ding
- Center of Orthopedics, The 903rd Hospital of People's Liberation Army, Hangzhou, Zhejiang, China
| | - Xiaotian Du
- Department of Orthopaedic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Chudi Fu
- Center of Orthopedics, The 903rd Hospital of People's Liberation Army, Hangzhou, Zhejiang, China
| | - Xinhua Zhao
- The 3(rd) Department of Orthopaedics, Zhejiang Hospital, Hangzhou, Zhejiang, China
| | - Yunlin Ge
- Center of Orthopedics, The 903rd Hospital of People's Liberation Army, Hangzhou, Zhejiang, China
| | - Yue Wang
- Department of Orthopaedic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
| |
Collapse
|
39
|
Dove L, Jones G, Kelsey LA, Cairns MC, Schmid AB. How effective are physiotherapy interventions in treating people with sciatica? A systematic review and meta-analysis. Eur Spine J 2023; 32:517-533. [PMID: 36580149 PMCID: PMC9925551 DOI: 10.1007/s00586-022-07356-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 07/20/2022] [Accepted: 08/16/2022] [Indexed: 12/30/2022]
Abstract
PURPOSE Physiotherapy interventions are prescribed as first-line treatment for people with sciatica; however, their effectiveness remains controversial. The purpose of this systematic review was to establish the short-, medium- and long-term effectiveness of physiotherapy interventions compared to control interventions for people with clinically diagnosed sciatica. METHODS This systematic review was registered on PROSPERO CRD42018103900. Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL (EBSCO), Embase, PEDro, PubMed, Scopus and grey literature were searched from inception to January 2021 without language restrictions. Inclusion criteria were randomised controlled trials evaluating physiotherapy interventions compared to a control intervention in people with clinical or imaging diagnosis of sciatica. Primary outcome measures were pain and disability. Study selection and data extraction were performed by two independent reviewers with consensus reached by discussion or third-party arbitration if required. Risk of bias was assessed independently by two reviewers using the Cochrane Risk of Bias tool with third-party consensus if required. Meta-analyses and sensitivity analyses were performed with random effects models using Revman v5.4. Subgroup analyses were undertaken to examine the effectiveness of physiotherapy interventions compared to minimal (e.g. advice only) or substantial control interventions (e.g. surgery). RESULTS Three thousand nine hundred and fifty eight records were identified, of which 18 trials were included, with a total number of 2699 participants. All trials had a high or unclear risk of bias. Meta-analysis of trials for the outcome of pain showed no difference in the short (SMD - 0.34 [95%CI - 1.05, 0.37] p = 0.34, I2 = 98%), medium (SMD 0.15 [95%CI - 0.09, 0.38], p = 0.22, I2 = 80%) or long term (SMD 0.09 [95%CI - 0.18, 0.36], p = 0.51, I2 = 82%). For disability there was no difference in the short (SMD - 0.00 [95%CI - 0.36, 0.35], p = 0.98, I2 = 92%, medium (SMD 0.25 [95%CI - 0.04, 0.55] p = 0.09, I2 = 87%), or long term (SMD 0.26 [95%CI - 0.16, 0.68] p = 0.22, I2 = 92%) between physiotherapy and control interventions. Subgroup analysis of studies comparing physiotherapy with minimal intervention favoured physiotherapy for pain at the long-term time points. Large confidence intervals and high heterogeneity indicate substantial uncertainly surrounding these estimates. Many trials evaluating physiotherapy intervention compared to substantial intervention did not use contemporary physiotherapy interventions. CONCLUSION Based on currently available, mostly high risk of bias and highly heterogeneous data, there is inadequate evidence to make clinical recommendations on the effectiveness of physiotherapy interventions for people with clinically diagnosed sciatica. Future studies should aim to reduce clinical heterogeneity and to use contemporary physiotherapy interventions.
Collapse
Affiliation(s)
- Lucy Dove
- grid.4991.50000 0004 1936 8948Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, The University of Oxford, West Wing Level 6, Oxford, OX3 9DU UK ,grid.410556.30000 0001 0440 1440Oxford Spine Service, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Gillian Jones
- grid.7628.b0000 0001 0726 8331Department of Sport, Health Sciences and Social Work, Oxford Brookes University, Oxford, UK
| | - Lee Anne Kelsey
- grid.451190.80000 0004 0573 576XOxford Health NHS Foundation Trust, Oxford, UK
| | - Melinda C. Cairns
- grid.5846.f0000 0001 2161 9644School of Health and Social Work, University of Hertfordshire, Hatfield, UK ,Physiocare Body Management, 6 Church St, Twyford, Reading, RG10 9DR UK
| | - Annina B. Schmid
- grid.4991.50000 0004 1936 8948Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, The University of Oxford, West Wing Level 6, Oxford, OX3 9DU UK
| |
Collapse
|
40
|
Lewis C, Stjernbrandt A, Wahlström J. The association between cold exposure and musculoskeletal disorders: a prospective population-based study. Int Arch Occup Environ Health 2023; 96:565-575. [PMID: 36592178 PMCID: PMC10079729 DOI: 10.1007/s00420-022-01949-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 12/16/2022] [Indexed: 01/03/2023]
Abstract
OBJECTIVES The aim of the study was to determine the association between occupational ambient cold exposure and neck-shoulder pain (NSP), low back pain (LBP), and radiating LBP. METHODS The study cohort comprised of 3,843 working subjects in northern Sweden who answered a baseline (spring 2015) and a follow-up questionnaire (spring 2021). NSP, LBP, and radiating LBP were assessed in both surveys. Occupational cold exposure was assessed at baseline, on a whole number numerical rating scale (NRS) and categorized in quartiles. Binary logistic regression determined the association between cold exposure at baseline and incident NSP, LBP, and radiating LBP, adjusted for age, gender, body mass index, smoking, mental stress, and physical workload. RESULTS There were statistically significant associations between high occupational ambient cold exposure (NRS 5-7 and NRS 8-10) and NSP (1.59; 95% CI 1.08-2.33 and OR 1.50; 95% CI 1.03-2.19); NRS 8-10 and LBP (OR 1.61; 95% CI 1.13-2.29); and NRS 5-7 and radiating LBP (OR 1.87; 95% CI 1.12-3.16). Gender-stratified analyses showed statistically significant associations between high occupational ambient cold exposure (NRS 5-7 and NRS 8-10) and NSP (OR 1.97; 95% CI 1.07-3.61 and OR 1.97; 95% CI 1.06-3.67) for men and between NRS 8-10 and LBP (OR 1.82; 95% CI 1.14-2.91) and NRS 5-7 and radiating LBP (OR 2.20; 95% CI 1.15-4.24) for women. CONCLUSIONS Occupational ambient cold exposure was associated with NSP, LBP, and radiating LBP, and should be recognised as a possible occupational risk factor.
Collapse
Affiliation(s)
- Charlotte Lewis
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, 901 87, Umeå, Sweden.
| | - Albin Stjernbrandt
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, 901 87, Umeå, Sweden
| | - Jens Wahlström
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, 901 87, Umeå, Sweden
| |
Collapse
|
41
|
Cheng CH, Che-Chao Chang MDP, Lin HL, Chuang HY, Lin RM, Foo NP. Intradural lumbar disc herniation: A case report and literature review. Heliyon 2022; 8:e12257. [PMID: 36578377 PMCID: PMC9791832 DOI: 10.1016/j.heliyon.2022.e12257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 09/25/2022] [Accepted: 12/02/2022] [Indexed: 12/23/2022] Open
Abstract
Study design and objection Intradural disc herniation is a unusual disease associated with spinal surgery. The definitive diagnosis of intradural herniation depends on intraoperative findings. Summary of background data We present the case of a 63-year-old woman with backache and left sciatica radiation for more than two months. The L2/3 laminectomy and discectomy were performed after magnetic resonance imaging (MRI) study; however, no disc rupture was noted during surgery. Follow-up lumbar spine MRI revealed one large, ruptured disc. The patient underwent revision surgery with durotomy. The large intradural disc was found and removed piece by piece. Methods Results and Conclusions Intradural disc herniation, especially large herniation, is hard to diagnose specifically despite the progression of neuroradiologic imaging techniques. A durotomy procedure should be considered if there is a missing ruptured disc or a palpable intradural mass during surgery.
Collapse
Affiliation(s)
- Cheng-Hsin Cheng
- Department of Neurosurgery, An Nan Hospital, China Medical University, 70965, Tainan, Taiwan,Graduate Institute of Medical Science, Chang Jung Christian University, Tainan, 71101, Taiwan
| | - MD, PhD. Che-Chao Chang
- Department of Neurosurgery, An Nan Hospital, China Medical University, 70965, Tainan, Taiwan,Neurophysiology Laboratory, Department of Surgery, National Cheng Kung University Medical Center and Medical School, 70101, Taiwan
| | - Hung-Lin Lin
- Department of Neurosurgery, China Medical University Hospital, Taichung, 40447, Taiwan
| | - Hao-Yu Chuang
- Department of Neurosurgery, An Nan Hospital, China Medical University, 70965, Tainan, Taiwan,Department of Neurosurgery, China Medical University Hospital, Taichung, 40447, Taiwan
| | - Ruey-Mo Lin
- Department of Orthopedics, An Nan Hospital, China Medical University, Tainan, 70101, Taiwan,Corresponding author.
| | - Ning-Ping Foo
- Graduate Institute of Medical Science, Chang Jung Christian University, Tainan, 71101, Taiwan,Department of Emergency Medicine, An Nan Hospital, China Medical University, Tainan 70965, Taiwan,Corresponding author.
| |
Collapse
|
42
|
Willems SJ, Coppieters MW, Rooker S, Ostelo R, Hoekstra T, Scholten-Peeters GGM. Variability in recovery following microdiscectomy and postoperative physiotherapy for lumbar radiculopathy: A latent class trajectory analysis. Clin Neurol Neurosurg 2022; 224:107551. [PMID: 36563569 DOI: 10.1016/j.clineuro.2022.107551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 11/24/2022] [Accepted: 11/27/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The clinical course of lumbar radiculopathy following microdiscectomy and post-operative physiotherapy varies substantially. No prior studies assessed this variability by deriving outcome trajectories. The primary aims of this study were to evaluate the variability in long-term recovery after lumbar microdiscectomy followed by post-operative physiotherapy and to identify outcome trajectories. The secondary aim was to assess whether demographic, clinical characteristics and patient-reported outcome measures routinely collected at baseline could predict poor outcome trajectories. METHODS We conducted a prospective cohort study with a 24-month follow-up. We included 479 patients with clinical signs and symptoms of lumbar radiculopathy confirmed by Magnetic Resonance Imaging findings, who underwent microdiscectomy and post-operative physiotherapy. Outcomes were leg pain and back pain measured with Visual Analogue Scales, and disability measured with the Roland-Morris Disability Questionnaire. Descriptive statistics were performed to present the average and the individual clinical course. A latent class trajectory analysis was conducted to identify leg pain, back pain, and disability outcome trajectories. The best number of clusters was determined using the Bayesian Information Criterion, Akaike's information criteria, entropy, and overall interpretability. Prediction models for poor outcome trajectories were assessed using multivariable logistic regression analyses. RESULTS Several outcome trajectories were identified. Most patients were assigned to the 'large improvement' trajectory (leg pain: 79.3%; back pain: 70.2%; disability: 59.5% of patients). Smaller proportions of patients were assigned to the 'moderate improvement' trajectory (leg pain: 7.9%; back pain: 10.6%; disability: 20.7% of patients), the 'minimal improvement' trajectory (leg pain: 4.9%, back pain: 6.7%, disability: 16.3% of patients) and the 'relapse' trajectory (leg pain: 7.9%; back pain: 12.5%; disability: 3.5%). Approximately one-third of patients (32.6%) belonged to one or more than one poor outcome trajectory. Patients with previous treatment (prior back surgery, injection therapy, and medication use) and those who had higher baseline pain and disability scores were more likely to belong to the poor outcome trajectories in comparison to the large improvement trajectories in back pain, leg pain and disability, and the moderate improvement trajectory in disability. The explained variance (Nagelkerke R2) of the prediction models ranged from 0.06 to 0.13 and the discriminative ability (Area Under the Curve) from 0.66 to 0.73. CONCLUSION The clinical course of lumbar radiculopathy varied following microdiscectomy and post-operative physiotherapy, and several outcome trajectories could be identified. Although most patients were allocated to favorable trajectories, one in three patients was assigned to one or more poor outcome trajectories following microdiscectomy and post-operative physiotherapy for lumbar radiculopathy. Routinely gathered data were unable to predict the poor outcome trajectories accurately. Prior to surgery, clinicians should discuss the high variability and the distinctive subgroups that are present in the clinical course with their patients.
Collapse
Affiliation(s)
- Stijn J Willems
- Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands.
| | - Michel W Coppieters
- Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands; Menzies Health Institute Queensland, Griffith University, Brisbane, Gold Coast, Australia; School of Health Sciences and Social Work, Griffith University, Brisbane, Gold Coast, Australia.
| | - Servan Rooker
- Department of Neurosurgery Kliniek ViaSana, Mill, the Netherlands; Department of Family medicine and population health (FAMPOP), University of Antwerp, Antwerp, Belgium.
| | - Raymond Ostelo
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences Research Institute,Amsterdam, the Netherlands; Department of Epidemiology and Data Science, Amsterdam UMC, Location VUmc, Amsterdam Movement Sciences Research Institute, Amsterdam, the Netherlands.
| | - Trynke Hoekstra
- Department of Health Sciences and the Amsterdam Public Health Research Institute, Faculty of Science, Vrije Universiteit Amsterdam, the Netherlands.
| | - Gwendolyne G M Scholten-Peeters
- Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands.
| |
Collapse
|
43
|
Han KH, Cho KH, Han C, Cui S, Lin L, Baek HY, Kim J. The effectiveness and safety of acupuncture treatment on sciatica: A systematic review and meta-analysis. Complement Ther Med 2022; 71:102872. [PMID: 35985442 DOI: 10.1016/j.ctim.2022.102872] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 07/28/2022] [Accepted: 08/15/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Sciatica results from primary or secondary damage to the sciatic nerve in the lumbar or gluteal region. The first option for sciatica is analgesics, but their therapeutic effect and safety in long-term use are questionable. On the other hand, acupuncture has recently been recognized as a complementary and alternative medicine (CAM) to conventional medicine, and studies on its effectiveness and safety have been actively conducted. OBJECTIVE To systematically compare acupuncture with analgesics in terms of effect, safety, and durability in the treatment of sciatica METHODS: This review was performed in accordance with Cochrane Handbook for Systematic Reviews of Interventions Version 6.2. Four databases were searched for this review: Wangfang, the Korean Traditional Knowledge Portal (KTKP), PubMed, and EBSCOhost. The primary outcome measures in the review were total effective rate (TER), visual analog scale (VAS) score and pain threshold, and the secondary ones were adverse effects (AEs) and relapse rates. Risk ratio (RR) for TER and mean difference (MD) for VAS score and pain threshold were used as statistics for the meta-analysis of effectiveness, along with associated 95 % confidence intervals (CIs) and P-values. AEs and relapse rates were used for the safety and durability of the interventions. Version 2 of the Cochrane risk-of-bias assessment tool for randomized trials (RoB 2) was used for the methodological quality of randomized controlled trials (RCTs) included in the review. RESULTS The synthesized TER of 28 RCTs involving 2707 participants was significantly higher in the acupuncture group compared to the analgesic group (RR [95 % CI] = 1.20 [1.16, 1.24], P < 0.001). The synthesized VAS score of 7 RCTs involving 589 participants was significantly reduced in the acupuncture group compared to the analgesic group (MD [95 % CI] = - 1.78 [- 2.44, - 1.12], P < 0.001). In 5 RCTs involving 311 participants, the synthesized pain threshold was significantly elevated in the acupuncture group compared to the analgesic group (MD [95 % CI] = 0.93 [0.64, 1.22], P < 0.001). Additionally, adverse effects (AEs) and relapse rates of RCTs in the review were lower in the acupuncture group compared to the analgesic group. CONCLUSION In this systematic review, acupuncture treatment was significantly effective and safe compared to analgesics in sciatica. In the future, studies with a rigorous study design are required to increase the validity of the effectiveness and safety of acupuncture treatment for sciatica.
Collapse
Affiliation(s)
- Kyou-Hwan Han
- SBU Research Institute of Integrative Medicine, South Baylo University, 2727 West 6th Street, Los Angeles, CA 90057, USA.
| | - Ki Haeng Cho
- SBU Research Institute of Integrative Medicine, South Baylo University, 2727 West 6th Street, Los Angeles, CA 90057, USA
| | - Caroline Han
- SBU Research Institute of Integrative Medicine, South Baylo University, 2727 West 6th Street, Los Angeles, CA 90057, USA
| | - Shanqin Cui
- SBU Research Institute of Integrative Medicine, South Baylo University, 2727 West 6th Street, Los Angeles, CA 90057, USA
| | - Lily Lin
- SBU Research Institute of Integrative Medicine, South Baylo University, 2727 West 6th Street, Los Angeles, CA 90057, USA
| | - Ho-Yu Baek
- School of Big Data and Financial Statistics, Wonkwang University, 460 Iksandaero, Iksan, Jeonbuk 54538, the Republic of Korea
| | - Jaejong Kim
- SBU Research Institute of Integrative Medicine, South Baylo University, 2727 West 6th Street, Los Angeles, CA 90057, USA
| |
Collapse
|
44
|
Kumar M, Bhushan B, Vaishy A, Kishan R, Fageria RS, Repaswal A. Multimodal cocktail analgesic injection in PIVD with lower limb radiculopathy - A mixed design cohart study. J Clin Orthop Trauma 2022; 35:102049. [PMID: 36387936 PMCID: PMC9663881 DOI: 10.1016/j.jcot.2022.102049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 08/10/2022] [Accepted: 10/18/2022] [Indexed: 11/13/2022] Open
Abstract
Background The role of Sodium Channel Blocker and steroid is well established for pain relief in neuropathic pain by reducing inflamation and desensitization of nerve roots. Our study aims at analyzing the effectiveness of multimodal cocktail injections for redicular pain relief & functional outcome in patients with intervertebral disc herniation. Material and method This was a Mixed design (prospective & retrospective) cohort study; we included 113 patients between the age group of 18-70 years, diagnosed with Prolapse of intervertebral disc (PIVD) with lower limb radiculopathy with MRI finding L4-L5/L5-S1 vertebral disc involvement. Patients were injected with total 15 ml of cocktail injection in 3 divided doses at 3 identified sites in affected lower limb. . Patient was examined & evaluated clinically for VAS pain score, SLRT, Sensory, Motor Examination on day 2, day 7, day 15 & after 1 month. Result We found that the mean pre-VAS score was 7.83 followed by the mean VAS score on post 2 days was 1.05, post 7 days was 3.47, post 15 days was 3.9 and post 30 days was 3.81. There was a statistically significant difference in the mean VAS score (p-value<0.0001). After one month majority of patients (54.62%) had comfortable painless walk and comfortable walking distance increased up to 1 km in 45.37% of them. Conclusion Use of cocktail multimodal injections for radiculopathy pain suggests that this non-operative,OPD based technique could be reasonable, efficient, and safe.
Collapse
Affiliation(s)
- Manoj Kumar
- Department of Orthopaedics,Dr.S.N Medical College, Jodhpur, India
| | | | - Arun Vaishy
- Department of Orthopaedics,Dr.S.N Medical College, Jodhpur, India
| | - Rama Kishan
- Department of Orthopaedics,Dr.S.N Medical College, Jodhpur, India
| | | | - Anju Repaswal
- Department of Pathology, Sardar Patel Medical College, Bikaner, India
| |
Collapse
|
45
|
Belavy DL, Tagliaferri SD, Buntine P, Saueressig T, Ehrenbrusthoff K, Chen X, Diwan A, Miller CT, Owen PJ. Interventions for promoting evidence-based guideline-consistent surgery in low back pain: a systematic review and meta-analysis of randomised controlled trials. Eur Spine J 2022; 31:2851-2865. [PMID: 36114891 DOI: 10.1007/s00586-022-07378-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 07/09/2022] [Accepted: 09/02/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE Examine the effectiveness of interventions to approach guideline-adherent surgical referrals for low back pain assessed via systematic review and meta-analysis. METHODS Five databases (10 September 2021), Google Scholar, reference lists of relevant systematic reviews were searched and forward and backward citation tracking of included studies were implemented. Randomised controlled/clinical trials in adults with low back pain of interventions to optimise surgery rates or referrals to surgery or secondary referral were included. Bias was assessed using the Cochrane ROB2 tool and evidence certainty via Grading of Recommendations Assessment, Development and Evaluation (GRADE). A random effects meta-analysis with a Paule Mandel estimator plus Hartung-Knapp-Sidik-Jonkman method was used to calculate the odds ratio and 95% confidence interval, respectively. RESULTS Of 886 records, 6 studies were included (N = 258,329) participants; cluster sizes ranged from 4 to 54. Five studies were rated as low risk of bias and one as having some concerns. Two studies reporting spine surgery referral or rates could only be pooled via combination of p values and gave evidence for a reduction (p = 0.021, Fisher's method, risk of bias: low). This did not persist with sensitivity analysis (p = 0.053). For secondary referral, meta-analysis revealed a non-significant odds ratio of 1.07 (95% CI [0.55, 2.06], I2 = 73.0%, n = 4 studies, Grading of Recommendations Assessment, Development and Evaluation [GRADE] evidence certainty: very low). CONCLUSION Few RCTs exist for interventions to improve guideline-adherent spine surgery rates or referral. Clinician education in isolation may not be effective. Future RCTs should consider organisational and/or policy level interventions. PROSPERO REGISTRATION CRD42020215137.
Collapse
Affiliation(s)
- Daniel L Belavy
- Division of Physiotherapy, Department of Applied Health Sciences, Hochschule Für Gesundheit (University of Applied Sciences), Gesundheitscampus 6-8, 44801, Bochum, Germany.
| | - Scott D Tagliaferri
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Paul Buntine
- Emergency Department, Box Hill Hospital, Eastern Health, Melbourne, VIC, Australia
- Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
| | | | - Katja Ehrenbrusthoff
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Xiaolong Chen
- Department of Orthopaedic Surgery, Spine Service, St. George Hospital, University of New South Wales, Sydney, Australia
| | - Ashish Diwan
- Department of Orthopaedic Surgery, Spine Service, St. George Hospital, University of New South Wales, Sydney, Australia
| | - Clint T Miller
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Patrick J Owen
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| |
Collapse
|
46
|
Zhang D, Jing B, Chen Z, Li X, Shi H, Zheng Y, Chang S, Zhao G. Ferulic acid alleviates sciatica by inhibiting peripheral sensitization through the RhoA/p38MAPK signalling pathway. Phytomedicine 2022; 106:154420. [PMID: 36115115 DOI: 10.1016/j.phymed.2022.154420] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 08/18/2022] [Accepted: 08/26/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Nonsteroidal anti-inflammatory drugs are used to relieve sciatica, but their effects are not satisfactory. PURPOSE This study aimed to explore the therapeutic effects of ferulic acid on sciatica. METHODS Thirty-two SD rats were randomly divided into 4 groups, i.e., sham operation group, chronic constriction injury (CCI) group, mecobalamin group, and ferulic acid group. We conducted behavioural tests, ELISA, PCR, Western blots, and immunofluorescence analysis. Specific inhibitors were used in cell experiments to explore the related mechanisms. RESULTS Thermal hyperalgesia was induced after CCI operation, and ferulic acid relieved thermal hyperalgesia. In addition, ferulic acid decreased the IL1β, IL6, TNF-α, and CRP mRNA levels; the IBA-1, iNOS, IL1β, RhoA, RhoA-GTP, COX2, Rock1, TRPV1, TRPA1, and p-p38MAPK levels in dorsal root ganglion (DRG) neurons; and the LPS, CRP, substance P (SP), and prostaglandin E2 (PGE2) levels in serum, and these levels were higher in the CCI group. In the cell experiments, LPS induced M1 polarization of GMI-R1 cells via the RhoA/Rock pathway. Ferulic acid attenuated LPS-induced M1 polarization by decreasing the levels of M1 polarization markers, including IL1β, IL6, TNF-α, iNOS, and CD32, and increased M2 polarization by increasing the levels of M2 polarization markers, including CD206 and Arg-1. LPS treatment clearly increased the iNOS, IL1β, RhoA, Rock1, Rock2 and p-p38 MAPK levels and reduced Arg-1 expression, and ferulic acid reversed these changes. CONCLUSION Ferulic acid can inhibit peripheral sensitization by reducing the levels of inflammatory factors, TRPA1 and TRPV1 through the RhoA/p38 MAPK pathway to alleviate sciatica.
Collapse
Affiliation(s)
- Di Zhang
- College of Traditional Chinese Medicine, Jinan University, Guangzhou, China.
| | - Bei Jing
- College of Traditional Chinese Medicine, Jinan University, Guangzhou, China
| | - Zhenni Chen
- College of Traditional Chinese Medicine, Jinan University, Guangzhou, China
| | - Xin Li
- College of Traditional Chinese Medicine, Jinan University, Guangzhou, China
| | - Huimei Shi
- College of Traditional Chinese Medicine, Jinan University, Guangzhou, China
| | - Yachun Zheng
- College of Traditional Chinese Medicine, Jinan University, Guangzhou, China
| | - Shiquan Chang
- College of Traditional Chinese Medicine, Jinan University, Guangzhou, China
| | - Guoping Zhao
- College of Traditional Chinese Medicine, Jinan University, Guangzhou, China.
| |
Collapse
|
47
|
Trager RJ, Prosak SE, Getty PJ, Barger RL, Saab ST, Dusek JA. Ischial osteochondroma as an unusual source of pregnancy-related sciatic pain: a case report. Chiropr Man Therap 2022; 30:45. [PMID: 36253863 PMCID: PMC9575271 DOI: 10.1186/s12998-022-00451-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 08/23/2022] [Accepted: 09/07/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND While most cases of sciatica result from degenerative conditions of the low back, some cases result from conditions of the hip and pelvic region. Sciatica developing in relation to pregnancy or labor also presents unique considerations. CASE PRESENTATION A 37-year-old African American woman with a history of hypertension and polycystic ovary syndrome presented to a chiropractor at a hospital-based outpatient clinic with a seven-week history of low back pain with radiation into the right lower extremity which began during labor. The chiropractor performed a brief trial of care, yet when the patient's symptoms worsened, ordered lumbar spine radiographs, followed by lumbar magnetic resonance imaging (MRI), which were both normal. The chiropractor then ordered hip radiographs, which were suggestive of ischial osteochondroma, and referred the patient to an orthopedic oncologist. MRI findings were compatible with an osteochondroma with associated adventitial bursitis and mass effect on the sciatic nerve. The patient initially chose conservative management with bursa aspiration and therapeutic injection. Despite initial relief, there was eventual return of symptoms. The patient elected to undergo surgical removal, with a positive outcome. CONCLUSION The key distinguishing features that led to a diagnosis of osteochondroma in this case included attention to the patient-reported symptoms and history, worsening of symptoms despite conservative care, and lack of explanatory findings on lumbar imaging. This case highlights the benefit of evaluating the hip and pelvis when the clinical features of sciatica cannot be ascribed to a lumbar etiology. This case also illustrates the role of a chiropractor working in an integrative health system to facilitate timely imaging and referrals to resolve a challenging diagnosis.
Collapse
Affiliation(s)
- Robert J. Trager
- grid.443867.a0000 0000 9149 4843Connor Whole Health, University Hospitals Cleveland Medical Center, 44106 Cleveland, OH USA
| | - Sarah E. Prosak
- grid.443867.a0000 0000 9149 4843Connor Whole Health, University Hospitals Cleveland Medical Center, 44106 Cleveland, OH USA
| | - Patrick J. Getty
- grid.443867.a0000 0000 9149 4843Musculoskeletal Surgical Oncology, University Hospitals Cleveland Medical Center, 44106 Cleveland, OH USA ,grid.67105.350000 0001 2164 3847Orthopaedic Surgery, Case Western Reserve University, 44106 Cleveland, OH USA
| | - Richard L. Barger
- grid.443867.a0000 0000 9149 4843Division of Musculoskeletal Radiology, University Hospitals Cleveland Medical Center, 44106 Cleveland, OH USA
| | - Shahrazad T. Saab
- grid.67105.350000 0001 2164 3847Department of Pathology, Case Western Reserve University School of Medicine, 44106 Cleveland, OH USA
| | - Jeffery A. Dusek
- grid.443867.a0000 0000 9149 4843Connor Whole Health, University Hospitals Cleveland Medical Center, 44106 Cleveland, OH USA ,grid.67105.350000 0001 2164 3847Department of Family Medicine and Community Health, School of Medicine, Case Western Reserve University, 44106 Cleveland, OH USA
| |
Collapse
|
48
|
Feller D, Giudice A, Faletra A, Salomon M, Galeno E, Rossettini G, Brindisino F, Maselli F, Hutting N, Mourad F. Identifying peripheral arterial diseases or flow limitations of the lower limb: Important aspects for cardiovascular screening for referral in physiotherapy. Musculoskelet Sci Pract 2022; 61:102611. [PMID: 35759957 DOI: 10.1016/j.msksp.2022.102611] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 06/08/2022] [Accepted: 06/16/2022] [Indexed: 10/17/2022]
Abstract
Many conditions could potentially cause pain in the lower limbs. One of these is peripheral arterial disease (PAD). PAD is often a real challenge to be recognized for clinicians due to symptoms that commonly mimic musculoskeletal conditions. PAD is defined as a total or partial blockage of the vessels that supply blood from the heart to the periphery. Its prevalence is around 7 percent in subjects between 55 and 59, reaching almost 25% in individuals between 95 and 99 years old. The most dominant symptom of PAD is lower limb pain. Also, PAD can produce other symptoms such as discoloration, altered skin temperature, and, when arterial blood flow is insufficient to meet the metabolic demands of resting muscle or tissue, focal areas of ischemia. In our view, physical therapists should be capable of triaging for PAD in a direct access setting. Therefore, in this Professional Issue, we present the main characteristics of PAD and the physiotherapy role in its management. A supplementary step-by-step guide will provide further resources for testing PAD.
Collapse
Affiliation(s)
- Daniel Feller
- Centre of Higher Education for Health Sciences, Trento, Italy.
| | - Andrea Giudice
- Department of Physical Therapy, Poliambulatorio Physio Power, Brescia, Italy.
| | - Agostino Faletra
- Queen Elizabeth Hospital, Clinical Support & Screening Service, Gateshead, United Kingdom.
| | - Mattia Salomon
- Department of Clinical Science and Translational Medicine, University of Roma "Tor Vergata", Roma, Italy; CST Centro Sanitario Trento s.r.l., 30121, Trento, Italy.
| | - Erasmo Galeno
- Polimedico Specialistico STEMA Fisiolab, Latina, Italy; Dip. Scienze mediche, chirurgiche e neuroscienze Università degli studi di Siena, Italy; Department of clinical science and translation medicine, University of Rome Tor Vergata, Roma, Italy.
| | | | - Fabrizio Brindisino
- Department of clinical science and translation medicine, University of Rome Tor Vergata, Roma, Italy; Department of Medicine and Health Science "Vincenzo Tiberio", University of Molise c/o Cardarelli Hospital, Campobasso, Italy.
| | - Filippo Maselli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Campus of Savona, University of Genoa, Savona, Italy; Sovrintendenza Sanitaria Regionale Puglia INAIL, Bari, Italy.
| | - Nathan Hutting
- Department of Occupation and Health, School of Organisation and Development, HAN University of Applied Sciences, Nijmegen, the Netherlands.
| | - 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.
| |
Collapse
|
49
|
Luites JWH, Kuijer PPFM, Hulshof CTJ, Kok R, Langendam MW, Oosterhuis T, Anema JR, Lapré-Utama VP, Everaert CPJ, Wind H, Smeets RJEM, van Zaanen Y, Hoebink EA, Voogt L, de Hoop W, Boerman DH, Hoving JL. The Dutch Multidisciplinary Occupational Health Guideline to Enhance Work Participation Among Low Back Pain and Lumbosacral Radicular Syndrome Patients. J Occup Rehabil 2022; 32:337-352. [PMID: 34313903 PMCID: PMC9576671 DOI: 10.1007/s10926-021-09993-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/28/2021] [Indexed: 05/06/2023]
Abstract
Purpose Based on current scientific evidence and best practice, the first Dutch multidisciplinary practice guideline for occupational health professionals was developed to stimulate prevention and enhance work participation in patients with low back pain (LBP) and lumbosacral radicular syndrome (LRS). Methods A multidisciplinary working group with health care professionals, a patient representative and researchers developed the recommendations after systematic review of evidence about (1) Risk factors, (2) Prevention, (3) Prognostic factors and (4) Interventions. Certainty of the evidence was rated with GRADE and the Evidence to Decision (EtD) framework was used to formulate recommendations. High or moderate certainty resulted in a recommendation "to advise", low to very low in a recommendation "to consider", unless other factors in the framework decided differently. Results An inventory of risk factors should be considered and an assessment of prognostic factors is advised. For prevention, physical exercises and education are advised, besides application of the evidence-based practical guidelines "lifting" and "whole body vibration". The stepped-care approach to enhance work participation starts with the advice to stay active, facilitated by informing the worker, reducing workload, an action plan and a time-contingent increase of work participation for a defined amount of hours and tasks. If work participation has not improved within 6 weeks, additional treatments should be considered based on the present risk and prognostic factors: (1) physiotherapy or exercise therapy; (2) an intensive workplace-oriented program; or (3) cognitive behavioural therapy. After 12 weeks, multi-disciplinary (occupational) rehabilitation therapy need to be considered. Conclusions Based on systematic reviews and expert consensus, the good practice recommendations in this guideline focus on enhancing work participation among workers with LBP and LRS using a stepped-care approach to complement existing guidelines focusing on recovery and daily functioning.
Collapse
Affiliation(s)
- J W H Luites
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam, The Netherlands.
| | - P P F M Kuijer
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam, The Netherlands
| | - C T J Hulshof
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam, The Netherlands
- Netherlands Society of Occupational Medicine (NVAB), Utrecht, The Netherlands
| | - R Kok
- Dutch Society of Insurance Medicine (NVVG), Amsterdam, The Netherlands
| | - M W Langendam
- Department of Epidemiology and Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam Institute of Public Health, Amsterdam, The Netherlands
| | - T Oosterhuis
- Netherlands Society of Occupational Medicine (NVAB), Utrecht, The Netherlands
| | - J R Anema
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam, The Netherlands
- Research Center for Insurance Medicine (KCVG), Amsterdam, The Netherlands
| | - V P Lapré-Utama
- Dutch Association of Medical Officers in Private Insurances (GAV), Utrecht, The Netherlands
| | - C P J Everaert
- Netherlands Society of Occupational Medicine (NVAB), Utrecht, The Netherlands
- Arbo Unie, Arnhem, The Netherlands
| | - H Wind
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam, The Netherlands
- Dutch Society of Insurance Medicine (NVVG), Amsterdam, The Netherlands
| | - R J E M Smeets
- Department of Rehabilitation Medicine, Maastricht University, Maastricht, the Netherlands
- Libra Rehabilitation and Audiology, Eindhoven, The Netherlands
- Netherlands Society of Physical and Rehabilitation Medicine (VRA), Utrecht, The Netherlands
| | - Y van Zaanen
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam, The Netherlands
- Dutch Association of Physiotherapists Working in Occupational Health and Ergonomics (NVBF-KNGF), Amersfoort, The Netherlands
| | - E A Hoebink
- Department of Orthopaedic Surgery, Foundation for Orthopaedic Research Care and Education (FORCE), Amphia Hospital, Breda, The Netherlands
| | - L Voogt
- Dutch Association for Patients With Back Problems (NVvR), Rotterdam, The Netherlands
| | - W de Hoop
- Dutch Association for Labour Experts (NVvA), Nijkerk, The Netherlands
| | - D H Boerman
- Department of Neurology, Rijnstate Hospital, Arnhem, The Netherlands
- Netherlands Society for Neurology (NVN), Utrecht, The Netherlands
| | - J L Hoving
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam, The Netherlands
- Research Center for Insurance Medicine (KCVG), Amsterdam, The Netherlands
| |
Collapse
|
50
|
Gadjradj PS, Vreeling A, Depauw PR, Schutte PJ, Harhangi BS. Surgeons Learning Curve of Transforaminal Endoscopic Discectomy for Sciatica. Neurospine 2022; 19:594-602. [PMID: 36203286 PMCID: PMC9537830 DOI: 10.14245/ns.2244342.171] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 07/17/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Full-endoscopic spine surgery is gaining interest as a less-invasive alternative to treat sciatica caused by a lumbar disc herniation. Concerns, however, exist with the learning curve as percutaneous transforaminal endoscopic discectomy (PTED) appears to be more difficult to be performed compared to other techniques. In this study, the clinical outcomes during and after the learning curve are presented of 3 surgeons naïve to PTED. METHODS In the first phase of a randomized controlled, noninferiority trial comparing PTED with microdiscectomy, 3 surgeons were trained in the PTED-procedure by a senior surgeon. After performing up to 20 cases under supervision, they started performing PTED on their own. Results of the early cases were compared to the later cases (>20). Furthermore, complications and reoperations were compared. Finally, differences in clinical outcomes between surgeons were compared. RESULTS At 12 months of follow-up, 87% of the patients had follow-up data available. In general, there were no significant differences in patient-reported outcomes between the early and later PTED cases. Furthermore, outcomes of the early PTED cases were comparable to the outcomes of microdiscectomy, while the later PTED cases had small, but more favorable outcomes compared to microdiscectomy. Two learning curve surgeons had substantially higher rates of reoperations within 1 year, compared to the senior surgeon or the microdiscectomy group. Duration of surgery was also longer for all learning curve surgeons. Finally, when comparing clinical outcomes of patients undergoing PTED versus microdiscectomy, there appears to be some statistically significant differences in outcomes compared between the senior and 3 learning curve surgeons. CONCLUSION PTED appears to be safe to be adopted by surgeons naïve to the procedure when they are initially supervised by an experienced senior surgeon. Duration of surgery and risk of repeated surgery are increased during the learning curve, but patient-reported outcomes of the early PTED cases are similar to the outcomes of later PTED cases, and similar to the outcomes of microdiscectomy cases. This study underlines the need for an experienced mentor for surgeons to safely adopt PTED.
Collapse
Affiliation(s)
- Pravesh S. Gadjradj
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, New York, NY, USA,Department of Neurosurgery, Park Medical Center, Rotterdam, The Netherlands,Corresponding Author Pravesh S. Gadjradj Department of Neurosurgery, Park Medical Center, S Gravendijkswal 230, Rotterdam, The Netherlands
| | - Arnold Vreeling
- Department of Orthopedic Surgery, Rijnstate Ziekenhuis, Arnhem, The Netherlands
| | - Paul R. Depauw
- Department of Neurosurgery, Elisabeth-TweeSteden Ziekenhuis, Tilburg, The Netherlands
| | - Pieter J. Schutte
- Department of Neurosurgery, Alrijne Ziekenhuis, Leiderdorp, The Netherlands
| | - Biswadjiet S. Harhangi
- Department of Neurosurgery, Park Medical Center, Rotterdam, The Netherlands,Department of Neurosurgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | | |
Collapse
|