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Citation Analysis

Sánchez-Polán M, Nagpal TS, Zhang D, Silva-Jose C, Montejo R, Barakat R. The Influence of Physical Activity during Pregnancy on Maternal Pain and Discomfort: A Meta-Analysis. J Pers Med 2023;14:44. [PMID: 38248744 PMCID: PMC10817295 DOI: 10.3390/jpm14010044] [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: 11/18/2023] [Revised: 12/22/2023] [Accepted: 12/27/2023] [Indexed: 01/23/2024] Open

Rapčan R, Kočan L, Witkovsky V, Rapčanová S, Mláka J, Tirpák R, Burianek M, Kočanová H, Vašková J, Gajdoš M. Endoscopic discectomy of the herniated intervertebral disc and changes in quality-of-life EQ-5D-5L analysis. Medicine (Baltimore) 2023;102:e34188. [PMID: 37390280 PMCID: PMC10313260 DOI: 10.1097/md.0000000000034188] [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: 05/08/2023] [Accepted: 06/13/2023] [Indexed: 07/02/2023] Open

Cho WJ, Chi HM, Ryu JH, Lee JS. Recanalization of external iliac artery occlusion in a patient with spinal stenosis using medications: a case report. J Int Med Res 2023;51:3000605231170550. [PMID: 37113054 PMCID: PMC10160338 DOI: 10.1177/03000605231170550] [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] [Indexed: 04/29/2023] Open

Hayashi K, Tanaka T, Sakawa A, Ebara T, Tanaka H, Nakamura H. Effects of self-quarantine during the COVID-19 pandemic on patients with lumbar spinal stenosis: A case-control study. Medicine (Baltimore) 2022;101:e29388. [PMID: 35713443 PMCID: PMC9276399 DOI: 10.1097/md.0000000000029388] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 04/12/2022] [Indexed: 11/27/2022] Open

Dunsmuir RA, Nisar S, Cruickshank JA, Loughenbury PR. No correlation identified between the proportional size of a prolapsed intravertebral disc with disability or leg pain. Bone Joint J 2022;104-B:715-720. [PMID: 35638217 DOI: 10.1302/0301-620x.104b6.bjj-2021-1725.r2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]

Abstract

AIMS

The aim of the study was to determine if there was a direct correlation between the pain and disability experienced by patients and size of their disc prolapse, measured by the disc's cross-sectional area on T2 axial MRI scans.

METHODS

Patients were asked to prospectively complete visual analogue scale (VAS) and Oswestry Disability Index (ODI) scores on the day of their MRI scan. All patients with primary disc herniation were included. Exclusion criteria included recurrent disc herniation, cauda equina syndrome, or any other associated spinal pathology. T2 weighted MRI scans were reviewed on picture archiving and communications software. The T2 axial image showing the disc protrusion with the largest cross sectional area was used for measurements. The area of the disc and canal were measured at this level. The size of the disc was measured as a percentage of the cross-sectional area of the spinal canal on the chosen image. The VAS leg pain and ODI scores were each correlated with the size of the disc using the Pearson correlation coefficient (PCC). Intraobserver reliability for MRI measurement was assessed using the interclass correlation coefficient (ICC). We assessed if the position of the disc prolapse (central, lateral recess, or foraminal) altered the symptoms described by the patient. The VAS and ODI scores from central and lateral recess disc prolapses were compared.

RESULTS

A total of 56 patients (mean age 41.1 years (22.8 to 70.3)) were included. A high degree of intraobserver reliability was observed for MRI measurement: single measure ICC was 0.99 (95% confidence interval (CI) from 0.97 to 0.99 (p < 0.001)). The PCC comparing VAS leg scores with canal occupancy for herniated disc was 0.056. The PCC comparing ODI for herniated disc was 0.070. We found 13 disc prolapses centrally and 43 lateral recess prolapses. There were no foraminal prolapses in this group. The position of the prolapse was not found to be related to the mean VAS score or ODI experienced by the patients (VAS, p = 0.251; ODI, p = 0.093).

CONCLUSION

The results of the statistical analysis show that there is no direct correlation between the size or position of the disc prolapse and a patient's symptoms. The symptoms experienced by patients should be the primary concern in deciding to perform discectomy. Cite this article: Bone Joint J 2022;104-B(6):715-720.

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Naidu I, Ryvlin J, Videlefsky D, Qin J, Mowrey WB, Choi JH, Citron C, Gary J, Benton JA, Weiss BT, Longo M, Matmati NN, De la Garza Ramos R, Krystal J, Echt M, Gelfand Y, Cezayirli P, Yassari N, Wang B, Castro-Rivas E, Headlam M, Udemba A, Williams L, Gitkind AI, Yassari R, Yanamadala V. The Effect of a Multidisciplinary Spine Clinic on Time to Care in Patients with Chronic Back and/or Leg Pain: A Propensity Score-Matched Analysis. J Clin Med 2022;11:2583. [PMID: 35566709 PMCID: PMC9103560 DOI: 10.3390/jcm11092583] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 04/27/2022] [Accepted: 04/29/2022] [Indexed: 02/04/2023] Open

Affiliation(s)

Ishan Naidu Spine Research Group, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (I.N.); (J.R.); (D.V.); (J.H.C.); (C.C.); (J.G.); (B.T.W.); (M.L.); (R.D.l.G.R.); (M.E.); (Y.G.); (P.C.); (N.Y.); (B.W.); (R.Y.)
Jessica Ryvlin Spine Research Group, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (I.N.); (J.R.); (D.V.); (J.H.C.); (C.C.); (J.G.); (B.T.W.); (M.L.); (R.D.l.G.R.); (M.E.); (Y.G.); (P.C.); (N.Y.); (B.W.); (R.Y.)
Devin Videlefsky Spine Research Group, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (I.N.); (J.R.); (D.V.); (J.H.C.); (C.C.); (J.G.); (B.T.W.); (M.L.); (R.D.l.G.R.); (M.E.); (Y.G.); (P.C.); (N.Y.); (B.W.); (R.Y.)
Jiyue Qin Department of Epidemiology and Public Health, Albert Einstein College of Medicine, New York, NY 10461, USA; (J.Q.); (W.B.M.)
Wenzhu B. Mowrey Department of Epidemiology and Public Health, Albert Einstein College of Medicine, New York, NY 10461, USA; (J.Q.); (W.B.M.)
Jong H. Choi Spine Research Group, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (I.N.); (J.R.); (D.V.); (J.H.C.); (C.C.); (J.G.); (B.T.W.); (M.L.); (R.D.l.G.R.); (M.E.); (Y.G.); (P.C.); (N.Y.); (B.W.); (R.Y.)
Chloe Citron Spine Research Group, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (I.N.); (J.R.); (D.V.); (J.H.C.); (C.C.); (J.G.); (B.T.W.); (M.L.); (R.D.l.G.R.); (M.E.); (Y.G.); (P.C.); (N.Y.); (B.W.); (R.Y.)
James Gary Spine Research Group, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (I.N.); (J.R.); (D.V.); (J.H.C.); (C.C.); (J.G.); (B.T.W.); (M.L.); (R.D.l.G.R.); (M.E.); (Y.G.); (P.C.); (N.Y.); (B.W.); (R.Y.)
Joshua A. Benton Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (J.A.B.); (E.C.-R.); (M.H.); (A.U.); (L.W.)
Brandon T. Weiss Spine Research Group, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (I.N.); (J.R.); (D.V.); (J.H.C.); (C.C.); (J.G.); (B.T.W.); (M.L.); (R.D.l.G.R.); (M.E.); (Y.G.); (P.C.); (N.Y.); (B.W.); (R.Y.)
Michael Longo Spine Research Group, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (I.N.); (J.R.); (D.V.); (J.H.C.); (C.C.); (J.G.); (B.T.W.); (M.L.); (R.D.l.G.R.); (M.E.); (Y.G.); (P.C.); (N.Y.); (B.W.); (R.Y.)
Nabil N. Matmati School of Medicine, Quinnipiac University, North Haven, CT 06518, USA;
Rafael De la Garza Ramos Spine Research Group, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (I.N.); (J.R.); (D.V.); (J.H.C.); (C.C.); (J.G.); (B.T.W.); (M.L.); (R.D.l.G.R.); (M.E.); (Y.G.); (P.C.); (N.Y.); (B.W.); (R.Y.) Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (J.A.B.); (E.C.-R.); (M.H.); (A.U.); (L.W.)
Jonathan Krystal Department of Orthopaedic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA;
Murray Echt Spine Research Group, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (I.N.); (J.R.); (D.V.); (J.H.C.); (C.C.); (J.G.); (B.T.W.); (M.L.); (R.D.l.G.R.); (M.E.); (Y.G.); (P.C.); (N.Y.); (B.W.); (R.Y.) Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (J.A.B.); (E.C.-R.); (M.H.); (A.U.); (L.W.)
Yaroslav Gelfand Spine Research Group, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (I.N.); (J.R.); (D.V.); (J.H.C.); (C.C.); (J.G.); (B.T.W.); (M.L.); (R.D.l.G.R.); (M.E.); (Y.G.); (P.C.); (N.Y.); (B.W.); (R.Y.) Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (J.A.B.); (E.C.-R.); (M.H.); (A.U.); (L.W.)
Phillip Cezayirli Spine Research Group, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (I.N.); (J.R.); (D.V.); (J.H.C.); (C.C.); (J.G.); (B.T.W.); (M.L.); (R.D.l.G.R.); (M.E.); (Y.G.); (P.C.); (N.Y.); (B.W.); (R.Y.) Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (J.A.B.); (E.C.-R.); (M.H.); (A.U.); (L.W.)
Neeky Yassari Spine Research Group, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (I.N.); (J.R.); (D.V.); (J.H.C.); (C.C.); (J.G.); (B.T.W.); (M.L.); (R.D.l.G.R.); (M.E.); (Y.G.); (P.C.); (N.Y.); (B.W.); (R.Y.)
Benjamin Wang Spine Research Group, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (I.N.); (J.R.); (D.V.); (J.H.C.); (C.C.); (J.G.); (B.T.W.); (M.L.); (R.D.l.G.R.); (M.E.); (Y.G.); (P.C.); (N.Y.); (B.W.); (R.Y.)
Erida Castro-Rivas Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (J.A.B.); (E.C.-R.); (M.H.); (A.U.); (L.W.)
Mark Headlam Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (J.A.B.); (E.C.-R.); (M.H.); (A.U.); (L.W.)
Adaobi Udemba Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (J.A.B.); (E.C.-R.); (M.H.); (A.U.); (L.W.)
Lavinia Williams Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (J.A.B.); (E.C.-R.); (M.H.); (A.U.); (L.W.)
Andrew I. Gitkind Department of Rehabilitation Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA;
Reza Yassari Spine Research Group, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (I.N.); (J.R.); (D.V.); (J.H.C.); (C.C.); (J.G.); (B.T.W.); (M.L.); (R.D.l.G.R.); (M.E.); (Y.G.); (P.C.); (N.Y.); (B.W.); (R.Y.) Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (J.A.B.); (E.C.-R.); (M.H.); (A.U.); (L.W.)
Vijay Yanamadala Spine Research Group, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (I.N.); (J.R.); (D.V.); (J.H.C.); (C.C.); (J.G.); (B.T.W.); (M.L.); (R.D.l.G.R.); (M.E.); (Y.G.); (P.C.); (N.Y.); (B.W.); (R.Y.) Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (J.A.B.); (E.C.-R.); (M.H.); (A.U.); (L.W.) Hartford HealthCare, Westport, CT 06880, USA

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Sigmundsson FG, Joelson A, Strömqvist F. Additional operations after surgery for lumbar disc prolapse : indications, type of surgery, and long-term follow-up of primary operations performed from 2007 to 2008. Bone Joint J 2022;104-B:627-632. [PMID: 35491575 DOI: 10.1302/0301-620x.104b5.bjj-2021-1706.r2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]

Abstract

AIMS

Lumbar disc prolapse is a frequent indication for surgery. The few available long-term follow-up studies focus mainly on repeated surgery for recurrent disease. The aim of this study was to analyze all reasons for additional surgery for patients operated on for a primary lumbar disc prolapse.

METHODS

We retrieved data from the Swedish spine register about 3,291 patients who underwent primary surgery for a lumbar disc prolapse between January 2007 and December 2008. These patients were followed until December 2020 to record all additional lumbar spine operations and the reason for them.

RESULTS

In total, 681 of the 3,291 patients (21%) needed one or more additional operations. More than three additional operations was uncommon (2%; 15/906). Overall, 906 additional operations were identified during the time period, with a mean time to the first of these of 3.7 years (SD 3.6). The most common reason for an additional operation was recurrent disc prolapse (47%; 426/906), followed by spinal stenosis or degenerative spondylolisthesis (19%; 176/906), and segmental pain (16%; 145/906). The most common surgical procedures were revision discectomy (43%; 385/906) and instrumented fusion (22%; 200/906). Degenerative spinal conditions other than disc prolapse became a more common reason for additional surgery with increasing length of follow-up. Most patients achieved the minimally important change (MIC) for the patient-reported outcomes after the index surgery. After the third additional spinal operation, only 20% (5/25) achieved the MIC in terms of leg pain, and 29% (7/24) in terms of the EuroQol five-dimension index questionnaire visual analogue scale.

CONCLUSION

More than one in five patients operated on for a lumbar disc prolapse underwent further surgery during the 13-year follow-up period. Recurrent disc prolapse was the most common reason for additional surgery, followed by spinal stenosis and segmental pain. This study shows that additional operations after primary disc surgery are needed more frequently than previously reported, and that the outcome profoundly deteriorates after the second additional operation. The findings from this study can be used in the shared decision-making process. Cite this article: Bone Joint J 2022;104-B(5):627-632.

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Brusalis CM, Duculan R, Cammisa FP, Sama AA, Hughes AP, Mancuso CA, Girardi FP. Low Back Pain Versus Back-Related Leg Pain: How Do Patient Expectations and Outcomes of Lumbar Spine Surgery Compare? HSS J 2022;18:83-90. [PMID: 35087337 PMCID: PMC8753548 DOI: 10.1177/15563316211010489] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 01/28/2021] [Indexed: 02/03/2023]

Abstract

Background: An increasing number of lumbar spine conditions are treated surgically. Such intervention, however, is commonly thought to be more effective in addressing leg pain than low back pain. Patient expectations may also contribute to self-reported surgical outcomes. Questions/Purposes: We sought to compare the expectations of patients in 2 groups undergoing lumbar spine surgery: those with predominantly low back pain and those with predominantly leg pain. We also sought to evaluate how these expectations were fulfilled for each group. Methods: We carried out a retrospective analysis of prospectively collected data from a prior study in which patients scheduled for lumbar spine surgery at a single institution completed validated surveys preoperatively and at 2 years postoperatively, including a 20-item survey on expectations for lumbar spine surgery. The patients were enrolled in the study between February 2010 and August 2012, and were divided into 2 cohorts: a "Back > Leg" group that consisted of patients with back pain that was isolated or greater than leg pain, and a "Leg ≥ Back" group that consisted of patients with leg pain that equaled or exceeded back pain. The primary analysis compared composite expectation scores (range, 0-100) between groups. Results: A total of 366 patients were deemed eligible for the study; of these, 162 patients were allocated to the Back > Leg group and 204 patients were allocated to the Leg ≥ Back group. Patients in the Leg ≥ Back group had a greater mean preoperative expectation score compared with those in the Back > Leg group. Multivariate analysis demonstrated that higher preoperative expectations were associated with leg pain symptoms after controlling for disease diagnosis. Both groups reported similar proportions of fulfilled expectations. Conclusion: Patients with predominantly leg pain hold greater preoperative expectations for lumbar spine surgery than do patients with predominantly back pain. That these patient groups reported similar fulfillment of their expectations at 2 years postoperatively illustrates the greater clinical outcomes achieved among patients who presented with predominantly leg pain.

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Jazdarehee A, Huget-Penner S, Pawlowska M. Pseudo-pheochromocytoma due to obstructive sleep apnea: a case report. Endocrinol Diabetes Metab Case Rep 2022;2022:21-0100. [PMID: 35212265 PMCID: PMC8897593 DOI: 10.1530/edm-21-0100] [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: 12/17/2021] [Accepted: 02/02/2022] [Indexed: 11/11/2022] Open

Rigoard P, Roulaud M, Goudman L, Adjali N, Ounajim A, Voirin J, Perruchoud C, Bouche B, Page P, Guillevin R, Naudin M, Simoneau M, Lorgeoux B, Baron S, Nivole K, Many M, Maitre I, Rigoard R, David R, Moens M, Billot M. Comparison of Spinal Cord Stimulation vs. Dorsal Root Ganglion Stimulation vs. Association of Both in Patients with Refractory Chronic Back and/or Lower Limb Neuropathic Pain: An International, Prospective, Randomized, Double-Blinded, Crossover Trial (BOOST-DRG Study). Medicina (Kaunas) 2021;58:7. [PMID: 35056316 PMCID: PMC8780129 DOI: 10.3390/medicina58010007] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 12/01/2021] [Accepted: 12/15/2021] [Indexed: 12/25/2022]

Affiliation(s)

Philippe Rigoard PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, 86021 Poitiers, France; (M.R.); (N.A.); (A.O.); (B.B.); (B.L.); (S.B.); (K.N.); (M.M.); (I.M.); (R.D.); (M.B.) Department of Spine Surgery & Neuromodulation, Poitiers University Hospital, 86021 Poitiers, France; Pprime Institute UPR 3346, CNRS, ISAE-ENSMA, University of Poitiers, 86360 Chasseneuil-du-Poitou, France
Manuel Roulaud PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, 86021 Poitiers, France; (M.R.); (N.A.); (A.O.); (B.B.); (B.L.); (S.B.); (K.N.); (M.M.); (I.M.); (R.D.); (M.B.)
Lisa Goudman Department of Neurosurgery, Universitair Ziekenhuis Brussel, 1090 Brussels, Belgium; (L.G.); (M.M.) STUMULUS Research Group, Vrije Universiteit Brussel, 1090 Brussels, Belgium
Nihel Adjali PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, 86021 Poitiers, France; (M.R.); (N.A.); (A.O.); (B.B.); (B.L.); (S.B.); (K.N.); (M.M.); (I.M.); (R.D.); (M.B.)
Amine Ounajim PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, 86021 Poitiers, France; (M.R.); (N.A.); (A.O.); (B.B.); (B.L.); (S.B.); (K.N.); (M.M.); (I.M.); (R.D.); (M.B.)
Jimmy Voirin Department of Neurosurgery, Hopitaux Civils de Colmar, 68000 Colmar, France;
Christophe Perruchoud Service of Anesthesiology and Pain Centre, University Hospital of Lausanne (CHUV), 1011 Lausanne, Switzerland;
Bénédicte Bouche PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, 86021 Poitiers, France; (M.R.); (N.A.); (A.O.); (B.B.); (B.L.); (S.B.); (K.N.); (M.M.); (I.M.); (R.D.); (M.B.) Department of Spine Surgery & Neuromodulation, Poitiers University Hospital, 86021 Poitiers, France;
Philippe Page Department of Spine Surgery & Neuromodulation, Poitiers University Hospital, 86021 Poitiers, France;
Rémy Guillevin Department of Radiology, Poitiers University Hospital, 86021 Poitiers, France; (R.G.); (M.N.) UMR CNRS 7348, DACTIM-MIS/LMA Laboratory, University of Poitiers, 86000 Poitiers, France
Mathieu Naudin Department of Radiology, Poitiers University Hospital, 86021 Poitiers, France; (R.G.); (M.N.) UMR CNRS 7348, DACTIM-MIS/LMA Laboratory, University of Poitiers, 86000 Poitiers, France
Martin Simoneau Department of Kinesiology, Faculty of Medicine, Laval University, Quebec, QC G1V 0A6, Canada; Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale (CIRRIS), Quebec, QC G1M 2S8, Canada
Bertille Lorgeoux PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, 86021 Poitiers, France; (M.R.); (N.A.); (A.O.); (B.B.); (B.L.); (S.B.); (K.N.); (M.M.); (I.M.); (R.D.); (M.B.)
Sandrine Baron PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, 86021 Poitiers, France; (M.R.); (N.A.); (A.O.); (B.B.); (B.L.); (S.B.); (K.N.); (M.M.); (I.M.); (R.D.); (M.B.)
Kevin Nivole PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, 86021 Poitiers, France; (M.R.); (N.A.); (A.O.); (B.B.); (B.L.); (S.B.); (K.N.); (M.M.); (I.M.); (R.D.); (M.B.)
Mathilde Many PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, 86021 Poitiers, France; (M.R.); (N.A.); (A.O.); (B.B.); (B.L.); (S.B.); (K.N.); (M.M.); (I.M.); (R.D.); (M.B.)
Iona Maitre PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, 86021 Poitiers, France; (M.R.); (N.A.); (A.O.); (B.B.); (B.L.); (S.B.); (K.N.); (M.M.); (I.M.); (R.D.); (M.B.)
Raphaël Rigoard CEA Cadarache, Département de Support Technique et Gestion, Service des Technologies de l’Information et de la Communication, 13108 Saint-Paul-Lez-Durance, France;
Romain David PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, 86021 Poitiers, France; (M.R.); (N.A.); (A.O.); (B.B.); (B.L.); (S.B.); (K.N.); (M.M.); (I.M.); (R.D.); (M.B.) Department of Physical and Rehabilitation Medicine, Poitiers University Hospital, University of Poitiers, 86021 Poitiers, France
Maarten Moens Department of Neurosurgery, Universitair Ziekenhuis Brussel, 1090 Brussels, Belgium; (L.G.); (M.M.) STUMULUS Research Group, Vrije Universiteit Brussel, 1090 Brussels, Belgium
Maxime Billot PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, 86021 Poitiers, France; (M.R.); (N.A.); (A.O.); (B.B.); (B.L.); (S.B.); (K.N.); (M.M.); (I.M.); (R.D.); (M.B.)

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Sigmundsson FG, Möller A, Strömqvist F. Surgery for Lumbar Spinal Stenosis in Patients With Mild Leg Pain Levels Is Associated With Unsatisfactory Outcome. Global Spine J 2021;11:1202-1207. [PMID: 32748656 PMCID: PMC8453672 DOI: 10.1177/2192568220942510] [Citation(s) in RCA: 3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open

Guyer RD, Ferko N, Bonner A, Situ A, Ohnmeiss DD. Incidence and Resolution Strategies for Early-Onset Postoperative Leg Pain Following Lumbar Total Disc Replacement. Int J Spine Surg 2021;15:978-987. [PMID: 34551924 PMCID: PMC8651205 DOI: 10.14444/8128] [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] [Indexed: 11/20/2022] Open

Abstract

BACKGROUND

Lumbar total disc replacement (TDR) has produced results similar or superior to fusion in treating symptomatic disc degeneration. Some patients have reported onset of leg pain early after surgery. Little information is available specifically on this problem. The purpose of this study was to investigate the incidence of early-onset postoperative leg pain following lumbar TDR and to describe strategies for its treatment.

METHODS

The study was based on a post hoc analysis of prospectively collected adverse event data from 283 patients in the activL Food and Drug Administration investigational device exemption study. Early-onset leg pain was defined as occurring between 0 and 4 weeks postprocedure, and the baseline visual analog scale score in the affected leg(s) was <25 (of 100). The treatment types these patients received were analyzed.

RESULTS

Among 283 patients, 26 (9.2%) had an early-onset leg pain event. The majority of these events resolved (20/26, 76.9%). Of those resolving, 55% (11/20) did so within 3 months. Most patients received at least 1 drug treatment for leg pain (92.3%). Of those receiving drug therapy, the most common type was neurogenic (61.5%), followed by narcotics (46.2%). Steroid use was prescribed in 30.8%. The majority of resolved cases were not on narcotics and resolved with neurogenic drugs. Three patients went on to have surgery, none of whom benefited from it. Age, body mass index, and baseline disability scores were predictive of time to resolution.

CONCLUSION

Early-onset postoperative leg pain occurred in approximately 10% of lumbar TDR patients. The majority of events resolved, often within 3 months. Treatment with conservative care, including medication(s), was more effective in resolving symptoms rather than surgery.

CLINICAL RELEVANCE

This study provides useful information for providers and patients on the incidence, treatment, and resolution of leg pain with onset after lumbar TDR and not related to direct neural compression identified by imaging.

LEVEL OF EVIDENCE

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Issa M, Abadin ZU. A Nearly Missed Pancoast Tumour From Isolated Persistent Leg Pain. Cureus 2021;13:e15328. [PMID: 34221774 PMCID: PMC8240066 DOI: 10.7759/cureus.15328] [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] [Accepted: 05/29/2021] [Indexed: 11/05/2022] Open

Kapetanakis S, Gkantsinikoudis N, Gkasdaris G, Charitoudis G. Treatment of adjacent segment disease with percutaneous transforaminal endoscopic discectomy: Early experience and results. J Orthop Surg (Hong Kong) 2021;28:2309499020960560. [PMID: 32990158 DOI: 10.1177/2309499020960560] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Indexed: 12/21/2022] Open

Geudeke MW, Krediet AC, Bilecen S, Huygen FJPM, Rijsdijk M. Effectiveness of Epiduroscopy for Patients with Failed Back Surgery Syndrome: A Systematic Review and Meta-analysis. Pain Pract 2020;21:468-481. [PMID: 33274591 PMCID: PMC8049022 DOI: 10.1111/papr.12974] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 07/02/2020] [Revised: 11/16/2020] [Accepted: 11/27/2020] [Indexed: 11/30/2022]

Massel DH, Mayo BC, Narain AS, Hijji FY, Louie PK, Jenkins NW, Parrish JM, Singh K. Improvements in Back and Leg Pain Following a Minimally Invasive Transforaminal Lumbar Interbody Fusion. Int J Spine Surg 2020;14:745-755. [PMID: 33184122 DOI: 10.14444/7107] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open

Abstract

BACKGROUND

Improvement in patient-reported outcomes after minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) is poorly defined. As such, the purpose of this study was to quantify improvements in Visual Analogue Scale back and leg pain, Oswestry Disability Index (ODI), and Short Form-12 (SF-12) Mental and Physical Composite scores following MIS-TLIF.

METHODS

A surgical registry of patients who underwent primary 1-level MIS-TLIF during 2014-2015 was reviewed. Comparisons of Visual Analogue Scale back and leg pain, ODI, and Short Form-12 Mental and Physical Composite scores were performed using paired t tests from preoperative to each postoperative time point. Analysis of variance was used to estimate the degree of improvement in back and leg pain over the first postoperative year. Subgroup analysis was performed for patients presenting with predominant back (pBP) or leg (pLP) pain. Multivariate linear regression was performed to compare patient-reported outcome scores by subgroup.

RESULTS

A total of 106 patients were identified. Visual Analogue Scale back and leg scores, and ODI improved from preoperative scores at all postoperative time points (P < .05 for each). Patients with pBP (n = 68) and patients with pLP (n = 38) reported reductions in both back and leg pain over the first postoperative year (P < .05 for each). In the pBP cohort, patients experienced significant reductions in ODI after the first 6 postoperative weeks (P < .05 for each). In the pLP cohort, patients experienced significant reductions in ODI throughout the first postoperative year (P < .05 for each). Patients with pLP and pBP experienced similar reductions in back pain, whereas patients with pLP experienced significantly greater reductions in leg pain at all postoperative time points (P < .05 for each).

CONCLUSIONS

The current study suggests patients experience significant improvements in back and leg pain following MIS-TLIF regardless of predominant symptom.

CLINICAL RELEVANCE

These results can assist surgeons when counseling their patients on the magnitude of symptom improvement they may experience following MIS-TLIF.

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Thein R, Tilbor I, Rom E, Herman A, Haviv B, Burstein G, Tenenbaum S. Return to sports after chronic anterior exertional compartment syndrome of the leg: Conservative treatment versus surgery. J Orthop Surg (Hong Kong) 2020;27:2309499019835651. [PMID: 30909799 DOI: 10.1177/2309499019835651] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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] [Indexed: 11/15/2022] Open

Mistry J, Falla D, Noblet T, Heneghan NR, Rushton AB. Clinical indicators to identify neuropathic pain in low back-related leg pain: protocol for a modified Delphi study. BMJ Open 2020;10:e033547. [PMID: 32071181 PMCID: PMC7045101 DOI: 10.1136/bmjopen-2019-033547] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open

Mistry J, Heneghan NR, Noblet T, Falla D, Rushton A. Diagnostic utility of patient history, clinical examination and screening tool data to identify neuropathic pain in low back-related leg pain: protocol for a systematic review. BMJ Open 2019;9:e033187. [PMID: 31767596 PMCID: PMC6887074 DOI: 10.1136/bmjopen-2019-033187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open

Abstract

INTRODUCTION

Neuropathic low back-related leg pain (LBLP) can be a challenge to healthcare providers to diagnose and treat. Accurate diagnosis of neuropathic pain is fundamental to ensure appropriate intervention is given. However, to date there is no gold standard to diagnose neuropathic LBLP. Patient examination guidelines and screening tools have been developed and validated for the purpose of diagnosing neuropathic pain in LBLP; however, there has been no systematic review conducted to compare the diagnostic validity of these methods. Therefore, this systematic review will investigate the diagnostic utility of patient history, clinical examination and screening tool data to identify neuropathic pain in LBLP.

METHODS AND ANALYSIS

This protocol is informed and reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis-Protocols. CINAHL, EMBASE, MEDLINE, Web of Science, Cochrane Library, AMED, Pedro, PubMed, key journals and grey literature will be searched rigorously to find diagnostic accuracy studies investigating patient examination data to identify neuropathic pain in LBLP patients. Two independent reviewers will conduct the search, extract the data and assess risk of bias for included studies using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. The overall quality of included studies will be evaluated using Grading of Recommendations, Assessment, Development and Evaluation guidelines. A meta-analysis will be conducted if deemed appropriate. Otherwise, a narrative synthesis will be conducted.

ETHICS AND DISSEMINATION

No research ethics is required for this systematic review since patient data will not be collected. This review will help to inform healthcare professionals and researchers on the most effective means in which to diagnose neuropathic pain in LBLP. Results of this review will be submitted for publication in a peer-review journal and conference presentations.

PROSPERO REGISTRATION NUMBER

CRD42019140861.

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Patel DV, Yoo JS, Karmarkar SS, Lamoutte EH, Singh K. Minimally invasive lumbar decompression in an ambulatory surgery center. J Spine Surg 2019;5:S166-S173. [PMID: 31656871 DOI: 10.21037/jss.2019.04.05] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]

Abstract

Background

There is limited data regarding clinical and surgical outcomes of minimally invasive lumbar decompression (MIS LD) as an outpatient procedure. In this context, our purpose is to evaluate a single surgeon's experience with performing MIS LD in the outpatient versus inpatient setting and determining if there are differences in surgical and clinical outcomes.

Methods

Patients undergoing primary, one- to three-level MIS LD were retrospectively reviewed and stratified by surgical setting: ambulatory surgical center (ASC) versus hospital. The cohorts were compared with respect to demographics, perioperative characteristics, complications, postoperative pain and narcotics consumption, and improvements in patient-reported outcomes.

Results

Five hundred and nine patients were included: 332 patients underwent surgery at an ASC and 177 patients underwent surgery at a hospital. The ASC patients were younger, more likely to be male, and carry Workers' Compensation insurance. The hospital patients were older, more likely to be diabetic, and had a greater comorbidity burden. Patients undergoing MIS LD in an ASC were less likely to have multi-level procedures and more likely to have decompression with discectomy compared to patients in the hospital cohort. There were two cases of superficial wound infection in the ASC cohort and a single case of a pulmonary embolus in the hospital cohort. Additionally, a total of 28 patients had recurrent herniated nucleus pulposus in the ASC cohort compared to 12 patients in the hospital cohort. There was one case of residual stenosis in the ASC cohort compared to eight cases in the hospital cohort. Both cohorts demonstrated similar preoperative ODI, VAS back pain, and VAS leg pain scores through 12-month follow-up.

Conclusions

MIS LD is a safe and effective procedure in an ASC, however, appropriate patient selection and postoperative protocols are imperative in minimizing complications and optimizing safety and efficacy in the outpatient setting.

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Knio ZO, Hsu W, Marquez-Lara A, Luo TD, St Angelo JM, Medda S, O'Gara TJ. Far Lateral Tubular Decompression: A Case Series Studying One and Two Year Outcomes with Predictors of Failure. Cureus 2019;11:e5133. [PMID: 31523563 PMCID: PMC6741369 DOI: 10.7759/cureus.5133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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] [Indexed: 11/05/2022] Open

Abstract

Introduction The optimal surgical treatment of isolated lumbar foraminal stenosis has not been defined. Minimally invasive decompression of the foramen from a far lateral tubular decompression (FLTD) approach has been shown to not only have minimal morbidity but also highly variable success rates at short-term follow-up. It is important to quantify improvement and define the demographic and radiographic parameters that predict failure in this promising, minimally invasive surgical technique. This study investigates pain and disability score improvement following FLTD at 12 and 24 months and investigates associations with failure. Methods All patients who underwent lumbar FLTD by a single surgeon at a single institution from September 2015 to January 2018 were included in this prospective case series. Visual analog scale (VAS) for back pain and leg pain and Oswestry Disability Index (ODI) were collected preoperatively and at the 12- and 24- month follow-ups. Outcomes between visits were fitted to a linear mixed-effects model. The univariate analysis investigated demographic, radiographic, and operative associations with subsequent open revision. Results A total of 42 patients were included in this study. Back pain (VAS 5.84 to 3.32, p<0.001), leg pain (VAS 7.33 to 2.71, p<0.001), and ODI (48.97 to 28.50, p<0.001) demonstrated significant improvements at the 12-month follow-up. Back pain (VAS 3.71, p=0.004), leg pain (VAS 3.04, p<0.001), and ODI (30.63, p<0.001) improvements were maintained at 24-month follow-up. Four patients (9.5%) required subsequent open revision. Subsequent open revision was associated with prior spine surgery (RR=2.85 (2.07-3.63), p=0.045) and scoliosis ≥10° (RR=6.33 (4.87-7.80), p=0.013). Conclusion Back pain, leg pain, and ODI showed significant improvement postoperatively. Improvement is maintained at two years. Prior spine surgery and scoliosis ≥ 10° may be relative contraindications to FLTD.

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Khalsa AS, Eghbali A, Eastlack RK, Tran S, Akbarnia BA, Ledesma JB, Mundis GM. Resting Pain Level as a Preoperative Predictor of Success With Indirect Decompression for Lumbar Spinal Stenosis: A Pilot Study. Global Spine J 2019;9:150-154. [PMID: 30984493 PMCID: PMC6448191 DOI: 10.1177/2192568218765986] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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] [Indexed: 11/22/2022] Open

Xu T, Tian R, Qiao P, Han Z, Shen Q, Jia Y. Application of continuous epidural anesthesia in transforaminal lumbar endoscopic surgery: a prospective randomized controlled trial. J Int Med Res 2019;47:1146-1153. [PMID: 30632428 PMCID: PMC6421380 DOI: 10.1177/0300060518817218] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 11/12/2018] [Indexed: 11/23/2022] Open

Duse G, Reverberi C, Dario A. Effects of Multiple Waveforms on Patient Preferences and Clinical Outcomes in Patients Treated With Spinal Cord Stimulation for Leg and/or Back Pain. Neuromodulation 2018;22:200-207. [PMID: 30548106 DOI: 10.1111/ner.12899] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 05/29/2018] [Revised: 10/07/2018] [Accepted: 10/23/2018] [Indexed: 01/19/2023]

Abstract

OBJECTIVES

We present the results of a prospective, randomized, crossover, single-blind, study in which each patient is in control of himself. The aim was to evaluate subperception-based (SP-SCS) waveforms in previously implanted spinal cord stimulation (SCS) patients with leg and/or back pain due to failed back surgery syndrome, who experienced only paresthesia-based stimulation (PB-SCS). Patients with PB-SCS experience in SCS was 4.7 years (SD 2.9).

MATERIALS AND METHODS

We enrolled 28 consecutive patients. Treatment consisted of seven days of PB-SCS, followed by a randomized, crossover phase to test SP-SCS waveforms (burst or 1 kHz frequency, seven days each). A maximum of three-day washout period separated each stimulation program.

RESULTS

Statistically significant pain relief was maintained using both SP-SCS waveforms, as indicated by the differences between the pre-PB-SCS numeric pain rating score (mean 9) and the pain score after using the burst program (pain relief 52%) or the 1 kHz program (pain relief 51%). There was no statistically significant superiority among PB-SCS, burst, and 1 kHz stimulation. Overall, 50% of patients preferred PB-SCS, 42% chose to move to SP-SCS stimulation, one patient was unable to give feedback, and one patient was unsuccessful with any type of stimulation. Overall, SCS has shown to be successful in pain relief and the patients switched to a SP-SCS waveform only for having higher pain relief.

CONCLUSIONS

There was a high heterogeneity regarding waveform preference, with patients who preferred to feel the tingling sensation and those who chose a SP-SCS option, mainly for greater pain relief. In general, SCS is successful, resulting in high pain relief, improvements in quality of life, and little depression. Overall, 42% patients benefited from the novel SP-SCS stimulation waveforms.

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Bliekendaal S, Moen M, Fokker Y, Stubbe JH, Twisk J, Verhagen E. Incidence and risk factors of medial tibial stress syndrome: a prospective study in Physical Education Teacher Education students. BMJ Open Sport Exerc Med 2018;4:e000421. [PMID: 30364458 PMCID: PMC6196946 DOI: 10.1136/bmjsem-2018-000421] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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] [Accepted: 08/29/2018] [Indexed: 11/24/2022] Open

Regus S, Almási-Sperling V, Janka R, Rother U, Lell M, Meyer A, Lang W. MRI to investigate iliac artery wall thickness in triathletes. PHYSICIAN SPORTSMED 2018. [PMID: 29522363 DOI: 10.1080/00913847.2018.1450060] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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] [Indexed: 10/17/2022]

Abstract

OBJECTIVES

Endofibrosis was first described in endurance athletes. This rare disease is characterized by intimal hyperplasia of iliac arteries. Due to non-specific symptoms diagnosing could be very challenging and delayed. This represents a serious problem not only for affected athletes but also for consulting physicians. The aim of this study was to analyze intimal thickness of iliac arteries using non-contrast magnetic resonance imaging (MRI) in competitive triathletes suffering from exercise induced leg pain consistent with symptoms caused by endofibrosis.

METHODS

18 highly trained triathletes (16 triathletes, 12 male) with a mean age of 45.4 ± 10.2 years were investigated by non-contrast MRI. We divided subjects into two groups: 10 complaint about exercise- induced leg pain and 7 were free of any symptoms. In all 10 symptomatic athletes consulting physicians excluded musculoskeletal or neurological disorders before and we suspected endofibrosis. One patient was excluded from statistical analysis due to a known recurrent external iliac artery (EIA) occlusion after surgical repair 6 month ago.

RESULTS

Mean wall thickness (T) of all 17 subjects was 1.34 ± 0.11mm for the common iliac artery (CIA) and 1.74 ± 0.18mm for the EIA. We found no significant differences by comparing T of symptomatic (s) and asymptomatic (a) legs. There were no significant differences in mean ratio of patent artery to whole artery between the symptomatic and asymptomatic legs for the CIA (0.81 vs 0.82, p = 0.87) and for the EIA (0.71 vs 0.72, p = 0.78). MRI shows a thickening of the left EIA (4.41mm) in the patient who suffered from recurrent occlusion of the left EIA and after surgical repair and histological examination confirmed an endofibrotic lesion.

CONCLUSION

Non-contrast MRI seems to be an appropriate diagnostic tool to exclude endofibrosis in triathletes, but it cannot be recommended as initial screening modality for athletes suffering from exercise-induced leg pain.

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Nakashima H, Kanemura T, Ando K, Kobayashi K, Yoneda M, Ishiguro N, Imagama S. Is Pregabalin Effective Against Acute Lumbar Radicular Pain ? Spine Surg Relat Res 2018;3:61-66. [PMID: 31435553 PMCID: PMC6690119 DOI: 10.22603/ssrr.2018-0003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 01/16/2018] [Accepted: 05/22/2018] [Indexed: 01/01/2023] Open

Di Mattia F, Tejani S, Hall T. Bed Rest for Sciatica: A Closer Look at the Evidence. J Orthop Sports Phys Ther 2018;48:436-8. [PMID: 29852836 DOI: 10.2519/jospt.2018.0609] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]

Williams MG, Wafai AM, Podmore MD. Functional outcomes of laminectomy and laminotomy for the surgical management lumbar spine stenosis. J Spine Surg 2017;3:580-586. [PMID: 29354735 DOI: 10.21037/jss.2017.10.08] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]

Abstract

Background

This clinical descriptive study aims to establish if differences exist in functional outcomes, to include both leg and lower back pain (LBP) as well as disability, in patients undergoing laminectomy or laminotomy surgery for lumbar spinal stenosis (LSS).

Methods

We conducted a single centre, prospective study of 119 patients undergoing laminectomy or laminotomy surgery for LSS, from 2006 and 2012. Clinical outcomes for back and leg pain were analyses using Oswestry Disability Index (ODI) questionnaires and visual analogue scale (VAS) scores collected preoperatively, at 6 weeks and 1 year. Further analysis subdivided patients into two groups based on initial LBP VAS scores.

Results

Fifty-five percent of patients were females (n=65) and 45% males (n=54), with a mean age of 68.7 years and L4/5 being the level most frequently decompressed. Considering all surgeries, a statistically significant reduction in VAS back pain between pre-op and 6 weeks was seen (4.99 to 3.00, P<0.001). There was a significant (P<0.0001) average reductions in LBP by 1.66 units and leg pain by 3.33 units after 1 year, with minimal difference between laminectomy and laminotomy. In the VAS back ≥5 group, laminectomy patient's pain increased by 0.63 units between 6 weeks and 1 year whilst laminotomy patients experienced a reduction in back pain of 0.51 units (P=0.063). ODI scores significantly improved for laminectomy and laminotomy by an average of 19.1%, 95% CI: 13.4-24.9% and 10.8%, 95% CI: 5.8-15.7%, with no statistically significant difference between groups.

Conclusions

No statistically significant differences were demonstrated between laminectomy and laminotomy outcomes, for LBP, leg pain or disability in our institute. On the basis of functional outcomes laminectomy remains a feasible approach in the treatment of lumbar spine stenosis. The data presented in this manuscript provides frequency data for subsequent comparative studies.

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Lux-Battistelli C, Battistelli D. Latent scurvy with tiredness and leg pain in alcoholics: An underestimated disease three case reports. Medicine (Baltimore) 2017;96:e8861. [PMID: 29382002 PMCID: PMC5709001 DOI: 10.1097/md.0000000000008861] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open

Vajapey S, Miller TL. Evaluation, diagnosis, and treatment of chronic exertional compartment syndrome: a review of current literature. PHYSICIAN SPORTSMED 2017;45:391-398. [PMID: 28952402 DOI: 10.1080/00913847.2017.1384289] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [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] [Indexed: 10/18/2022]

Russo M, Cousins MJ, Brooker C, Taylor N, Boesel T, Sullivan R, Poree L, Shariati NH, Hanson E, Parker J. Effective Relief of Pain and Associated Symptoms With Closed-Loop Spinal Cord Stimulation System: Preliminary Results of the Avalon Study. Neuromodulation 2017;21:38-47. [PMID: 28922517 DOI: 10.1111/ner.12684] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 07/04/2017] [Accepted: 07/17/2017] [Indexed: 01/11/2023]

Abstract

OBJECTIVES

Conventional spinal cord stimulation (SCS) delivers a fixed-input of energy into the dorsal column. Physiologic effects such as heartbeat, respiration, spinal cord movement, and history of stimulation can cause both the perceived intensity and recruitment of stimulation to increase or decrease, with clinical consequences. A new SCS system controls stimulation dose by measuring the recruitment of fibers in the dorsal column and by using the amplitude of the evoked compound action potentials (ECAPs) to maintain stimulation within an individualized therapeutic range. Safety and efficacy of this closed-loop system was evaluated through six-month postimplantation.

MATERIALS AND METHODS

Chronic pain subjects with back and/or leg pain who were successfully trialed received a permanent system (Evoke; Saluda Medical, Sydney, Australia). Ratings of pain (100-mm visual analogue scale [VAS] and Brief Pain Instrument [BPI]), quality of life (EuroQol instrument [EQ-5D-5L]), function (Oswestry Disability Index [ODI]), and sleep (Pittsburgh Sleep Quality Index [PSQI]) were collected at baseline and repeated three and six months after implantation.

RESULTS

Fifty-one subjects underwent a trial procedure; permanent implants were placed in 36 subjects. The proportion of subjects with ≥50% relief was 92.6% (back) and 91.3% (leg) at three months, and 85.7% (back) and 82.6% (leg) at six months. The proportion with ≥80% pain relief was 70.4% (back) and 56.5% (leg) at three months, and 64.3% (back) and 60.9% (leg) at six months. Statistically significant improvements in mean BPI, EQ-5D-5L, ODI, and PSQI were also observed at both time points.

CONCLUSIONS

The majority of subjects experienced profound pain relief at three and six months, providing preliminary evidence for the effectiveness of the closed-loop SCS system. The exact mechanism of action for these outcomes is still being explored, although one likely hypothesis holds that ECAP feedback control may minimize recruitment of Aβ nociceptors and Aδ fibers during daily use of SCS.

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Farber SH, Han JL, Elsamadicy AA, Hussaini Q, Yang S, Pagadala P, Parente B, Xie J, Lad SP. Long-term Cost Utility of Spinal Cord Stimulation in Patients with Failed Back Surgery Syndrome. Pain Physician 2017;20:E797-E805. [PMID: 28934786 PMCID: PMC8358894] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]

Abstract

BACKGROUND

Failed back surgery syndrome (FBSS) is a cause of significant morbidity for up to 40% of patients following spine surgery, and is estimated to cost almost $20 billion. Treatment options for these patients currently include conventional medical management (CMM), repeat operation, or spinal cord stimulation (SCS). Much of the published data regarding cost effectiveness of SCS comprise smaller scale randomized controlled trials (RCTs) rather than large databases capturing practices throughout the US. SCS has been shown to have superior outcomes to CMM or repeat spinal operation in several landmark studies, yet there are few large studies examining its long-term economic impact.

OBJECTIVES

This study compares health care utilization for SCS compared to other management in patients with FBSS.

STUDY DESIGN

Retrospective.

SETTING

Inpatient and outpatient sample.

METHODS

Patients with a history of FBSS from 2000 to 2012 were selected. We compared those who received SCS to those who underwent conventional management. A longitudinal analysis was used to model the value of log(cost) in each one year interval using a generalized estimating equations (GEE) model to account for the correlation of the same patient's cost in multiple years. Similarly, a Poisson GEE model with the log link was applied to correlated count outcomes.

RESULTS

We identified 122,827 FBSS patients. Of these, 5,328 underwent SCS implantation (4.34%) and 117,499 underwent conventional management. Total annual costs decreased over time following implantation of the SCS system, with follow-up analysis at 1, 3, 6, and 9 years. The longitudinal GEE model demonstrated that placement of an SCS system was associated with an initial increase in total costs at the time of implantation (cost ratio [CR]: 1.74; 95% confidence interval [CI]: 1.41, 2.15, P < 0.001), however there was a significant and sustained 68% decrease in cost in the year following SCS placement (CR: 0.32; 95% CI: 0.24, 0.42, P < 0.001) compared to CMM. There was also an aggregate time trend that for each additional year after SCS, cost decreased on average 40% percent annually (CR: 0.60; 95% CI: 0.55, 0.65, P < 0.001), with follow-up up to 1, 3, 6, and 9 years post-procedure.

LIMITATIONS

Costs are not correlated with patient outcomes, patients are not stratified in terms of complexity of prior back surgery, as well as inherent limitations of a retrospective analysis.

CONCLUSIONS

We found that from 2000 to 2012, only 4.3% of patients across the United States with FBSS were treated with SCS. Long-term total annual costs for these patients were significantly reduced compared to patients with conventional management. Although implantation of an SCS system results in a short-term increase in costs at one year, the subsequent annual cumulative costs were significantly decreased long-term in the following 9 years after implantation. This study combines the largest group of FBSS patients studied to date along with the longest follow-up interval ever analyzed. Since SCS has repeatedly been shown to have superior efficacy to CMM in randomized clinical trials, the current study demonstrating improved long-term health economics at 1, 3, 6, and 9 years supports the long-term cost utility of SCS in the treatment of FBSS patients. Key words: Failed back surgery syndrome, spinal cord stimulation, back pain, leg pain, neuromodulation, FBSS, SCS.

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Winkelmann ZK, Anderson D, Games KE, Eberman LE. Risk Factors for Medial Tibial Stress Syndrome in Active Individuals: An Evidence-Based Review. J Athl Train 2016;51:1049-1052. [PMID: 27835043 DOI: 10.4085/1062-6050-51.12.13] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]

Abstract

Reference/Citation: Hamstra-Wright KL, Bliven KC, Bay C. Risk factors for medial tibial stress syndrome in physically active individuals such as runners and military personnel: a systematic review and meta-analysis. Br J Sports Med. 2015;49(6):362-369.

CLINICAL QUESTION

What factors put physically active individuals at risk to develop medial tibial stress syndrome (MTSS)?

DATA SOURCES

The authors performed a literature search of CINAHL, the Cochrane Central Register of Controlled Trials, EMBASE, and MEDLINE from each database's inception to July 2013. The following key words were used together or in combination: armed forces, athlete, conditioning, disorder predictor, exercise, medial tibial stress syndrome, militaries, MTSS, military, military personnel, physically active, predictor, recruit, risk, risk characteristic, risk factor, run, shin pain, shin splints, and vulnerability factor.

STUDY SELECTION

Studies were included in this systematic review based on the following criteria: original research that (1) investigated risk factors associated with MTSS, (2) compared physically active individuals with and without MTSS, (3) was printed in English, and (4) was accessible in full text in peer-reviewed journals.

DATA EXTRACTION

Two authors independently screened titles or abstracts (or both) of studies to identify inclusion criteria and quality. If the article met the inclusion criteria, the authors extracted demographic information, study design and duration, participant selection, MTSS diagnosis, investigated risk factors, mean difference, clinical importance, effect size, odds ratio, and any other data deemed relevant. After the data extraction was complete, the authors compared findings for accuracy and completeness. When the mean and standard deviation of a particular risk factor were reported 3 or more times, that risk factor was included in the meta-analysis. In addition, the methodologic quality was assessed with an adapted checklist developed by previous researchers. The checklist contained 5 categories: study objective, study population, outcome measurements, assessment of the outcome, and analysis and data presentation. Any disagreement between the authors was discussed and resolved by consensus.

MAIN RESULTS

A total of 165 papers were initially identified, and 21 original research studies were included in this systematic review. More than 100 risk factors were identified in the 21 studies. Continuous data were reported 3 or more times for risk factors of body mass index (BMI), navicular drop, ankle plantar-flexion range of motion (ROM), ankle-dorsiflexion ROM, ankle-eversion ROM, ankle-inversion ROM, quadriceps angle, hip internal-rotation ROM, and hip external-rotation ROM. As compared with the control group, significant risk factors for developing MTSS identified in the literature were (1) greater BMI (mean difference [MD] = 0.79, 95% confidence interval [CI] = 0.38, 1.20; P < .001), (2) greater navicular drop (MD = 1.9 mm, 95% CI = 0.54, 1.84 mm; P < .001), (3) greater ankle plantar-flexion ROM (MD = 5.94°, 95% CI = 3.65°, 8.24°; P < .001), and (4) greater hip external-rotation ROM (MD = 3.95°, 95% CI = 1.78°, 6.13°; P < .001). Ankle-dorsiflexion ROM (MD = -0.01°, 95% CI = -0.96, 0.93; P = .98), ankle-eversion ROM (MD = 1.17°, 95% CI = -0.02, 2.36; P = .06), ankle-inversion ROM (MD = 0.98°, 95% CI = -3.11°, 5.07°; P = .64), quadriceps angle (MD = -0.22°, 95% CI = -0.95°, 0.50°; P = .54), and hip internal-rotation ROM (MD = 0.18°, 95% CI = -5.37°, 5.73°; P = .95), were not different between individuals with MTSS and controls.

CONCLUSIONS

The primary factors that appeared to put a physically active individual at risk for MTSS were increased BMI, increased navicular drop, greater ankle plantar-flexion ROM, and greater hip external-rotation ROM. These primary risk factors can guide health care professionals in the prevention and treatment of MTSS.

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Cumberledge J, Kumar B, Rudy D. Risking Life and Limb: A Case of Spontaneous Diabetic Muscle Infarction (Diabetic Myonecrosis). J Gen Intern Med 2016;31:696-8. [PMID: 26643376 PMCID: PMC4870412 DOI: 10.1007/s11606-015-3551-8] [Citation(s) in RCA: 4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]

de Bruijn JA, van Zantvoort APM, Winkes MB, Raaymakers L, van der Cruijsen-Raaijmakers M, Hoogeveen AR, Scheltinga MR. Feasibility and Safety of an Operative Tool for Anterior Chronic Exertional Compartment Syndrome Treatment. Foot Ankle Int 2015. [PMID: 26219908 DOI: 10.1177/1071100715596081] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [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] [Indexed: 02/01/2023]

Oesterling C, Kalia A, Chetcuti T, Walker S. Atypical leg symptoms: does routine measurement of the ankle brachial pressure index (ABPI) in primary care benefit patients? London J Prim Care (Abingdon) 2015;7:97-102. [PMID: 26681981 PMCID: PMC4673507 DOI: 10.1080/17571472.2015.1082345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]

Abstract

Background : Managing patients with atypical leg symptoms in primary care can be problematic. Determining the ankle brachial pressure index (ABPI) may be readily performed to help diagnose peripheral arterial disease, but is often omitted where signs and symptoms are unclear. Question: Does routine measurement of ABPI in patients with atypical leg symptoms aid management increase satisfaction and safely reduce hospital referral? Methodology: Patients with atypical leg symptoms but no skin changes or neurological symptoms underwent clinical review and Doppler ABPI measurement (suspicious finding ≤ 1.0). Testing was performed by the same doctor (study period: 30 months). Patient outcomes were determined from practice records, hospital letters and a telephone survey. Results : The study comprised 35 consecutive patients (males: N = 15), mean age 64 years (range: 39-88). Presentation included pain, cold feet, cramps, irritation and concerns regarding circulation. Prior to ABPI measurement, referral was considered necessary in 10, not required in 22 and unclear in 3. ABPI changed the referral decision in 10 (29%) and confirmed the decision in 25 (71%). During the study, 10 (29%) patients were referred (9 vascular, 1 neurology). Amongst the vascular referrals, significant peripheral arterial disease has been confirmed in six patients. A further two patients are under review and one did not attend. To date, lack of referral in patients with atypical leg symptoms but a normal ABPI has not increased morbidity. Current status was assessed by telephone review in 16/35 (46% contact rate; mean 18 months, range 2-28). Fifteen patients (94%) appreciated that their symptoms had been quickly and conveniently assessed, 8/11 (73%) with a normal ABPI were reassured by their result and in 8/11 symptoms have resolved. Discussion/Conclusion: APBI conveniently aids management of atypical leg symptoms by detecting unexpected peripheral arterial disease, avoids /confirms the need for referral, reassures patients and guides reassessment. This study suggests ABPI should be used more widely.

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Schäfer AGM, Hall TM, Rolke R, Treede RD, Lüdtke K, Mallwitz J, Briffa KN. Low back related leg pain: an investigation of construct validity of a new classification system. J Back Musculoskelet Rehabil 2015;27:409-18. [PMID: 24614828 DOI: 10.3233/bmr-140461] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [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] [Indexed: 02/04/2023]

Abstract

BACKGROUND

Leg pain is associated with back pain in 25-65% of all cases and classified as somatic referred pain or radicular pain. However, distinction between the two may be difficult as different pathomechanisms may cause similar patterns of pain. Therefore a pathomechanism based classification system was proposed, with four distinct hierarchical and mutually exclusive categories: Neuropathic Sensitization (NS) comprising major features of neuropathic pain with sensory sensitization; Denervation (D) arising from significant axonal compromise; Peripheral Nerve Sensitization (PNS) with marked nerve trunk mechanosensitivity; and Musculoskeletal (M) with pain referred from musculoskeletal structures.

OBJECTIVE

To investigate construct validity of the classification system.

METHODS

Construct validity was investigated by determining the relationship of nerve functioning with subgroups of patients and asymptomatic controls. Thus somatosensory profiles of subgroups of patients with low back related leg pain (LBRLP) and healthy controls were determined by a comprehensive quantitative sensory test (QST) protocol. It was hypothesized that subgroups of patients and healthy controls would show differences in QST profiles relating to underlying pathomechanisms.

RESULTS

77 subjects with LBRLP were recruited and classified in one of the four groups. Additionally, 18 age and gender matched asymptomatic controls were measured. QST revealed signs of pain hypersensitivity in group NS and sensory deficits in group D whereas Groups PNS and M showed no significant differences when compared to the asymptomatic group.

CONCLUSIONS

These findings support construct validity for two of the categories of the new classification system, however further research is warranted to achieve construct validation of the classification system as a whole.

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Burrus MT, Werner BC, Starman JS, Gwathmey FW, Carson EW, Wilder RP, Diduch DR. Chronic leg pain in athletes. Am J Sports Med 2015;43:1538-47. [PMID: 25157051 DOI: 10.1177/0363546514545859] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [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] [Indexed: 01/31/2023]

Waters TR, Dick RB. Evidence of health risks associated with prolonged standing at work and intervention effectiveness. Rehabil Nurs 2015;40:148-65. [PMID: 25041875 PMCID: PMC4591921 DOI: 10.1002/rnj.166] [Citation(s) in RCA: 151] [Impact Index Per Article: 16.8] [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] [Accepted: 04/06/2014] [Indexed: 11/11/2022]

Orlin JR, Oen J, Andersen JR, Tjugum IJ, Westbye HJ, Roska J, Aasved H, Hjelmeland K. Leg cramps in pregnancy caused by chronic compartment syndrome and relieved by fasciotomy after childbirth. Clin Case Rep 2014;2:103-7. [PMID: 25356260 PMCID: PMC4184604 DOI: 10.1002/ccr3.73] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 09/27/2013] [Revised: 01/09/2014] [Accepted: 02/20/2014] [Indexed: 11/17/2022] Open

Finestone AS, Noff M, Nassar Y, Moshe S, Agar G, Tamir E. Management of chronic exertional compartment syndrome and fascial hernias in the anterior lower leg with the forefoot rise test and limited fasciotomy. Foot Ankle Int 2014;35:285-92. [PMID: 24271459 DOI: 10.1177/1071100713514390] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [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] [Indexed: 02/01/2023]

Abstract

BACKGROUND

Chronic exertional compartment syndrome can present either as anterolateral lower leg pain or as painful muscle herniation. If an athlete or a soldier wants to continue training, there is no proven effective nonoperative treatment, and fasciotomy of 1 or more of the lower leg muscle compartments is usually recommended. Our clinical protocol differs from most reported ones in the use of the forefoot rise test to increase pressure and provoke pain and our recommending minimal surgery of the anterior compartment only. We present results of surgery based on our clinical management flowchart.

METHODS

Patients who had surgery during a 12-year period were reviewed by telephone interview or office examination. Pain was graded from 0 (none) to 4 (unbearable). Preoperative resting and exercise anterior compartment pressures were evaluated in most subjects before and immediately following a repeated weight-bearing forefoot rise test. Surgery was under local anesthesia, limited to the anterior compartment only and percutaneous (excepting muscle hernias). There were 36 patients, mean age 24 years.

RESULTS

Of 16 patients who were originally operated unilaterally, 5 patients were later operated on the other side. Mean presurgery resting pressure was 56 mm Hg (40-80 mm Hg) rising to 87 mm Hg (55-150 mm Hg) with exercise. Mean exercise pain score dropped from 2.9 presurgery to 1.3 postsurgery (n = 35, P < .0001). Complications included superficial peroneal nerve injury (3 legs in 3 patients, 1 requiring reoperation).

CONCLUSION

When we used our clinical management flowchart based on the forefoot rise test, percutaneous fasciotomy of the anterior compartment alone provided good clinical results. Care must be taken to prevent injury to the superficial peroneal nerve in the distal lower leg.

LEVEL OF EVIDENCE

Level IV, retrospective case series.

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Ferguson B, Gryfe D, Hsu W. Chronic recurrent multifocal osteomyelitis in a 13 year old female athlete: a case report. J Can Chiropr Assoc 2013;57:334-340. [PMID: 24302781 PMCID: PMC3845477] [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: 06/02/2023]

Isner-Horobeti ME, Dufour SP, Blaes C, Lecocq J. Intramuscular pressure before and after botulinum toxin in chronic exertional compartment syndrome of the leg: a preliminary study. Am J Sports Med 2013;41:2558-66. [PMID: 23969633 DOI: 10.1177/0363546513499183] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [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] [Indexed: 01/31/2023]

Abstract

BACKGROUND

Botulinum toxin A (BoNT-A) is used in the treatment of muscle hypertrophy but has never been used in chronic exertional compartment syndrome (CECS). The objective diagnostic criterion in this condition is an abnormally elevated intramuscular pressure (IMP) in the compartment. In this study, the IMP was measured 1 minute (P1) and 5 minutes (P5) after the exercise was stopped before and after BoNT-A injection.

HYPOTHESIS

Botulinum toxin A reduces the IMP (P1 and P5) and eliminates the pain associated with CECS.

STUDY DESIGN

Case series; Level of evidence, 4.

METHODS

Botulinum toxin A was injected into the muscles of moderately trained patients with an anterior or anterolateral exertional compartment syndrome of the leg. The BoNT-A dose (mean ± SD) ranged from 76 ± 7 to 108 ± 10 U per muscle, depending on which of the 5 muscles in the 2 compartments were injected. The primary end point was IMP (P1, P5). Secondary end points were exertional pain, muscle strength, and safety. Follow-up was conducted up to 9 months.

RESULTS

A total of 25 anterior compartments and 17 lateral compartments were injected in 16 patients. The time interval (mean ± SD) between the BoNT-A injection and after BoNT-A injection IMP measurement was 4.4 ± 1.6 months (range, 3-9 months). In the anterior compartment, P1 and P5 fell by 63% ± 17% (P < .00001) and 59% ± 24% (P < .0001), respectively; in the lateral compartment, P1 and P5 fell by 68% ± 21% (P < .001) and 63% ± 21% (P < .01), respectively. Exertional pain and muscle strength were monitored, based on the Medical Research Council score. The exertional pain was completely eliminated in 15 patients (94%). In 5 patients (31%), the strength of the injected muscles remained normal. In 11 patients (69%), strength decreased from 4.5 (out of 5) to 3.5 (P < .01), although without functional consequences. In the conditions of this study, BoNT-A showed a good safety profile in patients with CECS.

CONCLUSION

In this case series, BoNT-A reduced the IMP and eliminated exertional pain in anterior or anterolateral CECS of the leg for up to 9 months after the intervention. The mode of action of BoNT-A is still unclear. A randomized controlled study should be carried out to determine whether BoNT-A can be used as a medical alternative to surgical treatment.

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Kopp BT, Kirkby S, Hayes D, Flanigan KM. Diabetic myonecrosis in a cystic fibrosis patient. Respir Care 2013;58:e123-5. [PMID: 23362169 DOI: 10.4187/respcare.02299] [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] [Indexed: 11/05/2022]

Damle NA, Patnecha M, Kumar P, Gadodia A, Subbarao K, Bal C. Ribbing disease: Uncommon cause of a common symptom. Indian J Nucl Med 2013;26:36-9. [PMID: 21969779 PMCID: PMC3180721 DOI: 10.4103/0972-3919.84612] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]

Pearson A, Blood E, Lurie J, Abdu W, Sengupta D, Frymoyer JW, Weinstein J. Predominant leg pain is associated with better surgical outcomes in degenerative spondylolisthesis and spinal stenosis: results from the Spine Patient Outcomes Research Trial (SPORT). Spine (Phila Pa 1976) 2011;36:219-29. [PMID: 21124260 PMCID: PMC3057763 DOI: 10.1097/brs.0b013e3181d77c21] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [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] [Indexed: 02/01/2023]

Abstract

STUDY DESIGN

As-treated analysis of the Spine Patient Outcomes Research Trial.

OBJECTIVE

To compare baseline characteristics and surgical and nonoperative outcomes in degenerative spondylolisthesis (DS) and spinal stenosis (SpS) patients stratified by predominant pain location (i.e., leg vs. back).

SUMMARY OF BACKGROUND DATA

Evidence suggests that DS and SpS patients with predominant leg pain may have better surgical outcomes than patients with predominant low back pain (LBP).

METHODS

The DS cohort included 591 patients (62% underwent surgery), and the SpS cohort included 615 patients (62% underwent surgery). Patients were classified as leg pain predominant, LBP predominant, or having equal pain according to baseline pain scores. Baseline characteristics were compared between the 3 predominant pain location groups within each diagnostic category, and changes in surgical and nonoperative outcome scores were compared for 2 years. Longitudinal regression models including baseline covariates were used to control for confounders.

RESULTS

Among DS patients at baseline, 34% had predominant leg pain, 26% had predominant LBP, and 40% had equal pain. Similarly, 32% of SpS patients had predominant leg pain, 26% had predominant LBP, and 42% had equal pain. DS and SpS patients with predominant leg pain had baseline scores indicative of less severe symptoms. Leg pain predominant DS and SpS patients treated surgically improved significantly more than LBP predominant patients on all primary outcome measures at 1 and 2 years. Surgical outcomes for the equal pain groups were intermediate to those of the predominant leg pain and LBP groups. The differences in nonoperative outcomes were less consistent. Conclusion. Predominant leg pain patients improved significantly more with surgery than predominant LBP patients. However, predominant LBP patients still improved significantly more with surgery than with nonoperative treatment.

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Heinrichs KI, Lachowicz WM, Detmer DE. Concurrent periostalgia and chronic proximal deep posterior compartment syndrome in a collegiate track and field athlete: a case report. J Athl Train 2000;35:450-2. [PMID: 16558661 PMCID: PMC1323373] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]

McDermott MM, Mehta S, Liu K, Guralnik JM, Martin GJ, Criqui MH, Greenland P. Leg symptoms, the ankle-brachial index, and walking ability in patients with peripheral arterial disease. J Gen Intern Med 1999;14:173-81. [PMID: 10203623 PMCID: PMC1496547 DOI: 10.1046/j.1525-1497.1999.00309.x] [Citation(s) in RCA: 94] [Impact Index Per Article: 3.8] [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] [Indexed: 11/20/2022]

Abstract

OBJECTIVE

To determine how functional status and walking ability are related to both severity of lower extremity peripheral arterial disease (PAD) and PAD-related leg symptoms.

DESIGN

Cross-sectional study.

SETTING

Academic medical center.

PARTICIPANTS

Patients aged 55 years and older diagnosed with PAD in a blood flow laboratory or general medicine practice (n = 147). Randomly selected control patients without PAD were identified in a general medicine practice (n = 67).

MEASUREMENTS

Severity of PAD was measured with the ankle-brachial index (ABI). All patients were categorized according to whether they had (1) no exertional leg symptoms; (2) classic intermittent claudication; (3) exertional leg symptoms that also begin at rest (pain at rest), or (4) exertional leg symptoms other than intermittent claudication or pain at rest (atypical exertional leg symptoms). Participants completed the 36-Item Short-Form Health Survey (SF-36) and the Walking Impairment Questionnaire (WIQ). The WIQ quantifies patient-reported walking speed, walking distance, and stair-climbing ability, respectively, on a scale of 0 to 100 (100 = best).

MAIN RESULTS

In multivariate analyses patients with atypical exertional leg symptoms, intermittent claudication, and pain at rest, respectively, had progressively poorer scores for walking distance, walking speed, and stair climbing. The ABI was measurably and independently associated with walking distance (regression coefficient = 2.87/0.1 ABI unit, p =.002) and walking speed (regression coefficient = 2.09/0.1 ABI unit, p =.015) scores. Among PAD patients only, pain at rest was associated independently with all WIQ scores and six SF-36 domains, while ABI was an independent predictor of WIQ distance score.

CONCLUSIONS

Both PAD-related leg symptoms and ABI predict patient-perceived walking ability in PAD.

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Stollsteimer GT, Shelton WR. Acute atraumatic compartment syndrome in an athlete: a case report. J Athl Train 1997;32:248-50. [PMID: 16558458 PMCID: PMC1320246] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]

Abstract

OBJECTIVE

To present the case of a college football player with acute, atraumatic, exercise-induced compartment syndrome in the leg.

BACKGROUND

Acute, atraumatic, exercise-induced compartment syndrome is an infrequently reported cause of leg pain in the athlete. If left untreated, acute compartment syndrome can cause muscle necrosis.

DIFFERENTIAL DIAGNOSIS

Chronic exertional compartment syndrome, medial tibial syndrome, stress fracture.

TREATMENT

Treatment consists of compartment fasciotomy.

UNIQUENESS

This previously healthy, but unconditioned, athlete developed severe anterolateral left leg pain after two days of fall practice in which he was unable to run a mile in 7.5 minutes. Physical examination by the team physician revealed acute compartment syndrome, and an emergency anterolateral compartment fasciotomy was performed. Second-look débridement performed 48 hours later revealed no significant change in the necrotic appearance of the anterior compartment soft tissue. Therefore, the dead muscle was completely débrided, and a free-flap latissumus dorsi graft was used for coverage of the wound. With recovery, strength returned to normal in the lateral compartment but remained 0/5 in the anterior compartment. The patient had persistent sensory loss in the distributions of the superficial and deep peroneal nerves.

CONCLUSIONS

Although much less common than the more frequent causes of leg pain (ie, chronic exertional compartment syndrome, medial tibial syndrome, stress fracture), acute compartment syndrome is potentially more devastating. When the increased intracompartmental pressure within a closed tissue space exceeds capillary perfusion pressure, tissue perfusion is decreased, the soft tissue becomes ischemic, and cells die. The most important clinical diagnostic signs of compartment syndrome are pain with passive stretching of the compartment and pain out of proportion to the results of the physical examination.

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