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BMJ Open Dec 2022Chiropractic spinal manipulative therapy (CSMT) and lumbar discectomy are both used for lumbar disc herniation (LDH) and lumbosacral radiculopathy (LSR); however,...
Association between chiropractic spinal manipulation and lumbar discectomy in adults with lumbar disc herniation and radiculopathy: retrospective cohort study using United States' data.
OBJECTIVES
Chiropractic spinal manipulative therapy (CSMT) and lumbar discectomy are both used for lumbar disc herniation (LDH) and lumbosacral radiculopathy (LSR); however, limited research has examined the relationship between these therapies. We hypothesised that adults receiving CSMT for newly diagnosed LDH or LSR would have reduced odds of lumbar discectomy over 1-year and 2-year follow-up compared with those receiving other care.
DESIGN
Retrospective cohort study.
SETTING
101 million patient US health records network (TriNetX), queried on 24 October 2022, yielding data from 2012 query.
PARTICIPANTS
Adults age 18-49 with newly diagnosed LDH/LSR (first date of diagnosis) were included. Exclusions were prior lumbar surgery, absolute indications for surgery, trauma, spondylolisthesis and scoliosis. Propensity score matching controlled for variables associated with the likelihood of discectomy (eg, demographics, medications).
INTERVENTIONS
Patients were divided into cohorts according to receipt of CSMT.
PRIMARY AND SECONDARY OUTCOME MEASURES
ORs for lumbar discectomy; calculated by dividing odds in the CSMT cohort by odds in the cohort receiving other care.
RESULTS
After matching, there were 5785 patients per cohort (mean age 36.9±8.2). The ORs (95% CI) for discectomy were significantly reduced in the CSMT cohort compared with the cohort receiving other care over 1-year (0.69 (0.52 to 0.90), p=0.006) and 2-year follow-up (0.77 (0.60 to 0.99), p=0.040). E-value sensitivity analysis estimated the strength in terms of risk ratio an unmeasured confounding variable would need to account for study results, yielding point estimates for each follow-up (1 year: 2.26; 2 years: 1.92), which no variables in the literature reached.
CONCLUSIONS
Our findings suggest receiving CSMT compared with other care for newly diagnosed LDH/LSR is associated with significantly reduced odds of discectomy over 2-year follow-up. Given socioeconomic variables were unavailable and an observational design precludes inferring causality, the efficacy of CSMT for LDH/LSR should be examined via randomised controlled trial to eliminate residual confounding.
Topics: Humans; Adult; United States; Middle Aged; Adolescent; Young Adult; Intervertebral Disc Displacement; Radiculopathy; Manipulation, Spinal; Retrospective Studies; Chiropractic; Lumbar Vertebrae; Diskectomy; Treatment Outcome
PubMed: 36526306
DOI: 10.1136/bmjopen-2022-068262 -
Spine Mar 2012Review of surgical technique. (Review)
Review
STUDY DESIGN
Review of surgical technique.
OBJECTIVE
To provide accounts of the authors' preferred methods for performing anterior cervical surgery with personal tips and pearls.
SUMMARY OF BACKGROUND DATA
Many have described the various anterior surgical approaches to the cervical spine, and in this review, we hope to describe our preferences, highlighted with some tips and pearls.
METHODS
Various accounts of the transoral, the anterolateral (Smith-Robinson), and the split manubrium approaches were reviewed and used as the basis of the review. Additional notes with regard to the authors' preferences were noted to provide further guidance. The descriptions were delineated from the most cephalad to the most caudal.
RESULTS
The transoral, the anterolateral (Smith-Robinson), and the manubriotomy approaches were described. Each account starts with the basic preoperative considerations, then describes the incision and the main anatomical landmarks, and finally concludes with closure and main complications to monitor for. A brief description of the main pathologies that each approach may address is also provided.
CONCLUSION
The 3 anterior approaches to the cervical spine are direct and elegant solutions to pathologies arising from the anterior column. They supplement the more commonly used posterior approaches, which provide stronger multilevel fixation, and thus provide an essential tool in the armamentarium of spine surgeons.
Topics: Cervical Vertebrae; Decompression, Surgical; Humans; Neurosurgical Procedures; Radiculopathy; Risk Assessment; Spondylosis
PubMed: 22020587
DOI: 10.1097/BRS.0b013e318239ccd8 -
Acta Dermato-venereologica Mar 2012Patients with chronic itch are diagnosed and treated by dermatologists. However, itch is a neural sensation and some forms of chronic itch are the presenting symptoms of... (Review)
Review
Patients with chronic itch are diagnosed and treated by dermatologists. However, itch is a neural sensation and some forms of chronic itch are the presenting symptoms of neurological diseases. Dermatologists need some familiarity with the most common neuropathic itch syndromes to initiate diagnostic testing and to know when to refer to a neurologist. This review summarizes current knowledge, admittedly incomplete, on neuropathic itch caused by diseases of the brain, spinal cord, cranial or spinal nerve-roots, and peripheral nerves.
Topics: Central Nervous System Diseases; Humans; Nerve Fibers, Unmyelinated; Nociceptors; Pruritus; Radiculopathy; Syndrome; Trigeminal Nerve Diseases
PubMed: 22307048
DOI: 10.2340/00015555-1318 -
Neurology India 2008Lumbosacral radiculoplexus neuropathy (LRPN) originally described in diabetic patients is a distinct clinical condition characterized by debilitating pain, weakness and... (Review)
Review
BACKGROUND
Lumbosacral radiculoplexus neuropathy (LRPN) originally described in diabetic patients is a distinct clinical condition characterized by debilitating pain, weakness and atrophy most commonly affecting the proximal thigh muscles asymmetrically. The syndrome is usually monophasic and preceded by significant weight loss (at least more than 10 lbs). Though a self-limited condition, recovery is gradual with some residual weakness. Recent advances and research has provided new insights in the pathogenesis and thereby management of this syndrome. In this paper, we review the clinical and diagnostic features as well as discuss recent insights and treatment strategies along with our experience in the management of patients with diabetic and non-diabetic LRPN.
MATERIALS AND METHODS
Literature in English published between 1953 and 2008 was searched in the MEDLINE and Pubmed database, maintained by the US National library of medicine and National institutes of health, using key words of diabetic amyotrophy, lumbosacral radiculoplexus neuropathy, diabetic proximal neuropathy, diabetic radiculopathy and diabetic lumbosacral plexopathy. In addition, literature reported in various textbooks on peripheral neuropathy was reviewed as well.
OBSERVATION
The diagnosis relies mostly on clinical suspicion and characteristic electromyographic findings. The exact pathogenesis of the illness remains unknown, but there seems to be a component of immune-mediated inflammatory microvasculitis which causes secondary ischemia of the lumbosacral plexus. This has prompted a trial of immunosuppressive agents (like steroids) with an attempt to alter the course of the illness. A few reports have noted that immunosuppression when instituted early in the course of the illness (within three months of symptom onset) may hasten the recovery and improve symptoms.
CONCLUSION
Though the exact mechanism of LRPN in diabetic and non-diabetic patients remains unknown, new evidence alludes to an underlying inflammatory vasculitic process. Early treatment with immunosuppressants may be beneficial in some cases, although the data available at this time is limited to a small cohort of patients. The decision is individualized weighing the risks and benefits in a given patient. Future research in this direction with double-blinded case-controlled studies is required to investigate this further.
Topics: Diabetic Neuropathies; Disease Progression; Humans; Peripheral Nervous System Diseases; Prognosis; Radiculopathy
PubMed: 19127036
DOI: 10.4103/0028-3886.44814 -
European Journal of Pain (London,... Jul 2022Painful lumbar radiculopathy is a neuropathic pain condition, commonly attributed to nerve root inflammation/compression by disc herniation. The present exploratory...
BACKGROUND
Painful lumbar radiculopathy is a neuropathic pain condition, commonly attributed to nerve root inflammation/compression by disc herniation. The present exploratory study searched for associations between pain intensity and inflammatory markers, herniated disc size, infection, psychological factors and pain modulation in patients with confirmed painful lumbar radiculopathy scheduled for spine surgery.
METHODS
Prior to surgery, 53 patients underwent the following evaluation: pain intensity measured on a 0-10 numeric rating scale (NRS) and the Short-Form McGill Pain Questionnaire; sensory testing (modified DFNS protocol); pain processing including temporal summation and conditioned pain modulation (CPM); neurological examination; psychological assessment including Spielberger's Anxiety Inventory, Pain Sensitivity Questionnaire and the Pain Catastrophizing Scale. Pro-inflammatory cytokine levels (IL-1b, IL-6, IL-8, IL-17, TNFα, IFNg) and microbial infection (ELISA and rt-PCR) in blood and disc samples obtained during surgery. MRI scans assessments for disc herniation size/volume (MSU classification/ three-dimensional volumetric analysis).
RESULTS
Complete data were available from 40 (75%) patients (15 female) aged 44.8 ± 16.3 years. Pain intensity (NRS) positively correlated with pain catastrophizing and CPM (r = 0.437, p = 0.006; r = 0.421, p = 0.007; respectively), but not with disc/blood cytokine levels, bacterial infection or MRI measures. CPM (p = 0.001) and gender (p = 0.029) were associated with average pain intensity (adjusted R = 0.443).
CONCLUSIONS
This exploratory study suggests that pain catastrophizing, CPM and gender, seem to contribute to pain intensity in patients with painful lumbar radiculopathy. The role of mechanical compression and inflammation in determining the intensity of painful radiculopathy remains obscure.
SIGNIFICANCE OF STUDY
Pain catastrophizing, CPM and gender rather than objective measures of inflammation and imaging seem to contribute to pain in patients with painful radiculopathy.
Topics: Cytokines; Female; Humans; Inflammation; Intervertebral Disc Displacement; Lumbar Vertebrae; Pain; Radiculopathy
PubMed: 35357731
DOI: 10.1002/ejp.1947 -
Trials Apr 2022Lumbar disc herniation (LDH) is a common chronic musculoskeletal disorder that seriously affects quality of life. The percutaneous endoscopic lumbar diskectomy (PELD)...
Study on the efficacy and safety of the combination of Shi's manual therapy and percutaneous endoscopic lumbar diskectomy for lumbar disc herniation with radiculopathy: study protocol for a multicenter randomized controlled trial.
BACKGROUND
Lumbar disc herniation (LDH) is a common chronic musculoskeletal disorder that seriously affects quality of life. The percutaneous endoscopic lumbar diskectomy (PELD) technique was developed to address spinal nerve root compression through direct visualization of pathological findings while minimizing tissue destruction upon exposure. It is an effective and safe treatment for LDH. However, recurrent LDH is a major concern after lumbar discectomy for primary LDH. A considerable number of clinical studies have reported that patients with LDH with radiculopathy could benefit from manual therapy. Shi's manual therapy (SMT) was established based on traditional Chinese medicine (TCM) theory and has been shown to have a superior effect in alleviating muscle tension and loosening joints to improve lumbar and leg pain, radiculopathy, stiffness, activity discomfort, and related disorders. However, there is a lack of high-quality clinical evidence to support this conclusion. The purpose of this study is to evaluate the efficacy and safety of the combination of Shi's manual therapy (SMT) and PELD for LDH with radiculopathy.
METHODS/DESIGN
A multicenter randomized controlled trial (RCT) with a 1-year follow-up period will be performed. A total of 510 participants with LDH with radiculopathy will be recruited from four clinical centers. The sample size was estimated, and statistical analysis will be performed and supervised by biostatisticians from an independent third-party research institution. Two hundred fifty-five subjects will be randomly allocated to each group. The subjects in the control group will undergo PELD. Participants in the intervention group will be treated with a combination of SMT and PELD. Recurrence rate is the primary endpoint and the survival analysis of recurrence rate is the secondary endpoint, and the primary analysis of recurrence rate is the chi-square test and the secondary analysis of recurrence rate is survival analysis. The primary outcome measure is the recurrence rate of LDH with radiculopathy at the 1-year follow-up after treatment. The secondary outcome measures will be the ODI score, the VAS score for pain for the lumbar spine and lower limbs, the straight leg raise angle, the stability of the operated lumbar segment, and the SF-36 scores. Assessments will occur at baseline, postoperation, and 1 week, 4 weeks, 13 weeks, 26 weeks, and 1 year postoperation. In addition, adverse events related to clinical symptoms and signs and the results of laboratory tests will be documented during the clinical trials.
DISCUSSION
This study will provide reliable evidence of the effectiveness and safety of the combination of SMT and PELD for LDH with radiculopathy. If the results are favorable, it is expected that patients with LDH with radiculopathy will benefit from this study, and many patients could gain a good alternative treatment for LDH with radiculopathy.
TRIAL REGISTRATION
China Registered Clinical Trial Registration Center ChiCTR2000036515 . Registered on 13 November 2020.
Topics: Diskectomy; Endoscopy; Humans; Intervertebral Disc Displacement; Lumbar Vertebrae; Multicenter Studies as Topic; Musculoskeletal Manipulations; Pain; Radiculopathy; Randomized Controlled Trials as Topic; Retrospective Studies; Treatment Outcome
PubMed: 35461259
DOI: 10.1186/s13063-022-06195-y -
European Neurology 2008
Topics: Radiculopathy; Terminology as Topic
PubMed: 18832847
DOI: 10.1159/000159931 -
Canadian Association of Radiologists... Nov 2019Spinal synovial cysts are relatively uncommon and are most frequently found in the lumbar spine and rarely in the cervical spine. Intraspinal extradural cervical... (Review)
Review
Spinal synovial cysts are relatively uncommon and are most frequently found in the lumbar spine and rarely in the cervical spine. Intraspinal extradural cervical synovial cysts can occur and potentially cause cord/nerve root compression with symptoms of myelopathy/radiculopathy; however, most are asymptomatic and incidental findings. We conducted a literature review and present, to our knowledge, the largest imaging case series and describe the magnetic resonance imaging features of cervical synovial cysts.
Topics: Cervical Vertebrae; Humans; Magnetic Resonance Imaging; Radiculopathy; Synovial Cyst
PubMed: 30922789
DOI: 10.1016/j.carj.2018.12.005 -
Frontiers in Public Health 2022Traditionally paired meta-analysis revealed inconsistencies in the safety and effectiveness of surgical interventions. We conducted a network meta-analysis to assess... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Traditionally paired meta-analysis revealed inconsistencies in the safety and effectiveness of surgical interventions. We conducted a network meta-analysis to assess various treatments' clinical efficacy and safety for pure cervical radiculopathy.
METHODS
The Embase, PubMed, and Cochrane Library databases were searched for randomized controlled trials (RCTs) comparing different treatment options for patients with pure cervical radiculopathy from inception until October 23, 2021. The primary outcomes were postoperative success rates, postoperative complication rates, and postoperative reoperation rates. The pooled data were subjected to a random-effects consistency model. The protocol was published in PROSPERO (CRD42021284819).
RESULTS
This study included 23 RCTs ( = 1,844) that evaluated various treatments for patients with pure cervical radiculopathy. There were no statistical differences between treatments in the consistency model in terms of major clinical effectiveness and safety outcomes. Postoperative success rates were higher for anterior cervical foraminotomy (ACF: probability 38%), posterior cervical foraminotomy (PCF: 24%), and anterior cervical discectomy with fusion and additional plating (ACDFP: 21%). Postoperative complication rates ranked from high to low as follows: cervical disc replacement (CDR: probability 32%), physiotherapy (25%), ACF (25%). Autologous bone graft (ABG) had better relief from arm pain (probability 71%) and neck disability (71%). Among the seven surgical interventions with a statistical difference, anterior cervical discectomy with allograft bone graft plus plating (ABGP) had the shortest surgery time.
CONCLUSIONS
According to current results, all surgical interventions can achieve satisfactory results, and there are no statistically significant differences. As a result, based on their strengths and patient-related factors, surgeons can exercise discretion in determining the appropriate surgical intervention for pure cervical radiculopathy. CRD42021284819.
Topics: Cervical Vertebrae; Humans; Postoperative Complications; Radiculopathy; Spinal Fusion; Treatment Outcome
PubMed: 35910906
DOI: 10.3389/fpubh.2022.892042 -
Pain Physician Dec 2022Cervical epidural steroid injection (ESI) has been used to alleviate axial or radicular pain incurred from various cervical pathologies, including herniated... (Meta-Analysis)
Meta-Analysis
Comparison of Clinical Efficacy of Transforaminal and Interlaminar Epidural Steroid Injection in Radicular Pain due to Cervical Diseases: A Systematic Review and Meta-analysis.
BACKGROUND
Cervical epidural steroid injection (ESI) has been used to alleviate axial or radicular pain incurred from various cervical pathologies, including herniated intervertebral disc (HIVD) and spinal stenosis (SS). However, the superiority of the transforaminal ESI (TFESI) method over the interlaminar ESI (ILESI) in terms of clinical effectiveness for the radicular pain is still controversial.
OBJECTIVES
This study has compared TFESI and ILESI in terms of clinical effectiveness, such as pain control and functional improvement, as well as the incidence of adverse events in patients with radicular pain secondary to cervical HIVD or SS.
STUDY DESIGN
A systematic review and meta-analysis.
SETTING
Primary clinic and tertiary referral center.
METHODS
A literature search was performed using Medline (PubMed), Embase, Cochrane Review, and KoreaMed databases from the studies published until March 2022. After reviewing titles, abstracts, and full texts of 371 studies during the initial database search, 6 studies were included in a qualitative and quantitative synthesis. Data, including pain score, functional score, and adverse events were extracted from 6 studies and were analyzed using a random-effects model to obtain effect size and its statistical significance. Quality assessment and evidence level were established in accordance with the Grading of Recommendations Assessment, Development and Evaluation methodology.
RESULTS
Among 6 studies, including 4 randomized controlled trials (RCTs), only 1 RCT showed that TFESI achieved a significant lower Numeric Rating Scale (NRS-11) at 1 month than ILESI, but no advantage in the NRS-11 at 3 months and the Neck Disability Index at 1 month and 3 months, respectively. Another RCT indicated that ILESI achieved significantly more neck NRS-11 reduction at 1 month and 3 months than TFESI. The other 4 studies revealed no significant difference between the 2 groups. A meta-analysis showed no significance in clinical outcomes, except that ultrasound-guided TFESI featured less intravascular leakage of contrast than ILESI. The level of evidence was low because of inconsistency and imprecision.
LIMITATIONS
The feasible clinical heterogeneity from the relatively small number of patients included as well as differences in methodology across the studies.
CONCLUSIONS
Comprehensive reviews of selected articles revealed TFESI could not be recommended over ILESI for the sake of a preferential cervical radiculopathy control due to the weak evidential strength.
Topics: Humans; Low Back Pain; Injections, Epidural; Pain Management; Spinal Stenosis; Treatment Outcome; Radiculopathy; Steroids
PubMed: 36608007
DOI: No ID Found