scholarly journals Appropriateness of Lumbar Spine Referrals to a Neurosurgical Service

2010 ◽  
Vol 37 (6) ◽  
pp. 843-848 ◽  
Author(s):  
J. Max Findlay ◽  
Nathan Deis
Keyword(s):  
Lumbar Spine ◽  
Neurological Deficit ◽  
Nerve Root ◽  
Leg Pain ◽  
Lumbar Spine Surgery ◽  
Nerve Root Compression ◽  
Clinical Criteria ◽  
University Of Alberta ◽  
Radiological Evidence ◽  
The University

AbstractBackground:Patients with lumbar spine complaints are often referred for surgical assessment. Only those with clinical and radiological evidence of nerve root compression are potential candidates for surgery and appropriate for surgical assessment. This study examines the appropriateness of lumbar spine referrals made to neurosurgeons in Edmonton, Alberta.Methods:Lumbar spine referrals to a group of ten neurosurgeons at the University of Alberta were reviewed over three two month intervals. Clinical criteria for “appropriateness” for surgical assessment were as follows: •“Appropriate” referrals were those that stated leg pain was the chief complaint, or those that described physical exam evidence of neurological deficit, and imaging reports (CT or MRI) were positive for nerve root compression. •“Uncertain” referrals were those that reported both back and leg pain without specifying which was greater, without mention of neurologic deficit, and when at least possible nerve root compression was reported on imaging. •“Inappropriate” referrals contained no mention of leg symptoms or signs of neurological deficit, and/or had no description of nerve root compression on imaging.Results:Of the 303 referrals collected, 80 (26%) were appropriate, 92 (30%) were uncertain and 131 (44%) were inappropriate for surgical assessment.Conclusions:Physicians seeking specialist consultations for patients with lumbar spine complaints need to be better informed of the criteria which indicate an appropriate referral for surgical treatment, namely clinical and radiological evidence of nerve root compression. Avoiding inappropriate referrals could reduce wait-times for both surgical consultation and lumbar spine surgery for those patients requiring it.

A Variable-angled Suction Nerve Root Retractor for Lumbar Spine Surgery

Neurosurgery ◽  
1991 ◽  
Vol 29 (3) ◽  
pp. 419-420
Author(s):  
Michael H. Lavyne
Keyword(s):  
Lumbar Spine ◽  
Spine Surgery ◽  
Nerve Root ◽  
Lumbar Disc ◽  
Lumbar Disc Surgery ◽  
Lumbar Spine Surgery ◽  
Disc Surgery

Abstract A simple, variable-angled suction nerve root retractor is described for use primarilv in lumbar disc surgery.

scholarly journals Is the Hospital Anxiety and Depression Scale Associated With Outcomes After Lumbar Spine Surgery?

2019 ◽  
Vol 10 (3) ◽  
pp. 266-271 ◽  
Author(s):  
Leah Y. Carreon ◽  
Annette B. Jespersen ◽  
Christian C. Støttrup ◽  
Karen H. Hansen ◽  
Mikkel O. Andersen
Keyword(s):  
Lumbar Spine ◽  
Spine Surgery ◽  
Short Form ◽  
Depression Scale ◽  
Leg Pain ◽  
Anxiety And Depression ◽  
Lumbar Spine Surgery ◽  
Consecutive Series ◽  
Medical Patients ◽  
Hospital Anxiety

Study Design:Longitudinal cohort.Objectives:The Hospital Anxiety and Depression Scale (HADS) was developed to provide clinicians a reliable, valid, and practical tool to identify and quantify the anxiety and depression in medical patients. Several studies have shown that patients with chronic low back pain may have subclinical depression and impairments in mental health and that these in turn may lead to less than optimal results after lumbar spine surgery. The purpose of this study is to determine if there are associations between preoperative HADS and differences in pre- and postoperative health-related quality-of-life (HRQOLs) scores after spine surgery.Methods:From a single center, a consecutive series of patients completed the HADS, Oswestry Disability Index (ODI), Short Form-36 (SF-36), EuroQOL-5D (EQ-5D), and Visual Analog Scale (VAS) for back and leg pain. Except for HADS, the patients completed the same HRQOLs 1 year after surgery.Results:Of 308 eligible cases, 208 (68%) had follow-up data available and were included in the analysis. Patients in the HADS-Anxiety (HADS-A) Abnormal category had the worst preoperative HRQOLs but had the greatest improvement in 1-year postoperative scores. Except for VAS Leg Pain, preoperative HRQOLs were better in patients in the HADS-Depressed (HADS-D) Normal category. Patients in the HADS-D Abnormal category had statistically significantly greater improvement in 1-year postoperative EQ-5D and ODI scores when compared with the other cohorts.Conclusion:Worse HADS-A and HADS-D scores are associated with worse preoperative HRQOL scores in patients with lumbar degenerative disorders scheduled for spine surgery. However, similar improvements in HRQOLs can be expected 1 year postoperative regardless of the patients’ HADS scores.

Pneumatic nerve root compression: epidural gas in association with lateral disc herniation

1994 ◽  
Vol 81 (3) ◽  
pp. 453-458 ◽  
Author(s):  
Theresa M. Cheng ◽  
Michael J. Link ◽  
Burton M. Onofrio
Keyword(s):  
Disc Herniation ◽  
Nerve Root ◽  
Chronic Back Pain ◽  
Intervertebral Discs ◽  
Leg Pain ◽  
Nerve Root Compression ◽  
Disc Space ◽  
Content Type ◽  
Lumbar Nerve Root ◽  
Epidural Gas

✓ Extreme lateral disc herniations are increasingly recognized as a cause of lumbar nerve root compression syndromes. This disorder often presents major diagnostic and therapeutic challenges, especially in the presence of multiple degenerative changes and chronic back pain in elderly patients. The authors describe two patients with presentations and findings that have not been previously described in the literature. Both patients had histories of upper lumbar back and leg pain. Degenerative spine disease, gaseous degeneration of the intervertebral discs, and epidural gas in the lateral recesses were noted on imaging studies. However, because both patients had undergone prior epidural diagnostic and therapeutic procedures, the epidural gas in the lateral recesses could be attributed either to gaseous disc degeneration or to the previous intraspinal procedures. One patient was found to have a large, far lateral extruded disc fragment that contained air. The nerve root in the second patient was impaled by an unusual combination of a small extruded disc fragment as well as an air-filled sac that was surrounded by the walled-off fragment's capsule and which freely communicated with the gaseous degenerated disc space. The suspected mechanism of root compression is illustrated and discussed. The possibility of disc herniation should be seriously considered in cases of nerve root compression in which epidural gas is present, especially those associated with gaseous degenerated discs.

scholarly journals Where do patients with MRI-confirmed single-level radiculopathy experience pain, and what is the clinical interpretability of these pain patterns? A cross-sectional diagnostic accuracy study

2019 ◽  
Vol 27 (1) ◽  
Author(s):  
Hanne B. Albert ◽  
Jeanette Kaae Hansen ◽  
Helle Søgaard ◽  
Peter Kent
Keyword(s):  
Diagnostic Accuracy ◽  
Nerve Root ◽  
Radicular Pain ◽  
Leg Pain ◽  
Nerve Root Compression ◽  
Diagnostic Accuracy Study ◽  
Nerve Roots ◽  
Cross Sectional ◽  
Single Level ◽  
Accuracy Study

Abstract Background Clinicians nominate the distribution of leg pain as being important in diagnosing nerve root involvement. This study aimed to identify: (i) common unisegmental radicular pain patterns and whether they were dermatomal, and (ii) whether these radicular pain patterns assisted clinician discrimination of the nerve root level involved. Methods A cross-sectional diagnostic accuracy study of adult patients with radicular leg pain at a hospital in Denmark. All patients had positive neurological signs (average 2.8 signs - hypoalgesia, diminished reflexes, muscle weakness, positive Straight Leg Raise test). Part 1 (pain patterns) was a secondary analysis of baseline pain pattern data collected during a clinical trial. The pain charts of 93 patients with an MRI and clinically confirmed single-level disc herniation with nerve root compression were digitised and layered to form a composite picture of the radicular patterns for the L5 and S1 nerve roots, which were then compared to published dermatomes. In Part 2 (clinical utility) we prospectively measured the discriminative ability of the identified pain patterns. The accuracy was calculated of three groups of six clinicians at classifying the nerve root affected in a randomized sequence of 53 patients, when not shown, briefly shown or continuously shown the composite pain patterns. In each group were two chiropractors, two medical doctors and two physiotherapists. Results There was a wide overlap in pain patterns from compromised L5 and S1 nerve roots but some distinguishing features. These pain patterns had approximately 50 to 80% overlap with published dermatomes. Clinicians were unable to determine with any accuracy above chance whether an individual pain drawing was from a person with a compromised L5 or S1 nerve root, and use of the composite pain drawings did not improve that accuracy. Conclusions While pain distribution may be an indication of radiculopathy, pain patterns from L5 or S1 nerve root compression only approximated those of sensory dermatomes, and level-specific knowledge about radicular pain patterns did not assist clinicians’ diagnostic accuracy of the nerve root impinged. These results indicate that, on their own, pain patterns provide very limited additional diagnostic information about which individual nerve root is affected.

Chondroma of the Lumbar Spine, a Rare Cause of Sciatica: Case Report

Neurosurgery ◽  
1990 ◽  
Vol 26 (4) ◽  
pp. 685-688 ◽  
Author(s):  
Linda I. Bland ◽  
Joseph V. McDonald
Keyword(s):  
Case Report ◽  
Lumbar Spine ◽  
Nerve Root ◽  
Benign Tumor ◽  
Nerve Root Compression ◽  
Radicular Symptoms

Abstract A case of chondroma of the lumbar spine causing nerve root compression is presented. This benign tumor was completely removed, resulting in relief of all radicular symptoms.

Low Back Pain Versus Back-Related Leg Pain: How Do Patient Expectations and Outcomes of Lumbar Spine Surgery Compare?

2021 ◽  
pp. 155633162110104
Author(s):  
Christopher M. Brusalis ◽  
Roland Duculan ◽  
Frank P. Cammisa ◽  
Andrew A. Sama ◽  
Alexander P. Hughes ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Lumbar Spine ◽  
Spine Surgery ◽  
Patient Expectations ◽  
Leg Pain ◽  
Pain Patient ◽  
Lumbar Spine Surgery ◽  
Low Back ◽  
Preoperative Expectations

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.

scholarly journals Effects of smoking on pedicle screw–based dynamic stabilization: radiological and clinical evaluations of screw loosening in 306 patients

2020 ◽  
Vol 33 (3) ◽  
pp. 398-405
Author(s):  
Yi-Hsuan Kuo ◽  
Chao-Hung Kuo ◽  
Hsuan-Kan Chang ◽  
Tsung-Hsi Tu ◽  
Li-Yu Fay ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Pedicle Screw ◽  
Clinical Outcomes ◽  
Dynamic Stabilization ◽  
Leg Pain ◽  
Lumbar Spine Surgery ◽  
Screw Loosening ◽  
Secondary Surgery ◽  
Clinical Evaluations ◽  
Vas Scores

OBJECTIVECigarette smoking has been known to increase the risk of pseudarthrosis in spinal fusion. However, there is a paucity of data on the effects of smoking in dynamic stabilization following lumbar spine surgery. This study aimed to investigate the clinical outcomes and the incidence of screw loosening among patients who smoked.METHODSConsecutive patients who had lumbar spondylosis, recurrent disc herniations, or low-grade spondylolisthesis that was treated with 1- or 2-level surgical decompression and pedicle screw–based Dynesys dynamic stabilization (DDS) were retrospectively reviewed. Patients who did not complete the minimum 2 years of radiological and clinical evaluations were excluded. All screw loosening was determined by both radiographs and CT scans. Patient-reported outcomes, including visual analog scale (VAS) scores of back and leg pain, Japanese Orthopaedic Association (JOA) scores, and Oswestry Disability Index (ODI), were analyzed. Patients were grouped by smoking versus nonsmoking, and loosening versus intact screws, respectively. All radiological and clinical outcomes were compared between the groups.RESULTSA total of 306 patients (140 women), with a mean age of 60.2 ± 12.5 years, were analyzed during an average follow-up of 44 months. There were 34 smokers (9 women) and 272 nonsmokers (131 women, 48.2% more than the 26.5% of smokers, p = 0.017). Postoperatively, all the clinical outcomes improved (e.g., VAS back and leg pain, JOA scores, and ODI, all p < 0.001). The overall rate of screw loosening was 23.2% (71 patients), and patients who had loosened screws were older (61.7 ± 9.6 years vs 59.8 ± 13.2 years, p = 0.003) and had higher rates of diabetes mellitus (33.8% vs 21.7%, p = 0.038) than those who had intact DDS screws. Although the patients who smoked had similar clinical improvement (even better VAS scores in their legs, p = 0.038) and a nonsignificantly lower rate of screw loosening (17.7% and 23.9%, p = 0.416), the chances of secondary surgery for adjacent segment disease (ASD) were higher than for the nonsmokers (11.8% vs 1.5%, p < 0.001).CONCLUSIONSSmoking had no adverse effects on the improvements of clinical outcomes in the pedicle screw–based DDS surgery. For smokers, the rate of screw loosening trended lower (without significance), but the chances of secondary surgery for ASD were higher than for the nonsmoking patients. However, the optimal surgical strategy to stabilize the lumbar spine of smoking patients requires future investigation.

Sign in / Sign up

Export Citation Format

Share Document