Approach to Radiculopathy

AbstractLow back pain and neck pain, often with associated radiculopathy, are two of the most common reasons for referral to the outpatient neurology clinic. A thorough clinical evaluation remains paramount in establishing an accurate diagnosis and subsequently an appropriate treatment plan. In this article, we review anatomic considerations for spondylotic radiculopathy; outline the clinical approach for the evaluation of these patients, including discussion of electrodiagnostic and imaging modalities; and address treatment options based on a stratified treatment approach.

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Review on Efficacy of Lumber Traction on Low Back Pain

Journal of Medicine ◽

10.3329/jom.v8i2.1412 ◽

1970 ◽

Vol 8 (2) ◽

pp. 69-73

Author(s):

Md Shahidur Rahman ◽

Mohd Taslim Uddin ◽

Md Ahsanulla

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Clinical Practice ◽

Treatment Plan ◽

Treatment Options ◽

Clinical Findings ◽

Health Care Use ◽

Clinical Parameters ◽

Low Back ◽

Keywords Low Back Pain

Back pain is a problem to health professionals and to the society. Low back pain is now one of the most common reasons for work loss, health care use and sickness benefit. There are many causes of low back pain. Non-specific mechanical low back pain is most common. Treatment options include surgical and conservative. Conservative treatment is usually given with analgesics, thermo therapy and lumber traction. Treatment plan and referral is made on the basis of judgment on clinical findings. The aim of the present review was to assess the efficacy of traction for LBP patients with or without radiating pain. To reflect clinical practice, we need to understand the clinical parameters and treatment regimes being used by clinicians, and these must be addressed before a trial can be designed to look further at the effectiveness of traction for LBP with or without radiating pain. The evidence for the use of traction in LBP remains inconclusive because of the continued lack of methodological rigor and the limited application of clinical parameters as used in clinical practice. Keywords: Low back pain, Lumber traction, Efficacy. Â Â Â DOI = 10.3329/jom.v8i2.1412 J MEDICINE 2007; 8 : 69-73

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Implementing a targeted treatment approach for low back pain in primary care in Germany

Physiotherapy ◽

10.1016/j.physio.2015.03.3582 ◽

2015 ◽

Vol 101 ◽

pp. e724-e725 ◽

Cited By ~ 1

Author(s):

S. Karstens ◽

S. Joos ◽

J.C. Hill ◽

J. Szecsenyi ◽

J. Steinhaeuser

Keyword(s):

Primary Care ◽

Low Back Pain ◽

Back Pain ◽

Treatment Approach ◽

Targeted Treatment ◽

Low Back

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The effect of infliximab in patients with chronic low back pain and Modic changes (the BackToBasic study): study protocol of a randomized, double blind, placebo-controlled, multicenter trial

BMC Musculoskeletal Disorders ◽

10.1186/s12891-020-03720-5 ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Elisabeth Gjefsen ◽

Lars Christian Haugli Bråten ◽

Guro Løvik Goll ◽

Monica Wigemyr ◽

Nils Bolstad ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Chronic Low Back Pain ◽

Treatment Strategy ◽

Treatment Options ◽

Modic Changes ◽

Low Back ◽

Double Blind ◽

Link Type

Abstract Background Low back pain is common and a significant number of patients experience chronic low back pain. Current treatment options offer small to moderate effects. Patients with vertebral bone marrow lesions visualized as Modic changes on magnetic resonance imaging may represent a subgroup within the low back pain population. There is evidence for inflammatory mediators being involved in development of Modic changes; hence, suppression of inflammation could be a treatment strategy for these patients. This study examines the effect of anti-inflammatory treatment with the TNF-α inhibitor infliximab in patients with chronic low back pain and Modic changes. Methods/design The BackToBasic trial is a multicenter, double blind, randomized controlled trial conducted at six hospitals in Norway, comparing intravenous infusions with infliximab with placebo. One hundred twenty-six patients aged 18–65 with chronic low back pain and type 1 Modic changes will be recruited from secondary care outpatients’ clinics. The primary outcome is back pain-specific disability at day 154 (5 months). The study is designed to detect a difference in change of 10 (SD 18) in the Oswestry Disability Index at day 154/ 5 months. The study also aims to refine MRI-assessment, investigate safety and cost-effectiveness and explore the underlying biological mechanisms of Modic changes. Discussion Finding treatments that target underlying mechanisms could pose new treatment options for patients with low back pain. Suppression of inflammation could be a treatment strategy for patients with low back pain and Modic changes. This paper presents the design of the BackToBasic study, where we will assess the effect of an anti-inflammatory treatment versus placebo in patients with chronic low back pain and type 1 Modic changes. The study is registered at ClinicalTrials.gov under the identifier NCT03704363. The EudraCT Number: 2017–004861-29.

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Physiotherapists’ views of implementing a stratified treatment approach for patients with low back pain in Germany: a qualitative study

BMC Health Services Research ◽

10.1186/s12913-018-2991-3 ◽

2018 ◽

Vol 18 (1) ◽

Cited By ~ 4

Author(s):

Sven Karstens ◽

Pauline Kuithan ◽

Stefanie Joos ◽

Jonathan C. Hill ◽

Michel Wensing ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Qualitative Study ◽

Treatment Approach ◽

Low Back

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Low-back pain as the presenting sign in a patient with a giant, sacral cellular schwannoma: 10-year follow-up

Journal of Neurosurgery Spine ◽

10.3171/2010.10.spine1015 ◽

2011 ◽

Vol 14 (2) ◽

pp. 167-171 ◽

Cited By ~ 7

Author(s):

Alex Alfieri ◽

Mauro Campello ◽

Maximilian Broger ◽

Mario Vitale ◽

Andreas Schwarz

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Treatment Options ◽

Residual Tumor ◽

Low Back ◽

Cellular Schwannoma ◽

Feeding Vessels ◽

Sacral Tumors

Giant sacral tumors present unique challenges to surgeons because there is no established consensus regarding the best treatment options. The authors report on the care of and outcome in a patient presenting with low-back pain only, who underwent preoperative biopsy sampling and subsequent embolization of the feeding vessels of a giant, sacral cellular schwannoma. The main procedure was performed via a combined posterior-anterior approach with complete microsurgical removal of the tumor, without the use of instrumentation, bracing, or adjuvant radio- and chemotherapy. At the 10-year follow-up, no evidence of residual tumor, recurrence, or instability was recognizable. Giant, sacral cellular schwannomas can be aggressively completely removed without any significant morbidity, achieving long-term control of the disease.

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Lumbar Disc Disorders

10.1093/med/9780199350940.003.0013 ◽

2018 ◽

Author(s):

Daniel Kline ◽

Michael DePalma

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Imaging Techniques ◽

Lumbar Disc ◽

Adult Population ◽

Treatment Options ◽

Diagnosis And Treatment ◽

Low Back ◽

Accurate Identification ◽

Discogenic Low Back Pain

This chapter focuses on the diagnosis and treatment of discogenic low back pain. Discogenic low back pain is a prevalent condition that affects a large percentage of the adult population. Diagnosis and treatment of this condition remain challenging despite ongoing advances. Provocation lumbar discography has allowed for more accurate identification of painful discs than conventional imaging techniques. Current research focusing on regenerative treatment options may hold promise for the future.

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An Unusual Case of Radicular Pain Caused by Bilateral Lumbar Synovial Cyst: A Case Report and Review of the Literature

Case Reports in Orthopedics ◽

10.1155/2020/8821332 ◽

2020 ◽

Vol 2020 ◽

pp. 1-6

Author(s):

David Ruiz-Picazo ◽

José Ramírez-Villaescusa ◽

Ana Verdejo-González

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Treatment Options ◽

Synovial Cyst ◽

Radicular Pain ◽

Magnetic Resonance Images ◽

Leg Pain ◽

Low Back ◽

Disc Disease ◽

Management Options

Introduction. Spinal synovial cysts (SSCs) constitute an uncommon degenerative lesion of the spine. They are usually asymptomatic but they may also cause symptoms of variable severity. SSCs are benign growths adjoining the facet joints that may induce low back pain, lumbar radiculopathy, and neurological deficit. There are different treatment options that range from conservative management to interventions like image-guided epidural steroid injection or direct cyst puncture and finally to open or endoscopic spinal canal decompression and spinal bone fusion with/without instrumentation. A discussion of current management options for this unusual disease is presented. Material and Methods. A 52-year-old female patient presented with low back pain and left leg pain. Plain radiography demonstrated instability at the L4-L5 level. Magnetic resonance images (MRIs) revealed a bilateral cystic lesion at the L4-L5 level with associated instability and degenerative disc disease at the level L5-S1. Initially, conservative treatment was performed by aspiration of the left cyst and infiltration with corticosteroids with improvement of the pain for 1 year. After this period, the radicular and the low back pain reoccurred. Results. Following leg pain recurrence, a hybrid L4-S1 fusion was performed. After surgery, there was clinical improvement and six months later, the patient returned to daily activities. The radiological study after five-year follow-up shows adequate implant position, without signs of loosening, compatible with solid fusion. Conclusion. After reviewing the literature, the optimal management for patients with symptomatic lumbar synovial cyst must be very individualized, which is essential to achieve a favorable outcome.

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How Do Pain-Response Patterns Influence the Course of Acute Low Back Pain? A Longitudinal Cohort Study

10.21203/rs.3.rs-110189/v1 ◽

2020 ◽

Author(s):

Ursula Surbeck ◽

Fabian Pfeiffer ◽

Sabina Hotz-Boendermaker

Keyword(s):

Cohort Study ◽

Low Back Pain ◽

Back Pain ◽

Pain Intensity ◽

Movement Control ◽

Pain Response ◽

Clinical Approach ◽

Low Back ◽

Response Patterns ◽

Acute Low Back Pain

Abstract Background Pain-response patterns influence the daily activities and behavior of patients with low back pain (LBP). They are also a potential risk factor for pain persistence. Previous studies identified three subgroups of pain-response patterns: avoidance, endurance, and adaptive. In this study, we investigated the interaction effects of distinct pain-response patterns on pain intensity, disability and movement control impairment (MCI). Methods The 66 participants in this prospective cohort study had acute LBP, assessed at four time points over 6 months. Demographic, clinical and psychosocial data were collected, and MCI was examined.Results The results showed no significant between-group interactions of the different pain-response patterns with pain intensity, disability or MCI. However, within-group decreases in pain intensity and the disability level from the acute to the subacute phase were identified. In addition, the relative risk of persistent LBP was higher in the endurance response subgroup than in the adaptive subgroup at 6 months. MCI remained stable and at a low level throughout the observation period and did not correlate with pain or disability.Conclusions Screening for pain-response patterns may lead to a better understanding of patients’ underlying motivation in the broader context of their valued goals. Our findings provide further evidence of altered movement control throughout the course of LBP and thus the importance of early interventions. However, MCI tests allowing more subtle assessments of movement control are needed. Finally, patients with an acute episode of LBP may benefit from a multidimensional clinical approach that takes into account both physical and psychological health.

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