Relationship between Severity of Lumbar Disc Disease and Disability Scores in Sciatica Patients

Abstract OBJECTIVE To study the association between the clinical examination and the radiological assessment of lumbar disc disease in patients with sciatica. METHODS The study included 394 consecutive sciatica patients. The patients’ disabilities were evaluated by a visual analog pain scale, the Prolo functional-economic rating scale, the modified Roland-Morris disability questionnaire, and the health-related quality of life short form (SF-36) questionnaire. Radiological imaging findings were independently classified according to the Modic criteria into five groups of increasing severity of disc disease. Stepwise multivariate logistic regression was used to determine which scores were significant independent predictors of a severe disc disease (extrusion or sequestration). RESULTS Of these patients, 9.6% had no disc disease, 3.3% had a bulging, 11.4% had a protrusion, 68.5% had an extrusion, and 7.1% had a disc sequestration. Statistically significant positive linear associations with the severity of disc disease were found for the leg pain scale, the Roland-Morris and Prolo disability scales, and the SF-36 scores related to physical functioning, physical role, and bodily pain (all P < 0.005). A poor (<5) Prolo score (odds ratio, 2.91; 95% confidence interval, 1.74–4.87), a higher leg pain score (odds ratio, 1.16 per centimeter increase; 95% confidence interval, 1.07–1.27), and a lower low back pain score (odds ratio, 0.90 per centimeter decrease; 95% confidence interval, 0.82–0.98) were retained in the multivariate logistic model as independent predictors of severe disc disease. CONCLUSION The positive correlation between disability status and imaging findings validates both assessment methods. Routine use of disability scores brings a useful contribution to the assessment of sciatica patients.

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Does the Intradiscal Injection of Platelet Rich Plasma Have Any Beneficial Role in the Management of Lumbar Disc Disease?

Global Spine Journal ◽

10.1177/2192568221998367 ◽

2021 ◽

pp. 219256822199836

Author(s):

Sathish Muthu ◽

Madhan Jeyaraman ◽

Girinivasan Chellamuthu ◽

Naveen Jeyaraman ◽

Rashmi Jain ◽

...

Keyword(s):

Beneficial Effect ◽

Platelet Rich Plasma ◽

Lumbar Disc ◽

Meta Analysis ◽

Cochrane Library ◽

Significant Heterogeneity ◽

Disc Disease ◽

Lumbar Disc Disease ◽

Beneficial Role ◽

Sf 36

Study Design: Systematic review and meta-analysis. Objectives: We performed this meta-analysis to evaluate whether intradiscal Platelet Rich Plasma(PRP) injection has any beneficial role in the management of lumbar disc disease. Methods: We conducted independent and duplicate electronic database searches including PubMed, Embase, and Cochrane Library till September 2020 for studies investigating the role of intradiscal PRP in the management of lumbar disc disease. The analysis was performed in the R platform using OpenMeta[Analyst] software. Results: 13 studies including 2 RCTs, 5 prospective, and 6 retrospective studies involving 319 patients were included in the meta-analysis. A single-arm meta-analysis of the included studies showed a beneficial effect of the intervention in terms of pain relief outcomes like VAS score (p < 0.001), pain component of SF-36 (p = 0.003) while such improvement was not seen in functional outcome measures like ODI score (p = 0.071), the physical component of SF-36 (p = 0.130) with significant heterogeneity noted among the included studies. No structural improvement in magnetic resonance imaging was observed (p = 0.106). No additional procedure-related adverse events were noted in the included studies (p = 0.662). Conclusion: There is a paucity of high-quality studies to give conclusive evidence on the benefits of intradiscal PRP for lumbar disc disease. Although intradiscal PRP injection has shown some beneficial effect in controlling pain for lumbar disc disease, we could not find structural or functional improvement from the included studies. Hence, we recommend large double-blind double-arm randomized controlled studies to analyze the benefits of the intervention being analyzed.

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Encouraging Medium-term Results of Wallis Second Generation Dynamic Stabilisation Device

Ortopedia Traumatologia Rehabilitacja ◽

10.5604/01.3001.0012.0429 ◽

2018 ◽

Vol 20 (2) ◽

pp. 149-156

Author(s):

Awaiz Ahmed ◽

Abdulla Jawed ◽

Murali Venkatesan ◽

James Doyle

Keyword(s):

Oswestry Disability Index ◽

Second Generation ◽

Lumbar Disc ◽

Leg Pain ◽

Medium Term ◽

Disc Disease ◽

Lumbar Disc Disease ◽

Dynamic Stabilisation ◽

The Mean

Background. Aim of this prospective study was to evaluate safety and efficacy of second generation Wallis system for degenerative lumbar disc disease. Material and methods. 25 patients underwent discectomy and insertion of Wallis system. Outcome assessment was done using Modified Oswestry disability index (ODI) and visual analogue scale (VAS) for backache and leg pain. Results. The mean follow-up was 20.5 months. The mean VAS for backache and leg pain showed significant improvement from 7.2 to 3.0 (p<0.001) and mean modified Oswestry disability index showed significant improvement from 59.1 to 24.7 (p<0.001). Only one patient (4%) underwent revision surgery for persistent pain due to granulation tissue deep to the implant. There were no other complications. Conclusion. The Wallis spine system is a safe and effective implant for treating degenerative lumbar disc disease.

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The long-term results of chymopapain chemonucleolysis for lumbar disc disease

Journal of Neurosurgery ◽

10.3171/jns.1986.65.1.0001 ◽

1986 ◽

Vol 65 (1) ◽

pp. 1-8 ◽

Cited By ~ 7

Author(s):

Robert J. Maciunas ◽

Burton M. Onofrio

Keyword(s):

Surgical Procedures ◽

Lumbar Disc ◽

Leg Pain ◽

Long Term Results ◽

Disc Disease ◽

Lumbar Disc Disease ◽

Content Type ◽

Work Related ◽

Effective Treatment Modality

✓ The long-term clinical outcome is evaluated for 268 patients after chymopapain chemonucleolysis for radicular complaints referrable to documented intervertebral disc disease. The follow-up period for 92% of these patients was 10 years. No complications due to chymopapain toxicity were observed; 80.1% of patients were relieved of their presenting radicular leg pain and 75.1% were employed at a capacity equal to or more strenuous than before injection. Chemonucleolysis was demonstrated to be a safe and effective treatment modality, with long-term results that compare favorably with those of similarly selected patients undergoing open surgical procedures. In the patients whose chymopapain therapy failed, the outcome of subsequent open surgical procedures was not necessarily compromised by prior chemonucleolysis. A higher rate of failure and subsequent surgical intervention was seen in those patients with injections performed soon after an unsuccessful open procedure on the same side and at the same interspace, those with workmen's compensation or litigation pending, those with a history of work-related injury, those whose employment involved heavy manual labor or extensive driving, and those whose preinjection spine x-ray films indicated retrograde spondylolisthesis.

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Patient Weight as a Predictor of Pain Response to Morphine in the Emergency Department

Journal of Pharmacy Practice ◽

10.1177/0897190010362772 ◽

2010 ◽

Vol 24 (1) ◽

pp. 109-113 ◽

Cited By ~ 4

Author(s):

Asad E. Patanwala ◽

Adam D. Biggs ◽

Brian L. Erstad

Keyword(s):

Emergency Department ◽

Confidence Interval ◽

Pain Score ◽

Odds Ratio ◽

Retrospective Chart Review ◽

Pain Scale ◽

Pain Response ◽

Point Reduction ◽

Dosing Strategies ◽

Patient Weight

Study Objectives: There is little evidence that patient weight is associated with pain response to morphine in the emergency department (ED). The primary outcome of this study is to identify demographic variables including patient weight that are associated with an adequate pain reduction after the first dose of morphine. Methods: A retrospective chart review of all patients with severe nontraumatic abdominal pain receiving intravenous morphine was conducted in our ED over a 3-month time period. Pain score, using an 11-point verbal numerical pain scale (0-10), was measured before and after each dose of morphine. Adequate response was defined as a ≥ 4-point reduction from baseline pain score. Results: A total of 105 patients were included in the analysis. Univariate logistic regression analyses stratified by dose (2 or 4 mg) showed that patient weight was not predictive of adequate pain response after the first dose of morphine (2 mg: odds ratio = 1; 95% confidence interval 0.97-1.03; P = .88; 4 mg: odds ratio = 1; 95% confidence interval 0.97-1.03; P = .86). Conclusions: Patient weight may not predict pain response to morphine in the ED. Dosing strategies based on patient weight may not be necessary in this patient population.

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Surgically treated lumbar disc disease in the pediatric population: an outcome study

Journal of Neurosurgery Spine ◽

10.3171/spi.2000.92.1.0001 ◽

2000 ◽

Vol 92 (1) ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Susan R. Durham ◽

Peter P. Sun ◽

Leslie N. Sutton

Keyword(s):

Back Pain ◽

Pediatric Population ◽

Lumbar Disc ◽

Disc Disease ◽

Lumbar Disc Disease ◽

Content Type ◽

Sf 36 ◽

Study Population ◽

Fine Print

Object. This outcome study was undertaken to investigate the long-term results obtained in surgically treated pediatric patients with lumbar disc disease by using standardized medical outcome scales and clinical follow-up examination. Methods. Twenty nine patients 17 years of age or younger underwent surgery between 1968 and 1998 for lumbar disc disease. The follow-up period ranged from 4 months to 30.5 years (mean 8.5 years). Outcome scores (health profiles) were generated using a standardized medical outcome scale, the Short Form health survey questionnaire (SF-36), and a condition-specific back pain outcome scale. Clinical follow-up data were obtained by telephone interview. The health profile of the study population closely paralleled that of the normal population and was distinctly different from the health profile of adults with low-back pain. Only physical functioning, as measured by a scale of the SF-36, was found to be impaired in a subset of the study population. The rate of reoperation was 24% over the course of the follow-up period. In contrast to similar studies in adults, there were no identifiable predictive factors for either reoperation or poor outcome. Conclusions. Lumbar disc disease in the pediatric population does not appear to lead to chronic complaints of back pain, and it does not appear to have a negative impact on overall health. This finding suggests that pediatric lumbar disc disease may be a separate entity distinct from adult lumbar disc disease, and therefore, the same conclusions regarding long-term outcome cannot be applied to the pediatric population.

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Lumbar disc arthroplasty versus anterior lumbar interbody fusion: 5-year outcomes for patients in the Maverick disc investigational device exemption study

Journal of Neurosurgery Spine ◽

10.3171/2019.2.spine181037 ◽

2019 ◽

Vol 31 (3) ◽

pp. 347-356

Author(s):

Matthew F. Gornet ◽

J. Kenneth Burkus ◽

Randall F. Dryer ◽

John H. Peloza ◽

Francine W. Schranck ◽

...

Keyword(s):

Interbody Fusion ◽

Lumbar Disc ◽

Neurological Status ◽

Leg Pain ◽

Lumbar Interbody Fusion ◽

Disc Disease ◽

Disc Arthroplasty ◽

Investigational Device Exemption ◽

Sf 36 ◽

Lumbar Disc Arthroplasty

OBJECTIVEDespite evidence of its safety and effectiveness, the use of lumbar disc arthroplasty has been slow to expand due in part to concerns about late complications and the risks of revision surgery associated with early devices. More recently, FDA approval of newer devices and improving reimbursements have reversed this trend in the United States. Additional long-term data on lumbar disc arthroplasty are still needed. This study reports the 5-year results of the FDA investigational device exemption clinical trial of the Medtronic Spinal and Biologics’ Maverick total disc replacement.METHODSPatients with single-level degenerative disc disease from L4 to S1 were randomized 2:1 at 31 investigational sites. In the period from April 2003 to August 2004, 405 patients received the investigational device and 172 patients underwent the control procedure of anterior lumbar interbody fusion. Outcome measures included the Oswestry Disability Index (ODI), numeric rating scales (NRSs) for back and leg pain, the SF-36, disc height, interbody motion, heterotopic ossification (investigational device), adverse events (AEs), additional surgeries, and neurological status. Treatment was considered an overall success when all of the following criteria were met: 1) ODI score improvement ≥ 15 points over the preoperative score; 2) maintenance or improvement in neurological status compared with preoperatively; 3) disc height success, that is, no more than a 2-mm reduction in anterior or posterior height; 4) no serious AEs caused by the implant or by the implant and the surgical procedure; and 5) no additional surgery classified as a failure.RESULTSCompared to that in the control group, improvement in the investigational group was statistically greater according to the ODI and SF-36 Physical Component Summary (PCS) at 1, 2, and 5 years; the NRS for back pain at 1 and 2 years; and the NRS for leg pain at 1 year. The rates of heterotopic ossification increased over time: 1.0% (4/382) at 1 year, 2.6% (9/345) at 2 years, and 5.9% (11/187) at 5 years. Investigational patients had fewer device-related AEs and serious device-related AEs than the control patients at both 2 and 5 years postoperatively. Noninferiority of the composite measure overall success was demonstrated at all follow-up intervals; superiority was demonstrated at 1 and 2 years.CONCLUSIONSLumbar disc arthroplasty is a safe and effective treatment for single-level lumbar degenerative disc disease, resulting in improved physical function and reduced pain up to 5 years after surgery.Clinical trial registration no.: NCT00635843 (clinicaltrials.gov)

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