Effectiveness of active soft tissue release and trigger point block for the diagnosis and treatment of low back and leg pain of predominantly gluteus medius origin: a report of 115 cases

OBJECTIVEPersistent lumbar foraminal stenosis (LFS) is one of the most common reasons for poor postoperative outcomes and is a major contributor to “failed back surgery syndrome.” The authors describe a new surgical strategy for LFS based on anatomical considerations using 3D image fusion with MRI/CT analysis.METHODSA retrospective review was conducted on 78 consecutive patients surgically treated for LFS at the lumbosacral junction (2013–2017). The location and extent of stenosis, including the narrowest site and associated pathology (bone or soft tissue), were measured using 3D image fusion with MRI/CT. Stenosis was defined as medial intervertebral foraminal (MF; inner edge to pedicle center), lateral intervertebral foraminal (LF; pedicle center to outer edge), or extraforaminal (EF; outside the pedicle). Lumbar (low-back pain, leg pain) and patient satisfaction visual analog scale (VAS) scores and Japanese Orthopaedic Association (JOA) scores were evaluated. Surgical outcome was evaluated 2 years postoperatively.RESULTSMost instances of stenosis existed outside the pedicle’s center (94%), including LF (58%), EF (36%), and MF (6%). In all MF cases, stenosis resulted from soft-tissue structures. The narrowest stenosis sites were localized around the pedicle’s outer border. The areas for sufficient nerve decompression were extended in MF+LF (10%), MF+LF+EF (14%), LF+EF (39%), LF (11%), and EF (26%). No iatrogenic pars interarticularis damage occurred. The JOA score was 14.9 ± 2.6 points preoperatively and 22.4 ± 3.5 points at 2 years postoperatively. The JOA recovery rate was 56.0% ± 18.6%. The VAS score (low-back and leg pain) was significantly improved 2 years postoperatively (p < 0.01). According to patients’ self-assessment of the minimally invasive surgery, 62 (79.5%) chose “surgery met my expectations” at follow-up. Nine patients (11.5%) selected “I did not improve as much as I had hoped but I would undergo the same surgery for the same outcome.”CONCLUSIONSMost LFS existed outside the pedicle’s center and was rarely noted in the pars region. The main regions of stenosis were localized to the pedicle’s outer edge. Considering this anatomical distribution of LFS, the authors recommend that lateral fenestration should be the first priority for foraminal decompression. Other surgical options including foraminotomy, total facetectomy, and hemilaminectomy likely require more bone resections than LFS treatment. The microendoscopic surgery results were very good, indicating that this minimally invasive surgery was suitable for treating this disease.

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Middle cluneal nerve entrapment neuropathy attributable to lumbar disc herniation

Surgical Neurology International ◽

10.25259/sni_167_2021 ◽

2021 ◽

Vol 12 ◽

pp. 132

Author(s):

Juntaro Matsumoto ◽

Toyohiko Isu ◽

Kyongsong Kim ◽

Koichi Miki ◽

Masanori Isobe

Keyword(s):

Nerve Block ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Trigger Point ◽

Lumbar Disc ◽

Nerve Entrapment ◽

Entrapment Neuropathy ◽

Leg Pain ◽

Low Back ◽

Middle Cluneal Nerve

Background: Middle cluneal nerve entrapment neuropathy (MCN-EN) is a known cause of low back pain (LBP). Here, we succeeded in treating a patient with a lumbar disc herniation who actually had MCN-EN with a nerve block and neurolysis. Case Description: A 52-year-old female presented with severe left lower back and lateral thigh pain making it difficult to walk. The lumbar MRI revealed a disc herniation on the left at the L5/S1 level. On palpation, we identified a trigger point on the buttock where the MCN penetrates the long posterior sacroiliac ligament between the posterior superior and inferior iliac spine. Two left-sided MCN blocks, followed by the left MCN neurolysis procedure, were performed under local anesthesia. At the last follow-up, 10 months after surgery, the LBP has not recurred, and she requires no medications for pain control. Conclusion: Here, a patient with a left-sided L5S1 disc herniation and low back/leg pain was successfully treated for MCN-EN with nerve block followed by neurolysis.

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Physiotherapists’ pain attitudes and beliefs towards chronic low back pain and their association with treatment selection: a cross-sectional study

BMJ Open ◽

10.1136/bmjopen-2020-037159 ◽

2020 ◽

Vol 10 (6) ◽

pp. e037159 ◽

Cited By ~ 1

Author(s):

Mansour Abdullah Alshehri ◽

Hosam Alzahrani ◽

Mazyad Alotaibi ◽

Ahmed Alhowimel ◽

Omar Khoja

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Soft Tissue ◽

Cross Sectional Study ◽

Treatment Selection ◽

Soft Tissue Release ◽

Attitudes And Beliefs ◽

Low Back ◽

Sectional Study ◽

Cross Sectional

ObjectivesThe main aim of this study was to investigate physiotherapists’ pain attitudes and beliefs towardss non-specific chronic low back pain (NSCLBP) and identify whether they are associated with treatment selection.DesignCross-sectional study.SettingSaudi Arabia (SA).ParticipantsAn online survey was distributed to physiotherapists from April 2018 to January 2019.Primary and secondary outcome measures(1) Biomedical and biopsychosocial treatment orientations were assessed using the Pain Attitudes and Beliefs Scale for Physiotherapists. (2) Frequent potential treatments used by physiotherapists for individuals with NSCLBP were identified through a 20-item survey. (3) The association between physiotherapists’ pain attitudes and beliefs and treatment selection was investigated. Descriptive analysis, Pearson’s correlation and multinomial logistic regression were used to analyse the data using SPSS (V.26).ResultsA total of 304 responses were included in the analysis. The biomedical (34.45±7.84) and biopsychosocial (31.74±5.67) treatment orientations were relatively low. The most frequent treatments used by physiotherapists were home exercises (87.1%), patient education (82.0%), specific back exercises (80.6%), electrotherapy (61.9%), soft tissue release (58.8%) and spinal mobilisation or manipulation (57.8%). Physiotherapists with a stronger biomedical treatment orientation were more likely to use treatments (p<0.05) such as specific back exercises, electrotherapy, soft tissue release, hydrotherapy, massage, lumbar supports and acupuncture. However, physiotherapists with a stronger biopsychosocial treatment orientation were more likely to use cognitive functional therapy (p<0.01).ConclusionsBiomedical and biopsychosocial treatment orientations were relatively low among physiotherapists in SA. Although treatments such as home exercises and patient education were frequently used, some passive and traditional treatments not recommended by clinical practice guidelines continue to be commonly used by physiotherapists in SA. This study has confirmed that physiotherapists’ pain attitudes and beliefs are significantly associated with treatment selection when managing individuals with NSCLBP.Trial registration numberResearchregistry3944.

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The Automatization of a New Thermography Method Using Invasive Nociceptive Stimulation to Confirm an Autonomic Phenomenon within a Trigger Point Referred Pain Zone

Brain Sciences ◽

10.3390/brainsci11070893 ◽

2021 ◽

Vol 11 (7) ◽

pp. 893

Author(s):

Elżbieta Skorupska ◽

Tomasz Dybek ◽

Michał Rychlik ◽

Marta Jokiel ◽

Paweł Dobrakowski

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Trigger Point ◽

Invasive Procedure ◽

Trigger Points ◽

International Classification Of Diseases ◽

Referred Pain ◽

Low Back ◽

Classification Of Diseases ◽

Software Utility

The trigger points (TrPs) related to chronic low back pain that mimic sciatica have been lately recognized and included in the International Classification of Diseases, 11th Revision. This study examined the MATLAB software utility for the objective stratification of low back pain patients using the Minimally Invasive Procedure (MIP). The two diagnostic MIP parameters were: average temperature (ΔTavr) and autonomic referred pain (AURP). Chronic sciatica patients with TrPs (n = 20) and without TrPs (n = 20) were examined using the MIP. A significant increase in both parameters was confirmed for the thigh ROI of the TrP-positive patients, with ΔTavr being the leading parameter (p = 0.016, Exp(β) = 2.603). A continued significance of both parameters was confirmed from 6′00″ to 15′30″ (p < 0.05). The maximum AURP value was confirmed at 13′30″ (p < 0.05) (TrPs(+) 20.4 ± 19.9% vs. TrPs(-) 3.77 ± 9.14%; p = 0.000; CI (0.347,0.348)).

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