scholarly journals Diagnostic Utility of Selective Nerve Root Blocks in the Diagnosis of Lumbosacral Radicular Pain: Systematic Review and Update of Current Evidence

2013 ◽  
Vol 2s;16 (2s;4) ◽  
pp. SE97-SE124
Author(s):  
Laxmaiah Manchikanti
Keyword(s):  
Systematic Review ◽  
Low Back Pain ◽  
Lower Extremity ◽  
Diagnostic Tool ◽  
Nerve Root ◽  
Radicular Pain ◽  
Low Back ◽  
Limited Evidence ◽  
Lower Extremity Pain ◽  
Nerve Root Blocks

Background: Lumbosacral selective nerve root blocks and/ or transforaminal epidural injections are used for diagnosis and treatment of different disorders causing low back and lower extremity pain. A clear consensus on the use of selective nerve root injections as a diagnostic tool does not currently exist. Additionally, the validity of this procedure as a diagnostic tool is not clear. Objective: To evaluate and update the accuracy of selective nerve root injections in diagnosing lumbar spinal disorders. Study Design: A systematic review of selective nerve root blocks for the diagnosis of low back and lower extremity pain. Methods: Methodological quality assessment of included studies was performed using the Quality Appraisal of Reliability Studies (QAREL) checklist. Only diagnostic accuracy studies meeting at least 50% of the designated inclusion criteria were utilized for analysis. Studies scoring less than 50% are presented descriptively and analyzed critically. The level of evidence was classified as good, fair, or limited or poor based on the quality of evidence grading scale developed by the United States Preventive Services Task Force (USPSTF). Data sources included relevant literature identified through searches of PubMed and EMBASE from 1966 to September 2012, and manual searches of the bibliographies of known primary and review articles. Outcome Measures: In this review, we evaluated studies in which controlled local anesthetic blocks were performed using at least 50% pain relief as the reference standard. Results: There is limited evidence for the accuracy of selective nerve root injections as a diagnostic tool for lumbosacral disorders. There is limited evidence for their use in the preoperative evaluation of patients with negative or inconclusive imaging studies. Limitations: The limitations of this systematic review include a paucity of literature, variations in technique, and variable criterion standards for the diagnosis of lumbar radicular pain. Conclusions: There is limited evidence for selective nerve root injections as a diagnostic tool in evaluating low back pain with radicular features. However, their role needs to be further clarified by additional research and consensus. Key words: Low back pain, lower extremity pain, selective nerve root block, transforaminal epidural injection, discogenic pain, radiculitis, sciatica radiculopathy, nerve root pain

scholarly journals Systematic Review of Effectiveness and Complications of Adhesiolysis in the Management of Chronic Spinal Pain: An Update

2007 ◽  
Vol 1;10 (1;1) ◽  
pp. 129-146
Author(s):  
Andrea M Trescot
Keyword(s):  
Systematic Review ◽  
Low Back Pain ◽  
Back Pain ◽  
Lower Extremity ◽  
Randomized Trials ◽  
Spinal Pain ◽  
Low Back ◽  
Short Term ◽  
Lower Extremity Pain

Background: Percutaneous epidural adhesiolysis and spinal endoscopic adhesiolysis are interventional pain management techniques used to treat patients with refractory low back pain due to epidural scarring. Standard epidural steroid injections are often ineffective, especially in patients with prior back surgery. Adhesions in the epidural space can prevent the flow of medicine to the target area; lysis of these adhesions can improve the delivery of medication to the affected areas, potentially improving the therapeutic efficacy of the injected medications. Study Design: A systematic review utilizing the methodologic quality criteria of the Cochrane Musculoskeletal Review Group for randomized trials and the criteria established by the Agency for Healthcare Research and Quality (AHRQ) for evaluation of randomized and non-randomized trials. Objective: To evaluate and update the effectiveness of percutaneous adhesiolysis and spinal endoscopic adhesiolysis in managing chronic low back and lower extremity pain due to radiculopathy, with or without prior lumbar surgery, since the 2005 systematic review. Methods: Basic search identified the relevant literature, in the MEDLINE, EMBASE, and BioMed databases (November 2004 to September 2006). Manual searches of bibliographies of known primary and review articles, and abstracts from scientific meetings within the last 2 years were reviewed. Randomized and non-randomized studies are included in the review based on criteria established. Percutaneous adhesiolysis and endoscopic adhesiolysis are analyzed separately. Outcome Measures: The primary outcome measure was significant pain relief (50% or greater). Other outcome measures were functional improvement, improvement of psychological status, and return to work. Short-term relief was defined as less than 3 months, and long-term relief was defined as 3 months or longer. Results: Studies regarding the treatment of epidural adhesions for the treatment of low back and lower extremity pain were sought and reviewed. The evidence from the previous systematic review was combined with new studies since November 2004. There is strong evidence for short term and moderate evidence for long term effectiveness of percutaneous adhesiolysis and spinal endoscopy. Conclusion: Percutaneous adhesiolysis and spinal endoscopy may be effective interventions to treat low back and lower extremity pain caused by epidural adhesions. Key Words: Spinal pain, chronic low back pain, percutaneous adhesiolysis, spinal endoscopic adhesiolysis, spinal stenosis, post lumbar laminectomy syndrome, epidural fibrosis, epidural adhesions, caudal neuroplasty.

scholarly journals Lumbar Interlaminar Epidural Injections in Managing Chronic Low Back and Lower Extremity Pain: A Systematic Review

2009 ◽  
Vol 1;12 (1;1) ◽  
pp. 163-188 ◽  
Author(s):  
Allan T. Parr
Keyword(s):  
Systematic Review ◽  
Lower Extremity ◽  
Spinal Stenosis ◽  
Disc Herniation ◽  
Low Back ◽  
Short Term ◽  
Discogenic Pain ◽  
Epidural Injections ◽  
Lower Extremity Pain

Background: Low back pain with or without lower extremity pain is the most common problem among chronic pain disorders with significant economic, societal, and health impact. Epidural injections are one of the most commonly performed interventions in the United States in managing chronic low back pain. However the evidence is highly variable among different techniques utilized – namely interlaminar, caudal, transforaminal – and for various conditions, namely – intervertebral disc herniation, spinal stenosis, and discogenic pain without disc herniation or radiculitis. Study Design: A systematic review of lumbar interlaminar epidural injections with or without steroids. Objective: To evaluate the effect of lumbar interlaminar epidural injections with or without steroids in managing various types of chronic low back and lower extremity pain emanating as a result of disc herniation or radiculitis, spinal stenosis, and chronic discogenic pain. Methods: Review of the literature and methodologic quality assessment were performed according to the Cochrane Musculoskeletal Review Group Criteria as utilized for interventional techniques for randomized trials and the Agency for Healthcare Research and Quality (AHRQ) criteria for observational studies. The level of evidence was classified as Level I, II, or III based on the quality of evidence developed by the U.S. Preventive Services Task Force (USPSTF) for therapeutic interventions. Data sources included relevant literature of the English language identified through searches of PubMed and EMBASE from 1966 to November 2008, and manual searches of bibliographies of known primary and review articles. Results of analysis were performed for multiple conditions separately. Outcome Measures: The primary outcome measure was pain relief (short-term relief = up to 6 months and long-term > 6 months). Secondary outcome measures were improvement in functional status, psychological status, return to work, and reduction in opioid intake. Results: The available literature included only blind epidural injections without fluoroscopy. The indicated evidence is positive (Level II-2) for short-term relief of pain of disc herniation or radiculitis utilizing blind interlaminar epidural steroid injections with lacking of evidence with Level III for long-term relief for disc herniation and radiculitis. The evidence is lacking with Level III for short and long-term relief for spinal stenosis and discogenic pain without radiculitis or disc herniation utilizing blind epidural injections. Limitations: The limitations of this study include paucity of literature, lack of quality evidence, lack of fluoroscopic procedures, and lack of applicable evidence in contemporary interventional pain management practices. Conclusion: The evidence based on this systematic review is limited for blind interlaminar epidurals in managing all types of pain except for short-term relief of pain secondary to disc herniation and radiculitis. This evidence does not represent contemporary interventional pain management practices and also the evidence may not be extrapolated to fluoroscopically directed lumbar interlaminar epidural injections. Key words: Chronic low back pain, lower extremity pain, disc herniation, radiculitis, spinal stenosis, discogenic pain, lumbar interlaminar epidural injections, caudal epidural injections, transforaminal epidural injections, epidural steroids, local anesthetic

Low back pain in persons with lower extremity amputation: a systematic review of the literature

2019 ◽  
Vol 19 (3) ◽  
pp. 552-563 ◽  
Author(s):  
M. Jason Highsmith ◽  
Lisa M. Goff ◽  
Amanda L. Lewandowski ◽  
Shawn Farrokhi ◽  
Brad D. Hendershot ◽  
...  
Keyword(s):  
Systematic Review ◽  
Low Back Pain ◽  
Back Pain ◽  
Lower Extremity ◽  
Lower Extremity Amputation ◽  
Low Back ◽  
Review Of The Literature ◽  
Extremity Amputation

scholarly journals Analgesic medicines for adults with low back pain: protocol for a systematic review and network meta-analysis

2020 ◽  
Vol 9 (1) ◽  
Author(s):  
Michael A. Wewege ◽  
◽  
Matthew K. Bagg ◽  
Matthew D. Jones ◽  
James H. McAuley
Keyword(s):  
Systematic Review ◽  
Low Back Pain ◽  
Back Pain ◽  
Analgesic Effect ◽  
Meta Analysis ◽  
Low Back ◽  
Randomised Trials ◽  
Limited Evidence ◽  
Pain Duration ◽  
Secondary Outcomes

Abstract Background There is limited evidence for the comparative effectiveness of analgesic medicines for adults with low back pain. This systematic review and network meta-analysis aims to determine the analgesic effect, safety, acceptability, effect on function, and relative rank according to analgesic effect, safety, acceptability, and effect on function of a single course of [an] analgesic medicine(s) or combination of these medicines for people with low back pain. Methods We will include published and unpublished randomised trials written in any language that compare an analgesic medicine to either another medicine, placebo/sham, or no intervention in adults with low back pain, grouped according to pain duration: acute (fewer than 6 weeks), sub-acute (6 to 12 weeks), and chronic (greater than 12 weeks). The co-primary outcomes are pain intensity following treatment and safety (adverse events). The secondary outcomes are function and acceptability (all-cause dropouts). We will perform a network meta-analysis to compare and rank analgesic medicines. We will form judgements of confidence in the results using the Confidence in Network Meta-Analysis (CINeMA) methodology. Discussion This network meta-analysis will establish which medicine, or combination of medicines, is most effective for reducing pain and safest for adults with low back pain. Systematic review registration PROSPERO CRD42019145257

Diagnostic accuracy of self-report and subjective history in the diagnosis of low back pain with non-specific lower extremity symptoms: A systematic review

2015 ◽  
Vol 20 (1) ◽  
pp. 18-27 ◽  
Author(s):  
Susan Shultz ◽  
Kristina Averell ◽  
Angela Eickelman ◽  
Holly Sanker ◽  
Megan Burrowbridge Donaldson
Keyword(s):  
Systematic Review ◽  
Low Back Pain ◽  
Back Pain ◽  
Lower Extremity ◽  
Diagnostic Accuracy ◽  
Self Report ◽  
Low Back
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