The value of quantitative sensory testing in spine research

Anja Tschugg,Wolfgang N Löscher,Claudius Thomé,Sara Lener,Sabrina Neururer,Matthias Wildauer,Sebastian Hartmann

doi:10.1007/s10143-016-0798-4

Anja Tschugg, Wolfgang N Löscher + Show 5 more

Open Access

https://doi.org/10.1007/s10143-016-0798-4

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Journal: Neurosurgical review	Publication Date: Nov 28, 2016
Citations: 10	License type: open-access

Affiliation: Innsbruck Medical University

Abstract

The improvement of pain and functionality is the major goal of a surgical intervention. Thus, the purpose of the present prospective study was to evaluate whether subjective sensory deficits in patients with lumbar radiculopathy caused by a lumbar disc herniation are related to clinical status, using several outcome scores and the quantitative sensory testing (QST) pre- and 12 months postoperatively. We applied the QST in 52 patients with a single lumbar disc herniation treated by lumbar sequestrectomy pre- and 12 months postoperatively. Further evaluation included numeric rating scale (NRS) for leg, EuroQoL-5D (EQ-5D), Core Outcome Measure Index (COMI), Oswestry Disability Index (ODI), Beck Depression Inventory (BDI) and PaindDetect questionnaire (PD-Q). Patients were then categorized into two groups based on their subjective recovery of sensory function. The patients’ self-assessment and QST were correlated with each other for the pre- and postoperative visit after 12 months. The two groups showed postoperative differences in mechanical and vibration detection threshold as well as in the postoperative PD-Q (p < 0.005). Multidimensional scores did not consistently match the QST parameters in patients with a lumbar disc herniation. Commonly used clinical scores in spine research show low or no correlation with QST. Nevertheless, mechanical thresholds seem to play an important role to detect and follow up a sensory deficit investigated by QST.

Highlights

Due to the high prevalence of spinal degenerative diseases, the frequency of surgical interventions for degenerative spine pathologies rose dramatically within the last decade [2, 13]
The most common pain scales and functional scores used in spine research are the numeric rating scale (NRS) and the Oswestry Disability Index (ODI) [7]
Lumbar sequestrectomy resulted in a dramatic reduction of leg pain at rest (NRS 6.0 ± 2 vs. 0.8 ± 2) postoperatively (p = 0.000)

Summary

Introduction

Due to the high prevalence of spinal degenerative diseases, the frequency of surgical interventions for degenerative spine pathologies rose dramatically within the last decade [2, 13]. The use of standardized outcome instruments is important to document the treatment effects of surgical interventions and point out potential advantages of new surgical techniques, in the setting of prospective comparative trials. The most common pain scales and functional scores used in spine research are the numeric rating scale (NRS) and the Oswestry Disability Index (ODI) [7]. Quantitative sensory testing (QST) gained popularity as a diagnostic tool to quantify pain and assess sensory function, especially to document a treatment’s effectiveness [9, 10, 16, 19,20,21]. There is still controversy regarding the current evidence for the association between QST values and the patient’s reported pain and sensory intensity, disability and quality of life [8]

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Conclusion