Changes In Leg Pain Research Articles

Association of Abdominal Aortic Calcification and Clinical Outcomes in LDH Patients Treated with Endoscopic Lumbar Discectomy.

To determine any significant associations between abdominal aortic calcification (AAC) and clinical manifestations of pain symptoms following endoscopic lumbar discectomy. Patients sequentially presenting with a history of unilateral radiculopathy with or without back pain, and with magnetic resonance imaging (MRI)-confirmed diagnosis of posterolateral disc herniation between August 2021 and December 2023 were eligible for inclusion in the study. All patients underwent endoscopic discectomy at our center during the study period. AAC stages were classified based on the Kauppila classification system using lateral lumbar radiographs. Between August 2021 and December 2023 a total of 120 patients were included in the study for analysis, of whom 82 (68.3%) exhibited mild AAC and 38 (31.7%) had moderate-severe AAC. Analyses using the multivariate linear regression model revealed a significant correlation between AAC comorbidity and postoperative clinical outcomes. At 1 year post-surgery, the mean change in leg pain following endoscopic lumbar discectomy was significantly less for patients with moderate-severe AAC (5.0 points) than for patients with mild ACC (p < 0.001). Even after adjusting for relevant confounders, this difference remained significant. Similar results were also observed in the postoperative improvement of back pain, the Oswestry Disability Index score, and the physical functioning, role physical, and bodily pain components of the 36-item Short Form Health Survey questionnaire. There was no significant difference in the rate of repeat surgery or post-surgical new-onset back pain between patients with different levels of severity of AAC at 1 year post-surgery. There is a significant association between the severity of AAC and clinical outcomes among patients with lumbar disk herniation who underwent endoscopic lumbar discectomy. AAC may serve as a prognostic factor in predicting surgical outcomes and guiding management strategies for patients with lumbar disk herniation following endoscopic lumbar discectomy.

Efficacy of Percutaneous Laser Disc Decompression (PLDD) Combined with an Oral Food Supplement for Lumbar Disc Herniation.

Background: In recent years, minimally invasive treatment options for lumbar disc herniation, such as percutaneous laser disc decompression (PLDD), have been introduced to avoid more invasive surgical methods. Combining these minimally invasive approaches with nutraceuticals that are effective in neuroprotection and pain management may lead to better long-term outcomes. Methods: The present study evaluated the beneficial effects of a new oral food supplement composed of acetyl-L-carnitine, α-lipoic acid, quercetin, bromelain, pantothenic acid, and vitamins C, B1, B2, B6, and B12 in patients with neuropathic pain due to herniated lumbar discs treated with PLDD. Patients were divided into two groups of 26 patients each: group A underwent PLDD alone, while group B underwent PLDD followed by a dietary supplement for two months after surgery. Preoperative VAS scores for leg pain were recorded for both groups and no significant difference was observed (8.7 for Group A and 8.6 for Group B). Results: In Group A, the mean postoperative VAS score for leg pain at a 1-month follow-up was 2.5, which remained stable at 3 months. In Group B, the mean postoperative VAS score was 2.0 at 1-month and improved to 1.6 at the 3-month follow-up. According to self-reported leg pain assessments, 66.5% of the patients using the dietary supplement reported a significantly better pain condition, and 43.5% reported a somewhat better situation. In contrast, 7.7% of the patients who underwent PLDD alone reported no changes in leg pain at the final follow-up. Conclusions: The results of our study indicate that the oral food supplement could provide a safe and effective treatment in patients with painful radiculopathy, enhancing the recovery of sensory fiber function in lumbar nerve roots after surgical lumbar disc decompression.

Effects of self-quarantine during the COVID-19 pandemic on patients with lumbar spinal stenosis: A case-control study.

Prospective case-control studyThis study aimed to investigate the effect of self-quarantine on the changes in low back symptoms and activities of daily living (ADL) due to low physical activity because of the COVID-19 pandemic in patients with lumbar spinal stenosis (LSS).The frequency and intensity of low back and leg pain have reportedly increased in healthy subjects because of self-quarantine.Patients with LSS who self-quarantined from baseline (SQ group) were matched to controls who did not self-quarantine (non-SQ group), based on age, sex, medication, ADL, and the numeric rating scale score for low back symptoms. The change in low back symptoms, ADL, and health-related quality of life between baseline and follow-up were compared between the groups.The SQ and non-SQ group included 80 and 60 patients, respectively. Compared with the baseline, the numeric rating scale score for low back pain at follow-up in the SQ group significantly improved (P = .004, median; 1 point), but not in the non-SQ group. No significant difference was found regarding changes in leg pain or numbness. Low back pain improvement did not lead to ADL improvement. The short form 12 evaluation revealed the role/social component score in the SQ group to be significantly lower than that in the non-SQ group; no difference was found for the physical or mental components at follow-up.Self-quarantine with conservative treatment effected short-term low back pain improvement in patients with LSS. However, no improvement in ADL was found. Self-quarantine had an unfavorable impact for health-related quality of life. The effect of self-quarantine can influence the treatment results of LSS.

Effectiveness of an Annular Closure Device to Prevent Recurrent Lumbar Disc Herniation

Patients with large annular defects following lumbar microdiscectomy for disc herniation are at increased risk for symptomatic recurrence and reoperation.To determine whether a bone-anchored annular closure device in addition to lumbar microdiscectomy resulted in lower reherniation and reoperation rates vs lumbar microdiscectomy alone.This secondary analysis of a multicenter randomized clinical trial reports 5-year follow-up for enrolled patients between December 2010 and October 2014 at 21 clinical sites. Patients in this study had a large annular defect (6-10 mm width) following lumbar microdiscectomy for treatment of lumbar disc herniation. Statistical analysis was performed from November to December 2020.Lumbar microdiscectomy with additional bone-anchored annular closure device (device group) or lumbar microdiscectomy only (control group).The incidence of symptomatic reherniation, reoperation, and adverse events as well as changes in leg pain, Oswestry Disability Index, and health-related quality of life when comparing the device and control groups over 5 years of follow-up.Among 554 randomized participants (mean [SD] age: 43 [11] years; 327 [59%] were men), 550 were included in the modified intent-to-treat efficacy population (device group: n = 272; 270 [99%] were White); control group: n = 278; 273 [98%] were White) and 550 were included in the as-treated safety population (device group: n = 267; control group: n = 283). The risk of symptomatic reherniation (18.8% [SE, 2.5%] vs 31.6% [SE, 2.9%]; P < .001) and reoperation (16.0% [SE, 2.3%] vs 22.6% [SE, 2.6%]; P = .03) was lower in the device group. There were 53 reoperations in 40 patients in the device group and 82 reoperations in 58 patients in the control group. Scores for leg pain severity, Oswestry Disability Index, and health-related quality of life significantly improved over 5 years of follow-up with no clinically relevant differences between groups. The frequency of serious adverse events was comparable between the treatment groups. Serious adverse events associated with the device or procedure were less frequent in the device group (12.0% vs 20.5%; difference, -8.5%; 95% CI, -14.6% to -2.3%; P = .008).In patients who are at high risk of recurrent herniation following lumbar microdiscectomy owing to a large defect in the annulus fibrosus, this study's findings suggest that annular closure with a bone-anchored implant lowers the risk of symptomatic recurrence and reoperation over 5 years of follow-up.ClinicalTrials.gov Identifier: NCT01283438.

Are degenerative spondylolisthesis and further slippage postoperatively really issues in spinal stenosis surgery?

Background and aims Opinions diverge concerning the prognostic importance of preoperative degenerative spondylolisthesis in patients with lumbar spinal stenosis, as well as the significance of further slippage post-operatively following decompression alone. However, a slip is only one among several factors related to the topic, e.g. duration and intensity of back and leg pain, pre-operative walking ability, number of levels operated and not least the experience of the surgeon. Our aim was to take all of the above-mentioned factors into consideration when analysing the patients' clinical outcome, reported as Change in back pain, Change in leg pain, Overall satisfaction and Change in walking ability, with special emphasis on the possible importance of pre- and/or post-operative degenerative spondylolisthesis. Methods We studied 200 consecutive patients, mean follow-up time 81 months (range 62-108). Before treatment and on the follow-up occasion all patients answered the SF-36 questionnaire and assessed their back and leg pain on a visual analogue scale (VAS). At follow-up the patients were asked about possible changes in back and leg pain (completely free, much better, somewhat better, unchanged, somewhat worse, much worse) and whether they were; satisfied with the outcome, in doubt or not satisfied. Before treatment and at follow-up the presence or not of degenerative spondylolisthesis was determined in the lateral view on a plain X-ray or MRI. By use of a microsurgical technique decompression was achieved in all patients by bilateral laminotomy not sparing the midline ligaments, irrespective of a degenerative spondylolisthesis or not. Eight surgeons with different surgical experience performed the operations. Four separate multivariate analyses were conducted, one for each clinical outcome. The Lasso method was used for variable selection and multiple imputation was applied to handle missing values. Results At follow-up 78.5% of the patients were completely satisfied with the outcome. Minimal clinical important difference (MCID) was achieved for 69% of the patients. Before surgery 28 patients were able to walk more than 1 km compared to 111 at follow-up. The reoperation rate at 6.8 years was 12% further decompressions and 2.5% fusions at the index level. Post-operative slippage was equally common in patients with and without a preoperative slip (around 30%). There were no notable differences in outcome in patients with and without a preoperative slip and no effect of further slippage at the index or another level post-operatively. Nor could the statistical analysis show any of the other covariates (age, gender, duration and intensity of back and leg pain, pre-operative walking ability or number of levels operated) to be of statistically significant importance for predicting the outcome. In the univariate statistical analysis differences were found between the patients of individual surgeons regarding satisfaction, pain improvement, and reoperation rates in favour of surgical experience, which were, however, not statistically significant in the multivariate analysis. Conclusions None of the covariates, including pre-operative spondylolisthesis and further slippage post-operatively, were statistically significant for predicting the clinical outcome. Implication Our results provide no evidence for adding fusion to the decompression.

Short-term improvements in disability mediate patient satisfaction after epidural corticosteroid injections for symptomatic lumbar spinal stenosis.

Secondary analysis of data from a double-blind randomized controlled trial. To identify mediators of the effect of lumbar epidural injections of corticosteroid plus lidocaine on patient satisfaction at 6 weeks postinjection in patients with lumbar spinal stenosis. We hypothesized that short-term (≤3 wk) change in leg pain would be a significant mediator of satisfaction. No prior studies have identified mediators of effects of epidural injections on patient satisfaction with treatment of lumbar spinal stenosis. We used mediation analysis methods to examine selected intermediate variables (adverse events and change in leg pain, back pain, disability, depression, and fatigue at 3 wk) as potential mediators of the effect of lumbar epidural injections of corticosteroid plus lidocaine on patient satisfaction with treatment. We used the overall satisfaction item from the Swiss Spinal Stenosis Questionnaire as our primary outcome to measure patient satisfaction with the injection procedure at 6 weeks. Among 400 patients randomized to receive epidural injections with corticosteroid plus lidocaine or with lidocaine alone, 369 had complete data for the satisfaction outcome and potential mediators and served as the analysis sample. Contrary to our expectations, 3-week change in leg pain intensity did not have significant mediation effects on patient satisfaction. Three-week change in disability as measured by the Roland-Morris Disability Questionnaire was a significant mediator of the effects of lumbar epidural corticosteroid injections on patient satisfaction at 6 weeks, explaining 48% to 60% of the treatment effect on satisfaction. Changes in pain intensity in the leg and back together explained very little of the treatment effect on satisfaction beyond the information contributed by disability change alone. We did not find other intermediate variables to be mediators of patient satisfaction. These findings support the current approach of examining disability as a primary patient-reported outcome in comparative effectiveness studies of lumbar spinal stenosis. 2.

Changes in leg pain after bilateral fasciotomy to treat chronic compartment syndrome: a case series study

BackgroundIntracompartmental pressure (ICP) as the diagnostic gold standard in the management of chronic compartment syndrome (CCS) is debated. We present a diagnostic protocol in which the decision to operate can be based upon clinical findings alone. The aim of this study was to examine whether patients who underwent surgery for CCS based on clinical findings experienced significant long-term pain relief.MethodsA standardized clinical examination, including skin sensitivity, was performed in patients with bilateral leg pain and/or cramps. Before and after a symptom-provoking step test, ICPs were measured. The primary outcome was self-reported leg pain measured on a visual analogue scale. Secondary outcomes were satisfaction with the treatment result and health-related quality of life (HRQL) measured with the SF-8 questionnaire. Postoperative data were collected after 2 years.ResultsFollow-up was completed for 37 of 40 patients. ICP was increased in 80.5% of the compartments examined before surgery, but did not correlate with the degree of leg pain. The remaining compartments were diagnosed as CCS based on clinical findings, despite ICPs below the threshold. Leg cramps occurred in 32 of 37 (86.5%) patients during physical activity and at night. Leg pain improved from a score of 8.0 ± 1.5 to 2.3 ± 2.1, P < 0.001. Satisfaction with the treatment result was reported by 81.1% of the patients, accompanied by normalized HRQL.ConclusionsThe diagnostic protocol led to a fasciotomy in all compartments of both legs, which was associated with substantial and sustained relief of leg pain, improved HRQL, and patient satisfaction.

The Use Of Computerized Activity Monitors To Assess Changes In Community Participation After Epidural Steroid Injections For Lumbar Spinal Stenosis

PURPOSE: Walking limitation associated with neurogenic claudication is a hallmark of disability in lumbar spinal stenosis (LSS). Capacity and performance have been defined as two distinct aspects of disability. Research suggests that epidural steroid injections may reduce claudication symptoms and thereby improve walking capacity over the short term in people with LSS. However, it is not known whether this translates to increased participation in the community. Computerized activity monitors allow us to examine this concept. The purpose of this study was to examine changes in community participation following steroid injections for LSS, using activity monitors. METHODS: Individuals with LSS confirmed on imaging who were having an epidural steroid injection for symptomatic LSS participated. One week prior to injection and two weeks post-injection, subjects performed a self-paced walking test (SPWT) of up to 30 minutes and filled out questionnaires. Subjects wore an Actigraph activity monitor during waking hours for the 7 days prior to injection and day 7-14 post-injection. Community participation was assessed with activity counts and steps per day. RESULTS: Subjects (n=12) had a mean age of 66.3±9.8 years and were 67% male; All reported symptoms of neurogenic claudication with walking. Both participation indices (activity counts and steps per day) showed a non-significant trend toward improvement post-injection. Daily activity counts improved from 640008±530808 to 718377±504246, while steps per day increased from 2718±2096 to 2891±2016. Non-significant improvements were also observed in leg pain, back pain, Oswestry Disability Index, SPWT, Physical Function Scale of the Stucki Questionnaire and SF-36 Quality of Life. Changes in activity counts (participation) were significantly (p<0.05) related to changes in leg pain (r=0.77), quality of life (r=0.78) and walking capacity (SPWT) (r=0.61). In order to increase power to detect changes, subject recruitment continues. CONCLUSION: Community participation measured with activity monitors increased slightly post-epidural steroid injection in patients with symptomatic LSS. This short term change in activity level was related to reductions in leg pain, increased walking capacity and improved quality of life.

Correlations of Changes in Back and Leg Pain with Changes in Oswestry Disability Index, SRS-22, and SF-12 in Surgically Treated Patients with Adult Scoliosis

INTRODUCTION: The Oswestry Disability Index (ODI), SRS-22, and SF-12 demonstrate improvement of adult scoliosis patients after surgical treatment. None of these measures specifically addresses leg pain, the presence of which is an independent predictor of a patient's choice for operative care. The purpose of this study was to assess whether improvement in leg pain after surgery is correlated with improvements in standardized outcome measures, independent of improvement in back pain. METHODS: This study is a retrospective review of a prospective multicenter database of adults with spinal deformity. At the time of enrollment and follow-up, patients complete the ODI, SRS-22, and SF-12, as well as assessment of leg and back pain (visual analog score [VAS]). Multiple linear regression analyses were used to assess for correlation between changes in back and leg pain and changes in ODI, SRS-22, and SF-12 at 2 years after surgery. RESULTS: 101 surgically-treated adult scoliosis patients with both baseline back and leg pain (VAS > 0) were included. Two years after surgery, all mean measures of outcome assessed significantly improved, including ODI (41–24, P < 0.001), SRS-22 (2.8–3.7, P < 0.0001), SF-12 PCS (physical component score, 30–40, P < 0.0001), SF-12 MCS (mental component score, 50–53, P = 0.04), VAS for back pain (6.9–2.8, P < 0.0001), and VAS for leg pain (5.4–2.1, P < 0.0001). Improvements in both back and leg pain were significantly and independently correlated with improvement in ODI (leg pain: B = 1.43, P = 0.001; back pain: B = 1.80, P < 0.001; R = 0.59) and SRS-22 (leg pain: B = −0.058, P = 0.004; back pain: B = −0.071, P = 0.002; R = 0.28). Only change in back pain VAS correlated with change in SF-12 PCS (B = −2.12, P < 0.001; R = 0.49), and only change in leg pain VAS correlated with change in SF-12 MCS (B = −1.44, P = 0.001; R = 0.37). CONCLUSION: Improvement in leg pain after surgery is correlated with improvement in standardized measures of health status and disability, independent of improvement in back pain. These findings emphasize the importance of recognizing and addressing leg pain in adults with scoliosis when contemplating surgical treatment.