Discogenic Radiculopathy Research Articles

Muscle relaxers in acute musculoskeletal back pain

Treatment of patients with back pain is a global public health problem. The diagnosis of acute non-specific (musculoskeletal) back pain (ANBP) is made based on anamnestic data, results of somatic, neurological and neuroorthopaedic examinations, and exclusion of specific causes of back pain and discogenic radiculopathy. For ANBP, pharmacological treatment includes non-steroidal anti-inflammatory drugs (NSAIDs) and muscle relaxers (MR). Most modern clinical guidelines recommend non-benzodiazepine MR as the treatment of choice for ANBP. The results of randomized clinical trials have shown the efficacy and good tolerability of tolperisone (Mydocalm) as monotherapy and in combination with NSAIDs for ANBP. Tolperisone (Mydocalm) has analgesic properties and its main advantage over other MR is that it has no sedative effect.

Patient with discogenic radiculopathy: diagnostic and treatment algorithms

Low back pain is one of the most common causes of seeking medical care, loss of ability to work, and is a heavy socio-economic burden for the country. In the vast majority of cases, the pain syndrome is musculoskeletal, associated with pathology of joints, muscles and ligaments and is benign in nature. Discogenic compression-ischemic radiculopathy is less common, but this pathology is associated with a wide range of issues in differential diagnosis and correct treatment tactics for patients. This article provides an overview of modern clinical guidelines for the diagnosis and treatment of discogenic radiculopathies. The diagnosis of discogenic radiculopathy is clinical. MRI of the spine is performed to exclude secondary causes of nerve root compression if treatment is ineffective. An important direction in the treatment of radiculopathy is non-drug treatment, which includes informing the patient about the benign nature of the disease, the possibility of spontaneous regression of a disc herniation, therapeutic exercises, maintaining the maximum tolerated amount of physical activity, social and professional activity Treatment of back pain is associated with an increased risk of side effects of non-steroidal anti-inflammatory drugs, which patients often use uncontrollably. The issue of safe relief of pain syndromes remains relevant. This can be achieved using a combination of non-steroidal anti-inflammatory drugs and high-dose B vitamins. B vitamins also have a neurotrophic effect, which allows the restoration of impaired neurological functions.

Interventional diagnosis and treatment methods of discogenic and musculoskeletal low back pain

Low back pain (lumbar pain) is one of the most common causes of disability in the population. In cases where conservative treatment of discogenic or musculoskeletal low back pain does not have a positive effect, interventional methods of diagnosis and treatment are used, which are developing actively on the background of rapid technological progress. Being on the border of interdisciplinary interaction, interventional methods can significantly shorten the duration of conservative therapy and, in many cases, avoid surgical decompressive interventions, which are associated with a considerable risk of complications. The methods, efficacy and safety of epidural administration of glucocorticoids for discogenic radiculopathy and lumbar stenosis as well as the methods of radiofrequency denervation for musculoskeletal pain due to the facet joints and the sacroiliac joint involvement are discussed. The possibilities of drug therapy for musculoskeletal pain of the lumbar spine, and combination of non-steroidal anti-inflammatory drugs and a vitamin B complex, are discussed.

Efficiency evaluation of the Neuromidin in the treatment of pain of the patients with discogenic lumbosacral radiculopathy: results of a multicenter post-registration prospective open comparative trial

Evaluation of the effect of Neuromidine on the dynamics of pain syndrome in the treatment of patients with discogenic lumbosacral radiculopathy. Patients with a confirmed diagnosis of discogenic lumbosacral radiculopathy no more than one year old and moderate intensity of pain syndrome on a visual analog scale were included in the main group (OH, n=62, age - 53.1±15.6 yrs) and the comparison group (HS, n=40, age - 53.7±12.9 yrs). OG patients received Neuromidine (15 mg/1 mL 1 once a day IM for 10 days, then 20 mg 3 times a day for 8 weeks) in addition to the standard drug therapy, HS patients received only standard drug therapy. The duration of the study was 8 weeks. The degree of decrease in the intensity and dynamics of pain syndrome, activity and frequency of pain in the lumbar spine, changes in the level of physical activity, and the severity of emotional disorders were evaluated. The level of inflammatory markers in the blood and the dynamics of monosynaptic spinal H-reflex parameters were evaluated. Before the study, there were no statistically significant differences there were no results of clinical and laboratory-instrumental examination between groups. After 8 weeks, the reduction of pain by VAS in the main group was statistically significant in contrast to the comparison group (p=0.0001). In the main group there was a statistically significant increase in the mean cognitive impairment score (p=0.0029), as well as an improvement in psycho-emotional state with a significant decrease in GAD-7 (p=0.0002) and PHQ-9 (p=0.0096). After 8 weeks of therapy, IL-6 level in the main group was statistically significantly lower (p=0.0027) than in the comparison group. The results of H-reflex study revealed an increase in its amplitude and some shortening of latency at the end of Neuromidine therapy. The drug had no undesirable side effects and was well tolerated. Administration of Neuromidine 15 mg/1 ml once a day intramuscularly for 10 days followed by 20 mg 3 times a day for 8 weeks has an effective analgesic effect as adjuvant therapy in patients with discogenic lumbosacral radiculopathy. The inclusion of Neuromidine in the complex treatment of patients with pain syndrome in discogenic radiculopathy is superior in efficacy to standard drug therapy.

History and Evolution of the Minimally Invasive Transforaminal Lumbar Interbody Fusion.

The minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) is a popular surgical technique for lumbar arthrodesis, widely considered to hold great efficacy while conferring an impressive safety profile through the minimization of soft tissue damage. This elegant approach to lumbar stabilization is the byproduct of several innovations throughout the past century. In 1934, Mixter and Barr’s paper in the New England Journal of Medicine elucidated the role of disc herniation in spinal instability and radiculopathy, prompting surgeons to explore new approaches and instruments to access the disc space. In 1944, Briggs and Milligan published their novel technique, the posterior lumbar interbody fusion (PLIF), involving continuous removal of vertebral bone chips and replacement of the disc with a round bone peg. The following decades witnessed several PLIF modifications, including the addition of long pedicle screws. In 1982, Harms and Rolinger sought to redefine the posterior corridor by approaching the disc space through the intervertebral foramen, establishing the transforaminal lumbar interbody fusion (TLIF). In the 1990s, lumbar spine surgery experienced a paradigm shift, with surgeons placing increased emphasis on tissue-sparing minimally invasive techniques. Spurred by this revolution, Foley and Lefkowitz published the novel MIS-TLIF technique in 2002. The MIS-TLIF has demonstrated comparable surgical outcomes to the TLIF, with an improved safety profile. Here, we present a view into the history of the posterior-approach treatment of the discogenic radiculopathy, culminating in the MIS-TLIF. Additionally, we evaluate the hallmark characteristics, technical variability, and reported outcomes of the modern MIS-TLIF and take a brief look at technologies that may define the future MIS-TLIF.

PSYCHONEUROLOGICAL ASPECTS OF CHRONIC PAIN SYNDROME IN LUMBAR RADICULOPATHY

Discogenic radiculopathy is the most severe form of degenerative-dystrophic lesion of the spine, which is based on disc degeneration with subsequent involvement of adjacent vertebral bodies, intervertebral joints, and ligamentous apparatus [2,8]. So far, there are many unresolved questions in the etiology and pathogenesis of this disease. Despite the progress in understanding the pathomorphology and clinic of discogenic radiculopathy, the search for pathogenetic, and, therefore, highly effective treatment has not been completed [4,15]. Today, in the practice of a neurologist, the definition of lumbosacral radiculopathy (RCR) is widespread as a nosology characterized by damage to the nerve roots at the lumbosacral level with damage to the intervertebral discs (IVD) and joints of the spinal motion segments (SDS), ligamentous and muscular apparatus with the formation compression-ischemic and concomitant muscular-tonic syndromes caused by functional overstrain of organs and systems. In this paper, in accordance with the international trend, the term “chronic lumbar radiculopathy” refers to chronic pain in the lumbar region of non-visceral etiology.

Risk factors for chronization of low back pain syndrome

Low back pain is a leading cause of disability. Acute and chronic back pain affects 90% of the population.Objectives — to analyze the risk factors for chronic low back pain.Material and methods. A prospective study of nonspecific low back pain of 50 patients was carried out in the neurological department of the Emergency Clinic in Ufa. The exclusion criteria were discogenic compression radiculopathy, spinal stenosis, oncological pathology. By gender, men predominated. The average age of the patients was 48.44 ± 15.1 years. All patients underwent clinical neurological, neuropsychological and laboratory-instrumental studies. To study the nature of the pain syndrome, assess the cognitive and emotional spheres, we used diagnostic questionnaires, including the questionnaire of risk and chronicity of pain the Keele STarT Back Screening Tool. Three months after the onset of pain syndrome, all patients were interviewed by telephone in order to identify cases of persistent back pain and analyze its causes, for which a group of patients with chronic pain syndrome was singled out.Results. 32% of patients had pain syndrome 3 months after inpatient treatment. The following risk factors for chronic pain syndrome were identified: high intensity of pain, its duration, neuropathic component, older age (p = 0.018), depression (p = 0.02), obesity (p = 0.024).Conclusion. Risk factors for chronic low back pain are diverse, predictors of its development after episodes of acute pain, and should be identified as early as the onset of pain syndrome.

The first experience with fully endoscopic posterior cervical foraminotomy and discectomy for radiculopathy performed in Viet Duc University Hospital

The aim of the article is to present the first experience of applying a full-endoscopic posterior cervical foraminotomy and discectomy performed at Viet Duc University Hospital in Hanoi and describe the outcomes of such surgical intervention. This surgical series includes 20 patients underwent surgery through full-endoscopic posterior cervical foraminotomy and discectomy. The definitive diagnosis of the patients and the evidence for surgical treatment was radiculopathy due to lateral or intraforaminal disk herniation, foraminal stenosis, and lateral recess stenosis. Patients with discogenic cervical radiculopathy but with a contraindication to endoscopic posterior cervical foraminotomy and discectomy were not subject to surgical intervention. All patients underwent a CT and MRT examination of the cervical spine before and after surgery as complementary diagnostic methods. Besides radiological diagnostic methods, electroneuromyography and spondylography were performed with functional samples, i.e., with head tilts in the front and back, to eliminate segmental instability. The timing and degree of the root pain syndrome regression were assessed using a VAS scale (visual and analog scale) with a subsequent comparison of preoperative and postoperative performance. Immediately after the operation, all patients noted a complete or nearly complete regression of the pain syndrome.

Результати лікування дискогенних поперекових радикулопатій методом радіочастотної холодноплазмової нуклеопластики

Актуальність. Біль у нижній частині спини з іррадіацією в нижні кінцівки продовжує залишатися серйозною медичною проблемою. Останнім часом мінімально інвазивні черезшкірні методи з використанням внутрішньодискового підходу в лікуванні болю у спині набувають все більшої популярності. Нуклеопластика — процедура, при якій для декомпресії диска використовується радіочастотний біполярний електрод, що генерує холодноплазмову енергію в процесі так званої коблації. Основні переваги цієї внутрішньодискової технології — відсутність грубого теплового ураження оброб-люваної поверхні та міні-інвазивність. Мета дослідження: оцінити ефективність лікування больового синдрому методом черезшкірної радіочастотної холодноплазмової нуклеопластики (коблації) у пацієнтів, які страждають від хронічних поперекових дискогенних радикулопатій. Матеріали та методи. У дослідження були включені 58 пацієнтів віком від 29 до 55 років (43,0 ± 4,6 року), які проходили лікування в 2017–2018 рр. у клініці «Нейромед» та відділенні спінальної хірургії ДУ «Інститут травматології та ортопедії НАМН України» (м. Київ). Результати. До лікування середній показник рівня болю за візуальною аналоговою шкалою (ВАШ) в обстежуваних становив 7,9 ± 0,8 бала, після процедури було відзначено позитивну динаміку в межах 3,44 ± 0,98 бала. Через місяць після маніпуляції хворі описували свої відчуття як легкий, часом помірний біль (ВАШ 1,83 ± 0,98 бала). При обстеженні через 6 місяців рівень болю у групі знаходився на відмітці 1,3 ± 1,5 бала. Негативний результат відзначений у 4 пацієнтів. Висновки. Радіочастотна холодноплазмова нуклеопластика (коблація) може бути рекомендована як ефективний метод лікування дискогенних поперекових радикулопатій.

Heterogeneous macrophages contribute to the pathology of disc herniation induced radiculopathy

Macrophages play important roles in the progression of intervertebral disc herniation and radiculopathy. To better understand the roles of macrophages in this process, we developed a new mouse model that mimics human radiculopathy. A preclinical randomized animal study. Three types of surgeries were performed in randomly assigned Balb/c mice. These were spinal nerve exposure, traditional anterior disc puncture, and lateral disc puncture with nerve exposure (n=16/group). For the nerve exposure group, the left L5 spinal nerve was exposed without disc injury. For the traditional anterior puncture, L5/6 disc was punctured by an anterior approach as previously established. For lateral puncture with nerve exposure, the left L5 spinal nerve was exposed by removing the psoas major muscle fibers, and the L5/6 disc was punctured laterally on the left side with a 30G needle, allowing the nucleus to protrude toward the L5 spinal nerve. Mechanical hyperalgesia (pain sensitivity) of hind paws was assessed with electronic von Frey assay on alternative day for up to 2 weeks. MRI, histology, and immunostaining were performed to confirm disc herniation and inflammation. Ipsilateral pain in the lateral puncture with nerve exposure group was significantly greater than the other groups. Pro-inflammatory cytokines IL-1β and IL-6 were markedly elevated at the hernia sites of both puncture groups and the spinal nerve of lateral puncture with never exposure group on postoperative day 7. Heterogeneous populations of macrophages were detected in the infiltration tissue of this mouse model and in tissue from patients undergone discectomy. We have established a new mouse model that mimics human radiculopathy and demonstrated that a mixed phenotype of macrophages contribute to the pathogenesis of acute discogenic radiculopathy. This study provides a clinically relevant in vivo animal model to elucidate complex interactions of disc herniation and radicular pain, which may present opportunities for the development of macrophage-anchored therapeutics to manage radiculopathy.

Diagnostic and treatment algorithms for acute low back pain

Low back pain (LBP) is one of the most common reasons to see a physician. In 90–95% of cases, LBP is nonspecific (musculoskeletal). Timely diagnosis of acute nonspecific LBP and its effective treatment are of practical importance, have a favorable effect on the prognosis of recovery and significantly reduce the risk of chronic pain. The diagnosis of acute nonspecific LBP is established on the basis of complaints, clinical picture, data of somatic and neurological examination, absence of “red flags” (symptoms and signs characteristic of specific causes of back pain, discogenic radiculopathy or lumbar stenosis). Drug and non-drug methods are used in the treatment of acute nonspecific LBP. In acute nonspecific LBP, great importance is attached to informing the patient about the causes of pain and a favorable prognosis, the need to stay active, avoid staying in bed and wearing corsets. As pharmacotherapy, the prescription of nonsteroidal anti-inflammatory drugs (NSAIDs) is effective. Nimesulide, an NSAID that is used to treat various pain syndromes, is effective and safe in the treatment of acute nonspecific LBP. In addition to NSAIDs, muscle relaxants and B vitamins may be prescribed. Therapeutic exercises are not prescribed during the acute period of back pain. Therapeutic exercises are effective in preventing exacerbations of LBP. We present our own clinical example of managing a patient with acute nonspecific LBP. Complex treatment based on international and Russian recommendations allowed to help her relatively quickly and effectively. The achieved positive effect was maintained for 3 months of follow-up of the patient.

Diagnosis and treatment of acute lumbar pain

Lumbar pain (LP) is one of the most frequent causes of appeal to a doctor and temporary disability. LP is most often caused by the musculoskeletal (non-specific) pathologies, less often discogenic radiculopathy, lumbar stenosis or specific pathology. The diagnosis of acute (up to 4 weeks) of skeletal muscle pain and discogenic radiculopathy is based on clinical manifestations and the exclusion of specific pathology, and neuroimaging is not required if there are no symptoms of a dangerous disease. Conducting X-ray, computed tomography or magnetic resonanse tomography in patients with skeletal-muscular LP does not improve the prognosis of the disease, does not affect the development of complications and chronizing the process, and the cost of the examination, the patient’s concern and the frequency of surgical interventions are unreasonably increasing. A patient with acute nonspecific LP or discogenic radiculopathy should be informed about the benign nature of the disease, a favorable forecast, expediency to maintain physical and social activity, avoid bed regime. Therapeutic gymnastics is not recommended for acute LP, but it is joined by reducing pain, it is advisable to teach the patient to avoid excessive static and physical exertion for the prevention of relapses and chronic. To facilitate pain, unnecessary anti-inflammatory drugs can be used in minimally effective doses and a short course, muscle relaxants. The use of group vitamins in both additional analgesics during acute LP is discussed, the results of their own studies on the treatment of patients with acute pain in the back and discogenic lumbosacral radiculopathy are analyzed. It is noted, that patients with acute LP are relatively rarely informed by doctors about its favorable forecast, the possibilities of the natural regression of the hernia of the disk and neurological symptoms at discogenic LP and radiculopathy.

CT-guided transforaminal epidural steroid injection for discogenic lumbar radiculopathy: influence of contrast dispersion and radiologist\u2019s experience on clinical outcome

ObjectiveTo investigate the impact of contrast dispersion pattern/location during lumbar CT-guided transforaminal epidural steroid injection (TFESI) and experience of the performing radiologist on therapeutic outcome.Materials and methodsIn this single-center retrospective cohort study, two observers analyzed contrast dispersion during CT-guided TFESI of 204 patients (age 61.1 ± 14 years) with discogenic unilateral single-level L4 or L5 radiculopathy. The contrast dispersion pattern was classified as “focal,” “linear,” or “tram-track”; the location was divided into “extraforaminal,” “foraminal,” or “recessal.” Pain was assessed before and 4 weeks after treatment using a numerical rating scale (0, no pain; 10, intolerable pain). Additionally, the patient global impression of change (PGIC) was assessed. The TFESI was performed by musculoskeletal radiologists (experience range: first year of musculoskeletal fellowship training to 19 years). Contrast pattern/location and radiologist’s experience were compared between “good responder” (≥ 50% pain reduction) and “poor responder” (< 50%). A p-value < 0.05 was considered to be statistically significant.ResultsOverall, CT-guided TFESI resulted in a substantial pain reduction in 46.6% of patients with discogenic radiculopathy. The contrast dispersion pattern and location had no effect on pain relief (p = 0.75 and p = 0.09) and PGIC (p = 0.70 and p = 0.21) 4 weeks after TFESI. Additionally, the experience of the radiologist had no influence on pain reduction (p = 0.92) or PGIC (p = 0.75). Regarding pre-interventional imaging findings, both the location and grading of nerve compression had no effect on pain relief (p = 0.91 and p = 0.85) and PGIC (p = 0.18 and p = 0.31).ConclusionOur results indicate that neither contrast agent dispersion/location nor the experience of the radiologist allows predicting the therapeutic outcome 4 weeks after the procedure.

THE ROLE OF DISCOGENOUS RADICULOPATHIES AND SPONDYLOLYSTHESIS IN THE STRUCTURE OF PAIN SYNDROME AFTER TOTAL HIP ARTHROPLASTY

Resume. In the structure of complications, pain syndrome, which is not associated with instability of the components of the endoprosthesis or infection, remains a serious problem due to difficulties in diagnosis and treatment. The cause of residual pain may be the presence in the patient of discogenic radiculopathy or spon-dylolisthesis of the lumbar spine. The aim of the study. To determine the role of discogenic radiculopathies and spondylolisthesis of the lumbar spine in the structure of pain after hip arthroplasty. Materials and methods. A sample and retrospective analysis of case histories of 138 patients with hip and lumbar syndrome, who under-went hip arthroplasty in the clinic of orthopedics and traumatology of adults SI "ITO NAMS of Ukraine". All patients were examined clinically and radiologically. Additionally, all patients were examined by a neurolo-gist to determine the neurological status of patients, diagnosis. Evaluation of the effectiveness of treatment of patients with residual effects of discogenic radiculopathy and spondylolisthesis after hip arthroplasty was performed on the functional scale of Oswestry. Results. The analysis of the patient database revealed a statisti-cally significant (p≤0.05) predominance of patients with the presence of disc herniation at the level of L3-L4 and hypolordosis. The survey revealed 9 cases of discogenic radiculopathy and 6 cases of spondylolisthesis in patients with PD, which amounted to 6.5% and 4.5% of the total number of examined patients. The high effi-ciency of the developed treatment-and-prophylactic measures in patients with discogenic radiculopathy or spondylolisthesis and lumbar-lumbar syndrome has been determined. Timely appointment of complex conserva-tive and operative methods allowed to achieve satisfactory results in 100% of cases. Conclusions. Studies to determine the role of discogenic radiculopathy and spondylolisthesis of the lumbar spine in the structure of pain after hip arthroplasty will contribute to the further development of clinical, diagnostic and treatment algorithms for patients with hip and lumbar syndrome.

Clinical principles for the diagnosis and treatment of musculoskeletal (non-specific) lower back pain

Low back pain (LBP) is one of the most common reasons for a neurologist visit. In 90–95% of cases, LBP is nonspecific (musculoskeletal). The diagnosis of nonspecific LBP based on symptoms, somatic and neurological examination data, the absence of «red flags» (symptoms and signs characteristic of specific causes of back pain, discogenic radiculopathy, or lumbar stenosis). We review the modern principles of acute, subacute, and chronic nonspecific LBP treatment. We also discuss interventional and non-interventional treatment approaches, emphasizing the importance of combination therapy and an interdisciplinary approach.

Clinical manifestations, diagnosis, and surgical treatment of compressive common peroneal neuropathy at the level of the fibular head

Common peroneal neuropathy (CPN) is the most common tunnel neuropathy in the lower extremities, many issues of diagnosis and treatment of which require further study.Objective: to analyze the clinical manifestations of CPN, methods of its diagnosis and treatment results.Patients and methods. Eighty patients (31 women and 49 men) aged 18 to 82 years (mean age, 51 years) with compressive CPN were followed up during 2012–2018. Unilateral CPN and bilateral CPN were found in 76 and 4 patients, respectively. Eighty-four common peroneal nerve decompression operations were performed.Results and discussion. There was paralytic CPN in 73 (87%) surgical cases, painful CPN in 8 (9.5%), and intermittent CPN in 3 (3.5%). Diagnostic errors (when CPN was regarded as discogenic radiculopathy or lumbar stenosis) were noted in the painful and intermittent forms of the disease. After surgical treatment, complete recovery of peroneal nerve function was observed in 61 (72.6%) of the 84 surgical cases; its partial recovery in 15 (17.9%). Positive results were seen in all cases of painful and intermittent CPN, whereas they were more often observed in paralytic CPN if the operation was performed early (up to 12 months) after the onset of the disease.Conclusion. Common peroneal nerve decompression is an effective and safe therapeutic method that, in painful and intermittent CPN, leads to complete reversal of symptoms and, in the paralytic form of the disease, it is most effective in the early stages of the disease.

Neck pain as the problem of our time

During life, neck pain occurs in 20-70% of people, its prevalence in the total population is 4.9%, and the annual morbidity varies from 30 to 70%. Neck pain significantly reduces the quality of life and can lead to disability. It was found that the economic burden of neck pain is high and is associated with the amount of money spent on treatment, with «lost profits» due to employee illness, compensation for examinations and sick leave. Over the past decade, there has been an increase in the prevalence of neck pain, which increases the importance of improving the diagnostics, prevention and treatment of neck pain. Depending on the duration, neck pain is classified as acute, subacute and chronic. Neck pain may be non-specific (skeletal-muscular), secondary (specific, symptomatic) or associated with discogenic radiculopathy or cervical myelopathy. Nonspecific neck pain is the most common. Effective treatment of nonspecific neck pain includes therapeutic gymnastics, manual therapy, recommendations on lifestyle, activity and ergonomics in the organization of the workplace. Identification and correction of risk factors of neck pain occurrence, persistence and chronization are of great importance in the prevention and treatment of patients. Neck pain pharmacotherapy includes drugs from the group of non-steroidal anti-inflammatory drugs (NSAIDs): lor-noxicam, which has shown its effectiveness and good tolerance in the treatment of neck pain, cervicocranialgia, postoperative and skeletal-muscular pain. It is recommended to prescribe a short course of NSAIDs therapy in minimal therapeutic doses. In the chronic course of neck pain, antidepressants may be prescribed, especially when combined with depression.

The effectiveness of electrophoresis with caripain in the treatment of discogenic radiculopathy in the cervical spine. Clinical case.

In this article, we demonstrate a clinical case with high efficacy of Karipain electrophoresis in the treatment of a patient with discogenic radiculopathy in the cervical spine. The positive result was a complete regression of motor deficiency, restoration of sensory function and a decrease in the size of a hernia of the intervertebral disc at the level of C5C6 by 40%.

Tolperisone in the treatment of acute and chronic nonspecific back pain

Nonspecific back pain (NBP) is one of the most common reasons to see a neurologist or therapist. Acute (&lt;4 weeks' duration), subacute (4 to 12 weeks), and chronic (&gt;12 weeks) NBPs are recognized. The diagnosis of NBP is based on anamnestic data, somatic, neurological, and neurologic-and-orthopedic examination findings and on the exclusion of the specific causes of back pain, discogenic radiculopathy, and vertebral canal stenosis. Nonsteroidal anti-inflammatory drugs (NSAIDs) and muscle relaxants are used in the pharmacotherapy of acute, subacute, and chronic NBP. Tolperisone is widely used as a muscle relaxant in Russia and in the countries of Europe and Asia. Clinical trials have shown the efficacy and good tolerance of tolperisone used alone and in combination with NSAIDs for NBP. The review presents clinical recommendations from different countries on the use of muscle relaxants in the treatment of acute and chronic NBP. It is concluded that a large-scale qualitative randomized trial should be conducted to investigate the efficacy of muscle relaxants, tolperisone in particular, in the treatment of acute, subacute, and chronic NBP.

Personalized, interdisciplinary approach to the treatment of chronic low back pain: clinical observation

Nonspecific (musculoskeletal) pain is the most common cause of low back pain (LBP). Chronic nonspecific LBP is a particular problem, as it significantly reduces the quality of life and functional activity of the patient. The diagnosis of chronic non-specific LBP is made after exclusion of a specific cause of pain, discogenic radiculopathy and lumbar stenosis. Unfortunately, patients with chronic non-specific LBP are often misdiagnosed, pain chronization factors (“yellow flags”) are ignored and ineffective treatment is prescribed. Clinical observation of a patient with chronic non-specific LBP, who was initially wrongly diagnosed with spinal osteochondrosis and the treatment was ineffective, is presented. A personalized, multidisciplinary approach to treatment allowed the patient to cope with back pain and to return to his previous daily activities. The patient’s treatment plan included non-drug methods of treatment (educational conversation, physical activity, mindfulness, cognitive-behavioural therapy) and rational pharmacotherapy (non-steroidal anti-inflammatory drug, NSAID). Clinical observation showed the efficacy and good tolerability of NSAID - dexketoprofen (in the form of Dexalgin and Dexalgin 25), which was administered in a stepwise scheme for 5 days. According to modern recommendations, NSAIDs are first-line drugs in chronic non-specific LBP. The results of clinical studies on efficacy and safety in back pain of such NSAIDs as dexketoprofen and nimesulide are presented. In case of prolonged exacerbation the possibility of dexketoprofen prescription with subsequent transition to nimesulide is discussed.