Lower Limb Radicular Pain Research Articles

Ability of diagnostic injection to predict surgical outcomes in patients with chronic low back pain and lumbar radiculopathy

BackgroundArising from different anatomical structures of the spine, chronic low back pain is one of the leading causes of disability, and its management is still controversial. Thus, appropriate and effective management of chronic low back pain requires a precise diagnostic tool in order to target pain generators. Therefore, the role of diagnostic injection in predicting the outcome of surgical treatment of chronic low back pain and lower limb radicular pain need to be evaluated in order to guide the surgeon, especially in case of unclear pathoanatomical features. Thus, the aim of this study was to assess the predictive value of lumbar spine diagnostic injections in surgical outcome in patients with chronic low back pain and lumbar radiculopathy.Patients and methodsThis study included 30 patients complaining of chronic low back pain and/or lumbar radiculopathy who underwent lumbar spine surgery following positive diagnostic injections. The pre- and postoperative assessments consisted of a general neurological examination, evaluation of the Oswestry disability index, and a visual analog scale.ResultsThis prospective non-controlled study was conducted on 30 patients complaining of chronic low back pain and/or lumbar radiculopathy. The mean age was 42.60 ± 8.27 years with a range of 24.0–62.0 years. The visual analog scale decreased significantly from preoperative mean value of 8.26 ± 0.79 to postoperative mean value of 1.97 ± 0.92; with almost two-thirds of the patients experienced more than 75% pain reduction. The Oswestry disability index decreased significantly from preoperative mean value of 34.13 ± 4.88 to 11.47 ± 3.36 after surgery in the whole sample. The post-selective nerve root block visual analog scale was significantly correlated to the postoperative visual analog scale, while the postoperative Oswestry disability index was not significantly associated with the post-selective nerve root block visual analog scale.ConclusionThe use of lumbar selective nerve root block and lumbar provocative discography for patients with chronic low back pain and radiculopathy and equivocal radiological findings can improve surgical outcomes regarding pain intensity and spine functional outcomes. Diagnostic selective nerve root block can predict the postoperative pain relief.

Understanding the Pathophysiology of L5-S1 Loss of Lordosis and Retrolisthesis: An EOS Study of Lumbopelvic Movement Between Standing and Slump Sitting Postures

To understand the pathophysiology of L5-S1 loss of lordosis and retrolisthesis by comparing 2 commonly assumed physiological weight-bearing postures. This was a prospective comparative study of whole-body standing and slump sitting EOS radiographs in clinic patients presenting with back pain or lower limb radicular pain. Patients with prior spinal intervention, malignancy, trauma, inflammatory diseases, transitional lumbosacral vertebra, pregnancy, and L5-S1 retrolisthesis or spondylolisthesis from nondegenerative causes were excluded. C7 sagittal vertical axis, global cervical angle, global thoracic angle, global lumbar angle, thoracolumbar angle, T1-slope, pelvic incidence, pelvic tilt, sacral slope, L5-S1 angle, L5-S1 vertebral translation, L5-S1 disc height, and presence of L4-5 vertebral translation were measured. Univariate and multivariate analyses were performed to identify predictors of L5-S1 lordosis loss and retrolisthesis. L5-S1 loss of lumbar lordosis (7.02 ± 9.90°, P < 0.001), retrolisthesis (0.07 ± 0.411 cm, P < 0.001), and loss of disc height (0.10 ± 0.23 cm, P < 0.001) occurred when changing from standing to slump sitting along with other sagittal profile changes (P < 0.001). Taller L5-S1 disc height (odds ratio [OR] 2.57, P= 0.04), larger lumbar range-of-motion change (OR 3.82, P= 0.012), lower sacral slope on sitting (OR 2.50, P= 0.043), and presence of L4-5 spondylolisthesis (OR 2.75, P= 0.032) were predictive of larger L5-S1 lordosis loss (>7°) on multivariate analysis, while larger lumbar range-of-motion change (OR 2.21, P= 0.050) and presence of L4-5 spondylolisthesis (OR 3.08, P= 0.023) were predictive of greater L5-S1 retrolisthesis (>0.07 cm). Degenerative L5-S1 loss of lordosis and retrolisthesis likely result from long-standing lower lumbar spine bending forces against the posterior ligamentous complex with slump sitting, predisposed by a negatively sloped sacrum and increased lumbar flexibility.

Bilateral Calf Hypertrophy With Increased Muscle Enzyme Levels

A 57-year-old female presented with progressive swelling of both calves (Fig.1A), associated with dull-aching pain on exertion for last 6 months. She underwent L5-S1 discectomy in 2006 for right lower limb radicular pain and L4-L5 laminectomy with discectomy in 2008 for recurrence of symptoms. Investigations revealed normal hemogram, liver and kidney function tests, thyroid profile, and inflammatory markers. Creatine phosphokinase was 542U/L (Normal<145) and lactate dehydrogenase was 948U/L (Normal<480).

Posterior Lumbar Interbody Fusion with Spinal Decompression using Minimally Invasive Spine Surgery in the Treatment of Symptomatic Degenerative Spinal Stenosis

Introduction &#x0D; Lumbar spinal stenosis is often the result of advanced degeneration of motion segments of the lumbar spine. The incidence of this case is 3.57% (3570 per 100,000) population in Southeast Asia. The main symptoms are low back pain, numbness, and weakness in the lower extremity that occur and intensify on walking caused by the load of the body weight on the spine. Loss of disc height, facet displacement and hypertrophy, spondylosis, and spondylolisthesis , all contribute to impact the spinal canal and intervertebral foramen in lumbar stenosis . There is a subgroup of patients with spinal stenosis in whom the spine is unstable preoperatively or become destabilized following decompression who would benefit from fusion procedure.&#x0D; Objective&#x0D; Surgical treatment of lumbar spinal stenosis by posterior lumbar interbody fusion is indicated for patients with symptoms of low back pain and lower limb radicular pain, that are unsuccessful treated with medicines and /or patients with persisting or worsening neurological deficit.However, this procedure may lead to possible complications. This case report study was conducted to show how our hospital handling spinal stenosis case.&#x0D; Case&#x0D; A 67-year-old woman presented with low back pain that has occured for two years, and had been worsening for the past 3 months. She described the pain as an intermitten ache down on her leg, the pain was severe and worsened when the patient is standing, sitting, or walking for a long time , The pain severity was measured by visual analog score (vas), graded between 7/10 to 9/10. She also complained numbness from the bilateral gluteal region to the lateral side of lower extremities, when she feel too tired. On the physical examination, She was found to have limited range of motion for flexion and extension, on the lumbar spine, due to pain. The motoric strength of both lower limbs were decreased, so did the sensory function. The Radiological examination showed a severe stenosis at lumbar spinal bone region on L4-L5 area. After the examination, the patient agreed to undergo the suggested operative procedure and gare the consent at the hospital.

Percutaneous Endoscopic Interlaminar Unilateral Ventral Dural Approach for Symptomatic Bilateral L5-S1 Herniated Nucleus Pulposus: Technical Note.

Percutaneous endoscopic lumbar diskectomy is a good treatment modality for lumbar disk herniation. However, when a patient complains of bilateral lower limb radicular pain with severe disk protrusion at the L5-S1 level, the transforaminal approach is often unable to resolve both lesions owing to anatomical limitations. It is also very difficult to resolve both lesions in an ipsilateral direction using the percutaneous interlaminar approach. We report our surgical technique and clinical results using a ventral dural approach of percutaneous endoscopic interlaminar lumbar diskectomy for L5-S1 herniated nucleus pulposus (HNP) in patients with bilateral radiculopathy due to a severe disk protrusion. Twenty-seven patients with severe L5-S1 HNP complaining of back pain and bilateral lower limb pain were included in the study. The unilateral ventral dural approach of percutaneous full endoscopic interlaminar lumbar diskectomy technique was used. The visual analog scale (VAS) and Macnab criteria were used for clinical evaluation. All assessments were completed 1 day before surgery, 1 week after surgery, 6 months after surgery, and at final follow-up after surgery. The mean preoperative back and leg pain VAS scores decreased from 5.67 ± 0.78 and 7.81 ± 0.83 to 2.44 ± 0.58 and 2.26 ± 0.53 at 1 week, 1.78 ± 0.51 and 1.52 ± 0.58 at 6 months, and 1.56 ± 0.70 and 1.67 ± 0.96, respectively, at the final follow-up after surgery. With respect to the Macnab criteria, 51.85% of the results were excellent, 44.44% were good, and 3.70% were fair. Four cases recurred: three patients underwent conservative treatment and one patient operated with percutaneous endoscopic interlaminar lumbar diskectomy. According to the results of this study, the ventral dural approach of percutaneous full endoscopic interlaminar lumbar diskectomy in patients with L5-S1 HNP associated with bilateral lower limb pain due to a severely protruded HNP is a good option for a minimally invasive surgical approach.

Efficacy of epidural methylprednisolone in radicular pain

IntroductionDegenerative disc disease is a prevalent and disabling disease. When the conservative treatment fails to obtain pain relief, epidural steroids are an alternative frequently used worldwide. ObjectivesTo evaluate the efficacy and safety of epidural methylprednisolone in patients with radicular pain. MethodologyDescriptive longitudinal retrospective study in patients with chronic radicular pain who received fluoroscopy-guided interventional treatment, between July 2010 and December 2011 at Instituto Colombiano del Dolor (Medellín-Colombia), to determine the efficacy and safety of epidural methylprednisolone in clinical practice. Pain relief was followed using the visual analogue scale, during at least 8 weeks. Results254 patients were analyzed. The mean age of the patients was 52.8 years (SD±15); 52.8% were men. The main diagnosis was lower-limb radicular pain (87.7%). The most frequent procedures were transforaminal lumbar injection (54.3%) and interlaminar lumbar injection (17.7%). The proportion of patients with more than 50% pain relief 50% was 85.8%. There were no differences in efficacy between the procedures. Pain improvement lasted more than 8 weeks in 55% of patients. The incidence of complications was lower than 1%. ConclusionsWhen radicular pain is refractory to conservative treatment based on pharmacological and physical therapy, epidural methylprednisolone is an effective and safe method in our setting.

Eficacia de la metilprednisolona epidural en el dolor radicular

IntroductionDegenerative disc disease is a prevalent and disabling disease. When the conservative treatment fails to obtain pain relief, epidural steroids are an alternative frequently used worldwide. ObjectivesTo evaluate the efficacy and safety of epidural methylprednisolone in patients with radicular pain. MethodologyDescriptive longitudinal retrospective study in patients with chronic radicular pain who received fluoroscopy-guided interventional treatment, between July 2010 and December 2011 at Instituto Colombiano del Dolor (Medellín-Colombia), to determine the efficacy and safety of epidural methylprednisolone in clinical practice. Pain relief was followed using the visual analogue scale, during at least 8 weeks. Results254 patients were analysed. The mean age of the patients was 52.8 years (SD±15); 52.8% were men. The main diagnosis was lower-limb radicular pain (87.7%). The most frequent procedures were transforaminal lumbar injection (54.3%) and interlaminar lumbar injection (17.7%). The proportion of patients with more than 50% pain relief 50% was 85.8%. There were no differences in efficacy between the procedures. Pain improvement lasted more than 8 weeks in 55% of patients. The incidence of complications was lower than 1%. ConclusionsWhen radicular pain is refractory to conservative treatment based on pharmacological and physical therapy, epidural methylprednisolone is an effective and safe method in our setting.

Spinal Tuberculosis as a Cause of Low Back Pain—A Timely Reminder

To the Editor: We describe a recent case of a 74-year-old lady with no recent travel history who presented with low back pain and right lower limb radicular pain of 3 months duration refractory to medical therapy. Plain x-rays of the lumbar spine revealed collapse of the T12 and L1 vertebral bodies (Figure 1). Provisional diagnosis was of osteoporotic compression fracture. The patient initially declined a magnetic resonance imaging (MRI) scan due to costs. In view of the radicular pain, an epidural steroid injection was performed at the T12-L1 level which afforded transient improvement. However, the pain recurred and an eventual MRI …

Neuroschistosomiasis

Schistosomiasis (bilharzia) is a neglected tropical disease caused by digenetic trematode platyhelminths of the genus Schistosoma. Neuroschistosomiasis is one of the most severe clinical outcomes associated with schistosome infection. Neurological complications early during the course of infection are thought to occur through in situ egg deposition following aberrant migration of adult worms to the brain or spinal cord. The presence of eggs in the CNS induces a cell-mediated Th2-driven periovular granulomatous reaction. The mass effect of thousands of eggs and the large granulomas concentrated within the brain or spinal cord explain the signs and symptoms of increased intracranial pressure, myelopathy, radiculopathy and subsequent clinical sequelae. Myelopathy (acute transverse myelitis and subacute myeloradiculopathy) of the lumbosacral region is the most common neurological manifestation of S. mansoni or S. haematobium infection, whereas acute encephalitis of the cortex, subcortical white matter, basal ganglia or internal capsule is typical of S. japonicum infection. Cerebral complications include encephalopathy with headache, visual impairment, delirium, seizures, motor deficits and ataxia, whereas spinal symptoms include lumbar pain, lower limb radicular pain, muscle weakness, sensory loss and bladder dysfunction. The finding of eggs in the stool or a positive serology, provides supportive but not direct evidence of neuroschistosomiasis. A definitive diagnosis can only be made with histopathological study showing Schistosoma eggs and granulomas. Schistosomicidal drugs (notably praziquantel), steroids and surgery are currently used for the treatment of neuroschistosomiasis. During the 'acute phase' of the disease, neuroschistosomiasis is treated with corticosteroids which are augmented with a course of praziquantel once female worm ovipositioning commences. Surgery should be reserved for special cases such as in those with evidence of medullary compression and in those who deteriorate despite clinical management.

Labor-Related Sacral Stress Fracture Presenting as Lower Limb Radicular Pain

In contrast to radicular pain during pregnancy, the incidence of postpartum radicular pain is rare. Sacral stress fractures are unusual but important causes for low-back and buttock pain and even postpartum radicular pain. To date, only 10 postpartum sacral stress fractures have been reported in the literature, with two descriptions of radicular pain as the presenting symptom. A 36-year-old woman, 7 days after her second delivery, presented with symptoms of spontaneous acute claudicating in conjunction with a left-leg radicular pain for 5 days. Imaging studies revealed a left sacral stress fracture. Bone mineral density was normal. The patient reported no pelvic, back, or radicular pain during the pregnancy, and had no history of menstrual irregularities, previous fracture, eating disorder, trauma or endocrine or metabolic diseases. No smoking or use of anticoagulation drugs was reported. Her obstetric and labor history showed no other risk factors. Epidural analgesia was used. Treatment consisted of toe-touch walking with crutches for 2 months, followed by full weight bearing, which resolved nearly all her symptoms. Clinicians should consider sacral fracture as a diagnostic possibility in postpartum and pregnant patients with lower back and/or buttock pain with or without radicular pain. Bone scintigraphy and computed tomography are considered harmful for the fetus. Magnetic resonance imaging, which is more suitable for pregnancy, is more sensitive than bone scintigraphy in revealing stress injuries of the bone. Physical examination and proper radiologic evaluation are the main keys for revealing the pathology.

Fluoroscopically guided aspiration of a symptomatic lumbar zygapophyseal joint cyst: A case report

Lutz GE, Shen TC. Fluoroscopically guided aspiration of a symptomatic lumbar zygapophyseal joint cyst: a case report. Arch Phys Med Rehabil 2002;83:1789-91. Lumbar zygapophyseal joint cysts are potential pain generators in patients with axial pain and/or lower-limb radicular pain. The traditional treatment of symptomatic cysts that do not respond to conservative measures is surgical decompression. Percutaneous needle aspiration under fluoroscopic guidance is a potential minimally invasive treatment option. We present a patient with a large symptomatic L4–5 zygapophyseal joint cyst and right L5 radiculopathy who responded well to percutaneous aspiration. © 2002 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation