Presence Of Nerve Root Compression Research Articles

Changes in pain scores and walking distance after transforaminal epidural steroid injection in patients with lumbar foraminal spinal stenosis.

Transforaminal epidural steroid injections (TFESI) are widely used in patients with lumbar foraminal spinal stenosis. Previous studies have evaluated the effects of TFESI on lumbar foraminal spinal stenosis using only pain scores. However, no study has evaluated the effect of TFESI on pain scores and walking distance in patients with lumbar foraminal spinal stenosis. This study aimed to assess the effect of TFESI on pain scores and walking distance in patients with lumbar foraminal spinal stenosis stratified according to disease severity. This retrospective study reviewed the medical records of patients who received TFESI for lumbar foraminal spinal stenosis. A total of 128 patients were divided into the moderate and severe groups based on the extent of fat obliteration and the presence of nerve root compression. A significant decrease in the numeric rating scale (NRS) scores was observed in the moderate and severe groups compared with the corresponding baseline values 4 weeks after TFESI; however, the NRS pain scores were lower in the moderate group than those in the severe group. In addition, the proportion of patients who experienced pain reduction (≥50%) was higher in the moderate group than that in the severe group. The moderate and severe groups showed a significant increase in walking distance compared with the baseline values 4 weeks after the treatment. However, the walking distance values did not differ significantly between the moderate and severe groups. Furthermore, the degree of satisfaction was higher in the moderate group than that in the severe group. Lumbar TFESI may reduce pain scores and increase walking distance in patients with moderate or severe lumbar foraminal spinal stenosis. Patients with moderate foraminal stenosis had better pain relief outcomes than those with severe foraminal stenosis.

Some magnetic resonance imaging findings may predict future low back pain and disability: a systematic review

Do magnetic resonance imaging (MRI) findings predict future low back pain (LBP), associated disability and global recovery in people with current LBP? Do MRI findings predict these outcomes in people with no current LBP? Do MRI findings predict these outcomes in a mixed sample of people with and without current LBP? This review is an update of a previous systematic review investigating the relationship between lumbar spine MRI findings and future LBP. People with or without LBP with lumbar MRI scans. MRI findings, pain and disability. Of the included studies, 28 reported on participants with current LBP, eight reported on participants with no LBP and four reported on a mixed sample. Most results were based on single studies and did not demonstrate clear relationships between MRI findings and future LBP. In populations with current LBP, pooling demonstrated that the presence of Modic type 1 changes alone or Modic type 1 and 2 changes were associated with slightly worse pain or disability outcomes in the short term, and the presence of disc degeneration was associated with worse pain and disability outcomes in the long term. In populations with current LBP, pooling demonstrated no evidence of an association between the presence of nerve root compression and disability outcomes in the short term, and no evidence of an association between the presence of disc height reduction, disc herniation, spinal stenosis, high-intensity zone and clinical outcomes in the long term. In populations with no LBP, pooling demonstrated that the presence of disc degeneration may increase the likelihood of experiencing pain in the long term. In mixed populations, no pooling was possible; however, single studies demonstrated that Modic type 1, 2 or 3 changes and disc herniation were each associated with worse pain in the long term. The results suggest that some MRI findings may have weak associations with future LBP; however, larger high-quality studies are needed to resolve uncertainty. PROSPERO CRD42021252919.

Correlation of clinical manifestation of lumbar disc prolapse with magnetic resonance imaging findings among adult patients

BACKGROUND & OBJECTIVE: The most common cause of low back pain is disc prolapse. Disc prolapse occurs in both gender, but females are more prone to disc degenerative changes. The aim of this study was to determine the correlation between clinical findings and MRI findings of lumbar disc prolapse patients.
 METHODOLOGY: This study recruited 32 participants of either gender, between the ages of 19 to 65, in the Radiology department of Shalamar Hospital. This study was carried out in six months with follow-up. Only diagnosed patients with lumbar disc prolapse on MRI were recruited. NPRS was used to identify the intensity of pain. History and neurological examinations were done in all diagnosed patients. MRI reports of all these patients were reviewed. All these findings of MRI were correlated with the clinical findings at different levels of lumbar vertebrae.
 RESULTS: There was a statistically significant positive correlation of MRI findings with clinical findings in the presence of nerve root compression at the L1-L2 level of lumbar vertebrae. All abnormal findings on MRI did not correlate with clinical findings because some patients did not produce symptoms. According to the Pearson coefficient correlation, there was a positive but insignificant (p-value≥0.05) correlation between clinical features (sensations, power and reflexes) and MRI findings at all the levels of lumbar vertebrae except L2 dermatome and myotome.
 CONCLUSION: There was a not good correlation between MRI findings and clinical findings of patients with lumbar disc prolapse except L2.

Added value of hybrid SPECT with CT imaging for predicting poor therapeutic efficacy of 89Sr in patients with bone metastasis

To utilize single-photon emission computed tomography/computed tomography (SPECT/CT) scanning to investigate the usefulness of nerve root compression (NRC) and radioactive cold zone lesions (RCZLs) for predicting poor therapeutic efficacy of strontium-89 chloride (Sr-89) in patients with bone metastasis. Patients with bone metastatic neoplasms who had undergone baseline bone SPECT/CT scanning before Sr-89 therapy (148 MBq Sr-89 chloride by an intravenous injection for each patient) between July 2011 and July 2018 were included. Bone SPECT/CT images were assessed by two readers independently. Associations between imaging features and therapeutic efficacy were obtained via multivariate logistic regression analysis. Of 231 patients analyzed, 50 (21.6%) had NRC at baseline. Of 31 patients who experienced poor therapeutic efficacy, 29 (93.5%) had NRC. In multivariate logistic regression analysis baseline NRC independently predicted poor therapeutic efficacy. The sensitivity of NRC for predicting poor therapeutic efficacy was 93.5%, specificity was 89.5%, positive predictive value was 58.0%, and negative predictive value was 98.9%. RCZLs were detected in17 patients (7.4%), of whom 14 experienced poor Sr-89 therapeutic efficacy. The sensitivity of the presence of RCZLs for predicting poor therapeutic efficacy was 45.2%, specificity was 98.5%, positive predictive value was 82.4%, and negative predictive value was 92.1%. After adjusting for age, bone metabolism and lesion type, the significant independent predictors of poor Sr-89 therapeutic efficacy were presence of NRC (p < 0.001) and RCZL (p = 0.001). NRC and RCZL on baseline bone SPECT/CT are reliable independent predictors of poor Sr-89 therapeutic efficacy in patients with bone metastasis. These associations may facilitate the administration of more effective therapeutic interventions.

Weight-Bearing MRI of the Lumbosacral Spine: Difference between Supine and Weight Bearing Positions and Additional Value in Patients with Low Back Pain

Objective: To study the difference of magnetic resonance imaging (MRI) parameters of the lumbosacral spine between weight-bearing and supine positions, and evaluate whether there is additional value in patients with low back pain. Materials and Methods: Eight-six patients with low back pain with or without leg pain who underwent MRI of the lumbosacral spine in weight-bearing and supine positions were included in the present retrospective study. The patients’ characteristics and MRI parameters were measured. The data were analyzed to find significant differences between these two positions. Results: MRI parameters which significantly increased in weight-bearing position compared to supine position (p&lt;0.05) included lumbar lordotic angle, lumbosacral angle, presence of spondylolisthesis (at L4/L5 level), and presence of nerve root compression (at L3/L4, L4/L5, and L5/S1 levels). Parameters or findings that significantly decreased were spinal canal diameter (at L2/L3, L4/L5, and L5/S1 levels), and intervertebral disk height (at L2/L3, L4/L5, and L5/S1 levels). Older age group (mean age of 54.3 years versus 45.6 years as younger group) showed a significant change in number of nerve root compression. Forty-three percent of patients with radiating symptom showed a changed number of nerve root compression but this was not statistically significant. Conclusion: Multiple MRI parameters of the lumbosacral spine show significant change in weight-bearing compared to supine position. Increased presence of spondylolisthesis and nerve root compression might be beneficial in patients with radiating symptom unexplained by conventional MR studies in supine position. Older age group showed a significant change in number of nerve root compression. Keywords: Weight-bearing, MRI, Lumbar spine, Back pain

Prognostic value of magnetic resonance imaging findings in patients with sciatica

OBJECTIVE This study aimed to determine the prognostic value of MRI variables to predict outcome in patients with herniated disc-related sciatica, and whether MRI could facilitate the decision making between early surgery and prolonged conservative care in these patients. METHODS A prospective observational evaluation of patients enrolled in a randomized trial with 1-year follow-up was completed. A total of 283 patients with sciatica who had a radiologically confirmed disc herniation were randomized either to surgery or to prolonged conservative care with surgery if needed. Outcome measures were recovery and leg pain severity. Recovery was registered on a 7-point Likert scale. Complete/near complete recovery was considered a satisfactory outcome. Leg pain severity was measured on a 0- to 100-mm visual analog scale. Multiple MRI characteristics of the degenerated disc herniation were independently scored by 3 spine experts. Cox models were used to study the influence of MRI variables on rate of recovery, and linear mixed models were used to determine the predictive value of MRI variables for leg pain severity during follow-up. The interaction of each MRI predictor with treatment allocation was tested. There were no study-specific conflicts of interest. RESULTS Baseline MRI variables associated with less leg pain severity were the reader's assessment of presence of nerve root compression (p < 0.001), and assessment of extrusion compared with protrusion of the disc herniation (p = 0.006). Both variables tended to be associated, but not significantly, with satisfactory outcome during follow-up (HR 1.45, 95% CI 0.93-2.24, and HR 1.24, 95% CI 0.96-1.61, respectively). The size of disc herniation at baseline was not associated with outcome. There was no significant change in the effects between treatment groups. CONCLUSIONS MRI assessment of the presence of nerve root compression and extrusion of a herniated disc at baseline was associated with less leg pain during 1-year follow-up, irrespective of a surgical or conservative treatment. MRI findings seem not to be helpful in determining which patients might fare better with early surgery compared with a strategy of prolonged conservative care. Clinical trial registration no.: ISRCTN26872154 ( controlled-trials.com ).

A diagnostic study in patients with sciatica establishing the importance of localization of worsening of pain during coughing, sneezing and straining to assess nerve root compression on MRI.

To test whether the localization of worsening of pain during coughing, sneezing and straining matters in the assessment of lumbosacral nerve root compression or disc herniation on MRI. Recently the diagnostic accuracy of history items to assess disc herniation or nerve root compression on magnetic resonance imaging (MRI) was investigated. A total of 395 adult patients with severe sciatica of 6-12weeks duration were included in this study. The question regarding the influence of coughing, sneezing and straining on the intensity of pain could be answered on a 4 point scale: no worsening of pain, worsening of back pain, worsening of leg pain, worsening of back and leg pain. Diagnostic odds ratio's (DORs) were calculated for the various dichotomization options. The DOR changed into significant values when the answer option was more narrowed to worsening of leg pain. The highest DOR was observed for the answer option 'worsening of leg pain' with a DOR of 2.28 (95% CI 1.28-4.04) for the presence of nerve root compression and a DOR of 2.50 (95% CI 1.27-4.90) for the presence of a herniated disc on MRI. Worsening of leg pain during coughing, sneezing or straining has a significant diagnostic value for the presence of nerve root compression and disc herniation on MRI in patients with sciatica. This study also highlights the importance of the formulation of answer options in history taking.

Persistent Genital Arousal Disorder Caused by Spinal Meningeal Cysts in the Sacrum: Successful Neurosurgical Treatment.

To evaluate whether treatment of spinal meningeal cysts that compress sacral spinal nerve roots is associated with relief of persistent genital arousal disorder. In this case series we encountered a group of patients with persistent genital arousal disorder among a larger cohort undergoing a prospective outcomes study on the surgical treatment of symptomatic spinal meningeal cysts. Epidemiologic data were collected and the type, number, and location of the meningeal cysts in each patient were determined on magnetic resonance imaging. Postoperatively patients were asked to self-report whether their persistent genital arousal disorder was eliminated, significantly better, the same, or worse. In a cohort of 1,045 patients with symptomatic spinal meningeal cysts, we identified 11 with persistent genital arousal disorder; all were female and all had meningeal cysts in the sacral spinal canal causing sacral nerve root compression. In addition to persistent genital arousal disorder, all patients had other symptoms typical of sacral nerve root compression such as perineal, bladder, and bowel symptoms. Although multiple types of meningeal cysts were encountered, Tarlov cysts were the most common (8/11). Postoperatively, seven (64%) patients reported elimination of their persistent genital arousal disorder, three (27%) noted significant improvement, one (9%) said they were unchanged, and none experienced worsening with an average follow-up of 23 months ranging from 2 months to 6 years. Although Tarlov cysts were more numerous, the presence of persistent genital arousal disorder and the surgical outcomes appeared unrelated to the type of spinal meningeal cyst treated. Our case series suggests that sacral nerve root compression caused by spinal meningeal cysts can cause persistent genital arousal disorder. The presence of nerve root compression appears to be more important than the particular type of meningeal cyst involved. Microsurgical cyst treatment cured or significantly reduced persistent genital arousal disorder symptoms in 91% of the patients. III.

Long Term Outcomes from CT-guided Indirect Cervical Nerve Root Blocks and their relationship to the MRI findings--A prospective Study.

To investigate long-term pain reduction and 'improvement' in patients with indirect cervical nerve-root-blocks in comparison to MRI findings. One hundred and twelve patients with MRI confirmed cervical radiculopathy and an indirect cervical nerve-root-block were included. Two radiologists independently evaluated the MRI examinations. 12 different MRI abnormalities at the level and side of infiltration were compared to pain relief and 'improvement' at 1-month, 3-months and 1-year post injection. The proportion of patients reporting clinically relevant 'improvement' was 36.7% at 1-month, 53.9% at 3-months and 68.1% at 1-year. At 1-month post injection, a statistically significantly lower percentage of patients eventually requiring surgery reported improvement and lower NRS change scores compared to those who did not undergo surgery (p = 0.001). Patients with extrusion of the disc were around 4-times more likely to have surgery. At 1-year post-injection the presence of nerve-root compromise was significantly linked to treatment outcome (p = 0.011). Patients with nerve root compression were more likely to report improvement at 1 year. Patients with disc extrusions have less pain relief and are 4 times more likely to go to surgery than patients with disc protrusions. • Good long term outcomes after indirect nerve root infiltrations with non-particulate steroids. • The presence of nerve root compression was a predictive finding of 'improvement'. • Significantly less patients subsequently having surgery had lower NRS scores 1-month post injection. • There is less pain relief in patients with disc extrusions. • There are less improvement in patients with modic type I changes.

Clinical Correlation of a New MR Imaging Method for Assessing Lumbar Foraminal Stenosis

Recently, Lee et al reported a new grading system for the lumbar spinal foraminal stenosis. They considered the type of stenosis, the amount of fat obliteration, and the presence of nerve root compression. Our aim was to evaluate whether a new MR imaging grading system correlated with symptoms and neurologic signs and could replace the previous grading system. We examined 91 patients (M/F = 49:42; mean age, 50 years) who visited our institution and underwent MR imaging of the L-spine and were evaluated by 2 musculoskeletal radiologists. The presence and grade of lumbar foraminal stenosis at the maximal narrowing point was assessed according to the new grading system suggested by Lee et al (Lee system) and the Wildermuth grading system (Wildermuth system). Results were correlated with clinical manifestations and neurologic physical examination. Statistical analysis was performed by using κ statistics, categoric regression analysis, and nonparametric correlation analysis (Spearman correlation). Interobserver agreement in the grading of foraminal stenosis between the 2 readers was substantially correlated (κ of Lee system = 0.767, κ of Wildermuth system = 0.734). The Rs for reader 1 and reader 2 between the Lee system and the Wildermuth system were 0.880 and 0.885, between Lee system and PNM were 0.715 and 0.604, and between the Wildermuth system and PNM were 0.800 and 0.680. For patients younger than 50 years of age, the R between the Lee and Wildermuth systems was higher than that for patients 50 years or older, but the Rs between the grading system and PNM were lower in the younger group than in the older group. The Rs of the Wildermuth system with PNM were higher in the older group than in the younger group; the differences between the Rs of the Lee system with PNM and the Wildermuth system with PNM were higher in the older group (0.016 [young] versus 0.130 [old] and 0.008 versus 0.107). Interobserver agreement of the Lee system was slightly higher than the Wildermuth system and substantially correlated. Both systems are good for evaluation of lumbar spinal foraminal stenosis, but the Lee system showed slightly better interobserver agreement and good clinical correlation in the younger group of patients.

Low Back Pain in Changi General Hospital: An Observational Study

Aims: The aim is to study the profile of local low back pain (LBP) patients and their physiotherapy management in an outpatient physiotherapy clinic. Methods: A retrospective study was done with records of LBP patients attending the Musculoskeletal Physiotherapy Clinic at Changi General Hospital from January to June 2009. Age, LBP onset, occupation, time off work, investigation results, and functional outcomes were obtained. Results: Ninety-four records were screened. Majority of patients (59.6%) were aged between 30–50 years old. Sixty-six percent were engaged in occupations that involved sustained postures. Majority of patients (91.5%) had minor/no trauma in association to the onset of their symptoms. Although majority of patients (64.9%) did not take any time off work to manage their LBP, a total of 640 days were lost off work due to LBP. Majority of patients (93.6%) underwent radiological investigations. There was no significant correlation between radiating symptoms and presence of nerve root compression on MRI (p = 0.144). In addition, pathology did not significantly impact on rehabilitative outcome in our sample (p = 0.397, p = 0.602). A review of clinical practice with regards to ordering radiological investigations may be required to minimise radiation exposure and increase cost effectiveness. Patients improved from a mean of 4.00 to 9.10 on the Patient Specific Functional Scale (PSFS) within an average of 3.65 sessions. There was a significant relationship between earlier onset of therapy and better functional improvement on the PSFS (r= −0.299, p = 0.026). Starting a physiotherapy service in our accident and emergency department may be a good consideration to implement in our hospital. Conclusions: Sustained postures may contribute to LBP in local patients. Disability and time lost off work as result of LBP appears to be a significant problem locally. Radiology has no correlation with symptoms, nor rehabilitative outcomes. Pathology may have only limited value in determining treatment or prognosis in nontraumatic LBP. A tailored physiotherapy approach towards education, manual therapy and exercises may be effective in improving functional capabilities in local LBP patients. Earlier onset of physiotherapy is associated with better functional recovery in LBP patients.

Morphological Analysis in Patients With Sciatica

A prospective observational study of patients with sciatica. We investigated the effectiveness of 3-dimensional high-spatial resolution diffusion-weighted MR neurography based on steady state free precession (3-dimensional diffusion-weighted steady-state free precession [DW-SSFP]) in the diagnosis of sciatica. Patients with sciatica challenge a physician who desires a precise diagnosis for the etiology of the pain. Direct imaging of the sciatic nerve with high resolution and high contrast may contribute to accurate localization and help to find the causes of sciatica and provide reliable information to clinicians in treatment choice. Thus, we supposed that 3-dimensional DW-SSFP method have the ability to confirm the etiologies of sciatica. The 3-dimensional DW-SSFP sequence was performed on 137 patients with sciatica and 32 patients in control group. The postprocessing techniques were used to generate images of lumbosacral plexus and sciatic nerve, and the images acquired were assessed based on the presence or absence of nerve abnormality. The certainty of identifying the lumbosacral plexus and main branches from all cases was determined in each of the reconstruction planes for each case individually and assessed by using a 3-score scale. All subjects were successfully performed. The sciatic nerve and its main branches were differentiated and a clear picture was obtained in all subjects. Compared with the control group, the presence of nerve root compression or increased T2 signal intensity changes can be observed in all patients. The mean score of certainty of identifying the sciatic nerve and main branches was 1.76 +/- 0.4, which indicate that the sciatic nerve and main branches can be identified with certainty. The 3-dimensional DW-SSFP MRI with high spatial and sufficient contrast is an excellent technique to define the nature of sciatica and assists in prognostication and possibly in management.

The Sensitivity and Specificity of the Slump and the Straight Leg Raising Tests in Patients With Lumbar Disc Herniation

An accurate and specific diagnosis prevents the recurrences of low back pain and chronic spinal pain. The physical examination is the most useful tool to diagnosis. The examiner must aim to determine the exact tissue that pain arises from to make the specific diagnosis. Lumbar disc herniation is 1 disease that physical examination, symptoms, and findings on imaging technique do not always correlate with each other. The Straight Leg Raising (SLR) test has been used as the primary test to diagnosis lumbar disc herniations and found to have high correlation with findings on operation since its sensitivity is high in only disc herniations leading to root compression that may eventually need operation. More sensitive test, like the Slump, might be used in herniations in which the SLR is negative. The Slump test is really a variant of the SLR and the Lasègue's tests performed in the seated position and is a progressive series of maneuvers designed to place the sciatic nerve roots under increasing tension. At each step in the procedure, the patient informs the examiner what is being felt and whether radicular pain is produced. As a result, the Slump test applies traction to the nerve roots by incorporating spinal and hip joint flexion into the leg raising and would warn the examiner of the presence of nerve root compression when there is a negative SLR test. This study measured the sensitivity and specificity of the Slump test and compare it with the SLR test in patients with and without lumbar disc herniations. A prospective case control study of 75 patients with complaints suggestive of lumbar disc herniation was carried out in the outpatient clinics of the neurosurgery department of a state teaching hospital. Seventy-five referred or self-admitted patients with low back, leg, or low back and leg pain who had results of magnetic resonance imaging (MRI) of the lumbar spine were included in the study. Thirty-eight patients had signs of herniation demonstrated by MRI. Control patients (n = 37) had no disc bulges or herniations on MRI. Both the Slump and SLR tests were performed during the assessment of all the patients by the second author. The MRI results were assessed and recorded by the first author. The Slump test was found to be more sensitive (0.84) than the SLR (0.52) in the patients with lumbar disc herniations. However, the SLR was found to be a slightly more specific test (0.89) than the Slump test (0.83). The Slump test might be used more frequently as a sensitive physical examination tool in patients with symptoms of lumbar disc herniations. In contrast, owing to its higher specificity, the SLR test may especially help identify patients who have herniations with root compression requiring surgery.

Chronic Pain: Management Strategies That Work

Chronic Pain: Management Strategies That Work

Life events in neurological patients with headache and low back pain (in relation to diagnosis and persistence of pain)

The series comprised 253 hospitalized patients with 3 groups of patients with low back pain differing in respect to the presence of nerve root compression, and 2 headache groups i.e., migraine and other non-organic headache. Comparison of the frequency of single life events within the previous 12 months revealed no statistically significant differences among the diagnostic groups. Nor were there any statistically significant differences among the means of the total number of life events, the number of life events with transient distress and the number of life events with enduring distress. Self-rated treatment outcome on pain 6 months after discharge showed for headache patients a statistically significant negative association between persistence of pain and the number of life events with transient distress. In conclusion the findings attach more weight to vulnerability factors or coping abilities compared to social stress.