Radiating Leg Pain Research Articles

Clinical Course and Prognostic Factors of Older Patients With Back Pain and Radiating Leg Pain in General Practice: BACE Cohort Study.

Patients with back pain (BP) and radiating leg pain have poorer clinical outcomes compared to patients with BP alone. We aimed to describe the 1-year clinical course and to identify prognostic factors associated with non-recovery in older BP patients with radiating leg pain. Patients in the BACE cohort aged >55years with a new episode of BP and radiating leg pain were included (n=377). Data on clinical outcomes were collected until 1-year follow-up. Uni- and multivariable regression analyses were performed to investigate the association between potential prognostic factors and three non-recovery outcomes at the 1-year follow-up. More than half of the patients (65%) did not recover after 12months. In multivariable analyses, poor self-rated health (odds ratio [OR] 2.34, 95% CI: 1.20-4.56) and BP duration at baseline (OR 1.48, 1.12-1.96) were significantly associated with non-recovery for BP as outcome; age (OR 1.04, 1.03-1.05), smoking (OR 1.14, 1.00-1.30), depressive symptomatology (OR 1.03, 1.02-1.04), kinesiophobia (OR 1.03, 1.02-1.04), poor self-rated health (OR 2.09, 1.83-2.39), baseline disability (OR 1.16, 1.14-1.17), BP duration (OR 1.49, 1.41-1.57), leg pain (OR 1.52, 1.37-1.68), pain during rotation (OR 1.71, 1.53-1.90) and other musculoskeletal complaints (OR 1.34, 1.17-1.52) were associated with disability. No factors were associated with leg pain. Several prognostic factors were associated with non-recovery in older patients with BP and radiating leg pain. Primary care clinicians should be aware of these factors in managing these patients.

Lumbar foraminal stenosis was associated with back pain and leg pain: epidemiological evidence from a population-based cohort.

To determine the characteristics of lumbar foraminal stenosis (LFS) on magnetic resonance (MR) images and their association with back pain and radiating leg pain in a population-based sample of Chinese subjects. This study was an extension of the Hangzhou Lumbar Spine Study, a cross-sectional study focusing on back pain and lumbar spine MR imaging findings. Questionnaire data, including demographics, lifestyle, occupational exposures, back pain and radiating leg pain were included. On lumbar spine MR images, disc degeneration was assessed using Pfirrmann grade and Modic changes were evaluated. Using Lee's scale, the L3-S1 intervertebral foramina were evaluated, with grade 2-3 representing substantial LFS and grade 0-1 no LFS. Characteristics of LFS were noted, and associations of LFS with back pain and radiating leg pain were examined. Among the 644 study subjects, 141 (21.9%) had at least one LFS, and its occurrence was associated with greater age (OR = 1.93 for each 10 years, p < 0.001). Substantial LFS was associated with the presence of back pain (OR = 1.92, p = 0.001) and the intensity of the worst back pain (Coef = 8.30, p < 0.001) over the past 12 months, and disabling back pain during their lifetime (OR = 2.25, p < 0.001). Substantial LFS was also associated with leg pain (OR = 14.27, p < 0.001), with a sensitivity of 75.7% for the presence of radiating leg pain and a specificity of 81.4%. Substantial LFS on MR images was a common age-related degenerative phenotype in adults, and appears to be an independent risk factor for back pain and leg pain.

Characteristics and outcomes of patients with low back pain with and without radiating leg pain following the GLA:D back program

BackgroundSome patients with low back pain (LBP) also report radiating leg pain which is a prognostic factor for poorer clinical outcomes. We aimed: 1) to compare the baseline characteristics of patients with LBP with - (LBP + leg pain) and without radiating leg pain (LBP - alone); 2) to investigate whether patients with LBP + leg pain show similar post-treatment outcomes as compared to LBP – alone, after participation in an exercise and patient education program, i.e. the GLA:D Back program. MethodsThe patient sample included 3508 patients in the GLA:D Back program between March 2018 and August 2022. The outcomes were mean changes in LBP intensity, back-related activity limitation, self-efficacy and fear of movement measured from baseline to 3, 6 and 12 months. Baseline characteristics were compared with descriptive statistics, and linear mixed models were used to estimate group differences in changes from baseline to 3-, 6- and 12 months. Results1915 (55%) of the patients were in the group LBP- alone and 1593 (45%) in the LBP + leg pain. The LBP + leg pain group displayed higher STarT back classification (greater risk of chronicity) compared to the LBP–alone. The LBP + leg pain group showed almost similar improvements in all outcomes compared to LBP – alone after the GLA:D Back program. ConclusionIn long-lasting (chronic) LBP patients, the LBP + leg pain group improved to the same extent as LBP - alone regarding LBP intensity, disability, and fear of movement following an exercise and patient education program, GLA:D Back.

The prevalence, incidence and management of low back pain with radiating leg pain in Dutch general practice: A population-based cohort study in the Rijnmond Primary Care Database.

Radiating leg pain is common in patients with low back pain (LBP). In this study, we aimed to determine the prevalence and incidence of LBP with radiating leg pain in Dutch general practice, and to describe the prescribed medications and requested imaging diagnostics. The Rijnmond Primary Care Database containing over 500,000 primary care patients was used to select patients ≥18 years with LBP with radiating leg pain between 2013 and 2021. Data on patient characteristics, LBP episodes, prescribed medication and requested imaging in the first 3 months of an episode was extracted. Descriptive statistics were used to present patient characteristics and diagnostic/therapeutic interventions. A total of 27,695 patients were included. The total number of LBP with radiating leg pain episodes in these patients was 36,268. In 2021, the incidence and prevalence were 19.1 and 25.7 per 1000 patient years, respectively. In 60% of patients, the episode duration was shorter than 1 month. In 62% of the episodes, patients visited the general practitioner (GP) one to two times. In 59% of the episodes, at least one medication was prescribed, non-steroidal anti-inflammatory drugs (NSAIDs) being the most common one (45%). In approximately 11% of the episodes, additional diagnostic imaging was requested. LBP with radiating leg pain is common in Dutch general practice patients. About 2/3rd were prescribed pain medications. Dutch request few to none diagnostic imaging for these patients which is in line with clinical practice guidelines. In this new study, we have gained insights into the incidence and prevalence of LBP with radiating leg pain in Dutch general practice. Both remained fairly stable over the study period of 9 years (2013-2021). Overall, the care burden regarding seeking contact with the GPs and the requested diagnostics seem not to be that high. In 62% of the care episodes, there were one or two consultations with the GP, and in 11% of the episodes a diagnostic imaging was requested. Pain medications frequently prescribed (i.e. 2/3rd of the episodes), with NSAIDs being the most common ones.

The association of the STarT Back Screening Tool and type of leg pain with low back pain disability trajectories: a prospective cohort study

BackgroundMultiple factors influence the recovery process of low back pain (LBP). The identification and increased knowledge of prognostic factors might contribute to a better understanding of the course of LBP. The purpose of this study is to investigate the association of the STarT Back Screening Tool (SBST) risk score and the type of leg pain (non-radiating LBP, referred non-radicular, and radicular radiating leg pain) with the disability trajectory (at baseline, the slope, and recovery at one year) in adults with low back pain.MethodsThis is a prospective cohort study in 347 patients with low back pain who sought physiotherapy care at three primary care practices in the Netherlands. Linear mixed models were estimated to describe the association of the SBST risk score and the type of leg pain with disability at baseline, the slope in the disability trajectory, and at twelve months follow-up.ResultsA medium/high risk score on the SBST is associated with higher baseline disability scores on the Oswestry Disability Index (ODI), faster initial recovery, and still a higher disability ODI score at 12 months follow-up. Non-radicular referred and radicular radiating leg pain were associated with worse baseline disability ODI scores in LBP. This association was not present for the initial recovery or at the 12 months follow-up.ConclusionThe SBST is associated with the LBP recovery trajectory. The SBST might be a useful tool to predict the disability trajectory in a heterogeneous group of people with low back pain in primary care and might, therefore, be recommended in future clinical practice guidelines. The type of leg pain was not associated with the recovery trajectory of LBP. Future research might focus on evaluating different types of leg pain.Trial registrationClinicaltrials.gov: 109,643.

Clinical efficacy of nucleoplasty for uncontained lumbar disc herniation: a retrospective study

BackgroundThere are insufficient in-depth studies on whether percutaneous lumbar nucleoplasty (PLN) is effective and safe for the treatment of uncontained lumbar disc herniation (ULDH). This study aimed to investigate the clinical efficacy of PLN on radiating leg pain caused by ULDH.MethodsPatients who underwent PLN for ULDH and met the inclusion criteria between June 2018 and July 2022 were included. Clinical outcomes were evaluated using the numeric rating scale (NRS) for radiating pain preoperatively; at 1 day, 1 week, and 1 month postoperatively; and at the last follow-up. Patient satisfaction was assessed using MacNab criteria.ResultsForty-one patients were enrolled. The mean age was 50.2 years (range 24–73 years). The mean and standard deviation of the preoperative NRS in 39 patients with radiating pain was 9.0 ± 1.2. The NRS scores at 1 day, 1 week, and 1 month postoperatively and at the last follow-up were 4.6 ± 3.2, 3.6 ± 3.3, 2.9 ± 3.2, and 1.4 ± 2.0, respectively, showing significant improvement (all, p < 0.001). The number of patients (percentage) with excellent or good satisfaction according to the MacNab criteria was 29 (70.7%). Major complications were not observed. Three patients underwent additional surgery after PLN because of persistent radiating pain.ConclusionsPLN is a safe and feasible treatment option for ULDH. Treatment outcomes were favorable on average; however, the lack of consistency was a drawback.

Percutaneous uniportal full-endoscopic surgery for treating symptomatic lumbar facet joint cysts under local anesthesia combined with monitored anesthesia care: a preliminary report of eight cases with at least 1 year follow-up.

Lumbar facet joint cysts (FJCs) are a relatively rare clinical pathology that can result in radiculopathy or neurogenic claudication. Various treatments such as percutaneous aspiration and surgery have been reported to have good clinical outcomes. However, few clinical studies have aimed to treat symptomatic lumbar FJCs by using uniportal full-endoscopic (UFE) surgery. This study aimed to investigate the preliminary clinical outcomes of UFE surgery for the treatment of lumbar FJCs under local anesthesia combined with monitored anesthesia care (MAC). Eight patients (five males and three females) with symptomatic lumbar FJCs who underwent UFE surgery under local and MAC anesthesia were enrolled in this study between January 2018 and April 2022. The clinical characteristics, radiological features, operative information, visual analog scale (VAS) score, Oswestry disability index (ODI), and overall outcome rating based on the modified MacNab criteria were retrospectively analyzed. Of the eight patients, four underwent a transforaminal approach and four underwent an interlaminar approach. Postoperatively, the mean VAS score for leg pain decreased from 6.1 before surgery to 0.6 after surgery, and the ODI decreased from 74.5% to 14.7%. All patients were followed up for more than 1 year, and the good-to-excellent rate based on the modified MacNab criteria remained 100% at the last follow-up. No complications occurred during the follow-up period. Lumbar FJCs can cause severe radiating leg pain and/or neurogenic claudication due to the dural sac compression and nerve roots. As an alternative treatment, UFE decompression under local and MAC anesthesia may provide effective clinical outcomes for symptomatic lumbar FJCs.

A case report: Unilateral biportal endoscopic revision for adjacent segmental disease: Case presentations and literature review.

Biportal endoscopic revision surgery for adjacent segmental disease (ASD) after lumbar arthrodesis is seldomly reported. Herein, we present 3 cases of ASD with radiculopathy wherein satisfactory results were obtained using unilateral biportal endoscopic (UBE) decompression. Case 1 was of a 56-year-old male who presented with a chief complaint of Intermittent claudication since 2-year. Case 2 involved a 78-year-old female who was admitted to the hospital with a chief complaint of radiating pain and weakness in the left leg for at least 1 year. Case 3 was a 67-year-old woman who visited our hospital because of radiating leg pain for 5 months. All the cases had a history of L4 to L5 lumbar interbody fusion surgery. Computed tomography and magnetic resonance imaging showed the spinal epidural lipomatosis at the L3 to L4 level in case 1, the up-migrated lumbar disc herniation at L3 to L4 level in case 2 and unilateral foraminal stenosis at the L5 to S1 level in case 3. Under UBE guidance, the ipsilateral approach was used to treat adjacent lumbar stenosis caused by spinal epidural lipomatosis. The contralateral approach was used to remove the up-migrated herniated disc. The paraspinal approach was applied to decompress the foraminal stenosis. Postoperative parameters were improved clinically, and nerve roots were decompressed radiologically. No complications were developed. UBE revision surgery showed a favorable clinical and radiological result without complications and may be a safe and effective alternative technique for ASD.

Are Primary Outcomes Really Primary? An Exploratory Cross-Sectional Nationwide Web-Based Survey Study for Outcomes Reflecting Real Symptoms and Needs of Patients with Lumbar Disc Herniation.

As primary outcomes differ among clinical lumbar disc herniation (LDH) studies, this study aimed to explore outcomes reflecting real-world patient experiences through an exploratory questionnaire survey. Those diagnosed with LDH having radiating leg pain in South Korea in November of 2022 (N = 500) were administered a questionnaire including basic characteristics, disease onset, symptoms and severity, priority symptoms for improvement, and important treatment factors. Outcome measures included the identification of priority symptoms and disabilities. Most common symptoms were numbness in the leg (N = 435, 87.0%) and back pain (N = 406, 81.2%); most common disabilities were discomfort in sitting (N = 323, 64.6%) and lifting (N = 318, 63.6%). The highest priority symptom was back pain (N = 242, 48.4%). A satisfactory degree of symptom improvement was a decrease of at least 3 points on the numeric rating scale. The majority of respondents preferred improvement in disability over pain (N = 270, 55.8%), a stable effect over a rapid effect (N = 391, 78.2%), and safety over treatment efficacy (N = 282, 56.4%). Safety (N = 129, 25.8%) and cost (N = 111, 22.2%) were the most important treatment factors. Improvements in back pain, leg pain, sitting, and sleeping were prioritized, and safety, stable treatment effect, and functional recovery were desired. Clinical trials for LDH should be designed to reflect this real-world patient need. Further study to examine the patients' symptoms and needs in details is needed.

A Pilot Study for Effectiveness of Non-Pharmacological versus Pharmacological Treatment Strategies for Lumbar Disc Herniation: A Pragmatic Randomized Controlled Trial.

We aimed to compare the efficacy, safety, and cost-effectiveness of non-pharmacological- and pharmacological treatment strategies for Lumbar disc herniation (LDH) in pragmatic clinical settings. This study was a pilot, two-armed, parallel pragmatic randomized controlled trial. Thirty patients aged 19-70 years with a numeric rating scale (NRS) score ≥5 for sciatica and confirmed LDH on magnetic resonance imaging (MRI) were included. Participants were assigned in a 1:1 ratio to non-pharmacological (non-Phm) or pharmacological (Phm) treatment group. They were treated for 8 weeks and a total follow-up period was 26 weeks after randomization. Non-Phm treatment included acupuncture, spinal manual therapy, etc., Phm included medication, injection, nerve block, etc., The primary outcome was a numeric rating scale (NRS) of radiating leg pain. NRS for low back pain, Oswestry disability index, visual analog scale, Fear-Avoidance Beliefs Questionnaire, patient global impression of change, Short Form-12 Health Survey, version 2, 5-level European Quality of Life-5 dimensions (EQ-5D) were also measured. Linear mixed model was used to evaluated the difference in change of outcomes from baseline between two groups. An economic evaluation was conducted using incremental cost-effectiveness ratios. There was no significant difference between the two groups in the intervention period, but non-Phm group showed significantly greater degree of improvement in follow-up of Week 14. Difference in the NRS for sciatica and ODI were 1.65 (95% CI 0.59 to 2.71, p=0.003) and 8.67 (95% CI 1.37 to 15.98, p=0.21), respectively in Week 14. The quality-adjusted life year (QALY) value calculated by EQ-5D and Short Form-6 Dimension were 0.006 (95% CI -0.012 to 0.024, p=0.472) and 0.015 (95% CI -0.008 to 0.038, p=0.195) higher in non-Phm group than in Phm group. The cost was lower in non-Phm group than in Phm group (Difference: -682, 95% CI -3349 to 1699, p=0.563). We confirmed that the non-Phm treatment could be more cost-effective treatments than Phm treatments and feasibility of a large-scale of main study in future.

Occult proximal femoral fracture with radiating leg pain masquerading as sciatica: a case report

BackgroundOccult proximal femoral fractures do not appear as fracture lines in radiographs, causing misdiagnosis and delayed diagnosis unless additional imaging studies, such as computed tomography or magnetic resonance imaging, are performed. Here, we present a 51-year-old male with an occult proximal femoral fracture who experienced radiating unilateral leg pain that took 3 months to be diagnosed because his symptoms mimicked lumbar spine disease.Case presentationA 51-year-old Japanese male experienced persistent lower back and left thigh pain after falling off a bicycle, and was referred to our hospital 3 months thereafter. Whole-spine computed tomography and magnetic resonance imaging revealed minute ossification of the ligamentum flavum at T5/6 without spinal nerve compression, but this did not explain his leg pain. Additional magnetic resonance imaging of the hip joint revealed a fresh left proximal femoral fracture without displacement. He underwent surgery for in situ fixation using a compression hip screw. Post-surgical pain relief was immediate.ConclusionsMisdiagnosis of occult femoral fractures as lumbar spinal disease may occur if distally radiating referred pain is present. Hip joint disease should be considered as a differential diagnosis in cases of sciatica-like pain with an unknown spinal origin and no specific findings on spinal computed tomography or magnetic resonance imaging accounting for the leg pain, especially following trauma.

Effect of Godelieve Denys-Struyf (GDS) muscle and articulation chain treatment on clinical variables of patients with chronic low back pain and lumbar disc degeneration: a pilot feasibility randomized controlled trial

BackgroundPatients with chronic low back pain (LBP) and lumbar disc degeneration are recommended to try out nonsurgical treatment options before surgery. There is need for good nonsurgical alternatives that can be adapted to the patient’s needs and level of function. The aim of this pilot trial was to test study feasibility of a future full randomized controlled trial (RCT) evaluating the feasibility and benefit of the physiotherapy-based Godelieve Denys-Struyf (GDS) muscle and articulation chain treatment for patients with chronic LBP and lumbar disc degeneration referred to surgical assessment in a hospital outpatient clinic.MethodsThis study is a single-center, two-arm, single-blinded, pilot RCT conducted in a regional hospital in Norway. Patients of age 35–75 years with chronic (> 3 months) LBP and degenerative lumbar disc(s) verified by imaging were included. They filled in a baseline questionnaire prior to randomization, including the Oswestry Disability Index (ODI), numerical rating scale for pain in back and pain in leg, and the EuroQoL 5L. Patients in the control group were free to use treatment as usual. Patients in the intervention group received 8 sessions over a period of 10 to 14 weeks of GDS muscle and articulation chain treatment.ResultsThe recruitment rate was slow, approximately 3/4th of the referred patients met the inclusion criteria, but majority of eligible participants (94%) were willing to participate. A total of 30 patients were randomized into the two groups. The randomization led to skewed distribution of radiating leg pain in the two groups. All participants except one (97%) completed 4 months follow-up. No serious adverse events attributable to the trial treatments were reported. The Oswestry Disability Index (ODI) and leg pain intensity scale were both suitable as primary outcomes in a full trial. The mean change in the ODI score was 8.7 (SD 16.1) points in the GDS arm, whereas there was a minor deterioration in the ODI scores of −3.7 (7.5) points in the control arm. A sample size calculation based on the ODI scores resulted in a number needed to treat of 3.ConclusionsA future full RCT is feasible and would provide evidence about the effectiveness of a GDS treatment for patients with chronic LBP and lumbar disc degeneration.Trial registrationClinicalTrials.gov ID: 910193.

Differentiating Lumbar Spinal Etiology from Peripheral Plexopathies

Clinicians have managed and treated lower back pain since the earliest days of practice. Historically, lower back pain and its accompanying symptoms of radiating leg pain and muscle weakness have been recognized to be due to any of the various lumbar spine pathologies that lead to the compression of the lumbar nerves at the root, the most common of which is the radiculopathy known as sciatica. More recently, however, with the increased rise in chronic diseases, the importance of differentially diagnosing a similarly presenting pathology, known as lumbosacral plexopathy, cannot be understated. Given the similar clinical presentation of lumbar spine pathologies and lumbosacral plexopathies, it can be difficult to differentiate these two diagnoses in the clinical setting. Resultingly, the inappropriate diagnosis of either pathology can result in ineffective clinical management. Thus, this review aims to aid in the clinical differentiation between lumbar spine pathology and lumbosacral plexopathy. Specifically, this paper delves into spine and plexus anatomy, delineates the clinical assessment of both pathologies, and highlights powerful diagnostic tools in the hopes of bolstering appropriate diagnosis and treatment. Lastly, this review will describe emerging treatment options for both pathologies in the preclinical and clinical realms, with a special emphasis on regenerative nerve therapies.

A Study Protocol for a Multicenter, Pragmatic, Randomized Controlled, Parallel-Grouped Pilot Clinical Trial: Effectiveness of Non-Pharmacological Versus Pharmacological Treatments for Non-Acute Lumbar Disc Herniation

Background: This study was the development of a protocol for the comparison between the efficacy of non-pharmacological and pharmacological treatment approaches for lumbar disc herniation in a pragmatic environment to obtain real-world based study data.Methods: The protocol sets out a two-armed, parallel, multicenter pragmatic, randomized-controlled trial (RCT) which will be conducted in four spine specialist hospitals in Korea to determine cost-efficiency.Results: The study will enroll 36 participants and allocate patients into either the non-pharmacological treatment group or the pharmacological treatment group in a 1:2 ratio. Patients must have evidence of disc-related disease diagnosed using MRI, as well as having lower back pain or radiating leg pain (numeric rating scale score ≥ 5). The treatment will last for 8 weeks with a 26-week follow-up. The primary outcome will be measured using the Oswestry Disability Index score from Week 9. Secondary outcomes related to lower back pain and radiating leg pain will be measured using the scores from the numeric rating scale, the visual analogue scale, the European Quality of Life 5 Dimensions 5 Level Version), the 12-item Short Form Survey, and the patient global impression of change.Conclusion: This is the first protocol for a pragmatic RCT evaluating the efficacy, safety, and cost-efficiency of non-pharmacological and pharmacological treatment strategies in a clinical setting. Following the basis of this protocol, RCTs may play an important role in establishing guidelines for treating radiating leg pain and lower back pain and provide effective information to clinicians in practical settings.

Clinical and radiologic outcomes of biportal endoscopic lumbar discectomy in obese patients: a retrospective case-control study

BackgroundObese patients have a higher risk of complications during spinal surgery than non-obese patients. To the best of our knowledge, no studies have examined the differences in clinical and radiological outcomes after biportal endoscopic lumbar discectomy (BELD) between obese and non-obese patients. The study evaluated the association between obesity and outcomes after BELD in patients with lumbar disc herniation.MethodsThis was a retrospective case-control study conducted from March 2017 to March 2021 at two hospitals with 360 patients who underwent BELD after showing no improvement with conservative treatment. Clinical and radiologic outcomes were retrospectively analyzed after BELD in the non-obese (body mass index [BMI] < 30 kg/m2) and obese (BMI ≥ 30 kg/m2) groups. Demographic data and surgery-related factors were compared between the two groups. Clinical outcomes were followed up for 12 months after surgery and analyzed for differences.ResultsA total of 211 patients were enrolled in this study, and through case-control matching, the data of 115 patients (29, obese group; 86, non-obese group) were analyzed. The two groups showed no significant differences in Oswestry Disability Index, European Quality of Life-5 Dimensions (EQ-5D), and visual analog scale scores measured immediately after BELD and 12 months after surgery. After surgery, back pain, radiating leg pain, and EQ-5D scores improved. However, there was no significant difference in improvement, residual herniated disc, hematoma, or recurrence between the groups.ConclusionsObese patients who underwent BELD for lumbar disc herniation showed no significant difference in clinical and radiologic outcomes compared with non-obese patients.

Long-Term Follow-Up of Intensive Integrative Treatment including Motion Style Acupuncture Treatment (MSAT) in Hospitalized Patients with Lumbar Disc Herniation: An Observational Study.

This study aimed to investigate the long-term effects of and satisfaction with integrative Korean medicine treatment and motion style acupuncture treatment (MSAT) in patients with lumbar disc herniation (LDH). We retrospectively analyzed medical charts and prospectively surveyed adult patients aged between 19 and 64 years treated for lumbar disc herniation for at least 6 days at three Korean hospitals from 1 January 2015 to 31 December 2020. The primary outcome was the Numeric Rating Scale (NRS) for back pain. Secondary outcome measures included the NRS for radiating leg pain, the Oswestry Disability Index (ODI), and the European Quality of Life-5 Dimension-5 Level (EQ-5D-5L) questionnaire. The NRS scores for low back pain decreased from 5.40 ± 1.58 to 2.92 ± 2.09, NRS for radiating leg pain from 5.57 ± 1.56 to 1.78 ± 2.36, and ODI from 46.39 ± 16.72 to 16.47 ± 15.61 at baseline and survey, respectively. The EQ-5D-5L increased from 0.57 ± 0.19 to 0.82 ± 0.14. In conclusion, Korean medicine and MSAT could be effective treatment methods for patients with LDH. The results of this study can be used as helpful information for clinicians who treat patients with LDH in real clinical settings.

Long-Term Follow-Up (>11 Years) on Successful Pregnancies With Ziconotide Monotherapy for Arachnoiditis-Related Chronic Pain

The inflammation in arachnoiditis may arise in response to several different stimuli, including central nervous system infections, surgical trauma, or spinal cord tumors. The initial inflammatory response is followed by the development of intrathecal (IT) adhesions that may disrupt the flow of the cerebrospinal fluid (CSF).1 Symptoms of arachnoiditis include lower back pain with radiating leg pain and neurological abnormalities. Magnetic resonance imaging (MRI) is used to confirm the presence of arachnoiditis.

Oblique Lateral Endoscopic Decompression and Interbody Fusion for Severe Lumbar Spinal Stenosis: Technical Note and Preliminary Results.

Adequacy of decompression for oblique lateral interbody fusion (OLIF) is a real concern in patients with severe lumbar spinal stenosis (LSS). With this in mind, we combined OLIF with spinal endoscopic technique to achieve a solid fusion and an adequate decompression after one operation. This is a technical note. The theoretical basis and operation process of this technique were introduced, and consecutive cases were retrospectively collected. Consecutive patients diagnosed with monosegmental severe LSS (L4/5) and underwent oblique lateral endoscopic decompression and interbody fusion (OLEDIF) from January 2018 to February 2020 were retrospectively collected. Clinical outcomes were assessed by claudication distance, Visual Analog Scale (VAS), and Oswestry Disability Index (ODI) scores. Secondary indicators included operation time, operative blood loss, and postoperative complications. Ten patients were selected for the OLEDIF procedure. They were five women and five men ranging in age from 49 to 75 years (mean age of 63.9 years) and in BMI from 25.4 to 30.2 kg/m2 (mean BMI of 27.5 kg/m2 ). The preoperative claudication distance was 160.00 ± 68.96 m (range 70-250 m), which was significantly extended on the 3-month and 1-year follow-up (1020.00 ± 407.70 m and 1040.00 ± 416.87 m, respectively). The preoperative VAS score of back pain and radiating leg pain was 5.50 ± 0.97 (range 4-7) and 6.40 ± 0.97 (range 5-8). The score on postoperative month 3 was 1.60 ± 0.52 (range 1-2) and 1.20 ± 0.79 (range 0-2), and the 1-year follow-up score was 1.90 ± 0.74 (range 1-3) and 1.60 ± 0.70 (range 1-3), respectively. The preoperative ODI was 72.23 ± 6.30 (range 64.4-82.2), the 3-month follow-up ODI was 31.12 ± 4.20 (range 24.4-35.6), and the 1-year follow-up ODI was 29.33 ± 5.92 (range 20.0-37.8). Compared with the transforaminal lumbar interbody fusion (TLIF) in the literature, the operation time was not prolonged (189.3 ± 32.5min vs. 214.9 ± 60.0 min) but the amount of blood loss decreased significantly (113.3 ± 26.7ml vs. 366.8 ± 298.2ml). No complications were found except one case presented with dysesthesia of the left leg. Imaging results showed good fusion without cage subsidence during 1-year follow-up. OLEDIF can achieve complete ventral decompression of the spinal canal and solid fusion of the lumbar spine at one time. It is an effective minimally invasive technique for the treatment of monosegmental severe LSS, which is promising and worthy of further clinical practice.

Effectiveness and Safety of Pharmacopuncture Therapy for Chronic Low Back Pain: A Protocol for a Pragmatic Randomized Controlled Trial.

PurposeChronic low back pain (LBP) is a common musculoskeletal disorder that affects everyday life; moreover, it occasionally causes disability and increases medical expenditure. This pragmatic randomized clinical trial aims to investigate the effects of pharmacopuncture on chronic LBP by comparing the effectiveness of pharmacopuncture and physiotherapy strategies.Patients and MethodsIn this two-armed, parallel, multi-center randomized controlled study, the participants will randomly undergo 10 sessions of pharmacopuncture therapy or physiotherapy over five weeks based on the randomization outcomes. The primary outcome will be the numeric rating scale (NRS) score of LBP. The secondary outcomes will include the NRS score of radiating leg pain, visual analog scale (VAS) score of LBP and radiating leg pain, Oswestry disability index, the Korean version of the Roland–Morris disability questionnaire, patient global impression of change (PGIC), short Form-12 health survey version 2, and 5-level EuroQol-5 dimension (EQ-5D-5L).ConclusionThis protocol aims to examine the comparative effectiveness of pharmacopuncture, which is a widely used therapy in Korean medicine, with respect to the standard therapy through a pragmatic randomized controlled trial to present useful data to facilitate clinical or policy decision making.Trial RegistrationClinicaltrials.gov (NCT04833309); Clinical Research Information Service (KCT0006088).

Full Endoscopic Interlaminar Contralateral Lumbar Foraminotomy for Recurrent L5-S1 Foraminal-extraforaminal Stenosis: A Case Report with a Technical Note

After endoscopic lumbar foraminotomy, decreased disc height commonly causes foraminal restenosis and accompanying lateral recess stenosis. Interlaminar contralateral endoscopic lumbar foraminotomy can be used to treat multiple recurrent lesions instead of fusion surgery. Dorsal foraminal-extraforaminal decompression is challenging because of severe perineural adhesions. Therefore, neural decompression should be focused on the ventral foraminal expansion along the virgin dissection plane between the exiting nerve root and ventral foraminal pathologies. The prominent bony spur and herniated disc were removed using an endoscopic drill and forceps. As the foramen was enlarged, the endoscope was introduced deeper through the caudal-ventral foramen space to explore the extraforaminal and far-out lesions. Postoperatively, neurological deficits of L5 radiculopathy and radiating leg pain improved. The expanded foraminal-extraforaminal space was well maintained without progression of lateral wedging on the one-year follow-up images. We successfully treated recurrent foraminal-extraforaminal stenosis and combined lateral recess stenosis using the full endoscopic interlaminar contralateral approach at the L5-S1 level. This technique may be an alternative surgical method to treat the recurrent foraminal-extraforaminal stenosis in the collapse of the L5-S1 neuroforamen. However, this technique should be considered in highly selected patients unsuitable for fusion operations.