Sciatica Bothersomeness Index Research Articles

The Relationship between Magnetic Resonance Imaging and Functional Tests Assessment in Patients with Lumbar Disk Hernia.

Although magnetic resonance imaging (MRI) findings are the gold standard for diagnosing herniated discs, there are many limitations to accessing MRI scanning devices in practice. This study aimed to evaluate the relationship between functional tests (the visual analog scale (VAS), the SLUMP test, the Sciatica Bothersomeness Index (SBI), the Oswestry Disability Index (ODI), and the LASEGUE test and MRI findings (LSA, IVDH L4-L5, IVDH L5-S1, DHS L4-L5, and DHS L5-S1) in patients diagnosed with disc herniation. Seventy-eight patients who met the inclusion criteria participated in the study. Radiologists and neurologists evaluated patients with disc herniation. After the disc hernia diagnosis, the patients were referred to a physical therapist for conservative management of the disk hernia. The physical therapists assessed the pain level and performed functional tests on patients. All statistical analyses were performed using R (Core Team) software. The correlation between the measured variables was conducted using the Pearson and Spearman tests. The study results indicated statistically significant correlations between DHS L4-L5 vertebral level and functional tests (VAS: r = 0.49, p = 0.00; SBI: r = 0.44, p = 0.00; ODI: r = 0.49, p = 0.00; LASEGUE: r = -0.48, p = 0.00; SLUMP: r = 0.50, p = 0.00). In conclusion, physiotherapists may prefer functional tests to diagnose the herniated disc, and these functional tests may contribute to performing evidence-based assessments.

Factors predicting the transition from acute to persistent pain in people with ‘sciatica’: the FORECAST longitudinal prognostic factor cohort study protocol

IntroductionSciatica is a common condition and is associated with higher levels of pain, disability, poorer quality of life, and increased use of health resources compared with low back pain alone....

Reliability and validity of Turkish versions of Sciatica Bothersomeness and Sciatica Frequency Index.

The Sciatica Frequency Index (SFI) and Sciatica Bothersomeness Index (SBI) are two separate indices scored for both the bothersomeness and frequency of radiating symptoms. There is no Turkish scale used specifically for sciatica. We aimed to translate SBI and SBI in Turkish and investigate the reliability and validity of these indices. A total of 80 patients with lumbar disc herniation (LDH) were prospectively included. Construct validity was assessed by comparing the SBI and SFI with subscales of Short Form 36 (SF-36), back and leg Numeric Rating Scale (NRS) and Roland Morris Disability Questionnaire (RMDQ). Reliability was assessed by internal consistency (Cronbach's alpha) and test-retest reliability. A weak correlation was found between SBI/SFI, back NRS and SF-36 subgroups while a moderate correlation was found between SBI/SFI, RMDQ and leg NRS. The SBI and SFI had high internal consistency measured by Cronbach's alpha (0.76 and 0.73). Test-retest reliability of the SBI and SFI were 0.95 (95% CI: 0.92-0.97) and 0.95 (95% CI: 0.92-0.97) respectively, indicating excellent reliability. The Turkish versions of the SFI/SBI are a valid and reliable tool supporting their usability in patients with LDH-induced sciatica.

Prevalence of Sciatica in Pregnancy and Its Impact on Quality of Life - A Cross Sectional Study

Background: Sciatica is a rare clinical entity of LBP that is experienced during pregnancy which can be caused due to various factors and may or may not affect the quality of life during pregnancy. Objectives: The aim of this study was to find out the prevalence of sciatica in pregnant women and its related quality of life in pregnant women with sciatica symptoms Methods: A cross sectional study including total of 812 who are in their third trimester pregnant women who visited the Obstetrics and Gynaecology outpatient department of SDM hospital and gave the consent were included in this study. Age, BMI, occupation, trimester, MC-LBP, PR-PBP and sciatica symptoms were recorded. The severity of the sciatica symptoms were measured using Sciatica Bothersomeness Index and quality of life was assessed using WHOQOL-BREF Results: Prevalence was found out to be 16.9% in 812 pregnant ladies. Age, BMI, MC-LBP, PR-LBP, were significantly associated with sciatica in the third trimester of pregnancy. Physical domain of WHOQOL-BREF had a significance difference between the sciatica pregnant women and non-sciatica pregnant women. Conclusion: Prevalence rate is 16.9% and is associated with QOL with or without sciatica symptoms in third trimester pregnant women. Keywords: Pregnancy, Sciatica, QOL, pregnancy related back pain.

Comparison of early and delayed lumbar disc herniation surgery and the treatment outcome.

Aim To evaluate the influence of preoperative symptoms duration on surgical outcome of one-level lumbar disc herniation surgery. Methods In a prospective randomized study, 67 adult patients with one-level lumbar disc herniation were analysed. The patients whose duration of symptoms was <6 months were included in the case group, while those with the duration of symptoms ˃6 months formed the control group. The investigated preoperative variables were: pain intensity in the back and legs (Visual Analogue Scale - VAS), Sciatica Bothersomeness Index (SBI), index of disability (Oswestry Disability Index - ODI). Postoperative variables were: pain intensity in the back and legs (VAS), SBI, ODI, and outcome according to the Odom's criteria (excellent, good, satisfactory and poor). Significance level was set at p <0.05. Results A statistically significant difference was recorded between the groups, showing a better decrease of radicular pain intensity and sciatica bothersome, as well as patients disability in the case group (p<0.001). According to the Odom's criteria the outcome was better in the case group, since the difference between the groups was statistically significant too (p<0.05). Conclusion Early lumbar disc herniation surgery performed within the first 6 months from the start of symptoms is beneficial due to decreases of radicular pain intensity, sciatica bothersomeness, and patient's disability.

Two manual therapy techniques for management of lumbar radiculopathy: a randomized clinical trial.

Evidence has shown that spinal mobilization with leg movement (SMWLM) and progressive inhibition of neuromuscular structures (PINS) are individually effective in the management of lumbar radiculopathy. However, previous evidence reported data for only a short-term study period and did not investigate the effect of the combined manual therapy techniques. To compare the combined effects of two manual therapy techniques (SMWLM and PINS) with the individual techniques alone (SMWLM or PINS) in the management of individuals with lumbar radiculopathy. A total of 60 patients diagnosed with unilateral lumbar radiculopathy secondary to disc herniation were randomly allocated into three groups: 20 participants each in the SMWLM, PINS, and combined SMWLM+PINS groups. Each group attended two treatments per week for 30min each, for three months. Participants were assessed at baseline, immediately posttreatment, and then at three, six, and nine months follow-up using the Visual Analog Scale (VAS), Rolland-Morris Disability Questionnaire (RMDQ), and Sciatica Bothersomeness Index (SBI). Between-groups analyses using a two-way repeated-measures analysis of variance indicated significant interactions between groups and follow-up times for all outcomes (p=0.001). Participants receiving combined SMWLM+PINS treatment experienced greater improvement in leg pain, back pain, disability, and sciatica at all timelines (immediately posttreatment, and three, six, and nine months follow-up) than the participants receiving SMWLM or PINS alone (p<0.05). However, participants receiving SMWLM alone showed better improvement than the participants receiving PINS alone at all timelines (p<0.05). A combined SMWLM+PINS treatment protocol showed greater improvement than the individual techniques alone in the management of individuals with LR in this study.

Cross-cultural validation of the start back screening tool in a Greek low back pain sample

BackgroundKeele STarT Back Screening Tool (SBST) is a popular 9-item prognostic recovery questionnaire for low back pain (LBP) with validation studies in several cultural settings, but not Greek. ObjectivesThe cross-cultural adaptation and validation of the SBST into Greek among LBP and LBP-associated leg pain patients. MethodsA five-stage forward-backward translation procedure developed the Greek SBST. LBP and sciatica patients completed SBST, Roland-Morris Disability Questionnaire (RMDQ), Hospital Anxiety and Depression Scale (HADS), Short-form Health Survey (SF-12), Sciatica Bothersomeness Index (SBI), numeric pain rating scale (NPRS) and body chart pain location sites. Measurement properties (internal consistency, content, construct and discriminatory validity) were explored. Test-retest reliability was explored by re-administering SBST after 7–10 days across patients whose symptoms remained unchanged. Results124 LBP patients (75 females, 49.1 ± 14.2 years-old) 43.5% of whom had sciatica completed Greek SBST. No floor/ceiling effects were detected. Mean score distributions were statistically different across SBST groups. Moderate to strong correlations were found for SBST (total and psychosocial scores) with RMDQ, SBI, HADS and SF-12 (Spearman's ρ = 0.42–0.60). Most associations between individual SBST items and reference standards were moderately correlated (ρ = 0.32–0.49). Greek SBST yielded acceptable discriminant validity with RMDQ (AUC of 0.80). Items 1, 3, 4, and 9 yielded acceptable discrimination against reference standards. Test-retest reliability was satisfactory for total score (ICC2,2 = 0.93) and individual items (kappa = 0.59–0.88). Cronbach's α was 0.70 (total score) and 0.76 (psychosocial subscale). ConclusionsThe Greek SBST was comprehensible, valid and reliable and may thus, be used across Greek cross-cultural rehabilitation research and practice.

Effect of neurodynamic techniques on radiating symptoms and mechanosensitivity of neural tissue in subjects with lumbosacral radiculopathy: A double-blind randomized controlled trial

Background: Lumbosacral radiculopathy has a prevalence ranging from 1.2% to 43%. It is associated with altered mechanosensitivity of the neural tissue and symptoms of pain and paresthesia radiating to the lower extremity. Neurodynamic techniques described by Shacklock have shown beneficial results clinically in subjects with radiculopathy. However, there is lack of research on systematic protocol of neurodynamic techniques in lower limb radiculopathy. Objectives: The objectives of the present study were to evaluate the effect of neurodynamic techniques including treatment of neural tissues and interface dysfunctions as advocated by Michael Shacklock. Materials and Methods: A double-blind randomized controlled trial on 108 subjects with lumbosacral radiculopathy was conducted using computer generated block randomization after taking ethics approval. They were divided into two equal groups of 54. The treatment for both groups was given in six sessions, thrice a week for 2 weeks. Interventional group received neurodynamic techniques based on diagnosis of neural and interface dysfunctions and control group received sham neurodynamic techniques. Both groups additionally received hydrocollator packs for 20 min and 10 repetitions of isometric back exercises. The outcome measures were Sciatica Bothersomeness Index and Sciatica Frequency Index for Bothersomeness and frequency of radiating symptoms, pain site codes on overlay template for centralization of radiating symptoms and active knee extension range of motion in slump posture using universal goniometer for mechanosensitivity of neural tissue. The outcome assessor and the subjects were blinded to the treatment allocation. Results: Wilcoxon signed-ranks test showed a statistically significant difference in all the outcome measures in both groups (P < 0.05). Mann–Whitney U-test showed that the interventional group had better improvement compared to the control group (P < 0.05). Conclusion: Neurodynamic techniques are effective in reducing the Bothersomeness and frequency of radiating symptoms, producing centralization, and reducing mechanosensitivity of the neural tissue in subjects with lumbosacral radiculopathy.

Application of Gunja (Abrus precatorius Linn.) Beeja lepa: An Ayurvedic protocol for the treatment of Gridhrasi (sciatica)

The most common musculoskeletal disorder affecting the movement of legs is low back pain. Among the affected patients, 40% have ridiculer pain, and these cases can be classified under the umbrella of the sciatic syndrome. Low back pain is extraordinarily common, frequently resulting from degenerative arthritis of the lumbosacral spine. The annual prevalence of disc-related sciatica in the general population is estimated at 2.2%. Sciatica is characterised by constant aching pain which felt in the lumbar region may radiate to the buttock, thigh, calf and foot. Acharaya Charaka explained Gridhrasi in eighty types of nanatmaja Vata vikara. The present study is aimed at evaluating the effect of Gunja (Abrus precatorius Linn.) Beeja lepa in the management of Gridhrasi (Sciatica) and thereby assessing the changes in quality life. The present study is designed as a Non-randomized controlled clinical study, in which a minimum of 30 patients will be enrolled. Gunja beej lepa will be administered external application two times in a day with lukewarm water. Assessment will be recorded on the 3rd, 5th, 7th, 14th and 28th day. Changes will be observed in subjective parameters such as Ruk (pain) Toda (pin pricking sensation) Stambha (Stiffness), Spandana (Fasciculation) and objective parameters such as measuring the changes in the angle of elevation of the leg by SLR Test, Sciatica Bothersomeness Index and Sciatica Frequency Index before and after the treatment. Suitable conclusion will be drawn post completion of the trial.

Comparison of Functional Outcomes Between Lumbar Interbody Fusion Surgery and Discectomy in Massive Lumbar Disc Herniation: A Retrospective Analysis.

Study Design:Retrospective analysis.Objective:Lumbar disc herniation is one the most common condition responsible for low back and radicular pain. Although the symptoms are not proportional to the size of disc prolapse but massive disc herniation frequently needs surgical management. According to literature, the incidence of low back pain, recurrent disc herniation and segmental instability are more in discectomy whereas incidence of adjacent segment degeneration (ASD) is more after fusion surgery. There are very few studies that directly compare long-term functional outcome of both these procedures. We compared the functional outcome of both the procedures in this study.Methods:All patients of massive disc prolapse, operated at our center between 2011 to 2017, were contacted. All the patients underwent either discectomy or transforaminal lumbar interbody fusion (TLIF). Functional outcomes of all the patients were collected using visual analogue scale (VAS) (back), VAS (leg), modified Oswestry Disability Index (mODI), Sciatica Bothersomeness Index (SBI), and McNab’s criterion. Various complications were also analyzed.Results:There were 144 patients in the discectomy group and 123 patients in the TLIF group. Mean duration of follow-up was 55.07 months and 51.86 months, respectively. Both the groups show no significant difference in VAS. Significant difference was seen in mODI and SBI favoring discectomy. McNab’s criterion showed excellent result in 80% of patients of discectomy compared with 68% patients of TLIF. Overall complication rate in discectomy group was 11% whereas 13% in TLIF group.Conclusion:Both show good functional outcome but better in discectomy. Recurrent herniation and instability were noticed more with discectomy and ASD was more common after fusion surgeries. The choice of procedure should be individualized, and it also depends on surgical expertise, but in developing countries where resources are constrained, discectomy should be preferred.

Comparing Patient-reported Outcomes to Patient Satisfaction After a Microdiscectomy for Patient’s With a Lumbar Disk Herniation

A retrospective cohort study. The objective of this study was to determine if patient satisfaction is predicted by improvement in health-related quality of life (HRQOL) metrics. Patient satisfaction is becoming an increasingly common proxy for treatment quality; however, the correlation between patient satisfaction and HRQOL outcome metrics following a lumbar disk herniation is unclear. Patients enrolled in the Spine Patient Outcomes Research Trial (SPORT) study were prospectively enrolled at 13 institutions. A retrospective subgroup analysis of prospectively collected data from the SPORT trial was performed. Receiver operating characteristic curves were used to determine if improvement in HRQOL metrics could accurately identify patient satisfaction. HRQOL metrics included: Short Form-36 (SF-36), Oswestry Disability Index (ODI), Sciatica Bothersomeness Index, Back Pain Bothersomeness Scale, and Leg Pain Bothersomeness Scale. A total of 709 patients who underwent surgery and 319 patients treated without surgery were included. In the surgical cohort, receiver operating characteristic curve analysis demonstrated that SF-36 Physical Component Summary improvement had moderate accuracy [area under the curve (AUC)=0.77 (95% confidence interval, CI: 0.73-0.82)] at predicting satisfaction at 3 months, and it had excellent accuracy at predicting satisfaction at 2 years [AUC=0.81 (95% CI: 0.77-0.85)] and 4 years [AUC=0.81 (95% CI: 0.76-0.85)]. Absolute Physical Component Summary score had excellent accuracy at 3 months [AUC=0.83 (95% CI: 0.79-0.87)], 2 years [AUC=0.87 (95% CI: 0.84-0.9)] and 4 years [AUC=0.84 (95% CI: 0.8-0.89)]. Similarly improvement in the ODI had moderate accuracy of predicting satisfaction at 3 months [AUC=0.77 (95% CI: 0.72-0.81)], 2 years [AUC=0.78 (95% CI: 0.74-0.82)] and 4 years [AUC=0.78 (95% CI: 0.73-0.83)], and the absolute ODI score had excellent accuracy at 3 months [AUC=0.85 (95% CI: 0.82-0.89)], 2 years [AUC=0.89 (95% CI: 0.86-0.92)], and 4 years [AUC=0.88 (95% CI: 0.85-0.92)]. HRQOL metrics can accurately predict patient satisfaction with symptoms at 3 months, 2 years, and 4 years after surgical intervention for a lumbar disk herniation. Absolute outcome scores were somewhat more predictive than change scores.

Numbness and Weakness Recovered at a Less Extent in Patients with Lumbar Disc Herniation after Percutaneous Endoscopic Lumbar Discectomy.

Background Patients with lumbar disc herniation (LDH) may present with motor disorders and various sensory disorders, among which pain and numbness are the most common ones. Percutaneous endoscopic lumbar discectomy (PELD) is reported to be both safe and effective. However, most of the previous studies focused on the recovery of pain, and the relief extent of numbness and weakness has rarely been reported. The Sciatica Bothersomeness Index (SBI) is a self-assessment tool for LDH patients. It has demonstrated acceptable reliability, construct validity, and responsiveness. Objectives Our aim was to explore the curative effect of percutaneous endoscopic lumbar discectomy and to compare the various extent of relief among pain, numbness, and weakness. Methods The medical records of patients admitted for LDH from September 2016 to December 2018 were collected, and the patients were followed up for 3 months to evaluate the relief of their clinical symptoms. Preoperative and postoperative total scores and subitem scores of SBI were compared to evaluate the relief of pain, numbness, and weakness. Surgical outcomes of PELD were evaluated by the Nakai score, and patients were divided into two groups accordingly, which were the relief group (excellent and good in the Nakai score) and the less relief group (fair and poor in the Nakai score). Risk factors for PELD outcomes and preoperative presence of numbness and/or weakness were analyzed by the logistic model, and p value less than 0.05 was considered significant. Results A total of 86 patients met the inclusion criteria and acquired 3 months follow-up. Relief extent of pain, numbness, and weakness, was 82%, 41%, and 21%, respectively. There were 71 cases in the relief group and 15 cases in the less relief group. Results of the logistic regression analysis showed that the preoperative pain score of SBI (p=0.002; OR: 1.647 (1.199–2.261)) was a relatively independent risk factor for PELD outcomes, and multiplicativity of duration of preoperative symptoms and imaging grade [p=0.004; OR: 1.015 (1.005–1.026)] was a relatively independent risk factor for preoperative presence of numbness and/or weakness. Conclusions PELD had a good curative effect in the treatment of LDH. Patients of LDH recovered best from pain, followed by numbness and weakness after PELD. Higher level of patients self-reported preoperative pain indicated a better surgical outcome for LDH patients, and preoperative long duration of symptoms together with a severe compression of nerve root significantly increased the risk of presenting numbness and/or weakness.

Therapeutic Efficacy and the Impact of the "Dose" Effect of Acupuncture to Treat Sciatica: A Randomized Controlled Pilot Study.

PurposeTo investigate the required sample size for and feasibility of a full-scale randomized controlled trial examining the impact of the “dose” effect of acupuncture in treating sciatica.Patients and methodsFifty-seven patients with sciatica, aged 35–70 years, were recruited and screened. Thirty-one participants were randomly assigned to receive “low-dose” manual acupuncture (MAL) (n= 15) or “high-dose” manual acupuncture (MAH) (n=16). The acupuncture treatment was administered twice weekly for 4 weeks. The primary outcome was the visual analog scale (VAS) score at baseline and after 4 weeks of acupuncture treatment. Secondary outcomes included the Roland Disability Questionnaire for Sciatica (RDQS), the Sciatica Bothersomeness Index (SBI), and the World Health Organization Quality of Life in the Brief Edition (WHOQOL-BREF) scores at baseline and after 4 weeks of acupuncture treatment.ResultsThirty patients completed the study. For all patients, acupuncture achieved significant improvement in the VAS (5.48±2.0, p<0.001), RDQS (3.18±2.83, p=0.004), and SBI (2.85±3.23, p=0.008) scores, but not in the WHOQOL-BREF scores. In the between-group analysis, the assessed scales showed no significant differences between the MAL and MAH groups. However, based on the level of chronicity, the MAH group demonstrated greater improvement in the outcomes and a significant benefit in the physical subscale of the WHOQOL-BREF (p<0.05).ConclusionResults of this pilot study indicate that acupuncture is safe and may effectively relieve symptoms and disability in patients with non-acute sciatica. MAL was as effective as MAH in treating sciatica. A subsequent trial with a larger sample size (estimated at n=96) is required to confirm whether patients with a high level of chronicity would benefit from MAH treatment.Trial registrationNCT03489681.

Comparative Effectiveness of 2 Manual Therapy Techniques in the Management of Lumbar Radiculopathy: A Randomized Clinical Trial

ObjectiveThe purpose of this study was to compare the effectiveness of Dowling's and Mulligan's manual therapy techniques on pain and disability in the management of lumbar disc herniation with radiculopathy (LDHR). MethodsA total of 40 individuals with LDHR were randomly allocated into 2 groups, 20 participants each in PINS and SMWLM groups. Each participant was assessed at baseline, 4 weeks, and 8 weeks postintervention. The primary outcomes measured were pain (visual analog scale) and disability (Roland-Morris Disability Questionnaire). Secondary variables were quality of life (Short-Form 36 Health Survey), sciatica bothersomeness (Sciatica Bothersomeness Index), sciatica frequency (Sciatica Frequency Index), and general perception of recovery (Global Rating of Change Scale). Repeated-measures analysis of variance was used to compute within-group and between-groups interactions. ResultsNo significant differences were observed in the baseline characteristics of participants in both groups. The results indicate that there were significant time effects for all outcomes in the study (P < .001) within each group. However, there was no significant difference between the 2 groups on any outcome variable (P > .05). ConclusionThe findings indicate that there was no difference in pain or disability between the 2 manual therapy techniques in the management of LDHR.

Effect of Spinal Manipulation Compared with Spinal Mobilization for Lumbar Disc Herniation with Radiculopathy: Design of a Randomized Clinical Trial with 1 Year Follow-Up

Objectives: The aim of this study is to examine the effect of spinal manipulation (SMT) compared with spinal mobilization (MOB) on pain, disability, quality of life, sciatica and general perception of recovery in individuals with lumbar disk herniation with radiculopathy (LDHR). Methods: A total of 40 individuals with LDHR will be randomly allocated into 2 groups; 20 participants each in SMT and MOB groups. Each participant will be assessed at baseline, 6 and 12 weeks of intervention. Outcomes will also be assessed at 6th and 12th months of follow-up. Outcomes to be assessed will include pain (VAS), functional disability (RMDQ - Rolland Morris disability questionnaire), sciatica bothersomeness index (SBI), sciatica frequency index (SFI), quality of life (SF-36), general perception of recovery (GROC) and objective functional impairment (TUG-timed up and go test). Discussion: This trial will determine the difference in outcomes between spinal manipulative therapy and spinal mobilization groups in individuals with LDHR.

Retrolisthesis and lumbar disc herniation: a postoperative assessment of outcomes at 8-year follow-up

BACKGROUND CONTEXTLumbar disc herniation and retrolisthesis have been shown to be significant degenerative changes that can be associated with back pain. Current literature has shown evidence that retrolisthesis is associated with similar baseline function in patients with L5–S1 disc herniation, but worse postoperative outcomes 2 years after lumbar discectomy. However, literature comparing long-term postoperative outcomes at 8-year follow-up in patients with L5–S1 disc herniation with retrolisthesis is lacking. PURPOSEThe purpose of the present study is to compare long-term postoperative outcomes at 8-year follow-up in patients with retrolisthesis and L5–S1 disc herniations to patients with L5–S1 disc herniations without retrolisthesis. STUDY DESIGNRetrospective review of prospectively collected data from the Spine Patients Outcomes Research Trial (SPORT) database. PATIENT SAMPLESixty-five patients who underwent lumbar discectomy for L5–S1 disc herniations with 8-year follow-up from the SPORT. OUTCOME MEASURESShort Form (SF)-36 bodily pain scale, SF-36 physical function scale, Oswestry Disability Index, Sciatica Bothersomeness Index, and reoperation rate. METHODSBaseline surgical parameters, length of stay, complication rates, reoperation rates, and outcome measures were recorded in the SPORT database. Follow-up data were collected at 6 weeks, 3 months, 6 months, 1 year, 2 years, 3 years, 4 years, 5 years, 6 years, 7 years, and 8 years. Retrolisthesis was defined as posterior subluxation ≥8%. Patients with and without retrolisthesis were compared using a mixed-effects model of longitudinal regression. Outcomes were calculated as time-weighted averages over 8 years. Reoperation rates were compared using the log-rank test based on time to first reoperation. RESULTSOne hundred-twenty five patients met inclusion criteria for the present study, including 29 patients with retrolisthesis (23.3%) and 96 patients who did not have retrolisthesis (76.7%). The greatest difference in clinical outcome measures was found at 2 years postoperatively. This was the only point at which both the Short Form-36 Bodily Pain scale (SF-36 BP) and PF showed significant differences between the retrolisthesis and nonretrolisthesis group. At 3 years, SF-36 BP was significantly lower in patients with retrolisthesis (39.9 vs. 52, p=.046).At 8-year follow-up, the presence of retrolisthesis in patients undergoing L5–S1 discectomy was not associated with worse outcome measure scores based on the area under the curve analysis for any metric investigated (SF-36 BP 41.4 vs. 47.1, p=.18; SF-36 Physical Function scale 38.9 vs. 45.4, p=.12; Oswestry Disability Index −39.4 vs. −34.8, p=.23; −11.6 vs. −10.4, p=.25) or a difference in reoperation rate (retrolisthesis group 10%, nonretrolisthesis group 17%, p=.41). CONCLUSIONSWhile retrolisthesis can contribute to low back pain and dysfunction in patients undergoing lumbar discectomy for L5–S1 herniated nucleus pulposus in early follow-up, no significant difference was found in postoperative outcomes after 3 years. Additionally, retrolisthesis was not found to be associated with different reoperation rates at 8 years postoperatively.

Радиочастотная импульсная абляция спинальных ганглиев в лечении послеоперационного корешкового болевого синдрома

Introduction The incidence of radicular pain that arises without a surgically significant cause of compression is 4.8–10.2 % in the structure of the failed back surgery Pulsed radiofrequency treatment (PRF) is successfully used for several neuropathic pain syndromes, but its effectiveness for postoperative radicular pain has not been studied sufficiently. Materials and methods Prospective non-randomized open study was performed. A group of 56 patients with postoperative radicular pain syndrome was included. Twenty-two patients of the index group underwent PRF treatment of dorsal root ganglia (DRG) in combination with transforaminal epidural steroid injection (TFES) while 34 patients of the control group received only TFES. Outcome of a successful response was defined as a 50 % reduction in numeric rating scale (NRS-11) or 4-points pain reduction and/or a 20 % decrease in the Oswestry Disability Index (ODI), and/or an 8-point decrease in the sciatica bothersomeness index (SBI) from the baseline and the effect duration for six or more months. Dynamics of the decrease in the parameters studied was assessed and compared; a search for significant prognostic factors was carried out. Results Positive results of interventions, based on specified criteria, were obtained in 18 patients (81.82 %) in the index group and in 19 patients (55.88 %) in the control group (significant difference, p = 0.045). There was a significant decrease in all indices after the intervention, a decrease in SBI in the main group was significantly lower than in the control one, p = 0.021. There were no major complications and side effects. The presence of allodynia/hyperpathy was the main negative prognostic factor in the index and in control groups with OR 0.79 at 95 % CI (0.735–0.897) and OR 0.82 at 95 % CI (0.780–0.929), respectively. Conclusion The use of the PRF in combination with TFES is an effective method in comparison with TFES alone for treatment of postsurgical radicular pain syndrome.

Diagnosis and interventional treatment of pain syndromes after surgery for degenerative lumbar spine diseases

The study purpose was to investigate the structure of pain syndromes after surgery for DSDs of the lumbar spine, based on complex diagnostics, as well as to evaluate the capabilities of interventional treatment. We examined 310 patients with postoperative pain syndromes. Patients with obvious indications for repeated surgery were excluded from the analysis; the remaining patients underwent selective diagnostic blockades followed by interventional (puncture) treatment. A positive outcome was defined as a reduction in pain by 50% on the numerical rating scale (NRS-11), by 20% in the Oswestry index (ODI), and by 8 points in the sciatica bothersomeness index (SBI), with the effect lasting for 12 months. Predictive factors for the risk of pain syndromes were analyzed. Out of 310 patients, 162 (52.6%) patients had no obvious indications for surgery. Radicular pain was detected in 56 (18.6%) of 310 patients; the positive treatment outcome was achieved in 38 (67.86%) of 56 patients. Facet pain was present in 29 (9.35%) patients; the positive treatment outcome was achieved in 23 (79.31%) patients. Discogenic pain was found in 12 (3.87%) patients; the positive treatment outcome was achieved in 5 (41.63%) patients. sacroiliac joint (SIJ) pain was present in 42 (13.55%) patients; the positive treatment outcome was achieved in 36 (85.71%) patients. Myofascial and competing pain was detected in 12 (3.87%) patients; the causes were not identified in 11 (3.55%) cases. The main risk factors were sagittal balance parameters. Complex diagnostics revealed postoperative pain not associated with surgical causes in 52.6% of cases; the origin of pain was identified in 49.95% of cases. Interventional treatment was effective in 64.81% of cases; failed back surgery syndrome was diagnosed in 16.13% of patients.

Subcutaneous Injection of Adalimumab Trial compared with Control (SCIATiC): a randomised controlled trial of adalimumab injection compared with placebo for patients receiving physiotherapy treatment for sciatica.

Biological treatments such as adalimumab (Humira®; AbbVie Ltd, Maidenhead, UK) are antibodies targeting tumour necrosis factor alpha, released from ruptured intervertebral discs, which might be useful in sciatica. Recent systematic reviews concluded that they might be effective, but that a definitive randomised controlled trial was needed. Usual care in the NHS typically includes a physiotherapy intervention. To test whether or not injections of adalimumab plus physiotherapy are more clinically effective and cost-effective than injections of saline plus physiotherapy for patients with sciatica. Pragmatic, parallel-group, randomised controlled trial with blinded participants and clinicians, and an outcome assessment and statistical analysis with concurrent economic evaluation and internal pilot. Participants were referred from primary care and musculoskeletal services to outpatient physiotherapy clinics. Adults with persistent symptoms of sciatica of 1-6 months' duration and with moderate to high levels of disability. Eligibility was assessed by research physiotherapists according to clinical criteria for diagnosing sciatica. After a second eligibility check, trial participants were randomised to receive two doses of adalimumab (80 mg and then 40 mg 2 weeks later) or saline injections. Both groups were referred for a course of physiotherapy. Outcomes were measured at the start, and after 6 weeks' and 6 months' follow-up. The main outcome measure was the Oswestry Disability Index (ODI). Other outcomes: leg pain version of the Roland-Morris Disability Questionnaire, Sciatica Bothersomeness Index, EuroQol-5 Dimensions, 5-level version, Hospital Anxiety and Depression Scale, resource use, risk of persistent disabling pain, pain trajectory based on a single question, Pain Self-Efficacy Questionnaire, Tampa Scale of Kinesiophobia and adverse effects. To detect an effect size of 0.4 with 90% power, a 5% significance level for a two-tailed t-test and 80% retention rate, 332 participants would have needed to be recruited. The primary effectiveness analysis would have been linear mixed models for repeated measures to measure the effects of time and group allocation. An internal pilot study would have involved the first 50 participants recruited across all centres. The primary economic analysis would have been a cost-utility analysis. The internal pilot study was discontinued as a result of low recruitment after eight participants were recruited from two out of six sites. One site withdrew from the study before recruitment started, one site did not complete contract negotiations and two sites signed contracts shortly before trial closure. In the two sites that did recruit participants, recruitment was slow. This was partly because of operational issues, but also because of a low rate of uptake from potential participants. Although large numbers of invitations were sent to potential participants, identified by retrospective searches of general practitioner (GP) records, there was a low rate of uptake. Two sites planned to recruit participants during GP consultations but opened too late to recruit any participants. The main failure was attributable to problems with contracts. Because of this we were not able to complete the internal pilot or to test all of the different methods for primary care recruitment we had planned. A trial of biological therapy in patients with sciatica still needs to be done, but would require a clearer contracting process, qualitative research to ensure that patients would be willing to participate, and simpler recruitment methods. Current Controlled Trials ISRCTN14569274. This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 60. See the NIHR Journals Library website for further project information.

Reoperation for Recurrent Intervertebral Disc Herniation in the Spine Patient Outcomes Research Trial: Analysis of Rate, Risk Factors, and Outcome.

This study was a post-hoc subgroup analysis of prospectively collected data in the Spine Patient Outcomes Research Trial (SPORT). The aim of this study was to determine the risk factors for and to compare the outcomes of patients undergoing revision disc excision surgery in SPORT. Risk factors for reherniation and outcomes after revision surgery have not been well-studied. This information is critical for proper patient counseling and decision-making. Patients who underwent primary discectomy in the SPORT intervertebral disc herniation cohort were analyzed to determine risk factors for undergoing revision surgery. Risk factors for undergoing revision surgery for reherniation were evaluated using univariate and multivariate analysis. Primary outcome measures consisted of Oswestry Disability Index (ODI), the Sciatica Bothersomeness index (SBI), and the Short Form 36 (SF-36) at 6 weeks, 3 months, 6 months, and yearly to 4 years. Of 810 surgical patients, 74 (9.1%) received revision surgery for reherniation. Risk factors for reherniation included: younger age (hazard ratio [HR] 0.96 [0.94-0.99]), lack of a sensory deficit (HR 0.61 [0.37-0.99]) lack of motor deficit (HR 0.54 [0.32-0.91]), and higher baseline ODI score (HR 1.02 [1.01-1.03]). The time-adjusted mean improvement from baseline to 4 years was less for the reherniation group on all outcome measures (Bodily Pain Index [BP] 39.5 vs. 44.9, P = 0.001; Physical Function Index [PF] 37.1 vs. 44.5, P < 0.001; ODI 33.9 vs. 38.3, P < 0.001; SBI 8.7 vs. 10.5, P < 0.001). At 4 years, only SBI (-9 vs. -11.4, P = 0.002) was significantly lower in the reherniation group. Younger patients with higher baseline disability without neurological deficit are at increased risk of undergoing revision surgery for reherniation. Those considering revision surgery for reherniation will likely improve significantly following surgery, but possibly not as much as with primary discectomy. 3.