Clinical Outcomes for Neurogenic Claudication Using a Multimodal Program for Lumbar Spinal Stenosis: A Retrospective Study

Ammendolia, Carlo; Chow, Ngai

doi:10.1016/j.jmpt.2014.12.006

Cited by 18 publications

(13 citation statements)

References 42 publications

(42 reference statements)

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“…Treatment options for neurogenic claudication include manipulation, active and passive physical therapies, medication, epidural steroid injections, and decompression surgery [ 1 ]. The evidence for chiropractic treatment options is sparse [ 1 , 11 – 14 ]. However several studies have found that a combination of manual care methods, most often including flexion distraction and sciatic nerve mobilization, have been effective in reducing patient reported disability [ 11 – 14 ].…”

Section: Discussionmentioning

confidence: 99%

“…The evidence for chiropractic treatment options is sparse [ 1 , 11 – 14 ]. However several studies have found that a combination of manual care methods, most often including flexion distraction and sciatic nerve mobilization, have been effective in reducing patient reported disability [ 11 – 14 ]. Ammendolia and Chow conducted a preliminary study incorporating a conservative multimodal treatment method with 49 patients, which demonstrated promising outcomes for neurogenic claudication [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

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Spinal epidural lipomatosis presenting to a U.S. Veterans Affairs pain and rehabilitation department: a report of two cases

et al. 2018

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BackgroundSpinal epidural lipomatosis is an uncommon source of neurogenic claudication. We present two cases of spinal epidural lipomatosis as it relates to diagnosis, management, and a possible association with common medical intervention.Case presentationCase 1: 63-year old male patient presented with neurogenic claudication symptoms, but without evidence of bony central canal stenosis on lumbar computed tomography. He entered a trial of spinal manipulation with transient beneficial gains after seven appointments, but no durable change in neurogenic claudication. An MRI was recommended at this point which revealed grade III spinal epidural lipomatosis at the L5/S1 level.Case 2: 51-year old male patient presented to a pain management physician with radicular symptoms for a series of lumbar epidural steroid injections. He completed a series of three lumbar epidural steroid injections with only short-term benefit. A repeat MRI demonstrated the presence of grade I (borderline grade II) spinal epidural lipomatosis.ConclusionsThe first case illustrates a limitation of ruling out central canal stenosis with computed tomography for patients unable to undergo an MRI. The second case demonstrates a possible association between steroid injections and spinal epidural lipomatosis. An association of this kind has not been established; further research is needed to determine the significance.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Spinal epidural lipomatosis presenting to a U.S. Veterans Affairs pain and rehabilitation department: a report of two cases

et al. 2018

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“…45 Radicular pain is defined as ectopic nociceptive firing within spinal nerves due to inflammation, mechanical strain, or possible ischemic damage to dorsal root ganglia, resulting in pain perceived in the nerve-supplied territory. 45 Interventions: Education about the condition 13,[25][26][27][28][29]33,34 Neurodynamics (neural mobilization) when tolerated 46 Spinal manipulation (thrust and/or nonthrust as tolerated) 10,14,16,39,47 Directional preference exercises 42 Neurogenic claudication: pain caused by intermittent compression and/or ischemia of a single or multiple nerve roots 48 Interventions: Education about the condition 13,[25][26][27][28][29]33,34 Spinal manipulation (thrust and/or nonthrust as tolerated) [49][50][51] Neurodynamics (neural mobilization) [49][50][51] Muscle stretching 49,51 Lumbar mobilization exercise 49,51 Self-management via a cognitive behavioral approach including goal-setting, graded activity, pacing, relaxation, and body positioning techniques to reduce lumbar lordosis 49,51 Home exercises when tolerated 49,51 Comanage with other providers when needed 52 Central sensitization...…”

Section: Consensus Statements: 6 Components Of Multimodal Chiropractimentioning

confidence: 99%

Development of a Clinical Decision Aid for Chiropractic Management of Common Conditions Causing Low Back Pain in Veterans: Results of a Consensus Process

Vining

Shannon

Salsbury

et al. 2019

Journal of Manipulative and Physiological Therapeutics

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Objective: The purpose of this study was to develop a clinical decision aid for chiropractic management of common conditions causing low back pain (LBP) in veterans receiving treatment in US Veterans Affairs (VA) health care facilities. Methods: A consensus study using an online, modified Delphi technique and Research Electronic Data Capture web application was conducted among VA doctors of chiropractic. Investigators reviewed the scientific literature pertaining to diagnosis and treatment of nonsurgical, neuromusculoskeletal LBP. Thirty seed statements summarizing evidence for chiropractic management, a graphical stepped management tool outlining diagnosis-informed treatment approaches, and support materials were then reviewed by an expert advisory committee. Email notifications invited 113 VA chiropractic clinicians to participate as Delphi panelists. Panelists rated the appropriateness of the seed statements and the stepped process on a 1-to-9 scale using the RAND/University of California, Los Angeles methodology. Statements were accepted when both the median rating and 80% of all ratings occurred within the highly appropriate range. Results: Thirty-nine panelists (74% male) with a mean (standard deviation) age of 46 (11) years and clinical experience of 17 (11) years participated in the study. Accepted statements addressed included (1) essential components of chiropractic care, (2) treatments for conditions causing or contributing to LBP, (3) spinal manipulation mechanisms, (4) descriptions and mechanisms of commonly used chiropractic interventions, and (5) a graphical stepped clinical management tool. Conclusion: This study group produced a chiropractic clinical decision aid for LBP management, which can be used to support evidence-based care decisions for veterans with LBP.

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“…We have designed and implemented a training program for LSS known as the Boot Camp Program for LSS [ 24 ]. This program aims to address the multi-faceted aspects of LSS using a multi-modal non-surgical approach with a focus on self-management and the goals of improved walking ability, overall functional status and quality of life.…”

Section: Introductionmentioning

confidence: 99%

“…In a previous retrospective study we evaluated 49 consecutive patients who completed the Boot Camp Program and assessed the difference in self-report outcomes selected a priori [ 24 ]. Outcome measures included the Oswestry Low Back Pain Disability Index, the walking score of the Oswestry Low Back Pain Disability Index, the three subscales of the Zurich Swiss Spinal Questionnaire, and the Numeric Rating Scale for leg and back pain.…”

Section: Introductionmentioning

confidence: 99%

The boot camp program for lumbar spinal stenosis: a protocol for a randomized controlled trial

et al. 2016

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BackgroundLumbar spinal stenosis (LSS) causing neurogenic claudication is a leading cause of pain, disability and loss of independence in older adults. The prevalence of lumbar spinal stenosis is growing rapidly due to an aging population. The dominant limitation in LSS is walking ability. Postural, physical and psychosocial factors can impact symptoms and functional ability. LSS is the most common reason for spine surgery in older adults yet the vast majority of people with LSS receive non-surgical treatment. What constitutes effective non-surgical treatment is unknown. The purpose of this study is to evaluate the effectiveness of a multi-modal and self-management training program, known as the Boot Camp Program for LSS aimed at improving walking ability and other relevant patient-centred outcomes.MethodsWe will use a pragmatic two-arm randomized controlled single blinded (assessor) study design. Eligible and consenting participants will be randomized to receive from licensed chiropractors either a 6-week (twice weekly) self-management training program (manual therapy, education, home exercises) with an instructional workbook and video and a pedometer or a single instructional session with an instructional workbook and video and pedometer. The main outcome measure will be the self-paced walking test measured at 6 months. We will also assess outcomes at 8 weeks and 3 and 12 months.DiscussionSymptoms and functional limitations in LSS are variable and influenced by changes in spinal alignment. Physical and psychological factors result in chronic disability for patients with LSS. The Boot Camp Program is a 6-week self-management training program aimed at the multi-faceted aspects of LSS and trains individuals to use self-management strategies. The goal is to provide life-long self-management strategies that maximize walking and overall functional abilities and quality of life.Trial registrationClinicalTrials.gov ID: NCT02592642.

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Clinical Outcomes for Neurogenic Claudication Using a Multimodal Program for Lumbar Spinal Stenosis: A Retrospective Study

Abstract: This study showed preliminary evidence for improved outcomes in patients with neurogenic claudication participating in a 6-week nonsurgical multimodal Boot Camp Program.

Cited by 18 publications

References 42 publications

Spinal epidural lipomatosis presenting to a U.S. Veterans Affairs pain and rehabilitation department: a report of two cases

Spinal epidural lipomatosis presenting to a U.S. Veterans Affairs pain and rehabilitation department: a report of two cases

Development of a Clinical Decision Aid for Chiropractic Management of Common Conditions Causing Low Back Pain in Veterans: Results of a Consensus Process

The boot camp program for lumbar spinal stenosis: a protocol for a randomized controlled trial

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