Physiotherapy and spinal nerve root adhesion: a caution

Lewis, Cynthia

doi:10.1002/pri.320

Cited by 4 publications

(4 citation statements)

References 17 publications

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“…Three large spinal fusion ± rhBMP-2 studies with thousands of patients each were excluded from analysis-one with unexplained data errors after author discussion [895], one missing arachnoiditis codes [896], and one considered financially biased with unexplained doubled AE in the control group [897]. Two other studies were excluded due to serious methodology errors [898,899].…”

Section: Plos Onementioning

confidence: 99%

The leptomeninges as a critical organ for normal CNS development and function: First patient and public involved systematic review of arachnoiditis (chronic meningitis)

Palackdkharry¹,

Wottrich²,

Dienes³

et al. 2022

PLoS ONE

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Background & importance This patient and public-involved systematic review originally focused on arachnoiditis, a supposedly rare “iatrogenic chronic meningitis” causing permanent neurologic damage and intractable pain. We sought to prove disease existence, causation, symptoms, and inform future directions. After 63 terms for the same pathology were found, the study was renamed Diseases of the Leptomeninges (DLMs). We present results that nullify traditional clinical thinking about DLMs, answer study questions, and create a unified path forward. Methods The prospective PRISMA protocol is published at Arcsology.org. We used four platforms, 10 sources, extraction software, and critical review with ≥2 researchers at each phase. All human sources to 12/6/2020 were eligible for qualitative synthesis utilizing R. Weekly updates since cutoff strengthen conclusions. Results Included were 887/14286 sources containing 12721 DLMs patients. Pathology involves the subarachnoid space (SAS) and pia. DLMs occurred in all countries as a contributor to the top 10 causes of disability-adjusted life years lost, with communicable diseases (CDs) predominating. In the USA, the ratio of CDs to iatrogenic causes is 2.4:1, contradicting arachnoiditis literature. Spinal fusion surgery comprised 54.7% of the iatrogenic category, with rhBMP-2 resulting in 2.4x more DLMs than no use (p<0.0001). Spinal injections and neuraxial anesthesia procedures cause 1.1%, and 0.2% permanent DLMs, respectively. Syringomyelia, hydrocephalus, and arachnoid cysts are complications caused by blocked CSF flow. CNS neuron death occurs due to insufficient arterial supply from compromised vasculature and nerves traversing the SAS. Contrast MRI is currently the diagnostic test of choice. Lack of radiologist recognition is problematic. Discussion & conclusion DLMs are common. The LM clinically functions as an organ with critical CNS-sustaining roles involving the SAS-pia structure, enclosed cells, lymphatics, and biologic pathways. Cases involve all specialties. Causes are numerous, symptoms predictable, and outcomes dependent on time to treatment and extent of residual SAS damage. An international disease classification and possible treatment trials are proposed.

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Section: Plos Onementioning

confidence: 99%

The leptomeninges as a critical organ for normal CNS development and function: First patient and public involved systematic review of arachnoiditis (chronic meningitis)

Palackdkharry¹,

Wottrich²,

Dienes³

et al. 2022

PLoS ONE

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“…Chronic lower back pain (LBP) or lower leg radicular pain is one of the leading causes of poor quality of life 1 , 2 . Conservative management is the first-line treatment for chronic lumbar radicular pain; this includes exercise, oral therapy, physiotherapy, and epidural injections 3 - 5 . Neuropathic components often ensue in patients with chronic lumbar radicular pain, and the interventional treatment for neuropathic radicular pain is limited to symptom management 6 , 7 .…”

Section: Introductionmentioning

confidence: 99%

“…Chronic lower back pain (LBP) or lower leg radicular pain is one of the leading causes of poor quality of life [1,2]. Conservative management is the first-line treatment for chronic lumbar radicular pain; this includes exercise, oral therapy, physiotherapy, and epidural injections [3][4][5]. Neuropathic…”

Section: Introductionmentioning

confidence: 99%

Adjuvant administration of hypertonic saline in lumbar epidural intervention may be associated with successful response in patients with probable neuropathic radicular pain Screened by Douleur Neuropathique 4

et al. 2021

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Background: Chronic lumbar radicular pain often accompanies neuropathic pain. The treatment may follow a screening for probable neuropathic pain rather than the definitive diagnosis, which is often difficult in daily practice. However, interventional management may have limited effects on symptoms in patients with neuropathic radicular pain refractory to conservative treatments. The purpose of this study is to evaluate the factors associated with successful responses after lumbar epidural intervention in patients with chronic lumbar neuropathic radicular pain determined by Douleur Neuropathique 4 (DN4). Methods: We retrospectively reviewed 221 chronic lumbar radicular pain patients using a DN4 questionnaire prior to the epidural interventional procedure. The patients were divided into two groups according to the DN4 questionnaire: <4-point DN4 and ≥4 DN4. The numerical rating scale (NRS) for pain intensity, changes in physical functional status, and the use of pain medication were obtained before and 1 month after the procedure. Successful responder was defined based on robust combination of outcome parameters. The factors associated with successful response were analyzed using univariate and multivariate regression. Results: We found 170 (76.9%) patients with DN4 <4 and 51 (23.1%) with a score ≥4. Among the total 221 patients, 129 (58.4%) were successful responders and 92 (41.6%) were non-responders regardless of DN4 score. We observed a significantly lower proportion of successful responders among patients with a DN4 score ≥4 (22, 43.1%) than patients with a score <4 (107, 62.9%) (P=0.012). After adjusting in multivariate regression analysis, the DN4 score was independently associated with response after lumbar epidural intervention (odds ratio [OR]=0.838; 95% confidence interval [CI]=0.718-0.978; P=0.025). In subgroup logistic regression analysis according to the DN4 score, adjuvant administration of hypertonic saline during epidural interventions in patients with a DN4 score ≥4 (OR=3.71; CI=1.142-12.457; P=0.029) was associated with the success of the lumbar epidural procedure at 1 month. Conclusion: The adjuvant use of hypertonic saline in lumbar epidural interventions may be effective at least 1 month after the intervention in patients with probable neuropathic lumbar radicular pain ≥4 using the DN4.

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“…Die Beeinträchtigung der Beweglichkeit von Nervenwurzeln durch narbige Verwachsungen nach Bandscheibenoperationen kann erhebliche Beschwerden verursachen, die mit konventioneller Physiotherapie kaum beeinflussbar sind [14]. Aus diesem Grund legten einige Arbeitsgruppen in der unmittelbar postoperativen Physiotherapie besonderen Wert auf die Mobilisation von Nerven, um damit eine stärkere Narbenbildung zu vermeiden [3,10,17,21].…”

unclassified

Wirksamkeit der neuralen Mobilisation in der postoperativen Physiotherapie nach nicht instrumentierten Bandscheibenoperationen

Konrad¹,

Thue²,

Robinson³

et al. 2008

manuelletherapie

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Physiotherapy and spinal nerve root adhesion: a caution

Cited by 4 publications

References 17 publications

The leptomeninges as a critical organ for normal CNS development and function: First patient and public involved systematic review of arachnoiditis (chronic meningitis)

The leptomeninges as a critical organ for normal CNS development and function: First patient and public involved systematic review of arachnoiditis (chronic meningitis)

Adjuvant administration of hypertonic saline in lumbar epidural intervention may be associated with successful response in patients with probable neuropathic radicular pain Screened by Douleur Neuropathique 4

Wirksamkeit der neuralen Mobilisation in der postoperativen Physiotherapie nach nicht instrumentierten Bandscheibenoperationen

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