Treatment of lumbar disc herniation with radiculopathy. Clinical practice guidelines endorsed by The Polish Society of Spinal Surgery

Łątka, Dariusz; Miękisiak, Grzegorz; Jarmużek, Paweł; Lachowski, M; Kaczmarczyk, Jacek

doi:10.1016/j.pjnns.2015.12.001

Cited by 16 publications

(20 citation statements)

References 100 publications

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“…The clinical consequences of LDH physiology are spinal pain and stiffness, prolapse with nerve root pain, and stenosis with spinal claudication 2. Pain is the most common complaint in LDH patients.…”

Section: Introductionmentioning

confidence: 99%

Increased local expressions of CX3CL1 and CCL2 are related to clinical severity in lumbar disk herniation patients with sciatic pain

Peng¹,

Chen²,

Fang³

et al. 2017

JPR

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BackgroundChemokines have been identified to be involved in the modulation of pain through both peripheral and central mechanisms. However, the role of chemokines in lumbar disk herniation (LDH) with sciatic pain remains unknown.ObjectiveThe current study was performed to explore the expression of two most commonly studied chemokines CX3CL1 and CCL2 and assess their associations with clinical severity in LDH patients with sciatic pain.MethodsThe soft tissues around nerve root (STANR), annulus fibrosus (AF), and nucleus pulposus (NP) biopsies were obtained from 36 LDH patients with chronic sciatic pain and 10 scoliosis patients (painless controls). The serum and local expressions of CX3CL1 and CCL2 were determined using enzyme-linked immunosorbent assay and Western blot analysis, respectively. The visual analog scale (VAS) scores for low back pain and lower extremity pain and Japanese Orthopaedic Association (JOA) scores were recorded on the day of hospital admission to evaluate the clinical severity. LDH patients with sciatic pain were divided into severe pain (SP) group (VAS ≥7; n=18) and mild-to-moderate pain (M-MP) group (VAS <7; n=18) for lower extremity pain.ResultsLocal expressions instead of CX3CL1 and CCL2 in STANR, AF, and NP were significantly higher in the SP group than in M-MP compared with scoliosis painless group. Expressions of both CX3CL1 and CCL2 in STANR and AF were positively correlated with VAS scores for lower extremity and for low back pain, respectively. In addition, CX3CL1 and CCL2 expressions in STANR were negatively associated with JOA scores. There were no significant differences of serum CX3CL1 and CCL2 levels among SP group, M-MP group, and scoliosis painless group.ConclusionBoth CX3CL1 and CCL2 may play important roles in maintaining pain in LDH patients. Local blockade of CX3CL1 and CCL2 in LDH patients with persistent pain deserves further intensive study.

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Section: Introductionmentioning

confidence: 99%

Increased local expressions of CX3CL1 and CCL2 are related to clinical severity in lumbar disk herniation patients with sciatic pain

Peng¹,

Chen²,

Fang³

et al. 2017

JPR

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“…Treatment consists of rest, ice, and activity modification acute phase. This can be followed with bracing, physical therapy, oral non-steroidal antiinflammatory drugs, topical applications, and injections of cortisone [1,3]. When conservative treatments fail, autologous PRP may be considered.…”

Section: Spine Research Issn 2471-8173mentioning

confidence: 99%

“…The literature is replete with evidence of an evolving view of the disease from a supernatural to a scientific basis [1]. The ancient Greeks and Egyptians began to take a more naturalistic view [2].…”

Section: Introductionmentioning

confidence: 99%

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Autologous Platelet Rich Plasma for Neck and Lower Back Pain Secondary to Spinal Disc Herniation: Midterm Results

Cameron¹,

Thielen²

2017

Spine Res

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“…LDH is the most common spine disorder requiring surgical intervention [3, 4]. Clinical guidelines recommend history taking and physical examination to rule out LDH diagnosis [4].…”

Section: Introductionmentioning

confidence: 99%

Diagnostic accuracy of diagnostic imaging for lumbar disc herniation in adults with low back pain or sciatica is unknown; a systematic review

et al. 2018

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Main textWe aim to summarize the available evidence on the diagnostic accuracy of imaging (index test) compared to surgery (reference test) for identifying lumbar disc herniation (LDH) in adult patients.For this systematic review we searched MEDLINE, EMBASE and CINAHL (June 2017) for studies that assessed the diagnostic accuracy of imaging for LDH in adult patients with low back pain and surgery as the reference standard. Two review authors independently selected studies, extracted data and assessed risk of bias. We calculated summary estimates of sensitivity and specificity using bivariate analysis, generated linked ROC plots in case of direct comparison of diagnostic imaging tests and assessed the quality of evidence using the GRADE-approach.We found 14 studies, all but one done before 1995, including 940 patients. Nine studies investigated Computed Tomography (CT), eight myelography and six Magnetic Resonance Imaging (MRI). The prior probability of LDH varied from 48.6 to 98.7%. The summary estimates for MRI and myelography were comparable with CT (sensitivity: 81.3% (95%CI 72.3–87.7%) and specificity: 77.1% (95%CI 61.9–87.5%)). The quality of evidence was moderate to very low.ConclusionsThe diagnostic accuracy of CT, myelography and MRI of today is unknown, as we found no studies evaluating today’s more advanced imaging techniques. Concerning the older techniques we found moderate diagnostic accuracy for all CT, myelography and MRI, indicating a large proportion of false positives and negatives.

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Treatment of lumbar disc herniation with radiculopathy. Clinical practice guidelines endorsed by The Polish Society of Spinal Surgery

Cited by 16 publications

References 100 publications

Increased local expressions of CX3CL1 and CCL2 are related to clinical severity in lumbar disk herniation patients with sciatic pain

Increased local expressions of CX3CL1 and CCL2 are related to clinical severity in lumbar disk herniation patients with sciatic pain

Autologous Platelet Rich Plasma for Neck and Lower Back Pain Secondary to Spinal Disc Herniation: Midterm Results

Diagnostic accuracy of diagnostic imaging for lumbar disc herniation in adults with low back pain or sciatica is unknown; a systematic review

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