An evidence-based clinical guideline for the diagnosis and treatment of lumbar disc herniation with radiculopathy

Kreiner, D. Scott; Hwang, Steven W.; Easa, John E.; Resnick, Daniel K.; Baisden, Jamie; Bess, Shay; Cho, Charles H.; DePalma, Michael J.; Dougherty, Paul; Fernand, Robert; Ghiselli, Gary; Hanna, Amgad S.; Lamer, Tim J.; Lisi, Anthony J.; Mazanec, Daniel J.; Meagher, Richard J.; Nucci, Robert; Patel, Rakesh; Sembrano, Jonathan N.; Sharma, Anil Kumar; Summers, Jeffrey T.; Taleghani, Christopher K.; Tontz, William; Toton, John F.

doi:10.1016/j.spinee.2013.08.003

Cited by 501 publications

(460 citation statements)

References 114 publications

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“…Although radiculopathy and radicular pain often accompany one another, radiculopathy has been observed in the absence of pain, and radicular pain may happen in the absence of radiculopathy 46, 47 . It is important to underline that, contrary to popular belief, it is not possible to make a distinction among the patterns of L4, L5, and S1 radicular pain 48, 49 . In fact, only when radiculopathy is seen together with radicular pain can segments be estimated.…”

Section: Type Of Spinal Pain According To Pain Generatormentioning

confidence: 85%

Mechanisms of low back pain: a guide for diagnosis and therapy

et al. 2016

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Chronic low back pain (CLBP) is a chronic pain syndrome in the lower back region, lasting for at least 3 months. CLBP represents the second leading cause of disability worldwide being a major welfare and economic problem. The prevalence of CLBP in adults has increased more than 100% in the last decade and continues to increase dramatically in the aging population, affecting both men and women in all ethnic groups, with a significant impact on functional capacity and occupational activities. It can also be influenced by psychological factors, such as stress, depression and/or anxiety. Given this complexity, the diagnostic evaluation of patients with CLBP can be very challenging and requires complex clinical decision-making. Answering the question “what is the pain generator” among the several structures potentially involved in CLBP is a key factor in the management of these patients, since a mis-diagnosis can generate therapeutical mistakes. Traditionally, the notion that the etiology of 80% to 90% of LBP cases is unknown has been mistaken perpetuated across decades. In most cases, low back pain can be attributed to specific pain generator, with its own characteristics and with different therapeutical opportunity. Here we discuss about radicular pain, facet Joint pain, sacro-iliac pain, pain related to lumbar stenosis, discogenic pain. Our article aims to offer to the clinicians a simple guidance to identify pain generators in a safer and faster way, relying a correct diagnosis and further therapeutical approach.

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Section: Type Of Spinal Pain According To Pain Generatormentioning

confidence: 85%

Mechanisms of low back pain: a guide for diagnosis and therapy

et al. 2016

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“…LDH with radiculopathy is defined as localized displacement of disc material beyond the normal margins of the intervertebral disc space, resulting in pain, weakness or numbness, in a myotomal or dermatomal distribution (20). LDH accounts for approximately 5% of all LBP (21).…”

Section: Lumbar Disc Herniationmentioning

confidence: 99%

“…Large LDH is more common in men than in women (23), and large LDH resolves better than small (24). To reach a diagnosis of LDH, it is necessary that clinical presentation is consistent with the findings of magnetic resonance imaging (MRI) or computed tomography (20). Disc bulging is common and appears in 30% of people 20 years of age.…”

Section: Lumbar Disc Herniationmentioning

confidence: 99%

“…It is recommended that non-surgical interventions be exhausted before deciding to undertake surgery for LSS (10,51), LDH (9,10,20), spondylolisthesis (53), or DDD (9, 10). Exercise plays a major role in the treatment of chronic LBP with or without sciatica according to three large recently updated guidelines (9)(10)(11), of which the UK guidelines give exercise the most central role in non-surgical interventions.…”

Section: Interventionsmentioning

confidence: 99%

“…Assessment for signs of psychological distress, such as somatization and/or depression, prior to surgery is recommended (20). There is evidence level B (fair evidence) that patients with signs of psychological distress have worse outcomes, compared to those without such signs (20).…”

Section: Surgerymentioning

confidence: 99%

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