Chapter 4
European guidelines
for the management of chronic
nonspecific low back pain

Airaksinen, Olavi; Brox, Jens Ivar; Cedraschi, Christine; Hildebrandt, J.; Klaber-Moffett, Jennifer; Kovacs, Francisco M.; Mannion, Anne F.; Reis, Shmuel; Staal, J. Bart; Ursin, Holger; Zanoli, Gustavo

doi:10.1007/s00586-006-1072-1

Cited by 2,180 publications

(1,910 citation statements)

References 308 publications

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“…Even with needle or wire EMG, some far field potentials originating in co‐contracting muscles are seen, making it difficult to correctly identify the onset of muscle activity in the multifidus. European Guidelines on NSLBP 1 state the EMG procedures “have no clear relevance to clinical diagnostics although they may still be useful in experimental studies and/or in the rehabilitation environment for examining mechanisms of back muscle function/dysfunction.”…”

Section: Diagnostic Tests For Motor Control Dysfunctionmentioning

confidence: 99%

“…Low back pain (LBP) is usually defined as pain and discomfort, localized below the costal margin and above the inferior gluteal fold, with or without referred leg pain 1, 2. The NIH Task Force on Research Standards for Chronic LBP (CLBP) recommended 3 that CLBP be defined as a back pain problem that has persisted for at least three months and has resulted in pain on at least half the days in the past 6 months.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Muscle Control and Non-specific Chronic Low Back Pain

Russo¹,

Deckers

Eldabe

et al. 2018

Neuromodulation: Technology at the Neural Interface

126

116

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ObjectivesChronic low back pain (CLBP) is the most prevalent of the painful musculoskeletal conditions. CLBP is a heterogeneous condition with many causes and diagnoses, but there are few established therapies with strong evidence of effectiveness (or cost effectiveness). CLBP for which it is not possible to identify any specific cause is often referred to as non‐specific chronic LBP (NSCLBP). One type of NSCLBP is continuing and recurrent primarily nociceptive CLBP due to vertebral joint overload subsequent to functional instability of the lumbar spine. This condition may occur due to disruption of the motor control system to the key stabilizing muscles in the lumbar spine, particularly the lumbar multifidus muscle (MF).MethodsThis review presents the evidence for MF involvement in CLBP, mechanisms of action of disruption of control of the MF, and options for restoring control of the MF as a treatment for NSCLBP.ResultsImaging assessment of motor control dysfunction of the MF in individual patients is fraught with difficulty. MRI or ultrasound imaging techniques, while reliable, have limited diagnostic or predictive utility. For some patients, restoration of motor control to the MF with specific exercises can be effective, but population results are not persuasive since most patients are unable to voluntarily contract the MF and may be inhibited from doing so due to arthrogenic muscle inhibition.ConclusionsTargeting MF control with restorative neurostimulation promises a new treatment option.

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Section: Diagnostic Tests For Motor Control Dysfunctionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Muscle Control and Non-specific Chronic Low Back Pain

Russo¹,

Deckers

Eldabe

et al. 2018

Neuromodulation: Technology at the Neural Interface

126

116

View full text Add to dashboard Cite

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“…Current guidelines recommend that interventionalists performing epidural injections aim to deposit corticosteroids in the ventral part of the epidural space, near the targeted nerve root. 19 Epidural injections at the level of the lumbar spine are performed via caudal, transforaminal, and interlaminar routes. Caudal epidural injections are frequently performed using fluoroscopy guidance as it is considered the safest technique for this purpose, with minimal risk of dural puncture.…”

Section: Discussionmentioning

confidence: 99%

Electrophysiological stimulation (Tsui test) is feasible for epidural catheter positioning in adults with chronic back pain: a cohort study

McAuliffe

Pickworth

DiRenna

et al. 2013

Can J Anesth/J Can Anesth

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Purpose Determining epidural catheter placement and accurately depositing corticosteroids at the site of the pathology in adults with chronic back pain can be challenging. Fluoroscopy is considered the standard of care for guiding epidural catheter positioning and subsequent injection in patients receiving epidural corticosteroids, but the technique has some limitations. We hypothesized that electrophysiological stimulation using the Tsui test is feasible for determining the appropriate epidural catheter position in adults with chronic back pain receiving epidural corticosteroids. Methods We conducted a prospective cohort study of 12 patients receiving epidural corticosteroid injections for chronic back pain. Anatomical landmarks and epidural needle positions were initially confirmed by fluoroscopy. Epidural catheter position was assessed according to sensory and motor responses, as described by Tsui et al. (Can J Anaesth 45: 640-644, 1998). The current was increased slowly from zero until muscle activity was visible or the current reached 10 mA. The catheter was then advanced until muscle responses occurred in the desired myotome. The test was deemed positive or negative according to the Tsui criteria. The anatomical level was confirmed by fluoroscopy prior to injection. Results Electrophysiological stimulation effectively established the appropriate epidural catheter position in 11 patients (92%). Epidural stimulation occurred at a mean (SD) threshold of 3.95 (3.35) mA. The kappa statistic between interventions was 0.65, indicating a substantial level of agreement. Conclusion This study demonstrated that electrophysiological stimulation using the Tsui technique is feasible for epidural catheter positioning in adults with chronic back pain. It may optimize epidural steroid injection in this population. RésuméObjectif Il peut être difficile de déterminer le positionnement du cathéter péridural et de placer de façon précise les corticostéroïdes au site de la lésion chez les adultes souffrant de maux de dos chroniques. La fluoroscopie est considérée comme la norme de soins pour guider le positionnement du cathéter péridural et l'injection subséquente chez les patients recevant des corticostéroïdes par voie péridurale, mais la technique comporte certaines limites. Nous avons émis l'hypothèse que la stimulation électrophysiologique réalisée à l'aide du test de Tsui était faisable pour déterminer le positionnement adéquat du cathéter péridural chez les adultes souffrant de maux de dos Author contributions Niamh McAuliffe made substantial contributions to conception and design, acquisition of data, analysis and interpretation of data; drafted the article and revised the manuscript; and approved the final version to be published. Sharon Pickworth made substantial contributions to conception and design, acquisition of data; revised the manuscript; and approved the final version to be published. Tania DiRenna made substantial contributions to conception and design, acquisition of data; and revised the manuscript;...

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“…Up to 78% of the low back pain (LBP) patients relapse into a pain episode (Airaksinen et al, 2006). When persistent nerve root compression caused by disc herniation is present, lumbar microdiscectomy is recommended.…”

Section: Introductionmentioning

confidence: 99%

Proprioceptive use and sit-to-stand-to-sit after lumbar microdiscectomy: The effect of surgical approach and early physiotherapy

Janssens

Brumagne

Claeys

et al. 2016

Clinical Biomechanics

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Background: Individuals with non-specific low back pain show decreased reliance on lumbosacral proprioceptive signals and slower sit-to-stand-to-sit performance. However, little is known in patients after lumbar microdiscectomy. Methods: Patients were randomly assigned into transmuscular (n = 12) or paramedian lumbar surgery (n = 13). After surgery, the same patients were randomly assigned into individualized active physiotherapy starting 2 weeks after surgery (n = 12) or usual care (n = 13). Primary outcomes were center of pressure displacement during ankle and back muscles vibration (to evaluate proprioceptive use), and the duration of five sit-to-stand-to-sit movements, evaluated at 2 (baseline), 8 and 24 weeks after surgery. Findings: Two weeks after surgery, all patients showed smaller responses to back compared to ankle muscles vibration (P b 0.05). Patients that underwent a transmuscular surgical procedure and patients that received physiotherapy switched to larger responses to back muscles vibration at 24 weeks, compared to 2 weeks after surgery (P b 0.005), although not seen in the paramedian group and usual care group (P N 0.05). Already 8 weeks after surgery, the physiotherapy group needed significantly less time to perform five sit-to-stand-to-sit movements compared to the usual care group (P b 0.05). Interpretation: Shortly after lumbar microdiscectomy, patients favor reliance on ankle proprioceptive signals over lumbosacral proprioceptive reliance to maintain posture, which resembles the behavior of patients with non-specific low back pain. However, early active physiotherapy after lumbar microdiscectomy facilitated higher reliance on lumbosacral proprioceptive signals and early improvement of sit-to-stand-to-sit performance. Transmuscular lumbar surgery favoured recovery of lumbosacral proprioception 6 months after surgery. Clinical Trial Number: NCT01505595

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Chapter 4 European guidelines for the management of chronic nonspecific low back pain

Cited by 2,180 publications

References 308 publications

Muscle Control and Non-specific Chronic Low Back Pain

Muscle Control and Non-specific Chronic Low Back Pain

Electrophysiological stimulation (Tsui test) is feasible for epidural catheter positioning in adults with chronic back pain: a cohort study

Proprioceptive use and sit-to-stand-to-sit after lumbar microdiscectomy: The effect of surgical approach and early physiotherapy

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