Clinical evaluation versus magnetic resonance imaging findings in patients with radicular arm pain—A pragmatic study

Redebrandt, Henrietta Nittby; Brandt, Christian; Hawran, Said; Bendix, Tom

doi:10.1002/hsr2.589

Cited by 7 publications

(10 citation statements)

References 34 publications

(64 reference statements)

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“…As a result, similar to lumbar radiculopathy, the main criteria we recommended for RCTs assessing conservative interventions are based on history and clinical examination findings 110. Researchers who use imaging for further confirmation need to correlate findings to participants clinical presentation as in isolation, imaging cannot reliably be used due to its high false-positive rate 45,64,92,102,111. If authors use imaging to help diagnose CR, we urge them to identify and report the symptom etiology.…”

Section: Discussionmentioning

confidence: 99%

“…110 Researchers who use imaging for further confirmation need to correlate findings to participants clinical presentation as in isolation, imaging cannot reliably be used due to its high false-positive rate. 45,64,92,102,111 If authors use imaging to help diagnose CR, we urge them to identify and report the symptom etiology. As our review found, the body of literature surrounding the impact of different aetiologies on the clinical course of CR is lacking and more information is needed.…”

Section: Proposed Recommended Inclusion Criteria and Justificationmentioning

confidence: 99%

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Eligibility Criteria of Participants in Randomized Controlled Trials Assessing Conservative Management of Cervical Radiculopathy: A Systematic Review

Plener

Silva-Oolup

et al. 2022

Spine

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Study Design. Systematic review. Objective. The aim of this study was to evaluate the inclusion and exclusion criteria for participants in randomized control trials (RCTs) assessing conservative management for cervical radiculopathy (CR), to determine if any consensus exists within the literature. Summary of Background Data. A 2012 systematic review identified a lack of uniformity for the eligibility criteria of participants in RCTs evaluating conservative interventions for CR. Since then, a large number of RCTs have been published, signaling the need for an updated evaluation of this topic. Materials and Methods. We electronically searched MEDLINE, CENTRAL, CINAHL, Embase, and PsycINFO from inception to June 15, 2022, to identify RCTs assessing conservative management of CR. Information extracted was analyzed to determine the level of homogeneity and/or heterogeneity of the inclusion and exclusion criteria across studies. Results. Seventy-six RCTs met our inclusion criteria with 68 distinct trials identified. The inclusion of arm pain with or without another symptom (i.e. numbness, paresthesia, or weakness) was required in 69.12% of trials, 50% of trials required participants to exhibit neck symptoms, and 73.53% of studies required some form of clinical examination findings, but inconsistencies existed for the number and type of tests used. Furthermore, 41.18% of trials included imaging, with 33.82% of trials requiring magnetic resonance imaging findings. The most common exclusion criteria included were the presence of red flags and cervical myelopathy in 66.18% and 58.82% of trials, respectively. Conclusions. Overall, there is still a lack of uniformity for the inclusion/exclusion criteria of trials assessing the conservative management of CR, with some improvements noted compared with the 2012 review. Based on the current literature assessing the diagnostic utility of clinical symptoms and confirmatory tests, we proposed inclusion criteria for trials assessing conservative interventions. Future research should aim to develop standardized classification criteria to improve consistency among studies.

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Section: Discussionmentioning

confidence: 99%

Section: Proposed Recommended Inclusion Criteria and Justificationmentioning

confidence: 99%

Eligibility Criteria of Participants in Randomized Controlled Trials Assessing Conservative Management of Cervical Radiculopathy: A Systematic Review

Plener

Silva-Oolup

et al. 2022

Spine

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“…In addition, since it takes many years for degeneration to extend to multiple intervertebral levels or distal to the intervertebral foramen, irreversible damage to the nerve roots may occur due to chronic nerve root compression. Furthermore, since the imaging evaluation of the intervertebral foramen for cervical radiculopathy is sometimes mismatched with physical findings, 6,14 the imaging of multilevel intervertebral stenosis for a definitive diagnosis of the responsible levels may be difficult.…”

Section: Discussionmentioning

confidence: 99%

“…[2][3][4] Moreover, physical examination findings often mismatch or overlap with the classical dermatome of each nerve root, 5 resulting in a low correlation between subjective symptoms and objective imaging findings. 6 When there is no diagnostic confidence regarding the site of the responsible lesion, electromyography (EMG) or selective nerve root block (SNRB) is sometimes used. However, these invasive techniques do not always provide an accurate diagnosis.…”

mentioning

confidence: 99%

A Propensity Score-matched Analysis of Clinical Outcomes between Single- and Multi-level Intervertebral Decompression for Cervical Radiculopathy

Oshina

Kawamura²,

Hara

et al. 2022

Spine

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Study Design. Retrospective multicenter study with propensity score matching. Objective. To compare the clinical outcomes of single-level and multilevel intervertebral decompression for cervical degenerative radiculopathy. Summary of Background Data. In patients with cervical radiculopathy, physical examination findings are sometimes inconsistent with imaging data. Multilevel decompression may be necessary for multiple foraminal stenosis. Additional decompression is more invasive yet expected to comprehensively decompress all suspected nerve root compression areas. However, the surgical outcomes of this approach compared with that of single-level decompression remain unknown. Materials and Methods. The data of patients with spinal surgery for pure cervical radiculopathy were collected. Patients were categorized into the single-level (SLDG) or multilevel (MLDG) intervertebral decompression group at C3/C4/C5/C6/C7/T1. Demographic data and patient-reported outcome scores, including the Neck Disability Index (NDI) and Numerical Rating Scale (NRS) scores for pain and numbness in the neck, upper back, and arms, were collected. The NDI improvement rates and changes in NRS scores were analyzed one year postoperatively at patient-reported outcome evaluation. Propensity score matching was performed to compare both groups after adjusting for baseline characteristics, including the preoperative NDI and NRS scores. Results. Among the 357 patients in this study, SLDG and MLDG comprised 231 and 126 patients, respectively. Two groups (n = 112, each) were created by propensity score matching. Compared with the MLDG, the SLDG had a higher postoperative NDI improvement rate (P = 0.029) and lower postoperative arm numbness NRS score (P = 0.037). Other outcomes tended to be more favorable in the SLDG than in the MLDG, yet no statistical significance was detected. Conclusions. In patients with cervical radiculopathy, the surgical outcomes of the SLDG showed better improvement in clinical outcomes than those of the MLDG. Numbness remained on the distal (arms) rather than the central (neck and upper back) areas in patients receiving multilevel decompression.

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“…A cervical MRI is a definitive examination for evaluating patients with a history of cervical radiculopathy or myelopathy symptoms [25]. In cases of radiculopathy, the results of the MRI examination should be related to the physical examination, considering that protrusion or extrusion of the disc can reach > 30% of patients [26].…”

Section: Laboratory Tests and Imagingmentioning

confidence: 99%

Clinical Approach to Diagnosing and Treatment of Neck Pain

Siahaan¹

2022

OJMS

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Background: Neck pain is one of the most common reasons patients seek treatment in the hospital. The causes of neck pain vary widely, trigger misdiagnosis, and often result in mistreatment. Misdiagnoses and mistreatment-related neck pain diagnoses are often associated with a diagnosis of cervical herniated disc. The implication of the misdiagnosis is the use of excessive investigations and inappropriate therapy. This review aims to determine the causes of neck pain often obtained in daily practice and how to diagnose and treat it. Method: Search relevant articles on clinical diagnosis of neck pain with the keywords neck pain diagnostic therapy using Medline and PubMed databases. Results: Neck pain can be in the form of axial pain, which is mostly related to disorders of the joints and muscles of the neck, or in the form of pain in the roots and spinal cord. Investigations and therapy must be related to the clinical diagnosis of neck pain experienced by patients with a history of neck pain. Conclusion: Neck pain is one of the most common complaints encountered in outpatient department settings, associated with reduced quality of life. Patients may come with differing degrees of pain, various symptoms, and aetiologies making it quite challenging to treat them into complete remission. Despite being frequently encountered, some patients with neck pain are underdiagnosed and undertreated due to failure to understand the clinical symptoms before deciding possible aetiologies.

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Clinical evaluation versus magnetic resonance imaging findings in patients with radicular arm pain—A pragmatic study

Cited by 7 publications

References 34 publications

Eligibility Criteria of Participants in Randomized Controlled Trials Assessing Conservative Management of Cervical Radiculopathy: A Systematic Review

Eligibility Criteria of Participants in Randomized Controlled Trials Assessing Conservative Management of Cervical Radiculopathy: A Systematic Review

A Propensity Score-matched Analysis of Clinical Outcomes between Single- and Multi-level Intervertebral Decompression for Cervical Radiculopathy

Clinical Approach to Diagnosing and Treatment of Neck Pain

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