Outcome of invasive treatment modalities on back pain and sciatica: an evidence-based review

Tulder, Maurits W. van; Koes, Bart W.; Seitsalo, Seppo; Malmivaara, Antti

doi:10.1007/s00586-005-1049-5

Cited by 109 publications

(71 citation statements)

References 93 publications

(38 reference statements)

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“…There is no or only conflicting evidence suggesting that fluoroscopically guided spine infiltrations can achieve any mid-or long-term improvement for the treatment of LBP [19,44,65]. Similarly, our results showed only a short term-improvement, whilst longer FU revealed recurrent symptoms and deteriorating results (Fig.…”

Section: Diagnostic Challengessupporting

confidence: 48%

Analysis of post-operative pain patterns following total lumbar disc replacement: results from fluoroscopically guided spine infiltrations

Siepe¹,

Korge²,

Grochulla³

et al. 2007

Eur Spine J

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Although a variety of biomechanical laboratory investigations and radiological studies have highlighted the potential problems associated with total lumbar disc replacement (TDR), no previous study has performed a systematic clinical failure analysis. The aim of this study was to identify the post-operative pain sources, establish the incidence of post-operative pain patterns and investigate the effect on post-operative outcome with the help of fluoroscopically guided spine infiltrations in patients from an ongoing prospective study with ProDisc II. Patients who reported unsatisfactory results at any of the FU-examinations received fluoroscopically guided spine infiltrations as part of a semi-invasive diagnostic and conservative treatment program. Pain sources were identified in patients with reproducible (C29) significant (50-75%) or highly significant (75-100%) pain relief. Results were correlated with outcome parameters visual analogue scale (VAS), Oswestry disability index (ODI) and the subjective patient satisfaction rate. From a total of 175 operated patients with a mean follow-up (FU) of 29.3 months (range 12.2-74.9 months), n = 342 infiltrations were performed in n = 58 patients (33.1%) overall. Facet joint pain, predominantly at the index level (86.4%), was identified in n = 22 patients (12.6%). The sacroiliac joint was a similarly frequent cause of post-operative pain (n = 21, 12.0%). Pain from both structures influenced all outcome parameters negatively (P \ 0.05). Patients with an early onset of pain (B6 months) were 2-59 higher at risk of developing persisting complaints and unsatisfactory outcome at later FU-stages in comparison to the entire study cohort (P \ 0.05). The level of TDR significantly influenced postoperative outcome. Best results were achieved for the TDRs above the lumbosacral junction at L4/5 (incidence of posterior joint pain 14.8%). Inferior outcome and a significantly higher incidence of posterior joint pain were observed for TDR at L5/S1 (21.6%) and bisegmental TDR at L4/5/S1 (33.3%), respectively. Lumbar facet and/or ISJpain are a frequent and currently underestimated source of post-operative pain and the most common reasons for unsatisfactory results following TDR. Further failureanalysis studies are required and adequate salvage treatment options need to be established with respect to the underlying pathology of post-operative pain. The question as to whether or not TDR will reduce the incidence of posterior joint pain, which has been previously attributed to lumbar fusion procedures, remains unanswered. Additional studies will have to investigate whether TDR compromises the index-segment in an attempt to avoid adjacent segment degeneration.

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Section: Diagnostic Challengessupporting

confidence: 48%

Analysis of post-operative pain patterns following total lumbar disc replacement: results from fluoroscopically guided spine infiltrations

Siepe¹,

Korge²,

Grochulla³

et al. 2007

Eur Spine J

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“…During the initial physical consultation, diverse medical and functional data were gathered and patients were informed about the study aims. For the purpose of assignment, depressive symptoms were assessed by the German version of the Center of Epidemiologic Studies-Depression Scale (Allgemeine Depressions-Skala, ADS; [19]). The assignment was conducted by an independent doctoral student at the University of Bremen.…”

Section: Design and Proceduresmentioning

confidence: 99%

“…All patients participated in a multidisciplinary standard rehabilitation in orthopedic inpatient units following a biopsycho-social approach of CLBP, lasting 3 to 4 weeks (for evidence-based health care in CLBP, see [19]). The standard program was comprised of diverse evidence-based treatment modules including four 1-h sessions of cognitivebehavioral pain-management.…”

Section: Treatmentmentioning

confidence: 99%

Long-term effects of a cognitive-behavioral training program for the management of depressive symptoms among patients in orthopedic inpatient rehabilitation of chronic low back pain: a 2-year follow-up

Tlach¹,

Hampel²

2011

Eur Spine J

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The aim of the present study was to investigate the 2-year outcome of a cognitive-behavioral training program for the management of depressive symptoms for patients with chronic low back pain (CLBP) and co-existing depressive symptoms compared with the standard rehabilitation. Therefore, a quasi-experimental 3 9 2 9 5 (treatment condition 9 gender 9 time) repeated measures design with five assessment points (pre-treatment, posttreatment, 6-, 12-, and 24-month follow-up) was employed among N = 153 patients with CLBP, aged 33-62 years. Patients were consecutively assigned to one of three treatment conditions: patients with no or mild depressive symptoms were treated with the standard rehabilitation (CG) and patients with moderate or severe depressive symptoms were either treated with the standard rehabilitation (CG depr ) or the standard rehabilitation plus cognitive-behavioral management of depressive symptoms (IG depr ). Patients in the IG depr significantly improved in mental health up to the 6-month follow-up and in anxiety and depressive symptoms up to the 24-month follow-up. Only short-or mid-term improvements were found in the CG depr . In conclusion, the new cognitive-behavioral training program augmented the long-term rehabilitation success in this highly strained subgroup of patients with CLBP and depressive symptoms.

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“…Those patients benefit from multidisciplinary treatment, which leads to significantly better outcomes compared with a purely biomedical treatment [9]. To avoid the high costs of intensive multidisciplinary treatment and prevent the personal suffering associated with long-term disability, it is necessary to identify factors that predict therapeutic outcome, i.e.…”

Section: Introductionmentioning

confidence: 99%

Effects of multidisciplinary pain treatment can be predicted without elaborate questionnaires

Fischer

Neubauer

Adams

et al. 2013

International Orthopaedics (SICOT)

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Purpose Low back pain is one of the most common and expensive diseases of Western societies. Psychosocial factors such as low social status, depression, or work dissatisfaction are known to promote chronicity of low back pain. With a multidisciplinary approach, better outcomes can be achieved than with purely biomedical treatment. Optimal patient selection for multidisciplinary therapy reduces costs and labour. This study investigated whether elaborated questionnaires exceed simple items in predicting multimodal therapy success. Methods In this prospective longitudinal clinical study, 330 patients were followed up for six months after multidisciplinary therapy. We applied the patient questionnaire Heidelberg Short Early Risk Assessment Questionnaire for the Prediction of Chronicity in Low Back Pain (HKF-R10) that is approved and established for predicting chronicity in patients with acute low back pain to forecast the therapeutic outcome. Outcome criteria were QOL, pain reduction and back to work. Results With regard to outcome criteria, the HKF-R10 was unable to anticipate therapeutic success, but education level, depression, best pain condition, and helplessness predicted therapy success with an 80 % probability for QOL improvement. Conclusions It is not necessary to confront patients with an extensive and complicated questionnaire to predict the outcome of multidisciplinary therapy. In fact, assessing a few specific items allows better and easier prognosis estimation.

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Outcome of invasive treatment modalities on back pain and sciatica: an evidence-based review

Cited by 109 publications

References 93 publications

Analysis of post-operative pain patterns following total lumbar disc replacement: results from fluoroscopically guided spine infiltrations

Analysis of post-operative pain patterns following total lumbar disc replacement: results from fluoroscopically guided spine infiltrations

Long-term effects of a cognitive-behavioral training program for the management of depressive symptoms among patients in orthopedic inpatient rehabilitation of chronic low back pain: a 2-year follow-up

Effects of multidisciplinary pain treatment can be predicted without elaborate questionnaires

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