Prediction of long-term clinical outcome in patients with lumbar spinal stenosis

Adamová, Blanka; Voháňka, Stanislav; Dušek, Ladislav; Jarkovský, Jiří; Bednařík, Josef

doi:10.1007/s00586-012-2424-7

Cited by 30 publications

(17 citation statements)

References 22 publications

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“…The deterioration criteria were the appearance of pain in the second leg and a similar intensity of pain in L-S spine in both examinations. 21,22,24,30,31 The main irregularities of H-refl ex recorded in the patients with damage to the S1 root are prolonged latency, decreased amplitude, or absence of response, which was confi rmed in this research. Signifi cantly higher proportion of patients with deterioration in the postoperative follow-up in terms of neurophysiological analysis compared with clinical evaluation can be explained by the greater accuracy of neurophysiological tests, which may reveal subclinical changes.…”

Section: Resultssupporting

confidence: 78%

“…Compared with similar studies that have been done by other researchers, 10,21,22,26,36 this is the fi rst presentation that includes results of correlations between pre-and postoperative MEP, ENG, H-refl ex, and EMG examination in patients experiencing lumbosacral radiculopathy. In the studies by Tullberg et al 10 in the postoperative evaluation performed after 1 year in 20 patients with L-S disc herniation, MEP examination was not measured.…”

Section: Discussionmentioning

confidence: 94%

See 1 more Smart Citation

Pre- and Postoperative Evaluation of Patients With Lumbosacral Disc Herniation by Neurophysiological and Clinical Assessment

Wojtysiak¹,

Huber²,

Wiertel-Krawczuk³

et al. 2014

Spine

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Section: Resultssupporting

confidence: 78%

Section: Discussionmentioning

confidence: 94%

Pre- and Postoperative Evaluation of Patients With Lumbosacral Disc Herniation by Neurophysiological and Clinical Assessment

Wojtysiak¹,

Huber²,

Wiertel-Krawczuk³

et al. 2014

Spine

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show abstract

“…35 Although acute neuropathic symptoms in spinal stenosis will stabilize or improve in over half of individuals, the anatomic derangements do not generally improve without treatment. 36,37 Cervical myelopathy involves pathology of the cervical spinal cord due to either trauma (spinal cord injury) or inflammation (myelitis), resulting in upper motor neuron signs. The natural course of nonsurgically treated myelopathy is highly variable.…”

Section: Natural Course Of Neck Painmentioning

confidence: 99%

Epidemiology, Diagnosis, and Treatment of Neck Pain

Cohen

2015

Mayo Clinic Proceedings

474

303

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Neck pain is the fourth leading cause of disability, with an annual prevalence rate exceeding 30%. Most episodes of acute neck pain will resolve with or without treatment, but nearly 50% of individuals will continue to experience some degree of pain or frequent occurrences. History and physical examination can provide important clues as to whether the pain is neuropathic or mechanical and can also be used to identify "red flags" that may signify serious pathology, such as myelopathy, atlantoaxial subluxation, and metastases. Magnetic resonance imaging is characterized by a high prevalence of abnormal findings in asymptomatic individuals but should be considered for cases involving focal neurologic symptoms, pain refractory to conventional treatment, and when referring a patient for interventional treatment. Few clinical trials have evaluated treatments for neck pain. Exercise treatment appears to be beneficial in patients with neck pain. There is some evidence to support muscle relaxants in acute neck pain associated with muscle spasm, conflicting evidence for epidural corticosteroid injections for radiculopathy, and weak positive evidence for cervical facet joint radiofrequency denervation. In patients with radiculopathy or myelopathy, surgery appears to be more effective than nonsurgical therapy in the short term but not in the long term for most people.

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“…At a mean follow-up period of 11.1 years, Minamide et al 34 found that similar proportions of 34 patients with lumbar spinal stenosis treated conservatively experienced improvement, no change, or worsening of symptoms. A cohort study 35 evaluating 56 patients with symptomatic mild-to-moderate lumbar spinal stenosis symptoms who were treated conservatively found that 34 patients (60.7%) had a stable or improved clinical status at a median follow-up period of 88 months. These findings are consistent with several older studies 36,37 exhibiting that most patients with conservatively treated spinal stenosis will report either stable or improved symptoms at least 3 years after the presentation.…”

Section: Lumbar Spinal Stenosismentioning

confidence: 99%

Evaluation and Treatment of Low Back Pain

Hooten

Cohen

2015

Mayo Clinic Proceedings

109

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Low back pain (LBP) is a leading cause of disability worldwide. In the absence of a classification system for pain syndromes, classification of LBP on the basis of the distribution of pain as axial (pain generally localized to the low back) or radicular neuropathic (pain radiating to the lower extremities) is relevant to clinical practice because the distribution of pain is often a corollary of frequently occurring disease processes involving the lumbar spine. Common sources of axial LBP include the intervertebral disc, facet joint, sacroiliac joint, and paraspinal musculature, whereas common sources of radicular pain include a herniated intervertebral disc and spinal stenosis. The accuracy of historical and physical examination findings has been established for sacroiliac joint pain, radiculopathy, and lumbar spinal stenosis. However, the accuracy of similar data, so-called red flags, for identifying the underlying medical sources of LBP has been overstated. Diagnostic imaging studies can be useful, and adherence to established guidelines can protect against overuse. Multiple pharmacological trials exist for the management of LBP; however, the long-term outcomes of commonly used drugs are mixed. For carefully selected patients with axial LBP, radiofrequency denervation techniques can provide sustained pain relief. In patients with radicular pain, transforaminal epidural steroid injections may provide short-term pain relief, but neurostimulation may confer more enduring benefits of refractory symptoms. Pain-related indications for commonly performed operations include spinal decompression for radicular symptoms as well as spinal fusion or disc prosthesis for discogenic LBP. Physical modalities and psychological treatments can improve pain and functioning, but patient preferences may influence treatment adherence.

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Prediction of long-term clinical outcome in patients with lumbar spinal stenosis

Cited by 30 publications

References 22 publications

Pre- and Postoperative Evaluation of Patients With Lumbosacral Disc Herniation by Neurophysiological and Clinical Assessment

Pre- and Postoperative Evaluation of Patients With Lumbosacral Disc Herniation by Neurophysiological and Clinical Assessment

Epidemiology, Diagnosis, and Treatment of Neck Pain

Evaluation and Treatment of Low Back Pain

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