Surgical Management of Lumbar Radiculopathy: a Systematic Review

The objective of this review was to determine the efficacy, safety, and cost of surgical versus nonsurgical management of symptomatic lumbar radiculopathy in adults.MethodsWe searched PubMed from January 1, 2007, to April 10, 2019 with hand searches of systematic reviews for studies prior to 2007. One reviewer extracted data and a second checked for accuracy. Two reviewers completed independent risk of bias and strength of evidence ratings.ResultsWe included seven RCTs (N = 1158) and three cost-effectiveness analysis. Surgery reduced leg pain by 6 to 26 points more than nonsurgical interventions as measured on a 0- to 100-point visual analog scale of pain at up to 26 weeks follow-up; differences between groups did not persist at 1 year or later. The evidence was somewhat mixed for function and disability in follow-up through 26 weeks (standardized mean difference [SMD] − 0.16 (95% CI, − 0.30 to − 0.03); minimal differences were observed at 2 years (SMD − 0.06 (95% CI, − 0.20 to 0.07). There were similar improvements in quality of life, neurologic symptoms, and return to work. No surgical deaths occurred and surgical morbidity was infrequent. Th e incidence of reoperations ranged from 0 to 10%. The average cost per quality-adjusted life year gained from a healthcare payor perspective ranged from $51,156 to $83,322 for surgery compared to nonsurgical interventions.DiscussionMost findings are based on a body of RCT...
Source: Journal of General Internal Medicine - Category: Internal Medicine Source Type: research

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Conclusions: Both microdecompression and wide open laminectomy with posterior stabilization were effective in treatment of multilevel lumbar spinal stenosis with superior results of microdecompression regarding less back pain postoperatively with less blood loss and soft tissue dissection. Clinical trial number: NCT04087694. PMID: 31827656 [PubMed - in process]
Source: Pain Research and Management - Category: Anesthesiology Authors: Tags: Pain Res Manag Source Type: research
Migraine is a huge medical problem, accounting for half of the disability produced by all neurologic diseases worldwide. The medication sumatriptan (Imitrex) is well known for the treatment of a migraine attack. Sumatriptan is part of a group of medications known as the triptans. Triptan medications have been in use for over 20 years and are very effective for the acute treatment of headache (relieving migraine headaches that are already in progress). But they also have limitations; triptans can cause temporary narrowing of blood vessels in the heart and elsewhere that can result in side effects, such as chest pain or tigh...
Source: Harvard Health Blog - Category: Consumer Health News Authors: Tags: Drugs and Supplements Headache Health Source Type: blogs
Conclusion. Long-term evidence supports lumbar total disc replacement as safe. The next-generation activL Artificial Disc is more effective at preserving range of motion than first-generation lumbar TDRs (ProDisc-L and Charité) and offers a higher safety profile. Other primary and secondary outcomes are similar between disc designs. Level of Evidence: 2
Source: Spine - Category: Orthopaedics Tags: RANDOMIZED TRIAL Source Type: research
Study Design. Retrospective cohort study. Objective. The aim of this study was to compare clinical and radiographic outcomes of patients who underwent stand-alone lateral lumbar interbody fusion (LLIF) to those who underwent posterolateral fusion (PLF) for symptomatic adjacent segment disease (ASD). Summary of Background Data. Recent studies have suggested that LLIF can successfully treat ASD; however, there are no studies to date that compare LLIF with the traditional open PLF in this cohort. Methods. A total of 47 consecutive patients who underwent LLIF or PLF for symptomatic ASD between January 2007 and Augus...
Source: Spine - Category: Orthopaedics Tags: SURGERY Source Type: research
Authors: Petala E, Mironidou-Tzouveleki M, Nanassis K, Pagkalidou E, Kyriakou C, Kapoukranidou D Abstract BACKGROUND: Cervical pain is very common among population and several methods have been used until now in order to evaluate it. The main aim of this study is to estimate the prevalence of non-specific neck pain and the special features of it through its relation to demographic agents, habits and physiology parameters. Additionally, this study aims to select the most valid and objective methods for neck pain evaluation, which could also be useful in Primary Health Care and could give new prospectives. METHOD...
Source: Hellenic Journal of Nuclear Medicine - Category: Nuclear Medicine Tags: Hell J Nucl Med Source Type: research
Low back pain is the primary cause of adult disability worldwide and if poorly managed can precipitate the unnecessary use of opioids, diminish physical functioning, and lead to comorbid conditions interfering with patient quality of life. Providers who collaborate with a spinal interventionalist can effectively manage acute and chronic low back pain, improve physical functioning, and reduce the use of opioid analgesics. The implementation of specific spinal interventions, adjuvant analgesics, and collaboration with a multidisciplinary team can promote health and wellness for 1 of the most prevalent and debilitating global health conditions.
Source: The Journal for Nurse Practitioners - Category: Nursing Authors: Tags: Feature Article Source Type: research
CONCLUSION: Three sessions of thoracic manipulation, education, and exercise did not result in improved outcomes when compared to a sham manipulation, education, and exercise in individuals with chronic LBP. Future studies are needed to identify the most effective management strategies for the treatment of low back pain. Registered at clinicaltrials.gov (NCT02853357). LEVEL OF EVIDENCE: Therapy, level 1b. J Orthop Sports Phys Ther, Epub 6 Dec 2019. doi:10.2519/jospt.2020.8928. PMID: 31810405 [PubMed - as supplied by publisher]
Source: Physical Therapy - Category: Physiotherapy Authors: Tags: J Orthop Sports Phys Ther Source Type: research
Authors: Namnaqani FI, Mashabi AS, Yaseen KM, Alshehri MA Abstract The aim of this study was to evaluate the effectiveness of the McKenzie method compared to manual therapy in the management of patients with chronic low back pain (CLBP). Randomised controlled trials evaluating the McKenzie method in treating CLBP in adults compared to manual therapy (MT) were searched in MEDLINE, CINAHL, Cochrane Library, and PEDro. The primary outcomes were pain and disability. Five trials were eligible for inclusion in the review, of which, most had a score of 8 out of 11 on the PEDro scale. At 2-3 months, all studies reported si...
Source: Journal of Musculoskeletal Neuronal Interactions - Category: Neurology Tags: J Musculoskelet Neuronal Interact Source Type: research
ConclusionsThis review suggests that there are unmet needs for migraine in terms of sufficient and appropriate diagnosis, and better management and therapies for treatment of migraine in East Asia. The findings are limited by a lack of recent information and significant gaps in the literature. More recent, population-based studies assessing disease burden and clinical management of migraine are needed to confirm unmet needs for migraine across East Asia.
Source: The Journal of Headache and Pain - Category: Neurology Source Type: research
Publication date: Available online 2 December 2019Source: Medical Journal Armed Forces IndiaAuthor(s): Vijay Singh, Abdul NasserAbstractCongenitally deaf and mute adult patients have speech and language disabilities. Establishing meaningful communication with these patients is a challenge in acute hospital-care settings, particularly when anaesthetic care is to be provided. Several methods can be adopted to facilitate interaction, such as sensitisation of health-care providers and training them in ways to communicate effectively. A thorough preoperative assessment and customised perioperative management satisfying the pati...
Source: Medical Journal Armed Forces India - Category: General Medicine Source Type: research
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