A systematic review of pain and disability ... - The Spine Journal

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Lianne Wood, Paul Hendrick, Nasir Quraishi; Queens Medical Centre,. Spinal Outpatient Department, UK. BACKGROUND CONTEXT: Pain neuroscience ...

Podium Presentations / The Spine Journal 16 (2016) S45–S63 Clinical usefulness and safety of selective lumbar nerve root blocks Grzegorz Rudol, Darren Richardson, Ata Kasis, Cyrus Jensen; Spinal Unit, Leeds General Infirmary, Leeds, UK BACKGROUND CONTEXT: Nerve root blocks in the treatment of radicular and central canal stenosis symptoms are controversial. PURPOSE: Analyse efficacy, safety and usefulness of this procedure performed by a fellowship trained spinal surgeons. STUDY DESIGN/SETTING: Selective nerve root block(s) for lumbar radiculopathy or central stenosis were carried out; patients were followed up at 6 weeks and 6 months. PATIENT SAMPLE: 550 patients with more than 6 weeks lasting symptoms. OUTCOME MEASURES: Visual analogue scale (VAS) for pain, length of improvement, achieving ‘cured’ status at the 6-month follow-up, postponing or avoiding surgical intervention. METHODS: Injections: 40 mg methylprednisolone and 3 mL of 0.25% bupivacaine. Statistical analysis: logistic regression. RESULTS: Underlying pathology was radiculopathy (225–41%), central canal stenosis (96–17.5%), mixed (210–38.2%). 78 (14.2%) patients had noticeable 1-week improvement, 152 (28%) up to 3 months, 224 (40%) more than 3 months. In 6-month follow-up 125 (23%) patients regarded themselves as ‘cured’. 249 (44.5%) patients did not require any surgical intervention nor spinal follow-up as regarded improvement was satisfactory. Logistic regression identified gender, age and underlying pathology as predictive of immediate and prolonged satisfactory response following nerve root blockage. Most likely to respond was a male with a predominantly radicular pain; advancing age increased one’s chances for a satisfactory outcome. None of the patients developed any significant complications. CONCLUSIONS: Nerve root blocks are a safe option for radiculopathic and stenotic patients. They play an important diagnostic role and in planning/ avoiding potential spinal surgery. A significant proportion (82.5%) of patients experienced some relief of symptoms, and for many this was a lasting benefit which lead them to avoid the need for surgery. CONFLICTS OF INTEREST: None. FUNDING SOURCES: None. http://dx.doi.org/10.1016/j.spinee.2016.01.041

A systematic review of pain and disability outcomes of pain neuroscience education (PNE) in the management of chronic low back pain Lianne Wood, Paul Hendrick, Nasir Quraishi; Queens Medical Centre, Spinal Outpatient Department, UK BACKGROUND CONTEXT: Pain neuroscience education is employed in patients with chronic low back pain (CLBP) to reduce pain-related behaviours. However, its efficacy has not been systematically evaluated.


PURPOSE: The aim of this review is to systematically evaluate the literature regarding pain neuroscience education in patients with chronic low back pain. STUDY DESIGN/SETTING: Systematic review and meta-analysis. PATIENT SAMPLE: Patients with chronic low back pain (CLBP). OUTCOME MEASURES: Pain and disability scores (Ronald Morris Disability Questionnaire [RMDQ]). METHODS: A literature search of CINAHL, MEDLINE, Web of Science, Scopus, Cochrane and Science Direct was performed from 2011 (01) to 2015 (07). Appraisal and synthesis was assessed using the CONSORT and Cochrane Risk of Bias Tool. The main outcome measures assessed were pain and disability. Pain and disability scores were collated, and meta-analysis was performed where possible. RESULTS: Three of the four included studies were of moderate quality with one study of high quality according to the Cochrane risk of Bias tool. Three papers assessed pain neuroscience education (PNE) in CLBP and one evaluated PNE in a pre-operative subgroup. Meta-analysis was performed excluding the pre-operative paper for homogeneity. Statistically significant but clinically small improvements in chronic low back pain were demonstrated for short-term pain: overall mean difference (OMD) 0.77 (95% confidence interval 0.00; 1.55) (N=101) (p=.05). Disability scores showed a statistically and clinically significant improvement in the RMDQ (p=.003): OMD of 3.23 (95% confidence interval 1.12; 5.34) (N=39). CONCLUSIONS: The addition of PNE to usual care in a CLBP subgroup generated improved pain and disability scores in the short- and mediumterm. Further powered randomised controlled trials (RCTs) are required to support these findings. CONFLICTS OF INTEREST: None. FUNDING SOURCES: None. http://dx.doi.org/10.1016/j.spinee.2016.01.042

Spinal Deformity The development and validation of a 3D ultrasound system for monitoring curve progression of patients with scoliosis Eskinder Solomon, Adam P. Shortland, Adnan K. Meyer, Jonathan D. Lucas; Guy’s and St Thomas NHS Foundation Trust, UK BACKGROUND CONTEXT: The standard approach of monitoring scoliosis involves using the Cobb angle from posteroanterior (PA) radiograph. This approach has two key limitations: (1) It involves exposing the patients to ionising radiation during a period of heightened radiosensitivity. (2) The 2D X-ray image is a projection image of a 3D deformity and the Cobb angle represents only lateral rotation. 3D ultrasound (3DUS) could overcome both these limitations.

Figure. 3DUS of the spine. The spinous processes (SP) and laminae are highlighted on the transverse image on the left. 3D automated rendering of the spine from the ultrasound data is shown on the right.

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