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Background Several authors have reported favorable results in low back pain (LBP) for patients with lumbar disc herniation (LDH) treated with discectomy. However, detailed changes over time in the characteristics and location of LBP before and after discectomy for LDH remain unclear. To clarify these points, we conducted an observational study to determine the detailed characteristics and location of LBP before and after discectomy for LDH, using a detailed visual analog scale (VAS) bilaterally. Methods We included 65 patients with LDH treated by discectomy in this study. A detailed VAS for LBP was administered with the patient under 3 different conditions: in motion, standing, and sitting. Bilateral VAS was also administered (affected versus opposite side) for LBP, lower extremity pain (LEP), and lower extremity numbness (LEN). The Oswestry Disability Index (ODI) was used to quantify clinical status. Changes over time in these VAS and ODI were investigated. Pfirrmann grading and Modic change as seen by magnetic resonance imaging (MRI) were reviewed before and 1 year after discectomy to determine disc and endplate condition. Results Before surgery, LBP on the affected side while the patients were in motion was significantly higher than LBP while they were sitting ( p  = 0.025). This increased LBP on the affected side in motion was improved significantly after discectomy ( p  < 0.001). By contrast, the residual LBP while sitting at 1 year after surgery was significantly higher than the LBP while they were in motion or standing ( p  = 0.015). At 1 year following discectomy, residual LBP while sitting was significantly greater in cases showing changes in Pfirrmann grade ( p  = 0.002) or Modic type ( p  = 0.025). Conclusions Improvement of LBP on the affected side while the patient is in motion suggests that radicular LBP is improved following discectomy by nerve root decompression. Furthermore, residual LBP may reflect increased load and pressure on the disc and endplate in the sitting position.

Mini AbstractThis literature review summarized studies that evaluated the effects of epidural steroid injections (ESIs) on skeletal health. While evidence is limited, studies suggest that ESIs may cause bone loss. Better understanding of these skeletal consequences will help foster strategies to prevent bone loss in the growing population of patients receiving ESIs.PurposeApproximately nine million epidural steroid injections (ESIs) are administered annually in the United States to treat radicular back pain. ESIs often provide pain relief and functional improvement. While the overall incidence of adverse events resulting from ESIs is low, their effects on the skeleton are poorly understood. This is an important consideration given the profound skeletal impact of other forms of glucocorticoids.Methods Ovid MEDLINE and PubMed search results since 2010, including older, frequently referenced publications were reviewed.ResultsSystemic absorption of glucocorticoids occurs after ESI, which can cause hyperglycemia and endogenous cortisol suppression. The majority of studies investigating the skeletal effects of ESIs are retrospective. Several have found a relationship between low areal bone mineral density (BMD) by dual-energy x-ray absorptiometry and ESI exposure, but this finding is not uniform. Recently a dose-response relationship between ESI exposure and low spine volumetric BMD by computed tomography has been reported. Few studies have investigated the relationship between ESI exposure and fracture risk. Results of these studies are conflicting, and most have not been adequately powered to detect fracture outcomes.ConclusionsWhile evidence is limited, studies suggest that ESIs may cause bone loss, particularly those investigating volumetric BMD. Larger doses appear to confer greater risk. Further prospective studies are needed to investigate the relationship between ESI and fracture risk. Better understanding of the skeletal consequences of ESIs will help foster strategies to prevent bone loss in the growing population of patients receiving this treatment.

Background/Objectives: Sciatica secondary to lumbar disc herniation is a common cause of chronic radicular pain and functional disability. Since the sciatic nerve is involved in the motor and sensory innervation of the foot, it is important to evaluate the potential distal biomechanical alterations it produces. Evidence regarding the effect of radicular pain on kinetic parameters remains limited and heterogeneous. The aim of this study was to describe gait characteristics in people with chronic unilateral radicular pain due to non-traumatic lumbar or lumbosacral disc herniation and to compare kinetic differences between the affected and unaffected limbs. Methods: A cross-sectional analytical observational study was conducted in 41 patients who met the inclusion criteria. Dynamic baropodometric assessment was performed using the Footscan® system. The analysis focused on kinetic parameters, including surface area, pressure, and maximum force, as well as spatiotemporal variables comprising stance time, step time, step length, and plantar push-off mechanics. Demographic data, Foot Posture Index (FPI) scores, and muscle strength were also recorded. Results: According to patient reports, the left foot was the most severely affected. Significant differences in muscle strength were found between the affected and unaffected limbs. However, no significant differences were observed in any of the kinetic or spatiotemporal parameters evaluated. Conclusions: Patients with unilateral sciatica due to lumbar disc herniation showed reduced muscle strength in the affected limb with no significant differences in kinetic or spatiotemporal gait parameters, suggesting compensatory mechanisms.

Aims: Prolotherapy is a regenerative treatment that induces the local inflammation response and has been used clinically for many musculoskeletal system disorders. Dextrose is the most common solution that is used for prolotherapy. Dextrose prolotherapy can be used as a complementary treatment for various musculoskeletal system disorders including low back pain. The aim of our trial is to assess the potential effectiveness of 5% dextrose injection for radicular low back pain resulting from lumbar disc herniation. Methods: We evaluated a total of 40 patients treated with 5% dextrose prolotherapy for radicular low back pain for one year. Of these patients, 20 patients were treated with only prolotherapy. The other 20 patients were treated with prolotheraphy and physical therapy. 5% dextrose solution is used for the treatment and the solution being injected to iliolumbar and transverse ligament insertion levels and at the facet level. We used Visual Analog Scale (VAS) 10 cm, Oswestry Disability Index (ODI) and Short Form-36 (SF-36) for the evaluation of pain, mobility, quality of life and functional status of the patients. Results: A significant reduction in pain was reported in all patients in both groups. The pain and disability scores significantly improved both in two groups at the 3, 12 and 52-week follow-up with no significant difference between the groups. Conclusions: Patients with radicular low back pain resulting from disc herniation can be treated effectively by using 5% dextrose prolotheraphy. Keywords: Prolotherapy, dextrose, radicular low back pain, lumbar disc herniation.

Introduction: Radicular low back pain is a disorder involving the dysfunction of the lumbosacral nerve roots. Clinical rehabilitation approaches for low back pain include kinesiotherapy, and physical therapy procedures: ice , rest , heat, ultrasound, TENS, but evidences regarding their effectiveness are lacking. The purpose of this study was to determine if nerve mobilization brings better improvements in pain, SLR test and functional disability in patients with radicular low back pain compared to standard physical therapy. Methods: The study was conducted on a 60 patients with Radicular low back pain, treated in Regional medical center \"Dr Safet Mujić\", Mostar, during the period from 01.04.2010 untill 31.04.2011. Patients were divided into two groups. First group (n=30) received a 4-week rehabilitation program including neural mobilization and lumbar stabilization program. Second group (n=30) received a 4-week rehabilitation program including active range of motion (ROM) exercises and lumbar stabilization program. Results: At the beginning, the two groups were not signifi cantly different in terms of score or SLR. After therapy there was statistically signifi cant improvement between groups in both VAS scores[Group A: 1.16±1.5; Group B: 2.25±2.2] and SLR [Group A: 80.9±17.4; Group B: 65.9±16.4]. ]. After the treatment, in group A, 46.6% (14) participants had been rated with 4, but in Group B: 33.3% (10) participants had been rated with 3. Conclusions: Patients treated with neural mobilization and lumbar stabilization showed better VAS scores and Straight Leg Test scores compared to patients treated with active range of motion exercises and lumbar stabilization. Further research to investigate their long term effi cacy is warranted, with emphasis on greater number of participants.

Introduction: Radicular low back pain is a disorder involving the dysfunction of the lumbosacral nerve roots. Clinical rehabilitation approaches for low back pain include kinesiotherapy, and physical therapyprocedures: ice , rest , heat, ultrasound, TENS, but evidences regarding their effectiveness are lacking. The purpose of this study was to determine if nerve mobilization brings better improvements in pain, SLR testand functional disability in patients with radicular low back pain compared to standard physical therapy.Methods: The study was conducted on a 60 patients with Radicular low back pain, treated in Regional medical center \"Dr Safet Mujić\", Mostar, during the period from 01.04.2010 untill 31.04.2011. Patientswere divided into two groups. First group (n=30) received a 4-week rehabilitation program including neural mobilization and lumbar stabilization program. Second group (n=30) received a 4-week rehabilitation program including active range of motion (ROM) exercises and lumbar stabilization program.Results: At the beginning, the two groups were not signifi cantly different in terms of score or SLR. After therapy there was statistically signifi cant improvement between groups in both VAS scores[Group A: 1.16±1.5; Group B: 2.25±2.2] and SLR [Group A: 80.9±17.4; Group B: 65.9±16.4]. ]. After the treatment, in group A, 46.6% (14) participants had been rated with 4, but in Group B: 33.3% (10) participants had been rated with 3.Conclusions: Patients treated with neural mobilization and lumbar stabilization showed better VAS scores and Straight Leg Test scores compared to patients treated with active range of motion exercises and lumbar stabilization. Further research to investigate their long term effi cacy is warranted, with emphasis on greater number of participants.

Fifty-six patients with low back pain and sciatica following radiological investigation were found to have abnormalities at multiple levels, more than one of which could be responsible for the clinical picture or at a single level, which correlated poorly with the clinical findings. Thirty-four patients had a diagnostic peri-neural root infiltration to clarify whether surgery would be appropriate. Evaluation of the technique was by reduction in analgesia. Eighteen patients have had surgery, 14 with a successful, two a moderate and two a poor outcome. Four patients have been denied and two are awaiting an operation. Ten patients referred for a diagnostic procedure deferred surgery in favour of a therapeutic course. Of 22 patients referred directly for a therapeutic course, 15 had a successful, three a moderate and four a poor result. CT-directed peri-radicular root infiltration is a useful adjunct in the management of low back pain and sciatica.

Low back pain represents a significant socioeconomic burden. Several nonsurgical medical treatments have been proposed for the treatment of this disabling condition. Epidural steroid injections (ESIs) are commonly used to treat lumbosacral radicular pain and to avoid surgery. Even though it is still not clear which type of conservative intervention is superior, several studies have proved that ESIs are able to increase patients’ quality of life, relieve lumbosacral radicular pain and finally, reduce or delay more invasive interventions, such as spinal surgery. The aim of this narrative review is to analyze the mechanism of action of ESIs in patients affected by low back pain and investigate their current application in treating this widespread pathology.

PurposeClinical pathways for low back pain (LBP) have potential to improve clinical outcomes and health service efficiency. This systematic review aimed to synthesise the evidence for clinical pathways for LBP and/or radicular leg pain from primary to specialised care and to describe key pathway components. MethodsElectronic database searches (CINAHL, MEDLINE, Cochrane Library, EMBASE) from 2006 onwards were conducted with further manual and citation searching. Two independent reviewers conducted eligibility assessment, data extraction and quality appraisal. A narrative synthesis of findings is presented.ResultsFrom 18,443 identified studies, 28 papers met inclusion criteria. Pathways were developed primarily to address over-burdened secondary care services in high-income countries and almost universally used interface services with a triage remit at the primary-secondary care boundary. Accordingly, evaluation of healthcare resource use and patient flow predominated, with interface services associated with enhanced service efficiency through decreased wait times and appropriate use of consultant appointments. Low quality study designs, heterogeneous outcomes and insufficient comparative data precluded definitive conclusions regarding clinical- and cost-effectiveness. Pathways demonstrated basic levels of care integration across the primary-secondary care boundary.ConclusionsThe limited volume of research evaluating clinical pathways for LBP/radicular leg pain and spanning primary and specialised care predominantly used interface services to ensure appropriate specialised care referrals with associated increased efficiency of care delivery. Pathways demonstrated basic levels of care integration across healthcare boundaries. Well-designed randomised controlled trials to explore the potential of clinical pathways to improve clinical outcomes, deliver cost-effective, guideline-concordant care and enhance care integration are required.

Background Low back pain, a common problem worldwide, causes more global disability than any other condition and is associated with high costs to society. This observational registry-based study describes the current trends in the medical treatment of neuropathic low back pain in the Swedish region of Västra Götaland, which has a population of 1.7 million. The study aims to; (1) identify the prevalence of neuropathic low back pain within the study population; (2) to explore the patterns of medical treatment utilization, including the prevalence and distribution of opioids (OG) and analgesics specified for neuropathic low back pain (NG) and (3) to evaluate the long-term trends and changes in medical treatment practice for neuropathic low back pain over the study period. Methods This study includes a descriptive analysis of aggregated data extracted from the Swedish primary care registry VEGA and the pharmaceutical prescription registry Digitalis between the years 2017 and 2021. The data were stratified by year, age, gender, pharmaceutical code (ATC), and sub-diagnoses and presented as the prevalence of unique patients retrieving prescribed medication within six months before or after a registered diagnosis of neuropathic low back pain. The pharmaceutical codes were furthermore grouped into two groups depending on their mechanism of action; opioid group (OG) and neuropathic group (NG). Results In all four diagnosis groups, more patients used opioid analgesics than neuropathic analgesics. The greatest difference between the opioid group and neuropathic group was in the lumbar spinal stenosis diagnosis group (67.1% vs. 40.6%), followed by the lumbar root canal stenosis diagnosis (65.9% vs. 44.2%), the nerve root and plexus compressions in intervertebral disc disorders diagnosis (57.5% vs. 40.8%), and lumbago with sciatica diagnosis (38.4% vs. 22.7%). Conclusions The trends suggest a general increase in the prescription rate and therefore patients’ use of neuropathic analgesics for neuropathic pain associated with the studied diagnoses. However, opioid treatment remains the most common. The results indicate that the treatment for neuropathic low back pain needs to be improved.