Explore the vast range of titles available.

Pain is a multidimensional experience mediated by distributed neural networks in the brain. To study this phenomenon, EEGs were collected from 20 subjects with chronic lumbar radiculopathy, 20 age and gender matched healthy subjects, and 17 subjects with chronic lumbar pain scheduled to receive an implanted spinal cord stimulator. Analysis of power spectral density, coherence, and phase-amplitude coupling using conventional statistics showed that there were no significant differences between the radiculopathy and control groups after correcting for multiple comparisons. However, analysis of transient spectral events showed that there were differences between these two groups in terms of the number, power, and frequency-span of events in a low gamma band. Finally, we trained a binary support vector machine to classify radiculopathy versus healthy subjects, as well as a 3-way classifier for subjects in the 3 groups. Both classifiers performed significantly better than chance, indicating that EEG features contain relevant information pertaining to sensory states, and may be used to help distinguish between pain states when other clinical signs are inconclusive.

Neck pain imposes a considerable personal and socioeconomic burden—it is one of the top five chronic pain conditions in terms of prevalence and years lost to disability—yet it receives a fraction of the research funding given to low back pain. Although most acute episodes resolve spontaneously, more than a third of affected people still have low grade symptoms or recurrences more than one year later, with genetics and psychosocial factors being risk factors for persistence. Nearly half of people with chronic neck pain have mixed neuropathic-nociceptive symptoms or predominantly neuropathic symptoms. Few clinical trials are dedicated solely to neck pain. Muscle relaxants and non-steroidal anti-inflammatory drugs are effective for acute neck pain, and clinical practice is mostly guided by the results of studies performed for other chronic pain conditions. Among complementary and alternative treatments, the strongest evidence is for exercise, with weaker evidence supporting massage, acupuncture, yoga, and spinal manipulation in different contexts. For cervical radiculopathy and facet arthropathy, weak evidence supports epidural steroid injections and radiofrequency denervation, respectively. Surgery is more effective than conservative treatment in the short term but not in the long term for most of these patients, and clinical observation is a reasonable strategy before surgery.

Background Anterior cervical discectomy and fusion is a standard surgical treatment for cervical radiculopathy and myelopathy, but reoperations sometimes are performed to treat complications of fusion such as pseudarthrosis and adjacent-segment degeneration. A cervical disc arthroplasty is designed to preserve motion and avoid the shortcomings of fusion. Available evidence suggests that a cervical disc arthroplasty can provide pain relief and functional improvements similar or superior to an anterior cervical discectomy and fusion. However, there is controversy regarding whether a cervical disc arthroplasty can reduce the frequency of reoperations. Questions/purposes We performed a meta-analysis of randomized controlled trials (RCTs) to compare cervical disc arthroplasty with anterior cervical discectomy and fusion regarding (1) the overall frequency of reoperation at the index and adjacent levels; (2) the frequency of reoperation at the index level; and (3) the frequency of reoperation at the adjacent levels. Methods PubMed, EMBASE, and the Cochrane Register of Controlled Trials databases were searched to identify RCTs comparing cervical disc arthroplasty with anterior cervical discectomy and fusion and reporting the frequency of reoperation. We also manually searched the reference lists of articles and reviews for possible relevant studies. Twelve RCTs with a total of 3234 randomized patients were included. Eight types of disc prostheses were used in the included studies. In the anterior cervical discectomy and fusion group, autograft was used in one study and allograft in 11 studies. Nine of 12 studies were industry sponsored. Pooled risk ratio (RR) and associated 95% CI were calculated for the frequency of reoperation using random-effects or fixed-effects models depending on the heterogeneity of the included studies. A funnel plot suggested the possible presence of publication bias in the available pool of studies; that is, the shape of the plot suggests that smaller negative or no-difference studies may have been performed but have not been published, and so were not identified and included in this meta-analysis. Results The overall frequency of reoperation at the index and adjacent levels was lower in the cervical disc arthroplasty group (6%; 108/1762) than in the anterior cervical discectomy and fusion group (12%; 171/1472) (RR, 0.54; 95% CI, 0.36–0.80; p = 0.002). Subgroup analyses were performed according to secondary surgical level. Compared with anterior cervical discectomy and fusion, cervical disc arthroplasty was associated with fewer reoperations at the index level (RR, 0.50; 95% CI, 0.37–0.68; p < 0.001) and adjacent levels (RR, 0.52; 95% CI, 0.37–0.74; p < 0.001). Conclusions Cervical disc arthroplasty is associated with fewer reoperations than anterior cervical discectomy and fusion, indicating that it is a safe and effective alternative to fusion for cervical radiculopathy and myelopathy. However, because of some limitations, these findings should be interpreted with caution. Additional studies are needed. Level of Evidence Level I, therapeutic study.

Cervical spine radiculopathy [CSR] is a complex condition that is challenging to diagnose. The assessment methods used by United Kingdom [UK] physiotherapists to diagnose CSR remain unclear. A mixed-methods explanatory sequential design was used to investigate the assessment strategies that UK Health and Care Professions Council HCPC physiotherapists use and the reasons behind this decision-making in clinical practice. Phase 1 of the mixed methods research [MMR] study was a national online survey. The 63 respondents reported that the most common assessment strategies included muscle strength [94%], light touch sensation [78%] and reflex testing [89%]. Phase 2 of the MMR study included 11 qualitative interviews with Phase 1 [survey] participants. Four themes were established: perception of role, service constraints, minimising risk, and understanding symptoms. Physiotherapists often explained decision making in practice is based upon individual and organisational barriers. The choices available to physiotherapists may be based on cost, departmental knowledge and skill or convenience. However, the best available evidence suggests that physiotherapists should continue to use a biopsychosocial approach when establishing a CSR diagnosis. Physiotherapists should continue to embrace all assessment strategies available and strive to enhance or change practice.

Chronic low back pain (CLBP) is linked to reduced excitability in the primary motor (M1) and sensory (S1) cortices. Combining sensory-motor exercises with transcranial direct current stimulation (tDCS) to boost M1 and S1 excitability may improve treatment outcomes. This combined approach aligns with the neurophysiological mechanisms underlying CLBP and may target the neuroplastic changes induced by low back pain. This study aimed to assess whether enhancing M1 and S1 excitability via tDCS, alongside sensory-motor exercises, offers additional benefits for CLBP patients. Participants were randomly assigned to receive either real or sham tDCS alongside sensory-motor exercises. Outcome measures included pain intensity, disability level, motor control ability, amplitudes of N80 and N150, and the amplitude of motor-evoked potential (MEP) and active motor threshold (AMT) for the multifidus (MF) and transversus abdominis/internal oblique (TrA/IO) muscles. A linear mixed-effects model (LMM) analyzed group, time, and interaction effects, while Spearman's correlation assessed relationships between neurophysiological and clinical outcomes. The results showed significant reductions in pain intensity and disability levels (P < 0.001) and improved motor control (P < 0.001) in both groups. Both groups also exhibited increase in MF MEP amplitude (P = 0.042) and N150 amplitude (P = 0.028). The tDCS group demonstrated a significant decrease in AMT of MF and TrA/IO muscles (P < 0.05) and an increase in N80 amplitude (P = 0.027), with no significant changes in the control group. Additionally, the tDCS group had significantly lower AMT for the TrA/IO muscle in the post-test compared to the sham group (P = 0.001). Increased N150 amplitude was correlated with improved motor control. The findings showed that sensory-motor exercises combined with either tDCS or sham tDCS effectively reduced pain intensity, decreased disability, and improved lumbar motor control in lumbosacral radiculopathy patients. No significant differences were observed between groups, indicating no added clinical benefit from tDCS over exercises alone. However, both groups demonstrated increased N150 and MF MEP amplitudes, suggesting enhanced cortical excitability in motor and sensory regions. While clinical outcomes were similar, neurophysiological data indicate that sensory-motor exercises play a central role in boosting cortical excitability, with tDCS further amplifying this effect, as evidenced by a significant AMT reduction in MF and TrA/IO muscles and an increase in N80 amplitude.

Isolated lumbar extension resistance exercise (ILEX) has been shown to effectively address chronic low back pain (LBP) and paraspinal deconditioning. However, its role within the widely recommended multimodal management approaches remains unclear. This study aimed to: (1) closely monitor the effects of ILEX throughout the course of a 16-weeks intervention, applied as a stand-alone approach in patients with nociceptive and/or neuropathic pain and (2) to compare this intervention with a multimodal treatment program including general exercise (GE) and manual therapy (MT). Fifty-eight LBP patients were enrolled in this single-center (Wuerzburg, Germany), prospective, non-randomized controlled trial. The ILEX-only group ( Powerspine Back [ PSB] : n = 29) completed 25 sessions of ILEX, whereas the integrative group ( PSB + : n = 29) also received GE (added to each session) and MT (5 to 7 sessions). Outcome measures were assessed at baseline, 3, 6, 9 and 16 weeks including lumbar multifidus cross-sectional area (CSA), muscle thickness (MT), echointensity (EI) (ultrasound-derived), isometric lumbar strength (isokinetic device) and validated questionnaires (Visual Analog Scale [VAS]; Oswestry Disability Index [ODI]; Short-Form 36). Between-subjects repeated measures ANOVA and correlation analyses were performed. Both groups (PSB: m = 16, f = 15, Ø40.26 (± 13.71) years, BMI 25.16 (± 4.07) kg/m 2 ; PSB+ : m = 16, f = 13, Ø42.00 (± 12.69) years, BMI 25.20 (± 3.29) kg/m 2 ) demonstrated comparable linear improvements in multifidus CSA (PSB: Δ0.59 [95% CI 0.36–0.82] cm 2 ; PSB+ : Δ0.72 [95% CI 0.49–0.96] cm 2 , both p  < 0.001; main effect (group): p  = 0.52) along with similar strength gains (PSB: Δ96.79 [95% CI 57.64–135.93] Nm; PSB+ : Δ86.88 [95% CI 48.70–125.06] Nm; both p  < 0.001; main effect (group): p  = 0.91) over time. EI remained unchanged in both groups. No-between group differences were observed for self-reported measures, while all outcomes significantly improved (ODI: PSB: − 15.0 [95% CI − 19.3 to − 10.8], PSB+ : − 11.7 [95% CI − 16.0 to − 7.4]; VAS: PSB: − 29.30 [95% CI − 37.73 to − 20.86], PSB+ : − 29.34 [95% CI − 37.78 to − 20.91], both p  < 0.001). Only PSB+ showed correlations between multifidus changes and clinical outcomes. Stand-alone and combined isolated lumbar extension resistance exercise interventions are effective in reversing muscle deconditioning and produce comparable clinical outcomes. The results inform clinical decision-making and support the development of targeted, resource-efficient rehabilitation strategies. ClinicalTrials.gov Identifier NCT06890052 (20/03/2025) ( https://clinicaltrials.gov/study/NCT06890052?cond=NCT06890052%20&rank=1 )

Amyotrophic lateral sclerosis (ALS) is a rare, fatal, and irreversible disease that shares some key clinical features with radiculopathy, including muscle atrophy, muscle cramps, and fasciculation. The aim of this study was to find a reliable method to differentiate these two diseases. Machine learning was used to discover new clinical biomarkers for the differential diagnosis of ALS from radiculopathy using nerve conduction study (NCS) data from patients. Data preparation and feature selection were performed by a random forest classifier algorithm, as well as a confusion matrix tool for model selection. After selecting the minimum number of features and the best algorithm, grid search cross-validation was used to optimize the hyperparameters of the chosen algorithm. 77 features were ranked according to their importance. The results of 20 algorithms acting on 8 different groups of features showed that the best performance (accuracy, precision, recall, f-1 score) was obtained using 35 important features and the XGB algorithm, particularly for the recall parameter. Using the XGB algorithm, ALS patients could be identified with accuracy = 0.871, precision = 0.923, recall = 0.850, and f-1 score = 0.857. The XGB algorithm using 35 NCS features could differentiate radiculopathy from ALS in patients with high accuracy.

Background. Cervical radiculopathy is defined as a disorder involving dysfunction of the cervical nerve roots characterised by pain radiating and/or loss of motor and sensory function towards the root affected. There is no consensus on a good definition of the term. In addition, the evidence regarding the effectiveness of manual therapy in radiculopathy is contradictory. Objective. To assess the effectiveness of manual therapy in improving pain, functional capacity, and range of motion in treating cervical radiculopathy with and without confirmation of altered nerve conduction. Methods. Systematic review of randomised clinical trials on cervical radiculopathy and manual therapy, in PubMed, Web of Science, Scopus, PEDro, and Cochrane Library Plus databases. The PRISMA checklist was followed. Methodological quality was evaluated using the PEDro scale and RoB 2.0. tool. Results. 17 clinical trials published in the past 10 years were selected. Manual therapy was effective in the treatment of symptoms related to cervical radiculopathy in all studies, regardless of the type of technique and dose applied. Conclusions. This systematic review did not establish which manual therapy techniques are the most effective for cervical radiculopathy with electrophysiological confirmation of altered nerve conduction. Without this confirmation, the application of manual therapy, regardless of the protocol applied and the manual therapy technique selected, appears to be effective in reducing chronic cervical pain and decreasing the index of cervical disability in cervical radiculopathy in the short term. However, it would be necessary to agree on a definition and diagnostic criteria of radiculopathy, as well as the definition and standardisation of manual techniques, to analyse the effectiveness of manual therapy in cervical radiculopathy in depth.

Background To diagnose cervical radiculopathy according to the International Association for the Study of Pain definition, signs of neurological deficits must be examined with the neurological examination. However, the diagnostic accuracy of the standard neurological examination remains unclear, and no clear recommendations exist about standard components. Therefore, the objectives of this review are to map the research about the diagnostic accuracy, components, and performance of the neurological examination for cervical radiculopathy. Method PubMed, Embase, Scopus, Cinhal, DiTA databases were searched up to February 23rd, 2024. Additional studies were identified through screening reference lists of the included studies. Studies on neurological examination procedures and their diagnostic accuracy for cervical radiculopathy were included. Results From an initial 12,365 records, 6 articles met the inclusion criteria. All articles were cross-sectional studies and compared the neurological examination with electrodiagnostic tests or magnetic resonance imaging. Reduced tendon reflexes were found to be most specific (81% (95% CI 69–89%) to 99% (95% CI not reported)), while somatosensation testing was least sensitive (25% (95% CI 12–38%; -LR 0.84) to 52% (95% CI 30–74%)). Taking all components into account resulted in higher specificity (98% (95% CI not reported) to 99% (95% CI 95–100%)) but lower sensitivity (7% (95% CI not reported) to 14% (95% CI 5–16%)) compared to electrodiagnostic tests. Conclusions We found varying operational definitions of radiculopathy, suboptimal reference standards, and great heterogeneity in the neurological examination procedure and its diagnostic accuracy. Future research should address these issues to establish the clinical utility of the neurological examination for cervical radiculopathy. Protocol https://doi.org/10.1101/2023.05.22.23290194 . Key messages What is already known about this topic According to the International Association for the Study of Pain, cervical radiculopathy is defined by neurological deficit which can be probed by a bedside neurological examination. Little is known about its diagnostic accuracy and procedure. What does the study add There is heterogeneity in the neurological examination procedure, the reference standards (e.g., electrophysiology and diagnostic imaging), and its diagnostic accuracy. Components of the neurological examination for cervical radiculopathy have high specificity but low sensitivity.

Background Cervical radiculopathy (CR) is a common condition, often associated with cervicogenic headache (CGH), a secondary headache arising from cervical spine disorders. Mechanical intermittent cervical traction (MICT) is frequently prescribed to treat CR symptoms. The purpose of the study was to make a preliminary estimate of efficacy of adding MICT to conventional rehabilitation on CGH in patients with cervical radiculopathy. Methods A total of 36 CR patients with CGH were randomly allocated to 3 equally sized groups (A, B and C). The treatment consisted of twelve sessions of conventional rehabilitation (4 weeks) combined with MICT (2 kg for group A, 8 kg for group B and 12 kg for group C). Primary outcomes were CGH intensity (visual analog scale) and frequency (days per week). Secondary outcomes were radicular pain intensity (visual analog scale), cervical range of motion (cervical range of motion instrument), proprioception (cervical range of motion instrument) and muscle strength (MicroFET2 dynamometer), handgrip strength (handheld dynamometer), function (Neck Disability Index), kinesiophobia (Tampa Scale for KInesiophobia), anxiety and depression (Hospital Anxiety and Depresion questionnaire), and quality of life (World Health Organization Quality of Life). Patients were assessed at baseline, one, three and six months after the beginning of treatment. The post hoc Dunn testing was used to determine which traction load had the better effect on CGH symptoms. Results At one, three and six months follow-ups, Group C exhibited the highest improvement in CGH intensity and frequency compared to the other groups ( p  = 0.021 and p  = 0.023; p  = 0.012 and p  = 0.01; p  = 0.005 and p  = 0.005). Both groups C and B showed a significant improvement in radicular pain compared to group A at one month follow-up ( p  = 0.05).The improvement in group C was significantly better in terms of function ( p  = 0.049) and anxiety ( p  = 0.011) at three months and quality of life at six months (Psychological p  = 0.046 and Environment p  = 0.006). Conclusions The blend of conventional rehabilitation alongside 12 kg MICT seems to be efficacious in diminishing both the intensity and frequency of CGH in patients with CR. These advantages appear to last for up to six months following the treatment period, potentially leading to decreased CGH severity and occurrence rates, heightened functionality, reduced anxiety levels, and an overall enhancement in quality of life. These findings are preliminary and require confirmation in larger trials. Trial registration The study protocol was retrospectively registered at the Pan African Clinical Trial Registry (PACTR202401838955948). Date of registration is 16/01/2024.