Treatment of Sciatica and Lumbar Radiculopathy with an Intervertebral Foramen Opening Protocol: Pilot Study in a Hospital Emergency and In-patient Setting.

Aims: Perform a pilot study of a static nerve root foramen opening protocol for lumbar radiculopathy from disc hernia in an emergency hospital setting to establish if patients could execute the protocol, consistency would occur across outcomes, superior outcomes would occur in the experimental group, and if the protocol would be safe.

Methods: Patients with sciatica arrived of their own volition at the local emergency hospital department, were admitted for care and were randomized into two groups: 1) control (n = 10): forward bending, walking, and medication; and 2) experimental (n = 10) as control subjects, plus a static lumbar foramen opening protocol using flexion and contralateral lateral flexion (side-lying). Outcomes were back and leg pain (i.

Extending the straight leg raise test for improved clinical evaluation of sciatica: validity and diagnostic performance with reference to the magnetic resonance imaging.

Background: The straight leg raise test (SLR) is one of the most utilized and studied physical tests in patients with low back pain (LBP) for the detection of lumbar disc herniation (LDH), showing high sensitivity and heterogeneous or low specificity. The high incidence of asymptomatic 'pathologic' findings in the magnetic resonance imaging (MRI) scans may cause verification bias to these results. We studied an extended SLR (ESLR) by adding location-specific structural differentiation movements (hip internal rotation or ankle dorsiflexion) to the traditional SLR for it to better differentiate neural symptoms from musculoskeletal.

Extending the straight leg raise test for improved clinical evaluation of sciatica: reliability of hip internal rotation or ankle dorsiflexion.

Background: The straight leg raise (SLR) is the most commonly applied physical tests on patients with sciatica, but the sensitivity and specificity ratings for disc hernia and neural compression leave areas for improvement. Hip internal rotation tensions the lumbosacral nerve roots and ankle dorsiflexion tensions the sciatic nerve along its course. We added these movements to the SLR (extended SLR = ESLR) as structural differentiators and tested inter-rater reliability in patients with LBP, with and without sciatica.

Preoperative Predictors of Better Long-term Functional Ability and Decreased Pain Following LSS Surgery: A Prospective Observational Study with a 10-year Follow-up Period.

Study Design: A prospective observational 10-year follow-up study.

Objective: This study aimed to examine preoperative predictors for better surgical outcomes in patients with lumbar spinal stenosis (LSS) 10 years after surgery.

Summary Of Background Data: LSS is a leading cause of low back surgery in patients older than 65 years.

Normalization of Spinal Cord Displacement With the Straight Leg Raise and Resolution of Sciatica in Patients With Lumbar Intervertebral Disc Herniation: A 1.5-year Follow-up Study.

Study Design: A controlled radiologic follow-up study.

Objective: The aim of this study was to ascertain whether changes in cord excursion with straight leg raise test (SLR) at 1.5-year follow-up time accompany changes in clinical symptoms.

Intervertebral Disc Biology: Genetic Basis of Disc Degeneration.

Purpose Of Review: This review aims to highlight recent advances in understanding the genetic basis of intervertebral disc degeneration (IDD).

Recent Findings: It has been known for some time that IDD is highly heritable. Recent studies, and in particular the availability of agnostic techniques such as genome-wide association studies, have identified new variants in a variety of genes which contribute to the risk of IDD and to back pain.

Strong association between vertebral endplate defect and Modic change in the general population.

Modic change (MC) is considered an independent risk factor for low back pain (LBP) but its aetiology remains unclear. In this cross-sectional, large-scale population-based study we sought to characterise associations between endplate defect (ED) and MC in a population sample of broad age range. The study population consisted of 831 twin volunteers (including 4155 discs and 8310 endplates) from TwinsUK.

Endplate Defect Is Heritable, Associated With Low Back Pain and Triggers Intervertebral Disc Degeneration: A Longitudinal Study From TwinsUK.

Study Design: Longitudinal study of spine magnetic resonance imaging (MRI) in a large-scale population-based study.

Objective: To determine the order of appearance of degenerative change in vertebral bodies and intervertebral discs. We also sought to define the influence of endplate defect on low back pain (LBP) and to determine whether there is a genetic influence on endplate defect.

Vertebral Endplate Defect as Initiating Factor in Intervertebral Disc Degeneration: Strong Association Between Endplate Defect and Disc Degeneration in the General Population.

Study Design: Cross-sectional study of spine magnetic resonance in a population, predominantly female, sample.

Objective: To determine the relationship between vertebral endplate defect and intervertebral disc degeneration (DD) in general population.

Summary Of Background Data: Precise understanding of the mechanisms leading to DD development is lacking.

Reduced Spinal Cord Movement With the Straight Leg Raise Test in Patients With Lumbar Intervertebral Disc Herniation.

Study Design: Controlled radiological study.

Objective: To explore whether impairment of neural excursion during the straight leg raise test occurs in patients with sciatic symptoms secondary to lumbar intervertebral disc herniation (LIDH).

Summary Of Background Data: Earlier studies have shown that during the straight leg raise (SLR) test in asymptomatic volunteers tensile forces are consistently transmitted throughout the neural system and the thoracolumbar spinal cord slides distally.

Normal multiplanar movement of the spinal cord during unilateral and bilateral straight leg raise: Quantification, mechanisms, and overview.

The purpose of this investigation was to provide a full set of normal data describing neural biomechanics within the vertebral canal in all three planes with unilateral and bilateral SLR tests to allow for clinical comparison with clinical cases. This is done following the notion that, due to neural continuum, tensile forces are transmitted through the lumbosacral nerve roots and dura to the conus medullaris (linear dependency principle). In this controlled radiologic study 10 asymptomatic volunteers were scanned with 1.

Slump Test: Effect of Contralateral Knee Extension on Response Sensations in Asymptomatic Subjects and Cadaver Study.

Study Design: Part 1: A randomized, single-blind study on the effect of contralateral knee extension on sensations produced by the slump test (ST) in asymptomatic subjects. Part 2: A cadaver study simulating the nerve root behavior of part 1.

Objective: Part 1: Test if contralateral knee extension consistently reduces normal stretch sensations with the ST.

Part 3: Developing Methods of In Vivo MRI Measurement of Spinal Cord Displacement in the Thoracolumbar Region of Asymptomatic Subjects With Unilateral and Bilateral Straight Leg Raise Tests.

Study Design: Controlled radiological study.

Objective: Verify (1) whether conus medullaris displacement varies with the range of hip flexion and (2) whether the acquired data support the "principle of linear dependence."

Summary Of Background Data: We have previously quantified normal displacement of the conus with unilateral and bilateral straight leg raise (SLR) and have described the "principle of linear dependence.

Correlation analysis of demographic and anthropometric factors, hip flexion angle and conus medullaris displacement with unilateral and bilateral straight leg raise.

Purpose: It has been shown that the conus medullaris displaces significantly and consistently in response to both unilateral and bilateral SLRs. Point of interest is represented by whether the magnitude of this displacement can be predicted in asymptomatic subjects. The purpose was to investigate whether any correlations existed between demographic and anthropometric factors and hip flexion angle with magnitude of conus medullaris displacement with the unilateral and bilateral SLR.

Effect of glenohumeral forward flexion on upper limb myoelectric activity during simulated mills manipulation; relations to peripheral nerve biomechanics.

Background: It is generally accepted that muscles may activate via the common nociceptive flexion reflex (NFR) in response to painful stimuli associated with tensile or compressive forces on peripheral nerves. Following the basic assumption that the radial nerve may be stressed around the elbow during the execution of the Mills manipulation, two positions considered to have different mechanical effects on the radial nerve and the brachial plexus were tested in order to i) explore whether muscles are activated in certain patterns with concomitant changes in nerve tension, ii) establish whether muscle responses can be modified with mechanical unloading of the brachial plexus.

Methods: Muscle responses were quantified bilaterally in eight subjects (N = 16) during Mills Manipulation (MM) pre-manipulative positioning and a Varied position that putatively produces less mechanical tension in the brachial plexus.

2014 young investigator award winner: In vivo magnetic resonance imaging measurement of spinal cord displacement in the thoracolumbar region of asymptomatic subjects: part 2: comparison between unilateral and bilateral straight leg raise tests.

Study Design: Controlled radiological study.

Objective: Ascertain if a difference exists in the mechanical effects on the cord between the unilateral and bilateral straight leg raise (SLR) and to verify whether the effect on the spinal cord may be cumulative between the two.

Summary Of Background Data: To the authors' knowledge these are the first data on noninvasive, in vivo, normative measurement of spinal cord displacement with bilateral SLR test.

2014 young investigator award winner: In vivo magnetic resonance imaging measurement of spinal cord displacement in the thoracolumbar region of asymptomatic subjects: part 1: straight leg raise test.

Study Design: Controlled radiological study.

Objective: To investigate noninvasively in vivo spinal cord displacement in the vertebral canal during the passive straight leg raise (SLR) in asymptomatic subjects. The basic assumption is that the cord follows L5 and S1 nerve roots displacement by similar magnitude and direction (principle of linear dependence).

Effect of cervical spine position on upper limb myoelectric activity during pre-manipulative stretch for Mills manipulation: a new model, relations to peripheral nerve biomechanics and specificity of Mills manipulation.

Objectives: (A) Describe a new method of investigation of the possible muscular effects of the commonly practiced Mills manipulation for lateral elbow pain (epicondylalgia), (B) ascertain if myoelectric activity is influenced during the pre-manipulative stretch for Mills manipulation, (C) establish whether muscle responses are influenced by ipsilateral lateral flexion of the cervical spine which reduces mechanical tension in the peripheral nerves of the upper limb.

Sample: Eight asymptomatic subjects were tested bilaterally (N=16).

Methods: Myoelectric measurements - EMG signals were recorded with a 16 channel pocket EMG patient unit and processed off-line.