Effectiveness of Low-Level Laser Therapy in Patients with Discogenic Lumbar Radiculopathy: A Double-Blind Randomized Controlled Trial.

Purpose: To determine the effectiveness of low-level laser therapy (LLLT) in patients with discogenic lumbar radiculopathy and correlation among pain intensity, functional disability, and lumbar range of motion (LROM). Study Design/Setting. A double-blind RCT was conducted at physical therapy departments of different hospitals of Islamabad, Pakistan. The study period was March 2020 to August 2021. Patient Sample. The study comprised 110 patients with acute LBP and unilateral discogenic lumbar radiculopathy. Outcome Measures. The outcomes of the treatment were measured on the first day and then after 18 sessions from each patient's pain intensity, functional disability, L-ROM, and straight leg raise by using visual analogue scale, Oswestry disability index, dual inclinometer, and straight leg raise test. Methods: A total of 110 participants with a mean age of 38 ± 7.4 years were randomly assigned into two groups of 55 each. The experimental group of 55 patients was treated with LLLT and conventional physical therapy. The control group of 55 patients was treated with conventional physical therapy alone. Both groups had received 18 treatment sessions. The data were analyzed through SPSS-21.0. Results: The results of the Wilcoxon signed-rank test score as well as Mann-Whitney U test indicated a statistically significant difference in values (p < 0.05 in all instances) within the groups and between the groups, respectively. Conclusions: The LLLT is proved as an efficient adjunct therapy to conventional physical therapy for discogenic lumbar radiculopathy.

Pulsed Electromagnetic Fields Accelerate Sensorimotor Recovery Following Experimental Disc Herniation.

STUDY DESIGN: An experimental animal study. OBJECTIVE: The aim of this study was to investigate the effect of pulsed electromagnetic fields (PEMF) on recovery of sensorimotor function in a rodent model of disc herniation (DH). SUMMARY OF BACKGROUND DATA: Radiculopathy associated with DH is mediated by proinflammatory cytokines. Although we have demonstrated the anti-inflammatory effects of PEMF on various tissues, we have not investigated the potential therapeutic effect of PEMF on radiculopathy resulting from DH. METHODS: Nineteen rats were divided into three groups: positive control (PC; left L4 nerve ligation) (n = 6), DH alone (DH; exposure of left L4 dorsal root ganglion [DRG] to harvested nucleus pulposus and DRG displacement) (n = 6), and DH + PEMF (n = 7). Rodents from the DH + PEMF group were exposed to PEMF immediately postoperatively and for 3 hours/day until the end of the study. Sensory function was assessed via paw withdrawal thresholds to non-noxious stimuli preoperatively and 1 and 3 days postoperatively, and every 7 days thereafter until 7 weeks after surgery. Motor function was assessed via DigiGait treadmill analysis preoperatively and weekly starting 7 days following surgery until 7 weeks following surgery. RESULTS: All groups demonstrated marked increases in the left hindlimb response threshold postoperatively. However, 1 week following surgery, there was a significant effect of condition on left hindlimb withdrawal thresholds (one-way analysis of variance: F = 3.82, df = 2, P = 0.044) where a more rapid recovery to baseline threshold was evident for DH + PEMF compared to PC and DH alone. All groups demonstrated gait disturbance postoperatively. However, DH + PEMF rodents were able to regain baseline gait speeds before DH and PC rodents. When comparing gait parameters, DH + PEMF showed consistently less impairment postoperatively suggesting that PEMF treatment was associated with less severe gait disturbance. CONCLUSION: These data demonstrate that PEMF accelerates sensorimotor recovery in a rodent model of DH, suggesting that PEMF may be reasonable to evaluate for the clinical management of patients with herniation-associated radiculopathy.Level of Evidence: N/A.

Effect of bipolar pulsed radiofrequency on chronic cervical radicular pain refractory to monopolar pulsed radiofrequency.

BACKGROUND: We aimed to evaluate the effect of bipolar pulsed radiofrequency (PRF) in patients with chronic cervical radicular pain who were refractory to monopolar PRF and transforaminal epidural steroid injection (TFESI). METHODS: Twenty patients with chronic cervical radicular pain who were unresponsive to monopolar PRF and TFESI were included and underwent bipolar PRF of their cervical dorsal root ganglion (DRG). Treatment outcomes were evaluated using the Numeric Rating Scale (NRS) for cervical radicular pain before treatment and 1, 2, and 3 months post-treatment. Successful pain relief was defined as ≥50% reduction in the NRS score compared with the score prior to treatment. Furthermore, at 3 months post-treatment, patient satisfaction levels were evaluated; those with very good (score =7) or good (score =6) results were considered to be satisfied with the bipolar PRF procedure. RESULTS: Cervical radicular pain was significantly reduced at 1, 2, and 3 months post-PRF (P<0.001). In addition, at 3 months post-PRF, half of the patients achieved a successful response and were satisfied with the treatment results. CONCLUSIONS: Bipolar PRF on cervical DRG may be a good treatment option for managing refractory chronic cervical radicular pain.

Dorsal root ganglion pulsed radiofrequency treatment for chronic cervical radicular pain: a retrospective review of outcomes in fifty-nine cases.

Pulsed radiofrequency treatment adjacent to the cervical dorsal root ganglion is used to treat persistent cervical radicular pain that has not responded to conservative therapies. This technique has gained popularity in years for both cervical and lumbosacral radicular pain. The evidence to support its use is still evolving. METHODS: We performed a retrospective review of outcomes in 59 patients who underwent this therapy over a 3-year period in our institution. We evaluated a reduction in pain, duration of pain relief, reduction in use of analgesics and progression to surgery. RESULTS: Our results demonstrated 49 patients experienced some relief. Forty patients of the 59 experienced an improvement in pain of 50% or more. The mean duration of relief in this group was 37 weeks. Seven patients experienced complete resolution of their pain. In this group, the mean duration of relief was 39 weeks. Regarding the 53 patients who were taking medication for pain prior to the procedure, 37 patients reduced or discontinued their usage after the procedure. CONCLUSION: Despite the limitations of a retrospective study, we feel our study adds to the growing evidence base that pulsed radiofrequency treatment adjacent to the cervical dorsal root ganglion has a role in the treatment of chronic cervical radicular pain.

Basilar Artery Ectasia Causing Trigeminal Neuralgia: An Evolved Technique of Transpositional Suture-Pexy.

BACKGROUND: Microvascular decompression for patients with trigeminal neuralgia (TGN) is widely accepted as one of the modalities of treatment. The standard approach has been retrosigmoid suboccipital craniotomy with placement of a Teflon pledget to cushion the trigeminal nerve from the offending artery, or cauterize and divide the offending vein(s). However, in cases of severe compression caused by a large artery, the standard decompression technique may not be effective. OBJECTIVE: To describe a unique technique of vasculopexy of the ectatic basilar artery to the tentorium in a patient with TGN attributed to a severely ectatic and tortuous basilar artery. A case series of patients who underwent this technique of vasculopexy for arterial compression is presented. METHODS: The patient underwent a subtemporal transtentorial approach and the basilar artery was mobilized away from the trigeminal nerve. A suture was then passed through the wall of the basilar artery (tunica media) and secured to the tentorial edge, to keep the artery away from the nerve. RESULTS: The neuralgia was promptly relieved after the operation, with no complications. A postoperative magnetic resonance imaging scan showed the basilar artery to be away from the trigeminal root. In a series of 7 patients who underwent this technique of vasculopexy, no arterial complications were noted at short- or long-term follow-up. CONCLUSION: Repositioning and vasculopexy of an ectatic basilar artery for the treatment of TGN is safe and effective. This technique can also be used for other neuropathies that result from direct arterial compression.

Radiofrecuencia pulsada del ganglio de la raíz dorsal en un caso de sindrome radicular lumbosacro crónico refractario a los esteroides epidurales / Pulsed radiofrequency of dorsal root glanglion a clinical case of chronic lumbosacro syndrome refractory to epidural steroids

Las inyecciones epidurales de esteroides son frecuentemente indicadas en el sindrome radicular lumbosacro, producido por hernias de disco, protrusiones discales o estenosis del canal, cuando éste no responde al tratamiento no intervencionista. Sin embargo, por distintas causas, aproximadamente 20% de los pacientes no responden a estas inyecciones, quedando pocas opciones terapéuticas disponibles. La radiofrecuencia pulsada del Ganglio de la Raíz Dorsal de las raíces afectadas es una alternativa válida para tratar el sindrome cuando es refractario al tratamiento con inyecciones epidurales de esteroides, en caso de que la cirugía de columna no está indicada o se prefiera evitar. Se presenta un caso clínico de un sindrome radicular lumbosacro refractario, causado por protrusiones discales lumbares, donde se utilizó la radiofrecuencia pulsada del ganglio de la raíz dorsal con buenos resultados, evaluados mediante el Inventario Abreviado del Dolor (Brief Pain Inventory).

Lumbosacral radicular syndrome, produced by discs herniations, discs protrusions or spinal stenosis is frequently treated by injecting steroids in the epidural space. However, 20% of the patients are resistant to this treatment, so few therapeutics options for them are left. Pulsed radiofrequency of the Dorsal Root Ganglion is a validated therapeutic option, when the syndrome is refractory to epidural steroid injections and spinal surgery is not indicated or elected. We report a clinical case of a lumbosacral radicular syndrome, refractory to epidural steroid injections, successfully treated with pulsed radiofrequency of lumbar Dorsal Root Ganglion, utilizing the Spanish version of the Brief Pain Inventory, as an outcome evaluation tool.

Pulsed radiofrequency on dorsal root ganglia for chronic pain / Radiofrequência pulsada no gânglio da raiz dorsal para tratamento de dor crônica

Objective: Evaluate clinical outcome of dorsal root ganglia (DRG) pulsed radiofrequency (PRF) treatment in neuropathic pain of patients with radiculopathy regarding improvement of pain and degree of patients? satisfaction. Method: Forty-five procedures in cervical and lumbossacral spine. Data collected by phone call interviews (independent researcher). Evaluation done after one month and at minimum three months follow-up. Analyzed data included objective and subjective improvement, and degree of satisfaction. Results: Outcome much better in 31%, 36% better, 24% unchanged, 9% worse. At initial evaluation, relief was rated: 24% excellent, 16% good, 27% moderate, 33% poor. At late evaluation, 27% excellent, 18% good, 7% moderate, 49% poor. Degree of satisfaction was high (82% of patients reported they certainly or probably would repeat the procedure). Conclusion: PRF was effective and safe in selected patients. Most patients were satisfied and would repeat/recommend the procedure...

Objetivo: Avaliar a evolução clínica do tratamento com radiofrequência pulsada (RFP) de gânglio da raiz dorsal (GRD) na dor neuropática em pacientes com radiculopatia, considerando melhora da dor e grau de satisfação dos pacientes. Método: Quarenta e cinco procedimentos na coluna cervical e lombossacra. Os dados foram coletados por meio de entrevistas telefônicas (pesquisador independente). Avaliação inicial feita após um mês e final no mínimo de três meses de acompanhamento. Dados analisados incluíram melhora objetiva, subjetiva e o grau de satisfação. Resultados: Evolução ?muito melhor? em 31%, ?melhor? em 36%, ?inalterado? em 24%, ?pior? em 9%. Na avaliação inicial: 24% ?excelente?, 16% ?bom?, 27% ?moderada?, 33% ?pobre?. Na avaliação final, 27% ?excelente?, 18% ?bom?, 7% ?moderada?, 49% ?pobre?. O grau de satisfação foi elevado (82% dos pacientes relataram que certamente ou provavelmente repetiriam o procedimento). Conclusão: RFP foi eficaz e segura em pacientes selecionados. A maioria dos pacientes ficou satisfeita e repetiu/recomendou o procedimento...

Clinical and functional evaluation of patients with acute low back pain and radiculopathy treated with different energy doses of low level laser therapy.

BACKGROUND/AIM: The main clinical phenomena in acute low back pain (LBP) with radiculopathy are pain and neurological disorders. Although some studies show that low level laser therapy (LLLT) has the ability to modulate inflammatory processes and relieve acute pain condition, the laser therapy dose protocol has not been yet completely established. The aim of this study was to investigate the effects of three different energy doses of LLLT in patients with acute LBP and radiculopathy. METHODS: The study included 66 patients with acute LBP and radiculopathy who had been randomly divided into three groups (22 patients each) received three different doses of LLLT. The patients were treated 5 times weekly, for a total of 10 treatments, with the following parameters: wave length 904 nm, frequency 3,000 Hz, average diode power 25 mW; energy dose of 0.1 J per point in the first group, 1 J per point in the second and 4 J per point in the third group; daily treatment time and accumulated energy were 16 s and 0.4 J in the first group, 160 s and 4J in the second group and 640 s and 16 J in the third group, respectively. The parameters of assessment before and after the therapy were: lumbar and leg pain measured by visual analogue scale (VAS), local and general functional changes (Schober test, manual muscle test, straight leg raise test and the modified North American Spine Society-Low Back Pain Outcome Instrument-NASS LBP). RESULTS: Highly significant improvements (p < 0.01) were noted in all the groups after LLLT with respect to all the investigated parameters. The VAS scores were significantly lower in all the groups without a difference between the groups (p > 0,05). Functional improvements were better in the third group treated with the dose of 4 J per point than in other two groups (p < 0.05). CONCLUSIONS: Three different energy doses of LLLT were equally effective in alleviating lumbar and leg pain without side effects, but the dose of 4 J per point seemed to be more effective in improving the activities of daily living and lumbar mobility.

Low-level laser therapy for acute neck pain with radiculopathy: a double-blind placebo-controlled randomized study.

OBJECTIVE: The objective of the study was to investigate clinical effects of low-level laser therapy (LLLT) in patients with acute neck pain with radiculopathy. DESIGN: Double-blind, randomized, placebo-controlled study. SETTING: The study was carried out between January 2005 and September 2007 at the Clinic for Rehabilitation at the Medical School, University of Belgrade, Serbia. PATIENTS AND INTERVENTION: Sixty subjects received a course of 15 treatments over 3 weeks with active or an inactivated laser as a placebo procedure. LLLT was applied to the skin projection at the anatomical site of the spinal segment involved with the following parameters: wavelength 905 nm, frequency 5,000 Hz, power density of 12 mW/cm(2), and dose of 2 J/cm(2), treatment time 120 seconds, at whole doses 12 J/cm(2). OUTCOME MEASURES: The primary outcome measure was pain intensity as measured by a visual analog scale. Secondary outcome measures were neck movement, neck disability index, and quality of life. Measurements were taken before treatment and at the end of the 3-week treatment period. RESULTS: Statistically significant differences between groups were found for intensity of arm pain (P = 0.003, with high effect size d = 0.92) and for neck extension (P = 0.003 with high effect size d = 0.94). CONCLUSION: LLLT gave more effective short-term relief of arm pain and increased range of neck extension in patients with acute neck pain with radiculopathy in comparison to the placebo procedure.

Spinal leptomeningeal metastasis from cerebral glioblastoma multiforme presenting with radicular pain: case report and literature review.

BACKGROUND: We present a case of spinal leptomeningeal metastasis from an intracranial glioblastoma multiforme that presented with radicular pain. CASE DESCRIPTION: A 55-year-old man with a previously treated supratentorial glioblastoma multiforme presented with a 12-month history of thoracic radicular pain. MRI of the thoracic spine demonstrated an intradural extramedullary metastatic tumor deposit at the levels of T8-T10. External beam radiotherapy to the thoracic spine provided a minimal decrease in the intensity of the radicular pain. The lack of appreciation of the metastatic potential of the primary intracranial tumor resulted in delayed diagnosis and treatment. CONCLUSION: Spinal leptomeningeal metastasis needs to be suspected in patients with a past history of intracranial glioblastoma multiforme, who present with the clinical features of radiculopathy or myelopathy. Awareness of this condition will facilitate appropriate intervention.