A clinical audit of the Emergency Department: Doctors' opinions on the diagnosis and management of cervical spine radiculopathy.

OBJECTIVE: A clinical audit was carried out on the opinions of doctors working in the Emergency Department (ED) of a large urban hospital regarding the diagnosis and management of cervical spine radiculopathy (CSR). Using international guidelines and current research, it aimed to determine if patients attending this ED were diagnosed and managed in line with best practice, and to identify any discrepancies or areas for improvement in relation to this. METHOD: Doctors working in this ED were sent an online questionnaire and descriptive analysis was performed on the results to ascertain how they diagnose and manage patients who present with symptoms of CSR. It covered; presentation and definitions of CSR, identification of red flags, clinical tests used, diagnostic test criteria, appropriate management, education and advice given, and the criteria for further management. Additionally, it looked at their opinion on the services' needs. RESULTS: Most agreed that CSR will improve within 4 weeks with non-operative management; however, there was a lack of consensus regarding the most affected nerve root, differential diagnosis and appropriate diagnostic tests. Opinions aligned regarding the identification of red flags and early management, especially with widespread neurological deficits. However, the management of ongoing pain or new neurological signs, differed between clinicians. Most participants strongly agreed that access to MRIs affected referrals within an ED episode. CONCLUSION: Overall, the opinions matched recommended guidelines; however, some gaps in knowledge and differing management approaches were identified, indicating the need for ongoing education and standardisation of management.

Cervical radiculopathy secondary to vertebral artery dissection: clinical features and outcomes.

PURPOSE: Cervical radiculopathy due to various mechanical causes is commonly seen, however, cervical vertebral artery dissection (cVAD)-related radiculopathy is very rare with poorly characterized clinical outcomes. Thus, we conducted a systematic review of published literature and reported an institutional case to provide a better illustration of this rare entity. METHODS: We systematically reviewed the PubMed literature and queried the clinical database at our center for cVAD-related radiculopathy. We described the baseline characteristics of patients with cVAD-related radiculopathy, the involved segment, diagnostic approach and treatment options. RESULT: 14 previously published studies met the inclusion criteria and along with the case we identified in our center, our study included 17 patients total (median age: 35 years, 9 females). C5 was the most commonly affected root and ipsilateral shoulder/arm pain along with shoulder abduction weakness was most common presentation. Antiplatelet or anticoagulant therapy was the treatment of choice. Most cases managed conservatively (82%). Majority of the cases (92%) had either complete or partial resolution of their symptoms. CONCLUSION: Despite its limitations, this study show that cVAD related radiculopathy is a relatively benign entity with excellent clinical outcomes when managed medically.

The immediate effect of cervical rotation-traction manipulation on cervical paravertebral soft tissue: a study using soft tissue tension cloud chart technology.

BACKGROUND: To evaluate the reliability of the Soft Tissue Tension Cloud Chart (STTCC) technology, an original method combining multi-point Cervical Paravertebral Soft Tissue Test (CPSTT) with MATLAB software, we conducted a preliminary analysis on the immediate effects of Orthopaedic Manual Therapy (OMT) on cervical paravertebral soft tissue. METHODS: 30 patients with Cervical Spondylotic Radiculopathy (CSR) were included in this study. We analyzed the differences in CPSTT before and after treatment with Cervical Rotation-Traction Manipulation (CRTM), a representative OMT technique in Traditional Chinese Medicine, using the STTCC technology. RESULTS: The STTCC results demonstrated that post-treatment CPSTT levels in CSR patients were significantly lower than pre-treatment levels after application of CRTM, with a statistically significant difference (P < 0.001). Additionally, pre-treatment CPSTT levels on the symptomatic side (with radicular pain or numbness) were higher across the C5 to C7 vertebrae compared to the asymptomatic side (without symptoms) (P < 0.001). However, this difference disappeared after CRTM treatment (P = 0.231). CONCLUSIONS: The STTCC technology represents a reliable method for analyzing the immediate effects of OMT. CSR patients display uneven distribution of CPSTT characterized by higher tension on the symptomatic side. CRTM not only reduces overall cervical soft tissue tension in CSR patients, but can also balance the asymmetrical tension between the symptomatic and asymptomatic sides. TRIAL REGISTRATION: This study was approved by the Chinese Clinical Trials Registry (Website: . https://www.chictr.org.cn .) on 20/04/2021 and the Registration Number is ChiCTR2100045648.

Comparison of positional distraction with stabilisation exercises versus stabilisation exercises alone in the management of lumbar radiculopathy: A randomized controlled-trial.

OBJECTIVE: To compare the effects of positional distraction with stabilisation exercises versus stabilisation exercises alone in the management of lumbar radiculopathy. METHODS: The randomised controlled trial was conducted from July to December 2020 at the Institute of Physical Medicine and Rehabilitation, Dow University of Health Sciences, and the Neurosurgery ward of Civil Hospital, Karachi, and comprised individuals of either gender with lumbar radiculopathy pain who were randomised into positional distraction with stabilisation exercises group A and stabilisation exercise group B. The treatment duration was 3 sessions per week for 8 weeks. Intensity of pain and disability were assessed using the Visual Analogue Scale and the Roland Morris Disability Questionnaire, respectively. Data was analysed using SPSS 21. RESULTS: Of the 100 patients, 63(63%) were males and 37(37%) were females. Overall, 89(89%) were married. There were 50(50%) subjects in group A with mean age 39.42±6.36 years and 50(%) in group B with mean age 38.80±6.69 years. There was no significant difference in terms of age, gender and marital status between the groups (p>0.05). The study was completed by 96(96%) patients; 48(50%) in each of the 2 groups. Intragroup improvement post-intervention compared to baseline was significant (p<0.001) in both groups. Outcomes in group A were significantly better than in group B (p<0.05). CONCLUSIONS: Addition of positional distraction to stabilisation exercises was found to have superior effects compared to stabilisation exercise alone on pain and functional disability among patients with lumbar radiculopathy. Clinical Trial Number: NCT04427423 dated 27th April 2020.

Clinical Efficiency of High-Intensity Laser Therapy in Patients With Cervical Radiculopathy: A 12-Week Follow-up, Randomized, Placebo-Controlled Trial.

OBJECTIVE: The purpose of this study was to research the clinical effectiveness of high-intensity laser therapy combined with exercise on pain, quality of life, and disability in patients with cervical radiculopathy and compared it with that of placebo and exercise alone. DESIGN: Ninety participants with cervical radiculopathy were randomized into the following three groups: high-intensity laser therapy + exercise ( n = 30), placebo + exercise ( n = 30), and exercise only ( n = 30). Pain, cervical range of motion, disability, and quality of life (36-item Short Form Health Survey) were assessed at baseline and weeks 4 and 12. RESULTS: The mean age of the patients (66.7% female) was 48.9 ± 9.3 yrs. Pain intensity in the arm and neck, neuropathic and radicular pain levels, disability, and several parameters of the 36-item Short Form Health Survey showed an improvement in the short and medium term in all three groups. These improvements were greater in the high-intensity laser therapy + exercise group than in the other two groups. CONCLUSIONS: High-intensity laser therapy + exercise was much more effective in improving medium-term radicular pain, quality of life, and functionality in patients with cervical radiculopathy. Thus, high-intensity laser therapy should be considered for the management of cervical radiculopathy. TO CLAIM CME CREDITS: Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME. CME OBJECTIVES: At the conclusion of this article, readers will be able to: (1) Define cervical radicular pain and its clinical presentation, and explain the main pathomechanism in cervical radiculopathy (CR); (2) Describe the effects of laser administration on neuropathic pain; and (3) Discuss the clinical significance of coadministration of high-intensity laser therapy (HILT) with exercise (HILT + EX) in CR. LEVEL: Advanced. ACCREDITATION: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s) ™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Output Current and Efficacy of Pulsed Radiofrequency of the Lumbar Dorsal Root Ganglion in Patients With Lumbar Radiculopathy: A Prospective, Double-blind, Randomized Pilot Study.

BACKGROUND: Lumbar radicular pain (LRP) is a common but challenging clinical symptom. Pulsed radiofrequency (PRF), a neuromodulation technique that uses short pulses of radiofrequency current, is effective in treating various pain disorders. However, few studies have been conducted on the effects of PRF and its modifying parameters. OBJECTIVES: Our study aimed to determine the intraoperative parameters of PRF of the lumbar dorsal root ganglion (DRG) that are related to clinical effects in patients with LRP unresponsive to transforaminal epidural steroid injections (TFESI). STUDY DESIGN: Prospective double-blind randomized controlled trial, pilot study. SETTING: Single medical center in the Republic of Korea. METHODS: Patients were allocated to one of 2 groups, high-voltage (60 V) or standard-voltage (45 V), according to the preset maximum voltage at which the active tip temperature does not exceed 42°C. Intraoperative parameters, such as output current, sensory threshold, and impedance, were measured. The primary outcomes were radicular pain intensity, physical functioning, global improvement and satisfaction with treatment, and adverse events. The assessments were performed up to 3 months postprocedure. RESULTS: The patients in the standard-voltage group showed significant improvements in the Numeric Rating Scale pain score (P = 0.007) and Oswestry Disability Index (ODI) (P = 0.008) scores at 3 months post-PRF; however, no difference was observed in the high-voltage group. Among the intraoperative parameters, the output current showed a significant negative linear relationship with analgesic efficacy. The output current also showed a significant association with pain intensity (P = 0.005, R2 = 0.422) and ODI score (P = 0.004, R2 = 0.427) at 3 months postprocedure in a multiple regression analysis. The optimal cut-off value of the output current to lower pain intensity after 3 months was 163.5 mA with a sensitivity of 87.5%, specificity of 100%, and an area under the receiver operating characteristic curve value of 0.92 (95% CI. 0.76 - 1.00). LIMITATIONS: Limitations of our study include an imbalance of baseline characteristics, small sample sizes, and short follow-up periods. CONCLUSIONS: Lower output currents during PRF application to the lumbar DRG were associated with greater analgesic effects in patients who did not respond to therapeutic TFESI.

Upper limb neurodynamic mobilization disperses intraneural fluid in cervical nerve roots: A human cadaveric investigation.

BACKGROUND: Cervical radiculopathy is a common cause of neck pain with resultant intraneural edema and impaired nerve function. One strategy to treat radiculopathy is neurodynamic mobilization (NDM); however, little is known about the effect of this treatment on nerve tissue fluid dynamics. OBJECTIVE: Investigate the impact of upper limb, median nerve-biased NDM on longitudinal intraneural fluid dispersion in the C5,C6,C7 nerve roots in un-embalmed cadavers. DESIGN: In situ repeated measures. METHODS: Human cadavers (n = 8) were dissected to expose and inject C5,C6,C7 cervical nerve roots with a dying agent. Initial longitudinal dye spread was recorded after dye spread stabilization. Cadavers were taken through 150 repetitions of upper limb, median nerve-biased NDM followed by dye spread re-measurement. Paired-samples t-tests with Bonferroni correction (α = 0.017) were used to compare pre-vs post-NDM dye spread measurements at C5,C6,C7 nerve roots; a one-way repeated measures ANOVA (α = 0.05) was used to examine differences between change scores for C5,C6,C7 nerve roots. RESULTS: Median nerve-biased NDM resulted in significant intraneural longitudinal dye spread at C5 and C6 nerve roots of 0.6 ± 0.6 mm and 3.4 ± 3.9 mm, respectively (p < 0.014). Dye spread was not significant at C7 nerve root (0.4 ± 0.7 mm). There was no between root difference in change of longitudinal dye spread between C5, C6, and C7 nerve roots. CONCLUSIONS: The results of this study show median nerve-biased NDM produced internal fluid movement within C5 and C6 cervical nerve roots. Results provide insight regarding possible mechanism of action and feasibility of NDM in treatment of patients with cervical radiculopathy.

Effectiveness Of Neuro Mobilisation On Pain, Range Of Motion, Muscle Endurance And Disability In Cervical Radiculopathy: A Systematic Review.

Objective: To assess the effects of the neural mobilisation technique on mobility, pain and disability in cervical radiculopathy patients, and to assess the functional activity level. METHODS: The systematic review was conducted from January 5 to July 5, 2022, and comprised search on Medline, PEDro, Cochrane Library and Embase databases for randomised controlled trials involving patients diagnosed with cervical radiculopathy that were published in the preceding 10 years in the English language. The search terms were divided into four classes by using the guideline for systematic reviews of trials of interventions in the Cochrane neck and back groups and related spinal disorders. Data wasretrieved afterthe studies were subjected to quality assessment and risk of biasness. RESULTS: Of the 1563 studies initially found, 8 (0.51%)were reviewed.Nomatter the approach ordosage used,manual therapy was successful in treating cervical radiculopathy symptomsin all investigations. Conclusion: A multimodal strategy incorporating neural mobilisation appears to be the most successful short-term technique.

Ultrasound-guided nerve hydrodissection of cervical nerve roots for cervical radicular pain in patients with mild and moderate to severe stenosis: a retrospective cohort study.

Because fascial entrapment neuropathy can occur in multiple locations, ultrasound-guided nerve hydrodissection has become a key component of the treatment of cervical radicular pain. In this paper, we propose a combination of injectates used for nerve hydrodissection of the cervical nerve roots and compare the clinical outcomes of this treatment among patients with different severities of stenosis. This is a retrospective cohort study designed to compare outcomes between patients with mild stenosis and moderate to severe stenosis. Forty-four patients with mild cervical stenosis and 30 patients with moderate to severe cervical stenosis were consecutively enrolled into two groups. A 10-mL mixture in a single level consisting of 5% in Dextrose, 0.2% lidocaine (Xylocaine), and 4 mg betamethasone (Rinderon) was used for nerve roots hydrodissection. The two groups were compared with regard to their numeric rating scales (NRS) of pain, proportion of patients who exhibited a favorable outcome (a reduction of pain ≥ 50%), duration of patient exhibited a favorable outcome, and occurrence of serious complications and minor side effects. The follow-up period ranged from 3 to 20 months. The NRS of both groups improved significantly by 1 week, 1 month, 3 months, and final follow-up after the initial injection. Differences in the groups' NRS, proportion of patients who exhibited a favorable outcome, duration of patient exhibited a favorable outcome, and occurrence of serious complications and minor side effects were nonsignificant. There were 4 patients (5.4%) experienced dizziness in that resolved without further treatment. Ultrasound-guided nerve hydrodissection of cervical nerve roots is a safe procedure that reduces pain associated with cervical radicular pain, even in patients with moderate to severe stenosis.

Clinical effect and safety analysis of long-round needle usage in treating cervical spondylotic radiotelegraphy and its effect on pain and functional recovery.

BACKGROUND: Long-round needle usage can treat muscular pain, but there is little research on cervical spondylotic radiculopathy (CSR). OBJECTIVE: To explore the efficacy and safety of long-round needle usage in treating CSR. METHODS: Ninety-eight patients with CSR were randomly divided into control and observation groups. They were treated with filiform needles and long-round needles, respectively. The therapeutic effect, safety, inflammatory factors and neck dysfunction index (NDI), McGill pain questionnaire (MPQ) and Generic Quality of Life Inventory-74 (GQOL-74) scores were compared between the two groups. RESULTS: After treatment, the effective rate and safety of the observation group were better than those of the control group. The NDI and MPQ scores in the observation group were significantly lower than those in the control group, and the GQOL-74 score was higher than that in the control group. The level of interleukin-8 in the observation group was significantly lower than that in the control group, and the level of interleukin-10 was significantly higher than that in the control group. CONCLUSIONS: Long-round needle therapy has a good effect on patients with CSR, which can safely improve the quality of life of patients with mild local inflammatory damage.

Ultrasound-guided injection acupotomy as a minimally invasive intervention therapy for cervical spondylotic radiculopathy: a randomized control trial.

OBJECTIVE: To explore the efficacy and safety of ultrasound-guided injection acupotomy as a minimally invasive intervention treatment of cervical spondylotic radiculopathy (CSR). METHODS: 160 CSR subjects were recruited who met the inclusion criteria in our hospital from October 2019 to December 2021. The subjects were randomly divided into the experimental and control group, with 80 cases in each. The experimental group received ultrasound-guided injection acupotomy as a minimally invasive intervention therapy. The control group received ultrasound-guided selective nerve root block (SNRB). The Odom's criteria clinical curative effect, visual analogue scale (VAS), neck disability index (NDI), and 36-Item Short Form Health Survey questionnaire (SF-36) were used to evaluate the outcome of subjects at several different points in time. RESULTS: At 30 min and 1 month after the end of treatment, there was no significant difference in any scores. However, after six months, the excellent and good rate was better in the experimental group compared to the control (RD = 0.175; 95% CI, 0.044-0.300, p = 0.009). The total effective rate was also better in the experimental group (RD = 0.126; 95% CI, 0.021-0.232, p = 0.018). In contrast, the VAS score (MD = -0.500; 95% CI, -1.000-0.000, p = 0.030) and NDI score (MD = -6.460; 95% CI, -11.067 to -1.852, p = 0.006) were lower in the experimental group compared to the control. The total SF-36 score was higher in the experimental group (MD = 7.568; 95% CI, 2.459-12.677, p = 0.004). CONCLUSION: Ultrasound-guided injection acupotomy minimally invasive interventional treatment of CSR has no significant difference in short-term curative effect compared with ultrasound-guided SNRB, but the data indicators are significantly better than the latter at 6 months after the end of the course of treatment, showing better long-term efficacy.

2. Cervical radicular pain.

INTRODUCTION: Cervical radicular pain is pain perceived in the upper limb, caused by irritation or compression of a cervical spine nerve, the roots of the nerve, or both. METHODS: The literature on the diagnosis and treatment of cervical radicular pain was retrieved and summarized. RESULTS: The diagnosis is made by combining elements from the patient's history, physical examination, and supplementary tests. The Spurling and shoulder abduction tests are the two most common examinations used to identify cervical radicular pain. MRI without contrast, CT scanning, and in some cases plain radiography can all be appropriate imaging techniques for nontraumatic cervical radiculopathy. MRI is recommended prior to interventional treatments. Exercise with or without other treatments can be beneficial. There is scant evidence for the use of paracetamol, nonsteroidal anti-inflammatory drugs, and neuropathic pain medications such as gabapentin, pregabalin, tricyclic antidepressants, and anticonvulsants for the treatment of radicular pain. Acute and subacute cervical radicular pain may respond well to epidural corticosteroid administration, preferentially using an interlaminar approach. By contrast, for chronic cervical radicular pain, the efficacy of epidural corticosteroid administration is limited. In these patients, pulsed radiofrequency treatment adjacent to the dorsal root ganglion may be considered. CONCLUSIONS: There is currently no gold standard for the diagnosis of cervical radicular pain. There is scant evidence for the use of medication. Epidural corticosteroid injection and pulsed radiofrequency adjacent to the dorsal root ganglion may be considered. [Correction added on 12 June 2023, after first online publication: The preceding sentence was corrected.].

Six-Month Follow-up of a Trial of Spinal Cord Burst Stimulation vs Placebo Stimulation and Disability in Patients With Chronic Radicular Pain After Lumbar Spine Surgery.

This follow-up study examines back pain­related disability at 6 months following a randomized trial of spinal cord burst stimulation for chronic radicular pain after lumbar spine surgery.

[Study on the correlation between the thickness of superficial fascia at Dazhui(GV14) and cervical spondylosis].

OBJECTIVE: To observe the correlation between the thickness of superficial fascia at Dazhui (GV14) acupoint and cervical spondylosis, so as to explore the essence of its morphological and structural changes of acupoint sensitivity. METHODS: A retrospective study was conducted. According to the diagnostic criteria of "Guidelines for Diagnosis, Treatment and Rehabilitation of Cervical Spondylosis" (2017), 344 cases of cervical spine magnetic resonance imaging (MRI) examination were included and divided into control group (73 cases) and observation group (271 cases). The control group was healthy population, and the observation group was patients with cervical spondylosis conforming to the diagnostic criteria, including cervical spondylosis of neck type, cervical spondylosis radiculopathy, cervical spondylotic myelopathy, cervical spondylosis of vertebral artery type, and sympathetic cervical spondylosis. According to MRI images of cervical spine, the structure of GV14 acupoint including skin, superficial fascia layer and aponeurosis ligament layer were measured. RESULTS: The acupoint depth and the superficial fascia thickness at GV14 in the observation group were (56.6±8.8) mm and (22.8±7.6) mm, the acupoint depth and the superficial fascia thickness at GV14 were (49.8±7.0) mm and (16.6±6.6)mm in the control group, which were significantly greater in the observation group than in the control group (P<0.01). The superficial fascia thickness at GV14 of cervical spondylotic mye-lopathy, cervical spondylosis of neck type and cervical spondylosis radiculopathy in the observation group was (23.8±8.1)mm, (23.0±7.3)mm and (22.6±6.5)mm, the acupoint depth of GV14 was (58.7±8.8)mm, (56.2±9.1)mm and (55.8±6.4)mm, which were significantly thicker than the superficial fascia thickness and the acupoint depth in the control group (P<0.01). In the observation group，the superficial fascia thickness of GV14 of cervical spondylosis myelopathy was significantly thicker than those of sympathetic cervical spondylosis (17.8±8.1) mm and cervical spondylosis of vertebral artery type (19.9±5.9) mm (P<0.01, P<0.05). In the observation group, the depth of GV14 of cervical spondylosis myelopathy was thicker than that of cervical spondylosis of neck type, cervical spondylosis radiculopathy, sympathetic cervical spondylosis and cervical spondylosis of vertebral artery type(P<0.05，P<0.01)； the depth of GV14 of sympathetic cervical spondylosis was thinner than that of cervical spondylosis of neck type and cervical spondylosis radiculopathy (P<0.01). CONCLUSION: The superficial fascia thickness at GV14 was correlated with cervical spondylosis, and it is also related to cervical spondylotic myelopathy, cervical spondylosis of neck type and cervical spondylosis radiculopathy. The morphological and structural changes of GV14 in the state of cervical spondylosis were mainly the thickness of the superficial fascia.

Patient expectations and levels of satisfaction in chiropractic treatment for lumbar radiculopathy. A mixed methods study.

BACKGROUND: Chiropractic patients are generally satisfied with the care received. It is unclear if this also applies to Danish patients with lumbar radiculopathy included in a standardised chiropractic care package (SCCP). This study aimed to investigate patient satisfaction and explore perspectives on the SCCP for lumbar radiculopathy. METHODS: An explanatory sequential mixed methods design with three separate phases was used. Phase one was a quantitative analysis based on a survey in a prospective cohort of patients with lumbar radiculopathy in an SCCP from 2018 to 2020. Patients rated their satisfaction with the examination, information, treatment effect, and overall management of their problem on a 0-10 scale. In phase two, six semi-structured interviews conducted in 2021 were used to gain further explanatory insights into the findings from phase one. Data were analysed using systematic text condensation. In phase three, the quantitative and qualitative data were merged in a narrative joint display to obtain a deeper understanding of the overall results. RESULTS: Of 303 eligible patients, 238 responded to the survey. Of these, 80-90% were very satisfied (≥ 8) when asked about the examination, information, and overall management, whereas 50% were very satisfied with the treatment effect. The qualitative analysis led to the emergence of four themes: 'Understanding the standardised care packages', 'Expectations regarding consultation and treatment effect', 'Information about diagnosis and prognosis', and 'Interdisciplinary collaboration'. The joint display analysis showed that high patient satisfaction with the examination could be explained by the patients' feeling of being carefully and thoroughly examined by the chiropractor and by referrals to MRI. Advice and information given to patients on variations in symptoms and the expected prognosis were considered reassuring. Satisfaction with the chiropractor's coordination of care and with referral to other healthcare professionals was explained by the patients' positive experiences of coordinated care and their sense of alleviated responsibility. CONCLUSION: Overall, patients were satisfied with the SCCP for lumbar radiculopathy. From a patient's perspective, the consultation should include a thorough examination and a focus on communication and information relating to symptoms and prognosis, while expectations regarding the content and efficacy of the treatment should be addressed and aligned.

Comparison of efficacy according to voltage of pulsed radiofrequency treatment to lumbar dorsal root ganglion in patient with lumbar radiculopathy: Pilot study.

BACKGROUND: Lumbar radicular pain (LRP) is a common symptom, but a challenging clinical problem. Pulsed radiofrequency (PRF) is a more recently developed technique that uses short pulses of radiofrequency current with intervals of longer pauses to prevent temperature from rising to the level of permanent tissue damage and has been advocated in treatment of such patients. But there were no comparative studies on the analgesic effects according to output voltage during PRF in patients with LRP. The goal of this study is to determine the clinical effect of high-voltage (60V) versus standard-voltage (45V) PRF of lumbar dorsal root ganglion. METHODS/DESIGN: This study will be a prospective, double-blind randomized controlled pilot study. In this study, total 20 patients will be recruited and distributed equally into 2 groups: high-voltage (60V) PRF, low-voltage (45V) PRF. Outcomes will be radicular pain intensity; physical functioning; global improvement and satisfaction with treatment; and adverse events. The assessments will be performed at the 3-month follow-up period after the end of the treatments. The findings will be analyzed statistically considering a 5% significance level (P ≤ .05). DISCUSSION: The results of this trial will help determine which voltage could be applied for PRF to dorsal root ganglion in LRP and be a basis for subsequent trials.

Comparison between two patient-reported outcome measures for patients with cervical radiculopathy: A think-aloud study.

BACKGROUND: The Cervical Radiculopathy Impact Scale (CRIS) and Patient Specific Functional Scale 2.0 (PSFS 2.0) are patient-reported outcome measures (PROMs) used to assess activity limitations in patients with cervical radiculopathy (CR). This study a) compared the CRIS subscale 3 and the PSFS 2.0 in patients with CR with respect to completeness and patient preference, b) established the correlation between both PROMs in assessing the individual patient's level of functional limitations and c) assessed the frequency of reported functional limitations. METHODS: Participants with CR participated in semi-structured, individual, face-to-face interviews as part of a "think-aloud" process; verbalising their thoughts while completing both PROMs. Sessions were digitally recorded and transcribed verbatim for analysis. RESULTS: Twenty-two patients were recruited. The most frequently reported functional limitation on the CRIS was: 'working at a computer' (n = 17) and overhead activities' (n = 10) for the PSFS 2.0. There was significant moderate positive correlation between the scores on the PSFS 2.0 and the CRIS (Spearman's r = 0.55, n = 22 p = .008). Most patients (n = 18; 82%) preferred the ability to present their own individual functional limitations of the PSFS 2.0. Eleven participants (50%) preferred the 11-point scale of the PSFS 2.0 over the 5-point Likert scale scoring option of the CRIS. CONCLUSION: Both easy to complete PROMs capture functional limitations in patients with CR. Most patients prefer the PSFS 2.0 over the CRIS. The wording and layout of both PROMs need refinement to enhance user-friendliness and avoid misinterpretation.

Acute cervical radiculopathy after anterior scalene muscle massage: A case report.

RATIONALE: Deep tissue massage (DTM) is a form of therapeutic massage therapy for muscles and is often used to treat musculoskeletal pain. This was an uncommon case of acute cervical radiculopathy that occurred after DTM. PATIENT CONCERNS: A 47-year-old Asian woman with low weight visited our clinic due to complaints of sudden unilateral paralysis, radiating pain in the left shoulder, and wrist weakness after undergoing a 3-minute DTM of the anterior scalene muscle. Electrodiagnostic examination indicated acute injuries in the left cervical 5 and 6 (cervical 5 and cervical 6) nerve roots. DIAGNOSES: Acute cervical radiculopathy associated with anterior scalene DTM. INTERVENTION: The patient underwent ultrasound-guided cervical 5 and cervical 6 selective nerve root block twice through the injection of 0.25% lidocaine and 20 mg dexamethasone and regularly participated in a biweekly rehabilitation program and a home exercise program. OUTCOME: After a 6-month follow-up, the patient's shoulder and wrist strength had recovered, and the electrodiagnostic findings had improved. LESSONS: DTM of the anterior scalene muscle should be carefully performed to avoid cervical nerve root injury, particularly in underweight patients.