Back Pain Clinical Trial
Official title:
Impact of Muscle Degeneration in Chronic ow Back Pain in Patients Undergoing Neural Decompression
Surgical interventions for the removal of intervertebral disc fragments or to enlarge a narrow spine canal are commonly performed worldwide and are considered efficient. Concomitant low back pain is not uncommon among patients with lumbar nerve compression and neurological symptoms. When present, controversy persists in the literature regarding its ideal management. Although neurological symptoms improve after decompressive surgery, the presence of residual chronic low back pain may worsen satisfaction scores and cause functional disability. The hypothesis of the present study is that the presence of atrophy of the paraspinal and trunk muscles predicts chronic low back pain after lumbar neural decompression. If confirmed, this finding will aid in better planning of physical rehabilitation strategies for this group of patients, as well as a clearer prediction regarding surgical treatment outcomes for patients and health professionals.
This is a prospective cohort study. Patients with lumbar degenerative diseases and symptoms of nerve compression (radiculopathy or neurogenic claudication) who will undergo surgical treatment for neural decompression (discectomy, foraminotomy or laminectomy). The cohort will be followed by a team researcher (not blinded to the purpose of the study) at preoperative (up to 1 month before surgery), immediate postoperative (12 to 24 hours after procedure), 06, 12 and 24 months after surgery. Imaging tests will be performed on the preoperative evaluation and at six months follow-up after the operation. The treatment will consist of lumbar decompression surgery, which may consist of discectomy, foraminotomy or laminectomy, according to the type and location of the compression. The choice of surgical technique will be made by the assistant surgeon. Patients will be divided into four groups regarding the type of soft tissue retractor and image magnification: Group 1: (minimally invasive microdiscectomy): surgeries performed with loupes or microscope plus minimally invasive soft tissue retractors (tubular or "Caspar"). Group 2: (open microdiscectomy) surgeries performed with loupes or microscope plus conventional soft tissue retractors (auto static, "Taylor" or "McCulloch"). Group 3: (endoscopic discectomy): surgeries performed by means of the "full endoscopic" technique; Group 4: (open discectomy "with the naked eye"): surgeries performed without image magnification. Use of conventional soft tissue retractors (auto static, "Taylor" or "McCulloch"). Image Evaluation: 1. X-Rays (anteroposterior, lateral, dynamic lateral films) - to evaluate and measure the presence of scoliosis, spondylolisthesis or Degenerative vertebral dislocations. 2. MRI: to detect and to grade the presence of fat infiltration of the Psoas and Multifidus muscles (Arabanas et al); to grade Modic Signal and facet joint degeneration (Weishaupt et al). Sample size: For the sample size estimation, we considered the main outcome of the study, a 1.5-point change in the pain scale (VAS) among patients with fat infiltration (grades 1, 2, or 3) and without fat infiltration (grade 0), after 6 months of spine surgery, with 80% power and 95% confidence, the sample required for the study is 28 patients in each group considering a two-tailed test. Similarly to the previous study, we observed that the first 14 patients in the pilot study, 20% of patients had without fat infiltration, therefore, as the admission of patients into the study is consecutive, we expect to find this same percentage of patients without fat infiltration in the final sample of patients, so 140 patients are needed to get 28 patients without fat infiltration. Predicting a loss of 20% of patients at 6 months of follow-up, the initial sample to be considered will be 168 patients to obtain the minimum number of patients required in each group. Statistics: Numerical variables with normal distribution will be described by means and standard deviations and variables with non-normal distribution by medians and interquartile ranges, in addition to the minimum and maximum values. The distributions of numerical variables will be verified by histograms, boxplots, and, if necessary, Shapiro-Wilk normality tests. Categorical variables will be described by absolute frequencies and percentages. The analyzes will be performed with the SPSS26 program, considering a 5% significance level. ;
Status | Clinical Trial | Phase | |
---|---|---|---|
Completed |
NCT05982483 -
Erector Spinae Plane Block vs. Usual Care for ED Patients With Mechanical Back Pain
|
N/A | |
Completed |
NCT04744246 -
Muscle Activity During Load Carriage in ROTC Cadets
|
N/A | |
Completed |
NCT03273114 -
Cognitive Functional Therapy (CFT) Compared With Core Training Exercise and Manual Therapy (CORE-MT) in Patients With Chronic Low Back Pain
|
N/A | |
Active, not recruiting |
NCT03680846 -
Comparison of HF10 Therapy Combined With CMM to CMM Alone in the Treatment of Non-Surgical Refractory Back Pain
|
N/A | |
Completed |
NCT05597189 -
Clinical Study for Palliative/Preventive Treatment of Chronic Back Pain
|
N/A | |
Completed |
NCT05342181 -
Static and Dynamic Core Stability Exercises in Potpartum Back Pain
|
N/A | |
Completed |
NCT02955342 -
Back and Neck Pain in Adolescence
|
||
Completed |
NCT02704845 -
Biopsychosocial Exploration of Pain Profiles in Inflammatory and Chronic Non-specific Axial Low Back Pain
|
N/A | |
Not yet recruiting |
NCT02536274 -
"Examination of the Impact of a Dynamic Flexion Orthosis (Dynaflex®Ottobock) or of a Back Bandage (Lumbo Sensa®Ottobock) on the Voluntary Activation of the Back Muscles in Patients With Specific Back Pain"
|
N/A | |
Recruiting |
NCT02237105 -
The Effect of Cognitive Behavioral Therapy on the Outcome of Spinal Surgery
|
N/A | |
Enrolling by invitation |
NCT02485795 -
Observational Study of the Impact of Genetic Testing on Healthcare Decisions and Care in Interventional Pain Management
|
N/A | |
Completed |
NCT02254694 -
The Influence of High Heeled Shoes on the Sagittal Balance of the Spine and Whole Body
|
N/A | |
Completed |
NCT02609009 -
Back Pain and Spinal Manipulation in Adolescent Scoliosis
|
N/A | |
Terminated |
NCT02239627 -
Epidural Clonidine Versus Corticosteroid for Low Back Pain
|
N/A | |
Completed |
NCT00986180 -
NUCYNTA (Tapentadol Immediate Release) Versus Oxycodone Immediate Release in the Treatment of Acute Low Back Pain
|
Phase 3 | |
Completed |
NCT00771758 -
Tapentadol IR vs Oxycodone IR vs Placebo in Acute Pain From Vertebral Compression Fracture Associated With Osteoporosis
|
Phase 3 | |
Terminated |
NCT00769626 -
Standardizing Management of Patients With Low Back Pain in Primary Care and Physical Therapy
|
Phase 3 | |
Withdrawn |
NCT00231374 -
Measure of Cerebrospinal Fluid (CSF) Pressure Variation With Patient Positioning
|
N/A | |
Completed |
NCT00454064 -
Cognitive-behavioural Treatment of Chronic Back Pain
|
Phase 3 | |
Completed |
NCT00103675 -
Sensor Measurement of Acupuncture Needle Manipulation
|
Phase 1 |