View clinical trials related to Lumbar Disc Herniation.
Filter by:Fat infiltration and atrophy of lumbar muscles are related to spinal degenerative conditions, which can be seen reliably on MRI scans of lumbar disc herniation (LDH) patients. The aim of this study was to investigate the relationship between the degeneration of core muscles, obesity and chronic LDH. Fifty-five healthy volunteers and fifty-five chronic LDH patients (the course of the disease is more than six months) were enrolled. Core muscle percent fat and subcutaneous fat tissue thickness(SFTT) were used as the outcome measure, and logistic regression and independent samples t-test as the analytical methods to compare the relationship of the following five independent variables (erector spinae, rectus abdominis, [transversus abdominal, internal abdominal oblique, and external abdominal oblique muscle], lumbar multifidus, and psoas major muscles) and SFTT with LDH.
The Effect of Core Stabilization Exercises on Balance and Quality of Life in Chronic Period in Individuals With Lumbar Disc Herniation
Lumbar disc prolapse is a common cause of disabling Low back pain. The prevalence of disc prolapses or herniation in the general population increases with age. The underlying mechanism of pain is related to a complex interaction between inflammatory, compressive and immunological factors. The pressure exerted by the prolapsed disc on the longitudinal ligaments and the irritation caused by the released inflammatory chemokines results in localized back pain. The lumbar disc-related radicular pain arises when the prolapsed disc exerts pressure on the thecal sac or lumbar nerve roots, resulting in nerve root inflammation and ischemia. Chronic pain has been associated with poor cognitive functions in multiple domains, especially in the older population. Significant cognitive dysfunction has been reported in the domains of memory, executive functioning, attention abilities, psychomotor and processing speeds. Also, chronic pain was associated with physical limitations in walking speed and activities of daily living. MicroRNAs (miRNAs) are small endogenous RNAs that repress gene expressions post-transcriptionally. They are involved in the processes of neuropathic pain regulation through targeting the 3'UTR of mRNAs. miR-155 is a multifunctional miRNA, being a fundamental regulatory factor in immune response, neuro-inflammation, cognitive impairment and neuropathies. Previous studies suggest evidence that miRNA-155 promotes the release of pro-inflammatory mediators and cytokines that may alter neuronal sensitivity and modulate nerve plasticity, causing neuropathic pain. miR-155 also has a role in inflammatory reactions and targeting inflammation-related proteins such as serum and glucocorticoid-regulated protein kinase 3 (SGK3). Transforaminal epidural steroid injection (TFESI) is a common intervention for the treatment of neuropathic pain related to disc prolapse. Steroids inhibit the production of several proinflammatory mediators, leading to the reduction of nerve root inflammation induced by mechanical compression. Further, it can block neural transmission through nociceptive nerve fibres. A paucity of data is available about the effect of the different therapeutic modalities of lumbar disc-related radicular or low back pain on the pain-related functional and structural brain alterations and the associated cognitive dysfunction This study is designed to evaluate the impact of TFESI in lumbar disc prolapse on pain intensity, cognitive function, and miR-155 serum level. The second objective was to study the relationship between pain intensity, cognitive function, and miRNA-155 serum level in patients with lumbar disc prolapse.
Motorized traction and non-surgical spinal decompression treatments are relatively new treatments for which there is insufficient evidence in the literature. In this study investigators aimed to retrospectively compare the effectiveness of these treatments, which are in the field of their routine practice in their clinic.
Nerve compression due to lumbar disc herniation and related radicular pain is a very common condition when the lifetime prevalence is considered. Lumbosacral radicular pain can be defined as pain originating from the lumbar level and spreading to the lower extremities along the distribution area of one or more spinal nerves. It is thought that the mechanical pressure of the disc material herniated to the dorsal nerve root or ganglion or the inflammation created by the chemokines and enzymes in the disc are involved in the pain formation mechanism. Various methods such as medical agents, physical therapy modalities, epidural steroid injections and surgical methods can be used in the treatment of the related condition. Epidural injections have been used for the treatment of lower back and lower extremity pain since about 1900. Epidural injections exert their effects through the anti-inflammatory and neural membrane stabilizing effects of steroids, as well as by local anesthetics increasing blood flow to the ischemic spinal root and by the removal of cytokines from the area by the injection material. Epidural injections can be performed with various different approaches, including caudal, interlaminar and transforaminal. Among these approaches, the transforaminal approach is the most recently developed approach in the late 1990s, which allows drugs to be administered directly to the pathology area. The effect of obesity, which is one of the factors thought to predispose to low back pain and lumbosacral radicular pain, has been evaluated in various studies and it has been found that it is positively correlated with low back pain and is an independent risk factor for lumbar herniation. So, does obesity have an effect on the success of transforaminal epidural steroid injection treatment? According to the literature, no significant effect on treatment success has been demonstrated. Although the body mass index, which is used in the evaluation of obesity, has provided us important information about the health of the person in general for a long time, it is now thought to lead to an incomplete assessment. Because it does not provide information about body composition ratios (fat amount / lean body mass). Studies have shown that there is a high correlation between the percentage of body fat and the thickness of the subcutaneous fat tissue in the lumbar region, and there is a significant relationship between the lumbar region subcutaneous fat tissue thickness (especially L1-L2 level) and the degree of intervertebral disc degeneration and vertebral surface change. From this point of view, in another study, the L1-L2 disc level subcutaneous fat tissue thickness, was called the subcutaneous fat index, and the cut-off values that showed a significant relationship with spinal degeneration were determined. In the study we planned, in cases of spinal radicular pain (etiologically caused by intervertebral disc herniation), body mass index, lumbar level subcutaneous fat tissue thickness and subcutaneous fat index data whether be or be not correlated with treatment effectiveness/success in patients who received transforaminal epidural steroid injection, and if so, the level of significance intended to work. Before applying for surgery, we aim to develop a practical approach that can be used by relevant clinicians and contribute to the literature, which can predict 'what level of treatment success can we achieve in which patient?' with this injection method.
The aim of this study was to research the effect of the Lumbar Spinal Rotational Mobilization technique on radiological findings, pain, disability and joint range of motion (ROM) in patients with lumbar disc herniation
This study focused on examining the effect of mobilization protocol assisted with simulated clinical immersion videos on postoperative pain, fear of movement, mobility level and satisfaction in patients undergoing lumbar spine surgery.
Rationale: Lumbar spine surgery is associated with high postoperative pain scores and analgesic use, despite use of multimodal analgesia. The erector spinae plane block (ESPB) is a promising locoregional anesthetic technique for this type of surgery. The literature is not yet conclusive about the effectiveness of this technique on reducing postoperative pain intensity. Objective: The objective of this study is to evaluate the analgesic effect of ESPB as add-on therapy to multimodal analgesia on early postoperative pain intensity after lumbar spinal fusion surgery compared to placebo. Study design: The study is designed as a prospective mono-centre, randomized, double-blinded, placebo-controlled trial. Study population: 76 patients ≥ 18 years of age requiring elective lumbar spinal fusion surgery involving one to four fusion levels. Intervention: Patients will receive ultrasound-guided ESPB with either ropivacaine or placebo at the end of surgery. Main study parameters/endpoints: Main study parameter is pain intensity upon emergence from anesthesia measured with the Numeric Rating Scale. A minimal clinically important difference is considered to be a decrease of 1.5 points. Secondary endpoints are pain intensity during hospital stay and after 30 days, opioid use during hospital stay and after 30 days, opioid side effects, use of anti-emetics, time to first opioid use/request, length of hospital stay, quality of recovery at discharge. Nature and extent of the burden and risks associated with participation, benefit and group relatedness: The Sint Maartenskliniek is experienced in applying locoregional analgesia, the use of ropivacaine and using sonography. The procedure of administering ESPB has a very low risk of complications. Receiving placebo is justifiable because this group will not be withhold standard treatment. The risks of receiving placebo are negligible. The patients will visit the clinic at regular follow-up moments.
Lumbar radiculopathy is a term that describes symptoms of pain, numbness, and/or weakness that radiate along the sciatic nerve from the lower back to the buttocks and leg (1). Lumbar radiculopathy is a relevant health problem that affects quality of life, resulting in high health costs and economic loss worldwide (2). The reported prevalence of sciatica varies widely from 1.2% and 43% in the general population (3). Although initially believed to be a primary mechanical insult to the nerve root and dorsal root ganglion, lumbar radiculopathy is possibly caused by inflammatory changes in the nerve root (4). The role of cytokine-mediated neuroimmune interactions in the development and persistence of pain has been extensively studied (5,6,7). Intraneural application of pro-inflammatory cytokines induces behavioral signs associated with pain (8). Anti-inflammatory cytokine treatment effectively reduces hyperalgesia (9). Inflammatory cytokine inhibitors provided long-lasting analgesia in an inflammatory neuropathic pain model. On the basis of these findings, we evaluated whether cytokine profiles differ between severe and mild human sciatica, as well as whether distinct cytokine profiles provide relevant information regarding lumbar radiculopathy pathogenesis. (10,11). Tumor necrosis factor-alpha (TNF-α) is a pleiotropic cytokine that can stimulate inflammatory responses of synapses and myelin sheath, promote cellular apoptosis because of its cytotoxic effect, and induce nerve swelling and neuropathic pain (12). TNF-α influences neural survival, exerting both neuroprotective and neurodegenerative actions (13). Following peripheral nerve injury, upregulation of TNF-α expression has been documented in several neuropathic pain models (14). Pulsed radiofrequency (PRF) is a relatively new developed technique that is a variation of conventional radiofrequency treatment. PRF treatment does not allow temperatures above 42°C at the tip of the electrode. PRF provides advantage avoiding thermal tissue destruction and pain sequelae in management of pain. Recently, it has been recommended for treatment of chronic pain (15). Electromagnetic field which is thought to be responsible for the clinical effect of pulsed RF spread from active tip of electrode to around the electrode. The most intense part of the electromagnetic field is pointed tip of the electrode (16). It is a minimally invasive technique that involves application of electric fields to nerves to inhibit nociceptive stimuli and prevent pain transmission. PRF can be considered when conventional treatments have intolerable side effects or do not sufficiently relieve pain (17). Working mechanism of PRF which is recently more preferred technique to treat chronic pain due to not forming tissue damage and less painful procedure is not exactly known but it is considered to act neuromodulation (18). The aim of this work is to compare the effect of transforaminal injection of Steroids alone versus Radiofrequency pulsed mode on dorsal root ganglion combined with transforaminal steroids injection on TNF-α level in lumbar disc related radicular pain
We aimed to assess the influence of progressive muscle relaxation exercise on kinesiophobia and pain during after lumbar disc surgery using the Visual Analog Scale (VAS) and the Tampa Kinesiophobia Scale in a prospective, randomized fashion.