test

The Quebec Task Force: sciatica & spinal stenosis

On November 4, 2011, in , by admin
The Quebec Task Force classification for Spinal Disorders and the severity, treatment, and outcomes of sciatica and lumbar spinal stenosis. Source Medical Practices Evaluation Center, Massachusetts General Hospital, Harvard Medical School, Boston, USA. Abstract STUDY DESIGN: A prospective cohort study of patients in Maine with sciatica and lumbar spinal stenosis treated surgically and nonsurgically. SUMMARY […]

The Quebec Task Force classification for Spinal Disorders and the severity, treatment, and outcomes of sciatica and lumbar spinal stenosis.

Source

Medical Practices Evaluation Center, Massachusetts General Hospital, Harvard Medical School, Boston, USA.

Abstract

STUDY DESIGN:

A prospective cohort study of patients in Maine with sciatica and lumbar spinal stenosis treated surgically and nonsurgically.

SUMMARY OF BACKGROUND DATA:

In 1987, the Quebec Task Force on Spinal Disorders proposed a diagnostic classification to help make clinical decisions, evaluate quality of care, assess prognosis, and conduct research.

OBJECTIVES:

To assess the Quebec Task Force classification’s ability to stratify patients according to severity and treatment at baseline, and to assess changes over time in health-related quality of life, including symptoms, functional status, and disability.

METHODS:

Five hundred sixteen patients participating in the Maine Lumbar Spine Study who completed baseline and 1-year follow-up evaluations were classified successfully according to the Quebec Task Force classification. Patient characteristics and treatments were compared across Quebec Task Force classification categories. Changes in health-related quality of life over 1 year were assessed according to Quebec Task Force classification category and type of treatment.

RESULTS:

Among patients with sciatica (n = 370), higher Quebec Task Force classification categories (from 2, pain radiating to the proximal extremity, to 6, sciatica with evidence of nerve root compression) were associated with increased severity of symptoms at baseline. There was no association between Quebec Task Force classification and baseline functional status. Quebec Task Force classification was associated strongly with the likelihood of receiving surgical treatment (P < or = 0.005). Among patients with sciatica treated nonsurgically, improvement at 1 year in back-specific and generic physical function increased with higher Quebec Task Force classification category (P < or = 0.05). Only a nonsignificant trend was observed for surgically treated patients. Patients with lumbar spinal stenosis (Quebec Task Force classification 7, n = 131) had baseline features and outcomes distinct from patients with sciatica.

CONCLUSIONS:

For patients with sciatica, the Quebec Task Force classification was highly associated with the severity of symptoms and the probability of subsequent surgical treatment. Nonsurgically treated patients in Quebec Task Force classification categories reflecting nerve root compression had greater improvement than those with pain symptoms alone. Among surgical patients, the Quebec Task Force classification was not associated with outcome. These results provide validation for the classification and its wider adoption. Nonetheless, improved diagnostic classifications are needed to predict outcomes better in patients with sciatica who undergo surgery.

Atlas SJ, Deyo RA, Patrick DL, Convery K, Keller RB, Singer DE, Spine (Phila Pa 1976).1996 Dec 15;21(24):2885-92.

PMID: 9112713

Causes of low back pain

On September 27, 2010, in , by admin
Let’s have a look a the causes of low back pain and how it could be related to degenerative disc disease and herniated discs. common complaint among adults lifetime prevalence in working population up to 80% 60% experience functional limitation or disability second most common reason for work disability despite advances in imaging and surgical […]

Let’s have a look a the causes of low back pain and how it could be related to degenerative disc disease and herniated discs.

  • common complaint among adults
  • lifetime prevalence in working population up to 80%
  • 60% experience functional limitation or disability
  • second most common reason for work disability
  • despite advances in imaging and surgical techniques LBP prevalence and its cost are relatively unchanged
  • 90% people age >50 have Degenerative Disc Disease
  • Large disc herniation does NOT always need surgery
  • Neurologic loss is NOT an absolute indication for surgery
  • Small disc bulge is NOT always normal
  • Surgery does not have an 80% success rate
  • Conservative treatment is reversible. Surgery is not.

 

Cause of low back pain

Causes of low back pain - Click to enlarge

Back pain causes:

  • Spasm
  • Sprain/strain
  • Biomechanical
  • Disc herniation
  • Disc bulge
  • Degenerative osteoarthritis
  • Facet syndrome
  • Spondylolithesis
  • Spinal stenosis
  • Osteoporosis
  • Inflammatory
  • Infection
  • Cancer

 

Disc Degeneration

Normal Vs Disc Degeneration - Clic to enlarge

Disc degeneration (arthrosis)

  • Changes in hydrostatic pressure
  • Lack of oxygen
  • Lack of glucose
  • Changes in pH levels
  • Death of proteoglycans

If the cells of the disc failed to get proper nutrients – such as oxygen, or glucose – or if the pH level of the disc drops (because waste is not being diffused out of the disc and it becomes anaerobic), disc cells would die and stop producing the vital proteoglycan aggregates. The disc loses its water content (dehydrates) and loses its hydrostatic pressure (osmotic pressure).

Symptoms of lumbar disc disease are the result of either herniation of the nucleus pulposus through a mechanically weak annulus fibrosis or from tearing of the annulus itself. This can lead to Radiculopathy from nerve root compression and/or Radiculitis – an inflammatory process affecting nerve roots or the spinal cord.  Herniation is thought to be the result of a defect in the annulus fibrosis, most likely the result of excessive stress applied to the disc.


Herniated disc

Three types of annular tears:

  1. Rim lesion – horizontal tearing of the very outer fibers of the disc near their attachments into the ring apophysis;
  2. Concentric tear – splitting apart of the lamellae of the annulus in a circumferential direction
  3. Radial tear – horizontal or obliquely horizontal tears

Next page – Causes

The facts about herniated discs

On September 27, 2010, in , by admin
If you have a herniated disc, you should carefully read the following: A health problem as serious needs to be taken care of by a competent health professional. Such a condition when poorly managed can have a disastrous effect on your health for the rest of your days. [flv:http://www.sosherniateddisc.com/wp-content/uploads/2010/09/Welcome-to-3Drx-HybridOnline.com_.flv] The facts about herniated discs: Herniated […]

If you have a herniated disc, you should carefully read the following:

A health problem as serious needs to be taken care of by a competent health professional. Such a condition when poorly managed can have a disastrous effect on your health for the rest of your days.

[flv:http://www.sosherniateddisc.com/wp-content/uploads/2010/09/Welcome-to-3Drx-HybridOnline.com_.flv]

Herniated disc

Herniated disc click to enlarge

The facts about herniated discs:

  • Herniated Discs are not all inherently painful
  • Most bulging discs are not symptomatic
  • A bulging disc may be as painful as an herniated disc
  • Surgery or non-surgical spinal decompression is required to correct an herniated disc
  • In most cases, surgery actually offers poor curative results for an herniated disc
  • Herniated Discs does notworsen with time but the disc does end up with degenerative disc disease.
  • Most herniated discs won’t resolve on their own. The pain may subside because of posture and structural compensation
  • Herniated discs cannot be diagnosed with an x-ray. You need an MRI
  • Herniated discs are not always due to injury
  • Herniated discs can happen because of a spinal rotational decompensation caused by a pelvis misalignment
  • Medical treatment is not necessary for most herniated discs
  • Many disc pain conditions are misdiagnosed

If I were to gather a group of middle age folks (45 average age) who have NEVER had back pain before and shoot MRIs on them all, here’s what we would find:

  • 38% would have disc bulges,
  • 37% disc protrusions (aka: contained herniations),
  • 11% disc extrusions (aka: non-contained herniations),
  • 0% disc sequestrations (aka: free fragments) and
  • 4% nerve root compression by the disc herniation.

A more shocking statistic is that 60% of asymptomatic middle aged people would have findings of disc bulge or worse (protrusion, extrusion) on MRI!

Disc herniation, the leading cause of lombosciatica, is a result of a long and silent degenerative disc which will decompensate more or less abruptly on the occasion of an effort, sometimes minimal.

The lombosciatica almost never an “accident” occurring on a perfectly healthy spine.

References:
1. Jensen MC, et al. “MRI imaging of the lumbar spine in people without back pain.” N Engl J Med – 1994; 331:369-373

2. Boden SD et al. “Abnormal magnetic resonance scans of the lumbar spine in asymptomatic subjects: A prospective investigation.” J Bone Joint Surg Am 1990; 72A:403-408

3. Weishaupt D et al. “MRI of the lumbar spine: Prevalence of intervertebral disc extrusion and sequestration, nerve root compression and plate abnormalities, and osteoarthritis of the fact joints in Asymptomatic Volunteers.” Radiology – 1998; 209:661-666

4. Boos N, et al. “1995 Volvo Award in clinical science: The diagnostic accuracy of MRI, work perception, and psychosocial factors in identifying symptomatic disc herniations.” Spine – 1995; 20:2613-2625

5. Powell MC, et al. “Prevalence of lumbar disc degeneration observed by magnetic resonance in symptomless women.” Lancer – 1986; 2:1366-7

6. Boos N, et al. “Natural history of individuals with asymptomatic disc abnormalities in MRI: Predictors of low back pain-related medical consultation and work incapacity.” Spine 2000; 25:1484

7. Borenstein G, Boden SD, Wiesel SW, et al. “The value of magnetic resonance imaging of the lumbar spine to predict low-back pain in asymptomatic individuals: A 7-year follow-up study. J Bone Joint [am] 2001; 83:320-34

8. Wiesel SW, et al. “A study of computer-associated tomography: I. The incidence of positive CAT scans in asymptomatic group of patients.” Spine 1984;9:549-51

11. Wood KB, et al. ‘Magnetic resonance imaging of the thoracic spine. Evaluation of asymptomatic individual s.’ J Bone Joint Surg Am. 1995 Nov;77(11):1631-8

20. Jarvik JJ, et al. “The longitudinal assessment of imaging and disability of the back (LAIDBack) Study.” Spine 2001;26: 1158-66.

25. Boden SD, et al. “Abnormal Magnetic-Resonance Scans of the Lumbar Spine in Asymptomatci Subjects.” J Bone Joint Surg [AM] 1990; 72:403-408

26. Fraser RD, Sandhu A, Gogan WJ. ‘Magnetic resonance imaging findings 10 years after treatment for lumbar disc herniation.’ Spine 1995 Mar 15;20(6):710-4. “The findings of this study indicate that long-term improvement of a patient’s symptoms after treatment of disc herniation may occur with or without resolution of the hernia. This and the similar morphologic findings in the different groups is consistent with the 10-year clinical results after the treatment of disc herniation reported by Weber.”

27. Masui T, et al. ‘Natural History of Patients with Lumbar Disc Herniation Observed by Magnetic Resonance Imaging for Minimum 7 Years.’ J Spinal Disord Tech. 2005 Apr;18(2):121-126. “Clinical outcome did not depend on the size of herniation or the grade of degeneration of the intervertebral disc in the minimum 7-year follow-up.”

517. Giuliano V, et al. ‘The use of flexion and extension MR in the evaluation of cervical spine trauma: initial experience in 100 trauma patients compared with 100 normal subjects.’ Emerg Radiol. 2002 Nov;9(5):249-53.

Next page – chronic back pain

Business Opportunity

We are looking for new partners with an existing chiropractic clinic in Trois-Rivières, Drummundville, Longueuil and Sherbrooke to open up new spinal decompression clinics.

More info...