Factors of lumbosacral radiculopathy chronicity

Authors

DOI:

https://doi.org/10.14739/2310-1210.2023.2.273614

Keywords:

lumbar vertebrae, radiculopathy, neurometry, chronic pain, low back pain

Abstract

Assessment of chronic factors of acute lumbosacral radiculopathy is an urgent problem due to the disease impact on the quality of life of patients, possible loss of work capacity and disability.

The aim of the work is to identify chronicity factors of acute compressive lumbosacral radiculopathy depending on the severity of degenerative-dystrophic changes in the spine and pathomorphological changes in the zone of disc-radicular conflict based on complex clinical-neurological, neuro-orthopedic, neuroimaging, neurophysiological and statistical methods of examination.

Materials and methods. 100 patients with acute lumbosacral radiculopathy were examined. The patients were divided into two groups: 45 patients with radiculopathy and both discogenic pathology and stenotic process in the spinal canal and/or lateral openings, and 55 patients with radiculopathy developed secondary to a pathology between the vertebral disc at the level of one vertebromotor segment. All the patients underwent neurological, neuroorthopedic, neurophysiological examinations. The study was conducted in two stages – 3–7 days and one months after the disease onset.

Results. On the basis of comprehensive clinical, neuroimaging, neurophysiological examinations and statistical processing of the obtained data, factors affecting the chronicity of acute compressive lumbosacral radiculopathy were identified: age (rs = 0.25, P = 0.012), sex (rs = 0.25, P = 0.012), pain syndrome severity according to the VAS (rs = 0.25, P = 0.011), the presence of a neuropathic component of pain according to the PainDETECT questionnaire (rs = 0.74, P < 0.001), biomechanical disorders of the spine during the Schober test (rs = -0.41, P < 0.001), lateroflexion (rs = -0.30, P = 0.003), extension (rs = 0.28, p = 0.004), damage to Aβ fibers (rs = -0.36, P = 0.009), Aδ-fibers (rs = -0.38, P = 0.006), C-fibers (rs = -0.37, P = 0.008), allodynia (rs = 0.38, P < 0.001), hyperalgesia (rs = -0.24, p = 0.014), muscular-tonic syndrome index (rs = 0.26, p = 0.008), the presence of lumbar canal stenosis (rs = 0.42, P < 0.001), spondyloarthrosis (rs = 0.22, P = 0.028), spondylolisthesis (rs = 0.20, P = 0.047).

Conclusions. The conducted study has revealed the main factors contributing to the development of acute lumbosacral radiculopathy chronicity. The presence of a neuropathic component of pain in the mechanism of pain syndrome development in the acute period of the disease and the involvement of C-fibers in the pathological process in the late stages of the disease are among the important markers contributing to the disease prolongation. Assessment of the factors that determine the chronicity of the course in the acute period of the disease allows to prescribe complex differential therapy at the early stage of the disease.

Author Biographies

L. A. Dziak, Dnipro State Medical University, Ukraine

MD, PhD, DSc, Professor, Head of the Department of Nervous Diseases and Neurosurgery of Postgraduate Faculty, Corresponding Member of the National Academy of Medical Sciences of Ukraine

O. O. Shulha, Dnipro State Medical University, Ukraine

MD, PhD, Assistant of the Department of Nervous Diseases and Neurosurgery of Postgraduate Faculty

V. M. Suk, Dnipro State Medical University, Ukraine

MD, Assistant of the Department of Nervous Diseases and Neurosurgery of Postgraduate Faculty

References

Benyamin, R. M., Smith, W. J., Lieber, J., & Vallejo, R. (2019). Lumbar Radiculopathy. In Y. Khelemsky, A. Malhotra, K. Gritsenko (Eds.). Academic Pain Medicine. Springer, Cham. (pp. 227-233). https://doi.org/10.1007/978-3-030-18005-8_31

Berry, J. A., Elia, C., Saini, H. S., & Miulli, D. E. (2019). A Review of Lumbar Radiculopathy, Diagnosis, and Treatment. Cureus, 11(10), e5934. https://doi.org/10.7759/cureus.5934

Rana, A. Q., Ghouse, A. T., & Govindarajan, R. (2016). Radiculopathies. In: Neurophysiology in Clinical Practice (pp. 91-98). Springer, Cham. https://doi.org/10.1007/978-3-319-39342-1_11

Tolba, R. (2017). Radiculopathy. In: J. Pope, T. Deer (Eds.). Treatment of Chronic Pain Conditions (pp. 253-255). Springer, New York, NY. https://doi.org/10.1007/978-1-4939-6976-0_74

Dunsmuir, R. A., Nisar, S., Cruickshank, J. A., & Loughenbury, P. R. (2022). No correlation identified between the proportional size of a prolapsed intravertebral disc with disability or leg pain. The bone & joint journal, 104-B(6), 715-720. https://doi.org/10.1302/0301-620X.104B6.BJJ-2021-1725.R2

Mariajoseph, F. P., Castle-Kirszbaum, M., Kam, J., Rogers, M., Sher, R., Daly, C., Roadley, J., Risbey, P., Fryer, K., & Goldschlager, T. (2022). Relationship between herniated intervertebral disc fragment weight and pain in lumbar microdiscectomy patients. Journal of clinical neuroscience, 102, 75-79. https://doi.org/10.1016/j.jocn.2022.06.012

Sadowska, A., Touli, E., Hitzl, W., Greutert, H., Ferguson, S. J., Wuertz-Kozak, K., & Hausmann, O. N. (2018). Inflammaging in cervical and lumbar degenerated intervertebral discs: analysis of proinflammatory cytokine and TRP channel expression. European spine journal, 27(3), 564-577. https://doi.org/10.1007/s00586-017-5360-8

Wei, Q., Zhang, X., Zhou, C., Ren, Q., & Zhang, Y. (2019). Roles of large aggregating proteoglycans in human intervertebral disc degeneration. Connective tissue research, 60(3), 209-218. https://doi.org/10.1080/03008207.2018.1499731

Kim, H. S., Wu, P. H., & Jang, I. T. (2020). Lumbar Degenerative Disease Part 1: Anatomy and Pathophysiology of Intervertebral Discogenic Pain and Radiofrequency Ablation of Basivertebral and Sinuvertebral Nerve Treatment for Chronic Discogenic Back Pain: A Prospective Case Series and Review of Literature. International journal of molecular sciences, 21(4), 1483. https://doi.org/10.3390/ijms21041483

Tampin, B., Slater, H., Jacques, A., & Lind, C. R. P. (2020). Association of quantitative sensory testing parameters with clinical outcome in patients with lumbar radiculopathy undergoing microdiscectomy. European journal of pain, 24(7), 1377-1392. https://doi.org/10.1002/ejp.1586

Dzyak, L. A., & Shulha, O. O. (2021). Dynamika perebihu bolovoho syndromu u khvorykh iz hostrymy poperekovo-kryzhovymy radykulopatiiamy [Dynamics of pain syndrome in patients with acute lumbar-sacral radiculopathies]. Zhurnal Nevrolohii im. B. M. Mankovskoho, 9(4), 41-47. [in Ukrainian].

Department of Veterans Affairs. Department of Defense. (2017). VA/DoD Clinical Practice Guideline for Diagnosis and Treatment of Low Back Pain. Version 2.0 – 2017. https://www.healthquality.va.gov/guidelines/Pain/lbp/VADoDLBPCPG092917.pdf

Karran, E. L., Grant, A. R., & Moseley, G. L. (2020). Low back pain and the social determinants of health: a systematic review and narrative synthesis. Pain, 161(11), 2476-2493. https://doi.org/10.1097/j.pain.0000000000001944

Luksanapruksa, P., Zinboonyahgoon, N., Ruangchainikom, M., Santipas, B., Panatreswas, N., & Wilartratsami, S. (2022). Hidden Neuropathic Pain in Chronic Low Back Pain: Prevalence, Pattern, and Impact on Quality of Life. Siriraj Medical Journal, 74(8), 480-486. https://doi.org/10.33192/Smj.2022.57

Benzakour, T., Igoumenou, V., Mavrogenis, A. F., & Benzakour, A. (2019). Current concepts for lumbar disc herniation. International orthopaedics, 43(4), 841-851. https://doi.org/10.1007/s00264-018-4247-6

Parreira, P., Maher, C. G., Steffens, D., Hancock, M. J., & Ferreira, M. L. (2018). Risk factors for low back pain and sciatica: an umbrella review. The spine journal, 18(9), 1715-1721. https://doi.org/10.1016/j.spinee.2018.05.018

Niederer, D., & Mueller, J. (2020). Sustainability effects of motor control stabilisation exercises on pain and function in chronic nonspecific low back pain patients: A systematic review with meta-analysis and meta-regression. PloS one, 15(1), e0227423. https://doi.org/10.1371/journal.pone.0227423

Øiestad, B. E., Hilde, G., Tveter, A. T., Peat, G. G., Thomas, M. J., Dunn, K. M., & Grotle, M. (2020). Risk factors for episodes of back pain in emerging adults. A systematic review. European journal of pain, 24(1), 19-38. https://doi.org/10.1002/ejp.1474

Li, P., Gan, Y., Xu, Y., Song, L., Wang, L., Ouyang, B., Zhang, C., & Zhou, Q. (2017). The inflammatory cytokine TNF-α promotes the premature senescence of rat nucleus pulposus cells via the PI3K/Akt signaling pathway. Scientific reports, 7, 42938. https://doi.org/10.1038/srep42938

De Geer C. M. (2018). Cytokine Involvement in Biological Inflammation Related to Degenerative Disorders of the Intervertebral Disk: A Narrative Review. Journal of chiropractic medicine, 17(1), 54-62. https://doi.org/10.1016/j.jcm.2017.09.003

Albrecht, D. S., Ahmed, S. U., Kettner, N. W., Borra, R. J. H., Cohen-Adad, J., Deng, H., Houle, T. T., Opalacz, A., Roth, S. A., Melo, M. F. V., Chen, L., Mao, J., Hooker, J. M., Loggia, M. L., & Zhang, Y. (2018). Neuroinflammation of the spinal cord and nerve roots in chronic radicular pain patients. Pain, 159(5), 968-977. https://doi.org/10.1097/j.pain.0000000000001171

Urits, I., Burshtein, A., Sharma, M., Testa, L., Gold, P. A., Orhurhu, V., Viswanath, O., Jones, M. R., Sidransky, M. A., Spektor, B., & Kaye, A. D. (2019). Low Back Pain, a Comprehensive Review: Pathophysiology, Diagnosis, and Treatment. Current pain and headache reports, 23(3), 23. https://doi.org/10.1007/s11916-019-0757-1

Debnath, U. K. (2018). Etiology and Risk Factors of Lumbar Intervertebral Disc (IVD) Degeneration. Research in Medical & Engineering Sciences, 4(5). https://doi.org/10.31031/rmes.2018.04.000597

Fields, A. J., Ballatori, A., Liebenberg, E. C., & Lotz, J. C. (2018). Contribution of the Endplates to Disc Degeneration. Current Molecular Biology Reports, 4(4), 151-160. https://doi.org/10.1007/s40610-018-0105-y

Downloads

Published

2023-03-28

How to Cite

1.
Dziak LA, Shulha OO, Suk VM. Factors of lumbosacral radiculopathy chronicity. Zaporozhye medical journal [Internet]. 2023Mar.28 [cited 2024Apr.24];25(2):122-9. Available from: http://zmj.zsmu.edu.ua/article/view/273614

Issue

Vol. 25 No. 2 (2023): Zaporozhye medical journal

Section

Original research

License

Authors who publish with this journal agree to the following terms:

    1. Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.  Лицензия Creative Commons
    2. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
    3. Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access)