Clinical and imaging characteristics of patients with extreme low back pain or sciatica referred for spinal injection
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To analyze the causes of pain, imaging characteristics, and therapeutic effect of spinal injection in patients with extreme low back pain or sciatica.
We analyzed 381 consecutive patients with extreme low back pain or sciatica visiting our spinal intervention center between January and December 2017. Clinical and imaging characteristics were analyzed. The treatment response, defined as a numerical pain rating scale decrease of ≥ 30%, was measured. Fisher’s exact test was performed to identify the association between the injection response and subsequent lumbar surgery rate.
The most frequent cause of pain was spinal stenosis, followed by herniated intervertebral disc, facet osteoarthritis, and osteoporotic compression fracture. A herniated intervertebral disc was the most common disorder in patients < 50 years of age, while spinal stenosis was the most common in patients ≥ 50 years of age. Women comprised 66.4% of the study population. The majority of lumbar pathologies occurred below L3/4. Spinal injection was found to be effective in 44.2% of cases. Those who responded to the injection showed a significantly lower rate of lumbar surgery within 6 months (P = 0.004).
Those with extreme low back pain or sciatica had clinical and imaging characteristics similar to those with typical low back pain referred for spinal injection. Spinal injection could be an effective method of pain control for patients with extreme low back pain or sciatica.
KeywordsSpinal injection Extreme low back pain Clinical characteristics Treatment outcome
None to declare.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflicts of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
For this type of study formal consent is not required.
- 2.Hartvigsen J, Hancock MJ, Kongsted A, Louw Q, Ferreira ML, Genevay S, Hoy D, Karppinen J, Pransky G, Sieper J, Smeets RJ, Underwood M, Buchbinder R, Hartvigsen J, Cherkin D, Foster NE, Maher CG, Underwood M, van Tulder M, Anema JR, Chou R, Cohen SP, Menezes Costa L, Croft P, Ferreira M, Ferreira PH, Fritz JM, Genevay S, Gross DP, Hancock MJ, Hoy D, Karppinen J, Koes BW, Kongsted A, Louw Q, Öberg B, Peul WC, Pransky G, Schoene M, Sieper J, Smeets RJ, Turner JA, Woolf A (2018) What low back pain is and why we need to pay attention. Lancet 391(10137):2356–2367CrossRefGoogle Scholar
- 3.Manchikanti L, Singh V, Datta S, Cohen SP, Hirsch JA (2009) Comprehensive review of epidemiology, scope, and impact of spinal pain. Pain Physician 12(4):E35–E70Google Scholar
- 5.Foster NE, Anema JR, Cherkin D, Chou R, Cohen SP, Gross DP, Ferreira PH, Fritz JM, Koes BW, Peul W, Turner JA, Maher CG, Buchbinder R, Hartvigsen J, Cherkin D, Foster NE, Maher CG, Underwood M, van Tulder M, Anema JR, Chou R, Cohen SP, Menezes Costa L, Croft P, Ferreira M, Ferreira PH, Fritz JM, Genevay S, Gross DP, Hancock MJ, Hoy D, Karppinen J, Koes BW, Kongsted A, Louw Q, Öberg B, Peul WC, Pransky G, Schoene M, Sieper J, Smeets RJ, Turner JA, Woolf A (2018) Prevention and treatment of low back pain: evidence, challenges, and promising directions. Lancet 391(10137):2368–2383CrossRefGoogle Scholar
- 6.Qaseem A, Wilt TJ, McLean RM, Forciea MA (2017) Clinical Guidelines Committee of the American College of Physicians (2017) Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline from the American College of Physicians. Ann Intern Med 166(7):514–530CrossRefGoogle Scholar
- 7.National Institute for Health and Care Excellence (2016) Low back pain and sciatica in over 16s: assessment and management. National Institute for Health and Care Excellence: Clinical Guidelines, LondonGoogle Scholar
- 9.Manchikanti L, Abdi S, Atluri S et al (2013) An update of comprehensive evidence-based guidelines for interventional techniques in chronic spinal pain. Part II: guidance and recommendations. Pain Physician 16(2):S49–S283Google Scholar
- 10.Kreiner DS, Shaffer WO, Baisden JL, Gilbert TJ, Summers JT, Toton JF, Hwang SW, Mendel RC, Reitman CA, North American Spine Society (2013) An evidence-based clinical guideline for the diagnosis and treatment of degenerative lumbar spinal stenosis (update). Spine J 13(7):734–743CrossRefGoogle Scholar
- 11.Kreiner DS, Hwang SW, Easa JE, Resnick DK, Baisden JL, Bess S, Cho CH, DePalma M, Dougherty P 2nd, Fernand R, Ghiselli G, Hanna AS, Lamer T, Lisi AJ, Mazanec DJ, Meagher RJ, Nucci RC, Patel RD, Sembrano JN, Sharma AK, Summers JT, Taleghani CK, Tontz WL Jr, Toton JF, North American Spine Society (2014) An evidence-based clinical guideline for the diagnosis and treatment of lumbar disc herniation with radiculopathy. Spine J 14(1):180–191CrossRefGoogle Scholar
- 13.Sharma AK, Vorobeychik Y, Wasserman R, Jameson J, Moradian M, Duszynski B, Kennedy DJ, Standards Division of the Spine Intervention Society (2017) The effectiveness and risks of fluoroscopically guided lumbar interlaminar epidural steroid injections: a systematic review with comprehensive analysis of the published data. Pain Med 18(2):239–251Google Scholar
- 16.Hawker GA, Mian S, Kendzerska T, French M (2011) Measures of adult pain: Visual Analog Scale for pain (VAS Pain), Numeric Rating Scale for pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care Res (Hoboken) 63(Suppl 11):S240–S252CrossRefGoogle Scholar
- 18.Patel IJ, Davidson JC, Nikolic B, Salazar GM, Schwartzberg MS, Walker TG, Saad WE, Standards of Practice Committee, with Cardiovascular and Interventional Radiological Society of Europe (CIRSE) Endorsement, Standards of Practice Committee of the Society of Interventional Radiology (2013) Addendum of newer anticoagulants to the SIR consensus guideline. J Vasc Interv Radiol 24(5):641–645CrossRefGoogle Scholar
- 22.Fardon DF, Williams AL, Dohring EJ, Murtagh FR, Gabriel Rothman SL, Sze GK (2014) Lumbar disc nomenclature: version 2.0: recommendations of the combined task forces of the North American Spine Society, the American Society of Spine Radiology and the American Society of Neuroradiology. Spine J 14(11):2525–2545CrossRefGoogle Scholar
- 30.Heliövaara M (1988) Epidemiology of sciatica and herniated lumbar intervertebral disc. Publications of the Social Insurance Institution, HelsinkiGoogle Scholar
- 43.Doan L, Patel H, Aronova Y, Gharibo C (2018) Variations in interlaminar epidural steroid injection practice patterns by interventional pain management physicians in the United States. Pain Physician 21(5):E493–E499Google Scholar