Advertisement

Huisarts en wetenschap

, Volume 59, Issue 3, pp 105–107 | Cite as

De geheimen van het lumbosacraal radiculair syndroom

  • Annemieke VerwoerdEmail author
Beschouwing
  • 65 Downloads

Samenvatting

Verwoerd JH. De geheimen van het lumbosacraal radiculair syndroom. Huisarts Wet 2016;59(3):105-7.

Het lumbosacraal radiculair syndroom komt vaak voor en geeft een grote ziektelast, maar etiologie, behandeling en prognose zijn op cruciale onderdelen nog onvoldoende wetenschappelijk onderbouwd. In de spreekkamer hebben huisarts en patiënt het vaak over ‘hernia in de rug’, maar die diagnose kan niet gesteld worden op basis van anamnese en lichamelijk onderzoek alleen: daarvoor is beeldvorming nodig. Wel kan de anamnese significante aanwijzingen opleveren voor een hernia: BMI < 30, niet-plotseling begin, gevoelsstoornis en verergering van de beenpijn bij hoesten, niezen of persen. De enige bevinding die de kans op een operatie voorspelt, is de ernst van de pijn in het been; andere factoren die de prognose consistent beïnvloeden zijn nog niet gevonden. Er is dan ook meer onderzoek nodig naar de rol van inflammatoire factoren, naar de werkzaamheid van veelgebruikte behandelingen, zoals pijnmedicatie en fysiotherapie, en naar subgroepen van patiënten die baat hebben bij een bepaalde behandeling. Zulk onderzoek zou vooral ook in de eerste lijn gedaan moeten worden.

Abstract

Verwoerd JH. The secrets of sciatica. Huisarts Wet 2016;59(3):105-7.

Lumbosacral radicular syndrome (sciatica) is common and causes significant disability, but crucial aspects of our knowledge of its aetiology, treatments, and prognosis lack a firm scientific basis. It has several potential causes, such as inflammation and disc herniation. While general practitioners and patients often talk about a ‘herniated or slipped disc’, this diagnosis cannot be made on the basis of the patient history and physical examination alone but requires imaging. However, some patient information may be suggestive of a hernia, such as a body mass index lower than 30, non-sudden onset, sensory loss, and worsening of leg pain on coughing, sneezing, or straining. The only predictor of the need for surgery is the severity of the leg pain; other factors that influence the prognosis have not yet been identified. There is a need for research not only into the role of inflammatory factors but also into the effectiveness of common treatments, such as analgesics and physiotherapy, and into patient subgroups that might benefit from a particular treatment approach. Such research should especially be done in primary care.

Literatuur

  1. 1.
    Lin CW, Verwoerd AJ, Maher CG, Verhagen AP, Pinto RZ, Luijsterburg PA, et al. How is radiating leg pain defined in randomized controlled trials of conservative treatments in primary care? A systematic review. Eur J Pain 2014;18:455–64.CrossRefPubMedGoogle Scholar
  2. 2.
    Vroomen PCAJ, Peul WC, Pols MA, Kuijpers T, Van de Steeg HC, Bartels RHMA, et al. Richtlijn lumbosacraal radiculair syndroom. Utrecht: Nederlandse Vereniging voor Neurologie, 2008.Google Scholar
  3. 3.
    Schaafstra A, Spinnewijn WEM, Bons SCS, Borg MAJP, Koes BW, Ostelo RWJG, et al. NHG Standaard Lumbosacraal radiculair syndroom (tweede herziening). Huisarts Wet 2015;58(6):308–20.Google Scholar
  4. 4.
    Verwoerd JH. Diagnosis and prognosis of sciatica [proefschrift]. Rotterdam: Erasmus Universiteit, 2015.Google Scholar
  5. 5.
    Van der Windt DA, Simons, Laslett M, et al. Physical examination for lumbar radiculopathy due to disc herniation in patients with low-back pain. Cochrane Database Syst Rev 2010;2:CD007431.PubMedGoogle Scholar
  6. 6.
    Verwoerd AJ, Peul WC, Willemsen SP, Koes BW, Vleggeert-Lankamp CL, El Barzouhi A, et al. Diagnostic accuracy of history taking to assess lumbosacral nerve root compression. Spine J 2014;14:2028–37.CrossRefPubMedGoogle Scholar
  7. 7.
    Vroomen PC, De Krom MC, Wilmink JT, Kester AD, Knottnerus JA. Diagnostic value of history and physical examination in patients suspected of lumbosacral nerve root compression. J Neurol Neurosurg Psychiatry 2002;72:630–4.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Boos N, Rieder R, Schade V, Spratt KF, Semmer N, Aebi M. 1995 Volvo Award in clinical sciences. The diagnostic accuracy of magnetic resonance imaging, work perception, and psychosocial factors in identifying symptomatic disc herniations. Spine (Phila Pa 1976) 1995;20:2613–25.Google Scholar
  9. 9.
    Jensen MC, Brant-Zawadzki MN, Obuchowski N, Modic MT, Malkasian D, Ross JS. Magnetic resonance imaging of the lumbar spine in people without back pain. N Engl J Med 1994;331:69–73.CrossRefPubMedGoogle Scholar
  10. 10.
    Sirvanci M, Kara B, Duran C, Ozturk E, Karatoprak O, Onat L, et al. Value of perineural edema/inflammation detected by fat saturation sequences in lumbar magnetic resonance imaging of patients with unilateral sciatica. Acta Radiol 2009;50:205–11.CrossRefPubMedGoogle Scholar
  11. 11.
    Di Martino A, Merlini L, Faldini C. Autoimmunity in intervertebral disc herniation: from bench to bedside. Expert opinion on therapeutic targets. 2013;17:1461–70.Google Scholar
  12. 12.
    El Barzouhi A, Vleggeert-Lankamp, Verwoerd AJ, et al. Magnetic resonance imaging interpretation in patients with sciatica who are potential candidates for lumbar disc surgery. PLoS One 2013;8:e68411.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Wassenaar M, Van Rijn RM, Van Tulder MW, Verhagen AP, Van der Windt DA, Koes BW, et al. Magnetic resonance imaging for diagnosing lumbar spinal pathology in adult patients with low back pain or sciatica: a diagnostic systematic review. Eur Spine J 2012;21:220–7.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Weber H, Holme I, Amlie E. The natural course of acute sciatica with nerve root symptoms in a double-blind placebo-controlled trial evaluating the effect of piroxicam. Spine (Phila Pa 1976) 1993;18:1433–8.CrossRefGoogle Scholar
  15. 15.
    Verwoerd AJ, Luijsterburg PA, Lin CW, Jacobs WC, Koes BW, Verhagen AP. Systematic review of prognostic factors predicting outcome in non-surgically treated patients with sciatica. Eur J Pain 2013;17:1126–37.CrossRefPubMedGoogle Scholar
  16. 16.
    El Barzouhi A, Verwoerd AJ, Peul WC, Verhagen AP, Lycklama à Nijeholt GJ, Van der Kallen BF, et al. Prognostic value of Magnetic Resonance Imaging findings in patients with sciatica. J Neurosurg Spine. Accepted for publication 2015.Google Scholar
  17. 17.
    Chiu CC, Chuang TY, Chang KH, Wu CH, Lin PW, Hsu WY. The probability of spontaneous regression of lumbar herniated disc: a systematic review. Clin Rehabil 2015;29:184–95.CrossRefPubMedGoogle Scholar
  18. 18.
    Pinto RZ, Maher CG, Ferreira ML, Ferreira PH, Hancock M, Oliveira VC, et al. Drugs for relief of pain in patients with sciatica: systematic review and meta-analysis. BMJ 2012;344:e49–7.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Verwoerd AJ, Luijsterburg PA, Koes BW, El Barzouhi A, Verhagen AP. Does kinesiophobia modify the effects of physical therapy on outcomes in patients with sciatica in primary care? Subgroup analysis from a randomized controlled trial. Phys Ther 2015;95:1217–23.CrossRefPubMedGoogle Scholar

Copyright information

© Bohn Stafleu van Loghum 2016

Authors and Affiliations

  1. 1.Afdeling HuisartsgeneeskundeErasmus MCRotterdamThe Netherlands

Personalised recommendations