Articles: low-back-pain.
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Lumbar selective nerve root blocks have been performed to establish the origin of lumbar radiculopathy in clinically difficult cases. The diagnostic ability of selective nerve root blocks remains controversial because of concern over potential spread of an injectate onto adjacent structures. ⋯ Injection of 1 ml of contrast under fluoroscopic guidance does not guarantee selective spread of the contrast around L4 or L5 nerve roots only. There is also spread toward the more medial nerve root in the same spinal segment during L4 and L5 nerve root infiltration. These findings suggest that it is possible to differentiate between L4 and L5 nerve root pathology using a sequential nerve root blocks under fluoroscopic guidance.
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Spinal injections are commonly used to treat lumbar radiculitis and back pain. Delivery of medication to specific targeted pathology is considered important for a successful therapeutic outcome. A variety of routes of injection have been devised for epidural injection of corticosteroid. ⋯ The radiographic findings demonstrate a difference between classic infra-pedicular versus retrodiscal transforaminal epidural contrast injection patterns, particularly at relatively low volumes. The clinical advantage of one technique versus the other should be established in randomized prospective studies.
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Comparative Study
MRI of paraspinal muscles in lumbar degenerative kyphosis patients and control patients with chronic low back pain.
To compare lumbar musculature in lumbar degenerative kyphosis (LDK) patients and chronic low-back pain (CLBP) patients. ⋯ Evaluation of paraspinal musculature should be considered when assessing MRI images of the lumbar spine. Measurement of the CSA, visual grading of fatty atrophy and the assessment of the fascia may help physician and radiologist reach a more confident diagnosis for the patients with clinically suspicious LDK.
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Prolotherapy involves repeated injections of irritant solutions to strengthen lumbosacral ligaments and reduce some types of chronic low-back pain; spinal manipulation and exercises are often used to enhance its effectiveness. ⋯ There is conflicting evidence regarding the efficacy of prolotherapy injections for patients with chronic low-back pain. When used alone, prolotherapy is not an effective treatment for chronic low-back pain. When combined with spinal manipulation, exercise, and other co-interventions, prolotherapy may improve chronic low-back pain and disability. Conclusions are confounded by clinical heterogeneity amongst studies and by the presence of co-interventions.