المؤلفون: Simon Rio, Guillaume Coiffier, Benoit Le Goff, Pascal Guggenbuhl, François Robin, Christelle Darrieutort-Laffite, Jean-David Albert

المساهمون: CHU Pontchaillou [Rennes], Nutrition, Métabolismes et Cancer (NuMeCan), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Centre hospitalier universitaire de Nantes (CHU Nantes), Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)

المصدر: Joint Bone Spine
Joint Bone Spine, 2020, 87 (4), pp.364-365. ⟨10.1016/j.jbspin.2019.11.006⟩
Joint Bone Spine, Elsevier Masson, 2020, 87 (4), pp.364-365. ⟨10.1016/j.jbspin.2019.11.006⟩

مصطلحات موضوعية: musculoskeletal diseases, medicine.medical_specialty, Steroid injection, Injections, Epidural, caudal hiatus epidural injection, 03 medical and health sciences, 0302 clinical medicine, Lumbar, Rheumatology, medicine, Humans, Lower lumbar radicular pain, 030212 general & internal medicine, Prospective Studies, ultrasound-guided, Radiculopathy, Ultrasonography, Interventional, 030203 arthritis & rheumatology, Lumbar Vertebrae, business.industry, Joint bone, medicine.disease, Ultrasound guided, 3. Good health, [SDV.MHEP.RSOA]Life Sciences [q-bio]/Human health and pathology/Rhumatology and musculoskeletal system, Radicular pain, [SDV.SP.PHARMA]Life Sciences [q-bio]/Pharmaceutical sciences/Pharmacology, Observational study, Steroids, Radiology, business, Low Back Pain

الوصف: International audience; Lower lumbar radicular pain is a benign and frequent condition, mostly induced by disk herniation or osteoarthritis. The management of lower lumbar radicular pain is a public health problem, with multimodal management. Lumbar epidural steroid injections are considered as a treatment but their effectiveness remains controversial, with conflicting results. Injection via the caudal hiatus route (CH) under ultrasound (US) guidance has gained popularity because of accessibility or US equipment, absence of irradiation, feasibility and very few complications reported.A pragmatic prospective observational two-center (Rennes and Nantes University Hospitals) study was performed to evaluate the effectiveness of a single steroid (cortivazol) epidural injection delivered under US guidance via the CH on lower lumbar radicular pain. The primary outcome for success was achieving a numerical pain rating scale score (NPRS ≤ 3/10 at day 30 (D30) after epidural injection. The secondary endpoints were achieving a NPRS ≤ 3/10 at D30 without opiates and NSAIDs, level of analgesic and NSAIDs consumption, absence from work and occurrence of adverse events. Factors related to efficacy were not well established.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::a5a5b79217b011b702095c1b7fbd0af0Test
https://univ-rennes.hal.science/hal-02442527/documentTest

المؤلفون: Paul Arnolfo, Yves Maugars, Benoit Le Goff, Jean-Marie Berthelot, Christelle Darrieutort-Laffite, Joëlle Glémarec

المصدر: Joint bone spine. 88(1)

مصطلحات موضوعية: musculoskeletal diseases, medicine.medical_specialty, Lasègue test, Physical examination, Neurological examination, Sitting, 03 medical and health sciences, Sciatica, 0302 clinical medicine, Lumbar, Physical medicine and rehabilitation, Rheumatology, medicine, Humans, Medical history, 030212 general & internal medicine, Range of Motion, Articular, 030203 arthritis & rheumatology, Leg, Lumbar Vertebrae, medicine.diagnostic_test, business.industry, Lumbosacral Region, Test (assessment), medicine.symptom, business, Intervertebral Disc Displacement

الوصف: Diagnosis of sciatica mainly relies on pain reproduction by stretching of the lumbar roots since neurological examination and medical history are usually not sufficient to guarantee diagnosis. The Lasegue test is the most popular method, which starts with the straight leg-raising test (SLR). However it is not perfect, and is not always well performed or interpreted. Passive ankle dorsiflexion at the end of the SLR (Bragard test) is more sensitive, but can also remain normal in some cases of sciatica. Other stretching tests can help to recognise lumbar root damage in patients with poorly defined pain in a lower extremity: firstly, the Christodoulides test, i.e. reproduction of L5 sciatic pain by a femoral stretch test; secondly, the Slump test, performed on a patient in a sitting position, by slowly extending their painful leg then passively bending their neck (or the opposite); and thirdly, the Bowstring test, which requires, at the end of the Lasegue test, once the knee has been slightly flexed, pressing on the course of the peroneal and/or tibial nerves in the popliteal fossea to try and reproduce the exact pain felt by the patient. The combination of all these tests takes less than 2 minutes, and could improve both the sensitivity and specificity of the physical examination for the diagnosis of sciatica. This article is a review of the limitations of the Lasegue/SLR tests and of the efficacy of these other tests for stretching the lumbar roots.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::46a9eab49f1988767c89d527d2609134Test
https://pubmed.ncbi.nlm.nih.gov/32561431Test

المؤلفون: Philippe Montigny, Grégoire Cormier, Benoit Le Goff, Céline Cozic, Gilles Tanguy, Christelle Volteau, Yves Maugars, Stéphane Varin, Joëlle Glémarec, Christelle Darrieutort Laffite

المصدر: Joint Bone Spine. 85:359-363

مصطلحات موضوعية: Adult, Male, medicine.medical_specialty, Lidocaine, Visual analogue scale, medicine.drug_class, medicine.medical_treatment, Injections, Intralesional, Cortivazol, Placebo, Risk Assessment, Severity of Illness Index, Statistics, Nonparametric, 03 medical and health sciences, 0302 clinical medicine, Double-Blind Method, Rheumatology, Reference Values, 030202 anesthesiology, medicine, Humans, Prospective Studies, Anesthetics, Local, Glucocorticoids, Saline, Aged, Pain Measurement, Lumbar Vertebrae, Local anesthetic, business.industry, Lumbosacral Region, Middle Aged, Prognosis, Low back pain, Surgery, Treatment Outcome, Anesthesia, Drug Therapy, Combination, Female, medicine.symptom, Tomography, X-Ray Computed, business, Low Back Pain, 030217 neurology & neurosurgery, Lumbosacral joint, medicine.drug

الوصف: Objective The primary objective of this study was to compare the efficacy of local injection of a local anesthetic with a glucocorticoid versus a local anesthetic with saline to treat low back pain due to lumbosacral transitional vertebras (LSTV) with a pseudoarticulation. Methods A randomized placebo-controlled double-blind study was conducted in patients with unilateral low back pain ascribed clinically to LSTV. Patients were randomized to lidocaine plus saline (LS group) or lidocaine plus cortivazol (LC group) injected locally under computed tomography guidance. The primary outcome measure was the 24-hour mean visual analog scale (VAS) score for low back pain 4 weeks after the injection. Results Of 16 randomized patients, 15 were included in the analysis, 8 in the LS group and 7 in the LC group. The mean VAS pain score at week 4 was not significantly different between the two groups. In the two groups pooled, the mean VAS pain score decreased significantly from baseline to week 4, from 5.52 ± 0.99 to 3.86 ± 2.55 (P ≤ 0.05). The difference remained significant at week 12. Significant improvements occurred in the EIFEL disability index and items of the Dallas Pain Questionnaire. No adverse events were recorded. Conclusion In patients with chronic low back pain consistent with a symptomatic LSTV type II or IV in the Castellvi classification, a local injection of lidocaine with or without cortivazol may provide sustained improvements in pain and function. The underlying mechanism is unclear.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::a9bfad3bd3d962e0479cdcb9f6bd8f59Test
https://doi.org/10.1016/j.jbspin.2017.05.003Test

المؤلفون: Benoit Le Goff, Lucie Planche, Christelle Darrieutort-Laffite, Géraldine Bart, Yves Maugars, Joëlle Glémarec

المصدر: Joint Bone Spine. 82:356-361

مصطلحات موضوعية: Anesthesia, Epidural, Male, medicine.medical_specialty, Hydrocortisone, Visual analogue scale, medicine.medical_treatment, Anti-Inflammatory Agents, Injections, Epidural, Spinal Puncture, Palpation, law.invention, Sciatica, Lumbar, Rheumatology, Randomized controlled trial, law, medicine, Clinical endpoint, Humans, Single-Blind Method, Prospective Studies, Pain Measurement, Ultrasonography, Lumbar Vertebrae, medicine.diagnostic_test, Epidural steroid injection, business.industry, Lumbosacral Region, Middle Aged, Epidural space, Surgery, Treatment Outcome, medicine.anatomical_structure, Anesthesia, Feasibility Studies, Female, medicine.symptom, business, Low Back Pain

الوصف: Ultrasound (US) is widely used in rheumatology to study and guide injection of peripheral joints. It can also provide useful information about the anatomy of the lumbar spine. Studies have shown that US examination of the spine was a useful tool to help perform epidural anaesthesia. The purpose of the study was to determine if the selection of the optimum puncture level by US may facilitate epidural steroid injection in case of presumed difficult puncture (BMI30 kg/m(2), age60 years or lumbar scoliosis).We performed a prospective randomized controlled study. Eighty patients were randomized in two groups: US group (n=40) which underwent a pre-procedure spinal US to determine the optimal lumbar level for injection or control group (n=40) for which the level of injection was determined by palpation. Primary endpoint was the pain during the procedure assessed using the Visual Analogue Scale (VAS).We found a positive correlation between depth of the epidural space and BMI (P0.001) and a negative correlation between size of the interspinous spaces and age (P0.01). Visibility of the epidural space was not altered by obesity or age. We observed a trend toward a reduction in pain intensity during the procedure in the US group compared to the control group with a mean difference at -0.94 [-1.90; 0.02] but the difference was not significant (P=0.054).US of the lumbar spine was feasible in patients with lumbar conditions even in obese and old ones and allowed the visualization of the epidural space. However, pre-procedure US examination did not reduce pain during the procedure.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::19e267d8a378100ff867b09137e81d59Test
https://doi.org/10.1016/j.jbspin.2015.02.001Test

المؤلفون: Olivier Hamel, Benoit Le Goff, Joëlle Glémarec, Christelle Darrieutort-Laffite, Yves Maugars

المصدر: Joint Bone Spine. 81:130-136

مصطلحات موضوعية: musculoskeletal diseases, medicine.medical_specialty, Facet (geometry), Lumbar Vertebrae, Nerve root, business.industry, Ultrasound, Thoracolumbar fascia, Anatomy, musculoskeletal system, Rheumatology, Iliolumbar ligament, medicine.anatomical_structure, Internal medicine, medicine.ligament, Erector spinae muscles, Humans, Medicine, Lumbar spine, Radiology, business, Ultrasonography

الوصف: Ultrasonography of the bones and joints has gained considerable ground in the field of rheumatology over the past decade and is now used in everyday practice both for diagnostic purposes and to guide local injections. However, the use of ultrasonography is virtually confined to the peripheral joints, whereas spinal diseases make a major contribution to rheumatology practice. Studies have established that ultrasonography of the lumbar spine is feasible. Adequate equipment and familiarity with spinal sonoanatomy are required. In this update, we suggest starting with a systematic examination of the lumbar spine to assess the various anatomic structures, from the thoracolumbar fascia superficially to the posterior part of the vertebras at the deepest level. The ligaments, erector spinae muscles, facet joints, and transverse processes can be visualized. Ultrasonography can serve to guide injections into the facet joints, about the nerve roots, and into the iliolumbar ligaments; as well as to identify relevant landmarks before epidural injection. Although diagnostic applications are more limited at present, systematic studies of abnormal ultrasonography findings will allow evaluations of the potential usefulness of ultrasonography for diagnosing spinal disorders. The depth of the spinal structures limits the ability to obtain high-resolution images. However, future technical improvements in ultrasound transducers and machines, together with the growing number of physicians trained in ultrasonography, can be expected to benefit the development of spinal ultrasonography in the near future.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::61c26fff0314359e0a744ed99b80aab3Test
https://doi.org/10.1016/j.jbspin.2013.10.009Test

المؤلفون: Jean-Marie Berthelot, Christelle Darrieutort-Laffite, Benoit Le Goff, Hubert Desal

المصدر: Joint bone spine. 83(4)

مصطلحات موضوعية: Adult, medicine.medical_specialty, Vena Cava, Inferior, Lumbar vertebrae, Inferior vena cava, Multimodal Imaging, Sensitivity and Specificity, Varicose Veins, 03 medical and health sciences, 0302 clinical medicine, Lumbar, Rheumatology, Medicine, Humans, Ultrasonography, Doppler, Color, Ultrasonography, Interventional, 030203 arthritis & rheumatology, Varix, Lumbar Vertebrae, medicine.diagnostic_test, business.industry, Ultrasound, Magnetic resonance imaging, medicine.disease, Low back pain, Magnetic Resonance Imaging, medicine.anatomical_structure, medicine.vein, Female, Radiology, medicine.symptom, business, Venous malformation, Tomography, X-Ray Computed, Low Back Pain, 030217 neurology & neurosurgery

الوصف: Ultrasonography is currently widely used in the rheumatology practice. Although mainly performed to study peripheral joint, several articles have underlined its interest to study spinal anatomy. However, its ability to provide diagnostic features is unknown. We studied the case of a 25-year-old woman having low back pain. Three different imaging modalities (Computed Tomography [CT], Magnetic Resonance Imaging [MRI] and Ultrasound) were used to explore it. CT and MRI showed a foraminal dilation of the lombo-ovarian vein at the L3-L4 level with a scalloping of the lateral edge of L3. We were able to detect it with Color Doppler Ultrasound and a malformation of the inferior vena cava was also found. We showed for the first time that Color Doppler Ultrasound can detect venous malformation of the spine. This imaging modality could help us in the diagnosis of atypical lesions of the spine to confirm their vascular origin.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::0783278b2a1d4075b4af21126ec53d8aTest
https://pubmed.ncbi.nlm.nih.gov/27068620Test