Neurosurgical Evaluation for Patients with Chronic Lower Back Pain
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ANESTHETIC TECHNIQUES IN PAIN MANAGEMENT (D WANG, SECTION EDITOR)
Neurosurgical Evaluation for Patients with Chronic Lower Back Pain Daniel Franco 1
&
Aria Mahtabfar 1 & Kevin Hines 1 & Victor Sabourin 1 & Anthony Stefanelli 1 & James Harrop 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review Chronic low back pain (CLBP) is a major cause of disability in the USA, and it affects approximately 1 in 4 Americans. CLBP patients are commonly referred to or seek out neurosurgical evaluations and opinions for treatment and management. Recent Findings Literature shows that only a minority of patients with CLBP may benefit from a surgical procedure. These patients that present to clinic often have been ailing for a considerable amount of time and are eager for effective treatment to alleviate pain. However, determining if a patient with CLBP is a surgical candidate is predicated upon having no success of pain relief with non-operative management. Patients with CLBP require thorough and adequate imaging, clinical exam, and diagnostic evaluation. Summary When adequate non-operative management was provided, and proven fruitless, the patient may be considered an operative candidate. In this manuscript, a framework is presented for workup and evaluation of patients with CLBP. Keywords Chronic low back pain . Spinal fusion . Arthrodesis . Radiculopathy . Referred pain . Electromyography . Selective nerve root injection
Introduction Chronic low back pain (CLBP) is defined as ongoing lower back pain that lasts greater than 6 months’ time and is a major cause of disability in the USA. It accounts for the greatest number of years lived with disability in the US population [1••], and further acute and chronic LBP affects approximately 1 in 4 Americans [2, 3]. This problem causes a tremendous financial burden on the public healthcare system [4] and society [5]. Recent surveys estimate that 540 million people worldwide are affected with LBP globally [6]. In developed societies, CLBP accounts for 120 million days of absence from work each year, where 50% of patients are out of work for more than 6 months with a high rate of not returning [7, 8]. Unfortunately, CLBP patients have concurrent socioeconomic This article is part of the Topical Collection on Anesthetic Techniques in Pain Management * Daniel Franco [email protected]
disadvantage and clustering of behavioral, psychosocial, and medical issues [7]. CLBP is insidious and multifactorial, where often a specific diagnosis and etiology for this ailment are not identified and termed non-specific low back pain. CLBP patients are commonly referred to or seek out neurosurgical evaluations and opinions for treatment and management. A minority of patients with CLBP may benefit from a surgical procedure. In this manuscript, a framework is presented for workup and evaluation of patients.
Clinical Encounter in the Neurosurgical Spine Clinic The etiology of low back pain is complex and consists of a heterogeneous group of etiologies,
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