Lumbar intervertebral disc herniation

Does an Increase in Neural Adaptive Movement Decrease LBP Symptoms?

A controlled radiologic follow-up study 1 in the journal “Spine” decided to observe whether or not clinical symptoms changed due to changes in cord excursion with the SLR test.

What Was the Context?

Sciatica is known to have an economical, physical, and psychological impact on numerous people around the globe. It has been described as the type of pain that originates from the buttock distally in the lower limb in the sciatic nerve’s distribution.

The leading case of sciatica has been observed to be the LIDH or lumbar intervertebral disc herniation. The SLR or the straight leg raise test is a standard used around the world for diagnosing LIDH-led sciatica. However, the test is deemed insufficient in isolation.

That is why better knowledge regarding the neural biomechanics associated with SLR needs to be provided to improve test interpretation.

What Was the Objective?

Due to the nerve root excursion being impaired in people with lumbar intervertebral disc herniation during intraoperative investigations and because of this reduction being expressed in the conus medullaris (in LIDH having patients), the current research team followed up with the same patients over 1.5 years.

The objective was to investigate if there existed a relationship between the reduction of neural movement and symptomatology in patients having symptomatic radiculopathy. The study also investigated if such a relationship remained in people who have recovered.

What Methods Were Used?

In the 1.5 years follow-up, a total of 14 patients were reassessed clinically as well as radiologically using a 1.5T MRI scanner. All of the patients had significant sciatic symptoms because of a subacute single-level posterolateral LIDH.

The team quantified the conus medullaris’ displacement during SLR (bilateral and unilateral). The quantified collected data was compared to the data from the baseline.

Variables that were strongly associated with a decrease in LBP (Low Back Pain) and radicular symptoms were identified using the backward variable selection method and the multivariate regression models.

What Did the Results Show?

According to the results, the current data showed a significant increase in neural sliding (with respect to quantified maneuvers) when compared to the baseline values. Take note; the increase in neural sliding was observed to correlate significantly with a reduction in LBP and radicular symptoms.

The improvement of neural sliding was confirmed to be the primary variable associated with the improvement in a patient’s self-reported symptoms.

In conclusion, the shared data was deemed as the first noninvasive type of data that showed support regarding the relationship between the increase of neural adaptive movement and the resolution of LBP as well as radicular symptoms in in vivo and a human subject (who is structurally intact).