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Normalization of Spinal Cord Displacement With the Straight Leg Raise and Resolution of Sciatica in Patients With Lumbar Intervertebral Disc Herniation

A 1.5-year Follow-up Study

Pesonen, Janne MD∗,‡; Rade, Marinko MSc, Orth, Med, PhD†,∗∗,††; Könönen, Mervi PhD§; Marttila, Jarkko MD; Shacklock, Michael FACP, MAppSc, DipPhysio; Vanninen, Ritva MD, PhD§; Kankaanpää, Markku MD, PhD||; Airaksinen, Olavi MD, PhD∗∗

doi: 10.1097/BRS.0000000000003047
DIAGNOSTICS
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Study Design. A controlled radiologic follow-up study.

Objective. The aim of this study was to ascertain whether changes in cord excursion with straight leg raise test (SLR) at 1.5-year follow-up time accompany changes in clinical symptoms.

Summary of Background Data. Lumbar intervertebral disc herniation (LIDH) is known to be a key cause of sciatica. Previously, we found that a significant limitation of neural displacement (66.6%) was evident with the SLR on the symptomatic side of patients with subacute single level posterolateral LIDH.

Methods. Fourteen patients with significant sciatic symptoms due to a subacute single-level posterolateral LIDH were reassessed clinically and radiologically at 1.5 years follow-up with a 1.5T MRI scanner. Displacement of the conus medullaris during the unilateral and bilateral SLR was quantified reliably with a randomized procedure and compared between SLRs and to data from baseline. Multivariate regression models and backward variable selection method were employed to identify variables more strongly associated with a decrease in low back pain (LBP) and radicular symptoms.

Results. Compared with previously presented baseline values, the data showed a significant increase in neural sliding in all the quantified maneuvers (P ≤ 0.01), and particularly of 2.52 mm (P ≤ 0.001) with the symptomatic SLR.

Increase in neural sliding correlated significantly with decrease of both radicular symptoms (Pearson = -0.719, P ≤ 0.001) and LBP (Pearson = -0.693, P ≤ 0.001). Multivariate regression models and backward variable selection method confirmed the improvement of neural sliding effects (P ≤ 0.004) as the main variable being associated with improvement of self-reported clinical symptoms.

Conclusion. To our knowledge, these are the first noninvasive data to objectively support the association between increase in magnitude of neural adaptive movement and resolution of both radicular and LBP symptoms in in vivo and structurally intact human subjects.

Level of Evidence: 2

We show noninvasively data to objectively support the association between improvement of neural adaptive movement and resolution of clinical symptoms in in vivo and structurally intact human subjects with clinically and radiologically proven posterolateral lumbar intervertebral disc herniation.

Department of Rehabilitation, Kuopio University Hospital, Kuopio, Finland

Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Orthopaedic and Rehabilitation Hospital “Prim. dr. Martin Horvat”, Rovinj, Croatia

Department of Surgery (incl. Physiatry), Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland

§Department of Radiology, Kuopio University Hospital, Kuopio, Finland

Neurodynamic Solutions, Adelaide, South Australia, Australia

||Department of Physical and Rehabilitation Medicine, Tampere University Hospital, Tampere, Finland

∗∗Department of Physical and Rehabilitation Medicine, Kuopio University Hospital, Kuopio, Finland

††Juraj Dobrila University of Pula, Department of Natural and Health Studies, Pula, Croatia.

Address correspondence and reprint requests to Marinko Rade, MSc, Orth, Med, PhD, Kuopio University Hospital, Department of Physical and Rehabilitation Medicine, 3961, PL100, 70029 KYS, Finland; E-mail: ravnateljstvo@bolnica-rovinj.hr, marinko.rade@gmail.com; marinko.rade@kuh.fi

Received 26 July, 2018

Revised 6 February, 2019

Accepted 11 February, 2019

JP and MR hold shared authorship.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

No relevant financial activities outside the submitted work.

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