Recently, Research Review Service released a free bonus update
containing brief summaries of 20 studies that were not reviewed in full
for subscribers to the service in 2010. Below is an excerpt from one
summary contained in this document.
Study Title: Inciting events associated with lumbar disc herniation
Authors: Suri P et al.
Publication Information: The Spine Journal, 2010; 10: 388-395.
INTRODUCTION
Recently, Research Review Service released a free bonus update containing brief summaries of 20 studies that were not reviewed in full for subscribers to the service in 2010. Below is an excerpt from one summary contained in this document.
SUMMARY
To date, no study has investigated the frequency of patient-identified inciting events in lumbar disc herniation (LDH), or their clinical significance. Therefore, the aim of this study was to examine the clinical frequency of patient-identified inciting events in LDH, and to identify associations between the presence of inciting events and the severity of the clinical presentation. The study was conducted as a cross-sectional analysis of data from a cohort study with prospective recruitment, with retrospective data collection on inciting events. One hundred fifty-four adults with lumbosacral radicular pain and LDH confirmed by magnetic resonance imaging were analyzed.
RESULTS
In this study sample, 62 per cent of LDH did not have a specific patient-identified event associated with symptom onset. When there was an inciting event reported, the most common were non-lifting activities, comprising 26 per cent of all LDH. Heavy lifting (6.5 per cent), light lifting (2 per cent), non-exertional occurrences (2 per cent), and physical trauma (1.3 per cent) accounted for relatively small proportions of all LDH. Overall, in crude analyses, patient-identified inciting events were not significantly associated with a more severe clinical presentation.
COMMENTS
The results of this study can help guide clinicians as we deal with patients with LDH. It is apparent that many cases of LDH can occur without a specific inciting event. Further, even if an event is reported, this does not seem to correlate well with the severity of the clinical presentation. This finding supports the concept that disc degeneration and damage leading to overt herniation occurs over time, as a culmination of repeated faulty loading and disc nutrition. Repetitive microtrauma can lead to overt tissue failure even during a task that would seem insufficient to the patient. If patients believe that a particular strenuous activity either triggered their disc herniation or caused their injury to be more severe, they may be less inclined to comply with treatment recommendations when these involve increased activity or exercise. Communicating in an evidence-informed manner with your patients can help avoid such confusion.
To download the full document, visit www.researchreviewservice.com or e-mail Dr. Thistle at shawn@researchreviewservice.com.
Look for more reviews from the summary document in the May issue of Canadian Chiropractor magazine.•
Dr. Shawn Thistle is the founder and president of Research Review Service Inc., an online, subscription-based service designed to help busy practitioners to integrate current, relevant scientific evidence into their practice. Shawn graduated from CMCC and holds an Honours Degree in Kinesiology from McMaster University. He also holds a certificate in Contemporary Medical Acupuncture from McMaster University, and is a Certified Active Release Techniques (ART®) Provider. For more information about the Research Review Service, visit www.researchreviewservice.com .
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