Top

European Spine Journal

Published in:

01-04-2014 | Original Article

Is NICE guidance for identifying lumbar nerve root compression misguided?

Authors: Tim Germon, William Singleton, Jeremy Hobart

Published in: European Spine Journal | Special Issue 1/2014

Abstract

Purpose

To determine the extent to which the clinical manifestations of a cohort of people undergoing surgery for lumbosacral nerve root compression satisfy those described in The National Institute for Health and Care Excellence (NICE) guidance.

Method

We studied consecutive admissions for lumbar nerve root decompression surgery at two neurosurgical units. Pre-operatively, each person’s clinical manifestations were documented and compared with NICE’s description. Post-operatively, at three time points (within 48 h, 3 months, 12 months), each person rated their symptoms as either better, the same, or worse.

Results

Pre-operatively, one person (0.8 %), from 123 admissions, under 20 different consultant neurosurgeons, had manifestations consistent with NICE’s clinical description of lumbar nerve root compression. Post-operatively, self-reported benefit associated with surgery appeared high, at all three time points (78–91 %), supporting the diagnosis of symptomatic nerve root compression and the value of surgery.

Conclusions

In this small sample, from two units, NICE’s description of the clinical manifestations of lumbar nerve root compression did not describe 99 % of people having surgery for it. Using NICE’s definition to triage people with low back pain could result in prolonged symptoms and delayed treatment. Diagnosing lumbar nerve root compression is complex. NICE’s guidance requires examination.

The National Institute for Health and Care Excellence (NICE) is a non-departmental public body of the Department of Health in the United Kingdom, serving both the English NHS and the Welsh NHS.

Walker BF (2000) The prevalence of low back pain: a systematic review of the literature from 1966 to 1998. J Spinal Disord 13(3):205–217PubMedCrossRef

http://www.nice.org.uk/nicemedia/live/11887/44336/44336.pdf

Baron R, Elashaal A, Germon T, Hobart J (2006) Measuring outcomes in cervical spine surgery: think twice before using the SF-36. Spine 31(22):2575–2584PubMedCrossRef

Hobart JC, Cano SJ, Zajicek JP, Thompson AJ (2007) Rating scales as outcomes measures for clinical trials in neurology: problems, solutions, and recommendations. Lancet Neurol 6:1094–1105PubMedCrossRef

Tsang KT, Hobart JC, Sudhakar N, Germon TJ (2010) Spinal surgery: do current measures measure what needs to be measured? J Bone Joint Surg 92(supp III):381

Konstantinou K, Dunn K (2008) Sciatica: review of epidemiological studies and prevalence estimates. Spine 33(22):2462–2472CrossRef

Waddell G, Main CJ, Morris EW, Venner RM, Rae PS, Sharmy SH, Galloway H (1982) Normality and reliability in the clinical assessment of backache. Br Med J 284(6328):1519CrossRef

Clinical Standards Advisory Group (1994) Back pain. HMSO, London

Waddell G (1998) The back pain revolution. Churchill Livingstone, Edinburgh

10.

Vroomen PC, de Krom MC, Wilmink JT, Kester AD, Knottnerus JA (1999) Lack of effectiveness of bed rest for sciatica. N Engl J Med 340:418–423PubMedCrossRef

11.

Lewis R, Wiliams N, Matar HE, Din N, Fitzsimmons D, Philips C et al (2011) The clinical effectiveness and cost-effectiveness of management strategies for sciatica: systematic review and economic model. Health Technol Assess 15(39):1–578PubMed

12.

Weinstein JN, Lurie JD, Tosteson TD, Tosteson AN, Blood EA, Abdu WA, Herkowitz H, Hilibrand A, Albert T, Fischgrund J (2008) Surgical versus non-operative treatment for lumbar disc herniation: four-year results for the Spine Patient Outcomes Research Trial (SPORT). Spine 33(25):2789–2800PubMedCentralPubMedCrossRef

13.

Atlas SJ, Keller RB, Wu YA, Deyo RA, Singer DE (2005) Long-term outcomes of surgical and nonsurgical management of sciatica secondary to a lumbar disc herniation: 10 years results from the maine lumbar spine study. Spine 30(8):927–935PubMedCrossRef

14.

Weber H (1983) Lumbar disc herniation. A controlled, prospective study with ten years of observation. Spine 8(2):131–140PubMedCrossRef

15.

Chou R, Baisden J, Carragee EJ, Resnick DK, Shaffer W, Loeser JD (2009) Surgery for low back pain. Spine 34(10):1094–1109PubMedCrossRef

16.

Gibson JNA, Waddell G (2007) Surgical interventions for lumbar disc prolapse. Cochrane Database of Syst Rev 1(2):CD001350. doi:10.1002/14651858.CD001350.pub4

17.

http://www.nice.org.uk/nicemedia/live/14212/65526/65526.pdf

Title: Is NICE guidance for identifying lumbar nerve root compression misguided?
Authors: Tim Germon
William Singleton
Jeremy Hobart
Publication date: 01-04-2014
Publisher: Springer Berlin Heidelberg
Published in: European Spine Journal / Issue Special Issue 1/2014
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-014-3233-y

At a glance: The STEP trials

Springer Medicine

Is NICE guidance for identifying lumbar nerve root compression misguided?

Abstract

Purpose

Method

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Method

Results

Conclusions

Please log in to get access to this content

Other articles of this Special Issue 1/2014

The role of needle tip position on the accuracy of diagnostic selective nerve root blocks in spinal deformity

Calcified giant thoracic disc herniations: considerations and treatment strategies

The lumbar spine has an intrinsic shape specific to each individual that remains a characteristic throughout flexion and extension

Access-related complications in anterior lumbar surgery in patients over 60 years of age

Early experience of MAGEC magnetic growing rods in the treatment of early onset scoliosis

Reviewer’s comment concerning “Is NICE guidance for identifying lumbar nerve root compression misguided?” (doi:10.1007/s00586-014-3233-y by T. Germon et al.)