Lumbar Radiculopathy: a Descriptive Study on Red Flag and Neurologic Symptoms in Dr. Hasan Sadikin General Hospital Bandung

Astrid Feinisa Khairani, Kuheinderan Radha Krishnan, Umar Islami, Siti Aminah Sobana

Abstract


Over 80% of the adult population will experience an episode of low back pain (LBP). Low back pain is a pain in the lumbosacral region. When it progresses, which may be identified earlier with signs of a red flag, the manifestation might become radiculopathy. Radiculopathies are nerve root disease which may show signs of neurologic symptoms from the sensory, motoric, or autonomic origin. This study to help identify the clinical characteristics of a red flag in low back pain patients, which became lumbar radiculopathy for prognostic and diagnostic use. It is a descriptive quantitative cross-sectional study of medical records from patients hospitalized with complaints of low back pain with lumbar radiculopathy between January 2013–December 2015 in the Department of Neurology, Dr. Hasan Sadikin General Hospital, Bandung. It identifies a specific red flag and neurogenic symptoms. Patients most affected were housewives (26%), females (60%), and middle-aged adults (31%). The highest recorded symptom being sensory (76%), the highest progression was sensory to motoric (59%), affected by all three neurologic symptoms (39%), and trauma was the highest red flag recorded (48%). Low back pain patients who have signs of red flag show a high tendency to develop radiculopathy, which shows neurologic symptoms. If left untreated earlier, it may become a permanent disability.

 

RADIKULOPATI LUMBAR: STUDI DESKRIPTIF GEJALA KLINIS RED FLAG DAN GEJALA NEUROLOGIS DI RSUP DR. HASAN SADIKIN BANDUNG

Lebih dari 80% populasi penduduk dewasa akan mengalami episode low back pain (LBP). Low back pain merupakan nyeri pada bagian tulang belakang regio lumbo-sakral. Pada saat rasa sakitnya bertambah berat, gejala berbahaya dapat menjadi awal perkembangan LBP menjadi radikulopati. Radikulopati merupakan penyakit saraf pada daerah radiks neuron berupa gejala sensorik, motorik, dan otonomik. Penelitian ini bertujuan mengidentifikasi karakteristik gejala klinis tanda berbahaya (red flag) pada pasien LBP yang berlanjut menjadi radikulopati lumbar sebagai alat bantu diagnostik dan prognostik. Penelitian ini menggunakan metode penelitian cross-sectional kuantitatif deskriptif dari rekam medis pasien yang dirawat dengan diagnosis LBP dan radikulopati lumbar antara bulan Januari 2013–Desember 2015 di Departemen Ilmu Penyakit Saraf, RSUP Dr. Hasan Sadikin, Bandung. Penelitian ini mengidentifikasi gejala klinis red flag spesifik dan neurologis. Pasien yang terkena terutama ibu rumah tangga (26%), wanita (60%), usia dewasa pertengahan (31%). Gejala yang tercatat paling banyak adalah sensorik (76%), perkembangan progresif sensorik ke motorik (59%), mengalami gangguan ketiganya (39%), dan trauma menjadi penyebab red flag yang paling tinggi (48%). Pasien LBP yang memiliki gejala tanda berbahaya (red flag) memiliki kecenderungan tinggi berkembang menjadi radikulopati yang menunjukkan gejala neurologis. Jika tidak diobati lebih awal, ini dapat mengakibatkan kecacatan permanen.


Keywords


Low back pain; red flag; radiculopathy; radikulopati

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References


Ferguson SA, Merryweather A, Thiese MS, Hegmann KT, Lu ML, Kapellusch JM, et al. Prevalence of low back pain, seeking medical care, and lost time due to low back pain among manual material handling workers in the United States. BMC Musculoskelet Disord. 2019;20(1):243.

Duthey B. Background paper 6.24: low back pain. In: Kaplan W, Wirtz VJ, Mantel-Teeuwisse A, Stolk P, Duthey B, Laing R, editors. Priority medicines for Europe and the world: 2013 updated. Geneva: WHO Press; 2013. p. 6.24-1–29.

GBD 2015 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388(10053):1545–602.

Raison NT, Alwan W, Abbot A, Farook M, Khaleel A. The reliability of red flags in spinal cord compression. Arch Trauma Res. 2014;3(1):e17850.

Delitto A, George SZ, Van Dillen L, Whitman JM, Sowa GA, Shekelle P, et al. Low back pain: clinical practice guidelines linked to the international classification of functioning, disability, and health from the orthopaedic section of the American Physical Therapy Association. J Orthop Sports Phys Ther. 2012;42(4):A1–57.

Hooten WM, Cohen SP. Evaluation and treatment of low back pain: a clinically focused review for primary care specialists. Mayo Clin Proc. 2015;90(12):1699–718.

Wong AY, Karppinen J, Samartzis D. Low back pain in older adults: risk factors, management options and future directions. Scoliosis Spinal Disord. 2017;12:14.

Stochkendahl MJ, Kjaer P, Hartvigsen J, Kongsted A, Aaboe J, Andersen M, et al. National Clinical Guidelines for non-surgical treatment of patients with recent onset low back pain or lumbar radiculopathy. Eur Spine J. 2018;27(1):60–75.

Kreiner DS, Hwang SW, Easa JE, Resnick DK, Baisden JL, Bess S, et al. An evidence-based clinical guideline for the diagnosis and treatment of lumbar disc herniation with radiculopathy. Spine J. 2014;14(1):180–91.

Verhagen AP, Downie A, Popal N, Maher C, Koes BW. Red flags presented in current low back pain guidelines: a review. Eur Spine J. 2016;25(9):2788–802.

Yusuf M, Finucane L, Selfe J. Red flags for the early detection of spinal infection in back pain patients. BMC Musculoskelet Disord. 2019;20(1):606.

Tawa N, Rhoda A, Diener I. Accuracy of clinical neurological examination in diagnosing lumbo-sacral radiculopathy: a systematic literature review. BMC Musculoskelet Disord. 2017;18(1):93.

Berry JA, Elia C, Saini HS, Miulli DE. A review of lumbar radiculopathy, diagnosis, and treatment. Cureus. 2019;11(10):e5934.

Patrick N, Emanski E, Knaub MA. Acute and chronic low back pain. Med Clin North Am. 2016;100(1):169–81.

Williams CM, Henschke N, Maher CG, van Tulder MW, Koes BW, Macaskill P, et al. Red flags to screen for vertebral fracture in patients presenting with low-back pain. Cochrane Database Syst Rev. 2013;(1):CD008643.

Underwood M, Buchbinder R. Red flags for back pain. BMJ. 2013;347:f7432

Schoenfeld A, Laughlin M, Bader JO, Bono CM. Characterization of the incidence and risk factors for the development of lumbar radiculopathy. J Spinal Disord Tech. 2012;25(3):163–7.

Bener A, Dafeeah EE, Alnaqbi K. Prevalence and correlates of low back pain in primary care: what are the contributing factors in a rapidly developing country. Asian Spine J. 2014;8(3):227–36.

Akter S. Prevalence of low back pain among the housewives [dissertation]. Dhaka: Bangladesh Health Professions Institute (BHPI); 2014 [cited 2016 January 31]. Available from: http://dspace.crp-bangladesh.org:8080/xmlui/bitstream/handle/123456789/118/504%20Sonia%20Akter.pdf?sequence=1&isAllowed=y.

Wang C, Yu X, Yan Y, Yang W, Zhang S, Xiang Y, et al. Tumor necrosis factor-α: a key contributor to intervertebral disc degeneration. Acta Biochim Biophys Sin (Shanghai). 2017 Jan;49(1):1–13.

Fillingim RB, King CD, Ribeiro-Dasilva MC, Rahim-Williams B, Riley JL 3rd. Sex, gender, and pain: a review of recent clinical and experimental findings. J Pain. 2009;10(5):447–85.

Wáng YXJ, Wáng JQ, Káplár Z. Increased low back pain prevalence in females than in males after menopause age: evidences based on synthetic literature review. Quant Imaging Med Surg. 2016;6(2):199–206.

Shankar N, Thakur ML, Tandon OP, Saxena AK, Arora S, Bhattacharya N. Autonomic status and pain profile in patients of chronic low back pain and following electro acupuncture therapy: a randomized control trial. Indian J Physiol Pharmacol. 2011;55(1):25–36.

Friedman BW, Gensler S, Yoon A, Nerenberg R, Holden L, Bijur PE, et al. Predicting three-month functional outcomes after an ED visit for acute low back pain. Am J Emerg Med. 2017;35(2):299–305.

Gregory DS, Seto CK, Wortley GC, Shugart CM. Acute lumbar disk pain: navigating evaluation and treatment choices. Am Fam Physician. 2008;78(7):835–42.




DOI: https://doi.org/10.29313/gmhc.v8i1.5253


pISSN 2301-9123 | eISSN 2460-5441

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