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Nikolai Bogduk

Publications and source records attributed to Nikolai Bogduk.

41 records · Page 3Linked to original sources
PubMedDate not supplied

A narrative review of intra-articular corticosteroid injections for low back pain.

OBJECTIVE: To summarize and to analyze the available literature on the efficacy of intra-articular injections of corticosteroids for low back pain. DESIGN: Publications, in English, French, and German, were obtained that reported the proportions of patients who obtained complete relief of pain following intra-articular steroids, and that provided any form of follow-up. These publications were analyzed to determine the rationale, indications, and outcomes of the treatment. RESULTS: The only rationale for intra-articular steroids appears to be the expectation that they should work. The most commonly used indication has been back pain, for which no specific diagnosis has been made. When the results of observational studies are pooled, they paint a picture of impressive immediate responses, but a rapid decay of outcomes by three and six months. Initial responses, however, are dissonant with the literature from controlled studies of the prevalence of lumbar zygapophysial joint pain. Moreover, controlled trials have shown that there is no attributable effect to the injection of steroids. CONCLUSION: The apparent efficacy of lumbar intra-articular steroids is no greater than that of a sham injection. There is no justification for the continued use of this intervention. Better outcomes can be achieved with deliberate placebo therapy.

Adrenal Cortex Hormones↗
PubMedDate not supplied

Pressure-controlled lumbar discography in volunteers without low back symptoms.

BACKGROUND: For lack of a criterion standard for lumbar discogenic pain, the validity of lumbar discography cannot be determined directly. The false-positive rate of discography, however, can be inferred from the prevalence of positive responses in asymptomatic volunteers. Responses in normal volunteers have been reported in only three studies, and the prevalence of positive responses has been "occasionally, zero, and 10%." None of these studies, however, controlled for both pressure of injection and intensity of response. PURPOSE: To determine the prevalence of positive responses to lumbar discography in asymptomatic volunteers, controlled for pressure of injection and intensity of response. STUDY DESIGN/SETTING: Prospective, observational study, conducted in a private spine center. Patient Sample. Four lay persons and nine physicians underwent lumbar discography, with manometry. OUTCOME MEASURES: The prevalence of painful responses were tabulated in terms of the intensity of response, the pressure of injection, the segment stimulated, disc morphology, and past history of low back pain. RESULTS: Some 56% of discs were not painful, despite maximum pressurization. The remaining 44% of discs were painful, to various degrees, at various pressures. Most discs required high pressures of injection to be painful but even so, were only mildly painful. A receiver-operator curve was derived to demonstrate combinations of pain intensity and pressure below which the probability of a response was zero or less than 10%. CONCLUSIONS: Lumbar discs in asymptomatic volunteers can be made painful, but as a rule, the pain is mild and requires high pressures of injection. If attention is paid to pressure of injection and intensity of response, operational criteria can be defined that provide lumbar discography with a potential false-positive rate of zero or less than 10%.

Adult↗
PubMedDate not supplied

Comparative effectiveness of cervical transforaminal injections with particulate and nonparticulate corticosteroid preparations for cervical radicular pain.

OBJECTIVES: Cervical transforaminal epidural injections of corticosteroids have been used in the treatment of radicular pain. Particulate agents have been associated with rare adverse neurological outcomes. It is unknown whether nonparticulate preparations are any less effective than particulate preparations. Therefore, a study was designed to determine whether there is a basis for promoting a theoretically safer nonparticulate corticosteroid preparation. DESIGN: Volunteer patients were randomized to receive a single cervical transforaminal epidural injection with one of two corticosteroid preparations. SETTING: This study was undertaken in a private practice setting. PATIENTS: Those with single-level, unilateral radicular pain with advanced imaging demonstrating single-level neural compression. INTERVENTIONS: Patients received a single cervical transforaminal epidural injection with either dexamethasone or triamcinolone. OUTCOME MEASURES: Ratings were obtained by an independent unbiased assessor at 4 weeks via a telephone interview. A visual analog pain scale was used preprocedurally and a verbal integer scale was used at 4 weeks to assess the severity of the patient's radicular pain. As a secondary outcome measure, a patient-specified functional outcome measure was obtained. RESULTS: Both groups exhibited statistically and clinically significant improvements in pain at 4 weeks. Although the triamcinolone group exhibited a somewhat greater improvement, the difference between groups was not significantly different. CONCLUSION: The study found that the effectiveness of dexamethasone was slightly less than that of triamcinolone, but the difference was neither statistically nor clinically significant. A theoretically safer nonparticulant agent appears to be a valid alternative to particulate agents that have been used to date, and which have been associated with hazard.

Adrenal Cortex Hormones↗