Magnetic Resonance Neurography in Chronic Lumbosacral and Pelvic Pain: Diagnostic and Management Impact–Institutional Audit

Riham Dessouky, Yin Xi, Kelly M. Scott, Mohammed Khaleel, Kevin Gill, Stephanie Jones, Dalia N. Khalifa, Hazim I. Tantawy, Magdy A. Aidaros, Avneesh Chhabra

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background/Objective: Low back and pelvic pain are among the most prevalent conditions worldwide, with major social and economic costs. The aim of this study was to evaluate the role of magnetic resonance neurography (MRN) of lumbosacral plexus in the management and outcomes of these patients with chronic pain. Methods: Consecutive patients with chronic lumbosacral and pelvic pain referred for MRN over a year were included. Preimaging and postimaging clinical diagnosis and treatment, pain levels, and location were recorded. Pain-free survival was compared between treatments using a Cox proportional hazards model. Results: A total of 202 patients with mean age 53.7 ± 14.8 years and a male/female ratio of 1:1.53 were included. Of these patients, 115 presented with radiculopathy (57%), 56 with pelvic pain (28%), and 31 with groin pain (15%). Mean initial pain level was 6.9 ± 1.9. Mean symptom duration was 4.21 ± 5.86 years. Of these patients, 143 (71%) had a change in management because of MRN. After MRN, reduction in pain levels was observed in 21 of 32 patients receiving conservative treatment (66%), 42 of 67 receiving injections (63%), and 27 of 33 receiving surgery (82%). Follow-ups were available in 131 patients. Median pain-free survival was 12 months. Patients treated with surgery had significantly lower pain recurrence than patients receiving other treatments in the same time frame (hazard ratio, 3.6; 95% confidence interval, 1.4–9.2; P = 0.0061). Conclusions: MRN use in chronic lumbosacral and pelvic pain led to a meaningful change in diagnosis and treatment. After MRN, conservative treatment and injections provided pain relief; however, patients benefited more from surgery than from any other treatment.

Original languageEnglish (US)
JournalWorld Neurosurgery
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Management Audit
Pelvic Pain
Pain Management
Chronic Pain
Magnetic Resonance Spectroscopy
Pain
Lumbosacral Plexus
Therapeutics
Injections
Radiculopathy
Survival
Groin
Low Back Pain
Proportional Hazards Models

Keywords

  • Lumbosacral
  • Management
  • MRN
  • Outcome
  • Pelvic pain

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Magnetic Resonance Neurography in Chronic Lumbosacral and Pelvic Pain : Diagnostic and Management Impact–Institutional Audit. / Dessouky, Riham; Xi, Yin; Scott, Kelly M.; Khaleel, Mohammed; Gill, Kevin; Jones, Stephanie; Khalifa, Dalia N.; Tantawy, Hazim I.; Aidaros, Magdy A.; Chhabra, Avneesh.

In: World Neurosurgery, 01.01.2018.

Research output: Contribution to journalArticle

@article{01741134eb7542cfa16565806fa3b074,
title = "Magnetic Resonance Neurography in Chronic Lumbosacral and Pelvic Pain: Diagnostic and Management Impact–Institutional Audit",
abstract = "Background/Objective: Low back and pelvic pain are among the most prevalent conditions worldwide, with major social and economic costs. The aim of this study was to evaluate the role of magnetic resonance neurography (MRN) of lumbosacral plexus in the management and outcomes of these patients with chronic pain. Methods: Consecutive patients with chronic lumbosacral and pelvic pain referred for MRN over a year were included. Preimaging and postimaging clinical diagnosis and treatment, pain levels, and location were recorded. Pain-free survival was compared between treatments using a Cox proportional hazards model. Results: A total of 202 patients with mean age 53.7 ± 14.8 years and a male/female ratio of 1:1.53 were included. Of these patients, 115 presented with radiculopathy (57{\%}), 56 with pelvic pain (28{\%}), and 31 with groin pain (15{\%}). Mean initial pain level was 6.9 ± 1.9. Mean symptom duration was 4.21 ± 5.86 years. Of these patients, 143 (71{\%}) had a change in management because of MRN. After MRN, reduction in pain levels was observed in 21 of 32 patients receiving conservative treatment (66{\%}), 42 of 67 receiving injections (63{\%}), and 27 of 33 receiving surgery (82{\%}). Follow-ups were available in 131 patients. Median pain-free survival was 12 months. Patients treated with surgery had significantly lower pain recurrence than patients receiving other treatments in the same time frame (hazard ratio, 3.6; 95{\%} confidence interval, 1.4–9.2; P = 0.0061). Conclusions: MRN use in chronic lumbosacral and pelvic pain led to a meaningful change in diagnosis and treatment. After MRN, conservative treatment and injections provided pain relief; however, patients benefited more from surgery than from any other treatment.",
keywords = "Lumbosacral, Management, MRN, Outcome, Pelvic pain",
author = "Riham Dessouky and Yin Xi and Scott, {Kelly M.} and Mohammed Khaleel and Kevin Gill and Stephanie Jones and Khalifa, {Dalia N.} and Tantawy, {Hazim I.} and Aidaros, {Magdy A.} and Avneesh Chhabra",
year = "2018",
month = "1",
day = "1",
doi = "10.1016/j.wneu.2018.02.072",
language = "English (US)",
journal = "World Neurosurgery",
issn = "1878-8750",
publisher = "Elsevier Inc.",

}

TY - JOUR

T1 - Magnetic Resonance Neurography in Chronic Lumbosacral and Pelvic Pain

T2 - Diagnostic and Management Impact–Institutional Audit

AU - Dessouky, Riham

AU - Xi, Yin

AU - Scott, Kelly M.

AU - Khaleel, Mohammed

AU - Gill, Kevin

AU - Jones, Stephanie

AU - Khalifa, Dalia N.

AU - Tantawy, Hazim I.

AU - Aidaros, Magdy A.

AU - Chhabra, Avneesh

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background/Objective: Low back and pelvic pain are among the most prevalent conditions worldwide, with major social and economic costs. The aim of this study was to evaluate the role of magnetic resonance neurography (MRN) of lumbosacral plexus in the management and outcomes of these patients with chronic pain. Methods: Consecutive patients with chronic lumbosacral and pelvic pain referred for MRN over a year were included. Preimaging and postimaging clinical diagnosis and treatment, pain levels, and location were recorded. Pain-free survival was compared between treatments using a Cox proportional hazards model. Results: A total of 202 patients with mean age 53.7 ± 14.8 years and a male/female ratio of 1:1.53 were included. Of these patients, 115 presented with radiculopathy (57%), 56 with pelvic pain (28%), and 31 with groin pain (15%). Mean initial pain level was 6.9 ± 1.9. Mean symptom duration was 4.21 ± 5.86 years. Of these patients, 143 (71%) had a change in management because of MRN. After MRN, reduction in pain levels was observed in 21 of 32 patients receiving conservative treatment (66%), 42 of 67 receiving injections (63%), and 27 of 33 receiving surgery (82%). Follow-ups were available in 131 patients. Median pain-free survival was 12 months. Patients treated with surgery had significantly lower pain recurrence than patients receiving other treatments in the same time frame (hazard ratio, 3.6; 95% confidence interval, 1.4–9.2; P = 0.0061). Conclusions: MRN use in chronic lumbosacral and pelvic pain led to a meaningful change in diagnosis and treatment. After MRN, conservative treatment and injections provided pain relief; however, patients benefited more from surgery than from any other treatment.

AB - Background/Objective: Low back and pelvic pain are among the most prevalent conditions worldwide, with major social and economic costs. The aim of this study was to evaluate the role of magnetic resonance neurography (MRN) of lumbosacral plexus in the management and outcomes of these patients with chronic pain. Methods: Consecutive patients with chronic lumbosacral and pelvic pain referred for MRN over a year were included. Preimaging and postimaging clinical diagnosis and treatment, pain levels, and location were recorded. Pain-free survival was compared between treatments using a Cox proportional hazards model. Results: A total of 202 patients with mean age 53.7 ± 14.8 years and a male/female ratio of 1:1.53 were included. Of these patients, 115 presented with radiculopathy (57%), 56 with pelvic pain (28%), and 31 with groin pain (15%). Mean initial pain level was 6.9 ± 1.9. Mean symptom duration was 4.21 ± 5.86 years. Of these patients, 143 (71%) had a change in management because of MRN. After MRN, reduction in pain levels was observed in 21 of 32 patients receiving conservative treatment (66%), 42 of 67 receiving injections (63%), and 27 of 33 receiving surgery (82%). Follow-ups were available in 131 patients. Median pain-free survival was 12 months. Patients treated with surgery had significantly lower pain recurrence than patients receiving other treatments in the same time frame (hazard ratio, 3.6; 95% confidence interval, 1.4–9.2; P = 0.0061). Conclusions: MRN use in chronic lumbosacral and pelvic pain led to a meaningful change in diagnosis and treatment. After MRN, conservative treatment and injections provided pain relief; however, patients benefited more from surgery than from any other treatment.

KW - Lumbosacral

KW - Management

KW - MRN

KW - Outcome

KW - Pelvic pain

UR - http://www.scopus.com/inward/record.url?scp=85045956287&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85045956287&partnerID=8YFLogxK

U2 - 10.1016/j.wneu.2018.02.072

DO - 10.1016/j.wneu.2018.02.072

M3 - Article

C2 - 29581014

AN - SCOPUS:85045956287

JO - World Neurosurgery

JF - World Neurosurgery

SN - 1878-8750

ER -