Article Figures & Data
Figures
- Figure 1
Panjabi’s model of spinal stability.9
- Figure 2
The US health care spending by payer for low back and neck pain totals $134.5 billion, compared with total diabetes spending of $111.2 billion and ischemic heart disease spending of $89.3 billion14 Reproduced with permission from Dieleman, J. L., et al., Journal of the American Medical Association, 2020, 323 (9) 863-884. Copyright © 2020. American Medical Association. All rights reserved.
- Figure 3
Motor control feedforward and feedback loops. Source: Adapted from Holm et al.74
- Figure 4
Key muscles of the lumbar trunk.
- Figure 5
Progression of acute to chronic low back pain. Source: Adapted from Hodges et al.7
- Figure 6
Anatomical orientation of the lumbar dorsal ramus.
- Figure 7
A restorative neurostimulation system.
- Figure 8
Implanted restorative neurostimulation system with lead fixation to the L2/3 intertransversarii.
- Figure 9
Anteroposterior and lateral view of the implanted leads. The leads are placed outside the spinal canal, adjacent to the peripheral nerve that innervates the multifidus muscle.
- Figure 10
Prone Instability Test. Source: Reprinted from Chakravarthy et al. Restorative neurostimulation: a clinical guide for therapy adoption. J Pain Res. 2022;15:1759–1774 under the Creative Commons Attribution Non-commercial license.
- Figure 11
Multifidus lift test. Source: Reprinted from Chakravarthy et al. Restorative neurostimulation: a clinical guide for therapy adoption. J Pain Res. 2022;15:1759–1774 under the Creative Commons Attribution Non-commercial license. The negative and positive responses have been reversed from the published version.
- Figure 12
Aberrant movement patterns/multifidus toe touch test.
- Figure 13
Magnetic resonance imaging classification of fatty infiltration. Source:Reprinted from Chakravarthy et al. Restorative neurostimulation: a clinical guide for therapy adoption. J Pain Res. 2022;15:1759–1774 under the Creative Commons Attribution Non-commercial license.
- Figure 14
Aggregated clinical data from published studies on restorative neurostimulation (ReActiv8-A Study,146,147 ReActiv8-B Study,150–153 ReActiv8-C Study,154 and ReActiv8-A-PMCF Study148,149).
Tables
Treatment Comparison and Timeframe Pain Depression Functional Status Cognitive behavioral therapy vs waiting list control Short term −0.6 (−0.97, –0.22) −1.92 (−6.16, 2.32) −0.37 (−0.87, 0.13) Behavioral treatment vs group exercise Short term −2.31 (−6.33, 1.7) 0.25 (−0.07, 0.58) - Intermediate term 1.18 (3.16, 5.53) 0.02 (−0.32, 0.35) - Long term 0.14 (−4.4, 4.67) 0.07 (−0.27, 0.41) - - Table 2
Subjective factors for chronic low back resulting from clinical lumbar spine instability.
Consultation Considerations Neuropathic origin Does the pain present in a dermatomal pattern?
Is the pain unilateral leg pain?
Is the leg pain greater than the low back pain?
Are there sensory disturbances, such as allodynia or paresthesia?
Is there a lower limb motor disturbance?
Is there a positive Lasègue’s sign or straight leg raise?
Mechanical origin Does your back giving way or giving out cause feelings of instability?
Do you need to frequently crack or pop the back to reduce symptoms?
Do you experience painful catching or locking during trunk motions?
Do you experience pain during transitional activities (sit to stand, etc)?
Does returning to an erect position from flexion cause greater pain?
Do you find it more difficult to sit unsupported than with a backrest?
Do sudden, trivial, or mild movements such as brushing teeth or low load task while flexed cause pain?
Is pain worse with sustained postures (driving, extended standing, etc)?
Are you fearful of moving?
Clinical Study Number of Participants LOF Evidence Level Publication Feasibility study 26 3 mo II-1 Deckers et al 2015145 ReActiv8-A 53 12 mo II-1 Deckers et al 2018146 48 mo II-1 Mitchell et al 2021147 ReActiv8- PMCF 37 24 mo II-1 Thomson et al 2021148 36 mo II-1 Thomson et al 2023149 ReActiv8-B 204 120 d/12 mo I/II Gilligan et al 2021150 24 mo II-1 Gilligan et al 2022151 36 mo II-1 Gilligan et al 2022152 48 mo N/A Gilligan et al153 Subanalysis II-1 Shaffrey et al 2022135 ReActiv8-C 41 12 mo II-1 Ardeshiri et al 2022154 Abbreviation: LOF, length of follow-up.
In this issue
Jump to section
- Article
- Abstract
- MECHANICAL CHRONIC LOW BACK PAIN CLINICAL PRESENTATION
- PREVALENCE
- ROLE OF MUSCLES IN LBP
- CURRENT TREATMENTS FOR CLBP
- REVIEW OF RESTORATIVE NEUROSTIMULATION
- PATIENT SELECTION CHARACTERISTICS
- CLINICAL EVIDENCE SUMMARY
- COMBINED OUTCOMES OF ReActiv8-A, ReActiv8-B, ReActiv8-C, AND ReActiv8-A-PMCF—1- TO 4-YEAR COMPLETERS
- GUIDANCE ON APPROPRIATE COVERAGE CRITERIA
- CURRENT COSTS ASSOCIATED WITH THE TREATMENT OF CLBP
- CODING FOR RESTORATIVE NEUROSTIMULATION
- CONCLUSION
- LIMITATIONS
- Footnotes
- References
- Figures & Data
- Info & Metrics
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