In order to promote the standardization of the treatment of neuropathic pain by spinal dorsal root entry surgery, alleviate the pain of certain specific neuropathic pain patients, and improve their quality of life and survival, experts with experience in neuropathic pain and spinal dorsal root entry surgery were organized by Functional Neurosurgery Group of the Neurosurgery Branch of the Chinese Medical Association and Functional Neurosurgery Expert Committee of Chinese Congress of Neurological Surgeons to write this consensus. Based on a systematic review and summary of literature and clinical evidence at home and abroad, this consensus discusses the diagnosis and drug treatment of neuropathic pain, clinical application of, spinal dorsal root entry surgery the selection of patients receiving surgery of dorsal root entry zone, preoperative examination, surgical procedures, postoperative management, and the prevention and management of postoperative complications, and forms 12 recommended recommendations, providing reference and guidance for clinical work on the treatment of neuropathic pain through spinal dorsal root entry surgery.
为促进脊髓背根入髓区手术对神经病理性疼痛治疗的标准化与规范化，缓解某些特定神经病理性疼痛患者的病痛，提高其生活和生存质量，中华医学会神经外科分会功能神经外科学组、中国医师协会神经外科医师分会功能神经外科专家委员会组织神经病理性疼痛及具有脊髓背根入髓区手术经验方面的专家撰写本共识。本共识在系统回顾与总结国内外文献及临床证据基础上，就神经病理性疼痛的诊断与药物治疗、脊髓背根入髓区手术的临床应用、接受脊髓入髓区手术治疗患者的选择、术前检查、手术操作、术后管理以及术后并发症预防与处理等方面进行了论述并形成12条推荐建议，为临床开展脊髓背根入髓区手术治疗神经病理性疼痛方面的工作提供参考与指导。.

Spinal pain (SP) is a common condition that has a major negative impact on a patient\'s quality of life. Recent developments in ultrasound-guided injections for the treatment of SP are increasingly being used in clinical practice. This clinical expert consensus describes the purpose, significance, implementation methods, indications, contraindications, and techniques of ultrasound-guided injections. This consensus offers a practical reference point for physicians to implement successfully ultrasound-guided injections in the treatment of chronic SP.

Intraoperative monitoring (IOM) is commonly used during lumbar fusion surgery for the prevention of nerve root injury. Justification for its use stems from the belief that IOM can prevent nerve root injury during the placement of pedicle screws. A thorough literature review was conducted to determine if the use of IOM could prevent nerve root injury during the placement of instrumentation in lumbar or lumbosacral fusion. There is no evidence to date that IOM can prevent injury to the nerve roots. There is limited evidence that a threshold below 5 mA from direct stimulation of the screw can indicate a medial pedicle breach by the screw. Unfortunately, once a nerve root injury has taken place, changing the direction of the screw does not alter the outcome. The recommendations formulated in the original guideline effort are neither supported nor refuted with the evidence obtained with the current studies.

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OBJECTIVE: The objectives of this study were to develop consensus on (i) the content of a clinical assessment for adults presenting to primary care with low back and leg pain, and (ii) the most important items for diagnosing spinal nerve root involvement.
METHODS: Existing literature and expert knowledge was used to compile a list of items pertaining to clinical history questions and examination tests employed in the assessment of patients with low back pain with suspected spinal nerve involvement. A Delphi consensus method was employed to rate the importance of items for clinical assessment and for diagnosis in two web-based rounds. A multidisciplinary group of 42, including GPs, physiotherapists, osteopaths, rheumatologists, spinal orthopaedic surgeons and chiropractors took part. Items were included in the final assessment when over 70% of participants rated them as important.
RESULTS: Thirty-four items were included in the clinical assessment, and 15 items for diagnosis. History items included pain distribution in the leg, pain quality and behaviour, altered sensation, functional limitations and yellow flags, previous history of similar symptoms and outcome of previous treatment/management. Examination items included typical neurological tests including neural tension and \'demonstration of movement that produces symptoms\'.
CONCLUSIONS: We have developed a clinical assessment schedule for patients with low back pain and leg pain presenting in primary care. History and clinical items considered important for their contribution in the diagnosis of nerve root involvement were also established.

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A consensus development meeting concerning the treatment of lumbosacral radicular syndrome (LRS) by entrapment by a herniated disc or spinal stenosis was held on June 9th, 1995. It was observed that there is a lack of good evidence on many aspects of diagnosis and treatment of LRS. Agreement was reached on the thesis that the natural course of LRS is often benign. Diagnosis and treatment can usually be left to the primary care physician. Specialist consultation and ancillary investigations are only needed if an operation is indicated or in case of persistent diagnostic uncertainty. If imaging is needed MRI is preferred to CT or myelography. MRI is highly sensitive, but less specific, and may thus give false-positive results. Neurophysiologic testing may be informative in selected cases. Plain spinal X-rays are not useful in most cases. The traditional non-invasive treatments (such as bedrest, traction, physiotherapy, spinal manipulation) are not based upon convincing scientific evidence. Diagnostic imaging and invasive treatment should be considered in patients with a severe LRS that does not improve within a 4 to 8 week period. Both discectomy and chemonucleolysis are effective treatments. The principal indication is incapacitating radicular pain. There is no sound evidence that the prognosis of paresis is improved by operation. A cauda equina syndrome urgently needs surgical treatment. The efficacy of percutaneous interventions (nucleotomy, laser therapy) has not been proven. There are no strategies for the primary or secondary prevention of LRS that have demonstrated their efficacy. Psychological, social and financial factors probably contribute significantly to the occurrence of persisting symptoms after a LRS. Advice not to work after treatment for LRS may impede rehabilitation.

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