Marina Sangheli - Academia.edu (original) (raw)

Papers by Marina Sangheli

Buletinul Academiei de Ştiinţe a Moldovei. Ştiinţe Medicale, Jul 1, 2009

The Moldovan Medical Journal, Mar 31, 2023

Background: Low back pain (LBP) for many years is considered one of the most common conditions ca... more Background: Low back pain (LBP) for many years is considered one of the most common conditions causing work absenteeism and long-term disability, with important implications for public health systems and economies. Pain generators of LBP are various, being distinguished specific and non-specific causative mechanisms. The term "non-specific" LBP remains ambiguous as potential sources of pain are supposed to be muscles or joints, but supplementary investigations do not correlate enough to explain the pain intensity and disability. The nociceptive and/or neuropathic mechanisms characteristic for acute pain tend to be influenced by central sensitization while pain chronification occurs, leading to new descriptor as nociplastic pain. Chronic low back pain, considered mostly non-specific, was mechanistically referred to primary musculoskeletal low back pain, the concept introduced in the new ICD-11 classification. The process of acceptance by the scientific medical community raised debates and discussions. The aim of the study was to analyze the evolving concept of non-specific low back pain to chronic primary musculoskeletal low back pain. A narrative literature review was carried out. Conclusions: The term non-specific low back pain is used when the pain generators have not been accurately determined or cannot fully explain the existing symptomatology. Chronic primary musculoskeletal low back pain is better explained by central sensitization mechanisms and altered nociception, named nociplastic pain. Because of raised ambiguities regarding this concept further studies are expected to shed light on the problem.

Curierul Medical, Apr 1, 2014

Background: Association of congenital myopathy with COVID-19-associated peripheral neuropathy is ... more Background: Association of congenital myopathy with COVID-19-associated peripheral neuropathy is not reported. We aim to present such a case. Material and methods: Clinical case of a 14-year-old male with history of myopathy from the age of 5 who presented with features of COVID-19-related polyneuropathy and multiple organ dysfunction syndrome. Results: The patient was admitted with generalized muscle weakness, motor difficulties, unsteady gait, chest pain, respiratory failure. Physically-hyposthenic body type, muscle atrophy, cyanosis, shortness of breath, tachycardia, hepatomegaly. Neurologically-muscle pain on palpation, hypotonia, especially in lower limbs, distal hypoesthesia, loss of deep tendon reflexes and myopathic gait. IgG and IgM SARS-Cov-2 were elevated and the patient presented a history of fever one month before admission. The albumin and total protein were low, but serum creatine kinase, creatine kinase-MB, LDH, liver enzymes, D-dimers were elevated, as well as cerebrospinal fluid protein level. The chest CT showed fibro atelectasis of S3 and S10 segments of the left lung, pleural adhesions. Electromyography studies showed a myopathic pattern. The patient received five plasma exchange treatments and was weaned from mechanical ventilation. The treatment also included antibiotics, infusion therapy, dexamethasone, which resulted in a partial response. Conclusions: The presented case of the association of congenital myopathy and Covid-19 associated peripheral neuropathy had a partial response to treatment. Such cases should be tailored by a multidisciplinary management team.

Background: Cervical pain related to different spine pathologies is a major cause of disability. ... more Background: Cervical pain related to different spine pathologies is a major cause of disability. The relationship between clinical patterns, pain, psychological states was demonstrated. Disability in patients with cervical pain remains still high. Material and methods: A total of 42 patients (14 males, 28 females) with cervical pain were assed using visual analogue scale (VAS), hospital anxiety and depression scale (HADS), patient health questionare-9 (PHQ-9), neck disability index (NDI) and other clinical data. Results: Acute pain was present in 24 % of patients while gradual in 76%. Among clinical patterns the most common form was referred pain (52%) followed by axial neck pain (33%) and radiculopathy in (14%). NDI correlated with pain intensity (VAS) and the psycho-emotional state (for HADS and PHQ-9, p < 0.001). A higher depression score was found in patient with referred pain and radiculopathy (mean 8.0 points ±4 points according to PHQ9 score). Also, NDI was higher in patients with comorbidities, current joint pain and systemic disorders, referred pain, with acute onset, and no previous trauma. Conclusions: The results from the current study highlighted an association between NDI and pain intensity and psychological state, predominantly in the group with referred pain, and radiculopathy. Acute cervical pain, with no previous trauma, with systemic disorders and other joint pain interfered with a higher risk for developing disabilities. Further research looking at multiple factors such as clinical presentation features of cervical pain and clinical outcomes will additionally guide the development of adequate management strategies for cervical pain.

European Journal of Pain, Sep 1, 2009

In this study we analysed 224 patients who had been operated in the period of 2003–2008. We compa... more In this study we analysed 224 patients who had been operated in the period of 2003–2008. We compared the efficacy of analgesic methods by using visual analog scale (VAS). Treatment of postoperative pain was different. Patients were divided in 3 groups: group A (n =75) patients were treated only with ketoprofen, group B (n =71) patients were treated with ketorolak and tramadol, group C (n =78) patients were treated with acetaminofen and tramadol, and were placed peridural cateter. A combination of acetaminofen and tramadol with peridural cateter can reduce 40% of the total amount of nonopioids and opioids needed postoperatively and also reduce its side effects.

Terapia prin iradiere este o metodă folosită cel mai frecvent în tratamentul pacienţilor cu tumor... more Terapia prin iradiere este o metodă folosită cel mai frecvent în tratamentul pacienţilor cu tumori de diversă localizare. Analiza riguroasă a benefi ciilor şi efectelor adverse posibile, de rând cu evaluarea factorilor de risc, permit evitarea uneia din cele mai grave complicaţii, cum ar fi mielopatia de iradiere. Forma tardivă a maladiei are сel mai nefast prognostic. Cazul clinic prezentat a evidenţiat atât probleme de diagnostic diferenţial, cât şi importanţa determinării localizării ţesuturilor vulnerabile de vecinătate, în raport cu organul-ţintă expus iradierii

Buletinul Academiei de Ştiinţe a Moldovei. Ştiinţe Medicale, Oct 1, 2013

Общественное здоровье, экономика и менеджмент в медицине, 2020

Miastenia gravis (MG) este o afecțiune în care transmiterea neuromusculară este perturbată ca urm... more Miastenia gravis (MG) este o afecțiune în care transmiterea neuromusculară este perturbată ca urmare a unui atac autoimun asupra țintelor antigenice postsinaptice, producând slăbiciunea fluctuantă a mușchilor scheletici. Mai des e o maladie sporadică, cazurile familiale fi ind foarte rare, reprezentând doar 3-5% din totalul cazurilor de MG. A fost efectuată sinteza literaturii de specialitate, consacrate ca zurilor familiale de MG. În contextul analizei rolului factorului ereditar prin prisma sintezei cercetărilor existente, se prezintă cazul unei paciente cu formă generalizată de MG, care are un istoric familial de MG oculară la cele două surori, una dintre care este sora geamănă, toate trei având un debut tardiv al manifestărilor clinice și statut serologic identic pentru anticorpi ai receptorilor de acetilcolină (Ac AchR). Suspiciunea clinică și testarea ulterioară a Ac AchR la cele două surori ale pacientei au permis stabilirea diagnosticului și raportarea acestui caz familial de miastenie gravis. Tomografi a computerizată (TC) a mediastinului nu a confi rmat patologia timică. În schimb, în toate cele trei cazuri a fost evidențiată patologia autoimună a glandei tiroide, ceea ce demonstrează importanța factorului genetic în apariția maladiei. Analiza cazului clinic prezentat subliniază importanța investigării rudelor pacienților miastenici și a cunoașterii riscului relativ al acestora pentru MG în vederea consilierii adecvate. Sunt necesare studii ulterioare ale cazurilor familiale de MG pentru clarifi carea contribuției factorilor genetici în apariția bolii.

European teaching course on neurorehabilitation, 2016

7th Congress of the Society of Neurologists Issue of the Republic of Moldova, 2021

Background: The cerebrovascular pathologies are among the most important causes of morbidity, mor... more Background: The cerebrovascular pathologies are among the most important causes of morbidity, mortality and disabilities worldwide and in the Republic of Moldova. The aim of the study was the analysis of the stroke care quality indicators of patients in Balti Clinical Hospital. Material and methods: We present a retrospective study that included medical records (from January to April, 2021) of 72 patients with stroke, confirmed clinically and by cerebral CT scan. Results: The mean age of the patients included in our study was 65.8 ± 14.7 years old, 34 men and 38 women. The mean timing from the first symptoms till the admission at the Emergency department was 7.0±3.5 hours. The mean timing spent at the Emergency department was 3.0 ± 1.5 hours. CT-scan examination 24 hours after hospitalization was performed in 63.75% of the patients. Cerebral vessel dopplerography was performed in 6 patients. Thrombolytic therapy was not performed in any of the patients. The mean duration of treatment was 10.0 ± 3.0 days. 65 patients were discharged with an amelioration, while 7 patients died. Conclusions: The qualitative indices in specialized medical care for cerebral attack patients in Balti Clinical Hospital were influenced by the following factors: patients' presentation out of the therapeutical window as well as the impossibility of performing a cerebral CT-scan in the first 24 hours at the hospital, as well as the Covid-19 pandemic situation.

Catedra Neurologie, Catedra Medicină Internă nr.3, USMF ”Nicolae Testemițanu”,Centrul Medical ”Ex... more Catedra Neurologie, Catedra Medicină Internă nr.3, USMF ”Nicolae Testemițanu”,Centrul Medical ”Excellence”

European Journal of Pain, 2009

In this study we analysed 224 patients who had been operated in the period of 2003–2008. We compa... more In this study we analysed 224 patients who had been operated in the period of 2003–2008. We compared the efficacy of analgesic methods by using visual analog scale (VAS). Treatment of postoperative pain was different. Patients were divided in 3 groups: group A (n =75) patients were treated only with ketoprofen, group B (n =71) patients were treated with ketorolak and tramadol, group C (n =78) patients were treated with acetaminofen and tramadol, and were placed peridural cateter. A combination of acetaminofen and tramadol with peridural cateter can reduce 40% of the total amount of nonopioids and opioids needed postoperatively and also reduce its side effects.

Catedra Neurologie USMF „Nicolae Testemiţanu” Laboratorul Vertebroneurologie, IMSP Institutul de ... more Catedra Neurologie USMF „Nicolae Testemiţanu” Laboratorul Vertebroneurologie, IMSP Institutul de Neurologie si Neurochirurgie

Scleroza multiplă (SM) este o boală inflamatorie cronică a sistemului nervos central, care poate ... more Scleroza multiplă (SM) este o boală inflamatorie cronică a sistemului nervos central, care poate duce la invaliditate permanentă la adulţii tineri. Investigarea epidemiologiei SM în Republica Moldova prezintă interes, luând în consideraţie şi faptul că evoluţia naturală a bolii încă nu este influenţată de utilizarea medicamentelor modifi catoare a bolii. În studiu au fost incluşi pacienţii diagnosticaţi cu SM conform criteriilor McDonald 2010, formele clinic şi imagistic defi nite. 747 de pacienţi cu SM locuiau în zona de studiu, la ziua de prevalenţă, 31 decembrie 2012. Prevalenţa era de 21,0 la 100000 (95% CI: 14,8 – 27,1). Din 724 de cazuri prevalente, 460 (63,5%) au fost de sex feminin, cu vârsta medie de 42,1 ± 11,9 ani şi 264 (36,5%) au fost de sex masculin, cu vârsta medie 40,8 ± 12,8 ani. Cele mai mari estimări au fost observate în grupa de vârstă 40-49 ani, pentru femei, 57,0 la 100000 locuitori şi pentru bărbaţi, 29,0 la 100000 locuitori. Prevalenţa brută estimată a sclero...

În baza studiului clinico-morfologic a fost elaborată o nouă clasificare a mielopatiei vasculare ... more În baza studiului clinico-morfologic a fost elaborată o nouă clasificare a mielopatiei vasculare ischemice, care conţine 6 capitole: după etiologie, caracterul ischemiei, localizarea focarului, vasul afectat şi formele clinice. Este prevăzută şi expertiza medicală a vitalităţii

Articolul actual este rezultatul selectării și analizei ghidurilor internaționale publicate, conc... more Articolul actual este rezultatul selectării și analizei ghidurilor internaționale publicate, concepute evidențierii punctelorcheie decizionale în managementul durerii lombare. Cercetarea riguroasă a acestor resurse relevă direcțiile de diagnosticare, terapie sau prevenție, dovedite a fi cele mai eficiente în abordarea pacienților cu sindrom algic lombar, luând în considerație existența incertitudinilor cu privire la cea mai bună abordare a patologiei date, deoarece publicațiile existente în marea majoritate sunt cu rezultate contradictorii și mai mult țin de epidemiologie, decât de aspecte clinice

Buletinul Academiei de Ştiinţe a Moldovei. Ştiinţe Medicale, Jul 1, 2009

The Moldovan Medical Journal, Mar 31, 2023

Background: Low back pain (LBP) for many years is considered one of the most common conditions ca... more Background: Low back pain (LBP) for many years is considered one of the most common conditions causing work absenteeism and long-term disability, with important implications for public health systems and economies. Pain generators of LBP are various, being distinguished specific and non-specific causative mechanisms. The term "non-specific" LBP remains ambiguous as potential sources of pain are supposed to be muscles or joints, but supplementary investigations do not correlate enough to explain the pain intensity and disability. The nociceptive and/or neuropathic mechanisms characteristic for acute pain tend to be influenced by central sensitization while pain chronification occurs, leading to new descriptor as nociplastic pain. Chronic low back pain, considered mostly non-specific, was mechanistically referred to primary musculoskeletal low back pain, the concept introduced in the new ICD-11 classification. The process of acceptance by the scientific medical community raised debates and discussions. The aim of the study was to analyze the evolving concept of non-specific low back pain to chronic primary musculoskeletal low back pain. A narrative literature review was carried out. Conclusions: The term non-specific low back pain is used when the pain generators have not been accurately determined or cannot fully explain the existing symptomatology. Chronic primary musculoskeletal low back pain is better explained by central sensitization mechanisms and altered nociception, named nociplastic pain. Because of raised ambiguities regarding this concept further studies are expected to shed light on the problem.

Curierul Medical, Apr 1, 2014

Background: Association of congenital myopathy with COVID-19-associated peripheral neuropathy is ... more Background: Association of congenital myopathy with COVID-19-associated peripheral neuropathy is not reported. We aim to present such a case. Material and methods: Clinical case of a 14-year-old male with history of myopathy from the age of 5 who presented with features of COVID-19-related polyneuropathy and multiple organ dysfunction syndrome. Results: The patient was admitted with generalized muscle weakness, motor difficulties, unsteady gait, chest pain, respiratory failure. Physically-hyposthenic body type, muscle atrophy, cyanosis, shortness of breath, tachycardia, hepatomegaly. Neurologically-muscle pain on palpation, hypotonia, especially in lower limbs, distal hypoesthesia, loss of deep tendon reflexes and myopathic gait. IgG and IgM SARS-Cov-2 were elevated and the patient presented a history of fever one month before admission. The albumin and total protein were low, but serum creatine kinase, creatine kinase-MB, LDH, liver enzymes, D-dimers were elevated, as well as cerebrospinal fluid protein level. The chest CT showed fibro atelectasis of S3 and S10 segments of the left lung, pleural adhesions. Electromyography studies showed a myopathic pattern. The patient received five plasma exchange treatments and was weaned from mechanical ventilation. The treatment also included antibiotics, infusion therapy, dexamethasone, which resulted in a partial response. Conclusions: The presented case of the association of congenital myopathy and Covid-19 associated peripheral neuropathy had a partial response to treatment. Such cases should be tailored by a multidisciplinary management team.

Background: Cervical pain related to different spine pathologies is a major cause of disability. ... more Background: Cervical pain related to different spine pathologies is a major cause of disability. The relationship between clinical patterns, pain, psychological states was demonstrated. Disability in patients with cervical pain remains still high. Material and methods: A total of 42 patients (14 males, 28 females) with cervical pain were assed using visual analogue scale (VAS), hospital anxiety and depression scale (HADS), patient health questionare-9 (PHQ-9), neck disability index (NDI) and other clinical data. Results: Acute pain was present in 24 % of patients while gradual in 76%. Among clinical patterns the most common form was referred pain (52%) followed by axial neck pain (33%) and radiculopathy in (14%). NDI correlated with pain intensity (VAS) and the psycho-emotional state (for HADS and PHQ-9, p < 0.001). A higher depression score was found in patient with referred pain and radiculopathy (mean 8.0 points ±4 points according to PHQ9 score). Also, NDI was higher in patients with comorbidities, current joint pain and systemic disorders, referred pain, with acute onset, and no previous trauma. Conclusions: The results from the current study highlighted an association between NDI and pain intensity and psychological state, predominantly in the group with referred pain, and radiculopathy. Acute cervical pain, with no previous trauma, with systemic disorders and other joint pain interfered with a higher risk for developing disabilities. Further research looking at multiple factors such as clinical presentation features of cervical pain and clinical outcomes will additionally guide the development of adequate management strategies for cervical pain.

European Journal of Pain, Sep 1, 2009

In this study we analysed 224 patients who had been operated in the period of 2003–2008. We compa... more In this study we analysed 224 patients who had been operated in the period of 2003–2008. We compared the efficacy of analgesic methods by using visual analog scale (VAS). Treatment of postoperative pain was different. Patients were divided in 3 groups: group A (n =75) patients were treated only with ketoprofen, group B (n =71) patients were treated with ketorolak and tramadol, group C (n =78) patients were treated with acetaminofen and tramadol, and were placed peridural cateter. A combination of acetaminofen and tramadol with peridural cateter can reduce 40% of the total amount of nonopioids and opioids needed postoperatively and also reduce its side effects.

Terapia prin iradiere este o metodă folosită cel mai frecvent în tratamentul pacienţilor cu tumor... more Terapia prin iradiere este o metodă folosită cel mai frecvent în tratamentul pacienţilor cu tumori de diversă localizare. Analiza riguroasă a benefi ciilor şi efectelor adverse posibile, de rând cu evaluarea factorilor de risc, permit evitarea uneia din cele mai grave complicaţii, cum ar fi mielopatia de iradiere. Forma tardivă a maladiei are сel mai nefast prognostic. Cazul clinic prezentat a evidenţiat atât probleme de diagnostic diferenţial, cât şi importanţa determinării localizării ţesuturilor vulnerabile de vecinătate, în raport cu organul-ţintă expus iradierii

Buletinul Academiei de Ştiinţe a Moldovei. Ştiinţe Medicale, Oct 1, 2013

Общественное здоровье, экономика и менеджмент в медицине, 2020

Miastenia gravis (MG) este o afecțiune în care transmiterea neuromusculară este perturbată ca urm... more Miastenia gravis (MG) este o afecțiune în care transmiterea neuromusculară este perturbată ca urmare a unui atac autoimun asupra țintelor antigenice postsinaptice, producând slăbiciunea fluctuantă a mușchilor scheletici. Mai des e o maladie sporadică, cazurile familiale fi ind foarte rare, reprezentând doar 3-5% din totalul cazurilor de MG. A fost efectuată sinteza literaturii de specialitate, consacrate ca zurilor familiale de MG. În contextul analizei rolului factorului ereditar prin prisma sintezei cercetărilor existente, se prezintă cazul unei paciente cu formă generalizată de MG, care are un istoric familial de MG oculară la cele două surori, una dintre care este sora geamănă, toate trei având un debut tardiv al manifestărilor clinice și statut serologic identic pentru anticorpi ai receptorilor de acetilcolină (Ac AchR). Suspiciunea clinică și testarea ulterioară a Ac AchR la cele două surori ale pacientei au permis stabilirea diagnosticului și raportarea acestui caz familial de miastenie gravis. Tomografi a computerizată (TC) a mediastinului nu a confi rmat patologia timică. În schimb, în toate cele trei cazuri a fost evidențiată patologia autoimună a glandei tiroide, ceea ce demonstrează importanța factorului genetic în apariția maladiei. Analiza cazului clinic prezentat subliniază importanța investigării rudelor pacienților miastenici și a cunoașterii riscului relativ al acestora pentru MG în vederea consilierii adecvate. Sunt necesare studii ulterioare ale cazurilor familiale de MG pentru clarifi carea contribuției factorilor genetici în apariția bolii.

European teaching course on neurorehabilitation, 2016

7th Congress of the Society of Neurologists Issue of the Republic of Moldova, 2021

Background: The cerebrovascular pathologies are among the most important causes of morbidity, mor... more Background: The cerebrovascular pathologies are among the most important causes of morbidity, mortality and disabilities worldwide and in the Republic of Moldova. The aim of the study was the analysis of the stroke care quality indicators of patients in Balti Clinical Hospital. Material and methods: We present a retrospective study that included medical records (from January to April, 2021) of 72 patients with stroke, confirmed clinically and by cerebral CT scan. Results: The mean age of the patients included in our study was 65.8 ± 14.7 years old, 34 men and 38 women. The mean timing from the first symptoms till the admission at the Emergency department was 7.0±3.5 hours. The mean timing spent at the Emergency department was 3.0 ± 1.5 hours. CT-scan examination 24 hours after hospitalization was performed in 63.75% of the patients. Cerebral vessel dopplerography was performed in 6 patients. Thrombolytic therapy was not performed in any of the patients. The mean duration of treatment was 10.0 ± 3.0 days. 65 patients were discharged with an amelioration, while 7 patients died. Conclusions: The qualitative indices in specialized medical care for cerebral attack patients in Balti Clinical Hospital were influenced by the following factors: patients' presentation out of the therapeutical window as well as the impossibility of performing a cerebral CT-scan in the first 24 hours at the hospital, as well as the Covid-19 pandemic situation.

Catedra Neurologie, Catedra Medicină Internă nr.3, USMF ”Nicolae Testemițanu”,Centrul Medical ”Ex... more Catedra Neurologie, Catedra Medicină Internă nr.3, USMF ”Nicolae Testemițanu”,Centrul Medical ”Excellence”

European Journal of Pain, 2009

In this study we analysed 224 patients who had been operated in the period of 2003–2008. We compa... more In this study we analysed 224 patients who had been operated in the period of 2003–2008. We compared the efficacy of analgesic methods by using visual analog scale (VAS). Treatment of postoperative pain was different. Patients were divided in 3 groups: group A (n =75) patients were treated only with ketoprofen, group B (n =71) patients were treated with ketorolak and tramadol, group C (n =78) patients were treated with acetaminofen and tramadol, and were placed peridural cateter. A combination of acetaminofen and tramadol with peridural cateter can reduce 40% of the total amount of nonopioids and opioids needed postoperatively and also reduce its side effects.

Catedra Neurologie USMF „Nicolae Testemiţanu” Laboratorul Vertebroneurologie, IMSP Institutul de ... more Catedra Neurologie USMF „Nicolae Testemiţanu” Laboratorul Vertebroneurologie, IMSP Institutul de Neurologie si Neurochirurgie

Scleroza multiplă (SM) este o boală inflamatorie cronică a sistemului nervos central, care poate ... more Scleroza multiplă (SM) este o boală inflamatorie cronică a sistemului nervos central, care poate duce la invaliditate permanentă la adulţii tineri. Investigarea epidemiologiei SM în Republica Moldova prezintă interes, luând în consideraţie şi faptul că evoluţia naturală a bolii încă nu este influenţată de utilizarea medicamentelor modifi catoare a bolii. În studiu au fost incluşi pacienţii diagnosticaţi cu SM conform criteriilor McDonald 2010, formele clinic şi imagistic defi nite. 747 de pacienţi cu SM locuiau în zona de studiu, la ziua de prevalenţă, 31 decembrie 2012. Prevalenţa era de 21,0 la 100000 (95% CI: 14,8 – 27,1). Din 724 de cazuri prevalente, 460 (63,5%) au fost de sex feminin, cu vârsta medie de 42,1 ± 11,9 ani şi 264 (36,5%) au fost de sex masculin, cu vârsta medie 40,8 ± 12,8 ani. Cele mai mari estimări au fost observate în grupa de vârstă 40-49 ani, pentru femei, 57,0 la 100000 locuitori şi pentru bărbaţi, 29,0 la 100000 locuitori. Prevalenţa brută estimată a sclero...

În baza studiului clinico-morfologic a fost elaborată o nouă clasificare a mielopatiei vasculare ... more În baza studiului clinico-morfologic a fost elaborată o nouă clasificare a mielopatiei vasculare ischemice, care conţine 6 capitole: după etiologie, caracterul ischemiei, localizarea focarului, vasul afectat şi formele clinice. Este prevăzută şi expertiza medicală a vitalităţii

Articolul actual este rezultatul selectării și analizei ghidurilor internaționale publicate, conc... more Articolul actual este rezultatul selectării și analizei ghidurilor internaționale publicate, concepute evidențierii punctelorcheie decizionale în managementul durerii lombare. Cercetarea riguroasă a acestor resurse relevă direcțiile de diagnosticare, terapie sau prevenție, dovedite a fi cele mai eficiente în abordarea pacienților cu sindrom algic lombar, luând în considerație existența incertitudinilor cu privire la cea mai bună abordare a patologiei date, deoarece publicațiile existente în marea majoritate sunt cu rezultate contradictorii și mai mult țin de epidemiologie, decât de aspecte clinice