RESUMO
For vertebromedullary injuries, epidemiological knowledge is essential to guide the choice of the most effective diagnostic method. The objective of this retrospective study was to describe the epidemiological profile of animals and thoracolumbar and lumbosacral spine lesions diagnosed by computed tomography scan. A compilation of CT scan reports for the aforementioned regions performed in a comercial diagnostic center from 04/01/2017 to 04/30/2020, contrasted and non-contrasted, from routine, was performed in order to list the most common lesions and their locations, as well as the species, breeds and ages most affected. There were 1164 CT scans performed in the period evaluated, all of them in dogs, 57,56% (n=670) for the spine, with 89,7% reports accessed (n=601), where the regions mentioned here added up to 73,05% studies (n=439). In both regions, male French Bulldog dogs had the most injuries. For the thoracolumbar region, disk mineralization, followed by extrusion, were the most frequent injuries, while the site was T12-13 and the mean age 6,5±3,63 years old. In the lumbosacral, disk protrusion was most frequent, the most affected site was L7-S1 and age 6,65±3,79 years. It was concluded that the spine is the main target of CT scans, and that lesions related to the intervertebral disk were the main ones identified, with chondrodystrophic animals being more predisposed to injury.
Para lesões vertebromedulares é indispensável o conhecimento epidemiológico para direcionar a escolha do método diagnóstico mais eficaz. O objetivo desse estudo retrospectivo foi descrever o perfil epidemiológico dos animais e das lesões em coluna vertebral toracolombar e lombossacral diagnosticadas através de exame tomográfico. Realizou-se a compilação de laudos de tomografias computadorizadas para as referidas regiões realizadas em centro diagnóstico comercial, entre 01/04/2017 a 30/04/2020, contrastadas e não-contrastadas, provenientes da rotina, a fim de relacionar as lesões e seus locais de ocorrência, bem como a espécie, raças e idades mais comuns. Foram realizados 1164 exames tomográficos no período avaliado, sendo 57,56% (n=670) para a coluna, com 89,7% laudos acessados (n=601), nos quais as regiões toracolombar e lombossacral somaram 73,05% dos estudos (n=439). Em ambas as regiões, os cães Bulldog Francês machos foram os que mais apresentaram lesões. Para a região toracolombar, a mineralização de disco, seguida pela extrusão, foram as lesões mais frequentes, enquanto o local foi T12-13 e a média de idade 6,5±3,63 anos. Na lombossacral, a protusão de disco foi mais frequente, o local mais afetado foi L7-S1 e idade de 6,65±3,79 anos. Concluiu-se que a coluna vertebral é o principal alvo de tomografias, e que as lesões relacionadas ao disco intervertebral foram as principais identificadas, sendo os animais condrodistróficos mais predispostos a lesões.
Assuntos
Animais , Gatos , Cães , Traumatismos da Coluna Vertebral/veterinária , Coluna Vertebral/diagnóstico por imagem , Tomografia Computadorizada por Raios X/veterinária , Gatos/lesões , Cães/lesões , Disco Intervertebral/lesões , Vértebras Lombares/lesões , Região Lombossacral/anormalidadesRESUMO
ABSTRACT: To describe the retroperitoneoscopic debridement technique and evaluate the clinical outcome of internal fixation for the treatment of lumbar tuberculosis.Twenty-eight patients were performed conventional laparoendoscopic technique (nâ=â17) or laparoendoscopic single-site technique (nâ=â11). Antituberculosis chemotherapy and thoracolumbosacral orthosis were given to all patients. The clinical outcomes were evaluated with preoperative and postoperative Visual Analog Scale, and radiographs with respect to sagittal angle and fusion status.Average time of the 28 procedures was 220.6â±â50.9âmin (180-365âmin). The average intraoperative blood loss was 108.6â±â95.3âmL (50-400âmL). All patients showed significant improvement of their Visual Analog Scale back pain score at follow-up and were classified as having a radiographic fusion in this study. The mean sagittal angle was 11.2â±â3.6° before operation, significantly improved to 3.7â±â2.4° after operation. There were no recurrent infections during the follow-up period. Complications included loosening of anterior fixation and temporary deficit of the sympathetic nerve.Retroperitoneal laparoscopic approach with CO2 insufflation technique is a challenging but safe and effective procedure for lumbar spine tuberculosis. Retroperitoneal laparoendoscopic single-site can be used for anterior lumbar spine surgery, offer exposure for L1 through L5.
Assuntos
Desbridamento/normas , Fixadores Internos/normas , Tuberculose Osteoarticular/cirurgia , Adulto , Idoso , Desbridamento/métodos , Desbridamento/estatística & dados numéricos , Feminino , Humanos , Fixadores Internos/estatística & dados numéricos , Região Lombossacral/anormalidades , Região Lombossacral/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Espaço Retroperitoneal/anormalidades , Espaço Retroperitoneal/diagnóstico por imagem , Estudos Retrospectivos , Resultado do TratamentoRESUMO
RATIONALE: Herpes zoster frequently causes dermatomal vesicular rash accompanied by severe neuralgia, and reaching a differential diagnosis may be challenging before the appearance of the vesicular rash. PATIENT CONCERNS: A 40-year-old male patient visited the emergency department with a complaint of sudden onset motor weakness and ipsilateral radiating neuralgia to the Lt. thigh. He had suffered from chickenpox during childhood. DIAGNOSES: No skin lesion was present at the initial visit. The reverse Straight Leg Raise test was negative. Magnetic resonance imaging showed asymmetrically swollen dorsal root ganglion with Gadolinium enhancement. The vesicular rash that appeared on the sixth day after the symptom onset led to the diagnosis of herpes zoster. INTERVENTIONS: Antiviral agent of valacyclovir (1000âmg t.i.d.) was administered for 7 days. OUTCOMES: The patient recovered from motor weaknesses by 2 weeks from the onset of the symptom. Mild degree post-herpetic neuralgia recovered by 2 months. LESSONS: A high index of suspicion is necessary to differentiate early herpes zoster radiculitis before the appearance of vesicular rash from compressive radiculopathy. In L2-3 ipsilateral radiating pain along the dermatome or myotome, the absence of reverse Straight Leg Raise sign may be a possible factor in differentiating herpes zoster radiculitis from compressive radiculopathy.
Assuntos
Herpes Zoster/complicações , Região Lombossacral/anormalidades , Paresia/etiologia , Radiculopatia/complicações , Adulto , Antivirais/farmacologia , Antivirais/uso terapêutico , Meios de Contraste/uso terapêutico , Gadolínio/uso terapêutico , Herpes Zoster/tratamento farmacológico , Herpes Zoster/fisiopatologia , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Paresia/tratamento farmacológico , República da Coreia , Valaciclovir/farmacologia , Valaciclovir/uso terapêuticoRESUMO
Lateral recess stenosis is a common pathology causing clinical syndromes in the elderly population, and there is some concern regarding the number of comorbidities that can occur when performing surgery for this condition in the elderly. However, little research has focused on the issues related to older age, and limited data is available to help the clinician counsel elderly patients undergoing percutaneous endoscopic transforaminal decompression. The present study aimed to explore the safety and efficacy of percutaneous endoscopic transforaminal decompression for lumbar degenerative disease in elderly patients with lumbar lateral recess stenosis and to determine whether age and comorbidity affect the outcome and complication rate.We identified 117 patients in our patient database who underwent percutaneous endoscopic transforaminal decompression for single-level lumbar lateral recess stenosis. Data regarding the Oswestry Disability Index and visual analog scale for back and leg pain were collected preoperatively, postoperatively, and at the last follow-up. Other data, including preoperative comorbidities, operation time, and intraoperative and postoperative complications, were recorded.The average follow-up period was 29.9â±â5.5 months, with a mean age of 69.8â±â5.4 years in elderly patients (group A) and 50.4â±â6.4 years in younger patients (group B). Group A had a higher percentage of comorbidity than group B (83.9% vs 18.0%, Pâ<â.001). Both visual analog scale scores for leg pain and Oswestry Disability Index were significantly improved in the 2 groups, and no difference was found between the groups regarding both parameters (P >.05). The elderly patients had the same high rate of favorable outcomes as group B (Pâ>â.05). Moreover, there was no difference in surgical complications, recurrence, and neurologic deficit recovery rate between both groups. No major complications or perioperative deaths occurred in both groups.The present study demonstrates that percutaneous endoscopic transforaminal decompression for lateral recess stenosis in elderly patients may be a reasonable treatment associated with substantial benefit.
Assuntos
Fatores Etários , Descompressão Cirúrgica/métodos , Região Lombossacral/cirurgia , Estenose Espinal/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Descompressão Cirúrgica/estatística & dados numéricos , Endoscopia/métodos , Feminino , Humanos , Região Lombossacral/anormalidades , Região Lombossacral/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Estenose Espinal/complicações , Estenose Espinal/epidemiologia , Resultado do TratamentoRESUMO
RATIONALE: Diffuse idiopathic skeletal hyperostosis (DISH) is characterized by ossification along the anterolateral aspect of at least 4 contiguous vertebral bodies. A fracture involving the fused vertebra in patients with DISH often leads to severe instability and spinal cord injury. Spinal metastasis (Mets) and DISH can coexist in elderly patients and increase their risk of pathologic vertebral fractures. However, there are few reports on concomitant spinal Mets and DISH. PATIENT CONCERNS: A 78-year-old man who complained of gradual onset of paraparesis, sensory loss below the umbilicus, and incontinence (case 1) and a 63-year-old woman who complained of severe back pain and urinary incontinence (case 2). DIAGNOSIS: Two patients were diagnosed with spinal Mets and DISH. INTERVENTIONS: Decompression surgery was performed at the metastatic sites in case 1 whereas instrumentation surgery was performed in case 2 despite the fracture having a benign appearance with no associated neurologic symptoms. OUTCOMES: A vertebral fracture developed at the metastatic vertebra after decompression surgery in case 1. Severe instability of the surgical site in this case resulted in persistent paralysis even after subsequent revision surgery with instrumentation. In contrast, the clinical course was benign without any neurologic dysfunction at the 2-year follow-up in case 2. LESSONS: Instrumentation surgery should be performed in patients with DISH who develop spinal Mets even if there is no apparent instability.
Assuntos
Hiperostose Esquelética Difusa Idiopática/complicações , Neoplasias da Coluna Vertebral/secundário , Idoso , Blefaroptose , Neoplasias da Mama/patologia , Anormalidades Congênitas , Descompressão Cirúrgica/métodos , Feminino , Fixação Interna de Fraturas/métodos , Humanos , Hiperostose Esquelética Difusa Idiopática/cirurgia , Região Lombossacral/anormalidades , Masculino , Pessoa de Meia-Idade , Neoplasias da Próstata/patologia , Fraturas da Coluna Vertebral/etiologia , Fraturas da Coluna Vertebral/cirurgia , Neoplasias da Coluna Vertebral/complicações , Neoplasias da Coluna Vertebral/cirurgia , Vértebras Torácicas/lesões , Vértebras Torácicas/cirurgiaRESUMO
INTRODUCTION: Numerous case reports have indicated that the "human tail" is not always a harmless protrusion but can be associated with anomalies such as occult dysraphic malformations. However, the definition and classification of this anomaly have not been discussed. A prevailing hypothesis is that the "human tail" is a residual embryonic tail. Herein, we attempted to classify and define the human tail and investigate the frequency of this anomaly. MATERIALS AND METHODS: We first defined the human tail as a protrusion on the dorsal side of the lumbar, sacrococcygeal, and para-anal regions identified after birth. We collected case reports written in English, Japanese, French, German, and Italian that were published from the 1880s to the present. RESULTS: We discovered two important findings: (a) the cause of this anomaly may differ even though the "tails" resemble each other closely in appearance and (b) its position tends to be correlated with the type of anomaly and its associated cause. We propose a new classification of the human tail based on these findings. CONCLUSION: Our classification may facilitate more accurate treatment and precise case descriptions of the human tail.
Assuntos
Região Lombossacral/anormalidades , Pelve/anormalidades , Região Sacrococcígea/anormalidades , Anormalidades da Pele/patologia , Criança , Feminino , Humanos , Lactente , Recém-Nascido , MasculinoRESUMO
OBJECTIVES: To assess the prevalence of lumbosacral transitional vertebra (LSTV) and associated spinal degenerative changes on abdominal CT scans in Caucasian population. MATERIAL AND METHODS: A total of 3855 abdominal CT scans of the year 2017 from a single hospital were retrospectively assessed for LSTV, disc degeneration (DD), and facet joint degeneration (FD). An age- and sex-matched 150-subject control group without LSTV was picked at random. Multivariable logistic regression was used for the analysis. RESULTS: LSTV was found in 1101 (29%) scans: Castellvi type I in 68%, type II in 16%, type III in 13%, and type IV in 3% of scans. Age- and sex-adjusted prevalence of DD was significantly higher in Castellvi type II and III groups at multiple lumbar levels, and in IV group at L4/5 than in control group (p < 0.001-0.034). At L5/S1, the prevalence of DD was significantly higher in the control group than in type II, III, or IV groups (p < 0.001-0.017). After combining Castellvi types II, III, and IV into one group, significant differences were found at all lumbar levels except L2/3 (p < 0.001-0.016). Prevalence of FD was significantly higher at L4/5 in Castellvi groups I, II, and III than in the control group (p < 0.001-0.002). When Castellvi types II, III, and IV were combined into one group, significant differences were found at lumbar levels L2/3, L3/4, and L4/5 (p < 0.001-0.021). CONCLUSION: Lumbosacral vertebrae of Castellvi types II, III, and IV are associated with greater lumbar degeneration, warranting meticulous evaluation of spinal anatomy, even on CT. KEY POINTS: ⢠Lumbosacral transitional vertebra is a common incidental finding on abdominal CT scans with a high prevalence of 29%. ⢠When assessing whole lumbar spine, lumbosacral vertebrae of Castellvi types II, III, and IV were associated with greater lumbar degeneration, warranting careful evaluation of the lumbar spine on abdominal CT scans.
Assuntos
Variação Anatômica , Degeneração do Disco Intervertebral/epidemiologia , Vértebras Lombares/diagnóstico por imagem , Sacro/diagnóstico por imagem , Espondilose/epidemiologia , Abdome/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Degeneração do Disco Intervertebral/diagnóstico por imagem , Modelos Logísticos , Vértebras Lombares/anormalidades , Região Lombossacral/anormalidades , Região Lombossacral/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Sacro/anormalidades , Espondilose/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adulto JovemRESUMO
OBJECTIVE: To report the surgical treatment and outcome of six bulldogs with spina bifida (SB) and meningocele (MC) or meningomyelocele (MMC). STUDY DESIGN: Case series. ANIMALS: Five French bulldogs and one English bulldog with MC or MMC. METHODS: Medical records of dogs with spinal MC or MMC diagnosed by MRI at two institutions between 2013 and 2016 were reviewed for surgical treatment and outcomes. RESULTS: Meningocele was diagnosed in two dogs, and MMC was diagnosed in four dogs. A lumbosacral dimple was noted in all dogs along with neurological deficits most commonly consisting of urinary and fecal incontinence (n = 6) and mild/moderate paraparesis (n = 3). Dorsal laminectomy was performed in all dogs to allow dissection of the meningeal sac to the vertebral column defect. In dogs with MMC, nerves were repositioned and protruded meninges were removed prior to suturing remaining meninges. Adhesions and filum terminale were resected in two dogs with suspected tethered cord syndrome. Urinary and fecal incontinence improved in two dogs and remained unchanged in four. Paraparesis improved in two dogs. CONCLUSION: Surgical treatment resulted in partial improvement of the urinary and fecal incontinence (2/6 dogs) and paraparesis (2/3 dogs) or stable neurological condition (3/6 dogs), with only minor temporary complications. CLINICAL SIGNIFICANCE: In the absence of published data comparing surgical and conservative treatment of puppies affected by SB and MC or MMC, early surgical treatment can be considered to prevent deterioration of neurological signs and, eventually, facilitate improvement of neurological signs.
Assuntos
Cães/cirurgia , Meningocele/veterinária , Meningomielocele/veterinária , Animais , Cães/anormalidades , Feminino , Laminectomia/veterinária , Região Lombossacral/anormalidades , Região Lombossacral/cirurgia , Masculino , Meningocele/cirurgia , Meningomielocele/cirurgia , Especificidade da Espécie , Resultado do TratamentoAssuntos
Hérnia Abdominal/diagnóstico por imagem , Hérnia/diagnóstico , Região Lombossacral/anormalidades , Idoso de 80 Anos ou mais , Dor no Flanco/etiologia , Hérnia/etiologia , Hérnia Abdominal/etiologia , Hérnia Abdominal/patologia , Hérnia Abdominal/cirurgia , Humanos , Laparoscopia/métodos , Região Lombossacral/patologia , Masculino , Tomografia Computadorizada por Raios X/métodos , Resultado do TratamentoRESUMO
Background and Objectives: Lumbar traction is widely used as a non-operative treatment for lumbar intervertebral disc disease. The effect of traditional traction (TT) using linear-type traction devices remains controversial for various reasons, including technical limitations. Thus, the purpose of this study was to compare the effects of the newly developed lumbar lordotic curve-controlled traction (L-LCCT) and TT on functional changes in patients and morphological changes in the vertebral disc. Materials and Methods: A total of 40 patients with lumbar intervertebral disc disease at the L4/5 or L5/S1 level as confirmed by magnetic resonance imaging were recruited and divided into two groups (L-LCCT or TT). The comprehensive health status changes of the patients were recorded using pain and functional scores (the visual analogue scale, the Oswestry Disability Index, and the Roland-Morris Disability Questionnaire) and morphological changes (in the lumbar central canal area) before and after traction treatment. Results: Pain scores were significantly decreased after traction in both groups (p < 0.05). However, functional scores and morphological changes improved significantly after treatment in the L-LCCT group only (p < 0.05). Conclusions: We suggest that L-LCCT is a viable option for resolving the technical limitations of TT by maintaining the lumbar lordotic curve in patients with lumbar intervertebral disc disease.
Assuntos
Deslocamento do Disco Intervertebral/terapia , Recuperação de Função Fisiológica , Tração/normas , Adulto , Método Duplo-Cego , Feminino , Humanos , Deslocamento do Disco Intervertebral/complicações , Região Lombossacral/anormalidades , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Dor/etiologia , Manejo da Dor/métodos , Manejo da Dor/normas , Tração/métodos , Tração/estatística & dados numéricosRESUMO
BACKGROUND: Spontaneous spinal and intracranial subdural hematomas are rarely reported, especially occurring simultaneously. Anticoagulation use has been associated with spontaneous hemorrhages. Prompt diagnosis is required to prevent permanent neurological sequelae. In this case report, we describe a spontaneous spinal and intracranial subdural hematoma in a woman taking warfarin and initially presenting with severe vaginal pain. CASE REPORT: A 42-year-old woman who had a history of mechanical valve replacement and was therefore taking warfarin, came to an emergency department for relief of severe vaginal pain. Mild concurrent lumbar pain increased concern about spinal pathology, so magnetic resonance imaging of her spine was performed. It revealed a subdural hematoma extending from L1-S1 with arachnoiditis, which suggested intracranial pathology, though the patient had no complaint of a headache. Computed tomography of her brain demonstrated a large right subdural hemorrhage with midline shift. Subsequent imaging revealed no aneurysm or source of the intracranial bleeding. We concluded that the patient experienced spontaneous anticoagulation-related intracranial hemorrhage resulting in lumbar subdural hematoma and arachnoiditis with referred vaginal pain. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Pelvic, vaginal, or perineal pain may be the presenting symptom in patients with lower spinal pathology. It is important to consider causes other than gynecological ones in the differential diagnosis of these patients, as well as to be cognizant of the relationship between spinal and intracranial subdural hemorrhages. In patients with back pain or radiating lumbar pain, especially coupled with neurological effects, clinicians should consider spinal subdural hemorrhage and arachnoiditis to expedite imaging studies and treatment of these rare entities.
Assuntos
Hematoma Subdural Intracraniano/diagnóstico , Região Lombossacral/anormalidades , Dor/etiologia , Vagina/anormalidades , Adulto , Feminino , Hematoma Subdural Intracraniano/complicações , Humanos , Dor Lombar/etiologia , Região Lombossacral/fisiopatologia , Dor/fisiopatologia , Tomografia Computadorizada por Raios X/métodos , Vagina/fisiopatologiaRESUMO
INTRODUCTION: To evaluate the prevalence of subtypes of congenital lumbosacral transition vertebra (LSTV) in young male populations with low back pain (LBP) and their relationship to lumbar disc and facet degeneration. MATERIALS AND METHODS: 1875 patients (male, aged; 18-40 years) with LBP were investigated retrospectively. Standard lumbar MRI protocol of sagittal, and axial T1 weighted images (WI) and T2 WI and coronal short tau inversion recovery (STIR) T2 WI were obtained. Castellvi classification of LSTV were used for subtyping. The level and above the level of LSTV were evaluated for the lumbar disc space and facet degeneration based on grading methods which compares subtype groups with each other. RESULTS: Prevalence of LSTV was 32% (600 of 1875). The most frequent LSTV types were type I (dysplastic enlarged transverse process; 66.5%) and type II (pseudoarticulation; 21.8%). Eight percent of the patients were type III (fusion) and 3.6% patients type IV (one transverse process fused and one with pseudoarticulation). The most commonly detected LSTV types were type I + II (88%) and all bilateral LSTV types were seen much more than unilateral types (bilateral versus unilateral 63.2%, 33.2%). The LSTV type I highly correlated with the disc degeneration and facet arthrosis. But the groups with higher grade of disc degeneration were type IV and III. CONCLUSION: In young male patients with LBP, LSTV was found to be high in frequency and mostly occurred to be subtype I. LSTV type I and associated disk and facet degeneration were found to be remarkable in this group. Coronal T2 STIR images are useful in showing lumbosacral region anomalies and variants, and should be included in the routine lumbar MRI protocol.
Assuntos
Degeneração do Disco Intervertebral/diagnóstico por imagem , Dor Lombar/diagnóstico por imagem , Região Lombossacral/anormalidades , Região Lombossacral/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Adolescente , Adulto , Humanos , Masculino , Estudos RetrospectivosRESUMO
To investigate the abnormalities that are specific to administration of flucytosine at one time point during embryonic organogenesis, flucytosine was administered orally to pregnant Sprague Dawley (SD) rats in a single dose on day 11 of pregnancy at 25 or 35 mg/kg. Fetuses on day 20 of pregnancy were externally, viscerally, and skeletally examined. Maternal body weight gain and food consumption were suppressed the day after administration of a 35 mg/kg. Fetal examinations revealed various alterations in both dose groups: externally preaxial polydactyly in the hind limb; skeletally fused lumbar centrum, absent sacral centrum, supernumerary sacral vertebra, and absent ribs. Our findings indicated that specific types of external and skeletal anomalies were induced following flucytosine administration on day 11 of pregnancy.
Assuntos
Anormalidades Induzidas por Medicamentos/patologia , Ectromelia/patologia , Desenvolvimento Fetal/efeitos dos fármacos , Flucitosina/toxicidade , Polidactilia/patologia , Teratogênicos/toxicidade , Anormalidades Induzidas por Medicamentos/etiologia , Administração Oral , Animais , Esquema de Medicação , Ingestão de Alimentos/efeitos dos fármacos , Ectromelia/induzido quimicamente , Feminino , Feto , Membro Posterior/anormalidades , Membro Posterior/efeitos dos fármacos , Região Lombossacral/anormalidades , Masculino , Exposição Materna/efeitos adversos , Organogênese/efeitos dos fármacos , Polidactilia/induzido quimicamente , Gravidez , Ratos , Ratos Sprague-Dawley , Costelas/anormalidades , Costelas/efeitos dos fármacos , Aumento de Peso/efeitos dos fármacosRESUMO
BACKGROUND: Compartment syndrome is a life-threatening complication of traumatic injury, most commonly, direct trauma. Back pain is a common cause of visits to the emergency department (ED) and often is treated without imaging or diagnostic testing. Lumbar paraspinal compartment syndrome is a rare cause of acute back pain. CASE REPORT: A 43-year-old woman presented to the ED after direct trauma to the lower back. Laboratory studies revealed rhabdomyolysis and acute kidney injury, with examination findings and imaging consistent with lumbar paraspinal compartment syndrome. She was taken to the operating room for emergent fasciotomy. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: It is the job of the emergency physician to identify the red flags in history and physical examination that warrant further diagnostic testing. Early diagnosis and surgical consultation is the key in avoiding morbidity and achieving good outcomes in all forms of compartment syndrome.
Assuntos
Síndromes Compartimentais/diagnóstico , Região Lombossacral/irrigação sanguínea , Acidentes por Quedas , Adulto , Analgésicos Opioides/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Dor nas Costas/tratamento farmacológico , Síndromes Compartimentais/etiologia , Síndromes Compartimentais/cirurgia , Feminino , Humanos , Ibuprofeno/uso terapêutico , Cetorolaco/uso terapêutico , Região Lombossacral/anormalidades , Morfina/uso terapêutico , Obesidade Mórbida/complicações , Músculos Paraespinais/anormalidades , Músculos Paraespinais/lesões , Tomografia Computadorizada por Raios X/métodosAssuntos
Anormalidades Congênitas/diagnóstico , Dor Lombar/etiologia , Região Lombossacral/anormalidades , Adulto , Anormalidades Congênitas/diagnóstico por imagem , Feminino , Humanos , Dor Lombar/genética , Região Lombossacral/diagnóstico por imagem , Radiografia/métodos , Tomografia Computadorizada por Raios X/métodosRESUMO
BACKGROUND: Although the use of prescription opioid analgesics to treat acute, postoperative pain is a well-established practice, the role of opioids in the management of persistent, postoperative pain remains ill-defined. Nevertheless, high rates of long-term opioid use following lumbar fusion have been reported. AIM: The goal of this prospective, longitudinal study was to identify predictors of weeks to opioid cessation in a cohort of patients undergoing elective lumbar fusion. METHODS: Prior to surgery, participants self-reported demographic and clinical data and completed a validated measure of pain catastrophizing. Three months following surgery, participants self-reported prescription opioid use. RESULTS: Forty-four percent (n = 22) of participants reported opioid use 12 weeks following lumbar fusion. Bivariate analysis identified a strong correlation between weeks to opioid cessation and preoperative opioid use, r = .46, and a moderate correlation between weeks to opioid cessation and disability, r = .29. The multiple regression model predicting weeks to opioid cessation from age, sex, employment status, educational level, preoperative pain intensity, preoperative opioid use, disability status, and pain catastrophizing was significant, F(8, 38) = 2.254, p = .044, and accounted for 18% of the variance. Among preoperative patient characteristics, only preoperative opioid use significantly predicted weeks to opioid cessation, ß = .466; p = .005. CONCLUSION: Thus, nurses and nurse practitioners may be able to identify patients at risk for long-term opioid use following lumbar fusion by screening patients for preoperative opioid use.
Assuntos
Analgésicos Opioides/uso terapêutico , Região Lombossacral/cirurgia , Fusão Vertebral/efeitos adversos , Idoso , Estudos de Coortes , Feminino , Humanos , Modelos Logísticos , Estudos Longitudinais , Região Lombossacral/anormalidades , Masculino , Pessoa de Meia-Idade , Dor Pós-Operatória/tratamento farmacológico , Estudos Prospectivos , Psicometria/instrumentação , Psicometria/métodos , Autorrelato , Fusão Vertebral/métodos , Inquéritos e Questionários , Fatores de TempoRESUMO
Bertolotti syndrome describes lower back pain secondary to an anatomical lumbosacral transitional vertebrae. We present the case of a 37â¯year old female with chronic lower back pain with radiological evidence of an anatomical lumbosacral pseudojoint. The patient underwent minimally invasive resection of her pseudojoint with complete resolution of symptoms postoperatively. We, as the authors would like to highlight that in patients with pain secondary to an aberrant lumbosacral articulation, consideration should be given to treatment via a minimally invasive technique.
Assuntos
Dor Lombar/cirurgia , Vértebras Lombares/anormalidades , Vértebras Lombares/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Sacro/anormalidades , Sacro/cirurgia , Adulto , Feminino , Humanos , Dor Lombar/diagnóstico por imagem , Vértebras Lombares/diagnóstico por imagem , Região Lombossacral/anormalidades , Região Lombossacral/diagnóstico por imagem , Região Lombossacral/cirurgia , Sacro/diagnóstico por imagem , Resultado do TratamentoRESUMO
STUDY DESIGN: Structured literature review. OBJECTIVES: The Scoliosis Research Society (SRS) requested an assessment of the current state of peer-reviewed evidence regarding pediatric lumbar spondylolisthesis with the goal of identifying what is known and what gaps remain in further understanding the diagnostic methods for pediatric spondylolisthesis. SUMMARY OF BACKGROUND DATA: Spondylolisthesis in the lumbar spine is common among children and adolescents and no formal synthesis of the published literature regarding diagnostic methods has been previously performed. METHODS: A comprehensive literature search was performed. Abstracts were reviewed and data from included studies were analyzed by the committee. From 6600 initial citations with abstract, 663 articles underwent full-text review. The best available evidence for the clinical questions regarding diagnostic methods was provided by 26 included studies. Six of the studies were graded as Level III (retrospective comparative), and represent the current best available evidence whereas 20 of the studies were graded as Level IV (retrospective case series) evidence. No Level V (expert opinion) studies were included in the final list. None of the studies were graded as Level I or Level II. RESULTS: Plain radiography is the workhorse imaging modality for diagnosing spondylolisthesis. No association between radiologic grade of spondylolisthesis and clinical presentation were noted; however, grade III and IV slips more often required surgery, and increasing slip angles were associated with worse baseline outcome scores. There is Level III evidence that the Meyerding grade appears to be more accurate for measuring slip percentage whereas the Lonstein Slip angle and Dubousset Lumbosacral Kyphosis angles are the best for measuring lumbosacral kyphosis in spondylolisthesis. In addition, higher sacral table index, pelvic incidence, sacral slope, and lower sacral table angle were associated with spondylolisthesis. True incidence could not be determined by the current literature available. However, studies in adolescent athletes demonstrated an incidence of 6% to 7% across studies. CONCLUSIONS: The current "best available" evidence to guide the diagnosis and characterization of pediatric spondylolisthesis is presented. Future studies are needed to provide more high-quality evidence to answer these clinically relevant questions. LEVEL OF EVIDENCE: Level III, review of Level III studies.