Prediction of transforaminal epidural injection success in sciatica (POTEISS): a protocol for the development of a multivariable prediction model for outcome after transforaminal epidural steroid injection in patients with lumbar radicular pain due to disc herniation or stenosis.

BACKGROUND: Transforaminal epidural injections (TEI) can alleviate symptoms and help to maintain physical functioning and quality of life in patients with lumbar radicular pain. We aim to develop a prediction model for patient outcome after TEI in patients suffering from unilateral lumbar radicular pain due to lumbar disc herniation (LDH) or single-level spinal stenosis (LSS). The secondary aim is to estimate short-term patient outcome differences between LDH and LSS patients, the association between psychological variables and patient outcome, the rate of additional injections, surgery and complications, and to explore the short-term cost-effectiveness of TEI. METHODS: This study is designed as a multi-centre, observational, prospective cohort study in two large regional hospitals in the Netherlands. Patients diagnosed with unilateral lumbar radicular pain secondary to LDH or LSS and congruent with MRI findings, who are referred for TEI along usual care pathways, are eligible for study participation. A total of 388 patients with LDH or LSS will be included. A pre-defined set of demographic, clinical and radiological variables will be used as the predictors in the model. The primary outcome measure is the Numerical Rating Scale (NRS) for leg pain. Secondary outcome measures include back pain, physical functioning, perceived recovery, pain coping strategies, anxiety and depression and use of analgesics and physical therapy. Patients will be evaluated at baseline, 2 weeks and 6 weeks after treatment. NRS leg pain and Likert perceived recovery data will be used as the dependent variables in a generalized linear mixed model for prediction of TEI outcome, with internal validation of performance (explained variation) by bootstrap resampling. Cost-effectiveness for a period of 6 weeks prior to and after treatment will be performed with decision-analytic modelling. DISCUSSION: Patients with severe lumbar radicular pain often request additional treatment when conservative care is insufficient. TEI can offer relief of symptoms. Currently, it is not possible to predict responsiveness to this treatment for individual patients. This study is designed to explore predictors that can differentiate between patients that will and will not have a positive outcome after TEI. This information may support treatment strategies for this patient group. TRIAL REGISTRATION: This study is registered at ClinicalTrials.gov database under registry number NCT04540068 on September 1, 2020.

Combined Ultrasound and Fluoroscopy versus Ultrasound versus Fluoroscopy-Guided Caudal Epidural Steroid Injection for the Treatment of Unilateral Lower Lumbar Radicular Pain: A Retrospective Comparative Study.

Background and Objectives: This study aimed to evaluate the mid-term effectiveness and safety of a combined ultrasound (US) and fluoroscopy (FL)-guided approach in comparison to US-guided and FL-guided caudal epidural steroid injections (CESI) for treating unilateral lower lumbar radicular pain. Materials and Methods: A total of 154 patients who underwent CESI between 2018 and 2022 were included. Patients were categorized into three groups based on the guidance method: combined US and FL (n = 51), US-guided (n = 51), and FL-guided (n = 52). The study design was retrospective case-controlled, utilizing patient charts and standardized forms to assess clinical outcomes, adverse events, complications during the procedures. Results: In all groups, Oswestry Disability Index and Verbal Numeric Scale scores improved at 1, 3, and 6 months after the last injection, with no significant differences between groups (p < 0.05). The treatment success rate at all time points was also similar among the groups. Logistic regression analysis showed that injection method, cause, sex, age, number of injections, and pain duration did not independently predict treatment success. Blood was aspirated before injection in 2% (n = 1), 13.5% (n = 7), and 4% (n = 2) of patients in the combined US and FL groups, FL-guided groups, and US-guided groups, respectively. Intravascular contrast spread was detected in one patient in the combined method groups and seven in the FL-guided groups. Conclusions: When comparing pain reduction and functional improvement, there was no significant difference between the three methods. The combined method took less time compared to using FL alone. The combined approach also showed a lower occurrence of intravascular injection compared to using FL alone. Moreover, blood vessels at the injection site can be identified with an ultrasound using the combined method. Given these advantages, it might be advisable to prioritize the combined US- and FL-guided therapy when administering CESI for patients with unilateral lumbar radicular pain.

Comparison of Selective Nerve Root Pulsed Radiofrequency Vs Paramedian Interlaminar Epidural Steroid Injection for the Treatment of Painful Cervical Radiculopathy.

BACKGROUND: Although there are studies evaluating ultrasound-guided selective nerve root pulsed radiofrequency (ULSD-SNRPRF) and fluoroscopy-guided paramedian cervical interlaminar epidural steroid injection (FL-CIESI) for the treatment of chronic cervical radicular pain, no study has compared the efficacy of these 2 methods. OBJECTIVES: This study aimed to compare the efficacy of these 2 methods, their superiority to each other, and the incidence of adverse events. STUDY DESIGN: A prospective, randomized controlled trial. SETTING: Outpatient department of a single-center pain clinic. METHODS: Sixty patients who did not respond to conservative treatments for lower cervical radicular pain were randomly divided into 2 groups. One group underwent ULSD-SNRPRF (Group U), and the other underwent paramedian FL-CIESI (Group F). Patients were evaluated pretreatment, and 3 and 6 months posttreatment. The Numeric Rating Scale (NRS-11) was used to assess clinical improvement, The Neck Disability Index (NDI) to assess improvement in functional disability, and the Self-Leeds Assessment of Neuropathic Symptoms and Signs Pain Score (S-LANSS) to assess the treatment's effect on neuropathic pain. Clinically significant pain relief was defined as a 50% or more pain reduction in the NRS-11. The posttreatment reduction in medication consumption was assessed using the Medication Quantification Scale Version III (MQS III). We also evaluated whether there was a difference in treatment-related characteristics, such as procedure time and adverse events. RESULTS: The procedure time was significantly longer in Group U. Blood aspiration was observed in 2 patients in Group U and vascular spread in one patient in Group F, with no significant difference. At 3 and 6 months posttreatment, NRS-11 and NDI scores showed a significant decrease compared to the pretreatment scores in both groups; there was no difference between the groups. Both treatments effectively improved neuropathic pain, with no significant difference between the S-LANSS scores. There was no difference in the reduction of medication consumption between the groups. LIMITATIONS: There was no sham or control group, and the follow-up period was limited to 6 months. CONCLUSIONS: Pain relief, functional improvement, and safety were similar between groups. ULSD-SNRPRF and paramedian FL-CIESI are 2 different effective techniques for chronic cervical radicular pain. The choice of method should depend on various factors, such as patient preference, operator experience, and availability of resources. An advantage of ULSD over fluoroscopy is that patients and physicians are not exposed to radiation.

Neumoencéfalo como complicación de bloqueo regional epidural por radiculopatía lumbosacra / Pneumocephalus as a Complication of Regional Epidural Block Due to Lumbosacral Radiculopathy

Introducción: El neumoencéfalo (sinonimia: aerocele o neumatocele intracerebral), se define como la presencia de gas dentro de cualquiera de los compartimentos intracraneales (intraventricular, intraparenquimatosa, subaracnoidea, subdural y epidural). Objetivo: Describir los hallazgos clínicos, estudios complementarios, conducta terapéutica y evolución de un caso con neumoencéfalo como complicación de bloqueo regional epidural por radiculopatía lumbosacra. Presentación de caso: Se presentó un paciente masculino de 57 años de edad que comenzó con un cuadro súbito de desorientación, excitabilidad psicomotriz y convulsiones tónico-clónicas, a partir de una inyección epidural de metilprednisolona como método analgésico. Conclusiones: El caso presentado exhibió manifestaciones neurológicas inespecíficas, la aparición súbita posterior al proceder invasivo hizo sospechar en un evento neurológico agudo o fenómeno tromboembólico. Los estudios complementarios como la tomografía axial computarizada craneal simple, permitió su diagnóstico para tener una conducta consecuente. El manejo conservador del neumoencéfalo como complicación del uso de anestesia epidural, constituyó una conducta terapéutica eficaz y repercutió en la satisfactoria evolución del paciente(AU)

Introduction: Pneumocephalus (synonym: aerocele or intracerebral pneumatocele), is defined as the presence of gas within any of the intracranial compartments (intraventricular, intraparenchymal, subarachnoid, subdural and epidural). Objective: To describe the clinical findings, complementary studies, therapeutic conduct and evolution of a case with pneumocephalus as a complication of regional epidural block due to lumbosacral radiculopathy Case presentation: A 57-year-old male patient was presented who began with a sudden episode of disorientation, psychomotor excitability and tonic-clonic seizures, following an epidural injection of methylprednisolone as an analgesic method. Conclusions: The case presented exhibited non-specific neurological manifestations, the sudden appearance after the invasive procedure raised suspicion of an acute neurological event or thromboembolic phenomenon. Complementary studies such as simple cranial computed axial tomography, allowed its diagnosis to have a consistent conduct. The conservative management of pneumocephalus as a complication of the use of epidural anesthesia constituted an effective therapeutic approach and had an impact on the patient's satisfactory evolution(AU)

Pseudohipertrofia gemelar / Calf pseudohipertrophy

La pseudohipertrofia gemelar secundaria a una radiculopatía es un fenómeno excepcional raramente descrito. Presentamos el caso de una mujer de 67 años con antecedentes de cirugía discal lumbar que consultaba por aumento progresivo de más de un año de evolución, no doloroso, de la región gemelar derecha con ligera pérdida de fuerza asociada. Los hallazgos electromiográficos evidenciaron una radiculopatía crónica S1 y radiológicamente se apreciaba, en territorio del gastrocnemio medial y sóleo derechos, una sustitución del tejido muscular normal por tejido adiposo, sin evidencia de miopatía o degeneración sarcomatosa (AU)

Calf pseudohypertrophy due to radiculopathy is an exceptional phenomenon rarely described. We report a 67 year old woman with a previous history of lumbar disc surgery consulting by progressive increase for more than a year of evolution painless right calf associated loss of strength. Electromyographic findings showed chronic S1 radiculopathy and radiologically was appreciated in the medial gastrocnemius and soleus rights substitution of normal muscle tissue by adipose tissue without evidence of myopathy or sarcomatous degeneration (AU)

Dedo en martillo agudo / Acute hammer toe

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Adaptación al español para la población mexicana con radiculopatía lumbar de la Escala de Evaluación Estandarizada del Dolor (StEP) / Adaptation in Spanish for the Mexican population with lumbar radiculopathy of the Standardized Evaluation of Pain

Introducción: La evaluación clínica de dolor radicular asocia síntomas y signos del fenotipo doloroso con el mecanismo de base. La escala de evaluación estandarizada del dolor (StEP) diferencia dolor lumbar axial del radicular mediante interrogatorio (3 preguntas) y examen físico (8 pruebas). Objetivo: Adaptar la escala StEP al español. Metodología: Selección de escala, traducción-retraducción, ajustes ítems y utilidad, prueba piloto, análisis de validez y confiabilidad. Inclusión: Cualquier género, mayor de 18 años, dolor lumbar con o sin irradiación, que firmen consentimiento informado. Exclusión: Neuropatías, polineuropatías, miopatías, enfermedad neurológica, miofascial, venosa, siquiátrica, cardiovascular, postoperados. Muestra: 21 pacientes. Resultados: Evaluación en 2 ocasiones por paciente, intervalo de una semana, 2 evaluadores. 21 pacientes, 9 femeninos (42.9%) y 12 masculinos (57.1%); edad: 22 a 58 años (media 38). Diagnósticos: lumbalgia 7 (33.3%), lumbociática 6 (28.6%), hernia discal 5 (23.8%), espondilolistesis 2 (9.5%), radiculopatía 1 (4.8%). Evaluador 1: axial 18 (85.7%), radicular 3 (14.3%). Evaluador 2: axial 14 (66.7%), radicular 7 (33.3%). Resultados de validez adecuados. Consistencia interna (alpha de Cronbach) 0.7. Tiempo prueba/reprueba: 15 a 10 minutos. Confiabilidad inter-evaluador (índice Kappa) 0.5. Conclusión: La escala presenta variabilidad en la identificación del dolor radicular en comparación a lo reportado inicialmente por su autor; sin embargo, se considera de utilidad en la identificación clínica de la radiculopatía.

Introduction: The clinical assessment of radicular pain associates the signs and symptoms of the painful phenotype with the underlying mechanism. The Standardized Evaluation of Pain (StEP) distinguishes between axial and radicular lumbar pain by means of a questionnaire (3 questions) and a physical exam (8 tests). Objective: To adapt the StEP scale to Spanish. Methodology: Selection of the scale, translation-back translation, adjustments, items and utility, pilot test, validity and reliability tests. Inclusion criteria: Any sex, over age 18, lumbar pain with or without irradiation, signing of the informed consent. Exclusion criteria: Neuropathies, polyneuropathies, myopathies, neurologic, myofascial, venous, psychiatric, cardiovascular disease, postoperative status. Sample: 21 patients. Results: Patients were assessed twice with a one-week interval with the help of 2 evaluators. There were 21 patients, 9 females (42.9%) and 12 males (57.1%); ages 22-58 years (mean 38). Diagnoses: low back pain, 7 (33.3%); lumbosciatica, 6 (28.6%); disc herniation, 5 (23.8%); spondylolisthesis, 2 (9.5%); radiculopathy, 1 (4.8%). Evaluator 1: axial, 18 (85.7%); radicular, 3 (14.3%). Evaluator 2: axial, 14 (66.7%); radicular, 7 (33.3%). Validity results were appropriate. Internal consistency (Cornbach's alpha), 0.7. Test/re-test time: 10-15 minutes. Inter-evaluator reliability (Kappa index), 0.5. Conclusion: The scale showed variability in identifying radicular pain compared to what its author reported initially. However, it is considered as a useful tool to clinically identify radiculopathy.

Miositis focal secundaria a radiculopatía / Focal myositis associated to radiculopathy

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Radiculopatía lumbosacra severa tras un parto con analgesia epidural / No disponible

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CMV and HSV-2 myeloradiculitis in an HIV infected patient / Mieloradiculite por CMV e HSV2 em paciente infectado pelo HIV

While CMV myeloradiculitis is a known complication in AIDS patients with severe immunosuppression, HSV-2 necrotizing myeloradiculitis is rare and often associated with disabling a fatal outcome. We hereby describe a 46 year-old HIV infected patient with profound and sustained immunosuppression who presented with an acute ascending paraparesis and urinary retention. Lumbar spine MRI showed contrast enhancement at the conus medullaris and cauda equine, and both CMV and HSV-2 CSF PCR were positive. Despite treatment, the patient died 20 days later. We review the main diagnostic and therapeutic aspects of herpes virus associated myeloradiculitis and discuss the approach in similar cases.

Enquanto a mieloradiculite pelo CMV é complicação conhecida em pacientes com SIDA e imunossupressão grave, a mieloradiculite necrosante por HSV-2 é rara e muitas vezes associada a sequelas ou desfecho fatal. Descrevemos um paciente de 46 anos de idade, infectado pelo HIV com imunossupressão profunda e sustentada que apresentou paraparesia aguda ascendente e retenção urinária. A RM de coluna lombar mostrou o realce de contraste no cone medular e cauda equina e ambos PCR para CMV e HSV-2 no LCR foram positivos. Apesar do tratamento, o paciente morreu 20 dias depois. Revisamos os principais aspectos diagnósticos e terapêuticos da mieloradiculite associada aos herpesvírus e discutimos a abordagem em casos semelhantes.

Simultaneous occurrence of brain tumor and myeloradiculopathy in schistosomiasis mansoni: case report / Ocorrência simultânea de tumor cerebral e mielorradiculopatia na esquistossomose mansoni: relato de caso

Simultaneous occurrence of brain tumor and myeloradiculopathy in cases of Manson's schistosomiasis have only rarely been described. We report the case of a 38-year-old man who developed seizures during a trip to Puerto Rico and in whom a brain tumor was diagnosed by magnetic resonance imaging: brain biopsy revealed the diagnosis of schistosomiasis. He was transferred to a hospital in the United States and, during hospitalization, he developed sudden paraplegia. The diagnosis of myeloradiculopathy was confirmed at that time. He was administered praziquantel and steroids. The brain tumor disappeared, but the patient was left with paraplegia and fecal and urinary dysfunction. He has now been followed up in Brazil for one year, and his clinical state, imaging examinations and laboratory tests are presented here.

Tem sido descrita, raramente, na esquistossomose mansônica, a ocorrência simultânea de tumor cerebral e mielorradiculopatia. Relatamos aqui o caso de um homem de 38 anos que desenvolveu convulsões, durante viagem a Porto Rico, e um tumor cerebral foi diagnosticado à ressonância magnética: a biópsia do cérebro revelou o diagnóstico de esquistossomose. Ele foi transferido para hospital na América do Norte e durante a hospitalização desenvolveu súbita paraplegia. O diagnóstico de mielorradiculopatia foi confirmado na ocasião. Ele recebeu praziquantel e esteróides. O tumor cerebral desapareceu, mas o paciente permaneceu com paraplegia, disfunção urinária e fecal. Ele tem sido acompanhado no Brasil no último ano e o seu estado clínico, os métodos de imagem e os exames de laboratório são apresentados aqui.

Quiste de Tarlov y disfunción vesical sintomática / Tarlov cyst and symptomatic bladder disfunction

El quiste de Tarlov o quiste perineural son lesiones de las raíces nerviosas localizadas a nivel de la región sacra y de etiología incierta. La mayoría de estos quistes permanecen asintomáticos y carecen de relevancia clínica. Los quistes sintomáticos son infrecuentes y los síntomas más habituales son el dolor y las radiculopatías. Nosotros presentamos el caso de una mujer de 53 años con un quiste de Tarlov sintomático ( síndrome de frecuencia y urgencia miccional) que tras el tratamiento quirúrgico presenta una mejoría clínica importante (AU)

Tarlov cysts or perineural cyst are lesions of the nerve roots located at the sacral level and uncertain etiology. Most of these cysts remain asymptomatic with no clinical relevance. The symptomatic cysts are uncommon and the usual symptoms are pain or radiculopathy. We report the case of a 53 year old woman with a symptomatic cyst (with a history of frequency and urgency syndrom), that disappears after surgery (AU)

Abdominal wall protrusion following herpes zoster

We present the case of a 62-year-old woman with abdominal segmental paresis consequent to radiculopathy caused by zoster, which was confirmed by electroneuromyography. The paresis resolved completely within three months. Recognition of this complication caused by zoster, which is easily misdiagnosed as abdominal herniation, is important for diagnosing this self-limited condition and avoiding unnecessary procedures.

Apresenta-se caso de uma paciente de 62 anos com paresia abdominal segmentar, confirmada por eletroneuromiografia, conseqüente a uma radiculopatia devida a zoster. A paresia resolveu-se completamente em três meses. O reconhecimento desta complicação do zoster, passível de confusão com hérnia abdominal, é importante para o diagnóstico desta condição auto-limitada, sem a utilização de procedimentos desnecessários.

Reabsorción radicular en el tratamiento de ortodoncia. Un trabajo de revisión. Parte I / No disponible

Un aspecto importante a lo largo de un tratamiento de ortodoncia es la posible aparición de complicaciones. De entre ellas, cabe destacar la aparición de reabsorciones radiculares (1, 2, 3,),cuyo problema radica en la dificultad de su prevención El objetivo de este trabajo, es realizar una revisión bibliográfica sobre la reabsorción radicular relacionada con el tratamiento de ortodoncia ( incidencia, factores favorecedores, forma de actuar ante este proceso, etc) (AU)

An important aspect during the treatment of orthodontics is the possible appearance of complications. Of between them it is necessary to emphasize the reabsorption radicular,, whose problem consists of the difficulty of prevention. The aim of this work is to realize a review on the reabsorption radicular related to the treatment of orthodontics (AU)

Reabsorción radicular en el tratamiento de ortodoncia un trabajo de revisión. Parte II / No disponible

En esta segunda parte del trabajo de revisión acerca de la reabsorción radicular analizamos el diagnóstico, las causas y los posibles tratamientos. El objetivo de este trabajo, es realizar una revisión bibliográfica sobre la reabsorción radicular relacionada con el tratamiento de ortodoncia (AU)

In this second part of the work of review about the resorption we analyze the diagnosis, the etiology and the possible treatments. The aim of this work is to realize a review on the reabsorption radicular related to the treatment of orthodontics (AU)

Alteración intestinal de larga evolución como forma de presentación de una espondilodiscitis / Long standing intestinal disorder as a form of presentation of spondylodiscitis

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Prurito braquiorradial como síntoma de radiculopatía cervical / Brachioradial pruritus as a symptom of cervical radiculopathy

El prurito braquiorradial (PBR) se caracteriza por la presencia de prurito localizado en la cara lateralde los brazos. Se trata de una entidad enigmática con una etiología controvertida; mientras que algunos autoresconsideran el PBR como una fotodermatosis, otros atribuyen su aparición a la presencia de una radiculopatíacervical subyacente. En este artículo se presenta nuestra experiencia con esta entidad y se discute el papel de una neuropatía subyacente en la etiología de este y otros pruritos localizados como la notalgia parestésica, el prurito anogenital o el síndrome de la boca ardiente (AU)

Brachioradial pruritus is characterized by the presence of pruritus on the lateral aspect of the arms. The etiology of this enigmatic entity is the subject of some debate -some authors claim that brachioradial pruritus is a photodermatosis whereas others attribute it to the presence of underlying cervical radiculopathy. In these case reports, we present our experience with brachioradial pruritus and discuss the role of underlyingneuropathy in its etiology and that of other types of localized pruritus such as notalgia paresthetica, anogenital pruritus, and burning mouth syndrome (AU)

Dolor radicular / No disponible

Las hernias discales y la enfermedad degenerativa artrósica de la columna son responsables de la gran mayoría de los dolores radiculares. El mecanismo fisiopatológico de la p roducción del dolor radicular no ha sido completamente establecido, probablemente factores mecánicos, isquémicos e inflamatorios (radiculitis química) actuarían conjuntamente. Existe una gran número de procesos que pueden dar origen a un dolor radicular: hernias de disco, tumores, infecciones, traumatismos, etc. Una correcta historia clínica y exploración orientan el diagnóstico, que confirmará la Resonancia Magnética. El tratamiento debe ser etiológico. En patología discal y degenerativa el tratamiento conservador consigue una mejoría en el 80-90% de los pacientes. Cuando a pesar del tratamiento etiológico adecuado (médico y/o quirúrgico) persiste el dolor radicular es preciso efectuar un tratamiento neuroquirúrgico del dolor, mediante intervenciones sobre las raíces (rizotomías), sobre la médula espinal (DREZ, cordotomías) y mediante intervenciones de neuroestimulación (periférica, medular o cerebral). El tratamiento ideal debe ser el más eficaz, el menos invasivo, el de menor morbilidad, el más confortable para el paciente y el de menor coste económico (AU)

Disk disease and arthrosic degenerative disease of the column are responsible of most radicular pains. The physiopathologic mechanism of radicular pain has not been fully established, but probably several mechanical, ischemic and inflammatory (chemical radiculitis) factors act simultaneously. There are many processes that may cause radicular pain: disk hernias, tumors, infections, traumas, etc. A correct clinical history and examination guides the diagnosis, which is confirmed by Magnetic Resonance. The treatment must have an etiologic focus. In disk and degenerative pathology, the conservative therapy allows an improvement in 80-90 per cent of the patients. When despite an appropriate etiologic therapy (medical and/or surgical), the radicular pain persists, a neurosurgical management of pain is required, with procedures involving the roots (rhizotomies), the spinal cord (DREZ, cordotomies ) and through neuroestimulation (peripheral, medullar or cerebral). The ideal therapy would be the most effective, the less invasive, the less morbid, the most comfortable for the patient and the one with the less economic cost (AU)

Efectividad del tratamiento rehabilitador del síndrome cervical doloroso en pacientes que asistieron a consulta externa del Hospital Aldo Chavarría en el período de abril del 2007- a enero del 2008 / Effectiveness of rehabilitative treatment of cervical pain syndrome in patients who attended outpatient clinics of the Hospital Aldo Chavarria in the period April 2007 - January 2008

El dolor cervical, asociado o no a otros síntomas, es uno de los motivos más comunes de consulta en un departamento de Medicina Física y de Rehabilitación. Se realizó un estudio descriptivo, prospectivo, longitudinal y no probabilistico para evaluar la efectividad del tratamiento rehabilitador del síndrome cervical doloroso a través de la aplicación de la escala del dolor de Borg en pacientes que asistieron a consulta externa del Hospital Atdo Chavarría en el período de abril del 2007 a enero del 2008. De estos pacientes 65 fueron varones y 85 fueron mujeres. Las patologías que se encontraron frecuentes en el sexo masculino son las siguientes: 29 casos de contractura muscular, 26 casos de osteoartrosis cervical y 10 casos de radiculopatia cervical más osteoartrosis cervical. En el sexo femenino las patologías que se encontraron frecuentes fueron : 37 casos de contractura muscular, 23 casos de osteoartrosis cervical y 25 casos de radiculopatía cervical más osteoartrosis. Entre los síntomas del aparato locomotor relacionados con cervicalgia independientemente del sexo se hallá que había dolor irradiado a 1 ó 2 miembros superiores en 68 de los casos estudiados y parestesias en 1 6 2 miembros superiores en 63 de los casos. Había dolor lumbar en 15 de los casos y dolor dorsal en 5 de los pacientes. El síntoma dolor fue evaluado antes y después del tratamiento mediante la escala del dolor de Borg. Los cortes evaluativos se hicieron cada 5 sesiones de tratamiento siendo la número 15 la final. Se obtuvieron los siguientes resultados: al inicio del tratamiento se ubicaron en el nivel 6 a 11(7.3%) de los pacientes, en el nivel 7 a 52 (34%) de los pacientes, en el nivel 8 a 48 (32%) de los pacientes, en el nivel 9 a 23(15%) d elos pacientes y en el nivel 10 a16(10.6%) de los pacientes. El tratamiento rehabilitador fue efectivo para el 55.3% de lo pacientes que disminuyeron su dolor a nivel 0. Un 26 disminuyó el dolor al nivel 1 y el 13.3% refieren un dolor constante...

Estudo de diferentes dermátomos do ser humano pelos métodos eletroneuromiográfico, neurorradiológico, clínico e neurocirúrgico / Study of different dermatome of the human being by the eletroneuromyographic, neuroradiologic, clinical and neurosurgical methods

A literatura registra grandes controvérsias em relação aos dermátomos. Neste trabalho foram estudados diferentes dermátomos do ser humano: C5 e C6 (membro superior) e L4, L5 e S1 (membro inferior). O método consistiu em confrontar os dados do exame eletroneuromiográfico com os achados neurorradiológicos, por tomografia computadorizada ou ressonância magnética, com os achados neurocirúrgicos e com os dados clínicos, em cada paciente. Foi observada grande variabilidade clínica, de um para outro paciente. Entretanto, foi possível concluir, pela análise dos dados dos membros superiores, em 18 pacientes, que o dermátomo C5 provavelmente esteja localizado na face lateral do braço, e o C6, na face lateral do antebraço e dedos I e II da mão. A análise dos dados dos membros inferiores, em 59 pacientes, sugere que o dermátomo L4 esteja localizado provavelmente na face medial da perna, L5 na face lateral da perna e dorso do pé, e S1 na face plantar do pé.