Is there effect of intervertebral disc herniation on the lumbar spine in early period? A morphometric and stereological study / ¿Existe algún efecto de la hernia de disco intervertebral en la columna lumbar en el período temprano? Un estudio morfométrico y estereológico

The degeneration of the Lumbar Intervertebral Disc (LIVD) and the other elements of the spine are an inevitable result of aging. However, it is observed that the same degree of degenerative change does not occur in each individual. In the present study, the purpose was to compare the morphometric changes on the lumbar spine with or without intervertebral disc herniation in early period. Group 1 (the Patient Group) consisted of the patients who were diagnosed with lumbar intervertebral disc hernia and who were not operated at least one month clinical duration. Group 2 (the Control Group) consisted of individuals who were selected randomly, had only back pain, underwent magnetic resonance imaging (MRI), and were determined to have intact intervertebral disc. The sagittal and axial MRI sections of lumbar spine was used for measurements and statistical evaluation. There were no statistically significant differences between the intervertebral disc volumes, vertebral body volumes and intervertebral disc anterior and posterior heights of Group 1 and 2 (p>0.05). In terms of anterior-posterior length, the length of the L5 vertebral body was determined to be more in the Patient Group (p<0.05). A correlation was determined in terms of the increase in L2, L4 and L5 volumes with increasing age; however, there were no statistically significant correlations between age increase and a decrease in the intervertebral disc volumes. There were no correlations between the increase in age and the decrease in intervertebral disc heights (p>0.05). There were no apparent relations between the change on the lumbar vertebra corpus and intervertebral disc in early period. It was concluded that the intact intervertebral disc could protect the lower lumbar vertebra corpus from degenerative changes. Although the herniation of the intervertebral disc is newly formed, it is understood that the physiological process or morphometric changes started earlier.

La degeneración del disco intervertebral lumbar y de otros elementos de la columna vertebral son un resultado inevitable del envejecimiento. Sin embargo, no se observa el mismo grado de degeneración en cada individuo. En el presente estudio, el objetivo era comparar los cambios morfométricos en la columna lumbar con o sin hernia de disco intervertebral en el período temprano. El grupo 1 (grupo de pacientes) estaba formado por los pacientes diagnosticados con hernia de disco intervertebral lumbar y que no fueron operados durante al menos un mes. El Grupo 2 (Grupo de Control) consistió en sujetos que fueron seleccionados al azar, reportaban solamente dolor de espalda, fueron sometidos a una resonancia magnética (MRI) y se determinó un disco intervertebral intacto. Las secciones de resonancia magnética sagital y axial de la columna lumbar se utilizaron para las mediciones y la evaluación estadística. No hubo diferencias estadísticamente significativas entre los volúmenes del disco intervertebral, los volúmenes del cuerpo vertebral y las alturas anterior y posterior del disco intervertebral de los Grupos 1 y 2 (p> 0,05). En términos de longitud anterior-posterior, se determinó que la longitud del cuerpo vertebral L5 era mayor en el grupo de pacientes (p <0,05). Se determinó una correlación en términos del aumento en los volúmenes L2, L4 y L5 con el aumento de la edad; sin embargo, no hubo correlaciones estadísticamente significativas entre el aumento de la edad y una disminución en los volúmenes del disco intervertebral. No hubo correlaciones entre el aumento de la edad y la disminución de las alturas de los discos intervertebrales (p> 0,05). No hubo relaciones aparentes entre el cambio en el cuerpo de la vértebra lumbar y el disco intervertebral en el período temprano. Se concluyó que el disco intervertebral intacto podría proteger el cuerpo de la vértebra lumbar inferior de los cambios degenerativos. Aun cuando la formación de la hernia del disco fue reciente, se entiende que el proceso fisiológico o los cambios morfométricos habían comenzado antes.

Efficacy of gabapentin in the improvement of pruritus and quality of life of patients with notalgia paresthetica

BACKGROUND: notalgia paresthetica is a subdiagnosed sensory neuropathy presenting as a condition of intense itching and hyperchromic macule on the back that interferes with daily habits. OBJECTIVES: To determine the efficacy of treatment of notalgia paresthetica using oral gabapentin, assessing the degree of improvement in itching and influence on quality of life. Moreover, to evaluate the signs and symptoms associated with notalgia paresthetica. METHODS: We conducted an experimental, non-randomized, parallel, non-blinded study including 20 patients with clinical and histopathological diagnosis of notalgia paresthetica. After application of the visual analogue scale of pain adapted for pruritus and of the questionnaire of dermatology life quality index (DLQI), ten patients with visual analogue scale > 5 were given treatment with gabapentin at the dose of 300 mg/day for four weeks. The other ten were treated with topical capsaicin 0.025% daily for four weeks. After the treatment period, patients answered again the scale of itching. RESULTS: The use of gabapentin was responsible for a significant improvement in pruritus (p=0.0020). Besides itching and hyperchromic stain on the back, patients reported paresthesia and back pain. It was observed that the main factor in the worsening of the rash is heat. CONCLUSION: Gabapentin is a good option for the treatment of severe itching caused by nostalgia paresthetica. .