Impact of surgery on pain, disability, and quality of life of patients with degenerative lumbar disease: Brazilian data / Impacto da cirurgia na dor, incapacidade e qualidade de vida de portadores de doença degenerativa lombar: dados brasileiros

ABSTRACT Objective: To study the impact of surgery on pain, disability, quality of life, and patient satisfaction in a sample of patients with Degenerative Lumbar Disease (DLD). Methods: Retrospective analysis of prospectively collected data. Comparison between pre and postoperative (6 - 12 months) ODI and SF-36, plus postoperative Patient Satisfaction Index. Results: From a total of 216 patients included, improvement was observed in average scores of pain (201.2%), disability (39.7%), physical quality of life (42%), and mental quality of life (37.8%). Among these patients, 57.7% reached or surpassed the minimal clinically important difference (MCID) for ODI, 57.7% for the SF-36 pain component, 59.7% for the SF-36 physical component summary, and 50.5% achieved or surpassed the MCID for the SF-36 mental component summary. Conclusions: Surgery produced a significantly positive impact on pain, disability, and quality of life of patients. Overall, 82.5% of the patients were satisfied.

RESUMO Objetivo: Descrever o impacto da cirurgia na dor, incapacidade, qualidade de vida e a satisfação global do paciente numa amostra unificada de pacientes portadores de DDL. Métodos: Análise retrospectiva de dados colhidos prospectivamente em pacientes operados no período de janeiro de 2014 a março de 2017, que tivessem avaliação pré-operatória e pelo menos uma avaliação pós-operatória entre 6 e 12 meses com os questionários de ODI, SF-36 e o ISP. Resultados: Um total 216 pacientes preenchia os critérios de inclusão. Houve melhora no escore médio de dor (201,2%), incapacidade (39,7%), qualidade de vida física (42%) e mental (37,8%). Da amostra, 57,7% alcançaram o MCID de dor, 59,7% de ODI, 59,7% 50,5% de PCS e 50,5% de MCS; 82,5% dos pacientes se consideraram "Satisfeitos". Conclusões: O efeito da cirurgia foi amplamente favorável na dor, incapacidade e qualidade de vida dos pacientes portadores de DDL. Estes dados podem servir de guia para aconselhamento pré-operatório quanto às perspectivas de sucesso.

Comparison of short-segment monoaxial and polyaxial pedicle screw fixation combined with intermediate screws in traumatic thoracolumbar fractures: a finite element study and clinical radiographic review

OBJECTIVES: No studies have compared monoaxial and polyaxial pedicle screws with regard to the von Mises stress of the instrumentation, intradiscal pressures of the adjacent segment and adjacent segment degeneration. METHODS: Short-segment monoaxial/polyaxial pedicle screw fixation techniques were compared using finite element methods, and the redistributed T11-L1 segment range of motion, largest maximal von Mises stress of the instrumentation, and intradiscal pressures of the adjacent segment under displacement loading were evaluated. Radiographic results of 230 patients with traumatic thoracolumbar fractures treated with these fixations were reviewed, and the sagittal Cobb's angle, vertebral body angle, anterior vertebral body height of the fractured vertebrae and adjacent segment degeneration were calculated and evaluated. RESULTS: The largest maximal values of the von Mises stress were 376.8 MPa for the pedicle screws in the short-segment monoaxial pedicle screw fixation model and 439.9 MPa for the rods in the intermediate monoaxial pedicle screw fixation model. The maximal intradiscal pressures of the upper adjacent segments were all greater than those of the lower adjacent segments. The maximal intradiscal pressures of the monoaxial pedicle screw fixation model were larger than those in the corresponding segments of the normal model. The radiographic results at the final follow-up evaluation showed that the mean loss of correction of the sagittal Cobb's angle, vertebral body angle and anterior vertebral body height were smallest in the intermediate monoaxial pedicle screw fixation group. Adjacent segment degeneration was less likely to be observed in the intermediate polyaxial pedicle screw fixation group but more likely to be observed in the intermediate monoaxial pedicle screw fixation group. CONCLUSION: Smaller von Mises stress in the pedicle screws and lower intradiscal pressure in the adjacent segment were observed in the polyaxial screw model than in the monoaxial pedicle screw fixation spine models. Fracture-level fixation could significantly correct kyphosis and reduce correction loss, and adjacent segment degeneration was less likely to be observed in the intermediate polyaxial pedicle screw fixation group.

Conservative and Surgical Treatment Improves Pain and Ankle-Brachial Index in Patients with Lumbar Spinal Stenosis

PURPOSE: The pathological mechanism of lumbar spinal stenosis is reduced blood flow in nerve roots and degeneration of nerve roots. Exercise and prostaglandin E1 is used for patients with peripheral arterial disease to increase capillary flow around the main artery and improve symptoms; however, the ankle-brachial index (ABI), an estimation of blood flow in the main artery in the leg, does not change after treatment. Lumbar spinal nerve roots contain somatosensory, somatomotor, and unmyelinated autonomic nerves. Improved blood flow by medication with prostaglandin E1 and decompression surgery in these spinal nerve roots may improve the function of nerve fibers innervating muscle, capillary, and main vessels in the lower leg, resulting in an increased ABI. The purpose of the study was to examine whether these treatments can improve ABI. MATERIALS AND METHODS: One hundred and seven patients who received conservative treatment such as exercise and medication (n=56) or surgical treatment (n=51) were included. Low back pain and leg pain scores, walking distance, and ABI were measured before treatment and after 3 months of conservative treatment alone or surgical treatment followed by conservative treatment. RESULTS: Low back pain, leg pain, and walking distance significantly improved after both treatments (p<0.05). ABI significantly increased in each group (p<0.05). CONCLUSION: This is the first investigation of changes in ABI after treatment in patients with lumbar spinal stenosis. Improvement of the spinal nerve roots by medication and decompression surgery may improve the supply of blood flow to the lower leg in patients with lumbar spinal stenosis.

Relationship between Bone Mineral Density and Moderate to Severe Chronic Kidney Disease among General Population in Korea

Recent studies in Western countries have reported a significant association between glomerular filtration rate (GFR) and bone mineral density (BMD) in the absence of dialysis among the general population. However, there have been few studies regarding renal function and BMD among Korean or Asian subjects with moderate to severe (stage 3 or 4) chronic kidney disease (MS-CKD). The aim of the present study was to investigate the association between MS-CKD and BMD in the general Korean population. BMD, serum creatinine and other measures were obtained from 3,190 subjects (1,428 males and 1,762 females; the fourth Korean National Health and Nutrition Examination Survey). GFR was estimated using the Cockcroft-Gault formula, with adjustment for body surface area. After adjustment for all variables, multiple regression analysis showed that BMD in the femur neck, total femur and lumbar spine were positively associated with eGFR in both males and females. Additional analysis showed that MS-CKD was also significantly associated with osteoporosis in both males and females (odds ratio [OR] 2.20, 95% confidence interval [CI] 1.15-4.20 in males; and OR 1.96, 95% CI 1.33-2.88 in females). Individuals with MS-CKD may be at higher risk of osteoporosis even among Asians.

Valoración del morfotipo raquídeo en el plano sagital en ciclistas de categoría máster 40 / Spinal posture of thoracic and lumbar spine in master 40 cyclists

El objetivo principal del estudio fue valorar la disposición sagital del raquis torácico y lumbar en bipedestación y sobre la bicicleta, en ciclistas de la categoría máster 40. Un total de 50 ciclistas máster 40 (media de edad: 44,02 +/- 2,51 años) fueron evaluados mediante el sistema Spinal Mouse en bipedestación y sobre la bicicleta en tres agarres del manillar: transversal, de manetas y bajo. En bipedestación, los valores angulares medios para el raquis torácico y lumbar fueron de 49,42 +/- 9,00 y -22,74 +/- 9,38, respectivamente. Un elevado porcentaje de los ciclistas (68 por ciento) presentaron una hipercifosis torácica, mientras que la mayoría tenían valores normales en la lordosis lumbar. Sobre la bicicleta, los ciclistas mostraron una reducción significativa de la cifosis torácica con respecto a la bipedestación, mientras que el raquis lumbar se disponía en una postura de inversión. En conclusión, la frecuente hipercifosis torácica en bipedestación de los ciclistas de la categoría máster 40 no está relacionada directamente con la postura adoptada sobre la bicicleta.

The aim of this study was to determine the sagittal spinal morphology of thoracic and lumbar spine in relaxed standing and sitting on the bycicle in master 40 cyclists. A total of 50 master 40 male cyclists (mean age: 44.02 +/- 2.51 years) were evaluated. The Spinal Mouse system was used to measure the sagittal thoracic and lumbar curve in standing and sitting on the bicycle at three different handlebar-hand positions (high, medium, and low). The values for thoracic and lumbar curvatures in standing were 49.42 +/- 9.00 and -22.74 +/- 9.38, respectively. A high frecuency of thoracic hyperkyphosis in standing was observed (68 percent). When sitting on the bicycle the thoracic curve showed lower angles in the three handlebar.hand positions that in standing. The lumbar curve adopted a kyphotic posture. The standing thoracic hyperkyphosis in master 40 cyclists may be related to other factors than the posture adopted on the bicycle.

Influence of obesity on bone density in postmenopausal women

OBJECTIVE: To evaluate the influence of obesity, age, and years since menopause on bone density. METHODS: A retrospective analysis of bone mineral density (BMD) obtained from 588 women, 41 to 60 years, previously menopaused (1-10 years before). RESULTS: Positive influence of obesity was confirmed by the significant differences in BMD at lumbar spine, femoral neck (FN), and trochanter (TR) between the groups (p < 0.01). Age and years since menopause (YSM) were negatively correlated with BMD at all sites (p = 0.000). Comparing patients within 1 to < 6 YSM versus 6 to 10 YSM, BMD was higher in the former at LS and FN (p < 0.005), despite the higher BMI in the older group (p = 0.01). Obese patients had a lower prevalence of osteoporosis at LS and FN (p = 0.009). Regression analysis identified BMI as the strongest determinant of FN and TR BMD, while YSM was the strongest determinant of LS BMD. CONCLUSION: The protective effect of obesity is overtaken by age and estradiol deficiency. We recommend that even obese postmenopausal women should be screened for osteoporosis.

OBJETIVO: Avaliar a influência de obesidade, idade e anos de menopausa sobre a densidade óssea. MÉTODOS: Análise retrospectiva da densidade mineral óssea (DMO) obtida em 588 mulheres de 41 a 60 anos, já menopausadas (1-10 anos antes). RESULTADOS: A influência positiva da obesidade foi confirmada através de diferenças significativas da DMO entre os grupos na coluna lombar (CL), colo de fêmur (CF) e trocânter (TR) (p < 0,01). Idade e anos desde a menopausa (ADM) foram correlacionados negativamente com DMO em todos os sítios (p = 0,000). Comparando-se pacientes entre 1 e < 6 ADM vs 6 e 10 AMD, a DMO foi maior no primeiro grupo na CL e CF (p < 0,005), apesar de maior DMO no grupo de mais idade (p = 0,01). Pacientes obesas tiveram uma prevalência mais baixa de osteoporose na CL e CF (p = 0,009). Análise de regressão identificou o IMC como o determinante mais forte da DMO de CF e trocânter, enquanto a ADM foi o determinante mais forte da DMO na CL. CONCLUSÃO: O efeito protetor da obesidade é sobrepujado pela deficiência de estradiol. Recomendamos que mesmo mulheres obesas na pós-menopausa devam ser examinadas para osteoporose.

Operative results of adolescent idiopathic scoliosis in Lerdsin Hospital.

OBJECTIVE: Evaluate the results of the posterior instrumentation for the correction of adolescent idiopathic scoliosis (AIS) in Lerdsin Hospital. MATERIAL AND METHOD: A retrospective study was conducted to determine the effectiveness of surgical treatment of idiopathic scoliosis in Lerdsin Hospital. The pre-operative, immediate post operative, and the most recent follow-up (minimum 2 years) x-ray of 17 patients were evaluated for curve correction and spinal balance. RESULT: The present study found that the curvatures in thoracic King type II and III were corrected by about 58% post operatively. The curve progressed 3 degrees (5%) at the end of 2 years. For lumbar curve in King types I and II, there was the correction of 51% and 59%. After 2 years, the curve progressed around 6 degrees (7%) and 8 degrees (14%). Trunk balance was corrected by 60% in King type III. Degrees of thoracic kyphosis was decreased about 4 degrees. CONCLUSION: Frontal and sagittal thoracic and lumbar curve correction can be satisfactorily obtained by posterior spinal correction with instrumentation.

Osteoporosis among male Saudi Arabs: a pilot study

Little attention has been paid to the problem of male osteopororsis in Saudi Arabia. In this prospective study we assessed the prevalence of male osteoporosis among Saudi Arabs. We studied Saudi Arabian males > 50 years of age attending outpatient clinics at King Fahd Hospital of the University, AI-Khobar, between 1 May 2005 and 30 January 2006. We determined body mass index [BMI] and tests were done to rule out secondary osteoporosis. All subjects had a bone mineral density [BMD] measurement of the hip area and the lumbar spine using dual energy X-ray absorptiometry [DEXA]. A T-score of

The prevalence and risk factors of osteoporosis in Thai renal-transplant patients.

OBJECTIVES: To determine the prevalence and risk factors of osteoporosis after renal transplantation in Thai patients. MATERIAL AND METHOD: A single-center cross-sectional study of bone mineral density was conducted in 102 Thai renal allograft recipients. Correlations were made between the clinical parameters and the occurrences of osteoporosis. RESULTS: The prevalence of osteoporosis was 24.5%, 9.8% and 26.4% at lumbar vertebrae, hip region, and any sites, respectively. Binary logistic regression analysis revealed that cumulative dosage of steroids was significantly correlated with osteoporosis of the lumbar spine (p = 0.023, adjusted OR = 1.005), while body mass index (p = 0.005, adjusted OR = 0.738) and age (p = 0.052, adjusted OR = 1.077) were correlated with osteoporosis of the hip region. CONCLUSION: Osteoporosis is common in Thai renal allograft recipients, particularly of the lumbar vertebrae. Cumulative dosage of steroids is the most important risk factor of low BMD of the lumbar vertebrae.

Comparison of bone mineral density with dual energy x-ray absorptiometry, quantitative ultrasound and single energy x-ray absorptiometry

We conducted this prospective study to establish the correlation between dual energy x-ray absorptiometry [DXA], quantitative ultrasound [QUS] and single energy x-ray absorptiometry [SXA] and to establish the role of QUS and SXA as a screening tool for osteoporosis. We carried out measurements of bone mineral density [BMD] of lumbar spine and femoral neck using DXA, QUS of heel using ultrasound densitometer, and BMD of forearm using SXA. We performed all the measurements at the Nuclear Medicine Division of King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia between 2002 and 2004. We obtained the measurements of 437 female adult patients, aged 20-87 years. We expressed all the values as mean +/- SD. The BMD [g/cm2] of lumbar spine was 1 +/- 0.18, and femoral neck was 0.88 +/- 0.17. The broad band ultrasound attenuation [BUA] of the heel was 74.9 +/- 39.1 dB/MHz, the speed of sound [SOS] was 1542.5 +/- 81.4 m/s, and the estimated BMD was 0.52 +/- 0.15 [g/cm2]. The BMD of forearm showed a value of 0.44 +/- 0.10 g/cm2. The best correlation was between absolute values of BMD of lumbar spine and femoral neck [r=0.71, p=0.000]. The correlation between BMD of lumbar spine, QUS heel and forearm BMD was significant, but low to moderate [r=0.43-0.64, p=0.000]. A strong correlation existed between the various parameters of heel, namely, BUA, SOS and estimated BMD [r=0.85-0.96, p=0.000]. We used the World Health Organization [WHO] criterion of T-score to diagnose the patients with osteoporosis or osteopenia with each modality. We diagnosed a maximum number of patients to have osteoporosis with BMD estimation of lumbar spine [31%], followed by femoral neck [14%], forearm [11%], and heel [6%]. The correlation between all modalities was significant, but varied from high to low. It was high between lumbar spine and femoral neck, moderate between lumbar spine and forearm and low between lumbar spine and QUS of heel. When we used the same WHO criterion of T-score [more than -2.5 SD below normal], QUS detected significantly less numbers with osteoporosis. We conclude that with the present cut-off of T-score, the QUS may not be used as a screening tool. It may need some modification of T-score. However, we need larger multi-center studies with a larger number of patients for further validation

Fraturas com arrancamento do anel apofisário ("limbus") póstero-superior da vértebra L5, associado com hérnia discal pré-marginal em atletas / Avulsion fractures of apophysial ring (

O aumento de adolescentes praticando esportes de forma cada vez mais competitiva tem causado o aumento de lesões relacionadas à prática desportiva. A dor lombar é uma queixa freqüente entre os atletas, geralmente relacionada a contraturas da musculatura paravertebral e fraturas ( espondilólise ) devido ao excesso de treinamento e aplicação de técnicas incorretas. Porém, outras etiologias podem causar a dor lombar, como processos infecciosos, tumorais e fraturas. As fraturas com arrancamento do anel apofisário são lesões incomuns e raramente ocorrem na região póstero-superior da vértebra L5. Os relatos da literatura mostram que o local mais acometido é a região póstero-inferior da vértebra L4. Apresentamos dois casos de atletas jovens com esta incomum lesão. O objetivo deste trabalho é discutir a possível etiologia, os melhores métodos para o diagnóstico e possíveis formas de tratamento desta patologia.

Impact of degenerative radiographic abnormalities and vertebral fractures on spinal bone density of women with osteoporosis

CONTEXT: Measurements of bone density taken by dual-energy x-ray absorptiometry are the most accurate procedure for the diagnosis of osteoporosis. This procedure has the disadvantage of measuring the density of all mineral components, including osteophytes, vascular and extra vertebral calcifications. These alterations can influence bone density results and densitometry interpretation. OBJECTIVE: To correlate radiography and densitometry findings from women with osteoporosis, analyzing the influence of degenerative processes and vertebral fractures on the evaluation of bone density. DESIGN: Retrospective study. SETTING: Osteoporosis outpatients' clinic at Hospital das Clínicas, Universidade Estadual de Campinas. PARTICIPANTS: Ninety-six postmenopausal women presenting osteoporosis diagnosed by bone density. MAIN MEASUREMENTS: Bone mineral density of the lumbar spine and femoral neck were measured by the technique of dual-energy x-ray absorptiometry, using a LUNAR-DPX densitometer. Fractures, osteophytes and aortic calcifications were evaluated by simple x-rays of the thoracic and lumbar spine. RESULTS: The x-rays confirmed vertebral fractures in 41.6 percent, osteophytes in 33.3 percent and calcifications of the aorta in 30.2 percent. The prevalence of fractures and aortic calcifications increased with age. The mean bone mineral density was 0.783g/cm² and the mean T-score was --3.47 DP. Neither fractures nor aortic calcifications had significant influence on bone mineral density (P = 0.36 and P = 0.09, respectively), despite the fractured vertebrae having greater bone mineral density (P < 0.02). Patients with lumbar spine osteophytes showed greater bone mineral density (P = 0.04). Osteophytosis was associated with lumbar spine bone mineral density after adjustment for fractures and aortic calcifications by multiple regression (P = 0.01). CONCLUSION: Osteophytes and lumbar spine fractures can overestimate bone density interpretation. The interpretation of densitometry results should be carried out together with the interpretation of a simple lumbar spine x-ray in elderly women

Interspinous bursa and spinal instability.

STUDY DESIGN: This is a prospective study. Interspinous tissue was taken intraoperatively for pathological examination for the presence of bursa. The pathologist was unaware of the X-ray findings in each specimen. The presence of bursa was then correlated with X-ray evidence of hypermobility in each segment. OBJECTIVE: To verify the pathogenesis of interspinous bursal formation. SUMMARY OF BACKGROUND DATA: Interspinous bursa is common in the older population. It has been associated with degenerative lumbar diseases, aging and anatomical distance between the spinous process. However, no detailed exploration of the segmental instability as a cause of bursal formation has been done. METHOD: The insterspinous tissue was taken intraoperatively from patients diagnosed as multilevelled spinal stenosis who underwent extensive decompression, fusion and instrumentation. The specimens were examined by the same pathologist for the existence of bursa. The presence of bursa was correlated with X-ray motion study of each spinal segment by student t-test. RESULTS: The existence of bursal was significantly correlated with angular mobility of more than 10 degrees. CONCLUSION: Angular mobility is a possible cause of interspinous bursa. On the contrary, the presence of insterspinous bursa may be evidence of segmental hypermobility.

Fracturas lumbares en un paciente con síndrome hipereosinofílico idiopático / Lumbar fractures in a patient with idiopathic hypereosinophilic syndrome

El síndrome hipereosinofílico idiopático (SHI) es un trastorno hematológico poco frecuente que causa activación y degranulación de eosinófilos en diversos tejidos con el consecuente daño tisular y funcional. Los tejidos más afectados son: corazón, pulmón, piel, sistema nervioso, aparato digestivo y riñón. El ataque al hueso y específicamente a columna vertebral, es de extrema rareza. El objetivo del tratamiento es frenar la producción de eosinófilos y de su actividad lítica degranuladora mediante esteroides, citotóxicos, alfa interferón o trasplante de médula ósea. Se informa el caso de un hombre de 32 años con (SHI) con antecedente de púrpura en la infancia, cardiomiopatía dilatada, evento trombótico isquémico cerebral y lesiones en las vértebras lumbares 2 y 4, canal estrecho lumbar y paraparesia desproporcionada, manejado con artrodesis lumbar mediante tornillos transpendiculares y descompresión lumbar, con mejoría importante de la fuerza muscular que le permitió reinicial la deambulación por sí mismo. Los estudios de imagen de control a los seis meses de la cirugía, muestran adecuada alineación del segmento intervenido y no hay evidencia de progresión de la lesión hacia las vértebras adyacentes

Síndrome facetario, valoración de 20 criterio diagnóstico / Facetary symdrome: evaluation of twenty diagnostic criteria

Objetivo. Basados en un protocolo de trabajo valoramos en un estudio prospectivo 500 casos de lumbalgia crónica en pacientes menores de 45 años, buscando específicamente la presencia de síndrome facetario. Métodos. Para ello utilizamos 20 criterios diagnósticos de los cuales 14 fueron clínicos, 4 radiológicos y 2 tomográficos, valorando estadísticamente mediante prueba de Chi cuadrada la utilidad de cada uno. De la muestra, 85 pacientes (17 por ciento) a nuestro juicio presentaron síndrome facetario; para corroborar el diagnóstico se les dividió en 4 grupos de manera aleatoria y se les aplicó infiltración perifacetaria con mepivacaina en forma unilateral, bilateral, de uno o de dos segmentos a nivel L4/L5/S1 según correspondió a cada grupo. Resultados. 16 de 20 criterios utilizados presentaron significancia estadística para detectar síndrome facetario. Las respuestas a inyección perifacetaria fueron estadísticamente mayores cuando se infiltraron en forma bilateral los niveles L4/L5/S1 (p<0.05 con prueba de Fisher). Conclusión. El conjunto de criterios y no su hallazgo aislado es la mejor forma de llegar al diagnóstico presuncional de síndrome facetario. Para corroborar el diagnóstico deberá efectuarse bloqueo perifacetario bilateral por lo menos dos segmentos

Achados otoneurológicos na escoliose idiopática / Otoneurological findings in idiopathic scoliosis

Dez pacientes do sexo feminino, de 11 a 19 anos de idade, com escoliose idiopática nas vértebras torácicas e lombar foram submetidas à avaliaçäo otoneurológica realizada com vecto-eletronistagmografia, verificando-se que este distúrbio ostopédico näo afeta o funcionamento do sistema vestibular.

Enfermedad lumbar degenerativa / Degenerative lumbar disease

El concepto de "enfermedad lumbar degenerativa" se refiere al padecimiento que afecta la región lumbar como resultado de factores múltiples que, en forma aislada o combinada, producen un cuadro clínico principalmente con dolor en alguna fase de su evolución. En el proceso de instalación de la enfermedad lumbar degenerativa participan los cambios de envejecimiento "normal", que pueden predisponer a la aparición de cambios degenerativos en diferentes áreas de la región lumbar como las facetas articulares lumbares y el espacio intervertebral, en particular el disco. El mecanismo de producción de la enfermedad articular degenerativa y su estrecha relación con el proceso de degeneración discal constituyen la base fisiopatológica para comprender mejor la evolución de las hernias discales y su importancia en la producción de cuadros dolorosos locales o referidos. El análisis de otros factores contribuyentes a esta enfermedad incluye los músculos y ligamentos, así como causas de orden dinámico como la inestabilidad vertebral