RESUMEN
PURPOSE: To follow the clinical outcome after surgery for cervical radiculopathy caused by degenerative cervical disc disease and to compare it with the outcome after conservative treatment. METHOD: Forty-three patients all awaiting surgery were studied prospectively. A control group of 39 conservatively treated patients were chosen, matched for gender and age. All patients rated their Sickness Impact Profile (SIP) and pain (VAS) and were clinically examined by unbiased observers initially and after 3, 9 and 24 months. RESULTS: Long-lasting pain reduction was noted both in the neck and in the arm for the operated patients, as well as improved sensory function and reduction of reflex disturbances. Their SIP showed a temporary improvement in the overall index, in the psychosocial dimension, in sleep/rest and home management, but only mobility remained improved. Among the operated patients referred directly to us, there was an improvement in SIP at the final follow-up. The control group's SIP indicated only a temporary improvement in sleep/rest. CONCLUSIONS: Surgically treated patients experienced pain reduction which was partially maintained for at least 24 months. A sustained improvement in the health status measured by SIP was observed only among operated patients that were not referred via the social insurance offices.
Asunto(s)
Dolor de Cuello/terapia , Dolor Intratable/terapia , Radiculopatía/terapia , Perfil de Impacto de Enfermedad , Adulto , Anciano , Brazo , Estudios de Casos y Controles , Vértebras Cervicales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dolor de Cuello/etiología , Evaluación de Resultado en la Atención de Salud , Dimensión del Dolor , Dolor Intratable/etiología , Estudios Prospectivos , Radiculopatía/etiología , Derivación y Consulta , Análisis de Regresión , Factores Sexuales , Enfermedades de la Médula Espinal/complicaciones , Encuestas y CuestionariosRESUMEN
BACKGROUND: Parkinson's disease (PD) is a chronic neurodegenerative disorder. There is limited knowledge about the function of the hypothalamic-pituitary-adrenal axis in PD. The primary aim of this prospective study was to analyze diurnal salivary cortisol concentrations in patients with PD and correlate these with age, gender, body mass index (BMI), duration of PD, and pain. The secondary aim was to compare the results with a healthy reference group. METHODS: Fifty-nine PD patients, 35 women and 24 men, aged 50-79 years, were recruited. The reference group comprised healthy individuals matched for age, gender, BMI, and time point for sampling. Salivary cortisol was collected at 8 am, 1 pm, and 8 pm, and 8 am the next day using cotton-based Salivette(®) tubes and analyzed using Spectria(®) Cortisol I(125). A visual analog scale was used for estimation of pain. RESULTS: The median cortisol concentration was 16.0 (5.8-30.2) nmol/L at 8 am, 5.8 (3.0-16.4) at 1 pm, 2.8 (1.6-8.0) at 8 pm, and 14.0 (7.5-28.7) at 8 am the next day. Total secretion and rate of cortisol secretion during the day (8 am-8 pm) and the concentration of cortisol on the next morning were lower (12.5 nmol/L) in the reference group. No significant correlations with age, gender, BMI, duration of PD, Hoehn and Yahr score, Unified Parkinson's Disease Rating Scale III score, gait, pain, or cortisol concentrations were found. CONCLUSION: The neurodegenerative changes in PD does not seem to interfere with the hypothalamic-pituitary-adrenal axis. Salivary cortisol concentrations in PD patients were increased in the morning compared with the reference group, and were not influenced by motor dysfunction, duration of disease, or coexistence of chronic or acute pain.