ABSTRACT
Abstract Objective To assess the role of facet tropism (FT) in intervertebral disc prolapse. Methods A total 98 patients with lower back pain were included in the study. Magnetic resonance imaging scans were performed and analyzed. The angles of the right and left facets were measured on the axial section. Patients without disc prolapse at the L3-L4, L4-L5 and L5-S1 levels act as controls for those with disc prolapse at the same levels. A statistical analysis was also performed. Results The incidence of FT at the L3-L4 level was of 85.2% in patients with disc herniation (n= 27), and of 56.3% in the control group, which was statistically significant (p= 0.008). Similarly, at the L4-L5 level, incidence of FT among cases and controls was of 71.4% (n= 35) and 52.4% respectively (p= 0.066). At the L5-S1 the incidence was of 66% and 51% among cases and controls respectively (p= 0.13). Conclusion We found a positive association between FT and disc herniation at the L3-L4 level, but no association at the L4-L5 and L5-S1 levels.
Resumo Objetivo Avaliar o papel do tropismo facetário (TF) no prolapso discal intervertebral. Métodos Um total de 98 pacientes com dor lombar foram incluídos no estudo. Exames de ressonância magnética foram realizados e analisados, e os ângulos das facetas direita e esquerda foram medidos na seção axial. Os pacientes sem prolapso discal nos níveis L3-L4, L4-L5 e L5-S1 atuam como controles para aqueles com prolapso nos mesmos níveis. Fez-se também uma análise estatística. Resultados A incidência de TF no nível L3-L4 foi de 85,2% em pacientes com hérnia discal (n= 27), e de 56,3% no grupo controle, o que foi estatisticamente significativo (p= 0,008). Da mesma forma, a incidência de TF no nível L4-L5 entre casos e controles foi de 71,4% (n= 35) e 52,4%, respectivamente (p= 0,066). No nível L5-S1, a incidência foi de 66% e 51% nos caso e nos controles, respectivamente (p= 0,13). Conclusão Encontramos associação positiva entre TF e hérnia de disco no nível L3-L4, mas nenhuma associação nos níveis L4-L5 e L5-S1.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Spondylolisthesis , Magnetic Resonance Spectroscopy , Low Back Pain/diagnostic imaging , Intervertebral Disc Degeneration/diagnostic imaging , Lumbar Vertebrae/pathologyABSTRACT
While the developed world is focusing on laying guidelines for selecting out cases of Asymptomatic primary hyperparathyroidism (PHPT) for surgical intervention and promoting minimal access surgery, the developing world is observing a change in disease spectrum from advanced symptomatic to lesser degree of symptomatic disease and not many with associated Vitamin D deficiency. Few studies from the developing countries of the world have focused on the changing clinical spectrum of PHPT. Objective of this study is to review the changing profile of PHPT in developing world. A systematic literature search was done in December 2017 focussing on publications from the developing world. All studies pertaining to the epidemiology of PHPT published after 1st January 2000 and published in English language were included for analysis. Most of the studies published from developing countries report a predominance of symptomatic disease (79.6% of all included patients) with musculoskeletal disease present in the majority of patients (52.9%). The combined mean serum total calcium (11.9 ± 1.4 mg/dL), serum PTH (668.6 ± 539 pg/mL), serum alkaline phoshpatase (619 ± 826.9 IU/L) and weight of excised parathyroid glands (4.4 ± 3.8 grams) are much higher than those reported from the western studies. Despite this, we found that there is a distinct trend towards a milder form of disease presentation and biochemical profile noticeable in more recent times. Although there is a striking difference in all aspects of PHPT disease epidemiology, clinical presentation and biochemical profile of developing and developed countries, there is a distinct trend towards a milder form of disease presentation and biochemical profile in more recent times.
Subject(s)
Hyperparathyroidism, Primary , Developing Countries , Humans , Hyperparathyroidism, Primary/blood , Hyperparathyroidism, Primary/complications , Hyperparathyroidism, Primary/epidemiology , Severity of Illness IndexABSTRACT
ABSTRACT While the developed world is focusing on laying guidelines for selecting out cases of Asymptomatic primary hyperparathyroidism (PHPT) for surgical intervention and promoting minimal access surgery, the developing world is observing a change in disease spectrum from advanced symptomatic to lesser degree of symptomatic disease and not many with associated Vitamin D deficiency. Few studies from the developing countries of the world have focused on the changing clinical spectrum of PHPT. Objective of this study is to review the changing profile of PHPT in developing world. A systematic literature search was done in December 2017 focussing on publications from the developing world. All studies pertaining to the epidemiology of PHPT published after 1st January 2000 and published in English language were included for analysis. Most of the studies published from developing countries report a predominance of symptomatic disease (79.6% of all included patients) with musculoskeletal disease present in the majority of patients (52.9%). The combined mean serum total calcium (11.9 ± 1.4 mg/dL), serum PTH (668.6 ± 539 pg/mL), serum alkaline phoshpatase (619 ± 826.9 IU/L) and weight of excised parathyroid glands (4.4 ± 3.8 grams) are much higher than those reported from the western studies. Despite this, we found that there is a distinct trend towards a milder form of disease presentation and biochemical profile noticeable in more recent times. Although there is a striking difference in all aspects of PHPT disease epidemiology, clinical presentation and biochemical profile of developing and developed countries, there is a distinct trend towards a milder form of disease presentation and biochemical profile in more recent times.