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1.
Comput Math Methods Med ; 2022: 4799248, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35602348

RESUMEN

Objective: Physical therapy is a common clinical treatment for patients with lumbar disc herniation. The study is aimed at exploring the feasibility of mathematical expression and curative effect prediction of physical therapy in patients with lumbar disc herniation using a logistic model and gradient boosting machine (GBM). Methods: A total of 142 patients with lumbar disc herniation were treated with physical therapy. The pain was evaluated by the visual analogue scale (VAS) before each treatment. The logistic model was used to conduct a global regression analysis on patients with lumbar disc herniation. The final results of the whole course of treatment were predicted by the measured values of 2-9 times of treatment. The GBM model was used to predict and analyze the curative effect of physical therapy. Results: The mathematical expression ability of the logistic regression model for patients with lumbar disc herniation undergoing physical therapy was sufficient, and the global determination coefficient was 0.721. The results would be better for more than five measurements. The AUC of GBM mode logistic regression analysis was 0.936 and 0.883, and the prediction effect is statistically significant. Conclusion: Both the logistic and GBM model can fully express the changes in patients with lumbar disc herniation during physical therapy.


Asunto(s)
Desplazamiento del Disco Intervertebral , Humanos , Desplazamiento del Disco Intervertebral/terapia , Modelos Logísticos , Vértebras Lumbares , Modalidades de Fisioterapia , Estudios Retrospectivos , Resultado del Tratamiento
2.
J Healthc Eng ; 2022: 9185384, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35432832

RESUMEN

This study aimed for the analysis of the effect of acupuncture and moxibustion combined with needle-knife on pain and lumbar function in patients with lumbar disc herniation. From June 2019 to February 2021, the medical records of 126 patients with lumbar disc herniation admitted to the department of orthopedics of our hospital were selected and divided into the control group (n = 63) treated with acupuncture and moxibustion and the observation group (n = 63) treated with acupuncture and moxibustion combined with needle-knife according to different treatment regimens. After 4 weeks of treatment, the clinical efficacy, pain status, and lumbar function were compared between the two groups. The concentrations of relevant inflammatory factors (IL-6, IL-10, TNF-α, and MMP-2) in peripheral blood of the two patients before and after treatment were measured by enzyme-linked immunosorbent assay (ELISA). After treatment, the overall response rate was 93.65% in the observation group, which was higher than 80.95% in the control group (P < 0.05); the visual blurred score (VAS) scores of lower limbs and waist in the observation group were lower than those in the control group, while the expression of pain mediators serotonin (5-HT) and prostaglandin E2 (PEG2) was also lower than that in the control group (P < 0.05); the Oswestry disability index (ODI) in the observation group was lower than that in the control group, while the Japanese Orthopedic Association assessment treatment score (JOA) was higher than that in the control group (P < 0.05). After treatment, the concentration levels in peripheral blood (IL-6, IL-10, TNF-α, and MMP-2) were significantly lower in the observation group than in the control group (P < 0.05). Acupuncture and moxibustion combined with needle-knife is effective in the treatment of lumbar disc herniation, which helps to improve the clinical efficacy, relieve pain symptoms, promote the improvement of lumbar function, and contribute to the reduction of inflammatory factors.


Asunto(s)
Terapia por Acupuntura , Desplazamiento del Disco Intervertebral , Moxibustión , Humanos , Interleucina-10 , Interleucina-6 , Desplazamiento del Disco Intervertebral/complicaciones , Desplazamiento del Disco Intervertebral/terapia , Vértebras Lumbares , Metaloproteinasa 2 de la Matriz , Dolor , Resultado del Tratamiento , Factor de Necrosis Tumoral alfa
3.
Zhonghua Wai Ke Za Zhi ; 60(5): 401-408, 2022 May 01.
Artículo en Chino | MEDLINE | ID: mdl-35359080

RESUMEN

Recent years,the incidence of lumbar disc herniation is increasing annually,trending to younger age.There is a lack of clinical guideline for the management of lumbar disc herniation.Considering various problems in the management of lumbar disc herniation under different occasions,based on a systematic literature review,Basic Research and Transformation Society,Professional Committee of Spine and Spinal Cord organized experts to make this consensus jointly.This guideline aims to provide a standardized management of lumbar disc herniation with scientific principle and practical feasibility.Evidence-based medicine,and scientific suggestions are put forward specially for the management of lumbar disc herniation to standardize the diagnosis and treatment,promote the prognosis as well as improve the quality of life of patients.


Asunto(s)
Desplazamiento del Disco Intervertebral , Consenso , Humanos , Desplazamiento del Disco Intervertebral/diagnóstico , Desplazamiento del Disco Intervertebral/terapia , Vértebras Lumbares , Calidad de Vida
4.
BMC Med Imaging ; 22(1): 51, 2022 03 19.
Artículo en Inglés | MEDLINE | ID: mdl-35305577

RESUMEN

OBJECTIVE: To investigate and verify the efficiency and effectiveness of a nomogram based on radiomics labels in predicting the treatment of lumbar disc herniation (LDH). METHODS: By reviewing medical records that were analysed over the past three years, clinical and imaging data of 200 lumbar disc patients at the Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine were obtained. The collected cases were randomly divided into a training group (n = 140) and a testing group (n = 60) at a ratio of 7:3. Two radiologists with experience in reading orthopaedics images independently segmented the ROIs. The whole intervertebral disc with the most obvious protrusion in the sagittal plane T2WI lumbar MRI as a mask (ROI) is sketched. The LASSO (Least Absolute Shrinkage And Selection Operator) algorithm was used to filter the features after extracting the radiomics features. The multivariate logistic regression model was used to construct a quantitative imaging Rad­Score for the selected features with nonzero coefficients. The radiomics labels and nomogram were evaluated using the receiver operating characteristic curve (ROC) and the area under the curve (AUC). The calibration curve was used to evaluate the consistency between the nomogram prediction and the actual treatment plan. The DCA decision curve was used to evaluate the clinical applicability of the nomogram. RESULT: Following feature extraction, 11 radiomics features were used to construct the radiomics label for predicting the treatment plan of LDH. A nomogram was then constructed. The AUC was 0.93 (95% CI: 0.90-0.97), with a sensitivity of 89%, a specificity of 91%, a positive predictive value of 92.7%, a negative predictive value of 89.4%, and an accuracy of 91%. The calibration curve showed that there was good consistency between the prediction and the actual observation. The DCA decision curve analysis showed that the nomogram of the imaging group has great potential for clinical application when the risk threshold is between 5 and 72%. CONCLUSION: A nomogram based on radiomics labels has good predictive value for the treatment of LDH and can be used as a reference for clinical decision-making.


Asunto(s)
Desplazamiento del Disco Intervertebral , Disco Intervertebral , Humanos , Desplazamiento del Disco Intervertebral/diagnóstico por imagen , Desplazamiento del Disco Intervertebral/terapia , Imagen por Resonancia Magnética/métodos , Nomogramas , Estudios Retrospectivos
5.
Georgian Med News ; (323): 60-67, 2022 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-35271472

RESUMEN

Intervertebral disc degeneration often is a cause of low back pain (LBP) and radicular pain even without severe compression of the nerve root by hernial material. Thermodiscoplasty, or intradiscal electrothermal therapy (IDET) is used for minimally invasive treatment of discogenic pain. Pulsed radiofrequency (PRF) of the dorsal root ganglion (DRG) is used as an interventional method for radicular pain elimination. For the first time we have proposed the simultaneous combined use of these techniques. Our research's aim - to study the dynamics of pain syndrome and disability in patients undergone simultaneous combined treatment with the IDET and PRF DRG for pain associated with moderate disc herniation without spinal root severe compression, which confirmed motor and sensitive deficit absence. A retrospective analysis of 22 patients treated at the Neurospine clinic (Kyiv) from 2019 to 2020 was carried out. All patients had degenerative-dystrophic disease of the intervertebral discs L4-L5 and L5-S1 with therapeutically resistant radicular pain. The standard examination included two-plane spondylography and magnetic resonance imaging, as well as an assessment of neurological status. The discogenic origin of pain is confirmed by provocative contrasting discography. The interest of the corresponding spinal root was confirmed by performing selective radicular blockade.The treatment results were assessed using the Numerical rating scale (NRS) and the Oswestry disability index (ODI); statistical processing was carried out using Microsoft Excel and Statistica-10 program tools. There were no complications detected. All patients noted a significant reduction in pain and decrease of disability: VAS (Me) before treatment = 7.77±1.02, ODI (Ме) before treatment = 70.45±7.85; VAS (Me) immediately after surgery = 2.18±1.13. This trend persisted for six months: VAS (Me) 6 months after surgery = 2.0±0.75, ODI (Me) 6 months after surgery = 30.45±9.98. The simultaneous combined use of IDET and PRF DRG is an effective and safe treatment for therapeutically resistant chronic lumbosacral radicular pain associated with moderate disc herniation.


Asunto(s)
Desplazamiento del Disco Intervertebral , Dolor de la Región Lumbar , Radiculopatía , Dolor de Espalda , Humanos , Desplazamiento del Disco Intervertebral/complicaciones , Desplazamiento del Disco Intervertebral/terapia , Dolor de la Región Lumbar/cirugía , Dolor de la Región Lumbar/terapia , Radiculopatía/complicaciones , Radiculopatía/terapia , Estudios Retrospectivos
6.
Medicine (Baltimore) ; 101(6): e28831, 2022 Feb 11.
Artículo en Inglés | MEDLINE | ID: mdl-35147124

RESUMEN

RATIONALE: Discogenic low back pain often persists despite medication and medical intervention. In this study, intradiscal pulsed radiofrequency (PRF) was performed in a patient with discogenic low back pain who did not respond to oral medication, posterior medial branch block, epidural steroid injection, and percutaneous epidural adhesiolysis. PATIENT CONCERNS: A 28-year-old woman visited a pain clinic complaining of low back pain that was scored 8 out of 10 on a numerical rating scale. Her pain was present in any position throughout the day and worsened in the sitting position. DIAGNOSES: Magnetic resonance imaging showed L5-S1 internal discal disruption. Based on the medical history, physical examination, and magnetic resonance imaging, we determined that her pain originated from the L5-S1 disc. INTERVENTIONS: We performed an intradiscal PRF on the affected disc under C-arm fluoroscopy guidance. PRF was performed at 5 Hz, 20-ms pulse width, and 70 V for 15 minutes while ensuring that the electrode tip temperature was maintained below 42°C. OUTCOMES: Immediately after the procedure, the patient's pain subsided. At the 1-month follow-up visit, the patient reported complete relief of her low back pain. The Oswestry disability index, which indicates the degree of disability, improved significantly. She also reported that she could sit for long periods because the pain was reduced. No adverse effects from the procedure were found. LESSONS: Applying intradiscal PRF seems an effective and safe technique for treating discogenic low back pain.


Asunto(s)
Desplazamiento del Disco Intervertebral/terapia , Dolor de la Región Lumbar/terapia , Tratamiento de Radiofrecuencia Pulsada/métodos , Adulto , Femenino , Humanos , Degeneración del Disco Intervertebral/diagnóstico por imagen , Degeneración del Disco Intervertebral/terapia , Desplazamiento del Disco Intervertebral/diagnóstico por imagen , Dolor de la Región Lumbar/etiología , Imagen por Resonancia Magnética , Resultado del Tratamiento
7.
J Healthc Eng ; 2022: 1420392, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35126896

RESUMEN

OBJECTIVE: To explore the curative effects of remote home management combined with Feng's spinal manipulation on the treatment of elderly patients with lumbar disc herniation (LDH). METHODS: The clinical data of 100 patients with LDH in our hospital (December 2019-December 2020) were retrospectively reviewed. The 100 patients were equally divided into a routine treatment group and interventional group according to the order of admission. The routine treatment group received conventional rehabilitation training, and the interventional group received remote home management combined with Feng's spinal manipulation. The Oswestry disability index (ODI) and straight leg raising test were adopted for the assessment of the degrees of dysfunction and straight leg raising angles of the two groups after intervention. The curative effects of the two rehabilitation programs were evaluated. RESULTS: Compared with the routine treatment group, the interventional group had a remarkably higher excellent and good rate (P < 0.05), a significantly lower average ODI score after intervention (P < 0.001), notably higher straight leg raising angle, surface AEMG (average electromyogram) during stretching and tenderness threshold after intervention (P < 0.001), markedly lower muscular tension, surface AEMG during buckling, and flexion-extension relaxation ratio (FRR; (P < 0.001)), and much higher quality of life scores after intervention (P < 0.001). CONCLUSION: The remote home management combined with Feng's spinal manipulation, as a reliable method to improve the quality of life and the back muscular strength of the elderly patients with LDH, can substantially increase the straight leg raising angle and reduce the degree of dysfunction. Further study is conducive to establishing a better solution for the patients with LDH.


Asunto(s)
Desplazamiento del Disco Intervertebral , Manipulación Espinal , Anciano , Humanos , Desplazamiento del Disco Intervertebral/terapia , Vértebras Lumbares , Manipulación Espinal/métodos , Calidad de Vida , Estudios Retrospectivos , Resultado del Tratamiento
8.
Medicine (Baltimore) ; 101(5): e28775, 2022 Feb 04.
Artículo en Inglés | MEDLINE | ID: mdl-35119041

RESUMEN

BACKGROUND: Lumbar disc herniation (LDH) is a common disease, which can cause low back pain, sciatica, and even disability. The treatment of LDH is a global challenge. Conservative therapy with non-drugs is considered to be the first choice for patients with LDH. In recent years, an increasing number of systematic reviews and meta analyses on Daoyin and massage interventions in lumbar disc herniation have been implemented. However, the evidence quality and methodological quality of these systematic reviews/meta analyses are unknown and need to be systematically evaluated. This overview aims to systematically summarize and critically appraise the current evidence on Daoyin and massage for LDH. METHODS: Eight electronic data will be retrieved, including China National Knowledge Infrastructure (CNKI), Wanfang database (WF), China Biomedical database (CBM), Chinese Scientific Journals Database (VIP), PubMed, Cochrane Library, Web of Science (WOS), and EMBASE from their inception to March 1, 2022. The reporting quality, methodological quality, risk of bias, quality of evidence will be assessed by using The Preferred Reporting Items for Systematic Reviews and Meta-analyses 2020 (PRISMA 2020), the Assessment of Multiple Systematic Reviews 2 (AMSTAR-2), the Risk of Bias in Systematic Review (ROBIS), and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Two independent researchers conducted literature screening, data extraction, and quality evaluation process. In addition, we will establish an overlap matrix and calculate the corrected covered area to evaluate the impact of overlapping areas on conclusions. RESULTS: The results will be published in a peer-reviewed journal. CONCLUSION: This overview will provide comprehensive evidence of Daoyin and massage for treating lumbar disc herniation. SYSTEMATIC REVIEW REGISTRATION: INPLASY202210019.


Asunto(s)
Terapia por Acupuntura , Desplazamiento del Disco Intervertebral , Masaje , Ciática , China , Humanos , Desplazamiento del Disco Intervertebral/terapia , Ciática/terapia , Revisiones Sistemáticas como Asunto
9.
Healthcare (Basel) ; 10(2): 1-19, 20220127.
Artículo en Inglés | BIGG - guías GRADE, BIGG - guías GRADE | ID: biblio-1362484

RESUMEN

A significant number of individuals suffer from low back pain throughout their lifetime, and the medical costs related to low back pain and disc herniation are gradually increasing in Korea. Korean medicine interventions have been used for the treatment of lumbar intervertebral disc herniation. Therefore, we aimed to update the existing Korean medicine clinical practice guidelines for lumbar intervertebral disc herniation. A review of the existing guidelines for clinical treatment and analysis of questionnaires targeting Korean medicine doctors were performed. Subsequently, key questions on the treatment method of Korean medicine used for disc herniation in actual clinical trials were derived, and drafts of recommendations were formed after literature searches using the Grading of Recommendations, Assessment, Development and Evaluation. An expert consensus was reached on the draft through the Delphi method and final recommendations were made through review by the development project team and the monitoring committee. Fifteen recommendations for seven interventions for lumbar disc herniation were derived, along with the grade of recommendation and the level of evidence. The existing Korean medicine clinical practice guidelines for lumbar intervertebral disc herniation have been updated. Continuous updates will be needed through additional research in the future.


Asunto(s)
Humanos , Adulto , Terapia por Acupuntura , Dolor de la Región Lumbar/terapia , Desplazamiento del Disco Intervertebral/terapia , Desplazamiento del Disco Intervertebral/diagnóstico
10.
Medicine (Baltimore) ; 101(3): e28540, 2022 Jan 21.
Artículo en Inglés | MEDLINE | ID: mdl-35060512

RESUMEN

RATIONALE: With the spread of computers and mobile phones, cervical spondylosis has become a common occupational disease in clinics, which seriously affects the quality of life of patients. We used a nonsurgical spinal decompression system (SDS) combined with physical therapy electroacupuncture (EA) to treat a case of mixed cervical spondylosis caused by multi-level cervical disc herniation, and we achieved satisfactory results. PATIENT CONCERNS: A 44-year-old Caucasian Asian woman presented with neck pain and numbness on the left side of the limb. MRI showed the patient's C3-C7 segment cervical disc herniation, and the flexion arch of the cervical spine was reversed. DIAGNOSIS: The patient was diagnosed with a mixed cervical spondylosis. INTERVENTIONS: The patient received a month of physical therapy (SDS traction combined with EA). OUTCOMES: Before and after treatment: VAS score of neck pain decreased from 8 to 0; Cervical spine mobility returned to normal; The grip strength of left hand increased from 7.5 kg to 19.2 kg; Cervical curvature index changed from -16.04% to -3.50%; the physiological curvature of the cervical spine was significantly restored. There was no dizziness or neck discomfort at 6 month and 1 year follow-up. LESSONS SUBSETIONS: SDS traction combined with EA is effective for the treatment of cervical disc herniation and can help restore and rebuild the biomechanical balance of the cervical spine.


Asunto(s)
Vértebras Cervicales/diagnóstico por imagen , Descompresión/métodos , Electroacupuntura/métodos , Desplazamiento del Disco Intervertebral/terapia , Dolor de Cuello/etiología , Tracción , Adulto , Femenino , Humanos , Desplazamiento del Disco Intervertebral/psicología , Imagen por Resonancia Magnética , Dolor de Cuello/terapia , Calidad de Vida , Espondilosis/terapia , Resultado del Tratamiento
11.
Zhongguo Zhen Jiu ; 42(1): 35-40, 2022 Jan 12.
Artículo en Chino | MEDLINE | ID: mdl-35025155

RESUMEN

OBJECTIVE: To compare the clinical efficacy and safety among three different entry points of needle knife, including tenderness point, intervertebral foramen point and articular process node, for lumbar disc herniation (LDH). METHODS: A total of 105 patients with LDH were randomly divided into a tenderness point group (35 cases, 1 case dropped off ), an intervertebral foramen point group (35 cases) and an articular process node group (35 cases, 1 case dropped off ). In the three groups, the needle knife was given at positive tenderness points of lumbosacral and hip, the external point of intervertebral foramen and the node of vertebral joint process respectively, once a week for a total of 4 times. The scores of Japanese Orthopaedic Association (JOA), Oswestry disability index (ODI), visual analogue scale (VAS) were recorded before treatment, 2 weeks and 4 weeks into treatment, and 3 months follow-up after treatment, and the clinical efficacy and safety was observed. RESULTS: Compared before treatment, the JOA scores in each group were increased 2, 4 weeks into treatment and in the follow-up (P<0.05); 4 weeks into treatment and in the follow-up, the JOA scores in the tenderness point group and the articular process node group were higher than those in the intervertebral foramen point group (P<0.05). Compared before treatment, except for ODI score 2 weeks into treatment in the intervertebral foramen point group, the ODI and VAS scores in each group were decreased 2, 4 weeks into treatment and in the follow-up (P<0.05), and the ODI scores in the tenderness point group and the articular process node group were lower than those in the intervertebral foramen point group (P<0.05). In 2 weeks into treatment, the VAS scores in the tenderness point group and the articular process node group were lower than those in the intervertebral foramen point group (P<0.05); in 4 weeks into treatment and follow-up, the VAS scores in the tenderness point group were lower than the other two groups (P<0.05). After treatment, the clinical efficacy of each group was similar (P>0.05); during the follow-up, the total effective rate in the tenderness point group was higher than that in the intervertebral foramen point group (P<0.05). There were no serious adverse events in each group. CONCLUSION: The three different entry points of needle knife all could improve the symptoms of patients with LDH. The comprehensive effect of improving the subjective symptoms, lumbar function, pain degree and long-term curative effect is better in the tenderness point group.


Asunto(s)
Desplazamiento del Disco Intervertebral , Humanos , Desplazamiento del Disco Intervertebral/terapia , Vértebras Lumbares , Región Lumbosacra , Estudios Retrospectivos , Resultado del Tratamiento
12.
Explore (NY) ; 18(2): 240-249, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-34674966

RESUMEN

CONTEXT: Conservative treatment is effective for treating and managing herniated lumbar disc with radiating leg pain. OBJECTIVES: To investigate the effects of motion style acupuncture treatment (MSAT) on the pelvic joint for this condition. DESIGN: This prospective observational study was a pilot study for a future randomized, controlled trial (RCT). SETTING: [masked for review]. PATIENTS/INTERVENTIONS: We enroled 40 patients and allocated them to two groups (both n = 20). Groups 1 and 2 received integrative Korean medicine treatment (KMT) and integrative KMT with MSAT for pelvic joint, respectively. Primary outcome was the Numeric Rating Scale (NRS) score for low back pain. Secondary outcomes were the Oswestry Disability Index (ODI), Visual analogue Scale (VAS), and EuroQol 5-Dimension-5-level (EQ-5D-5 L) scores. Efficacy was assessed by comparing the baseline and Day 4 results. Safety was assessed based on the frequency and severity of all adverse events. RESULTS: On Day 14, except for ODI in Group 1, the NRS, VAS, and EQ-5D-5 L scores showed significant improvements in both groups. On Day 90, both groups showed significant improvements in the NRS, ODI, and EQ-5D-5 L scores. There was a significant between-group difference in the NRS score on Day 7. On Day 14, Group 2 had a significantly lower VAS score for radiating leg pain than Group 1. Twelve patients reported adverse events associated with integrative KMT; however, there was no association with pelvic joint MSAT. CONCLUSION: Adding MSAT for pelvic joint to conventional integrative KMT may ameliorate radiating leg pain and improve the quality of life.


Asunto(s)
Terapia por Acupuntura , Desplazamiento del Disco Intervertebral , Dolor de la Región Lumbar , Terapia por Acupuntura/métodos , Humanos , Desplazamiento del Disco Intervertebral/complicaciones , Desplazamiento del Disco Intervertebral/terapia , Dolor de la Región Lumbar/etiología , Dolor de la Región Lumbar/terapia , Proyectos Piloto , Estudios Prospectivos , Resultado del Tratamiento
13.
Clin Orthop Relat Res ; 480(3): 574-584, 2022 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-34597280

RESUMEN

BACKGROUND: A recent randomized controlled trial (RCT), performed by the authors, comparing early surgical microdiscectomy with 6 months of nonoperative care for chronic lumbar radiculopathy showed that early surgery resulted in improved outcomes. However, estimates of the incremental cost-utility ratio (ICUR), which is often expressed as the cost of gaining one quality-adjusted life year (QALY), of microdiscectomy versus nonsurgical management have varied. Radiculopathy lasting more than 4 months is less likely to improve without surgical intervention and may have a more favorable ICUR than previously reported for acute radiculopathy. QUESTION/PURPOSE: In the setting of chronic radiculopathy caused by lumbar disc herniation, defined as symptoms and/or signs of 4 to 12 months duration, is surgical management more cost-effective than 6 months of nonoperative care from the third-party payer perspective based on a willingness to pay of less than CAD 50,000/QALY? METHODS: A decision analysis model served as the vehicle for the cost-utility analysis. A decision tree was parameterized using data from our single-center RCT that was augmented with institutional microcost data from the Ontario Case Costing Initiative. Bottom-up case costing methodology generates more accurate cost estimates, although institutional costs are known to vary. There were no major surgical cost drivers such as implants or bone graft substitutes, and therefore, the jurisdictional variance would be minimal for tertiary care centers. QALYs derived from the EuroQoL-5D were the health outcome and were derived exclusively from the RCT data, given the paucity of studies evaluating the surgical treatment of lumbar radiculopathy lasting 4 to 12 months. Cost-effectiveness was assessed using the ICUR and a threshold of willingness to pay CAD 50,000 (USD 41,220) per QALY in the base case. Sensitivity analyses were performed to account for the uncertainties within the estimate of cost utility, using both a probabilistic sensitivity analysis and two one-way sensitivity analyses with varying crossover rates after the 6-month nonsurgical treatment had concluded. RESULTS: Early surgical treatment of patients with chronic lumbar radiculopathy (defined as symptoms of 4 to 12 months duration) was cost-effective, in that the cost of one QALY was lower than the CAD 50,000 threshold (note: the purchasing power parity conversion factor between the Canadian dollar (CAD) and the US dollar (USD) for 2019 was 1 USD = 1.213 CAD; therefore, our threshold was USD 41,220). Patients in the early surgical treatment group had higher expected costs (CAD 4118 [95% CI 3429 to 4867]) than those with nonsurgical treatment (CAD 2377 [95% CI 1622 to 3518]), but they had better expected health outcomes (1.48 QALYs [95% CI 1.39 to 1.57] versus 1.30 [95% CI 1.22 to 1.37]). The ICUR was CAD 5822 per QALY gained (95% CI 3029 to 30,461). The 2-year probabilistic sensitivity analysis demonstrated that the likelihood that early surgical treatment was cost-effective was 0.99 at the willingness-to-pay threshold, as did the one-way sensitivity analyses. CONCLUSION: Early surgery is cost-effective compared with nonoperative care in patients who have had chronic sciatica for 4 to 12 months. Decision-makers should ensure adequate funding to allow timely access to surgical care given that it is highly likely that early surgical intervention is potentially cost-effective in single-payer systems. Future work should focus on both the clinical effectiveness of the treatment of chronic radiculopathy and the costs of these treatments from a societal perspective to account for occupational absences and lost patient productivity. Parallel cost-utility analyses are critical so that appropriate decisions about resource allocation can be made. LEVEL OF EVIDENCE: Level III, economic and decision analysis.


Asunto(s)
Discectomía/economía , Desplazamiento del Disco Intervertebral/economía , Desplazamiento del Disco Intervertebral/terapia , Microcirugia/economía , Modalidades de Fisioterapia/economía , Radiculopatía/economía , Radiculopatía/terapia , Adulto , Análisis Costo-Beneficio , Discectomía/métodos , Femenino , Humanos , Vértebras Lumbares , Masculino , Microcirugia/métodos , Persona de Mediana Edad , Dimensión del Dolor , Calidad de Vida , Años de Vida Ajustados por Calidad de Vida
14.
J Back Musculoskelet Rehabil ; 35(2): 363-371, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-34180407

RESUMEN

BACKGROUND: Electrotherapy is part of a physician's toolbox for treating various musculoskeletal conditions, including radicular pain, but the preferred modality is yet unclear. OBJECTIVE: To compare the short-term efficacy of three electrotherapeutic modalities in relieving lumbar disc herniation (LDH)-induced radicular pain. METHODS: Fourteen patients with LDH-induced radicular pain attended a single session of electrotherapy, which included four 10-min consecutive treatments: transcutaneous electrical nerve stimulation (TENS), interferential (IF) stimulation, a combined treatment with pulsed ultrasound and IF current (CTPI), and a sham control. Treatments were randomized and the straight leg raise (SLR) degree was measured immediately before and after each treatment. RESULTS: Each of the three active modalities significantly improved the SLR score. The most prominent improvement was observed in the CTPI condition, followed by IF and, finally, TENS. The sham stimulation did not affect the SLR scores. CONCLUSIONS: A single session with either TENS, IF current or CTPI is sufficient to improve the range of motion and degree of radicular pain associated with LDH. CTPI appears to be the most effective modality of the three, possibly due to greater penetration efficiency of the induced current. The effects of a long-term treatment schedule are yet to be identified.


Asunto(s)
Terapia por Estimulación Eléctrica , Desplazamiento del Disco Intervertebral , Estimulación Eléctrica Transcutánea del Nervio , Humanos , Desplazamiento del Disco Intervertebral/complicaciones , Desplazamiento del Disco Intervertebral/terapia , Dolor/complicaciones , Resultado del Tratamiento , Ondas Ultrasónicas
15.
Asian J Surg ; 45(1): 277-283, 2022 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-34384675

RESUMEN

BACKGROUND: The objective of this study was to identify the predictors of the conservative management outcomes in patients with lumbar herniated nucleus pulposus (HNP). METHODS: A prospective study was conducted between June 2010 and April 2012 in Banda Aceh, Indonesia. Clinical and baseline neurologic examinations such as passive straight leg raising test (SLRT), cross SLRT, and patellar and Achilles reflexes were assessed prior to the conservative management. The patients were evaluated at 2nd, 4th, 8th, 12th and 24th week following commencement of the conservative management. RESULTS: We recruited and followed 171 HNP patients of which 35.7% of them had good outcome. At univariate analysis, patients with more than 12 months duration of complaint, those with dominant radicular pain, severe pain intensity (visual analogue scale 7-10), positive SLRT, positive cross SLRT, and reduced motor power of knee extensors (muscle strength grade 1-4), were associated with poor outcome. Multivariate analysis suggested that patients with dominant radicular type of pain were likely to had poor outcome compared to those with dominant back pain (odd ratio (OR) 10.57 with 95% confidence interval (CI) 1.15-96.93). Patients with reduced motor power of knee extensors also had a higher chance to have poor outcome compared to those who were normal (OR: 10.57; 95% CI: 1.15-96.93). CONCLUSION: Type of pain and the strength of lower extremities could be able to predict the failure of conservative management in patients with lumbar disc herniation. However, further studies with the bigger sample size are warrant to validate our results.


Asunto(s)
Desplazamiento del Disco Intervertebral , Núcleo Pulposo , Tratamiento Conservador , Humanos , Indonesia , Desplazamiento del Disco Intervertebral/terapia , Vértebras Lumbares , Estudios Prospectivos
16.
Biomed Res Int ; 2021: 3554397, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34734084

RESUMEN

BACKGROUND: The extracorporeal shock wave therapy (ESWT) has been fully utilized in orthopedics, but there are few studies in the treatment of lower limb spasm and pain caused by lumbar degenerative disorders (LDD). This study assesses the influence of ESWT in patients with LDD. METHODS: From October 2017 to June 2019, 126 patients with LDD were enrolled. All patients received shock wave therapy, once every two days for four weeks in total. Each treatment consisted of 2,000 shocks with a frequency of 8-10 shocks per second. To analyze the therapeutic progress, the following tests were performed (before and after therapy; 1- and 3-month follow-up) to assess pain and functional efficiency: (1) Visual Analog Scale (VAS), (2) the frequency and duration of muscle cramps, and (3) Fugl-Meyer (LL). RESULTS: Mean BMI of the participants was 26.1 ± 3.0 kg/m2. There was no statistically significant difference in terms of age or BMI between the groups (p > 0.05). Although all scoring parameters improved in both groups, the improvement in the ESWT group was more pronounced in pain (p < 0.001 and p < 0.001, respectively). A review of the LMA scores of our patients demonstrated moderate functional limitations before treatment and increased functional status after treatment in all patients, while overall functional status was fully improved in patients of the ESWT group (p < 0.001). CONCLUSION: The ESWT is particularly effective effect for patients with LDD. The use of ESWT has a significant long-term influence on the reduction of pain, leg cramps, and the improvement of the general functional state in relation to the conventional motor improvement program.


Asunto(s)
Tratamiento con Ondas de Choque Extracorpóreas/métodos , Degeneración del Disco Intervertebral/terapia , Desplazamiento del Disco Intervertebral/terapia , Trastornos de la Transición Sueño-Vigilia/terapia , Adulto , Anciano , Anciano de 80 o más Años , China , Femenino , Humanos , Pierna , Región Lumbosacra , Masculino , Persona de Mediana Edad , Calambre Muscular/terapia , Dolor/etiología , Manejo del Dolor/métodos , Dimensión del Dolor/métodos , Estudios Retrospectivos , Resultado del Tratamiento , Escala Visual Analógica
17.
Eur Rev Med Pharmacol Sci ; 25(19): 6034-6046, 2021 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-34661263

RESUMEN

OBJECTIVE: The aim of the study was to review the available literature on the application of oxygen-ozone therapy (OOT) in the treatment of low back pain (LBP), to understand its therapeutic potential and compare it with other available treatment options. MATERIALS AND METHODS: A systematic review was performed on the PubMed and Scopus databases, with the following inclusion criteria: (1) randomized controlled trials (RCTs), (2) published in the last 20 years, (3) dealing with OOT in patients with LBP and herniated disc, (4) comparing the results of OOT with those of other treatments. The risk of bias was assessed by the Cochrane Risk of Bias tool. RESULTS: Fifteen studies involving 2597 patients in total were included. Patients in the control groups received different treatments, from oral drugs to other injections, instrumental therapy and even surgery: corticosteroids were used in 5 studies, analgesic therapy in 2 studies; placebo, microdiscectomy, laser-therapy, TENS and postural rehabilitation, percutaneous radiofrequency intradiscal thermocoagulation and psoas compartmental block were tested in the other trials. Looking at the quality of the literature, none of the studies included reached "good quality" standard, 3 were ranked as "fair" and the rest were considered "poor". Comparison of OOT results with other approaches showed that, in the majority of studies, OOT was superior to the control treatment, and also when compared to microdiscectomy, ozone showed non inferiority in terms of clinical outcomes. CONCLUSIONS: The analysis of literature revealed overall poor methodologic quality, with most studies flawed by relevant bias. However, OOT has proven to be a safe treatment with beneficial effects in pain control and functional recovery at short to medium term follow-up.


Asunto(s)
Dolor de la Región Lumbar/terapia , Oxígeno/administración & dosificación , Ozono/administración & dosificación , Sesgo , Humanos , Desplazamiento del Disco Intervertebral/terapia , Ensayos Clínicos Controlados Aleatorios como Asunto , Resultado del Tratamiento
18.
JBJS Rev ; 9(10)2021 10 12.
Artículo en Inglés | MEDLINE | ID: mdl-34637405

RESUMEN

¼: Lumbar disc herniation is one of the most common spinal pathologies, often occurring at the L4-L5 and L5-S1 levels. The highest incidence has been reported in patients between the fourth and sixth decades of life. ¼: The severity of symptoms is influenced by the patient's risk factors, the location, and the extent and type of disc herniation. ¼: Lumbar disc herniation can be effectively treated with multiple treatment protocols. In most cases, first-line treatment includes oral analgesic medication, activity modification, and physical therapy. When nonoperative treatments do not provide adequate relief, patients may elect to undergo a fluoroscopically guided contrast-enhanced epidural steroid injection. A subgroup of patients whose condition is refractory to any type of nonoperative modalities will proceed to surgery, most commonly an open or minimally invasive discectomy. ¼: The treatment algorithm for symptomatic lumbar disc herniation often is a stepwise approach: failure of initial nonoperative measures leads to more aggressive treatment when symptoms mandate and, as such, necessitates the use of a multidisciplinary team approach. The core team should consist of an interventional physiatrist, an orthopaedic surgeon, a physician assistant, and a physical therapist. Additional team members may include nurses, radiologists, neurologists, anesthesiologists, spine fellows, psychologists, and case managers. ¼: This review article describes a case scenario that uses a multidisciplinary team approach for the treatment of an acute L4-L5 disc herniation in a 31-year-old patient without any major comorbidities.


Asunto(s)
Desplazamiento del Disco Intervertebral , Adulto , Humanos , Incidencia , Desplazamiento del Disco Intervertebral/diagnóstico , Desplazamiento del Disco Intervertebral/patología , Desplazamiento del Disco Intervertebral/terapia , Vértebras Lumbares/cirugía , Factores de Riesgo
19.
Medicine (Baltimore) ; 100(40): e27519, 2021 Oct 08.
Artículo en Inglés | MEDLINE | ID: mdl-34622885

RESUMEN

BACKGROUND: Patients with lumbar disc herniation, who undergo spine surgery, occasionally complain of pain and functional disability. Fortunately, the concept of enhanced recovery after surgery has emerged recently. As a result, patients seek traditional Chinese medicine after spine surgery. This systematic review will thoroughly analyze and synthesize evidence on integrative traditional Chinese medicine therapy for lumbar disc herniation after surgery. METHODS: The following databases will be utilized to search for pertinent studies: the Cochrane Central Register of Controlled Trials, MEDLINE/PubMed, EMBASE, Chinese National Knowledge Infrastructure, Japan Medical Abstracts Society, and 7 Korean databases (the Korean Studies Information Service System, Korean Association of Medical Journal Editors, National Digital Science Library, Database Periodical Information Academic Korean Traditional Knowledge Portal, Oriental Medicine Advanced Searching Integrated System, and Korean National Assembly Digital Library). The risk of bias of the selected studies will be assessed according to the Cochrane assessment tool for risk of bias. For articles that used the same measurements, a meta-analysis will be conducted to synthesize the results of each trial. Pain severity will be the primary outcome, while the results of functional questionnaires and range of motion, etc, will be the secondary outcomes. RESULTS AND CONCLUSION: Since this protocol does not include any data from patients, ethics approval is not required. The results of this review will be disseminated through a peer-reviewed journal. REGISTRATION NUMBER: DOI 10.17605/OSF.IO/KP47A (https://osf.io/kp47a).


Asunto(s)
Desplazamiento del Disco Intervertebral/terapia , Vértebras Lumbares/patología , Medicina China Tradicional/métodos , Humanos , Ensayos Clínicos Controlados Aleatorios como Asunto , Recuperación de la Función , Proyectos de Investigación
20.
Zhongguo Gu Shang ; 34(8): 780-4, 2021 Aug 25.
Artículo en Chino | MEDLINE | ID: mdl-34423625

RESUMEN

OBJECTIVE: To observe the analgesic effect of lever positioning manipulation combined with pulsed electric field on patients with lumbar disc herniation and the influence on serum IL-1ß and TNF-α. METHODS: From January 2018 to March 2019, 58 patients with lumbar disc herniation were included in the study, which were randomly divided into observation group and control group by digital table method. Observation group of 29 cases, including 16 males and 13 females, aged (38.03±11.29) years old, were treated with lever positioning manipulation combined with pulsed electric field. The 29 cases in control group, including 17 males and 12 females, aged (38.21±9.16) years old, were treated with pulsed electric field. Both groups of patients were treated 3 times a week, once every other day, 3 times as a course of treatment. After 2 courses of treatment, the two groups of patients were scored before and after treatment by the numeric rating scales (NRS);at the same time, the serum levels of IL-1ß and TNF-α were measured before and after treatment. RESULTS: The NRS scores of observation group and control group were 4.21±1.76, 4.66±1.61 before treatment, and 1.28±0.84, 2.10±1.35 after treatment, respectively. The NRS scores of the observation group after treatment was significantly lower than that of the control group (P<0.05). After treatment, the concentrations of IL-1ß and TNF-α in both groups became lower(P<0.05). The levels of IL-1ß in observation group and control group before treatment were (119.01±69.65), (112.23±78.43) pg /ml, and after treatment were (59.78±36.60), (77.51±40.46) pg/ml, respectively. The levels of TNF-α in observation group and control group before treatment were (1.68± 1.13), (1.74±0.70) pg /ml, and after treatment were (1.14±0.56), (1.45±0.58) pg /ml, respectively. The change of IL-1ß and TNF-α in observation group was better than that in control group (P<0.05). CONCLUSION: The lever positioning manipulation combined with pulsed electric field has a good analgesic effect on patients with lumbar disc herniation, and it has a significant impact on the patient's serum IL-1ß and TNF-α concentration, which can be used as a clinical guide. However, the synergistic effect of lever positioning technique combined with pulsed electric field and guidelines for clinical treatment need further research.


Asunto(s)
Degeneración del Disco Intervertebral , Desplazamiento del Disco Intervertebral , Adulto , Femenino , Humanos , Desplazamiento del Disco Intervertebral/terapia , Masculino , Persona de Mediana Edad , Factor de Necrosis Tumoral alfa
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