Duración del dolor preoperatorio y retorno laboral después de una microdiscectomía lumbar en un Hospital del Seguro Social Lima, Perú / Duration of preoperative pain and return to work after lumbar microdiscectomy in a Social Security Hspital Lima, Peru

Objetivo: Determinar si existe relación significativa entre la duración del dolor preoperatorio y el tiempo para el retorno laboral en pacientes operados de hernia discal lumbar. El estudio: Estudio retrospectivo, transversal y analítico. Pacientes operados de hernia discal lumbar por microdiscectomía. La "duración del dolor preoperatorio" se integró en dos grupos: >6 y ≤6 meses de dolor hasta el momento de la cirugía. "Retorno laboral" con punto de corte 3 meses. Se utilizó SPSS, se calculó el OR. Hallazgos: Se analizó 68 pacientes. 55,9% se operaron luego de 6 meses de iniciado los síntomas, 30,9% no retornaron al trabajo a los 3 meses después de la cirugía. El OR para el no retorno al trabajo a los 3 meses fue de 3.65 (IC95%:1.14­11.5 p:0,034). Conclusiones: La duración del dolor preoperatorio y el tiempo para el retorno laboral en pacientes operados con hernia discal lumbar, tienen una relación estadísticamente significativa.

Objetive:To determine if there is a significant relationship between the duration of preoperative pain and the time to return to work in patients undergoing surgery for lumbar disc herniation. : Retrospective, The studycross-sectional and analytical study. Patients undergoing microdiscectomy due to lumbar disc herniation. The duration of preoperative pain was divided into two groups: >6 and ≤ 6 months of pain until the time of surgery. "Return to work" with a cutoff point of 3 months. SPSS program was used, OR was calculated. Findings: 68 patients were analyzed. 55.9% were operated after 6 months of symptoms, 30.9% did not return to work at 3 months after surgery. The OR for "non-return to work at 3 months" group was 3.65 (95% CI:1.14-11.5 p:0.034). Conclusions: The duration of preoperative pain and the time to return to work, in patients undergoing surgery for lumbar disc herniation, have a statistically significant relationship

Predictive value of Modic type II changes in the choice of surgical treatment of lumbar disc herniation. / Valor predictivo de cambios Modic tipo II en la elección del tratamiento quirúrgico de hernia discal lumbar.

OBJECTIVE: To evaluate the predictive value of Modic typeII changes on nuclear magnetic resonance (NMR) prior to intervention by discectomy for lumbar disc herniation in patients with radicular symptoms. MATERIAL AND METHOD: Retrospective descriptive study of 190 patients (58.2% men and 41.8% women) with a mean age of 43.5 years, treated between December 2005 and January 2013. They were divided into group 1, single disc herniation (n=85), and group 2, with disc herniation and changes Modic typeII (n=80). Variables studied: weight, height, handedness, level of injury, previous neurological deficit, postoperative complications, persistent pain and need for posterior lumbar fusion, with a mean of 67 months (group 1: 68.1; group 2: 66.8). RESULTS: In group 1 there were four hernia recurrences requiring revision surgery and six patients needed lumbar fusion. In group 2, four recurrences were also revised and eight cases requiring arthrodesis were observed. No statistically significant differences were found when comparing the occurrence of relapse (P=.903), the need for subsequent fusion (P=.572) or in the remaining variables. DISCUSSION: The data obtained and the characteristics of our study, we cannot say that Modic typeII changes were a predictive sign of the result of lumbar discectomy in our study population.

Lombociatalgia, um desafio na prática clínica / Sciatalgia, a challenge in clinical practice

A lombociatalgia afeta uma proporção significativa da população, sendo uma das principais queixas no consultório médico. O termo ciatalgia pode causar confusão, já que tem sido usado para descrever qualquer dor, incluindo dor referida, sentida na distribuição do nervo ciático na perna. Neste contexto, cabe ao estudo revisar a correta avaliação e o tratamento da dor ciática verdadeira.

Low back pain affects a significant proportion of the population; being one of the most common pain reports in the medical office. The term ciatic neuralgia can cause confusion as it has been used to define any pain, including referred, felt in the leg along the sciatic nerve. In this context, this study will review the correct way to evaluate and treat the true sciatica.

Manifestações clínicas da hérnia discal lombar / Clinical manifestations of lombar discernal hernia

A lombalgia é uma das queixas mais prevalentes nas clínicas ortopédica e neurológica. O principal fator etiológico da lombociatalgia são os transtornos degenerativos lombares, entre eles a hérnia discal. O presente artigo busca fazer uma revisão das principais manifestações clinicas e do exame físico da hérnia discal lombar para o médico generalista.

Low back pain is one of the most prevalent complaints in orthopedic and neurological clinics. The lumbar degenerative disorders, including disc hernia, are the main etiological factor of low back pain. This article aims to review the main clinical manifestations and physical examination of the lumbar disc hernia to the generalist physician.

Manejo del síndrome doloroso lumbar / Management of lumbar syndrome

Se realizó una revisión bibliográfica del síndrome doloroso lumbar y se seleccionaron los artículos relacionados con este síndrome publicados desde 1991 hasta 2009. Se hizo hincapié en la búsqueda de guías para el manejo del dolor lumbar en la práctica clínica, y sus criterios fueron revisados por el equipo de especialistas en Ortopedia y Traumatología del Servicio de columna vertebral del Hospital Ortopédico Docente Fructuoso Rodríguez y adaptados a las condiciones del Sistema Nacional de Salud cubano(AU)

A bibliographic review on painful syndrome was made selecting the articles published from 1991 to 2009 related to this syndrome. Authors emphasize in the search of guides for management of lumbar pain in the clinical practice, whose criteria were analyzed by the team Orthopedics and Traumatology team of the spinal column service from the Fructuoso Rodríguez Hospital and adjusted to conditions of the Cuban Health System(AU)

Manejo del síndrome doloroso lumbar / Management of lumbar syndrome

Se realizó una revisión bibliográfica del síndrome doloroso lumbar y se seleccionaron los artículos relacionados con este síndrome publicados desde 1991 hasta 2009. Se hizo hincapié en la búsqueda de guías para el manejo del dolor lumbar en la práctica clínica, y sus criterios fueron revisados por el equipo de especialistas en Ortopedia y Traumatología del Servicio de columna vertebral del Hospital Ortopédico Docente Fructuoso Rodríguez y adaptados a las condiciones del Sistema Nacional de Salud cubano...

A bibliographic review on painful syndrome was made selecting the articles published from 1991 to 2009 related to this syndrome. Authors emphasize in the search of guides for management of lumbar pain in the clinical practice, whose criteria were analyzed by the team Orthopedics and Traumatology team of the spinal column service from the Fructuoso Rodríguez Hospital and adjusted to conditions of the Cuban Health System...

Efeitos do ultrassom terapêutico em modelo experimental de ciatalgia / Therapeutic ultrasound effects in a sciatica experimental model

A ciática possui grande prevalência geral e seu tratamento tende a resolver as causas de compressão nervosa. A fisioterapia objetiva reduzir os sintomas causados pela compressão. O presente estudo teve como objetivo avaliar a eficácia do ultrassom terapêutico sobre a dor, em animais submetidos a modelo experimental de ciatalgia. Foram usados 18 ratos neste estudo, divididos em três grupos: GS (n = 4), submetido a modelo de ciatalgia e tratados com ultrassom desligado; GUP (n = 7), submetido à ciatalgia e tratados com ultrassom pulsado 2W/cm² (SATP; 0,4 - SATA); e grupo GUC (n = 7), submetido à ciática e ultrassom contínuo (0,4W/cm²). O nervo ciático do membro posterior direito foi exposto à compressão com fio categute em quatro pontos. No 3º dia pós-operatório (PO), iniciou-se tratamento indireto por quatro dias. No 9º dia PO, o tratamento direto começou sobre a área do procedimento cirúrgico, por cinco dias consecutivos. O tempo de elevação da pata, durante a marcha, foi avaliado antes e após a ciatalgia, no 3º, 6º, 9º e 13º PO. Os resultados demonstraram que a aplicação do ultrassom reduziu a dor com ambos os tratamentos efetivos e tendeu a ser mais eficaz na forma pulsada.

The sciatica possesses great general population prevalence, and its treatment tends to solve the nervous compression causes. Physiotherapy aims to reduce the symptoms caused by compression. This study aimed to evaluate the effectiveness of therapeutic ultrasound on pain in animals subjected to sciatica experimental model. Eighteen rats were used and they were divided in 3 groups: group SG (n=4) submitted to the sciatica and treated with the ultrasound off, group PUG (n=7) submitted to the sciatica and treated with pulsed ultrasound 2 W/cm² (SATP; 0,4 - SATA) and group CUG (n=7) submitted to the sciatica and treated with continuous ultrasound (0,4 W/cm²). The sciatic nerve of the posterior right limb was exposed to the compression with Catgut wire in 4 points. In the 3rd postoperative day, the indirect treatment was started (right inferior limb) for four days. In the 9th postoperative day, the direct treatment begins on the surgical procedure area for 5 serial days. The paw elevation time, during the march, of the animal was verified before and after the sciatica, at the 3rd, 6th, 9th and 13th postoperative day. The results demonstrated that the application of the therapeutic ultrasound reduced the pain with both treatments in PUG and CUG, and it has tended larger effectiveness in the pulsed form.

A influência do uso de um apoio para coluna lombar sobre a lombalgia e ciatalgia em motoristas de ônibus / The influence of lumbar support use to lumbar spine on the low back pain and sciatica pain in bus drivers

Este estudo teve como objetivo verificar a influência do uso de um apoio lombar sobre a intensidade e localização da dor lombar e/ou ciática e sobre o nível de incapacidade determinado pela dor. A amostra foi composta por 24 motoristas de ônibus, com queixa de dor lombar e/ou ciática. os indivíduos foram divididos aleatoriamente em dois grupos e na seqüência foram avaliados e orientados quanto ao uso dos suportes de apoio. O grupo de tratamento utilizou uma toalha enrolada posicionada na região lombar durante a postura sentada, a fim de manter a lordose lombar. Para o grupo controle foi orientado a utilização de uma almofada de espuma sobre o assento (placebo). Após uma semana de uso dos suportes de apoio, verificou-se que houve diminuição e centralização da dor no grupo de tratamento. Com relação ao nível de incapacidade não houve diferença significativa em ambos os grupos.

The objective of this research was to verify the influence of lumbar support use on the intensity and local of the lumbar and/or sciatica pain and on the incapacity level determined by pain. The sample was compound for 24 bus drivers, with lumbar and/or sciatica pain. The individuals were randomly divided in two groups and in the sequence they were evaluated and oriented for supports use. The treatment group used a rolled cloth positioned in lumbar region, during sitting posture, to maintain the lumbar lordosis. For control group was oriented to use a foam cushion on the seat (Placebo). After a week of supports use , it was verified a reducing and centralization of pain in treatment group. The incapacity level didn't present statitiscally significant difference in both groups.

Sulfato de magnesio en el bloqueo analgésico del nervio ciático: estudio comparativo con anestésicos locales / Magnesium sulphate in analgesic sciatic nerve block: comparative study with local anesthetics

Introducción: el bloqueo analgésico del nervio ciático con anestésicos locales es un método eficaz en el manejo de la ciatalgia aguda. Objetivo: comparar los resultados del bloqueo analgésico del nervio ciático al emplear anestésico local o combinado con sulfato de magnesio. Material y Método: estudio comparativo, prospectivo y longitudinal a doble ciego, la población fueron 92 pacientes con diagnóstico de ciatalgia aguda, la muestra 60 en dos grupos de 30 pacientes cada uno: Grupo B: bupivacaína 0,25 porciento y Grupo BS: 37,5 mg de bupivacaína 0,25 porciento, más sulfato de magnesio. Las variables: edad, sexo, peso, talla, ASA, evaluación de la escala analógica visual numérica, tiempo de analgesia efectiva, frecuencia y cantidad de bloqueos requeridos y complicaciones. Resultados: los pacientes tratados con sulfato de magnesio presentaron alivio del dolor de aproximadamente 24 horas posterior al bloqueo del nervio ciático, necesitaron de un bloqueo cada 2,76 ±0,23 días, sin efectos colaterales. Conclusiones: el sulfato de magnesio añadido a bupivacaína en el bloqueo terapéutico del nervio ciático ofrece mejoría notable de la ciatalgia frente a los pacientes que recibieron sólo anestésico local, con un mayor tiempo de analgesia efectiva lograda, menor frecuencia y cantidad de bloqueos requeridos y ausencia de complicaciones(AU)

Introduction: sciatic nerve block with local anesthetics is an efficient method in the management of acute sciatalgia. Objective: to compare the results of the sciatic nerve analgesic block at the time of using local or combined anesthetics with magnesium sulphate. Material and Method: a comparative, prospective, longitudinal-double blind study, population was 92 patients with acute sciatalgia diagnosis, sample was 60 in two groups of 30 each one: Group B: Bupivacaine 0,25 percent BS Group: 37,5 mg of bupivacaine 0,25 percent, plus magnesium sulphate. Variables were: age, sex, weight and size, ASA, evaluation of the numerical visual analogue scale, effective analgesia time, frequency and number of blocks required and complications. Results: patients treated with magnesium sulphate showed pain relief about 24 hours after sciatic nerve block, needed a block every 2,76 ± 0,23 days, with no side effects. Conclusions: magnesium sulphate added to bupivacaine in the sciatic nerve therapeutic block offers a noticeable improvement in patients who received only local anesthetics, with a longer time of effective analgesia achieved, lower frequency and number blocks required and no complications(AU)