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1.
Spine (Phila Pa 1976) ; 46(5): 285-293, 2021 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-33534439

RESUMO

STUDY DESIGN: Multicenter double-blind randomized sham-controlled trial. OBJECTIVE: To assess the efficacy of radiofrequency (RF) denervation of the cervical facet joints in chronic cervical facet joint pain. SUMMARY OF BACKGROUND DATA: One randomized controlled trial showed efficacy of RF denervation in whiplash-associated disease. There are no randomized controlled trials on RF denervation in patients with chronic cervical facet joint pain. METHODS: Patients were randomized to receive RF denervation combined with bupivacaine (intervention group) or bupivacaine alone (control group). In the intervention group, an RF thermal lesion was made at the cervical medial branches after the injection of bupivacaine. The primary outcome was measured at 6 months and consisted of pain intensity, self-reported treatment effect, improvement on the Neck Disability Index, and the use of pain medication. Duration of effect was determined using telephone interviews. RESULTS: We included 76 patients. In the intervention group, 55.6% showed > 30% pain decrease versus 51.3% in the control group (P = 0.711); 50.0% reported success on the Patients' Global Impression of Change in the intervention group versus 41.0% (P = 0.435); the Neck Disability Index was 15.0 ±â€Š8.7 in the intervention group compared with 16.5 ±â€Š7.2 (P = 0.432), the need for pain medication did not differ significantly between groups (P = 0.461). The median time to end of treatment success for patients in the RF group was 42 months, compared with 12 months in the bupivacaine group (P = 0.014). CONCLUSIONS: We did not observe significant differences between RF denervation combined with injection of local anesthesia compared with local anesthesia only at 6 months follow-up. We found a difference in the long-term effect after 6 months follow-up in favor of the RF treatment.Level of Evidence: 2.


Assuntos
Artralgia/terapia , Bupivacaína/administração & dosagem , Vértebras Cervicais/patologia , Denervação/métodos , Cervicalgia/terapia , Articulação Zigapofisária/patologia , Idoso , Anestésicos Locais/administração & dosagem , Artralgia/diagnóstico , Vértebras Cervicais/efeitos dos fármacos , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cervicalgia/diagnóstico , Fatores de Tempo , Resultado do Tratamento , Articulação Zigapofisária/efeitos dos fármacos
2.
Spine (Phila Pa 1976) ; 46(5): E310-E317, 2021 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-33534441

RESUMO

STUDY DESIGN: A retrospective case-control study. OBJECTIVE: Investigating the correlation between the facet tropism (FT) and subaxial cervical disc herniation (CDH). SUMMARY OF BACKGROUND DATA: Although debatable, it was widely reported that FT was associated with lumbar disc herniation. However, the exact correlation between FT and subaxial CDH is still unclear. METHODS: Two-hundred patients with any disc herniation at C3/4, C4/5, C5/6, or C6/7 and 50 normal participants without CDH (normal control group) were included in this study. For patients, the cervical levels with CDH and the levels without herniation were classified into the "herniation group" and "patient control group," respectively. Bilateral facet joint angles at C3/4, C4/5, C5/6, and C6/7 on sagittal, axial, and coronal planes were measured on computed tomography (CT). The disc degeneration at each level was assessed on magnetic resonance imaging (MRI). RESULTS: Both the mean difference between left and right facet angles and tropism incidence in herniation group were significantly greater than those in two control groups whenever at C3/4, C4/5, C5/6, or C6/7 level and whenever on sagittal, axial, or coronal plane. The mean differences of angles and tropism incidences in most patient control groups were not significantly greater than those of corresponding normal control groups. The incidence of greater facet angle at the left or right side was not significantly different among the left, central, and right herniation groups. The mean disc degeneration grades in both herniation and patient control groups were significantly higher than those in normal control groups while no difference between herniation and patient control groups. CONCLUSION: The FT on the sagittal, axial, and coronal planes are all associated with CDH in the subaxial cervical spine. The greater facet angle at the left or right side does not affect the side of herniation. The severity of cervical disc degeneration is not associated with FT.Level of Evidence: 3.


Assuntos
Vértebras Cervicais/diagnóstico por imagem , Deslocamento do Disco Intervertebral/diagnóstico por imagem , Tropismo/fisiologia , Articulação Zigapofisária/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Vértebras Cervicais/fisiopatologia , Feminino , Humanos , Deslocamento do Disco Intervertebral/fisiopatologia , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/métodos , Articulação Zigapofisária/fisiopatologia
3.
Schmerz ; 35(2): 124-129, 2021 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-33447917

RESUMO

Radiofrequency denervation has been established for many years as an important minimally invasive procedure for the treatment of chronic pain conditions. Positive experiences of many users for various indications are contrasted by a nonuniform evidence. With meticulous patient selection and correct assessment of the indications a longer term reduction of pain, a reduced need for analgesics and an improvement in the quality of life can be achieved. The aim of this interdisciplinary position paper is to present the value of radiofrequency denervation in the treatment of chronic pain. The summarized recommendations of the expert group are based on the available evidence and on the clinical experiences of Austrian centers that frequently implement the procedure. The position paper contains recommendations on patient selection and proven indications. We discribe safety aspects, complications, side effects and contraindications.


Assuntos
Dor Crônica , Dor Lombar , Articulação Zigapofisária , Áustria , Dor Crônica/terapia , Denervação , Humanos , Dor Lombar/cirurgia , Vértebras Lombares , Qualidade de Vida , Resultado do Tratamento
4.
Medicine (Baltimore) ; 100(2): e24099, 2021 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-33466177

RESUMO

BACKGROUND: To explore the ideal trajectory of lumbar cortical bone trajectory screws and provide the optimal placement scheme in clinical applications. METHODS: Lumbar computed tomography (CT) data of 40 patients in our hospital were selected, and the cortical vertebral bone contour model was reconstructed in three dimensions (3D). Depending on the different regions of the screw through the entrance and exit of the pedicle, 9 trajectories were obtained through combinational design: T-Aa, T-Ab, T-Ac, T-Ba, T-Bb, T-Bc, T-Ca, T-Cb, and T-Cc. Cortical bone trajectory (CBT) screws with appropriate diameters were selected to simulate screw placement and measure the parameters corresponding to each trajectory (screw path diameter, screw trajectory length, cephalad angle, and lateral angle), and then determine the optimal screw according to the screw parameters and screw safety. Then, 23 patients in our hospital were selected, and the navigation template was designed based on the ideal trajectory before operation, CBT screws were placed during the operation to further verify the safety and feasibility of the ideal trajectory. RESULTS: T-Bc and T-Bb are the ideal screw trajectories for L1-L2 and L3-L5, respectively. The screw placement point is located at the intersection of the inner 1/3 vertical line of the superior facet joint and the bottom 1/3 horizontal line of the outer crest of the vertebral lamina (i.e., 2-4 mm inward at the bottom 1/3 of the outer crest of the vertebral lamina). CBT screws were successfully placed based on the ideal screw trajectory in clinical practice. During the operation or the follow-up period, there were no adverse events. CONCLUSION: CBT screw placement based on the ideal screw trajectory is a safe and reliable method for achieving effective fixation and satisfactory postoperative effects.


Assuntos
Osso Cortical/lesões , Fixação de Fratura/instrumentação , Vértebras Lombares/lesões , Parafusos Pediculares , Fraturas da Coluna Vertebral/cirurgia , Simulação por Computador , Osso Cortical/diagnóstico por imagem , Osso Cortical/cirurgia , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Modelos Anatômicos , Fraturas da Coluna Vertebral/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Articulação Zigapofisária/diagnóstico por imagem , Articulação Zigapofisária/cirurgia
5.
Spine (Phila Pa 1976) ; 46(2): 122-128, 2021 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-33347092

RESUMO

STUDY DESIGN: Cross-sectional study. OBJECTIVE: The aim of this study was to evaluate the actual prevalence of degenerative spinal changes and their association with age in a cohort of professional soccer players. SUMMARY OF BACKGROUND DATA: Presently, there are data that athletes have more degenerative changes than nonathletes; however, the research examining the prevalence of degenerative spinal conditions among professional elite soccer players is scarce. METHODS: Professional male soccer players were included in the study (n = 40, average age 26,6 ±â€Š4,5 years, average height 18 ±â€Š0.07 m, weight 76.7 ±â€Š7.1 kg). Lumbosacral spine MRI scanning at the L1-S1 level has been performed. Two radiologists with at least 7 years of experience of working with athletes evaluated all images independently of each other. RESULTS: 92.5% (n = 37) of soccer players had ≥1 spinal degenerative condition. Thirty-five percent (n = 14) of players had three to five, and 50% (n = 20) had six or more conditions. The average age of players who had six or more conditions was significantly higher than those who had zero to five or three to five conditions-28.1 ±â€Š4.8 years versus 25.1 ±â€Š3.6 years (P = 0.029), and 24.8 ±â€Š3.6 years, respectively.Kruskal-Wallis test has shown no association between the number of degenerative conditions and weight (P = 0.98) as well as body mass index (P = 0.99). The age was associated with degenerative changes (P = 0.008).Disc desiccation was the most common pathologic condition, which was found in 82.5% of athletes. Facet joint arthropathy and spondylosis were present in 70, and 50% of the studied lumbar spine MRI scans, respectively. The spondylolysis prevalence of 20% was noted. CONCLUSION: Elite professional soccer players demonstrate a high prevalence of asymptomatic degenerative lumbar spinal degenerative changes, which are significantly associated with age. These conditions might lead to the development of symptomatic lower back pain, given the high-intensity exercise required in professional soccer. It is presently unclear what measures might be applied for the primary prevention of these degenerative spinal conditions.Level of Evidence: 4.


Assuntos
Traumatismos em Atletas/patologia , Vértebras Lombares/patologia , Futebol , Doenças da Coluna Vertebral/patologia , Adolescente , Adulto , Atletas , Pré-Escolar , Estudos Transversais , Exercício Físico , Humanos , Dor Lombar , Região Lombossacral/patologia , Imagem por Ressonância Magnética , Masculino , Adulto Jovem , Articulação Zigapofisária/patologia
6.
Clin Nucl Med ; 46(1): e54-e56, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32956115

RESUMO

Spinal facet joint septic arthritis is a rare pathology associated with pyogenic organisms. It may present in older adults with back pain, fever, and positive bacterial blood cultures. However, clinical presentation may be equivocal, and diagnosis relies on anatomic imaging for differentiation from other pathologies. Magnetic resonance is considered the imaging modality of choice and has been found superior to CT; however, it is unable to differentiate facet joint septic arthritis from other inflammatory arthropathies. We present a case of lumbosacral facet joint septic arthritis as seen on In-oxine-WBC scintigraphy and SPECT/CT.


Assuntos
Artrite Infecciosa/diagnóstico por imagem , Compostos Organometálicos , Oxiquinolina/análogos & derivados , Tomografia Computadorizada com Tomografia Computadorizada de Emissão de Fóton Único , Articulação Zigapofisária/diagnóstico por imagem , Idoso , Artrite Infecciosa/microbiologia , Diagnóstico Diferencial , Humanos , Masculino , Articulação Zigapofisária/microbiologia , Articulação Zigapofisária/patologia
7.
Zhonghua Yi Xue Za Zhi ; 100(45): 3578-3583, 2020 Dec 08.
Artigo em Chinês | MEDLINE | ID: mdl-33333680

RESUMO

Objective: To investigate the correlation between the severity of uncovertebral joints degeneration and heterotopic ossification (HO) after single-level artificial cervical disc replacement (ACDR). Methods: From January 2005 to January 2016, 70 patients who had undergone single-level ACDR in Peking University Third Hospital and had at least 5 years follow-up were included in this study. There were 35 males and 35 females with an average age of (42±8) years (range, 25-62 years). Cervical spine A-P X-rays were taken to assess the degeneration of uncovertebral joints and lateral X-rays were taken to assess the degeneration of intervertebral space. Cervical spine lateral and the flexion-extension X-rays at 5 years follow up were taken to assess HO. Degeneration of uncovertebral joints were evaluated by the classification system set-up in Peking University Third Hospital. Kellgren&Lawrence grading system was used to evaluate the degeneration of intervertebral space. HO was evaluated by the McAfee grading standards. The data were collected before surgery and at 5-years follow-up, then the correlation between degeneration of uncovertebral joints, degeneration of intervertebral space and HO was analyzed with Spearman non-parametric test. Results: The average follow-up time of 70 patients was (62.7±4.8) years (range, 52-74 months). There was a significant positive correlation between preoperative uncovertebral joints degeneration and HO after ACDR (r=0.585, P<0.01). There was a significant positive correlation between preoperative intervertebral space degeneration and HO (r=0.557, P<0.01). There was a significant positive correlation between preoperative intervertebral space degeneration and preoperative uncovertebral joints degeneration (r=0.727, P<0.01). Conclusion: There is a significant positive correlation between preoperative uncovertebral joints degeneration and HO after ACDR.


Assuntos
Degeneração do Disco Intervertebral , Disco Intervertebral , Ossificação Heterotópica , Substituição Total de Disco , Articulação Zigapofisária , Adulto , Vértebras Cervicais/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pescoço , Resultado do Tratamento
8.
Neurocirugía (Soc. Luso-Esp. Neurocir.) ; 31(5): 253-258, sept.-oct. 2020. ilus, tab
Artigo em Inglês | IBECS | ID: ibc-195158

RESUMO

Late diagnosis of cervical bilateral facet dislocation is rare and contributes to concerns in the management of these patients. We present a case of a 44-year-old woman presented 8 months after a trauma with persistent neck pain, without neurological deficits. A bilateral C5-C6 facet dislocation was identified. The patient was treated with a combined C5-C6 approach: posterior facet joints release, anterior discectomy and fusion, bilateral posterior fixation. Surgery was performed under intraoperative neurophysiological monitoring. The postoperative period was uneventful, and the patient presented functional improvement. Late surgical treatment of bilateral cervical facet dislocation is safe and feasible. Combined procedures are needed for proper reduction and stabilization of the spine. Intraoperative neurophysiological monitoring adds value to this technique contributing to good outcomes


El diagnóstico tardío de la luxación facetaria bilateral cervical es infrecuente y contribuye a crear problemas en el tratamiento de estos pacientes. Presentamos el caso de una mujer de 44 años que, 8 meses después de un traumatismo, presentaba dolor continuo en el cuello, en ausencia de deficiencias neurológicas. Se identificó una luxación facetaria bilateral en C5-C6. La paciente recibió tratamiento quirúrgico combinado en C5-C6: liberación posterior de las articulaciones facetarias, discectomía anterior y artrodesis, fijación posterior bilateral. La intervención quirúrgica se realizó con monitorización neurofisiológica intraoperatoria. La paciente presentó una evolución postoperatoria sin complicaciones y mejoría funcional. El tratamiento quirúrgico tardío de la luxación facetaria cervical bilateral es seguro y viable. Es necesario utilizar procedimientos combinados para lograr una reducción y estabilización correctas de la columna vertebral. La monitorización neurofisiológica intraoperatoria aporta valor añadido a esta técnica y contribuye a lograr buenos resultados


Assuntos
Humanos , Feminino , Adulto , Articulação Zigapofisária/lesões , Articulação Zigapofisária/cirurgia , Vértebras Cervicais/cirurgia , Luxações Articulares/cirurgia , Vértebras Cervicais/lesões , Luxações Articulares/complicações , Discotomia/métodos , Espectroscopia de Ressonância Magnética , Espaço Subaracnóideo/diagnóstico por imagem , Espaço Subaracnóideo/cirurgia
9.
Rev. bras. ortop ; 55(5): 642-648, Sept.-Oct. 2020. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1144215

RESUMO

Abstract Objective To verify whether, regardless of the screw placement technique, there is a safe distance or angle in relation to the facets that can prevent violation of the facet joint when the screws are placed. Methods Retrospective, single, comparative, non-randomized center. We evaluated by axial computed tomography: the angle of the screw/rod in relation to the midline, the angle of the center of the facets in relation to the midline, the distance between the head of the screw/rod to the midline, and the distance from the center of the facets to the midline; the violation of the facet joint will be evaluated in a gradation of 0 to 2. Also will be measured the difference between the angle os the facets and the angle of the screws (Δ Angle) and, the difference between the facet distance and the screw distance (Δ Distance). Results A total of 212 patients and 397 facets were analyzed (196 on the left and 201 on the right). Of these, 303 were not violated (grade 0), corresponding to 76,32%, and 94 suffered some type of violation (grade 1 and 2), corresponding to 23,68%. The mean of Δ angle was 9.87° +/− 4.66° (grade 0), and of 3.77° +/− 4.93° in facets (grade 1 and 2) (p< 0.001), and the Δ mean distance in cases in which there was no violation was 0.94 arbitrary units (a.u.) +/− 0.39 a.u., while the Δ distance in G1 and G2 cases was 0.56 a.u. +/− 0.25 a.u. (p< 0.001). Conclusion The measurements of angle and distance between facet and screw can help in the placement of screws. These parameters can be used as safety measures with the most frequent use of surgical navigation techniques.


Resumo Objetivo Verificar se, independente da técnica de colocação do parafuso, há uma distância ou angulação segura em relação as facetas para que os parafusos sejam colocados de modo a evitar a violação da articulação facetária. Métodos Estudo retrospectivo, comparativo, não randomizado, em centro único. Foram avaliados em tomografia computadorizada axial: o ângulo do parafuso/barra em relação a linha média, o ângulo do centro das facetas em relação a linha média, a distância entre a cabeça do parafuso/barra até a linha média, e a distância do centro das facetas até a linha média; a violação da articulação facetária será avaliada em uma gradação de 0 a 2. Serão também calculados a diferença entre o ângulo do parafuso e ângulo da faceta (Δ Ångulo) e também a diferença entre a distância da faceta e a distância do parafuso (Δ Distância). Resultados Um total de 212 pacientes e 397 facetas foram analisados (196 do lado esquerdo e 201 do lado direito). Destes, 303 foram não violados (grau 0), correspondendo a 76,32%, e 94 sofreram algum tipo de violação (grau 1 e 2), correspondendo a 23,68%. A média do Δ ângulo foi de 9,87° +/− 4,66° (grau 0) e de 3,77° +/− 4,93° em facetas (grau 1 e 2) (p< 0.001), e o Δ distância médio nos casos em que não houve violação foi de 0,94 unidades aleatórias (u.a.) +/− 0,39 u.a., enquanto o Δ distância de casos G1 e G2 foi de 0,56 u.a. +/− 0,25 u.a. (p< 0.001). Conclusão As medidas de ângulo e distância entre faceta e parafuso, podem auxiliar na colocação de parafusos. Esses parâmetros podem ser utilizados como medidas de segurança com o uso mais frequentes das técnicas de navegação cirúrgica.


Assuntos
Humanos , Fusão Vertebral/métodos , Articulação Zigapofisária/cirurgia , Parafusos Pediculares , Tomografia Computadorizada por Raios X , Estudos Retrospectivos , Curva ROC , Articulação Zigapofisária/diagnóstico por imagem , Parafusos Pediculares/efeitos adversos
10.
Zhong Nan Da Xue Xue Bao Yi Xue Ban ; 45(7): 827-833, 2020 Jul 28.
Artigo em Inglês, Chinês | MEDLINE | ID: mdl-32879086

RESUMO

OBJECTIVES: Quantitative magnetic resonance imaging has been successfully applied to assess the status of cartilage biochemical components. This study aimed to investigate the performance of 3.0T magnetic resonance imaging T2 mapping combined with texture analysis for evaluating the early degeneration of lumbar facet joints. METHODS: A total of 38 patients (20 in the asymptomatic group and 18 in the symptomatic group) were enrolled. All patients underwent 3.0T magnetic resonance imaging conventional sequences, water excitation three-dimensional spoiled gradient echo sequence (3D-WATSc), and T2 mapping scans. The bilateral L4/5 and L5/S1 lumbar facet joints were morphological graded using the Weishaupt criteria, T2 values, and texture parameters derived from T2 mapping of cartilage. The Kruskal-Wallis H test was used to compare the differences of parameters among different groups. Multivariate logistic regression analysis was used to obtain the independent predictive factors for evaluating the early degeneration of lumbar facet joints. Receiver operating characteristic (ROC) curve was performed and the area under curve (AUC) was calculated. Spearman correlation analysis was used to evaluate the correlation of the independent predictors of cartilage T2 value and texture parameters with the subjects' Japanese Orthopedic Association (JOA) score or Visual Analogue Scale (VAS) score. RESULTS: A total of 148 facet joints were selected, including 70 in Weishaupt 0 (normal) group, 58 in Weishaupt 1 group, and 20 in Weishaupt 2-3 group. T2 value, entropy, and contrast increased significantly as the exacerbation of facet joint degeneration (all P<0.05), while the inverse difference moment, energy, and correlation decreased (all P<0.05). Entropy among different groups was significantly different (all P<0.05), and the differences of T2 value, contrast, inverse difference moment, and energy between Weishaupt 0 and Weishaupt 1 groups, or Weishaupt 0 and Weishaupt 2-3 groups were statistically significant (all P<0.05). Multivariate logistic regression analysis suggested that T2 value and inverse difference moment were the independent predictors for evaluating early degeneration of facet joints. The combination of T2 value with inverse difference moment achieved the best performance in distinguishing Weishaupt 0 from Weishaupt 1 (AUC=0.85), with sensitivity and specificity at 92.7% and 76.5%, respectively. In the symptom group, the cartilage T2 value combined inverse difference moment was positively correlated with JOA score (r=0.475, P<0.05) and VAS score (r=0.452, P<0.05). CONCLUSIONS: 3.0T magnetic resonance imaging T2 mapping combined with texture analysis is helpful to quantitatively evaluate the early degeneration of lumbar facet joints, in which the T2 value and inverse difference moment show an indicative significance..


Assuntos
Espondilose , Articulação Zigapofisária , Algoritmos , Humanos , Vértebras Lombares , Imagem por Ressonância Magnética , Sensibilidade e Especificidade
11.
J Clin Neurosci ; 78: 102-107, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32624368

RESUMO

PURPOSE: This study aimed to evaluate safety and effectiveness of simple anterior reduction and fusion for acute lower cervical unilateral facet dislocation without severe spinal cord injuries. MATERIALS AND METHODS: One hundred and two patients with unilateral cervical facet dislocations without severe spinal cord injuries who were surgically treated by the only anterior approach were analyzed. The treatment effects were evaluated based on the Visual Analogue Scale (VAS) scores, the Cobb angle of kyphosis, the Neck Disability Index (NDI) and Odom's criteria. Neurological recovery of patients was assessed by the Frankel grading. RESULTS: The mean duration of follow-up was 12.4 ± 4.2 years (range, 10 to 17 years). VAS scores, Kyphosis angle and NDI scores were significantly changed from preoperative values of 7.4 ± 0.8, 11.3° ± 6.8° and 29.3 ± 5.1 to last follow-up values of 1.3 ± 0.8, -6.1° ± 7.5° and 8.8 ± 3.6 (P = 0.000). Of patients, 92 (90.2%) had good to excellent outcomes, 9 (8.8%) had satisfactory outcomes, and 1 (1.0%) had poor outcomes. Patients have obtained satisfactory neurological recovery. Three patients needed additional posterior reduction. CONCLUSION: The anterior reduction and fusion is effective and safe for acute unilateral cervical facet dislocation, and can achieve good long-term clinical effects.


Assuntos
Vértebras Cervicais/cirurgia , Luxações Articulares/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Traumatismos da Medula Espinal , Fusão Vertebral/métodos , Articulação Zigapofisária/cirurgia , Adulto , Idoso , Vértebras Cervicais/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Luxações Articulares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem , Articulação Zigapofisária/diagnóstico por imagem
12.
J Clin Neurosci ; 78: 47-52, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32616353

RESUMO

BACKGROUND: The purpose of this study was to compare the incidence of facet joint violation (FJV) after placement of percutaneous pedicle screws (PPSs) in 2 cohorts of patients who underwent surgery in a single position or dual position following lateral lumbar interbody fusion (LLIF) (extreme lateral interbody fusion [XLIF]). METHODS: We reviewed 82 patients who underwent combined XLIF surgery and PPS fixation for the treatment of degenerative lumbar spinal disorders. Patient demographics were compared between 2 groups: those who remained in the lateral decubitus position for PPS fixation (SP group) and those who were turned to the prone position (DP group). Postoperative axial computed tomography scans were evaluated independently for FJV according to the following classification: grade 0, no impingement; grade 1, screw head in contact/suspected to be in contact with the facet joint; and grade 2, screw clearly invaded the facet joint. RESULTS: A total of 349 screws were graded. Using the consensus grades, the incidence of FJV was 13.2% (46/349), but the incidence of FJV did not differ significantly according to the position of the patient during PPS insertion (SP group; 15.4%, DP group; 10.8%, P = 0.204). CONCLUSIONS: Although the incidence of FJV after PPS insertion did not differ between the prone and lateral decubitus positions, grade 2 FJV was observed only in the SP group. To avoid FJV, the surgeon should pay close attention to the facet joints when inserting PPSs with the patient in a lateral decubitus position.


Assuntos
Parafusos Pediculares , Fusão Vertebral/métodos , Articulação Zigapofisária/cirurgia , Adulto , Idoso , Feminino , Humanos , Incidência , Vértebras Lombares/cirurgia , Região Lombossacral , Masculino , Pessoa de Meia-Idade , Posicionamento do Paciente , Cirurgiões , Tomografia Computadorizada por Raios X
13.
Pain Physician ; 23(4): E335-E342, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32709179

RESUMO

BACKGROUND: More patients with cardiac implantable electrical devices (CIEDs) are presenting to spine and pain practices for radiofrequency ablation (RFA) procedures for chronic pain. Although the potential for electromagnetic interference (EMI) affecting CIED function is known with RFA procedures, available guidelines do not specifically address CIED management for percutaneous RFA for zygapophyseal (z-joint) joint pain, and thus physician practice may vary. OBJECTIVES: To better understand current practices of physicians who perform RFA for chronic z-joint pain with respect to management of CIEDs. Perioperative CIED management guidelines are also reviewed to specifically address risk mitigation strategies for potential EMI created by ambulatory percutaneous spine RFA procedures. STUDY DESIGN: Web-based provider survey and narrative review. SETTING: Multispecialty pain clinic, academic medical center. METHODS: A web-based survey was created using Research Electronic Data Capture (REDCap). A survey link was provided via e-mail to active members of the Spine Intervention Society (SIS), American Society of Regional Anesthesia and Pain Medicine, as well as distributed freely to community Pain Physicians and any receptive academic departments of PM&R or Anesthesiology. The narrative review summarizes pertinent case series, review articles, a SIS recommendation statement, and multi-specialty peri-operative guidelines as they relate specifically to spine RFA procedures. RESULTS: A total of 197 clinicians participated in the survey from diverse clinical backgrounds, including anesthesiology, physical medicine and rehabilitation, radiology, neurosurgery, and neurology, with 81% reporting fellowship training. Survey responses indicate wide variability in provider management of CIEDs before, during, and after RFA for z-joint pain. Respondents indicated they would like more specific guidelines to aid in management and decision-making around CIEDs and spine RFA procedures. Literature review yielded several practice guidelines related to perioperative management of CIEDs, but no specific guideline for percutaneous spine RFA procedures. However, combining the risk mitigation strategies provided in these guidelines, with interventional pain physician clinical experience allows for reasonable management recommendations to aid in decision-making. LIMITATIONS: Although this manuscript can serve as a review of CIEDs and aid in management decisions in patients with CIEDs, it is not a clinical practice guideline. CONCLUSIONS: Practice patterns vary regarding CIED management in ambulatory spine RFA procedures. CIED presence is not a contraindication for spine RFA but does increase the complexity of a spine RFA procedure and necessitates some added precautions. KEY WORDS: Radiofrequency ablation, neurotomy, cardiac implantable electrical device, zygapophyseal joint, spondylosis, neck pain, low back pain, chronic pain.


Assuntos
Dor nas Costas/cirurgia , Ablação por Cateter/normas , Desfibriladores Implantáveis/normas , Médicos/normas , Guias de Prática Clínica como Assunto/normas , Inquéritos e Questionários , Anestesia por Condução/métodos , Anestesia por Condução/normas , Anestesiologia/métodos , Anestesiologia/normas , Ablação por Cateter/métodos , Dor Crônica/cirurgia , Humanos , Articulação Zigapofisária/cirurgia
14.
Jt Dis Relat Surg ; 31(2): 395-398, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32584744

RESUMO

Calcium pyrophosphate dihydrate deposition (CPPD) disease, also known as pseudogout, in which crystals are deposited in the joints and/or soft tissues, leads to a variety of articular and periarticular disorders. Herein we report a 67-year-old female patient with neck pain who was diagnosed as CPPD disease of both the atlantoaxial joint and right C4-C5 facet joint with radiological findings. The combined use of computed tomography and magnetic resonance imaging can be helpful in establishing a diagnosis and providing the correct treatment.


Assuntos
Articulação Atlantoaxial , Vértebras Cervicais , Condrocalcinose , Cervicalgia , Articulação Zigapofisária , Idoso , Articulação Atlantoaxial/diagnóstico por imagem , Articulação Atlantoaxial/patologia , Pirofosfato de Cálcio/análise , Condrocalcinose/diagnóstico , Condrocalcinose/metabolismo , Condrocalcinose/fisiopatologia , Diagnóstico Diferencial , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Cervicalgia/diagnóstico , Cervicalgia/etiologia , Tomografia Computadorizada por Raios X/métodos , Articulação Zigapofisária/diagnóstico por imagem , Articulação Zigapofisária/patologia
15.
Medicine (Baltimore) ; 99(26): e20893, 2020 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-32590797

RESUMO

RATIONALE: Tarsal tunnel syndrome (TTS) is a compressive neuropathy of the posterior tibial nerve and its branches. Tarsal coalition is defined as a fibrous, cartilaginous, or osseous bridging of 2 or more tarsal bones. TTS with tarsal coalition is uncommon. Here, we present a rare example of successful surgical management of TTS with posterior facet talocalcaneal coalition. PATIENT CONCERNS: A 74-year-old woman presented with hypoesthesia, numbness, and an intermittent tingling sensation on the plantar area over the right forefoot to the middle foot area. The hypoesthesia and paresthesia of the right foot began 6 years previously and were severe along the lateral plantar aspect. The symptoms were mild at rest and increased during daily activities. Tinel sign was positive along the posteroinferior aspect of the medial malleolus. DIAGNOSIS: Lateral ankle radiography showed joint-space narrowing and sclerotic bony changes with a deformed C-sign and humpback sign. Oblique coronal and sagittal computed tomography revealed an irregular medial posterior facet, partial coalition, narrowing, and subcortical cyst formation of the posterior subtalar joint. Magnetic resonance imaging showed an abnormal posterior talocalcaneal coalition compressing the posterior tibia nerve. Electromyography and nerve conduction velocity studies were performed, and the findings indicated that there was an incomplete lesion of the right plantar nerve, especially of the lateral plantar nerve, around the ankle level. INTERVENTIONS: Surgical decompression was performed. Intraoperatively, the lateral plantar nerve exhibited fibrotic changes and tightening below the posterior facet talocalcaneal coalition. The coalition was excised, and the lateral plantar nerve was released with soft-tissue dissection. OUTCOMES: The patient's symptoms of tingling sensation and hypoesthesia were almost relieved at 4 months postoperatively, but she complained of paresthesia with an itching sensation when the skin of the plantar area was touched. The paresthesia had disappeared almost completely at 8 months after surgery. She had no recurrence of symptoms at the 1-year follow-up. LESSONS: The TTS with tarsal coalition is rare. Supportive history and physical examination are essential for diagnosis. Plain radiographs and computed tomography or magnetic resonance imaging are helpful to determine the cause of TTS and verify the tarsal coalition. After diagnosis, surgical excision of the coalition may be appropriate for management with a good outcome.


Assuntos
Coalizão Tarsal/cirurgia , Síndrome do Túnel do Tarso/complicações , Síndrome do Túnel do Tarso/cirurgia , Articulação Zigapofisária/cirurgia , Idoso , Descompressão Cirúrgica/métodos , Eletromiografia/métodos , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Parestesia/etiologia , Coalizão Tarsal/fisiopatologia , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Articulação Zigapofisária/inervação
16.
Pain Physician ; 23(3S): S129-S147, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32503360

RESUMO

BACKGROUND: The trends of the expenditures of facet joint interventions have not been specifically assessed in the fee-for-service (FFS) Medicare population since 2009. OBJECTIVE: The objective of this investigation is to assess trends of expenditures and utilization of facet joint interventions in FFS Medicare population from 2009 to 2018. STUDY DESIGN: The study was designed to analyze trends of expenditures and utilization of facet joint interventions in FFS Medicare population from 2009-2018 in the United States. In this manuscript: • A patient was considered as undergoing facet joint interventions throughout the year. • A visit included all regions treated during the visit. • An episode was considered as one per region utilizing primary codes only. • Services or procedures were considered all procedures (multiple levels). Data for the analysis was obtained from the standard 5% national sample of the Centers for Medicare & Medicaid Services (CMS) physician outpatient billing claims for those enrolled in the FFS Medicare program from 2009 to 2018. All the expenditures were presented with allowed costs and also were inflation adjusted to 2018 US dollars. RESULTS: This analysis showed expenditures increased by 79% from 2009 to 2018 in the form of total cost for facet joint interventions, at an annual rate of 6.7%. Cervical and lumbar radiofrequency neurotomy procedures increased 185% and 169%. However, inflation-adjusted expenditures with 2018 US dollars showed an overall increase of 53% with an annual increase of 4.9%. In addition, using inflation-adjusted expenditures per procedures increased, the overall 6% with an annual increase of 0.7%. Overall, per patient costs, with inflation adjustment, decreased from $1,925 to $1,785 with a decline of 7% and an annual decline of 0.8%. Allowed charges per visit also declined after inflation adjustment from $951.76 to $849.86 with an overall decline of 11% and an annual decline of 1.3%. Staged episodes of radiofrequency neurotomy were performed in 23.9% of patients and more than 2 episodes for radiofrequency neurotomy in 6.9%, in lumbar spine and 19.6% staged and 5.1% more than 2 episodes in cervical spine of patients in 2018. LIMITATIONS: This analysis is limited by inclusion of only the FFS Medicare population, without adding utilization patterns of Medicare Advantage plans, which constitutes almost 30% of the Medicare population. CONCLUSIONS: Even after adjusting for inflation, there was a significant increase for the expenditures of facet joint interventions with an overall 53% increase. Costs per patient and cost per visit declined. Inflation-adjusted cost per year declined 7% overall and 0.8% annually from $1,925 to $1,785, and inflation-adjusted cost per visit also declined 11% annually and 1.3% per year from $952 in 2009 to $850 in 2018. KEY WORDS: Facet joint interventions, facet joint nerve blocks, facet joint neurolysis, facet joint injections, Medicare expenditures.


Assuntos
Gastos em Saúde , Procedimentos Neurocirúrgicos/economia , Manejo da Dor/economia , Articulação Zigapofisária , Idoso , Centers for Medicare and Medicaid Services, U.S. , Dor Crônica/economia , Dor Crônica/terapia , Feminino , Humanos , Masculino , Medicare/economia , Procedimentos Neurocirúrgicos/tendências , Manejo da Dor/métodos , Manejo da Dor/tendências , Estados Unidos
17.
Pain Physician ; 23(3S): S1-S127, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32503359

RESUMO

BACKGROUND: Chronic axial spinal pain is one of the major causes of significant disability and health care costs, with facet joints as one of the proven causes of pain. OBJECTIVE: To provide evidence-based guidance in performing diagnostic and therapeutic facet joint interventions. METHODS: The methodology utilized included the development of objectives and key questions with utilization of trustworthy standards. The literature pertaining to all aspects of facet joint interventions, was reviewed, with a best evidence synthesis of available literature and utilizing grading for recommendations.Summary of Evidence and Recommendations:Non-interventional diagnosis: • The level of evidence is II in selecting patients for facet joint nerve blocks at least 3 months after onset and failure of conservative management, with strong strength of recommendation for physical examination and clinical assessment. • The level of evidence is IV for accurate diagnosis of facet joint pain with physical examination based on symptoms and signs, with weak strength of recommendation. Imaging: • The level of evidence is I with strong strength of recommendation, for mandatory fluoroscopic or computed tomography (CT) guidance for all facet joint interventions. • The level of evidence is III with weak strength of recommendation for single photon emission computed tomography (SPECT) . • The level of evidence is V with weak strength of recommendation for scintography, magnetic resonance imaging (MRI), and computed tomography (CT) .Interventional Diagnosis:Lumbar Spine: • The level of evidence is I to II with moderate to strong strength of recommendation for lumbar diagnostic facet joint nerve blocks. • Ten relevant diagnostic accuracy studies with 4 of 10 studies utilizing controlled comparative local anesthetics with concordant pain relief criterion standard of ≥80% were included. • The prevalence rates ranged from 27% to 40% with false-positive rates of 27% to 47%, with ≥80% pain relief.Cervical Spine: • The level of evidence is II with moderate strength of recommendation. • Ten relevant diagnostic accuracy studies, 9 of the 10 studies with either controlled comparative local anesthetic blocks or placebo controls with concordant pain relief with a criterion standard of ≥80% were included. • The prevalence and false-positive rates ranged from 29% to 60% and of 27% to 63%, with high variability. Thoracic Spine: • The level of evidence is II with moderate strength of recommendation. • Three relevant diagnostic accuracy studies, with controlled comparative local anesthetic blocks, with concordant pain relief, with a criterion standard of ≥80% were included. • The prevalence varied from 34% to 48%, whereas false-positive rates varied from 42% to 58%.Therapeutic Facet Joint Interventions: Lumbar Spine: • The level of evidence is II with moderate strength of recommendation for lumbar radiofrequency ablation with inclusion of 11 relevant randomized controlled trials (RCTs) with 2 negative studies and 4 studies with long-term improvement. • The level of evidence is II with moderate strength of recommendation for therapeutic lumbar facet joint nerve blocks with inclusion of 3 relevant randomized controlled trials, with long-term improvement. • The level of evidence is IV with weak strength of recommendation for lumbar facet joint intraarticular injections with inclusion of 9 relevant randomized controlled trials, with majority of them showing lack of effectiveness without the use of local anesthetic. Cervical Spine: • The level of evidence is II with moderate strength of recommendation for cervical radiofrequency ablation with inclusion of one randomized controlled trial with positive results and 2 observational studies with long-term improvement. • The level of evidence is II with moderate strength of recommendation for therapeutic cervical facet joint nerve blocks with inclusion of one relevant randomized controlled trial and 3 observational studies, with long-term improvement. • The level of evidence is V with weak strength of recommendation for cervical intraarticular facet joint injections with inclusion of 3 relevant randomized controlled trials, with 2 observational studies, the majority showing lack of effectiveness, whereas one study with 6-month follow-up, showed lack of long-term improvement. Thoracic Spine: • The level of evidence is III with weak to moderate strength of recommendation with emerging evidence for thoracic radiofrequency ablation with inclusion of one relevant randomized controlled trial and 3 observational studies. • The level of evidence is II with moderate strength of recommendation for thoracic therapeutic facet joint nerve blocks with inclusion of 2 randomized controlled trials and one observational study with long-term improvement. • The level of evidence is III with weak to moderate strength of recommendation for thoracic intraarticular facet joint injections with inclusion of one randomized controlled trial with 6 month follow-up, with emerging evidence. Antithrombotic Therapy: • Facet joint interventions are considered as moderate to low risk procedures; consequently, antithrombotic therapy may be continued based on overall general status. Sedation: • The level of evidence is II with moderate strength of recommendation to avoid opioid analgesics during the diagnosis with interventional techniques. • The level of evidence is II with moderate strength of recommendation that moderate sedation may be utilized for patient comfort and to control anxiety for therapeutic facet joint interventions. LIMITATIONS: The limitations of these guidelines include a paucity of high-quality studies in the majority of aspects of diagnosis and therapy. CONCLUSIONS: These facet joint intervention guidelines were prepared with a comprehensive review of the literature with methodologic quality assessment with determination of level of evidence and strength of recommendations. KEY WORDS: Chronic spinal pain, interventional techniques, diagnostic blocks, therapeutic interventions, facet joint nerve blocks, intraarticular injections, radiofrequency neurolysis.


Assuntos
Dor nas Costas/terapia , Dor Crônica/terapia , Manejo da Dor/métodos , Articulação Zigapofisária , Humanos , Estados Unidos
18.
Value Health ; 23(5): 585-594, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32389224

RESUMO

OBJECTIVES: To evaluate the cost-effectiveness of radiofrequency denervation when added to a standardized exercise program for patients with chronic low back pain. METHODS: An economic evaluation was conducted alongside 3 pragmatic multicenter, nonblinded randomized clinical trials (RCTs) in The Netherlands with a follow up of 52 weeks. Eligible participants were included between January 1, 2013, and October 24, 2014, and had chronic low back pain; a positive diagnostic block at the facet joints (n = 251), sacroiliac (SI) joints (n = 228), or a combination of facet joints, SI joints, and intervertebral discs (n = 202); and were unresponsive to initial conservative care. Quality-adjusted life-years (QALYs) and societal costs were measured using self-reported questionnaires. Missing data were imputed using multiple imputation. Bootstrapping was used to estimate statistical uncertainty. RESULTS: After 52 weeks, no difference in costs between groups was found in the facet joint or combination RCT. The total costs were significantly higher for the intervention group in the SI joint RCT. The maximum probability of radiofrequency denervation being cost-effective when added to a standardized exercise program ranged from 0.10 in the facet joint RCT to 0.17 in the SI joint RCT irrespective of the ceiling ratio, and 0.65 at a ceiling ratio of €30 000 per QALY in the combination RCT. CONCLUSIONS: Although equivocal among patients with symptoms in a combination of the facet joints, SI joints, and intervertebral discs, evidence suggests that radiofrequency denervation combined with a standardized exercise program cannot be considered cost-effective from a societal perspective for patients with chronic low back pain originating from either facet or SI joints in a Dutch healthcare setting.


Assuntos
Dor Crônica/cirurgia , Análise Custo-Benefício , Denervação , Dor Lombar/cirurgia , Vértebras Lombares/inervação , Terapia por Radiofrequência , Terapia por Exercício , Feminino , Humanos , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Países Baixos , Anos de Vida Ajustados por Qualidade de Vida , Articulação Sacroilíaca/inervação , Articulação Sacroilíaca/cirurgia , Autorrelato , Inquéritos e Questionários , Articulação Zigapofisária/inervação , Articulação Zigapofisária/cirurgia
19.
J Clin Neurosci ; 77: 36-40, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32389542

RESUMO

Recurrent lumbar disc herniation (rLDH) is one of the major problems when surgically treating patients with LDH. Data on previous studies investigated the associations between facet joint parameters and rLDH appear only rarely in the literature. This study's objective was to evaluate the association between facet joint parameters [facet orientation (FO) and facet tropism (FT)] and rLDH. From June 2005 to January 2014, 346 patients having single-level lumbar disc herniation (LDH), who underwent surgery, were included in this study. We divided the patients into the recurrent group (R group) and the nonrecurrent group (N group). According to 25%, 50% and 75% quantiles of FO, all the cases were divided into 4 subgroups (<42°, 42~45°, 46~49°, and >49°). Cases were divided into 3 groups according to different range of FT (<3°, 3~4° and >4°). The relationships between the facet joint parameters and rLDH were evaluated. All cases in the study were followed up for more than 5 years postoperatively. The recurrence rates of different FO groups were statistically significant (P < 0.001). With the decrease of FO, the risk of rLDH increases continuously. Also, there were statistically significant recurrence rates in different FT groups (P < 0.001), which showed the incidence of rLDH increases gradually with the increase of FT. Facet joint parameters significantly influence the biomechanics of the corresponding segment. Facet joint parameters may play a more important role in the pathogenesis of rLDH.


Assuntos
Deslocamento do Disco Intervertebral/diagnóstico , Deslocamento do Disco Intervertebral/epidemiologia , Vértebras Lombares/anatomia & histologia , Vigilância da População , Articulação Zigapofisária/anatomia & histologia , Adulto , Idoso , Idoso de 80 Anos ou mais , China/epidemiologia , Estudos Transversais , Feminino , Seguimentos , Humanos , Deslocamento do Disco Intervertebral/cirurgia , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Vigilância da População/métodos , Recidiva , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem , Articulação Zigapofisária/cirurgia
20.
World Neurosurg ; 139: e716-e723, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32360675

RESUMO

OBJECTIVE: To investigate the incidence of superior facet joint violation (FJV) during percutaneous pedicle screw placement in minimally invasive transforaminal lumbar interbody fusion, and assess the possible risk factors for FJV. METHODS: An analysis of 91 patients with lumbar degenerative diseases treated with percutaneous pedicle screw placement via minimally invasive transforaminal lumbar interbody fusion from 2012 to 2018 was performed. Superior FJV was evaluated and graded by 3-dimensional lumbar computed tomography reconstruction. Analysis of possible risk factors included general condition of patients, anatomical characteristics of facet joint (FJ; axial, sagittal, and coronal diameters of FJ, facet angle, lumbar lordosis angle, lumbar lordosis index, and depth of lamina), and surgical factors (pedicle screw angle, screw-superior FJ distance, cranial angle, proximal rod length, and rod contouring). RESULTS: The overall violation rate of superior FJ was 34.07% (62/182), and high-grade violation rate was 16.06% (27/182). The logistic regression analysis revealed that body mass index ≥30 kg/m2 and pedicle screw placement at L5 were independent risk factors of FJV. Anatomical factors showed that the incidence of FJV was significantly increased when axial, sagittal, and coronal diameters of FJ were all ≥12 mm or FA was ≥40°. Surgical factors showed that the FJV group had a smaller pedicle screw angle and screw-superior FJ distance compared with the non-FJV group (P < 0.05). CONCLUSIONS: Body mass index ≥30 kg/m2 and pedicle screw placement at L5 were independent risk factors of superior FJV. FJV was more likely to occur in hypertrophic FJ (axial, sagittal, and coronal diameters ≥12 mm) or coronal orientation (FA ≥40°).


Assuntos
Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Parafusos Pediculares/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Fusão Vertebral/efeitos adversos , Adulto , Idoso , Feminino , Humanos , Incidência , Vértebras Lombares , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Obesidade/complicações , Fatores de Risco , Fusão Vertebral/métodos , Adulto Jovem , Articulação Zigapofisária/cirurgia
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