Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 725
Filtrar
1.
Pan Afr Med J ; 33: 242, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31692794

RESUMO

The sciatic nerve is the terminal branch of the sacral plexus. Sciatalgia is a nerve root pain. In most cases, sciatica originates from degenerative disc disease. Tumor involving the sciatic nerve is extremely rare. We here report the case of a 33-year old patient with nerve tumor detected on MRI performed for drug-resistant sciatica. Tumor involving the sciatic nerve is rare and diagnosis is difficult. MRI data are crucial for establishing an effective surgical approach.


Assuntos
Imagem por Ressonância Magnética/métodos , Neurilemoma/diagnóstico por imagem , Neurofibroma/diagnóstico por imagem , Nervo Isquiático/diagnóstico por imagem , Adulto , Diagnóstico Diferencial , Humanos , Masculino , Nervo Isquiático/patologia , Ciática/diagnóstico
4.
BMC Musculoskelet Disord ; 20(1): 313, 2019 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-31272439

RESUMO

BACKGROUND: Sciatica is a painful condition managed by a stepped care approach for most patients. Currently, there are no decision-making tools to guide matching care pathways for patients with sciatica without evidence of serious pathology, early in their presentation. This study sought to develop an algorithm to subgroup primary care patients with sciatica, for initial decision-making for matched care pathways, including fast-track referral to investigations and specialist spinal opinion. METHODS: This was an analysis of existing data from a UK NHS cohort study of patients consulting in primary care with sciatica (n = 429). Factors potentially associated with referral to specialist services, were identified from the literature and clinical opinion. Percentage of patients fast-tracked to specialists, sensitivity, specificity, positive and negative predictive values for identifying this subgroup, were calculated. RESULTS: The algorithm allocates patients to 1 of 3 groups, combining information about four clinical characteristics, and risk of poor prognosis (low, medium or high risk) in terms of pain-related persistent disability. Patients at low risk of poor prognosis, irrespective of clinical characteristics, are allocated to group 1. Patients at medium risk of poor prognosis who have all four clinical characteristics, and patients at high risk of poor prognosis with any three of the clinical characteristics, are allocated to group 3. The remainder are allocated to group 2. Sensitivity, specificity and positive predictive value of the algorithm for patient allocation to fast-track group 3, were 51, 73 and 22% respectively. CONCLUSION: We developed an algorithm to support clinical decisions regarding early referral for primary care patients with sciatica. Limitations of this study include the low positive predictive value and use of data from one cohort only. On-going research is investigating whether the use of this algorithm and the linked care pathways, leads to faster resolution of sciatica symptoms.


Assuntos
Procedimentos Clínicos , Técnicas de Apoio para a Decisão , Seleção de Pacientes , Ciática/diagnóstico , Adulto , Idoso , Tomada de Decisão Clínica , Estudos de Coortes , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Valor Preditivo dos Testes , Atenção Primária à Saúde , Encaminhamento e Consulta , Ciática/terapia , Sensibilidade e Especificidade , Fatores de Tempo
5.
BMC Musculoskelet Disord ; 20(1): 202, 2019 May 10.
Artigo em Inglês | MEDLINE | ID: mdl-31077179

RESUMO

BACKGROUND: There is increasing interest in the role of pro-inflammatory cytokines in the pathogenesis of sciatica and whether these could be potential targets for treatment. We sought to investigate serum biomarker levels in patients with low back-related leg pain, including sciatica. METHODS: Primary care consulters aged > 18 with low back-related leg pain were recruited to a cohort study (ATLAS). Participants underwent a standardised clinical assessment, lumbar spine MRI and a subsample (n = 119) had samples taken for biomarker analysis. Participants were classified having: a) clinically confirmed sciatica or referred leg pain, and then subdivided into those with (or without) MRI confirmed nerve root compression due to disc prolapse. Seventeen key cytokines, chemokines and matrix metalloproteinases (MMPs) implicated in sciatica pathogenesis including TNFα and IL-6, were assayed in duplicate using commercial multiplex detection kits and measured using a Luminex suspension array system. Median biomarker levels were compared between the groups using a Mann Whitney U test. Multivariate logistic regression analysis was used to investigate the association between clinical measures and biomarker levels adjusted for possible confounders such as age, sex, and symptom duration. RESULTS: No difference was found in the serum level of any of the 17 biomarkers tested in patients with (n = 93) or without (n = 26) clinically confirmed sciatica, nor between those with (n = 44) or without (n = 49) sciatica and MRI confirmed nerve root compression. CONCLUSION: In this cohort, no significant differences in serum levels of TNFα, IL-6 or any other biomarkers were seen between patients with sciatica and those with back pain with referred leg pain. These results suggest that in patients with low back-related leg pain, serum markers associated with inflammation do not discriminate between patients with or without clinically confirmed sciatica or between those with or without evidence of nerve root compression on MRI.


Assuntos
Mediadores da Inflamação/sangue , Deslocamento do Disco Intervertebral/diagnóstico , Dor Lombar/etiologia , Dor Referida/etiologia , Ciática/diagnóstico , Adulto , Idoso , Biomarcadores/sangue , Estudos de Casos e Controles , Diagnóstico Diferencial , Estudos de Viabilidade , Feminino , Humanos , Deslocamento do Disco Intervertebral/sangue , Deslocamento do Disco Intervertebral/complicações , Perna (Membro) , Estudos Longitudinais , Dor Lombar/sangue , Região Lombossacral/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Dor Referida/sangue , Atenção Primária à Saúde/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Ciática/sangue , Ciática/complicações
6.
BMC Musculoskelet Disord ; 20(1): 156, 2019 Apr 09.
Artigo em Inglês | MEDLINE | ID: mdl-30967132

RESUMO

BACKGROUND: This systematic review focusses on inflammation as an underlying pathogenic mechanism in sciatica. We addressed two questions in particular: (1) what inflammatory biomarkers have been identified in patients with sciatica in the literature so far? 2) is there an association between the level of inflammatory activity and clinical symptoms? METHODS: The search was conducted up to December 19th 2018 in MEDLINE, EMBASE, CENTRAL and Web of Science. The study selection criteria: (1) observational cohort studies, cross-sectional studies and randomized clinical trials (RCT), (2) adult population (≥ 18 years) population with sciatica, (3) concentrations of inflammatory biomarkers measured in serum, cerebrospinal fluid (CSF) or biopsies, and (4) evaluation of clinically relevant outcome measures (pain or functional status). Three reviewers independently selected studies and extracted data regarding the study characteristics and the outcomes. Risk of Bias was evaluated using an adjusted version of the Quality in Prognosis Studies (QUIPS) tool. RESULTS: In total 16 articles fulfilled the criteria for inclusion: 7 cross sectional observational studies and 9 prospective cohort studies that included a total of 1212 patients. With regard to question 1) the following markers were identified: interleukin (IL)-1ß, IL-2, IL-4, IL-6, IL-8, IL-10, IL-17, IL-21, tumor necrosis factor-α (TNF-α), phospholipase A2, high sensitivity C-reactive protein (hsCRP), C-X-C motif chemokine 5 (CXCM5), CX3CL1, CCL2, epidermal growth factor (EGF), and monocyte chemotactic protein 4 (MCP-4). With regard to question 2) several positive correlations were found in longitudinal studies: a strong positive correlation between inflammatory mediators or byproducts and pain (measured by visual analogue scale, VAS) was found for IL-21 in two studies (r > 0,8), and moderate positive correlations for TNF-a in both serum (r = 0,629) and biopsy (r = 0.65); severe pain (VAS > 4) is associated with increased hsCRP levels among patients with sciatica (adjusted OR = 3.4 (95% CI, 1.1 to 10). CONCLUSION: In this systematic review there was considerable heterogeneity in the type of biomarkers and in the clinical measurements in the included studies. Taking into account the overall risk of bias of the included studies there is insufficient evidence to draw firm conclusions regarding the relationship between inflammation and clinical symptoms in patients with sciatica.


Assuntos
Mediadores da Inflamação/sangue , Ciática/sangue , Ciática/diagnóstico , Biomarcadores/sangue , Estudos Transversais , Humanos , Estudos Observacionais como Assunto/métodos , Estudos Prospectivos , Ciática/epidemiologia
7.
Medicine (Baltimore) ; 98(14): e15105, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30946376

RESUMO

We tested the responsiveness of the modified Lower Extremity Functional Scale (LEFS) for patients with low back pain (LBP) and sciatica and made a comparison with the modified Roland-Morris Disability Scale for sciatica (RMS-L) and self-reported pain intensity measured by visual analogue scale (VAS).One hundred and forty-eight participants were recruited from 2 university hospitals. The evaluation included demographic data, LBP history, and the modified LEFS, RMS-L, and VAS, with a follow-up one month later. Several responsiveness statistics were calculated.The study followed 132 participants, approximately 25% reported improvement. Guyatt responsiveness index (GRI) was 0.8 or higher for 3 measures, while standardized response means were 0.8 or higher for the RMS-L and VAS, but only 0.6 for the modified LEFS among improved group. According to ROC analysis, the modified LEFS had an area under curve (AUC) similar to that of the modified RMS-L, but significantly smaller than that of the VAS.The responsiveness of the modified LEFS was moderate but not superior to the VAS or RMS-L. Although, the modified LEFS could not replace the RMS-L or VAS, it could still be used as a complementary measure since these three measurements covered different body function, activity and participation domains.


Assuntos
Avaliação da Deficiência , Dor Lombar/diagnóstico , Medição da Dor/normas , Ciática/diagnóstico , Adulto , Feminino , Humanos , Dor Lombar/fisiopatologia , Extremidade Inferior/fisiopatologia , Masculino , Pessoa de Meia-Idade , Curva ROC , Ciática/fisiopatologia , Autorrelato , Sensibilidade e Especificidade , Inquéritos e Questionários , Escala Visual Analógica
8.
Eur J Orthop Surg Traumatol ; 29(6): 1199-1204, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30955091

RESUMO

INTRODUCTION: There is a paucity of studies reporting responsiveness of visual analogue scale (VAS) measures in patients treated by discectomy for symptomatic lumbar disc herniation. The aim of this study was to evaluate the responsiveness of different types of VAS. METHODS: VAS score was measured separately for constant leg pain (VAS-LP-constant), severe episode of leg pain (VAS-LP-severe), constant backache (VAS-BP-constant) and severe episode of backache (VAS-BP-severe) in a cohort of patients undergoing discectomy surgery for sciatica. VAS was evaluated preoperatively and postoperatively at final follow-up. Responsiveness was determined using standardised response mean (SRM), effect size (ES) and the area under the curve (AUC) analysis using receiver operating characteristic curves. For AUC analysis, the success of discectomy from the patient's perspective was chosen as the external anchor. RESULTS: Ninety-eight patients were included in this prospective study. Outcome was assessed at a mean follow-up of 12 weeks postoperatively. The SRM of VAS-LP-severe, VAS-LP-constant, VAS-BP-severe and VAS-BP-constant was 2.16, 2.16, 0.87 and 0.53, respectively. The ES of VAS-LP-severe, VAS-LP-constant, VAS-BP-severe and VAS-BP-constant was 3.53, 2.70, 0.89 and 0.53, respectively. The AUC of VAS-LP-severe, VAS-LP-constant, VAS-BP-severe and VAS-BP-constant was 0.88, 0.75, 0.74 and 0.59, respectively. CONCLUSION: We recommend the use of VAS-LP-Severe as the most responsive VAS measure when evaluating the results of discectomy surgery for sciatica.


Assuntos
Discotomia , Degeneração do Disco Intervertebral/complicações , Deslocamento do Disco Intervertebral/complicações , Complicações Pós-Operatórias/diagnóstico , Ciática , Escala Visual Analógica , Assistência ao Convalescente/métodos , Discotomia/efeitos adversos , Discotomia/métodos , Feminino , Humanos , Degeneração do Disco Intervertebral/cirurgia , Deslocamento do Disco Intervertebral/cirurgia , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Medição da Dor/métodos , Seleção de Pacientes , Assistência Perioperatória/métodos , Ciática/diagnóstico , Ciática/etiologia , Resultado do Tratamento
9.
Trials ; 20(1): 56, 2019 Jan 16.
Artigo em Inglês | MEDLINE | ID: mdl-30651139

RESUMO

BACKGROUND: Sciatica is a relatively frequent illness that easily becomes a chronic and relapsing condition. Although numerous systematic reviews have analyzed various therapies for sciatica, the validity of their included studies is limited. Considering the limitations of conventional treatment options for sciatica, acupuncture is a possible option; however, evidence supporting its efficacy and mechanism in patients with sciatica is lacking. The aim of this proposed protocol is to investigate the effect and neurophysiological mechanism of acupuncture in patients with chronic sciatica. METHODS/DESIGN: This study is a randomized, patient-assessor blind, two-arm, parallel, non-penetrating, sham-controlled clinical trial. Eligible participants will include adults (aged 19-70 years old) with a clinical diagnosis of chronic sciatica (40 mm or more of a 100-mm visual analog scale (VAS) for bothersomeness) blinded to the treatment received. Patients will be randomly allocated into the acupuncture treatment group (manual acupuncture plus electroacupuncture (EA), n = 34) or the sham acupuncture control group (sham acupuncture plus placebo EA without electrical stimulation, n = 34). Groups will receive treatment twice a week for a total of eight sessions over 4 weeks. Functional magnetic resonance imaging will be implemented at baseline and endpoint to investigate the mechanism of acupuncture. The primary outcome measure is the VAS for bothersomeness and secondary outcomes include the VAS for pain intensity, Oswestry Disability Index, EuroQol 5-Dimension, Coping Strategy Questionnaire, Beck's Depression Inventory, and State-Trait Anxiety Inventory. Adverse events will be assessed at every visit. DISCUSSION: The results of this trial (which will be available in 2020) should provide important clinical evidence for the effect of acupuncture and demonstrate how acupuncture can be helpful for the treatment of chronic sciatica. TRIAL REGISTRATION: ClinicalTrials.gov, ID: NCT03350789 . Registered on 15 November 2017.


Assuntos
Terapia por Acupuntura , Dor Crônica/terapia , Ciática/terapia , Adaptação Psicológica , Adulto , Idoso , Dor Crônica/diagnóstico , Dor Crônica/fisiopatologia , Dor Crônica/psicologia , Avaliação da Deficiência , Emoções , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Medição da Dor , Ensaios Clínicos Controlados Aleatórios como Assunto , Ciática/diagnóstico , Ciática/fisiopatologia , Ciática/psicologia , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
10.
Arthritis Care Res (Hoboken) ; 71(2): 290-299, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30044543

RESUMO

OBJECTIVE: To identify risk factors for low back pain (LBP) and lumbar radicular pain and to assess whether obesity and exposure to workload factors modify the effect of leisure-time physical activity on LBP and lumbar radicular pain. METHODS: The population of this 11-year longitudinal study consists of a nationally representative sample of Finns ages ≥30 years (n = 3,505). The outcomes of the study were LBP and lumbar radicular pain for >7 days or for >30 days in the past 12 months at follow-up. RESULTS: LBP and lumbar radicular pain were more common in women than in men. LBP slightly declined with increasing age, while lumbar radicular pain increased with age. Abdominal obesity (defined by waist circumference) increased the risk of LBP (adjusted odds ratio [OR] 1.40 [95% confidence interval (95% CI) 1.16-1.68] for LBP >7 days and adjusted OR 1.41 [95% CI 1.13-1.76] for LBP >30 days) and general obesity (defined by body mass index) increased the risk of lumbar radicular pain (adjusted OR 1.44 [95% CI 1.12-1.85] for pain >7 days and adjusted OR 1.62 [95% CI 1.16-2.26] for pain >30 days). Smoking and strenuous physical work increased the risk of both LBP and lumbar radicular pain. Walking or cycling to work reduced the risk of LBP, particularly LBP for >30 days (adjusted OR 0.75 [95% CI 0.59-0.95]), with the largest reductions among nonabdominally obese individuals and among those not exposed to physical workload factors. Using vibrating tools increased the risk of lumbar radicular pain. CONCLUSION: Lifestyle and physical workload factors increase the risk of LBP and lumbar radicular pain. Walking and cycling may have preventive potential for LBP.


Assuntos
Dor Lombar/epidemiologia , Obesidade Abdominal/epidemiologia , Exposição Ocupacional , Vigilância da População , Ciática/epidemiologia , Fumar/epidemiologia , Adulto , Idoso , Exercício/fisiologia , Feminino , Finlândia/epidemiologia , Seguimentos , Inquéritos Epidemiológicos/métodos , Humanos , Estudos Longitudinais , Dor Lombar/diagnóstico , Dor Lombar/fisiopatologia , Masculino , Pessoa de Meia-Idade , Obesidade/diagnóstico , Obesidade/epidemiologia , Obesidade/fisiopatologia , Obesidade Abdominal/diagnóstico , Obesidade Abdominal/fisiopatologia , Exposição Ocupacional/efeitos adversos , Fatores de Risco , Ciática/diagnóstico , Ciática/fisiopatologia , Fumar/efeitos adversos , Circunferência da Cintura/fisiologia
11.
Am J Med ; 132(3): 300-306, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30291829

RESUMO

Atraumatic spinal emergencies often present a diagnostic and management dilemma for health care practitioners. Spinal epidural abscess, cauda equina syndrome, and spinal epidural hematoma are conditions that can insidiously present to outpatient medical offices, urgent care centers, and emergency departments. Unless a high level of clinical suspicion is maintained, these clinical entities may be initially misdiagnosed and mismanaged. Permanent neurologic sequela and even death can result if delays in appropriate treatment occur. A focused, critical review of 34 peer-reviewed articles was performed to identify current data about accurate diagnosis of spinal emergencies. This review highlights the key features of these 3 pathological entities with an emphasis on appropriate diagnostic strategy to intervene efficiently and minimize morbidity.


Assuntos
Síndrome da Cauda Equina/diagnóstico , Emergências , Abscesso Epidural/diagnóstico , Hematoma Epidural Espinal/diagnóstico , Atenção Primária à Saúde , Antibacterianos/uso terapêutico , Transtornos da Coagulação Sanguínea/complicações , Transtornos da Coagulação Sanguínea/diagnóstico , Transtornos da Coagulação Sanguínea/terapia , Síndrome da Cauda Equina/terapia , Desbridamento , Descompressão Cirúrgica , Diagnóstico Tardio/prevenção & controle , Diagnóstico Diferencial , Erros de Diagnóstico/prevenção & controle , Abscesso Epidural/terapia , Hematoma Epidural Espinal/etiologia , Hematoma Epidural Espinal/terapia , Humanos , Imagem por Ressonância Magnética , Mielografia , Ciática/diagnóstico , Tomografia Computadorizada por Raios X
12.
Br J Neurosurg ; 33(5): 562-565, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28906149

RESUMO

Intrapelvic sciatic nerve schwannomas are rare causes for non-discogenic sciatica. We describe a 44-year-old female who had a palpable mass on digital rectal examination that exhibited a positive Tinel's sign. The schwannoma was excised by a posterior transgluteal approach. Patients with negative spinal imaging should undergo pelvic scanning to rule out these tumors.


Assuntos
Neurilemoma/cirurgia , Neoplasias do Sistema Nervoso Periférico/cirurgia , Ciática/diagnóstico , Adulto , Exame Retal Digital , Feminino , Humanos , Achados Incidentais , Imagem por Ressonância Magnética/métodos , Imagem Multimodal , Neurilemoma/complicações , Neurilemoma/patologia , Neoplasias do Sistema Nervoso Periférico/complicações , Neoplasias do Sistema Nervoso Periférico/patologia , Nervo Isquiático , Ciática/cirurgia , Tomografia Computadorizada por Raios X
13.
Semin Neurol ; 38(6): 634-639, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30522138

RESUMO

Back pain is a top primary and urgent care complaint; radicular pain can be caused by herniation of the nucleus pulposus (intervertebral disc), spinal stenosis, or degenerative changes to the vertebrae. The focus of this clinical review will be the clinical approach and treatment of lumbar radicular pain, cervical radicular pain, and spinal stenosis. Usually localized through neurological history, exam, and imaging, specific signs and symptoms for lumbar radicular, spinal stenosis, and cervical radicular pain can help determine etiology. Once radicular back pain has been diagnosed, a multitude of treatment options are available from rest and physical therapy to medications, epidurals, and surgery. The most common and accepted are reviewed. With accurate diagnosis, safe and effective pain management can be employed to shorten radicular episodes and manage recurrent or chronic radicular syndromes. Using a step-wise approach from diagnosis to conservative therapy to potential surgery, radicular pain syndromes can improve or resolve, and patients may achieve a better functional status and quality of life.


Assuntos
Dor nas Costas/diagnóstico , Radiculopatia/diagnóstico , Ciática/diagnóstico , Estenose Espinal/diagnóstico , Dor nas Costas/terapia , Humanos , Manejo da Dor , Radiculopatia/terapia , Ciática/terapia , Estenose Espinal/terapia
14.
Trials ; 19(1): 475, 2018 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-30185221

RESUMO

BACKGROUND: Sciatica is a common condition reported to affect over 3% of the UK population at any time and is often caused by a prolapsed intervertebral disc (PID). Although the duration and severity of symptoms can vary, pain persisting beyond 6 weeks is unlikely to recover spontaneously and may require investigation and treatment. Currently, there is no specific care pathway for sciatica in the National Health Service (NHS), and no direct comparison exists between surgical microdiscectomy and transforaminal epidural steroid injection (TFESI). The NERVES (NErve Root block VErsus Surgery) trial aims to address this by comparing clinical and cost-effectiveness of surgical microdiscectomy and TFESI to treat sciatica secondary to a PID. METHODS/DESIGN: A total of 163 patients were recruited from NHS out-patient clinics across the UK and randomised to either microdiscectomy or TFESI. Adult patients (aged 16-65 years) with sciatic pain endured for between 6 weeks and 12 months are eligible if their symptoms have not been improved by at least one form of conservative (non-operative) treatment and they are willing to provide consent. Patients will be excluded if they present with neurological deficit or have had previous surgery at the same level. The primary outcome is patient-reported disability measured using the Oswestry Disability Questionnaire (ODQ) score at 18 weeks post randomisation and secondary outcomes include disability and pain scales using numerical pain ratings, modified Roland-Morris and Core Outcome Measures Index at 12-weekly intervals, and patient satisfaction at 54 weeks. Cost-effectiveness and quality of life (QOL) will be assessed using the EQ-5D-5 L and self-report cost data at 12-weekly intervals and Hospital Episode Statistics (HES) data. Adverse event data will be collected. Analysis will follow the principle of intention-to-treat. DISCUSSION: NERVES is the first trial to evaluate the comparative clinical and cost-effectiveness of microdiscectomy to local anaesthetic and steroid administered via TFESI. The results of this research may facilitate the development of an evidence-based treatment strategy for patients with sciatica. TRIAL REGISTRATION: ISRCTN, ID: ISRCTN04820368 . Registered on 5 June 2014. EudraCT EudraCT2014-002751-25. Registered on 8 October 2014.


Assuntos
Dor nas Costas/terapia , Discotomia/métodos , Glucocorticoides/administração & dosagem , Deslocamento do Disco Intervertebral/terapia , Microcirurgia/métodos , Bloqueio Nervoso/métodos , Ciática/terapia , Raízes Nervosas Espinhais/efeitos dos fármacos , Triancinolona/administração & dosagem , Adolescente , Adulto , Idoso , Dor nas Costas/diagnóstico , Dor nas Costas/etiologia , Dor nas Costas/fisiopatologia , Ensaios Clínicos Fase III como Assunto , Análise Custo-Benefício , Avaliação da Deficiência , Discotomia/efeitos adversos , Discotomia/economia , Custos de Medicamentos , Feminino , Glucocorticoides/efeitos adversos , Glucocorticoides/economia , Humanos , Injeções Epidurais , Deslocamento do Disco Intervertebral/complicações , Deslocamento do Disco Intervertebral/diagnóstico , Deslocamento do Disco Intervertebral/fisiopatologia , Masculino , Microcirurgia/efeitos adversos , Microcirurgia/economia , Pessoa de Meia-Idade , Estudos Multicêntricos como Assunto , Bloqueio Nervoso/efeitos adversos , Bloqueio Nervoso/economia , Medição da Dor , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Recuperação de Função Fisiológica , Ciática/diagnóstico , Ciática/etiologia , Ciática/fisiopatologia , Raízes Nervosas Espinhais/fisiopatologia , Fatores de Tempo , Resultado do Tratamento , Triancinolona/efeitos adversos , Triancinolona/economia , Reino Unido , Adulto Jovem
15.
Chiropr Man Therap ; 26: 37, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30151119

RESUMO

Main text: We aim to summarize the available evidence on the diagnostic accuracy of imaging (index test) compared to surgery (reference test) for identifying lumbar disc herniation (LDH) in adult patients.For this systematic review we searched MEDLINE, EMBASE and CINAHL (June 2017) for studies that assessed the diagnostic accuracy of imaging for LDH in adult patients with low back pain and surgery as the reference standard. Two review authors independently selected studies, extracted data and assessed risk of bias. We calculated summary estimates of sensitivity and specificity using bivariate analysis, generated linked ROC plots in case of direct comparison of diagnostic imaging tests and assessed the quality of evidence using the GRADE-approach.We found 14 studies, all but one done before 1995, including 940 patients. Nine studies investigated Computed Tomography (CT), eight myelography and six Magnetic Resonance Imaging (MRI). The prior probability of LDH varied from 48.6 to 98.7%. The summary estimates for MRI and myelography were comparable with CT (sensitivity: 81.3% (95%CI 72.3-87.7%) and specificity: 77.1% (95%CI 61.9-87.5%)). The quality of evidence was moderate to very low. Conclusions: The diagnostic accuracy of CT, myelography and MRI of today is unknown, as we found no studies evaluating today's more advanced imaging techniques. Concerning the older techniques we found moderate diagnostic accuracy for all CT, myelography and MRI, indicating a large proportion of false positives and negatives.


Assuntos
Deslocamento do Disco Intervertebral/diagnóstico por imagem , Dor Lombar/diagnóstico por imagem , Imagem por Ressonância Magnética/normas , Mielografia/normas , Ciática/diagnóstico por imagem , Tomógrafos Computadorizados/normas , Humanos , Deslocamento do Disco Intervertebral/diagnóstico , Dor Lombar/diagnóstico , Região Lombossacral/diagnóstico por imagem , Ensaios Clínicos Controlados Aleatórios como Assunto , Ciática/diagnóstico
16.
Trials ; 19(1): 408, 2018 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-30064491

RESUMO

BACKGROUND: Adalimumab, a biological treatment targeting tumour necrosis factor α, might be useful in sciatica. This paper describes the challenges faced when developing a new treatment pathway for a randomised controlled trial of adalimumab for people with sciatica, as well as the reasons why the trial discussed was stopped early. METHODS: A pragmatic, parallel group, randomised controlled trial with blinded (masked) participants, clinicians, outcome assessment and statistical analysis was conducted in six UK sites. Participants were identified and recruited from general practices, musculoskeletal services and outpatient physiotherapy clinics. They were adults with persistent symptoms of sciatica of 1 to 6 months' duration with moderate to high level of disability. Eligibility was assessed by research physiotherapists according to clinical criteria, and participants were randomised to receive two doses of adalimumab (80 mg then 40 mg 2 weeks later) or saline placebo subcutaneous injections in the posterior lateral thigh. Both groups were referred for a course of physiotherapy. Outcomes were measured at baseline, 6-week, 6-month and 12-month follow-up. The main outcome measure was disability measured using the Oswestry Disability Index. The planned sample size was 332, with the first 50 in an internal pilot phase. RESULTS: The internal pilot phase was discontinued after 10 months from opening owing to low recruitment (two of the six sites active, eight participants recruited). There were several challenges: contractual delays; one site did not complete contract negotiations, and two sites signed contracts shortly before trial closure; site withdrawal owing to patient safety concerns; difficulties obtaining excess treatment costs; and in the two sites that did recruit, recruitment was slower than planned because of operational issues and low uptake by potential participants. CONCLUSIONS: Improved patient care requires robust clinical research within contexts in which treatments can realistically be provided. Step changes in treatment, such as the introduction of biologic treatments for severe sciatica, raise complex issues that can delay trial initiation and retard recruitment. Additional preparatory work might be required before testing novel treatments. A randomised controlled trial of tumour necrosis factor-α blockade is still needed to determine its cost-effectiveness in severe sciatica. TRIAL REGISTRATION: Current Controlled Trials, ISRCTN14569274 . Registered on 15 December 2014.


Assuntos
Adalimumab/administração & dosagem , Anti-Inflamatórios/administração & dosagem , Término Precoce de Ensaios Clínicos , Modalidades de Fisioterapia , Ciática/tratamento farmacológico , Adalimumab/efeitos adversos , Anti-Inflamatórios/efeitos adversos , Terapia Combinada , Contratos , Avaliação da Deficiência , Término Precoce de Ensaios Clínicos/economia , Humanos , Injeções Subcutâneas , Medição da Dor , Seleção de Pacientes , Modalidades de Fisioterapia/efeitos adversos , Apoio à Pesquisa como Assunto , Ciática/diagnóstico , Ciática/imunologia , Ciática/fisiopatologia , Fatores de Tempo , Resultado do Tratamento , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Fator de Necrose Tumoral alfa/imunologia , Reino Unido
17.
Rev. esp. med. nucl. imagen mol. (Ed. impr.) ; 37(3): 172-174, mayo-jun. 2018. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-174495

RESUMO

Durante 4 semanas, un paciente varón de 36 años, sin historial clínico de relevancia, presentó entumecimiento en las extremidades inferiores, inestabilidad al andar, retención de orina y estreñimiento. La RM de la médula espinal mostró edema difuso en la médula dorsal cervicotorácica, así como imágenes de lesiones intramedulares sólidas indicativas de metástasis. Se realizó una 18F-FDG PET/TC para identificar la malignidad primaria de los focos hipermetabólicos dentro de la médula cervicotorácica, así como la leve linfoadenopatía hiliar bilateral hipermetabólica y los nódulos pulmonares hipermetabólicos indicativos de sarcoidosis frente a metástasis. El diagnóstico de sarcoidosis fue respaldado al identificarse un granuloma no caseificante en la biopsia del nódulo pulmonar. El paciente respondió bien al tratamiento con esteroides y los síntomas desaparecieron en 3 semanas


A 36 year-old male with no significant past medical history presented with lower extremity numbness, gait instability, and urinary and bowel retention of 4 weeks onset. Spine MRI revealed diffuse oedema of cervicothoracic spinal cord with several solid enhancing intramedullary lesions, suggestive of metastases. The 18F-FDG PET/CT performed to identify the primary malignancy demonstrated mild hypermetabolic foci within the cervicothoracic cord, as well as a mildly hypermetabolic bilateral hilar lymphadenopathy and a mildly hypermetabolic pulmonary nodule, suggestive of sarcoidosis versus metastasis. The diagnosis of sarcoidosis was supported by identifying non-caseating granuloma in the biopsy of the pulmonary nodule. The patient responded well to steroid-therapy, with the symptoms being resolved within 3 weeks


Assuntos
Humanos , Masculino , Adulto , Doenças do Sistema Nervoso Central/diagnóstico por imagem , Biópsia , Neoplasias Pulmonares/diagnóstico por imagem , Doenças do Sistema Nervoso Central/tratamento farmacológico , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Sarcoidose/diagnóstico por imagem , Ciática/diagnóstico , Medula Espinal/diagnóstico por imagem , Doenças do Sistema Nervoso Central/complicações , Doenças do Sistema Nervoso Central/patologia , Constipação Intestinal/etiologia , Diagnóstico Diferencial , Radioisótopos de Flúor/farmacocinética , Fluordesoxiglucose F18/farmacocinética , Granuloma/patologia , Neoplasias Pulmonares/secundário , Neoplasias da Medula Espinal/secundário , Transtornos Urinários/etiologia
18.
PLoS One ; 13(4): e0191852, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29621243

RESUMO

BACKGROUND: Identification of sciatica may assist timely management but can be challenging in clinical practice. Diagnostic models to identify sciatica have mainly been developed in secondary care settings with conflicting reference standard selection. This study explores the challenges of reference standard selection and aims to ascertain which combination of clinical assessment items best identify sciatica in people seeking primary healthcare. METHODS: Data on 394 low back-related leg pain consulters were analysed. Potential sciatica indicators were seven clinical assessment items. Two reference standards were used: (i) high confidence sciatica clinical diagnosis; (ii) high confidence sciatica clinical diagnosis with confirmatory magnetic resonance imaging findings. Multivariable logistic regression models were produced for both reference standards. A tool predicting sciatica diagnosis in low back-related leg pain was derived. Latent class modelling explored the validity of the reference standard. RESULTS: Model (i) retained five items; model (ii) retained six items. Four items remained in both models: below knee pain, leg pain worse than back pain, positive neural tension tests and neurological deficit. Model (i) was well calibrated (p = 0.18), discrimination was area under the receiver operating characteristic curve (AUC) 0.95 (95% CI 0.93, 0.98). Model (ii) showed good discrimination (AUC 0.82; 0.78, 0.86) but poor calibration (p = 0.004). Bootstrapping revealed minimal overfitting in both models. Agreement between the two latent classes and clinical diagnosis groups defined by model (i) was substantial, and fair for model (ii). CONCLUSION: Four clinical assessment items were common in both reference standard definitions of sciatica. A simple scoring tool for identifying sciatica was developed. These criteria could be used clinically and in research to improve accuracy of identification of this subgroup of back pain patients.


Assuntos
Dorso , Perna (Membro) , Modelos Estatísticos , Atenção Primária à Saúde , Ciática/diagnóstico , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Adulto Jovem
19.
Diagn Pathol ; 13(1): 18, 2018 Mar 02.
Artigo em Inglês | MEDLINE | ID: mdl-29499721

RESUMO

BACKGROUND: Ischemic fasciitis is a distinctive pseudosarcomatous entity with a marked predilection for elderly and physically debilitated or immobilized patients. The etiology of these lesions is unknown but felt to be related to ischemic vascular events. CASE PRESENTATION: Herein, we report for the first time, two cytogenetic translocations, t(1;2)(p36.1;q23) and t(7;19)(q32;q13.3) in a 75 year-old ambulating female with a history of left total hip arthroplasty 20 years ago. CONCLUSION: These translocations suggest a possible clonal pathogenetic link though their significance remains to be established.


Assuntos
Cromossomos Humanos , Fasciite/patologia , Síndrome do Músculo Piriforme/genética , Síndrome do Músculo Piriforme/patologia , Ciática/genética , Ciática/patologia , Translocação Genética/genética , Idoso , Fasciite/diagnóstico , Fasciite/genética , Feminino , Humanos , Isquemia/genética , Síndrome do Músculo Piriforme/diagnóstico , Ciática/diagnóstico
20.
Eur Spine J ; 27(7): 1509-1516, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29392417

RESUMO

PURPOSE: The purpose of this study is to point out the difficulty of differentiating great trochanter bursitis (GTB) from sciatica and estimating the prevalence of GTΒ, in patients poorly diagnosed with sciatica in their first visit to the general practitioner and referred to a spine infirmary. METHODS: The diagnosis of GTΒ was made based on history and physical examination, and was confirmed by ultrasonography and/or response to an anesthetic plus corticosteroid injection to the trochanteric bursa. Demographic and clinical characteristics of the study group were evaluated. The statistical analysis was held with the SPSS pc package (version 24.0). RESULTS: In a total of 657 referrals for sciatica, 72 patients (10.95%) were incorrectly diagnosed as suffering from sciatica, whereas, in fact, they were suffering from GTΒ. In addition, 18 patients (2.74%) were diagnosed as suffering from persistent sciatica with coexisting GTΒ. More women than men had GTΒ (79-11). Mean age for patients with sciatica diagnosis but suffering from GTΒ was 60 years. Mean age for patients with both sciatica and GTΒ was 61 years. CONCLUSIONS: The GTB is a common clinical entity in middle-aged women, which can escape from the physician in cases of incomplete medical history and clinical examination, leading to unnecessary imaging tests and treatment approaches, burdening both the patient and the health system. Early diagnosis of GTB may dramatically reduce cost, prevent unwanted and inappropriate imaging exams and treatment, and make the patient free of symptoms immediately. These slides can be retrieved under Electronic Supplementary Material.


Assuntos
Bursite/diagnóstico , Fêmur/fisiopatologia , Ciática/diagnóstico , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA