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1.
N Engl J Med ; 382(12): 1093-1102, 2020 03 19.
Artigo em Inglês | MEDLINE | ID: mdl-32187469

RESUMO

BACKGROUND: The treatment of chronic sciatica caused by herniation of a lumbar disk has not been well studied in comparison with acute disk herniation. Data are needed on whether diskectomy or a conservative approach is better for sciatica that has persisted for several months. METHODS: In a single-center trial, we randomly assigned patients with sciatica that had lasted for 4 to 12 months and lumbar disk herniation at the L4-L5 or L5-S1 level in a 1:1 ratio to undergo microdiskectomy or to receive 6 months of standardized nonoperative care followed by surgery if needed. Surgery was performed by spine surgeons who used conventional microdiskectomy techniques. The primary outcome was the intensity of leg pain on a visual analogue scale (ranging from 0 to 10, with higher scores indicating more severe pain) at 6 months after enrollment. Secondary outcomes were the score on the Oswestry Disability Index, back and leg pain, and quality-of-life scores at 6 weeks, 3 months, 6 months, and 1 year. RESULTS: From 2010 through 2016, a total of 790 patients were screened; of those patients, 128 were enrolled, with 64 in each group. Among the patients assigned to undergo surgery, the median time from randomization to surgery was 3.1 weeks; of the 64 patients in the nonsurgical group, 22 (34%) crossed over to undergo surgery at a median of 11 months after enrollment. At baseline, the mean score for leg-pain intensity was 7.7 in the surgical group and 8.0 in the nonsurgical group. The primary outcome of the leg-pain intensity score at 6 months was 2.8 in the surgical group and 5.2 in the nonsurgical group (adjusted mean difference, 2.4; 95% confidence interval, 1.4 to 3.4; P<0.001). Secondary outcomes including the score on the Owestry Disability Index and pain at 12 months were in the same direction as the primary outcome. Nine patients had adverse events associated with surgery, and one patient underwent repeat surgery for recurrent disk herniation. CONCLUSIONS: In this single-center trial involving patients with sciatica lasting more than 4 months and caused by lumbar disk herniation, microdiskectomy was superior to nonsurgical care with respect to pain intensity at 6 months of follow-up. (Funded by Physicians' Services Incorporated Foundation; ClinicalTrials.gov number, NCT01335646.).


Assuntos
Tratamento Conservador , Discotomia , Glucocorticoides/administração & dosagem , Deslocamento do Disco Intervertebral/cirurgia , Modalidades de Fisioterapia , Ciática/terapia , Adulto , Tratamento Conservador/métodos , Estudos Cross-Over , Discotomia/efeitos adversos , Feminino , Seguimentos , Humanos , Injeções Epidurais , Análise de Intenção de Tratamento , Deslocamento do Disco Intervertebral/complicações , Deslocamento do Disco Intervertebral/tratamento farmacológico , Masculino , Dor/etiologia , Medição da Dor , Satisfação do Paciente , Complicações Pós-Operatórias , Qualidade de Vida , Ciática/etiologia , Ciática/cirurgia , Resultado do Tratamento
2.
World Neurosurg ; 133: e452-e458, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31526879

RESUMO

OBJECTIVE: The most common cause of contralateral symptoms after unilateral transforaminal lumbar interbody fusion (TLIF) is contralateral foraminal stenosis (FS). This retrospective cohort study aimed to investigate the cause of and risk factors for contralateral FS after unilateral TLIF with a single cage. METHODS: Patients with degenerative lumbar spinal disorders who underwent unilateral TLIF at L4-5 were divided into 2 groups: those without contralateral radicular symptoms after surgery (group A; n = 340) and those with contralateral radicular symptoms after surgery (group B; n = 16). We investigated the influence of various radiological and cage-related factors on postoperative contralateral FS with radicular symptoms. The cage location indicates whether the cage's anterior tip crosses the disc midline-exceeding 50%-and in such a case, how far. RESULTS: Group B showed significantly increased postoperative coronal angle and sagittal angle and decreased contralateral foraminal height and foraminal area. Statistically significant (P < 0.01) factors according to the multivariate logistic regression analysis were the preoperative sagittal range of motion (odds ratio [OR]: 1.562, P = 0.004) and cage location (OR: 2.047, P = 0.015). The cutoff values for the sagittal range of motion and the cage location were 9.0° and 50.5%, respectively. The preoperative and postoperative 6-month visual analog scale scores and Oswestry disability index values were not significantly different between the groups. CONCLUSIONS: The 2 most meaningful risk factors were the preoperative sagittal range of motion and cage location. Inserting the cage beyond the disc midline, especially in patients with a high preoperative sagittal range of motion (≥9.0°), would help reduce postoperative complications.


Assuntos
Fixadores Internos/efeitos adversos , Vértebras Lombares/cirurgia , Complicações Pós-Operatórias/etiologia , Radiculopatia/etiologia , Fusão Vertebral/efeitos adversos , Estenose Espinal/cirurgia , Adulto , Idoso , Antropometria , Avaliação da Deficiência , Feminino , Humanos , Dor Lombar/epidemiologia , Dor Lombar/etiologia , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Medição da Dor , Dor Pós-Operatória/epidemiologia , Dor Pós-Operatória/etiologia , Complicações Pós-Operatórias/epidemiologia , Curva ROC , Radiculopatia/epidemiologia , Amplitude de Movimento Articular , Fatores de Risco , Ciática/epidemiologia , Ciática/etiologia , Fusão Vertebral/instrumentação , Fusão Vertebral/métodos , Estenose Espinal/complicações , Espondilolistese/complicações , Espondilolistese/cirurgia
3.
World Neurosurg ; 133: e26-e30, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31398523

RESUMO

OBJECTIVE: This study aims to report the clinical outcome of stand-alone lateral lumbar interbody fusion (LLIF) on recurrent disk herniation and to compare the outcome of stand-alone LLIF to that of conventional transforaminal lumbar interbody fusion (TLIF). METHODS: A retrospective study of 47 patients with recurrent disk herniation was included from January 2008 to October 2016. The inclusion criteria were 1) with recurrent disk herniation that needs revision surgery, 2) with only 1 previous percutaneous endoscopic lumbar diskectomy surgery, 3) underwent 1-level stand-alone LLIF or 1-level TLIF surgery, and 4) with follow-up more than 1 year. Patients were asked to complete the following questionnaires for outcome evaluation: visual analog scales (VAS) for both low back pain and leg pain, the Oswestry Disability Index (ODI), and the 12-item Short-Form Health Survey. RESULTS: Eighteen patients underwent stand-alone LLIF, and 29 patients underwent TLIF surgery. Radiographic analysis revealed a similar baseline and postoperative lumbar lordosis in both the LLIF and TLIF groups. Two weeks after surgery, the ODI and VAS scores showed a significant decrease in both groups. The TLIF group showed significantly larger postoperative VAS back pain after surgery (P = 0.03). For both VAS leg pain and ODI score during follow-up, no significance difference was found between the LLIF and TLIF groups. CONCLUSIONS: Stand-alone LLIF is a safe and effective approach with low morbidity and acceptable complication rates for patients with recurrent disk herniation after a previous percutaneous endoscopic lumbar diskectomy surgery. Compared with the TLIF procedure, LLIF could achieve a similar improvement of patient-reported outcome with a better VAS back pain score.


Assuntos
Discotomia Percutânea/métodos , Deslocamento do Disco Intervertebral/cirurgia , Vértebras Lombares/cirurgia , Neuroendoscopia/métodos , Reoperação/métodos , Idoso , Avaliação da Deficiência , Feminino , Humanos , Dor Lombar/etiologia , Masculino , Pessoa de Meia-Idade , Manejo da Dor , Complicações Pós-Operatórias/etiologia , Recidiva , Estudos Retrospectivos , Ciática/etiologia , Fusão Vertebral/métodos , Resultado do Tratamento
4.
J Comput Assist Tomogr ; 43(6): 976-980, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31688247

RESUMO

Endometriosis (EN) is a common gynecological condition characterized by the presence of functional endometrium located outside the uterine cavity. Sciatic nerve (SN) is rarely affected by EN. Magnetic resonance imaging allows a direct visualization of the spinal and SN, and it is the modality of choice for the study of SN involvement in extrapelvic EN. We report a case of an endometrioma located in the right SN with a systematic review of the literature.


Assuntos
Endometriose/diagnóstico por imagem , Nervo Isquiático/patologia , Ciática/diagnóstico por imagem , Adulto , Endometriose/complicações , Endometriose/cirurgia , Feminino , Humanos , Laparoscopia , Imagem por Ressonância Magnética/métodos , Nervo Isquiático/diagnóstico por imagem , Nervo Isquiático/cirurgia , Ciática/etiologia , Ciática/cirurgia , Resultado do Tratamento
5.
BMC Musculoskelet Disord ; 20(1): 438, 2019 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-31564252

RESUMO

BACKGROUND: The aim of this study was to find out whether the shear wave elastography (SWE) findings of patients with unilateral lumbar disc herniation (LDH) were related to clinical characteristics. METHODS: For this purpose, the study group included patients (N = 20; 13 male, 7 female) with complaints of unilateral sciatica, with foraminal stenosis caused by one level of LDH (L4-L5 or L5-S1). An gender-and age-matched control group (N = 27; 16 male, 11 female) was included. All the patients were examined on both the axial and longitudinal planes bilaterally at the same level using a convex array probe (1- 6 MHz, Supersonic Imagine, Aix en Provence, France). RESULTS: The sciatic nerve stiffness measured on longitudinal planes of the affected side was significantly higher than unaffected side (p < 0.001) and the control group (P < 0.05). Furthermore, the symptom duration of unilateral LDH is positively correlated with the stiffness the sciatic nerve (r = 0.52, p = 0.019). CONCLUSION: According to these findings, ultrasound imaging can be considered as a useful tool to detect changes in the sciatic nerve due to disc herniation. This technique will have a promising prospect for many patients with unilateral LDH in monitoring stiffness during rehabilitation and before or after surgery.


Assuntos
Técnicas de Imagem por Elasticidade/métodos , Deslocamento do Disco Intervertebral/diagnóstico por imagem , Nervo Isquiático/diagnóstico por imagem , Ciática/diagnóstico por imagem , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Disco Intervertebral/diagnóstico por imagem , Deslocamento do Disco Intervertebral/complicações , Deslocamento do Disco Intervertebral/terapia , Vértebras Lombares/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Ciática/etiologia , Ciática/terapia , Resultado do Tratamento
6.
BMC Womens Health ; 19(1): 95, 2019 07 12.
Artigo em Inglês | MEDLINE | ID: mdl-31299947

RESUMO

BACKGROUND: The combination of intrapelvic and extrapelvic endometriosis is a very rare condition in gynecology. Patients with endometriosis involving the sciatic nerve are easily misdiagnosed because they usually present with atypical symptoms of endometriosis. Here, we present a rare case of an endometrioma passing through the left greater sciatic foramen. Removal of the endometriotic lesion was performed with a concomitant laparoscopic and transgluteal approach through the cooperation of gynecologists and orthopedic (neuro)surgeons. CASE PRESENTATION: A 20-year-old woman presented with complaints of severe dysmenorrhea lasting for more than 6 years and dysfunction of her left lower limb lasting for approximately 4 months. Both CT and MRI demonstrated a suspected intrapelvic and extrapelvic endometriotic cyst (7.3 cm × 8.1 cm × 6.5 cm) passing through the left greater sciatic foramen. Laparoscopic exploration showed a cyst full of dark fluid occupying the left obturator fossa and extending outside the pelvis. A novel combination of transgluteal laparoscopy was performed for complete resection of the cyst and decompression of the sciatic nerve. Postoperative pathology confirmed the diagnosis of endometriosis. Long-term follow-up observation showed persistent pain relief and lower limb function recovery in the patient. DISCUSSION AND CONCLUSIONS: When a woman complains of unexplained unilateral sciatica, especially a woman suffering from dysmenorrhea, endometriosis of the sciatica nerve should be considered as a potential etiology. Complete excision of the endometriotic lesion and adequate neurolysis (or decompression) of the sciatic nerve through the multidisciplinary cooperation of experienced gynecologists with proper training in laparoscopic pelvic (neuro)surgery and orthopedic (neuro)surgeons is effective.


Assuntos
Dismenorreia/cirurgia , Endometriose/cirurgia , Laparoscopia/métodos , Ciática/cirurgia , Dismenorreia/etiologia , Dismenorreia/patologia , Endometriose/complicações , Endometriose/patologia , Feminino , Humanos , Extremidade Inferior/patologia , Extremidade Inferior/cirurgia , Pelve/patologia , Pelve/cirurgia , Nervo Isquiático/patologia , Nervo Isquiático/cirurgia , Ciática/etiologia , Ciática/patologia , Adulto Jovem
7.
J Back Musculoskelet Rehabil ; 32(4): 667-670, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31282403

RESUMO

BACKGROUND: Sciatica of extraspinal origin represents both a diagnostic and a therapeutic challenge for spine specialists. Among these, quadratus femoris muscle (QF) is often overlooked as a pain-generator. REPORTED CASE: A 62-year old man was referred from general practitioner for isolated sciatica in the left leg, refractory to conservative treatments. Plain x-rays of the spine did not show any pathological finding nor did magnetic resonance imaging (MRI). MRI and CT showed QF with unusual morphologic features and agenesis of the contralateral QF. Ultrasonography-guided injection in the muscle was performed with mepivacaine and methylprednisolone obtaining relief of the symptoms. DISCUSSION: Leg pain can be very disabling and, when combined with a normal MRI of the spine, diagnosis can be tricky. Several causes of sciatica of extraspinal origin have been described, some of them originating from the so-called "deep gluteal space". Anecdotal communications on anatomical variations of the quadratus femoris muscle are reported in literature. CONCLUSIONS: Differential diagnosis of sciatica of extraspinal origin must rule out sacroiliac and hip joint so as deep gluteal space structures. Among these, quadratus femoris muscle is often overlooked as a pain-generator. Ultrasonography-guided intramuscular injections and a program of stretching and strengthening exercises can achieve durable control on the symptoms.


Assuntos
Síndrome do Músculo Piriforme/etiologia , Músculo Quadríceps/diagnóstico por imagem , Ciática/etiologia , Variação Anatômica , Nádegas , Quadril , Articulação do Quadril , Humanos , Injeções Intramusculares , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Músculo Esquelético/diagnóstico por imagem , Síndrome do Músculo Piriforme/diagnóstico por imagem , Músculo Quadríceps/anatomia & histologia , Ciática/diagnóstico por imagem , Ultrassonografia
8.
BMC Health Serv Res ; 19(1): 406, 2019 Jun 21.
Artigo em Inglês | MEDLINE | ID: mdl-31226997

RESUMO

BACKGROUND: There is limited research on the economic burden of low back-related leg pain, including sciatica. The aim of this study was to describe healthcare resource utilisation and factors associated with cost and health outcomes in primary care patients consulting with symptoms of low back-related leg pain including sciatica. METHODS: This study is a prospective cohort of 609 adults visiting their family doctor with low back-related leg pain, with or without sciatica in a United Kingdom (UK) Setting. Participants completed questionnaires, underwent clinical assessments, received an MRI scan, and were followed-up for 12-months. The economic analysis outcome was the quality-adjusted life year (QALY) calculated from the EQ-5D-3 L data obtained at baseline, 4 and 12-months. Costs were measured based on patient self-reported information on resource use due to back-related leg pain and results are presented from a UK National Health Service (NHS) and Societal perspective. Factors associated with costs and outcomes were obtained using a generalised linear model. RESULTS: Base-case results showed improved health outcomes over 12-months for the whole cohort and slightly higher QALYs for patients in the sciatica group. NHS resource use was highest for physiotherapy and GP visits, and work-related productivity loss highest from a societal perspective. The sciatica group was associated with significantly higher work-related productivity costs. Cost was significantly associated with factors such as self-rated general health and care received as part of the study, while quality of life was significantly predicted by self-rated general health, and pain intensity, depression, and disability scores. CONCLUSIONS: Our results contribute to understanding the economics of low back- related leg pain and sciatica and may provide guidance for future actions on cost reduction and health care improvement strategies. TRIAL REGISTRATION: 13/09/2011 Retrospectively registered; ISRCTN62880786 .


Assuntos
Custos de Cuidados de Saúde/estatística & dados numéricos , Perna (Membro)/patologia , Dor Lombar/economia , Dor/economia , Atenção Primária à Saúde/economia , Ciática/economia , Adulto , Feminino , Humanos , Dor Lombar/complicações , Dor Lombar/terapia , Masculino , Pessoa de Meia-Idade , Dor/etiologia , Manejo da Dor , Estudos Prospectivos , Anos de Vida Ajustados por Qualidade de Vida , Ciática/etiologia , Ciática/terapia , Resultado do Tratamento , Reino Unido
9.
Neuroradiology ; 61(8): 881-889, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31101947

RESUMO

PURPOSE: To analyze the causes of pain, imaging characteristics, and therapeutic effect of spinal injection in patients with extreme low back pain or sciatica. METHODS: We analyzed 381 consecutive patients with extreme low back pain or sciatica visiting our spinal intervention center between January and December 2017. Clinical and imaging characteristics were analyzed. The treatment response, defined as a numerical pain rating scale decrease of ≥ 30%, was measured. Fisher's exact test was performed to identify the association between the injection response and subsequent lumbar surgery rate. RESULTS: The most frequent cause of pain was spinal stenosis, followed by herniated intervertebral disc, facet osteoarthritis, and osteoporotic compression fracture. A herniated intervertebral disc was the most common disorder in patients < 50 years of age, while spinal stenosis was the most common in patients ≥ 50 years of age. Women comprised 66.4% of the study population. The majority of lumbar pathologies occurred below L3/4. Spinal injection was found to be effective in 44.2% of cases. Those who responded to the injection showed a significantly lower rate of lumbar surgery within 6 months (P = 0.004). CONCLUSIONS: Those with extreme low back pain or sciatica had clinical and imaging characteristics similar to those with typical low back pain referred for spinal injection. Spinal injection could be an effective method of pain control for patients with extreme low back pain or sciatica.


Assuntos
Injeções Espinhais , Dor Lombar/diagnóstico por imagem , Vértebras Lombares , Imagem por Ressonância Magnética , Ciática/diagnóstico por imagem , Doenças da Coluna Vertebral/diagnóstico por imagem , Adulto , Idoso , Anestésicos Locais/administração & dosagem , Dexametasona/administração & dosagem , Feminino , Glucocorticoides/administração & dosagem , Humanos , Dor Lombar/tratamento farmacológico , Dor Lombar/etiologia , Masculino , Pessoa de Meia-Idade , Medição da Dor , Estudos Retrospectivos , Ropivacaina/administração & dosagem , Ciática/tratamento farmacológico , Ciática/etiologia , Doenças da Coluna Vertebral/complicações
10.
Clin Rheumatol ; 38(7): 1811-1821, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31049761

RESUMO

Piriformis pyomyositis is a rare form of purulent skeletal myositis. As previous studies concerning piriformis pyomyositis had lower level of evidence and no systematic review has been published yet, we performed a systematic search to review and describe causes, symptoms, red flags, and available treatment options for piriformis pyomyositis. Using PubMed and PubMed Central databases, we found 21 articles describing 23 cases of piriformis pyomyositis. Based on the retrieved information, alongside acute sciatica like buttock and/or hip pain, high-grade fever, aggressive deep seated gluteal pain, neurological deficit of sciatic nerve distribution, positive straight leg raising test, and raised inflammatory biomarkers (erythrocyte sedimentation rate, ESR, C-reactive protein, CRP) provide clues for diagnosis of piriformis pyomyositis. Some cases were very ill but no death was documented. Staphylococcus aureus was the most common pathogen, but Group A as well as Group ß Streptococcus, Salmonella typhi, Proteus mirabilis, Brucella melitensis, and Escherichia coli were also involved in the disorder. To treat the piriformis pyomyositis, broad-spectrum antibiotics were found to be useful; however, sometimes, antibiotic switching was warranted based on blood and tissue aspirate reports. Drainage and/or surgical exploration of the affected piriformis muscle were required in cases where antibiotics appeared ineffective. Piriformis pyomyositis is a rara avis and performing of prospective studies will hardly be feasible.


Assuntos
Dor Lombar/etiologia , Síndrome do Músculo Piriforme/diagnóstico , Piomiosite/diagnóstico , Ciática/etiologia , Infecções Estafilocócicas/diagnóstico , Antibacterianos/uso terapêutico , Infecções Bacterianas/diagnóstico , Infecções Bacterianas/tratamento farmacológico , Humanos , Dor Lombar/tratamento farmacológico , Síndrome do Músculo Piriforme/tratamento farmacológico , Síndrome do Músculo Piriforme/etiologia , Piomiosite/complicações , Piomiosite/tratamento farmacológico , Ciática/tratamento farmacológico , Infecções Estafilocócicas/tratamento farmacológico
11.
Clin J Sport Med ; 29(3): 203-208, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31033613

RESUMO

OBJECTIVE: The purpose of this study was to assess the endoscopic findings of the sciatic nerve and clinical outcomes of major traumatic sciatic nerve neuropathies after fracture or reconstructive surgery of the acetabulum with idiopathic deep gluteal syndrome (DGS) groups. DESIGN: Retrospective review of patient reports. SETTING: Level I trauma center of a tertiary university hospital. PARTICIPANTS: The study included 70 patients who consecutively underwent endoscopic sciatic nerve decompression. Patients who had previous fractures or reconstructive surgeries of the acetabulum were categorized as the major trauma group, whereas those without major trauma were categorized as the idiopathic group (45 patients) after a minimum of 24-months of follow-up period. MAIN OUTCOME MEASURES: The results were evaluated using the modified Harris Hip Score (mHHS), Hip outcome, and 12-Item Short Form Health Survey scores, respectively. RESULTS: In the major trauma group, all patients with sensory symptoms showed some degree of relief after the endoscopic sciatic nerve release. None of the patients with complete foot drop demonstrated complete improvement. Three patients with motor weakness without foot drop showed complete improvement in motor function. The mean mHHS increased from 61.5 ± 13.4 to 84.1 ± 8.1 (P = 0.031). In the idiopathic DGS group, the mean mHHS increased from 73.8 ± 10.3 to 94.4 ± 5.3 (P = 0.003). The Benson outcomes rating in the major trauma group was statistically lower than that in the idiopathic DGS group. CONCLUSION: Endoscopic release of the sciatic nerve after fractures or reconstructive surgeries could provide some improvements without complications. However, more favorable outcomes were observed in the idiopathic DGS group.


Assuntos
Acetábulo/cirurgia , Descompressão Cirúrgica , Fraturas Ósseas/complicações , Síndrome do Músculo Piriforme/etiologia , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Nervo Isquiático/cirurgia , Ciática/etiologia , Adulto , Endoscopia , Feminino , Fraturas Ósseas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Dor/etiologia , Estudos Retrospectivos , Nervo Isquiático/fisiopatologia , Resultado do Tratamento
12.
World Neurosurg ; 128: 114-121, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31028982

RESUMO

BACKGROUND: Lumbar radicular pain is one of the most commonly encountered clinical syndromes; however, its underlying mechanistic basis, and its relation to the natural history of the disease, are poorly understood. METHODS: We revieved the available literature to explore the pathophysiology and natural history of lumbar radicular pain. RESULTS: Experimental observations have spawned distinctive, but not mutually exclusive, pathophysiologic descriptions of radicular pain. These mechanisms include mechanical compression and inflammatory processes. In most cases, a complex interplay between these mechanisms is required to sustain the pain. However, when the dorsal root ganglion is mechanically deformed, sustained discharges causing pain can be evoked, leading to pain based on a purely mechanical basis. However, in other instances, previous sensitization of the nerve root by inflammatory processes is required. CONCLUSION: An understanding of these processes and the natural history of the syndrome is important to developing therapeutic strategies.


Assuntos
Vértebras Lombares , Ciática/fisiopatologia , Sensibilização do Sistema Nervoso Central/fisiologia , Progressão da Doença , Gânglios Espinais/fisiopatologia , Humanos , Inflamação/fisiopatologia , Deslocamento do Disco Intervertebral/complicações , Ciática/etiologia
13.
Spine (Phila Pa 1976) ; 44(15): 1064-1077, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-30985566

RESUMO

STUDY DESIGN: A controlled radiologic follow-up study. OBJECTIVE: The aim of this study was to ascertain whether changes in cord excursion with straight leg raise test (SLR) at 1.5-year follow-up time accompany changes in clinical symptoms. SUMMARY OF BACKGROUND DATA: Lumbar intervertebral disc herniation (LIDH) is known to be a key cause of sciatica. Previously, we found that a significant limitation of neural displacement (66.6%) was evident with the SLR on the symptomatic side of patients with subacute single level posterolateral LIDH. METHODS: Fourteen patients with significant sciatic symptoms due to a subacute single-level posterolateral LIDH were reassessed clinically and radiologically at 1.5 years follow-up with a 1.5T MRI scanner. Displacement of the conus medullaris during the unilateral and bilateral SLR was quantified reliably with a randomized procedure and compared between SLRs and to data from baseline. Multivariate regression models and backward variable selection method were employed to identify variables more strongly associated with a decrease in low back pain (LBP) and radicular symptoms. RESULTS: Compared with previously presented baseline values, the data showed a significant increase in neural sliding in all the quantified maneuvers (P ≤ 0.01), and particularly of 2.52 mm (P ≤ 0.001) with the symptomatic SLR.Increase in neural sliding correlated significantly with decrease of both radicular symptoms (Pearson = -0.719, P ≤ 0.001) and LBP (Pearson = -0.693, P ≤ 0.001). Multivariate regression models and backward variable selection method confirmed the improvement of neural sliding effects (P ≤ 0.004) as the main variable being associated with improvement of self-reported clinical symptoms. CONCLUSION: To our knowledge, these are the first noninvasive data to objectively support the association between increase in magnitude of neural adaptive movement and resolution of both radicular and LBP symptoms in in vivo and structurally intact human subjects. LEVEL OF EVIDENCE: 2.


Assuntos
Degeneração do Disco Intervertebral/diagnóstico por imagem , Deslocamento do Disco Intervertebral/diagnóstico por imagem , Vértebras Lombares/diagnóstico por imagem , Ciática/diagnóstico por imagem , Ciática/terapia , Medula Espinal/diagnóstico por imagem , Medula Espinal/patologia , Adulto , Feminino , Seguimentos , Humanos , Disco Intervertebral/diagnóstico por imagem , Degeneração do Disco Intervertebral/complicações , Deslocamento do Disco Intervertebral/complicações , Dor Lombar/etiologia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Movimento , Distribuição Aleatória , Ciática/etiologia
14.
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
15.
J Minim Invasive Gynecol ; 26(2): 360-361, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-29702268

RESUMO

STUDY OBJECTIVE: To demonstrate the laparoscopic approach to malformed branches of the vessels entrapping the nerves of the sacral plexus. DESIGN: A step-by-step explanation of the surgery using video (educative video) (Canadian Task force classification II). The university's Ethics Committee ruled that approval was not required for this video. SETTING: Kocaeli Derince Education and Research Hospital, Kocaeli, Turkey. PATIENT: A 26-year-old patient who had failed medical therapy and presented with complaints of numbness and burning pain on the right side of her vagina and pain radiating to her lower limbs for a period of approximately 36 months. INTERVENTION: The peritoneum was incised along the external iliac vessels, and these vessels were separated from the iliopsoas muscle on the right side of the pelvis. The laparoscopic decompression of intrapelvic vascular entrapment was performed at 3 sites: the lumbosacral trunk, sciatic nerve, and pudendal nerve. The aberrant dilated veins were gently dissected from nerves, and then coagulated and cut with the LigaSure sealing device (Medtronic, Minneapolis, Minn). MEASUREMENTS AND MAIN RESULTS: The operation was completed successfully with no complications, and the patient was discharged from the hospital 24 hours after the operation. At a 6-month follow-up, she reported complete resolution of dyspareunia and sciatica (visual analog scale score 1 of 10). CONCLUSION: A less well-known cause of chronic pelvic pain is compression of the sacral plexus by dilated or malformed branches of the internal iliac vessels. Laparoscopic management of vascular entrapment of the sacral plexus has been described by Possover et al [1,2] and Lemos et al [3]. This procedure appears to be feasible and effective, but requires significant experience and familiarity with laparoscopy techniques and pelvic nerve anatomy.


Assuntos
Laparoscopia/métodos , Neuralgia do Pudendo/etiologia , Ciática/etiologia , Adulto , Dor Crônica/cirurgia , Descompressão Cirúrgica/métodos , Dispareunia/cirurgia , Feminino , Humanos , Plexo Lombossacral/cirurgia , Dor Pélvica/etiologia , Pelve/cirurgia , Nervo Pudendo/cirurgia , Neuralgia do Pudendo/cirurgia , Nervo Isquiático/cirurgia , Ciática/cirurgia
16.
Skeletal Radiol ; 48(1): 129-136, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29982854

RESUMO

OBJECTIVE: The aim of this study was to compare strain elastography (SE) and shear wave elastography (SWE) findings of the sciatic nerve in patients with unilateral lumbar disc herniation (LDH) and healthy control subjects. MATERIALS AND METHODS: The study group included patients with complaints of unilateral sciatica for 3-12 months, with foraminal stenosis due to one level of LDH (L4-L5 or L5-S1). An age- and gender-matched control group was formed of healthy subjects. Evaluations were performed on both the axial and longitudinal planes from the bilateral gluteal region using a 5-9 MHz multifrequency convex probe. RESULTS: There were 40 patients (20 male, 20 female) with a mean age of 43.1 ± 12.7 years in the study group, and 40 healthy subjects (22 male, 18 female) with a mean age of 42.9 ± 10.7 years in the control group (p > 0.05). The sciatic nerve stiffness assessed on both the axial (12.3 ± 3.7 kPA) and longitudinal (14.3 ± 3.8 kPA) planes of the involved side was significantly higher than non-involved side (axial: 6.8 ± 2.1 and longitudinal: 8.3 ± 2.3 kPA) in the patient group (p < 0.001). CONCLUSIONS: Patients with unilateral LDH have increased stiffness of the sciatic nerve compared to healthy control subjects. Although the findings in this preliminary study show that shear wave elastography can detect a change in sciatic nerve stiffness in patients with unilateral LDH, larger studies are required to determine the clinical utility of this technique.


Assuntos
Técnicas de Imagem por Elasticidade/métodos , Degeneração do Disco Intervertebral/diagnóstico por imagem , Deslocamento do Disco Intervertebral/diagnóstico por imagem , Vértebras Lombares/diagnóstico por imagem , Nervo Isquiático/diagnóstico por imagem , Ciática/diagnóstico por imagem , Adulto , Estudos de Casos e Controles , Estudos Transversais , Feminino , Humanos , Degeneração do Disco Intervertebral/complicações , Deslocamento do Disco Intervertebral/complicações , Masculino , Ciática/etiologia
17.
Spine (Phila Pa 1976) ; 44(7): 454-463, 2019 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-28658038

RESUMO

STUDY DESIGN: A retrospective cohort study. OBJECTIVE: The aim of the study was to assess the impact of time to surgery in patients with motor deficits (MDs) on their functional outcome. The current single-center study presents results of emergency surgery for LDH in a group of patients with acute paresis in a "real-world" setting. SUMMARY OF BACKGROUND DATA: MDs are a frequent symptom of lumbar disc herniation (LDH). Although surgery within 48 hours has been recommended for cauda-equina syndrome, the best timing of surgery for acute MDs continues to be debated. The effect of early surgery has been proposed but remains to be unproven. METHODS: A total of 330 patients with acute paresis caused by LDH acutely referred to our department and surgically treated using microsurgical discectomy from January 2013 to December 2015 were included. Based on the duration of MD and surgical timing, all patients were classified into two categories: Group I included all patients with paresis <48 hours and Group II included all patients with paresis >48 hours. Patient demographics, LDH/clinical/treatment characteristics, and outcomes were collected prospectively.Severity of paresis [Medical Research Council (MRC) Grade 0-4], surgery-related complications, functional recovery of motor/sensory deficits, sciatica, retreatment/recurrence rates, and overall neurological outcome were analyzed. RESULTS: Group I showed significantly faster recovery of moderate/severe paresis (MRC 0-3) at discharge, and 6-weeks/3-months follow up (P ≤ 0.001), whereas there were no significant differences in recovery for mild paresis (MRC 4). Sensory deficits also recovered substantially faster in Group I at 6-weeks (P = 0.003) and 3-months follow up (P = 0.045). Body mass index, preoperative MRC-grade, and duration of MDs were identified as significant predictors for recovery of paresis at all follow ups with substantial impact on patient reported outcomes including sciatica and/or dermatomal sensory deficits. CONCLUSION: Given the superior rates of neurological recovery of acute moderate/severe MDs, immediate surgery should be the primary option. However, a prospective randomized clinical trial is needed to confirm the superiority of emergency surgery. LEVEL OF EVIDENCE: 3.


Assuntos
Discotomia , Degeneração do Disco Intervertebral/complicações , Degeneração do Disco Intervertebral/cirurgia , Deslocamento do Disco Intervertebral/complicações , Deslocamento do Disco Intervertebral/cirurgia , Vértebras Lombares , Paresia/etiologia , Doença Aguda , Adulto , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Paresia/fisiopatologia , Recuperação de Função Fisiológica , Estudos Retrospectivos , Ciática/etiologia , Índice de Gravidade de Doença , Distúrbios Somatossensoriais/etiologia , Distúrbios Somatossensoriais/fisiopatologia , Fatores de Tempo , Tempo para o Tratamento , Resultado do Tratamento , Adulto Jovem
18.
Acta Med Port ; 31(10): 568-575, 2018 Oct 31.
Artigo em Português | MEDLINE | ID: mdl-30387425

RESUMO

INTRODUCTION: The aim of the present study is to report an original, unusual, case of bilateral anatomical variation of the sciatic nerve, with low origin and high division. MATERIAL AND METHODS: Anatomical dissection was performed on a 66 year-old female cadaver. The corpse was embalmed and conserved through our original embalming techniques. RESULTS: The particular anatomical variation was first detected during routine dissection classes for undergraduate students. The study was completed with contralateral dissection to unveil bilateral variation. In both hind limbs, the sciatic nerve had a low origin, deep below the mid-gluteal region, and suffered high division, near the lower margin of the gluteal region, after a short length of circa 8 cm, to divide into the common fibular and tibial nerves. DISCUSSION: We detect several cases of sciatic nerve high division, in the reports of the earliest anatomists, such as Leonardo da Vinci, Vesalius, Da Cortona, or Eustachius. Such ancestral interest for these anatomical variations demonstrates the importance of their knowledge for health professionals of different areas. CONCLUSION: The accurate study of sciatic nerve anatomical variations bears evident surgical, anaesthesiology and clinical applications. As more meticulous as our anatomical studies may get, one will never reach the state of perfection to consider such studies as definitive.


Assuntos
Variação Anatômica , Nervo Isquiático/anatomia & histologia , Idoso , Anatomia/história , Cadáver , Feminino , História do Século XV , História do Século XVI , História do Século XIX , História do Século XX , Humanos , Ciática/etiologia
19.
BMC Complement Altern Med ; 18(1): 310, 2018 Nov 26.
Artigo em Inglês | MEDLINE | ID: mdl-30477485

RESUMO

BACKGROUND: Many studies on transcutaneous electrical nerve stimulation (TENS) had been undertaken to explore its pain relieving efficiency on several medicals/surgical conditions but none, specifically, had been carried out to determine the effect it has on post-injection sciatic pain (PISP) which comes about from wrong administration of intramuscular pain. This study aims to assess the effects of TENS in the management of PISP. METHODS: A total of 72 PISP subjects comprising 40 test subjects and 32 control subjects participated in a non-randomized controlled clinical trial in the current study. Participants were recruited from Department of Physiotherapy, Nnamdi Azikiwe University Teaching Hospital, Nnewi and Landmark Physiotherapy Services, Nnewi. The participants were however blinded to the intervention method they will receive before being allotted conveniently to test/experimental group (TG) or control group (CG). A written informed consent was obtained from participants before enrollments in the study. TENS and sham TENS (STENS) was applied to 40 test and 32 subjects respectively, 3 times a week, and 1 hour per session for the 10 weeks the study lasted. The Visual Analogue Scale was used to collect baseline data as well as those of 2nd, 4th, 6th, 8th and 10th weeks after TENS and STENS interventions. The data analysis was performed with the Descriptive statistic of Mean ± SD, mean comparison test, repeated analysis of variance and paired wise t-test. Statistical level of significance was set at P < 0.05. RESULT: Results of repeated measure ANOVA showed that the pain level among participants in the treatment group at the end (after 10 weeks) of the intervention was significantly lower than that of their counterparts in the control group (F = 16.26; p = 0.01); with the intervention accounting for the 19% of the variance. The effect size (partial eta squared) = 0.19. CONCLUSION: The outcome of this research has proved the effectiveness of TENS in the management of PISP and is being recommended in the management of PISP. TRIAL REGISTRATION: Pan Africa Clinical Trial Registry ( PACTR201805003408271 ). The study was registered retrospectively on the 29th May, 2018.


Assuntos
Injeções Intramusculares/efeitos adversos , Medição da Dor , Ciática/terapia , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nigéria , Estudos Retrospectivos , Ciática/etiologia , Estimulação Elétrica Nervosa Transcutânea , Resultado do Tratamento , Adulto Jovem
20.
World Neurosurg ; 120: e1331-e1336, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30261375

RESUMO

BACKGROUND: Limited data have been reported showing whether the second-generation Wallis interspinous spacer improves function after lumbar spine decompression or discectomy. METHODS: We evaluated Wallis interspinous spacer placement in patients with low back pain or sciatica secondary to a confirmed diagnosis of primary lumbar disc herniation. The patients were treated from July 2008 to July 2011 at 1 institution. Of the 77 patients, 40 allocated to undergo posterior lumbar discectomy with Wallis implantation and 37 without Wallis implantation. The primary outcomes were the visual analog scale score, Japanese Orthopedics Association score, and Oswestry Disability Index. The secondary outcomes were the intervertebral disc height, range of motion of the operated segments, complications, and operating time. RESULTS: At 3 years, the improvements in the primary outcomes were not different between the 2 groups (P > 0.05). The disc height was significantly greater in the Wallis group than in the control group (P < 0.001). Two patients in the Wallis group and three patients in the control group underwent further surgery to treat repeated prolapse of the index segment or an adjacent segment. No significant difference was found in the complication rate between the 2 groups (P > 0.05). CONCLUSIONS: We found that discectomy combined with Wallis implantation was not beneficial for pain relief or lumbar function improvement compared with lumbar discectomy alone. Although the Wallis implant was associated with maintenance of the intervertebral disc height and limited range of motion of the spine, it is probably incapable of preventing recurrent herniation or adjacent segment degeneration.


Assuntos
Fixadores Internos , Deslocamento do Disco Intervertebral/cirurgia , Vértebras Lombares/cirurgia , Adolescente , Adulto , Idoso , Discotomia , Feminino , Seguimentos , Humanos , Deslocamento do Disco Intervertebral/complicações , Dor Lombar/etiologia , Dor Lombar/cirurgia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Ciática/etiologia , Ciática/cirurgia , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
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