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1.
Med Gas Res ; 13(1): 1-6, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-35946215

RESUMO

Ozone can be medically useful concerning healing wounds and relieving pain in various conditions, such as disc disease. The aspects of human blood ozonation have been reviewed, as well as potential complications that may arise. The mechanisms of ozone therapy are discussed in detail. It is imperative to recognize ozone as a useful proxy in oxidative-stress related diseases, consolidating other medical gases recognized for their therapeutic importance. The utility of hyperbaric oxygen therapy is also discussed. Disc herniation is very common, as more than 3 million cases are treated per year. Herein we review the medical, surgical, and gene-based therapies that ozone therapy can provide regarding disc disease.


Assuntos
Oxigenoterapia Hiperbárica , Degeneração do Disco Intervertebral , Deslocamento do Disco Intervertebral , Ozônio , Humanos , Degeneração do Disco Intervertebral/tratamento farmacológico , Deslocamento do Disco Intervertebral/tratamento farmacológico , Deslocamento do Disco Intervertebral/cirurgia , Oxigênio , Ozônio/uso terapêutico
2.
Neurol India ; 70(Supplement): S211-S217, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36412371

RESUMO

Introduction: There is conflicting data on the risk factors for recurrent lumbar disc herniation (rLDH). Most of the predictors for rLDH identified so far are acquired risk factors or radiological factors at the level of the herniation. Whole lumbar spine (WLS) morphometry has not been evaluated as a possible predictor of rLDH. Objectives: We aimed to evaluate if preoperative spinal morphometry can predict the occurrence of rLDH requiring revision surgery. Methods: This retrospective case-control study on 250 patients included 45 patients operated for rLDH, 180 controls without rLDH who had previously undergone microdiscectomy for a single level lumbar disc prolapse, and a holdout validation set of 25 patients. Morphometric variables related to the WLS were recorded in addition to previously identified predictors of rLDH. Logistic regression (LR) analysis was performed to identify independent predictors of rLDH. Results: LR yielded four predictors of which two were WLS morphometric variables. While increasing age and smoking positively predicted rLDH, increasing WLS interfacet distance and WLS dural-sac circumference negatively predicted rLDH. The LR model was statistically significant, χ2 (4) =15.98, P = 0.003, and correctly classified 80.3% of cases. On validation, the model demonstrated a fair accuracy in predicting rLDH (accuracy: 0.80, AUC: 0.70). Conclusions: Larger mean lumbar bony canals and dural sacs protect from the occurrence of symptomatic rLDH. These WLS morphometric variables should be included in future risk stratification algorithms for lumbar disc disease. In addition to the previously recognized risk factors, our study points to an underlying developmental predisposition for rLDH.


Assuntos
Deslocamento do Disco Intervertebral , Humanos , Deslocamento do Disco Intervertebral/cirurgia , Estudos de Casos e Controles , Reoperação/métodos , Estudos Retrospectivos , Recidiva
3.
Neurol India ; 70(Supplement): S259-S262, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36412378

RESUMO

Background: Current methods used to measure the muscle strength required to achieve plantar flexion may yield highly variable results depending on the perception of the physician conducting the examination because these tests involve subjective and qualitative evaluation. Objective: To describe and evaluate the efficacy of a novel examination technique that can quantitatively measure plantar flexion in L5-S1 disc herniation. Materials and Methods: A total of 32 patients (average age: 49.4 years, range: 23-78) with L5-S1 disc herniations were included. The patient to be tested stood next to a table on which they could lean with their hands. The leg closer to the table was fully flexed at the knee, and the other foot was brought to maximum plantar flexion on the toes. At this point, a stopwatch was started to measure the time that passed until the muscles fatigued and the heel fell. The differences between the right and left plantar flexion times were noted. In addition, three different physicians graded muscle strength by using the classical "The Medical Research Council of the United Kingdom" method. Results: The time until fatigue in right and left plantar flexion was measured using the proposed method, and each test underwent a video recording. The Yilmaz-Ilbay plantar flexion test yielded the correct classification for all cases. Conclusion: We suggest that the proposed method "Yilmaz-Ilbay plantar flexion test" can serve as a useful, practical, and effective test to detect quantitative evaluation of plantar flexion in L5-S1 herniation.


Assuntos
Deslocamento do Disco Intervertebral , Vértebras Lombares , Humanos , Pessoa de Meia-Idade , Deslocamento do Disco Intervertebral/diagnóstico , Exame Neurológico , Força Muscular , Extremidade Inferior
4.
BMC Musculoskelet Disord ; 23(1): 998, 2022 Nov 19.
Artigo em Inglês | MEDLINE | ID: mdl-36401203

RESUMO

OBJECTIVE: Posterior instrumented fusion is the most widely accepted surgical treatment for spinal stenosis and disc herniation. However, fusion can affect daily activities due to lumbar stiffness. In recent years, dynamic stabilization has been introduced to overcome the drawbacks of fusion, however, it is inconclusive whether dynamic stabilization requires the maintenance of a level of activity that is closer to the physiological state of activity for better clinical efficacy. The purpose of this study was to compare the effectiveness of dynamic stabilization with different levels of activity (Isobar EVO and TTL) in the treatment of spinal stenosis and disc herniation. METHODS: This study retrospectively reviewed 80 consecutive patients with lumbar degenerative diseases who were undergoing surgical treatment between March 2014 and July 2018. 41 patients (EVO group) and 39 patients (TTL group) underwent fenestrated decompression with Isobar EVO stabilization and Isobar TTL stabilization, respectively. Clinical outcomes, radiographic data, and postoperative complications were compared between the two groups. RESULTS: At an average follow-up of 52.23 ± 2.97 months, there were no significant differences in the oswestry disability index (ODI) (P > 0.05). The visual analog scale for back pain (VASback) and visual analog scale for the leg pain (VASleg) of the EVO group were lower compared with the TTL group (P < 0.05). The range of motion (ROM) of operated segments were significantly higher in the EVO group as compared to the TTL group (P < 0.05). The intervertebral space height (ISH) of upper adjacent segments were significantly higher in the EVO group as compared to the TTL group (P < 0.05). The overall complications were less in the EVO group, but the difference was not statistically significant (P > 0.05). CONCLUSION: Both Isobar EVO dynamic stabilization and TTL dynamic stabilization can improve clinical outcomes of patients with spinal stenosis and disc herniation. Isobar EVO has advantages over Isobar TTL in terms of improving low back and leg pain, maintaining mobility of the operated segment, and preventing further degeneration of the upper adjacent segment.


Assuntos
Deslocamento do Disco Intervertebral , Estenose Espinal , Humanos , Estenose Espinal/diagnóstico por imagem , Estenose Espinal/cirurgia , Estudos Retrospectivos , Deslocamento do Disco Intervertebral/diagnóstico por imagem , Deslocamento do Disco Intervertebral/cirurgia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Dor
5.
BMC Musculoskelet Disord ; 23(1): 994, 2022 Nov 18.
Artigo em Inglês | MEDLINE | ID: mdl-36401228

RESUMO

OBJECTIVE: The objective of this study was to explore the morphological characteristics of paraspinal muscles in young patients with unilateral neurological symptoms of lumbar disc herniation. METHODS: This study retrospectively analyzed young patients aged 18-40 years who were hospitalized for lumbar disc herniation in our hospital from June 2017 to June 2020. Data on sex, age, body mass index (BMI), subcutaneous fat tissue thickness (SFTT) at the L1-L2 level, duration of symptoms, degree of lumbar disc herniation, visual analog scale (VAS) for the lower back, Mo-fi-disc score, relative cross-sectional area (RCAS) of the paravertebral muscles (psoas major [PM], multifidus [MF], and erector spinae [ES]), and degree of fat infiltration (DFF) of the paravertebral muscles were collected. The VAS was used to evaluate the intensity of low back pain. Patients with VAS-back >4 points were defined as the low back pain group, and patients with ≤4 points were defined as the control group. The demographic characteristics, as well as the bilateral and ipsilateral paravertebral muscles, of the two groups were compared and analyzed. RESULT: A total of 129 patients were included in this study (52 patients in the LBP group and 77 patients in the control group). There were no significant differences in sex, BMI, or Pfirrmann grade of lumbar disc herniation between the two groups (P > 0.05). The age of the LBP group (33.58 ± 2.98 years) was greater than that of the control group (24.13 ± 2.15 years) (P = 0.002), and the SFTT at the L1-L2 level (13.5 ± 7.14 mm) was higher than that of the control group (7.75 ± 6.31 mm) (P < 0.05). Moreover, the duration of symptoms (9.15 ± 0.31 months) was longer than that of the control group (3.72 ± 0.48 months) (P < 0.05), and the Mo-fi-disc score (8.41 ± 3.16) was higher than that of the control group (5.53 ± 2.85) (P < 0.05). At L3/4 and L5/S1, there was no significant difference in the RCSA and DFF of the bilateral and ipsilateral paraspinal muscles between the LBP group and the control group. At L4/5, there was no significant difference in the RCSA and DFF of the paraspinal muscles on either side in the LBP group (P > 0.05). In the control group, the RCSA of the MF muscle on the diseased side was smaller than that on the normal side (P < 0.05), and the DFF of the MF muscle on the diseased side was larger than that on the normal side (P < 0.05). In addition, there was no significant difference in the ES and PM muscles on both sides (P > 0.05). At L4/5, the RCSA of the MF muscle on the normal side was significantly smaller in the LBP group than in the control group (P < 0.05), and the DFF of the MF muscle on the normal side was significantly larger in the LBP group than in the control group (P < 0.05). There was no significant difference in the ES and PM muscles on the same side between the two groups (P > 0.05). CONCLUSION: In young patients with unilateral neurological symptoms of lumbar disc herniation, symmetrical atrophy of the bilateral MF muscle is more prone to causing low back pain. Older age, higher SFTT at the L1-L2 levels, longer symptom duration, higher Mo-fi-di score, and greater muscle atrophy on the normal side of the MF increased the incidence of low back pain in young patients with unilateral lumbar disc herniation.


Assuntos
Deslocamento do Disco Intervertebral , Dor Lombar , Humanos , Músculos Paraespinais/diagnóstico por imagem , Deslocamento do Disco Intervertebral/complicações , Deslocamento do Disco Intervertebral/diagnóstico por imagem , Dor Lombar/etiologia , Estudos Retrospectivos , Imageamento por Ressonância Magnética
6.
Jt Dis Relat Surg ; 33(3): 513-520, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36345178

RESUMO

OBJECTIVES: This study aims to compare the clinical effectiveness of transforaminal endoscopic spine system (TESSYS) technique combined with selective nerve root block (SNRB) in treating patients with far lateral lumbar disc herniation (FLDH) and patients with central or paracentral herniation (C/PDH). PATIENTS AND METHODS: Between June 2015 and June 2019, a total of 204 patients (80 males, 124 females; mean age: 62.3±5.4 years; range, 51 to 66 years) with a herniated disc were included. Of these, 22 consecutive adult patients with FLDH formed the FLDH group, while 182 patients with C/PDH formed the C/PDH group. Considering that FLDH was a rare type of LDH and occurred outside the spinal canal, the patients with LDH in the spinal canal (C/PDH) were selected as the controls in our study. All cases received ultrasound-guided SNRB to identify the diseased disc and treated by the TESSYS technique. Data including demographics, duration of operation, duration of hospital stay, surgical cost, complications, Visual Analog Scale (VAS) scores for the back and leg, and Oswestry Disability Index (ODI) scores and the modified MacNab criteria were analyzed. RESULTS: The FLDH group presented the similar clinical outcomes and costs with the C/PDH group. No significant differences in the VAS score, ODI score, and Macnab score were observed between the groups (p>0.05 for all). Both groups showed the significantly improved postoperative VAS scores on Day 3, at 1, 3, 6, and 12 months compared to baseline. The postoperative ODI scores at 6 and 12 months were also significantly improved (p<0.05). At the final follow-up at 12 months, the FLDH group showed the MacNab criteria rating excellent and good of 81.8% and C/PDH group showed 84.62%. CONCLUSION: The FLDH patients presented the comparable clinical effectiveness with C/PDH patients. Based on these findings, the TESSYS technique combined with ultrasound-guided SNRB for FLDH is safe and feasible with caution, although the risk of nerve root injury may be worried.


Assuntos
Discotomia Percutânea , Deslocamento do Disco Intervertebral , Adulto , Masculino , Feminino , Humanos , Pessoa de Meia-Idade , Idoso , Deslocamento do Disco Intervertebral/cirurgia , Discotomia Percutânea/métodos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Endoscopia/métodos , Resultado do Tratamento
7.
Sci Rep ; 12(1): 18854, 2022 Nov 07.
Artigo em Inglês | MEDLINE | ID: mdl-36344744

RESUMO

This study aimed to explore the effects on resorption of cervical disc herniation (CDH) and clinical outcomes of surgery. Cervical microendoscopic laminoplasty (CMEL), which is commonly preferable to anterior corpectomy and fusion, was applied to patients with 1- to 3-level degenerative cervical myelopathy (DCM). DCM patients with 1-3 levels DCM underwent either conservation treatment or CMEL. In conservation-treated patients (53 cases), CDH volume remained unchanged with no improvement in JOA and VAS scores. Conversely, 63 patients with 1-3 levels DCM were prospectively enrolled and exhibited a profound decrease in CDH volume: 89.1% of CDHs (123/138) regressed over 10%, 64.5% of CDHs (89/138) regressed over 25%, while 27.5% and 6.5% of CDHs (38/138 and 9/138) largely regressed over 50% and 75%, respectively. Meanwhile, the JOA and VAS scores were improved in different ways. Intriguingly, CDH volume changes correlated significantly with elevations in JOA scores, indicating an association of clinical CDH resolution with neurological recovery. We showed that CMEL induced clinically related diminishment of CDH and alleviation of clinical symptoms in patients with 1- to 3-level myelopathy and that it could help avoid anterior dissection of the disc to some extent.


Assuntos
Doenças da Medula Óssea , Deslocamento do Disco Intervertebral , Laminoplastia , Doenças da Medula Espinal , Humanos , Deslocamento do Disco Intervertebral/cirurgia , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Resultado do Tratamento , Doenças da Medula Espinal/diagnóstico por imagem , Doenças da Medula Espinal/cirurgia , Estudos Retrospectivos
8.
Pain Physician ; 25(8): 531-542, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36375181

RESUMO

BACKGROUND: Lumbar disc herniation (LDH) is the main cause of low back pain and/or radiculopathy. Currently, epidural intervention is a widely used and effective conservative treatment method for managing low back and radicular pain caused by LDH. OBJECTIVES: To explore the effectiveness of different epidural injection approaches in adult patients with lumbosacral radicular pain. STUDY DESIGN: Systematic review and network meta-analysis (NMA). METHODS: An electronic literature search was performed in the Pubmed, Embase, Cochrane Library, and Web of Science databases. Two authors independently performed data extraction and quality assessment. A Bayesian random effects model was conducted to incorporate the estimates of direct and indirect treatment comparisons and rank the interventions in order. Effect estimates from Bayesian NMA were presented as mean difference (MD) with 95% credible intervals (CrI). RESULTS: This NMA assessed caudal (C), interlaminar (IL), transforaminal (TF) and parasagittal interlaminar (PIL) epidural injection approaches for lumbosacral radicular pain from 7 trials. A statistically significant treatment difference for pain relief was reported for midline interlaminar (MIL) vs PIL (MD, 1.16; 95%CrI, 0.31-2.06), MIL vs TF (MD, 1.12; 95%CrI, 0.51-1.85), C vs TF (MD, 1.07; 95%CrI, 0.01-2.18) in short-term follow-up and MIL vs TF (MD, 1.8; 95% CrI, 0.3-3.48) in intermediate-term follow-up. For functional improvement, a statistically significant difference was observed with MIL vs PIL (MD, 9.9; 95% CrI, 0.64-19.94) and MIL vs TF (MD, 1.08; 95% CrI, 1.08-17.08) in short-term follow-up. Moreover, the PIL approach and TF appeoach were ranked in the top 2 for pain relief and functional improvement, both in short-term and intermediate-term follow-up. LIMITATIONS: 1) The number of studies included was small; 2) some treatments lacked direct comparisons; 3) only scores from the visual analog scale for pain and the Oswestry Disability Index were included in the result; 4) important outcomes, such as complications, were not included. CONCLUSION: In short-term and intermediate-term follow-up, the PIL approach has the highest probability for pain relief and functional improvement.


Assuntos
Deslocamento do Disco Intervertebral , Dor Lombar , Radiculopatia , Humanos , Adulto , Metanálise em Rede , Teorema de Bayes , Injeções Epidurais/métodos , Radiculopatia/tratamento farmacológico , Dor Lombar/tratamento farmacológico , Dor nas Costas
9.
Pain Physician ; 25(8): E1191-E1198, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36375189

RESUMO

BACKGROUND: Local anesthesia is feasible for both transforaminal and interlaminar approaches in percutaneous endoscopic lumbar discectomy (PELD). However, the optimal approach for PELD has not yet been established at the L5/S1 segment under local anesthesia with 1% lidocaine. OBJECTIVES: In this study, we compared the transforaminal approach with the interlaminar approach of PELD under local anesthesia for L5/S1 disc herniation (DH). STUDY DESIGN: This was a prospective randomized clinical trial. METHODS: From January 2019 to March 2020, 91 consecutive patients with L5/S1 DH who planned to undergo PELD in our unit were randomized to the transforaminal endoscopic lumbar discectomy (TELD, n = 46) or interlaminar endoscopic lumbar discectomy (IELD, n = 45). Both procedures were performed under local anesthesia with 1% lidocaine. The clinical outcomes were assessed as the Visual Analog Scale (VAS) score, Oswestry Disability Index (ODI) score, and modified MacNab criteria. Patient satisfaction surveys and surgical complications were also recorded and analyzed. RESULTS: Compared to the IELD group, the TELD group had a shorter operative time and postoperative bed rest time (P < 0.001) but a longer radiation time (P < 0.001) and lower VAS scores for intraoperative back pain (P < 0.001) and leg pain (P < 0.001). At the postoperative follow-up, there were no significant differences between the 2 groups in the VAS scores, ODI scores, or modified MacNab criteria. The surveys showed a significantly higher satisfaction rate in the TELD group than in the IELD group (P = 0.014). Six patients in the IELD group (13.3%) needed extra intravenous injections of sufentanil because of intense pain during the procedure. In the IELD group, there were 2 cases of neuropathic pain after surgery. LIMITATIONS: Due to the study was included in a single spine center with a relatively small population and its relatively short-term follow-up, the study is not generalizable. CONCLUSIONS: Both TELD and IELD can provide good clinical outcomes for L5/S1 DH under local anesthesia with 1% lidocaine. TELD was superior to IELD in terms of surgical-related experience and complications.


Assuntos
Discotomia Percutânea , Deslocamento do Disco Intervertebral , Humanos , Discotomia Percutânea/métodos , Vértebras Lombares/cirurgia , Deslocamento do Disco Intervertebral/cirurgia , Anestesia Local , Estudos Prospectivos , Estudos Retrospectivos , Discotomia , Endoscopia/métodos , Dor/cirurgia , Lidocaína/uso terapêutico , Resultado do Tratamento
10.
Pain Physician ; 25(8): 587-592, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36375192

RESUMO

BACKGROUND: Transforaminal epidural steroid injections (TFESI) are widely used to alleviate lumbosacral radicular pain. Knowledge of the therapeutic outcomes of TFESI allows clinicians to elucidate therapeutic plans for managing lumbosacral radicular pain. Deep learning (DL) can outperform traditional machine learning techniques and learn from unstructured and perceptual data. A convolutional neural network (CNN) is a representative DL model. OBJECTIVES: We developed and investigated the accuracy of a CNN model for predicting therapeutic outcomes after TFESI for controlling chronic lumbosacral radicular pain using T2-weighted sagittal lumbar spine magnetic resonance (MR) images as input data. STUDY DESIGN: Imaging study using DL. SETTING: At the spine center of a university hospital. METHODS: We collected whole T2-weighted sagittal lumbar spine MR images from 503 patients with chronic lumbosacral radicular pain due to a herniated lumbar disc (HLD) and spinal stenosis. A "good outcome" was defined as a >= 50% reduction in the numeric rating scale (NRS-11) score at 2 months after TFESI vs the pretreatment NRS-11 score. A "poor outcome" was defined as a < 50% decrease in the NRS-11 score at 2 months after TFESI vs pretreatment. RESULTS: In the prediction of therapeutic outcomes after TFESI on the validation dataset, the area under the curve was 0.827. LIMITATIONS: Our study was limited in that we used a small amount of lumbar spine MR imaging data to train the CNN model. CONCLUSIONS: We demonstrated that a CNN model trained, using whole lumbar spine sagittal T2-weighted MR images, could help determine outcomes after TFESI in patients with chronic lumbosacral radicular pain due to an HLD or spinal stenosis.


Assuntos
Aprendizado Profundo , Deslocamento do Disco Intervertebral , Radiculopatia , Estenose Espinal , Humanos , Injeções Epidurais/métodos , Estenose Espinal/tratamento farmacológico , Dor nas Costas/tratamento farmacológico , Deslocamento do Disco Intervertebral/tratamento farmacológico , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/patologia , Imageamento por Ressonância Magnética , Esteroides/uso terapêutico , Resultado do Tratamento , Radiculopatia/tratamento farmacológico
11.
Pain Physician ; 25(8): E1289-E1296, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36375202

RESUMO

BACKGROUND: Postoperative upper-limb palsy (ULP) is a serious complication after cervical spine surgery. ULP after posterior percutaneous endoscopic cervical foraminotomy and discectomy (PPCED) has not yet been reported. OBJECTIVE: To introduce cases of postoperative ULP after PPCED and associated risk factors. STUDY DESIGN: A single-center, retrospective, observational study. SETTING: Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China. METHODS: From January 2016 through January 2022, PPCED involving a total of 663 segments was performed in 610 patients with radiculopathy who were diagnosed with cervical radiculopathy or mixed cervical spondylosis caused by foraminal stenosis or posterolateral disc herniation. RESULTS: PPCED was successfully completed in 610 patients, 6 of whom (0.98%) developed ULP. Two patients were diagnosed with double-segment cervical nerve root canal stenosis (C4/5/6, C5/6/7) and 2 with migrated cervical disc soft herniation (a magnetic resonance image of one showed a migrated disc herniation downward from C4/5 in the sagittal plane; another showed this upward from C5/6); one patient was diagnosed with C5/6 intervertebral foraminal stenosis, and one had simple C4/5 lateral disc herniation. Postoperative ULP rates for C4/5 (2/30, 6.67%) and C5/6 (2/177, 1.13%) were much higher than those for the other levels. Anatomically, the width of the intervertebral foramen on computed tomography was 2.3 ± 1.12 mm in ULP cases, which was significantly lower than that in non-ULP cases (3.4 ± 1.83, P < 0.05). This suggests that preoperative foramen width correlates highly negatively with postoperative ULP incidence. LIMITATIONS: This was a single-center, retrospective, nonrandomized study with a low level of evidence. CONCLUSIONS: PPCED is a good treatment for cervical radiculopathy. The rate of postoperative ULP after PPCED is much lower than that after posterior cervical foraminotomy. Perturbation to the C5 (or C6) nerve root, thermal injury due to burr use or the radiofrequency applied, and marked foraminal stenosis are possible relevant factors associated with postoperative ULP.


Assuntos
Foraminotomia , Deslocamento do Disco Intervertebral , Radiculopatia , Humanos , Foraminotomia/métodos , Deslocamento do Disco Intervertebral/complicações , Radiculopatia/cirurgia , Radiculopatia/complicações , Constrição Patológica/complicações , Estudos Retrospectivos , Vértebras Cervicais/cirurgia , China , Discotomia/efeitos adversos , Paralisia/complicações , Paralisia/cirurgia , Extremidade Superior/cirurgia , Resultado do Tratamento
12.
Medicine (Baltimore) ; 101(43): e31152, 2022 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-36316862

RESUMO

OBJECTIVE: To investigate the association between interleukin (IL)-1α (rs1800587), IL-1ß (rs1143634) and IL-1 receptor antagonist (RN) variable number tandem repeat polymorphisms, expression levels and lumbar disc disease (LDD). METHODS: All relevant articles were searched from 4 databases including PubMed, Embase, Web of Science and China National Knowledge Infrastructure. Odds ratios (OR) with 95% confidence intervals (CI) were calculated to evaluate the association between IL-1 gene locus polymorphisms (rs1800587 in IL-1α, rs1143634 in IL-1ß, variable number tandem repeat in interleukin-1 receptor antagonist) and LDD susceptibility. Statistical analysis was conducted by Review Manager (Revman) 5.31 software (Nordic Cochrane Centre, Cochrane Collaboration, Copenhagen, Denmark). Furthermore, qRT-PCR and immunohistochemistry were performed to evaluate IL-1α, IL-1ß and interleukin-1 receptor antagonist expressions in the normal and degenerated disc. RESULTS: A total of 15 case-control studies (1455 cases and 2362 controls) were included in our meta-analysis. The pooled results suggested that IL-1α rs1800587 polymorphism was associated with an increased risk of LDD in overall population (T vs. C, OR = 1.21, 95% CI = 1.04-1.40, P = .01). The subgroup analysis found a significant association between IL-1ß rs1143634 polymorphism and LDD in Asian population (T vs. C, OR = 0.61, 95% CI = 0.39-0.96, P = .03). Results of qRT-PCR and immunohistochemistry demonstrated that expressions of IL-1α and IL-1ß were significantly increased in the degenerated disc. (all P < .05). CONCLUSION: IL-1α rs1800587 and IL-1ß rs1143634 polymorphisms were significantly associated with LDD in overall population and in Asian population, respectively. The increased expression levels of IL-1α and IL-1ß may be the important risk factors for LDD.


Assuntos
Predisposição Genética para Doença , Proteína Antagonista do Receptor de Interleucina 1 , Interleucina-1alfa , Interleucina-1beta , Deslocamento do Disco Intervertebral , Humanos , Estudos de Casos e Controles , Proteína Antagonista do Receptor de Interleucina 1/genética , Interleucina-1beta/genética , Deslocamento do Disco Intervertebral/genética , Polimorfismo de Nucleotídeo Único , Interleucina-1alfa/genética
13.
Bone Joint J ; 104-B(11): 1242-1248, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36317351

RESUMO

AIMS: The aim of this study was to investigate whether the type of cervical disc herniation influences the severity of symptoms at the time of presentation, and the outcome after surgical treatment. METHODS: The type and extent of disc herniation at the time of presentation in 108 patients who underwent anterior discectomy for cervical radiculopathy were analyzed on MRI, using a four-point scale. These were dichotomized into disc bulge and disc herniation groups. Clinical outcomes were evaluated using the Neck Disability Index (NDI), 36-Item Short Form Survey (SF-36), and a visual analogue scale (VAS) for pain in the neck and arm at baseline and two years postoperatively. The perceived recovery was also assessed at this time. RESULTS: At baseline, 46 patients had a disc bulge and 62 had a herniation. There was no significant difference in the mean NDI and SF-36 between the two groups at baseline. Those in the disc bulge group had a mean NDI of 44.6 (SD 15.2) compared with 43.8 (SD 16.0) in the herniation group (p = 0.799), and a mean SF-36 of 59.2 (SD 6.9) compared with 59.4 (SD 7.7) (p = 0.895). Likewise, there was no significant difference in the incidence of disabling arm pain in the disc bulge and herniation groups (84% vs 73%; p = 0.163), and no significant difference in the incidence of disabling neck pain in the two groups (70.5% (n = 31) vs 63% (n = 39); p = 0.491). At two years after surgery, no significant difference was found in any of the clinical parameters between the two groups. CONCLUSION: In patients with cervical radiculopathy, the type and extent of disc herniation measured on MRI prior to surgery correlated neither to the severity of the symptoms at presentation, nor to clinical outcomes at two years postoperatively.Cite this article: Bone Joint J 2022;104-B(11):1242-1248.


Assuntos
Degeneração do Disco Intervertebral , Deslocamento do Disco Intervertebral , Radiculopatia , Fusão Vertebral , Humanos , Deslocamento do Disco Intervertebral/diagnóstico por imagem , Deslocamento do Disco Intervertebral/cirurgia , Deslocamento do Disco Intervertebral/complicações , Radiculopatia/diagnóstico por imagem , Radiculopatia/etiologia , Radiculopatia/cirurgia , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Resultado do Tratamento , Discotomia/efeitos adversos , Cervicalgia/diagnóstico por imagem , Cervicalgia/etiologia , Imageamento por Ressonância Magnética , Fusão Vertebral/efeitos adversos , Degeneração do Disco Intervertebral/cirurgia
14.
Zhonghua Yi Xue Za Zhi ; 102(41): 3274-3280, 2022 Nov 08.
Artigo em Chinês | MEDLINE | ID: mdl-36319179

RESUMO

Objective: To compare the efficacy of unilateral biportal endoscopy (UBE) and coaxial large channel endoscopy for lumbar spinal stenosis. Methods: A total of 176 patients with lumbar spinal stenosis treated in Tianjin Hospital from March 2015 to October 2021 were included in this study. Of the patients, 110 cases were treated with UBE, including 52 males and 58 females, with a mean age of (75.1±10.4) years; while 66 cases were treated with coaxial large channel endoscopy, including 31 males and 35 females, with an average age of (77.2±13.1) years. The visual analogue scale (VAS) score of pain and Oswestry disability index (ODI) were compared before and after surgery between the two groups, with the improvement rate calculated. The operation time, intraoperative blood loss, perioperative conditions and complications were compared. The operation efficacy was evaluated according to MacNab scale and was compared between the two groups. Results: There was no significant differences in age, gender, disease course, VAS of pain, ODI and index levels between the two groups before operation (all P>0.05). The operation time and postoperative drainage in UBE group and coaxial large channel endoscopy group were comparable [(60.1±12.4)min, (62.5±13.2)min and (103.8±20.7)ml, (98.5±22.1)ml, respectively, both P>0.05]. After the operation, the VAS score of low back pain, VAS score of leg pain and ODI of the two groups were all lower than those before operation, and decreased continuously during follow-up; and under the repeated measures analysis of variance, significant differences were found between different time points (all P<0.05), no significant difference was found between the two groups (all P>0.05), nor interaction between groups and time points was detected (all P>0.05). The patients were followed-up for (18.0±4.2) months (6 to 30 months). There was no significant difference in VAS and ODI improvement rates and excellent rate of efficacy between the two groups at the last follow-up (all P>0.05). Conclusions: Both UBE and coaxial large channel endoscopy can provide excellent results for lumbar spinal stenosis. UBE has sufficient decompression and is convenient to explore and remove the herniated disc.


Assuntos
Deslocamento do Disco Intervertebral , Estenose Espinal , Masculino , Feminino , Humanos , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Estenose Espinal/cirurgia , Vértebras Lombares/cirurgia , Deslocamento do Disco Intervertebral/cirurgia , Endoscopia Gastrointestinal , Dor
15.
J Int Med Res ; 50(10): 3000605221129031, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-36221242

RESUMO

OBJECTIVE: To present our experience, discuss the complications, and assess early vs long-term outcomes of fluoroscopy-guided caudal epidural injection for lumbar disc herniation (LDH). METHODS: This was a prospective study of 309 patients who underwent fluoroscopy-guided caudal epidural injection from 2014 to 2020. The inclusion criteria were LDH diagnosis by magnetic resonance imaging, surgical treatment not required, age >18 years, and history of low back or leg pain despite >6 weeks of treatment comprising a combination of analgesics, anti-inflammatories, and physical therapy. The epidural injection solution comprised 8 mL of 0.5% bupivacaine hydrochloride (HCL), 2 mL dexamethasone, and 10 mL saline. Each patient completed a questionnaire comprising a visual analog scale (VAS) and the Back Pain Functional Scale (BPFS) at baseline, and 1 month and 1 year after injection. RESULTS: The VAS and BPFS scores indicated significantly less pain at 1 month and 1 year compared with the pre-procedure baseline values. Complications developed in 11 patients (reversible paresis in 7 patients, arrhythmia in 1 patient, headache in 1 patient, seizure in 1 patient, spondylodiscitis in 1 patient). CONCLUSIONS: Fluoroscopy-guided caudal epidural injection for LDH is safe, and the procedure reduced pain and improved functional capacity compared with baseline.


Assuntos
Deslocamento do Disco Intervertebral , Adolescente , Analgésicos/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Dor nas Costas/etiologia , Bupivacaína/uso terapêutico , Dexametasona/uso terapêutico , Fluoroscopia , Humanos , Injeções Epidurais/efeitos adversos , Injeções Epidurais/métodos , Deslocamento do Disco Intervertebral/complicações , Deslocamento do Disco Intervertebral/diagnóstico por imagem , Deslocamento do Disco Intervertebral/tratamento farmacológico , Vértebras Lombares/diagnóstico por imagem , Estudos Prospectivos , Resultado do Tratamento
16.
Comput Math Methods Med ; 2022: 1822262, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36199783

RESUMO

Purpose: To investigate the clinical efficacy of ultrasound (US) combined with neuromuscular electrical stimulation (NMES) in treating lumbar disc herniation (LDH) and its effect on the level of inflammatory factors. Methods: The data of 240 patients with LDH treated at our hospital from January 2020 to February 2021 were reviewed and classified into an US combined with NMES treatment group (US+NMES, n = 80), NMES only treatment group (NMES, n = 80), and US only treatment group (US, n = 80). Their Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) scores, levels of inflammatory factors and pain mediators, recovery rate, and total recovery time before and after treatment were compared. Additionally, the incidence of complications/adverse reactions was also investigated. Results: Compared with data before treatment, the three groups had lower VAS and ODI scores, inflammatory factor levels (interleukin- [IL-] 1, IL-6, and tumor necrosis factor- [TNF-] α), and pain mediators (transforming growth factor- [TGF-] ß1, prostaglandin E2 [PEG2], and 5-hydroxytryptamine [5-HT]) after treatment, with the most significant decrease observed in the US+NMES group. Compared with patients who received US or NMES treatment alone, patients from the US+NMES had faster recovery time and lower incidence of complications/adverse reactions. Conclusion: Collectively, US combined with NMES was associated with significant relief in pain and lumbar dysfunction and reduced local inflammatory response and pain mediator levels in LDH patients, suggesting that this combined approach could achieve better efficacy than US or NMES alone.


Assuntos
Deslocamento do Disco Intervertebral , Dinoprostona , Estimulação Elétrica , Humanos , Interleucina-6 , Deslocamento do Disco Intervertebral/diagnóstico por imagem , Deslocamento do Disco Intervertebral/terapia , Vértebras Lombares/diagnóstico por imagem , Dor/complicações , Estudos Retrospectivos , Serotonina , Resultado do Tratamento , Fatores de Necrose Tumoral
17.
Biomed Res Int ; 2022: 7562990, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36212723

RESUMO

The value of CT imaging in evaluating the efficacy of percutaneous transforaminal endoscopic discectomy (PTED) in the treatment of lumbar disc herniation (LDH) is explored. A total of 105 patients with LDH admitted to our hospital from March 2018 to September 2019 are selected for treatment with PTED, and all patients undergo CT examination before and after surgery. The CT imaging parameters (CT value of spinal canal soft tissue shadow, maximum back shift distance, longitudinal axis length, and intervertebral space height) before and 1 week after operation, the Japanese Orthopaedic Association (JOA) scores before and 6 months after the operation are compared, and the excellent and good rate of the operation effect is calculated. The correlation between JOA score and CT imaging parameters are analyzed by Pearson correlation method. The experimental results prove that PTED is effective in treating LDH. CT imaging can quantitatively measure the data of herniated intervertebral discs to clarify the recovery of the compressed dural sac and nerve roots, and the results are highly consistent with JOA score, which can be used as PTED objective evaluation method for the treatment of LDH.


Assuntos
Discotomia Percutânea , Deslocamento do Disco Intervertebral , Discotomia Percutânea/métodos , Endoscopia/métodos , Humanos , Deslocamento do Disco Intervertebral/diagnóstico por imagem , Deslocamento do Disco Intervertebral/cirurgia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Resultado do Tratamento
18.
Ann Palliat Med ; 11(9): 3005-3013, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36217628

RESUMO

BACKGROUND: Intradural lumbar disc herniation (ILDH) is special type of lumbar disc herniation in which the lumbar nucleus pulposus prolapses and enters the dura mater. ILDHs comprise 0.04-0.33% of all herniated discs. In most cases, the diagnosis could not be confirmed preoperatively by identifying the typical features of ILDH in radiological evaluation. In the current report, we present a case of ILDH at lumbar 2/3 level and discuss the clinical presentations, typical imaging features, treatments, and outcomes. CASE DESCRIPTION: We describe a rare case of ILDH. The patient was a 65-year-old man with pain in waist and back, and with bilateral radiating pain of lower extremities and fatigue for more than 2 weeks. Magnetic resonance imaging (MRI) revealed a large round, low-density mass at lumbar 2/3, which was easily mimicked as an intradural spinal tumor lesion. While enhanced MRI showed the typical rim enhancement sign and "Hawk beak" sign. Due to progressive decrease in muscle strength in both lower limbs, posterior microscopically assisted laminectomy, dural incision of the lumbar 2/3 was performed. Pathological examination revealed degenerated fibrous connective tissue and cartilage tissue. The patient's lower back pain and radiating pain and numbness of both legs improved remarkably postoperatively, and he became asymptomatic at 3 months and 1-year postoperatively. CONCLUSIONS: ILDH is a rare intervertebral disc herniation in clinical practice. The pathogenesis of ILDH may be related to aseptic inflammatory edema, closely fixing of ventral dura and the posterior longitudinal ligament, repeated mechanical action and chemical corrosion. Typical rim enhancement sign, "Hawk beak" sign and "Y" sign are important features of MRI in diagnosing ILDH, and intraspinal gas is also helpful in computed tomography (CT) diagnosis of ILDH. Prompt microscopically assisted laminectomy, dura mater incision to remove the intradural disc, pedicle screw fixation regardless of fusion, surgical results are usually favorable. We also reviewed the literature and discussed the epidemiology, potential pathogenesis, diagnosis, treatment and poor prognostic factors of ILDH.


Assuntos
Deslocamento do Disco Intervertebral , Neoplasias da Coluna Vertebral , Idoso , Dura-Máter/diagnóstico por imagem , Dura-Máter/patologia , Dura-Máter/cirurgia , Humanos , Deslocamento do Disco Intervertebral/diagnóstico por imagem , Deslocamento do Disco Intervertebral/cirurgia , Vértebras Lombares/patologia , Vértebras Lombares/cirurgia , Imageamento por Ressonância Magnética , Masculino , Dor , Neoplasias da Coluna Vertebral/patologia
19.
Comput Math Methods Med ; 2022: 7667463, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36188105

RESUMO

Objective: In minimally invasive spinal surgery, the treatment of lumbar spinal stenosis with microendoscopic discectomy (MED) or unilateral biportal endoscopic discectomy (UBED) shows effective results, but which is more effective is controversial. Our study aimed to evaluate the efficacy and safety of UBED versus MED in the treatment of lumbar spinal stenosis by a systematic review and meta-analysis, so as to provide reference for the promotion of UBED in clinical practice. Methods: The multiple databases like PubMed, EMBASE, Web of Science, Cochrane Library, Chinese National Knowledge Databases, Chinese BioMedical Database, and Wanfang Database were used to search for the relevant studies. Review Manager 5.4 was adopted to estimate the effects of the results among selected articles. Odds ratio (OR) and mean difference (MD) with 95% confidence intervals (CIs) were used to estimate the overall pooled effect. Subgroup analysis, forest plots, funnel plots and Egger's test for the articles included were also conducted. Results: Three randomized clinical trials and seven cohort studies were finally retrieved, these studies included 685 and 829 patients in the UBED and MED groups, respectively. There were no differences in terms of operation time (MD = -0.92, P =0.72), estimated blood loss (MD = -26.31, P =0.08), complications (MD =0.81, P =0.38) and Oswestry Disability Index (ODI) score (P >0.05 in four subgroup) between the two groups. The visual analog scale (VAS) score of back pain in the UBED group was better than MED group only at 6 months (MD = -0.23, P =0.006) after operation, the VAS score of leg pain in the UBED group was better than that of MED group at 3 mouths (MD = -0.22, P =0.002) and 6 months (MD = -0.24, P =0.006) after operation, the UBED group had a less postoperative length of stay than the MED group (MD = -1.85, P <0.001). The bias analysis showed that there was no potential publication bias in the included literature. Conclusion: This study showed that compared with MED, UBED has the advantages of short hospital stay and good short-term curative effect, but there is no significant difference in long-term efficacy and safety, they can be replaced by each other in clinical application.


Assuntos
Discotomia , Endoscopia , Deslocamento do Disco Intervertebral , Estenose Espinal , Discotomia/efeitos adversos , Discotomia/métodos , Endoscopia/métodos , Humanos , Deslocamento do Disco Intervertebral/cirurgia , Vértebras Lombares/cirurgia , Estenose Espinal/cirurgia
20.
Medicine (Baltimore) ; 101(39): e30412, 2022 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-36181014

RESUMO

BACKGROUND: The purpose of this study was to analyze unilateral biportal endoscopic discectomy (UBE) and percutaneous endoscopic lumbar discectomy (PELD) for the treatment of lumbar disc herniation. METHODS: PubMed, EMBASE, Web of Science, Cochrane Database, CNKI, and Wanfang databases were searched online. All statistical analyses were performed using STATA 16.0. RESULTS: The selection criteria were met by 6 studies with a total of 281 patients (142 cases in the UBE group and 139 cases in the PELD group) and good methodological quality. PELD has the potential to improve outcomes such as operation time and intraoperative hemorrhage (MD = 36.808, 95% CI (23.766, 49.850), P = .000; MD = 59.269, 95% CI (21.527, 97.010), P = .000) compared with UBE. No differences were found in the back pain VAS score at preoperative (MD = -0.024, 95% CI [-0.572, 0.092], P = .998), at 1 day after operation (MD = -0.300, 95% CI [-0.845, 0.246], P = .878), the VAS score of leg pain at preoperative (MD = -0.099, 95% CI [-0.417, 0.220], P = .762), at 1 day after operation (MD = 0.843, 95% CI [0.193, 1.492], P = .420), at 1 month after operation (MD = -0.027, 95% CI [-0.433, 0.380], P = .386), at 6 months after operation (MD = 0.122, 95% CI [-0.035, 0.278], P = .946), hospital stay (MD = 3.708, 95% CI [3.202, 4.214], P = .000) and other clinical effects between UBE and PELD group. CONCLUSIONS: There are no significant differences in clinical efficacy between UBE and PELD, according to the research. However, PELD has the potential to improve outcomes such as operation time and intraoperative hemorrhage. As just a result, PELD is better suited in the treatment of lumbar disc herniation.


Assuntos
Discotomia Percutânea , Deslocamento do Disco Intervertebral , Discotomia , Endoscopia , Hemorragia/cirurgia , Humanos , Deslocamento do Disco Intervertebral/cirurgia , Vértebras Lombares/cirurgia , Estudos Retrospectivos , Resultado do Tratamento
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