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1.
Instr Course Lect ; 70: 337-354, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33438920

RESUMO

Spinal injuries are common and are a significant burden in the professional athlete population. From single-level disk herniation to career-ending fractures, the consequences of these conditions vary widely. Both contact and noncontact injuries can substantially affect the health and performance of elite athletes competing in a variety of sports. The nature and severity of these injuries have great influence on the prospects for full recovery and successful return to play. Common spinal injuries, management decisions, and return to play prospects are important considerations in the professional athlete population.


Assuntos
Traumatismos em Atletas , Deslocamento do Disco Intervertebral , Doenças da Coluna Vertebral , Traumatismos da Coluna Vertebral , Esportes , Atletas , Traumatismos em Atletas/diagnóstico , Traumatismos em Atletas/terapia , Humanos , Traumatismos da Coluna Vertebral/diagnóstico , Traumatismos da Coluna Vertebral/terapia
2.
Medicine (Baltimore) ; 99(51): e23812, 2020 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-33371159

RESUMO

ABSTRACT: Ninety percent of elderly patients with lumbar disc herniation (LDH) have problems with the mechanics of the spine and muscle tissue. Shi-style spine balance manipulation combined with guidance (Daoyin) of muscle and bone as an alternative therapy for LDH can tone the muscle groups around the spine and maintain optimal mechanical and static sagittal balance of the spine. This study will be performed to investigate the effect of a combination of Shi-style spine balance manipulation and Daoyin therapy on LDH in middle-aged and elderly patients. In this non-blinded, randomized controlled trial, 72 eligible patients will be randomly divided into a treatment group (Shi-style spine balance manipulation combined with Daoyin therapy) and a control group (lumbar mechanical traction). Before and after the intervention, lumbar X-ray and magnetic resonance imaging examinations will be performed to observe the sagittal balance parameters of the spine and pelvis and the lumbar muscle strength. The visual analog scale score, Oswestry disability index score, and pressure pain threshold will be evaluated at baseline and at 2, 4, 12, and 24 weeks. During the treatment period, any signs of acute adverse events, such as paralysis of the lower extremities or cauda equina syndrome, will be recorded at each visit. Although Shi-style spine manipulation combined with Daoyin therapy has been used in the treatment of LDH in middle-aged and elderly people in China for many years, there is no consensus on its effectiveness. This experiment will provide convincing evidence of the efficacy of Shi-style spine manipulation combined with Daoyin therapy in the treatment of LDH in middle-aged and elderly people.


Assuntos
Degeneração do Disco Intervertebral/terapia , Deslocamento do Disco Intervertebral/terapia , Manipulação da Coluna/normas , Adulto , Idoso , Feminino , Humanos , Degeneração do Disco Intervertebral/complicações , Deslocamento do Disco Intervertebral/complicações , Dor Lombar/etiologia , Dor Lombar/terapia , Vértebras Lombares/fisiopatologia , Região Lombossacral/fisiopatologia , Imagem por Ressonância Magnética/métodos , Masculino , Manipulação da Coluna/métodos , Manipulação da Coluna/estatística & dados numéricos , Pessoa de Meia-Idade , Músculo Esquelético/fisiopatologia , Medição da Dor/métodos , Resultado do Tratamento , Ultrassonografia/métodos
3.
Medicine (Baltimore) ; 99(50): e23751, 2020 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-33327365

RESUMO

BACKGROUND: A very large acceleration in clinical studies on the efficacy of fire needle to treat lumbar disc herniation (LDH) are increasing, while studies on the assessment of its efficacy are still lacking. Therefore, this study will demonstrate the efficacy of fire needle in the treatment of LDH combining with the meta-analysis. METHODS: The studies on randomized controlled trials (RCTs) will be searched at the databases of China National Knowledge Infrastructure (CNKI), WANFANG database (Chinese Medicine Premier), Chinese Scientific Journal Database (VIP), Chinese Biomedical Literature database (CBM), PubMed, EMBASE, and Cochrane Library from their inception to May 1, 2020. RESULTS: This authentic and multi-dimensional study will shed light on the referable information for the treatment of LDH with fire needle. CONCLUSION: This study will evaluate the efficacy of fire needle in the treatment of LDH. REGISTRATION: PROSPERO (registration number CRD42020158596).


Assuntos
Terapia por Acupuntura/métodos , Degeneração do Disco Intervertebral/terapia , Deslocamento do Disco Intervertebral/terapia , Vértebras Lombares , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa
4.
Artigo em Russo | MEDLINE | ID: mdl-33306296

RESUMO

BACKGROUND: Surgical treatment of intervertebral disc herniation with a high degree of migration (beyond the vertebral pedicle) is a difficult problem without an unambiguous solution. In this manuscript, we compare the effectiveness of transpedicular endoscopy and standard discectomy in the treatment of patients with this disease. OBJECTIVE: To compare transpedicular endoscopic sequestrectomy and discectomy in the treatment of lumbar intervertebral disc herniation with a high degree of migration. MATERIAL AND METHODS: There were 28 patients divided into 2 groups: group 1 - 13 patients after transpedicular endoscopic sequestrectomy, group 2 - 15 patients after discectomy. RESULTS: Transpedicular endoscopic sequestrectomy ensured significantly better intraoperative parameters (incision length, blood loss, surgery time) (p<0.01). In both groups, postoperative VAS score of leg pain was significantly reduced within a day after surgery from 7.4±1.3 to 0.7±0.7 and from 7.1±1 to 0.8±0.5, respectively. In the 1st group, VAS score of back pain regressed from 5.2±0.7 to 1.1±0.89 by the end of the 1st postoperative day. This value was 0.6±0.5 a year later. In the 2nd group, VAS score of back pain regressed from 4.9±1 to 2.5±0.9 by the end of the 1st postoperative day. This value was 2.8±2.3 a year later. According to McNab clinical outcome scale, excellent and good results after transpedicular endoscopic sequestrectomy were obtained in all 13 (100%) patients, after discectomy - in 80% of cases. CONCLUSION: Transpedicular endoscopic sequestrectomy is optimal for intervertebral disc herniation with a high degree of migration due to fast postoperative recovery and no complications.


Assuntos
Discotomia Percutânea , Deslocamento do Disco Intervertebral , Disco Intervertebral , Discotomia , Endoscopia , Humanos , Deslocamento do Disco Intervertebral/cirurgia , Vértebras Lombares/cirurgia , Estudos Retrospectivos , Resultado do Tratamento
5.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(12): 1497-1506, 2020 Dec 15.
Artigo em Chinês | MEDLINE | ID: mdl-33319526

RESUMO

In recent years, enhanced recovery after surgery (ERAS) has been widely used in spine surgery and achieved satisfactory results. In order to standardize the ERAS implementation process and application in percutaneous endoscopic interlaminar lumbar decompression/discectomy (PEID), we reviewed the literatures and cited evidence-based medicine data, and had a national comprehensive discussion among experts of the Group of Minimally Invasive Spinal Surgery and Enhanced Recovery, Professional Committee of Orthopedic Surgery and Enhanced Recovery, Association of China Rehabilitation Technology Transformation and Promotion. Altogether, the up-to-date expert consensus have been achieved. The consensus may provide the reference for clinical treatment in aspect of the standardization of surgical operations, the reduction of surgical trauma and complications, the optimization of perioperative pain and sleep management, the prevention of venous thrombosis, and the guidance of patients' functional training and perioperative education.


Assuntos
Discotomia Percutânea , Deslocamento do Disco Intervertebral , China , Consenso , Descompressão , Endoscopia , Recuperação Pós-Cirúrgica Melhorada , Humanos , Deslocamento do Disco Intervertebral/cirurgia , Vértebras Lombares/cirurgia , Estudos Retrospectivos , Resultado do Tratamento
6.
Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi ; 38(10): 750-752, 2020 Oct 20.
Artigo em Chinês | MEDLINE | ID: mdl-33142378

RESUMO

Objective: To investigate the clinical effect of minimally invasive surgery in the treatment of professional drivers with lumbar disc herniation. Methods: 126 patients with lumbar disc herniation admitted to hospital from June 1, 2015 to December 30, 2018 were selected and divided into observation group (59 cases treated by percutaneous transforaminal endoscopy) and control group (67 cases treated with conventional conservative treatment) according to the treatment methods. The Visual Analogue Scale (VAS) and Japanese Orthopaedic Association Scores (JOA) before and after treatment were analyzed retrospectively. Length of stay, time out of bed, hospitalization expenses and recurrence rate were evaluated. The measurement data was expressed by x±s, the comparison between groups was performed by t test, and the count data were analyzed by descriptive analysis. Results: Before treatment, there was no significant difference in gender, age, VAS score and JOA score between the two groups (P>0.05) . After treatment, compared with the control group, the VAS score of the observation group was lower, the JOA score was higher, the time out of bed was shorter, the average hospitalization time was reduced, the average hospitalization cost was higher, and the recurrence rates after Six months and one year were lower in the observation group, the differences were statistically significant (P<0.05) . Conclusion: The clinical effect of percutaneous transforaminal endoscopic treatment is better than that of conventional conservative treatment for driver's lumbar disc herniation.


Assuntos
Discotomia Percutânea , Deslocamento do Disco Intervertebral , Humanos , Deslocamento do Disco Intervertebral/cirurgia , Vértebras Lombares/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos , Estudos Retrospectivos , Resultado do Tratamento
7.
PLoS One ; 15(11): e0241309, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33137112

RESUMO

Lumbar Spinal Stenosis causes low back pain through pressures exerted on the spinal nerves. This can be verified by measuring the anteroposterior diameter and foraminal widths of the patient's lumbar spine. Our goal is to develop a novel strategy for assessing the extent of Lumbar Spinal Stenosis by automatically calculating these distances from the patient's lumbar spine MRI. Our method starts with a semantic segmentation of T1- and T2-weighted composite axial MRI images using SegNet that partitions the image into six regions of interest. They consist of three main regions-of-interest, namely the Intervertebral Disc, Posterior Element, and Thecal Sac, and three auxiliary regions-of-interest that includes the Area between Anterior and Posterior elements. A novel contour evolution algorithm is then applied to improve the accuracy of the segmentation results along important region boundaries. Nine anatomical landmarks on the image are located by delineating the region boundaries found in the segmented image before the anteroposterior diameter and foraminal widths can be measured. The performance of the proposed algorithm was evaluated through a set of experiments on the Lumbar Spine MRI dataset containing MRI studies of 515 patients. These experiments compare the performance of our contour evolution algorithm with the Geodesic Active Contour and Chan-Vese methods over 22 different setups. We found that our method works best when our contour evolution algorithm is applied to improve the accuracy of both the label images used to train the SegNet model and the automatically segmented image. The average error of the calculated right and left foraminal distances relative to their expert-measured distances are 0.28 mm (p = 0.92) and 0.29 mm (p = 0.97), respectively. The average error of the calculated anteroposterior diameter relative to their expert-measured diameter is 0.90 mm (p = 0.92). The method also achieves 96.7% agreement with an expert opinion on determining the severity of the Intervertebral Disc herniations.


Assuntos
Degeneração do Disco Intervertebral/diagnóstico por imagem , Deslocamento do Disco Intervertebral/diagnóstico por imagem , Dor Lombar/diagnóstico por imagem , Região Lombossacral/diagnóstico por imagem , Estenose Espinal/diagnóstico por imagem , Feminino , Humanos , Degeneração do Disco Intervertebral/fisiopatologia , Deslocamento do Disco Intervertebral/fisiopatologia , Dor Lombar/fisiopatologia , Região Lombossacral/fisiopatologia , Imagem por Ressonância Magnética , Masculino , Canal Vertebral/diagnóstico por imagem , Canal Vertebral/fisiopatologia , Estenose Espinal/fisiopatologia
8.
Medicine (Baltimore) ; 99(46): e23000, 2020 Nov 13.
Artigo em Inglês | MEDLINE | ID: mdl-33181664

RESUMO

BACKGROUND: Both acupoint injection and sacral canal injection are widely adopted in the treatment of lumbar disc herniation (LDH), but there are still doubts about the effectiveness and safety of the 2 methods. Therefore, the objective of the randomized controlled trial is to evaluate the effectiveness and safety of acupoint injection and sacral canal injection in the treatment of LDH. METHOD: This is a prospective randomized controlled trial to study the effectiveness and safety of acupoint injection and sacral canal injection in the treatment of LDH. With the approval by the clinical research ethics committee of our hospital, patients were randomly included into 1 of 2 treatment protocols:Patients, doctors, nurses, and research assistants responsible for collecting data were blinded to group allocation. Main outcome observation indicator: visual analogue scale; secondary outcome observation indicator: Oswestry disability index scores; paresthesia score; adverse reactions. Data were analyzed using the statistical software package SPSS version 25.0 (Chicago, IL). DISCUSSION: The effectiveness and safety of acupoint injection and sacral canal injection in the treatment of LDH were evaluated in this study, and the results of this trial would establish clinical evidence for the adoption of acupoint injection or sacral canal injection to treat LDH. TRIAL REGISTRATION NUMBER: DOI 10.17605 / OSF.IO / VTFUD.


Assuntos
Pontos de Acupuntura , Terapia por Acupuntura/métodos , Injeções Espinhais/métodos , Deslocamento do Disco Intervertebral/terapia , Vértebras Lombares , Adulto , Idoso , Protocolos Clínicos , Avaliação da Deficiência , Feminino , Humanos , Plexo Lombossacral , Masculino , Pessoa de Meia-Idade , Medição da Dor , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Método Simples-Cego , Resultado do Tratamento , Escala Visual Analógica , Adulto Jovem
9.
Pol Merkur Lekarski ; 48(287): 318-322, 2020 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-33130790

RESUMO

The incidence of symptomatic intervertebral disc hernias in the thoracic segment is estimated at 1 case per million people per year, which is about 0.25-0.75% of all symptomatic intervertebral disc hernias and 0.15-1.85% of operative intervertebral disc diseases. AIM: The aim of the study was to assess the results of the surgical treatment of symptomatic discopathy in the thoracic spine through the posterior approach. MATERIALS AND METHODS: The results of the surgical treatment of 52 patients (35 women, 17 men) with symptomatic thoracic disc herniation in the Department of Neuroorthopedics in the years 2012-2019 were analyzed retrospectively. The neurological and functional status of patients before and after the surgery was assessed, as well as the average duration of the surgery and hospitalization, perioperative complications, intraoperative blood loss and the number of reoperations. Radiculopathy and myelopathy were the main indications for surgery. RESULTS: The largest group included patients operated on in the 5th and 6th decades of life, with women being the majority (67%). Hernia of the distal thoracic spine, i.e. Th10-Th11-Th12-L1, was most often operated on. According to the Frankel scale, the largest number of patients (47 before the surgery and 48 after the surgery) were qualified for groups D and E. As regards the WISCI scale the largest group of patients was classified as level 20. The rate of complications was 7%, the rate of neurological complications was 5.2% and the rate of reoperations was 3.5%. CONCLUSIONS: The vast majority of discopathies in the thoracic spine occur at lower levels, i.e. Th10-Th11-Th12-L1. The analysis of the functional status after the surgery of thoracic discopathy based on 2 scales showed a greater usefulness of the WISCI scale than the Frankel scale. A larger number of patients changed the group after surgery in the WISCI scale than in the Frankel scale. Therefore, we can conclude that the WISCI scale is more accurate in assessing the functional state of patients operated on due to thoracic discopathy.


Assuntos
Degeneração do Disco Intervertebral , Deslocamento do Disco Intervertebral , Feminino , Humanos , Deslocamento do Disco Intervertebral/cirurgia , Masculino , Estudos Retrospectivos , Vértebras Torácicas/cirurgia , Resultado do Tratamento
10.
J Biol Regul Homeost Agents ; 34(4 Suppl. 1): 15-19, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33176413

RESUMO

Low Back Pain (LBP) is the most common spine disease and it is the most common cause of absence from work in developed countries. At lumbar level, the natural history of herniated disc is characterized by a disappearance of clinical symptoms in up to 60% with conservative treatment through simple rest for about 6 weeks and reduction of the disk heniation revealed by CT or MR scans within eight to nine months after the onset of back pain. Surgery is considered the treatment of choice for extruded, migrated and free fragment herniated disk associated to clinical symptomatology of cono-cauda syndrome, progressive foot droop and hyperalgic radiculopathy. patients with a small or contained herniated disk, without any benefit from conservative medical treatment, can be candidates for one of minimally invasive percutaneous techniques, whose outcome, though, depends on the characteristics of hernia itself and on the chosen technique. The aim of this paper is to discuss about O2-O3 treatment for symptomatic not extruded herniated disk at lumbar level, highlighting about indication inclusion exclusion criteria and our results.


Assuntos
Deslocamento do Disco Intervertebral , Fluoroscopia , Humanos , Deslocamento do Disco Intervertebral/diagnóstico por imagem , Deslocamento do Disco Intervertebral/cirurgia , Dor Lombar/diagnóstico por imagem , Dor Lombar/etiologia , Dor Lombar/terapia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
11.
J Biol Regul Homeost Agents ; 34(4 Suppl. 1): 21-30, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33176414

RESUMO

Low back pain and sciatica are highly debilitating conditions affecting all socioeconomic groups at an increasingly early age. They are caused by different often concomitant spinal disorders: disc or facet joint disease, spondylolysis (with or without listhesis), vertebral body and interapophyseal arthrosis, spinal stenosis, radicular and synovial cysts and, more rarely, infections and primary or metastatic cancer. Treatment of low back pain and/or sciatica requires an accurate diagnosis based on thorough history-taking and physical examination followed by appropriate imaging tests, namely computed tomography, and/or magnetic resonance scans in addition to standard and morphodynamics X-rays of the spine. In recent years, several reports have demonstrated the utility of oxygen-ozone therapy in reducing the size of herniated discs. The present study reports on the outcome of oxygen-ozone treatment in 576 patients with non-discogenic low back pain caused by degenerative disease of the posterior vertebral compartment (facet synovitis, Baastrup syndrome, spondylolysis and spondylolisthesis, facet degeneration).


Assuntos
Dor Lombar , Ozônio , Humanos , Deslocamento do Disco Intervertebral , Dor Lombar/terapia , Vértebras Lombares/diagnóstico por imagem , Imagem por Ressonância Magnética , Oxigênio , Espondilolistese
12.
J Biol Regul Homeost Agents ; 34(4 Suppl. 1): 47-55, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33176417

RESUMO

This retrospective, observational, uncontrolled case series study was carried out to evaluate the clinical efficacy and safety of intramuscular paravertebral injections of an oxygen-ozone (O2-O3) mixture in patients with cervicobrachial pain. One hundred and sixty-eight subjects affected by cervicobrachial pain, referred to Ozone Therapy Unit at San Pietro Fatebenefratelli Hospital in Rome (Italy), were enrolled in the study. All the subjects (n=168, 106 females and 62 males) completed the treatment and the follow-up visits. Subjects received 12 cervical intramuscular injections of an O2-O3 mixture (5 mL) with an O3 concentration of 16 µg/mL once a week. The overall reduction of pain was measured by the change in mean of Visual Analogue Scale (VAS) score from baseline to the end of treatment and from baseline to one, two, three, four and five years of follow-up. Patient satisfaction was assessed at the end of treatment, by modified MacNab Questionnaire. Possible adverse events related to the treatment were recorded. The mean (± standard deviation) VAS pain score at baseline, at the end of treatment, and during the follow-up at one, two, three, four and five years were 7.82 (±1), 1.6 (±1.5), 1.5 (±1.4), 1.4 (±1.3), 1.6 (±1.2), 1.5 (±1.3) and 1.60 (±1.2), respectively, showing a significant reduction in pain over time (p<0.001). Of 156 patients who responded to treatment, 128 (82.05%) were pain free at one year, 110 (70.51%) at second year, 103 (66.02%) at third year, 94 (60.25%) at fourth year and 86 (55.12%) at fifth year follow-up visit. According to pain distribution all subjects showed a significant reduction in pain over time in each group (p<0.05). No significant differences were observed between groups. No serious adverse events were observed during the entire study. We suggest the use of intramuscular paravertebral injections of an oxygen-ozone (O2-O3) mixture in patients with cervicobrachial pain as an effective and safe treatment option to consider before surgical intervention.


Assuntos
Deslocamento do Disco Intervertebral , Ozônio , Feminino , Humanos , Itália , Masculino , Oxigênio , Dor , Manejo da Dor , Estudos Retrospectivos , Resultado do Tratamento
13.
J Biol Regul Homeost Agents ; 34(4 Suppl. 1): 57-61, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33176418

RESUMO

Among patients treated by intradiscal oxygen-ozone administration, in the period from January to June 18, because of disco radicular conflict, we randomly selected a group of 200 cases for this study. The classical instrument for studying nerve functioning alteration is EMGraphy. Repeated EMGraphic control during the treatment gives a valid parameter to quantify nerve root dysfunction: this is objective, repeatable and is precise data. The evolution of EMGraphic picture does not always correspond to the clinical situation. In several cases the normalization of the last radicular conflict will coexist with residual signs of EMGraphic dysfunction.


Assuntos
Degeneração do Disco Intervertebral , Deslocamento do Disco Intervertebral , Ozônio , Eletromiografia , Humanos , Deslocamento do Disco Intervertebral/terapia , Vértebras Lombares/diagnóstico por imagem , Oxigênio , Resultado do Tratamento
14.
PLoS One ; 15(11): e0241494, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33152001

RESUMO

OBJECTIVE: Full endoscopic lumbar discectomy (FELD) for lumbar disc herniation (LDH) has become popular in recent years. Previous studies have proven the efficacy, but few have discussed the possible risk factors of poor outcome. In this study, we reviewed patients who underwent FELD at Changhua Christian Hospital in the past 10 years and sought to identify factors associated with poor surgical outcomes and re-operations. METHODS: We retrospectively reviewed records from mid-2009 to mid-2018. Patients had undergone FELD and follow-up for ≥1 year were included. Factors included in the outcome evaluations were age, sex, surgical time, body mass index, surgical methods, disc herniation type, extension of herniation, degree of canal compromised, disc degenerative grade, smoking and alcohol use, surgical lumbar level, symptom duration, Oswestry low back disability index, and visual analog scale score. We had evolved from inside-out methods to outside-in methods after 2016, thus, we included this factor in the analysis. The primary outcomes of interest were poor/fair MacNab score and re-operation. RESULTS: From mid-2009 to mid-2018, 521 patients met our criteria and were analyzed. The median follow-up was 1685 days (range, 523-3923 days). Thirty-one (6.0%) patients had poor surgical outcomes (fair/poor MacNab score) and 45 (8.6%) patients required re-operation. Prolapsed herniated disc (P < 0.001), higher disc degenerative grade (P = 0.047), higher lumbar level (P = 0.026), longer preoperative symptoms (P < 0.001), and surgery before 2017 (outside-in technique, P = 0.020) were significant factors associated with poor outcomes in univariate analyses. In multivariate analyses, prolapsed herniated disc (P < 0.001), higher disc degenerative grade (P = 0.030), and higher lumbar level (P = 0.046) were statistically significant. The most common adverse symptom was numbness. Factors possibly associated with higher re-operation rate were older age (P = 0.045), alcohol use (P = 0.073) and higher lumbar level (P = 0.069). Only alcohol use showed statistically significant re-operation rates in multivariate analyses (P = 0.035). CONCLUSIONS: For treating LDH by FELD, we concluded that prolapsed disc, higher disc degenerative grade, higher lumbar level, and longer preoperative symptom duration were possibly associated with unsatisfactory surgical outcomes (poor/fair MacNab score). The outside-in technique might be superior to the inside-out technique. Older age and alcohol use might be associated with a higher re-operation rate.


Assuntos
Endoscopia , Deslocamento do Disco Intervertebral/cirurgia , Vértebras Lombares/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reoperação , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
16.
Medicine (Baltimore) ; 99(41): e22520, 2020 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-33031293

RESUMO

BACKGROUND: There is no consensus in existing literature on the pulse power, application time, frequency and the dose of energy of laser therapy for the patients. Therefore, we conducted this research for the assessment of safety and efficiency of ultrasound and high-intensity laser therapy (HILT) in the lumbar disc herniation (LDH) patients. METHODS: Our present research was approved by the institutional review board in the West China-Guangan Hospital. All the participants would acquire the written informed consent. From December 2020 to December 2021, we will conduct a prospective evaluation via a senior surgeon for 1 hundred LDH patients who plan to undergo the conservative treatment at our hospital. In this research, the inclusion criteria contained: the patients with lumbar disc herniation diagnosed by lumbar MRI; the patients with no history of trauma or congenital abnormalities; and the patients with sufficient psychological ability to understand and then answer the questions raised in assessment scale. The participants were randomly divided into the control group or HILT group after performing the examination of baseline. The main outcome was the pain score of visual analog scale. The other results contained the adverse effects, back range of motion as well as functional scores. CONCLUSIONS: We assumed that the HILT is as effective as the ultrasound therapy in treating pain for LDH. TRIAL REGISTRATION: This study protocol was registered in Research Registry (researchregistry5975).


Assuntos
Deslocamento do Disco Intervertebral/cirurgia , Terapia a Laser/métodos , Humanos , Deslocamento do Disco Intervertebral/complicações , Deslocamento do Disco Intervertebral/fisiopatologia , Deslocamento do Disco Intervertebral/terapia , Terapia a Laser/efeitos adversos , Dor Lombar/etiologia , Vértebras Lombares , Medição da Dor , Ensaios Clínicos Controlados Aleatórios como Assunto , Amplitude de Movimento Articular , Terapia por Ultrassom/efeitos adversos
17.
Zhong Nan Da Xue Xue Bao Yi Xue Ban ; 45(8): 948-953, 2020 Aug 28.
Artigo em Inglês, Chinês | MEDLINE | ID: mdl-33053537

RESUMO

OBJECTIVES: To explore the clinical efficacy of endoscopic L5/S1 discectomy through interlaminar approach for the patient with the high iliac crest and migrated disc herniation. METHODS: A retrospective study of 31 patients with the high iliac crest and migrated disc herniation at the L5/S1 level was conducted in our hospital. All of the consented patients accepted endoscopic L5/S1 discectomy through interlaminar approach from January 2016 to January 2019. Preoperative, postoperative, and follow-up Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) were used to assess the pain and waist function of patients. The clinical efficacy was evaluated according to Macnab criteria. RESULTS: All the patients were followed up for 12-48 (29.68±9.64) months. The operation time was (79.16±22.43) min. The times of fluoroscopy were 2.71±0.78. The VAS of low back and leg pain was 7.09±0.94 before the surgery, 1.45±1.23 at 3 months after the surgery, and 1.27±0.92 at the last follow-up. The VAS after the surgery and at the last follow-up was significantly lower than that before the operation (P<0.05). The ODI was 56.03±6.64 before the surgery, 16.45±6.83 at 3 months after the surgery, and 13.03±4.96 at the last follow-up. The ODI was significantly lower after the surgery and at the last follow-up compared with that before the surgery (P<0.05). The Macnab score at the last follow-up was graded as excellent in 26 cases, good in 3 cases, fair in 2 cases, and the percentage of excellent and good were 93.5%. Part of the nucleus pulposus remained in 2 cases after the operation, one case underwent endoscopic revision and one case received conservative treatment; postoperative pain due to nerve root irritation was in one case and relieved by conservative treatment. CONCLUSIONS: The endoscopic L5/S1 discectomy through interlaminar approach is a relatively safe and effective treatment for the patient with the high iliac crest and migrated disc herniation, which can reduce X-ray examinations and complications, and achieve satisfactory clinical outcomes.


Assuntos
Discotomia Percutânea , Deslocamento do Disco Intervertebral , Discotomia , Humanos , Ílio , Deslocamento do Disco Intervertebral/cirurgia , Vértebras Lombares/cirurgia , Estudos Retrospectivos
18.
Zhongguo Gu Shang ; 33(10): 943-7, 2020 Oct 25.
Artigo em Chinês | MEDLINE | ID: mdl-33107258

RESUMO

OBJECTIVE: To explore clinical application of the new three-dimensional foramen guide in percutaneous endoscopic lumbar discectomy. METHODS: Based on the principle of reverse positioning, a new three-dimensional foramen guide was designed. From May 2016 to May 2018, totally 40 patients with segmental lumbar disc herniation were underwent percutaneous endoscopic lumbar discectomy. The patients were divided into guide and control group, and 20 patients in each group. In guide group, there were 9 males and 11 females with an average age of (46.0±11.0) years old;5 patients on L3,4, 15 patients on L4,5; BMI was (25.4±3.2) kg /m2;three dimensional foramen guide was used to assist the operation. While in control group, there were 10 males and 10 females with an average age of (51.8±9.8) years old;4 patients on L3,4, 16 patients on L4,5;BMI was (24.8±3.5) kg /m2;the operation was completed with bare hands according to the experience. The puncture time, times of fluoroscopy and puncture between two groups were compared, as well as the preoperative and postoperative visual analogue scale (VAS) score and Japanese Orthopaedic Association (JOA) were compared. RESULTS: All patients had no serious complications, and successfully completed operation. Operation time, the times of fluoroscopy and puncture in guide group were better than those of control group (P<0.05). VAS score and JOA score between two groups were significantly relieved after operation (P<0.05), but there was no significant difference between two groups (P>0.05). CONCLUSION: The three dimensional foramen guide is compact in structure, simple in operation, which could reduce the time of puncture and damage of radiation, shorten the learning curve of puncture for beginners, and has certain clinical feasibility.


Assuntos
Discotomia Percutânea , Deslocamento do Disco Intervertebral , Adulto , Discotomia , Feminino , Humanos , Deslocamento do Disco Intervertebral/cirurgia , Vértebras Lombares/cirurgia , Região Lombossacral , Masculino , Pessoa de Meia-Idade
19.
Medicine (Baltimore) ; 99(40): e22186, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33019393

RESUMO

This study aimed to verify the relationship between the number of fusion level and the risk of screw loosening by using cortical bone trajectory (CBT) screws in patients with lumbar degenerative disease.We retrospectively reviewed the serial plain radiograph images of lumbar degenerative disease patients who had undergone posterior fixation and fusion surgery with CBT from 2014. All included patients should have been followed-up with computed tomography scan or plain radiograph for at least 6 months after operation. We individually evaluated the prevalence of screw loosening according to each vertebral level. We also determined whether the number of screw fixation affected the prevalence of screw loosening and whether S1 fixation increased the risk of screw loosening.The screw-loosening rates were high at the S1 level. Moreover, although fixation involved to S1, the loosening rates evidently increased (Fisher exact test, P = .002). The screw-loosening rate was 6.56% in 2 level fusion. However, it increased with the number of fusion levels (3 level: 25.00%, 4 level: 51.16%, and 5 level: 62.50%). To investigate if the number of fusion level affected the S1 screw loosening, we classified the cohort of patients into either involving S1 (S1+ group) or not (S1- group) according to different fusion levels (). The screw loosening between 2 group in 2 (5.56% vs 6.98%) and 3 fusion level (26.32% vs 22.73%) did not exhibit any significant difference. Interestingly, significantly high screw loosening was found in 4 fusion level (60.00% vs 15.38%), indicating that the higher fusion level (4 level) can directly increase the risk of S1 screw loosening.Our data confirmed that the screw-loosening rate increases rate when long segment CBT fixation involves to S1. Therefore, in case of long-segment fixation by using CBT screw, surgeons should be aware of the fusion level of S1.


Assuntos
Parafusos Ósseos , Degeneração do Disco Intervertebral/cirurgia , Deslocamento do Disco Intervertebral/cirurgia , Fusão Vertebral/instrumentação , Osso Cortical/diagnóstico por imagem , Análise de Falha de Equipamento/métodos , Feminino , Humanos , Vértebras Lombares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
20.
Medicine (Baltimore) ; 99(42): e22709, 2020 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-33080722

RESUMO

BACKGROUND: Despite some researchers have compared the safety and effectiveness of percutaneous endoscopic discectomy (PED) and microendoscopic discectomy (MD) for the lumbar disc herniation; however, they got conflicting outcomes in several variables. Therefore, our aim was to clarify whether PED produces less surgical trauma and better clinical results than MD. METHODS: A single-center, retrospective cohort trial was conducted for the comparison of the safety and effectiveness between the MD and PED in the patients with lumbar disc herniation who received surgery from May 2016 to July 2018 in our hospital. The inclusion criteria for our investigation included:The follow-ups were performed 6 weeks, 3, 6, 12 and 24 months after the surgery. Numeric Rating Scale, Short-form 36, and Oswestry Disability Index, as well as complications were evaluated in our study. The software of SPSS Version 22.0 (IBM Corporation, Armonk, NY) was applied to analyze all the statistical data. When P is less than .05, the difference is significant in statistics. RESULTS: This protocol will provide a solid theoretical basis for exploring which technique is better in treatment of lumbar disc herniation. TRIAL REGISTRATION: This protocol was registered in Research Registry (researchregistry6005).


Assuntos
Degeneração do Disco Intervertebral/cirurgia , Deslocamento do Disco Intervertebral/cirurgia , Vértebras Lombares , Estudos de Coortes , Discotomia Percutânea , Endoscopia , Humanos
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