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1.
Instr Course Lect ; 69: 607-624, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32017755

RESUMO

Symptomatic lumbar disk herniation is abundantly common in adult patients and can cause significant pain and disability in those affected. Both surgical and nonsurgical treatment options exist for the management of this heterogeneous condition; thus, it is important that surgeons and other healthcare providers understand the appropriate indications for surgical treatment of patients with lumbar disk herniation. Though there is still lack of consensus regarding the optimal treatment of lumbar disk herniation in all situations, many principles and preferred techniques are agreed upon in the literature. In this chapter, we provide an in-depth overview of the anatomy and pathophysiology, natural history, physical examination, treatment decision making, surgical treatment options, and postoperative complications pertaining to lumbar disk herniation.


Assuntos
Deslocamento do Disco Intervertebral , Vértebras Lombares , Adulto , Aconselhamento , Humanos , Dor , Exame Físico , Resultado do Tratamento
2.
Medicine (Baltimore) ; 99(5): e19055, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32000453

RESUMO

To investigate the outcomes and reliability of hybrid surgery (HS) versus anterior cervical discectomy and fusion (ACDF) for the treatment of multilevel cervical spondylosis and disc diseases.Hybrid surgery, combining cervical disc arthroplasty (CDA) with fusion, is a novel treatment to multilevel cervical degenerated disc disease in recent years. However, the effect and reliability of HS are still unclear compared with ACDF.To investigate the studies of HS versus ACDF in patients with multilevel cervical disease, electronic databases (Medline, Embase, Pubmed, Cochrane library, and Cochrane Central Register of Controlled Trials) were searched. Studies were included when they compared HS with ACDF and reported at least one of the following outcomes: functionality, neck pain, arm pain, cervical range of motion (ROM), quality of life, and incidence of complications. No language restrictions were used. Two authors independently assessed the methodological quality of included studies and extracted the relevant data.Seven clinical controlled trials were included in this study. Two trials were prospective and the other 5 were retrospective. The results of the meta-analysis indicated that HS achieved better recovery of NDI score (P = 0.038) and similar recovery of VAS score (P = 0.058) compared with ACDF at 2 years follow-up. Moreover, the total cervical ROM (C2-C7) after HS was preserved significantly more than the cervical ROM after ACDF (P = 0.000) at 2 years follow-up. Notably, the compensatory increase of the ROM of superior and inferior adjacent segments was significant in ACDF groups at 2-year follow-up (P < 0.01), compared with HS.The results demonstrate that HS provides equivalent outcomes and functional recovery for cervical disc diseases, and significantly better preservation of cervical ROM compared with ACDF in 2-year follow-up. This suggests the HS is an effective alternative invention for the treatment of multilevel cervical spondylosis to preserve cervical ROM and reduce the risk of adjacent disc degeneration. Nonetheless, more well-designed studies with large groups of patients are required to provide further evidence for the benefit and reliability of HS for the treatment of cervical disk diseases.


Assuntos
Vértebras Cervicais/cirurgia , Discotomia/métodos , Doenças da Coluna Vertebral/cirurgia , Fusão Vertebral/métodos , Humanos , Degeneração do Disco Intervertebral/cirurgia , Deslocamento do Disco Intervertebral/cirurgia , Espondilose/cirurgia
3.
Medicine (Baltimore) ; 99(5): e18781, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32000379

RESUMO

BACKGROUND: A large number of randomized controlled trials (RCTs) have shown that traditional Chinese exercises (TCE) have certain advantages in the treatment of lumbar disc herniation (LDH). However, due to the diversity of TCE methods, their relative effectiveness has not been studied and explained. Therefore, based on the network meta-analysis (NMA), this study will compare the differences in the effectiveness of TCE methods in the treatment of LDH, in order to provide a reference for clinical treatment. METHODS: We will search PubMed, MEDLINE, Embase, the Cochrane Library, China National Knowledge Infrastructure (CHKD-CNKI), WANFANG database (Chinese Medicine Premier), Chinese Biomedical Literature database VIP for relevant RCTs of ACU treatments for POP, from their inceptions to March 18, 2019. STATA 15.0 and GEMTC software will be used to perform a NMA. The evidence will be evaluated by the Grading of Recommendations Assessment, Development, and Evaluation approach and the type 1 error rate will be assessed by trial sequential analysis. RESULTS: The results of this review will be submitted to a recognized journal for publication. CONCLUSION: This proposed systematic review will evaluate the different advantages of various types of TCE in the treatment of LDH.


Assuntos
Técnicas de Exercício e de Movimento , Deslocamento do Disco Intervertebral/terapia , Medicina Tradicional Chinesa , Humanos , Vértebras Lombares , Metanálise como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto
4.
World Neurosurg ; 133: 163-166, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31606498

RESUMO

BACKGROUND: Cervical disk arthroplasty is now a widely accepted alternative to anterior cervical interbody fusion, which is known to reduce normal cervical motion and increase the incidence of adjacent segment disease. Although multiple studies report the use of cervical disk arthroplasty to treat multilevel cervical disease, this is the first report in the literature detailing the placement of multiple, noncontiguous artificial disks. CASE DESCRIPTION: We describe a 41-year-old male who presented with myelopathy and left upper extremity radiculopathy resulting from 2 cervical disk herniations separated by a normal intervening level. He underwent an anterior cervical diskectomy and placement of an artificial disk prosthesis at cervical (C) 4-5 and C6-7 while leaving C5-6 intact. CONCLUSIONS: This approach serves to preserve cervical motion, spinal stability, and lordosis across all 3 levels, thus demonstrating that it is a viable alternative to a multilevel anterior cervical interbody fusion.


Assuntos
Vértebras Cervicais/cirurgia , Discotomia/métodos , Deslocamento do Disco Intervertebral/cirurgia , Disco Intervertebral/cirurgia , Radiculopatia/cirurgia , Doenças da Medula Espinal/cirurgia , Substituição Total de Disco/métodos , Adulto , Humanos , Deslocamento do Disco Intervertebral/complicações , Masculino , Radiculopatia/etiologia , Doenças da Medula Espinal/etiologia , Resultado do Tratamento
5.
World Neurosurg ; 133: 135-141, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31505277

RESUMO

BACKGROUND: The occurrence rate of thoracic spinal stenosis caused by ossification of the ligamentum flavum combined with disk herniation is lower than that of ossified ligamentum flavum in the thoracic spine, and the treatment method has rarely been reported. In this paper, we applied an endoscopic technique to a patient with thoracic spinal stenosis caused by ossification of the ligamentum flavum combined with disk herniation at the T10-11 level. METHODS: We performed surgical decompression of the thoracic spinal cord for a patient diagnosed with thoracic spinal stenosis at the T10-11 level caused by ossification of the ligamentum flavum combined with disk herniation using percutaneous endoscopic surgery via the bilateral translaminar osseous channel approach. Pre- and postoperative computed tomography (CT) scan and magnetic resonance imaging (MRI) examinations were performed, and pre- and postoperative neurologic status was evaluated using the Modified Japanese Orthopaedic Association and visual analog scale scores. RESULTS: The ossified ligamentum flavum and herniated disk material were removed through this osseous channel. Postoperative CT and MRI scanning revealed adequate decompression of the spinal cord at the T10-11 level. The patient was discharged home on postoperative day 3. At 6-month postoperative follow-up, the patient experienced complete resolution of T12 dermatomal numbness. The strength in her bilateral lower extremities improved slightly to grade 5. CONCLUSIONS: We have applied percutaneous endoscopic surgery via bilateral translaminar osseous channels for the treatment of thoracic spinal stenosis caused by ossification of the ligamentum flavum combined with disk herniation. This surgery could provide sufficient decompression for thoracic spinal cord with minimum trauma.


Assuntos
Descompressão Cirúrgica/métodos , Endoscopia/métodos , Deslocamento do Disco Intervertebral/cirurgia , Ligamento Amarelo/patologia , Ossificação Heterotópica/cirurgia , Estenose Espinal/cirurgia , Vértebras Torácicas/cirurgia , Feminino , Humanos , Deslocamento do Disco Intervertebral/complicações , Deslocamento do Disco Intervertebral/patologia , Pessoa de Meia-Idade , Ossificação Heterotópica/complicações , Ossificação Heterotópica/patologia , Estenose Espinal/etiologia , Estenose Espinal/patologia , Resultado do Tratamento
6.
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
7.
World Neurosurg ; 133: 271-274, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31639501

RESUMO

BACKGROUND: Epidermoid cysts (ECs) account for 0.5% to 1% of all spinal tumors. They can be congenital or acquired. Acquired spinal ECs are extremely rare and are mostly caused by trauma, or secondary to iatrogenic procedure such as lumbar punctures or surgery for spina bifida. As far as we know, this is the first report of a spinal EC complicating surgery for a lumbar disc herniation. CASE DESCRIPTION: A 69-year-old woman, with a history of L3-L4 lumbar disc herniation surgery 30 years earlier, presented because of low back pain, weakness of her lower limbs, and bladder dysfunction evolving for 2 years. Magnetic resonance imaging identified an intradural cystic lesion extending from the medullary cone to the L4 level, evoking an EC. The diagnosis was confirmed peroperatively. Neurologic motor signs improved postoperatively but not the sphincter disorders. CONCLUSIONS: Despite the extreme rarity of this event, we should be aware of the potential de novo development of epidermoid tumors in patients who undergo surgery for lumbar disc herniation. Concerns must be given to persistent low back pain and delayed neurologic symptoms in these patients.


Assuntos
Cauda Equina/diagnóstico por imagem , Cisto Epidérmico/etiologia , Deslocamento do Disco Intervertebral/cirurgia , Vértebras Lombares/cirurgia , Procedimentos Ortopédicos/efeitos adversos , Doenças do Sistema Nervoso Periférico/etiologia , Idoso , Cauda Equina/cirurgia , Cisto Epidérmico/diagnóstico por imagem , Cisto Epidérmico/cirurgia , Feminino , Humanos , Laminectomia , Vértebras Lombares/diagnóstico por imagem , Imagem por Ressonância Magnética , Doenças do Sistema Nervoso Periférico/diagnóstico por imagem , Doenças do Sistema Nervoso Periférico/cirurgia , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Resultado do Tratamento
8.
Orthopade ; 49(1): 32-38, 2020 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-31089777

RESUMO

Further developments in disease diagnosis and treatment are of immense relevance for advancements in medical care of the population. A detailed cost-benefit analysis of direct and indirect costs is usually unavailable. In the current article, these aspects are investigated using prospectively collected randomized data over two years. Specifically, the surgical treatment of a herniated lumbar disc is addressed, and whether a newly introduced technique (e.g., annular closure device) can lead to a better quality of care and increased patient satisfaction when performed during the standard operation, while also being economically viable.


Assuntos
Degeneração do Disco Intervertebral , Deslocamento do Disco Intervertebral , Vértebras Lombares , Análise Custo-Benefício , Economia Médica , Humanos , Região Lombossacral
9.
Harefuah ; 158(12): 807-811, 2019 Dec.
Artigo em Hebraico | MEDLINE | ID: mdl-31823536

RESUMO

INTRODUCTION: Lumbar disc herniation is a medical condition in which obscurity exists in the relation between the clinical and the radiological definition. The following paper was written by both surgeons and a radiologist, who are engaged in the field of spine surgery. The aim is to provide clear definitions as to the different pathologies involving disc herniation. The secondary goal of this article is to differentiate between the radiological picture and the clinical syndrome which are not necessarily connected. We hope this review will illuminate these issues and simplify the definitions and make it easier for all to use, primary care practitioners, general orthopedics and trauma care providers.


Assuntos
Deslocamento do Disco Intervertebral , Vértebras Lombares , Humanos , Degeneração do Disco Intervertebral , Radiografia , Radiologia
11.
Bone Joint J ; 101-B(12): 1534-1541, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31786988

RESUMO

AIMS: The purpose of this study was to investigate the risk of additional surgery in the lumbar spine and to describe long-term changes in patient-reported outcomes after surgery for lumbar disc herniation in adolescents and young adults. PATIENTS AND METHODS: We conducted a retrospective study design on prospectively collected data from a national quality register. The 4537 patients were divided into two groups: adolescents (≤ 18 years old, n = 151) and young adults (19 to 39 years old, n = 4386). The risk of additional lumbar spine surgery was surveyed for a mean of 11.4 years (6.0 to 19.3) in all 4537 patients. Long-term patient-reported outcomes were available at a mean of 7.2 years (5.0 to 10.0) in up to 2716 patients and included satisfaction, global assessment for leg and back pain, Oswestry Disability Index, visual analogue scale for leg and back pain, EuroQol five-dimension questionnaire (EQ-5D), and 36-Item Short-Form Health Survey (SF-36) Mental Component Summary and Physical Component Summary scores. Statistical analyses were performed with Cox proportional hazard regression, chi-squared test, McNemar's test, Welch-Satterthwaite t-test, and Wilcoxon's signed-rank test. RESULTS: Any type of additional lumbar spine surgery was seen in 796 patients (18%). Surgery for lumbar disc herniation accounted for more than half of the additional surgeries. The risk of any additional surgery was 0.9 (95% confidence interval (CI) 0.6 to 1.4) and the risk of additional lumbar disc herniation surgery was 1.0 (0.6 to 1.7) in adolescents compared with the young adult group. Both age groups improved their patient-reported outcome data after surgery (all p < 0.001). Changes between short- (mean 1.9 years (1.0 to 2.0)) and long-term follow-up (mean 7.2 years (5.0 to 10.0)) were small. CONCLUSION: The risk of any additional lumbar spine surgery and additional lumbar disc herniation surgery was similar in adolescents and young adults. All patient-reported outcomes improved from preoperative to the short-term follow-up, while no likely clinically important differences between the short- and long-term follow-up were seen within both groups. Cite this article: Bone Joint J 2019;101-B:1534-1541.


Assuntos
Deslocamento do Disco Intervertebral/cirurgia , Vértebras Lombares/cirurgia , Procedimentos Ortopédicos , Adolescente , Adulto , Feminino , Seguimentos , Humanos , Masculino , Medidas de Resultados Relatados pelo Paciente , Sistema de Registros , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
12.
Georgian Med News ; (295): 13-16, 2019 Oct.
Artigo em Russo | MEDLINE | ID: mdl-31804191

RESUMO

The aim of the study is to evaluate the effectiveness of transforaminal endoscopic microdiscectomy in patients with herniated intervertebral discs at the L3 - S1 level of the lumbar spine. A retrospective analysis of the treatment of 468 patients with hernias of intervertebral discs of the lumbar spine was conducted, of them: 262 patients were treated in the Rivne Regional Clinical Hospital; 206 patients in the spinal surgery department of the State Institution "Institute of Traumatology and Orthopedics of the National Academy Medical Sciences of Ukraine". The study was conducted in the period from April 2016 to January 2019. In the preoperative period, all patients underwent an MRI or CT scan - examination of the lumbar spine, functional radiographs, and general clinical examinations were performed. According to the results of studies in the postoperative period, a significant improvement in the quality of life of the operated patients was revealed in accordance with the Oswestry Disability Index (the average for the group was 35,9%, which corresponds to a good result). There was a positive dynamics of pain in VAS (in the preoperative period - 8,8 ± 0,7 points; 6 months after the operation - 1,2 ± 0,5 points, with a predominance of lumbodynia and with an almost complete absence of radicular syndrome). In 28 (6,0%) patients, a hernia recurred within 6 months, however, in the remaining 440 (94,1%) patients, positive results of neurological symptoms were observed in dynamics. The obtained results confirm the high efficiency of ETD and the low risk of postoperative complications.


Assuntos
Deslocamento do Disco Intervertebral , Disco Intervertebral , Humanos , Deslocamento do Disco Intervertebral/terapia , Qualidade de Vida , Estudos Retrospectivos , Resultado do Tratamento , Ucrânia
13.
Medicine (Baltimore) ; 98(49): e18064, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31804313

RESUMO

Many studies have reported the good outcomes of percutaneous endoscopic lumbar discectomy (PELD) for the treatment of lumbar disc herniation (LDH). However, the majority of published studies on PELD showed an average hospital stay of 2 to 5 days. Thus, the purpose of this retrospective study was to evaluate and compare the clinical outcomes of patients undergoing PELD for LDH as day surgery with the outcomes of patients managed as inpatients.A total of 402 patients who underwent PELD for single-level LDH were included. The visual analog scale score (VAS) for leg and back pain, Oswestry Disability Index (ODI) score, and Macnab criteria were evaluated preoperatively and at 2 years postoperatively (final follow-up). Operation time, duration of hospital stay, cost, postoperative complications, and the rates of and reasons for delayed discharge and readmission were recorded and analyzed.The mean operative time was 45.8 ±â€Š8.4 minutes in the PELD-A (nonday surgery mode) group and 41.3 ±â€Š8.7 minutes in the PELD-D (day surgery mode) group (P = .63). The average duration of hospital stay was 2.8 ±â€Š1.1 days in the PELD-A group and 3.2 ±â€Š0.9 hours in the PELD-D group (P < .001). The average hospitalization expenses of the PELD-A and PELD-D groups were 28,090 ±â€Š286 RMB and 24,356 ±â€Š126 RMB (P = .03), respectively. In both groups, the mean VAS and ODI scores improved significantly postoperatively compared with the preoperative scores. The satisfactory result rate was 89.8% in the PELD-D group and 91.0% in the PELD-A group, without a significant difference (P = .68). The delayed discharge rate in the PELD-A and PELD-D groups was 8.20% and 8.43%, respectively (P = .93). The main reasons for delayed discharge were dysesthesia, neurologic deficit, nausea, headache and residential distance from the hospital. The overall readmission rates were 5.99% and 5.53% in the PELD-A and PELD-D groups, respectively (P = .85). The most common reasons for readmission were reherniation, sequestered herniation and pain.In conclusion, PELD is safe and effective for the treatment of LDH and can reduce medical costs as day surgery, and it thus warrants increased attention.


Assuntos
Procedimentos Cirúrgicos Ambulatórios/estatística & dados numéricos , Discotomia Percutânea/métodos , Discotomia Percutânea/estatística & dados numéricos , Deslocamento do Disco Intervertebral/cirurgia , Vértebras Lombares/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Preços Hospitalares/estatística & dados numéricos , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Readmissão do Paciente , Desempenho Físico Funcional , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Adulto Jovem
14.
Neurol Neurochir Pol ; 53(6): 492-499, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31804701

RESUMO

Minimally invasive surgical techniques are becoming increasingly common in spinal surgery in an attempt to decrease tissue trauma during surgery, which in turn decreases post-operative pain and opioid use. The aim of this study was to investigate the clinical outcomes of a large group of patients with lumbar disc disease who underwent full endoscopic surgery. 857 patients who underwent fully endoscopic lumbar discectomy were investigated retrospectively. General demographics were evaluated in terms of mean operating time, mean length of hospital stay, mean time to return to work, complications and recurrences. Clinical outcomes were evaluated using visual analogue scale (VAS) for low back and leg pain, and Oswestry Disability Index (ODI) for functional assessment. The mean follow-up time was 36 months. The operation time ranged from 20 to 65 minutes (39 min on average), and there was no measurable intraoperative blood loss. Patients were mobilised on average 3.5 hours after the surgery. The length of hospital stay after the operation was 12-24 hours (18 hours on average). During postoperative follow-up, 19 patients required revision surgery due to recurrence (2.2%). There was one case of nerve root injury in which the patient recovered well following physical therapy, and 11 cases of paresthesia that gradually improved following 2-6 weeks of rehabilitation and treatment with pregabalin. All types of lumbar disc herniations are accessible via the full-endoscopic technique. Full-endoscopic discectomy, as a minimally invasive procedure, has the technical advantages of less paraspinal muscle dissection, less tissue trauma, less risk of spinal instability, and minimal blood loss.


Assuntos
Discotomia Percutânea , Deslocamento do Disco Intervertebral , Discotomia , Endoscopia , Humanos , Vértebras Lombares , Estudos Retrospectivos , Resultado do Tratamento
15.
Medicine (Baltimore) ; 98(50): e16627, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31852061

RESUMO

BACKGROUND: The purpose of our study is to compare the outcomes and effectiveness of MED vs OLD for lumbar disc herniation. OBJECTIVES: To identify the functional outcomes in terms of ODI score, VAS score complications in terms of intraoperative blood loss, use of general anesthesia, and morbidity in terms of total hospital stay between MED and OLD. METHODS: In our randomized prospective study we analyzed 60 patients with clinical signs and symptoms with 2 weeks of failed conservative treatment plus MRI or CT scan findings of lumbar disc herniation who underwent MED and OLD. The study was undertaken from November 2017 to January 2019 at Guangzhou Medical University of Second Affiliated Hospital, department of orthopedic surgery in spinal Unit, Guangzhou, China. Patients were divided into 2 groups i.e. who underwent MED group and the OLD group then we compared the preoperative and postoperative ODI and VAS score, duration of total hospital stay, intraoperative blood loss, and operation time. RESULTS: We evaluated 60 patients. Among them, 30 underwent MED (15 female and 15 male) and 30 underwent OLD 14 male 16 female. Surgical and anesthesia time was significantly shorter, blood loss and hospital stay were significantly reduced in patients having MED than OLD (<0.005). The improvement in the ODI in both groups was clinically significant and statistically (P < .005) at postoperative 1st day (with greater improvement in the MED group), at 6 weeks (P > .005), month 6 (>0.005) statistically no significant. The clinical improvement was similar in both groups. VAS and ODI scores improved significantly postoperatively in both groups. However, the MED group was superior to the OLD group with less time in bed, shorter operation time, less blood loss which is clinically and statistically significant (P < .05). CONCLUSIONS: The standard surgical treatment of lumbar disc herniation has been open discectomy but there has been a trend towards minimally invasive procedures. MED for lumbar spine disc herniation is a well-known but developing field, which is increasingly spreading in the last few years. The success rate of MED is about approximately 90%. Both methods are equally effective in relieving radicular pain. MED was superior in terms of total hospital stay, morbidity, and earlier return to work and anesthetic exposure, blood loss, intra-op time comparing to OLD. MED is a safe and effective alternative to conventional OLD for patients with lumbar disc herniation.


Assuntos
Discotomia/métodos , Endoscopia/métodos , Deslocamento do Disco Intervertebral/cirurgia , Vértebras Lombares/cirurgia , Microcirurgia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Deslocamento do Disco Intervertebral/diagnóstico , Vértebras Lombares/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Adulto Jovem
16.
Medicine (Baltimore) ; 98(52): e18465, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31876730

RESUMO

This study aimed to investigate the correlation of long noncoding RNA zinc finger antisense 1 (lncRNA ZFAS1) expression with disease risk, disease severity and inflammatory cytokines levels in lumbar disc degeneration (LDD) patients.83 LDD patients underwent surgery and 28 traumatized, non-LDD patients underwent lumbar disc surgery (controls) were consecutively enrolled in this case-control study. Lumbar disc tissue was obtained during surgery and herniated nucleus pulposus (HNP) was isolated to detect lncRNA ZFAS1 expression and inflammatory cytokines mRNA levels by RT-qPCR, and determine protein levels of inflammatory cytokines by western blot.HNP lncRNA ZFAS1 expression in LDD patients was up-regulated compared with controls (P < .001), and receiver operating characteristic (ROC) curve showed lncRNA ZFAS1 expression disclosed a good predictive value for LDD risk with area under curve (AUC) 0.753 (95% CI 0.646-0.859). And after adjustment by age, gender and body mass index (BMI), lncRNA ZFAS1 (P = .017) remained to be an independent predictive factor for higher LDD risk. In addition, lncRNA ZFAS1 expression was positively associated with Modified Pfirrmann Grade (P = .015). As to inflammatory cytokines, lncRNA ZFAS1 expression was observed to be positively correlated with TNF-α (P = .002), IL-1ß (P = .007) and IL-6 (P = .015) mRNAs expressions while reversely associated with IL-10 mRNA level (P = .014); and lncRNA ZFAS1 expression was also positively correlated with protein levels of TNF-α (P = .038) and IL-6 (P = .027) while reversely associated with IL-10 protein expression (P = .039).lncRNA ZFAS1 expression associates with increased risk, elevated disease severity and higher inflammatory cytokines levels in LDD patients.


Assuntos
Citocinas/metabolismo , Degeneração do Disco Intervertebral/metabolismo , Deslocamento do Disco Intervertebral/metabolismo , Disco Intervertebral/metabolismo , Vértebras Lombares , RNA Antissenso/metabolismo , RNA Longo não Codificante/metabolismo , Adulto , Biomarcadores/análise , Western Blotting , Estudos de Casos e Controles , Citocinas/análise , Feminino , Humanos , Interleucina-10/análise , Interleucina-10/metabolismo , Interleucina-1beta/análise , Interleucina-1beta/metabolismo , Interleucina-6/análise , Interleucina-6/metabolismo , Disco Intervertebral/química , Masculino , Pessoa de Meia-Idade , RNA Longo não Codificante/genética , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Fatores de Risco , Índice de Gravidade de Doença , Fator de Necrose Tumoral alfa/análise , Fator de Necrose Tumoral alfa/metabolismo
17.
Medicine (Baltimore) ; 98(44): e17706, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689801

RESUMO

RATIONALE: Lumbar degeneration-related May-Thurner syndrome (dMTS) is characterized by venous compression induced by degenerated lower lumbar structures. Treatment strategies for May-Thurner syndrome (MTS) include clearing the thrombus and correcting venous compression. Despite having different etiological factors from other MTS types, treatments for dMTS are similar, including endovascular angioplasty and continuous anticoagulation therapies. Thus, a particular treatment was designed herein to focus on compressive lumbar structures instead of intravenous management. PATIENT CONCERNS: A 59-year-old female patient with dMTS, which was induced by inferior vena cava (IVC) stenosis compressed by L4-5 anterior disc herniation. DIAGNOSIS: The patient was diagnosed with IVC stenosis and L4-5 lumbar disc herniation based on abdominal computed tomography, ultrasound, and lumbar magnetic resonance imaging findings. INTERVENTIONS: Radiofrequency thermocoagulation (RF) was applied to the patient to decrease the compression caused by anterior disc herniation. OUTCOMES: After surgery, the patient's swelling started to improve within 5 hours and completely diminished after 48 hours. Postsurgical abdominal ultrasound showed that her IVC patency increased by 20%. On follow-up, her leg symptoms did not recur at 12 months after surgery. LESSONS: We provided a novel idea in the treatment of dMTS, in which we shifted the treatment focus from endovascular patency restoration to extravascular decompression. Our case proved that RF was effective in treating dMTS, which is a complementary treatment modality to angioplasty.


Assuntos
Deslocamento do Disco Intervertebral/cirurgia , Fotocoagulação a Laser/métodos , Síndrome de May-Thurner/cirurgia , Terapia por Radiofrequência/métodos , Feminino , Humanos , Deslocamento do Disco Intervertebral/complicações , Vértebras Lombares/cirurgia , Síndrome de May-Thurner/etiologia , Pessoa de Meia-Idade
18.
Medicine (Baltimore) ; 98(44): e17760, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689835

RESUMO

BACKGROUND: The risk of recurrent herniation after lumbar discectomy is highest during the first postoperative year. The purpose of this study was to determine whether implantation of a bone-anchored annular closure device (ACD) following limited lumbar discectomy reduced the risk of recurrent herniation and complications during the first year of follow-up compared to limited lumbar discectomy alone (Controls) and whether this risk was influenced by patient characteristics. METHODS: In this randomized multicenter trial, patients with symptomatic lumbar disc herniation and with a large annular defect following limited lumbar discectomy were randomized to bone-anchored ACD or Control groups. The risks of symptomatic reherniation, reoperation, and device- or procedure-related serious adverse events were reported over 1 year of follow-up. RESULTS: Among 554 patients (ACD 276; Control 278), 94% returned for 1-year follow-up. Bone-anchored ACD resulted in lower risks of symptomatic reherniation (8.4% vs. 17.3%, P = .002) and reoperation (6.7% vs. 12.9%, P = .015) versus Controls. Device- or procedure-related serious adverse events through 1 year were reported in 7.1% of ACD patients and 13.9% of Controls (P = .009). No baseline patient characteristic significantly influenced these risks. CONCLUSIONS: Among patients with large annular defects following limited lumbar discectomy, additional implantation with a bone-anchored ACD lowered the risk of symptomatic reherniation and reoperation over 1 year follow-up. Device- or procedure-related serious adverse events occurred less frequently in the ACD group. These conclusions were not influenced by patient characteristics. ClinicalTrials.gov (NCT01283438).


Assuntos
Prótese Ancorada no Osso , Discotomia/instrumentação , Deslocamento do Disco Intervertebral/cirurgia , Vértebras Lombares/cirurgia , Prevenção Secundária/métodos , Adulto , Discotomia/métodos , Feminino , Humanos , Masculino , Recidiva , Reoperação/estatística & dados numéricos , Resultado do Tratamento
19.
Medicine (Baltimore) ; 98(46): e18044, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31725682

RESUMO

Lumbar disc herniation (LDH) often results in back pain and radicular pain and is frequently treated with minimally invasive non-surgical methods in Korean Armed Forces Hospitals. Automated percutaneous lumbar discectomy (APLD) has been reported to have good clinical outcomes with low complication rates; however, the clinical efficacy of APLD performed in young male soldiers is uncertain. In order to clarify the efficacy of APLD for the treatment of LDH in young male soldiers, we designed a retrospective case-control study to compare patients who received APLD with patients treated with epidural steroid injection (ESI) alone.A total of 181 patients were enrolled and divided into the APLD (n = 92) and ESI (n = 89) groups according to the treatment modality. A simple logistic regression analysis was conducted to clarify the difference between the two. To optimize patient selection, APLD group was additionally divided for subgroup analysis into favorable (n = 59) and unfavorable (n = 33) groups based on satisfaction scales. A simple logistic analysis was also performed.The differences between pre- and postoperative numerical rating scale of pain (P = .0027) and hospital-own satisfaction scale (P = .0045) of the APLD group were significantly better compared to those of the ESI group. In terms of subgroup analysis, single-level pathology (P = 0.244) and protruded disc (P = .0443) were associated with favorable outcomes, whereas dual pathology and extruded disc were related with unfavorable outcomes.APLD using Dekompressor, performed in young male soldiers with back and radicular pain owing to LDH, showed better clinical outcomes compared to the ESI only therapy. Additionally, a single-level pathology with protruded disc was associated with favorable outcomes and may be indicated for treatment.


Assuntos
Discotomia Percutânea/métodos , Deslocamento do Disco Intervertebral/cirurgia , Vértebras Lombares/cirurgia , Militares , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Estudos de Casos e Controles , Discotomia Percutânea/instrumentação , Humanos , Modelos Logísticos , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Medição da Dor , Estudos Retrospectivos , Adulto Jovem
20.
Medicine (Baltimore) ; 98(45): e17847, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31702642

RESUMO

BACKGROUND: Lumbar herniated intervertebral disc (LHIVD) is a frequent disease among patients attending Korean medicine hospitals, and it is associated with considerable medical expenses for the patients. Although several recent randomized clinical trials (RCTs) have reported that thread-embedding acupuncture (TEA) has a more favorable therapeutic effect on LHIVD than other types of acupuncture or other treatments, the evidence remains limited because these trials used poor assessment methods and had a high risk of bias. This study aims to evaluate the evidence for the effectiveness and safety of TEA for LHIVD. In this article, we describe our methods and plan for a systematic review. METHODS: We will conduct an electronic search of the following databases from their inception to May 2018: MEDLINE; EMBASE; COCHRANE; China National Knowledge Infrastructure (CNKI) (a Chinese database); CiNii and J-STAGE (Japanese databases); and KoreaMed, Korean Medical Database (KMbase), Korean Studies Information Service System (KISS), National Digital Science Library (NDSL), Korea Institute of Science and Technology Information (KISTI), Oriental Medicine Advanced Searching Integrated System (OASIS). RCTs investigating any type of TEA will be included. The risk of bias in each study will be evaluated using the Cochrane risk of bias tool. Risk ratios or mean differences with 95% confidence intervals will be used to show the effects of TEA if it will be possible to conduct a meta-analysis. Sensitivity analyses will also be conducted in this study. ETHICS AND DISSEMINATION: Ethical approval is not necessary as this paper does not involve patient data. The review will be published in a peer-reviewed journal or presented in a conference. TRIAL REGISTRATION NUMBER: PROSPERO CRD42019133060.


Assuntos
Terapia por Acupuntura/métodos , Deslocamento do Disco Intervertebral/terapia , Terapia por Acupuntura/efeitos adversos , Adulto , Protocolos Clínicos , Humanos , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa , Resultado do Tratamento
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