Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 3.437
Filtrar
1.
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
2.
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
3.
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
4.
BMJ ; 367: l5654, 2019 10 16.
Artigo em Inglês | MEDLINE | ID: mdl-31619437

RESUMO

OBJECTIVE: To assess the efficacy of three months of antibiotic treatment compared with placebo in patients with chronic low back pain, previous disc herniation, and vertebral endplate changes (Modic changes). DESIGN: Double blind, parallel group, placebo controlled, multicentre trial. SETTING: Hospital outpatient clinics at six hospitals in Norway. PARTICIPANTS: 180 patients with chronic low back pain, previous disc herniation, and type 1 (n=118) or type 2 (n=62) Modic changes enrolled from June 2015 to September 2017. INTERVENTIONS: Patients were randomised to three months of oral treatment with either 750 mg amoxicillin or placebo three times daily. The allocation sequence was concealed by using a computer generated number on the prescription. MAIN OUTCOME MEASURES: The primary outcome was the Roland-Morris Disability Questionnaire (RMDQ) score (range 0-24) at one year follow-up in the intention to treat population. The minimal clinically important between group difference in mean RMDQ score was predefined as 4. RESULTS: In the primary analysis of the total cohort at one year, the difference in the mean RMDQ score between the amoxicillin group and the placebo group was -1.6 (95% confidence interval -3.1 to 0.0, P=0.04). In the secondary analysis, the difference in the mean RMDQ score between the groups was -2.3 (-4.2 to-0.4, P=0.02) for patients with type 1 Modic changes and -0.1 (-2.7 to 2.6, P=0.95) for patients with type 2 Modic changes. Fifty patients (56%) in the amoxicillin group experienced at least one drug related adverse event compared with 31 (34%) in the placebo group. CONCLUSIONS: In this study on patients with chronic low back pain and Modic changes at the level of a previous disc herniation, three months of treatment with amoxicillin did not provide a clinically important benefit compared with placebo. Secondary analyses and sensitivity analyses supported this finding. Therefore, our results do not support the use of antibiotic treatment for chronic low back pain and Modic changes. TRIAL REGISTRATION: ClinicalTrials.gov NCT02323412.


Assuntos
Amoxicilina , Degeneração do Disco Intervertebral/complicações , Deslocamento do Disco Intervertebral/complicações , Dor Lombar , Vértebras Lombares , Adulto , Amoxicilina/administração & dosagem , Amoxicilina/efeitos adversos , Antibacterianos/administração & dosagem , Antibacterianos/efeitos adversos , Dor Crônica/diagnóstico , Dor Crônica/tratamento farmacológico , Dor Crônica/etiologia , Avaliação da Deficiência , Método Duplo-Cego , Feminino , Humanos , Dor Lombar/diagnóstico , Dor Lombar/tratamento farmacológico , Dor Lombar/etiologia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/patologia , Masculino , Pessoa de Meia-Idade , Noruega , Medição da Dor/métodos , Resultado do Tratamento
5.
Neurocirugía (Soc. Luso-Esp. Neurocir.) ; 30(5): 238-242, sept.-oct. 2019. ilus, tab
Artigo em Inglês | IBECS | ID: ibc-183878

RESUMO

Spinal cord teratomas are rare. There are few reports of teratomas affecting the cervical spine and their association with spondylotic radiculopathy has not been described. A 59-year-old woman with history of fecal incontinence attended with cervical radicular pain radiating to upper limbs. Physical examination showed distal muscle hypotrophy and abolishment of bicipital, tricipital, and brachioradialis reflexes of the right arm, preserving proximal strength. Also, hiporreflexia and loss of proprioception in the right lower limb was observed. Magnetic resonance imaging showed an intramedullary mass at C7-T1, accompanied by intervertebral disk protrusions and dural sac compressions at the same level. One-stage posterior-anterior operative approach for tumor resection, decompression of the radiculopathy and replacement of intervertebral discs was performed. The histopathological diagnosis was for a mature teratoma. We described the first case of an intramedullary cervical teratoma associated with radiculopathy in an adult, providing evidence of rare long-lasting teratomas affecting the cervical spine


Los teratomas medulares son raros. La asociación de teratomas cervicales con radiculopatía espondilótica no ha sido descrita. Una mujer de 59 años con historia de incontinencia fecal acudió con dolor radicular cervical irradiado a miembros superiores. La exploración física reveló hipotrofia distal, arreflexia bicipital, tricipital y braquiorradial del brazo derecho, conservando la fuerza proximal. Se observó hiporreflexia y pérdida de la propiocepción en el miembro inferior derecho. La resonancia magnética reveló una masa intramedular en C7-T1, así como hernias discales y compresión del saco dural en dichos segmentos. Se realizó un doble abordaje posterior-anterior en un solo tiempo para resecar el tumor, descomprimir la radiculopatía y reemplazar los discos afectados. El diagnóstico histopatológico fue de un teratoma maduro. Describimos el primer caso de un teratoma intramedular cervical con radiculopatía espondilótica en un adulto, aportando evidencia sobre los teratomas raros de larga evolución que afectan a la columna cervical


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Teratoma/diagnóstico por imagem , Teratoma/cirurgia , Radiculopatia/diagnóstico por imagem , Radiculopatia/cirurgia , Neoplasias Ductais, Lobulares e Medulares/diagnóstico por imagem , Neoplasias Ductais, Lobulares e Medulares/cirurgia , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Cervicalgia/complicações , Cervicalgia/etiologia , Deslocamento do Disco Intervertebral/complicações , Deslocamento do Disco Intervertebral/diagnóstico por imagem , Procedimentos Neurocirúrgicos
6.
Top Spinal Cord Inj Rehabil ; 25(3): 205-213, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31548787

RESUMO

The authors review urologic dysfunction, including urine retention, incontinence, and recurrent and resistant urinary tract infection, in dogs as a sequela to acute spinal cord injury. Urologic sequelae to acute spinal cord injury (SCI) pose significant complications in human and canine patients impacting quality of life and long-term cost of treatment. Dogs with intervertebral disc extrusion may serve as a natural disease model of acute SCI for investigating translational interventions, both prophylactic and therapeutic, for urologic dysfunction in human SCI patients.


Assuntos
Doenças do Cão/terapia , Degeneração do Disco Intervertebral/veterinária , Deslocamento do Disco Intervertebral/veterinária , Traumatismos da Medula Espinal/veterinária , Bexiga Urinaria Neurogênica/terapia , Bexiga Urinaria Neurogênica/veterinária , Doença Aguda , Animais , Cateteres de Demora , Cães , Cateterismo Uretral Intermitente , Degeneração do Disco Intervertebral/complicações , Deslocamento do Disco Intervertebral/complicações , Traumatismos da Medula Espinal/complicações , Bexiga Urinaria Neurogênica/etiologia
7.
BMC Neurol ; 19(1): 216, 2019 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-31481010

RESUMO

BACKGROUND: Sciatica is a condition that is characterised by radicular pain in the leg and primarily caused by a herniated lumbar intervertebral disk. In addition to leg pain, patients can experience back pain, leg numbness and leg weakness resulting in decreased productivity and social activity. The majority of sciatica cases recovers spontaneously and therefore patients are initially treated conservatively with oral pain medication. However, some patients experience intractable pain that severely impedes them and no consensus exists on the optimal conservative treatment to reduce this discomfort in the acute phase of sciatica. The aim of the TEIAS trial is to assess the effectiveness, cost-effectiveness and predictive capability on patient outcome of transforaminal epidural injection (TEI) compared to treatment with standard pain medication. METHODS: This study is designed as a prospective, open-label, mono-centered, randomized controlled trial. Patients that visit their general practitioner with complaints of radicular leg pain and meet the selection criteria are asked to participate in this study. Eligible patients will be randomized to treatment with TEI or to treatment with standard oral pain medication. Treatment of TEI will comprise lidocaine with methylprednisolone acetate for L3 and below and lidocaine with dexamethasone above L3. A total of 142 patients will be recruited and follow-up will occur after 1, 2, 4, 10 and 21 weeks for assessment of pain, functionality, patient received recovery and cost-effectiveness. The primary outcome will be the average score for leg pain at 2 weeks. For this outcome we defined a clinically relevant difference as 1.5 on the 11-point NRS scale. DISCUSSION: Adequate conservative treatment in the acute phase of sciatica is lacking, particularly for patients with severe symptoms. Focusing on effectiveness, cost-effectiveness and predictive capability on patient outcome of TEI will produce useful information allowing for more lucid decision making in the conservative treatment of sciatica in the acute phase. TRIAL REGISTRATION: This trial is registered in the ClinicalTrials.gov database under registry number NCT03924791 on April 23, 2019.


Assuntos
Degeneração do Disco Intervertebral/complicações , Deslocamento do Disco Intervertebral/complicações , Dor/etiologia , Ciática/terapia , Análise Custo-Benefício , Dexametasona/uso terapêutico , Humanos , Injeções Epidurais , Vértebras Lombares , Medição da Dor , Estudos Prospectivos
9.
J Neurol Surg A Cent Eur Neurosurg ; 80(6): 503-506, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31430795

RESUMO

Oxygen-ozone therapy is used to treat degenerative pathology of the spine when surgery is not needed (e.g., removal of a herniated disk). Some authors have described it as a safe and effective procedure in ∼ 70 to 90% of patients. The aim of the therapy is to dehydrate the intervertebral disk and alter its contents. However, this treatment has been associated with some rare but very serious side effects. Both cardiac damage and a case of fulminant septicemia were reported. We describe a case of suspected pulmonary embolism, followed by sudden death, in an elderly woman treated with oxygen-ozone therapy for lumbar pain caused by disk protrusion. We believe a massive pulmonary embolism occurred, probably caused by an intradiskal injection that accidentally punctured a venous vessel and created emboli.


Assuntos
Deslocamento do Disco Intervertebral/terapia , Dor Lombar/terapia , Oxigênio/efeitos adversos , Ozônio/efeitos adversos , Embolia Pulmonar/etiologia , Idoso de 80 Anos ou mais , Feminino , Humanos , Deslocamento do Disco Intervertebral/complicações , Dor Lombar/etiologia , Oxigênio/uso terapêutico , Ozônio/uso terapêutico
10.
World Neurosurg ; 132: 47-52, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31442650

RESUMO

BACKGROUND: With the continuous advancement of the spinal endoscopic technique in recent years, full-endoscopic operations provide a new approach for the treatment of migrated cervical disk herniation. CASE DESCRIPTION: A 42-year-old man presented with nuchal pain and limb numbness for 2 months, with recently developed symptoms of unstable walking. Physical examination revealed a diminished skin sensitivity to pain and temperature, beginning at the C4 dermatome. The muscle strength of both upper limbs decreased to grade 4, and the muscle strength was grade 4 on both sides of the lower limbs. Hoffmann sign and ankle clonus were positive. Magnetic resonance imaging (MRI) and computed tomography (CT) scan demonstrated that a large piece of a segmental disk had migrated to the rear area of the C4 vertebral body and seriously compressed the spinal cord. A percutaneous full-endoscopic anterior transcorporeal cervical diskectomy was performed on the patient. CONCLUSIONS: The postoperative Japanese Orthopaedic Association (JOA) score increased from 8 to 11 points. At 2-year follow-up, the JOA score was 16 points, the improvement rate was 88.9%, and cervical vertebrae MRI, cervical CT scan, and 3-dimensional reconstruction showed that the cervical vertebrae channel healed without vertebral fractures, bony channel collapse, adjacent segment degeneration, or intervertebral space height.


Assuntos
Vértebras Cervicais/cirurgia , Discotomia Percutânea/métodos , Deslocamento do Disco Intervertebral/cirurgia , Neuroendoscopia/métodos , Compressão da Medula Espinal/cirurgia , Adulto , Vértebras Cervicais/diagnóstico por imagem , Humanos , Deslocamento do Disco Intervertebral/complicações , Deslocamento do Disco Intervertebral/diagnóstico por imagem , Masculino , Compressão da Medula Espinal/diagnóstico por imagem , Compressão da Medula Espinal/etiologia
11.
Medicine (Baltimore) ; 98(31): e16545, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31374017

RESUMO

Abnormal cervical curvature and cervical disc herniation are closely related to neck pain and should be taken into account before any treatment. However, studies have rarely reported on the correlation between cervical lordosis and cervical disc herniation in patients with neck pain. Therefore, in this study, we collect young neck pain patients with abnormal cervical curvature to evaluate the relationship between cervical lordosis and cervical disc herniation.Three hundred patients below 40 years old with neck pain were enrolled. Patient sex, age, apical vertebra, segment of intervertebral disc protrusionl, sagittal diameter of spinal duramater, saggital diameter of spinal canal, height of disc space were recorded, and the cervical curvature, and degree of cervical spinal cord compression (G/F ratio) were calculated. The change of degree of disc herniation and degree of cervical spinal cord compression were analyzed in different cervical curvature groups. Further more, collected these patients who had improved cervical curvature over a period of time, to compare the changes of degree of disc herniation, G/F ratio, and height of disc space.The median age of patients with kyphosis was lower than those with lordosis and straight cervical spine. The degree of disc herniation was higher in the straight and kyphosis groups compared to the lordosis group. Cervical lordosis was inversely correlated with the degree of disc herniation and positively with G/F ratio. Cervical curvature was significantly affected by sex, age, and the degree of disc herniation. With the improvement of cervical lordotic curvature, the degree of disc herniation decreased and height of disc space increased.The degree of disc herniation and cervical spinal cord compression are inversely correlated to cervical lordosis in young neck pain patients, and the degree of disc herniation and height of disc space can recover with the recovery of cervical lordotic curvature. These findings may indicating a link between cervical curvature and degenerative changes which have important clinical implications.


Assuntos
Deslocamento do Disco Intervertebral/complicações , Lordose/complicações , Cervicalgia/etiologia , Adulto , Vértebras Cervicais/anormalidades , Distribuição de Qui-Quadrado , Feminino , Humanos , Masculino , Radiografia/métodos , Estatísticas não Paramétricas
12.
World Neurosurg ; 131: e408-e414, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31376560

RESUMO

OBJECTIVE: To investigate the occurrence and progression of heterotopic ossification (HO) in patients treated by anterior cervical discectomy with arthroplasty. It was evaluated if HO affects clinical outcome and range of motion (ROM). Risk factors of HO was studied as well. METHODS: Patients who underwent anterior cervical discectomy with arthroplasty for a cervical radiculopathy because of a herniated disc from the NECK and PROCON trial were analyzed for HO at 12 and 24 months postoperatively. HO was scored according to the McAfee-Mehren classification. The index ROM was defined by a custom developed image analysis tool, and global cervical ROM was measured by Cobb's angle. Clinical outcome was evaluated by means of the Neck Disability Index and the 36-Item Short Form Health Survey. RESULTS: The occurrence of HO was 60% at 1 year, and it increased to 76% at 2-year follow-up. A total of 31% of patients were scored as high-grade HO at 1-year follow-up, and this percentage increased to 50% at 2-year follow-up. Clinical outcome does not correlate to HO grade, and no risk factor for high-grade HO could be identified. The ROM at the index level was significantly higher in low-grade HO group than those patients with high-grade HO, but in 15%-38% HO grade does not correspond to ROM. CONCLUSIONS: HO occurs in three fourths of the patients at 2 years after surgery, but does not necessarily correspond to clinical outcome, nor loss or preservation of ROM. The McAfee-Mehren classification should be combined with ROM evaluation to properly study HO.


Assuntos
Artroplastia , Vértebras Cervicais/cirurgia , Discotomia , Deslocamento do Disco Intervertebral/cirurgia , Ossificação Heterotópica/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Radiculopatia/cirurgia , Amplitude de Movimento Articular , Adulto , Idoso , Feminino , Humanos , Deslocamento do Disco Intervertebral/complicações , Masculino , Pessoa de Meia-Idade , Ossificação Heterotópica/fisiopatologia , Complicações Pós-Operatórias/fisiopatologia , Radiculopatia/etiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
13.
Medicine (Baltimore) ; 98(29): e16396, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31335689

RESUMO

RATIONALE: Cauda equina syndrome (CES) refers to a group of symptoms that occur when the nerves in the cauda equina become compressed or damaged. The most common etiology of CES is lumbar intervertebral disc herniation, but CES following lumbar spinal surgery is rare, especially without motor dysfunction. Herein, we illustrate a case of CES that developed as a complication of spinal surgery and to deduce its possible underlying cause. PATIENT CONCERNS: A 46-year-old man experienced lumbago, bilateral shank pain, and numbness with neurogenic claudication for 3 years due to degenerative lumbar disc herniation and spinal cord stenosis. After a thorough examination to diagnose lumbar spinal stenosis, the patient underwent bilateral decompression and pedicle screw system internal fixation with bone graft. Postoperatively, the patient showed regained strength in his bilateral shanks, and he did not complain of lumbago and shank pain, but CES occurred, which manifested as underpants-type numbness in the perineum without bladder, anal, and motor dysfunction. DIAGNOSES: CES as a postoperative complication of lumbar stenosis. INTERVENTIONS: The patient underwent bilateral laminectomies, partial facetectomies, and pedicle screw system internal fixation and fusion with bone graft. Postoperatively, the patient performed adequate rehabilitation exercises and was expected to recover spontaneously. OUTCOMES: The symptoms of pain and claudication resolved after 3 weeks in the hospital, but an underpants-type hypoesthesia in the perineum without motor dysfunction developed. The patient experienced full recovery from CES 6 months after surgery. LESSONS: CES as a complication of lumbar spinal surgery is very rare. Excessive sensitivity to the traction of the dural sac was, in our opinion, the most possible cause of postoperative CES in this case. When the nerve root is pulled intraoperatively, it is best not to cross the central line of the spinous process. The plane of the nerve retractor needs to be parallel to the dural sac at the pulling point to reduce the formation of shear force. Most importantly, gentle maneuver is required because sensitivity to the traction of the dural sac varies individually.


Assuntos
Síndrome da Cauda Equina , Laminectomia , Vértebras Lombares/cirurgia , Complicações Pós-Operatórias , Fusão Vertebral , Estenose Espinal , Síndrome da Cauda Equina/diagnóstico , Síndrome da Cauda Equina/etiologia , Síndrome da Cauda Equina/fisiopatologia , Humanos , Degeneração do Disco Intervertebral/complicações , Degeneração do Disco Intervertebral/diagnóstico , Degeneração do Disco Intervertebral/fisiopatologia , Deslocamento do Disco Intervertebral/complicações , Deslocamento do Disco Intervertebral/diagnóstico , Deslocamento do Disco Intervertebral/fisiopatologia , Laminectomia/efeitos adversos , Laminectomia/métodos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/fisiopatologia , Fusão Vertebral/efeitos adversos , Fusão Vertebral/métodos , Estenose Espinal/diagnóstico , Estenose Espinal/etiologia , Estenose Espinal/fisiopatologia , Estenose Espinal/cirurgia , Resultado do Tratamento
14.
BMC Musculoskelet Disord ; 20(1): 280, 2019 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-31182078

RESUMO

BACKGROUND: Compared to anterior cervical discectomy and fusion (ACDF), cervical motion segment and disc was retained through anterior transcorporeal herniotomy (ATH). But surgical field and manipulation in traditional ATH was restricted by the narrow channel. Percutaneous full-endoscopic transdiscal cervical discectomy is a minimally invasive and functional spine surgery. However, significant loss of intervertebral disc height was inevitable. This study was done to illustrate the feasibility, safety, and efficacy and present our surgical experience of percutaneous full-endoscopic anterior transcorporeal cervical discectomy (PEATCD) and channel repair (CR) for the treatment of cervical disc herniation (CDH). METHODS: Four patients with CDH were chosen to undergo PEATCD and CR with a follow-up care for at least 22 months. The visual analogue score (VAS), Japanese Orthopedic Association (JOA), and modified Macnab criteria were recorded during the postoperative periods. CT images were obtained to observe the healing of the channel at 1 week and 3 months after the operation. RESULTS: The average operating time was 83.75 min. Drainage tubes were unnecessary. No procedure-related complications occurred. The postoperative VAS and JOA scores were improved compared to those of the preoperative assessment. The clinical efficacy was excellent in 3 patients and good in 1 patient at final follow up stage according to the modified Macnab criteria. The hernia was removed completely in all patients according to postoperative MRI. Migration of the repair implementation and collapse of the drilled vertebrae were not observed during the postoperative periods. The bony channel was nearly absent on CT images obtained at 3 months postoperative. CONCLUSION: This is the first time that the anterior transcorporeal cervical discectomy and CR have been performed simultaneously under endoscopy. Less damage to disc and the retained cervical motion segment were achieved through this method. This is a feasible, safe, and minimally invasive procedure. TRIAL REGISTRATION: Numbers: ChiCTR1800016383 . Registered 29 may 2018. Retrospectively registered. TRIAL REGISTRY: Chinese Clinical Trial Registry.


Assuntos
Vértebras Cervicais/cirurgia , Discotomia Percutânea/métodos , Endoscopia/métodos , Deslocamento do Disco Intervertebral/cirurgia , Cervicalgia/cirurgia , Adulto , Vértebras Cervicais/diagnóstico por imagem , Discotomia Percutânea/efeitos adversos , Endoscopia/efeitos adversos , Estudos de Viabilidade , Feminino , Seguimentos , Humanos , Deslocamento do Disco Intervertebral/complicações , Deslocamento do Disco Intervertebral/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Cervicalgia/diagnóstico , Cervicalgia/etiologia , Medição da Dor , Resultado do Tratamento
15.
World Neurosurg ; 129: e881-e889, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31226457

RESUMO

OBJECTIVE: To report on the incidence of Modic changes (MCs) in patients with cervical radiculopathy due to a herniated disc. Presence of MCs was correlated to clinical outcomes and the presence of radiological degeneration. METHODS: Patients that underwent anterior discectomy for a cervical radiculopathy due to a herniating disc were analyzed for the presence of MCs at baseline and at 1-year follow-up after surgery. Neck Disability Index, physical component summary, mental component summary, and visual analog scale for neck pain and for arm pain were evaluated as clinical outcomes. The presence of radiological degeneration was defined by the method of Goffin. RESULTS: The prevalence of MCs was found at 18% at baseline and increased to 28% one year after surgery. Both at baseline and at 1-year follow-up, the percentage of patients with and without MCs reporting neck pain was comparable. Likewise, both at baseline and at 1-year follow-up, the percentage of patients with and without MCs reporting disabling arm pain was comparable. At baseline, the patients with MC demonstrated more radiologic degeneration than those without MC (OR 0.42), but this difference disappeared at 1 year after surgery. CONCLUSIONS: MCs were not associated with neck pain, nor with arm pain. Furthermore, there was a tendency for a correlation between the presence of MCs and radiological degeneration.


Assuntos
Vértebras Cervicais/patologia , Vértebras Cervicais/cirurgia , Deslocamento do Disco Intervertebral/cirurgia , Adulto , Idoso , Artroplastia/métodos , Vértebras Cervicais/diagnóstico por imagem , Discotomia/métodos , Feminino , Humanos , Deslocamento do Disco Intervertebral/complicações , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Cervicalgia/epidemiologia , Cervicalgia/etiologia , Radiculopatia/etiologia , Fusão Vertebral/métodos , Resultado do Tratamento
16.
BMC Surg ; 19(1): 66, 2019 Jun 21.
Artigo em Inglês | MEDLINE | ID: mdl-31226967

RESUMO

BACKGROUND: Spontaneous intracranial hypotension (SIH) is a rare pathology caused by a cerebrospinal fluid (CSF) leak. If intractable by conventional methods (i.e. bedrest, analgesics, or epidural blood patching) it may lead to the inability of the patient to cope with daily life and eventually to life-threatening complications. Recently, calcified discogenic microspurs or dorsal osteophytes were identified as a major cause for ventral CSF loss through vertical longitudinal dural slits. We report a rare case of intractable SIH due to an intradural disc herniation at the thoracolumbar junction (without signs of calcification) and its management. CASE PRESENTATION: A 46-year old woman suffered from orthostatic headache (sudden onset, no history of trauma) due to intractable SIH for over 2 month (without neurologic deficits). There was no clinical amelioration by conservative measures (analgesics, bedrest) and serial unspecific epidural blood patches (repeated for 3 times). She was diagnosed with an intradural disc herniation at the thoracolumbar junction causing a CSF leak. Surgical exploration by a translaminar and transdural approach with removal of the disc herniation and closure of the CSF leak was performed with immediate cessation of orthostatic symptoms. Histological workup revealed non-calcified intervertebral disc material. After 3 months of follow-up and no evidence for clinical relapse the patient returned to work. CONCLUSIONS: We report the rare phenomenon of an intradural non-calcified disc sequester at the thoracolumbar junction as the cause of a ventral dural tear leading to a CSF leak with intractable SIH. This is of particular interest as the major cause of ventral dural leakage is thought to arise from calcified discogenic microspurs or dorsal osteophytes. Furthermore, we comprehensively describe a short and reasonable diagnostic and surgical approach of this rare pathology, which may particularly be of use in daily clinical routine in neurological wards and general surgical spine centers not facing such pathologies on a regular basis.


Assuntos
Cefaleia/etiologia , Degeneração do Disco Intervertebral/complicações , Deslocamento do Disco Intervertebral/complicações , Hipotensão Intracraniana/etiologia , Placa de Sangue Epidural , Vazamento de Líquido Cefalorraquidiano , Feminino , Humanos , Deslocamento do Disco Intervertebral/cirurgia , Laminoplastia , Vértebras Lombares , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Vértebras Torácicas/cirurgia , Tomografia Computadorizada por Raios X
18.
Rev. Asoc. Argent. Ortop. Traumatol ; 84(2): 105-111, jun. 2019.
Artigo em Espanhol | LILACS | ID: biblio-1003018

RESUMO

Objetivo: Evaluar si la colocación de los dispositivos interespinosos siliconados tipo DIAM favorecen una tasa más alta de recidiva de la hernia discal homolateral clínica y por imágenes comparada con la discectomía pura. Materiales y Métodos: Se realizó un estudio prospectivo, observacional, aleatorizado desde mayo de 2009 hasta mayo de 2013, en nuestro Centro. Se evaluó a 123 pacientes, 3 se perdieron en el seguimiento; la muestra incluyó 120 sujetos. Todos fueron operados por el mismo equipo quirúrgico. Se formaron dos grupos: grupo A: discectomía más colocación de dispositivo interespinoso siliconado, 30 pacientes (16 mujeres y 14 hombres), con mayor frecuencia L4-L5 (27 pacientes, 90%) y grupo B: discectomías puras, 90 pacientes (53 mujeres y 37 hombres) con más frecuencia L4 y L5 (72 pacientes, 80%). Resultados: Seis de los pacientes del grupo A (20%) tuvieron una recidiva clínica y por imágenes, y 3 (10%) fueron operados nuevamente; en el grupo B, hubo 4 recidivas discales (4,4%), uno fue operado nuevamente (1,1%). Se hallaron diferencias significativas en las tasas de recidiva y reintervención entre los grupos (p = 0,0073 y p = 0,0188, respectivamente). Conclusiones: Los beneficios de los dispositivos interespinosos para tratar el canal estrecho lumbar secundario a hernia de disco son controvertidos, pero en nuestro estudio, se halló una diferencia significativa según el grupo. Al mantener el movimiento del segmento y cambiar ligeramente las cargas fisiológicas aumentarían la tasa de recidiva discal; no obstante, son necesarios estudios con mayor evidencia científica para corroborar estas tendencias. Nivel de Evidencia: III


Objective: The objective of this study was to determine if discectomy with placement of an interspinous DIAM silicon spacer is associated with a different rate of clinical and radiological recurrent ipsilateral disc herniation compared to discectomy alone. Methods: A prospective, observational, randomized study was performed from May 2009 to May 2013 at our center. Of the 123 patients included in the study, 3 were lost to follow-up, leaving 120 patients for data analysis. All patients were operated on by the same surgical team. Patients received one of two types of treatment. Group A consisted of 30 patients (16 women and 14 ment) who underwent discectomy with placement of an interspinous DIAM silicone spacer. Group B was comprised of 90 patients (53 women and 37 men) treated by discectomy alone. Results: Discectomy at L4-L5 level was the most common approach, being performed in 90% (27) of Group A patients and 80% (72) of Group B patients. Group A demonstrated clinical and radiological recurrent disc herniation in 6/30 (20%) patients. Recurrent disc herniation developed in 4/90 (4.4%) of Group B patients. One patient underwent surgical revision (1.1%). Both recurrence and surgical revision were significantly higher in Group A (p = 0.007 and p = 0.019, respectively). Conclusions: The benefits of interspinous devices for the treatment of the lumbar spinal stenosis secondary to disc herniation are controversial, and this study showed a significant intergroup difference. In this study, patients that underwent discectomy and interspinous spacer placement had higher revision and recurrence rates than discectomy patients that did not receive an interspinous spacer. Interspinous spacers may increase the rate of disc herniation by preserving movement at the level of the original disc herniation and changing the physiologic load. Further studies are needed to corroborate and evaluate these trends. Level of Evidence: III


Assuntos
Adulto , Pessoa de Meia-Idade , Recidiva , Fixadores Internos/efeitos adversos , Discotomia , Deslocamento do Disco Intervertebral/complicações , Vértebras Lombares/cirurgia , Seguimentos , Falha de Tratamento
19.
World Neurosurg ; 128: e562-e569, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31048055

RESUMO

OBJECTIVE: We aimed to discuss the surgical strategies, safety and clinical efficacy of percutaneous endoscopic transforaminal decompression for the treatment of patients with migrated lumbar disc herniation. METHODS: This is a retrospective study. From May 2014 to April 2017, a total of 56 patients (32 men and 24 women) with migrated lumbar disc herniation were operated on by percutaneous endoscopic decompression via transforaminal approach. All enrolled patients had clinical symptoms with radiculopathy, and were identified as single-level, soft herniated disc by computed tomography and magnetic resonance imaging. Clinical efficacy were evaluated chiefly by leg pain visual analogue scale score, Oswestry disability index score, and modified MacNab criteria. RESULTS: Patients were all successfully treated by percutaneous endoscopic transforaminal decompression, with an mean operation time of 63 ± 12 minutes. The patients were followed up for a mean duration of 15 ± 2.7 months (range 12-18 months). The leg pain visual analogue scale score was dropped from 8.2 ± 1.9 preoperatively to 2.4 ± 1.5, 2.2 ± 1.3, and 1.8 ± 1.1 at 1, 6, and 12 months after the operation, respectively. Similarly, the Oswestry disability index score was also decreased from 62.4 ± 8.2 preoperatively to 18.4 ± 6.2, 12.6 ± 5.1, and 9.2 ± 3.4 at 1, 6, and 12 months postoperatively. There were 38 excellent cases, 13 good cases, and 5 fair cases by the assessment method of modified MacNab criteria at 12 months after the operation, with an excellent and good rate of 91.07%. Two cases were complicated with low extremity numbness, which were recovered by conservative treatment in 3 weeks. No persistent neurological deficit or infection occurred in this group postoperatively. CONCLUSIONS: We consider that percutaneous endoscopic decompression via transforaminal approach provided a safe, effective and minimally invasive alternative for the treatment of patients with migrated lumbar disc herniation.


Assuntos
Descompressão Cirúrgica/métodos , Discotomia Percutânea/métodos , Deslocamento do Disco Intervertebral/cirurgia , Vértebras Lombares/cirurgia , Radiculopatia/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Deslocamento do Disco Intervertebral/complicações , Masculino , Pessoa de Meia-Idade , Neuroendoscopia/métodos , Radiculopatia/etiologia , Estudos Retrospectivos , Resultado do Tratamento
20.
BMC Musculoskelet Disord ; 20(1): 202, 2019 May 10.
Artigo em Inglês | MEDLINE | ID: mdl-31077179

RESUMO

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


Assuntos
Mediadores da Inflamação/sangue , Deslocamento do Disco Intervertebral/diagnóstico , Dor Lombar/etiologia , Dor Referida/etiologia , Ciática/diagnóstico , Adulto , Idoso , Biomarcadores/sangue , Estudos de Casos e Controles , Diagnóstico Diferencial , Estudos de Viabilidade , Feminino , Humanos , Deslocamento do Disco Intervertebral/sangue , Deslocamento do Disco Intervertebral/complicações , Perna (Membro) , Estudos Longitudinais , Dor Lombar/sangue , Região Lombossacral/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Dor Referida/sangue , Atenção Primária à Saúde/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Ciática/sangue , Ciática/complicações
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA