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1.
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
2.
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
3.
Medicine (Baltimore) ; 99(43): e22792, 2020 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-33120796

RESUMO

RATIONALE: We report a case of Schmorl node induced multiple radiculopathy. PATIENT CONCERNS: A 70-year-old female patient complained of lower back pain in the left leg accompanied by numbness and weakness. DIAGNOSIS: Radiographs showed obvious osteoporosis in the lumbar vertebrae. Computed tomography demonstrated a hole in the upper posterior half of the L2 vertebral body. Magnetic resonance imaging of the lumbar spine revealed a herniated disc involving a protrusion at the posterior wall of the L2 vertebral body, which was present in the left lateral and dorsal epidural spaces. There was significant lumbar stenosis at the L2 vertebral body secondary to dural sac compression due to the mass. INTERVENTION: Left-sided hemilaminectomy was performed at L2 with screw fixation at L1-3. Intraoperatively, the severely ruptured disc compression in the dural sac and nerve root was removed. OUTCOMES: The patient's leg pain was immediately resolved, and her back pain was reduced. The patient recovered normal motor function at 20 days after surgery. LESSONS: A Schmorl node can progress and break through the lumbar vertebral body, resulting in nerve compression. A large proximal herniated mass can cause distal multiple radiculopathy. Therefore, this special case of Schmorl node with multiple radiculopathy should be treated by removing the proximal herniated nucleus pulposus from the vertebral body.


Assuntos
Deslocamento do Disco Intervertebral/complicações , Vértebras Lombares/patologia , Radiculopatia/etiologia , Idoso , Constrição Patológica , Feminino , Humanos , Deslocamento do Disco Intervertebral/cirurgia , Laminectomia/métodos , Dor Lombar , Vértebras Lombares/cirurgia , Osteoporose/complicações
4.
Pain Physician ; 23(5): 477-484, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32967390

RESUMO

BACKGROUND: Intradiscal ozone therapy, a minimally invasive technique, is used in patients that do not respond to standard conservative therapies for low back pain due to degenerative disc-induced lumbar disc herniation (LDH). Many studies on clinical efficacy lack a standardized injection method and are limited by inadequate study design. OBJECTIVE: This study aimed to determine the efficacy of periforaminal steroid injection together with intradiscal ozone therapy. STUDY DESIGN: A prospective, double-blinded, randomized controlled trial. SETTING: A tertiary care center. METHODS: This study was conducted in 65 patients with low back and leg pain caused by LDH. Group 1 received intradiscal ozone therapy (n = 35) and Group 2 received intradiscal ozone therapy with periforaminal steroid injection (n = 30). Patients were evaluated for pain using the visual analogue scale (VAS), for disability using Oswestry Disability Index (ODI), and for quality of life using the short form 36 health survey administered pre-injection and at one and 6 months post-injection. All procedures were performed under sterile conditions using C-arm fluoroscopy. RESULTS: Significant improvements were observed in pain, disability, and quality of life in both groups post-treatment compared to pre-injection. Mean pre-injection VAS was not significantly different between the groups (VAS: 7.8 ± 1.1 for Group 1, 7.8 ± 1.2 for Group 2). VAS values at 6 months for Group 1 and Group 2 were as follows: 3.6 ± 2.4, 4.1 ± 1.6, respectively) (P < 0.001). Mean pre-injection ODI was not significantly different between the groups (ODI: 20.9 ± 9.6 for Group 1, 25.2 ± 10.3 for Group 2). ODI values at 6 months for Group 1 and Group 2 were as follows: 12.8 ± 9.2, 14.3 ± 7.2, respectively) (P < 0.001). However, there were no significant differences between the groups. Similarly, there was no significant difference between the 2 groups on any of these parameters. LIMITATIONS: A limited number of patients and limited follow-up time. CONCLUSION: This study showed that intradiscal ozone injection alone was sufficient to treat low back and leg pain caused by LDH and that periforaminal steroid injection does not provide additional benefit, which is contrary to the literature.


Assuntos
Quimiólise do Disco Intervertebral/métodos , Deslocamento do Disco Intervertebral/cirurgia , Ozônio/administração & dosagem , Esteroides/administração & dosagem , Adulto , Método Duplo-Cego , Feminino , Humanos , Injeções Espinhais/métodos , Deslocamento do Disco Intervertebral/complicações , Dor Lombar/tratamento farmacológico , Dor Lombar/etiologia , Vértebras Lombares , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento
5.
Pain Physician ; 23(5): E535-E540, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32967404

RESUMO

BACKGROUND: Discogenic pain is recognized as the most important and most common cause of low back pain (LBP). Intradiscal pulsed radiofrequency (ID-PRF) is used for the treatment of chronic discogenic pain. OBJECTIVES: We investigated the effects of the duration of percutaneous monopolar ID-PRF application on chronic discogenic LBP. STUDY DESIGN: Retrospective study. SETTING: Department of Anesthesiology and Pain Medicine, Neurosurgery at Wooridul Spine Hospital. METHODS: Forty-five patients were included in this retrospective study. The patients were assigned into 2 groups according to the duration of the PRF procedure they underwent (7-minute group = 17 patients vs. 15-minute group = 28 patients). The main outcome measures tested were pain score, as determined by the Numeric Rating Scale (NRS-11) and the Oswestry Disability Index (ODI), at baseline, at 2-week, and 6-month follow-up visits. Success was defined as a reduction in NRS-11 of 50% or more or an ODI reduction of 40% or more. RESULTS: The mean posttreatment pain scores at 2 weeks and 6 months were significantly lower (P < 0.05) in both groups, but the differences between the groups were not significant. ODI scores were also significantly lower compared with the baseline, but the differences between the groups were not significant. At the 6-month follow-up, 12 patients (70.6%) in the 7-minute group and 20 patients (71.4%) in the 15-minute group reported more than 50% reduction in the pain score (P = 0.16), and there was no significant difference between the 2 groups in the number of patients with more than 40% reduction in ODI score (P = 0.23). LIMITATIONS: This study was performed with a small sample size and there was no control group. Additional well-designed and well-controlled studies that include parameters such as the stimulation duration, mode, and intensity of PRF are needed to fully assess the efficiency of ID-PRF. CONCLUSIONS: ID-PRF was shown to be effective for the treatment of discogenic LBP regardless of duration of ID-PRF application (7 vs. 15 minutes).


Assuntos
Degeneração do Disco Intervertebral/complicações , Deslocamento do Disco Intervertebral/complicações , Dor Lombar/etiologia , Dor Lombar/terapia , Tratamento por Radiofrequência Pulsada/métodos , Adulto , Dor Crônica/etiologia , Dor Crônica/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
6.
Expert Rev Med Devices ; 17(9): 945-949, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32880493

RESUMO

Lumbosacral disc herniation (LDH) represents the most common cause of sciatica. Currently, there is limited evidence about minimally invasive interventional therapies for the treatment of this condition. This paper presents the protocol for a multicenter, prospective, randomized, controlled, phase III trial evaluating if PRF in addition to TFESI leads to better outcomes in patients with sciatica due to LDH, compared to TFESI alone, during the first year after treatment (Pulsed Radiofrequency in Addition to TFESI for Sciatica [PRATS]). Eligible patients are between 18 and 75 years of age, suffer from sciatica of less than 12-week duration with pain intensity >4 on the Visual Analogue Scale (VAS) and have unilateral LDH compatible with symptoms at MRI. The Medical Ethics Committee of participating hospitals approved the study protocol. Patients will be randomized to receive either combined treatment (PRF and TFESI) or TFESI alone. The primary outcome will be the assessment of pain intensity with VAS at different timepoints from week-1 to 52 after treatment; secondary outcomes will include Roland Disability Questionnaire for sciatica and Oswestry Disability Index, evaluated at 4, 12 and 52 weeks. The follow-up will last 52 weeks for each patient. Statistical analysis will be performed on a per-protocol basis.


Assuntos
Deslocamento do Disco Intervertebral/terapia , Tratamento por Radiofrequência Pulsada , Ciática/terapia , Esteroides/uso terapêutico , Doença Aguda , Terapia Combinada , Humanos , Injeções Epidurais/efeitos adversos , Injeções Epidurais/métodos , Deslocamento do Disco Intervertebral/complicações , Deslocamento do Disco Intervertebral/tratamento farmacológico , Avaliação de Resultados em Cuidados de Saúde , Estudos Prospectivos , Tratamento por Radiofrequência Pulsada/efeitos adversos , Ciática/complicações , Ciática/tratamento farmacológico , Resultado do Tratamento
7.
Ann Intern Med ; 173(4): JC20, 2020 08 18.
Artigo em Inglês | MEDLINE | ID: mdl-32805169

RESUMO

SOURCE CITATION: Bailey CS, Rasoulinejad P, Taylor D, et al. Surgery versus conservative care for persistent sciatica lasting 4 to 12 months. N Engl J Med. 2020;382:1093-102. 32187469.


Assuntos
Deslocamento do Disco Intervertebral , Ciática , Humanos , Deslocamento do Disco Intervertebral/complicações , Deslocamento do Disco Intervertebral/cirurgia , Perna (Membro) , Vértebras Lombares/cirurgia , Dor , Ciática/etiologia , Ciática/terapia
8.
World Neurosurg ; 140: 548-555, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32797986

RESUMO

BACKGROUND: Cervical spondylotic myelopathy (CSM) is a degenerative disease that represents the most common spinal cord disorder in adults. The best treatment option has remained controversial. We performed a prospective study to evaluate the clinical, radiographic, and neurophysiologic outcomes for anterior cervical corpectomy in the treatment of CSM. METHODS: From January 2011 to January 2017, 60 patients with CSM were prospectively enrolled in the present study. The patients were divided according to the modified Japanese Orthopaedic Association scale (mJOA) score into 2 groups: group A, patients with mild to moderate CSM (mJOA score ≥13); and group B, patients with severe myelopathy (mJOA score <13). Data were collected for each participating subject, including demographic information, symptoms, medical history, radiologic and neurophysiologic features, and functional impairment. RESULTS: Of the 60 patients, 35 were men (58.3%) and 25 were women (41.7%). Their average age was 57.48 ± 10.60 years. The mean symptom duration was 25.33 ± 16.00 months; range, 3-57 months). Of the 60 patients, 22 had undergone single-level corpectomy and 36 multilevel corpectomy. A significant improvement in the motor evoked potentials was observed in both groups. CONCLUSIONS: Single- and multilevel corpectomy are valid and safe options in the treatment of CSM. In the present prospective study, a statistically significant improvement in the mJOA score and neurophysiologic parameters was observed for both moderate and severe forms of CSM.


Assuntos
Vértebras Cervicais/cirurgia , Descompressão Cirúrgica/métodos , Compressão da Medula Espinal/cirurgia , Espondilose/cirurgia , Adulto , Idoso , Feminino , Humanos , Degeneração do Disco Intervertebral/complicações , Degeneração do Disco Intervertebral/fisiopatologia , Degeneração do Disco Intervertebral/cirurgia , Deslocamento do Disco Intervertebral/complicações , Deslocamento do Disco Intervertebral/fisiopatologia , Deslocamento do Disco Intervertebral/cirurgia , Masculino , Pessoa de Meia-Idade , Ossificação do Ligamento Longitudinal Posterior/complicações , Ossificação do Ligamento Longitudinal Posterior/fisiopatologia , Ossificação do Ligamento Longitudinal Posterior/cirurgia , Estudos Prospectivos , Índice de Gravidade de Doença , Compressão da Medula Espinal/etiologia , Compressão da Medula Espinal/fisiopatologia , Fusão Vertebral , Espondilose/complicações , Espondilose/fisiopatologia , Resultado do Tratamento , Adulto Jovem
9.
Pan Afr Med J ; 35: 103, 2020.
Artigo em Francês | MEDLINE | ID: mdl-32637001

RESUMO

Lumbosciatica is a public health problem because of its socio-professional impact. The purpose of our study is to evaluate the indication for surgical treatment and the role of each technique used. We conducted a retrospective study in the Department of Orthopaedics in Tataouine. The study involved 44 patients with common lumbosciatica and having undergone surgical treatment over the period from 2013 to 2018. The information sheet included the epidemiological data and the clinical data. The patients underwent radiological assessment including lumbar spine x-ray (frontal and lateral views) and lumbar computed scan (CT) scan which clarified the cause of sciatica. Surgical treatment was indicated after medical treatment failure, in patients with hyperalgesia and in patients with neurological complication. In our study, herniated disc was the primary cause of lumbosciatica (50% of cases) followed by lumbar spinal stenosis (25%), spondylolisthesis (22.7%) and transverse mega-apophysis of L5 vertebrae (2.3%). Traditional discectomy was the most used technique for surgical treatment of herniated disc. Eight patients had spondylolisthesis. They underwent laminectomy associated with posterior arthrodesis. Lumbar spinal stenosis was treated with laminectomy alone in 54.54% of cases. Outcome was favorable during the follow up period in 90% of cases (Visual Analog Scale 3±1 at follow-up). Surgical technique depends on etiology and imaging data on which to base the choice of arthrodesis stages.


Assuntos
Deslocamento do Disco Intervertebral/cirurgia , Vértebras Lombares/diagnóstico por imagem , Ciática/cirurgia , Estenose Espinal/cirurgia , Discotomia , Feminino , Seguimentos , Humanos , Deslocamento do Disco Intervertebral/complicações , Laminectomia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Ciática/etiologia , Estenose Espinal/complicações , Espondilolistese/complicações , Espondilolistese/cirurgia , Tomografia Computadorizada por Raios X , Tunísia
10.
Medicine (Baltimore) ; 99(21): e20083, 2020 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-32481274

RESUMO

We developed a protocol for a prospective registry to prove the effectiveness and safety of integrative Korean medicine treatment for inpatients with sciatica due to lumbar intervertebral disc herniation. We plan on recruiting 1000 inpatients receiving integrative Korean medicine treatment for lumbar intervertebral disc herniation at four spine specialized Korean medical hospitals. Patients enrolled in the registry will be evaluated at the time of hospitalization, 2 weeks after hospitalization, at discharge, and 6 months after hospitalization on predefined outcome variables such as intensity of back and leg pain, Oswestry Disability Index, quality of life, Patient Global Impression of Change, and adverse effects. The protocol of this study was registered in CRIS (KCT0003709) and Clinical trial gov (NCT03750591). This study is significant in that it cannot only be a basis for safety-related evidence of complementary alternative medicine, which has been lacking, but it also gives clear evidence on the effectiveness and validity of treatment effects such as accompaniment of stenosis, sex, age, and type of disc herniation.


Assuntos
Medicina Integrativa/métodos , Deslocamento do Disco Intervertebral/terapia , Medicina Tradicional Coreana/métodos , Ciática/terapia , Terapia por Acupuntura/métodos , Adulto , Idoso , Humanos , Deslocamento do Disco Intervertebral/complicações , Pessoa de Meia-Idade , Estudos Observacionais como Assunto , Estudos Prospectivos , Sistema de Registros , República da Coreia , Ciática/etiologia , Resultado do Tratamento , Adulto Jovem
11.
World Neurosurg ; 142: 147-151, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32599185

RESUMO

BACKGROUND: Intradural disc herniation (IDH) in the upper lumbar spine is rare. Preoperative radiologic diagnosis can be difficult, making operative planning challenging. We report on a 74-year-old female patient who was diagnosed with an L1-L2 IDH intraoperatively. This case report aims to highlight and discuss the radiological features of IDH and operative challenges when approaching IDH. CASE DESCRIPTION: A 74-year-old female patient presented to outpatient clinic with a 3-month history of significant intermittent neurological claudication and severe lumbar back pain. Her examination was unremarkable apart from a positive left-sided femoral stretch test. Magnetic resonance imaging (MRI) revealed a large central L1/L2 disc herniation causing significant compression of the thecal sac and proximal cauda equina nerve roots. She underwent an elective posterior L1/L2 lumbar exploration. Intraoperatively, identification of the disc was difficult, which led to inadvertent cerebrospinal fluid leak after incision of what was thought to be a disc bulge. Further exploration revealed an intradural disc that was removed via durotomy. The thecal sac was repaired with sutures and TISSEEL (Baxter, Deerfield, Illinois, USA). Postoperatively, the patient complained of weak left lower limb; MRI revealed residual disc remnants causing compression of the cauda equina. She successfully underwent an urgent revision decompression procedure. She was discharged to rehabilitation on postoperative day 14 with weakness in left knee flexion and extension (MRC grade 4/5) and left ankle plantar- and dorsiflexion (MRC grade 2/5). CONCLUSIONS: Upper lumbar IDH represent a surgical challenge. Intraoperative considerations include identification of the disc, intentional or incidental durotomy, intradural discectomy, and anatomical restrictions of operating at the level proximal to the cauda equina.


Assuntos
Síndrome da Cauda Equina/cirurgia , Dura-Máter/cirurgia , Deslocamento do Disco Intervertebral/cirurgia , Vértebras Lombares/cirurgia , Idoso , Síndrome da Cauda Equina/complicações , Síndrome da Cauda Equina/diagnóstico por imagem , Dura-Máter/diagnóstico por imagem , Feminino , Humanos , Disco Intervertebral/diagnóstico por imagem , Disco Intervertebral/cirurgia , Deslocamento do Disco Intervertebral/complicações , Deslocamento do Disco Intervertebral/diagnóstico por imagem , Vértebras Lombares/diagnóstico por imagem
12.
Pain Physician ; 23(3): 325-332, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32517399

RESUMO

BACKGROUND: Foraminal stenosis, defined as a narrowing of the cervical neural foramen, is one of the most common causes of upper extremity radicular pain. OBJECTIVES: The aim of our study was to determine the effects of the severity of neural foraminal stenosis and spinal herniation level on treatment success in patients treated with interlaminar epidural steroid injections (ILESI) due to cervical disc herniation-related radiculopathy and their possible predictive roles. STUDY DESIGN: A retrospective assessment. SETTING: A university hospital interventional pain management center. METHODS: We performed our study between August 2017 and February 2019, retrospectively. All patients' demographic characteristics, clinical and demographic data, including pain scores before and after cervical ILESI in the first hour, third week, and third month follow-ups, presence of motor deficits, symptom side, symptom duration before cervical ILESI, and whether there was progression to surgery in the 3-month period after injection, were collected. RESULTS: We evaluated 61 patients in the final analysis. When the spinal herniation levels and foraminal stenosis grades were compared, there was a significant difference between the groups (P = 0.003, P = 0.005). We reported significant correlations between foraminal stenosis grade (odds ratio [OR], -0.425, P = 0.038) and spinal herniation level (OR, -0.925, P = 0.001) and treatment success. LIMITATIONS: Our study's design was retrospective. CONCLUSIONS: Cervical ILESI is a reliable treatment option that provides a significant reduction in pain of patients with cervical radiculopathy. However, the success of ILESI treatment may be negatively affected in these patients in the presence of high spinal level cervical disc herniation and severe foraminal stenosis. Therefore considering these 2 parameters in predicting the patient population who will benefit from cervical ILESI is of importance in terms of decreasing potential complications. KEY WORDS: Interlaminar epidural steroid injections, foraminal stenosis, spinal level, cervical disc herniation, radicular pain.


Assuntos
Degeneração do Disco Intervertebral/patologia , Deslocamento do Disco Intervertebral/patologia , Radiculopatia/tratamento farmacológico , Radiculopatia/etiologia , Corticosteroides/administração & dosagem , Adulto , Constrição Patológica/complicações , Constrição Patológica/patologia , Feminino , Humanos , Injeções Epidurais , Degeneração do Disco Intervertebral/complicações , Deslocamento do Disco Intervertebral/complicações , Masculino , Pessoa de Meia-Idade , Manejo da Dor/métodos , Estudos Retrospectivos , Resultado do Tratamento
13.
Pain Physician ; 23(3): E259-E264, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32517401

RESUMO

BACKGROUND: Cauda equina syndrome (CES) is a rare and serious syndrome that requires urgent surgery to improve neurological symptoms. CES can be caused by lumber disc herniation (LDH) and accounts for about 1% to 3% of all cases of disc herniation. OBJECTIVES: The purpose of this study was to analyze the characteristics and outcomes of the cases of patients with CES caused by LDH and treated by percutaneous endoscopic lumbar discectomy (PELD). STUDY DESIGN: This study used a retrospective design. SETTING: Research took place at the Jiangyin Hospital affiliated with Nanjing University of Chinese Medicine, Jiangsu, China. METHODS: This was a retrospective study of patients treated for CES due to LDH with PELD as an emergent surgery at a single institutional department between January 2015 and March 2018. The following variables were analyzed: age, gender, the level of disc prolapse, time interval between diagnosis and surgery, lower extremity pain or weakness, perianal sensation, voluntary anal contraction, presence of bladder dysfunction, and the reversal of these deficits in follow-up. RESULTS: After the emergent surgery with PELD, the lower extremity symptoms were all completely recovered or partly decreased. Only one patient had weakness with plantar flexion of the left foot at the one-year time point. The decreased perianal sensations were partly recovered after surgery, and 9 cases had complete recovery and 2 cases had partial recovery at the one-year follow-up. No patients had anal contraction and bladder problems after the one-year follow-up. LIMITATIONS: The number of cases reported here is limited, so we will expand the study by including an increased number of patients and a longer follow-up duration. CONCLUSION: Taken together, these observations show that PELD, used as a minimally invasive choice of emergent surgery, can provide enough decompression of disc prolapse and a satisfactory outcome for patients with CES caused by LDH. KEY WORDS: Cauda equina syndrome, lumbar disc herniation, outcomes, percutaneous endoscopic lumbar discectomy.


Assuntos
Síndrome da Cauda Equina/etiologia , Síndrome da Cauda Equina/cirurgia , Discotomia Percutânea/métodos , Deslocamento do Disco Intervertebral/complicações , Deslocamento do Disco Intervertebral/cirurgia , Adulto , China , Descompressão Cirúrgica/métodos , Endoscopia/métodos , Feminino , Humanos , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
14.
Pain Physician ; 23(3): E273-E280, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32517403

RESUMO

BACKGROUND: Results of the lumbar transforaminal epidural steroid injection (L-TFESI) used in the treatment of lumbar radiculopathy may be affected by the current psychiatric condition of the patient. OBJECTIVES: The study aimed to assess the effects of pretreatment comorbid psychiatric conditions on patient outcomes in patients with lumbar disc herniation and radiculopathy. STUDY DESIGN: The study used a prospective-observational study design. SETTING: Research was conducted at a university hospital international pain management center. METHODS: In this observational study, 103 patients were included. All patients were evaluated with the Hospital Anxiety and Depression scale (HADS) for depression and anxiety levels and the Somatosensory Amplification Scale (SSAS) for somatization levels before the L-TFESI. The treatment results were evaluated with the Numeric Rating Scale (NRS) and the Oswestry Disability Index (ODI) at baseline, the third week, and the third month. Relative to baseline, a 50% reduction in the NRS was accepted as a successful treatment. RESULTS: HADS-depression, HADS-anxiety, and SSAS levels were similar between the patients with successful treatment outcome and the patients in whom treatment failed. However, there were negative correlations between percent reduction in the NRS and the HADS-depression levels at 3 weeks (r = -0.182, P = .022) and 3 months (r = -0.204, P = .037). Also, there were positive correlations between patients' pre-injection ODI scores and both the HADS-anxiety (r = 0.271, P = .001) and SSAS (r = 0.201, P = .013) scores. LIMITATIONS: The study was limited by a relatively short-term follow-up period. CONCLUSIONS: Although psychiatric conditions affected the pain and disability of patients before and after the L-TFESI, and may have an impact on patient-related outcomes, they should not be a reason to not treat patients or expect a lower chance of success. KEY WORDS: Anxiety, depression, disc herniation, low-back pain, lumbar radiculopathy, patient-related outcomes, somatization, transforaminal epidural steroid injection.


Assuntos
Ansiedade/complicações , Depressão/complicações , Radiculopatia/tratamento farmacológico , Transtornos Somatoformes/complicações , Resultado do Tratamento , Adulto , Idoso , Anestésicos Locais/administração & dosagem , Anti-Inflamatórios/administração & dosagem , Bupivacaína/administração & dosagem , Feminino , Humanos , Injeções Epidurais/métodos , Deslocamento do Disco Intervertebral/complicações , Deslocamento do Disco Intervertebral/tratamento farmacológico , Dor Lombar/tratamento farmacológico , Dor Lombar/etiologia , Vértebras Lombares , Masculino , Pessoa de Meia-Idade , Manejo da Dor/métodos , Prednisolona/administração & dosagem , Prednisolona/análogos & derivados , Estudos Prospectivos , Radiculopatia/etiologia
15.
Health Qual Life Outcomes ; 18(1): 175, 2020 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-32522196

RESUMO

BACKGROUND: Although the Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ), Numerical Pain Rating Scale (NPRS), Oswestry Disability Index (ODI), Roland Morris Disability Questionnaire (RMDQ), and Short Form 36 Health Survey (SF-36) has shown a preferable psychometric properties in patients with low back pain (LBP), but no study has yet determined these in conservative treatment of patients with lumbar disc herniation (LDH). Thus the current study aimed to compare those scales in LDH patients receiving conservative treatment to select the better option to assess the severity of disease. METHODS: LDH patients were invited to complete the JOABPEQ, NPRS, ODI, RMDQ, and SF-36 twice. The internal consistency was evaluated by the Cronbach's α. Test-retest reliability was tested by the intraclass correlation coefficient (ICC). The relationships of these scales were evaluated by the Pearson correlation coefficients (r). The responsiveness was operationalised using the receiver operating characteristic (ROC) curve, as well as the comparison of smallest detectable change (SDC), minimum important change (MIC). RESULTS: A total of 353 LDH patients were enrolled. Four subscales of the Chinese JOABPEQ were over 0.70, then the ICCs for the test-retest reliability were over 0.75. For functional status, remarked negative correlations could be seen between JOABPEQ Q2-Q4 and ODI, as well as RMDQ (r = - 0.634 to - 0.752). For general health status, remarkable positive correlations could also be seen between Q5 Mental health and SF-36 PCS (r = 0.724) as well as SF-36 MCS (r = 0.736). Besides, the area under of the curves (AUC) of the JOABPEQ ranged from 0.743 to 0.827, indicating acceptale responsiveness, as well as the NPRS, ODI, and RMDQ. CONCLUSION: NPRS, and ODI or RMDQ is recommended in studies related to LDH patients, while if the quality of life also is needed to observe, the NPRS, and JOABPEQ would be more appropriate rather than SF-36.


Assuntos
Degeneração do Disco Intervertebral/terapia , Deslocamento do Disco Intervertebral/terapia , Dor Lombar/diagnóstico , Medição da Dor/normas , Inquéritos e Questionários/normas , Adulto , Tratamento Conservador , Feminino , Humanos , Degeneração do Disco Intervertebral/complicações , Deslocamento do Disco Intervertebral/complicações , Dor Lombar/etiologia , Masculino , Pessoa de Meia-Idade , Diferença Mínima Clinicamente Importante , Qualidade de Vida , Reprodutibilidade dos Testes
16.
Medicine (Baltimore) ; 99(20): e20216, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32443351

RESUMO

To determine the short-term clinical outcomes of single-segment cervical spondylotic radiculopathy treated with posterior percutaneous endoscopic cervical discectomy (PPECD).Data of a total of 24 patients who underwent PPECD and local anesthesia for single-level segmental cervical spondylotic radiculopathy between March 2016 and December 2017 were reviewed. The Japanese Orthopaedic Association, visual analog scale (VAS), and neck disability index scores at preoperative 1 day, postoperative 1 day, 1 week, 1 month, 3 months, 6 months, and 1 year were recorded. The modified MacNab criteria at the last follow-up were re-recorded for the evaluation of clinical effectiveness.All operations were successfully completed under endoscopic guidance. No patient showed spinal cord, nerve root, vascular injuries, dural tears or other complications. The postoperative VAS scores of the arm and neck were significantly reduced compared with the preoperative VAS scores (P < .05), while postoperative the Japanese Orthopaedic Association scores were significantly increased (P < .05). The postoperative neck disability index scores were significantly reduced compared with preoperative scores (P < .05). The modified MacNab criteria at the last follow-up showed 16 excellent cases, 8 good cases, 0 fine cases, and 0 poor cases. Postoperative magnetic resonance imaging and cervical 3-dimensional computed tomography reconstruction showed that the intervertebral disc was adequately resected and the nerve root was not under compression.PPECD is safe and effective for the treatment of single-segment cervical spondylotic radiculopathy.


Assuntos
Discotomia Percutânea/métodos , Radiculopatia/cirurgia , Adulto , Discotomia Percutânea/normas , Discotomia Percutânea/estatística & dados numéricos , Endoscopia/métodos , Feminino , Humanos , Deslocamento do Disco Intervertebral/complicações , Deslocamento do Disco Intervertebral/cirurgia , Masculino , Pessoa de Meia-Idade , Radiculopatia/complicações , Espondilose/etiologia , Espondilose/cirurgia , Resultado do Tratamento
17.
World Neurosurg ; 140: e311-e319, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32439561

RESUMO

BACKGROUND: Intracranial hypotension (IH) has a widely variable clinical and radiologic presentation. Secondary IH may be caused by degenerative spine disorders and in particular by thoracic disk herniations (TDHs). METHODS: We present 2 patients with a transdural TDH, a secondary IH, and superficial siderosis in 1. RESULTS: Case 1 presented with headache, cognitive decline, staggering gait, bilateral subdural effusions, cerebral sagging, an extradural spinal cerebrospinal fluid (CSF) collection suggesting secondary IH, and a calcified TDH at T9-T10. Case 2 presented with intermittent pain at the craniocervical junction provoked exclusively by specific physical activities, superficial siderosis mainly in the posterior fossa, an extradural spinal CSF collection, and a calcified TDH at T7-T8 yet no intracranial signs of IH. In both cases, using strict thoracoscopic technique, we removed a transdural TDH and reconstructed an underlying longitudinal slitlike dural defect with smooth lining. Follow-up magnetic resonance imaging scans confirmed a dramatically improved situation without residual extradural intraspinal CSF collection or signs of IH. CONCLUSIONS: This paper adds to the evidence that some cases of IH and even superficial siderosis are caused by transdural erosion of a TDH that may be otherwise asymptomatic. The dura may degenerate due to chronic compression, and a longitudinal slitlike dural defect with smooth lining may develop, causing continuous (Case 1) or intermittent (Case 2) intraspinal CSF leakage. To the best of our knowledge, such dural defects closely resembling the ones observed in idiopathic spinal cord herniation have never been demonstrated on intraoperative endoscopic video in IH patients.


Assuntos
Vazamento de Líquido Cefalorraquidiano/etiologia , Dura-Máter/lesões , Deslocamento do Disco Intervertebral/complicações , Hipotensão Intracraniana/etiologia , Toracoscopia/métodos , Adulto , Vazamento de Líquido Cefalorraquidiano/cirurgia , Dura-Máter/cirurgia , Humanos , Deslocamento do Disco Intervertebral/cirurgia , Masculino , Pessoa de Meia-Idade , Vértebras Torácicas/cirurgia
18.
J Clin Neurosci ; 77: 211-212, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32409217

RESUMO

We present a case of a midline thoracic disc herniation causing acute anterior spinal artery (ASA) syndrome successfully managed surgically. A 54-year-old female with no significant past medical history presented with sudden onset severe back pain followed by rapidly evolving paraparesis with urinary and bowel incontinence. Her neurological exam was consistent with ASA syndrome. An MRI revealed T2 signal change in the thoracic spinal cord and midline disc herniation at the level of T8/T9. Spinal angiography revealed an ASA arising the right T11 segmental artery with no flow towards the T8/T9 region. The patient underwent a T8/T9 discectomy with a lateral interbody fusion that resulted in dramatic clinical improvement. A postoperative angiogram confirmed improvement of flow in the ASA. This is the first report of an angiographically confirmed symptomatic ASA syndrome caused by a thoracic disc herniation successfully managed with up-front surgery.


Assuntos
Síndrome da Artéria Espinal Anterior/etiologia , Deslocamento do Disco Intervertebral/complicações , Deslocamento do Disco Intervertebral/cirurgia , Angiografia/métodos , Síndrome da Artéria Espinal Anterior/cirurgia , Dor nas Costas/etiologia , Discotomia/métodos , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Pessoa de Meia-Idade , Paraparesia/etiologia , Fusão Vertebral/métodos , Vértebras Torácicas/cirurgia
19.
Vet Surg ; 49(5): 884-893, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32277768

RESUMO

OBJECTIVE: To report recovery of ambulation of dogs treated with extended thoracolumbar durotomy for severe spinal cord injury caused by intervertebral disc herniation. STUDY DESIGN: Descriptive cohort. ANIMALS: Twenty-six consecutive paraplegic dogs presented with loss of deep pain sensation after acute thoracolumbar intervertebral disc herniation. METHODS: Each dog underwent routine diagnostic assessment and surgery for removal of extradural herniated intervertebral disc, followed by a four-vertebral body length durotomy centered on the herniated disc. Each dog was followed up until it was able to walk 10 steps without assistance or until 6 months after surgery. RESULTS: Sixteen of 26 dogs recovered to walk unaided (all but one also recovered fecal and urinary continence), and six dogs did not; four dogs were lost to follow-up. One dog was euthanized because of signs consistent with progressive myelomalacia. There was no evidence of detrimental effects of durotomy within the period of study. Using Bayesian analysis, we found a point estimate of successful outcome of 71% with 95% credible interval from 52% to 87%. CONCLUSION: Extended durotomy seemed to improve the outcome of dogs in our case series without increase in morbidity. CLINICAL SIGNIFICANCE: Extended durotomy appears safe and may improve the outcome of dogs with severe thoracolumbar mixed contusion and compressive injuries associated with acute intervertebral disc extrusion.


Assuntos
Doenças do Cão/cirurgia , Dura-Máter/cirurgia , Deslocamento do Disco Intervertebral/veterinária , Traumatismos da Medula Espinal/veterinária , Animais , Estudos de Coortes , Cães , Feminino , Deslocamento do Disco Intervertebral/complicações , Deslocamento do Disco Intervertebral/cirurgia , Masculino , Traumatismos da Medula Espinal/etiologia , Traumatismos da Medula Espinal/cirurgia
20.
World Neurosurg ; 138: e867-e875, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32251813

RESUMO

BACKGROUND: In the present randomized prospective study, we compared the surgical invasiveness using a quantitative volumetric analysis of postoperative paravertebral muscle signal intensity changes between transforaminal full endoscopic lumbar discectomy (FELD) and open discectomy (OD). METHODS: We prospectively collected the data from 50 patients with a single-level lumbar foraminal herniation, invalidating radicular pain, and adequate imaging studies available (postoperative magnetic resonance imaging [MRI] <24 hours). These patients had been randomly assigned to FELD (n = 25) or OD (n = 25). Data were collected on age, sex, leg and back pain, complications, and follow-up time. Muscle segmentations were performed manually using 3DSlicer software on postoperative isovolumetric T1-weighted contrast-enhanced and T2-weighted short tau inversion recovery MRI scans. Both sequences were processed using multiplanar reconstruction in orthogonal planes. The clinical and demographic characteristics and volumetric data were then compared between the 2 groups. RESULTS: We found a higher mean volume of paravertebral muscle signal alterations among the OD-treated patients in both T2-weighted short tau inversion recovery MRI (P ≤ 0.001) and T1-weighted contrast-enhanced MRI (P ≤ 0.001) scans than among the FELD-treated patients. No differences were found between the median preoperative and postoperative leg pain between the 2 groups (P = 1.000). The median scores for postoperative back pain were significantly lower for the FELD group (P ≤ 0.001), as was the median interval from surgery to autonomous mobilization (P = 0.001). CONCLUSIONS: We found a significant difference in signal intensity of the paravertebral muscles between the FELD and OD groups, reflective of the minor surgical invasiveness of endoscopic discectomy. FELD resulted in less trauma to the paraspinal muscles, possibly also reducing inflammatory cytokine release and, therefore, is a valuable tool for spinal surgeons.


Assuntos
Discotomia Percutânea , Endoscopia , Deslocamento do Disco Intervertebral/diagnóstico por imagem , Deslocamento do Disco Intervertebral/cirurgia , Músculo Esquelético/diagnóstico por imagem , Adulto , Idoso , Dor nas Costas/etiologia , Humanos , Deslocamento do Disco Intervertebral/complicações , Região Lombossacral , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Músculo Esquelético/cirurgia , Álcool Feniletílico/análogos & derivados , Estudos Prospectivos , Resultado do Tratamento , Adulto Jovem
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