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1.
Medicine (Baltimore) ; 100(9): e25012, 2021 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-33655971

RESUMO

ABSTRACT: Epidural steroid injections (ESI) are commonly performed for the treatment of chronic cervical disc herniation (CDH). Although they are considered to be effective for both nociceptive and neuropathic types of pain, there is a lack of data regarding the impact of neuropathic pain (NP) and nociceptive pain components on treatment outcomes. The aim of this study is to compare the effectiveness of interlaminar epidural steroid injection (ILESI) between patients with predominantly NP and nociceptive pain due to CDH.Sixty five participants were initially included in the study and assessed by numeric rating scale (NRS), neck pain and disability scale (NPDS), short form-12 (SF-12), and self-reported Leeds assessment of neuropathic symptoms and signs (S-LANSS) pain scale at baseline and 1 month, 3 months, 6 months after ILESI.All patients were evaluated at 1st month and 3rd month follow-up periods while 54 of patients achieved to complete 6th month follow-up. There were significant improvements in all outcome measures for all time periods when compared with the pre-intervention scores. At baseline 24 (36.9%) of patients had predominantly NP in accordance with S-LANSS pain scale. The ratio of NP predominant patients reduced to 7.6% at 1st month, 12.3% at 3rd month, and 12.9% at 6th month with a significant difference for each follow-up period when compared with the baseline. Although all NRS and NPDS scores at baseline were significantly higher in patients with NP, improvement was significant at all follow-up periods in both groups. Minimal clinically important change in NRS was observed in >75% of patients at 1st, 3rd, and 6th month in both groups.The results of this study showed that NP is present in one-third of the patients suffering from neck and radiating arm pain due to CDH and cervical ILESI is an effective treatment approach for both neuropathic and nociceptive components of pain.Clinical Trials Registration Number: NCT04235478.


Assuntos
Glucocorticoides/administração & dosagem , Deslocamento do Disco Intervertebral/tratamento farmacológico , Cervicalgia/etiologia , Neuralgia/etiologia , Adolescente , Adulto , Idoso , Vértebras Cervicais , Doença Crônica , Feminino , Humanos , Injeções Epidurais , Deslocamento do Disco Intervertebral/complicações , Deslocamento do Disco Intervertebral/diagnóstico , Masculino , Pessoa de Meia-Idade , Cervicalgia/diagnóstico , Neuralgia/diagnóstico , Medição da Dor , Prognóstico , Estudos Prospectivos , Adulto Jovem
3.
PLoS One ; 15(12): e0243861, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33315945

RESUMO

The Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ) was created to evaluate specific treatment outcomes in terms of physical functioning, social ability, and mental health in patients with back pain-related diseases. In this study, we investigated whether the JOABPEQ could be used to construct a regression model to quantify low back pain and lower limb symptoms in patients with lumbar disc herniation (LDH). We reviewed 114 patients with LDH scheduled to undergo surgery at our hospital. We measured the degrees of 1) lower back pain, 2) lower limb pain, and 3) lower limb numbness using the visual analog scale before the surgery. All answers and physical function data were subjected to partial least squares regression analysis. The degrees of lower back and lower limb pain could be used as a regression model from the JOABPEQ and had a significant causal relationship with them. However, the degree of lower limb numbness could not be used for the same. Based on our results, the questions of the JOABPEQ can be used to multilaterally understand the degree of lower back pain and lower limb pain in patients with LDH. However, the degree of lower limb numbness has no causal relationship, so actual measurement is essential.


Assuntos
Degeneração do Disco Intervertebral/diagnóstico , Deslocamento do Disco Intervertebral/diagnóstico , Dor Lombar/diagnóstico , Extremidade Inferior/patologia , Ortopedia , Sociedades Médicas , Inquéritos e Questionários , Feminino , Humanos , Degeneração do Disco Intervertebral/complicações , Deslocamento do Disco Intervertebral/complicações , Japão , Análise dos Mínimos Quadrados , Dor Lombar/complicações , Masculino , Pessoa de Meia-Idade , Análise de Regressão , Escala Visual Analógica
4.
J Vet Sci ; 21(4): e52, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32735091

RESUMO

BACKGROUND: Intradural-intramedullary intervertebral disc extrusion (IIVDE) is a rare condition of intervertebral disc disease. However, the diagnosis of IIVDE is challenging because the prognosis and imaging characteristics are poorly characterized. OBJECTIVES: We aimed to describe the clinical and imaging characteristics of tentatively diagnosed IIVDE in dogs to assess the prognostic utility of neurological grade and magnetic resonance imaging (MRI) findings. METHODS: Twenty dogs were included in this retrospective cohort study. RESULTS: Nonchondrodystrophic breeds (n = 16) were more predisposed than chondrodystrophic breeds. Most dogs showed acute onset of clinical signs. Neurological examination at admission showed predominant non-ambulatory paraparesis (n = 9); paresis (n = 16) was confirmed more frequently than paralysis (n = 4). Follow-up neurological examination results were only available for 11 dogs, ten of whom showed neurological improvement and 8 showed successful outcomes at 1 month. The characteristic MRI findings include thoracic vertebra (T)2 hyperintense, T1 hypointense, intramedullary linear tracts with reduced disc volume, and cleft of the annulus fibrosus. None of the MRI measurements were significantly correlated with neurological grade at admission. Neurological grade did not differ according to the presence of parenchymal hemorrhage, parenchymal contrast enhancement, and meningeal contrast enhancement. Neurological grades at admission showed a statistical correlation with those observed at the 1-month follow-up (r = 0.814, p = 0.02). CONCLUSIONS: IIVDE is a rare form of disc extrusion commonly experienced after physical activity or trauma and most frequently affects the cranial-cervical and thoracolumbar regions of nonchondrodystrophic dog breeds. Neurological score at admission emerged as a more useful prognostic indicator than MRI findings in dogs with suspected IIVDE.


Assuntos
Doenças do Cão/diagnóstico , Degeneração do Disco Intervertebral/veterinária , Deslocamento do Disco Intervertebral/veterinária , Vértebras Torácicas/patologia , Animais , Doenças do Cão/diagnóstico por imagem , Cães , Feminino , Degeneração do Disco Intervertebral/diagnóstico , Degeneração do Disco Intervertebral/diagnóstico por imagem , Deslocamento do Disco Intervertebral/diagnóstico , Deslocamento do Disco Intervertebral/diagnóstico por imagem , Imagem por Ressonância Magnética/veterinária , Masculino , Estudos Retrospectivos , Vértebras Torácicas/diagnóstico por imagem
5.
Pain Physician ; 23(4): 365-374, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32709171

RESUMO

BACKGROUND: Previous meta-analyses examined only the short-term differences between lidocaine and steroids vs lidocaine alone in treating lumbar degenerative diseases. Long-term outcomes (1-2 years) in patients with lumbar disc herniation (LDH) and lumbar central spinal stenosis (LCSS) have not yet been systematically evaluated. OBJECTIVE: The objective of our study was to assess quantitatively the difference in efficacy at 1 to 2 years between lidocaine alone vs lidocaine and steroids for the management of LDH or LCSS. STUDY DESIGN: We conducted a meta-analysis. METHODS: PubMed, EMBASE, and the Cochrane library were electronically searched up to July 22, 2016, for randomized controlled trials comparing lidocaine alone vs in combination with steroids for the treatment of LDH and LCSS. Effective pain relief (EPR), Numeric Rating Scale (NRS-11), Oswestry Disability Index (ODI), opioid intake (OI), and total employed increased rate (TEIR) were the endpoints. Risk ratios (RRs) or weighted mean difference (WMD) with 95% confidence intervals (CIs) were calculated, and the pooled analysis was conducted using RevMan 5.2. RESULTS: Seven trials were included. EPR was not significantly different at 1 and 2 years, with RR = 1.08 (95% CI, 0.90-1.30; P = .39) and RR = 1.04 (95% CI, 0.92-1.18; P = .51), respectively, in patients treated with lidocaine alone vs in combination with steroids. The NRS-11 was also similar at 1 and 2 years. ODI and OI were not significantly different at 1 and 2 years. A similar TEIR effect was also observed for the 2 treatments. LIMITATIONS: This meta-analysis relied on a small sample size of trials. Significant heterogeneity among studies was observed. Several significant differences in terms of age of the patients were reported in one included trial. CONCLUSION: This meta-analysis confirmed the similar effects associated with lidocaine alone vs in combination with steroids for the management of LDH and LCSS. Studies with longer follow-up periods are still recommended. KEY WORDS: Effective pain relief, lidocaine, long-term, lumbar central spinal stenosis, lumbar disc herniation, Numeric Rating Scale, opioid intake, Oswestry Disability Index, steroids, total employed increased rate.


Assuntos
Degeneração do Disco Intervertebral/tratamento farmacológico , Deslocamento do Disco Intervertebral/tratamento farmacológico , Lidocaína/administração & dosagem , Vértebras Lombares , Manejo da Dor/métodos , Estenose Espinal/tratamento farmacológico , Esteroides/administração & dosagem , Anestésicos Locais/administração & dosagem , Ensaios Clínicos como Assunto/métodos , Quimioterapia Combinada , Feminino , Humanos , Injeções Epidurais/métodos , Injeções Epidurais/tendências , Degeneração do Disco Intervertebral/diagnóstico , Deslocamento do Disco Intervertebral/diagnóstico , Dor Lombar/diagnóstico , Dor Lombar/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Manejo da Dor/tendências , Estenose Espinal/diagnóstico , Esteroides/uso terapêutico , Resultado do Tratamento
6.
Niger J Clin Pract ; 23(6): 835-841, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32525120

RESUMO

Aims: This study aims to investigate the effectiveness of transforaminal epidural steroid injection (TFESI) in patients with lumbar radicular pain or radiculopathy caused by different spinal pathologies. Methods: One hundred and seventy seven patients who underwent single transforaminal epidural steroid injection were included in the study group and divided into 3 subgroups (central spinal stenosis + lateral recess stenosis, foraminal stenosis, lumbar disc herniation) according to existing spinal pathology. Patients' visuel analogue scale (VAS) measures and Oswestry Disability Index (ODI) scores were recorded and the patients who give favourable response to treatment were called respondents and who were not called as non-respondents. Subgroups were compared statistically at the end of 12 months. Results: Sixty patients (33.9%) were considered as respondents and 117 patients (66.1%) were non-respondents in the entire study group. Patients with foraminal stenosis included the vast majority of the respondents and showed better results of pain relief as opposed to patients of other groups at the end of 12 months (P < 0.001). Conclusion: TFESI was an effective treatment modality for pain relief and functional improvement in patients with foraminal stenosis. However, it could not produce the same results in patients with central spinal stenosis and lumbar disc herniations.


Assuntos
Dor nas Costas/tratamento farmacológico , Injeções Epidurais/efeitos adversos , Deslocamento do Disco Intervertebral/diagnóstico , Vértebras Lombares/fisiopatologia , Medição da Dor/métodos , Radiculopatia/tratamento farmacológico , Estenose Espinal/tratamento farmacológico , Esteroides/administração & dosagem , Adulto , Idoso , Dor nas Costas/etiologia , Feminino , Humanos , Vértebras Lombares/efeitos dos fármacos , Região Lombossacral/fisiopatologia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Manejo da Dor/métodos , Medição da Dor/efeitos dos fármacos , Estudos Retrospectivos , Estenose Espinal/complicações , Estenose Espinal/diagnóstico , Esteroides/efeitos adversos , Resultado do Tratamento , Escala Visual Analógica
7.
Acta Orthop Traumatol Turc ; 54(3): 287-292, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32544064

RESUMO

OBJECTIVE: The aim of this study was to detect the relationship between the development of Schmorl's nodes (SNs) and bone mineral density (BMD) in young patients. METHODS: Computerized tomography (CT) images of the thoracolumbar vertebral column were retrospectively examined by two experienced radiologists for SNs. The diagnostic criterion for SN was defined as a node size larger than one-third but not more than two-thirds of the relevant vertebral endplate. Considering the eligibility criteria, a total of 74 individuals (60 males and 14 females; mean age: 24.3 years; age range: 18-40 years) with SN at the thoracolumbar vertebrae were included in the patient group, and a total of 38 age- and gender-matched individuals (30 males and 8 females; mean age: 25 years) with no evidence of SN were included in the control group. All these individuals were younger than 40 years. In the patient group, SNs were assessed in terms of the distribution of the thoracolumbar vertebrae, the location of the upper and lower endplates, and the total number of lesions. In all individuals included in the study, BMD was measured from the axial CT sections by quantitative CT and then compared between the two groups. RESULTS: The distribution of age and gender was comparable between the two groups (p=0.438). A total of 208 SNs were identified in the patient group. Of these, 92 (44%) were located at the thoracic vertebrae and 116 (56%) at the lumbar vertebrae. The mean BMD was 131.6 g/cm3 in the patient group and 140.7 g/cm3 in the control group (p=0.03). There was no significant relationship between the total number of SNs per patient and the mean BMD (p=0.156). CONCLUSION: Evidence from this study revealed that low BMD may be a predisposing factor for the development of SNs in patients younger than 40 years. LEVEL OF EVIDENCE: Level III, Diagnostic Study.


Assuntos
Densidade Óssea , Degeneração do Disco Intervertebral , Deslocamento do Disco Intervertebral , Vértebras Lombares , Vértebras Torácicas , Adulto , Causalidade , Feminino , Humanos , Degeneração do Disco Intervertebral/diagnóstico , Degeneração do Disco Intervertebral/fisiopatologia , Deslocamento do Disco Intervertebral/diagnóstico , Deslocamento do Disco Intervertebral/fisiopatologia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/patologia , Masculino , Estudos Retrospectivos , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/patologia , Tomografia Computadorizada por Raios X/métodos
8.
J Clin Neurosci ; 77: 36-40, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32389542

RESUMO

Recurrent lumbar disc herniation (rLDH) is one of the major problems when surgically treating patients with LDH. Data on previous studies investigated the associations between facet joint parameters and rLDH appear only rarely in the literature. This study's objective was to evaluate the association between facet joint parameters [facet orientation (FO) and facet tropism (FT)] and rLDH. From June 2005 to January 2014, 346 patients having single-level lumbar disc herniation (LDH), who underwent surgery, were included in this study. We divided the patients into the recurrent group (R group) and the nonrecurrent group (N group). According to 25%, 50% and 75% quantiles of FO, all the cases were divided into 4 subgroups (<42°, 42~45°, 46~49°, and >49°). Cases were divided into 3 groups according to different range of FT (<3°, 3~4° and >4°). The relationships between the facet joint parameters and rLDH were evaluated. All cases in the study were followed up for more than 5 years postoperatively. The recurrence rates of different FO groups were statistically significant (P < 0.001). With the decrease of FO, the risk of rLDH increases continuously. Also, there were statistically significant recurrence rates in different FT groups (P < 0.001), which showed the incidence of rLDH increases gradually with the increase of FT. Facet joint parameters significantly influence the biomechanics of the corresponding segment. Facet joint parameters may play a more important role in the pathogenesis of rLDH.


Assuntos
Deslocamento do Disco Intervertebral/diagnóstico , Deslocamento do Disco Intervertebral/epidemiologia , Vértebras Lombares/anatomia & histologia , Vigilância da População , Articulação Zigapofisária/anatomia & histologia , Adulto , Idoso , Idoso de 80 Anos ou mais , China/epidemiologia , Estudos Transversais , Feminino , Seguimentos , Humanos , Deslocamento do Disco Intervertebral/cirurgia , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Vigilância da População/métodos , Recidiva , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem , Articulação Zigapofisária/cirurgia
9.
BMC Musculoskelet Disord ; 21(1): 72, 2020 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-32019544

RESUMO

BACKGROUND: Lumbar spinal disease causes disabilities in performing daily activities. Operative treatments are aimed at pain relief and rapid return to routine activity. Patient-based outcome measures are used to evaluate pathologies and therapeutic effects associated with lumbar spinal disease. Nevertheless, it remains unknown as to how much such treatment improves activity levels. The purpose of the current study was to measure changes in activity levels before and after lumbar spinal surgery using a wearable activity tracker and to analyze the differences between results and patient-based outcomes. METHODS: Sixty patients who underwent lumbar surgery were studied. The physical activity of participants was objectively evaluated using a wearable Micro-Motion logger system (Actigraph). We measured the amount of activity before and at 1, 3, 6, and 12 months after the surgery to evaluate postoperative changes. The Japanese Orthopaedic Association Back Pain Evaluation Questionnaire, Oswestry Disability Index, Roland-Morris Disability Questionnaire and visual analog scale were used to assess patient-based outcomes of pain and activities of daily living-related scores; we analyzed the relationships between scores and actual activity levels. RESULTS: The amount of actual activity decreased significantly 1 month after the surgery compared to that during the preoperative period, which then improved after 3 months postoperatively (p < 0.01). Furthermore, there was a significant improvement 6 months after the surgery compared to that during the preoperative period (p < 0.05). The changes in activity for each period were strongly correlated, regardless of the period. In contrast, a significant improvement was observed at 1 month after the surgery in almost all items of the patient-based questionnaires (p < 0.05). CONCLUSIONS: The objective activity tracker demonstrated that lumbar surgery results in the amount of activity decreasing 1 month just after surgery followed by gradual postoperative recovery within 3 months. By contrast, patient-based outcomes showed improvement in 1 month that was significantly different from the change in actual activity, indicating a gap between patient-oriented clinical scores and their actual activities.


Assuntos
Atividades Cotidianas , Descompressão Cirúrgica , Degeneração do Disco Intervertebral/cirurgia , Deslocamento do Disco Intervertebral/cirurgia , Dor Lombar/cirurgia , Recuperação de Função Fisiológica , Fusão Vertebral , Acelerometria/instrumentação , Acelerometria/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Avaliação da Deficiência , Feminino , Monitores de Aptidão Física , Humanos , Disco Intervertebral/diagnóstico por imagem , Disco Intervertebral/patologia , Disco Intervertebral/cirurgia , Degeneração do Disco Intervertebral/complicações , Degeneração do Disco Intervertebral/diagnóstico , Degeneração do Disco Intervertebral/patologia , Deslocamento do Disco Intervertebral/complicações , Deslocamento do Disco Intervertebral/diagnóstico , Deslocamento do Disco Intervertebral/patologia , Dor Lombar/etiologia , Dor Lombar/fisiopatologia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/patologia , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica/instrumentação , Monitorização Fisiológica/estatística & dados numéricos , Medidas de Resultados Relatados pelo Paciente , Período Pós-Operatório , Estudos Prospectivos , Autorrelato/estatística & dados numéricos , Resultado do Tratamento
11.
World Neurosurg ; 134: 540-543, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31786381

RESUMO

BACKGROUND: Intradural disk herniation (IDH) is defined as the displacement of the intervertebral disk nucleus pulposus into the dural sac. In this lumbar lesion, the affected level differs from that of a traditional extradural herniation: 55% of cases occur at the level of L4-5, 16% at L3-4, and 10% at L5-S1. Upper lumbar IDH is extremely rare. We present a case of an IDH at the level of L2-3 that was diagnosed during endoscopic surgery. CASE DESCRIPTION: A 65-year-old male patient presented with severe radiating pain in the anterior right thigh that was accompanied by a tingling sensation in the right calf and difficulty in walking. Physical examination showed normal strength. Bladder and bowel function was normal, but mild hypesthesia of the L3 sensory dermatome was observed. Magnetic resonance imaging revealed a herniated disk at the level of L2-L3 that was compressing the right side of the dura. A percutaneous transforaminal endoscopic lumbar diskectomy was planned. After foraminoplasty, no ruptured disk fragments could be found. During dissection of the adhesion between the dura and protruded disk, the dura was torn. Interestingly, through this dural opening, multiple fragmented disk portions were visualized among the nerve rootlets. We removed some of the soft disk material; however, complete removal of the disk fragments was predicted to damage the rootlets, and we decided to convert to microscopic surgery. The disk fragments were successfully removed via durotomy under microscopic assistance. The incised dorsal dura was primarily sutured with continuous stitches, and the defect on the ventrolateral side of the dura was patched and sealed using a harvested inner ligamentum flavum and Gelfoam (Pfizer, New York, New York, USA). After the operation, the patient's symptoms improved. There was no cerebrospinal fluid leakage. CONCLUSIONS: If there is any preoperative clinical or radiologic suspicion of IDH, a microscopic surgical approach should be considered to be the first-line option, as this is a safe and effective method for achieving IDH removal and dura repair without a postoperative neurologic deficit. Even during endoscopic surgery, if the surgeon expects even minor complications, we suggest converting to open surgery. In addition, the adequate sealing of the dura may be sufficient to prevent cerebrospinal fluid leakage, without the need for dural suture and lumbar drainage.


Assuntos
Dura-Máter/cirurgia , Degeneração do Disco Intervertebral/cirurgia , Deslocamento do Disco Intervertebral/cirurgia , Vértebras Lombares/cirurgia , Idoso , Discotomia Percutânea/métodos , Endoscopia/métodos , Humanos , Degeneração do Disco Intervertebral/diagnóstico , Deslocamento do Disco Intervertebral/diagnóstico , Região Lombossacral/cirurgia , Imagem por Ressonância Magnética , Masculino
12.
IEEE J Biomed Health Inform ; 24(1): 151-159, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-30794192

RESUMO

The aim of this research was to analyze objectively the process of disc herniation identification using Bayes Theorem. One of the symptoms of discus hernia is muscle weakness on the foot that is caused by displaced discs in the space of two vertebrae. This fact is used by experts in initial diagnosis of herniated discs and we used it to create non-invasive platform for the same purposes by measuring force values from four sensors placed on both feet (first, second, and fourth metatarsal head as well as the heel). Dataset consisted of several minute force recordings of 56 subjects with discus hernia and 15 healthy individuals during normal standing, standing on forefeet and heels. The subjects were diagnosed by a specialist with either L4/L5 or L5/S1 discus hernia. Collected recordings were processed in several steps including filtering, extraction of forefeet and heel recordings, classification of average values for forefeet, and heel sensors to the groups with or without foot muscle weakness. Application of Bayes Theorem on the attributes of interest showed average 78.3% accuracy with 62.6% sensitivity and 80.9% specificity, while application of naive Bayes Network showed average 83.1% accuracy with 57.6% sensitivity and 88.2% specificity. Very weak or no correlation was observed between gender and disc hernia diagnosis (or obesity type and disc hernia diagnosis). Obtained results show that this method can be used in initial screening of patients and be a supportive tool to doctors to send the same patients for further examination.


Assuntos
Diagnóstico por Computador , Deslocamento do Disco Intervertebral/diagnóstico , Deslocamento do Disco Intervertebral/fisiopatologia , Adulto , Teorema de Bayes , Diagnóstico por Computador/instrumentação , Diagnóstico por Computador/métodos , Diagnóstico Precoce , Desenho de Equipamento , Feminino , Pé/fisiopatologia , Humanos , Deslocamento do Disco Intervertebral/complicações , Vértebras Lombares/fisiopatologia , Masculino , Pessoa de Meia-Idade , Debilidade Muscular/diagnóstico , Debilidade Muscular/etiologia , Debilidade Muscular/fisiopatologia , Pressão , Sensibilidade e Especificidade , Processamento de Sinais Assistido por Computador
13.
J Med Life ; 13(4): 517-522, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33456600

RESUMO

Low back pain is a common complaint during pregnancy, affecting approximately half of pregnant women. However, true disc herniation is extremely rare, and the majority of patients heal without surgery. The purpose of this study was to provide an overview of conservative management strategies and delivery modes for pregnant patients suffering from lumbar disc herniation without severe neurologic deficits that would require emergency surgery. We performed a narrative review of the literature using the PubMed database. Thirty-one articles were originally retrieved, out of which 7 met the inclusion criteria, compiling a total of 10 cases of parturient patients with lumbar disc hernia treated conservatively until childbirth. The preferred delivery mode was a Cesarean section, which was performed in 6 out of 10 cases. Two patients developed the cauda equina syndrome, one during a failed induction and the other patient 4 weeks after vacuum extraction. However, the second patient failed to improve after surgery. No patients developed cauda equina syndrome during or after the Cesarean section. Based on limited data, the Cesarean section seems to be preferred compared to vaginal delivery to avoid worsening symptoms and progression to the cauda equina syndrome.


Assuntos
Parto Obstétrico , Deslocamento do Disco Intervertebral/complicações , Vértebras Lombares/patologia , Complicações na Gravidez/patologia , Gestantes , Adulto , Cesárea/efeitos adversos , Feminino , Humanos , Deslocamento do Disco Intervertebral/diagnóstico , Deslocamento do Disco Intervertebral/diagnóstico por imagem , Vértebras Lombares/diagnóstico por imagem , Imagem por Ressonância Magnética , Período Pós-Parto , Gravidez
14.
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.
JAAPA ; 32(12): 14-20, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31714344

RESUMO

Low back pain in adolescents is a common complaint in primary care. With an average prevalence rate of 40%, adolescent low back pain correlates with greater healthcare use, higher incidences of adult back pain, and negative effects on overall well-being. A thorough history and physical examination can increase early detection and accurate diagnosis while ensuring the judicious use of diagnostic modalities. Although underlying serious pathology is rare in adolescents with low back pain, clinicians should recognize specific signs and symptoms that necessitate urgent evaluation and intervention. This article emphasizes the value of using a thorough history and physical examination to guide the initial diagnostic workup and to enhance the early detection and accurate diagnosis of adolescents who present with low back pain.


Assuntos
Dor Lombar/diagnóstico , Anamnese , Exame Físico , Adolescente , Criança , Diagnóstico Diferencial , Humanos , Degeneração do Disco Intervertebral/complicações , Degeneração do Disco Intervertebral/diagnóstico , Deslocamento do Disco Intervertebral/complicações , Deslocamento do Disco Intervertebral/diagnóstico , Dor Lombar/etiologia , Imagem por Ressonância Magnética , Oncologia , Ortopedia , Radiografia , Encaminhamento e Consulta , Reumatologia , Sarcoma de Ewing/complicações , Sarcoma de Ewing/diagnóstico , Escoliose/complicações , Escoliose/diagnóstico , Neoplasias da Medula Espinal/complicações , Neoplasias da Medula Espinal/diagnóstico , Neoplasias da Coluna Vertebral/complicações , Neoplasias da Coluna Vertebral/diagnóstico , Espondilite Anquilosante/complicações , Espondilite Anquilosante/diagnóstico , Espondilolistese/complicações , Espondilolistese/diagnóstico , Espondilólise/complicações , Espondilólise/diagnóstico , Entorses e Distensões/complicações , Entorses e Distensões/diagnóstico , Adulto Jovem
17.
Artigo em Alemão | MEDLINE | ID: mdl-31627225

RESUMO

A large variety of etiologies is considered to be the cause of nerve root syndrome in dogs. Lateralized disc herniation, foraminal stenosis and malignant as well as benign nerve sheath tumors are some of the most important triggers described. The clinical signs of a nerve root syndrome are characterized by monoparesis in combination with progressive lameness, which may be accompanied by an elevation of the affected limb. Although the problem is well known among clinicians, there is no review article in the veterinary literature that specifically covers the subject of "nerve root syndrome in small animals". Mostly, this is merely mentioned as a symptom of its potential etiologies, as the so-called "nerve root sign" or "nerve root signature". In the pathophysiology of nerve root compression or irritation, a number of biomechanical and biochemical factors play a role. These occur individually or in combination and may lead to the same changes. The pathophysiology of the syndrome seems to focus around changes in microcirculation. These microcirculation disorders not only lead to pathomorphological changes such as edema formation, demyelination and axon death, but also initiate a cascade of reactions at the site of damage as well as in the central nervous tissue. This leads to the release of various neuropeptides, modulation of nerve excitability and impulse transmission. Different pathomechanisms therefore often lead to a uniform damage pattern, which makes it difficult to point out the original triggering factors. The body's response to these factors determines whether a nerve root syndrome actually develops or not. The treatment of the cause, if found, and an individual and multimodal pain therapy seem to be the most successful therapeutic approaches for nerve root syndrome in dogs.


Assuntos
Doenças do Cão/fisiopatologia , Doenças do Cão/terapia , Radiculopatia/veterinária , Animais , Doenças do Cão/diagnóstico , Cães , Deslocamento do Disco Intervertebral/diagnóstico , Deslocamento do Disco Intervertebral/fisiopatologia , Deslocamento do Disco Intervertebral/terapia , Deslocamento do Disco Intervertebral/veterinária , Neurofibrossarcoma/diagnóstico , Neurofibrossarcoma/fisiopatologia , Neurofibrossarcoma/terapia , Neurofibrossarcoma/veterinária , Radiculopatia/diagnóstico , Radiculopatia/fisiopatologia , Radiculopatia/terapia
18.
Biotech Histochem ; 94(7): 540-545, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31537133

RESUMO

Interleukin-23 (IL-23, IL-23p19) is a proinflammatory cytokine in the IL-12-related family. Although inflammatory cells in herniated discs have been shown to contain IL-23, little is known about the presence and role of IL-23 in human disc cells. We analyzed disc specimens for IL-23 localization using immunohistochemistry in control, herniated and non-herniated discs from which annulus fibrosus (annulus) cells were isolated and cultured to identify IL-23 gene expression and production. Microarray analysis was used to assess the expression of IL-23 in disc tissue and in cells exposed to two proinflammatory cytokines, IL-1ß and TNF-α. IL-23 was present in annulus cells at the protein level and its expression was up-regulated significantly in herniated compared to control disc tissue. Direct measurement of medium components confirmed production of IL-23 and its receptor, IL-23R, by annulus cells in vitro. Annulus cells in three-dimensional culture exposed to TNF-α, but not IL-1ß, resulted in significant up-regulation of IL-23 expression compared to control cells. Our findings are evidence for the constitutive presence of IL-23 in the human disc and that its expression in vitro is modified by exposure to TNF-α.


Assuntos
Subunidade p19 da Interleucina-23/metabolismo , Degeneração do Disco Intervertebral/metabolismo , Deslocamento do Disco Intervertebral/metabolismo , Disco Intervertebral/metabolismo , Fator de Necrose Tumoral alfa/metabolismo , Anel Fibroso/metabolismo , Células Cultivadas , Citocinas/metabolismo , Expressão Gênica/fisiologia , Humanos , Degeneração do Disco Intervertebral/diagnóstico , Deslocamento do Disco Intervertebral/diagnóstico , Regulação para Cima
19.
Trials ; 20(1): 470, 2019 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-31366405

RESUMO

BACKGROUND: As a common cause of low back pain, lumbosacral disc herniation (LDH) is usually dealt with using non-surgical interventions. In the face of concerns about prescription opioid abuse, alternative and complementary treatments may be promising, among which silver-needle warm acupuncture is considered as an upgrading option for its potential anti-inflammatory and strong analgesic effect for patients with chronic pain. In this proposed study, we aim to assess its clinical efficacy in comparison with conventional stainless steel filiform-needle warm acupuncture. METHODS/DESIGN: This is a randomized, two-armed, patient- and assessor-blinded trial. One hundred and sixty eligible patients recruited from December 2018 to June 2020 in three centers will be assigned for warm acupuncture treatment with either stainless steel filiform or silver needles. Nine sessions of 20-min treatment will be conducted during 3 consecutive weeks. Assessments with instruments including the Oswestry Disability Index, the visual analog scale, and the Japanese Orthopedic Association Back Pain Evaluation Questionnaire will be performed at four time points to explore the difference of clinical efficacy between two groups. DISCUSSION: If the results show that participants treated with silver-needle warm acupuncture gain a greater improvement in terms of pain intensity, physical function, and quality of life, this study is expected to offer reliable evidence to widely push this treatment for LDH in clinical practice. TRIAL REGISTRATION: Chinese Clinical Trial Registry, ChiCTR1800019051 . Registered on 24 October 2018.


Assuntos
Terapia por Acupuntura/instrumentação , Dor Aguda/terapia , Deslocamento do Disco Intervertebral/terapia , Disco Intervertebral/fisiopatologia , Dor Lombar/terapia , Vértebras Lombares/fisiopatologia , Agulhas , Sacro/fisiopatologia , Prata , Terapia por Acupuntura/efeitos adversos , Dor Aguda/diagnóstico , Dor Aguda/fisiopatologia , Adulto , China , Avaliação da Deficiência , Desenho de Equipamento , Feminino , Humanos , Deslocamento do Disco Intervertebral/diagnóstico , Deslocamento do Disco Intervertebral/fisiopatologia , Dor Lombar/diagnóstico , Dor Lombar/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estudos Multicêntricos como Assunto , Medição da Dor , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
20.
J Orthop Surg Res ; 14(1): 243, 2019 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-31362771

RESUMO

BACKGROUND: Lumbar disc herniation, a type of chronic low back pain syndrome, is caused by the lumbar intervertebral disk degeneration. Genetic variation in the CHRNA5/CHRNA3 has shown strong associations with smoking-related diseases. This study's aim is to test whether single-nucleotide polymorphisms in the CHRNA5/CHRNA3 gene are associated with lumbar disc herniation risk. METHODS: The genotype frequency distributions of the polymorphisms were detected by polymerase chain reaction-restriction fragment length polymorphism in 380 lumbar disc herniation patients (case group) and 400 healthy individuals (control group). Allelic, genotypic, and haplotype analyses were performed. RESULTS: We found that the individuals with rs8040868 CT genotype had a 0.46-fold higher risk of lumbar disc herniation than those with rs8040868 TT genotype, in men group (OR = 0.46, 95% CI 0.25-0.84, p = 0.012). Also among women, rs8040868 CT + CC genotype still reduced the risk of lumbar disc herniation under the dominant model (OR = 0.50, 95% CI 0.28-0.89, p = 0.019). Haplotype analysis showed that compared with the CHRNA5 "TACAACCG" wild-type, the "TACACCCG" haplotype was found to be associated with a decreased risk of lumbar disc herniation (LDH) (OR = 0.79, 95% CI 0.63-1.00, p = 0.047), while, in the less than 50-year-old group, CHRNA5 "TACACCCG" increased the risk of LDH (OR = 1.46, 95% CI 1.01-2.13, p = 0.047). CONCLUSIONS: Our data suggest that gene variance in the CHRNA5/CHRNA3 is associated with risk of lumbar disc herniation in the case-control study.


Assuntos
Deslocamento do Disco Intervertebral/genética , Vértebras Lombares , Família Multigênica/genética , Proteínas do Tecido Nervoso/genética , Receptores Nicotínicos/genética , Adulto , Estudos de Casos e Controles , Feminino , Estudos de Associação Genética/métodos , Humanos , Deslocamento do Disco Intervertebral/diagnóstico , Masculino , Pessoa de Meia-Idade , Polimorfismo de Nucleotídeo Único/genética , Fatores de Risco
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