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1.
Medicine (Baltimore) ; 99(17): e19867, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32332651

RESUMO

BACKGROUND: This systematic review aims to evaluate the effectiveness of electroacupuncture in treatment of lumbar disc herniation (LDH). METHODS: Electronic databases of all electroacupuncture for LDH will be searched at PubMed, Cochrane Library, Springer, EMBASE, China National Knowledge Infrastructure (CNKI), Wan-Fang, and Chinese Biological Medical disc, (CBM) from inception to February 29, 2020, with language restricted in Chinese and English. The primary outcome is Japanese Orthopedic Association Scores, a quantification scale for a comprehensive assessment according to patients' subjects feeling and objective function. Secondary outcomes included visual analogue scale (VAS), Oswestry dysfunction index (ODI), Pittsburgh sleep quality index (PSQI), Self-rating anxiety scale (SAS), self-depression rating scale (SDS), follow-up relapse rate. The systematic review and searches for randomized controlled trials of this therapy for LDH. The Cochrane RevMan V5.3 bias assessment tool is implemented to assess bias risk, data integration risk, meta-analysis risk, and subgroup analysis risk (if conditions are met). Mean difference (MD), standard mean deviation (SMD) and binary data will be used to represent continuous results. RESULTS: This study will provide a comprehensive review and evaluation of the available evidence for the treatment of LDH with this therapy. CONCLUSION: This study will provide new evidence to evaluate the effectiveness and side effects of electroacupuncture for LDH. Due to the data is not personalized, no formal ethical approval is required.


Assuntos
Eletroacupuntura/normas , Degeneração do Disco Intervertebral/terapia , Deslocamento do Disco Intervertebral/terapia , Protocolos Clínicos , Eletroacupuntura/métodos , Humanos , Degeneração do Disco Intervertebral/fisiopatologia , Deslocamento do Disco Intervertebral/fisiopatologia , Metanálise como Assunto , Literatura de Revisão como Assunto , Resultado do Tratamento
2.
Medicine (Baltimore) ; 99(9): e19310, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32118755

RESUMO

BACKGROUND: Lumbar disc herniation (LDH) is 1 of the most common diseases in orthopedics, which seriously affects people's daily life and brings a heavy burden on society and families. Chinese herbal medicine has been used in clinical practice for a long time and Duhuo Jisheng Decoction (DHJSD) is believed to help alleviate the symptoms of LDH. This systematic review aims to collect evidences from randomized clinical trials and evaluate the efficacy of DHJSD on LDH in order to provide a reference for clinicians and researchers. METHODS: We will comprehensively search the 8 electronic databases until December 2019 to identify related randomized controlled trials, including 4 foreign databases (PubMed, MEDLINE, EMBASE, Cochrane Library) and 4 Chinese databases (China National Knowledge Infrastructure Database, VIP Database, Wanfang Database and China Biology Medicine disc). The data of the World Health Organization International Clinical Trial Registry Platform and the Chinese Clinical Trial Registry also will be searched. The primary outcomes are Japanese Orthopaedic Association scores and visual analog scale scores. The risk of bias will be assessed using the Cochrane Collaboration tool. RevMan (V.5.3) software will be used for meta-analysis. RESULTS: This study will report the results of DHJSD for the treatment of LDH from the literature screening, the basic information of the included studies, the risk of bias of the included studies, treatment effects, safety, and so on. CONCLUSION: This systematic review will evaluate the effectiveness and safety of DHJSD for the treatment of LDH and provide the latest evidence for its clinical application. ETHICS AND DISSEMINATION: This is a literature-based study, therefore it does not require ethical approval. PROSPERO REGISTRATION NUMBER: CRD42019147302.


Assuntos
Medicamentos de Ervas Chinesas/uso terapêutico , Deslocamento do Disco Intervertebral/tratamento farmacológico , Região Lombossacral/lesões , Medicina Tradicional Chinesa/normas , Protocolos Clínicos , Medicamentos de Ervas Chinesas/normas , Humanos , Deslocamento do Disco Intervertebral/fisiopatologia , Medicina Tradicional Chinesa/métodos , Resultado do Tratamento
3.
Biomed Chromatogr ; 34(2): e4706, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31629372

RESUMO

Zhiqiao Gancao (ZQGC) decoction is widely used in China due to its therapeutic effect on lumbar disc herniation (LDH). In this study, we compared the clinical therapeutic effects among oral ZQGC decoction treatment, bed rest, and oral anti-inflammatory drug celecoxib treatment using visual analog scale, Oswestry Disability Index, and MacNab scores. The results showed that ZQGC decoction can significantly improve the symptoms of patients with LDH. A selective, sensitive, and rapid ultra-performance liquid chromatography-tandem mass spectrometry method was developed and validated for the determination of eight bioactive components in rat plasma. The plasma samples were extracted by simple protein precipitation with methanol. The protonated analytes were quantitated simultaneously in positive and negative ion modes by multiple reaction monitoring with a mass spectrometer. The calibration curve of eight components in plasma showed good linearity (r > .996) and the extraction recovery was 81.19% ± 2.15% - 100.39 ± 3.36 (relative standard deviation: 1.21%-10.70%). The accuracy of all the lower limit of quantitation values was quantified within 80%-120%, and the precision was less than 15%. This validated method was successfully applied to the pharmacokinetics study in rat plasma after ZQGC decoction oral treatment. Our research can provide experimental basis for the rational clinical application of ZQGC decoction in the treatment of LDH.


Assuntos
Analgésicos/uso terapêutico , Medicamentos de Ervas Chinesas/farmacocinética , Medicamentos de Ervas Chinesas/uso terapêutico , Administração Oral , Analgésicos/administração & dosagem , Analgésicos/sangue , Analgésicos/farmacocinética , Animais , Curcumina/análise , Curcumina/farmacocinética , Medicamentos de Ervas Chinesas/administração & dosagem , Medicamentos de Ervas Chinesas/análise , Flavonas/sangue , Flavonas/farmacocinética , Ácido Glicirretínico/sangue , Ácido Glicirretínico/farmacocinética , Humanos , Degeneração do Disco Intervertebral/tratamento farmacológico , Degeneração do Disco Intervertebral/fisiopatologia , Deslocamento do Disco Intervertebral/tratamento farmacológico , Deslocamento do Disco Intervertebral/fisiopatologia , Modelos Lineares , Masculino , Ratos , Ratos Sprague-Dawley , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
4.
PLoS Genet ; 15(10): e1008096, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31652254

RESUMO

Degenerative changes of the intervertebral disc (IVD) are a leading cause of disability affecting humans worldwide and has been attributed primarily to trauma and the accumulation of pathology during aging. While genetic defects have also been associated with disc degeneration, the precise mechanisms driving the initiation and progression of disease have remained elusive due to a paucity of genetic animal models. Here, we discuss a novel conditional mouse genetic model of endplate-oriented disc herniations in adult mice. Using conditional mouse genetics, we show increased mechanical stiffness and reveal dysregulation of typical gene expression profiles of the IVD in adhesion G-protein coupled receptor G6 (Adgrg6) mutant mice prior to the onset of endplate-oriented disc herniations in adult mice. We observed increased STAT3 activation prior to IVD defects and go on to demonstrate that treatment of Adgrg6 conditional mutant mice with a small molecule inhibitor of STAT3 activation ameliorates endplate-oriented herniations. These findings establish ADGRG6 and STAT3 as novel regulators of IVD endplate and growth plate integrity in the mouse, and implicate ADGRG6/STAT3 signaling as promising therapeutic targets for endplate-oriented disc degeneration.


Assuntos
Degeneração do Disco Intervertebral/genética , Deslocamento do Disco Intervertebral/genética , Receptores Acoplados a Proteínas-G/genética , Fator de Transcrição STAT3/genética , Animais , Modelos Animais de Doenças , Progressão da Doença , Lâmina de Crescimento , Humanos , Disco Intervertebral/crescimento & desenvolvimento , Disco Intervertebral/patologia , Degeneração do Disco Intervertebral/fisiopatologia , Deslocamento do Disco Intervertebral/fisiopatologia , Camundongos , Mutação , Transdução de Sinais
5.
Med Phys ; 46(10): 4553-4562, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31381174

RESUMO

PURPOSE: We have developed a clinically viable method for measurement of direct, patient-specific intravertebral displacements using a novel digital tomosynthesis based digital volume correlation technique. These displacements may be used to calculate vertebral stiffness under loads induced by a patient's body weight; this is particularly significant because, among biomechanical variables, stiffness is the strongest correlate of bone strength. In this proof of concept study, we assessed the feasibility of the method through a preliminary evaluation of the accuracy and precision of the method, identification of a range of physiological load levels for which displacements are measurable, assessment of the relationship of measured displacements with microcomputed tomography based standards, and demonstration of the in vivo application of the technique. METHODS: Five cadaveric T11 vertebrae were allocated to three groups in order to study (a) the optimization of digital volume correlation algorithm input parameters, (b) accuracy and precision of the method and the ability to measure displacements at a range of physiological load levels, and (c) the correlation between displacements measured using tomosynthesis based digital volume correlation vs. high resolution microcomputed tomography based digital volume correlation and large scale finite element models. Tomosynthesis images of one patient (Female, 60 yr old) were used to calculate displacement maps, and in turn stiffness, using images acquired in both standing and standing-with-weight (8 kg) configurations. RESULTS: We found that displacements were accurate (2.28 µm total error) and measurable at physiological load levels (above 267 N) with a linear response to applied load. Calculated stiffness among three tested vertebral bodies was within an acceptable range relative to reported values for vertebral stiffness (5651-13260 N/mm). Displacements were in good qualitative and quantitative agreement with both microcomputed tomography based finite element (r2  = 0.762, P < 0.001) and digital volume correlation (r2  = 0.799, P < 0.001) solutions. For one patient tested twice, once standing and once holding weights, results demonstrated excellent qualitative reproducibility of displacement distributions with superior endplate displacements increasing by 22% with added weight. CONCLUSIONS: The results of this work collectively suggest the feasibility of the method for in vivo measurement of intravertebral displacements and stiffness in humans. These findings suggest that digital volume correlation using digital tomosynthesis imaging may be useful in understanding the mechanical response of bone to disease and may further enhance our ability to assess fracture risk and treatment efficacy for the spine.


Assuntos
Processamento de Imagem Assistida por Computador/métodos , Deslocamento do Disco Intervertebral/diagnóstico por imagem , Deslocamento do Disco Intervertebral/fisiopatologia , Coluna Vertebral/diagnóstico por imagem , Coluna Vertebral/fisiopatologia , Microtomografia por Raio-X , Fenômenos Biomecânicos , Feminino , Humanos , Pessoa de Meia-Idade , Suporte de Carga
6.
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
7.
Turk J Med Sci ; 49(4): 1095-1101, 2019 08 08.
Artigo em Inglês | MEDLINE | ID: mdl-31385489

RESUMO

Background/aim: In this study, it was aimed to investigate the effects ofpulsed electromagnetic field(PEMF) therapy on pain, disability, psychological state, and quality of life in cervical disc herniation. Materials and methods: Patients were randomly divided into two groups, including Group 1, which received a therapy consisting of transcutaneous electrical nerve stimulation (TENS), hot pack (HP), and PEMF, and Group 2, which received a magnetic field (sham magnetic field) without current flow in addition to TENS and HP therapy. Pain was assessed by a visual analog scale (VAS, 0­10 cm). The other outcome measures were function (Neck Pain and Disability Scale), anxiety-depressive mood (Hospital Anxiety and Depression Scale), and quality of life (Nottingham Health Profile). All evaluations were performed at baseline, in the 3rd week, and in the 12th week after treatment. Results: A significant improvement was found in the neck pain, disability, depression, anxiety, and quality of life scores of both groups after treatment when compared to those before treatment. However, in the comparison between changes within groups, significant improvements were determined only in the VAS and Nottingham Health Profile sleep subparameter in the 12th week after treatment compared to those before treatment. Conclusion: PEMF therapy in cervical disc herniation can be used safely in routine treatment in addition to conventional physical therapy modalities.


Assuntos
Dor nas Costas , Depressão , Degeneração do Disco Intervertebral , Deslocamento do Disco Intervertebral , Terapia de Campo Magnético , Qualidade de Vida , Adulto , Dor nas Costas/etiologia , Dor nas Costas/terapia , Vértebras Cervicais/fisiopatologia , Depressão/etiologia , Depressão/terapia , Avaliação da Deficiência , Feminino , Humanos , Degeneração do Disco Intervertebral/complicações , Degeneração do Disco Intervertebral/fisiopatologia , Degeneração do Disco Intervertebral/terapia , Deslocamento do Disco Intervertebral/complicações , Deslocamento do Disco Intervertebral/fisiopatologia , Deslocamento do Disco Intervertebral/terapia , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
8.
J Orthop Surg Res ; 14(1): 264, 2019 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-31451116

RESUMO

BACKGROUND: To investigate the incidence of scoliosis and trunk shift in patients with LDH (lumbar disc herniation) and analyze the differences in spinopelvic alignment among patients with or without trunk shift and non-symptom controls. MATERIALS AND METHODS: All included subjects had standard upright antero-posterior and lateral radiographs of the whole spine taken. Evidence of disc herniation was confirmed by computed tomography or magnetic resonance imaging. The parameters measured included trunk shift and Cobb angle, TK (thoracic kyphosis), TLK (thoraco-lumbar junction kyphosis), LL (lumbar lordosis), PI (pelvic incidence), SS (sacral slope), PT (pelvic tilt) and SVA (sagittal vertical axis). RESULTS: Sixty-eight patients with LDH and 61 controls were included. There were significantly more male patients with trunk shift than the patients without trunk shift. Forty-two patients had curve magnitudes ranging from 5 to 38°. The trunk shift ranged from 0.5 to 7.3 cm. A total of 54.76% of patients had a disc herniation on the concave side of the main curve. Fifty percent of patients showed a trunk shift towards the opposite side of disc herniation. There were significant differences in spinopelvic parameters among groups. Significant correlations were also observed between several spinopelvic parameters in the three groups. However, the degrees of correlations among the spinopelvic parameters differed among the three groups. CONCLUSION: Spinal sagittal morphology in LDH patients with trunk shift exhibits a more anterior shift of the C7 plumb line, less LL, and a more horizontal sacrum. Correlation analysis indicated a disharmonious spinopelvic interaction and a change in the compensatory model in patients with LDH.


Assuntos
Deslocamento do Disco Intervertebral/diagnóstico por imagem , Vértebras Lombares/diagnóstico por imagem , Postura/fisiologia , Escoliose/diagnóstico por imagem , Adulto , Idoso , Feminino , Humanos , Deslocamento do Disco Intervertebral/fisiopatologia , Vértebras Lombares/fisiologia , Masculino , Pessoa de Meia-Idade , Sacro/diagnóstico por imagem , Sacro/fisiologia , Escoliose/fisiopatologia , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/fisiologia , Adulto Jovem
9.
Spine (Phila Pa 1976) ; 44(19): E1112-E1121, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31261268

RESUMO

STUDY DESIGN: A controlled, randomized, animal study. OBJECTIVE: The aim of this study was to investigate the role of src-family kinases/p38 pathway in a rat model of lumbar disc herniation (LDH). SUMMARY OF BACKGROUND DATA: LDH always generates radicular pain, and the mechanism remains unclear. We have reported that spinal src-family kinases (SFKs) may be involved in the process, but the downstream mechanism needs further investigation. METHODS: LDH was induced by implantation of autologous nucleus pulposus (NP), harvest from the tail, in lumbar 4/5 spinal nerve roots of rat. Von Frey filaments and radiant heat tests were performed to determine mechanical and thermal pain threshold respectively. Basso, Beattie, and Bresnahan (BBB) scale was assessed to test the locomotor function. The protein level of p-SFKs, t-SFKs, p-p38, t-p38 in spinal cord was examined by western blotting analysis. Cellular location of p-p38 was determined by immunochemistry staining. Spinal tumor necrosis factor-alpha (TNF-α), interleukin (IL)-1ß, and IL-6 levels were detected by enzyme-linked immunosorbent assay (ELISA). RESULTS: Rats with NP implantation showed persistent ipsilateral mechanical allodynia and thermal hyperalgesia, which manifested as obvious decrease of paw withdrawal threshold (PWT) and paw withdrawal latency (PWL). BBB scale indicated the locomotor function of hindpaws in rats with NP implantation kept intact. Western blotting and immunohistochemistry staining revealed that phosphorylated SFKs (p-SFKs) and phosphorylated p38 MAPK (p-p38) were sequentially upregulated in ipsilateral spinal dorsal horn, but not in contralateral side of rats with NP. Intrathecal delivery of SFKs inhibitor reduced spinal p-p38 expression. Both SFKs and p38 inhibitors alleviated pain behaviors in a dose-responsive manner without disturbing locomotor function and reduced spinal expression of TNF-α, IL-1ß, and IL-6 in rats with NP. CONCLUSION: Spinal SFKs contribute to radicular pain by activation of p38 MAPK and increasing pro-inflammatory cytokines expression in rats with NP implantation. Targeting SFKs/p38 pathway may be helpful for alleviating radicular pain. LEVEL OF EVIDENCE: N/A.


Assuntos
Citocinas/metabolismo , Deslocamento do Disco Intervertebral , Medula Espinal , Proteínas Quinases p38 Ativadas por Mitógeno/metabolismo , Quinases da Família src/metabolismo , Animais , Dor nas Costas/metabolismo , Dor nas Costas/fisiopatologia , Modelos Animais de Doenças , Deslocamento do Disco Intervertebral/metabolismo , Deslocamento do Disco Intervertebral/fisiopatologia , Vértebras Lombares/fisiopatologia , Sistema de Sinalização das MAP Quinases/fisiologia , Ratos , Medula Espinal/metabolismo , Medula Espinal/fisiopatologia
10.
Spine (Phila Pa 1976) ; 44(19): E1161-E1168, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31261283

RESUMO

STUDY DESIGN: Retrospective matched cohort study. OBJECTIVE: To determine if low-pressure lumbar provocation discography (PD) results in long-term accelerated disc degeneration, internal disc disruption, or disc herniation in patients with symptomatic low back pain (LBP). SUMMARY OF BACKGROUND DATA: Study of subjects without clinically-significant LBP suggests that high-pressure PD may accelerate disc degeneration. METHODS: Consecutive patients with symptomatic LBP who underwent magnetic resonance imaging (MRI), PD, and repeat MRI more than 7 years later, but did not undergo subsequent spinal fusion surgery, were included. Punctured discs were matched (1:2 to 1:4) to corresponding discs in a control cohort by age, BMI, Pfirrmann score (±2), and presence of disc herniation; control cohort inclusion required MRIs for symptomatic LBP, separated by more than 7 years. The primary outcome of the study was a progression in Pfirrmann score category (I-II, III-IV, V). MRI disc-to-CSF T2 signal-intensity ratio, disc height, disc herniations, high intensity zones (HIZs), and Modic changes were assessed. RESULTS: Baseline and follow-up MRIs were available for 77 discs exposed to PD, and for 260 discs in the matched control cohort. There was no difference in the proportion of punctured discs that advanced in Pfirrmann score category in the PD group (17%, 95% CI 9-27%) compared with corresponding discs in the Control group (21%, 95% CI 17-27%), P = 0.3578, or in non-punctured discs in the PD group (35%, 95% CI 21-51%) compared with corresponding discs in the Control group (34%, 95% CI 27-42%), P = 0.1169. There were no differences in disc-to-CSF T2 signal-intensity ratio, presence of disc herniations, HIZs, or Modic changes following puncture in the PD versus matched cohort discs or in the non-punctured PD cohort discs versus corresponding control cohort discs (P > 0.05). CONCLUSION: Patients with symptomatic LBP who underwent low-pressure PD, but who did not undergo a subsequent spinal fusion surgery, developed disc degeneration and new disc herniations at a similar rate to corresponding discs in matched control patients. LEVEL OF EVIDENCE: 3.


Assuntos
Degeneração do Disco Intervertebral , Deslocamento do Disco Intervertebral , Disco Intervertebral , Mielografia , Progressão da Doença , Humanos , Disco Intervertebral/diagnóstico por imagem , Disco Intervertebral/fisiopatologia , Degeneração do Disco Intervertebral/diagnóstico por imagem , Degeneração do Disco Intervertebral/fisiopatologia , Deslocamento do Disco Intervertebral/diagnóstico por imagem , Deslocamento do Disco Intervertebral/fisiopatologia , Imagem por Ressonância Magnética , Mielografia/efeitos adversos , Mielografia/métodos , Mielografia/estatística & dados numéricos , Estudos Retrospectivos
11.
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
12.
Proc Inst Mech Eng H ; 233(8): 858-867, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31203788

RESUMO

The intervertebral disk cushions the load generated by human activity and absorbs energy to keep the spine moving steadily. Vibration condition is one of the important causes of disk degeneration. Creep experiments using the sheep lumbar intervertebral disk were carried out under vibration compression. Regularities of the strain of the disk with time were obtained and compared with those of static load. The influence of vibration frequency and time on the creep properties of the intervertebral disk was analyzed. An intervertebral disk three-parameter solid creep constitutive model considering vibration factors was established and the parameters in the model were identified. The results show that the strain of the lumbar intervertebral disk exhibits an exponential relationship with time and is unrelated to static compression or vibration load. Under the same vibration amplitude, the creep increases with vibration frequency and the relationship between them is nonlinear. The vibration frequency has a significant effect on the strain. The creep rate decreases gradually with time and is obviously influenced by vibration frequency at low vibration amplitudes. The creep prediction results obtained using the constitutive model with the time-varying material parameters are in good agreement with the experimental results. The two elastic moduli in the model decrease with time and the viscosity coefficient increases with time.


Assuntos
Força Compressiva , Disco Intervertebral/fisiologia , Vértebras Lombares/fisiologia , Teste de Materiais/métodos , Vibração , Animais , Fenômenos Biomecânicos , Disco Intervertebral/fisiopatologia , Deslocamento do Disco Intervertebral/fisiopatologia , Vértebras Lombares/fisiopatologia , Teste de Materiais/instrumentação , Ovinos , Suporte de Carga
13.
Genes (Basel) ; 10(6)2019 06 07.
Artigo em Inglês | MEDLINE | ID: mdl-31181696

RESUMO

Two FGF4 retrogenes on chromosomes 12 (12-FGF4RG) and 18 (18-FGF4RG) contribute to short-limbed phenotypes in dogs. 12-FGF4RG has also been associated with intervertebral disc disease (IVDD). Both of these retrogenes were found to be widespread among dog breeds with allele frequencies ranging from 0.02 to 1; however, their additive contribution to disease is unknown. Surgical cases of IVDD (n = 569) were evaluated for age of onset, disc calcification, and genotypes for the FGF4 retrogenes. Multivariable linear regression analysis identified the presence of one or two copies of 12-FGF4RG associated with significantly younger age at first surgery in a dominant manner. 18-FGF4RG had only a minor effect in dogs with one copy. Multivariable logistic regression showed that 12-FGF4RG had an additive effect on radiographic disc calcification, while 18-FGF4RG had no effect. Multivariable logistic regression using mixed breed cases and controls identified only 12-FGF4RG as highly associated with disc herniation in a dominant manner (Odds Ratio, OR, 18.42, 95% Confidence Interval (CI) 7.44 to 50.26; P < 0.001). The relative risk for disc surgery associated with 12-FGF4RG varied from 5.5 to 15.1 within segregating breeds and mixed breeds. The FGF4 retrogene on CFA12 acts in a dominant manner to decrease the age of onset and increase the overall risk of disc disease in dogs. Other modifiers of risk may be present within certain breeds, including the FGF4 retrogene on CFA18.


Assuntos
Doenças do Cão/genética , Fator 4 de Crescimento de Fibroblastos/genética , Predisposição Genética para Doença , Degeneração do Disco Intervertebral/genética , Deslocamento do Disco Intervertebral/genética , Animais , Cruzamento , Doenças do Cão/fisiopatologia , Cães , Frequência do Gene , Genótipo , Disco Intervertebral/fisiopatologia , Degeneração do Disco Intervertebral/fisiopatologia , Deslocamento do Disco Intervertebral/fisiopatologia , Fenótipo
14.
Biomed Res Int ; 2019: 9794365, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31183381

RESUMO

The main purpose of this article is to study the biomechanics of spine tissue in elderly female. In this study, the L3-L5 lumbar bi-segmental finite element model for elderly female was obtained from the Advanced Human Modeling Laboratory of the Bioengineering Center at Wayne State University. The effects of flexion and extension on bone geometry, distribution of ligament fibers, location of nucleus, and changes in intervertebral disc height were studied by comparing the results obtained before and after the update of older female and middle-aged male models. For the purpose of comparing the calculated range of motion (ROM) with the experimental data, additional calculations for axial rotation and lateral bending were performed. The study found that the parameters of the model affected the deformation of the disc herniation, ligament and intervertebral disc, and the axial force carrying capacity of the model. The three predicted ROMs are usually similar to the experimental results. Only the older female model has a slightly larger ROM. Therefore, older women are more vulnerable to lumbar spine injuries than men.


Assuntos
Deslocamento do Disco Intervertebral/fisiopatologia , Disco Intervertebral/fisiopatologia , Vértebras Lombares/fisiopatologia , Modelos Biológicos , Rotação , Idoso , Fenômenos Biomecânicos , Feminino , Análise de Elementos Finitos , Humanos , Disco Intervertebral/patologia , Deslocamento do Disco Intervertebral/patologia , Vértebras Lombares/patologia , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular
15.
PLoS One ; 14(5): e0217357, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31136604

RESUMO

Back pain commonly arises from intervertebral disc (IVD) damage including annulus fibrosus (AF) defects and nucleus pulposus (NP) loss. Poor IVD healing motivates developing tissue engineering repair strategies. This study evaluated a composite injectable IVD biomaterial repair strategy using carboxymethylcellulose-methylcellulose (CMC-MC) and genipin-crosslinked fibrin (FibGen) that mimic NP and AF properties, respectively. Bovine ex vivo caudal IVDs were evaluated in cyclic compression-tension, torsion, and compression-to-failure tests to determine IVD biomechanical properties, height loss, and herniation risk following experimentally-induced severe herniation injury and discectomy (4 mm biopsy defect with 20% NP removed). FibGen with and without CMC-MC had failure strength similar to discectomy injury suggesting no increased risk compared to surgical procedures, yet no biomaterials improved axial or torsional biomechanical properties suggesting they were incapable of adequately restoring AF tension. FibGen had the largest failure strength and was further evaluated in additional discectomy injury models with varying AF defect types (2 mm biopsy, 4 mm cruciate, 4 mm biopsy) and NP removal volume (0%, 20%). All simulated discectomy defects significantly compromised failure strength and biomechanical properties. The 0% NP removal group had mean values of axial biomechanical properties closer to intact levels than defects with 20% NP removed but they were not statistically different and 0% NP removal also decreased failure strength. FibGen with and without CMC-MC failed at super-physiological stress levels above simulated discectomy suggesting repair with these tissue engineered biomaterials may perform better than discectomy alone, although restored biomechanical function may require additional healing with the potential application of these biomaterials as sealants and cell/drug delivery carriers.


Assuntos
Materiais Biocompatíveis/química , Deslocamento do Disco Intervertebral/fisiopatologia , Deslocamento do Disco Intervertebral/terapia , Animais , Anel Fibroso/lesões , Materiais Biocompatíveis/administração & dosagem , Fenômenos Biomecânicos , Carboximetilcelulose Sódica , Bovinos , Reagentes para Ligações Cruzadas , Modelos Animais de Doenças , Discotomia , Fibrina , Hidrogéis , Técnicas In Vitro , Injeções Espinhais , Iridoides , Teste de Materiais , Metilcelulose , Núcleo Pulposo/lesões
16.
BMC Musculoskelet Disord ; 20(1): 189, 2019 May 04.
Artigo em Inglês | MEDLINE | ID: mdl-31054566

RESUMO

BACKGROUND: Prolonged static postures (PSPs) may predispose dentists to develop cervical herniated intervertebral disc (C-HIVD); however, there is limited evidence supporting this in the literature thus far. We conducted this study to fit the data gap. METHODS: We conducted a retrospective nationwide population-based study using the Taiwan National Health Insurance Research Database to identify 10,930 dentists, an identical number of age- and sex-matched participants from the general population, and 73,718 other health care providers (HCPs, non-dentists). Comparisons for the risk of developing C-HIVD between dentists and the general population, and between dentists and other HCPs were performed by tracing their medical histories between 2007 and 2011. RESULTS: Dentists had a cumulative incidence rate of 1.1% for C-HIVD during the 5-year follow-up period. Overall, there was no difference of the risk for C-HIVD between dentists and the general population after adjusting for hypertension, hyperlipidemia, liver disease, mental disorders, diabetes mellitus, coronary artery disease, chronic obstructive pulmonary disease, malignancy, stroke, and renal disease (adjusted odds ratio [AOR]: 1.2, 95% confidence interval [CI]: 0.9-1.6). However, stratified analysis showed that younger dentists (≤ 34 years) had a trend of higher risk for C-HIVD than members of the younger general population (AOR: 1.9, 95% CI: 0.9-4.1). There was no difference found between dentists and other HCPs (AOR: 0.9, 95% CI: 0.8-1.1). CONCLUSION: Younger dentists had a trend of higher risk of developing C-HIVD than members of the general population.


Assuntos
Odontólogos/estatística & dados numéricos , Degeneração do Disco Intervertebral/epidemiologia , Deslocamento do Disco Intervertebral/epidemiologia , Disco Intervertebral/fisiopatologia , Doenças Profissionais/epidemiologia , Postura/fisiologia , Adulto , Fatores Etários , Feminino , Humanos , Degeneração do Disco Intervertebral/etiologia , Degeneração do Disco Intervertebral/fisiopatologia , Deslocamento do Disco Intervertebral/etiologia , Deslocamento do Disco Intervertebral/fisiopatologia , Masculino , Pessoa de Meia-Idade , Doenças Profissionais/etiologia , Doenças Profissionais/fisiopatologia , Sistema de Registros/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Taiwan/epidemiologia
17.
J Vasc Interv Radiol ; 30(6): 894-899, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30952522

RESUMO

PURPOSE: To determine the safety and efficacy of percutaneous lumbar discectomy (PLD) and percutaneous disc cementoplasty (PDCP) for painful lumbar disc herniation (LDH) in patients >60 years of age. MATERIALS AND METHODS: Sixteen older patients (mean age, 71.00 ± 6.24 years) with painful LDH were treated with PLD and PDCP. The outcome data (the Macnab criteria, visual analog scale score, and Oswestry disability index) were collected preoperatively; at 1 week postoperatively; at posttreatment months 1, 3, and 6; and every 6 months thereafter. In addition, treatment duration, injection volume of bone cement, length of hospital stay, and complications were assessed. RESULTS: Treatment was successful in all patients. The pain relief rate at the last follow-up was 87.5%. Six, 8, and 2 patients showed excellent, good, and fair results, respectively; no patient showed a poor result. The average visual analog scale for back and leg pain decreased from 6.75 ± 1.06 and 7.00 ± 0.89 before the procedure to 2.81 ± 1.60 and 2.87 ± 1.75 at 1 month, 2.79 ± 1.58 and 2.71 ± 1.64 at 6 months, and 2.90 ± 1.73 and 3.00 ± 1.76 at 1 year, respectively. The scores were 2.44 ± 1.63 and 2.44 ± 1.71, respectively, at the last follow-up. The Oswestry disability index also changed after the procedure, with significant differences between baseline scores and those at each follow-up (P < .001). The mean procedure duration, injection volume of bone cement, and length of hospital stay were 55.69 ± 5.86 minutes, 2.50 ± 0.63 mL, and 7.06 ± 2.41 days, respectively. There were no complications. CONCLUSIONS: The combination of PLD and PDCP is feasible, safe, and effective for older patients with painful LDH.


Assuntos
Dor nas Costas/cirurgia , Cimentos para Ossos/uso terapêutico , Cementoplastia , Discotomia Percutânea , Deslocamento do Disco Intervertebral/cirurgia , Disco Intervertebral/cirurgia , Vértebras Lombares/cirurgia , Idoso , Dor nas Costas/diagnóstico por imagem , Dor nas Costas/fisiopatologia , Cimentos para Ossos/efeitos adversos , Cementoplastia/efeitos adversos , Discotomia Percutânea/efeitos adversos , Feminino , Humanos , Disco Intervertebral/diagnóstico por imagem , Disco Intervertebral/fisiopatologia , Deslocamento do Disco Intervertebral/diagnóstico por imagem , Deslocamento do Disco Intervertebral/fisiopatologia , Tempo de Internação , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/fisiopatologia , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
18.
Medicine (Baltimore) ; 98(8): e14667, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30813213

RESUMO

Lumbar disc hernia is common disease, affecting about 5% of the population. Many studies to date reported regression of disc herniation without surgical intervention.Medical records of the patients who applied to the spine clinic in an outpatient setting were retrospectively reviewed. Age, sex, radiological findings, neurological examinations, and medical treatments of the patients were evaluated.Male patients constituted 52.6% of the cases (n = 40) and 47.4% (n = 36) were female. The ages of the patients ranged from 25 to 82 years, with a mean of 48.5 ±â€Š12.1 years. Visual analog scale (VAS) measurements ranged from 0 to 8 and the mean was determined as 2.65 ±â€Š1.98. The VAS score of pain severity of 12 (15.78%) cases was 0, VAS score of 39 (51.31%) cases was 1 to 3, VAS score of 20 (26.31%) cases was 4 to 6, VAS score of 5 (6.57%) cases was 7 to 10. Eighteen (23.68%) of the cases underwent neuropathic pain treatment for more than 6 months. Fifteen (19.7%) patients also developed permanent motor deficits.Findings of our study show that there was no direct association between radiological improvement and clinical improvement. Indication for surgery still existed in a high number of patients, substantial of which developed permanent motor deficits. Current results suggest that we need to advise our patients in favor of early surgery as soon as indication for surgery is established upon neurological and radiological examination.


Assuntos
Tratamento Conservador , Discotomia , Deslocamento do Disco Intervertebral , Vértebras Lombares , Transtornos Motores , Adulto , Tratamento Conservador/métodos , Tratamento Conservador/estatística & dados numéricos , Discotomia/métodos , Discotomia/estatística & dados numéricos , Eletromiografia/métodos , Feminino , Humanos , Deslocamento do Disco Intervertebral/diagnóstico , Deslocamento do Disco Intervertebral/fisiopatologia , Deslocamento do Disco Intervertebral/terapia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Transtornos Motores/diagnóstico , Transtornos Motores/etiologia , Transtornos Motores/cirurgia , Exame Neurológico/métodos , Núcleo Pulposo/diagnóstico por imagem , Medição da Dor/métodos , Radiografia/métodos , Remissão Espontânea , Resultado do Tratamento , Turquia
19.
Medicine (Baltimore) ; 98(11): e14874, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30882691

RESUMO

RATIONALE: Trans-sacral epiduroscopic laser decompression (SELD) is a noninvasive pain-relieving procedure for treatment of herniated lumbar disc (HLD), and is known to have positive effects in alleviating lower back pain or radicular leg pain after HLD. However, little is known about the possible complications of SELD. PATIENT CONCERNS: A 51-year-old woman received SELD with a holmium:yttrium-aluminum-garnet laser for controlling radicular pain due to HLD on L5-S1. However, 5 days after SELD, she complained of headache, and 9 days after the SELD, cauda equine syndrome (CES) symptoms, including motor weakness of both lower extremities (manual muscle testing-left: 3, right: 4), voiding and defecation difficulties, and neuropathic pain, were manifested. DIAGNOSES: Cerebrospinal fluid (CSF) analysis performed 15 days after the SELD revealed elevated white blood cell count 7560 cells/µL. Staphylococcus hominis sensitive to vancomycin was cultured from CSF. The gadolinium-enhanced magnetic resonance imaging showed diffuse leptomeningeal enhancement along the distal cord and cauda equina. The latency of electrically induced bulbocavernosus reflex (BCR) was delayed in the right side and no response of BCR was presented in the left side. Based on the patient's symptoms and the results of the clinical evaluation, we diagnosed the patient as having a bacterial meningitis and CES. INTERVENTIONS: The patient received 2 g per day of intravenous vancomycin for 2 months. OUTCOMES: After treatment with intravenous vancomycin for 2 months, all the CES symptoms were completely resolved. LESSONS: In this study, we described a patient who had bacterial meningitis after SELD. During SELD, clinicians should keep in mind the possibility of infection.


Assuntos
Síndrome da Cauda Equina/cirurgia , Descompressão Cirúrgica/métodos , Meningites Bacterianas/etiologia , Antibacterianos/uso terapêutico , Síndrome da Cauda Equina/complicações , Feminino , Humanos , Deslocamento do Disco Intervertebral/fisiopatologia , Deslocamento do Disco Intervertebral/cirurgia , Vértebras Lombares/fisiopatologia , Vértebras Lombares/cirurgia , Meningites Bacterianas/tratamento farmacológico , Pessoa de Meia-Idade , Dor/etiologia , Dor/cirurgia , Vancomicina/uso terapêutico
20.
Turk J Med Sci ; 49(2): 519-524, 2019 04 18.
Artigo em Inglês | MEDLINE | ID: mdl-30893981

RESUMO

Background/aim: Minimally invasive procedures have been increasingly used for the treatment of herniated discs. Nonsurgical interventions minimize the secondary damage to other tissues and shorten the length of hospital stay by avoiding general anesthesia. Possible complications are thermal injuries, root injury, discitis, endplate damage, dural injury, meningitis, infection, increase in pain, and muscle spasm. We aimed to evaluate the efficacy of percutaneous decompression therapy by using intradiscal navigable electrodes on pain and functional movement index in patients with herniated nucleus pulposus (HNP). Materials and methods: A total of 209 patients with protrusive lumbar disc herniation underwent percutaneous ablation decompression treatment using an intradiscal routable electrode (L-Disq) in our pain clinic. Visual analog scale (VAS) and Oswestry Disability Index (ODI) scores were recorded at the beginning and at the 1st, 3rd, 6th, and 12th months after treatment. Patient satisfaction was evaluated at the 12th month by a patient satisfaction scale (PSS). Results: When compared to initial values, VAS and ODI scores showed statistically significant improvement at the 1st, 3rd, 6th, and 12th months (P < 0.001). Mean VAS scores were 7.28 and 3.03 points (P < 0.001) while mean ODI scores were 32.46 and 20.48 points (P < 0.001) at the beginning and at the 12th month, respectively. Satisfaction rate of all patients was 81%. We also attempted to treat the existing annular fissure using an ablation method and we believe that treating the herniated disc together with the fissure in the same session increased our success rate. Conclusion: With clinical evidence, we suggest that L-Disq may be considered as an appropriate option with a low risk of complications in pain management in cases of lumbar disc herniation that are resistant to conservative methods.


Assuntos
Dor nas Costas/cirurgia , Descompressão Cirúrgica , Deslocamento do Disco Intervertebral/cirurgia , Vértebras Lombares/patologia , Manejo da Dor , Adulto , Idoso , Dor nas Costas/etiologia , Dor nas Costas/fisiopatologia , Descompressão Cirúrgica/instrumentação , Feminino , Humanos , Deslocamento do Disco Intervertebral/complicações , Deslocamento do Disco Intervertebral/fisiopatologia , Masculino , Pessoa de Meia-Idade , Medição da Dor , Satisfação do Paciente , Resultado do Tratamento , Escala Visual Analógica
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