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1.
Medicine (Baltimore) ; 99(9): e19117, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32118715

RESUMO

BACKGROUND: As development of society and change of modern life style, the prevalence of lumbar disc herniation (LDH) has been increasing. Being a major cause of low back pain, sciatica and radicular leg pain, LDH imposes a heavy burden on both individual and society. Because of high surgically intervene rate, non-invasive (non-surgical) treatments are recommended for most cases. Acupuncture has the advantages of low risk, good effect and low cost which has been proven that could alleviate pain while physical therapy plays a major role in the treatment of LDH in the vast majority of countries. The aim of this systematic review is to evaluate the effectiveness and safety of acupuncture for LDH. METHODS: RCTs on ACU treating LDH will be searched from the following databases: PubMed, Web of science, EmBase, Cochrane Library, China National Knowledge Infrastructure, Wanfang data, from their inception to May 2020. The primary outcomes are verbal rating scale and functional disability. Two reviewers will independently exclude substandard articles and extract eligible data. The risk of bias will be assessed using the Cochrane Handbook 5.1.0 for Systematic Reviews of Interventions. Egger test will be used to assess the reporting bias. Heterogeneity will be evaluated by the I statistic and Q test. We will conduct the meta-analysis using Stata V12.0 to evaluate the effectiveness of ACU for LDH. In case of high heterogeneity, sensitivity analysis of different items and subgroup analysis will be performed. The Grading of Recommendations Assessment, Development, and Evaluation System will be used to assess the quality of evidence. RESULTS: The results of this review will be submitted to a journal for publication. CONCLUSION: This proposed systematic review will evaluate the effectiveness and safety of acupuncture for LDH. REGISTRATION: PROSPERO (registration number CRD42019148272).


Assuntos
Terapia por Acupuntura , Deslocamento do Disco Intervertebral/terapia , Vértebras Lombares , Humanos , Metanálise como Assunto , Revisão Sistemática como Assunto
2.
Medicine (Baltimore) ; 99(9): e19280, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32118739

RESUMO

BACKGROUND: Lumbar disc herniation (LDH) is a disease commonly seen in clinical practice. In the majority of such patients presenting in clinic, the symptoms can be relieved or even abolished after non-surgical treatment. Floating needle therapy has attracted considerable attention as a promising non-surgical technique to treat LDH, as demonstrated in previous studies. The purpose of the present study was to evaluate the outcomes of patients treated using this therapy in a single blind and randomized controlled trial by recording patient report questionnaires and objective test data, and to explore the feasibility and preliminary effects of floating needle therapy for patients with LDH. METHODS: A total of 80 patients who fulfilled the inclusion criteria were randomly divided into a Fu's subcutaneous needling (FSN) group and an acupuncture group then treated in accordance with procedures appropriate for a single blind and randomized controlled trial. The FSN group received 12 FSN therapy sessions over a 3-week period, and the acupuncture group received acupuncture therapy at specified points using acupuncture needles. The principal measurements were scored using the visual analogue scale (VAS), Japanese Orthopedic Association (JOA) Score, and Oswestry disability index (ODI) before and 3 weeks after treatment. Secondary measurements included immune function IgG and IgM measurements performed at the same time and adverse reactions during treatment. RESULTS: The results of this trial will be published on the website of China Clinical Trial Registration Center (http://www.chictr.org.cn/searchprojen.aspx) and in peer-reviewed journals or academic conferences. CONCLUSIONS: This study will explore the feasibility and preliminary effects of floating needle therapy for the treatment of patients with LDH. REGISTRATION: PROSPERO (registration number ChiCTR1900024045).


Assuntos
Terapia por Acupuntura , Degeneração do Disco Intervertebral/terapia , Deslocamento do Disco Intervertebral/terapia , Dor Intratável/terapia , Adulto , Idoso , Feminino , Humanos , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Degeneração do Disco Intervertebral/sangue , Deslocamento do Disco Intervertebral/sangue , Vértebras Lombares , Masculino , Pessoa de Meia-Idade , Medição da Dor , Projetos de Pesquisa , Método Simples-Cego , Resultado do Tratamento , Escala Visual Analógica , Adulto Jovem
3.
Medicine (Baltimore) ; 99(5): e18781, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32000379

RESUMO

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


Assuntos
Técnicas de Exercício e de Movimento , Deslocamento do Disco Intervertebral/terapia , Medicina Tradicional Chinesa , Humanos , Vértebras Lombares , Metanálise como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto
4.
Georgian Med News ; (295): 13-16, 2019 Oct.
Artigo em Russo | MEDLINE | ID: mdl-31804191

RESUMO

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


Assuntos
Deslocamento do Disco Intervertebral , Disco Intervertebral , Humanos , Deslocamento do Disco Intervertebral/terapia , Qualidade de Vida , Estudos Retrospectivos , Resultado do Tratamento , Ucrânia
5.
Medicine (Baltimore) ; 98(45): e17847, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31702642

RESUMO

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


Assuntos
Terapia por Acupuntura/métodos , Deslocamento do Disco Intervertebral/terapia , Terapia por Acupuntura/efeitos adversos , Adulto , Protocolos Clínicos , Humanos , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa , Resultado do Tratamento
6.
BMC Musculoskelet Disord ; 20(1): 438, 2019 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-31564252

RESUMO

BACKGROUND: The aim of this study was to find out whether the shear wave elastography (SWE) findings of patients with unilateral lumbar disc herniation (LDH) were related to clinical characteristics. METHODS: For this purpose, the study group included patients (N = 20; 13 male, 7 female) with complaints of unilateral sciatica, with foraminal stenosis caused by one level of LDH (L4-L5 or L5-S1). An gender-and age-matched control group (N = 27; 16 male, 11 female) was included. All the patients were examined on both the axial and longitudinal planes bilaterally at the same level using a convex array probe (1- 6 MHz, Supersonic Imagine, Aix en Provence, France). RESULTS: The sciatic nerve stiffness measured on longitudinal planes of the affected side was significantly higher than unaffected side (p < 0.001) and the control group (P < 0.05). Furthermore, the symptom duration of unilateral LDH is positively correlated with the stiffness the sciatic nerve (r = 0.52, p = 0.019). CONCLUSION: According to these findings, ultrasound imaging can be considered as a useful tool to detect changes in the sciatic nerve due to disc herniation. This technique will have a promising prospect for many patients with unilateral LDH in monitoring stiffness during rehabilitation and before or after surgery.


Assuntos
Técnicas de Imagem por Elasticidade/métodos , Deslocamento do Disco Intervertebral/diagnóstico por imagem , Nervo Isquiático/diagnóstico por imagem , Ciática/diagnóstico por imagem , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Disco Intervertebral/diagnóstico por imagem , Deslocamento do Disco Intervertebral/complicações , Deslocamento do Disco Intervertebral/terapia , Vértebras Lombares/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Ciática/etiologia , Ciática/terapia , Resultado do Tratamento
7.
Zhongguo Zhen Jiu ; 39(9): 977-80, 2019 Sep 12.
Artigo em Chinês | MEDLINE | ID: mdl-31544387

RESUMO

The combination of acupuncture and medication is not the simple adding of the two treatments, but identifying the etiology and pathogenesis behind the disease at first, followed dynamic integration of different therapies according to the characteristics of acupuncture-moxibustion and medication. Professor LI Zi-ping believes that a more comprehensive understanding based on multi-system syndrome differentiation is essential for lumbar disc herniation. In treatment, the pan-long needling technique combined with flying needling could regulate collaterals and adjust spirit; acupoint injection could transfer medication into acupoints; herb decoction could eliminate the pathogens and strengthen the root; the balanced cupping combined with exercise therapy could regulate tendons and prevent recurrence. The principle of the combination of acupuncture and medication could organically integrate the advantages of different therapies, so their effects can be enhanced or supplemented. This method has achieved superior effects in clinical treatment.


Assuntos
Terapia por Acupuntura , Deslocamento do Disco Intervertebral , Moxibustão , Pontos de Acupuntura , Humanos , Deslocamento do Disco Intervertebral/terapia
8.
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
9.
J Neurol Surg A Cent Eur Neurosurg ; 80(6): 503-506, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31430795

RESUMO

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


Assuntos
Deslocamento do Disco Intervertebral/terapia , Dor Lombar/terapia , Oxigênio/efeitos adversos , Ozônio/efeitos adversos , Embolia Pulmonar/etiologia , Idoso de 80 Anos ou mais , Feminino , Humanos , Deslocamento do Disco Intervertebral/complicações , Dor Lombar/etiologia , Oxigênio/uso terapêutico , Ozônio/uso terapêutico
10.
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
11.
Transfus Apher Sci ; 58(4): 512-514, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31272859

RESUMO

A 31-year-old man with mild hemophilia B developed a herniated disc treated with prednisolone for back pain. Surprisingly, hemostasis result tests performed before epidural infiltration were a normal activated partial thrombin time at 36.1 s. (normal range 27.9-37.7 s.) and factor IX (FIX) level 76% (normal range>70%), 13 days after prednisolone introduction. After a second control with a normal FIX level and a second genetic confirmation of hemophilia, no FIX concentrates was administered to perform the infiltration, which occurred without hemorrhagic complication. This new case of FIX normalization showed the necessity to have a perfect knowledge of patient's treatment to avoid misdiagnosis and a temporary normal hemostasis permit to perform epidural infiltration without replacement therapy.


Assuntos
Fator IX/metabolismo , Hemofilia B/sangue , Deslocamento do Disco Intervertebral/sangue , Deslocamento do Disco Intervertebral/terapia , Prednisolona/administração & dosagem , Adulto , Humanos , Masculino , Tempo de Tromboplastina Parcial
13.
Artigo em Inglês | MEDLINE | ID: mdl-31248064

RESUMO

The newly developed cervical lordotic curve-controlled traction (C-LCCT) appears to be an ideal method to improve the treatment outcome in patients with cervical intervertebral disc disease. The purpose of this study was to investigate the treatment outcomes of C-LCCT including the functional and morphological changes of the cervical intervertebral disc compared to traditional traction (TT) with a randomized controlled trial design. A total of 40 patients with cervical intervertebral disc disease at the C5/6 level confirmed by magnetic resonance imaging were recruited and assigned to either the C-LCCT group or the TT group. The comprehensive health status changes of the patients were recorded using pain and functional scores (Visual Analogue Scale, Oswestry Disability Index) and morphological changes (cervical lordosis, cervical central canal area) before and after the traction treatment. Both groups showed a significant improvement in pain scores after traction (p < 0.05). The functional score and morphological changes improved significantly after treatment in the C-LCCT group. However, there was no significant improvement in the TT group (p < 0.05). The C-LCCT showed significant pain, functional, and morphological improvement compared to TT. C-LCCT could be effective in improving the treatment outcomes of the traction technique in patients with cervical intervertebral disc disease.


Assuntos
Degeneração do Disco Intervertebral/terapia , Deslocamento do Disco Intervertebral/terapia , Disco Intervertebral/fisiopatologia , Lordose/terapia , Tração/métodos , Adulto , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
14.
Spine (Phila Pa 1976) ; 44(22): 1571-1577, 2019 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-31205180

RESUMO

STUDY DESIGN: Retrospective cohort study. OBJECTIVE: The purpose of this investigation was to evaluate the regional variations in the use of nonoperative therapies in patients diagnosed with a lumbar intervertebral disc herniation 3 months prior to undergoing microdiscectomy surgery. SUMMARY OF BACKGROUND DATA: Regional variations in the management of chronic pain conditions have been previously identified. Patients suffering from a lumbar intervertebral disc herniation are typically treated with a brief course of conservative management prior to attempting microdiscectomy surgery. Whether regional differences exist in the utilization or costs of maximum nonoperative therapy (MNT) remains unknown. METHODS: Medical records from patients diagnosed with a lumbar intervertebral disc herniation undergoing 1, 2, or 3-level index microdiscectomy operations between 2007 and 2017 were gathered from the HORTHO insurance database consisting of private/commercially insured and Medicare Advantage beneficiaries. Patient regional designation was divided into Midwest, Northeast, South, and West territories and was derived from the insurance claim location. The utilization of MNT within 3 months after initial lumbar herniation diagnosis in adult patients was analyzed. RESULTS: Our population consisted of 13,106 patients who underwent primary index microdiscectomy surgery. Significant regional variation was identified in the nonoperative therapy failure rate (P<0.0001), with the highest proportion of Midwest patients failing (2.7%). There were statistical differences in the regional distribution of patients utilizing NSAIDs (P<0.0001), muscle relaxants (P <0.0001), lumbar epidural steroid injections (P <0.0001), physical therapy and occupational therapy sessions (P <0.0001), chiropractor treatments (P <0.0001), and emergency department services (P = 0.0049). The total direct cost associated with all MNT prior to microdiscectomy was $13,205,924, with 59.6% from the South, 31.1% from the Midwest, 8.3% from the West, and 1.1% from the Northeast. CONCLUSION: These findings indicate that regional differences exist in the utilization and costs of MNT of a lumbar intervertebral herniated disc prior to microdiscectomy surgery. LEVEL OF EVIDENCE: 3.


Assuntos
Discotomia , Custos de Cuidados de Saúde/estatística & dados numéricos , Degeneração do Disco Intervertebral , Deslocamento do Disco Intervertebral , Vértebras Lombares , Adulto , Anti-Inflamatórios não Esteroides/uso terapêutico , Discotomia/economia , Discotomia/estatística & dados numéricos , Serviços Médicos de Emergência/estatística & dados numéricos , Humanos , Degeneração do Disco Intervertebral/economia , Degeneração do Disco Intervertebral/terapia , Deslocamento do Disco Intervertebral/economia , Deslocamento do Disco Intervertebral/terapia , Vértebras Lombares/fisiopatologia , Vértebras Lombares/cirurgia , Medicare , Modalidades de Fisioterapia/estatística & dados numéricos , Estudos Retrospectivos , Falha de Tratamento , Estados Unidos
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.
Zhongguo Zhen Jiu ; 39(5): 457-61, 2019 May 12.
Artigo em Chinês | MEDLINE | ID: mdl-31099213

RESUMO

OBJECTIVE: To observe the effect of lumbar disc herniation treated with acupuncture at different time intervals. METHODS: A total of 180 patients of lumbar disc herniation were randomized into an observation group 1, an observation group 2 and an observation group 3, 60 cases in each one. All patients were treated with acupuncture at Jiaji L3-L5 (EX-B 2), Huantiao (GB 30), Weizhong (BL 40), etc. And then KWD-808 electroacupuncture instrument was connected, time intervals of acupuncture were once every day, once every 2 days and once every 3 days, 3 weeks were provided. At 1-week, 2-week and 3-week treatment, the visual analogous scale (VAS) and Japanese Orthopedics Association (JOA) scale were observated, and the effects were evaluated. RESULTS: The effective rates in the observation group 1 and the observation group 2 were 96.7% (58/60) and 95.0% (57/60), there was no significant different between the two groups (P>0.05), which were superior to 88.3% (53/60) in the observation group 3 (both P<0.01). The VAS score in each group decreased to different degrees at 1-week, 2-week and 3-week treatment compared with those before treatment (all P<0.01), there was no significant different between the observation group 1 and the observation group 2 (all P>0.05) at 1-week, 2-week and 3-week treatment, however, they were significantly reduced compared with the observation group 3 (all P<0.05). The JOA score in each group increased to different degrees at 1-week, 2-week and 3-week treatment compared with those before treatment (all P<0.01), there was no significant different between the observation group 1 and the observation group 2 (all P>0.05) at 1-week, 2-week and 3-week treatment, however, they were significantly increased compared with the observation group 3 at 3-week treatment (both P<0.05). CONCLUSION: Acupuncture once every day and once every 2 days in the treatment of lumbar disc herniation is equally effective, better than once every 3 days.


Assuntos
Eletroacupuntura , Deslocamento do Disco Intervertebral , Pontos de Acupuntura , Humanos , Deslocamento do Disco Intervertebral/terapia , Resultado do Tratamento
17.
J Pediatr Orthop ; 39(10): e791-e795, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30925581

RESUMO

BACKGROUND: Lumbar herniated nucleus pulposis (HNP) occurs infrequently in the pediatric/adolescent population. A minority of patients with radicular symptoms fail to improve with conservative management and require discectomy. The authors hypothesize that children who ultimately require surgical intervention have an underlying lumbar stenosis predisposing them to continued symptoms. METHODS: Pediatric patients with a lumbar HNP on advanced imaging were retrospectively identified at a tertiary pediatric orthopaedic institution. Patients with spondylolisthesis, fractures, previous spine surgery, or structural thoracolumbar scoliosis were excluded. On sagittal magnetic resonance imagings, measurements were taken of the L4 and L5 vertebral body diameters (VBD) and canal diameters (CD) by 2 independent reviewers. Statistical analysis was performed using 2 sample T tests followed by logistic regression analysis. This was utilized to identify significant associations between CD and need for surgical decompression. RESULTS: A total of 76 patients (37 males/39 females) were identified with a lumbar HNP from 2001 to 2016. Eleven patients underwent discectomy. Sixty-five patients were managed conservatively. Age at magnetic resonance imaging was not different between groups (15.1±1.7 vs. 14.9±2.2 y, P=0.82). VBD at L4 and L5 were not different between groups (P=0.2 and 0.36, respectively). The reviewers had fair to good (0.584-0.854) interrater reliability correlation coefficients. CD was decreased in the surgically treated cohort at L4 (11.6±1.6 vs. 14.2±2.1 mm, P=0.0002) and at L5 (10.1±1.3 vs. 14.2±2.2 mm, P<0.00001). The ratio of CD:VBD was lower in the surgically treated group at L4 (0.36±0.06 vs. 0.46±0.08, P=0.0002) and L5 (0.31±0.68 vs. 0.45±0.08, P<0.00001). Patients with a L4 CD<12.6 mm were 18.8× more likely to require surgical decompression. 100% of patients with a L5 CD<12.36 mm ultimately underwent surgical decompression. CONCLUSIONS: Adolescent patients with congenital lumbar stenosis that develop a lumbar HNP are significantly more likely to require surgical decompression to relieve persistent radicular symptoms. A L4 CD<12.6 mm and a L5 CD<12.36 mm were highly correlated with the need for decompression. LEVEL OF EVIDENCE: Level III-prognostic study.


Assuntos
Descompressão Cirúrgica , Deslocamento do Disco Intervertebral/cirurgia , Vértebras Lombares/diagnóstico por imagem , Estenose Espinal/diagnóstico por imagem , Estenose Espinal/cirurgia , Adolescente , Criança , Tratamento Conservador , Feminino , Humanos , Deslocamento do Disco Intervertebral/complicações , Deslocamento do Disco Intervertebral/terapia , Imagem por Ressonância Magnética , Masculino , Variações Dependentes do Observador , Prognóstico , Reprodutibilidade dos Testes , Estudos Retrospectivos , Estenose Espinal/complicações , Estenose Espinal/congênito
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.
Drugs Today (Barc) ; 55(1): 17-23, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30740609

RESUMO

Lumbar disc herniation (LDH) is generally treated with a conservative therapy, and surgery is the only therapeutic option currently available for patients unresponsive to the conservative therapy. In the 1980s, chemonucleolysis with chymopapain, a protease, was widely used as the intermediate treatment between conservative therapy and surgical therapy in the Western countries. However, since chymopapain was withdrawn from the market in 2002 for non-scientific commercial reasons, chemonucleolysis has not been a therapeutic option for LDH. Condoliase (chondroitin sulfate ABC endolyase), a glycosaminoglycan-degrading enzyme, was approved by the drug regulatory authority in Japan as a newer intradiscal therapy for LDH after clinical studies conducted in Japan demonstrated efficacy and safety for patients with LDH. This review will focus on the preclinical pharmacology, pharmacokinetics, efficacy and safety of condoliase as a new option for treatment of LDH.


Assuntos
Glucuronidase/uso terapêutico , Deslocamento do Disco Intervertebral/terapia , Liases/uso terapêutico , Quimopapaína , Glucuronidase/farmacocinética , Humanos , Quimiólise do Disco Intervertebral , Japão , Liases/farmacocinética
20.
Bosn J Basic Med Sci ; 19(2): 130-137, 2019 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-30726701

RESUMO

Intervertebral disc (IVD) degeneration (IDD) is associated with low back pain and significantly affects the patient's quality of life. Degeneration of the IVD alters disk height and the mechanics of the spine, leading to chronic segmental spinal instability. The pathophysiology of IVD disease is still not well understood. Current therapies for IDD include conservative and invasive approaches, but none of those treatments are able to restore the disc structure and function. Recently, tissue engineering techniques emerged as a possible approach to treat IDD, by replacing a damaged IVD with scaffolds and appropriate cells. Advances in manufacturing techniques, material processing and development, surface functionalization, drug delivery systems and cell incorporation furthered the development of tissue engineering therapies. In this review, biomaterial scaffolds and cell-based therapies for IVD regeneration are briefly discussed.


Assuntos
Degeneração do Disco Intervertebral/terapia , Deslocamento do Disco Intervertebral/terapia , Disco Intervertebral/fisiopatologia , Engenharia Tecidual/métodos , Animais , Materiais Biocompatíveis/química , Terapia Baseada em Transplante de Células e Tecidos , Sistemas de Liberação de Medicamentos , Humanos , Dor Lombar/terapia , Fenótipo , Polímeros/química , Qualidade de Vida , Tecidos Suporte/química
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