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1.
Medicine (Baltimore) ; 100(14): e24775, 2021 Apr 09.
Artigo em Inglês | MEDLINE | ID: mdl-33832066

RESUMO

BACKGROUND: The new emerging application of decompression combined with fusion comes with a concern of cost performance, however, it is a lack of big data support. We aimed to evaluate the necessity or not of the addition of fusion for decompression in patients with lumbar degenerative spondylolisthesis. METHODS: Potential studies were selected from PubMed, Web of Science, and Cochrane Library, and gray relevant studies were manually searched. We set the searching time spanning from the creating date of electronic engines to August 2020. STATA version 11.0 was exerted to process the pooled data. RESULTS: Six RCTs were included in this study. A total of 650 patients were divided into 275 in the decompression group and 375 in the fusion group. No statistic differences were found in the visual analog scales (VAS) score for low back pain (weighted mean difference [WMD], -0.045; 95% confidence interval [CI], -1.259-1.169; P = .942) and leg pain (WMD, 0.075; 95% CI, -1.201-1.35; P = .908), Oswestry Disability Index (ODI) score (WMD, 1.489; 95% CI, -7.232-10.211; P = .738), European Quality of Life-5 Dimensions (EQ-5D) score (WMD, 0.03; 95% CI, -0.05-0.12; P = .43), Odom classification (OR, 0.353; 95% CI 0.113-1.099; P = .072), postoperative complications (OR, 0.437; 95% CI, 0.065-2.949; P = .395), secondary operation (OR, 2.541; 95% CI 0.897-7.198; P = .079), and postoperative degenerative spondylolisthesis (OR = 8.59, P = .27). Subgroup analysis of VAS score on low back pain (OR = 0.77, 95% CI, 0.36-1.65; P = .50) was demonstrated as no significant difference as well. CONCLUSION: The overall efficacy of the decompression combined with fusion is not revealed to be superior to decompression alone. At the same time, more evidence-based performance is needed to supplement this opinion.


Assuntos
Descompressão Cirúrgica/efeitos adversos , Dor Lombar/cirurgia , Fusão Vertebral/efeitos adversos , Espondilolistese/cirurgia , Idoso , Idoso de 80 Anos ou mais , Humanos , Vértebras Lombares/cirurgia , Pessoa de Meia-Idade , Satisfação do Paciente , Ensaios Clínicos Controlados Aleatórios como Assunto , Escala Visual Analógica
2.
Bone Joint J ; 103-B(3): 542-546, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33641429

RESUMO

AIMS: The aim of this study was to investigate the efficacy of coccygectomy in patients with persistent coccydynia and coccygeal instability. METHODS: The Danish National Spine Registry, DaneSpine, was used to identify 134 consecutive patients who underwent surgery, performed by a single surgeon between 2011 and 2019. Routine demographic data, surgical variables, and patient-reported outcomes, including a visual analogue scale (VAS) (0 to 100) for pain, Oswestry Disability Index (ODI), EuroQol five-dimension questionnaire (EQ-5D), and the Physical Component Score (PCS) and Mental Component Score (MCS) of the 36-Item Short-Form Health Survey questionnaire (SF-36) were collected at baseline and one-year postoperatively. RESULTS: A total of 112 (84%) patients with a minimum follow-up of one year had data available for analysis. Their mean age was 41.9 years, and 15 (13%) were males. At 12 months postoperatively, there were statistically significant improvements (p < 0.001) from baseline for the mean VAS for pain (70.99 to 35.34), EQ-5D (0.52 to 0.75), ODI (31.84 to 18.00), and SF-36 PCS (38.17 to 44.74). A total of 78 patients (70%) were satisfied with the outcome of treatment. CONCLUSION: Patients with persistent coccydynia and coccygeal instability resistant to nonoperative treatment may benefit from coccygectomy. Cite this article: Bone Joint J 2021;103-B(3):542-546.


Assuntos
Cóccix/fisiopatologia , Cóccix/cirurgia , Dor Lombar/fisiopatologia , Dor Lombar/cirurgia , Adolescente , Adulto , Idoso , Dinamarca , Avaliação da Deficiência , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Manejo da Dor/métodos , Medição da Dor , Sistema de Registros , Inquéritos e Questionários
3.
BMJ Case Rep ; 14(2)2021 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-33547129

RESUMO

Tight filum terminale (TFT) is a general term for pathological conditions that result in abnormal tension on the spinal cord, pulling the conus medullaris caudally. Because symptoms can vary, we aim to review the usefulness of Komagata's criteria in our experience with four patients who had TFT that was missed in prior workups. We performed a retrospective review of the medical records of four patients who underwent resection of the filum terminale for TFT. A total of four patients underwent surgery. The patients' chief complaints were lower back pain, lower limb pain and numbness. All patients met the Komagata diagnostic criteria for TFT and also had neurological abnormalities of the upper limbs, such as numbness and pathological reflexes. We resected the filum terminale in all patients, and achieved resolution of their preoperative symptoms. Komagata's diagnostic criteria are seemingly useful for the diagnosis of TFT.


Assuntos
Cauda Equina/cirurgia , Dor Lombar/diagnóstico , Dor Lombar/cirurgia , Defeitos do Tubo Neural/diagnóstico , Defeitos do Tubo Neural/cirurgia , Adolescente , Adulto , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Estudos Retrospectivos
4.
Schmerz ; 35(2): 124-129, 2021 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-33447917

RESUMO

Radiofrequency denervation has been established for many years as an important minimally invasive procedure for the treatment of chronic pain conditions. Positive experiences of many users for various indications are contrasted by a nonuniform evidence. With meticulous patient selection and correct assessment of the indications a longer term reduction of pain, a reduced need for analgesics and an improvement in the quality of life can be achieved. The aim of this interdisciplinary position paper is to present the value of radiofrequency denervation in the treatment of chronic pain. The summarized recommendations of the expert group are based on the available evidence and on the clinical experiences of Austrian centers that frequently implement the procedure. The position paper contains recommendations on patient selection and proven indications. We discribe safety aspects, complications, side effects and contraindications.


Assuntos
Dor Crônica , Dor Lombar , Articulação Zigapofisária , Áustria , Dor Crônica/terapia , Denervação , Humanos , Dor Lombar/cirurgia , Vértebras Lombares , Qualidade de Vida , Resultado do Tratamento
5.
J Orthop Sports Phys Ther ; 51(3): 103-114, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33356804

RESUMO

OBJECTIVE: To assess the effectiveness of prehabilitation in patients with degenerative disorders of the lumbar spine who are scheduled for spine surgery. DESIGN: Intervention systematic review with meta-analysis. LITERATURE SEARCH: Seven electronic databases were systematically searched for randomized controlled trials or propensity-matched cohorts. STUDY SELECTION CRITERIA: Studies that measured the effect of prehabilitation interventions (ie, exercise therapy and cognitive behavioral therapy [CBT]) on physical functioning, pain, complications, adverse events related to prehabilitation, health-related quality of life, psychological outcomes, length of hospital stay, use of analgesics, and return to work were included. DATA SYNTHESIS: Data were extracted at baseline (preoperatively) and at short-term (6 weeks or less), medium-term (greater than 6 weeks and up to 6 months), and long-term (greater than 6 months) follow-ups. Pooled effects were analyzed as mean differences and 95% confidence intervals (CIs). Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. RESULTS: Cognitive behavioral therapy interventions were no more effective than usual care for all outcomes. Pooled effect sizes were -2.0 (95% CI: -4.4, 0.4) for physical functioning, -1.9 (95% CI: -5.2, 1.4) for back pain, and -0.4 (95% CI: -4.1, 0.4) for leg pain. Certainty of evidence for CBT ranged from very low to low. Only 1 study focused on exercise therapy and found a positive effect on short-term outcomes. CONCLUSION: There was very low-certainty to low-certainty evidence of no additional effect of CBT interventions on outcomes in patients scheduled for lumbar surgery. Existing evidence was too limited to draw conclusions about the effects of exercise therapy. J Orthop Sports Phys Ther 2021;51(3):103-114. Epub 25 Dec 2020. doi:10.2519/jospt.2021.9748.


Assuntos
Terapia Cognitivo-Comportamental , Terapia por Exercício , Dor Lombar/reabilitação , Dor Lombar/cirurgia , Vértebras Lombares/cirurgia , Humanos , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Inquéritos e Questionários , Resultado do Tratamento
6.
Tech Vasc Interv Radiol ; 23(4): 100700, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33308584

RESUMO

Degenerative lumbar spine disorder (DLSD) is a ubiquitously occurring event that may be induced or accelerated by multiple factors such as from overuse, trauma, genetic predisposition, nutrition deficiency, and others. While our understanding of this degenerative disorder is limited, in terms of prevention, the symptoms from DLSD can be significant and may lead to the reduction in the patient's quality of life and loss of work time. In the Global Burden of Disease Study, low back pain was ranked the highest of 291 different conditions, due to the number of years lost to disability, amounting to 83 million disability-adjusted life years lost in 2010. DLSD contains conditions involving disc degeneration, lumbar spinal stenosis, and spondylolisthesis, including symptoms ranging from low back pain to lower extremity radicular pain and weakness. In this issue, we will be discussing treatments for patients suffering with chronic low back pain from endplate disruption, utilizing basivertebral nerve radiofrequency ablation, also known as the INTRACEPT procedure. This issue will also cover minimally invasive lumbar decompression from lumbar spinal stenosis, due to contributory ligamentum flavum hypertrophy, utilizing the percutaneous image-guided lumbar decompression technique known as the MILD procedure.


Assuntos
Dor Crônica/cirurgia , Descompressão Cirúrgica , Dor Lombar/cirurgia , Vértebras Lombares/cirurgia , Manejo da Dor , Ablação por Radiofrequência , Radiografia Intervencionista , Doenças da Coluna Vertebral/cirurgia , Dor Crônica/diagnóstico , Dor Crônica/fisiopatologia , Descompressão Cirúrgica/efeitos adversos , Humanos , Dor Lombar/diagnóstico , Dor Lombar/fisiopatologia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/fisiopatologia , Manejo da Dor/efeitos adversos , Ablação por Radiofrequência/efeitos adversos , Radiografia Intervencionista/efeitos adversos , Doenças da Coluna Vertebral/diagnóstico por imagem , Doenças da Coluna Vertebral/fisiopatologia , Resultado do Tratamento
7.
Medicine (Baltimore) ; 99(51): e23337, 2020 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-33371065

RESUMO

ABSTRACT: Recently, trans-sacral epiduroscopic laser decompression (SELD) using flexible epiduroscopy and laser system is 1 of the options for minimally invasive surgery in herniated lumbar disc. However, outcomes after SELD in patients with disc herniation of lumbar spine are not proven worldwide. The authors reported clinical, surgical, and radiological outcome after SELD in patients with mild to moderate disc herniation.Between 2015 and 2018, eighty-two patients who underwent SELD for single level disc herniation with a minimum follow-up of 6.0 months were investigated retrospectively. Clinical outcomes were assessed using the visual analog scale for low back and leg pain and Odom's criteria for patient satisfaction. Also, surgical outcomes, including complications, recurrences, and revision surgeries, and radiological outcomes using regular simple radiograph were analyzed.The mean visual analog scale score of low back pain and leg pain improved from 5.43 ±â€Š1.73 and 6.10 ±â€Š1.67 to 2.80 ±â€Š1.43 and 3.58 ±â€Š2.08 at the final follow-up (p < 0.001). On the other hand, according to Odom's criteria, the success rate (excellent or good results at 6 months after surgery) was 58.5%. Surgical complications occurred in 7 patients (8.5%), including dura puncture during the procedure, transient headache or nuchal pain, and transient mild paralysis. The rate of additional procedures after SELD was 17.1% (6 patients of revision surgery and 8 patients of an additional nerve block).Our findings demonstrated that SELD for lumbar disc herniation achieved less favorable patient satisfaction compared with previous studies. Further study is needed to clarify the influencing factors on the clinical outcomes of SELD.


Assuntos
Descompressão Cirúrgica/métodos , Deslocamento do Disco Intervertebral/cirurgia , Terapia a Laser/métodos , Vértebras Lombares/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Adulto , Fatores Etários , Índice de Massa Corporal , Descompressão Cirúrgica/efeitos adversos , Feminino , Humanos , Estimativa de Kaplan-Meier , Terapia a Laser/efeitos adversos , Tempo de Internação/estatística & dados numéricos , Dor Lombar/cirurgia , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Duração da Cirurgia , Medição da Dor , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Retorno ao Trabalho/estatística & dados numéricos , Índice de Gravidade de Doença , Fatores Sexuais
8.
Spine (Phila Pa 1976) ; 45(15): 1047-1054, 2020 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-32675607

RESUMO

STUDY DESIGN: Retrospective observational cohort study. OBJECTIVES: To compare the benefits of long and short fusion treatments, and to identify factors potentially aiding surgeons' decision making about the surgical management of degenerative lumbar scoliosis associated with spinal stenosis (DLSS). SUMMARY OF BACKGROUND DATA: The comparative effectiveness of long and short segment fusion for the treatment of DLSS remains controversial. METHODS: Fifty-three patients with symptomatic DLSS managed by posterior-only fusion surgery were enrolled in this study. Twenty patients underwent short fusion (fewer than two segments), and 33 patients had more than three segments fused. The radiological outcomes were assessed by radiography. Health-related quality of life data, including visual analog scale (VAS) and Oswestry Disability Index (ODI) scores, were collected at all preoperative and follow-up visits. RESULTS: The short and long fusion groups showed significant differences in the change in the Cobb angle (4.2° vs. 11.2°), lumbar lordosis (3.9° vs. 11.5°), and pelvic incidence minus the lumbar lordosis angle (PI - LL; 3.2° vs. 11.2°). Both the short and long fusion achieved significant changes in low back pain and leg pain. Patients with PI -LLs > 10° had more relief of low back pain after long fusion (VAS 4.0 ±â€Š2.0) than after short fusion (VAS 2.6 ±â€Š1.7). Patients with PI - LLs > 10° showed significantly improved walking ability after long fusion (ODI 1.0 ±â€Š0.8). The improvement in standing ability after short fusion was greater when PI - LL ≤ 10°(ODI 0.9 ±â€Š0.6). CONCLUSION: Long segment fusion can relieve low back pain better and improve walking ability when PI-LL is mismatched, whereas short segment fusion is more advantageous in improving standing ability in cases of more balanced sagittal spinopelvic alignment. LEVEL OF EVIDENCE: 3.


Assuntos
Lordose/cirurgia , Dor Lombar/cirurgia , Vértebras Lombares/cirurgia , Ossos Pélvicos , Escoliose/cirurgia , Estenose Espinal/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Gerenciamento Clínico , Feminino , Humanos , Lordose/diagnóstico por imagem , Dor Lombar/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Ossos Pélvicos/diagnóstico por imagem , Estudos Retrospectivos , Escoliose/diagnóstico por imagem , Fusão Vertebral/métodos , Fusão Vertebral/tendências , Estenose Espinal/diagnóstico por imagem , Resultado do Tratamento
9.
J Ayub Med Coll Abbottabad ; 32(2): 234-237, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32584000

RESUMO

BACKGROUND: Lumbosacral transitional vertebra is a common anatomical variant of the spine that possibly is related to low back pain. The objective is to determine the frequency of Lumbosacral Transitional Vertebrae on lumbosacral radiographs in patients with low back pain visiting Neurosurgery OPD of Khyber Teaching Hospital Peshawar Khyber Pakhtunkhwa (KP). METHODS: This cross-sectional study was conducted on radiographs of lumbosacral spine in patients visiting for low back pain to the Neurosurgery OPD of Khyber Teaching Hospital Peshawar. A total of 300 anteroposterior (AP) and lateral lumbosacral plain radiographs were studied for the variation in lumbosacral spinal segment. The transition was classified according to the scheme used by Castellvi. RESULTS: Among a total of 300 patients, normal anatomy of lumbosacral segments was observed in 215 patients (72%). About 85 cases (28%) showed Lumbosacral Transitional Vertebrae. The relationship of vertebral variation with age and gender was not observed. With regard to morphology, 29 (34.1%) patients had Castellvi type I, 26 cases (30.5%) were observed with Castellvi type II and 12 patients (14.1%) had type III while 18 cases (21.2%) had type IV transitional morphology. CONCLUSIONS: Lumbosacral Transitional Vertebrae are commonly found in patient with low back pain. Identification of Lumbosacral Transitional Vertebrae is clinically important to prevent an intervention at an incorrect vertebral level.


Assuntos
Dor Lombar/diagnóstico por imagem , Vértebras Lombares , Sacro , Estudos Transversais , Humanos , Dor Lombar/cirurgia , Vértebras Lombares/anormalidades , Vértebras Lombares/diagnóstico por imagem , Procedimentos Neurocirúrgicos , Paquistão , Radiografia , Sacro/anormalidades , Sacro/diagnóstico por imagem
10.
Medicine (Baltimore) ; 99(23): e20014, 2020 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-32501966

RESUMO

To date, no studies have evaluated the outcomes of lumbar interbody fusion using the anterior to psoas (ATP) approach in patients with spondylolisthesis at L5/S1. We; therefore, aimed to evaluate short-term surgical outcomes of interbody fusion using the ATP approach combined with posterior fixation in these patients.We performed a retrospective analysis of 9 patients with grade I spondylolisthesis at L5/S1 who were treated with fusion and posterior fixation using the ATP approach at our hospital from April to July 2018. The recorded parameters included operation time, intraoperative blood loss, complications, intervertebral fusion rate, radiological intervertebral height, intervertebral foramen height, intervertebral foramen width, pain, visual analog scale, and Oswestry disability index.Four men and 5 women at an average age of 57.8 years (range: 46-71 years) were enrolled in the study. The average operation time was 152.8 ±â€Š22.9 minutes, and the average blood loss during surgery was 165 ±â€Š27.5 mL. All patients confirmed the relief of their low back pain, and there were no serious complications. The follow-up time was more than 6 months. The visual analog scale and Oswestry disability index scores 3 days postoperatively and at the last follow-up were significantly lower than those before surgery (P < .05). At the last follow-up, the intervertebral space of the surgical segment showed bony fusion in all patients, and the intervertebral height and intervertebral foramen height and width were significantly increased compared with those before surgery (P < .05).The ATP approach was safe and effective for the treatment of spondylolisthesis at L5/S1. It showed low vascular injury and cage shift rates and was technically easy to perform. We recommended that surgeons identify the vessels in the surgical field preoperatively so that they can be secured or safely ligated during surgery.


Assuntos
Vértebras Lombares/cirurgia , Sacro/cirurgia , Fusão Vertebral/métodos , Espondilolistese/cirurgia , Idoso , Feminino , Humanos , Dor Lombar/etiologia , Dor Lombar/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
11.
Medicine (Baltimore) ; 99(21): e20276, 2020 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-32481306

RESUMO

RATIONALE: The most common fractures of the spine are associated with the thoracolumbar junction (T10-L2). And burst fractures make up 15% of all traumatic thoracolumbar fractures, which are often accompanied by neurological deficits and require open surgeries. Common surgeries include either anterior, posterior or a combination of these approaches. Here, we report the first attempt to treat thoracolumbar burst fracture (TLBF) with severe neurologic deficits by percutaneous pedicle screw fixation (PPSF) and transforaminal endoscopic spinal canal decompression (TESCD). PATIENT CONCERNS: A 46-year-old Chinese woman suffered from severe lower back pain with grade 0 muscle strength of lower limbs, without any sensory function below the injury level, with an inability to urinate or defecate after a motor vehicle accident. Imaging studies confirmed that she had Magerl type A 3.2 L1 burst fracture. DIAGNOSES: Burst fracture at L1. INTERVENTIONS: The patient underwent PPSF at the level of T12 to L2, but her neurological function did not fully recover after the operation. One week after the injury, we performed TESCD on her. OUTCOMES: There was an immediate improvement in her neurological function in just 1 day after 2-stage operation. During the 6-month follow-up period, her neurological functions gradually recovered, and she was able to defecate and urinate. At the last follow-up visit, her spinal cord function was assessed to be at Frankel grade D. LESSONS: PPSF plus TESCD can achieve complete spinal cord decompression, promote neurological recovery, and is therefore an effective method for the treating lumbar burst fractures with severe neurologic deficits.


Assuntos
Endoscopia/métodos , Fixação Interna de Fraturas/métodos , Dor Lombar/etiologia , Vértebras Lombares/lesões , Parafusos Pediculares , Fraturas da Coluna Vertebral/cirurgia , Vértebras Torácicas/lesões , Descompressão Cirúrgica/métodos , Feminino , Fraturas por Compressão/complicações , Fraturas por Compressão/diagnóstico , Fraturas por Compressão/cirurgia , Humanos , Laminectomia/métodos , Dor Lombar/diagnóstico , Dor Lombar/cirurgia , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Fraturas da Coluna Vertebral/complicações , Fraturas da Coluna Vertebral/diagnóstico , Tomografia Computadorizada por Raios X
12.
Rev. esp. cir. ortop. traumatol. (Ed. impr.) ; 64(3): 177-184, mayo-jun. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-196338

RESUMO

ANTECEDENTES Y OBJETIVO: Hoy por hoy el dolor lumbar sigue constituyendo una entidad patológica de alta incidencia en la población occidental. No hemos encontrado en la literatura datos que evalúen si con una exploración física correcta y una valoración de las radiologías simples de la columna vertebral se puede diagnosticar a los pacientes con una alta probabilidad de ser candidatos a cirugía de columna lumbar, disminuyendo así la carga asistencial y el consumo de recursos que esta patología supone. El objetivo del estudio es desarrollar una calculadora de fácil manejo que permita derivar a las consultas de Cirugía del Raquis solo a los pacientes con elevada probabilidad de recibir tratamiento quirúrgico. MATERIALES Y MÉTODOS: Estudio observacional y retrospectivo que incluyó a todos los pacientes mayores de edad del Área Sanitaria de Talavera de la Reina (Toledo) con diagnóstico clínico y/o radiológico de patología lumbar degenerativa derivados, por otros especialistas durante un año natural, a la unidad de Cirugía de Columna para valorar la indicación de cirugía tras tratamiento conservador infructuoso. Todos los pacientes fueron evaluados bajo un mismo protocolo con un seguimiento de 6años, al final de los cuales se controló quiénes fueron intervenidos sobre la columna lumbar. RESULTADOS: Se estudiaron un total de 201 pacientes, y al final de los 6años de seguimiento se intervinieron un total de 77 pacientes. Se encontró una concordancia del 70% entre la indicación de tratamiento quirúrgico y el tratamiento recibido al final del seguimiento, por lo que se realizó una regresión logística tratando de hacer una predicción de los pacientes que se pueden derivar a las unidades de Cirugía del Raquis, y a partir de ahí se generó una calculadora, que incluía la variable radiología simple como ítem imprescindible, y que mostró como estadísticamente significativo (p < 0,05): la edad, los signos de no organicidad de Waddell, el signo de Lassegue y la valoración de la radiología simple. A partir de la obtención de esta herramienta, se realizó el cálculo de probabilidad de ser intervenido a todos los pacientes a los que se propuso tratamiento quirúrgico, obteniéndose como punto de corte, al emplear la calculadora, unos resultados por encima del 62%. CONCLUSIONES: El empleo de la calculadora diseñada predice la posibilidad de ser candidato a tratamiento quirúrgico con un 70% de fiabilidad, así que los pacientes con un resultado en la calculadora superior al 62% deben ser derivados a consultas de Cirugía del Raquis para valoración por un especialista


BACKGROUND AND AIM: Low-back pain remains a common pathological entity in the Western population. We have found no data in the literature that assess whether, with correct physical examination and evaluation of simple x-rays of the spine, it is possible to diagnose patients who are highly likely to be candidates for lumbar spine surgery and thus reduce the care burden and resource consumption that this disorder entails. The aim of the study was to develop a user-friendly calculator that allows only patients who are strong candidates for surgical treatment to be referred for spinal surgery consultation. MATERIAL AND METHOD: An observational and retrospective study that included all adult patients from the healthcare area of Talavera de la Reina (Toledo, Spain) with a clinical and/or radiological diagnosis of degenerative lumbar spine disease referred by other specialists over one calendar year to the spinal surgery unit to assess whether surgery was indicated after unsuccessful conservative treatment. All the patients were assessed under the same protocol with a follow-up of 6years, at the end of which we performed a check of those who had undergone lumber spine surgery. RESULTS: A total of 201 patients were studied and at the end of the 6-year follow-up, a total of 77 patients had been operated. Concordance of 70% was found between the indication for surgical treatment and the treatment received at the end of the follow-up. Therefore a logistic regression was performed in an attempt to predict the patients that could be referred to the spinal surgery units and from that a calculator was generated, which included the plain x-ray variable as an essential item, and which showed as statistically significant (P<.05): age, Waddell's non-organic signs, Lasegue's sign and plain x-ray assessment. Once this tool had been obtained, the likelihood of undergoing surgery was calculated for all patients who were proposed surgical treatment, obtaining results above 62% as the cut-off point when using the calculator. CONCLUSIONS: The use of the calculator predicts the possibility of being a candidate for surgical treatment with 70% reliability. Therefore, patients with a result in the calculator of above 62% should be referred for spinal surgery consultation for assessment by a specialist


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Equipamentos e Provisões , Seleção de Pacientes , Doenças da Coluna Vertebral/cirurgia , Dor Lombar/cirurgia , Doenças da Coluna Vertebral/diagnóstico por imagem , Estudos Retrospectivos , Encaminhamento e Consulta , Radiografia , Análise de Regressão
13.
Rev. Soc. Esp. Dolor ; 27(3): 160-167, mayo-jun. 2020. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-196765

RESUMO

INTRODUCCIÓN: La importancia del manejo del dolor lumbar radica en su recurrencia y en las manifestaciones tanto para el paciente como para la sociedad. Se hace necesario establecer qué factores llevan al éxito en términos de dolor y funcionalidad al momento de realizarse una artrodesis lumbar. MATERIALES Y MÉTODOS: Se realizó un estudio descriptivo retrospectivo que buscó determinar qué parámetros espinopélvicos de balance sagital y sus valores en términos de incidencia pélvica (PI), inclinación pélvica (PT), inclinación sacra, lordosis lumbar (LL), eje sagital vertical (SVA) y la diferencia entre la PI y LL (PI-LL), pueden tener una potencial relación con desenlaces posquirúrgicos favorables. Se incluyeron 44 pacientes tratados en el Hospital Universitario San Ignacio entre enero de 2016 y diciembre de 2017. Se tomaron en cuenta desenlaces de dolor y funcionalidad en términos la escala visual analógica y el Oswestry Disability Index (ODI). Se realizó un seguimiento prequirúrgico, y 2 posquirúrgicos a los 3 y 6 meses. Debido al tamaño de la muestra, los autores no pudieron encontrar una significancia estadística, sin embargo, los resultados son concordantes con lo publicado anteriormente en el área. RESULTADOS: El mayor cambio porcentual se encontró en el grupo de pacientes que tuvieron una PI-LL > 10° con un aumento del 50 % en el grupo de pacientes con buena funcionalidad (ODI: 0-20). En SVA > 5 cm, el rango de pacientes con una buena funcionalidad tuvo un aumento del 44,6 %. El rango de buena funcionalidad en pacientes con una PT < 20° aumentó 54,1 puntos porcentuales. CONCLUSIONES: En la presente cohorte se encontró que los parámetros radiológicos que condicionaron un mayor cambio porcentual en la funcionalidad de los pacientes después de ser llevados a cirugía de columna fueron: SVA de base > 5 cm y una PI-LL base > 10° y PT < 20°


INTRODUCTION: The importance of lumbar pain management lies in its recurrence and manifestations for both the patient and society. It is necessary to establish what factors lead to success in terms of pain and functionality at the time of a lumbar arthrodesis. MATERIAL AND METHODS: A retrospective descriptive study was conducted that sought to determine which spinopelvic parameters and their values in terms of pelvic incidence (PI), pelvic tilt (PT), sacral slope, lumbar lordosis (LL), sagittal vertical axis (SVA), and mismatch (PI-LL) might have a potential relationship with favorable postoperative outcomes. We included 44 patients who underwent MIS spinal approaches in our center between January 2016 to December 2017. Surgical outcomes of pain and functionality were assessed using visual analogue scale and Oswestry Disability Index (ODI). Follow up was conducted through three evaluations: one before surgical intervention and 2 at 3 and 6 months postop. Due to the sample size, the authors were unable to get statistically significant results. RESULTS: In our descriptive retrospective study on 44 patients, we found a big positive functional change in the group of patients who had a PI-LL > 10° with an increase of 50 percentage points in the group of patients with good functionality (ODI: 0-20). In SVA > 5 cm, the range of patients with good functionality had an increase of 44.6 percentage points. The range of good functionality in patients with a PT < 20° increased 54.1 percentage points. CONCLUSIONS: In the present cohort, it was found that the radiological parameters that conditioned greater percentage change in the functionality of the patients after being taken to spine surgery were SVA of base > 5 cm and a PI-LL base > 10° and PT < 20°


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Fenômenos Biomecânicos/fisiologia , Artrodese/métodos , Dor Lombar/cirurgia , Fusão Vertebral/métodos , Estudos Retrospectivos , Manejo da Dor/métodos , Recuperação de Função Fisiológica , Colômbia/epidemiologia
14.
Pain Res Manag ; 2020: 5971937, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32399129

RESUMO

Objective: To investigate the change of spinopelvic sagittal balance and clinical outcomes after posterior lumbar interbody fusion (PLIF) in patients with degenerative spondylolisthesis (DS), especially the relationship between sagittal spinopelvic parameters and persistent low back pain (PLBP). Methods: 107 patients who were diagnosed with DS and underwent PLIF in our department were enrolled retrospectively in the present study. Sagittal spinopelvic parameters including lumbar lordosis (LL), segmental lordosis (SL), height of the disc (HOD), sacral slope (SS), pelvic incidence (PI), and pelvic tilt (PT) were recorded pre- and postoperatively. Sagittal balance and clinical outcomes were compared between patients with and without PLBP. Pearson correlation was used to analyze the change of sagittal balance parameters and clinical functions. Logistic regression analysis was performed to examine the risk factors of PLBP. Results: It showed significant improvements of SL, HOD, and PT postoperatively. Both the Numeric Rating Scale (NRS) and Oswestry Disability Index (ODI) had significant improvement postoperatively. Change of PT and SL also differed observably between patients with and without PLBP. SL and PT were correlated with NRS and ODI, and insufficient restoration of PT was an independent factor for PLBP. Conclusion: The sagittal balance parameters and clinical outcomes can be improved markedly via PLIF for treating DS. Restoration of SL and PT was correlated with satisfactory outcomes, and adequate improvement of PT may have positive impact on reducing PLBP.


Assuntos
Síndrome Pós-Laminectomia , Fusão Vertebral/métodos , Espondilolistese/cirurgia , Resultado do Tratamento , Adulto , Idoso , Síndrome Pós-Laminectomia/epidemiologia , Síndrome Pós-Laminectomia/etiologia , Feminino , Humanos , Dor Lombar/etiologia , Dor Lombar/cirurgia , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Postura , Estudos Retrospectivos , Curvaturas da Coluna Vertebral/etiologia , Curvaturas da Coluna Vertebral/cirurgia , Espondilolistese/complicações
15.
Value Health ; 23(5): 585-594, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32389224

RESUMO

OBJECTIVES: To evaluate the cost-effectiveness of radiofrequency denervation when added to a standardized exercise program for patients with chronic low back pain. METHODS: An economic evaluation was conducted alongside 3 pragmatic multicenter, nonblinded randomized clinical trials (RCTs) in The Netherlands with a follow up of 52 weeks. Eligible participants were included between January 1, 2013, and October 24, 2014, and had chronic low back pain; a positive diagnostic block at the facet joints (n = 251), sacroiliac (SI) joints (n = 228), or a combination of facet joints, SI joints, and intervertebral discs (n = 202); and were unresponsive to initial conservative care. Quality-adjusted life-years (QALYs) and societal costs were measured using self-reported questionnaires. Missing data were imputed using multiple imputation. Bootstrapping was used to estimate statistical uncertainty. RESULTS: After 52 weeks, no difference in costs between groups was found in the facet joint or combination RCT. The total costs were significantly higher for the intervention group in the SI joint RCT. The maximum probability of radiofrequency denervation being cost-effective when added to a standardized exercise program ranged from 0.10 in the facet joint RCT to 0.17 in the SI joint RCT irrespective of the ceiling ratio, and 0.65 at a ceiling ratio of €30 000 per QALY in the combination RCT. CONCLUSIONS: Although equivocal among patients with symptoms in a combination of the facet joints, SI joints, and intervertebral discs, evidence suggests that radiofrequency denervation combined with a standardized exercise program cannot be considered cost-effective from a societal perspective for patients with chronic low back pain originating from either facet or SI joints in a Dutch healthcare setting.


Assuntos
Dor Crônica/cirurgia , Análise Custo-Benefício , Denervação , Dor Lombar/cirurgia , Vértebras Lombares/inervação , Terapia por Radiofrequência , Terapia por Exercício , Feminino , Humanos , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Países Baixos , Anos de Vida Ajustados por Qualidade de Vida , Articulação Sacroilíaca/inervação , Articulação Sacroilíaca/cirurgia , Autorrelato , Inquéritos e Questionários , Articulação Zigapofisária/inervação , Articulação Zigapofisária/cirurgia
16.
Rozhl Chir ; 99(1): 46-50, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32122139

RESUMO

INTRODUCTION: Chronic back pain (CBP) is a very common symptom. Multiple modalities are used in its evaluation. However, according to current evidence, none of them can be used with certainty to predict the success of fusion surgery. Given the growing experience with bone tissue examination using the methods of nuclear medicine, we have used this possibility in patients with CBP without disc herniation, degenerative spinal stenosis or instability. CASE REPORTS: We present case reports of 11 patients who underwent lumbar fusion (during two years period) for degenerative disc disease or facet arthropathy with adequate activity on PET or SPECT/CT examination. Rolland-Morris Questionnaire (RMQ), Oswestry Disability Index (ODI), and Visual Analogue Scale (VAS) were filled out pre-operatively and 24 months after surgery. RESULTS: Six patients after one-level stabilization for active osteochondrosis and one for active facet arthropathy improved on average by 82% (64-92%) in RMQ, by 72% (48-100%) in ODI and 75% (55-100%) in VAS. Results in cases after multilevel stabilizations were slightly worse, but still very significant in most parameters. Only one patient with the most severe morphological and clinical findings did not benefit from surgery. CONCLUSION: In 10 out of 11 patients, the lower back pain and quality of life improved significantly after lumbar fusion performed in levels diagnosed by PET or SPECT/CT. These methods certainly have their place in the evaluation of CBP, especially in the case of unclear findings or multiple degenerative changes.


Assuntos
Dor Lombar/diagnóstico por imagem , Dor Lombar/etiologia , Dor Lombar/cirurgia , Medicina Nuclear , Fusão Vertebral , Estenose Espinal/cirurgia , Humanos , Vértebras Lombares/diagnóstico por imagem , Qualidade de Vida , Resultado do Tratamento
17.
Sci Rep ; 10(1): 3708, 2020 02 28.
Artigo em Inglês | MEDLINE | ID: mdl-32111963

RESUMO

The incidence of intervertebral disc (IVD) degeneration disease, caused by changes in the osmotic pressure of nucleus pulposus (NP) cells, increases with age. In general, low back pain is associated with IVD degeneration. However, the mechanism and molecular target of low back pain have not been elucidated, and there are no data suggesting specific biomarkers of low back pain. Therefore, the research aims to identify and verify the significant gene biomarkers of low back pain. The differentially expressed genes (DEGs) were screened in the Gene Expression Omnibus (GEO) database, and the identification and analysis of significant gene biomarkers were also performed with various bioinformatics programs. A total of 120 patients with low back pain were recruited. Before surgery, the degree of pain was measured by the numeric rating scale (NRS), which enables comparison of the pain scores from individuals. After surgery, IVD tissues were obtained, and NP cells were isolated. The NP cells were cultured in two various osmotic media, including iso-osmotic media (293 mOsm/kg H2O) to account for the morbid environment of NP cells in IVD degeneration disease and hyper-osmotic media (450 mOsm/kg H2O) to account for the normal condition of NP cells in healthy individuals. The relative mRNA expression levels of CCL5, OPRL1, CXCL13, and SST were measured by quantitative real-time PCR in the in vitro analysis of the osmotic pressure experiments. Finally, correlation analysis and a neural network module were employed to explore the linkage between significant gene biomarkers and pain. A total of 371 DEGs were identified, including 128 downregulated genes and 243 upregulated genes. Furthermore, the four genes (CCL5, OPRL1, SST, and CXCL13) were identified as significant gene biomarkers of low back pain (P < 0.001) based on univariate linear regression, and CCL5 (odds ratio, 34.667; P = 0.003) and OPRL1 (odds ratio, 19.875; P < 0.001) were significantly related to low back pain through multivariate logistic regression. The expression of CCL5 and OPRL1 might be correlated with low back pain in patients with IVD degeneration disease caused by changes in the osmotic pressure of NP cells.


Assuntos
Dor Lombar/genética , Núcleo Pulposo/química , Expressão Gênica , Marcadores Genéticos , Humanos , Disco Intervertebral/química , Disco Intervertebral/metabolismo , Disco Intervertebral/cirurgia , Dor Lombar/metabolismo , Dor Lombar/cirurgia , Núcleo Pulposo/metabolismo , Pressão Osmótica , Proteínas/genética , Proteínas/metabolismo
18.
Medicine (Baltimore) ; 99(11): e19457, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32176077

RESUMO

BACKGROUND: Lumbar degenerative disease (LDD) is a very common disease. And decompression alone, posterior lumbar interbody fusion (PLIF), and interspinous device (Coflex) are generally accepted surgical techniques. However, the effectiveness and safety of the above techniques are still not clear. Network meta-analysis a comprehensive technique can compare multiple treatments based on indirect dates and all interventions are evaluated and ranked simultaneously. To figure out this problem and offer a better choice for LDD, we performed this network meta-analysis. METHODS: PubMed and WanFang databases were searched based on the following key words, "Coflex," "decompression," "PLIF," "Posterior Lumbar Interbody Fusion," "Coflex" "Lumbar interbody Fusion." Then the studies were sorted out on the basis of inclusion criteria and exclusion criteria. A network meta-analysis was performed using The University of Auckland, Auckland city, New Zealand R 3.5.3 software. RESULTS: A total of 10 eligible literatures were finally screened, including 946 patients. All studies were randomized controlled trials (RCTs). Compared with decompression alone group, there were no significant differences of Oswestry Disability Index (ODI) in Coflex and lumbar interbody fusion groups after surgery. However, Coflex and PLIF were better in decreasing Visual Analogue Scale (VAS) score compared with decompression alone. Furthermore, we found Coflex have a less complication incidence rate. CONCLUSION: Compared with decompression alone, Coflex and lumbar interbody fusion had the similar effectiveness in improving lumbar function and quality of life. However, the latter 2 techniques were better in relieving pain. Furthermore, Coflex included a lower complication incidence rate. So we suggested that Coflex technique was a better choice to cue lumbar spinal stenosis (LSS). LEVEL OF EVIDENCE: Systematic review and meta-analysis, level I.


Assuntos
Descompressão Cirúrgica , Fixadores Internos , Degeneração do Disco Intervertebral/cirurgia , Vértebras Lombares/cirurgia , Fusão Vertebral/métodos , Estenose Espinal/cirurgia , Avaliação da Deficiência , Humanos , Dor Lombar/cirurgia , Manejo da Dor , Qualidade de Vida
19.
Spine (Phila Pa 1976) ; 45(12): 820-824, 2020 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-32205705

RESUMO

STUDY DESIGN: We performed a comprehensive search of PubMed, MEDLINE, and EMBASE for all English language studies of all levels of evidence pertaining to Spine Patient Outcomes Research Trial (SPORT), in accordance with Preferred Reported Items for Systematic Reviews and Meta-analyses guidelines. OBJECTIVE: We aim to summarize the 10-year clinical outcomes of SPORT and its numerous follow-up studies for degenerative spondylolisthesis. SUMMARY OF BACKGROUND DATA: The SPORT was a landmark randomized control trial including approximately 2500 patients at 13 clinics across the country. SPORT compared surgical and nonoperative management of the three most common spinal pathologies. METHODS: Keywords used in the literature search included SPORT, spine patient outcomes research trial, degenerative spondylolisthesis, and surgical outcomes. RESULTS: The intent-to-treat analysis failed to show a significant difference between patients treated surgically as compared to those treated nonoperatively. However, as-treated analysis revealed statically greater improvements at 6 weeks, 2 years, and 4 years in patients treated surgically. Secondary outcomes such as low back pain, leg pain, stenosis bothersome scales, overall satisfaction with current symptoms, and self-rated progress were also significantly improved in surgical patients. Regardless of the initial grade of listhesis, disk height, or mobility, patients who had surgical treatment improved more in terms of Oswestry Disability Index, bodily pain, physical function, and low back pain bothersomeness scales. Risk of reoperation increased with age, having two or three moderate or severe stenotic levels, pain predominantly localized to the back, no physical therapy, the absence of neurogenic claudication, and greater leg pain scores. Risk of reoperation was not significantly affected by type of surgery performed, smoking, diabetes, obesity, longer duration of symptoms, or workman's compensation. CONCLUSION: Although intent-to-treat analysis failed to show significant differences in patients treated surgically, results of the as-treated analysis determined statically greater improvements in those patients with spondylolisthesis who were treated surgically as compared to those treated nonoperatively. LEVEL OF EVIDENCE: 2.


Assuntos
Avaliação de Resultados em Cuidados de Saúde , Espondilolistese/cirurgia , Espondilolistese/terapia , Resultado do Tratamento , Idoso , Feminino , Seguimentos , Humanos , Dor Lombar/cirurgia , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Medição da Dor , Complicações Pós-Operatórias/cirurgia , Ensaios Clínicos Controlados Aleatórios como Assunto , Reoperação , Estenose Espinal/cirurgia , Fatores de Tempo
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