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1.
World Neurosurg ; 133: 142-149, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31557552

RESUMO

BACKGROUND: Split cord malformations (SCMs) are among the rare congenital spinal anomalies. In 1992, Pang et al. proposed the unified theory of embryogenesis and explained the formation of SCM type 1 and 2. This theory has been widely accepted in the neurosurgical literature, backed by several studies. However, there have been reports in the literature that defy both the classification as well as the formation of SCMs, based on the unified theory of embryogenesis. We report a case of SCM that does not fit into this classification scheme and try to elucidate its embryologic basis, with review of the relevant literature. We also attempt to include this variety into the existing classification system of SCMs. CASE DESCRIPTION: An 11-year-old boy presented with low backache after trivial trauma. He was neurologically intact. Imaging showed low-lying tethered cord and a midline ventral bony spur (D12, L1) with a single dural sac encasing both the hemicords. Surgical exploration showed a ventral bony spur with 2 hemicords, enclosed in a single dural tube. Excision of the bony spur and detethering of the filum terminal were performed. The postoperative course was uneventful and the patient was discharged satisfactorily. CONCLUSIONS: SCMs possibly represent a continuum of changes beginning at the gestational age of days 20-30. Terminology such as mixed or intermediate type is used to denote SCMs that show features of both type 1 and type II. We prefer using type 1.5 SCMs for all such cases, thereby avoiding confusion and maintaining uniformity in the nomenclature. However, further experimental studies are required to substantiate our understanding of these complex embryologic anomalies on the basis of current hypotheses.


Assuntos
Dor Lombar/cirurgia , Medula Espinal/anormalidades , Criança , Humanos , Dor Lombar/diagnóstico por imagem , Dor Lombar/patologia , Imagem por Ressonância Magnética , Masculino , Procedimentos Neurocirúrgicos , Medula Espinal/diagnóstico por imagem , Medula Espinal/cirurgia , Resultado do Tratamento
2.
BMC Health Serv Res ; 19(1): 983, 2019 Dec 21.
Artigo em Inglês | MEDLINE | ID: mdl-31864352

RESUMO

BACKGROUND: The overuse of diagnostic imaging for low back pain (LBP) in Australia results in unnecessary cost to the health system and, for patients, avoidable exposure to radiation. The 2013 NPS MedicineWise LBP program aimed to reduce unnecessary diagnostic imaging for non-specific acute LBP in the Australian primary care setting. The LBP program delivered referral pattern feedback, a decision support tool and patient information to 19,997 (60%) of registered Australian general practitioners (GPs). This study describes the findings from evaluation of the effectiveness of the 2013 LBP program at reducing X-ray and computed tomography (CT) scans of the lower back, and the financial costs and benefits of the program to the government funder. METHODS: The effectiveness of the 2013 LBP program was evaluated using population-based time-series analysis of administrative claims data of Medicare Benefits Schedule (MBS) funded X-ray and CT scan services of the lower back. The CT scan referral trend of non-GP health professionals was used as an observational control group in a Bayesian structural time-series model. A retrospective cost-benefit analysis and cost-effectiveness analysis was conducted using program costs from organisational records and reimbursement data from the MBS. RESULTS: The 2013 NPS MedicineWise LBP program was associated with a statistically significant 10.85% relative reduction in the volume of CT scans of the lumbosacral region, equating to a cost reduction to the MBS of AUD$11,600,898. The best available estimate of program costs was AUD$141,154. Every dollar of funding spent on the 2013 LBP program saved AUD$82 of funding to the MBS for CT scan reimbursements. Therefore, from the perspective of the Australian Government Department of Health, the 2013 LBP program was cost saving. The program cost AUD$2.82 per CT scan averted in comparison to the scenario of no program. No association between the 2013 NPS MedicineWise LBP program and the volume of X-ray items on the MBS was observed. CONCLUSIONS: The 2013 NPS MedicineWise LBP program reduced CT scan referral by GPs, in line with the program's messages and clinical guidelines. Reducing this low-value care produced savings to the health system that exceeded the costs of program implementation.


Assuntos
Clínicos Gerais , Dor Lombar/diagnóstico por imagem , Programas Nacionais de Saúde/economia , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Procedimentos Desnecessários/estatística & dados numéricos , Austrália , Análise Custo-Benefício , Humanos , Atenção Primária à Saúde , Avaliação de Programas e Projetos de Saúde , Encaminhamento e Consulta/estatística & dados numéricos , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/economia , Procedimentos Desnecessários/economia
3.
Chiropr Man Therap ; 27: 50, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31608144

RESUMO

Background: Clinicians nominate the distribution of leg pain as being important in diagnosing nerve root involvement. This study aimed to identify: (i) common unisegmental radicular pain patterns and whether they were dermatomal, and (ii) whether these radicular pain patterns assisted clinician discrimination of the nerve root level involved. Methods: A cross-sectional diagnostic accuracy study of adult patients with radicular leg pain at a hospital in Denmark. All patients had positive neurological signs (average 2.8 signs - hypoalgesia, diminished reflexes, muscle weakness, positive Straight Leg Raise test).Part 1 (pain patterns) was a secondary analysis of baseline pain pattern data collected during a clinical trial. The pain charts of 93 patients with an MRI and clinically confirmed single-level disc herniation with nerve root compression were digitised and layered to form a composite picture of the radicular patterns for the L5 and S1 nerve roots, which were then compared to published dermatomes.In Part 2 (clinical utility) we prospectively measured the discriminative ability of the identified pain patterns. The accuracy was calculated of three groups of six clinicians at classifying the nerve root affected in a randomized sequence of 53 patients, when not shown, briefly shown or continuously shown the composite pain patterns. In each group were two chiropractors, two medical doctors and two physiotherapists. Results: There was a wide overlap in pain patterns from compromised L5 and S1 nerve roots but some distinguishing features. These pain patterns had approximately 50 to 80% overlap with published dermatomes. Clinicians were unable to determine with any accuracy above chance whether an individual pain drawing was from a person with a compromised L5 or S1 nerve root, and use of the composite pain drawings did not improve that accuracy. Conclusions: While pain distribution may be an indication of radiculopathy, pain patterns from L5 or S1 nerve root compression only approximated those of sensory dermatomes, and level-specific knowledge about radicular pain patterns did not assist clinicians' diagnostic accuracy of the nerve root impinged. These results indicate that, on their own, pain patterns provide very limited additional diagnostic information about which individual nerve root is affected.


Assuntos
Dor Lombar/diagnóstico por imagem , Radiculopatia/diagnóstico por imagem , Adulto , Estudos Transversais , Dinamarca , Feminino , Humanos , Dor Lombar/diagnóstico , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Medição da Dor , Radiculopatia/diagnóstico , Ensaios Clínicos Controlados Aleatórios como Assunto , Raízes Nervosas Espinhais/diagnóstico por imagem , Adulto Jovem
4.
J Orthop Surg Res ; 14(1): 252, 2019 Aug 08.
Artigo em Inglês | MEDLINE | ID: mdl-31395104

RESUMO

BACKGROUND: Conventional posterior open lumbar surgery is associated with considerable trauma to the paraspinal muscles. Severe damage to the paraspinal muscles could cause low back pain (LBP), resulting in poor functional outcomes. Thus, several studies have proposed numerous surgical techniques that can minimize damage to the paraspinal muscles, particularly unilateral laminotomy for bilateral decompression. The purpose of this study is to compare the degree of postoperative LBP, functional outcome, and quality of life of patients between bilateral decompression via unilateral laminotomy (BDUL; group U) and conventional laminectomy (CL; group C). METHODS: Of 87 patients who underwent diagnostic and decompression surgery, 50 patients who met the inclusion and exclusion criteria and were followed up for > 2 years were enrolled. The patients were asked to record their visual analog scale pain score after 6, 12, and 24 months postoperatively. BDUL was used for group U, whereas CL was used for group C. The patients were randomly divided based on one of the two techniques, and they were followed up for over 2 years. Functional outcomes were assessed by the Oswestry Disability Index (ODI), Roland-Morris Disability Questionnaire (RMDQ), and SF-36. RESULTS: Operation time was significantly shorter in group U than in group C (p = 0.003). At 6, 12, and 24 months, there was no significant difference between the two groups in terms of spine-related pain (all p > 0.05). Functional outcomes using ODI and RMDQ and quality of life using SF-36 were not significantly different between the groups (all p > 0.05). CONCLUSIONS: Regarding single-level decompression for degenerative lumbar spinal stenosis, group U had the advantages of shorter operation time than group C, but not in terms of back pain, functional outcome, and quality of life.


Assuntos
Descompressão Cirúrgica/métodos , Laminectomia/métodos , Dor Lombar/cirurgia , Doenças Neurodegenerativas/cirurgia , Qualidade de Vida , Estenose Espinal/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Descompressão Cirúrgica/normas , Feminino , Humanos , Laminectomia/normas , Dor Lombar/diagnóstico por imagem , Dor Lombar/epidemiologia , Masculino , Pessoa de Meia-Idade , Doenças Neurodegenerativas/diagnóstico por imagem , Doenças Neurodegenerativas/epidemiologia , Estudos Prospectivos , Estenose Espinal/diagnóstico por imagem , Estenose Espinal/epidemiologia , Resultado do Tratamento
5.
Biomed Res Int ; 2019: 9369853, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31380443

RESUMO

Purpose: The endplate defects (EDs), Modic changes (MCs), disc degeneration (DD), facet orientation (FO), and facet tropism (FT) were demonstrated to be related to the low back pain (LBP). The aim of this study was to investigate possible correlations between them. Methods: 75 patients were reviewed to evaluate the degenerative change in vertebral bodies (EDs and MCs), intervertebral discs (DD), and facet joint degeneration (FO and FT). All patients were categorized into four groups based on the grade of EDs. Clinical outcomes were evaluated with the visual analog scale (VAS) and Oswestry disability index (ODI) before and after surgery. Results: There was no difference between the four groups in baseline characteristics except for gender and weight. FT is positively correlated with FO. The same rule exists between EDs, the size of MCs II, FO (left) and FO (right), and VAS and ODI. The grade of EDs is positively correlated with the grade of DD. L4-L5 can bear more load than other levels; thus, the grade of EDs is higher than that of other lumbar levels. The preoperative LBP was relieved in all groups in varying degrees. The change of pain and dysfunction is inversely proportional to the grade of EDs in the general trend. Conclusion: The relationship between weight, gender, and disc degeneration provided a mechanism by which increasing weight can predispose to DD. Different grades of EDs had different effects on patients with LBP. There was a significant correlation between EDs, MCs II, DD, FT, and FO.


Assuntos
Degeneração do Disco Intervertebral/cirurgia , Dor Lombar/cirurgia , Espondilose/cirurgia , Articulação Zigapofisária/cirurgia , Idoso , Feminino , Humanos , Disco Intervertebral/diagnóstico por imagem , Disco Intervertebral/fisiopatologia , Disco Intervertebral/cirurgia , Degeneração do Disco Intervertebral/diagnóstico por imagem , Degeneração do Disco Intervertebral/fisiopatologia , Dor Lombar/diagnóstico por imagem , Dor Lombar/fisiopatologia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/fisiopatologia , Região Lombossacral/diagnóstico por imagem , Região Lombossacral/fisiopatologia , Região Lombossacral/cirurgia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Espondilose/complicações , Espondilose/fisiopatologia , Escala Visual Analógica , Articulação Zigapofisária/diagnóstico por imagem , Articulação Zigapofisária/fisiopatologia
6.
PLoS Med ; 16(8): e1002898, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31419219

RESUMO

BACKGROUND: Occupational medicine seeks to reduce sick leave; however, evidence for an add-on effect to usual care is sparse. The objective of the GOBACK trial was to test whether people with low back pain (LBP) in physically demanding jobs and at risk of sick leave gain additional benefit from a 3-month complex intervention that involves occupational medicine consultations, a work-related evaluation and workplace intervention plan, an optional workplace visit, and a physical activity program, over a single hospital consultation and an MRI. METHODS AND FINDINGS: We enrolled people from the capital region of Denmark to an open-label, parallel-group randomized controlled trial with a superiority design from March 2014 through December 2015. In a hospital setting 305 participants (99 women) with LBP and in physically demanding jobs were randomized to occupational intervention (n = 153) or no additional intervention (control group; n = 152) added to a single hospital consultation giving a thorough explanation of the pain (i.e., clinical examination and MRI) and instructions to stay active and continue working. Primary outcome was accumulated sick leave days due to LBP during 6 months. Secondary outcomes were changes in neuropathic pain (painDETECT questionnaire [PDQ]), pain 0-10 numerical rating scale (NRS), Fear-Avoidance Beliefs Questionnaire (FABQ), Roland-Morris Disability Questionnaire (RMDQ), Short Form Health Survey (SF-36) for physical and mental health-related quality of life (HRQoL), and self-assessed ability to continue working (range 0-10). An intention-to-treat analysis of sick leave at 6 months showed no significant difference between groups (mean difference in days suggestively in favor of no additional intervention: 3.50 [95% CI -5.08 to 12.07], P = 0.42). Both groups showed significant improvements in average pain score (NRS), disability (RMDQ), fear-avoidance beliefs about physical activities and work (FABQ), and physical HRQoL (SF-36 physical component summary); there were no significant differences between the groups in any secondary outcome. There was no statistically significant improvement in neuropathic pain (PDQ score), mental HRQoL (SF-36 mental component summary), and self-assessed ability to stay in job. Four participants could not complete the MRI or the intervention due to a claustrophobic attack or accentuated back pain. Workplace visits may be an important element in the occupational intervention, although not always needed. A per-protocol analysis that included the 40 participants in the intervention arm who received a workplace visit as part of the additional occupational intervention did not show an add-on benefit in terms of sick leave (available cases after 6 months, mean difference: -0.43 days [95% CI -12.8 to 11.94], P = 0.945). The main limitations were the small number of sick leave days taken and that the comprehensive use of MRI may limit generalization of the findings to other settings, for example, general practice. CONCLUSIONS: When given a single hospital consultation and MRI, people in physically demanding jobs at risk of sick leave due to LBP did not benefit from a complex additional occupational intervention. Occupational interventions aimed at limiting biopsychological obstacles (e.g., fear-avoidance beliefs and behaviors), barriers in the workplace, and system barriers seem essential to reduce sick leave in patients with LBP. This study indicates that these obstacles and barriers may be addressed by thorough usual care. TRIAL REGISTRATION: Clinical Trials.gov: NCT02015572.


Assuntos
Dor Lombar/prevenção & controle , Doenças Profissionais/prevenção & controle , Absenteísmo , Feminino , Humanos , Dor Lombar/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Medicina do Trabalho/métodos
7.
BMC Health Serv Res ; 19(1): 446, 2019 Jul 03.
Artigo em Inglês | MEDLINE | ID: mdl-31269933

RESUMO

BACKGROUND: Through the Choosing Wisely Canada (CWC) campaign, national medical specialty societies have released hundreds of recommendations against health care services that are unnecessary, i.e. present little to no benefit or cause avoidable harm. Despite growing interest in unnecessary care both within Canada and internationally, prior research has typically avoided taking a national or even multi-jurisdictional approach in measuring the extent of the issue. This study estimates use of three unnecessary services identified by CWC recommendations across multiple Canadian jurisdictions. METHODS: Two retrospective cohort studies were conducted using administrative health care data collected between fiscal years 2011/12 and 2012/13 to respectively quantify use of 1) diagnostic imaging (spinal X-ray, CT or MRI) among Albertan patients following a visit for lower back pain and 2) cardiac tests (electrocardiogram, chest X-ray, stress test, or transthoracic echocardiogram) prior to low-risk surgical procedures in Alberta, Saskatchewan, and Ontario. A cross-sectional study of the 2012 Canadian Community Health Survey was also conducted to estimate 3) the proportion of females aged 40-49 that reported having a routine mammogram in the past two years. RESULTS: Use of unnecessary care was relatively frequent across all three services and jurisdiction measured: 30.7% of Albertan patients had diagnostic imaging within six months of their initial visit for lower back pain; a cardiac test preceded 17.9 to 35.5% of low-risk surgical procedures across Alberta, Saskatchewan, and Ontario; and 22.2% of Canadian women aged 40-49 at average-risk for breast cancer reported having a routine screening mammogram in the past two years. CONCLUSIONS: The use of potentially unnecessary care appears to be common in Canada. This investigation provides methodology to facilitate future measurement efforts that may incorporate additional jurisdictions and/or unnecessary services.


Assuntos
Técnicas de Imagem Cardíaca/estatística & dados numéricos , Dor Lombar/diagnóstico por imagem , Mamografia/estatística & dados numéricos , Procedimentos Desnecessários , Canadá/epidemiologia , Estudos Transversais , Humanos , Sobremedicalização , Estudos Retrospectivos , Procedimentos Desnecessários/estatística & dados numéricos
8.
J Orthop Surg Res ; 14(1): 185, 2019 Jun 20.
Artigo em Inglês | MEDLINE | ID: mdl-31221166

RESUMO

BACKGROUND: Diagnosis of the cause of low back pain in the presence of degenerative spine disease using conventional imaging techniques, especially in elderly individuals, is challenging. Our aim was to describe our use of bone scintigraphy with single photon emission computed tomography (bone SPECT/CT) in the assessment of low back pain in elderly patients with degenerative lumbar spine disease, underlining the clinical utility of bone SPECT/CT imaging in this clinical population to inform diagnosis and treatment. METHODS: Between January 2016 and December 2017, we used bone SPECT/CT to successfully identify the cause of low back pain in five elderly patients. All patients had been scheduled for extensive spinal fusion surgery based on conventional imaging (plain radiography, computed tomography, and magnetic resonance). RESULTS: After diagnosis using bone SPECT/CT, three patients underwent spinal fusion at 1-2 levels with specific degenerative disk and joint disease, with the other two patients successfully treated using a conservative approach for a non-traumatic insufficiency fracture of the endplate of the L4 vertebral body and a fracture of the transverse process of L3. Clinically meaningful decrease in pain and fracture healing were obtained with conservative treatment. CONCLUSION: Bone SPECT/CT was useful to identify the specific cause of pain in elderly patients with lumbar degenerative disease and to provide appropriate treatment, avoiding the unnecessary use of invasive spinal fusion surgery. Therefore, the clinical utility of bone SPECT/CT is potentially high as it improves diagnosis and lowers the risk of inappropriate invasive spinal surgery.


Assuntos
Degeneração do Disco Intervertebral/diagnóstico por imagem , Dor Lombar/diagnóstico por imagem , Vértebras Lombares/diagnóstico por imagem , Idoso , Feminino , Humanos , Degeneração do Disco Intervertebral/complicações , Degeneração do Disco Intervertebral/diagnóstico , Degeneração do Disco Intervertebral/cirurgia , Dor Lombar/diagnóstico , Dor Lombar/etiologia , Vértebras Lombares/cirurgia , Reprodutibilidade dos Testes , Tomografia Computadorizada com Tomografia Computadorizada de Emissão de Fóton Único , Fusão Vertebral
9.
Acta Reumatol Port ; 44(1): 42-56, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31249275

RESUMO

In the second part of this review article we will describe the imaging features of non- spondyloarthritis (SpA) pathologies that may mimic sacroiliitis on Magnetic Resonance Imaging (MRI), and that readers should be aware (part 2). Based on the established literature, there is currently an "overcall" of sacroiliitis on MRIs. In this setting, differential diagnoses and their imaging features come into play. In fact, non-SpA related sacroiliac joints (SIJs) pathologies are more commonly found than true sacroiliitis on MRI of the SIJs, even in patients with inflammatory type back pain. An imaging literature review, highlighting "easy-to-use" learning points regarding MRI interpretations in patients with suspected sacroiliitis and/or nonspecific lumbar back pain is presented. This two-part article aims to be a snapshot of the most common inflammatory versus non-inflammatory entities found on SIJs imaging studies in routine practice, while trying to keep this review article simple, educational and above all, practical.


Assuntos
Imagem por Ressonância Magnética , Articulação Sacroilíaca/diagnóstico por imagem , Sacroileíte/diagnóstico por imagem , Espondilartrite/diagnóstico por imagem , Síndrome de Hiperostose Adquirida/diagnóstico por imagem , Adulto , Neoplasias Ósseas/diagnóstico por imagem , Diagnóstico Diferencial , Erros de Diagnóstico , Feminino , Fraturas de Estresse/diagnóstico por imagem , Gota/diagnóstico por imagem , Humanos , Hiperostose Esquelética Difusa Idiopática/diagnóstico por imagem , Hipertireoidismo/complicações , Dor Lombar/diagnóstico por imagem , Vértebras Lombares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Osteíte/diagnóstico por imagem , Osteíte Deformante/diagnóstico por imagem , Osteoartrite/diagnóstico por imagem , Articulação Sacroilíaca/anatomia & histologia , Sarcoidose/diagnóstico por imagem
10.
Am J Case Rep ; 20: 794-799, 2019 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-31168047

RESUMO

BACKGROUND Sacral stress fractures are rare complications of pregnancy and the early postpartum. Of these, few present with lumbosacral radiculopathy. We report the first Australian case of a young multiparous woman who sustained an atraumatic, fatigue sacral fracture with associated radiculopathy. We highlight the diagnostic process and chronic management of this case, particularly in relation to a future pregnancy. CASE REPORT A 26-year-old multiparous Caucasian female presented with worsening lumbosacral back pain and radicular symptoms following the rapid and spontaneous vaginal delivery of her second infant. Her pregnancy was unremarkable and she had no personal risk factors for osteoporosis. A magnetic resonance imaging (MRI) scan confirmed the diagnosis of a right S1 vertebral fracture. Bone densitometry and fasting bone metabolic testing excluded pregnancy-associated osteoporosis. She was managed conservatively with intermittent bed rest, regular physiotherapy and multimodal analgesia. During a future pregnancy, she experienced a severe exacerbation of her lumbosacral radiculopathy requiring hospital admission, up-titration of her analgesia and a right S1 epidural injection. She subsequently underwent an elective caesarean section and has since benefitted from regular hydrotherapy. CONCLUSIONS Lumbosacral radiculopathy in the absence of trauma during pregnancy or the early postpartum should prompt consideration of an underlying atraumatic, fatigue sacral fracture. Such fractures may result from the abnormal biomechanical loading of the sacrum during rapid vaginal deliveries and are most effectively diagnosed by MRI. Conservative management strategies involving physiotherapy and multimodal analgesia are recommended. Future pregnancies may exacerbate radicular symptoms. Such patients may subsequently benefit from elective caesarean section deliveries and hydrotherapy.


Assuntos
Fraturas Espontâneas/etiologia , Dor Lombar/fisiopatologia , Radiculopatia/diagnóstico por imagem , Fraturas da Coluna Vertebral/diagnóstico por imagem , Adulto , Austrália , Tratamento Conservador/métodos , Feminino , Fraturas Espontâneas/diagnóstico por imagem , Humanos , Dor Lombar/diagnóstico por imagem , Região Lombossacral , Imagem por Ressonância Magnética/métodos , Medição da Dor , Paridade , Período Pós-Parto , Gravidez , Prognóstico , Radiculopatia/complicações , Sacro/lesões , Fraturas da Coluna Vertebral/complicações , Fraturas da Coluna Vertebral/terapia
11.
Clin Orthop Surg ; 11(2): 176-182, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31156769

RESUMO

Background: The incidence of facet tropism (FT) and its correlation with low back pain (LBP) have, to our knowledge, not yet been investigated among selected community-based populations who visited departments unrelated to LBP with their chief complaints unrelated to LBP. In this study, we aimed to evaluate the prevalence of FT among selected patients in whom LBP was not the chief complaint and the correlation between FT and LBP among these patients. Methods: Among patients who underwent computed tomography during 2014 for reasons unrelated to LBP, we enrolled 462 patients who satisfied the inclusion and exclusion criteria. The degree of tropism was defined as grade 0, 1, and 2 for FT, FT+, and FT++, respectively. LBP was evaluated using a modified version of the Nordic low back pain questionnaire. For additional evaluation of dynamic LBP, the question, "Did your pain go away when lying down still or standing up straight, and did it also intensify when you bend or stretch your back?," was included in the questionnaire. Results: The L4-5 intervertebral area was most frequently and severely affected by FT with an incidence rate of 46.3%, and severe FT was observed in 24.7% of the patients. FT increased with age at L2-3 and L5-S1 levels. FT at L2-3 level was correlated with LBP (p = 0.035) and dynamic LBP (p = 0.033). The FT grade at L2-3 level was correlated with dynamic LBP (p = 0.022) but not with LBP (p = 0.077). The relative risk of FT at L2-3 level was 1.614 for LBP and 1.724 for dynamic LBP. Conclusions: The prevalence of FT among community-based populations was 46.3% and its severe form was more frequently observed at L4-5 level (24.7%). LBP was correlated with FT at L2-3 level. The relative FT-associated risk of LBP was 1.6 at L2-3 level, and the relative L2-3 FT-associated risk of dynamic LBP was 1.724.


Assuntos
Dor Lombar/fisiopatologia , Tropismo , Articulação Zigapofisária , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Incidência , Dor Lombar/diagnóstico por imagem , Dor Lombar/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , República da Coreia , Inquéritos e Questionários , Tomografia Computadorizada por Raios X
12.
Neurocirugía (Soc. Luso-Esp. Neurocir.) ; 30(3): 133-143, mayo-jun. 2019. ilus, graf, tab
Artigo em Espanhol | IBECS | ID: ibc-183576

RESUMO

Introducción: El dolor lumbar afecta entre el 60 y 90% de la población y es una causa frecuente de incapacidad en adultos. Puede ser generado por diferentes estructuras anatómicas, entre las cuales se encuentra la faceta articular. Actualmente, el diagnóstico de dolor lumbar de origen facetario depende de la realización de un procedimiento invasivo (bloqueo selectivo) y no puede hacerse exclusivamente con los hallazgos clínicos. Por lo cual, nuestro objetivo es desarrollar una escala de diagnóstico clínico para el dolor lumbar de origen facetario. Materiales y métodos: El estudio fue realizado por medio de 6 fases de la siguiente manera: Fase 1, se realizó una revisión sistemática de la literatura respecto al diagnóstico clínico del dolor lumbar de origen facetario basado en la lista de chequeo PRISMA. Fase 2, se realizó una lista de los signos y síntomas propuestos para diagnóstico de dolor lumbar de origen facetario. Fase 3, se sometió la lista de signos y síntomas encontrados a un comité de expertos para discriminar aquellos que son más significativos para los mismos, estos fueron unidos a variables generales sociodemográficas para desarrollar un cuestionario de evaluación. Fase 4, se aplicó el cuestionario de evaluación que incluía aquellos signos y síntomas seleccionados a un grupo de pacientes con diagnóstico clínico de dolor lumbar secundario a enfermedad facetaria y que fueron sometidos a un bloqueo facetario selectivo. Fase 5, bajo técnica estándar se realizó bloqueo facetario selectivo y posterior control clínico postoperatorio a un mes. Fase 6, se relacionaron los resultados pre- y posquirúrgicos con los signos positivos y se propone una escala clínica de evaluación diagnóstica. Resultados: Se encontraron un total de 36 signos y síntomas para el diagnóstico de síndrome facetario lumbar que fueron sometidos al grupo de expertos, donde fueron incluidos para la encuesta final un total de 12 (8 síntomas y 4 signos). Treinta y un pacientes fueron sometidos a bloqueo facetario lumbar selectivo, en su mayoría mujeres, con un promedio de 60±11,5 años, escala visual análoga del dolor prequirúrgica (EVAD) de 8/10, posquirúrgica de 1,7/10, los signos y síntomas más frecuentemente encontrados incluidos en una escala diagnóstica fueron: 3 síntomas, 1) dolor lumbar axial unilateral o bilateral, 2) mejoría con el reposo, 3) ausencia de patrón radicular, puede tener patrón pseudorradicular, sin embargo, el dolor es mayor el lumbar que dolor en la pierna. Y 3 signos clínicos, 1) signo Kemp, 2) dolor inducido en apófisis articular o transversa, 3) signo de estrés facetario o signo de Acevedo. Conclusión: El diagnóstico clínico del dolor facetario lumbar no es aún claro. Pocas escalas diagnosticas han sido postuladas, con poca o baja validez externa, por lo cual, el presente estudio propone una escala diagnóstica conformada por 3 síntomas y 3 signos clínicos


Introduction: Lumbar pain affects between 60-90% of people. It is a frequent cause of disability in adults. Pain may be generated by different anatomical structures such as the facet joint. However, nowadays pain produced by the facet joint has no clinical diagnosis. Therefore, the purpose of this article is to propose a clinical diagnostic scale for lumbar facet syndrome. Materials and methods: The study was conducted by means of 6 phases as follows, Phase 1, a systematic review of the literature was performed regarding the clinical diagnosis of facet-based lumbar pain based on the PRISMA checklist; Phase 2, a list of signs and symptoms proposed for diagnosis lumbar pain of facet origin was made. Phase 3, the list of signs and symptoms found was submitted to a committee of experts to discriminate the most significant signs and symptoms, these were linked to general sociodemographic variables to develop an evaluation questionnaire; Phase 4, the evaluation questionnaire was applied, including those selected signs and symptoms to a group of patients with clinical diagnosis of facet disease lumbar pain and who underwent a selective facet block. Phase 5, under standard technique selective facet block and subsequent postoperative clinical control at 1 month. Phase 6, given pre and postsurgical results associated with signs present in the patients we propose a clinical scale of diagnosis scale. Descriptive statistics and Stata 12.0 were used as statistical software. Results: A total of 36 signs and symptoms were found for the diagnosis of lumbar facet syndrome that were submitted to the group of experts, where a total of 12 (8 symptoms and 4 signs) were included for the final survey. 31 patients underwent selective lumbar facet blockade, mostly women, with an average of 60±11.5 years, analogous visual scale of preoperative pain of 8/10, postoperative of 1.7/10, the signs and symptoms most frequently found included in a diagnostic scale were: 3 symptoms 1) axial or bilateral axial lumbar pain, 2) improvement with rest, 3) absence of root pattern, may have pseudoradicular pattern, however, the pain is greater lumbar than pain in the leg and 3 clinical signs 1) Kemp sign, 2) pain induced in joint or transverse process, 3) facet stress sign or Acevedo sign. Conclusion: The clinical diagnosis of lumbar facet pain is still debated. Few diagnostic scales have been postulated, with little or no external validity, so the present study proposes a diagnostic scale consisting of 3 symptoms and 3 clinical signs


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Medição da Dor/métodos , Projetos Piloto , Avaliação da Deficiência , Articulação Zigapofisária/diagnóstico por imagem , Dor Lombar/diagnóstico por imagem , Articulação Zigapofisária/patologia , Inquéritos e Questionários , Cuidados Pós-Operatórios , Fluoroscopia/métodos , Dexametasona/uso terapêutico , Bloqueio de Ramo
13.
Neuroradiology ; 61(8): 881-889, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31101947

RESUMO

PURPOSE: To analyze the causes of pain, imaging characteristics, and therapeutic effect of spinal injection in patients with extreme low back pain or sciatica. METHODS: We analyzed 381 consecutive patients with extreme low back pain or sciatica visiting our spinal intervention center between January and December 2017. Clinical and imaging characteristics were analyzed. The treatment response, defined as a numerical pain rating scale decrease of ≥ 30%, was measured. Fisher's exact test was performed to identify the association between the injection response and subsequent lumbar surgery rate. RESULTS: The most frequent cause of pain was spinal stenosis, followed by herniated intervertebral disc, facet osteoarthritis, and osteoporotic compression fracture. A herniated intervertebral disc was the most common disorder in patients < 50 years of age, while spinal stenosis was the most common in patients ≥ 50 years of age. Women comprised 66.4% of the study population. The majority of lumbar pathologies occurred below L3/4. Spinal injection was found to be effective in 44.2% of cases. Those who responded to the injection showed a significantly lower rate of lumbar surgery within 6 months (P = 0.004). CONCLUSIONS: Those with extreme low back pain or sciatica had clinical and imaging characteristics similar to those with typical low back pain referred for spinal injection. Spinal injection could be an effective method of pain control for patients with extreme low back pain or sciatica.


Assuntos
Injeções Espinhais , Dor Lombar/diagnóstico por imagem , Vértebras Lombares , Imagem por Ressonância Magnética , Ciática/diagnóstico por imagem , Doenças da Coluna Vertebral/diagnóstico por imagem , Adulto , Idoso , Anestésicos Locais/administração & dosagem , Dexametasona/administração & dosagem , Feminino , Glucocorticoides/administração & dosagem , Humanos , Dor Lombar/tratamento farmacológico , Dor Lombar/etiologia , Masculino , Pessoa de Meia-Idade , Medição da Dor , Estudos Retrospectivos , Ropivacaina/administração & dosagem , Ciática/tratamento farmacológico , Ciática/etiologia , Doenças da Coluna Vertebral/complicações
14.
J Electromyogr Kinesiol ; 47: 19-24, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31077992

RESUMO

The purpose of this study was to investigate differences in passive muscular stiffness between the superficial multifidus (SM) and deep multifidus (DM), and to compare their passive and active stiffness in individuals with low back pain (LBP) and asymptomatic individuals. Fifteen LBP individuals and 15 asymptomatic individuals were recruited. Passive stiffness of the SM and DM was measured bilaterally using shear wave elastography (SWE) with participants lying prone. Active stiffness was measured for the SM during trunk extension, and the contraction ratio was calculated. DM displayed higher passive muscular stiffness than SM in both the asymptomatic and LBP groups (14.41 ±â€¯2.62 and 15.40 ±â€¯2.77 kPa respectively; p < 0.001). Individuals with LBP exhibited higher passive muscular stiffness of SM (LBP: 10.15 ±â€¯4.21, asymptomatic: 6.84 ±â€¯1.69 kPa; p < 0.005) and a lower contraction ratio (LBP: 1.54 ±â€¯0.47, asymptomatic: 2.65 ±â€¯1.36 kPa; p < 0.003) compared to the asymptomatic group. The findings support a differentiation in passive muscular stiffness between SM and DM and provide evidence for an alteration in muscular stiffness at rest in individuals with LBP. The lower increase of muscular stiffness with contraction observed for those with LBP may reflect a deficit in activation of the multifidus.


Assuntos
Técnicas de Imagem por Elasticidade/métodos , Dor Lombar/diagnóstico por imagem , Músculos Paraespinais/diagnóstico por imagem , Adulto , Fenômenos Biomecânicos , Feminino , Humanos , Dor Lombar/fisiopatologia , Masculino , Músculos Paraespinais/fisiopatologia , Adulto Jovem
15.
Acta Orthop Belg ; 85(1): 47-53, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31023199

RESUMO

High-intensity zone is an area of high-intensity signal within the posterior annulus fibrosus observed in magnetic resonance imaging; initially described in painful discs, recent studies have described similar prevalence in symptomatic and asymptomatic subjects. Since its' prevalence in the general population has not been established, we used a screening tool independent of spinal symptoms to determine high-intensity zone prevalence. We studied 217 patients evaluated with abdominal-pelvic magnetic resonance imaging; we looked for high-intensity zone, disc degeneration, spondylolysis, spondylolisthesis, Modic changes and scoliosis. We determined if these variables, age and sex affected the presence of high-intensity zone; through a logistic regression analysis we evaluated their independent effect. Patients' mean age was 56.3±17.4 years; 66.8% were females. Prevalence of high-intensity zone (11.06%) was larger in males (18.06%) than females (7.59%), p = 0.02. Patients with and without high-intensity zone did not differ in age or presence of scoliosis. High-intensity zone was more frequent in degenerated discs, but not in levels with spondylolisis, spondylolisthesis or Modic changes. Male sex (OR = 2.3, 1.04-5.38) and disc degeneration (OR = 6.76, 1.77-25.81) independently influenced the presence of high-intensity zone. The prevalence of high-intensity zone in this sample of the general population, including 217 subjects, was 11.06%. Similarly, a recent meta-analysis mentioned a 9.5% prevalence in asymptomatic subjects; on the other hand it stressed a 10.4% prevalence in symptomatic subjects. All these data do not plead for a strict correlation between high-intensity zone and low back pain complaints.


Assuntos
Degeneração do Disco Intervertebral/diagnóstico por imagem , Dor Lombar/diagnóstico por imagem , Vértebras Lombares/diagnóstico por imagem , Adulto , Idoso , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade
16.
Medicine (Baltimore) ; 98(17): e15377, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31027128

RESUMO

The aim of this observational, cross-sectional study was to analyse lumbar magnetic resonance imaging (MRI) findings in patients with non-specific chronic low back pain (CLBP), and to evaluate any correlation with pain intensity and their capacity to predict neuropathic pain (NP) in these patients.Fifty-two patients with non-specific CLBP, between 21 and 62 years of age, 50% men, were investigated. Lumbar MRI was employed to assess disc degeneration, endplate changes, Modic changes, disc displacement, facet degeneration, foraminal stenosis and central lumbar spinal stenosis. The characteristics of pain were evaluated and patients were divided into 2 subgroups: with NP (24 patients) and without NP (28 patients), based on the results of a DN4-interview. Correlations between particular MRI changes and their relations to the intensity of pain were evaluated. Logistic regression was used to disclose predictors of NP.Lumbar spine degenerative features were frequent in patients with non-specific CLBP, with L4/5 the most affected level. A significant correlation emerged between the severity of degenerative changes in particular lumbar spine structures (correlation coefficient ranging between 0.325 and 0.573), while no correlation was found between severity of degenerative changes and pain. Multivariate logistic regression revealed only 2 independent predictors of NP - female sex (odds ratio [OR] = 11.9) and a mean pain intensity of ≥4.5 in the previous 4 weeks (OR = 13.1).Degenerative changes in the lumbar spine are frequent MRI findings, but do not correlate with the intensity of pain and do not predict NP. However, female sex and pain intensity do predict NP.


Assuntos
Dor Lombar/diagnóstico por imagem , Vértebras Lombares/diagnóstico por imagem , Imagem por Ressonância Magnética , Neuralgia/diagnóstico , Doenças da Coluna Vertebral/diagnóstico por imagem , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Prognóstico , Fatores Sexuais , Adulto Jovem
17.
Pain Res Manag ; 2019: 8185316, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31015885

RESUMO

Objective: This study aimed to investigate if the presence of Modic changes (MCs) was correlated with lower back pain (LBP) and LBP-related disability in patients who underwent nonsurgical treatment. Methods: In this study, 129 patients who experienced consecutive LBP and underwent lumbar spine magnetic resonance imaging in our institute were divided into three groups according to the presence or type of MCs. The Oswestry Disability Index (ODI) and visual analog scale (VAS) were used to assess the outcomes of the treatment. Results: Based on the achieved results, there was no significant difference between three groups before treatment (P > 0.05). Three months after undergoing nonsurgical treatment, the rates of improved ODI and VAS scores were statistically significantly different (P=0.014, 0.023). After an additional 3 months of treatment, in patients with Modic type I changes, the symptoms significantly improved in comparison with those 3 months prior (P=0.037, 0.026), while that improvement did not occur in patients with Modic type II changes (P > 0.05). Conclusions: The existence of MCs affects the outcomes of nonsurgical treatment in patients with LBP. However, symptoms can be improved after an additional round of treatment for Modic type I changes, while this is not confirmed for Modic type II changes.


Assuntos
Tratamento Conservador/métodos , Dor Lombar/patologia , Dor Lombar/terapia , Adulto , Idoso , Feminino , Humanos , Dor Lombar/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
18.
J Am Coll Radiol ; 16(4 Pt B): 560-569, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30947888

RESUMO

PURPOSE: To evaluate the relationship between use of MRI of the lumbar spine for low back pain without prior conservative therapy and sociodemographic factors after the implementation of public reporting for Medicare's Hospital Outpatient Imaging Efficiency Measure for MRI Lumbar Spine for Low Back Pain (OP-8) metric. MATERIALS AND METHODS: We conducted a secondary data analysis using a nationally representative sample of 2009 to 2014 Medicare claims to evaluate trends in use of conservative therapy before MRI of the lumbar spine. Continuously enrolled fee-for-service Medicare beneficiaries were included. We applied the same criteria used by Medicare to generate a measure consistent with OP-8. Regression was used to evaluate trends in OP-8 by reporting status (outpatient hospital or clinic) and beneficiary characteristics. Age, sex, and race from the Medicare denominator and area-level socioeconomic measures from the Area Health Resource File were used as covariates. RESULTS: Use of conservative therapy before MRI increased regardless of OP-8 reporting status. Several sociodemographic characteristics were associated with the likelihood of receiving conservative therapy before MRI; beneficiaries were less likely to receive conservative therapy before MRI if they were male, older, black, Hispanic or Latino; if they lived in the West or in an area with more college graduates; or if they had low incomes. Beneficiaries were more likely to receive conservative therapy before MRI if they had poorer health or lived in areas with higher home values. CONCLUSION: Variations in use of conservative therapy according to factors other than clinically relevant factors, such as health status, are worrying. Further strategies are needed to improve appropriateness and equity in the provision of diagnostic imaging.


Assuntos
Tratamento Conservador/métodos , Dor Lombar/diagnóstico por imagem , Dor Lombar/terapia , Imagem por Ressonância Magnética/economia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Demografia , Escolaridade , Grupos Étnicos , Feminino , Humanos , Dor Lombar/epidemiologia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/fisiopatologia , Masculino , Medicare/economia , Projetos de Pesquisa , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Fatores Sexuais , Classe Social , Fatores Socioeconômicos , Estados Unidos
19.
Spine (Phila Pa 1976) ; 44(17): 1186-1192, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-30985571

RESUMO

STUDY DESIGN: A comparative cohort study with 13-year follow-up. OBJECTIVE: To assess whether Modic changes (MCs) are associated with long-term physical disability, back pain, and sick leave. SUMMARY OF BACKGROUND DATA: Previous studies have shown a conflicting association of low back pain (LBP) with MCs and disc degeneration. The long-term prognosis of patients with MCs is unclear. METHODS: In 2004 to 2005, patients aged 18 to 60 with daily LBP were enrolled in an randomized controlled trial study and lumbar magnetic resonance imaging (MRI) was performed. Patients completed numeric rating scales (0-10) for LBP and leg pain, Roland-Morris Disability Questionnaire (RMDQ), LBP Rating Scale for activity limitations (RS, 0-30), inflammatory pain pattern and sick leave days due to LBP at baseline and 13 years after the MRI. Patients were stratified based on the presence (+MC) or absence (-MC) of MCs on the MRI. RESULTS: Of 204 cases with baseline MRI, 170 (83%) were available for follow-up; 67 (39%) with MCs and 103 (61%) without MCs. Demographics, smoking status, BMI, use of antibiotics, LBP, leg pain, and inflammatory pain pattern scores at baseline and at 13-year follow-up were similar between the two groups. Also, baseline RMDQ was similar between the +MC and -MC groups. At 13 years, the RMDQ score was statistically significant better in the +MC group (7.4) compared with the -MC group (9.6, P = 0.024). Sick leave days due to LBP were similar at baseline but less in the +MC group (9.0) compared with the -MC group (22.9 d, P = 0.003) at 13 years. CONCLUSION: MCs were not found to be negatively associated with long-term pain, disability, or sick leave. Rather, the study found that LBP patients with MCs had significantly less disability and sick-leave at long-term follow-up. We encourage further studies to elucidate these findings. LEVEL OF EVIDENCE: 2.


Assuntos
Dor Lombar , Vértebras Lombares , Adolescente , Adulto , Pessoas com Deficiência , Seguimentos , Humanos , Dor Lombar/diagnóstico por imagem , Dor Lombar/epidemiologia , Dor Lombar/patologia , Dor Lombar/fisiopatologia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/patologia , Vértebras Lombares/fisiopatologia , Região Lombossacral/diagnóstico por imagem , Região Lombossacral/patologia , Região Lombossacral/fisiopatologia , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto , Licença Médica/estatística & dados numéricos , Adulto Jovem
20.
BMC Musculoskelet Disord ; 20(1): 100, 2019 Mar 04.
Artigo em Inglês | MEDLINE | ID: mdl-30832643

RESUMO

BACKGROUND: Unilateral laminectomy for bilateral decompression (ULBD) for lumbar spinal stenosis (LSS) is a less invasive technique compared to conventional laminectomy. Recently, several authors have reported favorable results of low back pain (LBP) in patients of LSS treated with ULBD. However, the detailed changes and localization of LBP before and after ULBD for LSS remain unclear. Furthermore, unsymmetrical invasion to para-spinal muscle and facet joint may result in the residual unsymmetrical symptoms. To clarify these points, we conducted an observational study and used detailed visual analog scale (VAS) scores to evaluate the characteristics and bilateral changes of LBP and lower extremity symptoms. METHODS: We included 50 patients with LSS treated with ULBD. A detailed visual analogue scale (VAS; 100 mm) score of LBP in three different postural positions: motion, standing, and sitting, and bilateral VAS score (approached side versus opposite side) of LBP, lower extremity pain (LEP), and lower extremity numbness (LEN) were measured. Oswestry Disability Index (ODI) was used to quantify the clinical improvement. RESULTS: Detailed LBP VAS score before surgery was 51.5 ± 32.5 in motion, 63.0 ± 30.1 while standing, and 37.8 ± 31.8 while sitting; and showed LBP while standing was significantly greater than LBP while sitting (p < 0.01). After surgery, LBP while standing was significantly improved relative to that while sitting (p < 0.05), and levels of LBP in the three postures became almost the same with ODI improvement. Bilateral VAS scores showed significant improvement equally on both sides (p < 0.01). CONCLUSIONS: ULBD improves LBP while standing equally on both sides in patients with LCS. The improvement of LBP by the ULBD surgery suggests radicular LBP improved because of decompression surgery. Furthermore, the symmetric improvement of LBP by the ULBD surgery suggests unsymmetrical invasion of the paraspinal muscles and facet joints is unrelated to residual LBP.


Assuntos
Descompressão Cirúrgica/métodos , Laminectomia/métodos , Dor Lombar/cirurgia , Vértebras Lombares/cirurgia , Medição da Dor/métodos , Estenose Espinal/cirurgia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Laminectomia/tendências , Dor Lombar/diagnóstico por imagem , Dor Lombar/epidemiologia , Vértebras Lombares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Medição da Dor/tendências , Postura/fisiologia , Estenose Espinal/diagnóstico por imagem , Estenose Espinal/epidemiologia , Resultado do Tratamento
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