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1.
BMJ Case Rep ; 14(1)2021 Jan 26.
Artigo em Inglês | MEDLINE | ID: mdl-33500296

RESUMO

Vertebral osteomyelitis is a rare diagnosis and often delayed diagnosis in children. This is a case of a child presenting with fever, back pain and raised C reactive protein who was found to have a Staphylococcus aureus (S.aureus) bacteraemia. Initial imaging with CT, MRI of the spine and abdominal ultrasound failed to demonstrate a vertebral osteomyelitis or identify another source of the bacteraemia. Due to the high clinical suspicion of a spinal source of the infection, second-line investigations were arranged. A bone scan identified an area of increase metabolic activity in the 12th thoracic vertebrae (T12) and subsequently a diagnosis was confirmed with a focused MRI of T12. This serves as an opportunity to discuss the diagnostic difficulty presented by paediatric vertebral osteomyelitis and more generally the need for clinicians to pursue their clinical suspicion in the face of false negative results to make an accurate and timely diagnosis.


Assuntos
Dor nas Costas/diagnóstico por imagem , Bacteriemia/diagnóstico , Osteomielite/diagnóstico por imagem , Espondilite/diagnóstico por imagem , Infecções Estafilocócicas/diagnóstico , Vértebras Torácicas/diagnóstico por imagem , Adolescente , Dor nas Costas/complicações , Dor nas Costas/etiologia , Bacteriemia/complicações , Feminino , Febre/etiologia , Humanos , Imagem por Ressonância Magnética , Osteomielite/complicações , Cintilografia , Espondilite/complicações , Staphylococcus aureus , Tomografia Computadorizada por Raios X , Ultrassonografia
2.
AJR Am J Roentgenol ; 215(3): 534-544, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32755228

RESUMO

OBJECTIVE. The purpose of this article is to provide a review of the imaging of spine fixation hardware. CONCLUSION. As the prevalence of neck and back pain continues to increase, so does the number of surgical procedures used to treat such pain. Accordingly, new techniques and hardware designs are used, and the hardware will be seen on postoperative imaging. It is critical that radiologists understand the appropriate imaging modalities for the assessment of spine fixation hardware, recognize the normal imaging appearance of such hardware, and be able to detect hardware-related complications.


Assuntos
Dor nas Costas/diagnóstico por imagem , Dor nas Costas/cirurgia , Cervicalgia/diagnóstico por imagem , Cervicalgia/cirurgia , Dispositivos de Fixação Ortopédica , Doenças da Coluna Vertebral/diagnóstico por imagem , Doenças da Coluna Vertebral/cirurgia , Humanos
3.
Proc Natl Acad Sci U S A ; 117(18): 10015-10023, 2020 05 05.
Artigo em Inglês | MEDLINE | ID: mdl-32312809

RESUMO

Chronic pain is a highly prevalent disease with poorly understood pathophysiology. In particular, the brain mechanisms mediating the transition from acute to chronic pain remain largely unknown. Here, we identify a subcortical signature of back pain. Specifically, subacute back pain patients who are at risk for developing chronic pain exhibit a smaller nucleus accumbens volume, which persists in the chronic phase, compared to healthy controls. The smaller accumbens volume was also observed in a separate cohort of chronic low-back pain patients and was associated with dynamic changes in functional connectivity. At baseline, subacute back pain patients showed altered local nucleus accumbens connectivity between putative shell and core, irrespective of the risk of transition to chronic pain. At follow-up, connectivity changes were observed between nucleus accumbens and rostral anterior cingulate cortex in the patients with persistent pain. Analysis of the power spectral density of nucleus accumbens resting-state activity in the subacute and chronic back pain patients revealed loss of power in the slow-5 frequency band (0.01 to 0.027 Hz) which developed only in the chronic phase of pain. This loss of power was reproducible across two cohorts of chronic low-back pain patients obtained from different sites and accurately classified chronic low-back pain patients in two additional independent datasets. Our results provide evidence that lower nucleus accumbens volume confers risk for developing chronic pain and altered nucleus accumbens activity is a signature of the state of chronic pain.


Assuntos
Dor nas Costas/fisiopatologia , Dor Crônica/fisiopatologia , Giro do Cíngulo/fisiopatologia , Núcleo Accumbens/fisiopatologia , Adulto , Dor nas Costas/diagnóstico por imagem , Encéfalo/diagnóstico por imagem , Encéfalo/fisiopatologia , Mapeamento Encefálico/métodos , Dor Crônica/diagnóstico por imagem , Feminino , Giro do Cíngulo/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Masculino , Rede Nervosa/fisiopatologia , Vias Neurais/fisiopatologia , Núcleo Accumbens/diagnóstico por imagem , Fatores de Risco
4.
Ann Rheum Dis ; 79(7): 929-934, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32299794

RESUMO

OBJECTIVES: Bone marrow oedema (BMO) on MRI of sacroiliac joints (SIJs) represents a hallmark of axial spondyloarthritis (SpA), yet such lesions may also occur under augmented mechanical stress in healthy subjects. We therefore sought to delineate the relationship between pregnancy/delivery and pelvic stress through a prospective study with repeated MRI. Results were matched with maternal, child and birth characteristics. METHODS: Thirty-five women underwent a baseline MRI-SIJ within the first 10 days after giving birth. MRI was repeated after 6 months and, if positive for sacroiliitis according to the Assessment of SpondyloArthritis International Society (ASAS) definition, after 12 months. BMO and structural lesions were scored by three trained readers using the Spondyloarthritis Research Consortium of Canada (SPARCC) method. RESULTS: Seventy-seven per cent of the subjects (27/35) displayed sacroiliac BMO immediately postpartum, 60% fulfilled the ASAS definition of a positive MRI. After 6 months, 46% of the subjects (15/33) still showed BMO, representing 15% (5/33) with a positive MRI. After 12 months, MRI was still positive in 12% of the subjects (4/33). Few structural lesions were detected. Intriguingly, in this study, the presence of BMO was related to a shorter duration of labour and lack of epidural anaesthesia. CONCLUSION: A surprisingly high prevalence of sacroiliac BMO occurs in women immediately postpartum. Our data reveal a need for a waiting period of at least 6 months to perform an MRI-SIJ in postpartum women with back pain. This study also underscores the importance of interpreting MRI-SIJ findings in the appropriate clinical context.


Assuntos
Parto Obstétrico/efeitos adversos , Imagem por Ressonância Magnética/métodos , Transtornos Puerperais/epidemiologia , Sacroileíte/epidemiologia , Adulto , Dor nas Costas/diagnóstico por imagem , Dor nas Costas/etiologia , Doenças da Medula Óssea/diagnóstico por imagem , Doenças da Medula Óssea/epidemiologia , Doenças da Medula Óssea/etiologia , Canadá/epidemiologia , Diagnóstico Diferencial , Edema/diagnóstico por imagem , Edema/epidemiologia , Edema/etiologia , Feminino , Humanos , Parto/fisiologia , Ossos Pélvicos/diagnóstico por imagem , Ossos Pélvicos/fisiopatologia , Período Pós-Parto , Gravidez , Prevalência , Estudos Prospectivos , Transtornos Puerperais/diagnóstico por imagem , Transtornos Puerperais/etiologia , Sacroileíte/diagnóstico por imagem , Sacroileíte/etiologia , Estresse Fisiológico
5.
Spine Deform ; 8(3): 499-505, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32152963

RESUMO

INTRODUCTION: Patient reported outcomes measurement information system (PROMIS) is a quality of life metric that has gained increased popularity due to computer adaptive testing. Previous studies have shown that PROMIS correlates with Oswestry Disability Index (ODI) in patients with back pain and takes significantly less time to complete. However, the ability of PROMIS to capture disability from spinal malalignment relative to established metrics is unknown. The aim of the present study is to validate the correlation between ODI and PROMIS in patients with back pain, analyze correlations of PROMIS and legacy metrics to sagittal alignment, and identify major drivers of PROMIS scores and ODI in patients with back pain. METHODS: A retrospective review was conducted of a prospectively collected outcome measures database (PROMIS, ODI, VAS Back, VAS Leg, VAS Neck, and VAS Arm) of spine patients > 18 years. Inclusion criteria for the present study was a chief complaint of back pain and full length weight bearing X-rays within 30 days of health related quality of life (HRQL) completion. Demographic information, radiographic alignment, psychiatric diagnoses, and comorbidities were recorded. PROMIS metrics were correlated to legacy metrics (ODI and VAS). Next, outcome metrics were correlated with sagittal alignment variables T1 Pelvic Angle (TPA), SVA, PT, and PI-LL. Patients were grouped based on the presence of spinal deformity (defined radiographically as any one of SVA > 4 cm, PI-LL > 10°, PT > 20°) and mean HRQL scores were investigated for the adult spinal deformity (ASD) and non-ASD groups. Finally, drivers of PROMIS PF scores and ODI scores were determined using multiple stepwise regression. RESULTS: 150 patients met inclusion criteria including 60 patients with ASD and 90 patients without. For the whole cohort, PROMIS PF correlated with ODI (r = - 0.651, p < 0.001), VAS Back (r = - 0.260, p = 0.014) and Charleson Comorbidity Index (r = - 0.336, p < 0.001). PROMIS PF had higher correlations than ODI for each sagittal alignment parameter tested, including TPA, SVA, PT, and PI-LL. When patients with ASD were compared to non-ASD patients, the PROMIS score was different between the groups but the ODI and VAS scores were not. Finally, stepwise linear regression showed that SVA, PI-LL, and VAS Leg were significant drivers of PROMIS PF (r2 = 0.406, p < 0.001). VAS Leg and VAS Back were significant contributors to ODI (r2 = 0.376, p < 0.001). CONCLUSIONS: In a cohort of 150 patients with back pain, PROMIS correlated strongly with legacy outcome metrics, including VAS and ODI. PROMIS PF correlated more strongly with sagittal malalignment than ODI. Additionally, patients with spinal deformity had significantly worse PROMIS PF scores but similar ODI scores as patients without ASD. Finally, sagittal alignment was found to be a significant driver of PROMIS PF scores but not ODI scores. PROMIS PF should be utilized as a disability assessment tool in patients with spinal deformity due to ease of use, strong correlations with legacy metrics, and ability to capture disability resulting from sagittal alignment.


Assuntos
Dor nas Costas/etiologia , Mau Alinhamento Ósseo/complicações , Avaliação da Deficiência , Vértebras Lombares , Avaliação de Resultados em Cuidados de Saúde/métodos , Vértebras Torácicas , Adulto , Idoso , Dor nas Costas/diagnóstico por imagem , Mau Alinhamento Ósseo/diagnóstico por imagem , Estudos de Coortes , Feminino , Humanos , Vértebras Lombares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Projetos de Pesquisa , Estudos Retrospectivos , Vértebras Torácicas/diagnóstico por imagem
6.
Int J Mol Sci ; 21(4)2020 Feb 21.
Artigo em Inglês | MEDLINE | ID: mdl-32098249

RESUMO

Degenerative disc disease is a leading cause of chronic back pain in the aging population in the world. Sinuvertebral nerve and basivertebral nerve are postulated to be associated with the pain pathway as a result of neurotization. Our goal is to perform a prospective study using radiofrequency ablation on sinuvertebral nerve and basivertebral nerve; evaluating its short and long term effect on pain score, disability score and patients' outcome. A review in literature is done on the pathoanatomy, pathophysiology and pain generation pathway in degenerative disc disease and chronic back pain. 30 patients with 38 levels of intervertebral disc presented with discogenic back pain with bulging degenerative intervertebral disc or spinal stenosis underwent Uniportal Full Endoscopic Radiofrequency Ablation application through either Transforaminal or Interlaminar Endoscopic Approaches. Their preoperative characteristics are recorded and prospective data was collected for Visualized Analogue Scale, Oswestry Disability Index and MacNab Criteria for pain were evaluated. There was statistically significant Visual Analogue Scale improvement from preoperative state at post-operative 1wk, 6 months and final follow up were 4.4 ± 1.0, 5.5 ± 1.2 and 5.7 ± 1.3, respectively, p < 0.0001. Oswestery Disability Index improvement from preoperative state at 1week, 6 months and final follow up were 45.8 ± 8.7, 50.4 ± 8.2 and 52.7 ± 10.3, p < 0.0001. MacNab criteria showed excellent outcomes in 17 cases, good outcomes in 11 cases and fair outcomes in 2 cases Sinuvertebral Nerve and Basivertebral Nerve Radiofrequency Ablation is effective in improving the patients' pain, disability status and patient outcome in our study.


Assuntos
Dor nas Costas , Ablação por Cateter , Dor Crônica , Degeneração do Disco Intervertebral , Vértebras Lombares , Nervos Espinhais , Adolescente , Adulto , Idoso , Dor nas Costas/diagnóstico por imagem , Dor nas Costas/fisiopatologia , Dor nas Costas/cirurgia , Dor Crônica/diagnóstico por imagem , Dor Crônica/fisiopatologia , Dor Crônica/cirurgia , Feminino , Humanos , Degeneração do Disco Intervertebral/diagnóstico por imagem , Degeneração do Disco Intervertebral/fisiopatologia , Degeneração do Disco Intervertebral/cirurgia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/fisiopatologia , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Nervos Espinhais/diagnóstico por imagem , Nervos Espinhais/fisiopatologia , Nervos Espinhais/cirurgia
7.
BMC Infect Dis ; 20(1): 133, 2020 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-32050917

RESUMO

BACKGROUND: Vertebral osteomyelitis can be attributed to many factors including immunosuppression, diabetes, malignancy, collagen disease, periodontal disease, open fractures, and endoscopic procedures. Anaerobic bacteria, such as Veillonella species, are found in the oral cavity and are rarely implicated in the infection. This report describes vertebral osteomyelitis secondary to a dental abscess with positive Veillonella cultures. CASE DESCRIPTION: A 76-year-old man presented to the hospital due to back pain with a four-day history of fever and chills. CT scans revealed several abscesses in the lumbar region as well as indications of vertebral osteomyelitis. After a psoas drain, the patient began antibiotics with a combination of ampicillin-sulbactam, metronidazole, and levofloxacin, but due to the patient's penicillin allergy, he was initially desensitized to this antibiotic for a significant period of time. Laminectomies, foraminotomies, and facetectomies were performed, but the infection spread to vertebral levels. The patient was then switched to a combination of vancomycin, metronidazole, and levofloxacin which eliminated the infection. Final laminectomy was performed with posterior segmental instrumentation and arthrodesis. Post-operatively, there were no signs of infection. The patient recovered well and regained mobility. Deeper examination of the patient's medical history revealed a severe tooth abscess immediately before the onset of bacteremia. CONCLUSION: We believe that a delay in the onset of antibiotic treatment is what led to the initial bacteremia that ultimately took root in the lower lumbar vertebrae. To the best of our ability, we could identify only one other case that linked vertebral osteomyelitis to the oral cavity.


Assuntos
Abscesso/tratamento farmacológico , Bacteriemia/microbiologia , Osteomielite/etiologia , Osteomielite/terapia , Abscesso Periodontal/complicações , Abscesso/diagnóstico por imagem , Idoso , Antibacterianos/uso terapêutico , Dor nas Costas/diagnóstico por imagem , Dor nas Costas/tratamento farmacológico , Bacteriemia/tratamento farmacológico , Bacteriemia/etiologia , Foraminotomia , Humanos , Laminectomia , Vértebras Lombares/microbiologia , Vértebras Lombares/cirurgia , Masculino , Osteomielite/diagnóstico por imagem , Osteomielite/microbiologia , Abscesso Periodontal/microbiologia , Tomografia Computadorizada por Raios X , Veillonella/patogenicidade
8.
World Neurosurg ; 137: e487-e492, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32059968

RESUMO

BACKGROUND: Few studies have used hybrid single-photon emission computed tomography (SPECT)/computed tomography (CT) scan to identify degenerative facet disease. We aimed to determine the incidence of hypermetabolic facets on SPECT/CT imaging in patients with axial neck or back pain to elucidate the value of SPECT/CT scan in identifying pain generators. METHODS: A retrospective review of adult patients with axial neck or back pain was conducted. A total of 190 patients underwent high-resolution SPECT/CT imaging using a standardized protocol from January 2010 to April 2018. Facet joints with increased radionuclide uptake on SPECT imaging were characterized as hypermetabolic. Number, level, and laterality of hypermetabolic facets were recorded based on review of imaging and radiologist impressions. RESULTS: The average age of the patients was 58 ± 13 years, and 51% of patients were men. A total of 85 patients (48%) demonstrated zygapophyseal joint hypermetabolism (ZJH) on SPECT imaging. A total of 202 hypermetabolic facets were identified, indicating the average number of facets with ZJH was 2.38 ± 1.91. Of patients with a positive scan, lumbar facets were most commonly affected (69% of ZJH) followed by cervical (24%) and thoracic regions (6%). C1-2 and C2-3 (22% each of cervical ZJH) and L4-5 (32% of lumbar ZJH) were most commonly affected in the cervical and lumbar regions, respectively. CONCLUSIONS: Nearly half of all patients with axial neck or back pain demonstrated ZJH on SPECT/CT imaging, supporting ZJH sites as potential pain generators and targets for treatment. Our results support the role for SPECT/CT imaging in the workup of patients with axial neck or back pain, which may reduce invasive diagnostic procedures and aid in treatment planning.


Assuntos
Artralgia/diagnóstico por imagem , Dor nas Costas/diagnóstico por imagem , Articulação Zigapofisária/diagnóstico por imagem , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tomografia Computadorizada com Tomografia Computadorizada de Emissão de Fóton Único
9.
J Clin Neurosci ; 72: 134-141, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31926664

RESUMO

PURPOSE: To assess preliminary associations between fatty-infiltration (FI) of cervical spine extensor musculature, cervical sagittal balance, and clinical outcomes in cervical deformity (CD) patients. METHODS: Operative CD patients (C2-C7 Cobb > 10°, CL > 10°, cSVA > 4 cm, or CBVA > 25°) with pre-operative (BL) MRIs and 1-year (1Y) post-operative MRIs or CTs were assessed for fatty-infiltration of cervical extensor musculature, using dedicated imaging software at each C2-C7 intervertebral level and the apex of deformity (apex). FI was gauged as a ratio of fat-free-muscle-cross-sectional-area (FCSA) over total-muscle-CSA (TCSA), with lower ratio values indicating greater FI. BL-1Y associations between FI, sagittal alignment, and clinical outcomes were assessed using appropriate parametric and non-parametric tests. RESULTS: 22 patients were included (Age 59.22, 71.4%F, BMI 29.2, CCI:0.75, Frailty: 0.43). BL deformity presentation: TS-CL: 29.0°, C2-C7 Sagittal Cobb:-1.6°, cSVA:30.4 mm. No correlations were observed between BL fatty-infiltration, sagittal alignment, frailty, or clinical outcomes (p > 0.05). Following surgical correction, C2-C7 (BL: 0.59 vs 1Y:0.67, p = 0.005) and apex (BL: 0.59 vs. 1Y: 0.66, p = 0.33) fatty-infiltration decreased. Achievement of lordotic curvature correlated with C2-C7 fatty infiltration reduction (Rs: 0.495, p < 0.05), and patients with residual postoperative TS-CL and cSVA malalignment were associated with greater apex fatty-infiltration (Rs: -0.565, -0.561; p < 0.05). C2-C7 FI improvement was associated with NRS back pain reduction (Rs: -0.630, p < 0.05), and greater apex fatty-infiltration at BL was associated with minor perioperative complication occurrence (Rs: 0.551, p = 0.014). CONCLUSIONS: Deformity correction and sagittal balance appear to influence the reestablishment of cervical muscle tone from C2-C7 and reduction of back pain for severely frail CD patients. This analysis helps to understand cervical extensor musculature's role amongst CD patients.


Assuntos
Tecido Adiposo/cirurgia , Vértebras Cervicais/cirurgia , Lordose/cirurgia , Imagem por Ressonância Magnética , Músculos do Pescoço/cirurgia , Equilíbrio Postural/fisiologia , Tecido Adiposo/diagnóstico por imagem , Adulto , Idoso , Dor nas Costas/diagnóstico por imagem , Dor nas Costas/cirurgia , Vértebras Cervicais/diagnóstico por imagem , Estudos de Coortes , Feminino , Humanos , Lordose/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Músculos do Pescoço/diagnóstico por imagem , Estudos Prospectivos , Estudos Retrospectivos , Resultado do Tratamento
10.
Radiologe ; 60(2): 123-131, 2020 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-31834417

RESUMO

Pain in general and back pain in particular are associated with a variety of pathological, clinical, and sociocultural factors. There are numerous clinical and therapeutic treatment as well as imaging-options available and comprehensive knowledge is required to meet the individual clinical needs of those affected. This requires a high degree of interdisciplinary cooperation. In addition, back pain is covered differently by various numbers of insurance companies. Imaging methods, including the example of periradicular image-assisted interventions, are presented with regard to their indication and efficiency. The existing guidelines and evaluation recommendations with different structural and targeted approaches are discussed in addition to extensive legal aspects in the literature. In addition, the structured reports and the certificated curricula of the AG Bildgebende Verfahren des Bewegungsapparates (Working Group "Imaging Procedures of the Musculoskeletal System") of the Deutsche Röntgengesellschaft ("German Society of Radiology") are recommended for the quality assurance.


Assuntos
Dor nas Costas , Dor nas Costas/diagnóstico por imagem , Dor nas Costas/terapia , Humanos , Guias de Prática Clínica como Assunto
11.
Spine (Phila Pa 1976) ; 45(8): 493-503, 2020 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-31703056

RESUMO

STUDY DESIGN: A prospective randomized controlled study. OBJECTIVE: To clarify whether percutaneous transforaminal endoscopic discectomy (PTED) has better clinical outcomes and less surgical trauma compared with microendoscopic discectomy (MED). SUMMARY OF BACKGROUND DATA: Two kinds of minimally invasive spine surgeries, PTED and MED, are now widely used for the treatment of lumbar disc herniation (LDH). It is still a controversial issue to choose the proper surgical approach. METHODS: In this single-center, open-label, randomized controlled trial, patients were included if they had persistent signs and symptoms of radiculopathy with corresponding imaging-confirmed LDH, and were randomly allocated to PTED or MED group. The primary outcome was the score of Oswestry Disability Index (ODI) and the secondary outcomes included the score of Medical Outcomes Study 36-Item Short-Form Health Survey bodily pain and physical function scales, European Quality of Life-5 Dimensions, and Visual Analogue Scales for back pain and leg pain. RESULTS: A total of 250 participants were randomly assigned to two treatment groups, 241 of that received the specific surgical procedure. Two hundred twenty-two patients (92.1%) have completed the 2-year follow-up. Both the primary and secondary outcomes did not differ significantly between the two treatment groups at each prespecified follow-up time (P > 0.05). For PTED, the postoperative improvement of ODI score in the median herniation subgroup was less compared with paramedian subgroup. For MED, less improvement of ODI score was found in far-lateral herniation subgroup compared with paramedian subgroup. Total complication rate over the course of 2 year was 13.44% in PTED group and 15.57% in MED group (P = 0.639). Ten cases (8.40%) in PTED group and five cases (4.10%) in MED group suffered from residue/recurrence of herniation, for which reoperation was required. CONCLUSION: Over the 2-year follow-up period, PTED did not show superior clinical outcomes and did not appear to be safer procedure for patients with LDH compared with MED. PTED had inferior results for median disc herniation, whereas MED did not appear to be the best option for far-lateral disc herniation. LEVEL OF EVIDENCE: 2.


Assuntos
Discotomia Percutânea/métodos , Endoscopia/métodos , Deslocamento do Disco Intervertebral/cirurgia , Vértebras Lombares/cirurgia , Microcirurgia/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Adulto , Dor nas Costas/diagnóstico por imagem , Dor nas Costas/cirurgia , Discotomia/métodos , Discotomia/tendências , Discotomia Percutânea/tendências , Endoscopia/tendências , Feminino , Seguimentos , Humanos , Deslocamento do Disco Intervertebral/diagnóstico por imagem , Vértebras Lombares/diagnóstico por imagem , Masculino , Microcirurgia/tendências , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/tendências , Estudos Prospectivos , Fatores de Tempo , Resultado do Tratamento
12.
Spine (Phila Pa 1976) ; 45(11): E647-E655, 2020 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31809471

RESUMO

STUDY DESIGN: Retrospective cohort study. OBJECTIVES: To report the feasibility, nuances, technical tips as well as outcomes of managing single-level grade D (extreme stenosis) and to compare the outcomes with nonextreme stenosis using the tubular retractor system. SUMMARY OF BACKGROUND DATA: Minimally invasive decompression in extreme stenosis is a challenge due to technical difficulty, feasibility of adequate decompression, and a steep learning curve. METHODS: Consecutive patients from January 2007 to January 2017 presenting with neurogenic claudication secondary to single-level spinal stenosis operated using tubular retractors were included in the study. The patients were divided into two groups; extreme-stenosis and nonextreme stenosis. The outcomes of surgery were evaluated and compared using visual analogue score (VAS) for leg and back pain, Oswestry disability index (ODI), and MacNab's criteria. RESULTS: A total of 325 patients (out of 446 patients after excluding the multilevel cases) fulfilled the inclusion criteria. One hundred forty patients were cases of extreme stenosis and 185 were nonextreme stenosis. The mean VAS for back and leg pain for extreme stenosis improved from 3.23 ±â€Š1.30 to 2.15 ±â€Š0.91 and 7.33 ±â€Š0.78 to 1.66 ±â€Š1.03 respectively as compared with nonextreme stenosis where the mean VAS for back and leg pain improved from 3.01 ±â€Š1.15 to 1.86 ±â€Š1.10 and 6.57 ±â€Š1.00 to 1.54 ±â€Š1.12 respectively. The mean ODI changed from 66.47 ±â€Š7.53 to 19.95 ±â€Š2.90 in extreme stenosis as compared with nonextreme stenosis where mean ODI changed from 59.05 ±â€Š5.08 to 19.88 ±â€Š2.67. As per MacNab's criteria 102 (of 120 patients) and 139 (of 157 patients) reported excellent and good outcomes in extreme and nonextreme stenosis respectively. CONCLUSION: Tubular decompression is feasible in patients with extreme-stenosis with no difference in the outcomes as well as complication rates when compared with a cohort of nonextreme stenosis. LEVEL OF EVIDENCE: 3.


Assuntos
Descompressão Cirúrgica/métodos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Estenose Espinal/diagnóstico por imagem , Estenose Espinal/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Dor nas Costas/diagnóstico por imagem , Dor nas Costas/cirurgia , Estudos de Coortes , Descompressão Cirúrgica/tendências , Estudos de Viabilidade , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
13.
Spine (Phila Pa 1976) ; 45(6): 390-396, 2020 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-31593057

RESUMO

STUDY DESIGN: A cross-sectional study. OBJECTIVE: This study investigates the prevalence of incidental vertebral marrow signal abnormality (VMSA) in thoracolumbar spine magnetic resonance imaging (MRI) ordered for the evaluation of back and/or leg pain and assess the clinical work-up for VMSAs. SUMMARY OF BACKGROUND DATA: Patients presenting with back pain are often referred for spine MRI for diagnostic evaluation. VMSA is most frequently found in the lumbar spine and is of clinical concern because it can represent malignancy. Standardized procedures for reporting and managing VMSAs do not exist. METHODS: The radiology database at the Oregon Health & Science University health system was queried to identify patients with thoracolumbar spine MRI scans performed between January 2014 and June 2016. Patients 16 years or older with MRIs ordered by providers at a multidisciplinary spine specialty clinic for the diagnostic evaluation of back and/or leg pain were included. Radiology reports were searched for keywords pertaining to VMSAs, such as "malignancy." Medical records of these patients were further reviewed for the clinical work-up and final diagnoses pertaining to the VMSA. RESULTS: The study sample included 1503 individual patients, of whom 65 (4%) had MRI radiology reports that described a VMSA. Thirty-one (48%) of the 65 patients with VMSAs had further evaluation recommended by radiology. Ten (32%) of these 31 patients were followed clinically without further diagnostic testing for the VMSA. Of the 65 patients with VMSAs, only one was diagnosed with malignancy (multiple myeloma). CONCLUSION: While VMSAs are not frequently found on thoracolumbar MRIs ordered to evaluate back and/or leg pain, there is a large amount of heterogeneity in how these abnormalities are documented and managed. This may indicate the need for clinical guidelines for the reporting and management of VMSAs detected on spine MRI and for improvement in communication between radiologists and ordering providers. LEVEL OF EVIDENCE: 3.


Assuntos
Medula Óssea/diagnóstico por imagem , Doenças do Tecido Conjuntivo/diagnóstico por imagem , Achados Incidentais , Vértebras Lombares/diagnóstico por imagem , Anormalidades Musculoesqueléticas/diagnóstico por imagem , Vértebras Torácicas/diagnóstico por imagem , Adulto , Idoso , Dor nas Costas/diagnóstico por imagem , Dor nas Costas/etiologia , Doenças do Tecido Conjuntivo/complicações , Doenças do Tecido Conjuntivo/epidemiologia , Estudos Transversais , Feminino , Seguimentos , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Anormalidades Musculoesqueléticas/complicações , Anormalidades Musculoesqueléticas/epidemiologia , Prevalência
14.
Rheumatology (Oxford) ; 59(7): 1679-1683, 2020 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31670801

RESUMO

OBJECTIVE: Lumbosacral transitional vertebras (LSTVs) are common in the general population, but their potential impact on the sacroiliac joints is unclear. We aimed to determine the prevalence of LSTVs and to assess their associations with sacroiliitis by standard radiography and MRI in a population with suspected axial spondyloarthritis. METHODS: The data were from the DESIR cohort of 688 patients aged 18-50 years with inflammatory low back pain for ⩾3 months but <3 years suggesting axial spondyloarthritis. The baseline pelvic radiographs were read by two blinded readers for the presence and type (Castellvi classification) of LSTVs. Associations between LSTVs and other variables collected at baseline and at the diagnosis were assessed using the χ2 test (or Fisher's exact test) or the Mann-Whitney test. RESULTS: LSTV was found in 200/688 (29.1%) patients. Castellvi type was Ia in 54 (7.8%), Ib in 76 (11.0%), IIa in 20 (2.9%), IIb in 12 (1.7%), IIIa in 7 (1.0%), IIIb in 21 (3.0%) and IV in 10 (1.4%) patients. Compared with the group without LSTVs, the group with LSTVs had higher proportions of patients meeting modified New York criteria for radiographic sacroiliitis (19% vs 27%, respectively; P = 0.013) and Assessment of SpondyloArthritis international Society MRI criteria for sacroiliitis (29% vs 39%, respectively; P = 0.019). CONCLUSION: In patients with inflammatory back pain suggesting axial spondyloarthritis, LSTVs are associated with both radiographic and MRI sacroiliitis.


Assuntos
Dor nas Costas/diagnóstico por imagem , Vértebras Lombares/diagnóstico por imagem , Sacroileíte/diagnóstico por imagem , Sacro/diagnóstico por imagem , Espondilartrite/diagnóstico por imagem , Adolescente , Adulto , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Radiografia , Índice de Gravidade de Doença , Adulto Jovem
15.
Eur J Pain ; 24(1): 19-38, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31433541

RESUMO

BACKGROUND AND OBJECTIVE: The transition from adolescence to adulthood is a sensitive period in life for health outcomes, including back pain. The objective was to synthesize evidence on risk factors for new episodes of back pain in emerging adults (18-29 years). METHODS: The protocol was registered in PROSPERO (CRD42016046635). We searched Medline; EMBASE; AMED and other databases up to September 2018 for prospective cohort studies that estimated the association between risk factor(s) and self-reported back pain. Risk factors could be measured before or during the age range 18-29 years, and back pain could be measured during or after this age range, with at least 12 months between assessments. Risk factors assessed in ≥3 studies were summarized. Risk of bias was assessed using a 6-item checklist. RESULTS: Forty-nine studies were included with more than 150 different risk factors studied. Nine studies had low risk of bias, 26 had moderate and 14 had high risk of bias. Age, sex, height, body mass index (BMI), smoking, physical activity level, a history of back pain, job satisfaction and structural imaging findings were investigated in three or more studies. History of back pain was the only risk factor consistently associated with back pain after adjustment (nine studies). CONCLUSION: There is moderate quality evidence that a history of back pain is a risk factor for back pain. There are inconsistent associations for age, sex, height, BMI, smoking and activity level. No associations were found between job satisfaction and structural imaging findings and back pain. SIGNIFICANCE: Emerging adulthood is a transitional period of life with changes in life style, potentially influencing future musculoskeletal health. This systematic review included 49 articles evaluating more than 150 potential risk factors for back pain, one of the most prevalent musculoskeletal disorders. No consistent results were found for life style factors such as physical activity level or BMI, both highlighted as important risk factors in previous literature. Importantly, a previous episode of back pain was a consistent risk factor for a new episode of back pain across several studies, and further investigation of risk factors for the first back pain episode is needed.


Assuntos
Dor nas Costas , Terapia por Exercício , Adolescente , Adulto , Dor nas Costas/diagnóstico por imagem , Dor nas Costas/epidemiologia , Pré-Escolar , Exercício Físico , Humanos , Lactente , Estudos Prospectivos , Fatores de Risco
16.
Rheumatology (Oxford) ; 59(1): 84-89, 2020 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-31236597

RESUMO

OBJECTIVE: To assess associations of spinal-pelvic orientation with clinical and imaging-study findings suggesting axial SpA (axSpA) in patients with recent-onset inflammatory back pain. METHODS: Spinal-pelvic orientation was assessed in DESIR cohort patients with recent-onset inflammatory back pain and suspected axSpA, by using lateral lumbar-spine radiographs to categorize sacral horizontal angle (<40° vs ⩾40°), lumbosacral angle (<15° vs ⩾15°) and lumbar lordosis (LL, <50° vs ⩾50°). Associations between these angle groups and variables collected at baseline and 2 years later were assessed using the χ2 test (or Fisher's exact) and the Mann-Whitney test. With Bonferroni's correction, P < 0.001 indicated significant differences. RESULTS: Of 362 patients, 358, 356 and 357 had available sacral horizontal angle, lumbosacral angle and LL values, respectively; means were 39.3°, 14.6° and 53.0°, respectively. The prevalence of sacroiliitis on both radiographs and MRI was higher in the LL < 50° group than in the LL ⩾50° group, but the difference was not statistically significant. Clinical presentation and confidence in a diagnosis of axSpA did not differ across angle groups. No significant differences were identified for degenerative changes according to sacral horizontal angle, lumbosacral angle or LL. CONCLUSION: Spinal-pelvic balance was not statistically associated with the clinical or imaging-study findings suggesting axSpA in patients with recent-onset inflammatory back pain.


Assuntos
Imagem por Ressonância Magnética/estatística & dados numéricos , Pelvimetria/estatística & dados numéricos , Radiografia/estatística & dados numéricos , Sacroileíte/diagnóstico por imagem , Espondilartrite/diagnóstico por imagem , Adulto , Dor nas Costas/diagnóstico por imagem , Dor nas Costas/fisiopatologia , Feminino , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/fisiopatologia , Masculino , Orientação Espacial , Ossos Pélvicos/diagnóstico por imagem , Ossos Pélvicos/fisiopatologia , Equilíbrio Postural , Estudos Prospectivos , Reprodutibilidade dos Testes , Sacroileíte/fisiopatologia
17.
Neuromodulation ; 23(1): 96-101, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31157949

RESUMO

BACKGROUND: "Traditional" spinal cord stimulation (SCS) trials with percutaneous electrodes externalized to a pulse generator (PG) are typically limited in duration due to risk of infection. Newer miniaturized wireless SCS technology eliminates the percutaneous extension (as well as PGs implanted for chronic use), thus facilitating a single-stage implantation after which the device can remain indefinitely. OBJECTIVE: To evaluate fully implanted wireless SCS devices during a 30-day screening trial in subjects with chronic low back pain and leg pain and a history of lumbosacral spine surgery. METHODS: In a randomized controlled trial of single-stage wireless SCS using a wireless percutaneous system, 99 subjects received either 10 kHz high frequency stimulation (HFS) or lower frequency stimulation (LFS) below 1500 Hz (Bolash R, Creamer M, Rauck R, et al. Wireless high frequency spinal cord stimulation (10 kHz) compared to multi-waveform low frequency spinal cord stimulation in the management of chronic pain in failed back surgery syndrome subjects: preliminary results of a multicenter, prospective, randomized controlled study. Pain Med 2019, https://doi.org/10.1093/pm/pnz019). In this report, we assess the 30-day trial success rate (≥50% pain relief from baseline) and complications. RESULTS: The overall trial success rate was 88% (87/99): 92% (46/50) for HFS and 84% (41/49) for LFS (NS). The trial success rate in the 64 subjects with predominant low back pain was 92% (59/64) vs. 80% (28/35) in those with leg pain ≥ low back pain (NS). During the screening trial, one infection occurred (1%) and one subject withdrew and was explanted (1%). Electrode migrations were seen on routine follow-up x-rays in 10 cases (10%). CONCLUSION: Using wireless SCS devices that allow for an extended trial period and evaluation of various waveforms, we observed a high rate trial success rate with both HFS and LFS waveforms, with minimal incidence of infection. Long-term follow-up will address the cost-effectiveness and morbidity associated with this technology, which facilitates single-stage treatment.


Assuntos
Dor nas Costas/terapia , Dor Crônica/terapia , Neuroestimuladores Implantáveis/tendências , Estimulação da Medula Espinal/tendências , Tecnologia sem Fio/tendências , Idoso , Dor nas Costas/diagnóstico por imagem , Dor Crônica/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estimulação da Medula Espinal/instrumentação , Estimulação da Medula Espinal/métodos , Tecnologia sem Fio/instrumentação
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