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1.
Medicine (Baltimore) ; 99(12): e19578, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32195971

RESUMO

INTRODUCTION: Spondyloptosis is a form of vertebral dislocation and the most advanced form of spondylolisthesis. Traumatic spondyloptosis is usually caused by high-energy impact and results in unstable spine deformity and spinal canal deformation, which lead to severe spinal cord injury. Traumatic spondyloptosis is mostly reported in the lumbo-sacral junction, while it is rarely documented in mid-lumbar segments. To the best of the authors' knowledge, only 16 cases of mid-lumbar spondyloptosis have been described previously. Herein, we present a L3 to L4 spondyloptosis case that did not involve neurological deficit. PATIENT CONCERNS: A 42-year-old man presented to the emergency department after an accident involving a fall. The patient developed severe back pain and spinal deformity, while his neurologic function remained intact. Radiological examinations indicated complete posterior vertebral dislocation at L3 to L4 and a fracture at the bilateral pelvic ischial tuberosity without major vessel injury or severe dura sac compression. DIAGNOSES: L3 to L4 complete vertebral dislocation, pelvic ischial tuberosity fracture. INTERVENTIONS: For treatment, the patient underwent fracture reduction, L3 to L4 intervertebral fusion, and internal fixation 7 days post-injury. OUTCOMES: Postoperative digital radiography showed the correction of the spinal deformity. The patient was pain-free and fully rehabilitated 3 months after the surgery. At the 1-year follow-up, the patient was completely asymptomatic and had achieved normal alignment. CONCLUSIONS: We reported an L3 to L4 traumatic spondyloptosis case that involved intact neurology, which is the first-ever reported mid-lumbar spondyloptosis case that involved complete posterior column and neural sparing. For the treatment of traumatic spondyloptosis without neurological deficit, restoring stability and preventing secondary cord injury should be taken into consideration.


Assuntos
Dor nas Costas/diagnóstico , Anormalidades Congênitas/diagnóstico , Vértebras Lombares/lesões , Espondilolistese/diagnóstico por imagem , Acidentes por Quedas , Adulto , Assistência ao Convalescente , Criança , Pré-Escolar , Feminino , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/cirurgia , Humanos , Luxações Articulares/diagnóstico por imagem , Luxações Articulares/cirurgia , Vértebras Lombares/patologia , Masculino , Pessoa de Meia-Idade , Ossos Pélvicos/lesões , Ossos Pélvicos/patologia , Radiografia/métodos , Fusão Vertebral/métodos , Coluna Vertebral/anormalidades , Espondilolistese/cirurgia , Resultado do Tratamento
2.
Radiologe ; 60(2): 109-116, 2020 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-31925466

RESUMO

BACKGROUND: Back pain is ranked as the fourth highest medical expense per year. The number of affected patients is constantly increasing because of increasing chronification due to insufficient recognition of the cause. METHODS: The diagnosis of back pain is based on three important pillars. On the one hand, a detailed anamnesis and correct clinical examination by the responsible physician is extremely important, followed by an experienced radiologist who is responsible for determining the imaged-based ethiology of the symptoms. RESULTS/CONCLUSION: Anamnesis and clinical examination play an important role in identifying patients with a real underlying pathology for the symptomatology in order to provide them with direct imaging for further evaluation. Corresponding pathology in most cases of acute back pain is generally not found but here psychosocial factors ("yellow flags") are in the foreground. Attention should always be paid to the presence of "red flags" and the possibility of extraspinal causes.


Assuntos
Dor nas Costas , Doença Aguda , Dor nas Costas/diagnóstico , Doença Crônica , Humanos
3.
Emerg Med Clin North Am ; 38(1): 167-191, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31757249

RESUMO

Neck and back pain are among the most common symptom-related complaints for visits to the emergency department (ED). They contribute to high levels of lost work days, disability, and health care use. The goal of ED assessment of patients with neck and back pain is to evaluate for potentially dangerous causes that could result in significant morbidity and mortality. This article discusses the efficient and effective evaluation, management, and treatment of patients with neck and back pain in the ED. Emphasis is placed on vertebral osteomyelitis, epidural abscess, acute transverse myelitis, epidural compression syndrome, spinal malignancy, and spinal stenosis.


Assuntos
Dor nas Costas/diagnóstico , Gerenciamento Clínico , Emergências , Cervicalgia/diagnóstico , Procedimentos Ortopédicos/métodos , Medição da Dor/métodos , Dor nas Costas/terapia , Humanos , Cervicalgia/terapia
4.
Clin Ter ; 170(1): e15-e18, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31850479

RESUMO

Spinal Epidural Abscess (SEA) is a rare pyogenic infection localized between dura mater and vertebral periostium. The development of SEA is associated with the presence of medical co-morbidities and risk factors that facilitate bacterial dissemination. It is possible distinguish two type of SEA: primary SEA due to pathogen hematogenous dissemination and secondary SEA resulting from direct inoculation of pathogen. This entity, very uncommon, shows a prevalence peak between the 5th and the 7th decade of life with predominance in males. The case is a 44 years old Caucasian man with chronic low back pain, treated with physiotherapy and anti-inflammatory drugs. Following an episode of acute severe exacerbation of pain, the patient underwent four session of dorsal and lumbo-sacral area mesotherapy. One month after the last session, the patient experienced acute sever lumbar pain, radiated to left lower limb and accompanied by fever and vomiting. During hospitalization, elevated levels of white blood cells and C Reactive Protein (CRP) were found. Moreover, a vertebral magnetic resonance imaging revealed the presence of intramedullary lesion. Furthermore, methicillin sensitive staphylococcus aureus was isolated from three blood cultures and antibiotic therapy was performed. In our case the patient had the typical SEA onset, without any specific risk factors excepting the execution of four session of mesotherapy. Aim of this study is to explain risk factors for the SEA development and to clarify how act as preventive measure, because also acupuncture can promote bacterial infection.


Assuntos
Antibacterianos/uso terapêutico , Dor nas Costas/tratamento farmacológico , Abscesso Epidural/diagnóstico , Abscesso Epidural/prevenção & controle , Mesoterapia/efeitos adversos , Gestão de Riscos/métodos , Infecções Estafilocócicas/tratamento farmacológico , Adulto , Dor nas Costas/diagnóstico , Dor Crônica/diagnóstico , Dor Crônica/tratamento farmacológico , Humanos , Imagem por Ressonância Magnética , Masculino , Fatores de Risco , Resultado do Tratamento
5.
Rev. Paul. Pediatr. (Ed. Port., Online) ; 37(4): 450-457, Oct.-Dec. 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1041368

RESUMO

ABSTRACT Objective: To propose and analyze the test-retest reliability of an instrument to verify the presence and intensity of pain in the cervical, thoracic and lumbar spine in Brazilian young people. Methods: This reliability study enrolled a sample of 458 participants (13 to 20 years). Two groups were formed for each sex according to the range of days for the test-retest (10±3 and 28±2 days). For analysis of spinal pain, a drawing of the human body with cervical, thoracic and lumbar spine areas delimited was presented. The following question was presented: during a normal day, do you feel pain in any of these regions of your spine? If so, what is the intensity from 0 to 10 (mark on the line)? The starting point, with the number 0, corresponded to no pain, and the number 10 to severe pain. The agreement of frequency and of intensity of pain was verified by Kappa test and Bland-Altman plot, respectively. Results: Intraclass correlation coefficients ranged from 0.71 (confidence interval of 95% - 95%CI - 0.59-0.79) to 0.94 (95%CI 0.90-0.96). The results concerning the agreement of pain scores showed the mean differences to be close to 0, and the largest mean difference was -0.40 (95%CI -5.14-4.34). The agreement in reported pain ranged from 72.2 (Kappa 0.43; 95%CI 0.28-0.58) to 90.1% (Kappa 0.76; 95%CI 0.60-0.92). Conclusions: This instrument was shown to be a reliable manner to verify the pain in different regions of the spine in Brazilian young people.


RESUMO Objetivo: Propor e analisar a reprodutibilidade de um instrumento para verificar a presença e a intensidade da dor na coluna cervical, torácica e lombar em jovens brasileiros. Métodos: Estudo de reprodutibilidade com uma amostra de 458 participantes (13 a 20 anos). Dois grupos foram formados para cada sexo de acordo com o intervalo de dias entre teste e reteste (10±3 e 28±2 dias). Para a análise da dor na coluna, foi apresentada a figura de um corpo humano com as áreas da coluna cervical, torácica e lombar delimitadas. A seguinte pergunta foi realizada: durante um dia comum, você sente dor em alguma dessas regiões da coluna? Se sim, qual é a intensidade de 0 a 10 (marque um traço)? A extremidade com o número 0 correspondia à ausência de dor e o número 10, à dor muito intensa. A concordância na frequência e intensidade da dor foi verificada por meio do teste Kappa e da plotagem de Bland-Altman, respectivamente. Resultados: Os coeficientes de correlação intraclasse variaram de 0,71 (intervalo de confiança de 95% - IC95% - 0,59-0,79) a 0,94 (IC95% 0,90-0,96). Os resultados relativos à concordância no escore de dor mostraram que as diferenças médias foram próximas de 0 e a maior diferença média foi de -0,40 (IC95% -5,14-4,34). A concordância no relato de dor variou de 72,2 (Kappa 0,43; IC95% 0,28-0,58) a 90,1% (Kappa 0,76; IC95% 0,60-0,92). Conclusões: O instrumento demonstrou ser uma forma reprodutível de verificar a dor em diferentes regiões da coluna vertebral em jovens brasileiros.


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Medição da Dor/métodos , Dor nas Costas/diagnóstico , Cervicalgia/diagnóstico , Coluna Vertebral , Brasil , Reprodutibilidade dos Testes
6.
Orthopade ; 48(12): 1061-1072, 2019 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-31720705

RESUMO

The treatment of patients with acute back pain is becoming increasingly more important due to the high incidence; however, acute clinical pictures from other disciplines can also primarily be symptomatic with back pain and falsely lead to a consultation with an orthopedist. In order to assure an adequate treatment of potentially critical patients, it is absolutely necessary to exclude life-threatening differential diagnoses by a structured study of the patient history, investigations and diagnostics. Depending on the suspected diagnosis, necessary first aid measures and emergency referral to the appropriate specialist department should be initiated. This article gives an overview of selected clinical pictures and tries to look beyond the field of orthopedics.


Assuntos
Dor nas Costas/diagnóstico , Dor nas Costas/etiologia , Ortopedia , Doença Aguda , Diagnóstico Diferencial , Humanos , Relações Interprofissionais , Encaminhamento e Consulta , Especialização
7.
Medicine (Baltimore) ; 98(41): e17579, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31593145

RESUMO

RATIONALE: Minimally invasive surgeries for thoracic disc herniation (TDH) evolved rapidly in recent years, and multiple approaches have been put forward. Thoracic discectomy via percutaneous spine endoscopy (PSE) is inadequately documented because of the low prevalence of TDH and the high difficulty of thoracic spine endoscopy techniques. Herein, we present a TDH case who underwent percutaneous endoscopic thoracic discectomy. PATIENT CONCERNS: A 28-year-old male suffered backpain and partial paralysis in lower extremities. DIAGNOSES: Magnet resonance imaging demonstrated T11-12 TDH, with cranially migrated disc fragment. INTERVENTIONS: The patient underwent percutaneous endoscopic thoracic discectomy via posterolateral approach with the assistance of endoscopic reamer in the procedure of foramino-laminaplasty. OUTCOMES: The patient's muscle force improved immediately, and the backpain relieved after 5 days post-surgery. In the 6-month follow-up, he had normal muscle force without paresthesia in lower limbs. LESSONS: The innovative design of endoscopic reamer provides effective plasty and access establishment with lower risk and difficulty, which ensures the vision and the operating space of the procedure of decompression. With this technique, the indications of thoracic PSE were broadened to both ventral and dorsal thoracic stenosis.


Assuntos
Discotomia Percutânea/métodos , Endoscopia/métodos , Deslocamento do Disco Intervertebral/cirurgia , Vértebras Torácicas/cirurgia , Adulto , Dor nas Costas/diagnóstico , Dor nas Costas/etiologia , Humanos , Disco Intervertebral/cirurgia , Deslocamento do Disco Intervertebral/diagnóstico por imagem , Deslocamento do Disco Intervertebral/patologia , Imagem por Ressonância Magnética , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Paraplegia/diagnóstico , Paraplegia/etiologia , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/patologia , Resultado do Tratamento
8.
BMC Musculoskelet Disord ; 20(1): 418, 2019 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-31506099

RESUMO

BACKGROUND: Resuming walking after lumbar surgery is a common focus of early post-operative rehabilitation, however there is no knowledge about whether increased walking is associated with better functional outcomes. This study aimed to determine whether time spent walking in the week after lumbar surgery, along with co-morbidities, pre-operative pain duration, pre-operative physical activity or function, or surgical variables predict substantial improvement in physical function six months after lumbar surgery. METHODS: A prospective cohort study design was utilized. Participants undergoing lumbar surgery (discectomy, decompression, fusion) were recruited between April and November 2016. Predictor variables were collected pre-operatively (age, sex, smoking status, obesity, diabetes, depression, anxiety, pre-operative pain duration, neurological deficit, physical activity levels, mobility restriction, function) and early post-operatively (post-operative walking time, surgical procedure, single/multi-level surgery). Outcome variables (physical function, back pain and leg pain severity) were measured pre-operatively and six-months post-operatively. Logistic regression analysis was used to establish prediction of substantial improvement in outcome at six months. RESULTS: Participants (N = 233; 50% female; age 61 (SD = 14) years) who walked more in the first post-operative week were more likely to have substantially improved function on the Oswestry Disability Questionnaire at six months (OR 1.18, 95%CI 1.02-1.37), as were participants with < 12 months pre-operative pain (OR 2.71, 95%CI 1.28-5.74), and those with lower pre-operative function (OR 4.02, 95%CI 2.33-6.93). Age < 65 years (OR 2.36, 95%CI 1.14-4.85), and < 12 months pre-operative pain (OR 3.52 95%CI 1.69-7.33) predicted substantial improvement on the SF-36 Physical Component Summary. There were no significant predictors for substantial improvement in either leg or back pain. CONCLUSIONS: Walking time in the week after lumbar surgery is one of several predictors of substantial improvement in function at six months. Further research is required to determine whether intervention designed to increase walking early after lumbar surgery results in improved longer-term recovery of function. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ANZCTR), registration number 12616000747426 . Retrospectively registered on the 7th of June 2016.


Assuntos
Dor nas Costas/cirurgia , Discotomia/reabilitação , Deambulação Precoce/métodos , Recuperação de Função Fisiológica , Doenças da Coluna Vertebral/cirurgia , Idoso , Austrália , Dor nas Costas/diagnóstico , Dor nas Costas/etiologia , Avaliação da Deficiência , Feminino , Humanos , Modelos Logísticos , Estudos Longitudinais , Vértebras Lombares/fisiopatologia , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Medição da Dor , Período Pós-Operatório , Prognóstico , Estudos Prospectivos , Doenças da Coluna Vertebral/complicações , Doenças da Coluna Vertebral/fisiopatologia , Fatores de Tempo , Resultado do Tratamento , Caminhada
9.
Sao Paulo Med J ; 137(3): 270-277, 2019 Aug 29.
Artigo em Inglês | MEDLINE | ID: mdl-31483012

RESUMO

BACKGROUND: The most recent editions of diagnostic manuals have proposed important modifications in posttraumatic stress disorder (PTSD) criteria. The International Trauma Questionnaire (ITQ) is the gold-standard measurement for assessing PTSD and complex PTSD in accordance with the model of the 11th International Classification of Diseases (ICD-11). OBJECTIVE: The aim of this study was to adapt the ITQ for the Brazilian context. DESIGN AND SETTING: The translation and cross-cultural adaptation of the ITQ for use in Brazilian Portuguese was performed in trauma research facilities in Porto Alegre, Rio de Janeiro and Belo Horizonte, Brazil. METHODS: The adaptation followed five steps: (1) translation; (2) committee synthesis; (3) experts' evaluation through the content validity index (CVI) and assessment of interrater agreement though kappa statistics; (4) comprehension test with clinical and community samples (n = 35); and (5) final back-translation and authors' evaluation. RESULTS: Two independent translations were conducted. While working on a synthesis of these translations, the committee proposed changes in six items to adapt idiomatic expressions or to achieve a more accurate technical fit. Both the expert judges' evaluation (CVI > 0.7; k > 0.55) and the pretest in the target population (mean comprehension > 3) indicated that the adapted items were adequate and comprehensible. The final back-translation was approved by the authors of the original instrument. CONCLUSION: ITQ in its Brazilian Portuguese version achieved satisfactory content validity, thus providing a tool for Brazilian research based on PTSD models of the ICD-11.


Assuntos
Dor nas Costas/diagnóstico , Inquéritos e Questionários , Adulto , Idoso , Brasil , Estudos Transversais , Características Culturais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Traduções
10.
J Vet Intern Med ; 33(5): 2167-2174, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31381186

RESUMO

BACKGROUND: Development of management strategies for lumbosacral stenosis in dogs is hampered by the lack of objective diagnostic criteria and outcome measures. OBJECTIVE: To explore the suitability of electrodiagnostic tests as ancillary diagnostic aids, inclusion criteria, or outcome measures. SAMPLE POPULATION: Sixty-one client-owned dogs with clinical signs of lumbosacral foraminal stenosis. METHODS: A blinded, cross-sectional cohort study. Fifty-one dogs exhibiting apparent lumbosacral pain or pelvic limb lameness with no detected orthopedic cause had blinded review of magnetic resonance imaging (MRI), allowing classification as affected with foraminal stenosis (25 dogs), unaffected (20 dogs), or another diagnosis (6 dogs). The presence of electromyographic changes and tibial neurography variables were compared between groups. RESULTS: Cord dorsum potential onset latency, F-wave onset latency (both corrected for limb length), and F-ratio were increased in dogs with lumbosacral foraminal stenosis versus those without, although there was overlap of the values between groups. The proportion of dogs with electromyographic changes was not significantly greater in MRI-affected dogs. CONCLUSION: Electrophysiological testing is a useful ancillary test, either to provide stricter inclusion criteria and outcome measures or to aid clinical decision-making in equivocal cases.


Assuntos
Doenças do Cão/diagnóstico , Eletromiografia/veterinária , Estenose Espinal/veterinária , Animais , Dor nas Costas/diagnóstico , Dor nas Costas/veterinária , Estudos Transversais , Cães , Coxeadura Animal/diagnóstico , Região Lombossacral/patologia , Imagem por Ressonância Magnética/veterinária , Estenose Espinal/diagnóstico
11.
BMC Res Notes ; 12(1): 547, 2019 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-31455415

RESUMO

OBJECTIVE: Earlier studies documenting the effect of candidate genes on recovery have seldom taken into consideration the impact of emotional distress. Thus, we aimed to assess the modifying effect of emotional distress on genetic variability as a predictor for pain recovery in lumbar radicular (LRP) and low back pain (LBP). RESULTS: The study population comprised 201 patients and mean age was 41.7 years. The significant association between MMP9 rs17576 (B = 0.71, 95% CI 0.18 to 1.24, p = 0.009) and pain recovery remained statistically significant after adjusting for pain intensity at baseline, age, gender, smoking, body mass index, pain localization and emotional distress (B = 0.68, 95% CI 0.18 to 1.18, p = 0.008). In contrast, the association between OPRM1 (B = - 0.85, 95% CI - 1.66 to - 0.05, p = 0.038) and pain recovery was abolished in the multivariate analysis (B = - 0.72, 95% CI - 1.46 to 0.02, p = 0.058). Hence, MMP9 rs17576 and emotional distress independently seem to predict persistent back pain. The predictive effect of OPRM1 rs179971 with regard to the same outcome is probably dependent on other factors including emotional processing. Trial registration The Regional Committee for Medical Research and Ethics reference number 2014/1754.


Assuntos
Dor nas Costas/fisiopatologia , Emoções , Dor Lombar/fisiopatologia , Vértebras Lombares/fisiopatologia , Adulto , Dor nas Costas/diagnóstico , Dor nas Costas/genética , Feminino , Predisposição Genética para Doença/genética , Humanos , Dor Lombar/diagnóstico , Dor Lombar/genética , Vértebras Lombares/metabolismo , Masculino , Metaloproteinase 9 da Matriz/genética , Pessoa de Meia-Idade , Medição da Dor/métodos , Polimorfismo de Nucleotídeo Único , Estudos Prospectivos , Fatores de Risco
12.
Trials ; 20(1): 441, 2019 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-31315670

RESUMO

BACKGROUND: Spine surgery is associated with considerable postoperative pain and can be challenging to treat. A loco-regional technique suitable for spine surgery should cover the dorsal root of the spinal nerves at the levels where surgery is performed. The erector spinae block is a loco-regional technique with promising results and was recently described at the thoracic level. There are no randomized trials of this technique on a lumbar level. This study tests the hypothesis that the 24-h postoperative morphine consumption is significantly lower in patients undergoing posterior lumbar inter-body fusion surgery with a lumbar erector spinae (LUMBES) block when compared with a sham block. METHODS: This prospective randomized double-blind multicenter study will randomly allocate 80 adult patients undergoing elective posterior lumbar inter-body fusion surgery during general anesthesia to one of two groups as follows: (1) bilateral erector spinae block (20 mL 0.25% levobupivacaine) or (2) bilateral sham block (20 mL NaCl 0.9%). Our primary endpoint is 24-h postoperative morphine consumption. Secondary endpoints include 72-h morphine consumption, intraoperative sufentanil dosage, postoperative pain scores at regular time intervals both at rest and during movement, time to first postoperative mobilization, and the Quality of Recovery 40 survey score. DISCUSSION: The LUMBES trial is a pragmatic clinical study that will provide evidence of whether a bilateral lumbar erector spinae block is effective in reducing 24-h postoperative morphine consumption in patients undergoing lumbar inter-body fusion surgery. If this hypothesis is confirmed, this finding could contribute to more widespread implementation of this technique. TRIAL REGISTRATION: Local ethics committee B300201837508, ClinicalTrials.gov identifier: NCT03825198 . Registered on 31 Jan 2019.


Assuntos
Analgésicos Opioides/administração & dosagem , Anestésicos Locais/administração & dosagem , Músculos do Dorso/inervação , Dor nas Costas/prevenção & controle , Levobupivacaína/administração & dosagem , Vértebras Lombares/cirurgia , Morfina/administração & dosagem , Bloqueio Nervoso/métodos , Dor Pós-Operatória/prevenção & controle , Fusão Vertebral/efeitos adversos , Adolescente , Adulto , Idoso , Analgésicos Opioides/efeitos adversos , Anestésicos Locais/efeitos adversos , Dor nas Costas/diagnóstico , Dor nas Costas/etiologia , Dor nas Costas/fisiopatologia , Bélgica , Método Duplo-Cego , Feminino , Humanos , Levobupivacaína/efeitos adversos , Masculino , Pessoa de Meia-Idade , Morfina/efeitos adversos , Estudos Multicêntricos como Assunto , Bloqueio Nervoso/efeitos adversos , Medição da Dor , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/fisiopatologia , Ensaios Clínicos Pragmáticos como Assunto , Estudos Prospectivos , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
13.
Mayo Clin Proc ; 94(8): 1475-1487, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31279543

RESUMO

OBJECTIVE: To synthesize the evidence regarding the effect of spinal stimulation (SS) vs medical therapy (MT) and the effect of newer SS technologies vs conventional SS on pain reduction in patients with intractable spine or limb pain. METHODS: A comprehensive literature search was conducted by a reference librarian. The literature search encompassed January 1, 1995 - December 31, 2017. Reviewers worked independently to select and appraise trials. Random-effect meta-analysis and frequentist indirect comparison methods were used to compare the three interventions. Results were expressed as odds ratio (OR) or weighted mean difference (WMD) with 95% CIs. RESULTS: We identified 12 trials enrolling 980 patients. Compared with MT, SS significantly increased the odds of reducing pain by 50% or more in three trials (OR, 13.01; 95% CI, 4.96-34.17) and significantly reduced pain as measured by visual analogue scale scores in three trials (WMD, 1.43 scale points; 95% CI, 0.16-2.71). Using the common comparator of MT, newer stimulation technology (eg, high-frequency 10 kilohertz spinal stimulation, Burst, dorsal root ganglion) was associated with increased odds of pain relief compared with conventional SS (OR, 2.07; 95% CI, 1.35-3.19). CONCLUSIONS: In patients with intractable spine/limb pain, SS was associated with better pain reduction than MT. New stimulation technology was likely associated with better pain reduction than conventional stimulation.


Assuntos
Dor nas Costas/terapia , Tratamento Conservador/métodos , Terapia por Estimulação Elétrica/métodos , Dor Musculoesquelética/terapia , Medição da Dor , Dor Intratável/terapia , Dor nas Costas/diagnóstico , Feminino , Humanos , Extremidade Inferior/fisiopatologia , Masculino , Dor Musculoesquelética/diagnóstico , Manejo da Dor/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
14.
Neurol India ; 67(3): 671-678, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31347533

RESUMO

Back pain is the most common manifestation among rheumatologic conditions, with an 80% lifetime risk of development in each individual. Most patients have no specific identifiable etiology. Low back pain has always been an important public health problem, having a significant impact on the working class of the population. Hence, it is pertinent for the physician to be aware of the various causes of back pain and identify promptly the various red flags and poor prognostic markers. Lamentably, widespread access to technology and fear of litigation in this era of evidence based medicine has made us slaves of medical imagery in the context of back pain. It is crucial to recognize the teachings of ancient medicine, where keen observation, a detailed history-taking and a meticulous examination were the mainstay of good decision-making. Its precise management can help in obviating debility, preventing the work absenteeism, and consequently, decreasing health-care expenses.


Assuntos
Dor nas Costas/terapia , Dor nas Costas/diagnóstico , Dor nas Costas/etiologia , Dor nas Costas/fisiopatologia , Tomada de Decisão Clínica , Humanos , Fatores de Risco
15.
J Fam Pract ; 68(4): E1-E6, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31226181

RESUMO

It can often take years for patients with this condition to learn the true cause of their pain. But this guide to the work-up can help speed the diagnostic process.


Assuntos
Dor nas Costas/etiologia , Espondilite Anquilosante/complicações , Adulto , Dor nas Costas/diagnóstico , Dor nas Costas/terapia , Diagnóstico Diferencial , Humanos , Masculino , Encaminhamento e Consulta , Espondilite Anquilosante/diagnóstico , Espondilite Anquilosante/terapia
16.
NeuroRehabilitation ; 44(3): 419-424, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31177242

RESUMO

BACKGROUND: Postural deformities, such as Pisa syndrome (PS), and camptocormia and antecollis (C&A) are common in patient with Parkinson's disease (PwPD). These deformities can lead to back disability and pain with different mechanisms, including abnormal loading or stress on soft tissues as muscles, lumbar discs and ligaments. OBJECTIVES: To evaluate the effect of different postural deformities including PS and C&A on back function and pain in PwPD. METHODS: The function, disability and pain were assessed by Oswestry disability index (ODI) and brief pain inventory (BPI). All participants completed clinical assessments by the Unified Parkinson's Disease Rating Scale (UPDRS), Modified Hoenh & Yahr (mH&Y) staging and the Levodopa Equivalent Daily Dose (LEDD). RESULTS: PS and C&A groups significantly showed worse disability ODI and pain BPI, and higher LEDD and mH&Y stage compared with PD groups. However, no differences were found in PD duration and UPDRS in the same groups. Moreover, no differences were observed between PS and C&A groups in the mentioned scales. CONCLUSION: These results demonstrated that PS and C&A are associated with severe impairment of back functions and pain. Rehabilitation programs for PwPD and PS, and C&A should include spine alignment and postural training.


Assuntos
Dor nas Costas/fisiopatologia , Atrofia Muscular Espinal/fisiopatologia , Doença de Parkinson/fisiopatologia , Postura/fisiologia , Curvaturas da Coluna Vertebral/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Dor nas Costas/diagnóstico , Dor nas Costas/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Atrofia Muscular Espinal/diagnóstico , Atrofia Muscular Espinal/epidemiologia , Medição da Dor/métodos , Doença de Parkinson/diagnóstico , Doença de Parkinson/epidemiologia , Curvaturas da Coluna Vertebral/diagnóstico , Curvaturas da Coluna Vertebral/epidemiologia
17.
BMC Musculoskelet Disord ; 20(1): 305, 2019 Jun 29.
Artigo em Inglês | MEDLINE | ID: mdl-31253156

RESUMO

BACKGROUND: Transpedicular intracorporeal cement augmentation (TCA) with short segmental posterior instrumentation (SSPI), which provides an ideal immediate analgesic effect and long-term reconstructive stability, is thought to be a sensible advancement to the operative strategy in treating osteonecrosis of the vertebral body (ONV). However, long-term follow-up studies about the treatment are scarce. METHODS: Forty-six ONV patients (22 males and 24 females, mean age of 62.8 ± 7.11 years) underwent TCA with SSPI were retrospectively analyzed. During follow-up, clinical outcomes, such as the Visual Analogue Scale (VAS) score and the Oswestry Disability Index (ODI) score, were evaluated, as well as radiologic outcomes, such as the average vertebral height and kyphotic angle. RESULTS: A total of 36 patients completed a follow-up period of at least 5 years (mean follow-up period of 67 ± 4.2 months). Among them, seven patients experienced complications, i.e., pneumonia (2/36, 5.56%), screw loosening (2/36, 5.56%), moderate hematoma in the subcutaneous tissue (1/36, 2.78%), and cement leakage (2/36, 5.56%). Compared to the preoperative score, the mean VAS score was significantly reduced 6 months postoperatively (P < 0.05), and it concluded being virtually identical to the preoperative score (P > 0.05). The mean ODI score exhibited a comparable trend. Regarding the radiologic evaluation, the mean kyphotic angle and average vertebral body height were significantly corrected postoperatively (both P < 0.05). However, these radiological parameters were maximally ameliorated during the direct postoperative period and slowly deteriorated over time. CONCLUSION: The present study shows that TCA with SSPI may be only mildly effective for symptom relief and correction of kyphotic deformity during a relatively long follow-up, thus we do not recommend it for ONV.


Assuntos
Dor nas Costas/cirurgia , Cimentos para Ossos/uso terapêutico , Cifose/cirurgia , Osteonecrose/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Vertebroplastia/métodos , Idoso , Dor nas Costas/diagnóstico , Dor nas Costas/etiologia , Feminino , Seguimentos , Humanos , Fixadores Internos , Cifose/diagnóstico por imagem , Cifose/etiologia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Osteonecrose/complicações , Osteonecrose/diagnóstico por imagem , Medição da Dor , Estudos Retrospectivos , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/etiologia , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/cirurgia , Resultado do Tratamento , Vertebroplastia/instrumentação
18.
Spine (Phila Pa 1976) ; 44(20): 1426-1434, 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31205183

RESUMO

STUDY DESIGN: Level 3, cohort study. OBJECTIVE: The aim of this study was to assess long-term clinical outcome, and rate of reoperation following microsurgical subtotal discectomy (MSD). SUMMARY OF BACKGROUND DATA: Lumbar disc herniation (LDH) is a common cause of discomfort. Studies with >25 years of follow-up are rare and the reported rate of clinical success and reoperation are not well understood. METHODS: Retrospectively, files with complete documentation of preoperative and postoperative neurological status, process during hospitalization, detailed report of MSD, outpatient visit notes, and full contact information of patients who underwent MSD for the treatment of LDH with a minimum follow-up of 25 years were reviewed. Patients were contacted for personal follow-up assessment which included Oswestry Disability Index (ODI), EQ-5D, and MacNab criteria, usage of pain medication for leg and back pain, limitations in daily life, and repeated procedures at the lumbar spine. RESULTS: A total of 355 patients were randomly selected and contacted for final follow-up and 158 patients with a mean follow-up 32 years participated in the study. Clinical success rate was 86.0%, mean ODI was 9% (0-58%), 69.6% of the patients were pain free, 13.9% of patients reported the daily intake of pain medication for back and leg pain. Reoperations were performed in 47 of the patients (29.7%), whereas the rate for recurrent disc herniation at the same level was 8.2%. Reoperation within the first 2 years after initial MSD had negative influence on clinical success. The preoperative physical working status and sex and working status had no influence on the clinical success. CONCLUSION: The MSD is an effective technique to achieve a high rate of patient satisfaction, and high rate of functional recovery. The overall reoperation rate is 30% within 30 years but only 8.2% of the patients underwent reoperation because of recurrent disc herniation at the same level. LEVEL OF EVIDENCE: 3.


Assuntos
Discotomia/tendências , Deslocamento do Disco Intervertebral/cirurgia , Vértebras Lombares/cirurgia , Microcirurgia/tendências , Satisfação do Paciente , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Dor nas Costas/diagnóstico , Dor nas Costas/cirurgia , Estudos de Coortes , Discotomia/métodos , Feminino , Seguimentos , Humanos , Deslocamento do Disco Intervertebral/diagnóstico , Masculino , Microcirurgia/métodos , Pessoa de Meia-Idade , Recuperação de Função Fisiológica/fisiologia , Reoperação/tendências , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
19.
Scand J Psychol ; 60(4): 338-347, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31124165

RESUMO

Nonspecific, functional, and somatoform (NFS) syndromes is an umbrella term for various diagnoses with medically unexplained symptoms. These syndromes are more prevalent among women than among men, and associated with negative preconceptions that can impede rehabilitation. In two studies, we quantitatively assess how patients' gender affects the diagnostic assessment of NFS syndromes, as well as the healthcare experiences of individuals diagnosed with NFS syndromes. In the first study, our vignette-based experiment showed that Swedish general practitioners (N = 90) were gender biased in their diagnostic assessment of NFS syndromes, such that a female patient with back pain was more likely to be assigned a NFS syndrome compared to an otherwise identical male patient. In the second study, a large community sample of Swedish individuals with medically explained (n = 432) and unexplained pain (n = 521) evaluated their treating physician's relational conduct. Even after accounting for a variety of sociodemographic variables and other pain characteristics, women with at least one NFS syndrome percieved their physician's relational conduct as significantly poorer than other women as well as men with and without NFS syndromes. When women's pain is more likely than men's to be assessed as NFS, their rehabilitation could be prolonged as pertient alternative diagnoses and treatments are omittied and their negative healthcare experiences lower their volition to partake and persevere in treatment.


Assuntos
Atitude do Pessoal de Saúde , Dor nas Costas/diagnóstico , Sintomas Inexplicáveis , Relações Médico-Paciente , Sexismo , Transtornos Somatoformes/diagnóstico , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Suécia
20.
Dtsch Med Wochenschr ; 144(10): 665-669, 2019 05.
Artigo em Alemão | MEDLINE | ID: mdl-31083735

RESUMO

In the case of acute back pain, the indication for inpatient diagnosis and therapy is rarely given. The indication is provided if a potentially dangerous disease situation is suspected and if the pain is immobilizing or cannot be controlled on an outpatient basis. The high treatment numbers in German hospitals indicate that there is overuse in the treatment of back pain. Back pain, especially acute low back pain, is a frequent consultative activity of general practitioners. Serious diseases of the spine occur in only about 1 % of cases in GP practices. Identifying potentially dangerous disease outcomes requires a detailed history and thorough physical examination of the unclothed patient. "Red flags", together with the overall clinical impression of the patient, provide decisive warnings for urgently needed back pain. Common non-specific low back pain can be treated on an outpatient basis by prescribing painkillers and instructions for exercise by GPs.


Assuntos
Dor nas Costas , Dor nas Costas/diagnóstico , Dor nas Costas/epidemiologia , Dor nas Costas/terapia , Alemanha , Humanos
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