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1.
Praxis (Bern 1994) ; 109(2): 117-122, 2020 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-32019457

RESUMO

Retroperitoneal Fibrosis - on the Benefits of Trustworthiness in Everyday Practice Abstract. Despite negative radiology results, the described patient's back pain clearly had to be a somatic one - concluded by his primary care provider because of the patient's trustworthiness. The clinical presentation, histopathology of surgical excision and chemistry (IgG4) revealed the diagnosis of a retroperitoneal fibrosis. The symptoms as well as the fibrosis disappeared due to glucosteroid and rituximab therapy.


Assuntos
Dor nas Costas , Fibrose Retroperitoneal , Dor nas Costas/etiologia , Fibrose , Humanos , Imunoglobulina G , Fibrose Retroperitoneal/complicações , Fibrose Retroperitoneal/diagnóstico
3.
Chiropr Man Therap ; 27: 61, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31827768

RESUMO

Background: Back pain is a global problem in terms of disability and financially, with a large burden both to the individual and to society. Back pain was previously believed to be uncommon in children. However, there is a growing body of evidence that this is not the case. Objective: Part I of this scoping review studied risk factors of incident and episodic back pain. In this part II we aimed to identify all risk factors and triggers with unclear or mixed type back pain in young people and to identify any gaps in the literature. Methods: A scoping review design was selected to summarise the evidence, as there are many studies on "risk factors" for back pain. The scoping review followed the PRISMSA-ScR guidelines. We considered all studies that tested potential risk factors and triggers for thoracic and/or lumbar spine pain, in children, adolescents, and young adults (≤ 24 years). PubMed and Cochrane databases were searched from inception to September 2018, to identify relevant English language articles. The results regarding potential risk factors were separated into temporal precursors and bidirectional risk factors and the studies were classified by study design. Results: Our comprehensive search strategy identified 7356 articles, of which 83 articles were considered eligible for this review (part II). There were 53 cross-sectional studies and 30 cohort studies. Potential risk factors for back pain were: female sex, older age, later pubertal status, positive family history of back pain, increased growth, and a history of back pain, most of which are temporal precursor variables. There was limited research for the illness factors, spinal posture, and muscle endurance in the development of back pain. Conclusion: Many of the included studies approached risk factors in similar ways and found factors that were associated with back pain but were not obvious risk factors as causality was uncertain. Future research should be more rigorous and innovative in the way that risk factors are considered. This could be through statistical approaches including cumulative exposures, or longitudinal approaches including multi-trajectory methods. Additionally, data on proposed risk factors should be collected before the onset of back pain.


Assuntos
Dor nas Costas/epidemiologia , Dor nas Costas/etiologia , Saúde da Criança , Estudos de Coortes , Estudos Transversais , Humanos , Fatores Desencadeantes , Fatores de Risco , Adulto Jovem
4.
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
5.
Sichuan Da Xue Xue Bao Yi Xue Ban ; 50(5): 765-767, 2019 Sep.
Artigo em Chinês | MEDLINE | ID: mdl-31762249

RESUMO

A healthy 52-year-old woman presented with 10-days history of back pain. Neurologic testing failed to detect any functional deficits in the upper and lower extremities, and the patient had a full range of cervical spine motion without associated pain. Spinal CT and MRI revealed a well-circumscribed intradural mass located at conus medullaris. The operation of L1 hemilaminectomy was performed, and pathological examination discovered dilatation of sweat ducts and suggested the diagnosis of ectopic sweat duct ectasia. IHC staining in epithelia immunophenotype showed: pan-cytokeratin (PCK)(+), epithelia membrane antigen (EMA)(+), P63(+), cytokeratin 5/6 (CK5/6)(+), gross cystic disease fluid protein 15 (GCDFP15)(-). Intraspinal ectopic sweat duct ectasia is extremely rare, which has not been reported in the literature to date.


Assuntos
Dor nas Costas/etiologia , Medula Espinal/diagnóstico por imagem , Glândulas Sudoríparas/patologia , Dilatação Patológica , Feminino , Humanos , Imagem por Ressonância Magnética , Pessoa de Meia-Idade
6.
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.
Rev Med Suisse ; 15(666): 1818-1822, 2019 Oct 09.
Artigo em Francês | MEDLINE | ID: mdl-31599523

RESUMO

Back pain is a frequent reason for consultation. Although commonplace most of the time, back pain can sometimes be the only symptom of vertebral osteomyelitis, an infection that usually affects an intervertebral disc and the two adjacent vertebrae. Microbiology varies with the host's risk factors and local epidemiology. MRI is the preferred radiologic modality. Nevertheless, the definitive diagnosis is based on microbiological and histopathological elements. Antibiotic therapy alone may in some cases lead to cure, while in other cases the use of surgery is necessary. If it isn't diagnosed in time, vertebral osteomyelitis can have serious consequences. Thus, the physician must be familiar with the anamnestic, clinical and paraclinical elements that will bring him to actively look for this disease.


Assuntos
Osteomielite , Adulto , Antibacterianos/uso terapêutico , Dor nas Costas/etiologia , Humanos , Disco Intervertebral/microbiologia , Disco Intervertebral/cirurgia , Vértebras Lombares/microbiologia , Vértebras Lombares/cirurgia , Imagem por Ressonância Magnética , Osteomielite/complicações , Osteomielite/diagnóstico , Osteomielite/microbiologia , Osteomielite/terapia
9.
Neurocirugía (Soc. Luso-Esp. Neurocir.) ; 30(5): 233-237, sept.-oct. 2019. ilus
Artigo em Inglês | IBECS | ID: ibc-183877

RESUMO

Vertebral hemangiomas are relatively common, but those causing spinal cord compression are rare. A 19-year-old male presented with thoracic back pain. The neurologic examination was normal and radiological examinations demonstrated an aggressive vertebral hemangioma centered within the T11 vertebral body. Damaged vertebral bone and soft tissue components of the mass were observed in the epidural space. Surgery was performed using a new technique involving radiofrequency ablation, injection of a hemostatic agent (FLOSEAL, Baxter, USA), and bone autograft placement in the affected vertebral body. There were no complications intra- or postoperatively, and the patient's back pain resolved completely during the postsurgical period. Bleeding is a serious issue in cases of aggressive vertebral hemangioma. This new technique provides improved bleeding control and strengthens the affected vertebra through autograft placement


Los hemangiomas vertebrales son relativamente comunes, pero los que causan la compresión de la médula espinal son raros. Un hombre de 19 años presentó dolor de espalda torácica. El examen neurológico fue normal y los exámenes radiológicos demostraron un hemangioma vertebral agresivo centrado en el cuerpo vertebral T11. Se observaron componentes óseos y vertebrales dañados de la masa en el espacio epidural. La cirugía se realizó utilizando una nueva técnica que incluía ablación por radiofrecuencia, inyección de un agente hemostático (FLOSEAL, Baxter, EE. UU.) Y colocación de autoinjerto de hueso en el cuerpo vertebral afectado. No hubo complicaciones intra y postoperatorias, y el dolor de espalda del paciente se resolvió completamente durante el período posquirúrgico. El sangrado es un problema grave en los casos de hemangioma vertebral agresivo. Esta nueva técnica proporciona un mejor control de la hemorragia y fortalece la vértebra afectada a través de la colocación del autoinjerto


Assuntos
Humanos , Masculino , Adulto Jovem , Hemangioma/diagnóstico por imagem , Hemangioma/cirurgia , Ablação por Radiofrequência/métodos , Hemostáticos/administração & dosagem , Transplante Autólogo/métodos , Medula Espinal/patologia , Dor nas Costas/etiologia , Espaço Epidural/diagnóstico por imagem , Espaço Epidural/cirurgia
10.
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
11.
Spine (Phila Pa 1976) ; 44(19): E1159-E1160, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31524840

RESUMO

: Johann Peter Frank (1745-1821) is generally known as one of the founders of the modern Hygiene and Public Health. It is less known his contribution in investigating the pathogenesis of spinal disorders. In his "De Vertebralis Columnae in Morbis Dignitate" (1791), Frank first proposed to use the Latin term "rhachialgia" (back pain) to indicate all the painful states of spine. He focused on the "plethora spinali" in the vessels of the spinal cord and its membrane, sustaining that blood congestion was the origin of all the spinal disorders. He also believed that the excess of blood was able to generate a "diffuse inflammation" of vertebral and medullary structures. The innovative concepts developed by Johann Peter Frank demonstrated that he could be worthily considered as a pioneer in the study of spinal disorders.Level of Evidence: 5.


Assuntos
Dor nas Costas , Médicos/história , Doenças da Coluna Vertebral , Dor nas Costas/etiologia , Dor nas Costas/história , Dor nas Costas/patologia , Dor nas Costas/fisiopatologia , Alemanha , História do Século XVIII , História do Século XIX , Humanos , Saúde Pública/história , Doenças da Coluna Vertebral/etiologia , Doenças da Coluna Vertebral/história , Doenças da Coluna Vertebral/patologia , Doenças da Coluna Vertebral/fisiopatologia
12.
Ned Tijdschr Geneeskd ; 1632019 09 24.
Artigo em Holandês | MEDLINE | ID: mdl-31556497

RESUMO

Lumbar spondylolisthesis is usually asymptomatic. However, symptomatic spondylolisthesis results in back and/or leg pain such as radicular syndrome or neurogenic claudication. Variation in symptoms is caused by different types of spondylolisthesis. Lytic spondylolisthesis, most common at L5S1, is caused by spondylolysis of the pars interarticularis. This results in foraminal nerve compression and radicular symptoms. Degenerative spondylolisthesis, most common at L4L5 in patients >50 years old, is caused by slippage of the vertebral body and lamina, resulting in lumbar spinal stenosis and neurogenic claudication. Iatrogenic spondylolisthesis develops in 1.6-32.0% of patients after decompression surgery, causing recurrent neurogenic symptoms. It is important to understand the main symptoms patients experience: back or leg pain. In both cases, the preferred treatment is conservative. Surgery is only an option if patients have persistent/progressive leg pain. Shared decision-making is necessary to select the most accurate surgery for each individual patient while also taking into account age, comorbidities and symptoms. Further research is necessary to determine the advantages of each surgery in order to improve advice to patients.


Assuntos
Dor nas Costas/etiologia , Claudicação Intermitente/etiologia , Vértebras Lombares/patologia , Radiculopatia/etiologia , Estenose Espinal/etiologia , Espondilolistese/complicações , Idoso , Descompressão Cirúrgica/efeitos adversos , Descompressão Cirúrgica/métodos , Feminino , Humanos , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Espondilolistese/patologia , Espondilolistese/cirurgia
13.
Ned Tijdschr Geneeskd ; 1632019 09 13.
Artigo em Holandês | MEDLINE | ID: mdl-31556498

RESUMO

Subarachnoid haemorrhages (SAH) are acute life-threatening events that are frequently misdiagnosed. 4% of patients with SAH do not have the typical acute intense headaches, but present with other symptoms. Misdiagnosis leads to treatment delays and, consequently, higher morbidity and mortality. We describe two patients with atypical symptoms after SAH and delay in diagnosis. The first patient came to the emergency room with cervical, back and radicular pain that spread to both legs. An acute headache had started 11 days earlier. Physical examination showed signs of meningeal irritation. A cerebral CT scan revealed a subarachnoid haemorrhage. The second patient came to the outpatient clinic with pain in his lower back, apathy, apraxia and unsteady gait after an acute headache had started nine days before. When the patient visited our outpatient clinic, the headache had disappeared. A cerebral CT scan nevertheless revealed a subarachnoid haemorrhage. When diagnosing SAH, it is important not to miss the acute headache in the history, even though this headache may no longer be present at the time of presentation.


Assuntos
Dor nas Costas/etiologia , Cefaleia/etiologia , Neuralgia/etiologia , Hemorragia Subaracnóidea/complicações , Hemorragia Subaracnóidea/diagnóstico por imagem , Idoso , Apatia , Apraxias/etiologia , Diagnóstico Tardio , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Exame Físico , Tempo para o Tratamento , Tomografia Computadorizada por Raios X
14.
J Radiol Case Rep ; 13(7): 21-28, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31558964

RESUMO

A previously well 81-year-old Chinese male presented with hoarseness and low back pain for one month. Chest radiography at presentation revealed widening of the mediastinal silhouette. Nasopharyngoscopy detected left vocal cord paralysis. CT aortogram revealed a large saccular aortic arch aneurysm with a dissection flap extending distally down to the aortic bifurcation. The combination of clinical and imaging findings was consistent with cardiovocal syndrome. In view of good premorbid function, surgical repair was offered, and the patient underwent surgical repair and recovered well with no further back pain. A review of cases of cardiovocal syndrome suggest that prognosis of recurrent laryngeal nerve paralysis is dependent on the degree and duration of compression, and usually persists despite treatment of the underlying aneurysm.


Assuntos
Aneurisma Dissecante/complicações , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Aórtico/complicações , Aneurisma Aórtico/diagnóstico por imagem , Dor nas Costas/etiologia , Rouquidão/etiologia , Idoso de 80 Anos ou mais , Aneurisma Dissecante/cirurgia , Aneurisma Aórtico/cirurgia , Humanos , Masculino , Síndrome , Tomografia Computadorizada por Raios X/métodos , Paralisia das Pregas Vocais/etiologia
15.
Gait Posture ; 74: 66-70, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31472331

RESUMO

BACKGROUND: Back pain prevalence may increase with lumbar lordosis during standing in individuals with cerebral palsy (CP). Multiple interventions undertaken in individuals with CP have been shown to increase anterior pelvic tilt. RESEARCH QUESTION: Are pelvic tilt and trunk tilt (proxy measurements for lumbar lordosis) during gait associated with back pain prevalence in ambulatory individuals with CP? METHODS: A retrospective investigation was performed among all patients with cerebral palsy visiting a single clinical motion analysis laboratory over a 3.5 year period (January 2015 - May 2018) who also had complete pain questionnaire data. Back pain prevalence and its association with sagittal plane kinematic parameters (pelvic tilt and trunk tilt) were analyzed. RESULTS: Among the 700 patients that met the inclusion criteria, 594 were children and 106 were adults. Back pain prevalence was 11.1% in children and 36.8% in adults. As pelvic tilt and age increased, back pain increased (odds ratio 95% confidence interval: 1.002-1.061 and 1.052-1.109, respectively). Walking with an assistive device was not associated with back pain, nor was trunk tilt. SIGNIFICANCE: Back pain was more common with increasing age in ambulatory individuals with CP. After controlling for assistive device use and age, there was a weak relationship between pelvic tilt and back pain. Future studies are needed to determine if this is this a causal relationship.


Assuntos
Dor nas Costas/fisiopatologia , Paralisia Cerebral/complicações , Marcha/fisiologia , Articulação do Quadril/fisiologia , Lordose/fisiopatologia , Postura/fisiologia , Caminhada/fisiologia , Adolescente , Adulto , Dor nas Costas/etiologia , Fenômenos Biomecânicos , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Estudos Retrospectivos , Adulto Jovem
16.
S Afr J Surg ; 57(3): 58, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31392870

RESUMO

BACKGROUND: Intradural extramedullary (IDEM) spinal masses are common lesions with varying histological diagnoses often associated with significant neurological deficits. This study aimed to describe the epidemiology, management and perioperative outcome of IDEM tumours seen at the teaching hospitals of the University of the Witwatersrand, Johannesburg, between 2014 and 2017. RESULTS: 92 patients were included in the study. The ages ranged from 21 to 87 years, sex ratio was M:F 1:1.4, and duration of symptoms prior to diagnosis ranged between 3 days to 18 months. Local and radicular type pain as well as motor weakness were the commonest symptoms. 67% had severe neurological deficit McCormick Grade III and IV. Schwannoma (26) Neurofibromas (21) and Meningiomas (16) and were the most frequent tumour types. Meningiomas predominantly occurred at the cranio-cervical and thoracic levels. Nerve sheath tumours were mostly found at the cervical and lumbar levels while filum terminale ependymomas occurred at the thoracolumbar area. Laminectomy was the commonest surgical approach employed, and the extent of resection varied, with total excision in half the cases. Neurological function was regained in 3 patients, deteriorated in two and was unchanged in the remainder. CONCLUSION: IDEM tumours are an important subset of spinal cord compressive lesions Presentation with severe neurological deficit is common and though resection is feasible neurological deficit remains in the vast majority. Earlier detection should improve the results of surgery.


Assuntos
Meningioma/cirurgia , Neurilemoma/cirurgia , Neurofibroma/cirurgia , Neoplasias da Medula Espinal/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Dor nas Costas/etiologia , Feminino , Hospitais de Ensino , Humanos , Laminectomia , Masculino , Meningioma/complicações , Meningioma/epidemiologia , Pessoa de Meia-Idade , Debilidade Muscular/etiologia , Neurilemoma/complicações , Neurilemoma/epidemiologia , Neurofibroma/complicações , Neurofibroma/epidemiologia , Radiculopatia/etiologia , África do Sul/epidemiologia , Compressão da Medula Espinal/etiologia , Neoplasias da Medula Espinal/complicações , Neoplasias da Medula Espinal/epidemiologia , Adulto Jovem
17.
World Neurosurg ; 132: 429-433.e1, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31394357

RESUMO

BACKGROUND: Osteoporotic vertebral nonunion is a special type of osteoporotic vertebral fracture and can gain satisfactory clinical outcomes using vertebral augmentation. In the rare occurrence that augmented vertebral nonunion occurs postoperatively, pedicle screw fixation is the primary strategy. However, is a different method like the second shot of cement reliable? The purpose of this study is to introduce the reperfusion revision surgery strategy for treatment of osteoporotic vertebral nonunion. CASE DESCRIPTION: An 80-year-old female patient experienced vertebral re-nonunion in situ after receiving kyphoplasty at the T11 vertebrae. During revision surgery, we tried a new, minimally invasive surgical method in which we inserted cement into the intravertebral cleft around the movable cement without obvious leakage. Special bone cement perfusion techniques (incremental temperature cement delivery and secondary cement preparation based-perfusion and blocking) were used. The cement tail was performed to increase the anchor and fastness between the cement and vertebral body. CONCLUSIONS: The patient gained immediate pain relief and vertebral stability after the revision surgery. A 2-year postoperative radiograph and follow-up showed sufficient vertebral height and clinical outcomes. Using special puncture and bone cement perfusion techniques, reperfusion revision surgery in situ is an effective strategy for the treatment of vertebral re-nonunion.


Assuntos
Cimentos para Ossos , Procedimentos Neurocirúrgicos/métodos , Fraturas por Osteoporose/cirurgia , Reoperação/métodos , Fraturas da Coluna Vertebral/cirurgia , Vértebras Torácicas/lesões , Vértebras Torácicas/cirurgia , Idoso de 80 Anos ou mais , Dor nas Costas/etiologia , Feminino , Humanos , Cifoplastia/métodos , Imagem por Ressonância Magnética , Procedimentos Cirúrgicos Minimamente Invasivos , Resultado do Tratamento
18.
Turk J Med Sci ; 49(4): 1095-1101, 2019 08 08.
Artigo em Inglês | MEDLINE | ID: mdl-31385489

RESUMO

Background/aim: In this study, it was aimed to investigate the effects ofpulsed electromagnetic field(PEMF) therapy on pain, disability, psychological state, and quality of life in cervical disc herniation. Materials and methods: Patients were randomly divided into two groups, including Group 1, which received a therapy consisting of transcutaneous electrical nerve stimulation (TENS), hot pack (HP), and PEMF, and Group 2, which received a magnetic field (sham magnetic field) without current flow in addition to TENS and HP therapy. Pain was assessed by a visual analog scale (VAS, 0­10 cm). The other outcome measures were function (Neck Pain and Disability Scale), anxiety-depressive mood (Hospital Anxiety and Depression Scale), and quality of life (Nottingham Health Profile). All evaluations were performed at baseline, in the 3rd week, and in the 12th week after treatment. Results: A significant improvement was found in the neck pain, disability, depression, anxiety, and quality of life scores of both groups after treatment when compared to those before treatment. However, in the comparison between changes within groups, significant improvements were determined only in the VAS and Nottingham Health Profile sleep subparameter in the 12th week after treatment compared to those before treatment. Conclusion: PEMF therapy in cervical disc herniation can be used safely in routine treatment in addition to conventional physical therapy modalities.


Assuntos
Dor nas Costas , Depressão , Degeneração do Disco Intervertebral , Deslocamento do Disco Intervertebral , Terapia de Campo Magnético , Qualidade de Vida , Adulto , Dor nas Costas/etiologia , Dor nas Costas/terapia , Vértebras Cervicais/fisiopatologia , Depressão/etiologia , Depressão/terapia , Avaliação da Deficiência , Feminino , Humanos , Degeneração do Disco Intervertebral/complicações , Degeneração do Disco Intervertebral/fisiopatologia , Degeneração do Disco Intervertebral/terapia , Deslocamento do Disco Intervertebral/complicações , Deslocamento do Disco Intervertebral/fisiopatologia , Deslocamento do Disco Intervertebral/terapia , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
19.
J Bone Joint Surg Am ; 101(16): 1460-1466, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31436653

RESUMO

BACKGROUND: Posterior spinal fusion with pedicle screws is the gold-standard treatment for adolescent idiopathic scoliosis (AIS); however, it is unclear whether this procedure results in improved long-term back pain and health-related quality of life compared with patients not surgically treated for AIS. The aim of the present study was to evaluate back pain and quality of life in surgically managed patients with a minimum follow-up of 5 years compared with patients with untreated AIS and a healthy control group. METHODS: Fifty-five consecutive adolescent patients who underwent posterior pedicle screw instrumentation for AIS by a single orthopaedic surgeon were prospectively enrolled. At a minimum of 5 years postoperatively, 49 patients completed Scoliosis Research Society (SRS)-24 questionnaires, and data on reoperation were collected. Pain and quality-of-life parameters were compared with those of 49 age and sex-matched patients with untreated AIS and 49 healthy controls. RESULTS: The major curve averaged 53° preoperatively and 12° at 2 years postoperatively. One reoperation (pedicle screw removal) was needed because of a new neurological deficit (transient). The SRS-24 pain, function, and total scores improved significantly from preoperatively to 5 years postoperatively (all p ≤ 0.016), with pain scores improving from 4.0 to 4.3 (p = 0.003). There was no association between pain scores and the preoperative major curve, instrumentation below L1, or postoperative rib hump. The surgical treatment group had significantly better pain, activity, and self-image domain scores at 5 years postoperatively compared with the untreated AIS group (all p ≤ 0.014), and similar pain, self-image, and activity domain scores compared with the healthy control group; function scores were significantly lower in the healthy control group compared with the surgical treatment group (p < 0.001). CONCLUSIONS: Patients who underwent posterior spinal fusion with pedicle screws experienced improved back pain and health-related quality of life compared with patients with untreated AIS. Patients in the surgical treatment group had similar health-related quality of life to that of the healthy control group, except for function, which was significantly lower. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Dor nas Costas/etiologia , Dor Pós-Operatória/fisiopatologia , Qualidade de Vida , Escoliose/cirurgia , Fusão Vertebral/efeitos adversos , Adolescente , Análise de Variância , Dor nas Costas/fisiopatologia , Dor nas Costas/psicologia , Criança , Estudos de Coortes , Feminino , Humanos , Fixadores Internos , Masculino , Análise Multivariada , Medição da Dor , Prognóstico , Valores de Referência , Estudos Retrospectivos , Escoliose/complicações , Escoliose/psicologia , Índice de Gravidade de Doença , Fusão Vertebral/métodos , Resultado do Tratamento , Adulto Jovem
20.
BMJ Case Rep ; 12(8)2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31439569

RESUMO

Phaeochromocytomas are rare neuroendocrine tumours (NET) with malignant behaviour in about 10% of cases. The median time from the diagnosis of primary tumour and bone metastasis is 3.4 years. We report a case of a 66-year-old woman presenting with a hypertensive crisis and back pain. She has a history of a phaeochromocytoma completely resected 18 years before. MRI showed a neoplastic mass on the 10th thoracic vertebra (T10), with fracture and spinal cord compression. The CT-guided biopsy was consistent with metastasis of a NET. Therefore, she was treated with phenoxybenzamine and external beam radiotherapy. However, clinical (dorsal pain) and biochemical (ie, elevated chromogranin A) signs suggested persistent disease and the patient was treated with iodine-131 metaiodobenzylguanidine and T10 kyphoplasty. After 8 years, she remains clinically stable. This case demonstrates that phaeochromocytomas may reveal malignant behaviour several years after diagnosis, and therefore patients should be maintained under long term surveillance.


Assuntos
Neoplasias das Glândulas Suprarrenais/diagnóstico , Feocromocitoma/diagnóstico , Neoplasias da Coluna Vertebral/diagnóstico , Vértebras Torácicas , Neoplasias das Glândulas Suprarrenais/patologia , Neoplasias das Glândulas Suprarrenais/cirurgia , Idoso , Dor nas Costas/etiologia , Diagnóstico Diferencial , Feminino , Humanos , Metástase Neoplásica , Feocromocitoma/secundário , Feocromocitoma/cirurgia , Neoplasias da Coluna Vertebral/complicações , Neoplasias da Coluna Vertebral/secundário , Neoplasias da Coluna Vertebral/cirurgia , Tomografia Computadorizada por Raios X
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