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1.
Medicine (Baltimore) ; 98(49): e18135, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31804324

RESUMO

BACKGROUND: Degenerative lumbar spondylolisthesis (DLS) is one of the common orthopedic diseases which causes low back pain in patients, which seriously affects people's daily life and work. As a method of conservative treatment of this disease, manipulation is widely used in clinical practice. We will summarize the current published evidence of manipulation in the treatment of DLS, and evaluate the effectiveness and safety of manipulation through systematic review and meta-analysis, so as to provide more reliable evidence for future clinical practice. METHODS: We will conduct a comprehensive search of the following 9 databases until January 2019: PubMed, Embase, Cochrane Library, ClinicalTrials.gov, Web of Science, Chinese National Knowledge Infrastructure, Chinese Science and Technique Journals Database, Wan Fang Database, and Chinese Biomedical Database. The 2 researchers will independently search, screen, extract data, and evaluate the quality of the literatures. The primary outcomes include clinical effectiveness, Japanese Orthopaedic Association scores, and the secondary outcomes include visual analog scale scores, symptom scores, and adverse events. Bias risk tools provided by Cochrane Collaboration will be used for literature quality assessment, and RevMan 5.3 software will be used for meta-analysis. RESULTS: The results of this study will systematically evaluate the effectiveness and safety of manipulation intervention for people with DLS, especially in improving lumbar function scores and pain scores. CONCLUSION: The systematic review of this study will summarize the current published evidence of manipulation for the treatment of DLS, which can further guide the promotion and application of it. ETHICS AND DISSEMINATION: This study does not require ethical approval and the results will be published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER: CRD42019139933.


Assuntos
Vértebras Lombares , Manipulação da Coluna/métodos , Espondilolistese/terapia , Humanos , Manipulação da Coluna/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa
2.
Bull Hosp Jt Dis (2013) ; 77(3): 172-182, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31487482

RESUMO

BACKGROUND: Bracing (thoraco-lumbar-sacral orthosis) has been accepted as mainstay of treatment for symptomatic spondylolysis (SP) and grade I spondylolisthesis (SPL1). However, increasing costs and patient noncompliance can make bracing prohibitive and difficult to manage. The purpose of this study was to determine if SP and SPL1 can be effectively treated using physical therapy and other non-bracing conservative management techniques in order to relieve pain and restore physical function. METHODS: We performed a cross-sectional study in which patients who presented from June 1, 2004, to May 1, 2015, with symptomatic SP and SPL1 who were treated with nonbracing conservative management, entailing a universal 6-week physical therapy program and restriction of offending activity, were considered for the study. Physical therapy included core strengthening activities, hamstrings stretching, and spine range of motion exercises. Patients meeting inclusion criteria were contacted via phone interview and asked to complete an Oswestry Disability Questionnaire (ODQ) in order to generate a disability score to assess their current pain and daily function. Patients were then stratified into groups based on their level of disability as denoted by their disability score; minimal disability = disability score of 0% to 19.9%, moderate disability = 20% to 39.9%, severe disability = 40% to 59.9%, crippled = 60% to 79.9%, and bed bound or exaggerating = 80% to 100%. RESULTS: Fourty-six patients were identified as meeting inclusion criteria (28 with SP and 18 with SPL1). Twenty-three of 46 were successfully contacted and agreed to complete the ODQ (10/23 with SP and 13/23 with SPL1). Twenty-two of 23 (96%) patients had a minimal disability score (0% to 19.9%), One of 23 (4%) patients had a moderate disability score (20% to 39.9%), and 18/23 (78%) patients had a disability score of zero, denoting no pain or limitation of function. CONCLUSION: The results of this study suggest that, in patients with symptomatic spondylolysis and grade I spondylolisthesis, pain relief and restoration of function can be achieved using conservative management techniques without use of a brace.


Assuntos
Tratamento Conservador/métodos , Terapia por Exercício/métodos , Dor Lombar , Recuperação de Função Fisiológica , Espondilolistese , Espondilólise , Adolescente , Adulto , Estudos Transversais , Avaliação da Deficiência , Feminino , Humanos , Dor Lombar/diagnóstico , Dor Lombar/etiologia , Dor Lombar/terapia , Masculino , Avaliação de Resultados da Assistência ao Paciente , Modalidades de Fisioterapia , Espondilolistese/fisiopatologia , Espondilolistese/terapia , Espondilólise/fisiopatologia , Espondilólise/terapia , Inquéritos e Questionários , Avaliação de Sintomas
3.
Orthop Traumatol Surg Res ; 105(6): 1157-1163, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31324520

RESUMO

BACKGROUND: This is a Phase IV, national, multicentre, retrospective study to observe the real-world use of rhBMP-2 in France. HYPOTHESIS: There was no statistical hypothesis, the statistical analyses were descriptive in nature. PATIENTS AND METHODS: Data was collected from patient medical files in 10 French spinal centres. Primary objectives were to understand which patients were treated with rhBMP-2, commercialised in Europe as InductOs™ and how rhBMP-2 was used during spinal fusion surgery in France between 2011 and 2012. RESULTS: Four hundred patients (634 levels) treated with rhBMP-2 were included in the analysis. The most frequent primary diagnostic indication for rhBMP-2 use was degenerative disc disease (DDD; 129/400; 32.3% of patients) followed by spondylolisthesis (119/400; 29.8%), deformity (59/400; 14.8%) and pseudoarthrosis (29/400; 7.3%). The most frequently treated level was L4-L5 (33.8% of levels in 53.5% of patients); followed by L5-S1 (29.8%, 47.3%), L3-L4 (16.7%, 26.5%), and L2-L3 (7.3%, 11.5%), all other levels (less than 5% of patients). No interbody fusion device was used in 42.7% of levels. Wetted matrix of rhBMP-2 was placed in the interbody space in 58.4% of levels (370/634). The most common procedure for rhBMP-2 treatment was posterior lumbar fusion (PLF) (221/634; 34.9% of levels), followed by anterior lumbar interbody fusion (ALIF) (188/634; 29.7%), posterior lumbar interbody fusion (PLIF) (111/634; 17.5%), lateral lumbar interbody fusion (LLIF) (106/634; 16.7%), transforaminal lumbar interbody fusion (TLIF) (4/634; 0.6%) and 'other' (4/634; 0.6%). Thirty-one adverse events of Interest (AEI) were recorded in 27 patients. One AEI was considered related to rhBMP-2. Unplanned secondary spine interventions at index level treated with rhBMP-2 were required in 4 patients. DISCUSSION: In years 2011 and 2012 when the surgeries captured in this retrospective study were done, rhBMP-2 was indicated for single level (L4-S1) anterior lumbar spine fusion as a substitute for autogenous bone graft in adults with DDD. The most common procedure for the treatment with rhBMP-2 was PLF (off-label use), followed by ALIF (on-label use). The safety findings confirm a predictable and manageable safety profile. LEVEL OF EVIDENCE: IV.


Assuntos
Proteína Morfogenética Óssea 2/farmacologia , Degeneração do Disco Intervertebral/terapia , Vértebras Lombares/cirurgia , Sacro/cirurgia , Fusão Vertebral/métodos , Espondilolistese/terapia , Fator de Crescimento Transformador beta/farmacologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , França , Humanos , Período Intraoperatório , Masculino , Pessoa de Meia-Idade , Proteínas Recombinantes/farmacologia , Estudos Retrospectivos , Sacro/diagnóstico por imagem , Adulto Jovem
4.
J Neurosurg Spine ; 30(6): 729-735, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31153155

RESUMO

OBJECTIVEThere are a wide variety of comparative treatment options in neurosurgery that do not lend themselves to traditional randomized controlled trials. The object of this article was to examine how clinical registries might be used to generate new evidence to support a particular treatment option when comparable options exist. Lumbar spondylolisthesis is used as an example.METHODSThe authors reviewed the literature examining the comparative effectiveness of decompression alone versus decompression with fusion for lumbar stenosis with degenerative spondylolisthesis. Modern data acquisition for the creation of registries was also reviewed with an eye toward how artificial intelligence for the treatment of lumbar spondylolisthesis might be explored.RESULTSCurrent randomized controlled trials differ on the importance of adding fusion when performing decompression for lumbar spondylolisthesis. Standardized approaches to extracting data from the electronic medical record as well as the ability to capture radiographic imaging and incorporate patient-reported outcomes (PROs) will ultimately lead to the development of modern, structured, data-filled registries that will lay the foundation for machine learning.CONCLUSIONSThere is a growing realization that patient experience, satisfaction, and outcomes are essential to improving the overall quality of spine care. There is a need to use practical, validated PRO tools in the quest to optimize outcomes within spine care. Registries will be designed to contain robust clinical data in which predictive analytics can be generated to develop and guide data-driven personalized spine care.


Assuntos
Espondilolistese/terapia , Inteligência Artificial , Humanos , Vértebras Lombares , Sistema de Registros , Espondilolistese/epidemiologia
5.
J Orthop Surg Res ; 14(1): 178, 2019 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-31200736

RESUMO

BACKGROUND: Symptomatic degenerative lumbar spondylolisthesis (DLS) presents spinal problems in daily life. Shi-style lumbar manipulation (SLM), as an alternative treatment for DLS, is popular in China. SLM is based on the channels and collaterals theory of the traditional Chinese medicine, in which the symptoms are believed to result from channel blockage and joint displacement. However, there is no solid evidence to show the effect of the SLM on the management of symptomatic DLS. METHODS/DESIGN: We conduct a prospective randomized, blinded, controlled trial to compare the effectiveness of SLM with mechanical lumbar traction and explore whether it could be a potential therapy for symptomatic DLS. A total of 60 patients with symptomatic DLS will be enrolled and treated with the SLM or mechanical lumbar traction for 2 weeks. VAS score and SF-36 questionnaire were assessed at baseline and at 2, 4, 12, and 24 weeks. Any signs of acute adverse reactions, such as lower limb paralysis or syndrome of cauda equina, will be recorded at each visit during treatment. DISCUSSION: Although the SLM has been used in China for many years to treat symptomatic DLS, there is a lack of consensus about its effectiveness. This trial will provide convincing evidence about the effect of SLM on symptomatic DLS. TRIAL REGISTRATION: Registered on 6 January 2019; the trial number is ChiCTR1900020519 .


Assuntos
Degeneração do Disco Intervertebral/terapia , Vértebras Lombares , Manipulação da Coluna/métodos , Espondilolistese/terapia , Seguimentos , Humanos , Degeneração do Disco Intervertebral/diagnóstico , Degeneração do Disco Intervertebral/epidemiologia , Manipulação da Coluna/tendências , Estudos Prospectivos , Método Simples-Cego , Espondilolistese/diagnóstico , Espondilolistese/epidemiologia , Resultado do Tratamento
6.
J Back Musculoskelet Rehabil ; 32(5): 701-706, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30664502

RESUMO

BACKGROUND: Non-surgical treatment is the primary approach to degenerative conditions of the lumbar spine and may involve multiple modalities. There is little literature to guide an evidence-based approach to care. OBJECTIVE: To determine the effectiveness of CNT (comprehensive non-surgical treatment) in patients with degenerative spondylolisthesis (DS) and spondylolytic spondylolisthesis (SS), and to identify predictor variables for success of CNT in avoiding surgery. METHODS: All patients who underwent CNT for spondylolisthesis (n: 203) were included. CNT consisted of patient education, pain control with transforaminal epidural steroid injections (TFEs) and/or medications, and exercise programs. RESULTS: Surgical and non-surgical patients were similar in age, smoking status, comorbidity scores, facet joint widening, and translation of spondylolisthesis. After CNT, only 21.6% of patients with DS and 31.3% of patients with SS chose to have surgery in 3-years follow-up. The non-surgical group reported significantly better pain relief (73.6% vs 55%) after TFEs for a longer period (152.8 vs 45.6 days) and lower opioid use than the surgical group (28.2% vs 55.3%). CONCLUSIONS: CNT is effective in spondylolisthesis and more successful in DS than SS. CNT may decrease the need for surgery, particularly in patients who report pain relief greater than 70% for average five months after TFEs.


Assuntos
Glucocorticoides/uso terapêutico , Manejo da Dor/métodos , Espondilolistese/terapia , Idoso , Idoso de 80 Anos ou mais , Terapia por Exercício , Feminino , Humanos , Injeções Epidurais , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Fusão Vertebral/métodos , Espondilolistese/tratamento farmacológico , Resultado do Tratamento , Articulação Zigapofisária/cirurgia
7.
Chin Med J (Engl) ; 131(21): 2537-2543, 2018 Nov 05.
Artigo em Inglês | MEDLINE | ID: mdl-30381586

RESUMO

Background: Many clinical studies over the past decade have indicated positive outcomes for patients treated with Dynesys dynamic stabilization for lumbar degenerative disease. However, long-term outcomes of Dynesys for lumbar spinal stenosis are rarely reported. The aim of this study was to analyze the long-term clinical and radiologic outcomes for patients with lumbar spinal stenosis treated with Dynesys stabilization. Methods: Thirty-eight patients with lumbar spinal stenosis were treated with Dynesys stabilization from July 2008 to March 2010. The minimal duration of follow-up was 72 months. The patients were divided into stenosis and spondylolisthesis groups according to degenerative spondylolisthesis. Clinical outcomes were evaluated using the Oswestry Disability Index (ODI) and visual analog scale (VAS). Radiographic evaluations included range of motion (ROM) and the disc heights of stabilized segments and the upper adjacent segments. We also evaluated the occurrence of radiographic and symptomatic adjacent segment degeneration (ASD). Results: There were 23 patients in stenosis group and 15 patients in spondylolisthesis group. The ODI scores were significantly improved at the final follow-up evaluation, as compared to the baseline values (16.1 ± 5.7 vs. 57. 2 ± 14.2, t = 61.41, P < 0.01). The VAS scores for back and leg pain were significantly improved from 4.82 ± 0.89 and 4.04 ± 0.82 preoperatively to 0.93 ± 0.61 and 0.54 ± 0.51 postoperatively (t = 6.59, P < 0.01, and t = 5.91, P < 0.01, respectively). There were no differences between the two groups with respect to VAS and ODI scores. The ROM of stabilized segments decreased significantly from 7.8° ± 2.4° to 4.5° ± 1.5° (t = 7.18, P < 0.05), while the upper adjacent segments increased significantly from 8.3° ± 2.4° to 10.4° ± 2.4° (t = 2.87, P = 0.01). The change in disc height of stabilized segments was not significant (11.9 ± 2.1 preoperatively vs. 12.5 ± 1.5 postoperatively, t = 1.43, P = 0.15), whereas the decrease in disc height of the upper adjacent segments was significant (12.5 ± 2.0 preoperatively vs. 11.0 ± 1.7 postoperatively, t = 2.94, P = 0.01). The occurrence of radiographic and symptomatic ASD was 16% (6/38) and 3% (1/38), respectively. Conclusions: Decompression and Dynesys stabilization for lumbar stenosis with or without spondylolisthesis showed good long-term clinical and radiographic results. Lumbar stenosis with or without Grade I spondylolisthesis, particularly in patients <60 years of age with mild-to-moderate lumbar disc degeneration, would be one of the main indications for the Dynesys system.


Assuntos
Vértebras Lombares/cirurgia , Estenose Espinal/cirurgia , Espondilolistese/cirurgia , Adulto , Descompressão Cirúrgica/métodos , Feminino , Humanos , Degeneração do Disco Intervertebral/cirurgia , Degeneração do Disco Intervertebral/terapia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Estenose Espinal/terapia , Espondilolistese/terapia , Resultado do Tratamento
8.
World Neurosurg ; 120: e580-e592, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30165230

RESUMO

OBJECTIVE: The purpose of the present study was to assess for gender-based differences in the usage and cost of maximal nonoperative therapy before spinal fusion surgery in patients with symptomatic lumbar stenosis or spondylolisthesis. METHODS: A large insurance database was queried for patients with symptomatic lumbar stenosis or spondylolisthesis undergoing index lumbar decompression and fusion procedures from 2007 to 2016. This database consists of 20.9 million covered lives and includes private or commercially insured and Medicare Advantage beneficiaries. Only patients continuously active within the Humana insurance system for ≥5 years before the index operation were eligible. Usage was characterized by the cost billed to the patient, prescriptions written, and number of units billed. RESULTS: A total of 4133 patients (58.5% women) underwent 1-, 2-, or 3-level posterior lumbar instrumented fusion. A significantly greater percentage of female patients used nonsteroidal anti-inflammatory drugs (P < 0.0001), lumbar epidural steroid injections (P = 0.0044), physical and/or occupational therapy (P < 0.0001), and muscle relaxants (P < 0.0001). The total direct cost associated with all maximal nonoperative therapy before index spinal fusion was $9,000,968, with men spending $3,451,479 ($2011.35 per patient) and women spending $5,549,489 ($2296.02 per patient). When considering the quantity of units billed, women used 61.5% of the medical therapy units disbursed despite constituting 58.5% of the cohort. When normalized by the number of pills billed per patient using therapy, female patients used more nonsteroidal anti-inflammatory drugs, opioids, and muscle relaxants. CONCLUSIONS: These results suggest that gender differences exist in the use of nonoperative therapies for symptomatic lumbar stenosis or spondylolisthesis before fusion surgery.


Assuntos
Vértebras Lombares/cirurgia , Procedimentos Neurocirúrgicos , Doenças da Coluna Vertebral/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Anti-Inflamatórios não Esteroides/economia , Anti-Inflamatórios não Esteroides/uso terapêutico , Estudos de Coortes , Custos e Análise de Custo , Bases de Dados Factuais , Descompressão Cirúrgica , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Relaxantes Musculares Centrais/economia , Relaxantes Musculares Centrais/uso terapêutico , Terapia Ocupacional/economia , Prescrições/estatística & dados numéricos , Caracteres Sexuais , Doenças da Coluna Vertebral/economia , Doenças da Coluna Vertebral/cirurgia , Fusão Vertebral/estatística & dados numéricos , Estenose Espinal/economia , Estenose Espinal/cirurgia , Estenose Espinal/terapia , Espondilolistese/economia , Espondilolistese/cirurgia , Espondilolistese/terapia , Resultado do Tratamento , Adulto Jovem
9.
Spine (Phila Pa 1976) ; 43(24): 1731-1738, 2018 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-29877995

RESUMO

STUDY DESIGN: Prospective evaluation of an informational web-based calculator for communicating estimates of personalized treatment outcomes. OBJECTIVE: To evaluate the usability, effectiveness in communicating benefits and risks, and impact on decision quality of a calculator tool for patients with intervertebral disc herniations, spinal stenosis, and degenerative spondylolisthesis who are deciding between surgical and nonsurgical treatments. SUMMARY OF BACKGROUND DATA: The decision to have back surgery is preference-sensitive and warrants shared decision making. However, more patient-specific, individualized tools for presenting clinical evidence on treatment outcomes are needed. METHODS: Using Spine Patient Outcomes Research Trial data, prediction models were designed and integrated into a web-based calculator tool: http://spinesurgerycalc.dartmouth.edu/calc/. Consumer Reports subscribers with back-related pain were invited to use the calculator via email, and patient participants were recruited to use the calculator in a prospective manner following an initial appointment at participating spine centers. Participants completed questionnaires before and after using the calculator. We randomly assigned previously validated questions that tested knowledge about the treatment options to be asked either before or after viewing the calculator. RESULTS: A total of 1256 consumer reports subscribers and 68 patient participants completed the calculator and questionnaires. Knowledge scores were higher in the postcalculator group compared to the precalculator group, indicating that calculator usage successfully informed users. Decisional conflict was lower when measured following calculator use, suggesting the calculator was beneficial in the decision-making process. Participants generally found the tool helpful and easy to use. CONCLUSION: Although the calculator is not a comprehensive decision aid, it does focus on communicating individualized risks and benefits for treatment options. Moreover, it appears to be helpful in achieving the goals of more traditional shared decision-making tools. It not only improved knowledge scores but also improved other aspects of decision quality. LEVEL OF EVIDENCE: 2.


Assuntos
Tomada de Decisões , Técnicas de Apoio para a Decisão , Internet , Degeneração do Disco Intervertebral/terapia , Deslocamento do Disco Intervertebral/terapia , Estenose Espinal/terapia , Espondilolistese/terapia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Inquéritos e Questionários , Resultado do Tratamento
10.
Orthop Traumatol Surg Res ; 104(5): 569-573, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29807187

RESUMO

BACKGROUND: In cases of spondylolysis, hypoplasia of L5 mimicking spondylolisthesis has been described, mainly based on MRI; however, the treatment implications have not been analyzed specifically. OBJECTIVE: Assess the impact of hypoplasia of the L5 vertebral body in the constitution of the spondylolisthesis associated with isthmic spondylolysis. MATERIAL AND METHODS: A retrospective radiographic study in the standing position was performed with 104 patients with L5 isthmic spondylolysis and 24 control subjects. RESULTS: Measurements of vertebral endplate length showed that the standard apparent posterior listhesis (APL) is made up of true listhesis (TL) and false listhesis (FL). FL is induced by hypoplasia of the L5 vertebral body relative to the S1 endplate. TL results from disk failure and leads to anterior listhesis (AL), which alters the balance of spinal curvatures. CONCLUSIONS: By integrating the potential for false listhesis into the classification systems for spondylolisthesis, we can adapt the treatment algorithms. TYPE OF STUDY: Retrospective radiography study. LEVEL OF EVIDENCE: IV Retrospective review of cases.


Assuntos
Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/patologia , Espondilolistese/diagnóstico por imagem , Espondilólise/diagnóstico por imagem , Adolescente , Adulto , Algoritmos , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Radiografia , Estudos Retrospectivos , Espondilolistese/complicações , Espondilolistese/terapia , Espondilólise/complicações , Espondilólise/terapia , Adulto Jovem
11.
Medicine (Baltimore) ; 97(19): e0667, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29742708

RESUMO

BACKGROUND: Surgery is generally accepted as the main therapeutic option for symptomatic lumbar spondylolisthesis. However, new nonsurgical therapeutic options need to be explored for this population. OBJECTIVES: The objective of this study is to assess the effectiveness and safety of a 5-week Mokhuri treatment program compared with conventional nonsurgical treatments for symptomatic lumbar spondylolisthesis. METHODS: This is a study protocol for a multinational, multicenter clinical randomized controlled trial comparing the effectiveness and safety of 5 weeks of nonsurgical integrative treatments (a Mokhuri treatment program consisting of Chuna, acupuncture, and patient education) with nonsurgical conventional treatments (drugs for pain relief, epidural steroid injections, and physical therapy). Clinical outcomes including visual analogue scale (VAS) scores ranging from 0 to 100 for low back pain and leg pain, EQ-5D scores, Oswestry disability index (ODI) scores, Roland-Morris Disability Questionnaire (RMDQ) scores, Zurich Claudication Questionnaire (ZCQ) scores, walking duration and distance without leg pain, and a 5-minute treadmill test, and the ratio between the actual duration of participation and the originally scheduled duration in each group, the presence of any additional spondylolisthesis treatments, the types of concomitant treatments during the follow-up period, and adverse events (AEs) will be assessed at 7 weeks, 18 weeks, 30 weeks, 54 weeks, and 102 weeks after the end of the treatments. CONCLUSION AND DISCUSSION: The results of this study will provide clinical evidence on nonsurgical integrative interventions for patients with symptomatic lumbar spondylolisthesis. CLINICAL TRIAL REGISTRY:: clinicaltrials.gov (NCT03107468).


Assuntos
Terapia por Acupuntura , Vértebras Lombares , Educação de Pacientes como Assunto , Espondilolistese/terapia , Terapia por Acupuntura/efeitos adversos , Corticosteroides/administração & dosagem , Adulto , Idoso , Analgésicos/uso terapêutico , Protocolos Clínicos , Humanos , Injeções Epidurais , Cooperação Internacional , Pessoa de Meia-Idade , Dor/prevenção & controle , Modalidades de Fisioterapia , Tamanho da Amostra , Espondilolistese/tratamento farmacológico , Espondilolistese/fisiopatologia , Resultado do Tratamento , Adulto Jovem
12.
Eur Spine J ; 27(Suppl 2): 206-212, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29654368

RESUMO

BACKGROUND: Pars defect and spondylolisthesis are frequent conditions, while bone tumors-particularly the primaries-are rare. The contemporary occurrence can delay the diagnosis of the tumor, if symptoms are considered related to spondylolisthesis, or can make reconstruction more demanding. To our knowledge, only two case reports of this contemporary occurrence have been published in the literature. Being such rare, guidelines on surgical treatment have not been proposed yet. MATERIALS AND METHODS: A retrospective review of patients treated for spine bone tumors by the senior author from 1990 to 2017 was performed to find cases of contemporary occurrence of spondylolisthesis and/or pars defect and spine bone tumors. General health data, radiological imaging, histological tumor diagnosis, treatment, and follow-up were analyzed and discussed. RESULTS: Among the 1870 patients treated for spinal tumors between 1990 and 2017 by the senior author, 14 cases of association between tumors and spondylolysis/spondylolisthesis were observed. The cohort includes five males (35.7%) and nine females (64.3%), aged 14-72. Mean age of patients at surgery time was 47. CONCLUSIONS: Interactions between spondylolisthesis and bone tumors of the spine are episodic. These two conditions rarely occur in the same patient. No treatment strategy has been described until now. The target of this paper is to propose an algorithm to surgically treat patients with concomitant bone tumor and spondylolisthesis. This classification identifies a treatment-oriented algorithm based on two major categories: type A, bone tumor arising on the same vertebra or to an adjacent level; type B, bone tumor arising at least one unit far from the spondylolisthesis. This algorithm can help the surgeon facing this rare combination of diseases in the appropriate preoperative planning. These slides can be retrieved under Electronic Supplementary Material.


Assuntos
Neoplasias da Coluna Vertebral , Espondilolistese , Adolescente , Adulto , Idoso , Algoritmos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Neoplasias da Coluna Vertebral/complicações , Neoplasias da Coluna Vertebral/epidemiologia , Neoplasias da Coluna Vertebral/terapia , Espondilolistese/complicações , Espondilolistese/epidemiologia , Espondilolistese/terapia , Adulto Jovem
13.
Spine (Phila Pa 1976) ; 43(23): 1619-1630, 2018 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-29652786

RESUMO

STUDY DESIGN: Randomized trial with a concurrent observational cohort study. OBJECTIVE: To compare 8-year outcomes between surgery and nonoperative care and among different fusion techniques for symptomatic lumbar degenerative spondylolisthesis (DS). SUMMARY OF BACKGROUND DATA: Surgical treatment of DS has been shown to be more effective than nonoperative treatment out to 4 years. This study sought to further determine the long-term (8-year) outcomes. METHODS: Surgical candidates with DS from 13 centers with at least 12 weeks of symptoms and confirmatory imaging were offered enrollment in a randomized controlled trial (RCT) or observational cohort study (OBS). Treatment consisted of standard decompressive laminectomy (with or without fusion) versus standard nonoperative care. Primary outcome measures were the Short Form-36 (SF-36) bodily pain and physical function scores and the modified Oswestry Disability Index at 6 weeks, 3 months, 6 months, and yearly up to 8 years. RESULTS: Data were obtained for 69% of the randomized cohort and 57% of the observational cohort at the 8-year follow up. Intent-to-treat analyses of the randomized group were limited by high levels of nonadherence to the randomized treatment. As-treated analyses in the randomized and observational groups showed significantly greater improvement in the surgery group on all primary outcome measures at all time points through 8 years. Outcomes were similar among patients treated with uninstrumented posterolateral fusion, instrumented posterolateral fusion, and 360° fusion. CONCLUSION: For patients with symptomatic DS, patients who received surgery had significantly greater improvements in pain and function compared with nonoperative treatment through 8 years of follow-up. Fusion technique did not affect outcomes. LEVEL OF EVIDENCE: 1.


Assuntos
Laminectomia/métodos , Vértebras Lombares/cirurgia , Fusão Vertebral/métodos , Espondilolistese/terapia , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Espondilolistese/cirurgia , Resultado do Tratamento
14.
Eur J Orthop Surg Traumatol ; 28(6): 1033-1038, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29569131

RESUMO

Acquired spondylolysis represents an uncommon complication of spine surgery, of an unknown incidence and etiology. We studied patients presenting this rare entity, with the purpose to investigate the incidence, imaging findings, patients' clinical characteristics, as well as to provide an interpretation of the mechanisms that may lead to this phenomenon. The presented working hypothesis, regarding etiology, suggests that there is a relation between variations in spinopelvic sagittal alignment and acquired spondylolysis. Between January 2010 and January 2015, six patients presented spondylolysis after short-segment transforaminal lumbar interbody fusion, at a mean time of 43 months after surgery. The preoperative intactness and postoperative defect of pars interarticularis were documented with computed tomography scans in all patients. Standard radiographical spinopelvic parameters were measured before and after surgery. The optimum values of lumbar lordosis (LL) and pelvic incidence minus lumbar lordosis modifier (PI-LL mismatch) were calculated as well. The incidence of acquired spondylolysis was 0.95% among patients with short-segment lumbar fusion. Patients presented high-grade PI with a vertically orientated sacral endplate, while LL was found 9° greater and PI-LL mismatch 9° lower than the respective optimum values, indicating a non-harmonized alignment. In conclusion, acquired spondylolysis, though rare, may occur in patients with high-grade PI and sacral slope, and suboptimal spinopelvic sagittal alignment after lumbar spine surgery, thereby highlighting the importance of detailed preoperative planning in spine surgery, along with the study of sagittal balance.


Assuntos
Mau Alinhamento Ósseo/diagnóstico por imagem , Degeneração do Disco Intervertebral/cirurgia , Lordose/diagnóstico por imagem , Vértebras Lombares/cirurgia , Fusão Vertebral/efeitos adversos , Espondilólise/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Mau Alinhamento Ósseo/etiologia , Feminino , Humanos , Degeneração do Disco Intervertebral/diagnóstico por imagem , Lordose/etiologia , Lordose/terapia , Vértebras Lombares/diagnóstico por imagem , Masculino , Ossos Pélvicos/diagnóstico por imagem , Reoperação , Estudos Retrospectivos , Espondilolistese/diagnóstico por imagem , Espondilolistese/etiologia , Espondilolistese/terapia , Espondilólise/etiologia , Espondilólise/terapia , Tomografia Computadorizada por Raios X
15.
Spine (Phila Pa 1976) ; 43(10): E574-E579, 2018 05 15.
Artigo em Inglês | MEDLINE | ID: mdl-28953710

RESUMO

STUDY DESIGN: A prospective cohort study of consecutive patients. OBJECTIVE: Determination of the quality of life (QoL) and prevalence of slip progression in patients with degenerative lumbar spondylolisthesis managed nonoperatively. SUMMARY OF BACKGROUND DATA: Lumbar spinal stenosis secondary to degenerative lumbar spondylolisthesis is a common radiographic diagnosis associated with chronic back pain and radicular symptoms. There is limited evidence as to the clinical course in terms of validated QoL measures, and the extent of slip progression in patients with this condition treated nonoperatively. METHODS: Validated disease-specific and generic QoL metrics including SF12 physical and mental scores [SF12-physical component summary (PCS) and SF12-mental component summary (MCS)], Oswestry Disability Index (ODI), and numeric scales for back and leg pain as well as radiographic assessment of slip extent were evaluated at initial consultation (baseline) and at a minimum of 5 years after the baseline assessment. Slip progression was defined by a >5% increase in slip percentage. RESULTS: Thirty-nine of 160 (24.4%) patients elected to switch to operative management, despite no slip progression on preoperative radiographs. Seventy spondylolisthetic levels in 66 participants were assessed after a minimum of 5 years of nonoperative management. Twenty-one participants (31.8%) had slip progression. SF12-PCS, ODI, and leg pain improved similarly in both groups (P < 0.05). SF12-MCS did not change significantly in either group. Back pain improved only in the nonprogressing group. CONCLUSION: The majority of cases of low-grade spondylolisthesis do not progress over 5 years with nonoperative management. Regardless of whether there was progression or not, the mean PCS, ODI, and leg pain improved from baseline, although symptoms remained and a significant number elected to switch to surgical management before 5 years. Back pain improved with nonoperative treatment only in those without progression. LEVEL OF EVIDENCE: 2.


Assuntos
Progressão da Doença , Vértebras Lombares/diagnóstico por imagem , Qualidade de Vida , Espondilolistese/diagnóstico por imagem , Espondilolistese/terapia , Idoso , Estudos de Coortes , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Qualidade de Vida/psicologia , Espondilolistese/psicologia , Resultado do Tratamento
16.
J Radiol Case Rep ; 11(5): 13-26, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-29299090

RESUMO

Objective: Discuss the use of non-surgical spinal rehabilitation protocol in the case of a 69-year-old female with a grade 2 spondylolisthesis. A selective literature review and discussion are provided. Clinical Features: A 69-year-old female presented with moderate low back pain (7/10 pain) and severe leg cramping (7/10 pain). Initial lateral lumbar x-ray revealed a grade 2 spondylolisthesis at L4-L5 measuring 13.3 mm. Interventions and Outcomes: The patient completed 60 sessions of Mirror Image® spinal exercises, adjustments, and traction over 45 weeks. Post-treatment lateral lumbar x-ray showed a decrease in translation of L4-L5 from 13.3 mm to 2.4 mm, within normal limits. Conclusions: This case provides the first documented evidence of a non-surgical or chiropractic treatment, specifically Chiropractic BioPhysics®, protocols of lumbar spondylolisthesis where spinal alignment was corrected. Additional research is needed to investigate the clinical implications and treatment methods.


Assuntos
Vértebras Lombares/diagnóstico por imagem , Manipulação Quiroprática/métodos , Espondilolistese/terapia , Tração/métodos , Idoso , Protocolos Clínicos , Feminino , Humanos , Dor Lombar/etiologia , Cãibra Muscular/etiologia , Reabilitação , Espondilolistese/complicações , Espondilolistese/diagnóstico por imagem , Espondilolistese/reabilitação
17.
J Pediatr Orthop B ; 26(4): 388-392, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-26945344

RESUMO

The pathogenesis of slippage in pediatric spondylolisthesis is still unclear, although epiphyseal injury may account for many cases based on preclinical studies. However, no reports have described a pediatric case of isthmic spondylolisthesis showing radiologic evidence of epiphyseal injury. We report such evidence in a 13-year-old boy with low-back pain. Radiography revealed rounding of the S1 surface, a fracture line below the S1 endplate surface, and a bone marrow lesion in addition to slippage. Slippage and the rounding deformity were partially reversed (from 20 to 14% and from 42 to 27%, respectively) with conservative treatment and natural bone remodeling.


Assuntos
Dor Lombar/etiologia , Vértebras Lombares/lesões , Fraturas Salter-Harris/diagnóstico por imagem , Espondilolistese/diagnóstico por imagem , Adolescente , Beisebol/lesões , Remodelação Óssea , Braquetes , Humanos , Masculino , Radiografia , Espondilolistese/terapia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
18.
Rev. int. androl. (Internet) ; 14(4): 148-152, oct.-dic. 2016. ilus
Artigo em Inglês | IBECS | ID: ibc-157591

RESUMO

Introduction. Thoracolumbar junction syndrome (TLJS) occurs as a result of a minor intervertebral dysfunction at the thoracolumbar junction, and causes pain in the low back, hip, groin, testicles and lower abdomen. Likewise the case hereunder, TLJS can often be confused with other pathologies that may cause these symptoms and leading to misdiagnosis and false treatment. Case report. A sixty-one year old man complained of pulsatile right testicle pain and low back pain after the instrumentation at L2-L5 level for spondylolisthesis. For his insistent complains, his right testicle was removed surgically and medical treatment was given for low back pain but his complains did not relieved. Physical examination revealed severe limitation of the lumbar spine, and pain in all directions. Posteroanterior pressure at the T12-L1 and L4-5 intervertebral spaces, at the T12 spinous processes and transverse pressure against the lateral aspect of the T12 spinous process were painful. Pinch and roll test and pressure over the right trochanteric and pubic region were painful. According to these findings, we diagnosed the patient as a TLJS but we could not apply diagnostic T12 periapophyseal joint block because the patient did not accept this intervention, manipulation could not be applied because of the instrumentation at the thoracolumbar spine. The spinal mobilization therapy to the thoracolumbar segment was applied gently and gabapentin was started at a low dose of 300mg/day, and increased gradually to 2400 mg/day. Exercise program and daily living activities were organized. His symptoms improved after 3 months of treatment. It was observed that the general well-being has continued after two years of follow up. Conclusion. Thoracolumbar junction syndrome is a pathology that should be considered in the differential diagnosis of testicular pain (AU)


Objetivo. El síndrome de unión toracolumbar (TLJS de sus siglas en inglés) se produce como consecuencia de una disfunción intervertebral menor en la unión toracolumbar, y causa dolor en la zona baja de la espalda, la cadera, la ingle, los testículos y el abdomen inferior. Como en el caso que se presenta, el TLJS puede confundirse a menudo con otras patologías que pueden causar estos síntomas, conduciendo a un diagnóstico erróneo y tratamiento equivocado. Caso. Un hombre de 61 años refería dolor pulsátil en el testículo derecho y dolor en la zona baja de la espalda después de la instrumentación para espondilolistesis a nivel de L2-L5. Por su insistente queja, fue sometido a orquiectomía derecha y se indicó tratamiento médico para el dolor de la zona baja de la espalda, a pesar de lo cual las molestias persistieron. Un examen físico bien hecho reveló una importante limitación de la columna lumbar y el dolor en todas las direcciones. La presión posteroanterior en los espacios intervertebrales T12-L1 y L4-L5, apófisis espinosas T12 y la presión transversal contra la cara lateral de la apófisis espinosa T12 eran dolorosas. El signo del pellizco o enrollamiento y la presión sobre la región del trocánter derecho y región púbica eran dolorosos. De acuerdo con estos hallazgos, se diagnosticó al paciente como un TLJS, pero no pudo aplicarse el diagnóstico por bloqueo periapofisario T12 porque el paciente no aceptó esta intervención; la manipulación no pudo aplicarse debido a la instrumentación de la columna dorsolumbar. La terapia de movilización espinal para el segmento toracolumbar se aplicó cuidadosamente y se instauró tratamiento con gabapentina a una dosis baja de 300mg/día, la cual fue incrementándose gradualmente hasta 2.400mg/día. Se organizó un programa de ejercicios y actividades de la vida diaria. Sus síntomas mejoraron después de 3 meses de tratamiento. Se observó que el bienestar general ha continuado después de 2 años de seguimiento. Conclusión. El TLJS es una patología que debe ser considerada en el diagnóstico diferencial del dolor testicular (AU)


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Doenças Testiculares/complicações , Dor/complicações , Dor/etiologia , Espondilolistese/complicações , Espondilolistese/terapia , Orquiectomia/métodos , Orquiectomia , Anti-Inflamatórios não Esteroides/uso terapêutico , Testículo , Testículo/patologia , Diagnóstico Diferencial , Dor Lombar/complicações , Dor Lombar/etiologia , Tratamento por Radiofrequência Pulsada/métodos
19.
Sports Med Arthrosc Rev ; 24(4): 184-187, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27811518

RESUMO

Pediatric spondylolysis and spondylolisthesis present with a wide spectrum of pathology and clinical findings, including back pain, leg pain, crouch gait, or neurological deficit. The treatment of spondylolysis alone is typically conservative with bracing, non-steroidal anti-inflammatory drug, and activity restriction, but refractory pain can be successfully surgically managed with intralaminar compression screw, wires, or pedicle screws with rods and laminar hook constructs. The treatment of dysplastic spondylolisthesis is aggressive to prevent neurological deficit, whereas even high-grade isthmic slips can be treated safely with nonoperative measures if no significant neurological deficits are present. However, patients with higher slip angles tend to progress and require fusion. More long-term data are needed to compare the outcomes of operative versus nonoperative treatment of high-grade slips. Although more evidence will be helpful in guiding surgical treatment, fortunately, the vast majority of these patients are successfully managed nonsurgically.


Assuntos
Espondilolistese/terapia , Espondilólise/terapia , Adolescente , Dor nas Costas/etiologia , Criança , Humanos , Espondilolistese/diagnóstico , Espondilólise/diagnóstico
20.
Spine J ; 16(12): 1478-1485, 2016 12.
Artigo em Inglês | MEDLINE | ID: mdl-27592807

RESUMO

BACKGROUND CONTEXT: The North American Spine Society's (NASS) Evidence-Based Clinical Guideline for the Diagnosis and Treatment of Adult Isthmic Spondylolisthesis features evidence-based recommendations for diagnosing and treating adult patients with isthmic spondylolisthesis. The guideline is intended to reflect contemporary treatment concepts for symptomatic isthmic spondylolisthesis as reflected in the highest quality clinical literature available on this subject as of June 2013. NASS' guideline on this topic is the only guideline on adult isthmic spondylolisthesis accepted in the Agency for Healthcare Research and Quality's National Guideline Clearinghouse. PURPOSE: The purpose of the guideline is to provide an evidence-based educational tool to assist spine specialists when making clinical decisions for adult patients with isthmic spondylolisthesis. This article provides a brief summary of the evidence-based guideline recommendations for diagnosing and treating patients with this condition. STUDY DESIGN: This is a guideline summary review. METHODS: This guideline is the product of the Adult Isthmic Spondylolisthesis Work Group of NASS' Evidence-Based Clinical Guideline Development Committee. The methods used to develop this guideline are detailed in the complete guideline and technical report available on the NASS website. In brief, a multidisciplinary work group of spine care specialists convened to identify clinical questionsto address in the guideline. The literature search strategy was developed in consultation with medical librarians. Upon completion of the systematic literature search, evidence relevant to the clinical questions posed in the guideline was reviewed. Work group members utilized NASS evidentiary table templates to summarize study conclusions, identify study strengths and weaknesses, and assign levels of evidence. Work group members participated in webcasts and in-person recommendation meetings to update and formulate evidence-based recommendations and incorporate expert opinion when necessary. The draft guidelines were submitted to an internal peer review process and ultimately approved by the NASS Board of Directors. Upon publication, the Adult Isthmic Spondylolisthesis guideline was accepted into the National Guideline Clearinghouse and will be updated approximately every 5 years. RESULTS: Thirty-one clinical questions were addressed, and the answers are summarized in this article. The respective recommendations were graded according to the levels of evidence of the supporting literature. CONCLUSIONS: The evidence-based clinical guideline has been created using techniques of evidence-based medicine and best available evidence to aid practitioners in the diagnosis and treatment of adult patients with isthmic spondylolisthesis. The entire guideline document, including the evidentiary tables, literature search parameters, literature attrition flowchart, suggestions for future research, and all of the references, is available electronically on the NASS website at https://www.spine.org/ResearchClinicalCare/QualityImprovement/ClinicalGuidelines.aspx and will remain updated on a timely schedule.


Assuntos
Medicina Baseada em Evidências/métodos , Guias de Prática Clínica como Assunto , Espondilolistese/diagnóstico , Adulto , Medicina Baseada em Evidências/normas , Humanos , Neurocirurgia/organização & administração , Sociedades Médicas , Espondilolistese/terapia , Estados Unidos
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