Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 6.138
Filtrar
1.
Praxis (Bern 1994) ; 109(2): 87-95, 2020 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-32019459

RESUMO

Everyone Has Low Back Pain: Degenerative Lumbar Spinal Disorders and Their Treatment Options Abstract. Back pain is one of the most widespread diseases. Up to 84 % of people have low back pain at some point in their lives. Unspecific back pain is treated conservatively. As supportive measure, interventional pain therapy can be performed. Surgery for low back pain should be considered in selected cases only. However, accompanying neurological symptoms are frequent, such as radiation, i.e. sciatica. Typical etiologies are disc herniation or - increasingly frequent, and due to the aging population increasingly frequent - spinal canal stenosis. Surgery has a better prognosis in cases where conservative management failed. If severe neurological symptoms are present, surgery is indicated. Osteoporotic compression fractures cause acute back pain. The decision whether these patients should undergo kypho- or vertebroplasty should be based on guidelines.


Assuntos
Dor Lombar , Doenças da Coluna Vertebral , Estenose Espinal , Idoso , Humanos , Dor Lombar/etiologia , Dor Lombar/terapia , Vértebras Lombares , Prognóstico , Doenças da Coluna Vertebral/complicações , Doenças da Coluna Vertebral/terapia , Estenose Espinal/complicações , Estenose Espinal/terapia
2.
Medicine (Baltimore) ; 99(1): e18555, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31895797

RESUMO

BACKGROUND: Lumbar spinal stenosis (LSS) is a common and frequently-occurring disease in the elderly. Percutaneous endoscopic decompression (PED) has become the first choice for the treatment of LSS because of its small wound, mild pain and rapid recovery. The surgical approaches are mainly divided into percutaneous interlaminar approach and transforaminal approach. However, these two surgical approaches have their own advantages, disadvantages and indications. Hence, the present study aims to synthesize the available direct and indirect evidence of transforaminal approach and interlaminar approach to prove their respective advantages and disadvantages. METHODS: The following databases will be searched: Cochrane Library, PubMed, Web of Science, Embase, CNKI, Wanfang data, and China Biomedical Literature Database (CBM). The search dates will be set from the inception to November 2019. Two researchers independently screened the literature, extracted the data and assessed the risk of bias in the included studies. The efficacy outcomes including: Back and Leg Visual Analog Scale (VAS) score, the MacNab criteria, the Oswestry Disability Index (ODI) and Japanese Orthopedic Association (JOA) score. The safety outcomes including: incidence of complications (dura tear, incomplete decompression, reoperation, etc.). The meta-analysis will be conducted using Stata 12.0 software. Grading of Recommendations Assessment, Development and Evaluation (GRADE) will be used to assess evidence quality. RESULTS: The results of this meta-analysis will be published in a peer-reviewed journal. CONCLUSION: The meta-analysis will provide a comprehensive summary of the evidence for 2 approaches to PED in patients with LSS. PROTOCOL REGISTRATION NUMBER: CRD42019128080.


Assuntos
Descompressão Cirúrgica/métodos , Endoscopia/métodos , Vértebras Lombares/cirurgia , Estenose Espinal/cirurgia , Adulto , Feminino , Humanos , Masculino , Metanálise como Assunto , Projetos de Pesquisa , Revisão Sistemática como Assunto , Resultado do Tratamento
3.
World Neurosurg ; 133: 135-141, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31505277

RESUMO

BACKGROUND: The occurrence rate of thoracic spinal stenosis caused by ossification of the ligamentum flavum combined with disk herniation is lower than that of ossified ligamentum flavum in the thoracic spine, and the treatment method has rarely been reported. In this paper, we applied an endoscopic technique to a patient with thoracic spinal stenosis caused by ossification of the ligamentum flavum combined with disk herniation at the T10-11 level. METHODS: We performed surgical decompression of the thoracic spinal cord for a patient diagnosed with thoracic spinal stenosis at the T10-11 level caused by ossification of the ligamentum flavum combined with disk herniation using percutaneous endoscopic surgery via the bilateral translaminar osseous channel approach. Pre- and postoperative computed tomography (CT) scan and magnetic resonance imaging (MRI) examinations were performed, and pre- and postoperative neurologic status was evaluated using the Modified Japanese Orthopaedic Association and visual analog scale scores. RESULTS: The ossified ligamentum flavum and herniated disk material were removed through this osseous channel. Postoperative CT and MRI scanning revealed adequate decompression of the spinal cord at the T10-11 level. The patient was discharged home on postoperative day 3. At 6-month postoperative follow-up, the patient experienced complete resolution of T12 dermatomal numbness. The strength in her bilateral lower extremities improved slightly to grade 5. CONCLUSIONS: We have applied percutaneous endoscopic surgery via bilateral translaminar osseous channels for the treatment of thoracic spinal stenosis caused by ossification of the ligamentum flavum combined with disk herniation. This surgery could provide sufficient decompression for thoracic spinal cord with minimum trauma.


Assuntos
Descompressão Cirúrgica/métodos , Endoscopia/métodos , Deslocamento do Disco Intervertebral/cirurgia , Ligamento Amarelo/patologia , Ossificação Heterotópica/cirurgia , Estenose Espinal/cirurgia , Vértebras Torácicas/cirurgia , Feminino , Humanos , Deslocamento do Disco Intervertebral/complicações , Deslocamento do Disco Intervertebral/patologia , Pessoa de Meia-Idade , Ossificação Heterotópica/complicações , Ossificação Heterotópica/patologia , Estenose Espinal/etiologia , Estenose Espinal/patologia , Resultado do Tratamento
4.
World Neurosurg ; 133: 314-317, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31648054

RESUMO

BACKGROUND: The adult spinal cord is typically resistant to hypoxic-ischemic injury because of collateral blood supply; however, congenital or acquired stenosis may result in baseline maximal vasodilation, such as superimposed hemodynamic stresses, that cannot be accommodated, leaving the spinal cord vulnerable to ischemic injury. We present a rare case of spinal cord hypoxic-ischemic injury in an adult with underlying cervical spinal stenosis. CASE DESCRIPTION: A 37-year-old man with a history of morbid obesity, diabetes mellitus, hypertension, and obstructive sleep apnea presented after developing progressive weakness in the extremities. Preoperative computed tomography myelography demonstrated ossification of the posterior longitudinal ligament and severe spinal canal narrowing. Approximately 1 week after posterior decompression, the patient experienced spinal hypoxic-ischemic injury. Imaging revealed cord expansion and abnormal T2 signal intensity. Axial diffusion tensor images of the brain revealed delayed ischemic leukoencephalopathy with restricted diffusion in the cerebral cortex and deep white matter; this led to the decision to withdraw care, and the patient died. CONCLUSIONS: We hypothesize that vascular dysregulation due to cervical stenosis made the cord parenchyma vulnerable to hypoxic and/or hypoperfusion stresses.


Assuntos
Descompressão Cirúrgica/efeitos adversos , Isquemia/etiologia , Leucoencefalopatias/etiologia , Ossificação do Ligamento Longitudinal Posterior/cirurgia , Medula Espinal/irrigação sanguínea , Estenose Espinal/cirurgia , Adulto , Evolução Fatal , Humanos , Isquemia/diagnóstico por imagem , Leucoencefalopatias/diagnóstico por imagem , Masculino , Ossificação do Ligamento Longitudinal Posterior/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Medula Espinal/diagnóstico por imagem , Estenose Espinal/diagnóstico por imagem
5.
Medicine (Baltimore) ; 98(50): e18277, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31852100

RESUMO

The aim of the study was to evaluate the clinical effect of the limited area decompression, intervertebral fusion, and pedicle screw fixation for treating degenerative lumbar spinal stenosis (DLSS) with instability. Hemilaminectomy decompression, intervertebral fusion, and pedicle screw fixation for treating DLSS with instability as the control group.Follow-up of 54 patients (26 males and 28 females; average age, 59.74 ±â€Š10.38 years) with DLSS with instability treated by limited area decompression, intervertebral fusion, and pedicle screw fixation (LIFP group), and 52 patients as control group with hemilaminectomy decompression, intervertebral fusion, and pedicle screw fixation (HIFP group). We assessed clinical effect according to the patients' functional outcome grading (good to excellent, fair, or poor), Oswestry Disability Index (ODI) and visual analogue scale (VAS) for low back pain and lower limb pain, which was administered preoperatively and at 3, 6, and 12 months postoperatively. Fusion status was assessed by radiologists at the last follow-up. Treatment satisfaction was assessed according to the subjective evaluations of the patients.At the 12-month follow-up, 96.2% (52/54) and 90.3% (47/52) of group LIFP and HIFP belonged to good to excellent outcome categories, respectively, while 3.7% (2/54) and 9.6% (5/52) of group LIFP and HIFP belonged to fair respectively, neither group belonged to poor. Satisfaction rates of patients in group LIFP and group HIFP were 98.1% (53/54) and 92.3% (48/52), respectively. The patients' functional outcome grading and satisfaction rate in group LIFP were better than that in group HIFP. The VAS for low back and lower limb pain and the ODI improved significantly during the 12 months after surgery (all P < .001) in 2 groups. The VAS for low back and lower limb pain were no difference between two groups, however, the ODI of group LIFP was lower than that of group HIFP (P < .001). All patients achieved radiological fusion.The limited area decompression, intervertebral fusion, and pedicle screw fixation had a satisfactory effect on patients with DLSS with instability.


Assuntos
Descompressão Cirúrgica/métodos , Instabilidade Articular/cirurgia , Laminectomia/métodos , Vértebras Lombares , Parafusos Pediculares , Fusão Vertebral/métodos , Estenose Espinal/cirurgia , Feminino , Fluoroscopia , Seguimentos , Humanos , Instabilidade Articular/complicações , Instabilidade Articular/diagnóstico , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Estenose Espinal/complicações , Estenose Espinal/diagnóstico , Cirurgia Assistida por Computador/métodos , Fatores de Tempo , Resultado do Tratamento
6.
Medicine (Baltimore) ; 98(46): e17849, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31725625

RESUMO

BACKGROUND: Although some studies had been published, it was more controversial on the superiority of decompression alone (D) and decompression with fusion (F) for the treatment of lumbar spinal stenosis (LSS) recently, especially newest articles with different opinions. A meta-analysis was performed to compare efficacy on D and F for LSS regardless of degenerative spondylolisthesis (DS) with randomized controlled trials (RCTs). METHODS: The databases include PUBMED/MEDLINE, EMBASE, Cochrane Library, and Web of Science from January 1970 to December 2018. The information of screened studies included demographics, clinical outcomes, and secondary measures, then data synthesis and meta-analysis were progressed. Subgroup analysis was stratified by DS and follow-up time (36 months). Continuous variables and dichotomous variables were respectively reported as weighted mean difference and odds ratios (ORs). The strength of evidence was evaluated by the grades of recommendation, assessment, development, and evaluation (GRADE) system. RESULTS: Nine RCTs met inclusion criteria with a total of 857 patients (367 were in D group and 490 were in F group). There were no statistical difference in visual analog scale changes on back and leg pain between D and F group (mean difference [MD] = -0.03, 95% confidence interval [CI] [-0.38, 0.76], z = 0.08, P = .94; MD = 0.11, 95% CI [-1.08, 1.30], z = 0.18, P = .86, respectively); patients' satisfaction was of no difference between the 2 groups, together with the change of the Oswestry disability index and European quality of life-5 dimensions (P > .05). There were no difference in the rate of complication (P = .50) and reoperation (P = .11) while a statistical significance of longer operation duration (P < .0001), more blood loss (P = .004) but amazing lower rate of adjacent segment degenerative/disease (ASD) (OR = 2.35, P = .02) in F group. The subgroup analysis on DS showed that basically all measures were in consistency with meta-analysis. There was a higher reoperation rate in middle-to-long term (>36 months) in D group and ASD was the most seasons of reoperation no matter the follow-up time. According to the GRADE system, the grade of this meta-analysis was of "High" quality. CONCLUSION: F group has no better clinical results than D alone in LSS, regardless of DS and follow-up. The conclusion is of "High" quality and the grade strength of recommendation was "Strong."


Assuntos
Descompressão Cirúrgica/métodos , Vértebras Lombares/cirurgia , Fusão Vertebral/métodos , Estenose Espinal/cirurgia , Avaliação da Deficiência , Humanos , Medição da Dor , Satisfação do Paciente , Complicações Pós-Operatórias , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Reoperação , Teste de Caminhada
7.
Oper Orthop Traumatol ; 31(6): 513-535, 2019 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-31728562

RESUMO

OBJECTIVE: The main goal is bilateral microsurgical decompression of the cauda equina using a unilateral over the top approach. The challenge is to achieve decompression with minimal iatrogenic trauma to anatomical structures in the approach region and in the target area. INDICATIONS: Degenerative spinal disorders including lumbar central stenosis, lumbar lateral recess spinal stenosis, and foraminal narrowing. This technique is performed in patients presenting primarily with neurogenic claudication, leg or buttock symptoms, heaviness in the legs with or without radicular symptoms, with or without neurological deficits, and comparable MRI findings. There are no limitations regarding number of affected segments or the extent of narrowing. CONTRAINDICATIONS: All available conservative treatment modalities not exhausted. Lack of serious neurological deficit. SURGICAL TECHNIQUE: Minimally invasive, muscle-sparing and facet-joint-sparing bilateral enlargement of the lumbar spinal canal through a unilateral microsurgical cross-over approach. POSTOPERATIVE MANAGEMENT: Patients are mobilized early 4-6 h postoperatively. Light sports activities (e.g., ergometer cycling, swimming) are allowed after 2 weeks. The same is true for the return to normal daily or work activities except for heavy physical work (usually 4 weeks out of work). Soft lumbar brace for 4 weeks (optional). RESULTS: The clinical outcomes are good to excellent. Meta-analyses and large case series report success rates for microsurgical decompression procedures of 73.5-95%. The reoperation rates are low (0.5-10%).


Assuntos
Descompressão Cirúrgica , Vértebras Lombares , Estenose Espinal , Humanos , Vértebras Lombares/cirurgia , Microcirurgia , Estenose Espinal/cirurgia , Resultado do Tratamento
8.
Lakartidningen ; 1162019 Nov 19.
Artigo em Sueco | MEDLINE | ID: mdl-31742654

RESUMO

Seventeen cases of infections in spinal structures were reported 2010-2017 to the Swedish Health and Social Care Inspectorate (IVO), a government agency responsible for supervising health care, for missed or delayed diagnosis. All patient records were scrutinized in order to find underlying causes and common factors. The delayed diagnoses were equally found among men and women and most frequent in in the age-group 65 to 79 years of age. The diagnostic delay most probably in many cases led to patient harm and avoidable sequelae, many with severe impairment for daily life. Several of the patients had a locus minoris resistentiae in the spine and in several cases the entry port of infections were cutaneous wounds, for example leg ulcers. The most important finding was that in the majority of cases the clinical investigation was inadequate and the clinical follow-up - while in hospital! - was inferior, without documentation of muscular weakness and sensory loss. In several cases a too passive management was found, when the losses eventually had become apparent, delaying surgical interventions.


Assuntos
Doenças da Coluna Vertebral , Idoso , Síndrome da Cauda Equina/complicações , Síndrome da Cauda Equina/diagnóstico , Síndrome da Cauda Equina/etiologia , Síndrome da Cauda Equina/terapia , Diagnóstico Tardio , Erros de Diagnóstico , Discite/complicações , Discite/diagnóstico , Discite/etiologia , Discite/terapia , Tratamento de Emergência , Feminino , Humanos , Masculino , Osteomielite/complicações , Osteomielite/diagnóstico , Osteomielite/etiologia , Osteomielite/terapia , Qualidade da Assistência à Saúde/normas , Doenças da Coluna Vertebral/complicações , Doenças da Coluna Vertebral/diagnóstico , Doenças da Coluna Vertebral/etiologia , Doenças da Coluna Vertebral/terapia , Estenose Espinal/complicações , Estenose Espinal/diagnóstico , Estenose Espinal/etiologia , Estenose Espinal/terapia , Espondilite/complicações , Espondilite/diagnóstico , Espondilite/etiologia , Espondilite/terapia , Vértebras Torácicas , Tempo para o Tratamento
9.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 33(11): 1399-1405, 2019 Nov 15.
Artigo em Chinês | MEDLINE | ID: mdl-31650756

RESUMO

Objective: To observe the effectiveness and safety of percutaneous endoscopic transforaminal bilateral decompression for severe central lumbar spinal stenosis. Methods: A retrospective analysis of 44 patients with single-segment severe central lumbar spinal stenosis with bilateral lower extremity symptoms between October 2015 and December 2017 was performed. Among them, 36 cases underwent bilateral decompression through bilateral transforaminal approach, and 8 cases underwent bilateral decompression through unilateral transforaminal approach. There were 25 males and 19 females, the age ranged from 56 to 89 years with an average of 68.6 years. The disease duration was 5-39 months with an average of 14.5 months. Involved segments: L 3, 4 in 6 cases, L 4, 5 in 33 cases, and L 5, S 1 in 5 cases. The dural sac cross-sectional area (DSCA) of the MRI was (66.36±8.48) mm 2. Morphological grading (MG) classification: 29 cases of grade C, 15 cases of grade D. The visual analogue scale (VAS) score of preoperative low back pain was 2.3±1.0 and the VAS score of lower extremity pain was 7.8±1.2; the Oswestry disability index (ODI) was 77.8±7.3. Postoperative VAS scores, ODI scores, MG classification, and DSCA were recorded and compared with preoperative ones, and clinical outcomes were assessed by using the modified MacNab criteria. Results: All patients successfully underwent surgery and the wounds healed by first intention. All 44 patients were followed up 13-46 months with an average of 24.8 months. One patient developed postoperative lower extremity paralysis and 1 patient developed a dural tear. There was no infection, recurrence, or revision surgery during the follow-up. Postoperative imaging showed that the central spinal canal was enlarged and the area of the dural sac was significantly increased compared with preoperative one. The VAS score of low back pain was 2.4±0.6 and 2.5±0.8 at 1 month after operation and at last follow-up, showing no significant difference when compared with preoperative scores ( P>0.05). The VAS of lower limb pain was 2.1±0.6 and 2.0±1.1 at 1 month after operation and at last follow-up, which was significantly improved when compared with preoperative scores ( P<0.05); but no significant difference was found between at 1 month after operation and at last follow-up ( P>0.05). At last follow-up, the ODI score was 19.7±6.4, and the DSCA was (104.93±12.56) mm 2, which was significantly improved when compared with preoperative values ( P<0.05). The MG classification was also significantly higher than preoperative one ( Z=-5.789, P=0.000). According to the modified MacNab criteria, the results were excellent in 32 cases, good in 9 cases, and fair in 3 cases, with an excellent and good rate of 93.2%. Conclusion: Percutaneous endoscopic transforaminal bilateral decompression for treating severe central lumbar spinal stenosis has the advantages of less trauma, adequate decompression, and rapid recovery. The short-term effectiveness is good.


Assuntos
Fusão Vertebral , Estenose Espinal , Idoso , Idoso de 80 Anos ou mais , Descompressão Cirúrgica , Feminino , Humanos , Vértebras Lombares , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
10.
Zh Vopr Neirokhir Im N N Burdenko ; 83(4): 104-112, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31577276

RESUMO

Magnetic resonance imaging (MRI) of lumbar spine is a very frequent examination in any computer tomography unit. However, there are still no scan standards or standards for scan interpretation in the world's medical community. In this article based on our experience we describe common problems encountered by a radiologist during MRI examination of lumbar spine and its subsequent description. The literature survey and analysis are presented with a summary of current recommendations. We examined routine sequences, which could be included in MRI protocol, discussed common terminology, and showed the incidence of different pathologies. The special emphasis is made on assessing lumbar canal stenosis. In this article we focus on qualitative and quantitative criteria of lumbar spinal stenosis.


Assuntos
Vértebras Lombares , Imagem por Ressonância Magnética , Estenose Espinal , Humanos , Vértebras Lombares/diagnóstico por imagem , Região Lombossacral , Estenose Espinal/diagnóstico por imagem , Tomografia Computadorizada por Raios X
11.
Medicine (Baltimore) ; 98(38): e17177, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31567958

RESUMO

Lumbar spinal canal stenosis (LSCS) associated with degenerative scoliosis has being increasingly aware by the public and studied by many researchers. Degenerative changes leading to spinal stenosis can precede a spinal deformity which will develop into the de novo scoliosis. There are few studies focusing on the risk factors contributing to the degenerative lumbar scoliosis (DLS) in lumbar spinal stenosis patients.From September, 2017 to December, 2017, 181 patients who were diagnosed with LSCS in the outpatient department of our hospital were enrolled in this retrospective investigation. The patients were divided into 2 groups: DLS group (Cobb angle >10°) and LSCS group. Sex, age, smoking status (yes or no), occupation (heavy or light labor), body mass index (BMI), bone mineral density (BMD) and radiographic parameters including the lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), thoracic kyphosis (TK), coronal vertical axis, and sagittal vertical axis (SVA) are all evaluated as potential risk factors. Multivariate logistic regression analysis and receiver-operating characteristic curves were used to identify potential risk factors.Forty-five of 181 patients were diagnosed with DLS and involved in the DLS group. There were significant differences between the 2 groups in BMI (P < .001), LL (P = .0046), BMD (P < .001), SVA (P < .001), and TK (P = .047). BMD < -1.85 g/cm (adjusted odds ratio [AOR] 0.030, 95% confidence interval [CI] 0.008-0.107, P < .001), BMI >25.57 kg/m (AOR 1.270, 95% CI 1.040-1.551, P = .019), and SVA >3.98 cm (AOR 3.651, 95% CI 2.226-5.990, P < .001) had good accuracy to predict the formation of degenerative lumbar scoliosis based on degenerative lumbar spinal stenosis.Degenerative lumbar scoliosis has a high incidence in degenerative lumbar spinal stenosis. BMD <-1.85 g/cm, BMI >25.57 kg/m, and SVA >3.98 cm were the potential risk factors for the formation of degenerative lumbar scoliosis based on degenerative lumbar spinal stenosis.


Assuntos
Vértebras Lombares , Escoliose/complicações , Estenose Espinal/etiologia , Estudos Transversais , Feminino , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/patologia , Masculino , Pessoa de Meia-Idade , Radiografia , Fatores de Risco , Escoliose/diagnóstico por imagem , Escoliose/patologia , Estenose Espinal/diagnóstico por imagem , Estenose Espinal/patologia
12.
Medicine (Baltimore) ; 98(42): e17422, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31626098

RESUMO

Symptoms of intervertebral foraminal stenosis are caused by compression of nerve root exiting the intervertebral foramen. Many attempts to measure the size of the neuromuscular exit have been made; however, only a few studies to compare the area differences between foramens by computed tomography (CT) were done. In this retrospective comparative study, we used the region of interest (ROI) in CT to measure and compare the area of intervertebral foramen between the healthy control group and the patient group.Eighty-one patients who underwent CT of the lumbar spine between May 2014 and December 2017 were enrolled. Using the medical imaging program, the foraminal area between L5 and S1 vertebrae was measured on the sagittal, coronal, and axial planes using ROI. Four groups were established for comparison: those diagnosed with foraminal stenosis by a radiologist and those who were not, those diagnosed with foraminal stenosis by orthopedic surgeons and those who were not. These groups were further divided into subcategories depending on whether the area was operated on for foraminal stenosis. Interobserver and intraobserver agreements were assessed.The mean age of patients was 56.5 years (range 17-84). The foraminal area of the surgical group on sagittal plane was significantly narrower than the control group (P = .005). However, the difference between the 2 groups on axial and coronal planes was not statistically significant (P > .1). Foraminal area <80 mm on sagittal images was a statistically significant risk factor for clinical symptom (P = .028) and that <65 mm was a statistically significant risk factor in predicting operability (P = .01). Interobserver and intraobserver agreements were fair to good on axial and coronal planes (about 0.7), whereas the agreements were excellent on sagittal plane (>0.9).In this study, we proved that measuring the intervertebral foraminal area using the ROI in CT in the lumbar spine is useful for diagnosing L5-S1 foraminal stenosis, especially on sagittal plane. Furthermore, not only does it provide aid in diagnosis, but it also helps predicting the operability of foraminal stenosis.


Assuntos
Vértebras Lombares/patologia , Estenose Espinal/diagnóstico por imagem , Estudos de Casos e Controles , Tratamento Conservador/estatística & dados numéricos , Constrição Patológica , Feminino , Humanos , Vértebras Lombares/diagnóstico por imagem , Região Lombossacral/diagnóstico por imagem , Região Lombossacral/patologia , Masculino , Pessoa de Meia-Idade , Análise de Regressão , Estudos Retrospectivos , Índice de Gravidade de Doença , Fusão Vertebral/estatística & dados numéricos , Raízes Nervosas Espinhais/diagnóstico por imagem , Raízes Nervosas Espinhais/patologia , Estenose Espinal/terapia , Tomografia Computadorizada por Raios X
13.
World Neurosurg ; 132: 273-281, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31521758

RESUMO

OBJECTIVE: Although many risk factors for cage retropulsion (CR) after lumbar interbody fusion (LIF) have been described in the literature, they still remain controversial. The purpose of this study is to investigate the risk factors for CR after LIF. METHODS: The literature was searched in PubMed, Cochrane library, and Embase from October 2000 to October 2018. The key words and combinations used in the search included LIF, cage, retropulsion, posterior migration, and risk factors. Only studies with sufficient data to calculate odds ratio for CR were included. Odds ratio and 95% confidence interval were calculated for outcomes via RevMan5.3 and SPSS 22.0. RESULTS: A total of 10 studies were included in this study. Twelve risk factors were assessed by analyzing 4467 patients. The pooled results indicated that a pear-shaped disk and straight cage were significant risk factors for CR. However, factors that had no significant relation with CR were preoperative diagnosis (disk herniation, spinal stenosis, and spondylolisthesis); gender; surgical segments (from L2 to S1); multilevel fusion; and unilateral pedicle screws fixation. CONCLUSIONS: According to current evidence, a pear-shaped disk and straight cage are significant risk factors for CR. However, preoperative diagnosis, gender, multilevel fusion, surgical segments, and unilateral pedicle screws fixation are not the risk factors associated with CR. A revision surgery is needed when neurologic symptoms happen after CR. The conclusion should be consulted cautiously due to the limited number of included studies. Therefore larger-scale studies are still needed to investigate the risk factors for CR.


Assuntos
Vértebras Lombares/cirurgia , Complicações Pós-Operatórias/epidemiologia , Falha de Prótese , Fusão Vertebral/instrumentação , Humanos , Disco Intervertebral/diagnóstico por imagem , Deslocamento do Disco Intervertebral/cirurgia , Vértebras Lombares/diagnóstico por imagem , Parafusos Pediculares , Reoperação , Fatores de Risco , Fusão Vertebral/métodos , Estenose Espinal/cirurgia , Espondilolistese/cirurgia
14.
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
15.
Kardiologiia ; 59(9): 83-90, 2019 Sep 20.
Artigo em Russo | MEDLINE | ID: mdl-31540579

RESUMO

This article describes for the first time in the domestic literature a clinical case of the therapeutic effect of neuromodulation on the permanent form of atrial fibrillation and chronic heart failure in an elderly patient with spinal stenosis which led to the development of pain syndrome and movement disorders. For the treatment of neurological pathology, at the beginning epidural administration of drugs was applied, followed by spinal cord stimulation trial and implantation of permanent neurostimulator. At each stage of treatment conducted by a functional neurosurgeon the patient had a spontaneous restoration of sinus rhythm, and during continuous neurostimulation a stable retention of sinus rhythm and regression of heart failure symptoms have been observed throughout a long observation period. The article also presents the data of a few experimental and clinical studies on the use of neuromodulation in cardiology, describes the method of implantation of spinal electrodes and analyzes possible mechanisms of modulation of the autonomic innervation of the heart, implemented by spinal cord stimulation.


Assuntos
Fibrilação Atrial , Estenose Espinal , Humanos , Federação Russa , Medula Espinal
17.
Acta Chir Orthop Traumatol Cech ; 86(4): 256-263, 2019.
Artigo em Tcheco | MEDLINE | ID: mdl-31524586

RESUMO

PURPOSE OF THE STUDY Lumbar spinal stenosis (LSS) is a serious and fairly frequent disorder with prevalence increasing with age which often results in a disability. The surgical procedures are often very risky due to the greater age of patients with severe stenosis and their comorbidities. The study aimed to assess the functional outcomes and complications in patients who underwent surgical treatment for LSS at one year postoperatively and to identify the differences in the functional outcomes, if any, in dependence on the number of operated segments. MATERIAL AND METHODS It was a prospective study which included 33 patients who underwent surgery at the authors department from 1 November 2015 to 1 October 2016 for LSS, the mean age of patients was 69.5 (43-83) years. The surgery was indicated based on the clinical examination, radiography and MR imaging and consisted in posterior decompression with or without stabilisation and fusion. Pre- and post-operatively, a neurological examination and evaluation of patient difficulties were performed by: VAS - particularly for low back pain (VAS-LB) and lower limb pain (VAS-LL), Oswestry Disability Index (ODI) and Swiss Spinal Stenosis Questionnaire (SSSQ). The evaluation was done at a half year and one year after the surgery. The authors made comparisons in dependence on the number of treated segments (1-2, 3-5 and Th-S stabilisation). RESULTS A significant improvement of all the followed-up parameters was reported at one year postoperatively. At one year after the surgery, the VAS-LB score showed a decrease by 2.39 (p = 0.001), the VAS-LL by 3.26 (p < 0.001), while a decrease by 2 or more points is considered clinically significant. When evaluating the SSSQ questionnaire, a decrease in subjective difficulties (SSSQ-S) was by 0.89 (p < 0.001), in physical function (SSSQ-F) by 0.87 (p < 0.001). In this questionnaire, the satisfaction rate with the surgery was 2 - i.e. somewhat satisfied. Altogether 76% of patients were very or somewhat satisfied, no one was very dissatisfied. When evaluating the ODI, an improvement by 20.6% (p < 0.001) was reported. The authors identified neither any significant differences in the outcomes at a one-year follow-up in dependence on the length of stabilisation, nor any significant differences between the six-months and one-year follow-up. Intraoperative complications occurred in 18%, early postoperative complications in 6% of patients. The ASD developed in 9% within one year. DISCUSSION The authors confirmed a significant improvement of the followed-up parameters (VAS-LB, VAS-LL, SSSQ, ODI) which corresponds with recent literature. The decrease in VAS and ODI in the authors study is more marked than the outcomes stated in literature. The authors outcomes clearly show that there is no correlation with the length of stabilisation and the number of decompressed segments. Conversely, the rate of complications was higher in this group than the rates stated in literature, but majority of complications had no consequences for the patients. CONCLUSIONS In the group of patients with a one-year follow-up the authors confirmed that surgical procedures will result in reduced subjective difficulties of patients, reduced pain and improvement of physical function. A significant improvement of all the followed-up parameters was reported. The authors did not confirm the correlation between the postoperative improvement and the number of treated segments. Key words:lumbar spinal stenosis, quality of life, post-operative outcomes, complications.


Assuntos
Vértebras Lombares/cirurgia , Estenose Espinal/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Descompressão Cirúrgica , Avaliação da Deficiência , Seguimentos , Humanos , Pessoa de Meia-Idade , Satisfação do Paciente , Estudos Prospectivos , Qualidade de Vida , Recuperação de Função Fisiológica , Fusão Vertebral , Estenose Espinal/diagnóstico , Estenose Espinal/diagnóstico por imagem , Inquéritos e Questionários , Resultado do Tratamento
19.
Clin Interv Aging ; 14: 1399-1405, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31496667

RESUMO

Purpose: The purpose of this study was to evaluate the association between the early stages of lumbar spinal stenosis (LSS) and the risk of locomotive syndrome, as well as its effect upon muscle strength of the back, upper extremities, and lower extremities. Patients and methods: LSS was diagnosed with a self-administered, self-reported history questionnaire. Participants (n=113) who agreed to be tested by the diagnostic support tool for LSS underwent three risk tests for locomotive syndrome: a stand-up test, a two-step test, and a 25-question Geriatric Locomotive Function Scale (GLFS-25), as well as measurements of the strength of their grip, back extensor, hip flexor, and knee extensor muscles. Results: Twenty-three participants were diagnosed with LSS by the questionnaire. Results of the stand-up test in the LSS group were significantly worse than those in the no-LSS group (P=0.003). The results of the two-step test and the total score on the GLFS-25 in the LSS group were significantly worse than those in the no-LSS group (P=0.002 and P<0.0001, respectively). The stages of locomotive syndrome assessed by the stand-up test, two-step test, and the GLFS-25 were significantly worse in the LSS group than in the no-LSS group (P=0.0004, P=0.0007, and P<0.0001, respectively). Hip flexor and knee extensor strength, but not grip and back extensor strength, in the LSS group were significantly lower than that in the no-LSS group. Conclusions: LSS diagnosed using the self-reported support tool worsened the stage of locomotive syndrome in older people. Furthermore, participants with LSS had significant lower extremity weakness.


Assuntos
Extremidade Inferior/fisiopatologia , Limitação da Mobilidade , Debilidade Muscular/etiologia , Estenose Espinal/complicações , Idoso , Idoso de 80 Anos ou mais , Progressão da Doença , Feminino , Avaliação Geriátrica , Humanos , Masculino , Pessoa de Meia-Idade , Força Muscular , Estenose Espinal/diagnóstico , Inquéritos e Questionários , Síndrome
20.
BMC Surg ; 19(1): 131, 2019 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-31500614

RESUMO

BACKGROUND: Surgery remains the main curative option for the treatment of intraspinal tumour. The purpose of the present study was to analyze the clinical outcomes of laminoplasty with process-lamina complex replantation compared with laminectomy with pedicle screw fixation for intraspinal tumours. METHODS: In our retrospective analysis, 27 patients received tumour resection surgery by laminoplasty with reconstruction plate fixation and 32 patients received laminectomy with pedicle screw fixation. All patients were followed up for at least 1 year. Data, including surgical time, blood loss, volume of drainage, drainage time, hospital stay, complications, and neurological status were compared. In addition, imaging evaluation was also included. RESULTS: Patients in the laminoplasty group had lower blood loss (laminoplasty group: 281.5 ± 130.2 mL; laminectomy group: 450.0 ± 224.3 mL; p = 0.001), shorter surgical time (laminoplasty group: 141.7 ± 26.2 min, laminectomy group: 175.3 ± 50.4 min; p = 0.003), lower volume of drainage (laminoplasty group: 1578.9 ± 821.7 mL, laminectomy group: 2621.2 ± 1351.0 mL; p = 0.001), shorter drainage time (laminoplasty group: 6.6 ± 2.5 days, laminectomy group: 9.7 ± 1.8 days; p = 0.000), and a shorter hospital stay (laminoplasty group: 16.9 ± 4.9 days, laminectomy group: 21.0 ± 4.4 days; p = 0.002) compared with patients in the laminectomy group. There were significant differences of oswestry dysfunction index (ODI) between the two groups at 12 months postoperatively (p = 0.034). The incidence of secondary spinal stenosis in the laminoplasty group was significantly reduced (p = 0.029). CONCLUSIONS: Laminoplasty in intraspinal tumour resection has a lower blood loss and volume of drainage, shorter surgical time and hospital stay as advantages over the standard laminectomy technique. Moreover, laminoplasty can effectively avoid iatrogenic spinal canal stenosis and thus enhancing functional recovery of spinal cord.


Assuntos
Laminectomia/métodos , Laminoplastia/métodos , Neoplasias da Coluna Vertebral/cirurgia , Estenose Espinal/epidemiologia , Adulto , Idoso , Placas Ósseas , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Parafusos Pediculares , Reimplante , Estudos Retrospectivos , Resultado do Tratamento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA