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1.
Medicine (Baltimore) ; 99(45): e22355, 2020 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-33157913

RESUMO

BACKGROUND: Most degenerative lumbar spinal stenosis (DLSS) patients primitively received the conservative treatment to control symptoms. In order to develop an optimal surgical treatment strategy, it is very significant to understand how the degenerative lumbar spondylolisthesis (DS) affects the effect of decompression in the DLSS. Thus, the aim of this current study was to explore whether the concomitant DS would affect the effect of decompression alone in the patients with DLSS. METHODS: The current study was carried out at our hospital and it was approved through our institutional review committee of General Hospital of Ningxia Medical University. During the period from January 2015 to December 2017, in our study, we identified consecutive patients who received the minimally invasive laminectomy to treat the DLSS. The inclusion criterion included radicular leg pain or neurogenic claudication with the neurological symptoms associated with DLSS syndrome, magnetic resonance imaging of the lumbar spine reveals at least 1 level of serious stenosis, the conservative treatment failed for at least 3 months, and patients agreed to provide the postoperative details. The major outcomes of this present research was Oswestry Disability Index. Secondary outcomes of this current study involved visual analog score, short form-36, surgical revision rate as well as complications. RESULTS: We assumed that previous DS possessed a negative effect on the postoperative results of the DLSS patients. TRIAL REGISTRATION: researchregistry5943.


Assuntos
Laminectomia/métodos , Vértebras Lombares/cirurgia , Estenose Espinal/cirurgia , Espondilolistese/complicações , Idoso , Avaliação da Deficiência , Feminino , Humanos , Vértebras Lombares/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Complicações Pós-Operatórias , Reoperação/estatística & dados numéricos , Projetos de Pesquisa , Estudos Retrospectivos , Estenose Espinal/diagnóstico por imagem , Espondilolistese/diagnóstico por imagem , Escala Visual Analógica
2.
PLoS One ; 15(11): e0241309, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33137112

RESUMO

Lumbar Spinal Stenosis causes low back pain through pressures exerted on the spinal nerves. This can be verified by measuring the anteroposterior diameter and foraminal widths of the patient's lumbar spine. Our goal is to develop a novel strategy for assessing the extent of Lumbar Spinal Stenosis by automatically calculating these distances from the patient's lumbar spine MRI. Our method starts with a semantic segmentation of T1- and T2-weighted composite axial MRI images using SegNet that partitions the image into six regions of interest. They consist of three main regions-of-interest, namely the Intervertebral Disc, Posterior Element, and Thecal Sac, and three auxiliary regions-of-interest that includes the Area between Anterior and Posterior elements. A novel contour evolution algorithm is then applied to improve the accuracy of the segmentation results along important region boundaries. Nine anatomical landmarks on the image are located by delineating the region boundaries found in the segmented image before the anteroposterior diameter and foraminal widths can be measured. The performance of the proposed algorithm was evaluated through a set of experiments on the Lumbar Spine MRI dataset containing MRI studies of 515 patients. These experiments compare the performance of our contour evolution algorithm with the Geodesic Active Contour and Chan-Vese methods over 22 different setups. We found that our method works best when our contour evolution algorithm is applied to improve the accuracy of both the label images used to train the SegNet model and the automatically segmented image. The average error of the calculated right and left foraminal distances relative to their expert-measured distances are 0.28 mm (p = 0.92) and 0.29 mm (p = 0.97), respectively. The average error of the calculated anteroposterior diameter relative to their expert-measured diameter is 0.90 mm (p = 0.92). The method also achieves 96.7% agreement with an expert opinion on determining the severity of the Intervertebral Disc herniations.


Assuntos
Degeneração do Disco Intervertebral/diagnóstico por imagem , Deslocamento do Disco Intervertebral/diagnóstico por imagem , Dor Lombar/diagnóstico por imagem , Região Lombossacral/diagnóstico por imagem , Estenose Espinal/diagnóstico por imagem , Feminino , Humanos , Degeneração do Disco Intervertebral/fisiopatologia , Deslocamento do Disco Intervertebral/fisiopatologia , Dor Lombar/fisiopatologia , Região Lombossacral/fisiopatologia , Imagem por Ressonância Magnética , Masculino , Canal Vertebral/diagnóstico por imagem , Canal Vertebral/fisiopatologia , Estenose Espinal/fisiopatologia
3.
Medicine (Baltimore) ; 99(44): e22997, 2020 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-33126379

RESUMO

BACKGROUND: Many complications are associated with thoracic open decompression surgery, such as dural tears and neurological deficits. The clinical outcomes are also not satisfactory. Full-endoscopic decompression of the lumbar spinal canal has achieved satisfactory results for the treatment of lumbar spinal stenosis. This surgery may be used for the treatment of thoracic ossification of the ligamentum flavum (OLF) under local anesthesia. The aim of our study is to introduce the surgical techniques used for full-endoscopic decompression for thoracic OLF and to evaluate its safety and efficacy. METHODS: Fourteen patients with thoracic OLF (4 combined with dural ossification) underwent full-endoscopic decompression surgery. An interlaminar approach was performed. The anchoring method was used to establish the working passage. Spinal cord exposure began at a space between the ossification and the spinal cord, and dorsal and contralateral decompression were performed with the "Over the Top" technique. The modified Japanese Orthopedic Association score (11 points) was used to evaluate the efficacy during follow-up. At the same time, the visual analogue scale score for assessing back pain before and after the operation was evaluated. RESULTS: The average operation time was 159.73 ±â€Š62.09 minutes, and the hospitalization time was 7.43 ±â€Š1.79 days. The follow-up period ranged from 8 to 22 months. Neurological function was improved. There were no serious complications. Dural tears occurred in 5 patients, intraoperative neurological deterioration occurred in 1 patient, and intraoperative headache and neck pain occurred in 1 patient. CONCLUSION: Full-endoscopic decompression is an effective, safe surgical technique for thoracic OLF even the cases combined with dural ossification.


Assuntos
Ligamento Amarelo/cirurgia , Estenose Espinal/cirurgia , Vértebras Torácicas/cirurgia , Adulto , Descompressão Cirúrgica , Endoscopia , Feminino , Humanos , Ligamento Amarelo/patologia , Masculino , Pessoa de Meia-Idade , Ossificação Heterotópica , Estudos Retrospectivos , Resultado do Tratamento
4.
Medicine (Baltimore) ; 99(33): e21690, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32872041

RESUMO

The clinical outcomes of redundant nerve root syndrome (RNRS) in patients with lumbar foraminal spinal stenosis (LFSS) are currently unknown. The purpose of this study was to evaluate the postprocedural outcomes of RNRS in LFSS after percutaneous lumbar foraminoplasty (PLF) and identify the factors associated with RNRS by comparative analysis between patients with and without RNRS.Patients with LFSS who underwent PLF were retrospectively analyzed. RNRS is defined as the presence of thick, elongated, and tortuous structures in the cauda equine associated with lumbar spinal stenosis. Based on the sagittal or transverse magnetic resonance imaging scans obtained before the PLF, the patients were stratified into 2 groups. Comparative analysis was performed between patients with RNRS (group R) and those without RNRS (group C).From March 2016 to January 2019, 8 of the 21 (38.1%) patients undergoing PLF showed signs of RNRS on magnetic resonance imaging images. PLF showed a tendency for less therapeutic effect with respect to changes in pain intensity in group R as compared to group C, but there were no statistically significant differences between the 2 groups. RNRS correlated with the cross-sectional area (CSA) of the dural sac and LFSS grade (P < .05). The CSA of the dural sac was smaller and the grade of LFSS was higher in group R than in group C.RNRS is commonly associated with lumbar spinal stenosis and could affect the treatment outcomes. Clinical outcomes in group R were not statistically different from those in group C, although group R showed slightly worse outcomes. The independent factors associated with RNRS were CSA of the dural sac and the LFSS grade.


Assuntos
Foraminotomia/métodos , Síndromes de Compressão Nervosa/cirurgia , Estenose Espinal/cirurgia , Estudos de Casos e Controles , Humanos , Vértebras Lombares/diagnóstico por imagem , Imagem por Ressonância Magnética , Síndromes de Compressão Nervosa/complicações , Síndromes de Compressão Nervosa/diagnóstico por imagem , Estudos Retrospectivos , Raízes Nervosas Espinhais/diagnóstico por imagem , Estenose Espinal/complicações , Estenose Espinal/diagnóstico por imagem
6.
Medicine (Baltimore) ; 99(38): e21973, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32957316

RESUMO

OBJECTIVE: The goal of this study was to review relevant studies in order to determine the efficacy of decompression with fusion versus decompression in the treatment of lumbar spinal stenosis. METHODS: Using appropriate keywords, we identified relevant studies using PubMed, the Cochrane library, and Embase. Key pertinent sources in the literature were also reviewed, and all articles published through October 2019 were considered for inclusion. For each study, we used odds ratios, mean difference (MD), and 95% confidence interval (95% CI) to assess and synthesize outcomes. RESULTS: We found 13 studies that were consistent with this meta-analysis with a total of 29066 patients. Compared with decompression, decompression with fusion significantly increased the incidence of complications (RR: 1.41, 95%CI: 1.26-1.57), the length of hospital stay (WMD: 1.868, 95%CI: 1.394-2.343), operative time (WMD: 80.399, 95%CI: 44.397-116.401), estimated blood loss (WMD: 309.356, 95%CI: 98.008-520.704) and Zurich claudication questionnaire in symptom severity (WMD: 0.200, 95%CI: 0.006-0.394). The reoperation rate was lower in the decompression with fusion group than the decompression group but without significant difference (RR: 0.91, 95%CI: 0.82-1.00). There was no significant difference between 2 groups in visual analog scale (leg pain and back pain), ODI, Short Form 36 Health Survey physical component summary, Short Form 36 Health Survey mental component summary, and Zurich claudication questionnaire physical function. CONCLUSION: Decompression with fusion has no significant clinical advantages in treatment of lumbar spinal stenosis when compared with decompression.


Assuntos
Descompressão Cirúrgica/métodos , Vértebras Lombares/cirurgia , Fusão Vertebral/métodos , Estenose Espinal/cirurgia , Perda Sanguínea Cirúrgica , Avaliação da Deficiência , Humanos , Tempo de Internação , Duração da Cirurgia , Complicações Pós-Operatórias/epidemiologia , Reoperação
7.
JAMA Netw Open ; 3(9): e2015015, 2020 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-32910195

RESUMO

Importance: Conflicting evidence and large practice variation are present in the surgical treatment of degenerative spondylolisthesis. More than 90% of surgical procedures in the United States include instrumented fusion compared with 50% or less in other countries. Objective: To evaluate whether the effectiveness of microdecompression alone is noninferior to decompression with instrumented fusion in a real-world setting. Design, Setting, and Participants: This multicenter comparative effectiveness study with a noninferiority design assessed prospective data from the Norwegian Registry for Spine Surgery. From September 19, 2007, to December 21, 2015, 1376 patients at 35 Norwegian orthopedic and neurosurgical departments underwent surgery for lumbar spinal stenosis with degenerative spondylolisthesis without scoliosis. After excluding patients undergoing laminectomy alone, fusion without instrumentation, or surgery in more than 2 levels and those with a former operation at the index level, 794 patients were included in the analyses, regardless of missing or incomplete follow-up data, before propensity score matching. Data were analyzed from March 20 to October 30, 2018. Exposures: Microdecompression alone or decompression with instrumented fusion. Main Outcomes and Measures: A reduction from baseline of 30% or greater in the Oswestry Disability Index at 12-month follow-up. Results: After propensity score matching, 570 patients (413 female [72%]; mean [SD] age, 64.7 [9.5] years) were included for comparison, with 285 undergoing microdecompression (mean [SD] age, 64.6 [9.8] years; 205 female [72%]) and 285 undergoing decompression with instrumented fusion (mean [SD] age, 64.8 [9.2] years; 208 female [73%]). The proportion of each type of procedure varied between departments. However, changes in outcome scores varied within patients but not between departments. The proportion of patients with improvement in the Oswestry Disability Index of at least 30% was 150 of 219 (68%) in the microdecompression group and 155 of 215 (72%) in the instrumentation group. The 95% CI (-12% to 5%) for the difference of -4% was above the predefined margin of noninferiority (-15%). Microdecompression alone was associated with shorter operation time (mean [SD], 89 [44] vs 180 [65] minutes; P < .001) and shorter hospital stay (mean [SD], 2.5 [2.4] vs 6.4 [3.0] days; P < .001). Conclusions and Relevance: Among patients with degenerative spondylolisthesis, the clinical effectiveness of microdecompression alone was noninferior to that of decompression with instrumented fusion. Microdecompression alone was also associated with shorter durations of surgery and hospital stay, supporting the suggestion that the less invasive procedure should be considered for most patients.


Assuntos
Descompressão Cirúrgica , Vértebras Lombares , Fusão Vertebral , Estenose Espinal , Espondilolistese , Pesquisa Comparativa da Efetividade , Descompressão Cirúrgica/métodos , Descompressão Cirúrgica/estatística & dados numéricos , Feminino , Humanos , Degeneração do Disco Intervertebral/complicações , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Noruega , Duração da Cirurgia , Avaliação de Processos e Resultados em Cuidados de Saúde , Sistema de Registros/estatística & dados numéricos , Fusão Vertebral/efeitos adversos , Fusão Vertebral/instrumentação , Fusão Vertebral/métodos , Estenose Espinal/diagnóstico , Estenose Espinal/etiologia , Estenose Espinal/cirurgia , Espondilolistese/diagnóstico , Espondilolistese/etiologia , Espondilolistese/cirurgia , Resultado do Tratamento
9.
Clin Orthop Surg ; 12(3): 330-336, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32904063

RESUMO

Backgroud: Biportal endoscopic unilateral laminectomy for bilateral decompression (ULBD) is an emerging minimally invasive procedure for spinal stenosis. However, reports of the results associated with this surgical method are still lacking. Methods: We conducted a retrospective study of 60 patients who underwent bilateral decompression for lumbar central canal stenosis. The patients were divided into 2 groups according to the surgical method (endoscopic ULBD vs. microscopic ULBD). We compared the outcomes between the 2 groups in terms of postoperative segmental spinal instability, dura expansion, operation time, estimated blood loss, serum creatine kinase (CK), serum C-reactive protein (CRP), visual analog scale (VAS) score, Oswestry Disability Index (ODI), modified MacNab score, and the incidence of complications. Results: The mean VAS, ODI, and modified MacNab score improved significantly from the preoperative period to the last follow-up in both groups and were better in the endoscopic ULBD group until the first day after treatment. The degree of horizontal displacement was lower in the endoscopic ULBD group than in the microscopic ULBD group at postoperative 12 months. Dura expansion, operation time, and estimated blood loss did not differ significantly between the 2 groups. Serum CK and CRP on the first day after treatment were lower in the endoscopic ULBD group than in the microscopic ULBD group. Conclusions: This study shows that both endoscopic ULBD and microscopic ULBD can provide favorable outcomes for lumbar central canal stenosis. However, compared to microscopic ULBD, endoscopic ULBD has advantages in terms of postoperative segmental spinal instability, pain control, and serum CK and CRP.


Assuntos
Descompressão Cirúrgica/métodos , Endoscopia/métodos , Laminectomia/métodos , Vértebras Lombares/cirurgia , Estenose Espinal/cirurgia , Idoso , Avaliação da Deficiência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos , Medição da Dor , Estudos Retrospectivos
10.
Clin Interv Aging ; 15: 1213-1219, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32821088

RESUMO

Purpose: Percutaneous transforaminal endoscopic decompression (PTED) is an ultra-minimally invasive surgical option for patients that does not involve the same amount of destabilizing facet joint removal as a traditional laminectomy. The objective of this study was to describe the procedure of PTED under local anesthesia for geriatric patients with central spinal stenosis and degenerative lumbar spondylolisthesis (CSS-DLS). Materials and Methods: From January 2016 to December 2018, 30 consecutive geriatric patients who underwent surgery for single-level CSS-DLS were retrospectively reviewed. All patients were followed for at least 12 months (12-24 months). The visual analog scale (VAS) scores, Oswestry disability index (ODI) scores and modified MacNab criteria were used to evaluate the clinical results. Results: The mean age was 73.1±6.0 years. Follow-up ranged from 12 to 36 months. The mean±SD values of the preoperative VAS for leg pain and ODI were 7.4±1.0 and 67.2±8.4, respectively. The values improved to 2.2±1.1 and 19.9±8.1 at 12 months postoperatively. The outcomes of the modified MacNab criteria showed that 93.3% of patients obtained a good-to-excellent rate. The percent slippage of spondylolisthesis before surgery (13.8±2.5%) and at the end of follow-up (14.0±2.5%) was not significantly different. Conclusion: PTED under local anesthesia could be a useful supplement to traditional decompression in geriatric patients with CSS-DLS.


Assuntos
Descompressão Cirúrgica/métodos , Região Lombossacral/cirurgia , Estenose Espinal/cirurgia , Espondilolistese/cirurgia , Idoso , Endoscopia/métodos , Feminino , Humanos , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Estudos Retrospectivos , Resultado do Tratamento
11.
Medicine (Baltimore) ; 99(31): e21444, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32756160

RESUMO

BACKGROUND: Currently, there is some clinical evidence supporting the use of acupuncture in alleviating pain and dysfunction in patients with lumbar spinal stenosis (LSS). However, the question of whether acupuncture could be efficacious for ageing patients remains unanswered. We designed a randomized controlled study to evaluate the safety and feasibility of acupuncture for participants with symptomatic LSS. METHODS: This study is a randomized, single-blind, noninferiority trial. This clinical trial was approved by the Linyi Cancer Hospital. We received informed consent from all patients before surgery. In preparing this report, we adhered to the Consolidated Standards of Reporting Trials guidelines. We randomized consented study participants on a 1:1 ratio to one of two study groups (acupuncture and control groups) using a computer-generated list of random numbers in varying block sizes. Three outcome measures were selected to evaluate the effectiveness and safety of the treatment: visual analogue score and Oswestry disability index, and complicatins. A P < .05 was regarded as statistically significant. RESULTS: The hypothesis was that the acupuncture group would achieve acceptable clinical outcomes as compared to the control group in LSS. TRIAL REGISTRATION: This study protocol was registered in Research Registry (researchregistry5744).


Assuntos
Terapia por Acupuntura/métodos , Vértebras Lombares/patologia , Estenose Espinal/terapia , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Estudos de Viabilidade , Humanos , Vértebras Lombares/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Segurança , Método Simples-Cego , Resultado do Tratamento , Escala Visual Analógica
12.
Medicine (Baltimore) ; 99(30): e21309, 2020 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-32791717

RESUMO

BACKGROUND: Microscopic bilateral decompression (MBD) has been suggested as an alternative to open laminectomy and fusion. Recently, percutaneous biportal endoscopic decompression (PBED) has begun to attract attention. The purpose of this retrospective study was to evaluate postoperative pain, functional disability, symptom reduction and satisfaction, and specific surgical parameters between the MBD and PBED techniques in patients with lumbar spinal stenosis (LSS). METHODS: A retrospective review of LSS patients performed with MBD or PBED technique between May 2015 and June 2018 was conducted. Institutional review board approval in People's Hospital of Ningxia Hui Nationality Autonomous Region was obtained prior to conducting chart review and analysis. We received informed consent from all patients before surgery. The primary outcomes assessed were the preoperative to postoperative changes in leg/back pain and disability/function, patient satisfaction with the procedure, and postoperative quality of life. The secondary outcomes including duration of postoperative hospital stay, time to mobilization, postoperative analgesic use, complication rates, and baseline patient characteristics were prospectively collected. RESULTS: The hypothesis was that the PBED technique would achieve better clinical outcomes as compared to the MBD technique in LSS.


Assuntos
Descompressão Cirúrgica/tendências , Vértebras Lombares/patologia , Estenose Espinal/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Protocolos Clínicos , Avaliação da Deficiência , Endoscopia/métodos , Humanos , Laminectomia/normas , Tempo de Internação/estatística & dados numéricos , Microscopia/instrumentação , Pessoa de Meia-Idade , Dor Pós-Operatória/epidemiologia , Satisfação do Paciente , Qualidade de Vida , Estudos Retrospectivos , Fusão Vertebral/normas , Resultado do Tratamento
13.
Medicine (Baltimore) ; 99(30): e21466, 2020 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-32791763

RESUMO

To evaluate the effect of the severity of spinal stenosis on the peripheral nerves of lower extremities by nerve conduction study (NCS).One hundred fifteen patients with lumbar spinal stenosis were recruited retrospectively in this study. The grading system for lumbar stenosis was used based on the degree of separation of the cauda equina. The degree of cauda equina damage caused by lumbar central stenosis was assessed by NCS of peripheral nerves. Multiple regression analysis was used to estimate which factors affect peripheral nerve injury, according to the presence of DM, total grading of lumbar central stenosis, and age.Only age was associated with low amplitude in the tibial and peroneal motor NCS in the multiple regression analysis. The severity of the compression of the cauda equina, caused by spinal stenosis, did not statistically significantly affect the NCS values of nerves on the lower extremities.In conclusion, the cauda equina is resilient against degenerative lumbar central stenosis. Unlike changes caused by peripheral nerve entrapment, lumbar central stenosis did not affect the findings of NCS on the peripheral nerve of lower extremities.


Assuntos
Cauda Equina/fisiopatologia , Condução Nervosa , Estenose Espinal/fisiopatologia , Idoso , Feminino , Humanos , Vértebras Lombares , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
14.
Sci Rep ; 10(1): 14135, 2020 08 24.
Artigo em Inglês | MEDLINE | ID: mdl-32839532

RESUMO

Despite the importance of sleep and the evidence on its relationship with various chronic diseases, quality of sleep is not considered in patients with lumbar spinal stenosis (LSS). This prospective comparative study aimed to investigate the changes in sleep disturbance after treatment in patients with LSS. Patients with LSS and sleep disturbance (n = 201; 147 conservatively treated and 54 patients with surgical treatment) were included. The Pittsburgh sleep quality index (PSQI) was used to evaluate sleep quality. Propensity score matching was used to attenuate the potential bias. Clinical outcome of surgery, as determined by the Oswestry disability index, and the PSQI was compared between the two groups at 6 weeks, 3 months, and 6 months after enrollment. Multivariate logistic analysis was performed to adjust for possible confounders within the matched cohorts. Among the 201 patients, 96 (47.7%) patients were finally matched (48 patients in each group). Sleep quality was initially improved after treatment, regardless of the treatment method. Sleep quality in the surgical group was improved by 6 weeks after surgery and consistently improved during the 6-month follow-up period, despite less use of pain killer. Conversely, the improvement in sleep quality at 6-weeks following conservative treatment was not maintained during the follow-up, although the treatment outcome for LSS measured by ODI was continuously improved. After multivariate logistic regression analysis within propensity score matched cohorts, surgical treatment had a significantly greater chance to improve sleep quality compared to conservative treatment. The failure of sleep improvement in conservative group was significantly associated with depression presented by worse score in Hamilton depression rating scale, and more severe degree of foraminal-type stenosis, which should be carefully considered for conservative treatment of LSS patients with sleep disturbance.


Assuntos
Descompressão Cirúrgica/métodos , Vértebras Lombares/cirurgia , Transtornos do Sono-Vigília/terapia , Sono/fisiologia , Estenose Espinal/cirurgia , Idoso , Analgésicos Opioides/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Tratamento Conservador , Depressão/complicações , Feminino , Gabapentina/uso terapêutico , Humanos , Vértebras Lombares/patologia , Masculino , Pregabalina/uso terapêutico , Pontuação de Propensão , Estudos Prospectivos , Medicamentos Indutores do Sono/uso terapêutico , Inquéritos e Questionários , Resultado do Tratamento
15.
BMC Med Inform Decis Mak ; 20(1): 187, 2020 08 12.
Artigo em Inglês | MEDLINE | ID: mdl-32787849

RESUMO

BACKGROUND: Determining the primary indication of a surgical procedure can be useful in identifying patients undergoing elective surgery where shared decision-making is recommended. The purpose of this study was to develop and validate an algorithm to identify patients receiving the following combinations of surgical procedure and primary indication as part of a study to promote shared decision-making: (1) knee arthroplasty to treat knee osteoarthritis (KOA); (2) hip arthroplasty to treat hip osteoarthritis (HOA); (3) spinal surgery to treat lumbar spinal stenosis (SpS); and (4) spinal surgery to treat lumbar herniated disc (HD). METHODS: Consecutive surgical procedures performed by participating spine, hip, and knee surgeons at four sites within an integrated care network were included. Study staff reviewed electronic medical records to ascertain a "gold standard" determination of the procedure and primary indication status. Electronic algorithms consisting of ICD-10 and CPT codes for each combination of procedure and indication were then applied to records for each case. The primary measures of validity for the algorithms were the sensitivity and specificity relative to the gold standard review. RESULTS: Participating surgeons performed 790 procedures included in this study. The sensitivity of the algorithms in determining whether a surgical case represented one of the combinations of procedure and primary indication ranged from 0.70 (HD) to 0.92 (KOA). The specificity ranged from 0.94 (SpS) to 0.99 (HOA, KOA). CONCLUSION: The electronic algorithm was able to identify all four procedure/primary indication combinations of interest with high specificity. Additionally, the sensitivity for the KOA cases was reasonably high. For HOA and the spine conditions, additional work is needed to improve the sensitivity of the algorithm to identify the primary indication for each case.


Assuntos
Algoritmos , Tomada de Decisões , Deslocamento do Disco Intervertebral/cirurgia , Procedimentos Ortopédicos/normas , Osteoartrite do Quadril/cirurgia , Osteoartrite do Joelho/cirurgia , Estenose Espinal/cirurgia , Artroplastia de Quadril , Artroplastia do Joelho , Eletrônica , Humanos , Reprodutibilidade dos Testes
16.
Georgian Med News ; (303): 21-27, 2020 Jun.
Artigo em Russo | MEDLINE | ID: mdl-32841175

RESUMO

The aim of the study was to analyze the results of treatment with biportal endoscopic decompression of patients with spinal stenosis. The treatment results of 62 patients who underwent surgery (for discectomy) (for decompression) in the period from March 2018 to June 2019 were analyzed. All 62 patients were operated by biportal endoscopy at the spine surgery clinic of the State Institution "Institute of Traumatology and Orthopedics of the National Academy of Medical Sciences of Ukraine". Pain intensity was assessed using a visual analogue pain scale (VAS), patient satisfaction and quality of life was assessed using a modified MacNab scale and the Oswestry Disability Index (ODI), respectively, 1 week, 3 months and 6 months after surgery. Perioperative data were also evaluated (duration of surgery and length of stay in the hospital, blood loss and complications). X-ray results were evaluated using pre- and postoperative MRI (6-8 weeks after surgery). According to the results of studies in the postoperative period, a positive trend was observed. So, the indicator of back pain according to VAS after surgery decreased to 0,9±1,4 points, and the indicator of pain in the leg according to VAS on average in the postoperative phase was 1,28±1,1 points, respectively. Assessing perioperative data, in the group of patients the level of blood loss was 34,8±16,2, and the length of stay in the hospital was 2,9±1,3 days. Among the complications, 4 cases of point wound of the dural membrane and 1 case of linear wound of the dural membrane, more than 1 cm long with the contents of the dural sac entering the epidural space, which required conversion to an open operation with suturing the defect, were noted. Biportal endoscopic spinal surgery is an effective method of treating lumbar spinal stenosis, which has several advantages over open surgery (less tissue trauma, less blood loss, high patient satisfaction with the treatment result). UBE has an advantage over microscopic technique in terms of achieving complete decompression in an enlarged arthroscopic field without restricting the movement of the instrument due to the use of an independent portal, and continuous irrigation with saline during surgery is a great advantage to prevent infection.


Assuntos
Estenose Espinal/cirurgia , Descompressão Cirúrgica , Endoscopia , Humanos , Vértebras Lombares , Qualidade de Vida , Estudos Retrospectivos , Resultado do Tratamento , Ucrânia
17.
Mymensingh Med J ; 29(3): 560-567, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32844794

RESUMO

Variety of conditions may be responsible for low back pain but lumber spinal canal stenosis is an important cause of low back pain. Lumber spinal canal stenosis usually presents with low backache with neurogenic claudication and shortness of walking distance in adult patient. Surgical management of lumbar spinal canal stenosis by decompression surgery is effective method. This prospective interventional study was performed in patient with clinical features like low back pain with radicular pain, neurogenic claudication, signs of root compression, positive MRI findings attending in department of Orthopaedic Surgery Mymensingh Medical College Hospital and Private Hospital from July 2016 to June 2019. Thirty patients were evaluated among those 20(66.6%) were 50 years and above. The mean age was 47.5±1.6 years. Male to female ratio was roughly 8:1. Almost all of the patients had low backache with radiation to the back of the thigh and leg with motor weakness (60%). About 66.6% of the patients had sensory deficit and 83.3% had neurogenic claudication. Majority (80.0%) of the patients at presentation had a suffering of 12 or >12 months. The mean duration of suffering was 14.7±5.1 months. About 55% of the patients were able to perform heel-walking and 36.0% tip-toe walking. Nearly 57% of the patients had sensory deficit along the distribution of 1st sacral nerve and 53.3% along the distribution of lumber 5 nerves. Diagnosis shows that 16.6% of patients had L4 lesion, 50% L5, 10.0% patients had L4 & L5 and 46.6% S1. Laminectomy was done in 26.6% of patients, laminectomy and disectomy in 33.3% and laminectomy, discectomy & foraminal decompression in 40.0% of patients. Twenty five (83.5%) of patients was free from symptoms. Eighty percent (80.0%) of patients shows minimal disability and 20.0% moderate disability on the basis of Oswestry Disability Index, while by MacNab criteria, most (80%) of patients was excellent, 10% good and another 10% fair. Repeated measure ANOVA statistics showed that mean Oswestry score decreased significantly from 54.5% at baseline to 22% at the end of 1 year (p<0.001).


Assuntos
Laminectomia , Estenose Espinal/cirurgia , Adulto , Constrição Patológica , Descompressão Cirúrgica , Feminino , Humanos , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Canal Vertebral/cirurgia , Resultado do Tratamento
18.
Zhonghua Yi Xue Za Zhi ; 100(31): 2435-2440, 2020 Aug 18.
Artigo em Chinês | MEDLINE | ID: mdl-32819059

RESUMO

Objective: To compare clinical outcomes of microsurgical bilateral decompression via unilateral approach (MBDU) between trans longissimus and iliocostalis approach, a novel lateral paraspinal approach(LPA), and classic Wiltseapproach for single level degenerative lumbar stenosis. Methods: LPA approach was researched by imaging measurement and cadaver anatomy. Retrospective analysis of a total 124 cases(male/female 75/49, aged(55±14) years) received single-level MBDU due to degenerative lumbar stenosis from 2016 to 2018 in Beijing Tiantan Hospital. Patients were categorized into two groups according to spinal canal morphology. Group A: trefoil shape (n=48), received MBDU via LPA; Group B: round & oval shape (n=76), received MBDU via Wiltse approach. Clinical parameters, including visual analogue scale (VAS) of pain, OswestryDability Index (ODI), satisfaction rate were assessed before the operation and at the latest follow-up. The internal fixation and intervertebral fusion were evaluated by X-ray and CT.The data were compared with single sample t test between the two groups. Results: The feasibility of trans longissimus and iliocostalis approach was proved by imaging measurement and anatomic study. The tube's maximum tilt angle in LPA group was 65°, and it was 40°in Wiltse group. There was no significantly difference in the operating time, bleeding and drainage volume between the two groups((120±27) min vs (115±32) min, (104±31) ml vs (110±41) ml, (50±15) ml vs (47±18) ml, respectively, t=1.246,-1.917,1.730,all P>0.05). In both groups, VAS and ODI scores significantly improved at the latest follow-up when compared with those before the operation (all P<0.05), but those were all comparable between the two groups(all P>0.05). The excellent rate of subjective satisfaction for the clinical efficacy in group A and B was 89.6%(43/48) and 86.8%(66/76) respectively (χ(2)=0.208,P>0.05). Conclusions: LPA approachfor microsurgical bilateral decompression via unilateral approach (MBDU) in degenerative lumbar stenosis is safe and effective, it has advantages in direct vison of contralateral nerve root canal decompression for trefoil shaped spinal canal.


Assuntos
Fusão Vertebral , Estenose Espinal/cirurgia , Adulto , Idoso , Constrição Patológica , Descompressão Cirúrgica , Feminino , Humanos , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
19.
Sci Rep ; 10(1): 13432, 2020 08 10.
Artigo em Inglês | MEDLINE | ID: mdl-32778718

RESUMO

There are a few studies on the postoperative changes in sagittal alignment and corresponding factors, including hand grip strength (HGS) and muscle performance tests for lumbar spinal stenosis (LSS). Thus, we aimed to determine whether HGS can be a surrogate marker for global sagittal alignment changes after decompression with fusion surgery for LSS. This retrospective observational study included 91 patients who underwent spine fusion surgery for LSS. Radiological spinopelvic parameters, including sagittal vertical axis (SVA), lumbar lordosis (LL), pelvic tilt (PT), pelvic incidence (PI), global tilt (GT), and T1 pelvic angle (T1PA), were analyzed preoperatively and 1 year after posterior decompression and fusion surgery. To assess muscle performance, the 6-m walk (SMT), timed up and go (TUGT), and sit-to-stand (STS) tests were conducted. The relationship between HGS and postoperative SVA was examined through multiple linear regression analysis. Additionally, the relationship between HGS and preoperative/postoperative radiologic spinopelvic parameters and muscle performance test results was analyzed through Pearson's correlation. HGS was significantly correlated with age, preoperative and postoperative SVA, and the muscle performance tests. Furthermore, HGS was a factor that can significantly influence postoperative SVA changes in multiple linear regression analyses. Therefore, HGS may be a good predictor of postoperative SVA change.


Assuntos
Força da Mão/fisiologia , Mãos/fisiologia , Estenose Espinal/cirurgia , Idoso , Biomarcadores , Descompressão Cirúrgica/métodos , Feminino , Humanos , Lordose/cirurgia , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Pacientes , Pelve/fisiologia , Período Pós-Operatório , Postura , Estudos Retrospectivos , Fatores de Risco , Fusão Vertebral/métodos , Estenose Espinal/diagnóstico por imagem , Resultado do Tratamento
20.
Clin Interv Aging ; 15: 1141-1150, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32764901

RESUMO

Background and Aim: Frailty is an independent predictor of mortality and adverse events (AEs) in patients undergoing surgery. This study aimed to quantify the ability of Modified Frailty Index (mFI) to predict AEs in older patients undergoing elective posterior thoracolumbar fusion surgery. Methods: We retrospectively reviewed the results of 426 patients with the following diagnoses and follow-up evaluations of at least 12 months duration: lumbar disc herniation, 125; degenerative spondylolisthesis, 81; lumbar spinal canal stenosis, 187; and adult spinal deformities, 33. The cases were divided into two groups. The long spinal fusion (LSF) group was defined as ≥3 spinal levels with segmental pedicle-screw fixation. Short spinal fusion (SSF) were defined with at most two levels. The mFI used in the present study is an 11-variable assessment. The association of frailty with AEs was determined after adjusting for known and suspected confounders. Results: Frailty was presented in 66 patients (15.5%) within the total population (LSF, 21.9% and SSF, 11.8%). Rates of AEs assessed in the study increased stepwise with an increase in the mFI for the two groups. The severity of frailty was an independent predictor of any, major, and minor complications in the LSF group and any, minor complication in the SSF group (P<0.05). A comparison of post-operative clinical outcomes showed that the ODI and SF-36 scores deteriorated as the mFI increased. Conclusion: Frailty was shown to be an independent predictor of AEs in older patients undergoing elective posterior thoracolumbar fusion surgery, especially for patients undergoing LSF.


Assuntos
Idoso Fragilizado/estatística & dados numéricos , Fragilidade/epidemiologia , Degeneração do Disco Intervertebral/fisiopatologia , Deslocamento do Disco Intervertebral/fisiopatologia , Complicações Pós-Operatórias/epidemiologia , Estenose Espinal/fisiopatologia , Idoso , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Feminino , Humanos , Degeneração do Disco Intervertebral/cirurgia , Deslocamento do Disco Intervertebral/cirurgia , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos Retrospectivos , Fusão Vertebral/efeitos adversos , Estenose Espinal/cirurgia , Resultado do Tratamento
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