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1.
J Korean Med Sci ; 35(13): e87, 2020 Apr 06.
Artigo em Inglês | MEDLINE | ID: mdl-32242344

RESUMO

BACKGROUND: It can be difficult to differentiate between vascular and neurogenic intermittent claudication. The exact diagnosis often cannot be made on clinical evidence and ultimately requires imaging. Perioperative screening for peripheral arterial disease (PAD) in lumbar spinal stenosis (LSS) patients is important because untreated PAD increases the risk of severe vascular events. The aims of this study were to study the prevalence of PAD in LSS patients with symptoms of intermittent claudication, and to study the independent risk factors for PAD. We specified the cases where it was necessary to perform computed tomography angiography (CTA) as a preoperative screening tool in surgery for spinal stenosis. METHODS: This study involved a retrospective analysis of 186 consecutive subjects with radiographic evidence of LSS and symptoms of intermittent claudication, who underwent 3D CTA of the lower extremities at our institution during a three-year period. More than 50% luminal narrowing on CT angiograms was determined to be clinically significant and placed in the PAD group. RESULTS: Thirty-two subjects were diagnosed with PAD and referred to the general vascular team in our hospital, where they received treatment for PAD. In the non-PAD group (154 subjects), 117 underwent definitive surgery for spinal stenosis such as posterior lumbar interbody fusion and a further 37 underwent conservative treatment. Only hypertension, diabetes, and men gender were found to be statistically significant predictors of PAD. CONCLUSION: The current study showed that man gender, diabetes and hypertension were the greatest risk factors for PAD. We conclude that man patients with diabetes and/or hypertension should be put under serious consideration for routine CTA examination when under evaluation for LSS and intermittent claudication.


Assuntos
Claudicação Intermitente , Doença Arterial Periférica , Estenose Espinal , Idoso , Angiografia , Angiografia por Tomografia Computadorizada , Feminino , Humanos , Vértebras Lombares , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/epidemiologia , Prevalência , Estudos Retrospectivos , Fatores de Risco , Estenose Espinal/complicações , Tomografia Computadorizada por Raios X
2.
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
3.
World Neurosurg ; 136: e386-e392, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31931247

RESUMO

OBJECTIVE: To investigate whether sacroiliac join (SIJ) pain can be secondary to walking with a flexed posture resulting from stenosis with neurogenic claudication, and resolves spontaneously after lumbar decompression. METHODS: A review of charts from January 1, 2014, through March 3, 2019, was performed to identify consecutive cases of adults 35 years of age or older with surgical spinal stenosis with neurogenic claudication as well as concomitant severe SIJ pain. Posture was considered flexed during walking if self-reported, confirmed by a close companion, or observed directly. SIJ pain was diagnosed clinically ± confirmatory injection. A 10-point visual analog scale was used to assess SIJ pain. The primary endpoint was SIJ pain improvement at a minimum of 24 months' follow-up. SIJ pain improvement at 3 months was used to assess the rate of improvement as a secondary endpoint. RESULTS: Ten patients (3 female) met entry criteria: 4 were treated with decompression alone; 6 with decompression and spinal fusion. Mean SIJ visual analog scale pain score improved by 6.9 ± 2.4 (8.7 ± 1.6-1.8 ± 2.2; P < 0.0005). Results were similar for 20 patients at the secondary endpoint of 3 months. CONCLUSIONS: Sacroiliac joint pain shows robust, rapid, reliable, and durable improvement following lumbar decompressive surgery. The addition of a spinal fusion also leads to a similar improvement in SIJ pain. This study demonstrates the importance of evaluating the specific source of low back pain in patients with stenosis, claudication, and SIJ pain so as to more effectively plan appropriate surgery.


Assuntos
Dor Lombar/cirurgia , Vértebras Lombares/cirurgia , Fusão Vertebral/métodos , Estenose Espinal/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Descompressão Cirúrgica/instrumentação , Descompressão Cirúrgica/métodos , Feminino , Humanos , Claudicação Intermitente/etiologia , Laminectomia/instrumentação , Laminectomia/métodos , Dor Lombar/etiologia , Masculino , Pessoa de Meia-Idade , Medição da Dor , Parafusos Pediculares , Postura , Estudos Retrospectivos , Articulação Sacroilíaca , Fusão Vertebral/instrumentação , Estenose Espinal/complicações , Resultado do Tratamento
4.
World Neurosurg ; 133: e452-e458, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31526879

RESUMO

OBJECTIVE: The most common cause of contralateral symptoms after unilateral transforaminal lumbar interbody fusion (TLIF) is contralateral foraminal stenosis (FS). This retrospective cohort study aimed to investigate the cause of and risk factors for contralateral FS after unilateral TLIF with a single cage. METHODS: Patients with degenerative lumbar spinal disorders who underwent unilateral TLIF at L4-5 were divided into 2 groups: those without contralateral radicular symptoms after surgery (group A; n = 340) and those with contralateral radicular symptoms after surgery (group B; n = 16). We investigated the influence of various radiological and cage-related factors on postoperative contralateral FS with radicular symptoms. The cage location indicates whether the cage's anterior tip crosses the disc midline-exceeding 50%-and in such a case, how far. RESULTS: Group B showed significantly increased postoperative coronal angle and sagittal angle and decreased contralateral foraminal height and foraminal area. Statistically significant (P < 0.01) factors according to the multivariate logistic regression analysis were the preoperative sagittal range of motion (odds ratio [OR]: 1.562, P = 0.004) and cage location (OR: 2.047, P = 0.015). The cutoff values for the sagittal range of motion and the cage location were 9.0° and 50.5%, respectively. The preoperative and postoperative 6-month visual analog scale scores and Oswestry disability index values were not significantly different between the groups. CONCLUSIONS: The 2 most meaningful risk factors were the preoperative sagittal range of motion and cage location. Inserting the cage beyond the disc midline, especially in patients with a high preoperative sagittal range of motion (≥9.0°), would help reduce postoperative complications.


Assuntos
Fixadores Internos/efeitos adversos , Vértebras Lombares/cirurgia , Complicações Pós-Operatórias/etiologia , Radiculopatia/etiologia , Fusão Vertebral/efeitos adversos , Estenose Espinal/cirurgia , Adulto , Idoso , Antropometria , Avaliação da Deficiência , Feminino , Humanos , Dor Lombar/epidemiologia , Dor Lombar/etiologia , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Medição da Dor , Dor Pós-Operatória/epidemiologia , Dor Pós-Operatória/etiologia , Complicações Pós-Operatórias/epidemiologia , Curva ROC , Radiculopatia/epidemiologia , Amplitude de Movimento Articular , Fatores de Risco , Ciática/epidemiologia , Ciática/etiologia , Fusão Vertebral/instrumentação , Fusão Vertebral/métodos , Estenose Espinal/complicações , Espondilolistese/complicações , Espondilolistese/cirurgia
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.
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
7.
Rinsho Shinkeigaku ; 59(9): 592-595, 2019 Sep 25.
Artigo em Japonês | MEDLINE | ID: mdl-31474639

RESUMO

A 72-year-old man presented with continuous hyperCKemia and intermittent claudication. He exhibited no calf muscle hypertrophy at that time or afterward. Other than an increased creatine kinase (CK) level (1,525 U/l), none of the laboratory tests was abnormal, including that for myositis-related autoantibodies. Electromyography showed neurogenic changes in the left gastrocnemius. Lumbar magnetic resonance imaging revealed spinal canal stenosis (L3/4, L4/5), left L4 radiculopathy, and bilateral S1 radiculopathy. T2-weighted and short tau inversion recovery images showed high signal intensity in the bilateral biceps femoris and gastrocnemius. Histopathological evaluation of a specimen obtained from the right gastrocnemius muscle revealed neurogenic changes. The patient was diagnosed with S1 radiculopathy caused by lumbar spinal canal stenosis with hyperCKemia. Although S1 radiculopathy with hyperCKemia is usually associated with calf muscle hypertrophy, we should consider S1 radiculopathy in patients with intermittent claudication and hyperCKemia even in the absence of calf muscle hypertrophy.


Assuntos
Creatina Quinase/sangue , Radiculopatia/diagnóstico , Radiculopatia/etiologia , Idoso , Imagem de Difusão por Ressonância Magnética , Humanos , Hipertrofia , Vértebras Lombares , Masculino , Músculo Esquelético/diagnóstico por imagem , Músculo Esquelético/patologia , Radiculopatia/diagnóstico por imagem , Estenose Espinal/complicações , Estenose Espinal/diagnóstico por imagem , Estenose Espinal/etiologia
8.
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
9.
BMC Musculoskelet Disord ; 20(1): 431, 2019 Sep 14.
Artigo em Inglês | MEDLINE | ID: mdl-31521138

RESUMO

BACKGROUND: Lumbar spinal stenosis (LSS) is a common spinal condition and the most frequent indication for spinal surgery in elderly people. General practitioners (GPs) are on the 1st line for its diagnosis and treatment. We aimed to assess how GPs diagnose and treat people with LSS in France. METHODS: We conducted a cross-sectional survey in a primary care setting. French GPs were selected by a random draw from the French Medical Board. The questionnaire was designed by 3 physicians specialized in physical and rehabilitation medicine and a resident in general practice. A provisional questionnaire was tested in a pilot survey of 11 French GPs. Participants' feedbacks served to build the final questionnaire. This latter was submitted by e-mail or mail to 330 GPs. GPs were surveyed about the 3 main domains relevant to the management of people with LSS in primary care: 1/ diagnosis, 2/ pharmacological treatments and 3/ non-pharmacological treatments, using self-administered open- and closed-ended questions and visual analog scales. RESULTS: Overall, 90/330 (27.3%) GPs completed the survey. 51/89 (57.3%) GPs were confident with managing people with LSS. Low back pain 51/87 (58.6%), neurogenic claudication 38/87 (43.7%) and paresthesia in the lower limbs 31/87 (35.6%) were the 3 most frequently cited clinical signs leading to the diagnosis of LSS. Improvement with lumbar flexion was mentioned by 9/87 (10.3%) GPs. 85/86 (98.8%) would consider prescribing lumbar imaging, 60/84 (71.4%) corticoid spinal injections and 42/79 (53.2%) would never prescribe lumbar flexion-based endurance training. All GPs would refer people with LSS to another specialist. CONCLUSIONS: French GPs lack confidence with diagnosing LSS and prescribing pharmacological and non-pharmacological treatments for people with LSS.


Assuntos
Clínicos Gerais/estatística & dados numéricos , Vértebras Lombares , Padrões de Prática Médica/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Estenose Espinal/diagnóstico , Adulto , Estudos Transversais , Feminino , França , Humanos , Claudicação Intermitente/etiologia , Dor Lombar/etiologia , Masculino , Pessoa de Meia-Idade , Parestesia/etiologia , Projetos Piloto , Estenose Espinal/complicações , Estenose Espinal/terapia , Inquéritos e Questionários/estatística & dados numéricos
10.
World Neurosurg ; 131: e570-e578, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31400524

RESUMO

OBJECTIVE: Spine surgeons increasingly encounter acute spinal pathologies in patients treated with direct oral anticoagulants (DOACs), but only limited data on the management of these patients are currently available. METHODS: We retrospectively analyzed patients who presented to our department with acute spinal pathology during treatment with DOAC and who required urgent surgical therapy. Patient characteristics and treatment modalities were studied, with specific focus on the management of hemostasis and surgical therapy. Furthermore, we analyzed 19 cases of spinal emergencies during DOAC treatment reported in the literature. RESULTS: A total of 12 patients were identified and included in the present analysis. Patients suffered from acute spinal cord compression caused by spinal tumor manifestation (n = 5), empyema (n = 4), degenerative spinal stenosis (n = 1), hematoma (n = 1), and vertebral body fracture/dislocation (n = 2). All patients underwent emergency surgical treatment. Prohemostatic substances were administered perioperatively in 10 patients (83%) and included administration of prothrombin complex concentrates (83%), tranexamic acid (17%), and transfusion of platelets (8%). A total of 9 patients (75%) showed postoperative improvement of neurologic symptoms, and the in-hospital mortality in this patient cohort was 17%. CONCLUSIONS: Emergency spine surgery is feasible and should be considered in patients on treatment with DOAC. The (low) risk of intraoperative bleeding complications has to be weighed against the risk of permanent disability if surgical decompression is delayed. Administration of prothrombin complex concentrates and tranexamic acid may improve the coagulation before surgery, especially in cases of unavailable specific antidotes.


Assuntos
Perda Sanguínea Cirúrgica/prevenção & controle , Descompressão Cirúrgica/métodos , Emergências , Inibidores do Fator Xa/efeitos adversos , Hemostáticos/uso terapêutico , Compressão da Medula Espinal/cirurgia , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/efeitos adversos , Antitrombinas/efeitos adversos , Fatores de Coagulação Sanguínea/uso terapêutico , Feminino , Hematoma Subdural Espinal/complicações , Hematoma Subdural Espinal/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Infecções Perimeníngeas/complicações , Infecções Perimeníngeas/cirurgia , Transfusão de Plaquetas , Estudos Retrospectivos , Compressão da Medula Espinal/etiologia , Fraturas da Coluna Vertebral/complicações , Fraturas da Coluna Vertebral/cirurgia , Neoplasias da Coluna Vertebral/complicações , Neoplasias da Coluna Vertebral/cirurgia , Estenose Espinal/complicações , Estenose Espinal/cirurgia , Ácido Tranexâmico/uso terapêutico
11.
World Neurosurg ; 131: e514-e520, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31394365

RESUMO

BACKGROUND: The cervicothoracic junction (CTJ) has often been identified as an area of biomechanical vulnerability; however, few studies have examined the relative merits of extending fusions across this area. In this study, we sought to investigate the tradeoffs involved in fusing across the CTJ in cases of elective posterior cervical laminectomy and fusion. METHODS: We conducted a single-institution retrospective cohort study of patients undergoing elective, multilevel, posterior cervical decompression and fusion for degenerative cervical stenosis. Data were collected on baseline clinical and radiographic variables as well any subsequent complications or reoperations. Outcomes measures were compared between those who received fusion stopping at C7 with those who received fusion crossing the CTJ, with multivariate logistic regression used to adjust for any known confounders. RESULTS: Patients whose fusion crossed the CTJ were found to have more levels fused (mean: 5.8 vs. 3.5 levels, P < 0.0001), longer surgical times (mean: 216 vs. 149 minutes, P < 0.0001), and higher estimated blood losses (mean: 475 vs. 116 mL, P < 0.0001) despite no significant differences in number of levels decompressed (mean: 4.2 vs. 4.3 levels, P = 0.63). The groups did not differ in overall reoperation rate (10.8% vs. 9.4%, P = 1.00), but crossing the CTJ was associated with a higher rate of wound dehiscence (7.8% vs. 0%, P = 0.03). This difference persisted in multivariate analysis (P < 0.001). CONCLUSIONS: Crossing the CTJ was associated with increased surgical time, estimated blood loss, and the rates of wound dehiscence. These tradeoffs should be considered in planning posterior cervical decompression and fusion procedures.


Assuntos
Vértebras Cervicais/cirurgia , Laminectomia/métodos , Compressão da Medula Espinal/cirurgia , Fusão Vertebral/métodos , Estenose Espinal/cirurgia , Espondilose/cirurgia , Vértebras Torácicas/cirurgia , Idoso , Perda Sanguínea Cirúrgica , Estudos de Coortes , Descompressão Cirúrgica , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Duração da Cirurgia , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Compressão da Medula Espinal/etiologia , Estenose Espinal/complicações , Espondilose/complicações
12.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 33(7): 795-800, 2019 Jul 15.
Artigo em Chinês | MEDLINE | ID: mdl-31297994

RESUMO

Objective: To summarize the research progress on the nerve root sedimentation sign of lumbar spinal stenosis. Methods: The recent domestic and foreign literature in recent years was reviewed. The definition, classification, and mechanism of nerve root sedimentation sign and the relation of nerve root sedimentation sign to diagnosis and treatment of lumbar spinal stenosis were summarized. Results: Nerve root sedimentation sign is a phenomena which is found in MRI images of lumbar spine. Its mechanism is mainly increased intraoperative epidural pressure. There are two types of classification and the classification in which nerve root sedimentation sign is classified into "positive" and "negative" is widely applied. It has high sensitivity and specificity in differential diagnosis patients with severe lumbar spinal stenosis and patients with nonspecific low back pain. As for treatment, the nerve root sedimentation sign is related to the surgical disc levels. However, it's not sure if the nerve root sedimentation sign is related to surgical outcome. In addition, a positive sedimentation sign turns negative after sufficient surgical decompression and a new positive sedimentation sign after sufficient decompression surgery could be used as an indicator of new stenosis in previously operated patients. Conclusion: For lumbar spinal stenosis, the nerve root sedimentation sign can be applied as an auxiliary diagnostic indicator, as a guidance for deciding the operated disc levels, and as a postoperative indicator for evaluating the effectiveness.


Assuntos
Raízes Nervosas Espinhais , Estenose Espinal , Descompressão Cirúrgica , Humanos , Vértebras Lombares , Região Lombossacral , Raízes Nervosas Espinhais/patologia , Estenose Espinal/complicações , Estenose Espinal/diagnóstico , Estenose Espinal/cirurgia
13.
World Neurosurg ; 130: 499-505, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31295597

RESUMO

BACKGROUND: Syringobulbia is an uncommon lesion that occurs in the central nervous system; it is often defined as a pathologic cavitation in the brainstem. The cases with partial blockage of the cerebrospinal fluid pathways at the level of the foramen magnum are more common and the most important group. The most common treatment of syringobulbia is craniovertebral decompression. CASE DESCRIPTION: This paper reports a case of a symptomatic syringobulbia in which an urgent endoscopic endonasal approach to the craniovertebral junction (CVJ) was done to limit bulbo-medullary compression and rapid neurologic deterioration. A 69-year-old man was admitted to the hospital because of acute onset of dysphonia, dysphagia, imbalance, and vomiting. Magnetic resonance imaging revealed a cystic lesion in the brainstem, suggestive of a syringobulbia in Klippel Feil syndrome with CVJ stenosis. CONCLUSIONS: This case report details the successful use of endoscopic endonasal anterior decompression to treat syringobulbia, and adds to the growing literature in support of the endonasal endoscopic approach as a safe and feasible means for decompressing the craniocervical junction, even in the setting of urgency. However, prudent patient selection, combined with sound clinical judgment, access to instrumentation, and intraoperative imaging cannot be overemphasized.


Assuntos
Neoplasias do Tronco Encefálico/cirurgia , Vértebras Cervicais/cirurgia , Descompressão Cirúrgica/métodos , Cirurgia Endoscópica por Orifício Natural/métodos , Procedimentos Neurocirúrgicos/métodos , Compressão da Medula Espinal/cirurgia , Idoso , Neoplasias do Tronco Encefálico/complicações , Humanos , Síndrome de Klippel-Feil/complicações , Síndrome de Klippel-Feil/cirurgia , Masculino , Nariz/cirurgia , Estenose Espinal/complicações , Estenose Espinal/cirurgia , Resultado do Tratamento
14.
World Neurosurg ; 131: e290-e297, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31356984

RESUMO

OBJECTIVE: To assess factors that may predict failure to improve at 12 and 24 months after unilateral laminotomy with bilateral decompression (ULBD) for the management of lumbar spinal stenosis. METHODS: A database of 255 patients who underwent microdecompression surgery by a single orthopedic spine surgeon between 2014 and 2018 was queried. Patients who underwent primary single-level ULBD of the lumbar spine were included. Visual analog scale (VAS) for back pain and leg pain and Oswestry Disability Index (ODI) results were collected preoperatively and at 12 and 24 months postoperatively. Demographic, radiographic, and operative factors were assessed for associations with failure to improve. Clinically important improvement was defined as reaching or surpassing the previously established minimum clinically important difference for ODI (12.8) and not requiring revision. RESULTS: A total of 68 patients were included. Compared with preoperative values for back pain, leg pain, and ODI (7.32, 7.53, and 51.22, respectively), there were significant improvements on follow-up at 12 months (2.89, 2.23, and 22.40, respectively; P < 0.001) and 24 months (2.80, 2.11, 20.32, respectively; P < 0.001). Based on the defined criteria, 50 patients showed clinically important improvement after ULBD. Of the 18 patients who failed to improve, 12 required revision. Independent predictors of failure to improve included female sex (adjusted odds ratio, 5.06; 95% confidence interval, 1.49-21.12; P = 0.014) and current smoker status (adjusted odds ratio, 5.39; 95% confidence interval, 1.39-23.97; P = 0.018). CONCLUSIONS: ULBD for the management of lumbar spinal stenosis leads to clinically important improvement that is maintained over a 24-month follow-up period. Female sex and tobacco smoking are associated with poorer outcomes.


Assuntos
Descompressão Cirúrgica , Laminectomia , Vértebras Lombares/cirurgia , Radiculopatia/cirurgia , Estenose Espinal/cirurgia , Idoso , Feminino , Humanos , Perna (Membro) , Dor Lombar/etiologia , Masculino , Pessoa de Meia-Idade , Diferença Mínima Clinicamente Importante , Razão de Chances , Dor , Medição da Dor , Radiculopatia/etiologia , Radiculopatia/fisiopatologia , Reoperação , Fatores Sexuais , Estenose Espinal/complicações , Estenose Espinal/fisiopatologia , Fumar Tabaco/epidemiologia , Falha de Tratamento
15.
Rev Assoc Med Bras (1992) ; 65(6): 779-785, 2019 Jul 22.
Artigo em Inglês | MEDLINE | ID: mdl-31340304

RESUMO

OBJECTIVE: To investigate the efficacy and safety of percutaneous transforaminal endoscopic discectomy (PTED) in the treatment of lumbar spinal stenosis (LSS) combined with osteoporosis. METHODS: Eighty patients with LSS combined with osteoporosis were divided into a control and PTED group, which received conventional transforaminal lumbar interbody fusion and PTED, respectively. The surgical indications, incision visual analogue scale (VAS), lumbar and leg pain VAS, lumbar Japanese Orthopaedic Association (JOA) and Oswestry disability index (ODI) scores, bone mineral density (BMD), and adverse reactions were observed. RESULTS: Compared with the control group, in the PTED group, the operation time, bleeding loss and hospitalization duration, incision VAS scores at postoperative 12, 24 and 48 h and lumbar and leg pain VAS and lumbar ODI scores on postoperative 6 months were significantly decreased (P < 0.01), and the lumbar JOA score on postoperative 6 months was significantly increased (P < 0.05). There was no significant difference in BMD between two groups (P > 0.05). Compared with the control group, in the PTED group, the total effective rate was significantly higher (P < 0.05), and the incidence of adverse reactions was significantly lower (P < 0.05). CONCLUSIONS: PTED is safe and effective in the treatment of LSS combined with osteoporosis.


Assuntos
Discotomia Percutânea/métodos , Vértebras Lombares/cirurgia , Osteoporose/cirurgia , Estenose Espinal/cirurgia , Idoso , Idoso de 80 Anos ou mais , Densidade Óssea , Avaliação da Deficiência , Discotomia Percutânea/normas , Humanos , Pessoa de Meia-Idade , Osteoporose/complicações , Cuidados Pós-Operatórios , Reprodutibilidade dos Testes , Estenose Espinal/complicações , Fatores de Tempo , Resultado do Tratamento , Escala Visual Analógica
16.
World Neurosurg ; 128: e504-e512, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31051300

RESUMO

OBJECTIVE: To explore the effect and safety of transforaminal percutaneous endoscopic decompression for lower thoracic spinal stenosis. METHODS: We reviewed 6 patients receiving transforaminal percutaneous endoscopic thoracic decompression for sympathetic symptoms in the lower extremities. Pre- and postoperative Frankel grade and Japanese Orthopaedic Association scale (JOA) score, Oswestry Disability Index (ODI) score, and visual analog scale (VAS) scores of back and lower extremities were also evaluated and recorded. Wilcoxon signed-rank test was performed for statistical analysis. RESULTS: All 6 patients completed the follow-up. Mean follow-up was 12.6 months. Frankel grade in all patients improved to normal at the third month after operation. JOA scores significantly increased from 4.4 (range, 3.5-5.0) preoperatively to 5.5 (range, 5.0-6.5) postoperatively, to 6.5 (range, 6.0-7.0) at 3 months, to 6.6 (range, 6.2-7.0) at 6 months, and to 6.6 (range, 6.2-7.1) at 12 months (P < 0.05). ODI scores significantly decreased from 71.2 (range, 65-78) preoperatively to 50.2 (range, 45-60) postoperatively, to 30.3 (range, 25-40) at 3 months, to 12.2 (range, 0-20) at 6 months, and to 10.2 (range, 0-15) at 12 months (P < 0.05). VAS back scores decreased from 7.8 (range, 7.0-9.0) preoperatively to 6.9 (range, 6.0-7.5) postoperatively, to 3.3 (range, 3.0-4.0) at 3 months, to 2.3 (range, 2.0-3.0) at 6 months, and to 1.9 (range, 1.5-3.0) at 12 months (P < 0.05). VAS lower extremity scores decreased from 8.7 (range, 8.0-9.0) preoperatively to 3.0 (range, 2.5-3.6) postoperatively, to 1.1 (range, 0.5-1.3) at 3 months, to 0.9 (range, 0.2-1.2) at 6 months, and to 0.3 (range, 0.1-1.0) at 12 months (P < 0.05). Four patients reported excellent results and 2 reported good results at the last follow-up. CONCLUSIONS: Percutaneous endoscopic transforaminal thoracic decompression is effective and safe in settling lower thoracic spinal stenosis.


Assuntos
Descompressão Cirúrgica/métodos , Discotomia Percutânea/métodos , Neuroendoscopia/métodos , Compressão da Medula Espinal/cirurgia , Estenose Espinal/cirurgia , Vértebras Torácicas/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Compressão da Medula Espinal/etiologia , Compressão da Medula Espinal/fisiopatologia , Estenose Espinal/complicações , Estenose Espinal/fisiopatologia
17.
World Neurosurg ; 128: e541-e551, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31051306

RESUMO

OBJECTIVE: To establish microscope-based augmented reality (AR) support for degenerative spine surgery. METHODS: Head-up displays of operating microscopes were used to establish AR in a series of 10 patients. Segmentation of the vertebra and additional target structures, which were visualized by AR, was based on preoperative magnetic resonance and computed tomography (CT) images, that were nonrigidly fused to low-dose intraoperative CT (iCT) data. AR registration was achieved by automatic registration applying iCT and microscope calibration. RESULTS: AR support could be smoothly implemented in the surgical workflow. AR allowed to visualize the target structures reliably in the surgical field, facilitating surgical orientation. Flexible placement of the reference array enabled AR implementation for anterior, lateral, posterior median, and posterior paramedian approaches. Identification of bony and artificial landmarks allowed validating registration accuracy; the measured target registration error was 1.11 ± 0.42 mm (mean ± standard deviation). The effective dose for registration scanning ranged from 0.52 to 8.71 mSv, which is on average about one-third of a standard diagnostic spine scan. This depended mainly on the scan length (mean scan length cervical/thoracic/lumbar: 99/218/118 mm). Longest scan ranges were in the mid-thoracic region to ensure unambiguous vertebra assignment as prerequisite for reliable nonlinear registration (mean cervical/thoracic/lumbar effective dose: 0.52/6.14/2.99 mSv). CONCLUSIONS: Reliable microscope-based AR support is possible because of automatic registration based on intraoperative imaging. Application of AR in degenerative spine surgery has a big potential; it might be especially helpful in complex anatomical situations and resident education.


Assuntos
57943 , Deslocamento do Disco Intervertebral/cirurgia , Pseudoartrose/cirurgia , Compressão da Medula Espinal/cirurgia , Estenose Espinal/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Vértebras Cervicais/cirurgia , Feminino , Humanos , Vértebras Lombares/cirurgia , Masculino , Microscopia/métodos , Pessoa de Meia-Idade , Neuronavegação/métodos , Compressão da Medula Espinal/etiologia , Estenose Espinal/complicações , Tomografia Computadorizada por Raios X
18.
Physiotherapy ; 105(2): 262-274, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30935673

RESUMO

Neurogenic claudication due to spinal stenosis is a common cause of disability in older adults. Conservative treatments are a favourable treatment option. This paper describes the development and delivery of the BOOST (Better Outcomes for Older adults with Spinal Trouble) intervention, a physiotherapist-delivered physical and psychological intervention for the management of neurogenic claudication in older adults. The BOOST intervention is being tested in a multi-centre, randomised controlled trial in UK National Health Service Trusts; delivered by physiotherapists registered with the Health and Care Professionals Council. Participants are aged 65 years or older, registered with a primary care practice, and report symptoms consistent with neurogenic claudication. Intervention content and delivery was initially informed by clinical and patient experts, research evidence, and behaviour change guidelines; and refined following an intervention development day attended by researchers, health professionals, and Patient and Public Involvement representatives. The BOOST intervention comprises 12 group sessions, promoting sustained adherence with a long term home and physical activity programme. Each session includes education and group discussion, individually tailored exercises, and walking. Initial exercise levels are set at a one-to-one assessment. Continued home exercise adherence and increased physical activity following completion of the sessions is facilitated through support telephone calls. Trial registration ISRCTN12698674.


Assuntos
Educação em Saúde/métodos , Claudicação Intermitente/reabilitação , Modalidades de Fisioterapia , Estenose Espinal/reabilitação , Idoso , Terapia Cognitivo-Comportamental , Avaliação da Deficiência , Feminino , Humanos , Claudicação Intermitente/etiologia , Claudicação Intermitente/psicologia , Masculino , Estenose Espinal/complicações , Estenose Espinal/psicologia , Reino Unido
19.
J Clin Neurosci ; 65: 148-150, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30975465

RESUMO

After spine fusion surgery, it is difficult to evaluate the spinal canal and nerve roots using magnetic resonance imaging (MRI) because of metallic implant-related artifacts. Digital tomosynthesis is a new radiographic technique that can acquire tomographic images with reduced metallic artifact effects compared with MRI. We report a case demonstrating the visualization of nerve roots nearby metallic implants using dynamic tomosynthesis-radiculography (DTRG) after spinal fusion surgery. A 77-year-old man, who 3 years earlier underwent spine fusion surgery at L3-L5, presented complaining of newly-onset low back pain and radicular symptoms in the right fifth lumbar (L5) nerve root area. His symptoms were exacerbated when he stood upright. We suspected right L5 nerve root radiculopathy, but MRI could not depict any lesion of the nerve root because of metallic implant-related artifacts. We performed DTRG at the right L5 nerve root with the patient in both prone and upright positions. The right L5 nerve root was detected clearly, and nerve root compression at the foramina when the patient was upright was exacerbated more than when the patient was in a prone position. DTRG is helpful to diagnose lumbar foraminal stenosis nearby metallic implants after spine fusion surgery.


Assuntos
Vértebras Lombares/cirurgia , Radiografia/métodos , Estenose Espinal/diagnóstico por imagem , Estenose Espinal/cirurgia , Idoso , Feminino , Humanos , Dor Lombar/etiologia , Região Lombossacral/patologia , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Posicionamento do Paciente , Radiculopatia/cirurgia , Canal Vertebral/patologia , Nervos Espinhais/patologia , Estenose Espinal/complicações , Tomografia Computadorizada por Raios X
20.
J Bone Joint Surg Am ; 101(7): 606-612, 2019 Apr 03.
Artigo em Inglês | MEDLINE | ID: mdl-30946194

RESUMO

BACKGROUND: Dural ossification represents a difficult problem in the surgical management of thoracic ossification of the ligamentum flavum. Few studies have focused on this condition because of the relatively low prevalence. We speculated that dural ossification occurs only when spinal stenosis of patients with thoracic ossification of the ligamentum flavum progresses. Herein, we aimed to determine the relationship between dural ossification and spinal stenosis in thoracic ossification of the ligamentum flavum. METHODS: In this study, 123 consecutive patients with ossification of the ligamentum flavum were retrospectively analyzed. Sixty-seven patients were ultimately included and were divided into a group that had dural ossification and a group that did not have dural ossification. Patient characteristics and radiographic data were recorded. The cross-sectional area occupying ratio ([1 - cross-sectional area of the narrowest level/normal cross-sectional area] × 100%) was measured and was calculated by 3 independent observers, followed by statistical analysis. RESULTS: The 2 groups were comparable with respect to sex, age, body mass index, and distribution of the segment with maximum compression. The mean cross-sectional area occupying ratio (and standard deviation) in the T9-T12 subgroup in the group with dural ossification (63.4% ± 8.6%) was significantly higher (p < 0.001) than that in the group without dural ossification (30.7% ± 10.4%). The overall interobserver reliability for measurements of the cross-sectional area occupying ratio (interclass correlation coefficient, 0.976) was excellent. Thus, the cross-sectional area occupying ratio could be used as an indicator to distinguish between patients with ossification of the ligamentum flavum who did and did not have dural ossification, with a high diagnostic value, in the T9-T12 subgroup. A cross-sectional area occupying ratio of >55% (sensitivity of 81.5% and specificity of 100%), the "ossification zone," was indicative of dural ossification in patients with ossification of the ligamentum flavum, whereas a value of <45% (sensitivity of 100% and specificity of 89.7%) was considered safe. Moreover, ratios between 45% and 55% were considered to be in the "gray zone." CONCLUSIONS: The results of this study indicate that the severity of spinal stenosis was significantly associated with dural ossification in ossification of the ligamentum flavum and the cross-sectional area occupying ratio may be used as an indicator of dural ossification in the lower thoracic spine. CLINICAL RELEVANCE: The diagnosis of dural ossification was based on the intraoperative evidence, and the results could help spine surgeons to prepare for the surgical procedure.


Assuntos
Dura-Máter/patologia , Ligamento Amarelo/patologia , Ossificação Heterotópica/diagnóstico , Ossificação Heterotópica/etiologia , Estenose Espinal/patologia , Vértebras Torácicas , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sensibilidade e Especificidade , Estenose Espinal/complicações
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