Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.319
Filtrar
1.
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
2.
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
3.
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
4.
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
5.
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
6.
J Vet Intern Med ; 33(5): 2167-2174, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31381186

RESUMO

BACKGROUND: Development of management strategies for lumbosacral stenosis in dogs is hampered by the lack of objective diagnostic criteria and outcome measures. OBJECTIVE: To explore the suitability of electrodiagnostic tests as ancillary diagnostic aids, inclusion criteria, or outcome measures. SAMPLE POPULATION: Sixty-one client-owned dogs with clinical signs of lumbosacral foraminal stenosis. METHODS: A blinded, cross-sectional cohort study. Fifty-one dogs exhibiting apparent lumbosacral pain or pelvic limb lameness with no detected orthopedic cause had blinded review of magnetic resonance imaging (MRI), allowing classification as affected with foraminal stenosis (25 dogs), unaffected (20 dogs), or another diagnosis (6 dogs). The presence of electromyographic changes and tibial neurography variables were compared between groups. RESULTS: Cord dorsum potential onset latency, F-wave onset latency (both corrected for limb length), and F-ratio were increased in dogs with lumbosacral foraminal stenosis versus those without, although there was overlap of the values between groups. The proportion of dogs with electromyographic changes was not significantly greater in MRI-affected dogs. CONCLUSION: Electrophysiological testing is a useful ancillary test, either to provide stricter inclusion criteria and outcome measures or to aid clinical decision-making in equivocal cases.


Assuntos
Doenças do Cão/diagnóstico , Eletromiografia/veterinária , Estenose Espinal/veterinária , Animais , Dor nas Costas/diagnóstico , Dor nas Costas/veterinária , Estudos Transversais , Cães , Coxeadura Animal/diagnóstico , Região Lombossacral/patologia , Imagem por Ressonância Magnética/veterinária , Estenose Espinal/diagnóstico
7.
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
8.
Medicine (Baltimore) ; 98(29): e16396, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31335689

RESUMO

RATIONALE: Cauda equina syndrome (CES) refers to a group of symptoms that occur when the nerves in the cauda equina become compressed or damaged. The most common etiology of CES is lumbar intervertebral disc herniation, but CES following lumbar spinal surgery is rare, especially without motor dysfunction. Herein, we illustrate a case of CES that developed as a complication of spinal surgery and to deduce its possible underlying cause. PATIENT CONCERNS: A 46-year-old man experienced lumbago, bilateral shank pain, and numbness with neurogenic claudication for 3 years due to degenerative lumbar disc herniation and spinal cord stenosis. After a thorough examination to diagnose lumbar spinal stenosis, the patient underwent bilateral decompression and pedicle screw system internal fixation with bone graft. Postoperatively, the patient showed regained strength in his bilateral shanks, and he did not complain of lumbago and shank pain, but CES occurred, which manifested as underpants-type numbness in the perineum without bladder, anal, and motor dysfunction. DIAGNOSES: CES as a postoperative complication of lumbar stenosis. INTERVENTIONS: The patient underwent bilateral laminectomies, partial facetectomies, and pedicle screw system internal fixation and fusion with bone graft. Postoperatively, the patient performed adequate rehabilitation exercises and was expected to recover spontaneously. OUTCOMES: The symptoms of pain and claudication resolved after 3 weeks in the hospital, but an underpants-type hypoesthesia in the perineum without motor dysfunction developed. The patient experienced full recovery from CES 6 months after surgery. LESSONS: CES as a complication of lumbar spinal surgery is very rare. Excessive sensitivity to the traction of the dural sac was, in our opinion, the most possible cause of postoperative CES in this case. When the nerve root is pulled intraoperatively, it is best not to cross the central line of the spinous process. The plane of the nerve retractor needs to be parallel to the dural sac at the pulling point to reduce the formation of shear force. Most importantly, gentle maneuver is required because sensitivity to the traction of the dural sac varies individually.


Assuntos
Síndrome da Cauda Equina , Laminectomia , Vértebras Lombares/cirurgia , Complicações Pós-Operatórias , Fusão Vertebral , Estenose Espinal , Síndrome da Cauda Equina/diagnóstico , Síndrome da Cauda Equina/etiologia , Síndrome da Cauda Equina/fisiopatologia , Humanos , Degeneração do Disco Intervertebral/complicações , Degeneração do Disco Intervertebral/diagnóstico , Degeneração do Disco Intervertebral/fisiopatologia , Deslocamento do Disco Intervertebral/complicações , Deslocamento do Disco Intervertebral/diagnóstico , Deslocamento do Disco Intervertebral/fisiopatologia , Laminectomia/efeitos adversos , Laminectomia/métodos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/fisiopatologia , Fusão Vertebral/efeitos adversos , Fusão Vertebral/métodos , Estenose Espinal/diagnóstico , Estenose Espinal/etiologia , Estenose Espinal/fisiopatologia , Estenose Espinal/cirurgia , Resultado do Tratamento
9.
World Neurosurg ; 130: 231-234, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31301444

RESUMO

BACKGROUND: The occurrence of adjacent-level disease in spinal fusion is a complex and contentious issue. Through the years, surgeons have developed various approaches to address this problem. While some have avoided fusion altogether, others have advocated for large, multilevel fusion constructs. With the advent of minimally invasive spine surgery, there are now novel approaches to the spine which allow for less onerous and morbid revision surgeries. In this paper, we present the case of a woman who previously underwent a posterior cervical fusion and presented with adjacent-level disease. CASE DESCRIPTION: A 63-year-old female who had previously undergone a cervical 5 to thoracic 1 posterior instrumented fusion presented with axial neck pain, hand numbness, and imbalance. Imaging demonstrated adjacent-level disease with anterolisthesis of cervical 4 on cervical 5. Rather than exposing her entire fusion construct, we used a new technique to link her old hardware to new instrumentation. CONCLUSIONS: We believe that our case is demonstrative of a new, modularized approach to spinal fusion and suggest a way forward in the treatment of adjacent-level disease.


Assuntos
Vértebras Cervicais/cirurgia , Reoperação , Fusão Vertebral , Estenose Espinal/cirurgia , Feminino , Humanos , Vértebras Lombares/cirurgia , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos , Próteses e Implantes , Reoperação/métodos , Doenças da Coluna Vertebral/cirurgia , Fusão Vertebral/métodos , Estenose Espinal/diagnóstico
10.
Int Immunopharmacol ; 74: 105705, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31228814

RESUMO

OBJECTIVE: Surgical site infection (SSI) is a common complication in patients following posterior lumbar spinal surgery. Various laboratory data such as laboratory parameters derived neutrophil/lymphocyte count ratio (NLR), have been applied for the prediction of SSI, but more studies are necessary to evaluate the significance of these indicators. Here, our study aims to investigate the predictive value of total white blood cells (WBCs), count and percentages of neutrophils and leukocytes, NLR, and C-reactive protein (CRP) for surgical site infection (SSI) in patients after posterior lumbar spinal surgery. METHODS: A total of 293 patients who underwent posterior lumbar spinal surgery were enrolled in this study. Each patient's medical history was retrospectively reviewed, and patients were divided into the deep SSI group (n = 13) and the non-SSI group (n = 280). Laboratory data including total WBC, count and percentages of neutrophils and leukocytes, NLR at 1 week before the operation and the 4 and 7 days post-operation, and CRP at 4 and 7 days post-operation were analysed between the SSI and non-SSI groups. Moreover, predictive power and cut-off of NLR for SSI were determined by receiver operating characteristic curve (ROC) results. RESULTS: Data revealed that the medians of NLR were markedly increased in the SSI group as compared to that in non-SSI group at 4 days (p = 0.011) and 7 days (p = 0.047) post-operation. Moreover, the neutrophil percentage was also dramatically increased in the SSI group at both 4 and 7 days post-operation (p = 0.010 and p = 0.030) respectively compared to the non-SSI group. However, no significant difference was observed between the groups 1 week before the operation. ROC results showed that NLR at 4 days (cut-off >5.19; sensitivity: 61.5%; specificity: 77.6%; AUC = 0.708) and 7 days (cut-off >3.85; sensitivity: 69.2%; specificity: 62.7%; AUC = 0.663) post-operation could significantly discriminate the SSI and non-SSI groups. Logistic regression analysis showed that NLR at both post-operative time points (OR = 1.218; p = 0.003 and OR = 1.296; p = 0.048) could be valuable predictors for SSI. CONCLUSION: NLR at 4 and 7 days post-operation are valuable laboratory predictors for SSI in patients with posterior lumbar spinal surgery.


Assuntos
Laminectomia/efeitos adversos , Contagem de Leucócitos/métodos , Linfócitos/patologia , Neutrófilos/patologia , Estenose Espinal/diagnóstico , Infecção da Ferida Cirúrgica/diagnóstico , Adulto , Idoso , Proteína C-Reativa/metabolismo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estenose Espinal/cirurgia
11.
BMC Musculoskelet Disord ; 20(1): 288, 2019 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-31202276

RESUMO

BACKGROUND: The purpose of this systematic review was to evaluate the accuracy and reliability of wearable devices for objective gait measurement of Lumbar Spinal Stenosis (LSS) patients, with a focus on relevant gait metrics. METHODS: Systematic searches were conducted of five electronic databases to identify studies that assessed gait metrics by wearable or portable technology. Data was collected according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement guidelines. RESULTS: Four articles were identified for inclusion in this review. The objectives, methodology and quality of the studies varied. No single gait metric was investigated in all four studies, making comparison difficult. The most relevant metrics reported included gait cycle, gait velocity, step length and cadence, which were reported in two studies. Two studies explored gait symmetry. Differences between LSS patients and normal healthy subjects are demonstrable using wearable technology. CONCLUSIONS: The measurements of gait cycle, cadence, step length, gait velocity, and number of steps with wearable devices can be used in the gait measurement of LSS patients for initial assessment, and objective outcomes following interventions. However, data and analysis are limited, and further studies are necessary to comment on reliability.


Assuntos
Análise da Marcha/instrumentação , Vértebras Lombares , Estenose Espinal/diagnóstico , Dispositivos Eletrônicos Vestíveis , Humanos , Reprodutibilidade dos Testes , Estenose Espinal/fisiopatologia , Estenose Espinal/cirurgia , Resultado do Tratamento
12.
Spine (Phila Pa 1976) ; 44(13): E800-E807, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31205178

RESUMO

STUDY DESIGN: Retrospective analysis. OBJECTIVE: To investigate sex differences in opioid use after lumbar decompression and fusion surgery for patients with symptomatic lumbar stenosis or spondylolisthesis. SUMMARY OF BACKGROUND DATA: Recent studies have demonstrated higher prevalence of chronic pain states and greater pain sensitivity among women compared with men. Furthermore, differences in responsivity to pharmacological and non-pharmacological treatments have been observed. Whether sex differences in perioperative opioid use exists in patients undergoing lumbar fusion for symptomatic stenosis or spondylolisthesis remains unknown. METHODS: An insurance database, including private/commercially insured and Medicare Advantage beneficiaries, was queried for patients with symptomatic lumbar stenosis or spondylolisthesis undergoing index 1,2, or 3-level index lumbar decompression and fusion procedures between 2007 and 2016. Records were searchable by International Classification of diseases diagnosis and procedure codes, and generic drug codes specific to Humana. Opioid use 6-months prior to through 2-years after index surgery was assessed. The primary outcome was sex differences in opioid use after index lumbar surgery. The secondary outcome was independent predictors of prolonged opioid use after lumbar fusion. RESULTS: Of the 13,257 participants (females: 7871, 59.8%), 58.4% of women used opioids compared with 56.9% of men prior to index surgery. At 1-year after surgery, continuous opioid use was observed in 67.1% of women compared with 64.2% of men (P < 0.001). Within 2-years postoperatively, opioid use was observed in 83.1% of women versus 82.5% men. In a multivariate logistic regression analysis, female sex (odds ration [OR] 1.14, 95% confidence interval [CI]: 1.058-1.237), obesity (OR 1.10, 95% CI: 1.004-1.212), and preoperative narcotic use (OR 3.43, 95% CI: 3.179-3.708) was independently associated with prolonged (>1 yr) opioid use after index surgery. CONCLUSION: We observed a higher prevalence of chronic opioid use among women following lumbar fusion surgery. Female sex was independently associated with prolonged opioid use after index surgery. LEVEL OF EVIDENCE: 3.


Assuntos
Descompressão Cirúrgica/efeitos adversos , Vértebras Lombares/cirurgia , Transtornos Relacionados ao Uso de Opioides , Caracteres Sexuais , Fusão Vertebral/efeitos adversos , Estenose Espinal/cirurgia , Espondilolistese/cirurgia , Adulto , Idoso , Analgésicos Opioides/efeitos adversos , Analgésicos Opioides/uso terapêutico , Descompressão Cirúrgica/tendências , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos Relacionados ao Uso de Opioides/diagnóstico , Transtornos Relacionados ao Uso de Opioides/etiologia , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/etiologia , Estudos Retrospectivos , Fusão Vertebral/tendências , Estenose Espinal/diagnóstico , Estenose Espinal/tratamento farmacológico , Espondilolistese/diagnóstico , Espondilolistese/tratamento farmacológico
13.
J Stroke Cerebrovasc Dis ; 28(7): e104-e105, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31103550

RESUMO

Remote cerebellar hemorrhage is rare but potentially fatal complication of cranial and spinal surgeries. The pathophysiology of this condition following spinal surgery is thought to be related to venous bleeding from cerebellar sagging and cerebrospinal fluid (CSF) hypotension. Most reported cases in the literature following spinal surgery involve intraoperative CSF leakage. We present a case of remote cerebellar hemorrhage following uncomplicated lumbar spinal decompression and fusion without CSF leakage.


Assuntos
Descompressão Cirúrgica/efeitos adversos , Hemorragias Intracranianas/etiologia , Fusão Vertebral/efeitos adversos , Estenose Espinal/cirurgia , Craniectomia Descompressiva , Feminino , Humanos , Hemorragias Intracranianas/diagnóstico por imagem , Hemorragias Intracranianas/cirurgia , Pessoa de Meia-Idade , Estenose Espinal/diagnóstico , Tomografia Computadorizada por Raios X , Resultado do Tratamento
14.
Orthopade ; 48(10): 816-823, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31101963

RESUMO

BACKGROUND: Lumbar spinal stenosis is caused by various pathological conditions. With the diagnostic tools available, a precise classification of the condition should be made, which enables a consistent and appropriate therapeutic approach. OBJECTIVES: In the present article, the currently used classifications of lumbar spinal stenosis are discussed and the diagnostic tools are presented, focussing on the imaging descriptions of morphological changes. MATERIALS AND METHODS: This article is based on a PubMed literature search of the past 60 years and our own experiences. RESULTS: Lumbar spinal stenosis is caused mainly by degenerative changes to the spine. MR tomographic imaging can result in precise anatomical illustration and classification of the stenosis. CONCLUSIONS: Although modern imaging procedures deliver a very precise illustration of lumbar spinal stenosis, clinical symptoms make a considerable contribution to therapeutic decision-making. With the anatomical classification, differentiated surgical decompression of the spinal canal can be planned.


Assuntos
Vértebras Lombares/diagnóstico por imagem , Imagem por Ressonância Magnética , Estenose Espinal/classificação , Estenose Espinal/diagnóstico , Descompressão Cirúrgica , Humanos , Canal Vertebral , Estenose Espinal/cirurgia
15.
World Neurosurg ; 122: e591-e597, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-31108075

RESUMO

OBJECTIVE: The main objective was to compare estimated walking perimeter (WP) and actual WP during a free walking test (6-minute walk test [6MWT]) in patients with lumbar spinal stenosis (LSS). The second objective was to describe the correlation between measured gait parameters and functional parameters. METHODS: This was a single-center prospective study including 38 patients with symptomatic LSS (23 men, 15 women; mean age, 69.3 ± 7.9 years). The intervention was the 6MWT. For the main outcome measure, patients were first asked to verbally estimate their WP. Then, WP was evaluated using a 6MWT at a self-selected speed. In the absence of need to stop, and if a distance of 500 m was not reached, the test was extended to this distance. Specific functional scores (Oswestry Disability Index and Quebec Back Pain Disability Scale) were recorded, and a quality of life questionnaire was completed. RESULTS: WP was estimated to be less than 500 m in 21 of 38 patients, but only 7 patients actually stopped walking before reaching 500 m. The median estimate error in these patients was 200 m (interquartile range, 65-250). The shorter the estimated distance was, the greater the estimation error (r = -0.63, P=0.002). The average walking speed was slow. Functional parameters (Oswestry Disability Index and Quebec Back Pain Disability Scale) were weakly and inversely correlated with real WP (r = -0.44 and r = -0.31, respectively) and moderately inversely correlated with measured walking speed (r = -0.51, P = 0.001 for both). CONCLUSIONS: Direct measurement of free walking speed should be considered as a valid functional assessment in current practice for patients with LSS instead of estimated WP. To assist therapeutic decision-making, the most relevant type of walking test (duration, distance, velocity) needs to be determined.


Assuntos
Estenose Espinal/diagnóstico , Velocidade de Caminhada , Idoso , Feminino , Humanos , Vértebras Lombares , Masculino , Estudos Prospectivos , Estenose Espinal/fisiopatologia , Teste de Caminhada
17.
Ugeskr Laeger ; 181(9)2019 Feb 25.
Artigo em Dinamarquês | MEDLINE | ID: mdl-30799808

RESUMO

Lumbar spinal stenosis is a clinical diagnosis of pain in the buttocks or lower extremities, with or without back pain. Symptoms increase with walking, and patients find relief when sitting or flexing the spine. Clinical care and research are complicated by the heterogeneity of the condition and high rates of anatomic stenosis on imaging studies in older people, who are completely asymptomatic. In Denmark, most patients with mild to moderate symptoms are treated in primary care. Patients with severe disability and no effect of non-surgical treatment may need referral to secondary care and surgery.


Assuntos
Vértebras Lombares , Estenose Espinal/diagnóstico , Estenose Espinal/terapia , Humanos , Estenose Espinal/complicações
18.
BMC Musculoskelet Disord ; 20(1): 36, 2019 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-30669998

RESUMO

BACKGROUND: Spinal stenosis is a clinical diagnosis in which the main symptom is pain radiating to the lower extremities, or neurogenic claudication. Radiological spinal stenosis is commonly observed in the population and it is debated whether patients with no lower extremity pain should be labelled as having spinal stenosis. However, these patients is found in the Norwegian Registry for Spine Surgery, the main object of the present study was to compare the clinical outcomes after decompressive surgery in patients with insignificant lower extremity pain, with those with more severe pain. METHODS: This study is based on data from the Norwegian Registry for Spine Surgery (NORspine). Patients who had decompressive surgery in the period from 7/1-2007 to 11/3-2013 at 31 hospitals were included. The patients was divided into four groups based on preoperative Numeric Rating Scale (NRS)-score for lower extremity pain. Patients in group 1 had insignificant pain, group 2 had mild or moderate pain, group 3 severe pain and group 4 extremely severe pain. The primary outcome was change in the Oswestry Disability Index (ODI). Successfully treated patients were defined as patients reporting at least 30% reduction of baseline ODI, and the number of successfully treated patients in each group were recorded. RESULTS: In total, 3181 patients were eligible; 154 patients in group 1; 753 in group 2; 1766 in group 3; and 528 in group 4. Group 1 had significantly less improvement from baseline in all the clinical scores 12 months after surgery compared to the other groups. However, with a mean reduction of 8 ODI points and 56% of patients showing a reduction of at least 30% in their ODI score, the proportion of patients defined as successfully treated in group 1, was not significantly different from that of other groups. CONCLUSION: This national register study shows that patients with insignificant lower extremity pain had less improvement in primary and secondary outcome parameters from baseline to follow-up compared to patients with more severe lower extremity pain.


Assuntos
Descompressão Cirúrgica/tendências , Extremidade Inferior , Vértebras Lombares/cirurgia , Medição da Dor/tendências , Sistema de Registros , Estenose Espinal/cirurgia , Idoso , Estudos de Coortes , Descompressão Cirúrgica/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Noruega/epidemiologia , Medição da Dor/métodos , Estudos Prospectivos , Estenose Espinal/diagnóstico , Estenose Espinal/epidemiologia , Resultado do Tratamento
19.
BMC Musculoskelet Disord ; 20(1): 31, 2019 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-30658613

RESUMO

BACKGROUND: Assessment of outcomes for spinal surgeries is challenging, and an ideal measurement that reflects all aspects of importance for the patients does not exist. Oswestry Disability Index (ODI), EuroQol (EQ-5D) and Numeric Rating Scales (NRS) for leg pain and for back pain are commonly used patients reported outcome measurements (PROMs). Reporting the proportion of individuals with an outcome of clinical importance is recommended. Knowledge of the ability of PROMs to identify clearly improved patients is essential. The purpose of this study was to search cut-off criteria for PROMs that best reflect an improvement considered by the patients to be of clinical importance. METHODS: The Global Perceived Effect scale was utilized to evaluate a clinically important outcome 12 months after surgery. The cut-offs for the PROMs that most accurately distinguish those who reported 'completely recovered' or 'much improved' from those who reported 'slightly improved', unchanged', 'slightly worse', 'much worse', or 'worse than ever' were estimated. For each PROM, we evaluated three candidate response parameters: the (raw) follow-up score, the (numerical) change score, and the percentage change score. RESULTS: We analysed 3859 patients with Lumbar Spinal Stenosis [(LSS); mean age 66; female gender 50%] and 617 patients with Lumbar Degenerative Spondylolisthesis [(LDS); mean age 67; 72% female gender]. The accuracy of identifying 'completely recovered' and 'much better' patients was generally high, but lower for EQ-5D than for the other PROMs. For all PROMs the accuracy was lower for the change score than for the follow-up score and the percentage change score, especially among patients with low and high PROM scores at baseline. The optimal threshold for a clinically important outcome was ≤24 for ODI, ≥0.69 for EQ-5D, ≤3 for NRS leg pain, and ≤ 4 for NRS back pain, and, for the percentage change score, ≥30% for ODI, ≥40% for NRS leg pain, and ≥ 33% for NRS back pain. The estimated cut-offs were similar for LSS and for LDS. CONCLUSION: For estimating a 'success' rate assessed by a PROM, we recommend using the follow-up score or the percentage change score. These scores reflected a clinically important outcome better than the change score.


Assuntos
Vértebras Lombares/cirurgia , Medição da Dor/tendências , Medidas de Resultados Relatados pelo Paciente , Sistema de Registros , Estenose Espinal/cirurgia , Espondilolistese/cirurgia , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Noruega/epidemiologia , Medição da Dor/métodos , Estenose Espinal/diagnóstico , Estenose Espinal/epidemiologia , Espondilolistese/diagnóstico , Espondilolistese/epidemiologia , Resultado do Tratamento
20.
JAMA Netw Open ; 2(1): e186828, 2019 01 04.
Artigo em Inglês | MEDLINE | ID: mdl-30646197

RESUMO

Importance: Lumbar spinal stenosis (LSS) is the most common reason for spine surgery in older US adults. There is an evidence gap about nonsurgical LSS treatment options. Objective: To explore the comparative clinical effectiveness of 3 nonsurgical interventions for patients with LSS. Design, Setting, and Participants: Three-arm randomized clinical trial of 3 years' duration (November 2013 to June 2016). Analysis began in August 2016. All interventions were delivered during 6 weeks with follow-up at 2 months and 6 months at an outpatient research clinic. Patients older than 60 years with LSS were recruited from the general public. Eligibility required anatomical evidence of central canal and/or lateral recess stenosis (magnetic resonance imaging/computed tomography) and clinical symptoms associated with LSS (neurogenic claudication; less symptoms with flexion). Analysis was intention to treat. Interventions: Medical care, group exercise, and manual therapy/individualized exercise. Medical care consisted of medications and/or epidural injections provided by a physiatrist. Group exercise classes were supervised by fitness instructors in senior community centers. Manual therapy/individualized exercise consisted of spinal mobilization, stretches, and strength training provided by chiropractors and physical therapists. Main Outcomes and Measures: Primary outcomes were between-group differences at 2 months in self-reported symptoms and physical function measured by the Swiss Spinal Stenosis questionnaire (score range, 12-55) and a measure of walking capacity using the self-paced walking test (meters walked for 0 to 30 minutes). Results: A total of 259 participants (mean [SD] age, 72.4 [7.8] years; 137 women [52.9%]) were allocated to medical care (88 [34.0%]), group exercise (84 [32.4%]), or manual therapy/individualized exercise (87 [33.6%]). Adjusted between-group analyses at 2 months showed manual therapy/individualized exercise had greater improvement of symptoms and physical function compared with medical care (-2.0; 95% CI, -3.6 to -0.4) or group exercise (-2.4; 95% CI, -4.1 to -0.8). Manual therapy/individualized exercise had a greater proportion of responders (≥30% improvement) in symptoms and physical function (20%) and walking capacity (65.3%) at 2 months compared with medical care (7.6% and 48.7%, respectively) or group exercise (3.0% and 46.2%, respectively). At 6 months, there were no between-group differences in mean outcome scores or responder rates. Conclusions and Relevance: A combination of manual therapy/individualized exercise provides greater short-term improvement in symptoms and physical function and walking capacity than medical care or group exercises, although all 3 interventions were associated with improvements in long-term walking capacity. Trial Registration: ClinicalTrials.gov Identifier: NCT01943435.


Assuntos
Tratamento Conservador/métodos , Terapia por Exercício/métodos , Injeções Epidurais/métodos , Vértebras Lombares/diagnóstico por imagem , Conduta do Tratamento Medicamentoso/estatística & dados numéricos , Manipulações Musculoesqueléticas/métodos , Estenose Espinal , Idoso , Instituições de Assistência Ambulatorial/estatística & dados numéricos , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Estenose Espinal/diagnóstico , Estenose Espinal/terapia , Tomografia Computadorizada por Raios X/métodos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA