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1.
BMC Musculoskelet Disord ; 23(1): 14, 2022 Jan 03.
Artigo em Inglês | MEDLINE | ID: mdl-34980073

RESUMO

BACKGROUND: Knee replacement is a very effective and indispensable treatment option for end-stage knee arthritis, and the number of cases has been increasing worldwide. A replaced knee joint without patient joint awareness is thought to be the ultimate goal of artificial knees. Joint awareness reportedly correlates with patient satisfaction. Although numbness around a replaced knee is a minor but common problem, its effect on postoperative outcome is controversial. Joint awareness also is sensitive to subtle abnormalities of the joint, so it must be negatively affected by numbness. Although numbness is minor, it cannot be ignored to further improve knee replacement outcomes. This study investigated the relationship between patient-reported numbness and other patient-reported outcome measures (PROMs), including joint awareness, and kneeling. We developed a numbness score based on a 5-point Likert scale on frequency of numbness, with an intraclass correlation coefficient of 0.76 and higher scores indicating less numbness. METHODS: The numbness score, New Knee Society Score (KSS), Knee Injury and Osteoarthritis Outcome Score (KOOS), Forgotten Joint Score-12 (FJS-12), and other clinical and radiological data from 311 patients (394 primary knee replacements) were analyzed. Kneeling ability was evaluated by using kneeling-specific items in the KSS (KSS-Kneeling). RESULTS: No numbness was found in 170 knees (43.1%), and some degree of numbness was found in the remaining 224 knees (56.9%). The numbness score showed weak-to-moderate correlations with KSS-Symptoms (r = 0.44), KSS-Satisfaction (r = 0.41), KSS-Activities (r = 0.29), and all KOOS subscales (r = 0.23-0.44), and FJS-12 (r = 0.42). Multiple regression analyses suggested that midline incision positively affected the numbness score over the anteromedial incision (p = 0.04) and that a better numbness score (p = 0.001), male sex (p < 0.0001), and better postoperative knee flexion angle (0.04) positively affected kneeling. CONCLUSIONS: The numbness score positively correlated with PROMs and positively affected kneeling. Knee replacements performed via an anteromedial incision may be at higher risk for numbness.


Assuntos
Hipestesia , Osteoartrite do Joelho , Cicatriz , Estudos de Coortes , Humanos , Hipestesia/diagnóstico , Hipestesia/epidemiologia , Hipestesia/etiologia , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Masculino , Medidas de Resultados Relatados pelo Paciente
2.
J Med Case Rep ; 15(1): 609, 2021 Dec 24.
Artigo em Inglês | MEDLINE | ID: mdl-34949222

RESUMO

BACKGROUND: Facial onset sensory and motor neuropathy is a very rare sensorimotor disorder characterized by facial onset and gradual progression, with approximately 100 cases reported worldwide in 2020. We report on our experience with a facial onset sensory and motor neuropathy case in our outpatient pain clinic. CASE PRESENTATION: A 71-year-old Japanese man with a previous diagnosis of trigeminal nerve palsy complained of facial paresthesia, cervical pain, and arm numbness. Cervical facet arthropathy was diagnosed initially, but neither pharmacotherapy nor nerve blocking alleviated his symptoms. We suspected bulbar palsy based on the presence of tongue fasciculation, which prompted referral to a neurologist. Based on a series of neurological examinations, facial onset sensory and motor neuropathy was ultimately diagnosed. CONCLUSIONS: Pain clinicians must be mindful of rare diseases such as facial onset sensory and motor neuropathy; if they are unable to make a diagnosis, they should consult with other competent specialists.


Assuntos
Face , Clínicas de Dor , Idoso , Humanos , Hipestesia , Masculino , Exame Neurológico , Parestesia
3.
J Clin Neurosci ; 93: 112-115, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34656233

RESUMO

Decompression surgery is the most common surgical treatment for lumbar spinal stenosis (LSS). Relatively low satisfaction rate was reported. Patients often complaint of residual numbness despite significant pain relief. We hypothesized that numbness had a significant impact on patient satisfaction, but had not been evaluated, which is associated with low satisfaction rate. This study aimed to examine how much numbness is associated with patient satisfaction. We retrospectively reviewed prospectively collected data from consecutive patients who underwent decompression without fusion for LSS. We evaluated the Numeric Rating Scale (NRS) scores of low back pain (LBP), leg pain, and leg numbness preoperatively and at the final follow-up visit. Improvement was evaluated using minimum clinically important differences (MCIDs). Patient satisfaction was evaluated using the question, "How satisfied are you with the overall result of your back operation?". There are four possible answers consisting of "very satisfied (4-point)", "somewhat satisfied (3-point)", "somewhat dissatisfied (2-point)", or "very dissatisfied (1-point)". Spearman correlation was used to evaluate the association between patient satisfaction and reaching MCIDs. A total of 116 patients were included. All three components had correlation with patient satisfaction with the correlation efficient of 0.30 in LBP, 0.22 in leg pain, and 0.33 in numbness. Numbness had greatest correlation efficient value. We showed that numbness has a greater impact than leg/back pain on patient satisfaction in patients undergoing decompression for LSS. We suggest not only LBP and leg pain but also numbness should be evaluated pre- and postoperatively.


Assuntos
Dor Lombar , Estenose Espinal , Descompressão Cirúrgica , Humanos , Hipestesia/etiologia , Perna (Membro) , Dor Lombar/cirurgia , Vértebras Lombares/cirurgia , Satisfação do Paciente , Estudos Retrospectivos , Estenose Espinal/complicações , Estenose Espinal/cirurgia , Resultado do Tratamento
4.
Artigo em Russo | MEDLINE | ID: mdl-34714008

RESUMO

There are no literature data on brainstem arachnoid cysts in humans. OBJECTIVE: To describe the clinical case of brainstem (pontomesencephalic) arachnoid cyst and to analyze classification, pathogenesis, differential diagnosis and treatment of this pathology considering literature data and own experience. MATERIAL AND METHODS: A 29-year-old patient with pontomesencephalic arachnoid cyst is reported. The disease manifested in childhood with a headache aggravated by bending and pushing. Later, syncope, vegetative-visceral paroxysms, mild oculomotor disturbances, transient paresthesia and numbness of the left half of the face occurred. Headaches became significantly more severe and resulted nausea and vomiting. Magnetic resonance imaging (MRI) revealed a two-chambered arachnoid cyst. A smaller chamber was localized in interpeduncular cistern, a larger one - in brainstem. RESULTS AND DISCUSSION: Differential diagnosis included cystic glioma and Virchow-Robin space enlargement. Fenestration of the cyst wall within interpeduncular cistern was performed via right-sided pterional approach. The diagnosis was verified by histological examination. The follow-up period was 14 months. We observed postoperative cyst reduction confirmed by MR data and regression of all symptoms except for minimal signs of medial longitudinal fasciculus dysfunction. CONCLUSION: Correct surgical approach for brainstem arachnoid cyst complicated by progressive neurological deterioration is confirmed by postoperative regression of cyst and symptoms.


Assuntos
Cistos Aracnóideos , Adulto , Cistos Aracnóideos/diagnóstico por imagem , Cistos Aracnóideos/cirurgia , Tronco Encefálico/diagnóstico por imagem , Tronco Encefálico/cirurgia , Diagnóstico Diferencial , Humanos , Hipestesia , Imageamento por Ressonância Magnética
5.
Rev. colomb. anestesiol ; 49(3): e600, July-Sept. 2021. tab, graf
Artigo em Inglês | LILACS, COLNAL | ID: biblio-1280183

RESUMO

Abstract Tuberous sclerosis (TSC) is a rare disease with multi-systemic involvement, predominantly neurological. Little evidence exists about the anesthetic management of patients with this disorder, particularly in pregnant women. This article discusses a case of a patient with TSC admitted to our hospital for the delivery of a twin gestation. Twenty-four hours after surgery, the patient presented left-side facial-brachial hypoesthesia and headache. A brain CT revealed a right frontal cortical bleeding tumor, which was diagnosed as glioblastoma multiforme. The patient was discharged 15 days after admission and a neurosurgical approach was suggested.


Resumen La esclerosis tuberosa es una enfermedad poco frecuente asociada con compromiso multisistémico, principalmente neurológico. Es poca la evidencia sobre el manejo anestésico de los pacientes con este trastorno, en particular las mujeres embarazadas. En este artículo presentamos el caso de una paciente con esclerosis tuberosa ingresada en nuestro hospital para el parto de una gestación gemelar. Veinticuatro horas después de la cirugía, la paciente presentó hipoestesia facial y braquial izquierda y cefalea. La tomografía cerebral mostró un tumor cortical sangrante en el lóbulo frontal derecho, diagnosticado como glioblastoma multiforme. La paciente fue dada de alta 15 días después de su ingreso y, con recomendación de manejo por neurocirugía.


Assuntos
Humanos , Feminino , Gravidez , Cesárea , Glioblastoma , Cefaleia , Anestesia Epidural , Anestésicos , Neurocirurgia , Esclerose Tuberosa , Encéfalo , Doenças Raras , Parto , Hemorragia , Hospitais , Hipestesia , Neoplasias , Doenças do Sistema Nervoso
7.
ANZ J Surg ; 91(10): 2167-2173, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34405531

RESUMO

INTRODUCTION: The most common incision for total knee arthroplasty is the anterior midline incision; however, it is commonly associated with lateral knee numbness, kneeling difficulties and restricted flexion range. We sought to review the literature regarding the neurovascular supply and angiosomes over the anterior knee, and evaluate the anterolateral incision as a viable alternative for knee arthroplasty. METHODS: A systematic review of the literature was performed searching PUBMED, MEDLINE and EMBASE to evaluate the incisions available for total knee arthroplasty with respect to neurological function, kneeling ability and complications. RESULTS: Ten studies were identified evaluating midline or anterolateral incisions for total knee arthroplasty, with a total of 664 knees for analysis. Mean patient age was 68 years (45-88), and average length of followup was 1 year. A total of 586 had an anterior midline incision and 78 had an anterolateral incision. A total of 62% of anterior midline incisions sustained altered sensation compared to 15% (12/78) of anterolateral incisions (p < 0.0001). Incision length was similar in both groups (19.8 cm midline vs. 20.8 cm anterolateral). Wound dehiscence was not significantly different between the two groups being 8.3% for midline incisions, and 2.5% for anterolateral incisions (p = 0.153). Kneeling ability was reported in two studies which reported an improved ability to kneel with an anterolateral incision. CONCLUSIONS: The lateral parapatellar incision respects the neurovascular anatomy of the knee and offers a significant reduction in sensory changes, better kneeling ability and similar rates of wound problems to a standard midline incision and should be considered as a viable alternative for knee arthroplasty.


Assuntos
Artroplastia do Joelho , Ferida Cirúrgica , Idoso , Idoso de 80 Anos ou mais , Humanos , Hipestesia , Articulação do Joelho/cirurgia , Pessoa de Meia-Idade , Amplitude de Movimento Articular
8.
Acta Neurochir (Wien) ; 163(9): 2407-2416, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34232394

RESUMO

BACKGROUND: To investigate the causes of failure and recurrence after microvascular decompression (MVD) for trigeminal neuralgia (TGN) and to analyze the results of redo surgery. METHODS: Sixty-three cases of redo surgery were retrospectively reviewed. Reasons for re-exploration were categorized into 4 groups based on the operative findings. Patient characteristics, outcomes of re-exploration, and operative complications were analyzed by Kaplan-Meier and logistic regression analyses. RESULTS: Reasons for redo surgery were divided into arterial compression in 13 patients (21%), venous compression in 11 patients (17%), prosthesis-related in 25 patients (40%), and adhesion or negative exploration in 14 patients (22%). Immediate pain relief was obtained in 59 patients (94%) postoperatively with newly developed facial numbness in 17 patients (27%). Of these, 48 patients (76%) maintained pain-free 1 year postoperatively. Overall recurrence was noted in 17 patients (27%) during the median 49-month follow-up period. Most recurrences occurred within 1 year after redo surgery, but the prosthesis-related patients showed a continuous recurrence up to 4 years. Patients having vascular compression showed significantly better pain control than those without vascular contact in Kaplan-Meier analyses (p = 0.0421). No prognostic factor for pain-free 1 year after redo surgery was found. CONCLUSIONS: Redo surgery is effective for patients with remaining vascular compression rather than those without vascular contact. Teflon contact onto the nerve root should be avoided because it is a potential risk for recurrence and causes poor prognosis after redo surgery.


Assuntos
Cirurgia de Descompressão Microvascular , Neuralgia do Trigêmeo , Humanos , Hipestesia , Estimativa de Kaplan-Meier , Recidiva , Estudos Retrospectivos , Resultado do Tratamento , Nervo Trigêmeo/cirurgia , Neuralgia do Trigêmeo/cirurgia
10.
J Toxicol Sci ; 46(6): 303-309, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34078837

RESUMO

Methylmercury (MeHg), the causal substrate in Minamata disease, can lead to severe and chronic neurological disorders. The main symptom of Minamata disease is sensory impairment in the four extremities; however, the sensitivity of individual sensory modalities to MeHg has not been investigated extensively. In the present study, we performed stimulus-response behavioral experiments in MeHg-exposed rats to compare the sensitivities to pain, heat, cold, and mechanical sensations. MeHg (6.7 mg/kg/day) was orally administered to 9-week-old Wistar rats for 5 days and discontinued for 2 days, then administered daily for another 5 days. The four behavioral experiments were performed daily on each rat from the beginning of MeHg treatment for 68 days. The pain sensation decreased significantly from day 11 onwards, but recovered to control levels on day 48. Other sensory modalities were not affected by MeHg exposure. These findings suggest that the pain sensation is the sensory modality most susceptive to MeHg toxicity and that this sensitivity is reversible following discontinuation of the exposure.


Assuntos
Hipestesia/etiologia , Hipestesia/fisiopatologia , Intoxicação do Sistema Nervoso por Mercúrio/etiologia , Intoxicação do Sistema Nervoso por Mercúrio/fisiopatologia , Compostos de Metilmercúrio/toxicidade , Dor/fisiopatologia , Animais , Masculino , Compostos de Metilmercúrio/administração & dosagem , Ratos Wistar
11.
Pediatr Infect Dis J ; 40(8): e310-e311, 2021 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-34117202

RESUMO

The dynamics of intrafamilial spread of SARS-CoV-2 during January-February 2021 when variant B.1.1.7 predominated were compared with data from April to May 2020, when other circulating variants prevailed. Much higher intrafamilial transmission rates among all age groups, in particular in young children, and lower rates of sensory impairment were demonstrated during January-February 2021.


Assuntos
COVID-19/epidemiologia , COVID-19/virologia , SARS-CoV-2/classificação , Adolescente , COVID-19/transmissão , Criança , Pré-Escolar , Feminino , Humanos , Hipestesia/epidemiologia , Hipestesia/virologia , Lactente , Recém-Nascido , Israel/epidemiologia , Masculino , SARS-CoV-2/genética , Adulto Jovem
13.
Ann R Coll Surg Engl ; 103(6): e181-e183, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34058120

RESUMO

A 63-year-old man presented to the emergency department with low back pain, perineal and genital numbness, together with bilateral lower limb paraesthesia and urinary retention. He was admitted under the orthopaedic service for investigation of suspected cauda equina syndrome. Magnetic resonance imaging of his spine did not reveal any evidence of cauda equina compression. Magnetic resonance imaging of his brain demonstrated nonspecific multiple hyperintensities in the right frontotemporal and left temporo-occipital regions. Computed tomography of his chest, abdomen, and pelvis did not identify any evidence of malignancy. Cerebrospinal fluid from a lumbar puncture showed a high leucocyte count (predominantly lymphocytes). Viral cerebrospinal fluid polymerase chain reaction was positive for varicella zoster virus. A diagnosis of varicella zoster virus myeloradiculitis (Elsberg syndrome) was established and the patient was treated with intravenous aciclovir. Unfortunately, the patient succumbed to a devastating intracerebral haemorrhage during his inpatient stay, probably due to vasculopathy from the underlying varicella zoster virus infection. This case describes a rare infectious mimic of cauda equina syndrome. Elsberg syndrome is an infectious syndrome characterised by bilateral lumbosacral myeloradiculitis, with varicella zoster virus being a well-recognised aetiological agent. We discuss the relevant literature in detail and identify the key, cautionary lessons learned from this case.


Assuntos
Síndrome da Cauda Equina/diagnóstico , Infecções do Sistema Nervoso Central/diagnóstico , Infecção pelo Vírus da Varicela-Zoster/diagnóstico , Infecções do Sistema Nervoso Central/complicações , Diagnóstico Diferencial , Evolução Fatal , Genitália Masculina , Humanos , Hipestesia/microbiologia , Dor Lombar/microbiologia , Extremidade Inferior , Masculino , Pessoa de Meia-Idade , Parestesia/microbiologia , Períneo , Retenção Urinária/microbiologia , Infecção pelo Vírus da Varicela-Zoster/complicações
14.
R I Med J (2013) ; 104(3): 51-52, 2021 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-33789411

RESUMO

Numb Chin Syndrome (NCS) is a sensory neuropathy that was first described in the early 1800s. It has various etiologies, most commonly benign local pathology. However, NCS has been documented as the primary presenting symptom of systemic malignancy, most commonly breast cancer.1 This is the case of a young male who presented to the emergency department with complaints of a numb chin and was ultimately found to have invasive neoplastic lesions in the right tonsillar and mandibular regions of the face arising from metastatic large B-cell lymphoma.


Assuntos
Hipestesia , Neoplasias , Queixo , Humanos , Hipestesia/etiologia , Masculino
15.
Artigo em Inglês | MEDLINE | ID: mdl-33926841

RESUMO

BACKGROUND: Bilateral sagittal split osteotomy (BSSO) is one of the most frequently used treatments for jaw deformity worldwide. However, lower lip hypoesthesia is a postoperative complication of BSSO. Trigeminal somatosensory evoked potential can be used to evaluate neural pathway abnormalities by measuring latency. The purposes of this study were to measure latency before and after BSSO and to examine the relationship between latency and the duration of hypoesthesia recovery. STUDY DESIGN AND METHODS: This observational retrospective case-control study analyzed data recorded from 2013 to 2018. We divided the patient data into 5 groups according to recovery time. Using the latency obtained in trigeminal somatosensory evoked potential as the main outcome, we examined the relationship between hypoesthesia recovery time and latency. RESULTS: The group with unresolved postoperative hypoesthesia 6 months after surgery had significantly greater latency values extension than the group without postoperative hypoesthesia. CONCLUSION: By measuring the degree of prolongation of latency before and after surgery, it is possible not only to indicate the presence of hypoesthesia but also to predict the hypoesthesia recovery period.


Assuntos
Hipestesia , Prognatismo , Estudos de Casos e Controles , Potenciais Somatossensoriais Evocados , Humanos , Hipestesia/etiologia , Lábio , Mandíbula , Osteotomia , Osteotomia Sagital do Ramo Mandibular , Estudos Retrospectivos
16.
J Neurol Surg A Cent Eur Neurosurg ; 82(4): 364-368, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33845508

RESUMO

BACKGROUND AND OBJECTIVE: Trigeminal neuralgia is a common neurologic disease that seriously impacts a patient's quality of life. We retrospectively investigated the efficacy and safety of internal neurolysis (nerve combing) for trigeminal neuralgia without vascular compression. PATIENTS AND METHODS: This study was a retrospective review of all patients with trigeminal neuralgia who were admitted between January 2014 and February 2019. A subgroup of 36 patients had no vascular compression at surgery and underwent internal neurolysis. Chart review and postoperative follow-up were performed to assess the overall outcomes of internal neurolysis. RESULTS: Thirty-six patients were identified, with a mean age of 44.89 ± 7.90 (rang: 31-65) years and a disease duration of 5.19 ± 2.61 years. The immediate postoperative pain relief (Barrow Neurological Institute [BNI] pain score of I or II) rate was 100%. The medium- to long-term pain relief rate was 91.7%. Three patients experienced recurrence. Facial numbness was the primary postoperative complication. Four patients with a score of III on the BNI numbness scale immediately after surgery had marked improvement at 6 months. No serious complications occurred. CONCLUSION: Internal neurolysis is a safe and effective treatment for trigeminal neuralgia without vascular compression or clear responsible vessels.


Assuntos
Hipestesia/epidemiologia , Procedimentos Neurocirúrgicos/métodos , Dor Pós-Operatória/epidemiologia , Neuralgia do Trigêmeo/cirurgia , Adulto , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/efeitos adversos , Qualidade de Vida , Recidiva
17.
Gen Dent ; 69(3): 58-60, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33908880

RESUMO

Metastatic disease to the oral cavity is rare and often presents with ambiguous symptoms and subtle or no radiographic changes. These factors make diagnosis challenging. This article describes a case of metastatic prostate cancer to the mandible that presented as altered sensation to the gingiva, lips, and chin without radiographic evidence of pathosis noted on standard dental imaging. At the time of presentation, the patient's prostate cancer, diagnosed 9 years previously, was thought to be well-controlled with medical therapy. With additional laboratory testing and medical imaging, widespread metastatic disease was discovered. This case reinforces the importance of including metastatic disease in the differential diagnosis as well as the utility of collaboration with providers outside dentistry.


Assuntos
Parestesia , Neoplasias da Próstata , Queixo , Humanos , Hipestesia , Masculino , Mandíbula , Parestesia/diagnóstico , Parestesia/etiologia , Neoplasias da Próstata/diagnóstico , Nervo Trigêmeo
18.
Acta Neurochir (Wien) ; 163(6): 1623-1634, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33751217

RESUMO

OBJECTIVE: Common surgical treatments for trigeminal neuralgia (TN) include microvascular decompression (MVD) and percutaneous procedures (glycerol rhizolysis; thermocoagulation; and balloon compression). Although the efficacy of each procedure has been documented, direct comparisons of their relative efficacies for TN are lacking. We aimed to directly compare long-term outcomes after first-time MVD with percutaneous surgery in primary (idiopathic and classical) TN and identify predictors of outcome. METHODS: We conducted a retrospective analysis of prospectively collected data on 185 patients undergoing MVD and 129 undergoing percutaneous surgery. Procedures were performed by one of two neurosurgeons in a single centre; an independent observer collected long-term follow-up data by interviews, using the same outcome measures for all procedures. RESULTS: MVD patients were younger than those undergoing percutaneous surgery (P <.001). MVD provided superior initial pain relief (P <.001): 87.0% had Barrow Neurological Institute class I or II pain scores after MVD compared with 67.2% after percutaneous surgery. The complication rate for percutaneous procedures was 35.7% and for MVDs was 24.9% (P =.04), including minor and transient complications. Kaplan-Meier analysis demonstrated that MVD provided longer pain relief than percutaneous procedures (P <.001); 25% of patients had recurrence at 96 months following MVD compared with 12 months after percutaneous surgery. Subgroup analysis showed that balloon compression provided more durable relief amongst percutaneous procedures. Multivariate analysis revealed that post-operative numbness and age were prognostic factors for percutaneous procedures (P =.03 and .01, respectively). CONCLUSIONS: MVD provides better initial pain relief and longer durability of relief than percutaneous surgery, although carrying a small risk of major complications. Amongst percutaneous procedures, balloon compression gave the most durable relief from pain. Older age and post-operative numbness were predictors of good outcome from percutaneous surgery. These results can help clinicians to counsel patients with primary TN on neurosurgical treatment selection for pain relief.


Assuntos
Oclusão com Balão/efeitos adversos , Eletrocoagulação/efeitos adversos , Cirurgia de Descompressão Microvascular/efeitos adversos , Neuralgia do Trigêmeo/cirurgia , Adulto , Idoso , Humanos , Hipestesia/epidemiologia , Hipestesia/etiologia , Masculino , Pessoa de Meia-Idade , Dor/epidemiologia , Dor/etiologia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Neuralgia do Trigêmeo/terapia
19.
World Neurosurg ; 150: e361-e371, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33722714

RESUMO

OBJECTIVE: To investigate and compare the clinical and radiological outcomes of lumbar endoscopic unilateral laminotomy for bilateral decompression (LE-ULBD) for lumbar spinal stenosis (LSS) patients with and without degenerative spondylolisthesis (DS). METHODS: A total of 129 patients who underwent LE-ULBD for single-level LSS were retrospectively reviewed. The patients were classified into 2 groups based on the presence of DS. Clinical outcomes were assessed with the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire and numeric rating scale (NRS) for low back pain, lower limb pain, and lower limb numbness. Scores were obtained at baseline and final follow-up (mean follow-up, 28.6 months [range, 24-63 months]). RESULTS: The follow-up rate was 77.5% (103 patients). All domains of the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire and NRS evaluations significantly improved during the follow-up period in both groups; group differences were not significant except for the postoperative NRS limb numbness score, which was higher in patients with DS. The Macnab outcome classification was excellent or good in 80% of patients without DS and 77.1% of patients with DS. During the follow-up period, the increase of vertebral slip was observed in 31% of the patients with DS that includes vertebral slip progression defined as percent slip >5% in 4% of the patients. The increase of vertebral slip was not related to a clinical outcome. Segmental motion of the affected intervertebral disc did not increase after surgery. CONCLUSIONS: LE-ULBD provides a comparably favorable outcome in LSS patients with and without DS. Postoperative segmental instability did not occur in patients with DS.


Assuntos
Descompressão Cirúrgica/métodos , Endoscopia/métodos , Degeneração do Disco Intervertebral/cirurgia , Laminectomia/métodos , Região Lombossacral/cirurgia , Procedimentos Neurocirúrgicos/métodos , Estenose Espinal/cirurgia , Espondilolistese/cirurgia , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Hipestesia/etiologia , Degeneração do Disco Intervertebral/complicações , Degeneração do Disco Intervertebral/diagnóstico por imagem , Dor Lombar/cirurgia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Estenose Espinal/complicações , Estenose Espinal/diagnóstico por imagem , Espondilolistese/complicações , Espondilolistese/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Resultado do Tratamento
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