Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 5.445
Filtrar
1.
BMC Musculoskelet Disord ; 22(1): 777, 2021 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-34511102

RESUMO

BACKGROUND: Biomechanical studies have demonstrated that uncovertebral joint contributes to segment mobility and stability to a certain extent. Simultaneously, osteophytes arising from the uncinate process are a common cause of cervical spondylotic radiculopathy (CSR). For such patients, partial uncinatectomy (UT) may be required. However, the clinical efficacy and sagittal alignment of partial UT during anterior cervical discectomy and fusion (ACDF) have not been fully elucidated. METHODS: A total of 87 patients who had undergone single level ACDF using a zero-profile device from July 2014 to December 2018 were included. Based on whether the foraminal part of the uncovertebral joint was resected or preserved, the patients were divided into the ACDF with UT group (n = 37) and the ACDF without UT group (n = 50). Perioperative data, radiographic parameters, clinical outcomes, and complications were compared between the two groups. RESULTS: The mean follow-up was 16.86 ± 5.63 and 18.36 ± 7.51 months in the ACDF with UT group and ACDF without UT group, respectively (p > 0.05). The average preoperative VAS arm score was 5.89 ± 1.00 in the ACDF with UT group and 5.18 ± 1.21 in the ACDF without UT group (p = 0.038). However, the average VAS arm score was 4.22 ± 0.64, 4.06 ± 1.13 and 1.68 ± 0.71, 1.60 ± 0.70 at 1 week post operation and at final follow up, respectively, (p > 0.05). We also found that the C2-7 SVA and St-SVA at the last follow-up and their change (last follow-up value - preoperative value) in the ACDF with UT group were significantly higher than ACDF without UT group (p < 0.05). No marked differences in the other cervical sagittal parameters, fusion rate or complications, including dysphagia, ASD, and subsidence, were observed. CONCLUSIONS: Our result indicates that ACDF using a zero-p implant with or without partial UT both provide satisfactory clinical efficacy and acceptable safety. However, additional partial UT may has a negative effect on cervical sagittal alignment.


Assuntos
Radiculopatia , Fusão Vertebral , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Discotomia/efeitos adversos , Seguimentos , Humanos , Radiculopatia/diagnóstico por imagem , Radiculopatia/cirurgia , Estudos Retrospectivos , Fusão Vertebral/efeitos adversos , Resultado do Tratamento
2.
Neurol India ; 69(4): 910-915, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34507411

RESUMO

Objective: This study aims to evaluate the effects of transforaminal epidural steroid injection (TFESI) on neuropathic pain (NP) in patients with chronic unilateral radiculopathy due to lumbar disc herniation (LDH). Patients and Methods: Between September 2018 and April 2019, a total of 61 patients who were diagnosed with unilateral/unilevel radiculopathy due to LDH and were scheduled for single-level TFESI were included in this study. The Numeric Rating Scale (NRS), modified Oswestry Disability Index (ODI), Beck Depression Inventory (BDI), and NP-Douleur Neuropathique 4 Questionnaire (DN4) were used before the procedure and at 1 hour, 3 weeks, and 3 months after the procedure. Results: There was a significant decrease in the NRS and significant improvement in the ODI, BDI, and DN4 scores in all patients at all postprocedural timepoints (P < 0.05). The number of patients with NP decreased from 35 (60.3%) at baseline to 23 (41.2%) at 3 months (P = 0.001). The NRS scores were similar at 3 weeks and 3 months between the patients with and without NP (P > 0.05). The ODI scores were significantly higher at 3 months in the patients with NP than those without NP (P = 0.013). The BDI scores at baseline, 3 weeks, and 3 months were significantly higher in the patients with NP than those without NP (P < 0.001, P = 0.016, and P = 0.016, respectively). Conclusion: Our study results suggest that TFESI is an effective and safe method to decrease not only nociceptive but also NP component in patients with chronic radiculopathy due to LDH. Clinicians should keep in mind that NP is a risk factor that adversely affects the TFESI success and patients should be evaluated before the procedure.


Assuntos
Deslocamento do Disco Intervertebral , Neuralgia , Radiculopatia , Humanos , Injeções Epidurais , Deslocamento do Disco Intervertebral/complicações , Deslocamento do Disco Intervertebral/tratamento farmacológico , Vértebras Lombares , Neuralgia/tratamento farmacológico , Neuralgia/etiologia , Estudos Prospectivos , Radiculopatia/tratamento farmacológico , Esteroides/uso terapêutico , Resultado do Tratamento
3.
Trials ; 22(1): 607, 2021 Sep 08.
Artigo em Inglês | MEDLINE | ID: mdl-34496941

RESUMO

BACKGROUND: Cervical radiculopathy is the most common disease in the cervical spine, affecting patients around 50-55 year of age. An operative treatment is common clinical praxis when non-operative treatment fails. The controversy is in the choice of operative treatment, conducting either anterior cervical decompression and fusion or posterior foraminotomy. The study objective is to evaluate short- and long-term outcome of anterior cervical decompression and fusion (ACDF) and posterior foraminotomy (PF) METHODS: A multicenter prospective randomized controlled trial with 1:1 randomization, ACDF vs. PF including 110 patients. The primary aim is to evaluate if PF is non-inferior to ACDF using a non-inferiority design with ACDF as "active control." The neck disability index (NDI) is the primary outcome measure, and duration of follow-up is 2 years. DISCUSSION: Due to absence of high level of evidence, the authors believe that a RCT will improve the evidence for using the different surgical treatments for cervical radiculopathy and strengthen current surgical treatment recommendation. TRIAL REGISTRATION: ClinicalTrials.gov NCT04177849. Registered on November 26, 2019.


Assuntos
Foraminotomia , Radiculopatia , Fusão Vertebral , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Descompressão , Discotomia , Foraminotomia/efeitos adversos , Humanos , Estudos Multicêntricos como Assunto , Estudos Prospectivos , Radiculopatia/diagnóstico , Radiculopatia/cirurgia , Ensaios Clínicos Controlados Aleatórios como Assunto , Fusão Vertebral/efeitos adversos , Resultado do Tratamento
4.
Medicine (Baltimore) ; 100(31): e26790, 2021 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-34397831

RESUMO

ABSTRACT: Hypertrophy of the uncinate process (UP) can cause radiculopathy. Minimal UP resection is considered to remove the lesion while minimizing the risk of complications. This study aimed to elucidate the surgical results of minimal oblique resection of the UP. This study is a retrospective review of about sixty segments in 34 patients who underwent anterior cervical discectomy and fusion (ACDF) with minimal oblique uncinectomy between 2016 and 2018. The cross-sectional area of the UP was measured pre- and postoperatively. The interspinous distance, segmental Cobb angle, subsidence, fusion rate, surgical time, estimated blood loss, and postoperative complications were evaluated. The mean resected areas of the UP were 17.4 ±â€Š8.7 mm2 (25.9%) on the right and 17.3 ±â€Š11.2 mm2 (26.2%) on the left. The difference in interspinous distance in flexion-extension was 7.1 ±â€Š3.2 and 1.6 ±â€Š0.6 mm pre- and postoperatively, respectively (P = .000). The fusion rate after ACDF was 91.7% when measured according to segment (55/60) and 91.2% when measured according to patients (31/34). The difference in the segmental Cobb angle in flexion-extension was 8.3 ±â€Š6.2° and 1.9 ±â€Š0.3° pre and postoperatively, respectively (P = .000). Subsidence occurred in 4 (11.8%) patients and 5 (8.3%) segments. The average surgical time per segment was 68.8 ±â€Š9.3 minute, and the estimated blood loss was 48.5 ±â€Š25.0 mL. Postoperative complications comprised 1 case each of neck swelling, wound infection, pneumonia, and gastrointestinal bleeding. Our findings therefore revealed that minimal oblique uncinectomy during an ACDF can maintain the stability of the uncovertebral joint while sufficiently decompressing the neural foramen.


Assuntos
Vértebras Cervicais , Discotomia , Complicações Pós-Operatórias , Radiculopatia , Doenças da Coluna Vertebral/cirurgia , Fusão Vertebral , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Descompressão Cirúrgica/métodos , Discotomia/efeitos adversos , Discotomia/métodos , Feminino , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Radiculopatia/etiologia , Radiculopatia/prevenção & controle , República da Coreia/epidemiologia , Estudos Retrospectivos , Risco Ajustado/métodos , Fusão Vertebral/efeitos adversos , Fusão Vertebral/métodos , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
5.
Medicine (Baltimore) ; 100(31): e26824, 2021 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-34397845

RESUMO

BACKGROUND: Cervical spondylotic radiculopathy (CSR) is one of the most common types of cervical spondylosis, and its treatments are mainly for relieving radicular pain and improving dysfunction. The existing randomized controlled trials (RCTs) suggest that fire needle may be a potential therapy in the treatment of CSR, but there is no evidence-based medical evidence to date. Therefore, this study will systematically evaluate the efficacy and safety of fire needle in the treatment of CSR. METHODS: We will search for 7 electronic databases (PubMed, EMBASE, Cochrane library, China National Knowledge Infrastructure, Chinese Scientific Journals Database, Sinomed, and Wanfang Database) and 2 trial registration platforms (ClinicalTrials.gov and Chinese Clinic Trials.gov) to collect eligible studies. The RCTs related to fire needle for CSR and published up to June 30, 2021 will be included, regardless of language. We will consider the visual analogue scale as the primary outcome and the secondary outcome will include cervical range of motion, assessment of muscle strength, neck disability index, the MOS item short from health survey, activities of daily living, total efficiency, and adverse reactions. We will use the standard proposed in Cochrane Handbook 5.1.0 to assess the quality and bias risk of every RCT, and all analyses will be conducted through RevMan software V5.3 (Copenhagen: Nordic Cochrane Center, Cochrane, Collaborative Organization, 2014). RESULTS: This systematic review and meta-analysis will provide a convincing synthesis of existing evidences on the efficacy and safety of fire needle for CSR, and the results will be submitted to a peer-reviewed journal for publication. CONCLUSION: The results of this study will provide high-quality evidence of fire needle in the treatment of CSR for clinical decision-making. INPLASY REGISTRATION NUMBER: INPLASY202170041.


Assuntos
Terapia por Acupuntura , Radiculopatia , Espondilose/complicações , Terapia por Acupuntura/efeitos adversos , Terapia por Acupuntura/instrumentação , Terapia por Acupuntura/métodos , Humanos , Metanálise como Assunto , Radiculopatia/etiologia , Radiculopatia/terapia , Projetos de Pesquisa , Revisões Sistemáticas como Assunto , Resultado do Tratamento
6.
J Int Med Res ; 49(8): 3000605211037475, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34461766

RESUMO

BACKGROUND: Unilateral transforminal lumbar interbody fusion (TLIF) with a single cage can provide circumferential fusion and biomechanical stability. However, the causes and prevention of contralateral radiculopathy following unilateral TLIF remain unclear. METHODS: In total, 190 patients who underwent unilateral TLIF from January 2017 to January 2019 were retrospectively reviewed. Radiological parameters including lumbar lordosis, segmental angle, anterior disc height, posterior disc height (PDH), foraminal height (FH), foraminal width, and foraminal area (FA) were measured preoperatively and postoperatively. Preoperative and postoperative visual analog scale scores were also recorded. RESULTS: The incidence of contralateral radiculopathy after unilateral TLIF was 5.3% (10/190). The most common cause was contralateral foraminal stenosis. Unilateral TLIF could increase the lumbar lordosis, segmental angle, and anterior disc height but decrease the PDH, FA, and FH in patients with symptomatic contralateral radiculopathy. The intervertebral cage should be placed to cover the epiphyseal ring and cortical compact bone of the midline, and the disc height can be increased to enlarge the contralateral foramen. CONCLUSION: The most common cause of contralateral radiculopathy is contralateral foraminal stenosis. Careful preoperative planning is necessary to achieve satisfactory outcomes. Improper unilateral TLIF will decrease the PDH, FA, and FH, resulting in contralateral radiculopathy.


Assuntos
Radiculopatia , Fusão Vertebral , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Região Lombossacral/diagnóstico por imagem , Região Lombossacral/cirurgia , Radiculopatia/etiologia , Radiculopatia/cirurgia , Estudos Retrospectivos , Fusão Vertebral/efeitos adversos
7.
Spine (Phila Pa 1976) ; 46(16): E859-E868, 2021 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-34398134

RESUMO

STUDY DESIGN: Animal experimental study with intervention. OBJECTIVE: To investigate the effect of melatonin on rat radiculopathy model and dorsal root ganglion (DRG) cells, and to elucidate the underlying mechanism. SUMMARY OF BACKGROUND DATA: Melatonin has a well-documented efficacy in intervertebral disc degeneration (IVDD) and low back pain. IVDD can also lead to other complications such as disc herniation which will cause radiculopathy. Herniated nucleus pulposus (NP) induced apoptosis and NLR pyrin domain containing 3 (NLRP3) activation in DRG. However, the effect and underlying mechanism of melatonin on radiculopathy and DRG cells are still unclear. METHODS: Rat radiculopathy model was induced by implanting NP tissue from the tail disc of the same rat into the left L4/5 inter-laminar space near the left DRG. Melatonin was injected intraperitoneally in the treated group to test its function. Apoptosis was determined by Tunnel staining and flow cytometry. NLRP3 inflammasome activation was determined by levels of NLRP3, ASC, GSMDM-N, IL-1ß, and Caspase-1. Mitophagy was determined by levels of Parkin, Beclin-1, p62, and LCB-II. Mitophagy was blocked by treatment with Parkin-si or cyclosporine A (CsA). RESULTS: NLRP3 was significantly upregulated in DRG of rat radiculopathy model; moreover, melatonin markedly decreased pain behavior in rat radiculopathy model. Furthermore, melatonin treatment decreases the incidence of apoptosis in DRG cells. Melatonin also promotes mitophagy and inhibits NLRP3 inflammasomes in DRG cells. In addition, mitophagy was blocked by treatment with Parkin-si and CsA. Both Parkin-si and CsA attenuated melatonin's inhibitory effect on apoptosis and the NLRP3 inflammasome, indicating that the beneficial effects of melatonin in DRG cells are mediated through the Parkin-mediated mitophagy. CONCLUSION: Melatonin alleviates radiculopathy against apoptosis and NLRP3 inflammasomes by promoting Parkin-mediated mitophagy, which may help us provide a potential target for the treatment of radiculopathy.Level of Evidence: N/A.


Assuntos
Melatonina , Radiculopatia , Animais , Apoptose , Inflamassomos , Melatonina/farmacologia , Mitofagia , Proteína 3 que Contém Domínio de Pirina da Família NLR , Radiculopatia/tratamento farmacológico , Ratos , Ubiquitina-Proteína Ligases
8.
Clin J Pain ; 37(9): 707-717, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-34265792

RESUMO

OBJECTIVE: Epidural steroid injections (ESIs) are a commonly utilized treatment for lumbosacral radicular pain caused by intervertebral disc herniation or stenosis. Although effective in certain patient populations, ESIs have been associated with serious complications, including paralysis and death. In 2014, the US Food and Drug Administration (FDA) issued a safety warning on the risk of injecting corticosteroids into the epidural space. The aims of this article were to review the neurological complications associated with ESIs and to compare the formulations, safety, and effectiveness of commercially available corticosteroids given by transforaminal, interlaminar, or caudal injection. METHODS: Serious adverse events associated with ESIs were identified by a search of the FDA Adverse Event Reporting System (FAERS) database. A MEDLINE search of the literature was conducted to identify clinical trials comparing the safety and effectiveness of nonparticulate and particulate corticosteroid formulations. RESULTS: Neurological complications with ESIs were rare and more often associated with the use of particulate corticosteroids administered by transforaminal injection. Among the 10 comparative-effectiveness studies reviewed, 7 found nonparticulate steroids had comparable efficacy to particulate steroids, and 3 studies suggested reduced efficacy or shorter duration of effect for nonparticulate steroids. DISCUSSION: The risk of complications for transforaminal ESI is greater with particulate corticosteroids. Nonparticulate corticosteroids, which are often recommended as first-line therapy, may have a short duration of effect, and many commercial formulations contain neurotoxic preservatives. The safety profile of ESIs may continue to improve with the development of safer, sterile formulations that reduce the risk of complications while maintaining efficacy.


Assuntos
Degeneração do Disco Intervertebral , Deslocamento do Disco Intervertebral , Radiculopatia , Dor nas Costas , Humanos , Injeções Epidurais , Região Lombossacral , Radiculopatia/tratamento farmacológico , Esteroides/efeitos adversos
9.
Artigo em Inglês | MEDLINE | ID: mdl-34200510

RESUMO

The aim of this study was to describe and update current knowledge of manual therapy accuracy in treating cervical and lumbar radiculopathy, to identify the limitations in current studies, and to suggest areas for future research. The study was conducted according to PRISMA guidelines for systematic reviews. A comprehensive literature review was conducted using PubMed and Web of Science databases up to April 2020. The following inclusion criteria were used: (1) presence of radiculopathy; (2) treatment defined as manual therapy (i.e., traction, manipulation, mobilization); and (3) publication defined as a Randomized Controlled Trial. The electronic literature search resulted in 473 potentially relevant articles. Finally, 27 articles were accepted: 21 on cervical (CR) and 6 in lumbar radiculopathy (LR). The mean PEDro score for CR was 6.6 (SD 1.3), and for LR 6.7 (SD 1.6). Traction-oriented techniques are the most frequently chosen treatment form for CR and are efficient in reducing pain and improving functional outcomes. In LR, each of the included publications used a different form of manual therapy, which makes it challenging to summarize knowledge in this group. Of included publications, 93% were either of moderate or low quality, which indicates that quality improvement is necessary for this type of research.


Assuntos
Manipulações Musculoesqueléticas , Radiculopatia , Humanos , Pescoço , Cervicalgia , Radiculopatia/terapia , Ensaios Clínicos Controlados Aleatórios como Assunto , Tração
10.
Musculoskelet Sci Pract ; 55: 102427, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34298491

RESUMO

BACKGROUND: Upper limb neurodynamic tests (ULNT) are used to diagnose neuropathic conditions such as cervical radiculopathy (CR). Within the literature, a positive ULNT is defined in markedly variable ways, which is likely why the diagnostic accuracy of these tests lacks consistency across studies. OBJECTIVES: To determine the diagnostic accuracy of single and combined upper limb neurodynamic tests ((ULNT)1,2a, 2b and 3) for cervical radiculopathy using test findings that are similar to those used in practice. DESIGN: Diagnostic accuracy study (prospective) design following the updated STARD 2015 reporting guideline. METHOD: From 109 consecutively enrolled individuals with suspected CR. Of the 85 participants included, 27 (31.7%) were diagnosed with CR (mean age, 43.9years; Neck Disability Index 38,16%). ULNTs test were performed by a blind examiner to a CR reference standard of clinical diagnosis and magnetic resonance imaging verification provided by a neurosurgeon. RESULTS: In general, the single tests were better at ruling in CR versus ruling out. Of the single ULNT, the ULNT3 demonstrated the strongest post-test probability change with a positive finding (73.28%). Three of four test combinations demonstrated the highest clinical utility for changing the post-test probability with a positive finding at 83.29% and with LR+ = 12.89 (95%CI: 3.10-53.62). Having none of the test's positive was able to rule out CR with LR- = 0.08 (95%CI: 0.01-0.56). CONCLUSION: ULNTs fail to significantly alter post-test probability when used singularly for diagnosis of CR. However, combinations of ULNT (3 out of 4 positive) can rule in CR, and rule out CR when all ULNT are negative.


Assuntos
Radiculopatia , Adulto , Humanos , Imageamento por Ressonância Magnética , Estudos Prospectivos , Radiculopatia/diagnóstico , Extremidade Superior
12.
J Int Med Res ; 49(6): 3000605211019664, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34078160

RESUMO

Delayed neurological deficits secondary to percutaneous vertebroplasty caused by cement leakage is a rare condition. Although cement extravasation during percutaneous vertebroplasty is not uncommon, most cases are clinically asymptomatic, and symptomatic cement extravasation that requires surgical excision is rarely reported. Herein, a case of L4 radiculopathy secondary to cement leakage is reported that involved the delayed onset of neurological symptoms. The patient was treated using a minimally invasive transforaminal endoscopic approach. The clinical and imaging findings and treatment methods are discussed.


Assuntos
Radiculopatia , Fraturas da Coluna Vertebral , Vertebroplastia , Cimentos Ósseos/efeitos adversos , Endoscopia , Humanos , Complicações Pós-Operatórias , Vertebroplastia/efeitos adversos
13.
BMJ Case Rep ; 14(5)2021 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-34059531

RESUMO

Gout is a common crystal-induced arthropathy affecting mainly the joints of the appendicular skeleton; however, rarely this condition affects the axial skeleton as well. Spinal gout can cause radiculopathy, cord compression, canal stenosis and discitis. We describe a case of a 71-year-old woman where the initial presentation of destructive arthropathy and spinal masses secondary to axial gout was mistaken for a metastatic malignancy. Despite chronic polyarthropathy and bilateral subcutaneous gouty tophi, spinal gout was not considered a differential diagnosis during initial assessment.The patient was managed conservatively with pharmacological treatment resulting in improvement of her upper limb radiculopathy and systemic joint pain, although little improvement in mobility. Such extensive involvement is rare and the masses can mimic an underlying metastatic disease. Careful history and clinical examination recognising polyarthropathy and subcutaneous tophi can aid the clinician to make the right diagnosis and institute correct treatment. Delay in recognising gout as a differential diagnosis can lead to marked morbidity as illustrated in our case.


Assuntos
Artrite Gotosa , Gota , Radiculopatia , Doenças da Coluna Vertebral , Idoso , Feminino , Gota/diagnóstico , Humanos , Coluna Vertebral
15.
Oper Neurosurg (Hagerstown) ; 21(3): E236, 2021 08 16.
Artigo em Inglês | MEDLINE | ID: mdl-34097744

RESUMO

Lumbar radiculopathy often results from direct compression of the exiting nerve roots. This may be caused mainly by spondylotic changes with any contribution from components like a herniated disc, facet overgrowth, and ligamentum flavum hypertrophy, or any combination of them. There are a wide range of surgical treatments directed at decompressing the neural elements. Over the last decade, endoscopic spine surgery has gained popular interest because of potential benefits, including decreased bony removal, less muscle disruption, and enhanced visualization.1 A unilateral endoscopic surgical approach can accomplish an effective bilateral decompression using the ipsilateral-contralateral technique.2 This method allows for addressing both central and bilateral recess stenoses. We present a case of a 48-yr-old female with persistent bilateral lower extremity radicular pain worse on the left side with severe lumbar 4/5 stenosis and a left-sided synovial cyst causing significant foraminal narrowing. This 2-dimensional video illustrates the technique used for an endoscopic interlaminar approach for lumbar 4/5 ipsilateral and contralateral decompression. We highlight key elements regarding the positioning, workflow, and surgical technique to successfully perform this approach. Patient consented to the procedure.


Assuntos
Deslocamento do Disco Intervertebral , Radiculopatia , Estenose Espinal , Descompressão Cirúrgica , Feminino , Humanos , Deslocamento do Disco Intervertebral/diagnóstico por imagem , Deslocamento do Disco Intervertebral/cirurgia , Pessoa de Meia-Idade , Radiculopatia/etiologia , Radiculopatia/cirurgia , Estenose Espinal/diagnóstico por imagem , Estenose Espinal/cirurgia
16.
Artigo em Russo | MEDLINE | ID: mdl-34156205

RESUMO

OBJECTIVE: To evaluate the correlation of trigeminal radiculopathy with anatomical relationships of trigeminal nerve root, brainstem, tumors and vessels in patients with vestibular schwannomas. MATERIAL AND METHODS: A retrospective analysis included 153 patients (106 females and 47 males aged 22-82 years) with vestibular schwannomas who underwent surgery via retromastoid approach. Preoperative trigeminal radiculopathy (facial pain and sensory disturbances) was examined after microsurgical resection. Brainstem compression was analyzed by comparison of transverse size of contralateral to vestibular schwannoma half of brainstem and ipsilateral side. RESULTS: Tumor-induced brainstem and trigeminal nerve compression was found in 115 cases. Sixty-four of these patients had trigeminal radiculopathy symptoms. Degree of brainstem compression was significantly higher in trigeminal radiculopathy group. Facial hypoesthesia was found in 61patients, trigeminal neuralgia - in 5 cases, neuropathic pain - in 3 patients. Thirty-seven patients without brainstem compression had no trigeminal nerve involvement. One patient had trigeminal neuralgia following compression by superior cerebellar artery. Total resection with brainstem and trigeminal nerve decompression were performed in all cases. Isolated or combined compression of trigeminal nerve root was noted in 9 patients with trigeminal neuralgia and neuropathic pain, in 2 with facial numbness and in 2 patients without trigeminal symptoms. In case of trigeminal neuralgia following compression by superior cerebellar artery, vascular decompression was performed only in patients with facial pain and numbness. Facial pain completely resolved in all patients. Complete or partial sensory restoration was noted in 25 cases. No facial sensory disorders were noted in 26 cases, transient sensory deterioration - in 10 patients. CONCLUSION: Trigeminal radiculopathy is caused by severe brainstem compression following vestibular schwannomas and usually results sensory disturbances and rarely facial pain. The impact of tumor on trigeminal nerve root and brainstem trigeminal pathways can be accompanied by vascular compression by superior cerebellar artery. Regression of trigeminal radiculopathy symptoms after resection of vestibular schwannoma is caused by decompression of trigeminal nerve root and brainstem. In case of concomitant neurovascular syndrome, vascular decompression is indicated.


Assuntos
Neuroma Acústico , Radiculopatia , Neuralgia do Trigêmeo , Feminino , Humanos , Masculino , Radiculopatia/etiologia , Radiculopatia/cirurgia , Estudos Retrospectivos , Nervo Trigêmeo/cirurgia , Neuralgia do Trigêmeo/etiologia , Neuralgia do Trigêmeo/cirurgia
17.
Medicine (Baltimore) ; 100(22): e26151, 2021 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-34087870

RESUMO

RATIONALE: Cervical spondylotic radiculopathy (CSR) is a common sensory, motor, and reflex disorder. Numbness, a common subjective symptom of CSR, lacks objective quantitative indicators and recognized effective treatments, but is also difficult to recover from. We present a case report describing a traditional acupuncture treatment for CSR, utilizing a special acupuncture method and point, namely the Yunmen point. PATIENT CONCERNS: A 40-year-old woman presented with unilateral arm numbness caused by CSR. DIAGNOSES: A diagnosis of CSR was made in the orthopedic department of a local hospital. INTERVENTIONS: We attempted acupuncture at the Yunmen (LU 2) acupoint combined with neck-seven-acupoint under computed tomographic guidance. OUTCOMES: After 10 times treatment sessions, the patient no longer experienced weakness, coldness, or numbness in the affected upper limb. In addition, the stiffness in the neck and shoulders was reduced. On physical examination, the patient's left brachial plexus traction test was negative; reassessment of the CSR-20-point score scale showed a perfect score, and the visual analog scale score was 0. LESSONS: Our report indicates that acupuncture at the LU 2 acupoint combined with neck-seven-acupoint is effective in treating numbness and coldness of the arm, and other neurological symptoms caused by cervical spondylosis. Moreover, with the appropriate acupuncture technique, the risk of acupuncture at the LU 2 acupoint can be minimized.


Assuntos
Terapia por Acupuntura/métodos , Radiculopatia/etiologia , Radiculopatia/terapia , Espondilose/complicações , Adulto , Feminino , Humanos
18.
Am J Phys Med Rehabil ; 100(7): 721-724, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34131095

RESUMO

ABSTRACT: Signs and symptoms of a C8 radiculopathy could mimic common comorbidities such as entrapment and peripheral neuropathies. These conditions and a C8 radiculopathy both can result in abnormal findings on needle examination of intrinsic hand muscles. It was hypothesized that needle examination of C8-innervated muscles in the forearm might improve concordance with magnetic resonance imaging (MRI) in the presence of underlying comorbidities. A retrospective analysis of electromyogram and C-spine MRI data in 80 patients with negative MRI of C-spine for C8-T1 neuroforaminal stenosis was performed. The percentage of false-positive results in the MRI-negative group undergoing electromyogram testing for hand and forearm muscles (MRI-NH + F) was 3% compared with 18% (P = 0.06) in the group with electromyogram of the hand intrinsic muscles only (MRI-NH). The false-positive result tends to be lower in the MRI-NH + F group in comparison with the MRI-NH group especially in the presence of underlying peripheral and entrapment neuropathies.


Assuntos
Eletromiografia , Imageamento por Ressonância Magnética , Síndromes de Compressão Nervosa/diagnóstico , Doenças do Sistema Nervoso Periférico/diagnóstico , Radiculopatia/diagnóstico , Idoso , Vértebras Cervicais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
19.
BMJ Case Rep ; 14(6)2021 Jun 21.
Artigo em Inglês | MEDLINE | ID: mdl-34155020

RESUMO

In this report, we describe a patient who developed an acute trigeminal neuritis and cervical radiculitis after receiving a Pfizer-BioNtech vaccination (tozinameran) against SARS-CoV-2.


Assuntos
COVID-19 , Neurite (Inflamação) , Radiculopatia , Humanos , Radiculopatia/induzido quimicamente , Radiculopatia/tratamento farmacológico , SARS-CoV-2 , Vacinação/efeitos adversos
20.
Medicine (Baltimore) ; 100(24): e26344, 2021 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-34128884

RESUMO

BACKGROUND: The effect of adding alpha lipoic acid (ALA) to pulsed radiofrequency (PRF) for treatment of lumbar-sacral pain was evaluated. OBJECTIVE: to evaluate the effect of using ALA as an adjuvant therapy with PRF for treatment of chronic lumbosacral radicular pain caused by herniated disc. METHODS: One hundred twenty patients with lumbo-sacral radicular pain allocated into 2 groups. Group I: treated with PRF at 42°C for 120 seconds. Group II: treated as in group I, plus oral ALA 600 mg (Thiotacid 600 mg, EVA PHARMA, Egypt) three times per day (1800 mg/day) for 3 weeks then 600 mg once daily for 2 weeks. The lumbo-sacral radicular pain evaluated using the numerical rating pain score and Oswestry Disability Index. RESULTS: Success rate was significantly higher in group II at 3 and 6 months after intervention. The median values of the numerical rating pain score and the Oswestry Disability Index were significantly lower in group II with no significant difference in Epworth Sleepiness Scale. No major complications were reported in both groups. CONCLUSION: The current study supports the use of ALA with PRF on the dorsal root ganglion for treating lumbosacral radicular pain.


Assuntos
Antioxidantes/uso terapêutico , Dor Crônica/terapia , Dor Lombar/terapia , Tratamento por Radiofrequência Pulsada/métodos , Radiculopatia/terapia , Ácido Tióctico/uso terapêutico , Quimioterapia Adjuvante , Dor Crônica/etiologia , Humanos , Deslocamento do Disco Intervertebral/complicações , Dor Lombar/etiologia , Manejo da Dor/métodos , Estudos Prospectivos , Radiculopatia/etiologia , Resultado do Tratamento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...