Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.618
Filtrar
1.
Neurosciences (Riyadh) ; 26(1): 93-96, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33530050

RESUMO

Pseudogout, also known as calcium pyrophosphate deposition disease, is an inflammatory arthropathy that primarily occurs in the peripheral joints, such as the knee or elbow. Spinal pseudogout is uncommon, and neck pain is its most common clinical manifestation. However, cervical myeloradiculopathy as an initial presentation of pseudogout attack of the ligamentum flavum has rarely been reported in the literature. We report a case of a 65-year-old woman who presented with neck pain, bilateral finger numbness, and left-sided upper extremity weakness. Magnetic resonance images showed an epidural mass at the C4-5 level, compressing the spinal cord. Following laminectomy with removal of the calcified mass, the profound neurologic deficits gradually recovered. A pathological examination confirmed the diagnosis of cervical pseudogout.


Assuntos
Medula Cervical/diagnóstico por imagem , Condrocalcinose/complicações , Ligamento Amarelo/diagnóstico por imagem , Radiculopatia/etiologia , Doenças da Medula Espinal/etiologia , Idoso , Medula Cervical/cirurgia , Condrocalcinose/diagnóstico por imagem , Condrocalcinose/cirurgia , Feminino , Humanos , Laminectomia , Ligamento Amarelo/cirurgia , Imagem por Ressonância Magnética , Radiculopatia/diagnóstico por imagem , Radiculopatia/cirurgia , Doenças da Medula Espinal/diagnóstico por imagem , Doenças da Medula Espinal/cirurgia , Resultado do Tratamento
2.
Spine (Phila Pa 1976) ; 46(4): E222-E233, 2021 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-33475275

RESUMO

STUDY DESIGN: An experimental animal study. OBJECTIVE: The aim of this study was to investigate the effect of pulsed electromagnetic fields (PEMF) on recovery of sensorimotor function in a rodent model of disc herniation (DH). SUMMARY OF BACKGROUND DATA: Radiculopathy associated with DH is mediated by proinflammatory cytokines. Although we have demonstrated the anti-inflammatory effects of PEMF on various tissues, we have not investigated the potential therapeutic effect of PEMF on radiculopathy resulting from DH. METHODS: Nineteen rats were divided into three groups: positive control (PC; left L4 nerve ligation) (n = 6), DH alone (DH; exposure of left L4 dorsal root ganglion [DRG] to harvested nucleus pulposus and DRG displacement) (n = 6), and DH + PEMF (n = 7). Rodents from the DH + PEMF group were exposed to PEMF immediately postoperatively and for 3 hours/day until the end of the study. Sensory function was assessed via paw withdrawal thresholds to non-noxious stimuli preoperatively and 1 and 3 days postoperatively, and every 7 days thereafter until 7 weeks after surgery. Motor function was assessed via DigiGait treadmill analysis preoperatively and weekly starting 7 days following surgery until 7 weeks following surgery. RESULTS: All groups demonstrated marked increases in the left hindlimb response threshold postoperatively. However, 1 week following surgery, there was a significant effect of condition on left hindlimb withdrawal thresholds (one-way analysis of variance: F = 3.82, df = 2, P = 0.044) where a more rapid recovery to baseline threshold was evident for DH + PEMF compared to PC and DH alone. All groups demonstrated gait disturbance postoperatively. However, DH + PEMF rodents were able to regain baseline gait speeds before DH and PC rodents. When comparing gait parameters, DH + PEMF showed consistently less impairment postoperatively suggesting that PEMF treatment was associated with less severe gait disturbance. CONCLUSION: These data demonstrate that PEMF accelerates sensorimotor recovery in a rodent model of DH, suggesting that PEMF may be reasonable to evaluate for the clinical management of patients with herniation-associated radiculopathy.Level of Evidence: N/A.


Assuntos
Deslocamento do Disco Intervertebral/fisiopatologia , Deslocamento do Disco Intervertebral/radioterapia , Animais , Citocinas , Gânglios Espinais/fisiopatologia , Gânglios Espinais/efeitos da radiação , Degeneração do Disco Intervertebral , Deslocamento do Disco Intervertebral/complicações , Masculino , Radiculopatia/etiologia , Radiculopatia/fisiopatologia , Radiculopatia/radioterapia , Ratos , Ratos Sprague-Dawley , Velocidade de Caminhada/efeitos da radiação
3.
Bone Joint J ; 103-B(1): 131-140, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33380193

RESUMO

AIMS: To study the associations of lumbar developmental spinal stenosis (DSS) with low back pain (LBP), radicular leg pain, and disability. METHODS: This was a cross-sectional study of 2,206 subjects along with L1-S1 axial and sagittal MRI. Clinical and radiological information regarding their demographics, workload, smoking habits, anteroposterior (AP) vertebral canal diameter, spondylolisthesis, and MRI changes were evaluated. Mann-Whitney U tests and chi-squared tests were conducted to search for differences between subjects with and without DSS. Associations of LBP and radicular pain reported within one month (30 days) and one year (365 days) of the MRI, with clinical and radiological information, were also investigated by utilizing univariate and multivariate logistic regressions. RESULTS: Subjects with DSS had higher prevalence of radicular leg pain, more pain-related disability, and lower quality of life (all p < 0.05). Subjects with DSS had 1.5 (95% confidence interval (CI) 1.0 to 2.1; p = 0.027) and 1.8 (95% CI 1.3 to 2.6; p = 0.001) times higher odds of having radicular leg pain in the past month and the past year, respectively. However, DSS was not associated with LBP. Although, subjects with a spondylolisthesis had 1.7 (95% CI 1.1 to 2.5; p = 0.011) and 2.0 (95% CI 1.2 to 3.2; p = 0.008) times greater odds to experience LBP in the past month and the past year, respectively. CONCLUSION: This large-scale study identified DSS as a risk factor of acute and chronic radicular leg pain. DSS was seen in 6.9% of the study cohort and these patients had narrower spinal canals. Subjects with DSS had earlier onset of symptoms, more severe radicular leg pain, which lasted for longer and were more likely to have worse disability and poorer quality of life. In these patients there is an increased likelihood of nerve root compression due to a pre-existing narrowed canal, which is important when planning surgery as patients are likely to require multi-level decompression surgery. Cite this article: Bone Joint J 2021;103-B(1):131-140.


Assuntos
Dor Lombar/etiologia , Vértebras Lombares , Radiculopatia/etiologia , Estenose Espinal/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Avaliação da Deficiência , Feminino , Hong Kong , Humanos , Perna (Membro) , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Qualidade de Vida , Fatores de Risco , Inquéritos e Questionários
4.
Medicine (Baltimore) ; 99(43): e22792, 2020 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-33120796

RESUMO

RATIONALE: We report a case of Schmorl node induced multiple radiculopathy. PATIENT CONCERNS: A 70-year-old female patient complained of lower back pain in the left leg accompanied by numbness and weakness. DIAGNOSIS: Radiographs showed obvious osteoporosis in the lumbar vertebrae. Computed tomography demonstrated a hole in the upper posterior half of the L2 vertebral body. Magnetic resonance imaging of the lumbar spine revealed a herniated disc involving a protrusion at the posterior wall of the L2 vertebral body, which was present in the left lateral and dorsal epidural spaces. There was significant lumbar stenosis at the L2 vertebral body secondary to dural sac compression due to the mass. INTERVENTION: Left-sided hemilaminectomy was performed at L2 with screw fixation at L1-3. Intraoperatively, the severely ruptured disc compression in the dural sac and nerve root was removed. OUTCOMES: The patient's leg pain was immediately resolved, and her back pain was reduced. The patient recovered normal motor function at 20 days after surgery. LESSONS: A Schmorl node can progress and break through the lumbar vertebral body, resulting in nerve compression. A large proximal herniated mass can cause distal multiple radiculopathy. Therefore, this special case of Schmorl node with multiple radiculopathy should be treated by removing the proximal herniated nucleus pulposus from the vertebral body.


Assuntos
Deslocamento do Disco Intervertebral/complicações , Vértebras Lombares/patologia , Radiculopatia/etiologia , Idoso , Constrição Patológica , Feminino , Humanos , Deslocamento do Disco Intervertebral/cirurgia , Laminectomia/métodos , Dor Lombar , Vértebras Lombares/cirurgia , Osteoporose/complicações
6.
Pain Physician ; 23(3): 315-324, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32517398

RESUMO

BACKGROUND: Vertebral cement augmentation is a commonly used procedure in patients with vertebral body compression fractures from primary or secondary osteoporosis, metastatic disease, or trauma. Many of these patients present with radiculopathy as a presenting symptom, and can experience symptomatic relief following the procedure. OBJECTIVES: To determine the incidence of preprocedural radiculopathy in patients with vertebral body compression fractures presenting for cement augmentation, and present their postoperative outcomes. STUDY DESIGN: Retrospective cohort study. SETTING: Interventional pain practice in a tertiary care university hospital. METHODS: In this cohort study, all patients who underwent kyphoplasty (KP) or vertebroplasty (VP) procedures in a 7-year period within our practice were evaluated through a search of the electronic medical records. The primary endpoint was to evaluate the prevalence of noncompressive preprocedural radiculopathy in our patients. Evaluation of each patient's relative improvement following the procedure, respective to the initial presence or absence of radicular symptoms (including and above T10, above and below T10, and below T10) was included as a secondary endpoint. Additional subanalysis was performed with respect to patients demographics, fracture location, and primary indication for the procedure (osteoporosis, trauma, etc.). RESULTS: A total of 302 procedures were performed during this time period, encompassing 544 total vertebral body levels. After exclusion criteria were applied to this cohort, 31.6% of patients demonstrated radiculopathy prior to the procedure that could not be explained by nerve impingement. Nearly half of patients demonstrated an optimal clinical outcome (48.5% nearly complete/complete resolution of symptoms, 40.1% partial resolution of symptoms, 11.4% little to no resolution of symptoms). Patients with fractures above T10 were more likely to see complete resolution, whereas patients with fractures above and below T10 were likely to not see any resolution. Men and women without initial radiculopathy symptoms were more likely to see little to no resolution, regardless of fracture location. LIMITATIONS: This retrospective study used an electronic chart review of clinicians' notes to determine the presence of radiculopathy and their relative improvement following the procedure. CONCLUSIONS: Preprocedural radiculopathy is a common symptom of patients presenting for the evaluation of VP or KP. The presence of radiculopathy in the absence of nerve impingement may be an important marker for those patients who may experience greater benefit from the procedure. KEY WORDS: Radiculopathy, kyphoplasty, vertebroplasty, osteoporosis, compression fracture, spine, cement augmentation.


Assuntos
Cimentos para Ossos/uso terapêutico , Fraturas por Compressão/complicações , Radiculopatia/epidemiologia , Radiculopatia/etiologia , Radiculopatia/cirurgia , Fraturas da Coluna Vertebral/complicações , Idoso , Estudos de Coortes , Feminino , Fraturas por Compressão/cirurgia , Humanos , Cifoplastia/métodos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Fraturas da Coluna Vertebral/cirurgia , Resultado do Tratamento , Vertebroplastia/métodos
7.
Pain Physician ; 23(3): 325-332, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32517399

RESUMO

BACKGROUND: Foraminal stenosis, defined as a narrowing of the cervical neural foramen, is one of the most common causes of upper extremity radicular pain. OBJECTIVES: The aim of our study was to determine the effects of the severity of neural foraminal stenosis and spinal herniation level on treatment success in patients treated with interlaminar epidural steroid injections (ILESI) due to cervical disc herniation-related radiculopathy and their possible predictive roles. STUDY DESIGN: A retrospective assessment. SETTING: A university hospital interventional pain management center. METHODS: We performed our study between August 2017 and February 2019, retrospectively. All patients' demographic characteristics, clinical and demographic data, including pain scores before and after cervical ILESI in the first hour, third week, and third month follow-ups, presence of motor deficits, symptom side, symptom duration before cervical ILESI, and whether there was progression to surgery in the 3-month period after injection, were collected. RESULTS: We evaluated 61 patients in the final analysis. When the spinal herniation levels and foraminal stenosis grades were compared, there was a significant difference between the groups (P = 0.003, P = 0.005). We reported significant correlations between foraminal stenosis grade (odds ratio [OR], -0.425, P = 0.038) and spinal herniation level (OR, -0.925, P = 0.001) and treatment success. LIMITATIONS: Our study's design was retrospective. CONCLUSIONS: Cervical ILESI is a reliable treatment option that provides a significant reduction in pain of patients with cervical radiculopathy. However, the success of ILESI treatment may be negatively affected in these patients in the presence of high spinal level cervical disc herniation and severe foraminal stenosis. Therefore considering these 2 parameters in predicting the patient population who will benefit from cervical ILESI is of importance in terms of decreasing potential complications. KEY WORDS: Interlaminar epidural steroid injections, foraminal stenosis, spinal level, cervical disc herniation, radicular pain.


Assuntos
Degeneração do Disco Intervertebral/patologia , Deslocamento do Disco Intervertebral/patologia , Radiculopatia/tratamento farmacológico , Radiculopatia/etiologia , Corticosteroides/administração & dosagem , Adulto , Constrição Patológica/complicações , Constrição Patológica/patologia , Feminino , Humanos , Injeções Epidurais , Degeneração do Disco Intervertebral/complicações , Deslocamento do Disco Intervertebral/complicações , Masculino , Pessoa de Meia-Idade , Manejo da Dor/métodos , Estudos Retrospectivos , Resultado do Tratamento
8.
Pain Physician ; 23(3): E273-E280, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32517403

RESUMO

BACKGROUND: Results of the lumbar transforaminal epidural steroid injection (L-TFESI) used in the treatment of lumbar radiculopathy may be affected by the current psychiatric condition of the patient. OBJECTIVES: The study aimed to assess the effects of pretreatment comorbid psychiatric conditions on patient outcomes in patients with lumbar disc herniation and radiculopathy. STUDY DESIGN: The study used a prospective-observational study design. SETTING: Research was conducted at a university hospital international pain management center. METHODS: In this observational study, 103 patients were included. All patients were evaluated with the Hospital Anxiety and Depression scale (HADS) for depression and anxiety levels and the Somatosensory Amplification Scale (SSAS) for somatization levels before the L-TFESI. The treatment results were evaluated with the Numeric Rating Scale (NRS) and the Oswestry Disability Index (ODI) at baseline, the third week, and the third month. Relative to baseline, a 50% reduction in the NRS was accepted as a successful treatment. RESULTS: HADS-depression, HADS-anxiety, and SSAS levels were similar between the patients with successful treatment outcome and the patients in whom treatment failed. However, there were negative correlations between percent reduction in the NRS and the HADS-depression levels at 3 weeks (r = -0.182, P = .022) and 3 months (r = -0.204, P = .037). Also, there were positive correlations between patients' pre-injection ODI scores and both the HADS-anxiety (r = 0.271, P = .001) and SSAS (r = 0.201, P = .013) scores. LIMITATIONS: The study was limited by a relatively short-term follow-up period. CONCLUSIONS: Although psychiatric conditions affected the pain and disability of patients before and after the L-TFESI, and may have an impact on patient-related outcomes, they should not be a reason to not treat patients or expect a lower chance of success. KEY WORDS: Anxiety, depression, disc herniation, low-back pain, lumbar radiculopathy, patient-related outcomes, somatization, transforaminal epidural steroid injection.


Assuntos
Ansiedade/complicações , Depressão/complicações , Radiculopatia/tratamento farmacológico , Transtornos Somatoformes/complicações , Resultado do Tratamento , Adulto , Idoso , Anestésicos Locais/administração & dosagem , Anti-Inflamatórios/administração & dosagem , Bupivacaína/administração & dosagem , Feminino , Humanos , Injeções Epidurais/métodos , Deslocamento do Disco Intervertebral/complicações , Deslocamento do Disco Intervertebral/tratamento farmacológico , Dor Lombar/tratamento farmacológico , Dor Lombar/etiologia , Vértebras Lombares , Masculino , Pessoa de Meia-Idade , Manejo da Dor/métodos , Prednisolona/administração & dosagem , Prednisolona/análogos & derivados , Estudos Prospectivos , Radiculopatia/etiologia
10.
Spine Deform ; 8(5): 1059-1067, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32378040

RESUMO

STUDY DESIGN: Multicenter retrospective. OBJECTIVE: To determine the long-term complication rate associated with surgical treatment of spondylolisthesis in adolescents. There is limited information on the complication rate associated with posterior spinal fusion (PSF) of spondylolisthesis in the pediatric and adolescent population. METHODS: Patients who underwent PSF for spondylolisthesis between 2004 and 2015 at four spine centers, < 21 years of age, were included. Exclusion criteria were < 2 years of follow-up or anterior approach. Charts and radiographs were reviewed. RESULTS: 50 patients had PSF for spondylolisthesis, 26 had PSF alone, while 24 had PSF with trans-foraminal lumbar interbody fusion (TLIF). Mean age was 13.9 years (range 9.6-18.4). Mean follow-up was 5.5 years (range 2-15). Mean preoperative slip was 61.2%. 20/50 patients (40%) experienced 23 complications requiring reoperation at a mean of 2.1 years (range 0-9.3) for the following: implant failure (12), persistent radiculopathy (3), infection (3), persistent back pain (2), extension of fusion (2), and hematoma (1). In addition, there were 22 cases of radiculopathy (44%) that were transient. Rate of implant failure was related to preoperative slip angle (p = 0.02). Reoperation rate and rates of implant failure were not associated with preoperative % slip (reoperation: p = 0.42, implant failure: p = 0.15), postoperative % slip (reoperation: p = 0.42, implant failure: p = 0.99), postoperative kyphosis of the lumbosacral angle (reoperation: p = 0.81, implant failure: p = 0.48), change in % slip (reoperation: p = 0.30, implant failure: p = 0.12), change in slip angle (reoperation: p = 0.42, implant failure: p = 0.40), graft used (reoperation: p = 0.22, implant failure: p = 0.81), or addition of a TLIF (reoperation: p = 0.55, implant failure: p = 0.76). CONCLUSION: PSF of spondylolisthesis in the adolescent population was associated with a 40% reoperation rate and high rate of post-operative radiculopathy. Addition of a TLIF did not impact reoperation rate or rate of radiculopathy.


Assuntos
Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Radiculopatia/epidemiologia , Radiculopatia/etiologia , Reoperação/estatística & dados numéricos , Fusão Vertebral/efeitos adversos , Espondilolistese/cirurgia , Adolescente , Criança , Falha de Equipamento , Feminino , Seguimentos , Humanos , Fixadores Internos/efeitos adversos , Cifose/epidemiologia , Cifose/etiologia , Cifose/cirurgia , Masculino , Estudos Multicêntricos como Assunto , Complicações Pós-Operatórias/cirurgia , Radiculopatia/cirurgia , Estudos Retrospectivos , Fusão Vertebral/instrumentação , Fusão Vertebral/métodos , Fatores de Tempo , Resultado do Tratamento
11.
World Neurosurg ; 140: 320-324, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32428722

RESUMO

BACKGROUND: Metastatic malignant melanoma of the spine is rare, while the spinal metastatic melanoma with unknown primary lesions presenting as radiculopathy is even rarer. Summarizing and analyzing this disease can provide insight into disease development and allow optimization of clinical management. CASE DESCRIPTION: A 55-year-old male patient was admitted to our institution presenting with lower back pain that had persisted for 3 years. It was aggravated, with radiating pain in bilateral lower extremities lasting 2 weeks. Neurologic examination revealed bilateral L5 motor deficit with paresis. Radiologic findings showed an irregularly destructive lesion of the L5 vertebral body, and the lesion extended dorsally, obstructing the spinal canal. The patient underwent complete resection of the L5 vertebral tumor with titanium mesh implantation and posterior fusion and instrumentation from L3-S2. The pathologic diagnosis after surgery was malignant melanoma. No obvious primary lesion was detected anywhere on the skin surface, mucosa, and retina. A postoperative positron emission tomography-computed tomography scan of the whole body displayed no abnormal uptake in other parts of the body. However, the patient didn't receive any chemotherapy or radiotherapy. Five months after operation, the tumor recurred and metastasis was detected in other sites. CONCLUSIONS: Although spinal metastatic melanoma with unknown primary lesions presenting as radiculopathy is rare, effective management and treatment of these patients remains an important challenge for surgeons. Surgical resection can alleviate patients' chief complaints and improve their quality of life. However, it may not prolong the survival period and improve the prognosis. Postoperative radiotherapy and/or chemotherapy may be needed.


Assuntos
Melanoma/complicações , Radiculopatia/etiologia , Neoplasias da Coluna Vertebral/complicações , Humanos , Masculino , Melanoma/diagnóstico por imagem , Melanoma/secundário , Melanoma/cirurgia , Pessoa de Meia-Idade , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Radiculopatia/diagnóstico por imagem , Radiculopatia/cirurgia , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/secundário , Neoplasias da Coluna Vertebral/cirurgia , Resultado do Tratamento
12.
J Am Acad Orthop Surg ; 28(17): 730-736, 2020 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-32324708

RESUMO

INTRODUCTION: Musculoskeletal injury can substantially affect orthopaedic surgeons and productivity. The objective of this study was to assess occupation-related neck pain and cervical radiculopathy/myelopathy among orthopaedic surgeons and to identify the potential risk factors for injury. METHODS: An online survey was sent to orthopaedic surgeons via their state orthopaedic society. The survey consisted of items related to orthopaedic practices, such as the number of arthroscopic procedures done and the use of microscopes/loupes. The prevalence, potential causes, and reporting practices of neck pain and cervical radiculopathy/myelopathy among orthopaedic surgeons were also assessed. RESULTS: There were 685 responses from surgeons representing 27 states. A total of 59.3% of respondents reported neck pain and 22.8% reported cervical radiculopathy. After adjusting for age and sex, surgeons performing arthroscopy had an odds ratio of 3.3 (95% confidence interval: 1.4 to 8.3, P = 0.007) for neck pain. Only five of the surgeons with neck pain and one of the surgeons with cervical radiculopathy/myelopathy had ergonomic evaluations. CONCLUSION: Neck pain and cervical radiculopathy/myelopathy are common among orthopaedic surgeons. Associated factors included older age, higher stress levels, and performing arthroscopy. Cervical injuries are rarely reported, and ergonomic workplace evaluations are infrequent.


Assuntos
Cervicalgia/epidemiologia , Doenças Profissionais/epidemiologia , Cirurgiões Ortopédicos/estatística & dados numéricos , Radiculopatia/epidemiologia , Doenças da Medula Espinal/epidemiologia , Adulto , Fatores Etários , Artroscopia/efeitos adversos , Artroscopia/estatística & dados numéricos , Vértebras Cervicais , Ergonomia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cervicalgia/etiologia , Doenças Profissionais/etiologia , Radiculopatia/etiologia , Fatores de Risco , Doenças da Medula Espinal/etiologia , Inquéritos e Questionários , Local de Trabalho
13.
World Neurosurg ; 138: 404-407, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32251830

RESUMO

BACKGROUND: Spinal dural arteriovenous fistulas (SDAVFs) are the most common type of spinal arteriovenous malformations; they frequently cause progressive myelopathy including gait disturbances and sensory disorders. CASE DESCRIPTION: We report a rare case of a middle-aged man who experienced right-sided chest pain and Th4 radiculopathy, without any other neurologic presentations. Magnetic resonance imaging showed a flow void sign on the dorsal aspect of the spinal cord; spinal angiography revealed an arteriovenous shunt between a radicular artery and an intradural vein. Suspecting SDAVF as the cause of the chest pain, we performed surgical resection. Intraoperatively, we observed compression of the rootlet by the draining vein. Right chest pain disappeared completely after obliteration of the SDAVF. The present patient had vascular compression of the spinal nerve rootlet without any venous congestion. CONCLUSIONS: Our experience shows that SDAVF can present not only as a myelopathy but also as a radiculopathy, indicating that radiculopathy may become a main symptom of SDAVF.


Assuntos
Malformações Vasculares do Sistema Nervoso Central/complicações , Malformações Vasculares do Sistema Nervoso Central/cirurgia , Radiculopatia/etiologia , Medula Espinal/patologia , Medula Espinal/cirurgia , Angiografia Digital , Malformações Vasculares do Sistema Nervoso Central/diagnóstico , Edema , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Doenças da Medula Espinal , Vértebras Torácicas
14.
World Neurosurg ; 137: 421-424, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32112937

RESUMO

BACKGROUND: An epidural nerve block injection is the most common modality of treatment for control of low backache associated with radiating pain. Epidural catheter injections are also widely used by pain physicians to control cancer pain. Epidural catheters could be associated with procedure-related complications, such as epidural hematoma, epidural abscess, and post-dural puncture headache, and rare complications, such as shearing or breakage of the catheter tip. In this report, we describe the full-endoscopic removal of a sheared epidural catheter fragment. CASE DESCRIPTION: A man aged 24 years presented with low backache radiating to his left leg with numbness and weakness. Left-sided L4-L5 disc herniation was diagnosed on magnetic resonance imaging, and the patient was posted for an epidural nerve block. The epidural catheter broke during removal, and a 4-cm fragment was retained in the epidural space. We performed an interlaminar full-endoscopic removal of the sheared epidural catheter. Postoperatively, the patient reported excellent clinical outcome. CONCLUSIONS: Interlaminar full-endoscopic procedure could be used for the removal of the retained epidural catheter as a practical option.


Assuntos
Cateteres , Falha de Equipamento , Corpos Estranhos/cirurgia , Deslocamento do Disco Intervertebral/diagnóstico por imagem , Dor Lombar/terapia , Neuroendoscopia/métodos , Radiculopatia/terapia , Analgesia Epidural/métodos , Humanos , Deslocamento do Disco Intervertebral/complicações , Dor Lombar/etiologia , Imagem por Ressonância Magnética , Masculino , Bloqueio Nervoso/métodos , Radiculopatia/etiologia , Adulto Jovem
15.
Muscle Nerve ; 61(5): 580-586, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32096875

RESUMO

BACKGROUND: Radiculopathies caused by spinal stenosis in the upper lumbar spinal canal (L1/2, L2/3, L3/4) have not been comprehensively investigated. METHODS: This retrospective study reviewed 14 patients from a tertiary hospital outpatient clinic. The inclusion criteria were upper lumbar stenosis seen on MRI and radiculopathies with active denervation confirmed on electromyography. Patients with any other conditions that could explain the clinical or electrophysiological manifestations were excluded. RESULTS: Neurogenic findings were predominantly observed in L5 or S1 myotomes on electromyography. Abnormal spontaneous activity was observed in distal muscles in all patients and in proximal muscles in eight patients. Axonal involvement was bilateral in 10 patients and unilaterally in 4 patients. MRI showed redundant nerve roots in 13 patients with chronic reinnervation on electromyography. CONCLUSIONS: Upper lumbar spinal stenosis usually causes L5 or S1 radiculopathies with diverse patterns. This discrepancy may cause diagnostic confusion.


Assuntos
Eletromiografia , Vértebras Lombares , Radiculopatia/fisiopatologia , Sacro , Estenose Espinal/fisiopatologia , Idoso , Eletrodiagnóstico , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Radiculopatia/diagnóstico , Radiculopatia/etiologia , Estudos Retrospectivos , Raízes Nervosas Espinhais/diagnóstico por imagem , Raízes Nervosas Espinhais/fisiopatologia , Estenose Espinal/complicações , Estenose Espinal/diagnóstico
16.
World Neurosurg ; 137: 363-366, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32058114

RESUMO

BACKGROUND: Epidermoid cysts can rarely arise as a late complication of lumbar puncture. We describe a young man who had a remote history of a lumbar puncture and who was subsequently found to have a lumbar spinal epidermoid cyst on imaging, after presenting with lower extremity radicular pain. CASE DESCRIPTION: A 24-year-old man with a remote history of lumbar puncture presented with lower back pain and radicular leg pain which had been ongoing for over a year. Despite conservative management, the patient's symptoms progressed to worsening back pain and left L4 radiculopathy. Magnetic resonance imaging of the lumbar spine demonstrated a peripherally enhancing, intradural, extramedullary lesion at L4-5. Diffusion-weighted imaging revealed diffusion restriction within the lesion, characteristic of an epidermoid cyst. The patient underwent an L4-5 laminectomy for resection of the intradural tumor. The lesion was noted to contain pearly white granules consistent with the appearance of an epidermoid cyst. Histopathology confirmed the diagnosis. On follow-up examination, the patient demonstrated improvement of his back pain and resolution of radicular symptoms. CONCLUSIONS: Lumbar spinal epidermoid cysts may be either congenital or secondary to an iatrogenic cause. This patient had a remote history of lumbar puncture during workup for meningitis as a child. As a complication of a lumbar puncture, the formation of an epidermoid cyst can occur and is thought to be the result of implanted cutaneous tissue. This case provides a comprehensive illustration of the clinical, radiographic, intraoperative, and pathologic findings consistent with an iatrogenic epidermoid cyst.


Assuntos
Doenças do Sistema Nervoso Central/diagnóstico por imagem , Cisto Epidérmico/diagnóstico por imagem , Vértebras Lombares/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico por imagem , Punção Espinal/efeitos adversos , Doenças do Sistema Nervoso Central/etiologia , Doenças do Sistema Nervoso Central/patologia , Doenças do Sistema Nervoso Central/cirurgia , Imagem de Difusão por Ressonância Magnética , Cisto Epidérmico/etiologia , Cisto Epidérmico/patologia , Cisto Epidérmico/cirurgia , Humanos , Doença Iatrogênica , Laminectomia , Dor Lombar/etiologia , Vértebras Lombares/cirurgia , Imagem por Ressonância Magnética , Masculino , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/patologia , Complicações Pós-Operatórias/cirurgia , Radiculopatia/etiologia , Canal Vertebral , Adulto Jovem
17.
World Neurosurg ; 137: 372-375, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32058121

RESUMO

BACKGROUND: Venous stenting is a common treatment for chronic peripheral venous disease. The most frequent complications caused by this technique are stent misplacement and intracardiac or intravascular stent migration. In this publication, we will describe the first case of an intraspinal stent misplacement leading to lumbar nerve root compression. CASE DESCRIPTION: Our patient was a 20-year-old woman with a bilateral pulmonary embolism caused by a right common iliac vein thrombosis and a severe compression of the left common iliac vein by the right common iliac artery (May-Thurner or Cockett syndrome). She underwent an endovascular stenting of the left iliac vein. A few days later, she reported some pain in the right L5 radicular and showed signs of hypoesthesia of the left leg and of paresis of the left extensor hallucis longus muscle. A lumbar computed tomography scan showed a stent misplacement into the spinal canal through the left L5 foramen with nerve root compression. She underwent a surgical removal of the stent through a unilateral L5-S1 laminarthrectomy. The postoperative follow-up showed a complete clinical recovery and a control lumbar computed tomography scan confirmed the L5 nerve root decompression. CONCLUSIONS: The intraspinal misplacement of a venous stent is a rare complication that may cause nerve root injury. It requires a prompt treatment. Surgically removing the stent by a posterior approach seems to be a simple and safe therapeutic option.


Assuntos
Procedimentos Endovasculares/efeitos adversos , Veia Ilíaca/cirurgia , Vértebras Lombares , Síndrome de May-Thurner/cirurgia , Complicações Pós-Operatórias/etiologia , Radiculopatia/etiologia , Stents/efeitos adversos , Trombose Venosa/cirurgia , Remoção de Dispositivo , Feminino , Humanos , Síndrome de May-Thurner/complicações , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/cirurgia , Embolia Pulmonar/etiologia , Radiculopatia/diagnóstico por imagem , Radiculopatia/cirurgia , Canal Vertebral , Tomografia Computadorizada por Raios X , Trombose Venosa/complicações , Adulto Jovem
18.
Trials ; 21(1): 143, 2020 Feb 06.
Artigo em Inglês | MEDLINE | ID: mdl-32029008

RESUMO

BACKGROUND: Thunder-fire moxibustion originated in China and contains traditional Chinese medicine. It can produce strong firepower, infrared thermal radiation, and medicinal effects when burning on the acupoints. Thunder-fire moxibustion is commonly used in patients with neck pain, but its efficacy has rarely been systematically demonstrated. We designed a randomized trial of thunder-fire moxibustion on cervical spondylotic radiculopathy (CSR) to investigate whether it is more effective than ibuprofen sustained-release capsules. METHODS: One hundred patients will be recruited and randomly divided into thunder-fire moxibustion and ibuprofen groups. The intervention consists of ten treatments and will last for 2 weeks. The Yasuhisa Tanaka 20 Score Scale is used as the primary outcome measure. It contains a combination of the self-conscious symptom in patients, objective clinical evaluation from doctors, and social evaluation (the ability to work and live). The objective and comprehensive evaluation of CSR patients before and after treatment is particularly needed. The Short-Form McGill Pain Questionnaire-2 (SF-MPQ-2), Neck Disability Index score scale (NDI), and the Quality of Life Assessment (SF-36) are applied as secondary outcome measures. The assessment will take place at the baseline and the first and second weekends of treatment. If an adverse event (AEs) occurs, it will be reported. DISCUSSION: The aim of this trial is to determine whether thunder-fire moxibustion is more effective than ibuprofen in the treatment of patients with CSR. TRIAL REGISTRATION: Chinese Clinical Trial Registry (http://www.chictr.org.cn), ChiCTR1800018820. Registered on 11 October 2018.


Assuntos
Anti-Inflamatórios não Esteroides/uso terapêutico , Ibuprofeno/uso terapêutico , Moxibustão/métodos , Radiculopatia/terapia , Espondilose/terapia , Pontos de Acupuntura , Adolescente , Adulto , Idoso , Preparações de Ação Retardada/uso terapêutico , Avaliação da Deficiência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Moxibustão/efeitos adversos , Qualidade de Vida , Radiculopatia/diagnóstico , Radiculopatia/etiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Espondilose/complicações , Espondilose/diagnóstico , Resultado do Tratamento , Adulto Jovem
19.
Medicine (Baltimore) ; 99(5): e18851, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32000386

RESUMO

BACKGROUND: The pathogenesis of cervical spondylotic is degenerative changes of the cervical intervertebral disc, or bone hyperplasia of the posterior and hook joints, and instability of the joints of the cervical vertebrae. It causes the nerve roots to be stimulated and oppressed. The clinical manifestations are the sensation, movement, and reflex disorder of the cervical spinal nerve roots that are stimulated and oppressed, especially the numbness and pain of the neck, shoulders, upper limbs, and fingers. In this systematic review, we aimed to evaluate the efficacy and safety of acupuncture and chiropractic in the treatment of cervical spondylotic. METHODS AND ANALYSIS: We will search for PubMed, Cochrane Library, AMED, Embase, WorldSciNet; Nature, Science online and China Journal Full-text Database (CNKI), China Biomedical Literature CD-ROM Database (CBM), and related randomized controlled trials included in the China Resources Database. The time is limited from the construction of the library to September 2019. We will use the criteria provided by Cochrane 5.1.0 for quality assessment and risk assessment of the included studies, and use the RevMan 5.3 and Stata 13.0 software for meta-analysis of the effectiveness, recurrence rate, and symptom scores of cervical spondylotic. ETHICS AND DISSEMINATION: This systematic review will evaluate the efficacy and safety of acupuncture and chiropractic for cervical spondylotic. Because all of the data used in this systematic review and meta-analysis have been published, this review does not require ethical approval. Furthermore, all data will be analyzed anonymously during the review process trial.


Assuntos
Terapia por Acupuntura , Manipulação Quiroprática , Radiculopatia/terapia , Humanos , Radiculopatia/etiologia , Espondilose/complicações
20.
World Neurosurg ; 138: 19-26, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32109644

RESUMO

BACKGROUND: Minimally invasive surgery in the treatment of lumbar disc herniation has gained popularity in recent years, as 2 dominant techniques, percutaneous endoscopic lumbar discectomy (PELD) and microendoscopic discectomy (MED) obtained comparable short-term clinical outcomes. However, midterm and long-term efficacy and reoperative rate are still debated. METHODS: Electronic databases Web of Science, PubMed, Scopus, Cochrane Library, EMBASE, Ovid, and EBSCO were searched. STATA 14.0 was used for statistical analysis. Odds ratio (OR) and 95% confidence interval (CI) were pooled to quantify the strength of the statistical differences. RESULTS: Nine studies (468 patients in the PELD group and 516 patients in the MED group) with high methodologic quality met the selection criteria. No differences were found in leg pain visual analog scale score before surgery or at any follow-up time after surgery. PELD obtained better outcomes in low back pain visual analog scale score, Oswestry Disability Index score, and excellent and good ratio after 24 months postoperatively (OR = -0.856, 95% CI -1.488 to -0.224, P = 0.008; OR = -0.425, 95% CI -0.724 to -0.127, P = 0.005; OR = 3.034; 95% CI 1.254 to 7.343; P = 0.014) compared with MED. No difference was found within 24 months postoperatively. No significant differences were found in complication, recurrence, and reoperation rates within and after 2 years postoperatively. CONCLUSIONS: Both PELD and MED can offer relatively effective and safe treatment for low back pain and radiculopathy associated with a herniated disc. PELD could obtain better midterm and long-term clinical outcomes compared with MED.


Assuntos
Discotomia Percutânea/métodos , Endoscopia/métodos , Deslocamento do Disco Intervertebral/cirurgia , Microcirurgia/métodos , Humanos , Deslocamento do Disco Intervertebral/complicações , Dor Lombar/etiologia , Dor Lombar/cirurgia , Vértebras Lombares/cirurgia , Radiculopatia/etiologia , Radiculopatia/cirurgia , Resultado do Tratamento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...