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1.
Medicine (Baltimore) ; 100(18): e25570, 2021 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-33950931

RESUMO

BACKGROUND: Cervical Spondylotic radiculopathy (CSR) is the most common spinal degenerative disease. Its clinical manifestations are pain and numbness in the neck and arm and limitation of neck movement, which greatly affects the life and work of patients. Acupuncture and electroacupuncture are commonly used in China, the efficacy of acupuncture has been confirmed. Existing evidence shows that electroacupuncture seems to be better than acupuncture, but there is a lack of clinical research to directly compare the two. METHODS: This is a prospective randomized controlled trial to compare the efficacy of electroacupuncture and acupuncture in the treatment of CSR and to explore the safety and potential mechanism of electroacupuncture in the treatment of CSR. Approved by the Clinical Research Ethics Committee of our hospital, the patients are randomly divided into an experimental group (electroacupuncture group) or control group (acupuncture group). The patients are followed up for 30 days after 4 weeks of treatment. Observation indexes included VAS score, Neck Disability Index, Yasuhisa Tanaka 20 Score Scale, adverse reactions and so on. Finally, the data will be analyzed by SPSS 18.0 software. DISCUSSION: This study will directly compare the advantages and disadvantages of electroacupuncture and acupuncture in the treatment of CSR. The results of this study will help to guide patients with CSR to choose appropriate treatment. TRIAL REGISTRATION: OSF Registration number: DOI 10.17605/OSF.IO/9MKPN.


Assuntos
Vértebras Cervicais , Eletroacupuntura/métodos , Cervicalgia/terapia , Radiculopatia/terapia , Espondilose/terapia , Adolescente , Adulto , Idoso , Avaliação da Deficiência , Eletroacupuntura/efeitos adversos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Cervicalgia/diagnóstico , Cervicalgia/etiologia , Medição da Dor , Estudos Prospectivos , Radiculopatia/etiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Espondilose/complicações , Resultado do Tratamento , Adulto Jovem
2.
BMJ Open ; 11(3): e043021, 2021 03 16.
Artigo em Inglês | MEDLINE | ID: mdl-33727266

RESUMO

INTRODUCTION: Cervical radiculopathy (CR) is a clinical condition whereby motor, reflex and/or sensory changes such as radicular pain, paraesthaesia or numbness can exist. Conservative management is a preferred first treatment option as the risk-benefit ratio for surgery is less favourable. Systematic reviews and treatment guidelines gather evidence on the effectiveness of non-surgical management of patients with CR from randomised controlled trials, which do not consider the natural course of recovery to modify the management strategy accordingly. The aim of this study is to establish consensus on effective non-surgical treatment modalities for patients in different stages (acute, subacute and chronic) of CR, using the Delphi method approach. METHODS AND ANALYSIS: Through an iterative multistage process, experts within the field will rate their agreement with a list of proposed treatment modalities and suggest any missing treatment modalities during each round. Agreement will be measured using a five-point Likert scale. Descriptive statistics will be used to measure agreement (median, IQR and percentage of agreement). Consensus criteria will be defined a priori for each round. Data analysis at the end of round three will produce a consensus list of effective treatment modalities for the management of patients with CR in different stages of recovery. ETHICS AND DISSEMINATION: Ethical approval has been granted from the University of Birmingham ethics committee under ERN_20-1121. The study findings will be submitted to a peer-reviewed journal and to relevant conferences for dissemination of the study results.


Assuntos
Radiculopatia , Terapia Combinada , Consenso , Técnica Delfos , Humanos , Radiculopatia/terapia , Projetos de Pesquisa
3.
Zhongguo Zhen Jiu ; 41(2): 197-200, 2021 Feb 12.
Artigo em Chinês | MEDLINE | ID: mdl-33788470

RESUMO

The clinical experience of professor WU Han-qing in treatment of cervical spondylotic radiculopathy (CSR) with the tendon-bone needling therapy of Chinese medicine is introduced. Professor WU believes that the pathogenesis of CSR is the damage on the neck and the sinew of hand three yang meridians, the formation of clustered nodules, obstruction in meridians and the stagnation of qi and blood. In treatment, the tendon-bone needling therapy is mainly adopted to relaxing clustered nodules and the sinew of hand three yang meridians and promoting qi and blood circulation. Regarding the acupoint selection, the "three-yangguan localization method" is used. The three hand-yangguan points and the three wrist-yangguan points are selected. The knotted points corresponding to the affected transverse processes of cervical vertebra are selected as well. Meanwhile, the adjuvant treatment points are selected on the base of the principle as "selecting the points along the affected meridian sinew". During treatment, according to needling sites and layers, the different needling techniques are optioned flexibly. Besides, the attentive experience in needling sensation in physician and the interaction between physician and patient are emphasized so as to improve the safety of treatment.


Assuntos
Terapia por Acupuntura , Meridianos , Radiculopatia , Pontos de Acupuntura , Humanos , Medicina Tradicional Chinesa , Radiculopatia/terapia , Tendões
4.
Medicine (Baltimore) ; 100(13): e25239, 2021 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-33787607

RESUMO

BACKGROUND: There is no systematic review to compare the efficacy of acupuncture and acupotomy in patients with cervical spondylotic radiculopathy. It is worthy to critically review the evidence of the comparison of these 2 therapies to inform clinical practice. Therefore, the purpose of this study was to compare the efficacy and safety of acupuncture and acupotomy in the treatment of cervical spondylotic radiculopathy and to provide evidence for clinical practice. METHODS: Seven electronic databases including Web of Science, Embase, PubMed, Wanfang Data, Scopus, Science Direct, Cochrane Library were searched in March 2021 by 2 independent reviewers. Data extraction was performed independently, and any conflict was resolved before final analysis. Only randomized clinical trials were included in this study. Outcomes included pain intensity, symptom score, neck disability index, total effective rate, and curative rate. The Cochrane risk of bias tool is used to evaluate the risk of bias of included randomized controlled trials by 2 independent reviewers. RESULTS: We hypothesized that these 2 methods would provide similar therapeutic benefits. The results of this research will be delivered in a peer-reviewed journal. CONCLUSION: This study expects to provide credible and scientific clinical evidence for the efficacy and safety of acupuncture and acupotomy in the treatment of cervical spondylotic radiculopathy. OSF REGISTRATION NUMBER: 10.17605/OSF.IO/U7T6A.


Assuntos
Terapia por Acupuntura/métodos , Radiculopatia/terapia , Espondilose/terapia , Humanos , Metanálise como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa , Revisões Sistemáticas como Assunto , Resultado do Tratamento
5.
Eur J Pain ; 25(5): 1162-1172, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33533164

RESUMO

BACKGROUND: The mechanisms of action that facilitate improved outcomes after conservative rehabilitation are unclear in individuals with cervical radiculopathy (CR). This study aims to determine the pathways of recovery of disability with different exercise programs in individuals with CR. METHODS: We analysed a dataset of 144 individuals with CR undergoing conservative rehabilitation. Eleven variables collected at baseline, 3, 6 and 12 months follow-up were used to build a Bayesian Network (BN) model: treatment group (neck-specific vs. general exercises), age, sex, self-efficacy, catastrophizing, kinesiophobia, anxiety, neck-arm pain intensity, headache pain intensity and disability. The model was used to quantify the contribution of different mediating pathways on the outcome of disability at 12th months. RESULTS: All modelled variables were conditionally independent from treatment groups. A one-point increase in anxiety at 3rd month was associated with a 2.45-point increase in 12th month disability (p <.001). A one-point increase in head pain at 3rd month was associated with a 0.08-point increase in 12th month disability (p <.001). Approximately 83% of the effect of anxiety on disability was attributable to self-efficacy. Approximately 88% of the effect of head pain on disability was attributable to neck-arm pain. CONCLUSIONS: No psychological or pain-related variables mediated the different treatment programs with respect to the outcome of disability. Thus, the specific characteristics investigated in this study did not explain the differences in mechanisms of effect between neck-specific training and prescribed physical activity. The present study provides candidate modifiable mediators that could be the target of future intervention trials. SIGNIFICANCE: Psychological and pain characteristics did not differentially explain the mechanism of effect that two exercise regimes had on disability in individuals with cervical radiculopathy. In addition, we found that improvements in self-efficacy was approximately five times more important than that of neck-arm pain intensity in mediating the anxiety-disability relationship. A mechanistic understanding of recovery provides candidate modifiable mediators that could be the target of future intervention trials. TRIALS REGISTRATION: ClinicalTrials.gov identifier: NCT01547611.


Assuntos
Radiculopatia , Teorema de Bayes , Vértebras Cervicais , Avaliação da Deficiência , Exercício Físico , Humanos , Cervicalgia/terapia , Radiculopatia/terapia , Resultado do Tratamento
6.
Medicine (Baltimore) ; 100(4): e23880, 2021 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-33530182

RESUMO

ABSTRACT: Cervical spondylotic radiculopathy (CSR) is the most common type of cervical spondylosis, accounting for about 60% of the incidence of cervical spondylosis. Both cervical traction and traditional Chinese medicine hot compress are common and effective treatment for CSR. This study will be performed to investigate the effect of a combination of cervical traction and traditional Chinese medicine hot compress on CSR. In this non-blinded, randomized controlled trial, 100 eligible patients will be randomly divided into a treatment group (intermittent cervical traction combines with traditional Chinese medicine hot compress) and a control group (intermittent cervical traction combined with hot compresses). Before and after the intervention, the Visual Analog Scale score, Neck Disability Index score, and 20-score scale of symptoms will be evaluated at baseline and at 7, 14, 21, and 28 days. During the treatment period, any signs of acute adverse events, such as paralysis of aggravated pain, nausea, dizzy, and even syncope, will be recorded at each visit. Although intermittent cervical traction and traditional Chinese medicine hot compress have been used in the treatment of CSR in China for many years, there is no consensus on its effectiveness of combination therapy. This experiment will provide convincing evidence of the efficacy of intermittent cervical traction combined with traditional Chinese medicine hot compress in the treatment of CSR.


Assuntos
Medicamentos de Ervas Chinesas/administração & dosagem , Radiculopatia/terapia , Espondilose/terapia , Tração , Terapia Combinada , Temperatura Alta , Humanos , Pressão , Estudos Prospectivos
7.
PLoS One ; 16(1): e0244992, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33406115

RESUMO

A modified interlaminar (MIL) approach has been proposed for improved accessibility to the target epidural space. However, even with fluoroscopic guidance, uncertainty about the distance between the needle tip and the epidural space can remain. Using the contralateral oblique (CLO) view, determination of the epidural space can be easier with clearer identification of the interlaminar opening. We inserted the needle at the midpoint of the interlaminar opening on the fluoroscopic anteroposterior (AP) view and made the needle oriented toward the pedicle of the target side. Then, CLO view was created by rotating the intensifier approximately 45 degrees to the contralateral side of the target. Through the CLO view, the ventral interlaminar line (VILL) was confirmed and the needle was able to enter the epidural space more easily. The medical records of 29 patients who were conducted MIL approach using CLO view were retrospectively analyzed to evaluate the effectiveness and safety of this procedure. The accessibility to the ventral epidural space was 93.1%. There was no procedure-related complication. Using CLO view, uncertainty can be reduced during the MIL approach, which in turn shortens procedure time and improves safety.


Assuntos
Analgesia/métodos , Anestesia Epidural/métodos , Espaço Epidural/diagnóstico por imagem , Vértebras Lombares/diagnóstico por imagem , Radiculopatia/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Fluoroscopia , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Radiculopatia/diagnóstico por imagem , Estudos Retrospectivos
8.
Medicine (Baltimore) ; 99(43): e22895, 2020 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-33120838

RESUMO

BACKGROUND: Traditionally, S1 transforaminal epidural steroid injection (TFESI) has been performed using an anteroposterior (AP) fluoroscopic view. In 2007, the oblique "Scotty dog" (OS) approach was introduced as an alternative technique. We compared passage time of the needle into S1 foramen (Tf) between the anteroposterior (AP) and oblique "Scotty dog" (OS) approach during S1 TFESI. METHODS: In this prospective randomized controlled trial, seventy patients scheduled S1 TFESI were randomly allocated into AP or OS groups. In the AP group, a slight cephalad-caudad tilt was used. In the OS group, the C-arm was rotated ipsilateral oblique degrees to view the S1 Scotty dog. Both groups received injection of steroid mixed with local anesthetics. We measured the passage time of the needle into S1 foramen (Tf), primary outcome, and total procedure time (Tt) between the groups. We also recorded presence of intravascular injection, patients-assessed pain relief for one month and complications. RESULTS: The Tf and Tt were shorter in the OS than in the AP group (24.4 ±â€Š24.0 s vs 47. 8 ±â€Š53.2seconds; 93.3 ±â€Š35.0 seconds vs 160.0 ±â€Š98.7 seconds, P < .001, both). Incidence of intravascular injection (AP, 8 [22.8%]; OS, 4 [11.4%], P = .205), pain score, and complication rates were not statistically different between the two groups. In logistic regression analysis, the body mass index (BMI) was a risk factor for longer Tt (odds ratio [OR] = 1.27, 95% CI: 1.02-1.58, P = .030). CONCLUSION: The passage time of the needle into S1 foramen was shorter in OS approach and the OS approach reduced the procedure time compared with the AP approach during S1 TFESI. The practitioners should note that procedure time can be prolonged in obese patients.


Assuntos
Fluoroscopia/instrumentação , Injeções Epidurais/métodos , Erros Médicos/efeitos adversos , Radiculopatia/terapia , Esteroides/administração & dosagem , Administração Intravenosa/estatística & dados numéricos , Idoso , Anestésicos Locais/administração & dosagem , Índice de Massa Corporal , Feminino , Humanos , Incidência , Injeções Epidurais/efeitos adversos , Região Lombossacral/diagnóstico por imagem , Região Lombossacral/fisiopatologia , Masculino , Pessoa de Meia-Idade , Agulhas/efeitos adversos , Medição da Dor/métodos , Estudos Prospectivos , República da Coreia/epidemiologia , Distúrbios Somatossensoriais/psicologia , Fatores de Tempo
9.
Medicine (Baltimore) ; 99(36): e22007, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32899050

RESUMO

BACKGROUND: Cervical radiculopathy (CR) describes compression or stimulation secondary to the cervical nerve root, 1 or 2 types of upper limb pain, and/or with neck. In clinical practice, both acupotomology and acupuncture are very widely and popular for the management of CR. So, we conducted a systematic review and meta-analysis to explore the efficacy, safety of acupotomology in the treatment of CR. METHODS: We will search the following databases from inception to the September 2019 : MEDLINE(PubMed), Web of Science(Thomson Reuters), Cochrane Library, Embase (Ovid, Elsevier), SinoMed, Clinical Trials. gov, the China National Knowledge Infrastructure, Wanfang database, and VIP database. We will apply no language restrictions. We will not use a randomized controlled trial filter in EMBASE, as the set of intervention terms will limit the results sufficiently. The randomised controlled trials of acupotomology versus acupuncture for CR; two independent researchers will use the bias risk tool provided by the Cochrane Collaboration to evaluate the quality of the literature using RevMan 5.3 software (Copenhagen, The Nordic Cochrane Centre, The Cochrane Collaboration, 2014). RESULTS: This systematic review and meta-analysis will provide a synthesis of existing evidence-based medical evidence for acupotomology/ acupotomy/needle knife in the treatment of CR. CONCLUSION: The conclusions of this systematic review and meta-analysis will provide evidence to evaluate the effectiveness of acupotomology/ acupotomy/needle knife for CR and further guide clinical decision-making. ETHICS AND DISSEMINATION: This study is based on literature and therefore does not require ethical approval or patient consent. The study will be published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER: CRD42020172274.


Assuntos
Terapia por Acupuntura , Vértebras Cervicais , Radiculopatia/terapia , Espondilose/terapia , Humanos , Metanálise como Assunto , Revisões Sistemáticas como Assunto
10.
Medicine (Baltimore) ; 99(32): e21587, 2020 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-32769910

RESUMO

BACKGROUND: Cervical spondylotic radiculopathy (CSR) is a clinical syndrome of radial neck and shoulder pain. Both Massage and Acupotomy have been widely used in the treatment of CSR, in China and achieved satisfied efficacy. Therefore, the aim of this study is to systematically evaluate the clinical efficacy of acupotomy combined with massage in the treatment of CSR. METHODS: The following electronic databases will be searched: PubMed, Web of Science, the Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane Library, Embase, SinoMed, Clinical Trials. gov, the China National Knowledge Infrastructure (CNKI), Wanfang database, and VIP database. Two review authors independently search databases from their respective inception dates to September 2019 to identify potentially eligible studies. Cochrane Handbook 5.1 risk of bias assessment tool will be used to evaluate the methodological quality of the included studies. The Review Manager 5.3 will be used for all statistical analysis of the final included study. RESULTS: The results of this systematic review and meta-analysis will provide a synthesis of existing evidences for the treatment of acupotomy combined with massage on CSR, especially in improving visual analog scale and symptom score. CONCLUSION: This study will summarize the current evidence of acupotomy combined with massage for the treatment of CSR. This study can further guide the promotion and clinical decisions. ETHICS AND DISSEMINATION: Ethical approval and patient consent are not required because this study is a literature-based study. This systematic review and meta-analysis will be published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER: CRD42020171825.


Assuntos
Terapia por Acupuntura/normas , Protocolos Clínicos , Massagem/normas , Radiculopatia/terapia , Espondilose/complicações , Terapia por Acupuntura/métodos , Humanos , Massagem/métodos , Metanálise como Assunto , Radiculopatia/fisiopatologia , Espondilose/fisiopatologia , Espondilose/terapia , Revisões Sistemáticas como Assunto
11.
Spine (Phila Pa 1976) ; 45(14): 952-959, 2020 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-32609465

RESUMO

STUDY DESIGN: A prospective randomized multicenter trial. OBJECTIVE: To investigate the effects of surgery with either structured postoperative physiotherapy or standard postoperative approach on neck-related headache in patients with cervical radiculopathy. Secondary, to investigate associations between change in neck-related headache and change in neck muscle endurance, neck mobility, or neck pain. SUMMARY OF BACKGROUND DATA: The effect of physiotherapy on individuals with neck-related headache after surgery for cervical radiculopathy due to magnetic resonance imaging-verified disc disease is unknown. METHODS: One hundred six patients with neck-related headache and participating in a randomized controlled trial evaluating the additional effects of physiotherapy after surgery for cervical radiculopathy were included. Patients were randomized preoperatively to structured postoperative physiotherapy (n = 51) or the standard postoperative approach (n = 55). Outcome measures were headache intensity and neck pain intensity, neck muscle endurance, and neck mobility. Measures were obtained preoperatively and at 6 weeks, 3 months, 6 months, and 1 year postoperatively. RESULTS: Headache intensity significantly changed from baseline to 1 year postoperatively (P < 0.001) in both groups. Post-hoc tests showed a significant difference between baseline and 6 weeks (P ≤ 0.05). No significant differences were found between groups (P > 0.05) or between-group differences in changes over time (P > 0.05). The change in current headache intensity over time was associated with a change in current neck pain intensity over time (P = 0.003, ß = 0.40). CONCLUSION: There was a significant improvement in headache intensity 1 year postoperatively in patients with cervical radiculopathy and neck-related headache, but there were no differences between groups over time. Change in current headache intensity was only associated with a change in current neck pain intensity. LEVEL OF EVIDENCE: 2.


Assuntos
Vértebras Cervicais/cirurgia , Cefaleia , Degeneração do Disco Intervertebral , Deslocamento do Disco Intervertebral , Modalidades de Fisioterapia , Complicações Pós-Operatórias , Seguimentos , Humanos , Degeneração do Disco Intervertebral/fisiopatologia , Degeneração do Disco Intervertebral/terapia , Deslocamento do Disco Intervertebral/fisiopatologia , Deslocamento do Disco Intervertebral/terapia , Imagem por Ressonância Magnética , Cervicalgia/cirurgia , Estudos Prospectivos , Radiculopatia/fisiopatologia , Radiculopatia/terapia , Amplitude de Movimento Articular , Resultado do Tratamento
12.
Artigo em Russo | MEDLINE | ID: mdl-32592568

RESUMO

INTRODUCTION: Hydrogalvanic baths are a hydrotherapy method based on the combined effect of electric current and fresh water on the body. AIM OF STUDY: Scientific evidence and evaluation of the effectiveness of use of general hydrogalvanic baths in the treatment of patients with lumbosacral radiculopathy with the background of degenerative spinal disorder. MATERIALS AND METHODS: A randomized comparative clinical trial included 84 patients. The 1st (active) group included 43 patients, the 2nd (control) had 41 patients. Patients of the 1st group received general hydrogalvanic baths. Patients in the control group - drug treatment, including NSAIDs, muscle relaxants, anticonvulsants. The assessment was carried out before treatment, at the end of the course (on the 14th day) and 3 months after the end of treatment according to the results of neurological examination, VAS questionnaires, Pain DETECT, Beck scale, Oswestry scale, SF-36 scales, electroneuromyography (nerve conduction study). RESULTS: In patients receiving general hydrogalvanic baths, in comparison with the control group, there was an improvement in sensitivity (the incidence of hypesthesia decreased from 77 to 11%, p=0.008) and conductivity in peripheral sensory fibers. A decrease in pain was observed in both groups, however, a decrease in neuropathic pain was recorded only in patients receiving drug treatment. In the 1st group during therapy, an improvement in the emotional state in patients and a decrease in the level of depression were revealed. An analysis of long-term results showed that the delayed effect of non-drug treatment significantly increased in patients of the 1st group in comparison with the control group (p<0.05). CONCLUSIONS: Exposure to general hydrogalvanic baths is an effective way to treat lumbosacral radiculopathy, the main registered effects are: improvement of sensitivity, reduction of pain and stabilization of the emotional background. However, the studied method does not affect neuropathic pain.


Assuntos
Balneologia , Neuralgia , Radiculopatia , Banhos , Humanos , Região Lombossacral , Radiculopatia/terapia , Coluna Vertebral , Resultado do Tratamento
13.
Muscle Nerve ; 62(4): 474-484, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32564381

RESUMO

The electrodiagnostic (EDX) examination with needle electromyography (EMG) is the most important means of testing for radiculopathy. This test has modest sensitivity but high specificity and complements imaging of the spine. In this second of a two-part review, the implications of electrodiagnostic findings for diagnosis and clinical management of persons with radiculopathy are reviewed. An EMG confirmed lumbosacral radiculopathy is associated with better clinical outcomes for persons undergoing aggressive conservative management. A positive EMG test portends a better clinical response to epidural corticosteroid injections. If a person undergoes spine surgery, a positive pre-operative EMG for radiculopathy is also associated with better outcomes.


Assuntos
Técnicas de Diagnóstico Neurológico , Eletromiografia/métodos , Condução Nervosa , Músculos Paraespinais/fisiopatologia , Radiculopatia/diagnóstico , Corticosteroides/uso terapêutico , Vértebras Cervicais , Tratamento Conservador , Eletrodiagnóstico/métodos , Humanos , Injeções Epidurais , Vértebras Lombares , Agulhas , Exame Neurológico , Procedimentos Neurocirúrgicos , Exame Físico , Prognóstico , Radiculopatia/fisiopatologia , Radiculopatia/terapia , Sacro , Sensibilidade e Especificidade , Raízes Nervosas Espinhais , Fatores de Tempo
14.
Medicine (Baltimore) ; 99(26): e20846, 2020 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-32590780

RESUMO

BACKGROUND: Among all types of cervical spondylitis, cervical spondylitis radiculopathy (CSR) has the highest incidence. The incidence of CSR increases year by year and is generally younger, which has seriously threatened people's quality of life and affected their work and life. This study proposes to improve the recovery rate of patients with CSR, delay the recurrence, improve the symptoms of patients, and improve the quality of life of patients through the rehabilitation and exercise of five-step cervical vertebra exercises. METHODS: For 90 patients with CSR that met the inclusion criteria, SPSS 23.0 software random number generator was used to randomly divide the patients into an experimental group and control group, with 45 cases in each group. The control group took basic nursing measures, and the experimental group took five steps of cervical vertebra rehabilitation exercises on the basis of elementary nursing measures. The rehabilitation effect of five-step exercises on CSR patients was evaluated by Neck Disability Index (NDI), Visual Analogue Scale (VAS), and Cervical range of motion measured (CROM) before and after intervention. RESULTS: The results of this trial will be published on the website of China Clinical Trial Registration Center (http://www.chictr.org.cn/searchproj.aspx) and in peer-reviewed journals or academic conferences. CONCLUSIONS: This study will examine the feasibility and preliminary effects of five-step exercises for the treatment of patients with CSR. TRIAL REGISTRATION: This protocol was registered in Clinical Trials platform with the number ChiCTR1900027299.


Assuntos
Terapia por Exercício/normas , Radiculopatia/terapia , Adulto , China , Exercício Físico/psicologia , Terapia por Exercício/métodos , Terapia por Exercício/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Radiculopatia/psicologia , Resultado do Tratamento
15.
Pain Physician ; 23(3): E265-E272, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32517402

RESUMO

BACKGROUND: The effect of pulsed radiofrequency (PRF) stimulation for alleviating cervical radicular pain has been demonstrated in several previous studies. OBJECTIVES: We aimed to evaluate the effectiveness of PRF with ultrasound (US) guidance in patients with chronic cervical radicular pain that was refractory to repeated transforaminal epidural steroid injections (TFESIs). STUDY DESIGN: A prospective outcome study. SETTING: The outpatient clinic of a single academic medical center. METHODS: This study included 49 patients with chronic cervical radicular pain, unresponsive to repeated TFESIs, and who underwent PRF stimulation under US guidance. Using US, a cannula was inserted toward the cervical spinal nerve. The pain intensity was evaluated using the Numeric Rating Scale (NRS-11) for cervical radicular pain at pretreatment and 1, 3, and 6 months posttreatment; and the Neck Disability Index (NDI) was used for evaluating functional disability before treatment and 6 months posttreatment. Successful pain relief was defined as >= 50% reduction in the NRS-11 score as compared with the score before treatment. RESULTS: Cervical radicular pain was significantly reduced at 1, 3, and 6 months post-PRF (P < 0.001). At 6 months post-PRF, functional disability (NDI score) had significantly reduced, and 63.3% of the patients achieved successful pain relief. LIMITATIONS: The small number of included patients and no long-term follow-up. CONCLUSIONS: PRF stimulation under the guidance of US is a potentially effective treatment method for managing refractory chronic cervical radicular pain. KEY WORDS: Ultrasound, pulsed radiofrequency, cervical radicular pain, chronic pain.


Assuntos
Cervicalgia/terapia , Manejo da Dor/métodos , Tratamento por Radiofrequência Pulsada/métodos , Radiculopatia/terapia , Ultrassonografia de Intervenção/métodos , Adulto , Dor Crônica/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cervicalgia/etiologia , Estudos Prospectivos , Radiculopatia/complicações , Resultado do Tratamento
16.
Medicine (Baltimore) ; 99(18): e0037s, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32358384

RESUMO

BACKGROUND: Cervical spondylotic radiculopathy (CSR) is one of the most common public health concerns in the world. Baduanjin is very widely and popularly practiced for the management of CSR. Therefore, we conducted a systematic review and meta-analysis to investigate the efficacy of Baduanjin exercise for patients with CSR. METHODS: The PubMed, Web of Science, Embase, Cochrane Central Register of Controlled Trials, Clinical Trials.gov, Cochrane Library, SinoMed, Chinese National Knowledge Infrastructure Database, Wan Fang database, and VIP databases were searched from inception to July 2019 to identify potentially eligible studies. The methodological quality of the included studies using the risk bias assessment tool of Cochrane. All statistical analysis are conducted with Revman 5.3. RESULTS: This systematic review and meta-analysis will provide a synthesis of existing evidences for the treatment of Baduanjin on CSR. CONCLUSION: The conclusions of this study will provide evidence to evaluate the effectiveness of Baduanjin for CSR, which can further guide the promotion and clinical decisions. PROSPERO REGISTRATION NUMBER: CRD42020149659.


Assuntos
Qigong/métodos , Radiculopatia/terapia , Espondilose/terapia , Humanos , Metanálise como Assunto , Projetos de Pesquisa , Revisões Sistemáticas como Assunto , Resultado do Tratamento
17.
Medicine (Baltimore) ; 99(16): e19791, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32311991

RESUMO

RATIONALE: In the medical field, the use of 3-dimensional (3D) printing is increasing explosively and it is especially widespread in the clinical application of fabricating orthosis. Advantages of 3D-printed orthosis compared to conventional ones include its lower cost, easier modification, and faster fabrication. The 3D-printing technique makes it possible for physicians to easily create individual-tailored products. Recently, many kinds of orthosis through 3D printing have been studied and used. The knee orthosis, ankle-foot orthosis, wrist orthosis, hand orthosis, and foot orthotics are examples used in the rehabilitation fields of orthotics. We reported 3 cases of 3D-printed orthoses in patients with peripheral nerve injuries. PATIENTS CONCERNS: In spite of the rapid development of the clinical use of 3D printing, to our knowledge, its application to patients with peripheral nerve injuries has not yet been reported. Two patients suffered from upper limb problems and 1 patient had a foot drop associated with peripheral nerve injury. DIAGNOSIS: Three patients diagnosed with median neuropathy, ulnar neuropathy, and right lower lumbar radiculopathy, respectively, by electromyography. INTERVENTIONS: Herein we present 3 case reports of patients with peripheral nerve injuries whose orthotic needs were fulfilled with the application of 3D-printed wrist orthosis and ankle-foot orthosis. OUTCOMES: For hand function evaluation, we assessed the Jebsen-Taylor hand function test. Grasp and pinch powers were assessed by a hand dynamometer before and after orthosis application. For lower limb functional evaluation, we used a 6-minute walking test and modified Emory Functional Ambulation Profile for ambulatory function. LESSONS: The 3D-printed orthosis could help functional improvement in patients with peripheral nerve injuries.


Assuntos
Síndrome do Túnel Carpal/terapia , Aparelhos Ortopédicos , Impressão Tridimensional , Radiculopatia/terapia , Neuropatias Ulnares/terapia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
18.
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
19.
Pain Physician ; 23(2): E203-E210, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32214299

RESUMO

BACKGROUND: During lumbar epidural injection (LEI) using a midline approach, we might encounter failure of identifying the epidural space owing to an equivocal or absent loss of resistance (LOR) sensation. The reason for such absence of LOR sensation has been suggested as paucity of midline ligamentum flavum, paravertebral muscle, and cyst in the interspinous ligament of the lumbar spine. Despite its low specificity, LOR is the most commonly used method to identify the epidural space. OBJECTIVES: The purpose of this study was to analyze lumbar epidural pressure decrease patterns and identify factors contributing to this pressure decrease. STUDY DESIGN: Prospective randomized trial. SETTING: An interventional pain management practice in South Korea. METHODS: This prospective study included 104 patients receiving LEI due to lumbar radiculopathy. A midline or paramedian approach of LEI was determined with randomization. Among various factors, gender, age, body mass index (BMI), and diagnosis were analyzed using a subgroup that included 60 cases of only a paramedian approach. RESULTS: Grades I, II (abrupt decrease), and III (gradual decrease) were found as patterns of epidural pressure decrease. Abrupt pressure decrease was more frequently observed in the paramedian group (P < 0.001). Age, gender, BMI, and diagnosis did not show any significant difference in frequencies between abrupt and gradual pressure decrease. LIMITATIONS: We could not match LOR sensation with epidural pressure decrease shown in the monitor. CONCLUSIONS: This study demonstrates that abrupt pressure decrease occurs more frequently with the paramedian approach. However, age, gender, BMI, or diagnosis did not affect the incidence of epidural pressure decrease. KEY WORDS: Epidural, paramedian, midline, pressure decrease.


Assuntos
Analgesia Epidural/métodos , Pressão do Líquido Cefalorraquidiano/fisiologia , Espaço Epidural/diagnóstico por imagem , Espaço Epidural/fisiologia , Vértebras Lombares/diagnóstico por imagem , Adulto , Índice de Massa Corporal , Feminino , Humanos , Injeções Epidurais/métodos , Ligamento Amarelo/diagnóstico por imagem , Ligamento Amarelo/fisiologia , Masculino , Pessoa de Meia-Idade , Manejo da Dor/métodos , Estudos Prospectivos , Radiculopatia/diagnóstico por imagem , Radiculopatia/terapia , República da Coreia/epidemiologia
20.
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
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