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1.
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
2.
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
3.
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
4.
World Neurosurg ; 134: e1028-e1036, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31759147

RESUMO

OBJECTIVE: To explore whether the cervical sagittal parameters affect the conservative treatment of single-segment cervical spondylotic radiculopathy and whether the conservative treatment of single-segment cervical spondylotic radiculopathy can be predicted by cervical sagittal parameters. METHODS: Cervical spondylotic radiculopathy is currently treated with a stepwise approach, and conservative treatment is recommended. However, there is insufficient evidence to support the efficacy of conservative treatment. Between January 2013 and January 2018, 121 patients with single-segment cervical spondylotic radiculopathy were enrolled in this study. The inclusion criteria included complete cervical lateral radiographs. The following radiographic parameters were measured: C0-2 Cobb angle; C2-7 Cobb angle (CL), C7 slope (C7S), neck tilt (NT), thoracic inlet angle (TIA), T1 slope (T1S), C2-7 sagittal vertical axis (SVA), cervical tilt, cranial tilt, and cervical curvature index (CCI). Cervical spine function and quality of life were assessed using a visual analog scale (VAS) and the Neck Disability Index (NDI). According to the therapeutic effect, the patients were divided into group A (effective conservative treatment group) and group B (ineffective conservative treatment group). Effective conservative treatment was defined as conservative treatment for 3 months (1 nonsteroidal analgesic and 1 neurotrophic drug, supplemented by cervical traction and a neck support brace) resulting in a 60% reduction in NDI score. The Pearson correlation coefficient was used to calculate the correlation between each sagittal parameter and functional score. Logistic regression analysis and receiver operating characteristic (ROC) curve analysis were used to determine independent risk factors and critical values. RESULTS: In the effective conservative treatment group (group A), the pretreatment NDI score was significantly positively correlated with the pretreatment VAS score and negatively correlated with CL, C7S, TIA, T1S, cervical tilt, and CCI. In the ineffective conservative treatment group (group B), the pretreatment NDI score was significantly positively correlated with the pretreatment VAS score and NT, and negatively correlated with age, CL, C7S, T1S, cervical tilt, and CCI. Based on logistic regression analysis and ROC curve analysis, we found that a larger C2-7 Cobb angle before treatment was the sole independent risk factor for conservative treatment (P < 0.001). Patients with a C2-7 Cobb angle >7.7° had a greater likelihood of receiving effective conservative treatment. CONCLUSIONS: In patients with single-segment cervical spondylotic radiculopathy, a larger C2-7 Cobb angle before treatment was the sole independent risk factor for effective conservative treatment (P < 0.001). Conservative treatment was more likely to be effective when the C2-7 Cobb angle is >7.7°.


Assuntos
Anti-Inflamatórios não Esteroides/uso terapêutico , Braquetes , Vértebras Cervicais/diagnóstico por imagem , Radiculopatia/terapia , Espondilose/terapia , Tração/métodos , Adulto , Idoso , Tratamento Conservador , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Prognóstico , Radiculopatia/diagnóstico por imagem , Radiculopatia/etiologia , Estudos Retrospectivos , Espondilose/complicações , Espondilose/diagnóstico por imagem
5.
Medicine (Baltimore) ; 98(44): e17865, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689879

RESUMO

RATIONALE: Most cases of foot drop are known to result from lower motor neuron pathologies, particularly lumbar radiculopathy and peripheral neuropathy, including common peroneal neuropathy. To improve the prognosis of foot drop, it is important to quickly and accurately diagnose the etiology and provide appropriate treatment. PATIENT CONCERNS: A 65-year-old female patient with a history of L4-5 intervertebral disc herniation presented with right foot drop that had developed 1 month previously. DIAGNOSIS: Electrodiagnostic examination revealed common peroneal neuropathy combined with L5 radiculopathy, with the former being the main cause of the foot drop. MRI of the right knee was performed to identify the cause of the peroneal nerve lesion, which revealed an intraneural ganglion cyst in the common peroneal nerve. INTERVENTIONS: The patient was treated by ultrasound-guided percutaneous cyst aspiration and corticosteroid injection into the decompressed ganglion, followed by strengthening exercise, electrical stimulation therapy, and prescription of an ankle foot orthosis. OUTCOMES: We confirmed regeneration of the injured peroneal nerve at the follow-up electrodiagnostic examination 12 weeks after the intervention. In addition, the manual motor power test demonstrated an increase in the ankle dorsiflexor function score by one grade. LESSONS: Diagnosing the cause of foot drop can be difficult with multiple co-existing pathologies, and consideration of various possible etiologies is the key for appropriate diagnosis and treatment. In addition to imaging modalities such as MRI, electrodiagnostic examination can help to improve diagnostic accuracy. Intraneural ganglion cyst of the common peroneal nerve is rare, but should be considered as a possible cause of foot drop.


Assuntos
Cistos Glanglionares/complicações , Neuropatias Fibulares/etiologia , Radiculopatia/complicações , Corticosteroides/uso terapêutico , Idoso , Terapia Combinada , Terapia por Estimulação Elétrica , Eletrodiagnóstico , Terapia por Exercício , Feminino , Órtoses do Pé , Cistos Glanglionares/diagnóstico , Cistos Glanglionares/terapia , Humanos , Vértebras Lombares , Imagem por Ressonância Magnética , Paracentese , Neuropatias Fibulares/terapia , Radiculopatia/diagnóstico , Radiculopatia/terapia
6.
J Pak Med Assoc ; 69(11): 1601-1604, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31740863

RESUMO

OBJECTIVE: To determine the effect of Mulligan Spinal Mobilisation with Arm Movement along with neurodynamics and manual traction on pain, disablity and cervical range of motion in cervical radiculopathy patients. METHODS: The randomised controlled trial (RCT) was conducted from August to December 2017 at the Railway General Hospital, Rawalpindi, Pakistan, and comprised cervical radiculopathy patients of either gender aged 20-60 years. They were randomised into two groups, with the experimental Group A getting treated with Spinal Mobilisation with Arm Movement along with neurodynamics and manual traction, while the control group B only getting treated with neurodynamics and manual traction. The pain, disability and cervical range of motion were assessed before and after treatment of 3 weeks using Numeric Pain Rating Scale, Neck Disability Index and Goniometry. Data was analyzed using SPSS 21. RESULTS: Of the 31 patients, 19(61.3%) were females and 12(38.7%) were males. The overall mean age was 41.65±9.714 years. There were 15(48.4%) patients in Group A, and 16(51.6%) in Group B. Group A showed significantly better results in terms of pain, disability and cervical range of motion (p<0.05 each). CONCLUSIONS: Patients treated with Spinal Mobilisation with Arm Movement along with neurodynamics and manual traction had better outcome compared to those who only got neurodynamics and manual traction.


Assuntos
Vértebras Cervicais/fisiopatologia , Manipulações Musculoesqueléticas/métodos , Radiculopatia/fisiopatologia , Radiculopatia/terapia , Adulto , Dor nas Costas/etiologia , Dor nas Costas/fisiopatologia , Dor nas Costas/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Radiculopatia/complicações , Amplitude de Movimento Articular/fisiologia , Tração
7.
Medicine (Baltimore) ; 98(48): e17974, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770206

RESUMO

BACKGROUND: Cervical spondylosis radiculopathy (CSR) is often described as neck pain accompanied with radiating pain and neurologic symptoms, such as numbness, muscle weakness, and diminished reflexes, in 1 or both upper extremities. As people's lifestyle changes and the population ages, the incidence of CSR continues to increase. Many clinical trials have proven that acupuncture and chiropractic has a significant effect in the treatment of CSR. In this systematic review, we aim to evaluate the effectiveness and safety of acupuncture and chiropractic for CSR. METHODS: We will search PubMed, Cochrane Library, AMED, EMbase, WorldSciNet; Nature, Science online and China Journal Full-text Database, China Biomedical Literature CD-ROM Database, and related randomized controlled trials included in the ChinaResources Database. The time is limited from the construction of the library to February, 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 Stata13.0 software for meta-analysis of the effectiveness, recurrence rate, and symptom scores of CSR. TRIAL REGISTRATION NUMBER: CRD42019119941.


Assuntos
Terapia por Acupuntura/métodos , Manipulação Quiroprática/métodos , Radiculopatia/terapia , Espondilose/terapia , Humanos , Resultado do Tratamento
8.
J Pak Med Assoc ; 69(9): 1237-1241, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31511705

RESUMO

OBJECTIVE: To compare the effects of manual traction, manual intervertebral foramen opening technique and combination of the two techniques in patients with cervical radiculopathy. METHODS: The single-blind randomised control trial was conducted at Fauji Foundation Hospital, Rawalpindi, Pakistan, from July 2017 to January 2018, and comprised patients of either gender having unilateral upper extremity pain, paresthesia or numbness. The subjects were placed into groups I, II and III using sealed envelope method. Group I was treated with the opening of intervertebral foramen technique, while group II received manual traction of cervical spine, and group III received both techniques. Three sessions were conducted per week for 3 weeks. The outcome measures were neck disability index, Numeric pain rating scale, patient-specific functional scale, and range of motions of cervical spine. SPSS 21 was used for data analysis. RESULTS: Of the 40 patients, 17(30%) were males and 23(70%) were females. There were 13(32.5%)patients each in groups I and II, while group III had 14(35%). Mean age in group I was 42.41±6.86 years, in group II 40.95±7 .32 years and in group III 42.50±5.77 years. There was no statisticallysignificant difference among the three groups with respect to any parameter (p>0.05). Individual group analysis showed significant improvement (p<0.05) in all parameters . CONCLUSIONS: Manual intervertebral foramen opening technique, manual traction, and combination of both techniques were equally effective in decreasing pain, level of disability and improved cervical mobility in patients with cervical radiculopathy.


Assuntos
Manipulação da Coluna/métodos , Cervicalgia/terapia , Radiculopatia/terapia , Tração/métodos , Adulto , Vértebras Cervicais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Manipulações Musculoesqueléticas/métodos , Amplitude de Movimento Articular , Método Simples-Cego
9.
Medicine (Baltimore) ; 98(35): e16975, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31464943

RESUMO

BACKGROUND: Significant functional limitations and disabilities are common presenting complaints for people suffering from cervical radiculopathy. Exercise is a common conservative treatment for this disease. Therefore, we conducted a systematic review and meta-analysis to explore the efficacy of exercise in the treatment of cervical radiculopathy. METHODS: A systematic literature search for studies will be performed in 7 databases, including PubMed, Web of Science, Embase, the Cochrane Library, the Chinese National Knowledge Infrastructure Database (CNKI), Wanfang database, and VIP database. The methodological quality of the included studies using the risk bias assessment tool of Cochrane and the level of evidence for results are assessed by the GRADE method. Statistical analysis is conducted with Revman 5.3. RESULTS: This systematic review and meta-analysis will provide a synthesis of existed evidences for exercise on cervical radiculopathy. CONCLUSION: The conclusion of this study will provide evidence to assess effectiveness of exercise on cervical radiculopathy, which can further guide clinical decision-making. PROSPERO REGISTRATION NUMBER: CRD42019121886.


Assuntos
Vértebras Cervicais , Exercício Físico/fisiologia , Radiculopatia/terapia , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa
10.
BMC Musculoskelet Disord ; 20(1): 265, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31153362

RESUMO

BACKGROUND: A research gap exists for optimal management of cervical radiculopathy in the first 12 weeks and short term natural history of the condition is somewhat unclear, although thought to be favourable. The primary aim of this assessor blinded, superiority, 2 parallel group randomised controlled trial is to investigate the effects of a 4 week physiotherapy programme (6-8 sessions) of manual therapy, exercise and upper limb neural unloading tape, compared to a control of weekly phone advice; on disability, pain and selected biopsychosocial measures, in acute and sub-acute cervical radiculopathy patients. A secondary aim is to identify whether any baseline variables, symptom duration or group allocation can predict outcome. METHODS: Participants are recruited from GP referrals in an urban setting, from a neurosurgery non-urgent waiting list and from self-referral through Facebook advertising. Eligible participants (n = 64) are diagnosed with radiculopathy based on a clinical prediction rule and must have symptoms of unilateral, single level, radiculopathy for between 2 and 12 weeks, without having yet received physiotherapy. Random 1:1 group allocation (using variable block sizes), allocation concealment, blinded assessment and intention to treat analysis are being employed. Treatment is provided by clinical specialist physiotherapists in primary and secondary care settings. Outcomes are measured at baseline, 4 (primary endpoint) and 12 weeks. Participants' report of pain, disability and their rating of recovery is also recorded by telephone interview at 6 months. Statistical analysis of between group differences will be performed with ANOVAs and MANOVAs, and multivariable regression analysis will be undertaken to explore predictor variables. Ethical approval for this study has been received from the Beaumont Hospital and Irish College of General Practitioners Research Ethics Committees. The trial is registered at ClinicalTrials.gov (NCT02449200). DISCUSSION: An internal pilot study to test retention and recruitment strategies led to trial expansion and this is now a multi centre trial involving 5 clinical sites. TRIAL REGISTRATION: NCT02449200 . Registered 20/05/15.


Assuntos
Tratamento Conservador/métodos , Cervicalgia/terapia , Radiculopatia/terapia , Adulto , Fita Atlética , Vértebras Cervicais , Terapia Combinada/métodos , Terapia por Exercício/métodos , Feminino , Humanos , Masculino , Estudos Multicêntricos como Assunto , Manipulações Musculoesqueléticas/métodos , Cervicalgia/diagnóstico , Cervicalgia/etiologia , Medição da Dor , Projetos Piloto , Qualidade de Vida , Radiculopatia/complicações , Ensaios Clínicos Controlados Aleatórios como Assunto , Reprodutibilidade dos Testes , Resultado do Tratamento , Adulto Jovem
11.
Spine (Phila Pa 1976) ; 44(13): 937-942, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31205171

RESUMO

STUDY DESIGN: Retrospective, observational study. OBJECTIVE: To examine the costs associated with nonoperative management (diagnosis and treatment) of cervical radiculopathy in the year prior to anterior cervical discectomy and fusion (ACDF). SUMMARY OF BACKGROUND DATA: While the costs of operative treatment have been previously described, less is known about nonoperative management costs of cervical radiculopathy leading up to surgery. METHODS: The Humana claims dataset (2007-2015) was queried to identify adult patients with cervical radiculopathy that underwent ACDF. Outcome endpoint was assessment of cumulative and per-capita costs for nonoperative diagnostic (x-rays, computed tomographic [CT], magnetic resonance imaging [MRI], electromyogram/nerve conduction studies [EMG/NCS]) and treatment modalities (injections, physical therapy [PT], braces, medications, chiropractic services) in the year preceding surgical intervention. RESULTS: Overall 12,514 patients (52% female) with cervical radiculopathy underwent ACDF. Cumulative costs and per-capita costs for nonoperative management, during the year prior to ACDF was $14.3 million and $1143, respectively. All patients underwent at least one diagnostic test (MRI: 86.7%; x-ray: 57.5%; CT: 35.2%) while 73.3% patients received a nonoperative treatment. Diagnostic testing comprised of over 62% of total nonoperative costs ($8.9 million) with MRI constituting the highest total relative spend ($5.3 million; per-capita: $489) followed by CT ($2.6 million; per-capita: $606), x-rays ($0.54 million; per-capita: $76), and EMG/NCS ($0.39 million; per-capita: $467). Conservative treatments comprised of 37.7% of the total nonoperative costs ($5.4 million) with injections costs constituting the highest relative spend ($3.01 million; per-capita: $988) followed by PT ($1.13 million; per-capita: $510) and medications (narcotics: $0.51 million, per-capita $101; gabapentin: $0.21 million, per-capita $93; NSAIDs: 0.107 million, per-capita $47), bracing ($0.25 million; per-capita: $193), and chiropractic services ($0.137 million; per-capita: $193). CONCLUSION: The study quantifies the cumulative and per-capital costs incurred 1-year prior to ACDF in patients with cervical radiculopathy for nonoperative diagnostic and treatment modalities. Approximately two-thirds of the costs associated with cervical radiculopathy are from diagnostic modalities. As institutions begin entering into bundled payments for cervical spine disease, understanding condition specific costs is a critical first step. LEVEL OF EVIDENCE: 3.


Assuntos
Vértebras Cervicais , Custos de Cuidados de Saúde , Formulário de Reclamação de Seguro/economia , Procedimentos Neurocirúrgicos/economia , Radiculopatia/economia , Radiculopatia/terapia , Adulto , Idoso , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Estudos de Coortes , Bases de Dados Factuais/economia , Bases de Dados Factuais/tendências , Discotomia/economia , Discotomia/tendências , Feminino , Custos de Cuidados de Saúde/tendências , Humanos , Formulário de Reclamação de Seguro/tendências , Imagem por Ressonância Magnética/economia , Imagem por Ressonância Magnética/tendências , Masculino , Manipulação Quiroprática/economia , Manipulação Quiroprática/tendências , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/tendências , Modalidades de Fisioterapia/economia , Modalidades de Fisioterapia/tendências , Radiculopatia/diagnóstico por imagem , Estudos Retrospectivos , Fusão Vertebral/economia , Fusão Vertebral/tendências , Tomografia Computadorizada por Raios X/economia , Tomografia Computadorizada por Raios X/tendências , Resultado do Tratamento
12.
World Neurosurg ; 128: 69-71, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31051307

RESUMO

BACKGROUND: Synovial cysts are most commonly found in the lumbar spine and are associated with low back pain and radiculopathy. Frequent use of imaging modalities has led to an increase in intraspinal synovial cyst identification. Treatment typically ranges from conservative measures to surgical decompression, but spontaneous resolution has previously been reported. Here, we present the first report of symptomatic lumbar synovial cyst resolution after a traumatic fall. CASE DESCRIPTION: We present a case of a symptomatic synovial cyst between the fourth (L4) and fifth (L5) lumbar vertebrae identified on magnetic resonance imaging (MRI). The patient presented with right paramedian back pain and right-sided L5 radiculopathy. She underwent unsuccessful trials of antiinflammatory agents and physical therapy. Less than 1 year since initial diagnosis, the patient sustained a mechanic fall followed by resolution of prior symptoms. A subsequent lumbar MRI revealed complete resolution of the intraspinal synovial cyst. CONCLUSIONS: The diagnosis of synovial cysts are increasing in frequency due to their ease of identification with computed tomography and MRI. For cases of refractory pain and/or neurologic deficits, surgical decompression is usually necessary. In rare instances, synovial cysts may spontaneously regress or resolve secondary to other events. This is the first description of resolution after a traumatic fall. Due to limited data on this topic, this report may provide additional insight into the pathophysiology of synovial cyst formation and resolution.


Assuntos
Acidentes por Quedas , Cisto Sinovial/diagnóstico por imagem , Articulação Zigapofisária/diagnóstico por imagem , Anti-Inflamatórios não Esteroides/uso terapêutico , Feminino , Humanos , Dor Lombar/etiologia , Dor Lombar/terapia , Vértebras Lombares , Imagem por Ressonância Magnética , Meloxicam/uso terapêutico , Pessoa de Meia-Idade , Modalidades de Fisioterapia , Radiculopatia/etiologia , Radiculopatia/terapia , Remissão Espontânea , Estenose Espinal/diagnóstico por imagem , Estenose Espinal/etiologia , Cisto Sinovial/complicações , Falha de Tratamento
14.
Clin Orthop Surg ; 11(1): 89-94, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30838112

RESUMO

Background: Buttock pain is common, and there are no fixed guidelines for its diagnosis and treatment. This study compared a selective nerve root block and a facet joint block for patients with degenerative spinal disease and buttock pain. Methods: Patients with degenerative spinal disease who presented with buttock pain, received a selective nerve root block (group A) or a facet joint block (group B) from June 2017 to September 2017, and were able to be followed up for more than 3 months were prospectively enrolled. Clinical results were assessed using a visual analog scale for comparative analysis. Results: One day after the procedure, an excellent response was found in 7% and 6% of groups A and B, respectively; a good response was found in 41% and 13% of groups A and B, respectively. Two weeks later, an excellent response was found in 11% and 4% of groups A and B, respectively; a good response was found in 41% and 20% of groups A and B, respectively. Six weeks later, an excellent response was found in 11% and 7% of groups A and B, respectively, and a good response was found in 41% and 20% of groups A and B, respectively. At the final follow-up, more than 47% and 46% of patients showed a good response in groups A and B, respectively. In group A, the visual analog scale score improved compared to the pre-procedure value of 5.01 to 2.74 on day 1, 2.51 at week 2, 2.38 at week 6, and 2.39 at week 12. In group B, the visual analog scale score improved compared to the preprocedure value of 5.24 to 3.94 on day 1, 3.99 at week 2, 3.24 at week 6, and 2.59 at week 12. On day 1 and at weeks 2 and 6, group A showed a significantly better outcome than group B (p < 0.05). Conclusions: The selective nerve root block showed superior results up to 6 weeks post-procedure. Considering that the selective nerve root block is effective for treating radiculopathy, the primary cause of buttock pain can be thought to be radiculopathy rather than degenerative changes of the facet joint.


Assuntos
Bloqueio Nervoso , Dor Referida/terapia , Radiculopatia/terapia , Estenose Espinal/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Nádegas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Dor Referida/etiologia , Estudos Prospectivos , Radiculopatia/etiologia , Raízes Nervosas Espinhais , Resultado do Tratamento , Articulação Zigapofisária
15.
J Back Musculoskelet Rehabil ; 32(5): 725-730, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30664500

RESUMO

BACKGROUND: Neural mobilization is an effective technique in the management of cervical radiculopathy (CR). However, the difference between active versus passive upper extremity (UE) neural mobilization techniques in the management of cervical radiculopathy is not well established. OBJECTIVE: To determine the role of active versus passive UE neural mobilization in females with cervical radiculopathy. METHODS: A double blind randomized controlled trial was conducted at Shifa International Hospital from Sep 2016 to Feb 2017, and 44 females were included and randomized into 2 groups, receiving 12 treatment sessions in total. Group A received active whereas Group B received passive UE neural mobilization, along with cervical traction and Unilateral Posterior Anterior (UPA) glide regardless of the group. Numeric pain rating scale (NPRS), Neck Disability Index (NDI) and cervical range of motion (ROM) were used as outcome measurement tools. Non-parametric tests of significance were used for inter group and intra group comparison (Mann-Whitney U test and Wilcoxon test). RESULTS: A statistically significant difference was observed between pre and post NPRS, NDI and ROM scores after 4 weeks of treatment for both groups (p< 0.05). However, no significant differences were observed in post treatment scores of active and passive neural mobilization groups (p> 0.05). CONCLUSION: Both active and passive neural mobilization is effective in the management of cervical radiculopathy. One of the interventions is not superior to the other.


Assuntos
Cervicalgia/terapia , Modalidades de Fisioterapia , Radiculopatia/terapia , Tração , Adulto , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cervicalgia/fisiopatologia , Medição da Dor , Radiculopatia/fisiopatologia , Amplitude de Movimento Articular/fisiologia , Resultado do Tratamento
16.
Spine J ; 19(2): 306-313, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-29981857

RESUMO

BACKGROUND: Lumbar disc surgery for radicular leg pain is one of the most frequently performed spine procedures. In approximately 20% of patients poor outcome is achieved. The most complex cases have persistent leg pain without residual nerve root compression. Treatment for refractory cases is limited to medical pain management, spinal cord stimulation (SCS), and dorsal root ganglion stimulation. For the latter two, fair to good results are obtained in only 50% of patients and costs and complication rates are high. An alternative surgical procedure is selective intradural dorsal rhizotomy (SIDR). This procedure has been largely abandoned, likely due to poor historic results and readily available modern alternatives. PURPOSE: The goal of this paper is to report our results for SIDR for persistent monoradicular leg pain without residual nerve root compression and to compare the results with those of SCS. STUDY DESIGN: Prospectively followed case series. PATIENT SAMPLE: Consecutive patients with persistent monoradicular leg pain without residual nerve root compression. OUTCOME MEASURES: Visual Analogue Scale (VAS) for leg pain, Roland Disability Questionnaire, and Likert Scale for leg pain were recorded. Complications were documented and patients were asked if, in retrospect, they would undergo the procedure again. METHODS: In Haaglanden Medical Center, SIDR was performed on eight consecutive patients with persistent monoradicular leg pain without residual nerve root compression between December 2013 and September 2017. Patients were followed prospectively and VAS for leg pain, Roland Disability Questionnaire (RDQ), and Likert Scale for leg pain were recorded at intake, 8 weeks and 1 year after surgery and yearly after that. Minimal clinically important differences (MCID) for VAS and RDQ were predefined. Means and ranges were calculated and due to the small sample size further analysis was limited to descriptive analysis. RESULTS: Mean follow-up was 20 months. VAS for leg pain improved from 80 mm at intake to 34 mm at latest follow-up. Five out of eight patients (63%) had good Likert Scale outcome (complete or near complete recovery of leg pain). Patients scored 19, 5 on the RDQ at intake and 12, 7 at the end of follow-up. Four patients (57%) reached a MCID for VAS at 1 year post surgery and one reached borderline MCID. Five patients (71%) reached a MCID for RDQ at 1 year post surgery. Six patients (75%) would undergo the procedure again. CONCLUSIONS: SIDR is a safe and effective procedure in strictly selected patients with persistent monoradicular leg pain without residual nerve root compression. Considering the high costs and complication rates of SCS, the results of this study warrant a randomized controlled trial comparing the cost-effectiveness of SIDR and SCS.


Assuntos
Complicações Pós-Operatórias/epidemiologia , Radiculopatia/cirurgia , Rizotomia/métodos , Adulto , Feminino , Humanos , Perna (Membro) , Masculino , Pessoa de Meia-Idade , Radiculopatia/terapia , Rizotomia/efeitos adversos , Estimulação da Medula Espinal/efeitos adversos
17.
Neuromodulation ; 22(3): 333-340, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30303595

RESUMO

OBJECTIVES: Currently little objective evidence exists regarding the phenotype or somato-sensory profile of patients with Failed Back Surgery Syndrome (FBSS). The aim of this study is to characterize the somato-sensory profile of the patients with FBSS undergoing spinal cord stimulation (SCS). METHODS: A combined quantitative sensory test and questionnaire approach was used to characterize the somatosensory profiles of patients undergoing SCS. RESULTS: Baseline somatosensory profiles were obtained from 23 patients and full three-month data was obtained from 19 patients. At baseline, there was a high prevalence (>50% prevalence of moderate to severe sensation) of burning, tingling, electric shock, numbness, and pressure pain sensitivity. None of the sensory symptoms were present at significant levels at three months following SCS. At baseline, 65% of patients had an inefficient conditioned pain modulation (CPM). Three months post-SCS, 95% of patients had an efficient CPM. All the patients who had an inefficient CPM at baseline had a successful implant at three months and their CPM became efficient in all but one patient. Only 50% of the patients with an efficient CPM at baseline, had a successful implant at three months post-SCS. CONCLUSION: Although very low numbers, we could demonstrate the somatosensory profiles of patients with FBSS undergoing SCS. Early indication may associate an efficient CPM profile having a higher chance of an unsuccessful implant at three months.


Assuntos
Potenciais Somatossensoriais Evocados/fisiologia , Síndrome Pós-Laminectomia/terapia , Medição da Dor/métodos , Radiculopatia/terapia , Estimulação da Medula Espinal/métodos , Idoso , Síndrome Pós-Laminectomia/diagnóstico , Síndrome Pós-Laminectomia/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Estudos Prospectivos , Radiculopatia/diagnóstico , Radiculopatia/fisiopatologia
18.
Neuromodulation ; 22(3): 327-332, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30328646

RESUMO

BACKGROUND: Spinal cord stimulation (SCS) is a well-known treatment in patients with failed back surgery syndrome (FBSS). Burst stimulation is a recently developed stimulation modality that seems to be superior to tonic stimulation. METHODS: This observational multicenter study compared tonic and burst stimulation during a trial period in patients with FBSS or radiculopathy. All the patients enrolled underwent two weeks of tonic stimulation followed by another two weeks of BurstDR stimulation, without randomization. The primary outcome was the reduction of pain in the legs and back. Health-related quality of life (EQ-5D) and the pain catastrophizing scale (PCS) were assessed before and after the trial. Patients were reevaluated after 12 months. RESULTS: We recruited 23 patients, 57% of whom had FBSS and 43% had radiculopathies. Five patients failed both the tonic and burst stimulation trials. While tonic stimulation reduced leg pain (p < 0.05), the burst mode added an extra pain reduction (ΔNRS 1.2 ± 1.5) (p < 0.01). No significant reduction in back pain was found (p 0.29). Pain on movement was reduced only by BurstDR (p < 0.01). Both stimulation modalities increased EQ-5D and reduced PCS from the baseline (p < 0.0001). At the end of the SCS trial phase, 26% patients chose tonic SCS, while 74% preferred burst. On 12-month follow-up examination, the benefits recorded at the end of the trial were maintained. CONCLUSIONS: Burst stimulation confers a greater reduction in leg pain intensity at rest and on movement. Reducing axial pain is still a challenge. Further studies are needed in order to provide each patient with the most appropriate stimulation paradigm.


Assuntos
Síndrome Pós-Laminectomia/terapia , Medição da Dor/métodos , Radiculopatia/terapia , Estimulação da Medula Espinal/métodos , Idoso , Estudos de Coortes , Síndrome Pós-Laminectomia/diagnóstico , Síndrome Pós-Laminectomia/fisiopatologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Radiculopatia/diagnóstico , Radiculopatia/fisiopatologia
19.
Musculoskelet Sci Pract ; 39: 51-57, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30500719

RESUMO

BACKGROUND: Patients with radicular symptoms can experience high levels of pain and disability with at least a third experiencing on-going symptoms 12 months after onset. AIMS: To explore 'what matters' about living with radicular symptoms at the point of seeing a spinal specialist and to consider how care can be aligned to best address need. METHODS: In this qualitative study, based on the principles of interpretative phenomenological analysis, 14 participants with a clinical presentation of radicular symptoms were purposively recruited from an NHS, Musculoskeletal Service in the UK. Individual, semi-structured interviews were undertaken, audio-recorded and transcribed verbatim. Data were managed using a Framework approach and analysed thematically. FINDINGS: Radicular symptoms were experienced as a protracted journey of acute exacerbations of symptoms that were difficult to make sense of. Adversely affecting almost all aspects of life, participants struggled to maintain their physical and functional independence; their important relationships; social networks and the roles and activities that provided joy and purpose. The impact of radicular symptoms was a 'life on hold' and an uncertain future, and 3/14 reported suicidal thoughts. CONCLUSIONS: This paper, the first to focus on the lived experience of radicular symptoms at the point of seeing a spinal specialist, reveals the severity and devastating impact of radicular symptoms. Important implications have been identified regarding the need for clinicians to legitimise the symptoms and impact of radicular symptoms; to identify early those patients who might benefit from injection/surgery; and to signpost appropriate patients to sources of psychological support.


Assuntos
Atividades Cotidianas , Medição da Dor/psicologia , Qualidade de Vida/psicologia , Radiculopatia/psicologia , Adaptação Psicológica , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Poder Psicológico , Pesquisa Qualitativa , Radiculopatia/terapia , Avaliação de Sintomas , Reino Unido
20.
J Am Acad Orthop Surg ; 27(14): 533-540, 2019 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-30407977

RESUMO

INTRODUCTION: This study directly compares the economical and clinical effectiveness of the use of cervical epidural injections and continued physical therapy versus surgical management in cases of cervical radiculopathy that have failed 6 weeks of conservative management. METHODS: A theoretical cohort of patients with cervical radiculopathy resistant to 6 weeks of noninvasive conservative management were simulated to treatment with either anterior cervical diskectomy and fusion (ACDF) or cervical epidural injections and continued physical therapy and analyzed with Markov chain decision tree Monte Carlo simulation. RESULTS: The average incremental cost-effectiveness ratio associated with ACDF was $6,768 per quality-adjusted life year over the lifetime of the patient, whereas the incremental cost-effectiveness ratio associated with cervical injections ranged from $9,033 to $4,044 per quality-adjusted life year based on the success rate. DISCUSSION: Our study suggests that for the management of recalcitrant cervical radiculopathy, ACDF remains the dominant strategy compared with cervical epidural injections if the surgical avoidance rate of such injections is less than 50%. If there is a greater than 50% surgery avoidance rate with injections, then cervical epidural injections would be considered a cost-effective strategy with a role in the management of cervical radiculopathy before surgery.


Assuntos
Tratamento Conservador/economia , Análise Custo-Benefício , Discotomia/economia , Radiculopatia/economia , Radiculopatia/terapia , Fusão Vertebral/economia , Estudos de Coortes , Feminino , Humanos , Injeções Epidurais/economia , Masculino , Pessoa de Meia-Idade , Método de Monte Carlo , Modalidades de Fisioterapia/economia , Resultado do Tratamento
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