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1.
Nan Fang Yi Ke Da Xue Xue Bao ; 40(12): 1804-1809, 2020 Dec 30.
Artigo em Chinês | MEDLINE | ID: mdl-33380385

RESUMO

OBJECTIVE: To evaluate the efficacy of lumbar transforaminal epidural block (LTEB) for treatment of low back pain with radicular pain. METHODS: We retrospectively analyzed the clinical data of 78 patients with low back pain and radicular pain admitted to the Department of Orthopedics of Beijing Chuiyangliu Hospital from March, 2017 to April, 2019. Thirty-three of the patients received treatment with LTEB (LTEB group), and 45 received comprehensive conservative treatment including traction, massage, acupuncture and physiotherapy (control group). The demographic and clinical data of the two groups were compared. The patients were followed up for 3 to 24 months, and numerical rating scale (NRS) and Oswestry disability index (ODI) scores of the patients were evaluated before the treatment and at 2 weeks, 1 month and 3 months after discharge to assess the efficacy of the treatment. RESULTS: The mean operation time of LTEB was 25.7 7.5 min (15-45 min). After the operation, 5 patients developed weakness of the lower limbs but all recovered within 24-72 h. The patients receiving LTEB all showed significantly decreased NRS scores for low back and radicular pain and ODI scores after the operation (P=0.001). At 2 weeks after the operation, the patients receiving LTEB showed significant relief of low back pain as compared with the patients in the control group (t=2.224, P=0.034), and the difference in NRS scores for low back pain between the two groups tended to diminish over time (F=1.743, P=0.183). Treatment with LTEB resulted in obvious relief of radicular pain and significant reduction of the ODI score of the patients (P < 0.001), and such improvements became more obvious over time after LTEB (P < 0.01). CONCLUSIONS: As a minimally invasive approach, LTEB is effective for treatment of low back pain with radicular pain and can produce good short-term effects of pain relief and functional improvement.


Assuntos
Dor Lombar , Radiculopatia , Humanos , Injeções Epidurais , Dor Lombar/tratamento farmacológico , Vértebras Lombares , Radiculopatia/complicações , Radiculopatia/tratamento farmacológico , Estudos Retrospectivos , Resultado do Tratamento
2.
BMJ Case Rep ; 13(12)2020 Dec 12.
Artigo em Inglês | MEDLINE | ID: mdl-33310829

RESUMO

Thoracic radiculopathy is a rare cause of thoracic-abdominal or abdominal pain in subjects with poorly controlled diabetes. We present a case of a young woman with type I diabetes and a severe abdominal pain in both lower quadrants. An extensive diagnostic gastroenterological and gynaecological workup did not disclose abnormalities. Electromyography revealed an initial polyneuropathy and significant neurogenic abnormalities in the T10-T12 paravertebral muscles. Following the hypothesis that the radiculopathy-related abdominal pain might have an immuno-mediated pathogenesis, the patient underwent a complex trial of immunotherapy, which was accompanied by a sustained improvement over months to full recovery. This report would support the hypothesis that immune-mediated mechanisms are still active even months after onset of symptoms.


Assuntos
Diabetes Mellitus Tipo 1/complicações , Imunoglobulinas Intravenosas/administração & dosagem , Radiculopatia/tratamento farmacológico , Dor Abdominal/diagnóstico , Adulto , Eletromiografia , Feminino , Humanos , Imunoterapia , Músculos/inervação , Radiculopatia/diagnóstico , Radiculopatia/fisiopatologia , Vértebras Torácicas/fisiopatologia , Resultado do Tratamento
3.
Artigo em Russo | MEDLINE | ID: mdl-33081445

RESUMO

OBJECTIVE: To improve the algorithm of differential diagnosis and complex treatment of patients with CR. MATERIAL AND METHODS: Forty-two patients with CR were divided into 2 groups. Patients of the first group (n=21) received basic treatment (NSAID, myorelaxants, local injections with glucocorticoids (on demand), B vitamins and non-pharmacological methods) and the anticholinesterase drug ipidacrine. The second group (n=21) had only basic treatment. The total duration of the study was 45 days. The effectiveness of treatment was evaluated with VAS, NDI, GROC and total duration of disability period. RESULTS: A battery of tests for the diagnosis of CR that included Spurling test, motor strength deficiency, ULTT, pain pattern, shoulder adduction test (diagnostic complex SPASIBO), has been developed. A positive result of all 5 tests guarantees the 94.7% accuracy of CR diagnosis. The application of ipidacrine has allowed a significant (p<0.05) reduction of pain, enhancement of daily living activities and subjective improvement of well-being of patients after 1 month of treatment and mostly after 45 days. Besides, there was a considerable (p<0.05) reduction of the disability period in the first group of patients compared to the control one. CONCLUSION: The diagnostic complex SPASIBO should be used in diagnosis of CR. It is highly recommended to include ipidacrine in the complex treatment of CR.


Assuntos
Radiculopatia , Atividades Cotidianas , Diagnóstico Diferencial , Humanos , Dor , Radiculopatia/diagnóstico , Radiculopatia/tratamento farmacológico
4.
Medicine (Baltimore) ; 99(30): e21283, 2020 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-32791709

RESUMO

BACKGROUND: Previous systemic reviews have examined the efficacy of individual therapeutic agents, but which type of treatment is superior to another has not been pooled or analyzed. The objective of the current study was to compare the clinical effectiveness of epidural steroid injection (ESI) versus conservative treatment for patients with lumbosacral radicular pain. METHODS: A systematic search was conducted with MEDLINE, EMBASE, and CENTRAL databases with a double-extraction technique for relevant studies published between 2000 and January 10, 2019. The randomized controlled trials which directly compared the efficacy of ESI with conservative treatment in patients with lumbosacral radicular pain were included. Outcomes included visual analog scale, numeric rating scale, Oswetry disability index, or successful events. Two reviewers extracted data and evaluated the methodological quality of papers using the Cochrane Collaboration Handbook. A meta-analysis was performed using Revman 5.2 software. The heterogeneity of the meta-analysis was also assessed. RESULTS: Of 1071 titles initially identified, 6 randomized controlled trials (249 patients with ESI and 241 patients with conservative treatment) were identified and included in this meta-analysis. The outcome of the pooled analysis showed that ESI was beneficial for pain relief at short-term and intermediate-term follow-up when compared with conservative treatment, but this effect was not maintained at long-term follow-up. Successful event rates were significantly higher in patients who received ESI than in patients who received conservative treatment. There were no statistically significant differences in functional improvement after ESI and conservative treatment at short-term and intermediate-term follow-up. The limitations of this meta-analysis resulted from the variation in types of interventions and small sample size. CONCLUSIONS: According to the results of this meta-analysis, the use of ESI is more effective for alleviating lumbosacral radicular pain than conservative treatments in terms of short-term and intermediate-term. Patients also reported more successful outcomes after receiving ESI when compared to conservative treatment. However, this effect was not maintained at long-term follow-up. This meta-analysis will help guide clinicians in making decisions for the treatment of patients with lumbosacral radicular pain, including the use of ESI, particularly in the management of pain at short-term.


Assuntos
Injeções Epidurais/métodos , Dor Lombar/tratamento farmacológico , Radiculopatia/tratamento farmacológico , Humanos , Região Lombossacral/fisiopatologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Esteroides/administração & dosagem
5.
Am J Emerg Med ; 38(9): 1792-1795, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32738473

RESUMO

Sciatic radicular back pain is a painful condition resulting in approximately 2% of emergency department (ED) visits a year. Typically, the ED treatment has been limited to various analgesic regimens with limited success sometimes resulting in hospital admissions for pain control. Regional anesthesia has become increasing popular for lower-limb analgesia, but has not universally permeated the ED setting. The transgluteal sciatic nerve block (TGSNB) is a procedure that can provide effective analgesia for lower extremity pain. Herein, we present the first technical description and clinical response to ultrasound-guided TGSNB performed by emergency physicians for acute pain control of sciatic back pain through a series of cases.


Assuntos
Analgesia/métodos , Dor nas Costas/tratamento farmacológico , Bloqueio Nervoso/métodos , Manejo da Dor/métodos , Radiculopatia/tratamento farmacológico , Nervo Isquiático , Ultrassonografia de Intervenção , Adulto , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor
6.
Pain Res Manag ; 2020: 9103421, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32617125

RESUMO

Background: Recently, ultrasound- (US-) guided selective nerve root block (SNRB) has been reported to have similar effects compared to fluoroscopy- (FL-) guided cervical epidural steroid injection (CESI). There is no published study comparing the therapeutic efficacy and safety of interlaminar- (IL-) CESI and transforaminal- (TF-) CESI with US-guided SNRB. Our retrospective study aimed to compare the mid-term effects and advantages of the US-guided SNRB, FL-guided IL-CESI, and TF-CESI for radicular pain in the lower cervical spine through assessment of pain relief and functional improvement. Methods: Patients with radicular pain in the lower cervical spine who received guided SNRB (n = 44) or FL-guided IL (n = 41) or TF-CESI (n = 37) were included in this retrospective study. All procedures were performed using a FL or US. The complication frequencies during the procedures, adverse event, treatment effects, and functional improvement were compared at 1, 3, and 6 months after the last injection. Results: Both the Neck Disability Index (NDI) and Verbal Numeric Scale (VNS) scores showed improvements at 1, 3, and 6 months after the last injection in all groups, with no significant differences between groups (P < 0.05). Furthermore, the treatment success rate at all time points was not significantly different between groups. Logistic regression analysis revealed that the injection method (US- or FL-guided), cause, sex, age, number of injections, and pain duration were not independent predictors of treatment success. Blood was aspirated before injection in 7% (n = 3), 14% (n = 6), and 0% patients in the FL-guided IL, TF, and US-guided groups, respectively. In 2 patients of FL-guided IL and 7 of FL-guided TF group, intravascular contrast spread was noted during injection. Conclusions: Our results suggest that, compared with FL-guided IL and TF-CESI, US-guided SNRB has a low intravascular injection rate; it is unlikely that serious complications will occur. Also, US-guided SNRB requires a shorter administration duration while providing similar pain relief and functional improvements. Therefore, for the treatment of patients with lower cervical radicular pain, US-guided SNRB should be considered as a prior epidural steroid injection.


Assuntos
Anestesia Epidural/métodos , Bloqueio Nervoso/métodos , Neuralgia/cirurgia , Radiculopatia/complicações , Ultrassonografia de Intervenção/métodos , Adulto , Vértebras Cervicais , Feminino , Fluoroscopia/métodos , Humanos , Injeções Epidurais/métodos , Masculino , Pessoa de Meia-Idade , Neuralgia/etiologia , Manejo da Dor/métodos , Radiculopatia/tratamento farmacológico , Estudos Retrospectivos , Resultado do Tratamento
7.
Pain Physician ; 23(4): 335-348, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32709169

RESUMO

BACKGROUND: Chronic neck pain is reportedly considered the fourth leading cause of disability. Cervical interlaminar epidural injections are among the commonly administered nonsurgical interventions for managing chronic neck pain, secondary to disc herniation and radiculitis, spinal stenosis, or chronic neck pain of discogenic origin. OBJECTIVES: To systematically review the differences in the effectiveness of cervical epidural injections with local anesthetics with or without steroids for the management of chronic neck pain. STUDY DESIGN: Systematic review and meta-analysis. METHODS: A comprehensive search of the literature of randomized controlled trials (RCTs) that compared epidural injections with local anesthetic with or without steroids was performed, including a search of PubMed, EMBASE, and Cochrane databases for all years up to May 2019. Meta-analysis was done for pain relief based on the Numeric Rating Scale, functional status based on the Neck Disability Index, and opioid intake dosage. RESULTS: Four studies met the inclusion criteria. A total of 370 patients were divided into 2 groups: the experimental group received cervical epidural injection with steroid and local anesthetic, and the control group received injection with local anesthetic only. Regrading pain relief, no significant difference was observed between both groups (weighted mean difference [WMD], -0.006; 95% confidence interval (CI), -0.275 to 0.263; P = 0.963; I² = 0.0% at 12 months). There was also no significant difference in the improvement of the functional status (WMD, 0.159; 95% CI, -1.231 to 1.549; P = 0.823; I² = 9.8% at 12 months). Similarly, there was no significant difference in opioid dosage (WMD, -0.093; 95% CI, -5.952 to 5.766; P = 0.975; I² = 0.0% at 12 months). LIMITATIONS: Only a few studies on this premise were found in the literature. There was also a lack of heterogeneity of the included RCT studies. CONCLUSIONS: The addition of steroids to anesthetic injectates was not associated with better pain and functional score outcomes compared with anesthetic injectate alone in patients with chronic neck pain. KEY WORDS: Chronic neck pain, cervical radiculopathy, cervical disc disease, spinal stenosis, facet joint pathology, cervical epidural injections, steroid injections, local anesthetic injections, systematic review, meta-analysis, randomized control trial.


Assuntos
Anestésicos Locais/administração & dosagem , Dor Crônica/tratamento farmacológico , Cervicalgia/tratamento farmacológico , Manejo da Dor/métodos , Esteroides/administração & dosagem , Dor Crônica/diagnóstico , Quimioterapia Combinada , Humanos , Injeções Epidurais/métodos , Cervicalgia/diagnóstico , Manejo da Dor/efeitos adversos , Radiculopatia/diagnóstico , Radiculopatia/tratamento farmacológico , Resultado do Tratamento
8.
Niger J Clin Pract ; 23(6): 835-841, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32525120

RESUMO

Aims: This study aims to investigate the effectiveness of transforaminal epidural steroid injection (TFESI) in patients with lumbar radicular pain or radiculopathy caused by different spinal pathologies. Methods: One hundred and seventy seven patients who underwent single transforaminal epidural steroid injection were included in the study group and divided into 3 subgroups (central spinal stenosis + lateral recess stenosis, foraminal stenosis, lumbar disc herniation) according to existing spinal pathology. Patients' visuel analogue scale (VAS) measures and Oswestry Disability Index (ODI) scores were recorded and the patients who give favourable response to treatment were called respondents and who were not called as non-respondents. Subgroups were compared statistically at the end of 12 months. Results: Sixty patients (33.9%) were considered as respondents and 117 patients (66.1%) were non-respondents in the entire study group. Patients with foraminal stenosis included the vast majority of the respondents and showed better results of pain relief as opposed to patients of other groups at the end of 12 months (P < 0.001). Conclusion: TFESI was an effective treatment modality for pain relief and functional improvement in patients with foraminal stenosis. However, it could not produce the same results in patients with central spinal stenosis and lumbar disc herniations.


Assuntos
Dor nas Costas/tratamento farmacológico , Injeções Epidurais/efeitos adversos , Deslocamento do Disco Intervertebral/diagnóstico , Vértebras Lombares/fisiopatologia , Medição da Dor/métodos , Radiculopatia/tratamento farmacológico , Estenose Espinal/tratamento farmacológico , Esteroides/administração & dosagem , Adulto , Idoso , Dor nas Costas/etiologia , Feminino , Humanos , Vértebras Lombares/efeitos dos fármacos , Região Lombossacral/fisiopatologia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Manejo da Dor/métodos , Medição da Dor/efeitos dos fármacos , Estudos Retrospectivos , Estenose Espinal/complicações , Estenose Espinal/diagnóstico , Esteroides/efeitos adversos , Resultado do Tratamento , Escala Visual Analógica
9.
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
10.
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
11.
Medicine (Baltimore) ; 99(7): e19137, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32049834

RESUMO

BACKGROUND: Huangqi Guizhi Wuwu Decoction (HGWD) is a common prescription for the treatment of cervical radiculopathy (CR). And the effectiveness and safety of HGWD for CR were assessed in this study. METHODS: Seven databases were searched. Randomized controlled trials involving HGWD alone or HGWD combined with conventional treatment were enrolled. The authors in pairs independently assessed the risk of bias and extracted the data. RESULTS: Eight studies involving 783 participants with CR were included. Meta-analysis revealed that the efficacy of HGWD for CR was significantly superior compared with control treatment (risk ratio = 1.12, 95% confidence interval [CI]:1.06-1.19, Z = 3.71; P = .0002). Compare with control group, there is an increase in visual analog scale (mean difference [MD] = 0.99; 95% CI: 0.83-1.14; Z = 12.57; P < .00001). There was also an improvement of neck disability index (MD = 9.2; 95% CI: 8.28-10.11; Z = 19.75; P < .00001). Adverse events were not mentioned in the 8 trials. CONCLUSION: HGWD alone or HGWD plus other treatment may be helpful to patients with CR. However, the methodological quality of the randomized controlled trials was generally low. Larger and better-designed randomized controlled trials are recommended.


Assuntos
Medicamentos de Ervas Chinesas/uso terapêutico , Radiculopatia/tratamento farmacológico , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
12.
Pain Pract ; 20(4): 396-398, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31816174

RESUMO

Lumbosacral radicular pain with or without radiculopathy is a fairly common clinical condition. In such cases, lumbosacral transforaminal epidural injection (TFEI) is one of the most commonly performed interventions. Recent studies have explored the effectiveness of ultrasound (US)-guided lumbosacral TFEI. Most of these studies have focused on lumbar TFEI via an in-plane approach. S1 TFEI can also be easily performed, since the S1 foramen is more superficial than the lumbar foramen. However, most studies regarding US-guided sacral TFEI use an out-of-plane technique. Therefore, in this report we present a video of US-guided S1 TFEI via an in-plane approach.


Assuntos
Injeções Epidurais/métodos , Ultrassonografia Doppler em Cores/métodos , Ultrassonografia de Intervenção/métodos , Dor nas Costas/tratamento farmacológico , Feminino , Humanos , Região Lombossacral , Masculino , Pessoa de Meia-Idade , Radiculopatia/tratamento farmacológico , Resultado do Tratamento
13.
World Neurosurg ; 133: e443-e447, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31526885

RESUMO

BACKGROUND: S1 transforaminal epidural steroid injection (S1-TFESI) results in positive clinical outcomes for the treatment of pain associated with the S1 nerve root. S1-TFESI via the transforaminal approach is commonly performed under fluoroscopic guidance. Ultrasound guidance is an alternative to mitigate radiation exposure. However, performing spinal procedures under ultrasound guidance has some limitations in confirming the position of the needle tip and vascular uptake. New techniques are therefore needed to make ultrasound and fluoroscopy complementary. Our objective was to describe a novel technique for S1-TFESI and confirm its reproducibility. METHODS: Records of patients with S1 radiculopathy were reviewed retrospectively; those treated using the new S1-TFESI technique were selected. Initially, ultrasound was used to distinguish anatomy of the sacral foramen and guide initial placement of the needle entry point. Fluoroscopy was subsequently used to confirm needle tip position and vascular injection. The number of times the needle required reinsertion was recorded, and ultrasound and C-arm images were stored. RESULTS: Sixty-seven S1-TFESIs were performed in 56 patients. All injections exhibited epidural spread of contrast media, not only to the S1 nerve. The cephalad angle was 16.25 ± 6.75° (range, 5-27°), the oblique angle was 2.48 ± 2.62° (range, 0-7°), and the mean number of attempts was 1.24 ± 1.25. CONCLUSIONS: The new technique, involving the use of ultrasound to guide initial placement of the needle entry point, followed by confirmatory imaging and any needed adjustment with the use of fluoroscopy, can be a technique to complement the shortcomings of using ultrasound or fluoroscopy alone.


Assuntos
Corticosteroides/administração & dosagem , Fluoroscopia/métodos , Injeções Epidurais/métodos , Bloqueio Nervoso/métodos , Radiculopatia/tratamento farmacológico , Radiografia Intervencionista/métodos , Ultrassonografia de Intervenção/métodos , Corticosteroides/uso terapêutico , Adulto , Idoso , Idoso de 80 Anos ou mais , Anestésicos Locais/administração & dosagem , Anestésicos Locais/uso terapêutico , Meios de Contraste , Feminino , Humanos , Vértebras Lombares , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sacro , Adulto Jovem
14.
Medicina (Kaunas) ; 55(11)2019 Nov 14.
Artigo em Inglês | MEDLINE | ID: mdl-31739434

RESUMO

BACKGROUND AND OBJECTIVES: The efficacy of commonly prescribed analgesic and adjuvant drugs for the management of patients with radiculopathy has not been well established. Oral steroids are commonly used to treat sciatica or radiculopathy due to a herniated disk but the effect remains controversial. L-lysine aescinate showed superiority over placebo or baseline therapy with NSAIDs alone in treating sciatica, but have not been evaluated in an appropriately powered clinical trial. MATERIALS AND METHODS: Randomized, double-blind clinical trial conducted in two health centers in collaboration with Uzhhorod Natioanl University in Ukraine. Adults (N = 90) with acute radicular pain and a herniated disk confirmed by MRI were eligible. Participants were randomly assigned to three groups (N = 30 in each) to receive a baseline therapy with lornoxicam (16 mg per day) and adjunctive 5-day course of IV dexamethasone (first group: 8 mg per day/40 mg total) or 0,1% solution of L-lysine aescinate (5 mL and 10 mL for group 2 and 3 respectively). Primary outcomes were Visual Analogue Scale changes and the straight leg raise angle at 15th and 30th day. RESULTS: The level of pain improvement at 15th days after initiation of therapy with dexamethasone or solution of L-lysine aescinate at doses of 5 or 10 mL was not significantly different. The lowest levels of pain were achieved in patients who received the L-lysine aescinate 10 mL, but the range of decrease in pain was slightly greater in the group administered dexamethasone. CONCLUSIONS: Among patients with acute radiculopathy due to a herniated lumbar disk a short course of IV dexamethasone or L-lysine aescinate resulted in pain improvement at 15th and 30th day. Dexamethasone may be preferable if a longer-term analgesic effect is needed. Taking into account side effects of dexamethasone, a solution of L-lysine aescinate can be used to relieve pain symptoms.


Assuntos
Deslocamento do Disco Intervertebral/complicações , Lisina/normas , Manejo da Dor/normas , Radiculopatia/tratamento farmacológico , Adulto , Dexametasona/farmacologia , Dexametasona/uso terapêutico , Método Duplo-Cego , Feminino , Humanos , Deslocamento do Disco Intervertebral/tratamento farmacológico , Dor Lombar/tratamento farmacológico , Dor Lombar/etiologia , Lisina/farmacologia , Lisina/uso terapêutico , Masculino , Pessoa de Meia-Idade , Manejo da Dor/métodos , Manejo da Dor/estatística & dados numéricos , Medição da Dor/métodos , Radiculopatia/etiologia , Resultado do Tratamento , Ucrânia
15.
Pain Physician ; 22(6): 561-573, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31775403

RESUMO

BACKGROUND: Epidural steroid injections (ESIs) are commonly used for management of lumbosacral radicular pain. Midline interlaminar (MIL) or transforaminal (TF) routes are commonly used. The TF route, although associated with higher delivery of drug to the ventral epidural space, has serious complications including spinal cord injury and permanent paralysis reported in literature. Therefore, there is a search for a technically better route with fewer complications and greater drug delivery into the ventral epidural space. Recently, a parasagittal interlaminar (PIL) approach has been defined. OBJECTIVES: We conducted this study to compare therapeutic effectiveness of 3 techniques of ESIs in patients having unilateral lumbar radiculopathy. Further, effect of ESI on bone mineral density (BMD) and serum osteocalcin levels were studied. STUDY DESIGN: Randomized double-blind trial. SETTING: Pain clinic of a tertiary care hospital. METHODS: Sixty-five patients were randomly allocated into group MIL, group PIL, and group TF to receive epidural injection with 80 mg of methylprednisolone and 2 mL of 2% lidocaine. Effective pain relief and improvement in disability were assessed using Visual Analog Scale (VAS) and Modified Oswestry Disability Questionnaire (MODQ) scores at 2 weeks, 4 weeks, 3 months, and 6 months, respectively. Patients with < 50% relief received additional injection. Primary outcome of study was effective pain relief at 6 months. Mean change in VAS and MODQ scores, BMD, and serum osteocalcin levels were secondary outcome assessed. RESULTS: Patients having effective pain relief were significantly higher in group PIL (16 of 20 [80%]) and group TF (15 of 20 [75%]) compared with group MIL. Patients receiving ESI in group PIL and group TF showed significantly lower VAS scores than group MIL (P = 0.02, P = 0.50 at 3 months and P = 0.00, P = 0.02 at 6 months, respectively). Mean MODQ scores in group PIL and group TF were significantly lower than group MIL. However, group PIL and group TF did not significantly differ in MODQ scores. There was no significant change in serum osteocalcin and BMD, as assessed by dual energy x-ray absorptiometry scan at 3 months. LIMITATIONS: The absence of a placebo control group, small sample size, and relatively short follow-up of 6 months were limitations. CONCLUSIONS: PIL approach is equivalent to TF and superior to MIL approach in terms of effective pain relief and decrease in disability in patients with unilateral lumbar radiculopathy. This study showed no deleterious effect on BMD. KEY WORDS: Epidural steroid, technique, efficacy, bone marrow density, serum osteocalcin.


Assuntos
Injeções Epidurais/métodos , Dor Lombar/tratamento farmacológico , Radiculopatia/tratamento farmacológico , Esteroides/administração & dosagem , Adulto , Método Duplo-Cego , Espaço Epidural , Feminino , Humanos , Lidocaína/administração & dosagem , Masculino , Metilprednisolona/administração & dosagem , Pessoa de Meia-Idade , Clínicas de Dor , Manejo da Dor/métodos , Resultado do Tratamento , Escala Visual Analógica
16.
J Altern Complement Med ; 25(12): 1183-1192, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31634001

RESUMO

Objective: Traditional Chinese Medicines (TCMs), as well as physiotherapy and chemical drugs, are recommended for the treatment of cervical spondylosis by Chinese guidelines for cervical spondylosis diagnosis and treatment. The aim of this study was to evaluate whether TCM Jingshu Granules are cost-effective in patients with cervical radiculopathy in China. Methods: A multicenter, double-blinded, randomized placebo-controlled trial was performed. A total of 480 patients were recruited from 14 tertiary hospitals in China and were randomly divided into an experimental group (Jingshu Granules) or control group (placebo) at a 3:1 ratio. All patients received 4 weeks of treatment. Clinical outcomes and cost data were collected during the trial, including the neck disability index (NDI), visual analog scale (VAS) of pain, VAS of numbness, 36-Item Short Form Health Survey (SF-36) score, willingness to pay (WTP) for VAS of pain, direct medical costs, and transport costs. From a social perspective, a decision-tree model and cost-effectiveness analysis were conducted. Results: The treatment group has a significant advantage in reducing NDI (9.41 ± 10.51 vs. 4.83 ± 8.43, p < 0.05), VAS of pain (22.72 ± 15.08 vs. 12.86 ± 13.45, p < 0.05), and VAS of numbness (16.96 ± 17.53 vs. 11.64 ± 16.54, p < 0.05), respectively, while there was no significant difference in the improvement of quality of life (QoL; SF-36 score, p > 0.05). The expected mean cost of the experimental group was 1144.34 yuan, and the effective rates were 57.9% for NDI and 72.9% for VAS of pain. The expected mean cost of the control group was 767.41 yuan, and the effective rates were 33.3% for NDI and 51.6% for VAS of pain. For the primary indicators (VAS of pain and NDI), the incremental cost-effectiveness ratio was 17.69 and 15.32, respectively. The WTP per efficacy for pain resolution of patients was 19.10 yuan. Setting the WTP as threshold, Jingshu Granules were found to be a cost-effectiveness strategy, and sensitivity analysis showed that the effective rates and inspection fees of both groups had a greater impact on the results of both groups. Conclusions: Jingshu Granules were shown to be effective for treating patients with cervical radiculopathy. This treatment was found to be cost-effective when considering VAS of pain and NDI as clinical outcome indicators compared to no treatment (placebo). A clinical study with longer duration or real world study is needed to determine the impact on QoL of patients in the future.


Assuntos
Vértebras Cervicais/fisiopatologia , Medicamentos de Ervas Chinesas/economia , Medicamentos de Ervas Chinesas/uso terapêutico , Radiculopatia/tratamento farmacológico , Análise Custo-Benefício , Método Duplo-Cego , Medicamentos de Ervas Chinesas/efeitos adversos , Feminino , Humanos , Masculino , Radiculopatia/fisiopatologia , Resultado do Tratamento
17.
World Neurosurg ; 132: 67-68, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31479794

RESUMO

Ehlers-Danlos syndrome can be associated with cerebrospinal fluid (CSF) disturbances including recurrent CSF leak and Chiari I malformations. Persistent pseudomeningoceles are known to be associated with raised intracranial pressure. We present an unusual case of a compressive epidural CSF collection occurring after a computed tomography-guided L5 nerve root block and describe an effective management strategy.


Assuntos
Vazamento de Líquido Cefalorraquidiano/etiologia , Síndrome de Ehlers-Danlos/complicações , Injeções Epidurais/efeitos adversos , Hipertensão Intracraniana/complicações , Compressão da Medula Espinal/etiologia , Adulto , Malformação de Arnold-Chiari/complicações , Vazamento de Líquido Cefalorraquidiano/diagnóstico por imagem , Vazamento de Líquido Cefalorraquidiano/cirurgia , Feminino , Humanos , Vértebras Lombares , Bloqueio Nervoso , Radiculopatia/tratamento farmacológico , Radiculopatia/etiologia , Compressão da Medula Espinal/diagnóstico por imagem , Compressão da Medula Espinal/cirurgia , Espondilolistese/complicações , Tomografia Computadorizada por Raios X
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