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1.
Medicine (Baltimore) ; 100(6): e24646, 2021 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-33578590

RESUMO

ABSTRACT: MR tractography of the lumbosacral plexus (LSP) is challenging due to the difficulty of acquiring high quality data and accurately estimating the neuronal tracts. We proposed an algorithm for an accurate visualization and assessment of the major LSP bundles using the segmentation of the cauda equina as seed points for the initial starting area for the fiber tracking algorithm.Twenty-six healthy volunteers underwent MRI examinations on a 3T MR scanner using the phased array coils with optimized measurement protocols for diffusion-weighted images and coronal T2 weighted 3D short-term inversion recovery sampling perfection with application optimized contrast using varying flip angle evaluation sequences used for LSP fiber reconstruction and MR neurography (MRN).The fiber bundles reconstruction was optimized in terms of eliminating the muscle fibers contamination using the segmentation of cauda equina, the effects of the normalized quantitative anisotropy (NQA) and angular threshold on reconstruction of the LSP. In this study, the NQA parameter has been used for fiber tracking instead of fractional anisotropy (FA) and the regions of interest positioning was precisely adjusted bilaterally and symmetrically in each individual subject.The diffusion data were processed in individual L3-S2 nerve fibers using the generalized Q-sampling imaging algorithm. Data (mean FA, mean diffusivity, axial diffusivity and radial diffusivity, and normalized quantitative anisotropy) were statistically analyzed using the linear mixed-effects model. The MR neurography was performed in MedINRIA and post-processed using the maximum intensity projection method to demonstrate LSP tracts in multiple planes.FA values significantly decreased towards the sacral region (P < .001); by contrast, mean diffusivity, axial diffusivity, radial diffusivity and NQA values significantly increased towards the sacral region (P < .001).Fiber tractography of the LSP was feasible in all examined subjects and closely corresponded with the nerves visible in the maximum intensity projection images of MR neurography. Usage of NQA instead of FA in the proposed algorithm enabled better separation of muscle and nerve fibers.The presented algorithm yields a high quality reconstruction of the LSP bundles that may be helpful both in research and clinical practice.


Assuntos
Imagem de Difusão por Ressonância Magnética/métodos , Imagem de Tensor de Difusão/métodos , Plexo Lombossacral/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Nervos Espinhais/diagnóstico por imagem , Adulto , Algoritmos , Anisotropia , Cauda Equina/diagnóstico por imagem , Feminino , Humanos , Processamento de Imagem Assistida por Computador/métodos , Imageamento Tridimensional/instrumentação , Região Lombossacral/inervação , Masculino , Nervos Espinhais/anatomia & histologia
2.
Medicine (Baltimore) ; 100(4): e23285, 2021 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-33530156

RESUMO

BACKGROUND: Intensive neuromuscular stabilization exercise on highly obese patients with low back pain results in positive effects of body fat decline and prevention of complications. The purpose of this study is to investigate the effects of progressive neuromuscular stabilization exercise on unstable surface on pain, motor function, psychosocial factors, balance, and abdominal contraction with highly obese patients with lumbar instability. METHODS: This study is a double-blinded randomized controlled trial. A total of 46 highly obese patients (body mass index [BMI] ≥ 30 kg/m2) with lumbar instability were assigned randomly to experimental group (n = 23) and control group (n = 23). The control group performed the intensive progressive exercise on a stable surface and the experimental group on an unstable surface. RESULT: Significant differences were shown for BMI, QVAS, K-ODI, FABQ, and balance ability for both groups before and after the intervention (P < .05), and only the experimental group showed significant difference for transverse abdominis muscle thickness in contraction and contraction rate (P < .05). Compared to the control group, the experimental group showed significant difference (P < .05) in the amount of changes for QVAS, K-ODI, balance ability, transverse abdominis muscle thickness in contraction, and contraction rate. CONCLUSION: Progressive neuromuscular stabilization exercise program on unstable surfaces demonstrated to be an effective and clinically useful method to decrease pain level, increase motor function, balance, and transverse abdominis muscle thickness in contraction and contraction rate for highly obese patients with lumbar instability.


Assuntos
Terapia por Exercício/métodos , Instabilidade Articular/terapia , Dor Lombar/terapia , Obesidade/complicações , Doenças da Coluna Vertebral/terapia , Músculos Abdominais/fisiopatologia , Adulto , Método Duplo-Cego , Feminino , Humanos , Instabilidade Articular/etiologia , Dor Lombar/etiologia , Vértebras Lombares/fisiopatologia , Região Lombossacral/fisiopatologia , Masculino , Contração Muscular , Obesidade/fisiopatologia , Medição da Dor , Equilíbrio Postural , Doenças da Coluna Vertebral/etiologia , Resultado do Tratamento
3.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 35(1): 130-136, 2021 Jan 15.
Artigo em Chinês | MEDLINE | ID: mdl-33448211

RESUMO

Objective: To review the effect of obesity on the effectiveness of posterior lumbar fusion in patients with lumbar degenerative diseases (LDD). Methods: The related literature at home and abroad was extensively reviewed. And the difficulty of operation, risk of complications, and long-term effectiveness of posterior lumbar fusion for obese patients with LDD were summarized. Results: Although some relevant literature suggest that the posterior lumbar fusion for obese patients is difficult and the risk of postoperative complications is high, the overall research results do not suggest that obesity is a risk factor for the implementation of posterior lumbar fusion. By assessing the physical condition of patients and strictly grasping the surgical indications, obese patients can obtain good surgical efficacy. Conclusion: Posterior lumbar fusion is an effective method for the treatment of LDD in obese patients. However, relevant studies need to be completed to further evaluate the safety and efficacy of posterior lumbar fusion for obese patients.


Assuntos
Fusão Vertebral , Humanos , Vértebras Lombares/cirurgia , Região Lombossacral , Obesidade/complicações , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Resultado do Tratamento
4.
Arch Osteoporos ; 16(1): 2, 2021 01 03.
Artigo em Inglês | MEDLINE | ID: mdl-33389230

RESUMO

We investigated the effect of paravertebral muscle (PVM) on poor prognosis in osteoporotic vertebral fracture (OVF) and remaining lower back pain (LBP) in the thoracolumbar and lower lumbar regions. Additional OVF occurrence in the thoracolumbar and remaining LBP in the lumbar region was significantly related to PVM fat infiltration percentage. PURPOSE: Paravertebral muscle (PVM) is an important component of the spinal column. However, its role in the healing process after osteoporotic vertebral fracture (OVF) is unclear. This study aimed to clarify the effect of PVM in thoracolumbar and lower lumbar regions on OVF clinical and radiological outcomes. METHODS: This was a multicenter prospective cohort study from 2012 to 2015. Patients ≥ 65 years old who presented within 2 weeks after fracture onset were followed up for 6 months. PVM was measured at the upper edge of the L1 and L5 vertebral body in the magnetic resonance imaging (MRI) T2-axial position at registration. The cross-sectional area (CSA), relative CSA (rCSA), and fat infiltration percentage (FI%) were measured. Severe vertebral compression, delayed union, new OVF, and remaining low back pain (LBP) were analyzed. RESULTS: Among 153 patients who were followed up for 6 months, 117 with measurable PVM were analyzed. Their average age was 79.1 ± 7.2 years, and 94 were women (80.3%). There were 48 cases of severe vertebral compression, 21 delayed unions, 11 new OVF, and 27 remaining LBP. Among all poor prognoses, only the FI% of the PVM was significantly associated with new OVF (p = 0.047) in the thoracolumbar region and remaining LBP (p = 0.042) in the lumbar region. CONCLUSION: The occurrence of additional OVF in the thoracolumbar region and remaining LBP in the lumbar region was significantly related to the FI% of the PVM. Physicians should be aware that patients with such fatty degeneration shown in acute MRI may require stronger treatment.


Assuntos
Fraturas por Osteoporose , Fraturas da Coluna Vertebral , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Vértebras Lombares/diagnóstico por imagem , Região Lombossacral , Imagem por Ressonância Magnética , Músculos , Fraturas por Osteoporose/diagnóstico por imagem , Fraturas por Osteoporose/epidemiologia , Estudos Prospectivos , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/epidemiologia , Coluna Vertebral
6.
Medicine (Baltimore) ; 99(51): e23812, 2020 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-33371159

RESUMO

ABSTRACT: Ninety percent of elderly patients with lumbar disc herniation (LDH) have problems with the mechanics of the spine and muscle tissue. Shi-style spine balance manipulation combined with guidance (Daoyin) of muscle and bone as an alternative therapy for LDH can tone the muscle groups around the spine and maintain optimal mechanical and static sagittal balance of the spine. This study will be performed to investigate the effect of a combination of Shi-style spine balance manipulation and Daoyin therapy on LDH in middle-aged and elderly patients. In this non-blinded, randomized controlled trial, 72 eligible patients will be randomly divided into a treatment group (Shi-style spine balance manipulation combined with Daoyin therapy) and a control group (lumbar mechanical traction). Before and after the intervention, lumbar X-ray and magnetic resonance imaging examinations will be performed to observe the sagittal balance parameters of the spine and pelvis and the lumbar muscle strength. The visual analog scale score, Oswestry disability index score, and pressure pain threshold will be evaluated at baseline and at 2, 4, 12, and 24 weeks. During the treatment period, any signs of acute adverse events, such as paralysis of the lower extremities or cauda equina syndrome, will be recorded at each visit. Although Shi-style spine manipulation combined with Daoyin therapy has been used in the treatment of LDH in middle-aged and elderly people in China for many years, there is no consensus on its effectiveness. This experiment will provide convincing evidence of the efficacy of Shi-style spine manipulation combined with Daoyin therapy in the treatment of LDH in middle-aged and elderly people.


Assuntos
Degeneração do Disco Intervertebral/terapia , Deslocamento do Disco Intervertebral/terapia , Manipulação da Coluna/normas , Adulto , Idoso , Feminino , Humanos , Degeneração do Disco Intervertebral/complicações , Deslocamento do Disco Intervertebral/complicações , Dor Lombar/etiologia , Dor Lombar/terapia , Vértebras Lombares/fisiopatologia , Região Lombossacral/fisiopatologia , Imagem por Ressonância Magnética/métodos , Masculino , Manipulação da Coluna/métodos , Manipulação da Coluna/estatística & dados numéricos , Pessoa de Meia-Idade , Músculo Esquelético/fisiopatologia , Medição da Dor/métodos , Resultado do Tratamento , Ultrassonografia/métodos
7.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(12): 1624-1629, 2020 Dec 15.
Artigo em Chinês | MEDLINE | ID: mdl-33319547

RESUMO

Objective: To summarize the research progress in creep characteristics of lumbar intervertebral disc. Methods: The relevant literature at home and abroad was systematically searched. Then, the concept and structural basis of lumbar disc creep, the description of creep characteristics, and the latest progress of its influencing factors were summarized and analyzed. Results: The intervertebral disc is viscoelastic. After loading, the deformation increases with time. However, the degree of increase is not linear with time. That is creep, which plays an important role in buffering the load generated by human activities and absorbing energy in order to maintain stable movement of the spine. Both experimental and simulation studies can well describe the creep behavior of intervertebral disc. Various models including standard linear solid model and corresponding constitutive equations can quantify and compare the creep characteristics, which can be obviously changed by the degeneration of intervertebral disc and the mode of loading stress. Conclusion: Creep is an important mechanical properties of intervertebral discs, and an in-depth understanding of the creep characteristics of lumbar intervertebral discs is of great guiding significance for the intervention and treatment of low back pain.


Assuntos
Degeneração do Disco Intervertebral , Disco Intervertebral , Fenômenos Biomecânicos , Humanos , Vértebras Lombares , Região Lombossacral , Estresse Mecânico , Suporte de Carga
8.
Zhongguo Gu Shang ; 33(12): 1142-7, 2020 Dec 25.
Artigo em Chinês | MEDLINE | ID: mdl-33369322

RESUMO

OBJECTIVE: To analyze the causes of vascular injury occurred in oblique lateral interbody fusion for treating lumbar degenerative diseases, and put forward preventive measures. METHODS: There were 235 patients analyzed from October 2014 to May 2017 in five hospitals, who were treated with oblique lateral interbody fusion with or without posterior pedicle screw fixation. There were 79 males and 156 females with an average age of (61.9±13.5) years old (ranged from 32 to 83 years). There were 7 cases of vascular injury, including 4 cases of segmental vessel injury, 1 case of left common iliac artery injury, 1 case of left common iliac veininjury and 1 case of ovarian vein injury. RESULTS: The follow up time ranged from 6 to 36 months, averagely (15.6±7.5) months. There was no pedicle screw loosen or fracture. The low back pain VAS decreased from preoperative 6.7±2.3 to 1.4±0.8 at the latest follow-up, which was statistically difference(t=7.21, P=0.033). The ODI decreased from preoperative (36.5±7.7)% to (9.4±3.6)% at the latest follow-up, which was statistically difference (t=8.11, P=0.025). CONCLUSION: Oblique lateral interbody fusion technique provides a new method for minimally invasive fusion of lumbar internal fixation. However, it has a risk of vascular injury. In order to effectively prevent the occurrence of vascular injury, the operative indications and careful and meticulous operation should be strictly grasped.


Assuntos
Parafusos Pediculares , Fusão Vertebral , Lesões do Sistema Vascular , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Vértebras Lombares/cirurgia , Região Lombossacral , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fusão Vertebral/efeitos adversos , Resultado do Tratamento , Lesões do Sistema Vascular/etiologia , Lesões do Sistema Vascular/prevenção & controle , Lesões do Sistema Vascular/cirurgia
9.
Rev Fac Cien Med Univ Nac Cordoba ; 77(4): 381-384, 2020 12 21.
Artigo em Inglês | MEDLINE | ID: mdl-33351385

RESUMO

Introduction: Chylous leakage into the retroperitoneum is a rare complication after spinal surgery using an anterior retroperitoneal approach. Chylothorax is the presence of lymphatic fluid in the pleural cavity and it is even less frequent during these surgeries. The aim of this work is to report the first case of isolated left chylothorax after a retroperitoneal Left Oblique Lumbar Interbody Fusion in supine position in an adult female patient. Case: A female 30-years-old patient underwent L4-L5 anterior interbody fusion. Four days after the intervention she was diagnosed with isolated left chylothorax that was drained and treated conservatively with good outcomes. Conclusion: Chylothorax is an extremely rare complication after anterior lumbar spine procedures, and it is usually secondary to a chyloretroperitoneum. We present a unique case of isolated chylothorax after anterior retroperitoneal lumbar approach successfully treated in a conservative manner. Key Words chylothorax; spine; lumbosacral region; arthrodesis.


Assuntos
Quilotórax , Adulto , Quilotórax/diagnóstico por imagem , Quilotórax/etiologia , Quilotórax/terapia , Feminino , Humanos , Vértebras Lombares/cirurgia , Região Lombossacral/cirurgia , Espaço Retroperitoneal/diagnóstico por imagem , Fusão Vertebral/efeitos adversos
10.
J Clin Neurosci ; 82(Pt A): 134-140, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33317722

RESUMO

INTRODUCTION: At L5-S1, anterior access can be performed with a supine anterior lumbar interbody fusion (ALIF) or lateral position oblique lumbar interbody fusion (LOLIF). We compared clinical and radiographic features of both approaches. METHODS: A retrospective study of L5-S1 ALIF and LOLIF patients (2013-2018) by 3 spine surgeons and a vascular surgeon at our hospital was performed. Inclusion criteria were patients undergoing L5-S1 anterior surgery only without other anterior or lateral fusion levels, and data collected were patient demographics, cage parameters, perioperative variables, and radiographic parameters. 58 patients were included (33 ALIF and 25 LOLIF). RESULTS: The average surgical time was 211.94 min for ALIF and 154.86 min for LOLIF (p < 0.001). The average blood loss was 214 ml for ALIF and 74 ml for LOLIF (p < 0.001). The average number of days to solid food was 2.55 for ALIF and 0.8 for LOLIF (p < 0.001). The average anterior L5-S1 disc height increase was 8.52 mm for ALIF and 5.02 mm LOLIF (p = 0.018), and the average posterior L5-S1 disc height increase was 3.34 mm for ALIF and 1.30 mm for LOLIF (p = 0.034). The average L5-S1 segmental lordosis increase was 6.82 degrees for ALIF and 7.63 degrees for LOLIF (p = 0.638). CONCLUSION: The LOLIF is a feasible option for L5-S1 anterior access compared to ALIF. However, supine ALIF afforded larger cages to be placed, resulting in greater postoperative disc height. There did not appear to be a significant difference in postoperative L5-S1 segmental lordosis between the two approaches.


Assuntos
Vértebras Lombares/cirurgia , Região Lombossacral/cirurgia , Fusão Vertebral/métodos , Adulto , Feminino , Humanos , Disco Intervertebral , Lordose , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
11.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(11): 1462-1467, 2020 Nov 15.
Artigo em Chinês | MEDLINE | ID: mdl-33191707

RESUMO

Objective: To review the evaluation method of paraspinal muscle and its role in lumbar spine diseases, and offer reference for further research on paraspinal muscles. Methods: The related literature of paraspinal muscle measurement and its role in lumbar spine diseases was reviewed. The evaluation methods of paraspinal muscle were analyzed from the advantages and disadvantages and the role of paraspinal muscle in lumbar spine diseases was summarized. Results: Radiographic methods are often used to evaluate the atrophy of paraspinal muscle, mainly including CT and MRI. The cross-sectional area and fatty infiltration of paraspinal muscle are two key parameters. Radiographic methods are reproducible and widely applied, but CT has the disadvantage of radiation exposure, while the cost of MRI is high. Besides, more and more researchers focus on the functional evaluation of paraspinal muscle, which mainly includes surface electromyogram analysis and back muscle strength test. The surface electromyogram analysis can quantitatively measure neuromuscular function, but the results could be affected by many influencing factors. The back muscle strength test is simple, but it lacks standardized posture. The atrophy of paraspinal muscle is related to many lumbar spine diseases, while the results of different researches are different. Conclusion: There are many methods to evaluate paraspinal muscles, but there is no unified standard. The role of paraspinal muscle in lumbar spine diseases need to be further studied.


Assuntos
Vértebras Lombares , Músculos Paraespinais , Eletromiografia , Vértebras Lombares/diagnóstico por imagem , Região Lombossacral/diagnóstico por imagem , Imagem por Ressonância Magnética , Músculos Paraespinais/diagnóstico por imagem
12.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(11): 1474-1477, 2020 Nov 15.
Artigo em Chinês | MEDLINE | ID: mdl-33191709

RESUMO

Objective: To summarize the research progress of ureteral injury in oblique lumbar interbody fusion (OLIF). Methods: The literature about incidence, clinical manifestations, diagnosis, and treatment of ureteral injury complications in OLIF was reviewed. Results: OLIF surgery poses a risk of ureteral injury because its surgical approach is anatomically adjacent to the left ureter. Ureteral injuries in OLIF are often insidious and have no specific clinical manifestations. CT urography is a common diagnostic method. The treatment of ureteral injury depends on a variety of factors such as the time of diagnosis, the location and degree of injury, and the treatment methods range from endoscopic treatment to replacement reconstruction. Conclusion: Surgeons should pay attention not to damage the ureter and find the abnormality in time during OLIF. High vigilance of abnormalities is conducive to the early diagnosis of ureteral injury. Furthermore, it is important to be familiar with ureter anatomy and gentle operation to prevent ureteral injury.


Assuntos
Fusão Vertebral , Ureter , Humanos , Vértebras Lombares/cirurgia , Região Lombossacral , Complicações Pós-Operatórias , Fusão Vertebral/efeitos adversos , Ureter/cirurgia
13.
Medicine (Baltimore) ; 99(46): e21717, 2020 Nov 13.
Artigo em Inglês | MEDLINE | ID: mdl-33181634

RESUMO

OBJECTIVE: To compare the effects of milrinone, sodium nitroprusside (SNP), and nitroglycerin (NTG) on induced hypotension, cerebral perfusion, and postoperative cognitive function in elderly patients undergoing spine surgery. METHODS: Sixty patients >60 years scheduled for lumbar fusion surgery were assigned to receive milrinone (group M), SNP (group S), or NTG (group N). The administration of the study drug was initiated immediately after perivertebral muscle retraction and was stopped after completion of interbody fusion. Target blood pressure was a decrease of 30% in systolic blood pressure from baseline or mean blood pressure of 60 to 65 mm Hg. The regional cerebral venous oxygen saturation (rSVO2), as a measure of cerebral perfusion, and the change in perioperative Mini-Mental State Examination (MMSE) score, as a measure of postoperative cognitive function, were assessed. RESULTS: During the administration of the study drug, the overall and lowest intraoperative rSVO2 values were significantly higher (P = .01 and P = .01, respectively), and the duration of rSVO2 <60% was shorter in group M than in the other groups (P = .03). In group M, intraoperative rSVO2 was not different from the basal value, whereas in groups S and N, rSVO2 was significantly lower than the basal value during the administration of the study drug, but then returned to the basal value after terminating the study drug. Basal MMSE scores were comparable among the 3 groups. The MMSE score on postoperative day 5 was higher in group M than the other groups. CONCLUSIONS: Milrinone used to induce hypotension resulted in better intraoperative cerebral perfusion and postoperative cognitive function compared to SNP and nitroglycerin.


Assuntos
Circulação Cerebrovascular/efeitos dos fármacos , Milrinona/uso terapêutico , Idoso , Cardiotônicos/farmacologia , Cardiotônicos/uso terapêutico , Cognição/fisiologia , Feminino , Humanos , Região Lombossacral/cirurgia , Masculino , Milrinona/farmacologia , Procedimentos Neurocirúrgicos/efeitos adversos , Procedimentos Neurocirúrgicos/métodos , Período Pós-Operatório , Estudos Prospectivos , República da Coreia
14.
Niger J Clin Pract ; 23(11): 1530-1535, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33221777

RESUMO

Background: Globally, low back pain (LBP) is now the leading cause of disability. Patients often have lumbar spine motion dysfunction (motion decrease/increase), and this may affect the lumbar lordosis (LL). Though the relationship between LL and LBP is controversial, it has immense clinical significance, because it serves as the basis of therapeutic exercises for treating and preventing LBP. An angular measure of LL that consistently detects even a small lordotic change (LC) would be considered reliable. Aims and Objectives: The consistency of some radiographic angles in detecting LC in a potential LBP disorder was evaluated, and LC fulcrum deducted. Materials and Methods: In both normal (control) and spondylotic (test) lateral lumbosacral radiographs of both genders, LL was retrospectively measured using the following angular measures and sample sizes: Lumbosacral angle (LSA, 125), Lumbosacral joint angle (LSJA, 115), Cobb angle (118), and Tangential radiologic assessment of lumbar lordosis (TRALL) angle (101). The angles' consistency in detecting intra-gender LC between control versus test was evaluated. The intervertebral disc (IVD) that sub-tended the most consistent angle represents the LC fulcrum. All cases were ≥17 years of age. Data was analyzed with IBM SPSS Statistics 23.0 (NY, USA); P < 0.05 was considered statistically significant. Results: LSJA detected slight intra-gender LC in both genders, LSA in males only, Cobb and TRALL angles in none. The IVD of L5/S1 sub-tended the LSJA and therefore represents the LC fulcrum. Conclusion: LSJA is a reliable measure of lumbar LC in physical therapy of LBP, especially, the non-specific LBP disorders.


Assuntos
Lordose/diagnóstico por imagem , Dor Lombar/diagnóstico por imagem , Vértebras Lombares/diagnóstico por imagem , Região Lombossacral/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Feminino , Humanos , Lordose/fisiopatologia , Vértebras Lombares/fisiopatologia , Região Lombossacral/fisiopatologia , Masculino , Pessoa de Meia-Idade , Radiografia , Estudos Retrospectivos
15.
Zhongguo Gu Shang ; 33(10): 943-7, 2020 Oct 25.
Artigo em Chinês | MEDLINE | ID: mdl-33107258

RESUMO

OBJECTIVE: To explore clinical application of the new three-dimensional foramen guide in percutaneous endoscopic lumbar discectomy. METHODS: Based on the principle of reverse positioning, a new three-dimensional foramen guide was designed. From May 2016 to May 2018, totally 40 patients with segmental lumbar disc herniation were underwent percutaneous endoscopic lumbar discectomy. The patients were divided into guide and control group, and 20 patients in each group. In guide group, there were 9 males and 11 females with an average age of (46.0±11.0) years old;5 patients on L3,4, 15 patients on L4,5; BMI was (25.4±3.2) kg /m2;three dimensional foramen guide was used to assist the operation. While in control group, there were 10 males and 10 females with an average age of (51.8±9.8) years old;4 patients on L3,4, 16 patients on L4,5;BMI was (24.8±3.5) kg /m2;the operation was completed with bare hands according to the experience. The puncture time, times of fluoroscopy and puncture between two groups were compared, as well as the preoperative and postoperative visual analogue scale (VAS) score and Japanese Orthopaedic Association (JOA) were compared. RESULTS: All patients had no serious complications, and successfully completed operation. Operation time, the times of fluoroscopy and puncture in guide group were better than those of control group (P<0.05). VAS score and JOA score between two groups were significantly relieved after operation (P<0.05), but there was no significant difference between two groups (P>0.05). CONCLUSION: The three dimensional foramen guide is compact in structure, simple in operation, which could reduce the time of puncture and damage of radiation, shorten the learning curve of puncture for beginners, and has certain clinical feasibility.


Assuntos
Discotomia Percutânea , Deslocamento do Disco Intervertebral , Adulto , Discotomia , Feminino , Humanos , Deslocamento do Disco Intervertebral/cirurgia , Vértebras Lombares/cirurgia , Região Lombossacral , Masculino , Pessoa de Meia-Idade
16.
Artigo em Russo | MEDLINE | ID: mdl-33095532

RESUMO

OBJECTIVE: To compare an effectiveness of different methods of rigid transpedicular fixation and decompression in patients with degenerative lumbar stenosis. MATERIAL AND METHODS: A prospective study included 160 patients with degenerative lumbar spine stenosis. In the first group (n=37), patients underwent laminectomy and transpedicular fixation, in the second group (n=60) - laminectomy, transpedicular fixation and implantation of interbody fusion cage. In the third group (n=30), interlaminar decompression and transpedicular fixation were carried oud, in the fourth group (n=33) - interlaminar decompression, transpedicular fixation and implantation of interbody fusion cage. Surgeries were performed in three clinics in Moscow. Outcomes were assessed using a visual analogue scale (VAS) and Oswestry questionnaire in 1 and 2 years after surgery. Between-group comparison of the outcomes was performed. In patients with unfavorable outcome, we analyzed the cause of unsatisfactory result and risk factors. RESULTS: Satisfactory result was noted in 103 patients (64%) in 2 years after surgery. Outcomes were comparable in all groups. More significant regression of back pain was noted in group II (laminectomy, transpedicular fixation, interbody cage) compared to other groups. Preoperative risk factors of adverse outcome were resting leg pain VAS score > 4 and age over 71 years. Incidence of pseudoarthrosis and back pain was higher among patients without interbody cage. Incidence of adjacent level lesion was higher among patients with interbody cages. CONCLUSION: Decompression type and implantation of interbody cage do not significantly change postoperative outcomes in most patients with degenerative lumbar stenosis undergoing transpedicular fixation. However, interbody cage implantation during transpedicular fixation is advisable in patients with severe back pain (VAS score > 5-6).


Assuntos
Fusão Vertebral , Constrição Patológica , Humanos , Região Lombossacral , Moscou , Estudos Prospectivos , Fusão Vertebral/efeitos adversos
17.
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
18.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 3525-3528, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018764

RESUMO

Intraspinal microstimulation is an effective method to rebuild motor function after spinal cord injury. However, in the implementation, available map of stimulation sites is lacking for reference. The location of electrode implantation can only be determined through multiple stimulation, causing secondary damage to the spinal cord. Therefore, in this paper, SD rats were chosen as the research subject, and the intraspinal microstimulation was used to perform three-dimensional scanning electrical stimulation on the lumbar spinal cord that controls the hindlimb motion. The site coordinates and corresponding threshold current that can induce motion of hip, knee and ankle joints were recorded. In order to reduce the individual variances and improve the universality and applicability of the map, the results of 6 groups were normalized, and three-dimensional map of spinal motor function were drawn in the same coordinate system. The overlap of the distribution area of the same motion in each group was defined as the core region. The threshold current of all sites were analyzed statistically to obtain the most appropriate range of current intensity required to induce hindlimb motion. Using appropriate current for intraspinal microstimulation in the core region can selectively induce desired hindlimb motion, greatly improving the accuracy and reliability of electrode implantation.


Assuntos
Região Lombossacral , Traumatismos da Medula Espinal , Animais , Ratos , Ratos Sprague-Dawley , Reprodutibilidade dos Testes , Traumatismos da Medula Espinal/terapia
19.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 4243-4247, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018933

RESUMO

A growing body of evidence has highlighted that inertial sensor data can increase the sensitivity and clinical utility of the Y Balance Test, a commonly used clinical dynamic balance assessment. While early work has demonstrated the value of a single lumbar worn inertial sensor in quantifying dynamic balance control, no research has investigated if alternative (shank) or combined (lumbar and shank) sensor mounting locations may improve the assessments discriminant capabilities. Determining the optimal sensor set-up is crucial to ensuring minimal cost and maximal utility for clinical users The aim of this cross-sectional study was to investigate if single or multiple inertial sensors, mounted on the lumbar spine and/or shank could differentiate young (18-40 years [n = 41]) and middle-aged (40-65 years [n = 42]) adults, based on dynamic balance performance. Random-forest classification highlighted that a single lumbar sensor could classify age-related differences in performance with an accuracy of 79% (sensitivity = 81%; specificity = 78%). The amalgamation of shank and lumbar data did not significantly improve the classification performance (accuracy = 73-77%; sensitivity = 71-76%; specificity = 73-78%). Jerk magnitude root-mean-square consistently demonstrated predictor importance across the three reach directions: posteromedial (rank 1), anterior (rank 3) and posterolateral (rank 6).


Assuntos
Perna (Membro) , Região Lombossacral , Estudos Transversais , Vértebras Lombares , Modalidades de Fisioterapia
20.
Zhonghua Yi Xue Za Zhi ; 100(33): 2586-2590, 2020 Sep 08.
Artigo em Chinês | MEDLINE | ID: mdl-32892603

RESUMO

Objective: To observe the clinical effects of CT-guided chemical destructive block of lumbar sympathetic nerve in the treatment of cold sensation of limbs. Methods: In this retrospective analysis, clinical data of 43 patients with cold sensation of limbs treated by lumbar sympathetic chemical destructive block in the Affiliated Hospital of Jiaxing University from January 2015 to January 2018 were collected. The changes of heart rate, non-invasive blood pressure (NIBP), oxygen saturation (SpO(2)), plantar temperature and peripheral perfusion index (PI) of patients were recorded and analyzed before treatment and 5 min after injection of anhydrous ethanol. The patients were followed up at postoperative 1 day, 1 week, 1 month, 3 months, 6 months, 1 year and 2 years. Results: Fourty-three patients underwent bilateral lumbar sympathetic nerve chemical destructive block under the CT-guided, and all patients were punctured to the target successfully. The PI of patients before and after treatment were 1.2±0.6, 7.2±3.0 respectively, which was significantly increased after treatment compared with before treatment, and the difference was statistically significant (t=12.386, P<0.05). The plantar temperature of patients before and after treatment respectively were (29.6±1.7)℃, (34.6±1.1)℃, which was significantly increased after treatment compared with before treatment, and the difference was statistically significant (t=15.057, P<0.05). There were no significant differences in heart rate, NIBP and SpO(2) between before and after treatment (all P>0.05). Lumbar sympathetic chemical destructive block was clinically effective in 39 patients (90.7%) and ineffective in 4 patients (9.3%). Among the 39 clinically effective patients, the curative effects were excellent in 29 cases and improved in 10 cases. Postoperative recurrence occurred in 10 cases (25.6%). The satisfaction rates of patients at 1 day, 1 week, 1 month, 3 months, 6 months, 1 year and 2 years after operation were 93.0%, 90.7%, 86.0%, 76.7%, 69.7%, 65.1% and 53.4%, respectively. Conclusion: Lumbar sympathetic chemical destructive block is a safe and effective way for the treatment of cold sensation of limbs, which can improve the symptoms of cold sensation of limbs to some extent.


Assuntos
Bloqueio Nervoso Autônomo , Humanos , Região Lombossacral , Estudos Retrospectivos , Sensação , Tomografia Computadorizada por Raios X , Resultado do Tratamento
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