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1.
J Sports Sci ; 38(1): 100-105, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31638481

RESUMO

A common practice in resistance training is to perform sets of exercises at, or close to failure, which can alter movement dynamics. This study examined ankle, knee, hip, and lumbo-pelvis dynamics during the barbell back squat under a moderate-heavy load (80% of 1 repetition maximum (1RM)) when performed to failure. Eleven resistance trained males performed three sets to volitional failure. Sagittal plane movement dynamics at the ankle, knee, hip, and lumbo-pelvis were examined; specifically, joint moments, joint angles, joint angular velocity, and joint power. The second repetition of the first set and the final repetition of the third set were compared. Results showed that while the joint movements slowed (p < 0.05), the joint ranges of motion were not altered There were significant changes in most mean joint moments (p < 0.05), indicating altered joint loading. The knee moment decreased while the hip and lumbo-pelvis moments underwent compensatory increases. At the knee and hip, there were significant decreases (p < 0.05) in concentric power output (p < 0.05). Whilst performing multiple sets to failure altered some joint kinetics, the comparable findings in joint range ofmotion suggest that technique was not altered. Therefore, skilled individuals appear to maintain technique when performing to failure.


Assuntos
Extremidade Inferior/fisiologia , Região Lombossacral/fisiologia , Pelve/fisiologia , Treinamento de Resistência/métodos , Levantamento de Peso/fisiologia , Adulto , Tornozelo/fisiologia , Fenômenos Biomecânicos , Quadril/fisiologia , Humanos , Joelho/fisiologia , Masculino , Análise e Desempenho de Tarefas , Adulto Jovem
2.
Orthopade ; 49(1): 32-38, 2020 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-31089777

RESUMO

Further developments in disease diagnosis and treatment are of immense relevance for advancements in medical care of the population. A detailed cost-benefit analysis of direct and indirect costs is usually unavailable. In the current article, these aspects are investigated using prospectively collected randomized data over two years. Specifically, the surgical treatment of a herniated lumbar disc is addressed, and whether a newly introduced technique (e.g., annular closure device) can lead to a better quality of care and increased patient satisfaction when performed during the standard operation, while also being economically viable.


Assuntos
Degeneração do Disco Intervertebral , Deslocamento do Disco Intervertebral , Vértebras Lombares , Análise Custo-Benefício , Economia Médica , Humanos , Região Lombossacral
3.
J Invest Surg ; 33(1): 79-93, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29856663

RESUMO

Purpose/Aim: Lumbar degenerative diseases (LDDs) cause pain and disability and are treated with lumbar fusion surgery. The aim of this study was to evaluate the efficacy of lumbar fusion surgery with ISOBAR devices versus posterior lumbar interbody fusion (PLIF) surgery for alleviating LDD-associated pain and disability. Materials and Methods: We performed a literature review and meta-analysis conducted in accordance with Cochrane methodology. The analysis included Group Reading Assessment and Diagnostic Evaluation assessments, Jadad Quality Score evaluations, and Risk of Bias in Non-randomized Studies of Interventions assessments. We searched PubMed, MEDLINE, the Cumulative Index to Nursing and Allied Health Literature, the Cochrane Library, ProQuest, the Airiti Library, and the China Academic Journals Full-text Database for relevant randomized controlled trials and cohort studies published in English or Chinese between 1997 and 2017. Outcome measures of interest included general pain, lower back pain, and disability. Results: Of the 18 studies that met the inclusion criteria, 16 examined general pain (802 patients), 5 examined lower back pain (274 patients), and 15 examined disability (734 patients). General pain, lower back pain, and disability scores were significantly lower after lumbar fusion surgery with ISOBAR devices compared to presurgery. Moreover, lumbar fusion surgery with ISOBAR devices was more effective than PLIF for decreasing postoperative disability, although it did not provide any benefit in terms of general pain or lower back pain. Conclusions: Lumbar fusion surgery with ISOBAR devices alleviates general pain, lower back pain, and disability in LDD patients and is superior to PLIF for reducing postoperative disability. Given possible publication bias, we recommend further large-scale studies.


Assuntos
Doença , Fusão Vertebral , China , Humanos , Região Lombossacral , Pacientes
4.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 33(12): 1572-1577, 2019 Dec 15.
Artigo em Chinês | MEDLINE | ID: mdl-31823561

RESUMO

Objective: To summarize the guiding role of imaging evaluation of oblique lumbar interbody fusion (OLIF) in recent years. Methods: The reports of OLIF surgical imaging research at home and abroad in recent years were extensively reviewed and analyzed. Results: Preoperative imaging evaluation plays an important role in guiding the operation of OLIF, the placement of fusion Cage, the selection of indications, and the reduction of complications. Conclusion: Detailed preoperative imaging evaluation can correctly estimate the indications of OLIF, and avoid the nerve, blood vessel, and muscle injuries.


Assuntos
Fusão Vertebral , Humanos , Vértebras Lombares , Região Lombossacral , Cuidados Pré-Operatórios
5.
Nan Fang Yi Ke Da Xue Xue Bao ; 39(10): 1246-1252, 2019 Oct 30.
Artigo em Chinês | MEDLINE | ID: mdl-31801716

RESUMO

OBJECTIVE: To compare 3 commonly used methods for drug delivery via the lumbar spinal subarachnoid space in rats. METHODS: We compared the effects of 3 methods for drug delivery via the lumbar spinal subarachnoid space in Sprague Dawley rats, namely acute needle puncture, chronic catheterization via laminectomy, and non-laminectomized catheterization. Body weight changes of the rats were measured, and their general and neurological conditions were assessed after the surgeries. The motor function of the rats was examined using rota rod test both before and after the surgeries. Nociceptive tests were performed to assess nociception of the rats. HE staining was used to examine local inflammation caused by the surgeries in the lumbar spinal cord tissue, and lidocaine paralysis detection and toluidine blue dye assay were used to confirm the precision of drug delivery using the 3 methods. RESULTS: Both needle puncture and catheterization via laminectomy resulted in a relatively low success rate of surgery and caused neurological abnormalities, severe motor dysfunction, hyperalgesia, allodynia and local inflammation. Catheterization without laminectomy had the highest success rate of surgery, and induced only mild agitation, slight cerebral spinal fluid leakage, mild sensory and motor abnormalities, and minimum pathology in the lumbar spinal cord. Catheterization without laminectomy produced less detectable effects on the behaviors in the rats and was well tolerated compared to the other two methods with also higher precision of drug delivery. CONCLUSIONS: Catheterization without laminectomy is a safe, accurate and effective approach to lumbar drug delivery in rats.


Assuntos
Sistemas de Liberação de Medicamentos/métodos , Região Lombossacral , Medula Espinal , Espaço Subaracnóideo , Animais , Cateterismo , Laminectomia , Agulhas , Ratos , Ratos Sprague-Dawley
6.
Zhonghua Yi Xue Za Zhi ; 99(47): 3703-3709, 2019 Dec 17.
Artigo em Chinês | MEDLINE | ID: mdl-31874494

RESUMO

Objective: To investigate the effects of Modic changes on the fusion rate and cage subsidence after transforaminal lumbar interbody fusion (TLIF). Methods: From January 2015 to January 2018, a total of 186 patients with degenerative lumbar disease who received lumbar instrumentation fusion and monosegmental TLIF with single polyetheretherketone (PEEK) cage in Nanjing Drum Tower Hospital were retrospectively reviewed. Patients with Modic changes at the level where the cage was placed were enrolled as Modic group, and the remaining were assigned into non-Modic group. Disk height, lumbar lordosis and segmental lordosis of the level with TLIF were measured based on the preoperative, postoperative and latest follow-up lateral radiograph. The fusion rate and cage subsidence (more than 2 mm on either endplate) were recorded based on CT scan at the latest follow-up. The Oswestry disability index (ODI) and visual analogue scale (VAS) of pain was used to evaluate the clinical outcome. The data were compared with paired t test between the two groups. Results: In this study, there were 70 males and 116 females with an average age of (55±13) years. There were 99 patients in the Modic group (25 with type 1, 66 with type 2, 8 with type 3), and 87 patients in the non-Modic group. There was no significant difference between Modic group and non-Modic group in demographics and postoperative radiographs. The patients were followed-up for (19±4) months (13 to 48 months). All patients achieved grade 1 or 2 fusion. Cage subsidence was detected in 34 patients (18.3%, 34/186). The incidence of subsidence in Modic group (24.2%, 24/99) was significantly higher than that in non-Modic group (11.5%, 10/87) (χ(2)=5.038, P<0.05), and the incidence of subsidence in type Ⅰ (28.0%, 7/25) and type Ⅱ (24.2%, 16/66) were higher than that in non-Modic group (11.5%, 10/87). There was no significant difference in ODI and VAS between Modic group and non-Modic group before and after the operation and at the latest follow-up (t=0.397-1.568, all P>0.05). Conclusion: Preoperative Modic changes have no impact on fusion rate after transforaminal lumbar interbody fusion, but both type Ⅰ and Ⅱ Modic changes do increase the risk of cage subsidence.


Assuntos
Fusão Vertebral , Adulto , Idoso , Feminino , Humanos , Vértebras Lombares , Região Lombossacral , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
7.
Medicine (Baltimore) ; 98(50): e18233, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31852086

RESUMO

Percutaneous epidural neuroplasty (PEN) is an effective interventional treatment for radicular pain. However, in some cases, contrast runoff to the spinal nerve root does not occur. We investigated whether contrast runoff to the spinal nerve root affects the success rate of PEN and whether additional transforaminal epidural blocks for intentional contrast runoff affect the success rate of PEN in cases in which contrast runoff is absent.This study was registered at ClinicalTrials.gov (Identifier: NCT03867630) in March 2019. We reviewed the medical records of 112 patients who underwent PEN with a wire-type catheter from May 2016 to August 2018. Patients were divided in 3 groups (Runoff group, Non-runoff group, Transforaminal group).Patients with low back pain and leg radicular pain who did not respond to lumbar epidural steroid injectionsPEN was performed in 112 patients with a wire-type catheter in target segment. We compared the success rate of PEN betweenThe success rate was significantly different between the Runoff group and the Non-runoff group (P < .0007) and between the Non-runoff group and the Transforaminal group (P = .0047), but not between the Runoff group and the Transforaminal group (P = .57).Contrast runoff influenced the success rate of PEN. In cases without contrast runoff, additional transforaminal epidural blocks for intentional contrast runoff increased the success rate of PEN with a wire-type catheter.


Assuntos
Anestesia Epidural/instrumentação , Cateteres , Dor Lombar/terapia , Procedimentos Neurocirúrgicos/métodos , Manejo da Dor/métodos , Raízes Nervosas Espinhais/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Fluoroscopia , Seguimentos , Humanos , Injeções Epidurais/métodos , Dor Lombar/diagnóstico , Região Lombossacral , Masculino , Pessoa de Meia-Idade , Medição da Dor , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
8.
No Shinkei Geka ; 47(10): 1081-1088, 2019 Oct.
Artigo em Japonês | MEDLINE | ID: mdl-31666425

RESUMO

Congenital dermal sinus(CDS)is a rare entity of spinal dysraphism, caused by the focal failure of disjunction leading to adhesion between the cutaneous and neural ectoderm. Some reports found that tumors, such as dermoid and epidermoid cysts, meningitis and subdural abscess are often complicated by CDS. A 1-year-old girl was referred to our department for CDS with a dermoid cyst complicated by brain and subdural abscesses. Diffusion weighted imaging and gadolinium-diethylenetriamine penta-aceticacid administration revealed ring-enhancing lesions, suggesting brain abscess, in the left temporal lobe, and subdural abscesses on the bilateral middle cranial bases. T1-and T2-weighted lumbar magnetic resonance imaging revealed CDS. With a preoperative diagnosis of CDS with brain and subdural abscesses, resection of CDS was performed after draining the brain abscess twice. The CDS extended into the spinal canal and it was completely exercised. We then performed sub-total resection of the dermoid cyst in the subdural space. Recent reports showed that dermoid cysts are related to CDS infection and deterioration of the infection, as seen in this case. Complication of dermoid cysts is an important consideration during CDS treatment. While the mechanism of the development of brain abscess in CDS patients has been unclear, this rare but important case revealed the mechanism to be the direct spread of inflammation via CDS.


Assuntos
Abscesso Encefálico , Cisto Dermoide , Espinha Bífida Oculta , Feminino , Humanos , Lactente , Região Lombossacral , Imagem por Ressonância Magnética , Meningite
9.
BMC Surg ; 19(1): 161, 2019 Nov 05.
Artigo em Inglês | MEDLINE | ID: mdl-31690303

RESUMO

BACKGROUND: Wound-related complications are an inevitable issue faced by spinal surgeons. Negative pressure drainage remains the most commonly used method to prevent postoperative hematoma and related complications. This prospective, randomized, controlled study was conducted to evaluate the efficacy of compression therapy following posterior lumbar interbody fusion, with emphasis on pain, anemia, and inflammation. METHODS: Sixty consecutive patients who have undergone posterior lumbar interbody fusion in the age range 43-78 years, with an average age of 59 years, were selected and randomly assigned into two groups. Factors, such as drainage volume, visual analog scale (VAS) pain score for back pain, white blood cell (WBC) count, red blood cell (RBC) count, hemoglobin (Hb) levels, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) levels assessed on the 1st, 3rd, and 10th days postoperatively, were compared between the two groups. RESULTS: The average follow-up was 6 months, ranging from 3 to 11 months. Drainage volume, VAS score, and CRP levels on the 10th day after the surgery were found to be significantly lower in the treatment group than in the control group. RBC count and Hb levels on the 3rd and 10th postoperative days were observed to be significantly higher in the treatment group than in the control group (P < 0.05). During discharge, the wounds of the patients of the both groups had healed and neither showed any symptoms of infection, hematoma, or necrosis. CONCLUSION: Compression therapy relieves pain, alleviates anemia, and the inflammatory response following posterior lumbar interbody fusion. TRIAL REGISTRATION: ChiCTR1800015825 on chictr.org.cn, April 23, 2018, the trial registry is Chinese Clinical Trial Registry.


Assuntos
Dor nas Costas/cirurgia , Vértebras Lombares/cirurgia , Fusão Vertebral/métodos , Adulto , Idoso , Feminino , Humanos , Inflamação/epidemiologia , Contagem de Leucócitos , Região Lombossacral , Masculino , Pessoa de Meia-Idade , Medição da Dor , Estudos Prospectivos , Resultado do Tratamento
10.
Pan Afr Med J ; 33: 247, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31692715

RESUMO

Hernia of the Jean Louis Petit triangle and hernia of Grynfeltt's quadrilateral space can be classified as lumbar hernias. Its clinical diagnosis is confirmed by computed tomography and, possibly, by ultrasound or x-ray. There is a formal indication for surgery including swelling or functional discomfort but, above all, the risk of strangulation. We here report a rare case of recurrence of primary hernia of the Jean Louis Petit triangle in a 65-year old man.


Assuntos
Hérnia/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Idoso , Humanos , Região Lombossacral , Masculino , Recidiva
11.
12.
Spine (Phila Pa 1976) ; 44(21): E1272-E1280, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31634303

RESUMO

STUDY DESIGN: Retrospective 1:1 propensity score-matched analysis on a national longitudinal database between 2007 and 2016. OBJECTIVE: The aim of this study was to compare complication rates, revision rates, and payment differences between navigated and conventional posterior lumbar fusion (PLF) procedures with instrumentation. SUMMARY OF BACKGROUND DATA: Stereotactic navigation techniques for spinal instrumentation have been widely demonstrated to improve screw placement accuracies and decrease perforation rates when compared to conventional fluoroscopic and free-hand techniques. However, the clinical utility of navigation for instrumented PLF remains controversial. METHODS: Patients who underwent elective laminectomy and instrumented PLF were stratified into "single level" and "3- to 6-level" cohorts. Navigation and conventional groups within each cohort were balanced using 1:1 propensity score matching, resulting in 1786 navigated and conventional patients in the single-level cohort and 2060 in the 3 to 6 level cohort. Outcomes were compared using bivariate analysis. RESULTS: For the single-level cohort, there were no significant differences in rates of complications, readmissions, revisions, and length of stay between the navigation and conventional groups. For the 3- to 6-level cohort, length of stay was significantly longer in the navigation group (P < 0.0001). Rates of readmissions were, however, greater for the conventional group (30-day: P = 0.0239; 90-day: P = 0.0449). Overall complications were also greater for the conventional group (P = 0.0338), whereas revision rate was not significantly different between the 2 groups. Total payments were significantly greater for the navigation group in both the single level and 3- to 6-level cohorts (P < 0.0001). CONCLUSION: Although use of navigation for 3- to 6-level instrumented PLF was associated with increased length of stay and payments, the concurrent decreased overall complication and readmission rates alluded to its potential clinical utility. However, for single-level instrumented PLF, no differences in outcomes were found between groups, suggesting that the value in navigation may lie in more complex procedures. LEVEL OF EVIDENCE: 3.


Assuntos
Vértebras Lombares/cirurgia , Fusão Vertebral/métodos , Adulto , Idoso , Estudos de Coortes , Bases de Dados Factuais , Procedimentos Cirúrgicos Eletivos , Feminino , Fluoroscopia , Humanos , Imagem Tridimensional/métodos , Laminectomia , Região Lombossacral/cirurgia , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos , Parafusos Pediculares , Pontuação de Propensão , Estudos Retrospectivos , Técnicas Estereotáxicas
13.
An Bras Dermatol ; 94(4): 455-457, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31644621

RESUMO

Agminated nevus refers to the presence of multiple nevi grouped in a circumscribed skin area; it is rarely reported in the literature. This report presents the case of a 10-year-old female patient with a history of Langerhans cell histiocytosis, who presents multiple nevi in the lumbar and inguinal region. In the histopathological study, an atypical melanocytic nevus was reported. Wood's lamp examination discarded the presence of nevus spilus, and the diagnosis of agminated nevus was reached. The association of this type of nevus with Langerhans cell histiocytosis is rare, and only four cases were found reported in the indexed literature. The reason for this association is unknown, thus a new theory about its origin is presented here.


Assuntos
Histiocitose de Células de Langerhans/patologia , Nevo Pigmentado/patologia , Neoplasias Cutâneas/patologia , Criança , Dermoscopia , Feminino , Humanos , Região Lombossacral
14.
BMC Surg ; 19(1): 145, 2019 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-31619222

RESUMO

BACKGROUND: Retroperitoneal abscess (RA) is an unusual life-threatening disease that has insidious and occult presentations. Although the incidence of this disease is low, diagnosis and treatment are challenging due to its nonspecific presentation and the complex anatomy of the retroperitoneal space. Recently, we experienced one case of a RA with extensive thrombophlebitis of the portal venous system. CASE PRESENTATION: An 80-year-old male presented to the emergency room with symptoms and signs of septic shock; however, the decision making for diagnosis and treatment was difficult, as no clinical and radiological evidence supported key findings regarding the origin of sepsis. Although this patient eventually recovered after surgical drainage, we suggested that more straightforward diagnostic and treatment procedures were required in this patient to avoid possible critical complications. Through a retrospective review of operative findings, patient history, and microbiology, we found that the RA in this patient was caused by lumbar acupuncture, which is usually performed for the management of chronic back pain with long needles. CONCLUSION: Early surgical intervention should be considered for RA whenever the patient does not respond to broad-spectrum antibiotic treatment. Acupuncture is a possible cause of otherwise unexplained soft tissue infections, such as RA, especially in Asian countries.


Assuntos
Abscesso Abdominal/etiologia , Abscesso/etiologia , Terapia por Acupuntura/efeitos adversos , Tromboflebite/etiologia , Idoso de 80 Anos ou mais , Humanos , Região Lombossacral , Masculino , Espaço Retroperitoneal/patologia
15.
Zh Vopr Neirokhir Im N N Burdenko ; 83(4): 104-112, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31577276

RESUMO

Magnetic resonance imaging (MRI) of lumbar spine is a very frequent examination in any computer tomography unit. However, there are still no scan standards or standards for scan interpretation in the world's medical community. In this article based on our experience we describe common problems encountered by a radiologist during MRI examination of lumbar spine and its subsequent description. The literature survey and analysis are presented with a summary of current recommendations. We examined routine sequences, which could be included in MRI protocol, discussed common terminology, and showed the incidence of different pathologies. The special emphasis is made on assessing lumbar canal stenosis. In this article we focus on qualitative and quantitative criteria of lumbar spinal stenosis.


Assuntos
Vértebras Lombares , Imagem por Ressonância Magnética , Estenose Espinal , Humanos , Vértebras Lombares/diagnóstico por imagem , Região Lombossacral , Estenose Espinal/diagnóstico por imagem , Tomografia Computadorizada por Raios X
16.
Medicine (Baltimore) ; 98(42): e17341, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31626091

RESUMO

RATIONALE: Schwannomas grow slowly, originating from the Schwann cells of the nerve sheath. Schwannomas of cranial origin have the highest incidence, followed by intraspinal schwannomas. However, paravertebral schwannoma is rare, and to our knowledge, giant paravertebral schwannomas near the lumbar nerve roots with bone destruction are extremely rare. PATIENT CONCERNS: A 47-year-old Chinese woman complained of lower back soreness and a sensation of a bulging lumbar disc with no obvious cause for the past 3 years. DIAGNOSIS: Lumbar magnetic resonance imaging showed a large mass with uneven density, 17 × 12 × 15 cm in size, located to the right of the 4th lumbar with obvious bony destruction. Histopathology and immunohistochemistry confirmed that this mass was a benign schwannoma. INTERVENTIONS: Complete resection of the tumor (measuring about 17 × 12 × 15 cm in size) and vertebral reconstruction using internal fixation were performed. OUTCOMES: The patient was discharged without complications after surgery. The 3-year follow-up revealed that the patient recovered well with no evidence of recurrence. LESSONS: Here, we emphasize the importance of careful radiological examination and reflect on the difficulty of tumor resection. Furthermore, understanding the treatment and diagnosis of lumbar paravertebral schwannoma is critical for plastic surgeons and radiologists when encountering similar cases.


Assuntos
Vértebras Lombares/patologia , Neurilemoma/patologia , Neoplasias da Coluna Vertebral/patologia , Raízes Nervosas Espinhais/patologia , Feminino , Humanos , Dor Lombar/etiologia , Vértebras Lombares/virologia , Região Lombossacral/diagnóstico por imagem , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Neurilemoma/diagnóstico por imagem , Neurilemoma/cirurgia , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/cirurgia , Raízes Nervosas Espinhais/diagnóstico por imagem , Raízes Nervosas Espinhais/cirurgia , Resultado do Tratamento
17.
Medicine (Baltimore) ; 98(42): e17422, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31626098

RESUMO

Symptoms of intervertebral foraminal stenosis are caused by compression of nerve root exiting the intervertebral foramen. Many attempts to measure the size of the neuromuscular exit have been made; however, only a few studies to compare the area differences between foramens by computed tomography (CT) were done. In this retrospective comparative study, we used the region of interest (ROI) in CT to measure and compare the area of intervertebral foramen between the healthy control group and the patient group.Eighty-one patients who underwent CT of the lumbar spine between May 2014 and December 2017 were enrolled. Using the medical imaging program, the foraminal area between L5 and S1 vertebrae was measured on the sagittal, coronal, and axial planes using ROI. Four groups were established for comparison: those diagnosed with foraminal stenosis by a radiologist and those who were not, those diagnosed with foraminal stenosis by orthopedic surgeons and those who were not. These groups were further divided into subcategories depending on whether the area was operated on for foraminal stenosis. Interobserver and intraobserver agreements were assessed.The mean age of patients was 56.5 years (range 17-84). The foraminal area of the surgical group on sagittal plane was significantly narrower than the control group (P = .005). However, the difference between the 2 groups on axial and coronal planes was not statistically significant (P > .1). Foraminal area <80 mm on sagittal images was a statistically significant risk factor for clinical symptom (P = .028) and that <65 mm was a statistically significant risk factor in predicting operability (P = .01). Interobserver and intraobserver agreements were fair to good on axial and coronal planes (about 0.7), whereas the agreements were excellent on sagittal plane (>0.9).In this study, we proved that measuring the intervertebral foraminal area using the ROI in CT in the lumbar spine is useful for diagnosing L5-S1 foraminal stenosis, especially on sagittal plane. Furthermore, not only does it provide aid in diagnosis, but it also helps predicting the operability of foraminal stenosis.


Assuntos
Vértebras Lombares/patologia , Estenose Espinal/diagnóstico por imagem , Estudos de Casos e Controles , Tratamento Conservador/estatística & dados numéricos , Constrição Patológica , Feminino , Humanos , Vértebras Lombares/diagnóstico por imagem , Região Lombossacral/diagnóstico por imagem , Região Lombossacral/patologia , Masculino , Pessoa de Meia-Idade , Análise de Regressão , Estudos Retrospectivos , Índice de Gravidade de Doença , Fusão Vertebral/estatística & dados numéricos , Raízes Nervosas Espinhais/diagnóstico por imagem , Raízes Nervosas Espinhais/patologia , Estenose Espinal/terapia , Tomografia Computadorizada por Raios X
18.
Neurocirugía (Soc. Luso-Esp. Neurocir.) ; 30(5): 254-258, sept.-oct. 2019. ilus
Artigo em Espanhol | IBECS | ID: ibc-183881

RESUMO

Objetivo: Presentar un caso de histiocitoma fibroso maligno vertebral a nivel de la cuarta vértebra lumbar que recibió tratamiento por una espondilectomía L4 y colocación de expansor intervertebral y fijación posterior. Caso clínico: Paciente masculino de 47 años de edad sin antecedentes de importancia, que presenta dolor lumbar de 2 meses de evolución. Se trata de forma conservadora, con una leve mejoría del dolor; sin embargo, persiste con dolor lumbar con irradiación a miembros pélvicos de predominio izquierdo, acompañado de debilidad y claudicación. Clínicamente presenta paraparesia 3/5 e hipoestesia L4, L5 y S1 de predominio izquierdo. La tomografía axial computarizada de la región lumbosacra evidencia una lesión osteolítica en cuerpo de L4 de predominio izquierdo con invasión a canal lumbar con márgenes poco delimitados. En el estudio de resonancia magnética de columna lumbosacra se observa lesión hiperintensa en T2, heterogénea, de bordes irregulares, que involucra más del 60% del cuerpo vertebral de L4 con invasión al canal raquídeo que ocasiona compresión a raíces. Se manejó con una espondilectomía L4 y la colocación de un expansor intervertebral y fijación posterior. Conclusión: La espondilectomía es una opción viable y efectiva para el tratamiento del histiocitoma fibroso maligno. La localización lumbar baja conlleva abordajes combinados; sin embargo, el desafío es mayor, ya que requiere de un conocimiento de los grandes vasos abdominales y de una intervención multidisciplinaria


Objective: To present a case of spinal malignant fibrous histiocytoma in the fourth lumbar vertebra that received treatment by an L4 spondylectomy and placement of intervertebral expander and posterior fixation. Case report: A 47-year-old male patient with no relevant history presented with lumbar pain of 2 months' evolution. Treated conservatively, with slight improvement in pain, the patient persisted with low back pain irradiation to pelvic members, predominantly left-sided, accompanied by weakness and claudication. Clinically, he presented with paresthesias 3/5, hypoaesthesia L4, L5 and S1, predominantly left-sided. Lumbosacral computerized axial tomography evidence of an osteolytic lesion in the L4 body, predominantly left-sided, with invasion of the lumbar canal with poorly delimited margins; lumbosacral spine MRI showed hyperintense lesion in T2, heterogeneous, with irregular borders involving more than 60% of the vertebral body of L4 with invasion of the spinal canal causing compression to the roots. He was treated with an L4 spondylectomy and placement of intervertebral expander and posterior fixation. Conclusion: Spondylectomy is an effective option for the treatment of spinal malignant fibrous histiocytoma that involves combined approaches. However the challenge is greater since it requires a knowledge of the great abdominal vessels and multidisciplinary intervention


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Histiocitoma Fibroso Maligno/diagnóstico por imagem , Histiocitoma Fibroso Maligno/cirurgia , Dor Lombar/etiologia , Paraparesia/complicações , Região Lombossacral/diagnóstico por imagem , Região Lombossacral/patologia , Tomografia Computadorizada de Emissão , Imuno-Histoquímica
19.
J Ayub Med Coll Abbottabad ; 31(3): 441-444, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31535524

RESUMO

BACKGROUND: Conservative management of traumatic CSF rhinorrhoea is associated with a greater risk of developing meningitis in the presence of active CSF leak. Lumbar drains have been reported to be better than conservative management alone in stopping CSF leaks following traumatic brain injury. METHODS: This randomized controlled trial enrolled 60 patients with CSF rhinorrhoea and divided them into two groups. One group was managed with conservative management plus a lumbar drain (group A) and the other was managed with conservative management alone (Group B). Length of CSF rhinorrhoea in days was estimated in both groups. RESULTS: There was a statistically significant difference in in mean length of CSF rhinorrhoea in both groups. In group A, mean Length of CSF rhinorrhoea was found to be 3.4 days ±1.1 SD, while in group B it was 6.75 days ±1.96 SD (p=0.001). Stratification with respect to gender, age, duration and type of trauma showed similar trend (p<0.05 in all cases). CONCLUSIONS: Patients who underwent lumbar drain insertion plus conservative management demonstrated significantly shorter length of CSF rhinorrhoea when compared to conservative management alone in the treatment of traumatic CSF rhinorrhoea.


Assuntos
Rinorreia de Líquido Cefalorraquidiano/terapia , Tratamento Conservador , Drenagem , Humanos , Região Lombossacral/cirurgia , Resultado do Tratamento
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