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1.
Medicine (Baltimore) ; 98(38): e17177, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31567958

RESUMO

Lumbar spinal canal stenosis (LSCS) associated with degenerative scoliosis has being increasingly aware by the public and studied by many researchers. Degenerative changes leading to spinal stenosis can precede a spinal deformity which will develop into the de novo scoliosis. There are few studies focusing on the risk factors contributing to the degenerative lumbar scoliosis (DLS) in lumbar spinal stenosis patients.From September, 2017 to December, 2017, 181 patients who were diagnosed with LSCS in the outpatient department of our hospital were enrolled in this retrospective investigation. The patients were divided into 2 groups: DLS group (Cobb angle >10°) and LSCS group. Sex, age, smoking status (yes or no), occupation (heavy or light labor), body mass index (BMI), bone mineral density (BMD) and radiographic parameters including the lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), thoracic kyphosis (TK), coronal vertical axis, and sagittal vertical axis (SVA) are all evaluated as potential risk factors. Multivariate logistic regression analysis and receiver-operating characteristic curves were used to identify potential risk factors.Forty-five of 181 patients were diagnosed with DLS and involved in the DLS group. There were significant differences between the 2 groups in BMI (P < .001), LL (P = .0046), BMD (P < .001), SVA (P < .001), and TK (P = .047). BMD < -1.85 g/cm (adjusted odds ratio [AOR] 0.030, 95% confidence interval [CI] 0.008-0.107, P < .001), BMI >25.57 kg/m (AOR 1.270, 95% CI 1.040-1.551, P = .019), and SVA >3.98 cm (AOR 3.651, 95% CI 2.226-5.990, P < .001) had good accuracy to predict the formation of degenerative lumbar scoliosis based on degenerative lumbar spinal stenosis.Degenerative lumbar scoliosis has a high incidence in degenerative lumbar spinal stenosis. BMD <-1.85 g/cm, BMI >25.57 kg/m, and SVA >3.98 cm were the potential risk factors for the formation of degenerative lumbar scoliosis based on degenerative lumbar spinal stenosis.


Assuntos
Vértebras Lombares , Escoliose/complicações , Estenose Espinal/etiologia , Estudos Transversais , Feminino , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/patologia , Masculino , Pessoa de Meia-Idade , Radiografia , Fatores de Risco , Escoliose/diagnóstico por imagem , Escoliose/patologia , Estenose Espinal/diagnóstico por imagem , Estenose Espinal/patologia
2.
Medicine (Baltimore) ; 98(39): e17316, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574861

RESUMO

The purpose of this study was to investigate the effect of intraoperative positions in single-level (L4-5) transforaminal lumbar interbody fusion (TLIF) on segmental and overall lumbar lordosis (LL) in patients with lumbar degenerative disease. Thirty-eight consecutive patients who had undergone single-segment (L4-5) TLIF with 0° polyetheretherketone (PEEK) cage and pedicle screw fixation were evaluated. Twenty patients underwent surgery on the four-poster type frame with hip flexion at 30° (Group I) and 18 patients were operated on a Jackson spinal table to adjust their hip flexion to 0° (Group II). Preoperative standing, intraoperative prone, and postoperative standing lateral radiographs were obtained in each patient. The overall and segmental LL were analyzed according to the position in which the patients were placed for their operation and results compared between Groups I and II. Intraoperative intervertebral segmental LL at L4-5 and L5-S1 was increased in Group II than in Group I, whereas postoperative intervertebral segmental LL at L4-5 (fused level) was increased LL. In Group I intraoperative intervertebral segmental LL at L4-5 did not achieve sufficient lordosis, whereas postoperative intervertebral segmental LL at L3-4 was increased. The overall spinal alignment was unaffected by the decreased segmental LL in the fused level owing to the compensation of the upper adjacent segments. The more the hip was extended intraoperatively, the more the segmental lordosis increased in the lower lumbar spine. Thus, selecting the appropriate surgical table and hip position are very important. Underachievement of segmental lordosis leads to the acceleration of upper adjacent segment load.


Assuntos
Cuidados Intraoperatórios/métodos , Lordose , Vértebras Lombares , Mesas Cirúrgicas , Posicionamento do Paciente/métodos , Fusão Vertebral , Idoso , Feminino , Humanos , Lordose/diagnóstico , Lordose/fisiopatologia , Lordose/cirurgia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/patologia , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados (Cuidados de Saúde) , Radiografia/métodos , Amplitude de Movimento Articular , Fusão Vertebral/efeitos adversos , Fusão Vertebral/métodos , Espondilolistese/cirurgia
3.
Medicine (Baltimore) ; 98(40): e17336, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31577728

RESUMO

Lumbar 3-joint complex degeneration is a multifactorial, pathological process. Previous studies included insufficient quantitative analyses to prove the relationship between disc degeneration and facet joint osteoarthritis (OA). We assessed the correlation between intervertebral disc and lumbar facet joint degeneration using computed tomography (CT) and magnetic resonance imaging (MRI) parameters.A total of 152 participants who underwent conventional MRI and CT in the clinostat position were included in this study. The presence of lumbar disc degeneration was identified using the Pfirrmann grading system, and the presence of lumbar facet joint degeneration was identified using the Weishaupt grading system. Facet tropism was defined as a divergence more than 7° between the facet joint angles of both sides at the same segment. The intervertebral disc heights were also measured.Most facet joint OA probably appeared at the segment with intervertebral disc degeneration of more than grade III. Facet joint OA was significantly exacerbated with the progression of disc degeneration grade. The intervertebral height significantly decreased with the progression of facet joint degeneration grades, except for grades 0 and 1.Our current study found that each individual joint degeneration influences the other 2 in the lumbar 3-joint complex. Facet tropism was significantly associated with lumbar disc degeneration. Narrowing of the intervertebral disc height probably aggravates the facet joint degeneration further at the same level.


Assuntos
Degeneração do Disco Intervertebral/diagnóstico por imagem , Vértebras Lombares/diagnóstico por imagem , Osteoartrite/diagnóstico por imagem , Articulação Zigapofisária/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Disco Intervertebral/patologia , Degeneração do Disco Intervertebral/complicações , Degeneração do Disco Intervertebral/patologia , Vértebras Lombares/patologia , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Osteoartrite/complicações , Osteoartrite/patologia , Estudos Retrospectivos , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X/métodos , Adulto Jovem , Articulação Zigapofisária/patologia
4.
BMJ ; 367: l5654, 2019 10 16.
Artigo em Inglês | MEDLINE | ID: mdl-31619437

RESUMO

OBJECTIVE: To assess the efficacy of three months of antibiotic treatment compared with placebo in patients with chronic low back pain, previous disc herniation, and vertebral endplate changes (Modic changes). DESIGN: Double blind, parallel group, placebo controlled, multicentre trial. SETTING: Hospital outpatient clinics at six hospitals in Norway. PARTICIPANTS: 180 patients with chronic low back pain, previous disc herniation, and type 1 (n=118) or type 2 (n=62) Modic changes enrolled from June 2015 to September 2017. INTERVENTIONS: Patients were randomised to three months of oral treatment with either 750 mg amoxicillin or placebo three times daily. The allocation sequence was concealed by using a computer generated number on the prescription. MAIN OUTCOME MEASURES: The primary outcome was the Roland-Morris Disability Questionnaire (RMDQ) score (range 0-24) at one year follow-up in the intention to treat population. The minimal clinically important between group difference in mean RMDQ score was predefined as 4. RESULTS: In the primary analysis of the total cohort at one year, the difference in the mean RMDQ score between the amoxicillin group and the placebo group was -1.6 (95% confidence interval -3.1 to 0.0, P=0.04). In the secondary analysis, the difference in the mean RMDQ score between the groups was -2.3 (-4.2 to-0.4, P=0.02) for patients with type 1 Modic changes and -0.1 (-2.7 to 2.6, P=0.95) for patients with type 2 Modic changes. Fifty patients (56%) in the amoxicillin group experienced at least one drug related adverse event compared with 31 (34%) in the placebo group. CONCLUSIONS: In this study on patients with chronic low back pain and Modic changes at the level of a previous disc herniation, three months of treatment with amoxicillin did not provide a clinically important benefit compared with placebo. Secondary analyses and sensitivity analyses supported this finding. Therefore, our results do not support the use of antibiotic treatment for chronic low back pain and Modic changes. TRIAL REGISTRATION: ClinicalTrials.gov NCT02323412.


Assuntos
Amoxicilina , Degeneração do Disco Intervertebral/complicações , Deslocamento do Disco Intervertebral/complicações , Dor Lombar , Vértebras Lombares , Adulto , Amoxicilina/administração & dosagem , Amoxicilina/efeitos adversos , Antibacterianos/administração & dosagem , Antibacterianos/efeitos adversos , Dor Crônica/diagnóstico , Dor Crônica/tratamento farmacológico , Dor Crônica/etiologia , Avaliação da Deficiência , Método Duplo-Cego , Feminino , Humanos , Dor Lombar/diagnóstico , Dor Lombar/tratamento farmacológico , Dor Lombar/etiologia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/patologia , Masculino , Pessoa de Meia-Idade , Noruega , Medição da Dor/métodos , Resultado do Tratamento
5.
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
6.
Am Surg ; 85(9): 985-991, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31638511

RESUMO

Radiologic indicators of sarcopenia have been associated with adverse operative outcomes in some surgical populations. This study assesses the association of radiologic indicators of frailty with outcomes after open ventral hernia repair (OVHR). A prospective, institutional, hernia-specific database was queried for patients undergoing OVHR from 2007 to 2018 with preoperative CT. Psoas muscle cross-sectional area at L3 was measured and adjusted for height (skeletal muscle index (SMI)). L3 vertebral body density (L3 VBD) was measured. Demographics and outcomes were evaluated as related to SMI and L3 VBD. Of 1178 patients, 9.7 per cent of females and 15.8 per cent of males had sarcopenia and 11.6 per cent of females and 9.2 per cent of males had osteopenia. Neither sarcopenia nor osteopenia were associated with outcomes of wound infection, readmission, reoperation, hernia recurrence, or major complications. When examined as continuous variables or by quartile, SMI and L3 VBD were not associated with adverse outcomes, including in subsets of male or female patients, the elderly, contaminated cases, and the obese. Radiologic markers of sarcopenia and osteopenia are not associated with adverse outcomes after OVHR. Further study should examine age or other potential predictors of outcomes in this patient population, such as independent status.


Assuntos
Fragilidade/complicações , Hérnia Ventral/complicações , Hérnia Ventral/cirurgia , Herniorrafia/efeitos adversos , Sarcopenia/complicações , Idoso , Doenças Ósseas Metabólicas/complicações , Doenças Ósseas Metabólicas/diagnóstico por imagem , Feminino , Fragilidade/diagnóstico por imagem , Herniorrafia/métodos , Humanos , Tempo de Internação , Vértebras Lombares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Músculos Psoas/diagnóstico por imagem , Estudos Retrospectivos , Sarcopenia/diagnóstico por imagem , Tomografia Computadorizada por Raios X
8.
Medicine (Baltimore) ; 98(35): e16953, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31464935

RESUMO

BACKGROUND: Patients with large defects in the annulus fibrosus following lumbar discectomy have high rates of symptomatic reherniation. The Barricaid annular closure device provides durable occlusion of the annular defect and has been shown to significantly lower the risk of symptomatic reherniation in a large European randomized trial. However, the performance of the Barricaid device in a United States (US) population has not been previously reported. DESIGN AND METHODS: This is a historically controlled post-market multicenter study to determine the safety and efficacy of the Barricaid device when used in addition to primary lumbar discectomy in a US population. A total of 75 patients with large annular defects will receive the Barricaid device following lumbar discectomy at up to 25 sites in the US and will return for clinical and imaging follow-up at 4 weeks, 3 months, and 1 year. Trial oversight will be provided by a data safety monitoring board and imaging studies will be read by an independent imaging core laboratory. Patients treated with the Barricaid device in a previous European randomized trial with comparable eligibility criteria, surgical procedures, and outcome measures will serve as historical controls. Main outcomes will include back pain severity, leg pain severity, Oswestry Disability Index, health utility on the EuroQol-5 Dimension questionnaire, complications, symptomatic reherniation, and reoperation. Propensity score adjustment using inverse probability of treatment weighting will be used to adjust for differences in baseline patient characteristics between the US trial participants and European historical controls. ETHICS AND DISSEMINATION: This study was approved by a central institutional review board. The study results of this trial will be widely disseminated at conference proceedings and published in peer-reviewed journals. The outcomes of this study will have important clinical and economic implications for all stakeholders involved in treating patients with lumbar discectomy in the US. STUDY REGISTRATION: ClinicalTrials.gov (https://clinicaltrials.gov): NCT03986580. LEVEL OF EVIDENCE: 3.


Assuntos
Discotomia/métodos , Deslocamento do Disco Intervertebral/cirurgia , Vértebras Lombares/cirurgia , Adulto , Idoso , Avaliação da Deficiência , Feminino , Nível de Saúde , Humanos , Deslocamento do Disco Intervertebral/diagnóstico por imagem , Vértebras Lombares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Dor/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Vigilância de Produtos Comercializados , Pontuação de Propensão , Qualidade de Vida , Reoperação/estatística & dados numéricos , Índice de Gravidade de Doença , Estados Unidos
9.
Medicine (Baltimore) ; 98(33): e16842, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31415408

RESUMO

INTRODUCTION: Engorgement of the epidural venous plexus (EVP) is a rare cause of nerve root impingement. Dilated epidural veins cause compression of the thecal sac and spinal nerve roots, leading to lumbar radiculopathy. PATIENT CONCERNS: Here we describe a case of severe lumbar radiculopathy in a 15-year-old morbidly obese boy. DIAGNOSIS: Enhanced lumbar magnetic resonance imaging revealed left sided L1-L2 disc protrusion and engorgement of the lumbar EVP, resulting in narrowing of the thecal sac in the entire lumbar spine. There was no evidence of an intra-abdominal mass, thrombosis of the inferior vena cava, or vascular malformation. INTERVENTIONS: A caudal epidural block was administered under fluoroscopic guidance. The patient reported a 30% reduction in pain intensity for just 1 day. OUTCOMES: The patient has been followed up for 2 years. He continues to take medication, including morphine sulfate 15 mg, gabapentin 300 mg, and oxycodone 20 mg per day. He is on a diet with exercise for weight reduction. CONCLUSION: An engorged EVP should be considered in the differential diagnosis of radiculopathy in morbidly obese patients.


Assuntos
Analgésicos Opioides/administração & dosagem , Morfina/administração & dosagem , Oxicodona/administração & dosagem , Dor Intratável/tratamento farmacológico , Radiculopatia/tratamento farmacológico , Adolescente , Anestesia Caudal/métodos , Humanos , Vértebras Lombares/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Morfina/uso terapêutico , Obesidade/complicações , Medição da Dor , Radiculopatia/diagnóstico por imagem
10.
Br J Radiol ; 92(1103): 20190386, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31356113

RESUMO

OBJECTIVE: Phantom studies and a prior patient study have shown up to 53% effective dose reduction when lumbar spine radiographs are acquired posteroanterior (PA) instead of anteroposterior (AP). Since November 2017, Taunton and Somerset NHS Foundation Trust has acquired all standing lumbar spine radiographs PA. The aim of this study was to locally evaluate dose and image quality in both projections and survey current UK practice. METHODS: 80 outpatients having a standing lumbar spine radiograph (40 AP; 40 PA) had their dose-area product recorded at a constant KV and focus film distance. Effective dose was calculated using PCXMC software. Each blinded radiograph was scored against an optimal reference image using European Guidelines criteria. The data were analyzed using Mann-Whitney U tests and linear regression. Eighty radiologists nationally were sent an anonymous survey to establish their current practice. RESULTS: A lumbar spine radiograph acquired PA instead of AP reduced effective dose by 41% (p < 0.001) with no difference in image quality (p = 0.9). 21 radiologists completed our survey and only 1 NHS Trust is currently using PA. CONCLUSION: PA lumbar spine radiography reduces patient radiation exposure with no affect on image quality, acquisition time or cost. The majority of NHS Trusts nationally are still using AP and it is time to standardize to PA. ADVANCES IN KNOWLEDGE: This patient study provides further good evidence of how reduction in exposure to ionizing radiation can be achieved in lumbar spine radiography and more widespread adoption of PA protocol could improve patient safety.


Assuntos
Vértebras Lombares/diagnóstico por imagem , Assistência Ambulatorial/estatística & dados numéricos , Protocolos Clínicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cirurgiões Ortopédicos/estatística & dados numéricos , Posicionamento do Paciente , Imagens de Fantasmas , Padrões de Prática Médica/estatística & dados numéricos , Doses de Radiação , Reino Unido
11.
Medicine (Baltimore) ; 98(27): e16189, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31277125

RESUMO

RATIONALE: Discal cysts are rare lesions characterized by pain caused by neurogenic compression with similar symptoms as those of disc herniation. This study aims to report the spontaneous regression of discal cyst achieved through nonsurgical integrative Korean Medicine treatment and the clinical epidemiological features of discal cyst cases collected from 4 institutions. PATIENT CONCERNS: A 31-year-old woman had low back pain and radiating pain equivalent to a numeral rating scale (NRS) of 8 and had limitations in daily work and activities. DIAGNOSES: The patient was diagnosed as having discal cysts that compressed the left S1 based on findings of L-spine magnetic resonance imaging (MRI) performed at our hospital. INTERVENTIONS: The patient received nonsurgical Korean Medicine treatment and after 24 days of treatment in the hospital, she underwent 16 additional treatments as an outpatient. OUTCOMES: Spontaneous regression was confirmed in the L-spine MRI follow-up at 36 days and 99 days after the initial test, and the patient underwent once-a-week follow up to examine NRS, Oswestry Disability Index (ODI), EuroQol-5 Dimensions (EQ-5D), and fear-avoidance beliefs questionnaire (FABQ) after 4 weeks, and 2, 3, and 6-month follow-ups after that. The patient was discharged in a painless condition, and she was able to carry on for 5 months without increased pain. LESSONS: Discal cysts are more rapid progress than disc herniation, it seems valid to attempt nonsurgical treatment. Epidemiologically, this is the first study to present the clinical epidemiological characteristics of discal cysts, it would provide valuable information to clinicians who treat and study discal cysts.


Assuntos
Cistos/terapia , Medicina Integrativa , Vértebras Lombares/diagnóstico por imagem , Medicina Tradicional do Leste Asiático/métodos , Terapia por Acupuntura , Adulto , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Medição da Dor , Modalidades de Fisioterapia , República da Coreia , Estudos Retrospectivos , Resultado do Tratamento
12.
Medicine (Baltimore) ; 98(27): e16388, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31277196

RESUMO

Tuffier line is a common landmark for spinal anesthesia. The 10th rib line has been suggested as a new landmark to predict the intervertebral levels. We evaluated the accuracy of these 2 anatomic landmarks for identifying the L4-L5 intervertebral space using ultrasonography in elderly patients with hip fracture.Seventy-nine elderly patients scheduled for hip fracture surgery under spinal anesthesia were included. In the lateral decubitus position with the fracture side up, the L4-L5 intervertebral space was identified alternately using Tuffier line, a line drawn between the highest points of both iliac crests, and the 10th rib line. The 10th rib line, an imaginary line that joints the 2 lowest points of the rib cage, passes through the L1-L2 intervertebral space or the body of L2. The L4-L5 intervertebral space was determined by the counting-down method from the 10th rib line. Then, the estimated intervertebral spaces were evaluated using ultrasonography.The L4-L5 intervertebral space was correctly identified in 47 (59%) patients with Tuffier line and 45 (57%) patients with the 10th rib line (P = .87). The estimation ratio related to the intervertebral levels was not different between the 2 landmarks (P = .40). The wrong identifications of intervertebral level with Tuffier line and the 10th rib line was observed in the following order: L3-L4 intervertebral space: 27% vs 24%, L5-S1 intervertebral space: 9% vs 16%, and L2-L3 intervertebral space: 5% vs 3%, respectively.Tuffier line and the 10th rib line may be unreliable to estimate the intervertebral space for spinal anesthesia in elderly patients with hip fracture.


Assuntos
Pontos de Referência Anatômicos/diagnóstico por imagem , Raquianestesia , Fraturas do Quadril/cirurgia , Vértebras Lombares/diagnóstico por imagem , Costelas/diagnóstico por imagem , Ultrassonografia , Idoso , Idoso de 80 Anos ou mais , Feminino , Fraturas do Quadril/diagnóstico por imagem , Humanos , Masculino , Estudos Prospectivos , Reprodutibilidade dos Testes
13.
J Comput Assist Tomogr ; 43(4): 568-571, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31310594

RESUMO

PURPOSE: The purpose of this study was to calculate the positive predictive value (PPV) of lumbar spine magnetic resonance imaging (MRI) findings for a painful disc using provocative discography. MATERIALS AND METHODS: Lumbar spine discography records and prediscography MRIs of 736 patients (2457 discs) who underwent discography for diagnostic purposes from 2003 to 2007 were retrospectively reviewed in an Institutional Review Board-exempt and Health Insurance Portability and Accountability Act-compliant protocol. Each level was identified as having high-intensity zone (HIZ) disc, disc protrusion, disc extrusion, or combination (any herniation type), disc bulge, disc degeneration, and spondylolisthesis. Statistical analysis used a 2 × 2 contingency table of significant discography results for each of the MRI variables to calculate P value and PPV with a confidence interval from a binomial distribution. RESULTS: An HIZ disc has a PPV of 0.71 (0.65-0.76, P = 4.31E - 44) for a provocative discography. A disc protrusion has a PPV of 0.79 (0.73-0.83, P = 2.68E - 53). A disc extrusion has a PPV of 0.93 (0.79-0.98, P = 1.34E - 14), a bulge of 0.43 (0.37-0.48, P = 0.002), and a degenerative disc of 0.32 (0.28-0.35, P = 0.08), and spondylolisthesis has a PPV of 0.67 (0.59-0.73, P = 1.70E - 20). A herniation of either type (extrusion or protrusion) has a PPV of 0.80 (0.75-0.84, P = 5.86E - 69). CONCLUSIONS: Disc herniations and HIZ discs have high predictive value in identifying a pain generator. An extruded disc herniation has the highest PPV for discogenic pain.


Assuntos
Vértebras Lombares/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Doenças da Coluna Vertebral/diagnóstico por imagem , Adulto , Idoso , Feminino , Humanos , Vértebras Lombares/patologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Doenças da Coluna Vertebral/patologia , Adulto Jovem
14.
Cancer Radiother ; 23(5): 408-415, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31331841

RESUMO

PURPOSE: Radiotherapy is a treatment method performed using ionizing radiation on cancer patients either alone or with surgery and/or chemotherapy. Although modern radiotherapy techniques provide a significant advantage in protecting healthy tissues, it is inevitable that normal tissues are also located in the areas targeted by radiations. In this study, we aimed to examine the bone mineral density changes in bone structures commonly included in the irradiated area such as, L5 vertebra, sacrum, and femur heads, in patients who have received pelvic radiotherapy; and the relationship between these changes with radiation dose. MATERIAL AND METHODS: Patients included in the study had been previously diagnosed with rectal cancer, which were operated or not. Preoperative or postoperative pelvic radiotherapy was planned for all patients. In terms of convenience when comparing with future scans, all densitometry and CT scans were performed with the same devices. Fifteen patients were included in the study. In order to determine the dose of radiation each identified area had taken after radiotherapy, the sacrum, L5 vertebra, bilateral femoral heads, and L1 regions were contoured in the CT scans in which treatment planning was done. Sagittal cross-sectional images were taken advantage of while these regions were being contoured. RESULTS: Bone mineral density was evaluated with CT and dual-energy X-ray absorptiometry before and after the treatment. The regions that have theoretically been exposed to irradiation, such as L5, sacrum, left to right femur were found to have significant difference in terms of bone density. According to CT evaluation, there was a significant decrease in bone intensity of L5, sacrum, left and right femurs. Dual-energy X-ray absorptiometry assessment revealed that the whole of the left femoral head, left femur neck and Ward's region were significantly affected by radiotherapy. However, there was no significant difference in the sacrum and L5 vertebra before and after radiotherapy. CONCLUSION: More accurate results could be achieved if the same study was conducted on a larger patient population, with a longer follow-up period. When the reduction in bone density is at maximum or a cure is likely in a long-term period, bone mineral density could be determined by measurements performed at regular intervals.


Assuntos
Densidade Óssea , Cabeça do Fêmur/efeitos da radiação , Vértebras Lombares/efeitos da radiação , Órgãos em Risco/efeitos da radiação , Radioterapia Conformacional/efeitos adversos , Neoplasias Retais/radioterapia , Sacro/efeitos da radiação , Absorciometria de Fóton , Adulto , Idoso , Doenças Ósseas Metabólicas/diagnóstico por imagem , Doenças Ósseas Metabólicas/etiologia , Terapia Combinada , Estudos Transversais , Feminino , Cabeça do Fêmur/diagnóstico por imagem , Cabeça do Fêmur/patologia , Seguimentos , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/patologia , Masculino , Órgãos em Risco/diagnóstico por imagem , Órgãos em Risco/patologia , Neoplasias Retais/cirurgia , Sacro/diagnóstico por imagem , Sacro/patologia , Tomografia Computadorizada por Raios X
15.
Medicine (Baltimore) ; 98(24): e16032, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31192958

RESUMO

Diffuse idiopathic skeletal hyperostosis (DISH) is the spontaneous osseous fusion of the spine with anterior bridging osteophytes. It is well-known that conservative treatment for vertebral fractures of fused segment among DISH spines is associated with worse clinical outcomes. However, the prognosis of conservatively treated stable vertebral fractures in neighboring nonfused segments among DISH spines is still unknown. The purpose of this study was to analyze the results of conservative treatment of stable low-energy thoracolumbar (TL) vertebral fracture in nonfused segments among patients with DISH lesions.A total of 390 consecutive patients who visited an emergency department by ambulance with spinal trauma between 2013 and 2017 were retrospectively reviewed. The diagnosis of DISH was determined based on fused spinal segments with bridging osteophytes in at least 3 adjacent vertebrae. For each case of stable TL vertebral fractures in nonfused segments of the DISH spine, we identified 2 age-, sex-, and fracture lesion-matched non-DISH controls who underwent conservative treatment for low-energy TL vertebral fractures during the same period.Of the 33 identified cases of TL fractures with DISH, 14 met our inclusion criteria. The bony union rates of the DISH group and control group were 57% and 75% at the 3-month follow-up examination (P = .38) and 69% and 100% at the 6-month follow-up examination (P = .02), respectively. Among the 13 patients with fractures below the TL junction, fused segments were not diagnosable based on the initial standard radiographs of the lumbar spine for 61.5% of patients.Although this study design was exploratory and the sample size was small, our results suggest that with conservative treatment, stable fractures in nonfused segments in the DISH spine might have a worse prognosis than ordinary osteoporotic vertebral fractures. The diagnosis of coexisting DISH lesions can be missed when only radiographs of the lumbar spine are used to determine the diagnosis.


Assuntos
Tratamento Conservador , Hiperostose Esquelética Difusa Idiopática/complicações , Vértebras Lombares/lesões , Fraturas da Coluna Vertebral/complicações , Fraturas da Coluna Vertebral/terapia , Vértebras Torácicas/lesões , Idoso , Ambulâncias , Estudos de Casos e Controles , Feminino , Seguimentos , Humanos , Hiperostose Esquelética Difusa Idiopática/diagnóstico por imagem , Hiperostose Esquelética Difusa Idiopática/terapia , Vértebras Lombares/diagnóstico por imagem , Masculino , Estudos Retrospectivos , Fraturas da Coluna Vertebral/diagnóstico por imagem , Vértebras Torácicas/diagnóstico por imagem , Resultado do Tratamento
16.
Clin Interv Aging ; 14: 959-968, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31213783

RESUMO

Objective: To bridge the efficacy and compare the safety of the 24-week teriparatide treatment in a Chinese osteoporosis study (NCT00414973) to a large international trial (FPT, NCT00670501) to determine whether long-term results from the international study were applicable to Chinese patients. Methods: In this post-hoc analysis, a propensity score matching method was used to select patients with similar baseline characteristics. Patients were female with osteoporosis at high risk of fracture, aged ≥55 years, and had no history of rheumatoid arthritis or corticosteroid use. Outcomes included percentage changes in lumbar-spine bone mineral density (LS-BMD) from baseline to 24 weeks, safety in matched-pair patients, and long-term percentage changes in LS-BMD and fragility fracture incidence in the matched fracture prevention trial (FPT) population. The determination of the acceptability of bridging results was based on the International Conference on Harmonization E5 guidelines. Results: A total number of 228 patients from each study were matched and paired. Patients were similar at baseline (P-values >0.33) except for ethnicity (98% Caucasian for FPT). For changes in LS-BMD from baseline to week 24, treatment with teriparatide showed significantly greater increases (P-values <0.001; least-squares mean difference: 5.0% in the Chinese study and 5.4% in FPT) than comparator (calcitonin/placebo). The safety profiles over 24 weeks were similar between two studies. For matched-pair FPT patients, long-term changes in LS-BMD were significantly greater (least-squares mean difference: 11.5%, P<0.001) and the fragility fracture rate was marginally lower in the teriparatide group compared with the placebo group (13.1% vs 22.3%, P=0.070). Conclusion: Assuming similar pharmacokinetic profiles for teriparatide between populations, comparable increases in LS-BMD and consistent safety profiles within 24 weeks of the treatment suggest long-term LS-BMD results from the FPT may be applicable to Chinese population.


Assuntos
Densidade Óssea/efeitos dos fármacos , Hormônios e Agentes Reguladores de Cálcio , Vértebras Lombares/diagnóstico por imagem , Fraturas por Osteoporose/prevenção & controle , Teriparatida , Idoso , Grupo com Ancestrais do Continente Asiático/estatística & dados numéricos , Calcitonina/uso terapêutico , Hormônios e Agentes Reguladores de Cálcio/administração & dosagem , Hormônios e Agentes Reguladores de Cálcio/efeitos adversos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Humanos , Análise por Pareamento , Pessoa de Meia-Idade , Osteoporose/complicações , Osteoporose/diagnóstico , Osteoporose/tratamento farmacológico , Teriparatida/administração & dosagem , Teriparatida/efeitos adversos , Resultado do Tratamento
17.
Spine (Phila Pa 1976) ; 44(13): E766-E773, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31205169

RESUMO

STUDY DESIGN: Reliability study. OBJECTIVE: To evaluate the applicability and reliability of 9.4T magnetic resonance imaging (MRI) in the assessment of degenerative disc disease compared with 3T MRI. SUMMARY OF BACKGROUND DATA: MRI is a reliable indicator of biochemical changes in the intervertebral disc (IVD) including hydration status, proteoglycan content, and disc degeneration compared with anatomical and histological studies. High-field 9.4T MRI has been shown to provide superior resolution and anatomical detail. However, it has not been tested against current standard MRI techniques. METHODS: Disc degeneration was initiated in 36 skeletally mature ewes 6 months prior to necropsy via validated surgical IVD injury models using either scalpel injury or drill-bit injury techniques at lumbar spine levels L2/3 and L3/4 with L1/2, L4/5, and L5/6 serving as control discs. All ex vivo IVDs were examined with 9.4T MRI and 3T MRI. All scans were analyzed using the Pfirrmann grading system by four independent observers. Intra- and interobserver reliability was assessed using kappa statistics and Spearman correlation. RESULTS: Inter- and intraobserver agreement for 9.4T MRI was excellent, both at κ 0.91 (P < 0.001). Comparatively, 3T interobserver reliability demonstrated substantial agreement at κ 0.61 (P < 0.001). Complete agreement was obtained in 92.7% to 100% of discs at 9.4T compared with 69.7% to 83.1% at 3T. A difference of one grade or more occurred in 6.7% at 9.4T and 39.3% at 3T. 9.4T MRI scored 97.3% of discs as grade 1 to 2 compared with 71.3% at 3T. 3T MRI tended to over-score the extent of disc degeneration with 28.6% of discs scored as grade 3 or higher compared with 2.7% at 9.4T MRI. CONCLUSION: 9.4T MRI study of IVD degeneration using the Pfirrmann grading system demonstrated excellent inter- and intraobserver reliability. Comparatively, 3T MRI demonstrated a tendency to over score the extent of disc degeneration. This improved reliability of 9.4T MRI holds great potential for its clinical applications. LEVEL OF EVIDENCE: 3.


Assuntos
Degeneração do Disco Intervertebral/diagnóstico por imagem , Disco Intervertebral/diagnóstico por imagem , Vértebras Lombares/diagnóstico por imagem , Imagem por Ressonância Magnética/normas , Animais , Biometria/métodos , Feminino , Disco Intervertebral/patologia , Degeneração do Disco Intervertebral/patologia , Deslocamento do Disco Intervertebral/patologia , Vértebras Lombares/patologia , Imagem por Ressonância Magnética/métodos , Reprodutibilidade dos Testes , Ovinos
18.
Spine (Phila Pa 1976) ; 44(13): E788-E799, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31205175

RESUMO

STUDY DESIGN: A systematic review. OBJECTIVE: To systemically review the previous literature regarding surgical treatment of Lenke type 5 adolescent idiopathic scoliosis (AIS). SUMMARY OF BACKGROUND DATA: The Lenke classification was published in 2001 as the classification of AIS. Since then, numerous articles have been published reporting the outcomes of surgical treatment of Lenke type 5 AIS. METHODS: The electronic databases PubMed, EMBASE, and Web of Science were queried up to Aug 2018 for articles regarding surgical treatment of Lenke type 5 AIS. Surgical variables, radiographic assessments, and clinical outcomes of surgical treatment of Lenke type 5 AIS were summarized. RESULTS: Fifty studies met the inclusion criteria. The average fused levels, % correction of thoracolumbar/lumbar curve at final follow-up, and % correction of thoracic curve at final follow-up for anterior and posterior procedures were reported to be 3.6-5.3 and 4.3-7.8 levels, 53-86 and 55-94% and 17-52 and 19-67%, respectively. Average coronal balance was imbalanced (≥20 mm) at preoperation in 22/43 reporting study groups and balanced (<20 mm) at final follow-up in all 37 reporting study groups. Scoliosis Research Society Version 22 scores showed no difference between anterior and posterior procedures in most of the reporting studies (5/6). CONCLUSION: Overall, the outcomes of surgical treatment of Lenke type 5 AIS are excellent. The thoracic curve was spontaneously corrected after surgery and coronal balance after surgery was better than before surgery. Both anterior and posterior procedures demonstrated satisfactory outcomes. LEVEL OF EVIDENCE: 4.


Assuntos
Vértebras Lombares/cirurgia , Escoliose/cirurgia , Fusão Vertebral/tendências , Vértebras Torácicas/cirurgia , Adolescente , Feminino , Humanos , Vértebras Lombares/diagnóstico por imagem , Masculino , Radiografia/métodos , Radiografia/tendências , Estudos Retrospectivos , Escoliose/diagnóstico por imagem , Fusão Vertebral/métodos , Vértebras Torácicas/diagnóstico por imagem , Resultado do Tratamento
19.
World Neurosurg ; 122: e627-e638, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-31108079

RESUMO

BACKGROUND: The effects of oblique lateral interbody fusion (OLIF) and minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) have not been compared by a meta-analysis. The present study aimed to summarize the radiographic and clinical outcomes of OLIF and MI-TLIF for degenerative lumbar disease. METHODS: We performed a systematic review of related studies and report the outcomes of OLIF and MI-TLIF for degenerative lumbar disease. The radiographic outcomes measures included disc height, segmental lordotic angle, lumbar lordotic angle, and fusion. The clinical and functional outcomes included operative blood loss, operative time, length of hospital stay, complications, visual analog scale, and Oswestry disability index. Data pooling and meta-analysis with the random effects model were performed to evaluate the results. RESULTS: A total of 47 studies met the inclusion criteria. Similar changes in terms of disc height, segmental lordotic angle, lumbar lordotic angle, length of hospital stay, visual analog scale, Oswestry disability index, and radiological evidence of fusion of >90% were observed between the 2 groups. The OLIF group showed less operative blood loss and operative time. The incidence of intraoperative and postoperative complications was 9.5% and 19.9% for the OLIF group and 3.5% and 8.5% for the MI-TLIF group, respectively. CONCLUSIONS: The radiographic and functional outcomes and length of hospital stay were similar between the 2 groups. The OLIF group showed advantages in operative blood loss and operative time; however, the incidence of complications in this technique was greater than that in the MI-TLIF group.


Assuntos
Degeneração do Disco Intervertebral/cirurgia , Vértebras Lombares/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos , Fusão Vertebral , Humanos , Degeneração do Disco Intervertebral/diagnóstico por imagem , Vértebras Lombares/diagnóstico por imagem
20.
Orthopade ; 48(10): 816-823, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31101963

RESUMO

BACKGROUND: Lumbar spinal stenosis is caused by various pathological conditions. With the diagnostic tools available, a precise classification of the condition should be made, which enables a consistent and appropriate therapeutic approach. OBJECTIVES: In the present article, the currently used classifications of lumbar spinal stenosis are discussed and the diagnostic tools are presented, focussing on the imaging descriptions of morphological changes. MATERIALS AND METHODS: This article is based on a PubMed literature search of the past 60 years and our own experiences. RESULTS: Lumbar spinal stenosis is caused mainly by degenerative changes to the spine. MR tomographic imaging can result in precise anatomical illustration and classification of the stenosis. CONCLUSIONS: Although modern imaging procedures deliver a very precise illustration of lumbar spinal stenosis, clinical symptoms make a considerable contribution to therapeutic decision-making. With the anatomical classification, differentiated surgical decompression of the spinal canal can be planned.


Assuntos
Vértebras Lombares/diagnóstico por imagem , Imagem por Ressonância Magnética , Estenose Espinal/classificação , Estenose Espinal/diagnóstico , Descompressão Cirúrgica , Humanos , Canal Vertebral , Estenose Espinal/cirurgia
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