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1.
Medicine (Baltimore) ; 99(40): e22186, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33019393

RESUMO

This study aimed to verify the relationship between the number of fusion level and the risk of screw loosening by using cortical bone trajectory (CBT) screws in patients with lumbar degenerative disease.We retrospectively reviewed the serial plain radiograph images of lumbar degenerative disease patients who had undergone posterior fixation and fusion surgery with CBT from 2014. All included patients should have been followed-up with computed tomography scan or plain radiograph for at least 6 months after operation. We individually evaluated the prevalence of screw loosening according to each vertebral level. We also determined whether the number of screw fixation affected the prevalence of screw loosening and whether S1 fixation increased the risk of screw loosening.The screw-loosening rates were high at the S1 level. Moreover, although fixation involved to S1, the loosening rates evidently increased (Fisher exact test, P = .002). The screw-loosening rate was 6.56% in 2 level fusion. However, it increased with the number of fusion levels (3 level: 25.00%, 4 level: 51.16%, and 5 level: 62.50%). To investigate if the number of fusion level affected the S1 screw loosening, we classified the cohort of patients into either involving S1 (S1+ group) or not (S1- group) according to different fusion levels (). The screw loosening between 2 group in 2 (5.56% vs 6.98%) and 3 fusion level (26.32% vs 22.73%) did not exhibit any significant difference. Interestingly, significantly high screw loosening was found in 4 fusion level (60.00% vs 15.38%), indicating that the higher fusion level (4 level) can directly increase the risk of S1 screw loosening.Our data confirmed that the screw-loosening rate increases rate when long segment CBT fixation involves to S1. Therefore, in case of long-segment fixation by using CBT screw, surgeons should be aware of the fusion level of S1.


Assuntos
Parafusos Ósseos , Degeneração do Disco Intervertebral/cirurgia , Deslocamento do Disco Intervertebral/cirurgia , Fusão Vertebral/instrumentação , Osso Cortical/diagnóstico por imagem , Análise de Falha de Equipamento/métodos , Feminino , Humanos , Vértebras Lombares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
2.
Medicine (Baltimore) ; 99(33): e21690, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32872041

RESUMO

The clinical outcomes of redundant nerve root syndrome (RNRS) in patients with lumbar foraminal spinal stenosis (LFSS) are currently unknown. The purpose of this study was to evaluate the postprocedural outcomes of RNRS in LFSS after percutaneous lumbar foraminoplasty (PLF) and identify the factors associated with RNRS by comparative analysis between patients with and without RNRS.Patients with LFSS who underwent PLF were retrospectively analyzed. RNRS is defined as the presence of thick, elongated, and tortuous structures in the cauda equine associated with lumbar spinal stenosis. Based on the sagittal or transverse magnetic resonance imaging scans obtained before the PLF, the patients were stratified into 2 groups. Comparative analysis was performed between patients with RNRS (group R) and those without RNRS (group C).From March 2016 to January 2019, 8 of the 21 (38.1%) patients undergoing PLF showed signs of RNRS on magnetic resonance imaging images. PLF showed a tendency for less therapeutic effect with respect to changes in pain intensity in group R as compared to group C, but there were no statistically significant differences between the 2 groups. RNRS correlated with the cross-sectional area (CSA) of the dural sac and LFSS grade (P < .05). The CSA of the dural sac was smaller and the grade of LFSS was higher in group R than in group C.RNRS is commonly associated with lumbar spinal stenosis and could affect the treatment outcomes. Clinical outcomes in group R were not statistically different from those in group C, although group R showed slightly worse outcomes. The independent factors associated with RNRS were CSA of the dural sac and the LFSS grade.


Assuntos
Foraminotomia/métodos , Síndromes de Compressão Nervosa/cirurgia , Estenose Espinal/cirurgia , Estudos de Casos e Controles , Humanos , Vértebras Lombares/diagnóstico por imagem , Imagem por Ressonância Magnética , Síndromes de Compressão Nervosa/complicações , Síndromes de Compressão Nervosa/diagnóstico por imagem , Estudos Retrospectivos , Raízes Nervosas Espinhais/diagnóstico por imagem , Estenose Espinal/complicações , Estenose Espinal/diagnóstico por imagem
3.
Medicine (Baltimore) ; 99(38): e22198, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32957350

RESUMO

Consistency between back pain intensity and degenerative changes on magnetic resonance imaging (MRI) of the lumbar spine is poor. This study aimed to show whether tender point (TP) examination, used as a test for diffuse central sensitization, may add valuable information to clinical assessment of patients with low back pain (LBP).This was a cross-sectional study including 141 patients with LBP on sick leave. Baseline measures comprised back pain, leg pain intensity, and LBP examination including TP examination. Degenerative MRI findings were assessed in a standardized manner and blinded for clinical data. The number of TPs was analyzed in relation to sex, widespread pain, radiculopathy, pain duration, and degenerative changes on MRI.The number of TPs was positively associated with the female sex, widespread pain, and pain duration. It was negatively associated with degenerative manifestations and radiculopathy, the latter displaying a low level similar to that of the general population. A positive association between back pain intensity and TPs was present in patients with and without radiculopathy and in patients with substantial degenerative changes. Men with >7-8 TPs and women with >10-11 TPs had more back pain and similar or fewer degenerative changes than patients with few TPs (<3 and <6 TPs, respectively), thereby identifying 34% to 44% of patients with nonspecific LBP and 5% to 8% of patients with radiculopathy, respectively, with disproportionate back pain in relation to degenerative changes.Supplemental TP examination improved clinical and MRI evaluation of patients with LBP. By using gender-specific cut points, patients with disproportionate back pain were identified, presumably indicating diffuse central sensitization.


Assuntos
Sensibilização do Sistema Nervoso Central , Dor Crônica/complicações , Hiperalgesia/diagnóstico , Dor Lombar/complicações , Adulto , Estudos Transversais , Feminino , Humanos , Hiperalgesia/etiologia , Dor Lombar/diagnóstico por imagem , Vértebras Lombares/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Tato
4.
BMJ Case Rep ; 13(9)2020 Sep 21.
Artigo em Inglês | MEDLINE | ID: mdl-32958554

RESUMO

Clinical manifestations of COVID-19 are known to be variable with growing evidence of nervous system involvement. In this case report, we describe the symptoms of a patient infected with SARS-CoV-2 whose clinical course was complicated with Guillain-Barré syndrome (GBS). We present a case of a 58-year-old woman who was initially diagnosed with COVID-19 pneumonia due to symptoms of fever and cough. Two weeks later, after the resolution of upper respiratory tract symptoms, she developed symmetric ascending quadriparesis and paresthesias. The diagnosis of GBS was made through cerebrospinal fluid analysis and she was successfully treated with intravenous immunoglobulin administration.


Assuntos
Infecções por Coronavirus/complicações , Síndrome de Guillain-Barré/fisiopatologia , Dor Lombar/fisiopatologia , Debilidade Muscular/fisiopatologia , Parestesia/fisiopatologia , Pneumonia Viral/complicações , Analgésicos/uso terapêutico , Betacoronavirus , Encéfalo/diagnóstico por imagem , Infecções por Coronavirus/diagnóstico , Diagnóstico Diferencial , Feminino , Gabapentina/uso terapêutico , Síndrome de Guillain-Barré/diagnóstico , Síndrome de Guillain-Barré/etiologia , Síndrome de Guillain-Barré/terapia , Humanos , Imunoglobulinas Intravenosas/uso terapêutico , Fatores Imunológicos/uso terapêutico , Vértebras Lombares/diagnóstico por imagem , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/diagnóstico , Radiculopatia/diagnóstico , Medula Espinal/diagnóstico por imagem
5.
Medicine (Baltimore) ; 99(31): e21444, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32756160

RESUMO

BACKGROUND: Currently, there is some clinical evidence supporting the use of acupuncture in alleviating pain and dysfunction in patients with lumbar spinal stenosis (LSS). However, the question of whether acupuncture could be efficacious for ageing patients remains unanswered. We designed a randomized controlled study to evaluate the safety and feasibility of acupuncture for participants with symptomatic LSS. METHODS: This study is a randomized, single-blind, noninferiority trial. This clinical trial was approved by the Linyi Cancer Hospital. We received informed consent from all patients before surgery. In preparing this report, we adhered to the Consolidated Standards of Reporting Trials guidelines. We randomized consented study participants on a 1:1 ratio to one of two study groups (acupuncture and control groups) using a computer-generated list of random numbers in varying block sizes. Three outcome measures were selected to evaluate the effectiveness and safety of the treatment: visual analogue score and Oswestry disability index, and complicatins. A P < .05 was regarded as statistically significant. RESULTS: The hypothesis was that the acupuncture group would achieve acceptable clinical outcomes as compared to the control group in LSS. TRIAL REGISTRATION: This study protocol was registered in Research Registry (researchregistry5744).


Assuntos
Terapia por Acupuntura/métodos , Vértebras Lombares/patologia , Estenose Espinal/terapia , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Estudos de Viabilidade , Humanos , Vértebras Lombares/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Segurança , Método Simples-Cego , Resultado do Tratamento , Escala Visual Analógica
6.
Orv Hetil ; 161(31): 1286-1292, 2020 08.
Artigo em Húngaro | MEDLINE | ID: mdl-32750014

RESUMO

INTRODUCTION: Low back pain is a major factor that influences both society and economy. In Hungary, 21% of the population suffers from low back pain or back pain, and six out of ten take medication for the disease. Therapy is complex and no single method has been proved effectively to treat this disease. There are four main factors associated with low back pain: the geometry of the spine, morphological degeneration, the pain of the patients associated with the degeneration and the degree of the impairment. AIM: To investigate the relationship between the distribution of lumbar lordosis and the degeneration of intervertebral discs by mathematical analysis and its software application. METHOD: Algorithmic analysis of 60 MRIs and their classification into degeneration classes using discriminant analysis. RESULTS: By the classification, three independent variables show significant results: the gender, the age, and the digression percentage (K), but not the gold standard Cobb-angle. The common correct predicted classification value of the classification functions is 83% and the correct predicted classification value is 92% in the most relevant serious degeneration class. CONCLUSION: According to our results, the average degeneration of lumbar spine can be determined indirectly by the gender, the age, and the K (lordosis distribution) values with the Spinalyze Software which is available online for free. Orv Hetil. 2020; 161(31): 1286-1292.


Assuntos
Degeneração do Disco Intervertebral/epidemiologia , Lordose/epidemiologia , Vértebras Lombares/diagnóstico por imagem , Análise Discriminante , Humanos , Hungria/epidemiologia , Disco Intervertebral , Vértebras Lombares/fisiopatologia , Imagem por Ressonância Magnética
7.
Medicine (Baltimore) ; 99(34): e21572, 2020 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-32846765

RESUMO

Traumatic end plate fractures (EPFs) refers to the EPF caused by trauma, rather than the pathological status of the end plate (EP). However, some old traumatic EPFs may be mistaken as osteoporotic in the elderly. The objective of this study is to describe the radiological features of traumatic EPF in different traumatic fracture type patients presenting in the Emergency department setting. And to compare the result with osteoporotic vertebral fracture (VF).This study retrospectively analyzed the anatomical location of acute thoracolumbar vertebral traumatic EPFs in males (age≤55 years) and females (age≤50 years). The anatomic distribution of EPFs, the anterior and posterior wall fracture were analyzed in patients, who were scanned with 1 or more of the following methods: radiography, CT, and magnetic resonance imaging.There were 194 cases of acute spine trauma involving at least 1 EPF, including 118 males and 76 females. The involved vertebra was mostly at L1 (29.7%), followed by T12 (18.3%), and then by L2 (12.9%). Excluding those with both upper and lower EP involvements, the ratio of superior EPF to inferior EPF was 33.5 for males and 45.5 for females. With the EP divided into 5 segments of equal length in the anteroposterior direction in different fracture types, fractures occurred mostly at a2 segment (71.48% for superior EPs and 7.60% for inferior EPs), followed by a1 segment (66.16% for superior EPs). The upper third of the anterior and posterior walls were most prone to fracture in traumatic vertebral fracture.Traumatic EPFs more likely involve the anterior EP more than the posterior EP and is correlated with fracture type. These characteristics may help radiologist differential diagnosis between traumatic and osteoporotic EPF.


Assuntos
Vértebras Lombares/lesões , Fraturas da Coluna Vertebral/diagnóstico por imagem , Vértebras Torácicas/lesões , Adolescente , Adulto , China/epidemiologia , Diagnóstico Diferencial , Feminino , Humanos , Vértebras Lombares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Fraturas por Osteoporose , Radiografia , Estudos Retrospectivos , Fraturas da Coluna Vertebral/epidemiologia , Fraturas da Coluna Vertebral/etiologia , Vértebras Torácicas/diagnóstico por imagem , Adulto Jovem
8.
Medicine (Baltimore) ; 99(28): e20906, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32664083

RESUMO

Osteoporosis (OP) is a metabolic bone disease that can cause structural changes in bone marrow cavity. Bone marrow is the hematopoietic organ of adults. Accumulating evidence has shown a close connection between bone marrow hematopoietic function and bone formation. Some studies have revealed that OP is associated with hematopoiesis. However, the relationship is not definite.This study aimed to evaluate the association between peripheral blood cell counts (white blood cells [WBC], red blood cells [RBC], platelets [PLT]), hemoglobin [HGB], and bone mineral density [BMD]) in a sample of Chinese postmenopausal women. This is a retrospective study involving 673 postmenopausal women cases. The BMD of lumbar spine and left hip joint were measured by dual-energy X-ray absorptiometry. The levels of blood cell counts and HGB were measured and analyzed.The study results showed the WBC, RBC, PLT, and HGB levels of postmenopausal women in the OP group were all higher than those in the non-osteoporosis group. Spearman linear trend analysis and partial correlation analysis demonstrated that BMD was negatively correlated with WBC, RBC, PLT, and HGB in postmenopausal women.Due to the differences between different countries and races, and there are few studies on the association of BMD with peripheral blood cell counts and HGB in Chinese Postmenopausal Women. Therefore, more large sample studies are needed.


Assuntos
Grupo com Ancestrais do Continente Asiático/etnologia , Contagem de Células Sanguíneas/métodos , Densidade Óssea/fisiologia , Hemoglobinas/análise , Pós-Menopausa/sangue , Absorciometria de Fóton/métodos , Idoso , Contagem de Células Sanguíneas/tendências , Doenças Ósseas Metabólicas/diagnóstico , Doenças Ósseas Metabólicas/epidemiologia , Doenças Ósseas Metabólicas/fisiopatologia , Estudos de Casos e Controles , Feminino , Hematopoese/fisiologia , Articulação do Quadril/diagnóstico por imagem , Articulação do Quadril/fisiopatologia , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/fisiopatologia , Pessoa de Meia-Idade , Osteogênese/fisiologia , Osteoporose/diagnóstico , Osteoporose/epidemiologia , Osteoporose/fisiopatologia , Estudos Retrospectivos
9.
Medicine (Baltimore) ; 99(28): e21178, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32664159

RESUMO

Lumbar and pelvic alignment may have a huge impact on the posture of the spine and other parts. The aim of this study were to compare the spinal curvature of the cervical, thoracic, and lumbar spine and the muscle activity of the cervical erector spinae muscle, upper trapezius muscle, and thoracic erector spinae muscle when sitting at 3 different sloped, seating surfaces. A 10° wedge was used as the seating surface and we compared a forward sloping seat surface, a flat seating surface, and a rear sloping seat surface, in that order. Twenty healthy officers were recruited for this study. The subjects sat on the seat of 3 different slopes and watched a total of 3 videos, 10 minutes each. The rest time was 10 minutes. Subjects were photographed while viewing videos and muscle activity was measured. There were significant differences in cervical, thoracic, lumbar curvatures, and muscle activity in the 3 different sitting positions according to seat tilt (P < .05). Among the 3 slopes, the forward slope decreased forward head posture and cervical erector spinae muscle activity (P < .05). The activity of the cervical erector spinae muscle was 2.67% with a forward sloping seat, 5.45% with a flat sloping seat, and 6.77% with a rear sloping seat, revealing a significant difference (P < .05). This suggests that a forward sloping seat surface was effective in maintaining a neutral alignment of the spine, and this decreased the cervical spine erector muscle activity. Based on this result, equipment and chair development to incline seats forward may improve posture and health, and prevent chronic pain.


Assuntos
Músculos do Dorso/fisiologia , Postura Sentada , Curvaturas da Coluna Vertebral/fisiopatologia , Coluna Vertebral/fisiologia , Adulto , Músculos do Dorso/diagnóstico por imagem , Fenômenos Biomecânicos , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/fisiologia , Feminino , Cabeça , Voluntários Saudáveis , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/fisiologia , Masculino , Pescoço/diagnóstico por imagem , Pescoço/fisiologia , Pelve/diagnóstico por imagem , Pelve/fisiologia , Curvaturas da Coluna Vertebral/diagnóstico por imagem , Coluna Vertebral/diagnóstico por imagem , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/fisiologia
10.
Medicine (Baltimore) ; 99(27): e21069, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-32629737

RESUMO

Lumbar disc herniation (LDH) is a common, disabling musculoskeletal disorder. Magnetic resonance imaging has clarified the natural history of lumbar disc lesions and has documented that disc lesions can become smaller and can even be completely resorbed. Previous studies have confirmed that some traditional Chinese medicine (TCM) therapies can promote resorption of the protrusion. However, high-quality research evidence is needed to support the effectiveness of the protocol. OBJECTIVE: This clinical trial aims to establish whether TCM can promote the resorption of LDH and to assess the efficacy of such therapy for LDH, thereby evaluating its clinical effect. METHODS: The present study design is for a single-center, 2-arm, open-label randomized controlled trial. A total of 150 eligible LDH patients will be randomly assigned to either a TCM treatment group or a control group in a 1:1 ratio. Patients in the TCM group will be administered a TCM decoction for 4 weeks. Patients in the conventional drug control group will be instructed to take a specific daily dose of celecoxib. The primary outcome measure is the change from baseline in the volume of the protrusion, as assessed using MR images. Secondary outcome measures include visual analog scale pain scores and Japanese Orthopaedic Association scores assessed at 3 and 6 months. DISCUSSION: The design and methodological rigor of this trial will allow evaluation of the basic clinical efficacy and safety data for TCM in the treatment of patients with LDH. The trial will also assess whether TCM can promote the resorption of LDH. This research will therefore help provide a solid foundation for the clinical treatment of LDH and for future research in TCM therapy. TRIAL REGISTRATION: ChiCTR1900022377.


Assuntos
Deslocamento do Disco Intervertebral/terapia , Vértebras Lombares/diagnóstico por imagem , Medicina Tradicional Chinesa/métodos , Adulto , Anti-Inflamatórios não Esteroides/uso terapêutico , Estudos de Casos e Controles , Celecoxib/uso terapêutico , Humanos , Deslocamento do Disco Intervertebral/diagnóstico por imagem , Vértebras Lombares/patologia , Imagem por Ressonância Magnética/métodos , Pessoa de Meia-Idade , Medição da Dor/métodos , Remissão Espontânea , Projetos de Pesquisa , Segurança , Resultado do Tratamento , Escala Visual Analógica
11.
J Comput Assist Tomogr ; 44(4): 562-568, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32697527

RESUMO

OBJECTIVE: The objective of this article was to study the association of aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) with bone mineral density (BMD). METHODS: Spine BMD was evaluated in a subset of 2028 participants from the Multiethnic Study of Atherosclerosis cohort who were NSAID users (including aspirin) and underwent both lumbar and thoracic imaging. Multiethnic Study of Atherosclerosis is a prospective cohort study that includes 4 ethnic groups (white, Asian, African American, and Hispanic). Trabecular BMD was evaluated by quantitative computed tomography based on cardiac computed tomography images, which were obtained during coronary calcium scans. The analyses were cross sectional using baseline examination data for exposure and outcomes. RESULTS: After adjustment for potential confounders including age, sex, race, and traditional cardiovascular risk factors, a small association between trabecular BMD and baseline use of COX-2-selective NSAID was observed. COX-2-selective NSAID use was associated with 7.4 mg/cm (95% confidence interval [CI], 1.6-13.3; P = 0. 013) higher trabecular BMD in thoracic spine and 10.6 mg/cm higher at lumbar spine (95% CI, 5.1-16.1; P < 0.001). Among regular aspirin users, there was no association between drug use and trabecular BMD. Considering all spine fractures together, the prevalence ratio of fractures among aspirin users was 1.0 (95% CI, 0.6-1.6) and 1.1 (95% CI, 0.5-2.3) among COX-2-selective NSAID users. CONCLUSIONS: Regular use of aspirin has no significant association with trabecular BMD in either the thoracic or lumbar spine and no association with fracture prevalence. COX-2-selective NSAIDs may have modest positive association with BMD, but the mechanisms were not assessed and the observational study design makes residual confounding a possible alternate explanation. Potential pathological mechanisms warrant further longitudinal exploration.


Assuntos
Anti-Inflamatórios não Esteroides/administração & dosagem , Aspirina/administração & dosagem , Osso Esponjoso/diagnóstico por imagem , Fraturas Ósseas/epidemiologia , Vértebras Lombares/diagnóstico por imagem , Vértebras Torácicas/diagnóstico por imagem , Idoso , Anti-Inflamatórios não Esteroides/efeitos adversos , Aspirina/efeitos adversos , Densidade Óssea/efeitos dos fármacos , Osso Esponjoso/efeitos dos fármacos , Estudos Transversais , Feminino , Fraturas Ósseas/diagnóstico por imagem , Humanos , Vértebras Lombares/efeitos dos fármacos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Vértebras Torácicas/efeitos dos fármacos , Tomografia Computadorizada por Raios X , Estados Unidos/etnologia
12.
PLoS One ; 15(7): e0236296, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32730347

RESUMO

OBJECTIVE: Many studies on the clinical outcome of full endoscopic spine surgery versus open spine surgery have been published. However, only a few studies have compared the learning curves of percutaneous endoscopic interlaminar lumbar discectomy (PEILD) and open lumbar microdiscectomy (OLM) at the L5-S1 level. This study included patients with disc herniation at the L5-S1 level, who underwent PEILD or OLM performed by a single novice surgeon and compared the learning curves. METHODS: Fifty-six patients who underwent PEILD or OLM at the L5-S1 level and completed a minimum 1-year follow-up were enrolled in the study. The patients were allocated to the PEILD group (n = 27, September 2014 to August 2016) or an OLM group (n = 29, September 2012 to August 2014). The learning curves were retrospectively compared based on operation time and surgical outcomes, including complication, failure, and recurrence rates were retrospectively compared. RESULTS: Significant intergroup differences were not noted with respect to the baseline characteristics, including age, sex, body mass index, preoperative symptoms, or preoperative radiological findings. The mean operation time was significantly shorter in the PEILD group than in the OLM group (63.89±17.99 min versus 78.03±19.01 min, p = 0.006). Based on the operation time according to the number of cases, the learning curve was more difficult in the PEILD group according to the cumulative analysis (case number cut-off for proficiency was 18 in the PEILD group versus 10 in the OLM group) and linear regression analysis (proportionality constant for decrease in the operation time was -0.922 in the PEILD group versus -1.738 in the OLM group) than that in the OLM group. However, the surgical outcomes, including failure, surgical efficacy based on nerve root decompression, complication, and recurrence rates did not differ between the two groups. CONCLUSION: Although the learning curve of PEILD was more difficult than that of OLM, the mean operation time was shorter in the PEILD group than that in the OLM group. Moreover, based on the surgical outcomes, PEILD showed efficacy and safety similar to those of OLM.


Assuntos
Discotomia Percutânea/educação , Endoscopia/educação , Curva de Aprendizado , Vértebras Lombares/cirurgia , Adulto , Feminino , Humanos , Estimativa de Kaplan-Meier , Modelos Lineares , Vértebras Lombares/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Duração da Cirurgia , Resultado do Tratamento
13.
Medicine (Baltimore) ; 99(21): e20125, 2020 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-32481280

RESUMO

RATIONALE: Intraspinal tophaceous gout is relatively rare condition presenting with major clinical manifestations, such as spinal cord or nerve roots compressions (radiculopathy). It is usually difficult to differentiate intraspinal tophaceous gout, lumbar disc herniation, stenosis of spinal canal, ossification of ligamentum flavum, and other degenerative spinal disorders from each other. PATIENT CONCERNS: A 64-year-old man was admitted with a history of progressive low back pain for 11 months. He also presented with radiculopathy and numbness of his left lower extremity. DIAGNOSES: Preoperative computed tomography (CT) and magnetic resonance imaging (MRI) showed L4/5 disc herniation and lateral recess stenosis on the left side. During the operation of percutaneous transforaminal endoscopic decompression, intraspinal chalky white material was seen. Post-operative pathologic results confirmed the diagnosis of gouty tophi. INTERVENTIONS: Percutaneous transforaminal endoscopic decompression was performed as treatment. Intraspinal chalky white material was seen. We removed most of the chalky white material and extruded nucleus. OUTCOMES: His symptom subsided rapidly and no deterioration was noted 1 year post-operatively. LESSONS: Although intraspinal tophaceous gout is not commonly seen, clinicians should take it into consideration as a possible differential diagnosis when the patient exhibits axial pain or neurological deficits with risk factors of gout. We identified and treated this case with percutaneous transforaminal endoscopic decompression for the first time and got an excellent outcome. Percutaneous transforaminal endoscopic surgery proved to be an effective and minimally invasive alternative for identifying and treating intraspinal tophaceous gout.


Assuntos
Descompressão Cirúrgica/métodos , Gota/complicações , Vértebras Lombares/cirurgia , Estenose Espinal/cirurgia , Humanos , Dor Lombar/etiologia , Vértebras Lombares/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estenose Espinal/diagnóstico por imagem , Estenose Espinal/etiologia , Tomografia Computadorizada por Raios X
15.
Artigo em Japonês | MEDLINE | ID: mdl-32565514

RESUMO

The purpose of this study was to measure the scatter radiation intensity during transforaminal lumbar interbody fusion using a mobile C-arm system (Arcadis Orbic 3D; Siemens) and minimize radiation exposure. Dosimetry was performed with anterior-posterior and lateral continuous fluoroscopy, and cone beam computed tomography (CT). A scaffold tower (L: 300 cm×W: 200 cm×H: 150 cm) was built with radiation-resistant paper cylinders at intervals of 50 cm and plastic joints over the bed, and 100 optically stimulated luminescence dosimeters (nanoDot; Nagase Landauer) were placed on each joint. A human torso phantom from head to pelvis (Kyoto Kagaku) was positioned on the bed in a prone position. The scatter radiation dose in a lateral view was highest on the X-ray tube side at the height of 100 cm (170.5 µGy/min). The scatter radiation dose increased significantly on the X-ray tube side during lateral continuous fluoroscopy. Continuous change of surgeons' standing positions is important to minimize radiation exposure received by a specific surgeon.


Assuntos
Exposição à Radiação , Fluoroscopia , Humanos , Vértebras Lombares/diagnóstico por imagem , Imagens de Fantasmas , Doses de Radiação , Radiometria , Espalhamento de Radiação
17.
PLoS One ; 15(5): e0233633, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32459814

RESUMO

OBJECTIVE: To assess the learnability of two magnetic resonance imaging (MRI) grading systems for lumbar central canal stenosis based on inter-observer agreement and test-retest reliability of doctors with no prior knowledge of the two systems. MATERIALS AND METHODS: Two clinical fellows, one novice radiology resident, one neurosurgeon, and one orthopedic surgeon, who were unaware of the two qualitative MRI grading systems prior to this study, acquainted themselves with the teaching files. All five observers independently assessed the LCCS grade of 70 patients using T2-weighted axial magnetic resonance images at the L2-3, L3-4, L3-4, and L5-S1 disc levels. Analysis was performed twice at an interval of two months. RESULTS: The inter-observer agreement among all five readers was excellent and test-retest reliability was moderate to excellent for both the Schizas and Lee systems. Positive percentage agreements were found to be over 0.8 in almost all observers with relatively narrow 95% confidence limits. CONCLUSION: Both Schizas and Lee MRI grading systems for LCCS are reliable grading systems, and can be used as a learnable method for both clinicians and radiologists.


Assuntos
Disco Intervertebral/diagnóstico por imagem , Vértebras Lombares/diagnóstico por imagem , Imagem por Ressonância Magnética , Índice de Gravidade de Doença , Estenose Espinal/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Disco Intervertebral/fisiopatologia , Vértebras Lombares/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estenose Espinal/fisiopatologia
18.
Trop Doct ; 50(3): 228-232, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32419634

RESUMO

Osteoporosis is characterised by low bone mineral density (BMD) and is a significant public health problem in India. This cross-sectional study was done to assess the relationship between various anthropometric measures and BMD in 308 rural dwelling South Indian postmenopausal women. Anthropometric variables such as weight, body mass index (BMI), waist circumference (WC), hip circumference (HC) and neck circumference (NC) were measured. BMD was assessed by dual-energy X-ray absorptiometry (DXA) scan at the lumbar spine (LS) and femoral neck (NOF). The mean age ± SD of study participants was 60.7 ± 7.8 years. All anthropometric variables showed positive correlation with BMD at NOF and LS (P < 0.05). Weight showed the best correlation (r = 0.482 for NOF and 0.412 for LS; P < 0.001). On multivariate logistic regression, age and weight remained significant for predicting femoral neck osteoporosis while weight and WC were the best predictors for LS osteoporosis. These anthropometric measures may serve as surrogate markers for osteoporosis and thus be used to screen postmenopausal women for referral to a centre with fewer limited resources.


Assuntos
Assistência Ambulatorial/métodos , Osteoporose Pós-Menopausa/diagnóstico , Absorciometria de Fóton , Idoso , Antropometria , Pesos e Medidas Corporais , Densidade Óssea/fisiologia , Estudos Transversais , Feminino , Colo do Fêmur/diagnóstico por imagem , Colo do Fêmur/fisiopatologia , Humanos , Índia/epidemiologia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/fisiopatologia , Pessoa de Meia-Idade , Osteoporose Pós-Menopausa/diagnóstico por imagem , Osteoporose Pós-Menopausa/epidemiologia , Osteoporose Pós-Menopausa/fisiopatologia , Fatores de Risco , População Rural
19.
Clin Imaging ; 66: 1-6, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32413808

RESUMO

We report a case of symptomatic Oppenheimer ossicle in an 18-year-old male who presented with back pain. L5 pars interarticularis defect was suspected on initial lumbar spine radiographs. A subsequent technetium99m-methylene diphosphonate (Tc99m-MDP) bone scintigraphy with single-photon emission computed tomography/computed tomography (SPECT/CT) revealed focal radiotracer uptake in an Oppenheimer ossicle in L2 vertebra. CT was negative for pars defect. Oppenheimer ossicle is a developmental variant resulting from an unfused accessory ossification center at the tip of the articular process. It is important to recognize this entity as a rare cause of low back pain. Focal tracer uptake can mimic changes from pars interarticularis defect on planar and SPECT images. SPECT/CT helps to resolve both entities. To our knowledge, this is also the first report in English literature describing a symptomatic Oppenheimer ossicle on a bone scan.


Assuntos
Dor Lombar/diagnóstico por imagem , Vértebras Lombares/diagnóstico por imagem , Adolescente , Adulto , Difosfonatos , Fraturas Ósseas , Humanos , Dor Lombar/etiologia , Região Lombossacral , Masculino , Pessoa de Meia-Idade , Radiografia , Tomografia Computadorizada de Emissão de Fóton Único/métodos
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