RESUMO
The study intended to evaluate the incidence and evolution of sacroiliac joint dysfunction (SIJD). To reach 50 patients with SIJD diagnosis, 192 patients with low back pain and failure in conservative approach were consecutively examined (26% incidence). Initially patients underwent intra-articular (IA) corticosteroid sacroiliac joint (SIJ) block followed, if necessary, by cooled SIJ radiofrequency or referred to surgical intervention, in order of complexity. From the 50 patients submitted to IA SI block, 41 (82%) referred pain and quality of life improvement and lesser rescue analgesics consumption for 25 weeks. The block induced a prompt onset of pain relief and there was a drop in mean pain score from 8 to 2 cm (p < 0.001) maintained up to 25 weeks. Rescue analgesic consumption also significantly dropped (p < 0.05). However, nine patients (18%) did not refer long lasting improvement in the third week evaluation and underwent cooled radiofrequency. From this population of nine, seven were successful (78%) while two were recommended surgery. In view of the 50 patients, 82% were comfortable after IA block, 18% were submitted to radiofrequency, with a success rate of 78%. The final incidence of surgery suggestion was 4%.
El estudio pretende evaluar la incidencia y evolución de la disfunción de la articulación sacroilíaca (DASI). Para llegar a 50 pacientes con diagnóstico de DASI, se examinaron consecutivamente 192 pacientes con dolor lumbar y fracaso en el abordaje conservador (26% de incidencia). Inicialmente, los pacientes se sometieron a un bloqueo de la articulación sacroilíaca (ASI) con corticosteroides intraarticulares (IA) seguido, si era necesario, de radiofrecuencia ASI enfriada o remitidos a una intervención quirúrgica, en orden de complejidad. De los 50 pacientes sometidos al bloqueo IA SI, 41 (82%) refirieron mejoría del dolor y de la calidad de vida y menor consumo de analgésicos de rescate durante 25 semanas. El bloqueo indujo un rápido inicio del alivio del dolor y hubo una caída en la puntuación media del dolor de 8 a 2 cm (p < 0.001) mantenida hasta 25 semanas. El consumo de analgésicos de rescate también disminuyó significativamente (p < 0.05). Sin embargo, nueve pacientes (18%) no refirieron una mejoría duradera en la evaluación de la tercera semana y se sometieron a radiofrecuencia fría. De esta población de nueve, siete tuvieron éxito (78%), mientras que a dos se les recomendó cirugía. De los 50 pacientes, 82% se sintió cómodo después del bloqueo IA, 18% fue sometido a radiofrecuencia, con una tasa de éxito de 78%. La incidencia final de sugerencia de cirugía fue de 4%.
Assuntos
Artropatias , Dor Lombar , Humanos , Dor Lombar/epidemiologia , Dor Lombar/etiologia , Dor Lombar/terapia , Articulação Sacroilíaca/cirurgia , Brasil , Qualidade de VidaRESUMO
Spinal cord injury is an extremely severe condition with no available effective therapies. We examined the effect of melatonin on traumatic compression of the spinal cord. Sixty male adult Wistar rats were divided into three groups: sham-operated animals and animals with 35 and 50% spinal cord compression with a polycarbonate rod spacer. Each group was divided into two subgroups, each receiving an injection of vehicle or melatonin (2.5 mg/kg, intraperitoneal) 5 min prior to and 1, 2, 3, and 4 h after injury. Functional recovery was monitored weekly by the open-field test, the Basso, Beattie and Bresnahan locomotor scale and the inclined plane test. Histological changes of the spinal cord were examined 35 days after injury. Motor scores were progressively lower as spacer size increased according to the motor scale and inclined plane test evaluation at all times of assessment. The results of the two tests were correlated. The open-field test presented similar results with a less pronounced difference between the 35 and 50% compression groups. The injured groups presented functional recovery that was more evident in the first and second weeks. Animals receiving melatonin treatment presented more pronounced functional recovery than vehicle-treated animals as measured by the motor scale or inclined plane. NADPH-d histochemistry revealed integrity of the spinal cord thoracic segment in sham-operated animals and confirmed the severity of the lesion after spinal cord narrowing. The results obtained after experimental compression of the spinal cord support the hypothesis that melatonin may be considered for use in clinical practice because of its protective effect on the secondary wave of neuronal death following the primary wave after spinal cord injury.
Assuntos
Animais , Masculino , Ratos , Melatonina/farmacologia , Atividade Motora/fisiologia , Fármacos Neuroprotetores/farmacologia , Recuperação de Função Fisiológica/efeitos dos fármacos , Compressão da Medula Espinal/tratamento farmacológico , Modelos Animais de Doenças , Melatonina/administração & dosagem , Fármacos Neuroprotetores/administração & dosagem , Ratos Wistar , Recuperação de Função Fisiológica/fisiologia , Compressão da Medula Espinal/patologia , Fatores de TempoRESUMO
Animal models of intervertebral disc degeneration play an important role in clarifying the physiopathological mechanisms and testing novel therapeutic strategies. The objective of the present study is to describe a simple animal model of disc degeneration involving Wistar rats to be used for research studies. Disc degeneration was confirmed and classified by radiography, magnetic resonance and histological evaluation. Adult male Wistar rats were anesthetized and submitted to percutaneous disc puncture with a 20-gauge needle on levels 6-7 and 8-9 of the coccygeal vertebrae. The needle was inserted into the discs guided by fluoroscopy and its tip was positioned crossing the nucleus pulposus up to the contralateral annulus fibrosus, rotated 360° twice, and held for 30 s. To grade the severity of intervertebral disc degeneration, we measured the intervertebral disc height from radiographic images 7 and 30 days after the injury, and the signal intensity T2-weighted magnetic resonance imaging. Histological analysis was performed with hematoxylin-eosin and collagen fiber orientation using picrosirius red staining and polarized light microscopy. Imaging and histological score analyses revealed significant disc degeneration both 7 and 30 days after the lesion, without deaths or systemic complications. Interobserver histological evaluation showed significant agreement. There was a significant positive correlation between histological score and intervertebral disc height 7 and 30 days after the lesion. We conclude that the tail disc puncture method using Wistar rats is a simple, cost-effective and reproducible model for inducing disc degeneration.
Assuntos
Animais , Masculino , Degeneração do Disco Intervertebral/patologia , Modelos Animais de Doenças , Degeneração do Disco Intervertebral , Imageamento por Ressonância Magnética , Variações Dependentes do Observador , Punções , Ratos Wistar , Índice de Gravidade de Doença , Fatores de TempoRESUMO
Osteoporosis is a major complication of chronic cholestatic liver disease (CCLD). We evaluated the efficacy of using disodium pamidronate (1.0 mg/kg body weight) for the prevention (Pr) or treatment (Tr) of cholestasis-induced osteoporosis in male Wistar rats: sham-operated (Sham = 12); bile duct-ligated (Bi = 15); bile duct-ligated animals previously treated with pamidronate before and 1 month after surgery (Pr = 9); bile duct-ligated animals treated with pamidronate 1 month after surgery (Tr = 9). Rats were sacrificed 8 weeks after surgery. Immunohistochemical expression of IGF-I and GH receptor was determined in the proximal growth plate cartilage of the left tibia. Histomorphometric analysis was performed in the right tibia and the right femur was used for biomechanical analysis. Bone material volume over tissue volume (BV/TV) was significantly affected by CCLD (Sham = 18.1 ± 3.2 vs Bi = 10.6 ± 2.2%) and pamidronate successfully increased bone volume. However, pamidronate administered in a preventive regimen presented no additional benefit on bone volume compared to secondary treatment (BV/TV: Pr = 39.4 ± 12.0; Tr = 41.2 ± 12.7%). Moreover, the force on the momentum of fracture was significantly reduced in Pr rats (Sham = 116.6 ± 23.0; Bi = 94.6 ± 33.8; Pr = 82.9 ± 22.8; Tr = 92.5 ± 29.5 N; P < 0.05, Sham vs Pr). Thus, CCLD had a significant impact on bone histomorphometric parameters and pamidronate was highly effective in increasing bone mass in CCLD; however, preventive therapy with pamidronate has no advantage regarding bone fragility.
Assuntos
Animais , Masculino , Conservadores da Densidade Óssea/uso terapêutico , Colestase Intra-Hepática/complicações , Difosfonatos/uso terapêutico , Osteoporose/prevenção & controle , Densidade Óssea/efeitos dos fármacos , Doença Crônica , Hormônio do Crescimento/sangue , Imuno-Histoquímica , Fator de Crescimento Insulin-Like I/análise , Osteoporose/etiologia , Ratos WistarRESUMO
Methods for reliable evaluation of spinal cord (SC) injury in rats at short periods (2 and 24 h) after lesion were tested to characterize the mechanisms implicated in primary SC damage. We measured the physiological changes occurring after several procedures for producing SC injury, with particular emphasis on sensorimotor functions. Segmental and suprasegmental reflexes were tested in 39 male Wistar rats weighing 250-300 g divided into three control groups that were subjected to a) anesthesia, b) dissection of soft prevertebral tissue, and c) laminectomy of the vertebral segments between T10 and L1. In the lesion group the SC was completely transected, hemisected or subjected to vertebral compression. All animals were evaluated 2 and 24 h after the experimental procedure by the hind limb motility index, Bohlman motor score, open-field, hot-plate, tail flick, and paw compression tests. The locomotion scale proved to be less sensitive than the sensorimotor tests. A reduction in exploratory movements was detected in the animals 24 h after the procedures. The hot-plate was the most sensitive test for detecting sensorimotor deficiencies following light, moderate or severe SC injury. The most sensitive and simplest test of reflex function was the hot-plate. The hemisection model promoted reproducible moderate SC injury which allowed us to quantify the resulting behavior and analyze the evolution of the lesion and its consequences during the first 24 h after injury. We conclude that hemisection permitted the quantitation of behavioral responses for evaluation of the development of deficits after lesions. Hind limb evaluation scores and spontaneous exploration events provided a sensitive index of immediate injury effects after SC lesion at 2 and 24 h. Taken together, locomotion scales, open-field, and hot-plate tests represent reproducible, quantitatively sensitive methods for detecting functional deficiencies within short periods of time, indicating their potential...
Assuntos
Animais , Masculino , Ratos , Comportamento Animal/fisiologia , Desempenho Psicomotor/fisiologia , Traumatismos da Medula Espinal/fisiopatologia , Modelos Animais de Doenças , Laminectomia , Exame Neurológico/métodos , Prognóstico , Ratos Wistar , Reprodutibilidade dos Testes , Índice de Gravidade de Doença , Fatores de TempoRESUMO
The objective of the present study was to identify neurons in the central nervous system that respond to spinal contusion injury in the rat by monitoring the expression of the nuclear protein encoded by the c-fos gene, an activity-dependent gene, in spinal cord and brainstem regions. Rats were anesthetized with urethane and the injury was produced by dropping a 5-g weight from 20.0 cm onto the exposed dura at the T10-L1 vertebral level (contusion group). The spinal cord was exposed but not lesioned in anesthetized control animals (laminectomy group); intact animals were also subjected to anesthesia (intact control). Behavioral alterations were analyzed by Tarlov/Bohlman scores, 2 h after the procedures and the animals were then perfused for immunocytochemistry. The patterns of Fos-like immunoreactivity (FLI) which were site-specific, reproducible and correlated with spinal laminae that respond predominantly to noxious stimulation or injury: laminae I-II (outer substantia gelatinosa) and X and the nucleus of the intermediolateral cell column. At the brain stem level FLI was detected in the reticular formation, area postrema and solitary tract nucleus of lesioned animals. No Fos staining was detected by immunocytochemistry in the intact control group. However, detection of FLI in the group submitted to anesthesia and surgical procedures, although less intense than in the lesion group, indicated that microtraumas may occur which are not detected by the Tarlov/Bohlman scores. There is both a local and remote effect of a distal contusion on the spinal cord of rats, implicating sensory neurons and centers related to autonomic control in the reaction to this kind of injury.
Assuntos
Animais , Masculino , Ratos , Tronco Encefálico/lesões , Genes fos/fisiologia , Neurônios/fisiologia , Proteínas Proto-Oncogênicas c-fos/biossíntese , Traumatismos da Medula Espinal/metabolismo , Biomarcadores , Tronco Encefálico/química , Tronco Encefálico/metabolismo , Estudos de Casos e Controles , Imuno-Histoquímica , Laminectomia , Proteínas Proto-Oncogênicas c-fos/análise , Ratos Wistar , Núcleo Solitário/química , Núcleo Solitário/metabolismo , Medula Espinal/química , Medula Espinal/metabolismoRESUMO
A escoliose e uma deformidade que afeta a coluna vertebral nos tres planos, sendo o desvio lateral no plano frontal, a rotacao vertebral no plano axial e a lordose no plano sagital, que produz uma topografia irregular na superficie do tronco, fato que tem levado varios autores a pesquisarem metodos para mensurar este fenomeno. Portanto, o presente estudo foi realizado com o proposito de avaliar a relacao da deformidade anatomica estrutural pela rotacao vertebral com a magnitude da curva na escoliose idiopatica, por meio da mensuracao da gibosidade feita em tres posicoes e por tres examinadores e tambem por meio de suas correlacoes com medidas radiologicas. Foram avaliados 52 pacientes com escoliose idiopatica a fim de comparar as mensuracoes da gibiosidade, realizadas com uma regua e um nivel da agua em tres posicoes e por tres examinadores: posicao 1 - flexao anterior da coluna com os membros superiores em pendulo, posicao 2 - flexao anterior da coluna com as maos unidas, e posicao 3 - flexao anterior da coluna na posicao sentada. Tambem foi estudado o coeficiente de correlacao linear de Pearson (valor de r) entre essas medidas, com a avaliacao radiologica na posicao ortostatica e de decubito dorsal, por meio das medidas do angulo de Cobb e da rotacao vertebral pelo metodo de Nash & Moe e pelo metodo de Raimondi...
Assuntos
Escoliose , Doenças da Coluna Vertebral , Coluna VertebralRESUMO
Os autores avaliaram o efeito da utilizaçÒo do instrumental de Cotrel-Dubousset na rotaçäo vertebral de pacientes portadores de escoliose. Foi escolhida a vértebra apical da curva escoliótica para o estudo da rotaçäo vertebral, que foi avaliada por meio de tomografia computadorizada, realizada no período pré e pós-operatório, tendo sido empregado o método de Ho et al. (1993) para a medida da rotaçäo vertebral, A média dos valores da rotaçäo da vértebra apical no período pré-operatório foi de 16,8 graus, e de 12 graus após a utilizaçäo do instrumental de Cotrel-Dubousset (correçÒo de 24 por cento), aplicando-se o primeiro método de Ho et al., e de 15,2 graus no pré-operatório e de 11,8 graus no pós-operatório (correçÒo de 29 por cento) com o uso do segundo método.