Empirical analysis on lumbar disc herniation treated with "sinew-bone three needling technique" of Chinese medicine / 中国针灸

The paper presents professor WU Han-qing's experience in treatment of lumbar disc herniation (LDH) with "sinew-bone three needling technique" of Chinese medicine. Based on the theory of meridian sinew, the points are located by "three-pass method" in terms of the distribution of meridian sinew and syndrome/pattern differentiation. The cord-like muscles and adhesion are relieved by relaxing technique to work directly on the affected sites and alleviate the local compression to the nerve root. The needle technique is operated flexibly according to the affected regions involved, due to which, the needling sensation is increased while the safety ensured. As a result, the meridian qi is enhanced, the mind and qi circulation is regulated; and the clinical effect is improved.

Guideline for diagnosis, treatment and rehabilitation of lumbar disc herniation / 中华外科杂志

Recent years,the incidence of lumbar disc herniation is increasing annually,trending to younger age.There is a lack of clinical guideline for the management of lumbar disc herniation.Considering various problems in the management of lumbar disc herniation under different occasions,based on a systematic literature review,Basic Research and Transformation Society,Professional Committee of Spine and Spinal Cord organized experts to make this consensus jointly.This guideline aims to provide a standardized management of lumbar disc herniation with scientific principle and practical feasibility.Evidence-based medicine,and scientific suggestions are put forward specially for the management of lumbar disc herniation to standardize the diagnosis and treatment,promote the prognosis as well as improve the quality of life of patients.

Different entry points of needle knife for lumbar disc herniation: a randomized controlled trial / 中国针灸

OBJECTIVE@#To compare the clinical efficacy and safety among three different entry points of needle knife, including tenderness point, intervertebral foramen point and articular process node, for lumbar disc herniation (LDH).@*METHODS@#A total of 105 patients with LDH were randomly divided into a tenderness point group (35 cases, 1 case dropped off ), an intervertebral foramen point group (35 cases) and an articular process node group (35 cases, 1 case dropped off ). In the three groups, the needle knife was given at positive tenderness points of lumbosacral and hip, the external point of intervertebral foramen and the node of vertebral joint process respectively, once a week for a total of 4 times. The scores of Japanese Orthopaedic Association (JOA), Oswestry disability index (ODI), visual analogue scale (VAS) were recorded before treatment, 2 weeks and 4 weeks into treatment, and 3 months follow-up after treatment, and the clinical efficacy and safety was observed.@*RESULTS@#Compared before treatment, the JOA scores in each group were increased 2, 4 weeks into treatment and in the follow-up (P<0.05); 4 weeks into treatment and in the follow-up, the JOA scores in the tenderness point group and the articular process node group were higher than those in the intervertebral foramen point group (P<0.05). Compared before treatment, except for ODI score 2 weeks into treatment in the intervertebral foramen point group, the ODI and VAS scores in each group were decreased 2, 4 weeks into treatment and in the follow-up (P<0.05), and the ODI scores in the tenderness point group and the articular process node group were lower than those in the intervertebral foramen point group (P<0.05). In 2 weeks into treatment, the VAS scores in the tenderness point group and the articular process node group were lower than those in the intervertebral foramen point group (P<0.05); in 4 weeks into treatment and follow-up, the VAS scores in the tenderness point group were lower than the other two groups (P<0.05). After treatment, the clinical efficacy of each group was similar (P>0.05); during the follow-up, the total effective rate in the tenderness point group was higher than that in the intervertebral foramen point group (P<0.05). There were no serious adverse events in each group.@*CONCLUSION@#The three different entry points of needle knife all could improve the symptoms of patients with LDH. The comprehensive effect of improving the subjective symptoms, lumbar function, pain degree and long-term curative effect is better in the tenderness point group.

Update on Cervical Hernia Treatment: Conservative Management and Indications of Different Surgical Techniques / Atualização no tratamento da hérnia discal cervical: Manejo conservador e indicações de diferentes técnicas cirúrgicas

Summary Cervical and root pain due to herniated disc is one a common cause of a visit to an orthopedic surgeon. It is important to know how to diagnose, treat and initially. What are the best options to treat a herniated disc nowadays? The present article reviews the literature and updates on the clinical and surgical treatment of cervical disc herniation.

Resumo A dor cervical e radicular devido à hérnia de disco é uma causa comum de uma visita a um cirurgião ortopédico. É importante saber diagnosticar, tratar e inicialmente. Quais são as melhores opções para tratar a hérnia de disco hoje em dia? Este artigo faz uma revisão da literatura e atualização sobre o tratamento clínico e cirúrgico da herniação do disco cervical.

Clinical effect of lever positioning manipulation for lumbar disc herniation and its influence on Cobb angle / 中国骨伤

OBJECTIVE@#To observe the clinical effect of lever positioning manipulation for the treatment of lumbar disc herniation and its effect on Cobb angle.@*METHODS@#From December 2017 to November 2018, 67 patients with lumbar disc herniation were included in the study. The patients were randomly divided into treatment group and control group by digital table method. There were 34 cases in the treatment group, including 20 males and 14 females, with an average age of (36.09±8.26) years old and a course of (13.79±15.50) months. Treatment group was treated with lever positioning manipulation. There were 33 cases in the control group, including 18 males and 15 females, with an average age of(36.48±7.81) years old and a course of (12.82±15.68) months. Control group was treated with lumbar slanting manipulation. Two groups were treated 3 times a week, once every other day, 6 times for a course of treatment, after 2 courses of treatment, the changes of Cobb angle before and after treatment were compared between two groups by imaging. The symptoms and signs were scored with reference to clinical evaluation standard;overall efficacy was evaluated with reference to "Diagnostic Efficacy Criteria of Traditional Chinese Medicine Syndrome" issued by the State Administration of Traditional Chinese Medicine for lumbar disc herniation.@*RESULTS@#One patient in each group dropped out. The symptom and sign scores of treatment group and control group before treatment were 18.56± 4.81, 18.61±3.72, while after treatment were 9.41±5.19, 13.55±3.68;treatment group was significantly lower than control group after treatment (@*CONCLUSION@#Both the lever positioning manipulation and the lumbar slanting manipulation methods are effective for the treatment of lumbar disc herniation, but clinical effect of lever positioning method on lumbar disc herniation is more significant, and the effect on Cobb angle is more obvious. It is worthy of promotion.

Effect of electroacupuncture on lumbar disc herniation with different multifidus fatty infiltration rates / 中国针灸

OBJECTIVE@#To observe the therapeutic effect of electroacupuncture on lumbar disc herniation (LDH) with different multifidus fatty infiltration rates.@*METHODS@#A total of 108 eligible LDH patients received MRI test before treatment and the multifidus fatty infiltration rate (FI) was measured. According to theresults, they were divided to group A (FI20%), 36 cases in each one. EA was provided in all of the groups. The selected acupoints were Jiaji (EX-B 2) from L@*RESULTS@#Compared with before treatment, ODI score was reduced (@*CONCLUSION@#Electroacupuncture relieves pain and improves physical and psychological health of LDH patients. Multifidus fatty infiltration rate is probably one of the factors to influence the therapeutic effect of electroacupuncture.

Research on community promotion and application of single acupoint electroacupuncture therapy for lumbar intervertebral disc herniation / 中国针灸

OBJECTIVE@#To observe the clinical effect of single acupoint [Yaotu (extra)] electroacupuncture (EA) therapy on lumbar intervertebral disc herniation (LIDH) and its promotion and application in community medical institutions.@*METHODS@#This research adopted a three-level promotion model, and used multi-center collaboration topics as a platform. A total of 240 patients with LIDH were divided into a group A (top three hospital, 80 cases, 3 cases dropped off), a group B (secondary hospital, 80 cases, 8 cases dropped off), and a group C (community health center, 80 cases, 7 cases dropped off). All groups were treated with EA at a single acupoint [Yaotu (extra)] under the guidance of a unified experimental protocol. The EA was given 60 min each time and performed 3 times a week for a total of 2 weeks. The changes of visual analogue scale (VAS) scores of three groups before and after each treatment were compared, and the clinical efficacy was evaluated.@*RESULTS@#Compared with before each treatment, the VAS scores of three groups after each treatment decreased (@*CONCLUSION@#The single acupoint EA therapy has a significant effect in the treatment of LIDH, can quickly relieve the pain symptoms, and has the characteristics of simple operation and easy control, suitable for promotion and application in primary hospitals.

Lever positioning manipulation combined with pulsed electric field on the analgesic effect of patients with lumbar disc herniation and its influence on IL-1β and TNF-α / 中国骨伤

OBJECTIVE@#To observe the analgesic effect of lever positioning manipulation combined with pulsed electric field on patients with lumbar disc herniation and the influence on serum IL-1β and TNF-α.@*METHODS@#From January 2018 to March 2019, 58 patients with lumbar disc herniation were included in the study, which were randomly divided into observation group and control group by digital table method. Observation group of 29 cases, including 16 males and 13 females, aged (38.03±11.29) years old, were treated with lever positioning manipulation combined with pulsed electric field. The 29 cases in control group, including 17 males and 12 females, aged (38.21±9.16) years old, were treated with pulsed electric field. Both groups of patients were treated 3 times a week, once every other day, 3 times as a course of treatment. After 2 courses of treatment, the two groups of patients were scored before and after treatment by the numeric rating scales (NRS);at the same time, the serum levels of IL-1β and TNF-α were measured before and after treatment.@*RESULTS@#The NRS scores of observation group and control group were 4.21±1.76, 4.66±1.61 before treatment, and 1.28±0.84, 2.10±1.35 after treatment, respectively. The NRS scores of the observation group after treatment was significantly lower than that of the control group (@*CONCLUSION@#The lever positioning manipulation combined with pulsed electric field has a good analgesic effect on patients with lumbar disc herniation, and it has a significant impact on the patient's serum IL-1β and TNF-α concentration, which can be used as a clinical guide. However, the synergistic effect of lever positioning technique combined with pulsed electric field and guidelines for clinical treatment need further research.

Hernia del disco intervetebral lumbar: revisión narrativa de clínica y manejo / Lumbar herniated disc: narrative review on clinical management

Los cuadros de lumbociática secundarios a hernia del disco intervertebral (hdi) son frecuentes y causantes de importante morbilidad. En esta revisión narrativa, nos enfocaremos en los aspectos clínicos y de manejo de esta frecuente patología. Se tiene que mantener un algo grado de sospecha, pues no siempre los cuadros clínicos son similares a lo descrito clásicamente. Los signos radiculares irritativos y un examen neurológico exhaustivo son fundamentales, asimismo la correlación entre este cuadro y las imágenes. El curso natural de la hdi es en general hacia la resolución y, por lo tanto, el tratamiento de elección es inicialmente conservador. La cirugía tiene un rol generalmente en pacientes que han fracasado con el manejo conservador. Esta tiene mejores resultados en el corto plazo que el tratamiento conservador continuo, pero en el largo plazo son equivalentes. Es fundamental discutir estos aspectos con el paciente, para lograr una elección informada del tratamiento, de acuerdo a sus preferencias

Sciatic pain caused by a herniated disk (ldh) is frequent and cause of significant morbidity. In this narrative review, we will discuss the clinical aspects and management of ldh diagnosis and management. High suspicion for ldh diagnosis must be kept, since its clinical picture is not always classical. Tension signs and neurological examination are key, along with correlation with images. Ldh natural history is generally towards resolution and therefore, conservative treatment is the first choice. Surgery has its role for patients who have failed conservative treatment. Surgery achieves a faster pain alleviation than conservative treatment, but on the long-term results tend to become equivalent. Ample and detailed discussion of these aspects with the patient are clue for an informed consent and satisfactory results.

Aplicación del ozono interescalénico en la radiculopatía cervical por hernia discal / Application of intercalenic ozone in cervical radiculopathy due to herniated disc

Introducción: el ozono es un gas médico descrito desde el siglo XIX que ha tenido su evolución hasta a la fecha en cuanto a sus aplicaciones y su utilidad en diversas enfermedades por su actuación a nivel molecular y en disímiles enfermedades asociadas a procesos dolorosos de origen inflamatorio como los presentes en las hernia discales de la columna vertebral. Método: estudio retrospectivo con 20 pacientes atendidos en la consulta externa de Neurocirugía del Hospital Miguel Enríquez desde de Diciembre 2016 hasta Abril 2017 con el diagnostico de una radiculopatía cervical por hernia discal. Se le aplicó 10 ML de ozono con una concentración 22 mg/litro tres veces en la semana durante 10 semanas solamente se utilizó este tipo de terapia; obteniendo mejoría en 15 pacientes. Resultados: predominando los mayores de 51 años para un 50 por ciento, en nuestra serie predominó el sexo femenino para un 80 por ciento. En cuanto al cuadro clínico prevaleció la disminución de la fuerza muscular para un 60 por ciento en 12 pacientes, seguidos del dolor cervical y el interescapular para un 75 por ciento y 55 por ciento respectivamente. Se halló mejoría en 15 pacientes para un 75 por ciento y en los otros 5, en tres pacientes no continuaron el tratamiento y en dos no se obtuvo mejoría. Conclusiones: tenemos otra alternativa en la aplicación del ozono por el espacio interescalénico como tratamiento analgésicos y antiinflamatorio en las radiculopatía por hernia discales cervicales(AU)

Introduction: Ozone is a medical gas described since the nineteenth century that has had its evolution up to date in terms of its applications and its usefulness in various diseases for its performance at the molecular level and dissimilar diseases associated with painful processes of inflammatory origin such as those present in herniated discs of the spine. Method: Retrospective study with 20 patients assisted in the outpatient consultation of the Miguel Enríquez Hospital from December 2016 to April 2017 with the diagnosis of a cervical radiculopathy by herniated disc. 10 ML of ozone applied with a concentration of 22 mg/liter three times in the week for 10 weeks only this type of therapy used getting improvement in 15 patients. Results: predominating the older than 51 years for 50 percent, in our series predominated the female sex for 80 percent .As for the clinical picture, decreased muscle strength was prevailed for 60 percent in 12 patients, followed by cervical pain and interescapular for 75 percent and 55 percent respectively. We found improvement in 15 patients for 75 percent and in the other 5, in 3 patients did not continue the treatment and in two, no improvement obtained. Conclusions: We have another alternative in the application of ozone by the intercalenic space as analgesic and anti-inflammatory treatment in cervical herniated discus radiculopathy(AU)

Resultados de la nucleotomía percutánea en el manejo de la hernia discal lumbar / Results of percutaneous discectomy in the management of lumbar disc herniation

Resumen: Introducción: La nucleotomía percutánea es una técnica de descompresión discal aprobada por la FDA que ha mostrado ser útil para mejorar el dolor causado por hernia discal. No obstante, su práctica se encuentra en discusión debido a que los beneficios de la técnica son controversiales. Objetivos: Describir los resultados de la evolución clínica de los pacientes con hernia discal lumbar baja (L4-L5, L5-S1) tratada mediante cirugía percutánea a un año de operados y mostrar que es una opción quirúrgica útil para el alivio de la sintomatología causada por esta entidad patológica. Material y métodos: Estudio de cohorte; presentamos la evolución clínica de 21 individuos con hernia discal lumbar tratados con nucleotomía percutánea manual durante Marzo 2011-Noviembre 2013. La evaluación fue hecha antes de la cirugía y a los cuatro, 30, 180 y 365 días después de operados mediante la escala numérica del dolor (END), índice de discapacidad funcional de Oswestry (IDO) y criterios de MacNab. Utilizamos estadística inferencial no paramétrica (Wilcoxon) para diferencias. Resultados: n = 21: seis (28.57%) hombres, 15 (71.42%) mujeres; edad promedio: 37.95 años (14-56), ± 10.60; el nivel vertebral más afectado: L4-L5, en 12 (57.14%) sujetos. La END preoperatoria promedio: 7.75 (5-9) ± 1.12; a los 365 días: promedio 2.14 (0-7) ± 2.37. El IDO preoperatorio promedio: 37% (28-40%) ± 3.06 y a los 365 días: 9.52% (0-40%) ± 13.92. El pronóstico (IDO) en el prequirúrgico fue bueno en cero (0%) personas y en 15 (71.42%) a los 365 días, regular en cinco (23.80%) y malo en una (4.78%) (p = 0.000 IC 95% 0.00-0.13, Wilcoxon); de acuerdo con los criterios de MacNab, en 15 (71.42%) casos fueron excelentes y buenos, pobres en cuatro (19.04%) y malos en dos (9.52%) (p = 0.00). Conclusiones: La nucleotomía percutánea ofrece buenos resultados para el tratamiento de las hernias discales lumbares (L4-L5, L5-S1) a los 365 días de operados los pacientes.

Abstract: Introduction: Percutaneous discectomy is a disc decompression technique approved by the FDA that is useful to improve pain caused by a herniated disc. However, its practice is under discussion because the benefits of the technique are controversial. Objectives: To describe the clinical course of patients with low lumbar disc herniation (L4-L5, L5-S1) treated by percutaneous surgery within one year of surgery and prove that it is a useful surgical option for the relief of symptoms caused by this pathological entity. Material and methods: Cohort study; the clinical course of 21 patients with lumbar disc herniation treated with percutaneous discectomy manually during March 2011-November 2013, is presented. The evaluation was made before surgery and at four, 30, 180 and 365 days after surgery by numerical pain scale (NPS), Oswestry (IDO) and MacNab criteria. We used nonparametric inferential statistics (Wilcoxon) for differences in proportions. Results: n = 21, six (28.57%) men, 15 (71.42%) women; average age: 37.95, (14-56) ± 10.60 years; the most affected vertebral level was L4-L5 in 57.14% of the patients; the NPS preoperative average was 7.75 (5-9) ± 1.12; at 365 days: average 2.14 (0-7) ± 2.37. The IDO preoperative average was 37% (28-40%) ± 3.06, and at 365 days: 9.52% (0-40%) ± 13.92. The prognosis (IDO) in the presurgical was good to zero (0%) patients and in 15 (71.42%) at 365 days, regular in five (23.80%) and poor in one (4.78%) (p = 0.00, CI 95% 0.00 to 0.13, Wilcoxon); according to MacNab criteria, in 15 (71.42%) patients were excellent and good, poor in four (19.04%) and bad in two (9.52%) (p = 0.00). Conclusions: Percutaneous discectomy provides good results for the treatment of lumbar disc herniation (L4-L5, L5-S1) at 365 days after surgery.

Hernia discal lumbar, una visión terapéutica / Une vision thérapeutique / Lumbar disc herniation, a therapeutic vision

INTRODUCCIÓN: la radiculopatía por hernia de disco lumbar es la mayor causa de morbilidad que enfrentan los cirujanos espinales. Existen múltiples estrategias de tratamiento para esta afección, sin consenso actual entre secuestrectomía y discectomía, y sobre la necesidad de fusionar el segmento. OBJETIVO: mostrar nuestros resultados a los 4 años de seguimiento, en el tratamiento quirúrgico de la hernia discal lumbar mediante discectomía foraminal. MÉTODO: estudio descriptivo prospectivo en pacientes diagnosticados con hernias discales lumbares y tratados quirúrgicamente mediante discectomía foraminal simple y evaluados 4 años después RESULTADOS: muestra constituida por 67 pacientes, la mayoría (62,69 %) del sexo masculino; edad media cercana a los 40 años en ambos sexos. Se confirmó el diagnóstico en el 85,3 % de los casos mediante IRM. Predominó la localización L5-S1 y L4-L5, con 16 % de más de un segmento. El índice de Oswestry y la Escala Visual Analógica del dolor mostraron significativa mejoría a los 4 años de operados. CONCLUSIONES: el tratamiento quirúrgico de las hernias de disco mediante discectomía foraminal simple, según nuestra experiencia, produce buenos resultados; a los 4 años de efectuada la operación se constató disminución del dolor y mejoría de la función.

INTRODUCTION: Radiculopathy by lumbar disc herniation is a major cause of morbidity faced by spinal surgeons. There are many treatment strategies for this condition, and no current consensus among sequestrectomy and discectomy, and the need to merge the segment. OBJECTIVE: Show our results at 4 years of follow-up in the surgical treatment of lumbar disc herniation by foraminal discectomy. METHOD: A prospective study was conducted in patients diagnosed with lumbar disc herniation and foraminal surgically treated by simple discectomy and assessed four years later. RESULTS: The sample consisted of 67 patients, the majority (62.69%) was male; average age of nearly 40 years in both sexes. The diagnosis was confirmed in 85.3% of cases by MRI. L5-S1 and L4-L5 locations predominated, with 16% of more than one segment. Oswestry index and the Visual Analog Scale for pain showed significant improvement after four years of surgery. CONCLUSIONS: The surgical treatment of herniated discs by simple foraminal discectomy, in our experience, has good results; at four years of operation pain decrease and improvement in function was found

INTRODUCTION: La radiculopathie par hernie discale lombaire est la cause de morbidité la plus souvent traitée par les chirurgiens spécialisés en moelle épinière. Il y a plusieurs stratégies de traitement pour cette affection, mais aujourd'hui il n'y a pas de consensus ni entre la séquestrectomie et la discectomie ni sur la nécessité de fusionner le segment. OBJECTIF: Le but de ce travail est de montrer, après 4 ans de suivi, nos résultats à propos du traitement chirurgical d'une hernie discale lombaire par décompression foraminale. MÉTHODE: Une étude descriptive et prospective de patients diagnostiqués de hernie discale lombaire, traités chirurgicalement par décompression foraminale simple et évalués quatre ans après, a été réalisée. RÉSULTATS: Dans un échantillon de 67 patients, dont la plupart étaient du sexe masculin (62,69 %) et avaient un moyen d'âge de 40 ans environ chez tous les deux sexes, on a confirmé le diagnostic par IRM dans 85,3 % des cas. Les hernies ont été souvent localisées aux niveaux L5-S1 et L4-L5, dont 16 % correspondait à plus d'un segment. Quatre ans après l'opération, l'indice d'Oswestry et l'échelle visuelle analogique de douleur ont montré une amélioration significative. CONCLUSIONS: D'après notre expérience, le traitement chirurgical des hernies discales lombaires par décompression foraminale simple a montré de très bons résultats. Quatre ans après l'opération, on a constaté une diminution de la douleur et une amélioration de la fonction.

Tratamiento de luxación discal sin reducción: responsabilidad del odontopediatra / Treatment of disk displacement without reduction: the pediatric dentist´s responsibility

Actualmente, es frecuente la consulta por trastornos temporomandibulares (TTM) en la clínica odontopediátrica, siendo reconocida la múltiple causalidad de los mismos. Se presenta la resolución de una situación clínica de una paciente de 13 años de edad que acudió a la Cátedra de Odontología Integral Niños (OIN), presentando dolor muscular y articular del lado derecho, limitando la apertura bucal a 25 mm confortable y a 28 mm forzada, con desvío de la mandíbula hacia la izquierda. Refería haber sido atendida en una guardia médica el día anterior con bloqueo en apertura, luego de 8 meses de evolución, con síntomas de chasquido y doloir, sin haber realizado consulta alguna. Se indicó tratamiento sintomático y se solicitaron estudios complementarios. El diagnóstico fue de luxación discal sin reducción. Con la evaluación integral, se hallaron factores concomitantes, tales como maloclusión, hiperlaxitud, respiración bucal y parafunciones. En el abordaje terapéutico, se colocó un intermediario oclusal para reposicionamiento mandibular, se realizó tratamiento fonoaudiológico miofuncional y reeducación postural global (RPG). La paciente evolucionó favorablemente; a los 6 meses resolvió el ruido articular y al año estaba asintomática, con 37 mm de apertura, comenzando su tratamiento de ortodoncia y manteniendo controles durante 4 años. El compromiso de la familia y la participación de un equipo de trabajo, permitió la resolución integral del caso. El odontopediatra tiene la responsabilidad de alertar a padres y pacientes sobre factores de riesgo, diagnosticar TTM y orientar los tratamientos, involucrándose cuando corresponde su intervención, o derivando en forma oportuna...

Extruded Lumbar Disc Herniation with Spontaneous Reabsorption: Case Report and Review / Reabsorção espontânea de hérnia discal lombar extrusa: relato de caso

Disc herniation is a common condition in the population and has a direct impact on the quality of life in patients, also causing functional limitations in the work place. Treatment protocols include conservative management and/or various surgical interventions. This paper reports on a case of symptomatic large extruded disc herniation, together with spontaneous clinical regression and total re-absorption. We show here conservative management, and a literature review of the main pathophysiological hypotheses for such an unusual evolution.

Hérnia discal é condição comum na população e tem impacto direto na qualidade de vida dos pacientes, assim como causa limitações funcionais em seu ambiente de trabalho. Protocolos de tratamento incluem manejo conservador e/ou diversos tipos de intervenção cirúrgica. Este artigo relata o caso de uma extensa hérnia extrusa sintomática, juntamente a sua regressão clínica espontânea e sua total reabsorção. Descrevemos também seu manejo conservador e uma revisão da literatura para a principal hipótese diagnóstica nesta evolução incomum.

Transplantation of adipose derived mesenchymal stem cells for acute thoracolumbar disc disease with no deep pain perception in dogs

Thirty-four dogs with no deep pain perception due to acute thoracolumbar intervertebral disc disease underwent decompression surgery within 1 week of diagnosis. All dogs underwent hemilaminectomy. Adipose derived mesenchymal stem cells (AD-MSCs) were transplanted into the injured spinal cord parenchyma for the AD-MSCs transplant dogs. Long-term outcome was evaluated at the end of the follow-up period (> 6 months). AD-MSCs combination treatment showed better recovery outcomes compared to decompression surgery alone. These results indicate that this stem cell therapy is a potential therapeutic strategy to overcome the limitations of treatment for spinal cord injury in clinical medicine.

Método Tres Escuadras en pacientes deportistas con hernia de disco lumbar en ámbito hospitalario. Trabajo prospectivo / Three Squares method in athletes with lumbar disc herniation. Prospective study

Se realizó un ensayo clínico controlado, prospectivo, no cegado y no randomizado en pacientes deportistas con hernia de disco lumbar (HDL) con o sin irradiación, tratados con medicación y con el Método de Reeducación postural MTE, Método Tres Escuadras. Objetivo: Determinar la existencia y magnitud de la diferencia entre el VAS final e inicial, la flexibilidad lumbar final e inicial y la funcionalidad final e inicial en cada uno de los grupos. Material y Método: Este estudio fue realizado desde abril de 2009 hasta abril de 2014, en pacientes deportistas que presentaban hernia de disco lumbar diagnosticada por resonancia magnética nuclear. La N inicial fue de 126 pacientes, de los cuáles 26 fueron eliminados, N final: 100 pacientes; con un grupo etario de 18 a 65 años. Todos los pacientes realizaban deporte. Se subdividieron en tres grupos según edad, deporte y nivel de competencia. Las variables analizadas fueron el VAS, el Schoeber lumbar, el Schoeber total y el test de Owestry. Se evaluaron en la sesión 1 y en la 10. Los pacientes fueron atendidos con 1 sesión semanal con el Método Tres Escuadras. Resultados: Se evidenció una disminución en el VAS del 83,33% post intervención con respecto al valor basal. Se evidenció un aumento en la maniobra de Schoeber lumbar del 3,57% con respecto al valor basal. Se evidenció un aumento en la maniobra de Schoeber total del 28,57% con respecto al valor basal. Se determinó una disminución en el Owestry del 20% con respecto al valor inicial. Conclusión: Hay una diferencia estadísticamente significativa para el VAS, Schoeber lumbar, Schoeber total y test de Owestry, pre y post-intervención (valor p= <0,001)...

La hernie discale lombaire au CHU de Cocody (Abidjan): aspects epidemiologiques; cliniques; radiologiques et therapeutiques

Objectif : Decrire les caracteristiques epidemiologiques; cliniques; radiologiques et therapeutiques des hernies discales lombaires vues en hospitalisation rhumatologique a Abidjan.Patients et methode : Etude retrospective descriptive sur 7 ans menee au service de Rhumatologie (unite d'hospitalisation) du CHU de Cocody portant sur 39 dossiers. Ont ete inclus tous les dossiers de patients ayant une hernie discale lombaire de diagnostic scannographique. Une fiche d'enquete a permis de recueillir les donnees epidemiologiques; cliniques; radiologiques et therapeutiques. Resultats : La frequence hospitaliere de la hernie discale lombaire etait de 4;1 par rapport a l'ensemble des pathologies lombaires (948 cas). Elle predominait chez l'adulte masculin (56;4) ages de 49 ans en moyenne. Les patients provenant du secteur informel (commercants; ouvriers; cultivateurs.) predominaient (30;8). Ils rapportaient des antecedents douloureux lombaires (82;1). La hernie discale lombaire se manifestait par une lombosciatalgie (82;1) hyperalgique de trajet monoradiculaire L5 (38;9) ou S1 (30;6). La radiographie standard montrait un pincement discal (56;4). Elle etait normale dans 15;4 des cas. La tomodensitometrie lombaire revelait la predominance des formes posteromedianes (30;8) et posterolaterales (25;6). La strategie therapeutique etait basee sur le traitement medicamenteux (89;7) et physique. La neurochirurgie etait indiquee dans 10;3 des cas. Conclusion : La hernie discale lombaire est peu frequente en hospitalisation rhumatologique a Abidjan. Elle s'exprime par un syndrome lomboradiculaire hyperalgique et est dominee par les formes postero-medianes et postero-laterales. Le traitement conservateur est le plus souvent indique. La lutte contre la baisse de productivite passe par la prevention par l'ecole du dos

Efeito da mobilização neural na melhora da dor e incapacidade funcional da hérnia de disco lombar subaguda / Effect of neural mobilization on pain relief and improvement of functional incapacity of subacute lumbar disc herniation

A Mobilização Neural é um recurso terapêutico para as diversas disfunções do tecido neural e do sistema musculoesquelético. No entanto, é uma técnica ainda pouco conhecida e explorada pelos profissionais da área da saúde no Brasil. Diante disto resolveu-se realizar este estudo com intuito de avaliar sua eficiência na hérnia de disco lombar em relação à fisioterapia convencional. Participaram do estudo 30 indivíduos com hérnia de disco lombar unilateral,voluntários, selecionados por conveniência, independente de sexo,idade, tempo de acometimento, etnia e atividade profissional, desde que preenchessem os critérios de inclusão e exclusão, que foram divididos em grupo experimental (EXP) e controle (CONT), com15 participantes em cada, que receberam tratamentos distintos. O grupo CONT recebeu tratamento fisioterápico convencional enquanto o grupo EXP foi submetido ao tratamento de Mobilização Neural. A duração do programa foi de quatro semanas, com três sessões semanais. Ao se avaliar o efeito terapêutico em relação à dor ea incapacidade funcional, não se observou diferença estatisticamente significativa no grupo controle (CONT) na comparação intra-grupo(pré x pós). Já no grupo experimental (EXP), esta mesma comparação,pré e pós-tratamento, mostrou diferença estatisticamente significativa em relação à dor e a capacidade funcional, pelo teste de Kruskal Wallis (p = 0,0001). Quando se realizou a comparação inter-grupos ( pós-EXP x pós-CONT), encontrou-se um intervalo de confiança (IC) favorável ao grupo EXP (IC: -46,48/-5,79). Os resultados deste estudo evidenciaram resposta terapêutica satisfatória para regressão da sintomatologia dolorosa e incapacidade funcional,utilizando-se a técnica de Mobilização Neural na hérnia de disco lombar, unilateral, póstero-lateral, subaguda em curto período de tempo.

The Neural Mobilization is a therapeutic resource in many neural tissue and musculoskeletal system dysfunctions. Nevertheless, this technique remains underexploited by the health professionals in Brazil. Thirty individuals with unilateral lumbar disc herniation were selected by convenience, regardless of gender, age, duration of symptoms, ethnical group and professional activity, since they satisfy the inclusion and exclusion criteria. This sample was divided into two groups: experimental (EXP) and control (CONT), with15 participants each group, who received different treatments. The group CONT received conventional physical therapy treatment while the EXP group was submitted to the neural mobilization treatment. The individuals were treated for 4 weeks, with 3 weekly sessions. The control group (CONT), after using the conventional physical therapy techniques, did not show a statistically significant difference in comparison to the intragroup (pretreatment x post--treatment). On the other hand, the experimental group (EXP)showed a statistically significant difference in relation to pain and the functional capacity using the Kruskal Wallis test (p = 0.0001).When the results in the pre and post-treatment were compared intragroup post-EXP x post-CONT, the confidence interval (IC)was in favor of group EXP (IC: -46.48/-5.79). The results, in this study, showed a good therapeutic response, with regression of the painful symptomatology and functional incapacity, using Neural Mobilization technique, in individuals with unilateral, posterolateral,subacute lumbar disc herniation, in a short period.

Hérnia discal lombar na infância / Disc herniation in infancy

Introdução: A hérnia discal na infância é rara. Apresenta etiologia controversa. As principais manifestações clínicas são dor e dificuldade na deambulação. A ressonância magnética tem sido considerada exame de eleição no diagnóstico e conduta. O tratamento inicial é conservador e, em caso de cirurgia, usar técnica minimamente invasiva. Metodologia: Artigo de revisão realizado com levantamento em base de dados Medline/Pubmed, SciELO e LILACS, incluindo um período de 1946 a 2010, com prioridade para artigos com maior relevância. Resultados: Foram analisados artigos relacionados à hérnia discal na infância, dos quais 39, revisados, resultaram no presente trabalho. Conclusões: Deve-se pensar na possibilidade de hérnia discal quando as crianças apresentam lombalgia ou restrição à deambulação, principalmente se houver história recente de trauma. Ressonância magnética é o exame de eleição no diagnóstico e conduta. O tratamento cirúrgico, através de técnicas minimamente invasivas, apresenta resultados satisfatórios.

Introduction: Disc herniation in childhood is a rare disease, and its etiology is still controversial. The main clinical features are back pain and walking difficulty. Magnetic resonance is considered the method of choice for diagnosis and therapeutic decision. Initial treatment is conservative and in surgical cases, minimally invasive techniques should be used. Method: Review article of a survey conducted in the Medline/PubMed, SciELO and LILACS databases, including a period from 1946 to 2010, giving priority to the most relevant articles. Results: We reviewed articles related to disc herniation in childhood, of which 39 have been revised and resulted in this work. Conclusions: Due to its low prevalence in the pediatric group, the hernia is often misdiagnosed. However, the presence of low back pain and restriction in walking, especially if there is a recent history of trauma associated, should alert health professionals to this etiologic possibility. MRI is the method of choice for diagnosis and management. Surgical treatment using minimally invasive techniques provides satisfactory results.