ABSTRACT
La estenosis espinal de las tres regiones de la columna en simultáneo es un cuadro infrecuente que requiere una adecuada valoración clínica y de las imágenes. En la actualidad, no existen guías establecidas para su abordaje diagnóstico y terapéutico. El objetivo de este artículo es describir la presentación clínica, el tratamiento y la evolución en un paciente con triple estenosis y contrastarlos con la evidencia disponible a través de una revisión narrativa de la bibliografía. Se presenta a una mujer de 69 años de edad que consultó con un cuadro de paraparesia progresiva asociado a ciatalgia derecha y signos de motoneurona superior positivos. En los estudios por imágenes, se constató una triple estenosis: cervical, torácica y lumbar. Se procedió a la descompresión y la resección tumoral torácica asociadas al tratamiento conservador de las estenosis cervical y lumbar. La evolución era favorable al año de la cirugía. La estenosis espinal de triple región sintomática es una condición rara, las valoraciones clínicas y radiológicas adecuadas permitirán un diagnóstico correcto con un abordaje adecuado y oportuno. Nivel de Evidencia: IV
Simultaneous spinal stenosis across all three regions of the spine is an uncommon condition that requires proper clinical and imaging assessment. There are currently no established guidelines for its diagnosis and treatment. The objective of this paper is to describe, based on a case report, the clinical presentation, treatment, and progression of triple stenosis in a patient and compare it with available evidence through a narrative literature review. A 69-year-old woman presented with progressive paraparesis associated with right sciatica and positive signs of upper motor neuron involvement. Imaging confirmed triple stenosis: cervical, thoracic, and lumbar. She underwent thoracic decompression and tumor resection, as well as conservative treatment for cervical and lumbar stenoses, and showed favorable progress one year after surgery. Symptomatic triple-region spinal stenosis is an uncommon condition. Proper clinical and radiological assessments will enable an accurate diagnosis with appropriate and timely intervention. Level of Evidence: IV
Subject(s)
Aged , Spinal Diseases , Spinal Stenosis , Thoracic Vertebrae , Cervical Vertebrae , Lumbar VertebraeABSTRACT
INTRODUCTION: Neurogenic claudication (NC) is the classic clinical presentation of patients with Lumbar Spinal Stenosis (LSS). These patients may or may not present with symptoms of leg pain and difficulty walking. These symptoms are exacerbated while walking and standing and are eased by sitting or bending forward. METHOD: Patients with LSS, having a lumbar canal diameter of ≤12mm, were recruited from a recognized Tertiary care hospital. Each subject's demographic characteristics and anthropometrics were noted, and the testing procedure was explained. The canal diameter was documented with the help of an MRI report. A self-paced walking test was used to assess the walking distance. STATISTICAL ANALYSIS: Depending on the normality of the data, the Pearson correlation coefficient (r) was used to find the correlation between canal diameter at different lumbar levels and walking distance in patients with LSS. RESULT: Pearson correlation coefficient (r) determined a fair positive correlation (r = 0.29) between lumbar canal diameter and walking distance. Stepwise multiple regression analysis was done, and a prediction equation was found for different levels of canal stenosis. CONCLUSION: Findings of our present study suggest a fair positive correlation between walking distance and canal diameter at L5-S1. This study may also be useful in predicting the approximate canal diameter by estimating the walking distance of the patient with symptoms of LSS and vice-versa.
INTRODUÇÃO: A claudicação neurogênica (CN) é a apresentação clínica clássica de pacientes com Estenose Espinhal Lombar (EEL). Esses pacientes podem ou não apresentar sintomas de dor nas pernas e dificuldade para caminhar. Esses sintomas são exacerbados ao caminhar e ficar em pé e são aliviados ao sentar ou inclinar-se para a frente. MÉTODO: Pacientes com EEL, com diâmetro do canal lombar ≤12mm, foram recrutados em um hospital terciário reconhecido. As características demográficas e antropométricas de cada sujeito foram anotadas e o procedimento do teste foi explicado. O diâmetro do canal foi documentado com a ajuda de um relatório de ressonância magnética. Um teste de caminhada individualizado foi usado para avaliar a distância percorrida. ANÁLISE ESTATÍSTICA: Dependendo da normalidade dos dados, o coeficiente de correlação de Pearson (r) foi usado para encontrar a correlação entre o diâmetro do canal em diferentes níveis lombares e a distância percorrida em pacientes com EEL. RESULTADO: O coeficiente de correlação de Pearson (r) determinou uma correlação positiva razoável (r = 0,29) entre o diâmetro do canal lombar e a distância percorrida. Análise de regressão múltipla stepwise foi feita, e uma equação de predição foi encontrada para diferentes níveis de estenose do canal. CONCLUSÃO: Os achados de nosso estudo sugerem uma correlação positiva razoável entre a distância percorrida e o diâmetro do canal em L5-S1. Este estudo também pode ser útil para prever o diâmetro aproximado do canal, estimando a distância percorrida pelo paciente com sintomas de EEL e vice-versa.
Subject(s)
Pilot Projects , Patients , Spinal StenosisABSTRACT
OBJECTIVE@#To investigate early clinical efficacy of unilateral biportal endoscopy technique for the treatment of lumbar postoperative adjacent segmental diseases.@*METHODS@#Fourteen patients with lumbar postoperative adjacent segmental diseases were treated with unilateral biportal endoscopy technique from June 2019 to June 2020. Among them, there were 9 males and 5 females, aged from 52 to 73 years old, and the interval between primary and revision operations ranged from 19 to 64 months. Adjacent segmental degeneration occurred after lumbar fusion in 10 patients and after lumbar nonfusion fixation in 4 patients. All the patients received unilateral biportal endoscopy assisted posterior unilateral lamina decompression or unilateral approach to the contralateral decompression. The operation time, postoperative hospital stay and complications were observed. The visual analogue scale (VAS) of low back pain and leg pain, Oswestry Disability Index (ODI), modified Japanese Orthopaedic Association (mJOA) score were recorded before operation and at 3 days, 3 months, and 6 months after operation.@*RESULTS@#All procedures were successfully completed. Surgical duration ranged from 32 to 151 min. Postoperative CT showed adequate decompression and preservation of most joints. Out of bed walking 1 to 3 days after surgery, postoperative hospital stay was 1 to 8 days, and postoperative follow-up was 6 to 11 months. All 14 patients returned to normal life within 3 weeks after surgery, and VAS, ODI, and mJOA scores improved significantly at 3 days and 3, 6 months after surgery. One patient occurred cerebrospinal fluid leak after operation, received local compression suture, and the wound healed after conservative treatment. One patient occurred postoperative cauda equina neurologic deficit, which was gradually recovered about 1 month after rehabilitation therapy. One patients advented transient pain of lower limbs after surgery, and the symptoms were relieved after 7 days of treatment with hormones, dehydration drugs and symptomatic management.@*CONCLUSION@#Unilateral biportal endoscopy technique has a good early clinical efficacy in the treatment of lumbar postoperative adjacent segmental diseases, which may provide a new minimally invasive, non-fixation option for the treatment of adjacent segment disease.
Subject(s)
Male , Female , Humans , Middle Aged , Aged , Spinal Stenosis/surgery , Lumbar Vertebrae/surgery , Endoscopy/methods , Treatment Outcome , Decompression, Surgical/methods , Spinal Fusion/methods , Retrospective StudiesABSTRACT
OBJECTIVE@#To compare the efficacy and muscle injury imaging between oblique lateral lumbar interbody fusion (OLIF) and transforaminal lumbar interbody fusion (TLIF) in the treatment of single-segment degenerative lumbar spinal stenosis.@*METHODS@#The clinical data of 60 patients with single-segment degenerative lumbar spinal stenosis who underwent surgical treatment from January 2018 to October 2019 was retrospectively analyzed. The patients were divided into OLIF groups and TLIF group according to different surgical methods. The 30 patients in the OLIF group were treated with OLIF plus posterior intermuscular screw rod internal fixation. There were 13 males and 17 females, aged from 52 to 74 years old with an average of (62.6±8.3) years old. And 30 patients in the TLIF group were treated with TLIF via the left approach. There were 14 males and 16 females, aged from 50 to 81 years old with an average of (61.7±10.4) years old. General data including operative time, intraoperative blood loss, postoperative drainage volume, and complications were recorded for both groups. Radiologic data including disc height (DH), the left psoas major muscle, multifidus muscle, longissimus muscle area, T2-weighted image hyperintensity changes and interbody fusion or nonfusion were observed. Laboratory parameters including creatine kinase (CK) values on postoperative 1st and 5th days were analyzed. Visual analogue scale(VAS) and Oswestry disability index(ODI) were used to assess clinical efficacy.@*RESULTS@#There was no significant difference in the operative time between two groups(P>0.05). The OLIF group had significantly less intraoperative blood loss and postoperative drainage volume compared to the TLIF group(P<0.01). The OLIF group also had DH better recovery compared to the TLIF group (P<0.05). There were no significant differences in left psoas major muscle area and the hyperintensity degree before and after the operation in the OLIF group (P>0.05). Postoperativly, the area of the left multifidus muscle and longissimus muscle, as well as the mean of the left multifidus muscle and longissimus muscle in the OLIF group, were lower than those in the TLIF group (P<0.05) .On the 1st day and the 5th day after operation, CK level in the OLIF group was lower than that in the TLIF group(P<0.05). On the 3rd day after operation, the VAS of low back pain and leg pain in the OLIF group were lower than those in the TLIF group (P<0.05). There were no significant differences in the ODI of postoperative 12 months, low back and leg pain VAS at 3, 6, 12 months between the two groups(P>0.05). In the OLIF group, 1 case of left lower extremity skin temperature increased after the operation, and the sympathetic chain was considered to be injured during the operation, and 2 cases of left thigh anterior numbness occurred, which was considered to be related to psoas major muscle stretch, resulting in a complication rate of 10% (3/30). In the TLIF group, one patient had limited ankle dorsiflexion, which was related to nerve root traction, two patients had cerebrospinal fluid leakage, and the dural sac was torn during the operation, and one patient had incision fat liquefaction, which was related to paraspinal muscle dissection injury, resulting in a complication rate of 13% (4/30). All patients achieved interbody fusion without cage collapse during the 6- month follow-up.@*CONCLUSION@#Both OLIF and TLIF are effective in the treatment of single-segment degenerative lumbar spinal stenosis. However, OLIF surgery has obviously advantages, including less intraoperative blood loss, less postoperative pain, and good recovery of intervertebral space height. From the changes in laboratory indexes of CK and the comparison of the left psoas major muscle, multifidus muscle, longissimus muscle area, and high signal intensity of T2 image on imaging, it can be seen that the degree of muscle damage and interference of OLIF surgery is lower than that of TLIF.
Subject(s)
Male , Female , Humans , Middle Aged , Aged , Aged, 80 and over , Retrospective Studies , Spinal Stenosis/surgery , Blood Loss, Surgical , Lumbar Vertebrae/surgery , Spinal Fusion/methods , Treatment Outcome , Pain, Postoperative , Muscles , Minimally Invasive Surgical Procedures/methodsABSTRACT
OBJECTIVE@#To review the application and progress of different minimally invasive spinal decompression in the treatment of lumbar spinal stenosis (LSS).@*METHODS@#The domestic and foreign literature on the application of different minimally invasive spinal decompression in the treatment of LSS was extensively reviewed, and the advantages, disadvantages, and complications of different surgical methods were summarized.@*RESULTS@#At present, minimally invasive spinal decompression mainly includes microscopic bilateral decompression, microendoscopic decompression, percutaneous endoscopic lumbar decompression, unilateral biportal endoscopy, and so on. Compared with traditional open surgery, different minimally invasive spinal decompression techniques can reduce the operation time, intraoperative blood loss, and postoperative pain of patients, thereby reducing hospital stay and saving treatment costs.@*CONCLUSION@#The indications of different minimally invasive spinal decompression are different, but there are certain advantages and disadvantages. When patients have clear surgical indications, individualized treatment plans should be formulated according to the symptoms and signs of patients, combined with imaging manifestations.
Subject(s)
Humans , Decompression, Surgical/methods , Endoscopy/methods , Laminectomy/methods , Lumbar Vertebrae/surgery , Minimally Invasive Surgical Procedures , Retrospective Studies , Spinal Stenosis/surgery , Treatment OutcomeABSTRACT
OBJECTIVE@#To analyze the early effectiveness of unilateral biportal endoscopy (UBE) laminectomy in the treatment of two-level lumbar spinal stenosis (LSS).@*METHODS@#The clinical data of 98 patients with two-level LSS treated with UBE between September 2020 and December 2021 were retrospectively analyzed. There were 53 males and 45 females with an average age of 59.9 years (range, 32-79 years). Among them, there were 56 cases of mixed spinal stenosis, 23 cases of central spinal canal stenosis, and 19 cases of nerve root canal stenosis. The duration of symptoms was 1.5- 10 years, with an average of 5.4 years. The operative segments were L 2, 3 and L 3, 4 in 2 cases, L 3, 4 and L 4, 5 in 29 cases, L 4, 5 and L 5, S 1 in 67 cases. All patients had different degrees of low back pain, among of which 76 cases were with unilateral lower extremity symptoms and 22 cases were with bilateral lower extremity symptoms. There were 29 cases of bilateral decompression in both segments, 63 cases of unilateral decompression in both segments, and 6 cases of unilateral decompression and bilateral decompression of each segment. The operation time, intraoperative blood loss, total incision length, hospitalization stay, ambulation time, and related complications were recorded. Visual analogue scale (VAS) score was used to assess the low back and leg pain before operation and at 3 days, 3 months after operation, and at last follow-up. The Oswestry disability index (ODI) was used to evaluate the functional recovery of lumbar spine before operation and at 3 months and last follow-up after operation. Modified MacNab criteria was used to evaluate clinical outcomes at last follow-up. Imaging examinations were performed before and after operation to measure the preservation rate of articular process, modified Pfirrmann scale, disc height (DH), lumbar lordosis angle (LLA), and cross-sectional area of the canal (CAC), and the CAC improvement rate was calculated.@*RESULTS@#All patients underwent surgery successfully. The operation time was (106.7±25.1) minutes, the intraoperative blood loss was (67.7±14.2) mL, and the total incision length was (3.2±0.4) cm. The hospitalization stay was 8 (7, 9) days, and the ambulation time was 3 (3, 4) days. All the wounds healed by first intention. Dural tear occurred in 1 case during operation, and mild headache occurred in 1 case after operation. All patients were followed up 13-28 months with an average of 19.3 months, and there was no recurrence or reoperation during the follow-up. At last follow-up, the preservation rate of articular process was 84.7%±7.3%. The modified Pfirrmann scale and DH were significantly different from those before operation ( P<0.05), while the LLA was not significantly different from that before operation ( P=0.050). The CAC significantly improved ( P<0.05), and the CAC improvement rate was 108.1%±17.8%. The VAS scores of low back pain and leg pain and ODI at each time point after operation significantly improved when compared with those before operation, and the differences between each time points were significant ( P<0.05). According to the modified MacNab criteria, 63 cases were excellent, 25 cases were good, and 10 cases were fair, with an excellent and good rate of 89.8%.@*CONCLUSION@#UBE laminectomy is a safe and effective technique with little trauma and fast recovery for two-level LSS and the early effectiveness is satisfactory.
Subject(s)
Male , Female , Humans , Middle Aged , Laminectomy , Spinal Stenosis/surgery , Constriction, Pathologic/surgery , Low Back Pain , Retrospective Studies , Blood Loss, Surgical , Endoscopy , Lumbar Vertebrae/surgery , Spinal Fusion/methods , Decompression, Surgical , Surgical Wound/surgery , Treatment OutcomeABSTRACT
OBJECTIVE@#To investigate the clinical efficacy and safety of percutaneous foraminal endoscopy in the treatment of lumbar lateral recess stenosis in elderly.@*METHODS@#The clinical data of 31 elderly patients with lumbar lateral recess stenosis treated by percutaneous foraminal endoscopic decompression from March 2018 to August 2019 were retrospectively analyzed. Including 16 males and 15 females, aged from 65 to 81 years with an average of (71.13±5.20) years, the course of disease ranged from 3 months to 7 years with an average of (14.36±6.52) months. Visual analogue scale (VAS) and Oswestry disability index (ODI) were used to assess clinical symptom and functional status before operation and 1, 6, 12 months after operation. At the final follow-up, the modified Macnab standard was used to evaluate clinical efficacy.@*RESULTS@#All patients were completed the operation successfully. The operation time was from 75 to 120 min with an average of (97.84±11.22 ) min. All 31 patients were followed up from 12 to 28 months with an average of (17.29±5.56) months. Postoperative lumbago-leg pain VAS and ODI were significantly improved at 1, 6, and 12 months(P<0.01). At the final follow-up, according to the modified Macnab standard to evaluate the effect, 23 got excellent results, 5 good, 3 fair. One patient had severe adhesions between peripheral tissues and nerve root, and postoperative sensory abnormalities in the lower extremities were treated conservatively with traditional Chinese medicine and neurotrophic drugs, which recovered at 2 weeks after surgery. No complications such as nerve root injury and infection occurred.@*CONCLUSION@#The intervertebral foraminal endoscopy technique, which is performed under local anesthesia for a short period of operation, ensures adequate decompression while minimizing complications, and is a safe and effective surgical procedure for elderly patients with lumbar lateral recess stenosis.
Subject(s)
Male , Female , Humans , Aged , Infant , Constriction, Pathologic/surgery , Spinal Stenosis/surgery , Decompression, Surgical/methods , Retrospective Studies , Lumbar Vertebrae/surgery , Endoscopy/methods , Treatment OutcomeABSTRACT
OBJECTIVE@#To compare the clinical efficacy of full endoscopic lamina fenestration discectomy (Endo-LOVE) with full endoscopic transforaminal approach discectomy in the treatment of degenerative lumbar lateral recess stenosis.@*METHODS@#A retrospective analysis of 48 patients with degenerative lumbar lateral recess stenosis between March 2018 and March 2019 was performed. There were 32 males and 16 females, aged from 60 to 83 years old with an average of (72.9±6.5) years, course of disease ranged from 5 to 16 years with an average of (8.0±2.8) years. The patients were divided into observation group and control group according to surgical approaches. There were 28 cases in observation group, underwent Endo-LOVE surgery;and 20 cases in control group, underwent full endoscopic foraminal approach discectomy. The operation time, intraoperative blood loss, hospitalization day and complications were observed between two groups. Visual analgue scale (VAS), Japanese Orthopaedic Association(JOA), Oswestry Disability Index(ODI), lateral crypt angle were compared between two groups. And clinical effects were evaluated by modified Macnab standard.@*RESULTS@#There was no significant difference in follow-up and operation time between two groups (P>0.05). Intraoperative blood loss was from 5 to 15 ml with an average of (8.4±3.6) ml in observation group and 5 to 25 ml with an average of (11.5±5.4) ml in control group. The hospitalization day was from 5 to 8 days with an average of (6.0±1.0) days in observation group and 6 to 9 days with an average (7.2±1.1) days in control group. Intraoperative blood loss and hospitalization day were significantly lower in observation group(P<0.05). There were no serious complications in both groups. The VAS, JOA scores, and ODI at 3-month and final follow-up were significantly improved in both groups (P<0.05), and observation group was significantly better than control group (P<0.05). The skeletal lateral crypt angle and soft lateral crypt angle were significantly greater than the preoperative angle at 3 days postoperatively(P<0.05), and observation group was significantly better than control group(P<0.05). At the final follow-up, the modified Macnab criteria was used to assess clinical efficacy, in observation group, 22 patients obtained excellent results, 5 good and 1 fair;while 11 excellent, 4 good and 5 fair in control group;the clinical efficacy of observation group was significantly better than that of control group(P<0.05).@*CONCLUSION@#Both surgical methods are performed under direct vision, with high safety and good clinical efficacy. However, Endo-LOVE enlarged the lateral crypt more fully.
Subject(s)
Male , Female , Humans , Child, Preschool , Child , Adolescent , Retrospective Studies , Blood Loss, Surgical , Constriction, Pathologic/surgery , Lumbar Vertebrae/surgery , Endoscopy/methods , Diskectomy/methods , Treatment Outcome , Spinal Stenosis/surgery , Intervertebral Disc Displacement/surgery , Diskectomy, Percutaneous/methodsABSTRACT
ABSTRACT Objective: The spinous process separation technique is a less invasive surgical technique for treating lumbar canal stenosis. The objective is to evaluate this technique's results in treating lumbar canal stenosis. Method: Thirty patients with lumbar spinal canal stenosis underwent surgical treatment using the spinous process separation technique and were evaluated in the 3-year postoperative period using the Denis Pain and Work Scale and by the SF-36 questionnaire and radiographic evaluation of the operated segment. Results: In the evaluation of the Denis pain scale, 21 (70%) patients had no pain (P1), and nine (30%) patients reported minimal low back pain, not needing medication (P2). Denis' work schedule showed that nine (30%) patients had restrictions on returning to their previous work activity (W2), and 21 (70%) patients were classified as W1. The SF-36 questionnaire showed results of 81.25 for physical aspects (PA), 81.9 for functional capacity (FC), 81.3 for emotional aspects (EA), 64.3 for vitality (V), 65.9 for mental health (MH), 81.98 for social aspects (SA), 75.6 for pain (P) and 68.1 for general health status (GHS). In addition, there were no radiographic signs of instability of the operated vertebral segment in the radiographic evaluation. Conclusion: The decompression of the lumbar spinal canal using the spinous process separation technique showed good results in the evaluated patients three years after the operation. Level of Evidence II, Retrospective Comparative Study.
Resumo: Objetivo: A técnica de separação do processo espinhoso é uma técnica cirúrgica menos invasiva para o tratamento da estenose do canal lombar. O objetivo é avaliar os resultados dessa técnica no tratamento da estenose do canal lombar. Método: Trinta pacientes portadores de estenose do canal vertebral lombar foram submetidos ao tratamento cirúrgico por meio da técnica da separação do processo espinhoso, tendo sido avaliados no período de três anos de pós-operatório, por meio da escala de dor e de trabalho de Denis, pelo questionário SF-36 e avaliação radiográfica do segmento operado. Resultados: Na avaliação da escala de dor de Denis, 21 (70%) pacientes não apresentavam dor (P1) e nove (30%) pacientes relataram dor mínima lombar, não necessitando medicação (P2). A escala de trabalho de Denis evidenciou que nove (30%) pacientes apresentavam restrições ao retorno à atividade prévia de trabalho (W2) e 21 (70%) pacientes foram classificados como W1. O questionário SF-36 apresentou resultados 81,25 para aspectos físicos (AF), 81,9 para capacidade funcional (CF), 81,3 para aspectos emocionais (AE), 64,3 para vitalidade(V), 65,9 para saúde mental (SM), 81,98 para aspectos sociais (AS), 75,6 para dor (D) e 68,1 para estado geral de saúde (EGS). Não foram observados sinais radiográficos de instabilidade do segmento vertebral operado na avaliação radiográfica. Conclusão: A descompressão do canal vertebral lombar por meio da técnica de separação do processo espinhoso apresentou bons resultados na avaliação num período de três anos de pós-operatório dos pacientes avaliados. Nível de Evidência II, Estudo Retrospectivo Comparativo.
Resumen: Objetivo: La técnica de separación de la apófisis espinosa es una técnica quirúrgica menos invasiva para el tratamiento de la estenosis del canal lumbar. El objetivo es evaluar los resultados de esta técnica en el tratamiento de la estenosis del canal lumbar. Método: Treinta pacientes con estenosis del conducto raquídeo lumbar fueron intervenidos quirúrgicamente mediante la técnica de separación de la apófisis espinosa, y fueron evaluados en el postoperatorio de tres años mediante la Escala de Dolor y Trabajo de Denis, mediante el cuestionario SF-36 y evaluación radiográfica del segmento operado. Resultados: En la evaluación de la escala de dolor de Denis, 21 (70%) pacientes no presentaron dolor (P1) y nueve (30%) pacientes refirieron dolor lumbar mínimo, sin necesidad de medicación (P2). La escala de trabajo de Denis mostró que nueve (30%) pacientes tenían restricciones para regresar a su actividad laboral anterior (W2) y 21 (70%) pacientes fueron clasificados como W1. El cuestionario SF-36 arrojó resultados 81,25 para aspectos físicos (AF), 81,9 para capacidad funcional (CF), 81,3 para aspectos emocionales (AE), 64,3 para vitalidad (V), 65,9 para salud mental (SM), 81,98 para aspectos sociales (AS), 75,6 para dolor (D) y 68,1 para estado general de salud (EGS). No hubo signos radiográficos de inestabilidad del segmento vertebral intervenido en la evaluación radiográfica. Conclusión: La descompresión del canal espinal lumbar mediante la técnica de separación de apófisis espinosa mostró buenos resultados en la evaluación de un período de 3 años después de la operación de los pacientes evaluados.
Subject(s)
Humans , Spinal Stenosis , Manipulation, Spinal , Spine , Low Back PainABSTRACT
ABSTRACT We describe two cases of surgical treatment of craniovertebral stenosis in preschool-aged brothers with Maroteaux-Lamy (MPS type VI) syndrome. The older brother was diagnosed with MPS during her second pregnancy. Literature describing familial cases of the disease and the treatment strategy in young children with MPS type VI and spinal canal stenosis is scarce. Based on the presented observations, indications, surgical treatment approaches, and perioperative management of patients with mucopolysac-charidosis are suggested. MPS type VI may have familial forms of the disease and the course of craniovertebral stenosis is similar in siblings. Surgical treatment of craniovertebral stenosis in these patients should be performed timely. We adhere to the point of view of early treatment of craniovertebral stenosis in patients with MPS before irreversible spinal cord dysfunction develops. Level of Evidence IV; Prognostic Studies - Investigating the Effect of a Patient Characteristic on the Outcome of Disease and Case series.
Resumo: Descreve-se dois casos de tratamento cirúrgico de estenose craniovertebral entre irmãos em idade pré-escolar com síndrome de Maroteaux-Lamy (MPS tipo VI). O irmão mais velho foi diagnosticado com MPS durante a segunda gravidez. A literatura que descreve casos familiares da doença e a estratégia de tratamento em crianças pequenas com MPS tipo VI e estenose do canal raquidiano é escassa. Com base nas observações apresentadas, foram sugeridas indicações, abordagens de tratamento cirúrgico e manejo perioperatório de pacientes com mucopolissacaridose. A MPS tipo VI pode apresentar formas familiares da doença e o curso da estenose craniovertebral é semelhante entre irmãos. O tratamento cirúrgico da estenose craniovertebral nesses pacientes deve ser realizado em tempo hábil. Adere-se ao conceito de tratamento precoce da estenose craniovertebral em pacientes com MPS antes que se desenvolva uma disfunção irreversível da medula espinhal. Nível de Evidência IV; Estudos Prognósticos - Investigando o Efeito de uma Característica de Paciente sobre o Resultado de uma Doença e de uma Série de Casos.
Resumen: Se describen dos casos de tratamiento quirúrgico de estenosis craneovertebral en hermanos de edad preescolar con síndrome de Maroteaux-Lamy (MPS tipo VI). Al hermano mayor se le diagnosticó MPS durante el segundo embarazo. La bibliografía que expone casos familiares de la enfermedad y la estrategia de tratamiento en niños pequeños con MPS tipo VI y estenosis del tubo vertebral es escasa. Sobre el fundamento de las observaciones presentadas, se sugieren indicaciones, enfoques de tratamiento quirúrgico y manejo perioperatorio de pacientes con mucopolisacaridosis. La MPS tipo VI puede presentar formas familiares de la enfermedad y el curso de la estenosis craneovertebral es semejante en los hermanos. El tratamiento quirúrgico de la estenosis craneovertebral en estos pacientes debe realizarse tempranamente. Se adhiere al planteamiento del tratamiento precoz de la estenosis craneovertebral en pacientes con MPS anticipándose al desarrollo de una disfunción irreversible de la médula espinal. Nivel de Evidencia IV; Estudios Pronósticos - Investigando el Efecto de una Característica del Paciente en el Resultado de la Enfermedad y Series de Casos.
Subject(s)
Humans , Child, Preschool , Spinal Stenosis , Mucopolysaccharidosis VI , Surgical Procedures, OperativeABSTRACT
INTRODUÇÃO: A claudicação neurogênica (CN) é a apresentação clínica clássica de pacientes com Estenose Espinhal Lombar (EEL). Esses pacientes podem ou não apresentar sintomas de dor nas pernas e dificuldade para caminhar. Esses sintomas são exacerbados ao caminhar e ficar em pé e são aliviados ao sentar ou inclinar-se para a frente. MÉTODO: Pacientes com EEL, com diâmetro do canal lombar ≤12mm, foram recrutados em um hospital terciário reconhecido. As características demográficas e antropométricas de cada sujeito foram anotadas e o procedimento do teste foi explicado. O diâmetro do canal foi documentado com a ajuda de um relatório de ressonância magnética. Um teste de caminhada individualizado foi usado para avaliar a distância percorrida. ANÁLISE ESTATÍSTICA: Dependendo da normalidade dos dados, o coeficiente de correlação de Pearson (r) foi usado para encontrar a correlação entre o diâmetro do canal em diferentes níveis lombares e a distância percorrida em pacientes com EEL. RESULTADO: O coeficiente de correlação de Pearson (r) determinou uma correlação positiva razoável (r = 0,29) entre o diâmetro do canal lombar e a distância percorrida. Análise de regressão múltipla stepwise foi feita, e uma equação de predição foi encontrada para diferentes níveis de estenose do canal. CONCLUSÃO: Os achados de nosso estudo sugerem uma correlação positiva razoável entre a distância percorrida e o diâmetro do canal em L5-S1. Este estudo também pode ser útil para prever o diâmetro aproximado do canal, estimando a distância percorrida pelo paciente com sintomas de EEL e vice-versa.
INTRODUCTION: Neurogenic claudication (NC) is the classic clinical presentation of patients with Lumbar Spinal Stenosis (LSS). These patients may or may not present with symptoms of leg pain and difficulty walking. These symptoms are exacerbated while walking and standing and are eased by sitting or bending forward. METHOD: Patients with LSS, having a lumbar canal diameter of ≤12mm, were recruited from a recognized Tertiary care hospital. Each subject's demographic characteristics and anthropometrics were noted, and the testing procedure was explained. The canal diameter was documented with the help of an MRI report. A self-paced walking test was used to assess the walking distance. STATISTICAL ANALYSIS: Depending on the normality of the data, the Pearson correlation coefficient (r) was used to find the correlation between canal diameter at different lumbar levels and walking distance in patients with LSS. RESULT: Pearson correlation coefficient (r) determined a fair positive correlation (r = 0.29) between lumbar canal diameter and walking distance. Stepwise multiple regression analysis was done, and a prediction equation was found for different levels of canal stenosis. CONCLUSION: Findings of our present study suggest a fair positive correlation between walking distance and canal diameter at L5-S1. This study may also be useful in predicting the approximate canal diameter by estimating the walking distance of the patient with symptoms of LSS and vice-versa.
Subject(s)
Spinal Stenosis , Patients , WalkingABSTRACT
ABSTRACT Objective: To evaluate degenerative lumbar stenosis in symptomatic patients submitted to surgeryand the correlation between probable determining factors. Methods: A retrospective descriptive study in which themagnetic resonance images of 73 patients with degenerative stenosis,who underwent surgeries involving 141 levels performed by a single surgeon at the Hospital Ortopédico de Passo Fundo from 2015 to 2018, were evaluated. The patients were stratified by the degree of facet tropism, facet arthrosis, disc degeneration, and operated side, as well as by epidemiological data such as age, sex, etc. Tropism was measured using the Karacan method and evaluated numerically and categorically. Disc degeneration was classified by Pfirrmann and facet arthrosis by Weishaupt. To analyze and obtain the results, the Chi-square test and ANOVA were used with the SPSS statistical program, version 18.0. Results: Statistical significance was found in the relationship between facet tropism and disc degeneration (p=0.026) at the L4-L5 level. No correlation was found between tropism and facet arthrosis (p=0.161) or tropism and the operated side (p=0.573). Conclusion: The degree of tropism directly influences disc degeneration and greater asymmetries are related to more severe degenerations. Although tropism has not shown a statistically significant correlation with the operated side (p=0.573), it is believed that further studies should be carried out on this correlation. Level of evidence II; Retrospective study.
RESUMO Objetivo: Avaliar a estenose lombar degenerativa em pacientes sintomáticos submetidos à cirurgia, analisando a correlação entre fatores determinantes prováveis. Métodos: Estudo retrospectivo descritivo, no qual foram avaliados exames de ressonância nuclear magnética de 73 pacientes, totalizando 141 níveis com estenose degenerativa submetidos a tratamento cirúrgico por um único cirurgião do Hospital Ortopédico de Passo Fundo, de 2015 até 2018. Os pacientes foram estratificados de acordo com grau do tropismo facetário, artrose facetária, degeneração discal e lado operado, assim como com dados epidemiológicos como idade, sexo, etc. O tropismo foi aferido pelo método de Karacan e avaliado de forma numérica e categórica. A degeneração discal foi classificada por Pfirrmann e a artrose facetária por Weishaupt. Para análise e obtenção dos resultados foi utilizado o teste do qui-quadrado e ANOVA com oprograma estatístico SPSS versão 18.0. Resultados: Verificou-se significância estatística na relação entre tropismo facetário e degeneração discal (p=0,026) no nível L4-L5. Não foi encontrada correlação entre tropismo e artrose facetária (p=0,161) ou tropismo e lado operado(p=0,573). Conclusões: O grau de tropismo influencia diretamente a degeneração discal, sendo que as assimetrias maiores estão relacionadas a degenerações mais graves. Embora o tropismo não tenha demonstrado correlação estatística significativa com o lado operado (p=0,573), acredita-se que deverão ser realizados novos estudos sobre essa correlação. Nível de evidência II; Estudo retrospectivo.
RESUMEN Objetivo: Evaluar la estenosis lumbar degenerativa en pacientes sintomáticos sometidos a cirugía, analizando la correlación entre probables factores determinantes.. Métodos: Estudio retrospectivo descriptivo, en el que se evaluaronlos exámenes de resonancia magnética nuclear de 73 pacientes, totalizando 141 niveles con estenosis degenerativa sometidos a tratamiento quirúrgico por un único cirujano en el Hospital Ortopédico de Passo Fundo, de 2015 a 2018. Los pacientes fueron estratificados según elgrado de tropismo facetario, artrosis facetaria, degeneración discal y lado operado, así como con datos epidemiológicos como edad, sexo, etc. El tropismo se midió utilizando el método de Karacan y se evaluó numérica y categóricamente. La degeneración discal fue clasificada por Pfirrmann y la artrosis facetaria por Weishaupt. Para analizar y obtener los resultados se utilizó la prueba de chi-cuadrado y ANOVA a través del programa estadístico SPSS versión 18.0. Resultados: Se encontró significación estadística en la relación entre el tropismo facetario y la degeneración discal (p=0,026) en el nivel L4-L5. No se encontró correlación entre el tropismo y la artrosis facetaria (p=0,161) ni el tropismo y el lado operado (p=0,573). Conclusión: El grado de tropismo influye directamente en la degeneración discal, y las mayores asimetrías se relacionan con degeneraciones más severas. Aunque el tropismo no ha mostrado una correlación estadísticamente significativa con el lado operado (p=0,573), se cree que deberían realizarse más estudios sobre esta correlación. Nivel de evidencia II; Estudio retrospectivo.
Subject(s)
Humans , Spinal Stenosis , SpineABSTRACT
ABSTRACT Objective This study was conducted to determine the frequency of vitamin D deficiency in patients with lumbar spinal stenosis and to define the relationship between vitamin D levels and obesity, depression, and pain intensity. Methods This study was conducted with 69 patients (Male = 32, Female = 37) diagnosed with lumbar spinal stenosis. The participants' 25(OH)D levels were measured by radioimmunoassay. In addition, bone metabolic status, including bone mineral density and bone turnover markers, was also evaluated. The Beck Depression Inventory was used to determine the depression statuses of the patients, while the McGill Melzack Pain Questionnaire was administered to measure pain intensity. The results were evaluated at a significance level of p<0.05. Results Vitamin D deficiency (<20 ng/mL) was found in 76.8% of the patients. Binary logistic regression analysis showed a significantly higher frequency of vitamin D deficiency in patients who: 1) had higher body mass indexes (OR 3.197, 95% CI 1.549-6.599); 2) fared higher in Beck's depression score (OR 1.817, 95% CI 1.027-3.217); and 3) were female rather than male (OR 1.700, 95% CI 0.931-3.224) (p<0.05). Conclusion In this study, vitamin D deficiency was prevalent in lumbar spinal stenosis patients. In addition, obese, depressed, and female individuals have higher risks of vitamin D deficiency.
RESUMO Objetivo Este estudo foi realizado para determinar a frequência de deficiência de vitamina D em pacientes com estenose espinhal lombar e para definir a relação entre os níveis de vitamina D e obesidade, depressão e intensidade da dor. Métodos Este estudo foi realizado com 69 pacientes (homens = 32, mulheres = 37) diagnosticados com estenose espinhal lombar. Os níveis de 25(OH)D dos participantes foram medidos por radioimunoensaio. Além disso, o estado metabólico ósseo, incluindo densidade mineral óssea e marcadores de remodelação óssea, também foi avaliado. O Inventário de Depressão de Beck foi usado para determinar os estados de depressão dos pacientes, enquanto o Questionário de Dor McGill Melzack foi aplicado para medir a intensidade da dor. Os resultados foram avaliados a um nível de significância de p<0,05. Resultados A deficiência de vitamina D (<20 ng/mL) foi encontrada em 76,8% dos pacientes. A análise de regressão logística binária mostrou uma frequência significativamente maior de deficiência de vitamina D nos seguintes pacientes: 1) com maior índice de massa corporal (OR 3,197, 95% IC 1,549-6,599); 2) com maior pontuação na escala de depressão de Beck (OR 1,817, 95% IC 1,027-3,217) e 3) do sexo feminino em vez de masculino (OR 1,700, 95% IC 0,931-3,224) (p<0,05). Conclusão Neste estudo, a deficiência de vitamina D foi prevalente em pacientes com estenose espinhal lombar. Além disso, pessoas obesas, deprimidas e mulheres correm maior risco de deficiência de vitamina D.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Spinal Stenosis/etiology , Vitamin D Deficiency/complications , Pain Measurement , Cross-Sectional Studies , Depression/etiology , Obesity/etiologyABSTRACT
OBJECTIVE@#To manufacture a new type of transverse process retractor by using computer-aided design(CAD) combined with 3D printing technology and investigate its clinical application effect.@*METHODS@#A new type of transverse protrusion retractor was developed by CAD combined with 3D printing technology. From September 2018 to September 2019, the new transverse process retractor was applied in clinic. Sixty patients with lumbar single segment lesions who needed treatment by pedicle screw fixation, bone grafting and interbody fusion were divided into new transverse process retractor group and control group, with 30 cases in each group. There were 14 males and 16 females in new type transverse process retractor group, the age was (68.0±4.3) years old on average; lesion segment of 8 cases were L3,4, 9 cases were L4,5, 13 cases were L5S1;5 cases of lumbar disc herniation, 20 cases of lumbar spinal stenosis, 5 cases of degenerative lumbar spondylolisthesis;new transverse process retractor was used to pedicle screw placement. While there were 15 males and 15 females in control group, with an average age of (69.2±4.5) years old;lesion segment of 8 cases were L3,4, 10 cases were L4,5, 12 cases were L5S1;5 cases of lumbar disc herniation, 21 cases of lumbar spinal stenosis, 4 cases of degenerative lumbar spondylolisthesis;the traditional lamina retractor was used for soft tissue pulling and finished pedicle screw placement by freehand. The length of surgical incision, the time required for inserting a single screw, fluoroscopy times, the times of adjusting the positioning needle or screw in insertion process, and the visual analogue scale (VAS) of surgical incision 72 hours after operation were compared between two groups.@*RESULTS@#Using CAD and 3D printing technology, a new type of transverse protrusion retractor was developed quickly. The length of surgical incision, the time required for inserting a single screw, fluoroscopy time, and the times of adjusting the positioning needle or screw in insertion process in new transverse process retractor group were less than those in control group(P<0.05). There was no significant difference in VAS of lumbar incision pain at 72 hours after operation between two groups(P>0.05).@*CONCLUSION@#Using CAD combined with 3D printing technology to develop a new transverse protrusion retractor has the advantages of convenient design, short development cycle and low cost. It provides a new idea for the research and development of new medical devices. The new transverse process retractor has the advantages of easy operation, reliable fixation, less damage to paravertebral muscle, convenient pedicle screw placement, reducing fluoroscopy time and so on.
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Intervertebral Disc Displacement/surgery , Low Back Pain , Lumbar Vertebrae/surgery , Pedicle Screws , Printing, Three-Dimensional , Spinal Fusion , Spinal Stenosis/surgery , Spondylolisthesis/surgery , Surgical Wound , Treatment OutcomeABSTRACT
Percutaneous endoscopic spine decompression(PSED) in recent years in the treatment of degenerative lumbar spinal stenosis(DLSS) achieved excellent results.Compared with traditional open surgery, which is characterized by large trauma, much bleeding, longer bed stay and slow recovery, the rapid development of PSED technology has greatly reduced the surgical trauma, postoperative recovery time and complications of DLSS patients. PSED core as the target therapy, with minimal trauma at the same time to achieve satisfactory decompression effect for lumbar spinal stenosis. Depending on the level, location, and degree of lumbar spinal stenosis, it is important to determine the ideal treatment. However, in practice, PSED has insufficient understanding of the treatment of different pathological types of lumbar spinal stenosis, such as indication selection, surgical approach selection, advantages and limitations of various approaches, and endoscopic vertebral fusion.At present, with the deepening of PSED research and the improvement of endoscopic instruments, great progress has been made in the treatment of DLSS.In this paper, the research progress in the treatment of DLSS by PSED in recent years will be described from four aspects, namely, the grasp of indications, the selection of approaches, the advantages and disadvantages of endoscopic approaches, and endoscope-assisted vertebral fusion, in order to provide certain guidance for the clinical treatment of DLSS by PSED.
Subject(s)
Humans , Decompression, Surgical/methods , Endoscopy/methods , Lumbar Vertebrae/surgery , Spinal Stenosis/surgery , Treatment OutcomeABSTRACT
El dolor lumbar bajo y el dolor cervical con o sin irradiación son causas muy comunes de consulta a los médicos generalistas en los países desarrollados. La discopatía aguda y el dolor por estenosis del canal espinal son los diagnósticos más frecuentes. La postura tradicional ha sido la de administrar antiinflamatorios no esteroideos (AINES) para estas lumbalgias o cervicalgias agudas. Cuando existe irradiación neural por compresión radicular es usual asociar al AINE un corticoide a baja dosis, así como un antineurítico, para lograr un mejor resultado. Con el objeto de documentar la utilidad de esta práctica habitual, efectuamos en 142 pacientes ambulatorios un estudio multicéntrico randomizado que compara la efectividad y la tolerancia de una asociación a dosis fija de diclofenac, betametasona y cianocobalamina administrada por vía oral versus la administración de diclofenac como monofármaco en el tratamiento de la patología dolorosa de la columna lumbar y cervical asociada a compresión neural. La asociación demostró ser más eficaz en controlar el dolor y mejorar la funcionalidad de los pacientes que la administración de diclofenac en forma aislada y se asoció a escasos efectos colaterales, principalmente digestivos
Low back pain and neck pain with or without radiation are very common causes of consultation with general practitioners in developed countries. Acute discopathy and pain due to spinal canal stenosis are the most frequent diagnoses. The traditional approach has been to administer non-steroidal antiinflammatory drugs (NSAIDs) for these acute low back or cervical pain. When there is neural radiation due to root compression, it is usual to associate a low-dose corticosteroid with the NSAID, as well as an antineuritic, to achieve a better result. In order to document the usefulness of this routine practice, we conducted a randomized multicenter study in 142 outpatients that compared the effectiveness and tolerance of a fixed-dose combination of diclofenac, betamethasone, and cyanocobalamin administered orally versus the administration of diclofenac as Monopharmaceutical in the treatment of painful pathology of the lumbar and cervical spine associated with neural compression. The association proved to be more effective in controlling pain and improving the functionality of patients than the administration of diclofenac in isolation and was associated with few side effects, mainly digestive
Subject(s)
Humans , Adult , Middle Aged , Cats , Spinal Stenosis/therapy , Vitamin B 12/administration & dosage , Randomized Controlled Trials as Topic , Diclofenac/administration & dosage , Administration, Oral , Treatment Outcome , Low Back Pain/drug therapy , Neck Pain/drug therapy , Drug Combinations , Drug EvaluationABSTRACT
ABSTRACT Objective To study the role of epidural steroid injection (ESI) in patients with lumbar disc herniation (LDH) and lumbar canal stenosis (LCS). ESIs are regularly used to support non-operative treatment for LBP, and our anecdotal impression is that a considerable proportion of patients report substantial pain relief after ESI. Methods One thousand consecutive patients (645 patients with LDH and 355 patients with LCS) who required ESI from January-August 2018 were included. All were given the same ESI, prepared with triamcinolone (80 mg), bupivacaine (0.25%, 4 ml) and normal saline (4 ml). Patients were evaluated using the numerical rating scale (NRS) immediately after the injection, after 7 days, and after 3 months. Results The mean NRS back-pain score of the LDH-group was reduced from 5 (range: 4-8) to 4 (range: 2-7) immediately after injection, 2 (range: 1-7) after 7 days and 2 (range: 1-7) after 3 months (p-value<0.001). The mean NRS back-pain score of the LCS-group was reduced from 5 (range: 4-8) to 4 (range: 2-7) immediately after injection, 2 (range: 1-7) after 7 days and 3 (range: 1-7) after 3 months (p-value <0.001). The mean NRS leg-pain score of the LDH group was reduced from 5 (range: 4-9) to 3 (range: 3-7) immediately after injection, 1 (range: 1-6) after 7 days and 2 (range: 1-7) after 3 months (p-value <0.001). The mean NRS leg-pain score of the LCS group was reduced from 5 (range: 4-9) to 4 (range: 3-7) immediately after injection, 3 (range: 1-7) after 7 days and 2 (range 1-6) after 3 months (p-value <0.001). Conclusion ESI causes statistically significant improvement in back and leg pain in patients with LDH and LCS. However, the short and medium-term efficacy of ESI in the LCS group was lower than in the LDH group. Level of evidence IV; Prospective hospital-based study.
RESUMO Objetivo Estudar o papel da injeção epidural de esteroides (IEE) em pacientes com hérnia de disco lombar (HDL) e estenose do canal lombar (ECL). As IEEs são usadas regularmente para dar suporte ao tratamento não cirúrgico da dor lombar e nossa impressão empírica é que uma proporção considerável de pacientes relata alívio substancial da dor depois da IEE. Métodos Foram incluídos mil pacientes consecutivos (645 pacientes com HDL e 355 pacientes com ECL) que precisaram de IEE de janeiro a agosto de 2018. Todos receberam a mesmo IEE preparada com triamcinolona (80 mg), bupivacaína (0,25% 4 ml) e solução salina normal (4 ml). Os pacientes foram avaliados pela Escala de Estimativa Numérica (NRS, Numeric Rating Scale) imediatamente, 7 dias e 3 meses depois. Resultados O escore médio de dor nas costas da NRS no grupo HDL foi reduzida de 5 (intervalo: 4-8) para 4 (intervalo: 2-7) imediatamente após a injeção, para 2 (intervalo: 1-7) após 7 dias e para 2 (intervalo: 1-7) após 3 meses (valor de p < 0,001). O escore médio de dor nas costas do NRS do grupo ECL foi reduzida de 5 (intervalo: 4-8) para 4 (intervalo: 2-7) imediatamente após a injeção, para 2 (intervalo: 1-7) após 7 dias e para 3 (intervalo: 1- 7) após 3 meses (valor de p <0,001). O escore médio de dor na perna da NRS do grupo HDL foi reduzida de 5 (intervalo: 4-9) para 3 (intervalo: 3-7) imediatamente após a injeção, para 1 (intervalo: 1-6) após 7 dias e para 2 (intervalo: 1-7) após 3 meses (valor de p < 0,001). O escore médio de dor na perna da NRS do grupo ECL foi reduzida de 5 (intervalo: 4-9) para 4 (intervalo: 3-7) imediatamente após a injeção, para 3 (intervalo: 1-7) após 7 dias e para 2 (intervalo 1-6) após 3 meses (valor de p < 0,001). Conclusão A IEE causa melhora estatisticamente significativa das dores nas costas e nas pernas em pacientes com HDL e ECL. No entanto, a eficácia a curto e médio prazo da IEE na ECL foi menor do que a da HDL. Nível de evidência IV; Estudo prospectivo baseado em hospital.
RESUMEN Objetivo Estudiar el papel de la inyección epidural de esteroides (IEE) en pacientes con hernia de disco lumbar (HDL) y estenosis del canal lumbar (ECL). Las IEE se utilizan regularmente para respaldar el tratamiento no quirúrgico del dolor lumbar y nuestra impresión empírica es que una proporción considerable de pacientes informa alivio sustancial del dolor después de la IEE. Métodos Se incluyeron mil pacientes consecutivos (645 pacientes con HDL y 355 pacientes con ECL) que necesitaron IEE de enero a agosto de 2018. A todos se les administró la misma IEE preparada con triamcinolona (80 mg), bupivacaina (0,25% 4 ml) y solución salina normal (4 ml). Los pacientes fueron evaluados usando una Escala de Valoración Numérica (NRS, Numeric Rating Scale) inmediatamente, 7 días y de 3 meses después. Resultados La puntuación media de dolor de espalda de la NRS del grupo HDL se redujo de 5 (rango: 4-8) a 4 (rango: 2-7) inmediatamente después de la inyección, a 2 (rango: 1-7) después de 7 días y a 2 (rango: 1-7) después de 3 meses (valor de p < 0,001). La puntuación media de dolor de espalda de la NRS del grupo ECL se redujo de 5 (rango: 4-8) a 4 (rango: 2-7) inmediatamente después de la inyección, a 2 (rango: 1-7) después de 7 días y a 3 (rango: 1- 7) después de 3 meses (valor de p < 0,001). La puntuación media de dolor de pierna de la NRS del grupo HDL se redujo de 5 (rango: 4-9) a 3 (rango: 3-7) inmediatamente después de la inyección, a 1 (rango: 1-6) después de 7 días y a 2 (rango: 1-7) después de 3 meses (valor p < 0,001). La puntuación media de dolor de pierna de la NRS del grupo ECL se redujo de 5 (rango: 4-9) a 4 (rango: 3-7) inmediatamente después de la inyección, a 3 (rango: 1-7) después de 7 días y a 2 (rango 1-6) después de 3 meses (valor p < 0,001). Conclusión IEE causa una mejoría estadísticamente significativa en el dolor de espalda y piernas en pacientes con HDL y ECL. Sin embargo, la eficacia a corto y medio plazo de la IEE en la ECL fue menor que la de HDL. Nivel de evidencia IV;Estudio prospectivo basado en hospitales.
Subject(s)
Humans , Spinal Stenosis , Back Pain , HerniaABSTRACT
ABSTRACT Objective: To verify the effectiveness of indirect decompression after lateral access fusion in patients with high pelvic incidence. Methods: A retrospective, non-comparative, non-randomized analysis of 22 patients with high pelvic incidence who underwent lateral access fusion, 11 of whom were male and 11 female, with a mean age of 63 years (52-74), was conducted. Magnetic resonance exams were performed within one year after surgery. The cross-sectional area of the thecal sac, anterior and posterior disc heights, and bilateral foramen heights, measured pre- and postoperatively in axial and sagittal magnetic resonance images, were analyzed. The sagittal alignment parameters were measured using simple radiographs. The clinical results were evaluated using the ODI and VAS (back and lower limbs) questionnaires. Results: In all cases, the technique was performed successfully without neural complications. The mean cross-sectional area increased from 126.5 mm preoperatively to 174.3 mm postoperatively. The mean anterior disc height increased from 9.4 mm preoperatively to 12.8 mm postoperatively, while the posterior disc height increased from 6.3 mm preoperatively to 8.1 mm postoperatively. The mean height of the right foramen increased from 157.3 mm in the preoperative period to 171.2 mm in the postoperative period and that of the left foramen increased from 139.3 mm in the preoperative to 158.9 mm in the postoperative. Conclusions: This technique is capable of correcting misalignment in spinal deformity, achieving fusion and promoting the decompression of neural elements. Level of evidence III; Retrospective study.
RESUMO Objetivo: Verificar a eficácia da descompressão indireta depois de fusão por acesso lateral em pacientes com alta incidência pélvica. Métodos: Análise retrospectiva, não comparativa, não randomizada de 22 pacientes com alta incidência pélvica submetidos à fusão por acesso lateral; 11 do sexo masculino e 11 do sexo feminino, com média de idade de 63 anos (52 a 74). Os exames de ressonância magnética foram realizados até um ano depois da cirurgia. Foram analisadas: área da seção transversal do saco tecal, altura discal anterior e posterior, altura dos forames bilaterais, medidas no pré e pós-operatório em imagens de ressonância magnética axial e sagital. Os parâmetros do alinhamento sagital foram medidos a partir de radiografia simples. Os resultados clínicos foram avaliados com os questionários ODI e EVA (costas e membros inferiores). Resultados: Em todos os casos, a técnica foi realizada com sucesso, sem complicações neurais. A área da secção transversal média aumentou de 126,5 mm no pré-operatório para 174,3 mm no pós-operatório. A média da altura anterior do disco aumentou de 9,4 mm no pré-operatório para 12,8 mm no pós-operatório, enquanto a altura posterior do disco aumentou de 6,3 mm no pré-operatório para 8,1 mm no pós-operatório. A média da altura do forame direito aumentou de 157,3 mm no pré-operatório para 171,2 mm no pós-operatório e a do forame esquerdo aumentou de 139,3 mm no pré-operatório para 158,9 mm no pós-operatório. Conclusões: Essa técnica é capaz de corrigir o desalinhamento na deformidade da coluna vertebral, alcançando a fusão e promovendo a descompressão dos elementos neurais. Nível de evidência III; Estudo Retrospectivo.
RESUMEN Objetivo: Verificar la eficacia de la descompresión indirecta después de fusión por acceso lateral en pacientes con alta incidencia pélvica. Métodos: Análisis retrospectivo, no comparativo, no aleatorizado de 22 pacientes con alta incidencia pélvica sometidos a fusión por acceso lateral; 11 del sexo masculino y 11 del sexo femenino, con promedio de edad de 63 años (52 a 74). Los exámenes de resonancia magnética fueron realizados hasta un año después de la cirugía. Fueron analizadas: área de la sección transversal del saco dural, altura discal anterior y posterior, altura de los for ámenes bilaterales, medidas en el pre y posoperatorio en imágenes de resonancia magnética axial y sagital. Los parámetros de la alineación sagital fueron medidos a partir de una radiografía simple. Los resultados clínicos fueron evaluados con los cuestionarios ODI y EVA (espalda y miembros inferiores). Resultados: En todos los casos, la técnica fue realizada con éxito, sin complicaciones neurales. El área de la sección transversal promedio aumentó de 126,5 mm en el preoperatorio para 174,3 mm en el postoperatorio. El promedio de altura anterior del disco aumentó de 9,4 mm en el preoperatorio para 12,8 mm en el postoperatorio, mientras que la altura posterior del disco aumentó de 6,3 mm en el preoperatorio para 8,1 mm en el postoperatorio. El promedio de altura del foramen derecho aumentó de 157,3 mm en el preoperatorio para 171,2 mm en el postoperatorio y la del foramen izquierdo aumentó de 139,3 mm en el preoperatorio para 158,9 mm en el postoperatorio. Conclusiones: Esta técnica es capaz de corregir la desalineación en la deformidad de la columna vertebral, alcanzando la fusión y promoviendo la descompresión de los elementos neurales. Nivel de evidencia III; Estudio retrospectivo.