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1.
Coluna/Columna ; 20(3): 161-164, July-Sept. 2021. tab, graf
Article in English | LILACS | ID: biblio-1339746

ABSTRACT

ABSTRACT Objectives To evaluate pain intensity and functional status before and 30 days following percutaneous lumbar endoscopic discectomy. Methods A retrospective cohort study that included patients who underwent percutaneous endoscopic discectomy from January 2019 to October 2020 at the Irmandade Santa Casa de Misericórdia Hospital, in Porto Alegre. The data were collected from the electronic medical records of the patients by two independent physicians. Clinical outcomes were assessed using visual analog scale (VAS) and Oswestry Disability Index (ODI) scores. Results Forty-six patients with a mean age of 52.6 ± 15.8 years, 27 of whom (58.7%) were male, were evaluated. Regarding clinical outcomes, a statistically significant improvement was observed in the comparison between the pre- and 30-day postoperative VAS and ODI scores, with no significant difference in relation to sex. No peri- or postoperative complications were observed. All patients successfully completed surgery and were discharged after recovery from anesthesia. Conclusion There was a significant improvement in pain and functional status 30 days after percutaneous endoscopic discectomy performed to correct lumbar disc herniation, with no difference in relation to sex. In addition, no peri- or postoperative complications were observed. Future studies, with longer follow-up times, comparing clinical outcomes from the various techniques of percutaneous endoscopic discectomy are necessary. Level of evidence III; Retrospective comparative study.


RESUMO Objetivos Avaliar a intensidade da dor e o estado funcional antes da cirurgia e em 30 dias de pós-operatório de discectomia endoscópica lombar percutânea. Métodos Estudo de coorte retrospectivo. Foram incluídos pacientes tratados com discectomia endoscópica percutânea, de janeiro de 2019 a outubro de 2020, no complexo hospitalar Irmandade Santa Casa de Misericórdia de Porto Alegre. Os dados foram coletados do prontuário eletrônico dos pacientes por dois médicos independentes. Os desfechos clínicos foram avaliados pela pontuação da Escala Visual Analógica (EVA) e do Índice de Incapacidade Oswestry (ODI). Resultados Foram incluídos 46 pacientes no estudo, com média de idade de 52,6 ± 15,8 anos, sendo 27 (58,7%), do sexo masculino. Quanto aos desfechos clínicos, observou-se melhora estatisticamente significativa com relação às escalas de EVA e ODI na comparação entre pré-operatório e 30 dias depois da cirurgia, sem diferença significativa com relação ao sexo. Não foram observadas complicações peri e pós-operatórias. Todos os pacientes completaram a cirurgia com sucesso e receberam alta após recuperação da anestesia. Conclusão Observou-se melhora significativa da dor e do estado funcional 30 dias depois da discectomia endoscópica percutânea realizada para correção da hérnia de disco lombar, sem diferença com relação ao sexo. Além disso, não foram observadas complicações peri e pós-operatórias, assim como não houve necessidade de internação hospitalar. Futuros estudos, com maior tempo de seguimento, que comparem os desfechos clínicos através das diversas técnicas de discectomia endoscópica percutânea fazem-se necessários. Nível de evidência III; Estudo retrospectivo comparativo


RESUMEN Objetivo Evaluar la intensidad del dolor y el estado funcional antes de la cirugía y 30 días después de la discectomía endoscópica lumbar percutánea. Métodos Estudio de cohorte retrospectivo. Se incluyeron pacientes tratados mediante discectomía endoscópica percutánea, de enero de 2019 a octubre de 2020, en el complejo hospitalario Hermandad Santa Casa de Misericordia de Porto Alegre. Los datos fueron recolectados de los registros médicos electrónicos de los pacientes por dos médicos independientes. Los resultados clínicos se evaluaron mediante la puntuación de la Escala Visual Analógica (EVA) y del Índice de Discapacidad de Oswestry (ODI). Resultados Se incluyeron 46 pacientes en el estudio, con una edad promedio de 52,6 ± 15,8 años, de los cuales 27 (58,7%) eran del sexo masculino. En cuanto a los resultados clínicos, hubo una mejoría estadísticamente significativa en relación a las escalas EVA y ODI al comparar el preoperatorio y 30 días después de la cirugía sin diferencia significativa en cuanto al sexo. No se observaron complicaciones perioperatorias y postoperatorias. Todos los pacientes completaron con éxito la cirugía e fueron dados de alta después de recuperarse de la anestesia, sin casos de reingreso hospitalario. Conclusión Hubo una mejoría significativa del dolor y del estado funcional luego de 30 días de discectomía endoscópica percutánea, realizada para corregir la hernia de disco lumbar, sin diferencias en cuanto al sexo. Además, no hubo complicaciones perioperatorias y postoperatorias, así como tampoco hubo necesidad de hospitalización. Son necesarios estudios futuros, con un período de seguimiento más largo, que comparen los resultados clínicos a través de las diferentes técnicas de discectomía endoscópica percutánea. Nivel de evidencia III; Estudio comparativo retrospectivo.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Pain, Postoperative , Spine/surgery , Low Back Pain/surgery , Diskectomy, Percutaneous/methods , Endoscopy/methods , Lumbosacral Region/surgery , Retrospective Studies , Recovery of Function , Herniorrhaphy
2.
Rev. Assoc. Med. Bras. (1992) ; 65(6): 779-785, June 2019. graf
Article in English | LILACS | ID: biblio-1012995

ABSTRACT

SUMMARY OBJECTIVE: To investigate the efficacy and safety of percutaneous transforaminal endoscopic discectomy (PTED) in the treatment of lumbar spinal stenosis (LSS) combined with osteoporosis. METHODS: Eighty patients with LSS combined with osteoporosis were divided into a control and PTED group, which received conventional transforaminal lumbar interbody fusion and PTED, respectively. The surgical indications, incision visual analogue scale (VAS), lumbar and leg pain VAS, lumbar Japanese Orthopaedic Association (JOA) and Oswestry disability index (ODI) scores, bone mineral density (BMD), and adverse reactions were observed. RESULTS: Compared with the control group, in the PTED group, the operation time, bleeding loss and hospitalization duration, incision VAS scores at postoperative 12, 24 and 48 h and lumbar and leg pain VAS and lumbar ODI scores on postoperative 6 months were significantly decreased (P < 0.01), and the lumbar JOA score on postoperative 6 months was significantly increased (P < 0.05). There was no significant difference in BMD between two groups (P > 0.05). Compared with the control group, in the PTED group, the total effective rate was significantly higher (P < 0.05), and the incidence of adverse reactions was significantly lower (P < 0.05). CONCLUSIONS: PTED is safe and effective in the treatment of LSS combined with osteoporosis.


RESUMO: OBJETIVO: Investigar a eficácia e segurança da discectomia endoscópica percutânea transforaminal (DEPT) no tratamento da estenose lombar (EL) combinada à osteoporose. MÉTODOS: Oitenta pacientes com EL combinada à osteoporose foram divididos entre um grupo de controle e um grupo de DEPT, que receberam tratamento convencional com fusão intersomática lombar transforaminal e DEPT, respectivamente. As indicações cirúrgicas, a escala analógica visual (VAS) da incisão e de dor lombar e nas pernas, os escores lombares de acordo com a Associação Ortopédica Japonesa (JOA) e o Oswestry Disability Index (ODI), a densidade mineral óssea (DMO) e possíveis reações adversas foram observados. RESULTADOS: Em comparação com o grupo de controle, no grupo de DEPT o tempo de operação, a perda de sangue e duração de internação, os escores VAS da incisão no pós-operatório após 12, 24 e 48 h, o VAS para dor lombar e nas pernas e os escores ODI lombares após 6 meses de pós-operatório foram significativamente menores (P < 0,01); já o escore JOA lombar após 6 meses de pós-operatório foi significativamente maior (P < 0,05). Não houve diferença significativa na densidade mineral óssea entre os dois grupos (P > 0,05). Em comparação com o grupo de controle, o grupo de DEPT teve uma taxa efetiva total significativamente maior (P < 0,05), e a incidência de reações adversas foi significativamente menor (P < 0,05). CONCLUSÕES: A discectomia endoscópica percutânea transforaminal é segura e eficaz no tratamento de EL combinada à osteoporose.


Subject(s)
Humans , Aged , Aged, 80 and over , Osteoporosis/surgery , Spinal Stenosis/surgery , Diskectomy, Percutaneous/methods , Lumbar Vertebrae/surgery , Osteoporosis/complications , Postoperative Care , Spinal Stenosis/complications , Time Factors , Bone Density , Reproducibility of Results , Treatment Outcome , Diskectomy, Percutaneous/standards , Disability Evaluation , Visual Analog Scale , Middle Aged
3.
Acta cir. bras ; 33(12): 1078-1086, Dec. 2018. tab, graf
Article in English | LILACS | ID: biblio-973488

ABSTRACT

Abstract Purpose: To validate the porcine spine as a model for learning and practicing transforaminal percutaneous endoscopic lumbar procedures (TF-PELP). Methods: TF-PELP was performed in three porcine cadaver lumbar spine levels. Anatomical features of the current cadaver were compared to human and porcine spines. Performance and documentation of endoscopic procedures were described. Results: This study shows that this representative animal model reflects anatomical characteristics of the human spine. Transforaminal approaches were successfully completed. Although lower disc heights make disc puncture more difficult, the outside-in technique is feasible and more useful to identify anatomical parameters and to practice different surgical steps and maneuvers. Conclusion: This is an effective and representative model for learning and practicing this procedure. Difficulties of the procedure, as well as the differences compared to the human spine, were described.


Subject(s)
Animals , Models, Animal , Endoscopy/education , Endoscopy/methods , Lumbar Vertebrae/surgery , Reference Standards , Reference Values , Swine , Cadaver , Reproducibility of Results , Diskectomy, Percutaneous/education , Diskectomy, Percutaneous/methods , Endoscopy/instrumentation , Anatomic Landmarks , Lumbar Vertebrae/anatomy & histology , Lumbar Vertebrae/diagnostic imaging , Needles
4.
Rev. Assoc. Med. Bras. (1992) ; 64(9): 778-782, Sept. 2018. tab
Article in English | LILACS | ID: biblio-976852

ABSTRACT

SUMMARY Lumbar herniated disc are common manifestations of degenerative spine diseases, the main cause of radiated lower back pain. This guideline followed standard of a systematic review with recovery of evidence based on the movement of evidence-based medicine. We used the structured method for formulating the question synthesized by the acronym p.I.C.O., In which the p corresponds to the lumbar herniated disc, i to the treatment intervention with percutaneous hydrodiscectomy, c comparing with other treatment modalities, o the outcome of clinical evolution and complications. From the structured question, we identify the descriptors which constituted the evidence search base in the medline-pubmed databases (636 papers) and therefore, after the eligibility criteria (inclusion and exclusion), eight papers were selected to answer to clinical question. The details of the methodology and the results of this guideline are exposed in annex i.


RESUMO Hérnias discais lombares são manifestações comuns das doenças degenerativas da coluna, sendo a principal causa de dor lombar irradiada. Esta diretriz seguiu padrão de uma revisão sistemática com recuperação de evidências com base no movimento da Medicina Baseada em Evidências. Utilizamos a forma estruturada de formular a pergunta sintetizada pelo acrônimo P.I.C.O., em que o P corresponde à Hérnia de disco lombar, I à intervenção Tratamento com hidrodiscectomia percutânea, C comparando com Outras modalidades de tratamento, O de desfecho de Evolução clínica e complicações. A partir da pergunta estruturada, identificamos os descritores que constituíram a base da busca da evidência nas bases de dados Medline-PubMed (636 trabalhos) e, assim, após os critérios de elegibilidade (inclusão e exclusão), oito trabalhos foram selecionados para responder à dúvida clínica. Os detalhes da metodologia e dos resultados desta diretriz estão expostos no Anexo I.


Subject(s)
Humans , Diskectomy, Percutaneous/methods , Intervertebral Disc Degeneration/surgery , Intervertebral Disc Displacement/surgery , Low Back Pain/surgery , Evidence-Based Medicine , Lumbar Vertebrae/surgery
5.
Clinics ; 71(5): 276-280, May 2016. tab, graf
Article in English | LILACS | ID: lil-782839

ABSTRACT

OBJECTIVES: Hydrodiscectomy is a new technique used for percutaneous spinal discectomy that employs a high-intensity stream of water for herniated disc ablation and tissue aspiration. No previous clinical study has examined the effects of percutaneous hydrodiscectomy. The aim of this study is to evaluate the outcomes of hydrodiscectomy compared to open microdiscectomy regarding pain, function, satisfaction, complications and recurrence rates. METHODS: In this randomized clinical trial, patients referred to our tertiary hospital for lumbar back pain were recruited and included in the study if they had disc protrusion or small herniation in only one level, without neurological deficits and with no resolution after six weeks of conservative treatment. One group underwent open microdiscectomy, and the other group underwent percutaneous microdiscectomy via hydrosurgery. Function was evaluated using the Oswestry Disability Index and pain was assessed using a visual analog scale. Evaluations were performed preoperatively, and then during the first week and at one, three, six and twelve months postoperatively. Personal satisfaction was verified. Clinicaltrials.gov: NCT01367860. RESULTS: During the study period, 20 patients were included in each arm and 39 completed one-year of follow-up (one patient died of unrelated causes). Both groups exhibited equal improvement on the visual analog scale and Oswestry evaluations after treatment, without any significant differences. The improvement in the lumbar visual analog scale score was not significant in the hydrodiscectomy group (p=0.138). The rates of infection, pain, recurrence and satisfaction were similar between the two groups. CONCLUSION: Percutaneous hydrodiscectomy was demonstrated to be as effective as open microdiscectomy for reducing pain. The rates of complications and recurrence of herniation were similar between groups. Patient satisfaction with the treatment was also similar between groups.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Diskectomy, Percutaneous/methods , Diskectomy/methods , Intervertebral Disc Displacement/surgery , Low Back Pain/surgery , Disability Evaluation , Pain, Postoperative/classification , Patient Satisfaction , Postoperative Period , Single-Blind Method , Treatment Outcome
6.
Arq. neuropsiquiatr ; 71(1): 46-50, Jan. 2013. ilus, tab
Article in English | LILACS | ID: lil-662410

ABSTRACT

OBJECTIVES: To make a retrospective analysis and evaluate a clinical response to the control of disc degeneration related pain of 396 patients submitted to percutaneous lumbar nucleoplasty; and to make a record of visual analogical scale (VAS) up to a three-year follow-up after the surgical procedure. METHODS: Analysis of VAS score in 396 patients with lumbar disc degeneration related pain, according to anamnesis, clinical examination and magnetic resonance imaging (MRI), without improvement of previous clinical treatment, submitted to percutaneous nucleoplasty. RESULTS: A total of 26% of the patients presented 100% remission of pain or paresthesia, of whom 75% showed at least 50% of pain improvement. The median VAS pain improvement was about 67%. CONCLUSIONS: The median VAS improvement in inferior disc levels was higher than four points. The VAS showed improvement of the pain and paresthesia up to a three-year follow up after the surgical procedure.


OBJETIVOS: Analisar retrospectivamente a resposta clínica no controle da dor relacionada à degeneração discal em 396 pacientes submetidos à nucleoplastia percutânea lombar; e fazer um registro da escala analógica visual (EAV) com seguimento de três anos após a cirurgia. MÉTODOS: Análise da EAV de 396 pacientes com diagnóstico de hérnia de disco, de acordo com anamnese, exame clínico e imagens por meio de ressonância magnética (RM), sendo que nenhum deles apresentou melhora com tratamento clínico prévio. Estes pacientes foram submetidos à nucleoplastia percutânea. O estudo utilizou, para avaliação, o registro de escala analógica visual (EAV) durante seguimento de até três anos após o procedimento cirúrgico. RESULTADOS: Um total de 26% apresentou 100% de remissão da dor ou parestesia; 75% apresentaram pelo menos 50% de melhora da dor. A mediana da EAV de melhora da dor foi de aproximadamente 67%. CONCLUSÕES: Houve melhora da EAV, com mediana maior do que quatro pontos nos pacientes com acometimento nos níveis discais inferiores. A EAV mostrou melhora da dor e parestesia num período de seguimento de até três anos após o procedimento cirúrgico.


Subject(s)
Adolescent , Adult , Aged, 80 and over , Female , Humans , Male , Middle Aged , Young Adult , Diskectomy, Percutaneous/methods , Intervertebral Disc Degeneration/surgery , Diskectomy, Percutaneous/adverse effects , Follow-Up Studies , Magnetic Resonance Imaging , Pain Measurement , Retrospective Studies , Treatment Outcome
8.
Rev. chil. neurocir ; 21: 87-93, 2003. ilus, tab
Article in Spanish | LILACS | ID: lil-416807

ABSTRACT

La hernia del núcleo pulposo como etiología de una radiculopatía fue señalada por primera vez en 1934, solo en década del 50 se planteó por primera vez un tratamiento quirúrgico. En 1984 Onik describió la nucleotomía percutánea autoimatizada como alternativa a la disquectomía convencional o microquirúrgica. El trabajo muestra la experiencia en 74 pacientes, entre las edades de 18 y 63 años, intervenidos quirúrgicamente por el autor, con la técnica de nucleotomía percutánea automatizada, 89 discos fueron operados, con un seguimiento de 3 a 42 meses, de los cuales 81 fueron lumbares y 8 cervicales. La tasa de éxito a largo plazo fue de 95,9 por ciento, con una morbilidad del 8 por ciento, la cual fue transitoria y no incidió en el resultado final de la cirugía. El porcentaje de recidiva en esta serie fue de 4,1 por ciento. No se registró mortalidad. Se hace énfasis en la selección de los pacientes desde el punto de vista clínico e imagenológico, dándole importancia a la integridad del ánulo fibroso discal, en una hernia protuída, usándose la resonancia magnética nuclear como examen de elección. Se destaca lo simple, lo poco invasivo y seguro del procedimiento quirúrgico, la corta hospitalización y la rápida reintegración laboral de los pacientes intervenidos.


Subject(s)
Humans , Surgery, Computer-Assisted/methods , Diskectomy, Percutaneous , Diskectomy, Percutaneous/methods , Hernia , Hernia/surgery , Minimally Invasive Surgical Procedures
9.
Rev. mex. ortop. traumatol ; 14(4): 313-316, jul.-ago. 2000. tab
Article in Spanish | LILACS | ID: lil-302801

ABSTRACT

Se estudiaron 22 pacientes con espondilo-disquitis piógena de columna lumbar, siendo 15 hombres y 7 mujeres con edad promedio de 54 aÏos. En sólo 2/3 partes se encontró el foco de infección con predominio de: Salmonella, Brucella, y cocos Gram +. El nivel m s afectado fue L3-4 y clínicamente todos tuvieron una lumbociatalgia sistematizada a algún dermatoma y los estudios de Rx mostraron un proceso óseo destructivo en plataformas con reacción esclerosa, espículas óseas, compresión neurológica por el absceso e inestabilidad segmentaria. Tradicionalmente existen 2 tipos de tratamiento: el conservador, con antibioticos y reposo en cama hasta por 9 meses; y el quirúrgico, con un riesgo alto de morbimortalidad. Nosotros proponemos otra alternativa viable de tratamiento, con el uso del Nucleotomo, para la desbridación percutánea del absceso por ser no invasivo y proporcionar muestra para estudio bacteriológico e histopatológico. Con la desbridación percutánea del absceso, se descomprimen las estructuras neurológicas y la lumbociatálgia remitió de 1-5 días con recuperación neurológica progresiva de 1-4 semanas en el 95 por ciento de los casos. Al drenar el absceso se observó una pronta reparación del defecto óseo y una fusión intersomática espontánea de 4-5 meses en los 22 casos, estabilizando la columna.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Debridement , Diskectomy, Percutaneous/methods , Discitis , Gram-Positive Bacterial Infections , Spinal Osteophytosis
10.
Article in English | IMSEAR | ID: sea-38483

ABSTRACT

Preoperative diagnosis of free disc fragment is important in order to avoid treatment by chymopapain and percutaneous method of disc removal or anterior discectomy. This retrospective case analysis was to study the cause, physical findings and appropriate investigation to identify free disc fragment before surgery. One hundred and thirteen operative patients of herniated lumbar disc were studied. Of these, eleven patients (9.7%) were diagnosed with free disc fragment. The results revealed that one patient was diagnosed preoperatively with free disc fragment by myelography and MRI and three other patients using MRI alone. We concluded that preoperative diagnosis of free disc fragment can be made through identification of a large myelographic defect and/or sagittal scan MRI showing migration of disc material from native disc space.


Subject(s)
Adult , Aged , Diskectomy, Percutaneous/methods , Female , Foreign Bodies/diagnosis , Foreign-Body Migration/diagnosis , Humans , Intervertebral Disc Displacement/complications , Lumbar Vertebrae , Magnetic Resonance Imaging , Male , Middle Aged , Myelography , Preoperative Care , Retrospective Studies , Sensitivity and Specificity , Subdural Space/pathology
11.
Rev. sanid. mil ; 53(4): 245-8, jul.-ago. 1999. ilus, tab
Article in Spanish | LILACS | ID: lil-266932

ABSTRACT

La aplicabilidad del uso de la toracoscopía vídeo-asistida (TVA) para resecar discos torácicos fue investigada. Fue un estudio de laboratorio llevado a cabo usando 10 puercos vivos y un perro vivo como especímenes. Un total de treinta y tres niveles fueron descomprimidos. El objetivo fue estudiar la eficacia de realizar las resecciones torácicas usando TVA. La TVA ha sido usada por los cirujanos torácicos desde 1991 para enfermedades pleuropulmonares y desde 1994 en indicaciones ortopédicas. Se hicieron resecciones quirúrgicas de 33 en 11 animales anestesiados, en todos los casos se usó la TVA para realizar el procedimiento y visualizar el sitio quirúrgico. Se evacuaron adecuadamente 30 de 33 espacios, esto fue confirmado por la visualización de las placas terminales y el ligamento común anterior en cada espacio. La media de tiempo operatorio fue de 2.7 horas (con un rango de 1.5 horas a 4 horas). La posición de decúbito lateral (DL), fue usada en 6 animales y la decúbito prono (DP) en 5, comparándolas. Cuando el cuerpo fue colocado en DP la orientación topográfica fue más rápida y mejor, y el efecto de las leyes de la gravedad protege a las estructuras viscerales y vasculares alejándolas del campo operatorio. Ocurrió un episodio de laceración vascular (vena ácigos) y la ruptura de la punta de un instrumento (Cuchilla). La técnica de TVA mejora el acceso a la columna torácica anterior y es una manera útil de realizar las disquectomías. No fueron necesarias incisiones largas para toracotomía. Al minimizar el tamaño de la incisión muchos de los riesgos de esta operación pueden ser evitados. La TVA parece una alternativa razonable para las disquectomías torácicas


Subject(s)
Animals , Dogs , Diskectomy, Percutaneous/instrumentation , Diskectomy, Percutaneous/methods , Disease Models, Animal , Microscopy, Video , Thoracoscopy
12.
Rev. chil. neurocir ; 12(n.esp): 69-73, 1998. ilus
Article in Spanish | LILACS | ID: lil-253071

ABSTRACT

Se presenta un análisis de 25 casos operados de patología discal lumbar a nivel L3L4, L4L5 y L5S1. En 21 pacientes (84 porciento) se objetivó una HNP, en 4 pacientes (16 porciento) una protrusión discal sintomática. En el 100 porciento se realizó discografía. El interés de la disectomía percutánea manual (DPM) consiste en evitar la vía intraraquídea. Sus ventajas son el uso de anestesia local, gesto poco traumatizante, disminución de riesgos de fibrosis peridural, corto período de hospitalización y menor costo. Los resultados obtenidos son satisfactorios en el 80 porciento de los casos a 2 años de seguimiento


Subject(s)
Humans , Female , Adult , Adolescent , Middle Aged , Diskectomy, Percutaneous/methods , Intervertebral Disc Displacement/surgery , Anesthesia, Local , Hospitalization/economics , Postoperative Complications
13.
Rev. colomb. neumol ; 8(2): 69-74, jul. 1996. ilus
Article in Spanish | LILACS | ID: lil-190601

ABSTRACT

Introducción: Los métodos invasivos de estudio de la pleura permiten examinar y tomar muestras de la hoja visceral. Por el contrario, los instrumentos de biopsia percutánea, menos invasivos, se limitan a la toma de material de la superficie parietal, que es afectada en forma más tardia por la enfermedad pleural. Sería deseable contar con un instrumento que reuniera las ventajas de ambos métodos al obtener por punción percutánea y hermética, muestras de pleura visceral, sin necesidad de anestesia general y de toracostomía luego del procedimiento. Objetivo: Evaluar la utilidad diagnóstica de un nuevo instrumento para la biopsia percutánea cerrada y ciega de pleura visceral en el estudio de la enfermedad pleural. Estudio de comparación entre dos métodos de toma de biopsia (biopsia visceral con el nuevo instrumento y biopsia con aguja de Abrams). Pacientes y Métodos: Pacientes con exudado pleural e indicación para biopsia que aceptaron someterse a ambos procedimiento en días diferentes. El orden de los procedimientos se seleccionó en forma aleatoria. Las muestras fueron analizadas por el mismo patólogo, sin datos acerca del método de toma de la biopsia. Los resultados se compararon con el diagnóstico final al egreso del paciente y se calculó la sensibilidad, especifidad y valores predictivos. Resultados: Se estudiaron 20 pacientes, 13 hombres y 7 mujeres, con edad promedio de 54,5 años, 75 años, 75 por ciento con exudado linfocítico, la mayoría (55 pór ciento) izquierdo, 85 por ciento libres y 50 por ciento con alteración del parénquima. Los diagnósticos finales fueron cáncer (10), tuberculosis (7) y tres pleuritis inespecíficas. La biopsia de pleura visceral diagnóstico correctamente nueve de las 10 neoplasias y cinco de las tuberculosis y la muestra pariental obtuvo diagnóstico correcto de cáncer en cinco y de tuberculosis en seis. Con cada método las muestras no fueron presentativas en dos casos. Se presentaron dos neumotórax con cada método de biopsia. La sensibilidad especifidad, valor predictivo positivo y negativo, calculados con estos datos, son similares entre los dos procedimientos. La sensibilidad de la biopsia con el nuevo método (90 por ciento) para el diagnóstico de cáncer es superior a al obtenida con la aguja de abrams (50 por ciento) y no hay otras diferencias entre ellos. Conclusión: El rendimiento diagnóstico del...


Subject(s)
Humans , Biopsy, Needle , Biopsy, Needle/instrumentation , Biopsy, Needle/trends , Biopsy, Needle/statistics & numerical data , Diskectomy, Percutaneous/instrumentation , Diskectomy, Percutaneous/methods , Exudates and Transudates/cytology , Pleural Diseases/diagnosis , Pleural Diseases/surgery
14.
Article in English | WPRIM | ID: wpr-108164

ABSTRACT

Automated percutaneous lumbar discectomy (APLD) has been developed since 1984 when Gary Onik first attempted it. This procedure has many advantages and has been used widely in the treatment of protruded disc diseases. The success rate of APLD by authors from March 1988 to February 1993 when the discographic computed tomography (CT) had not been performed was 74%. In evaluating lumbar disc diseases, we have used discographic CT. According to the patterns of dye distribution in the disc, two different types of protrusion can be distinguished: broad dye base protrusion and narrow dye base protrusion. From April 1993 to July 1994, 52 patients with protruded disc diseases were performed discographic CT. 23 Patients had narrow dye base protrusion and 29 patients had broad dye base protrusion. 29 patients with a broad dye base on discographic CT were treated with APLD and evaluated. The success rate in these patients was 93% by Macnab's criteria. Thus, we suggest that it is mandatory to apply discographic CT to increase the success rate of APLD in patients with protruded disc diseases.


Subject(s)
Adolescent , Adult , Child , Diskectomy, Percutaneous/methods , Female , Humans , Intervertebral Disc Displacement/surgery , Lumbar Vertebrae/surgery , Male , Middle Aged , Tomography, X-Ray Computed/methods
15.
Arq. bras. neurocir ; 13(4): 149-53, dez. 1994. ilus, tab
Article in Portuguese | LILACS | ID: lil-170079

ABSTRACT

Os autores apresentam um estudo anátomo-clínico do acesso cirúrgico percutâneo utilizado para hérnias discais lombares. Trinta exames por tomografia computadorizada de coluna lombar e dois cadaveres, preparados adequadamente para dissecaçäo e seccionados ao nível intervertebral L4-5, foram estudados. os possíveis acessos, ângulos, distâncias e estruturas anatômicas passíveis de lesäo foram analisados. Os dados da literatura säo revistos e discutidos


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Diskectomy, Percutaneous/methods , Intervertebral Disc Displacement/surgery , Evaluation Study
16.
New Egyptian Journal of Medicine [The]. 1993; 9 (4): 1146-50
in English | IMEMR | ID: emr-30169

ABSTRACT

In the search of less invasive techniques for the treatment of discogenic low back pain, percutaneous discectomy, especially in its automated form, has crept to occupy an important place in the range of different treatment modalities. Great experience is required, as well as strict adherence to patient selection rules. Failures and complications should be promptly dealt with. Ten cases with unsatisfactory results after one or two trials at PCD were presented. They necessitated open exploration and removal of the offending factors. All yielded excellent results and permitted to draw some guidelines governing the indications and techniques of PCD


Subject(s)
Diskectomy, Percutaneous/methods
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