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1.
Rev. bras. ortop ; 57(1): 55-60, Jan.-Feb. 2022. tab
Article in English | LILACS | ID: biblio-1365742

ABSTRACT

Abstract Objectives To evaluate the correlation between radiologic changes (Pfirrmann and Modic) and radicular pain intensity in patients who underwent transforaminal endoscopic surgery for lumbar disc herniation. Methods Series of cases with 39 patients, 50 intervertebral discs in preoperative evaluation from January 29, 2018 to August 28, 2019 in an endoscopic spine surgery service. Demographic data, surgical indication, operative details and complications were obtained from medical records. The patients were divided into three groups based on the Modic classification (Modic absence, Modic 1 and Modic 2) and into two groups considering the Pfirrmann classification (Pfirrmann IV and Pfirrmann V). Data were processed in IBM SPSS Statistics for Windows, Version 22.0 (IBM Corp., Armonk, NY, USA), with a significance level of p< 0,05. Results There was no difference between genders; age: 50,36 ± 15,05 years old; disease level: L2-L3 1 (2%), L3-L4 2 (4%), L4-L5 9 (18%), L5-S1 8 (16%), L3-L4 + L4-L5 4 (8%), and L4-L5 + L5-S1 26 (52%); location: right foraminal 7 (14%), left foraminal 15 (30%), central 9 (18%) and diffuse 19 (38%); radicular pain: left 25 (50%), right 11 (22%), and bilateral 14 (28%); preoperative visual analogue scale (VAS): 9,5 ± 0,91, postoperative: 2,5 ± 1,79; surgery duration: 100 ± 31,36 minutes; and follow-up: 8,4 ± 6,7 months. Less postoperative sciatica was registered in the Modic 2 versus Modic 1 group (p< 0,05). There was no difference in the postoperative radicular pain between the Pfirrmann groups (IV versus V). Conclusion Although there is no clinical difference between the groups, in advanced stages of disc degeneration, endoscopic transforaminal discectomy proved to be effective in diminishing radicular pain in patients with lumbar disc herniation.


Resumo Objetivos Avaliar a correlação entre as alterações radiológicas (Pfirrmann e Modic) e a intensidade da dor radicular em pacientes submetidos a cirurgia endoscópica transforaminal para hérnia de disco lombar. Métodos Uma sequência de casos com 39 pacientes, 50 discos intervertebrais em avaliação pré-operatória, no período de 29 de janeiro de 2018 a 28 de agosto de 2019, no serviço de cirurgia endoscópica da coluna vertebral. Os dados demográficos, indicação cirúrgica, detalhes operatórios e complicações foram todos obtidos junto aos prontuários clínicos. Os pacientes foram divididos em três grupos, com base na classificação Modic (ausência de Modic, Modic 1 e Modic 2) e em dois grupos, considerando a classificação de Pfirrmann (Pfirrmann IV e Pfirrmann V). Os dados foram processados no software IBM SPSS Statistics for Windows, versão 22.0 (IBM Corp., Armonk, NY, EUA), com nível de significância de p <0,05. Resultados Não houve diferença entre os gêneros; idade: 50,36 ± 15,05 anos; nível da doença: L2-L3 1 (2%), L3-L4 2 (4%), L4-L5 9 (18%), L5-S1 8 (16%), L3-L4 + L4-L5 4 (8%), e L4-L5 + L5-S1 26 (52%); localização: foraminal direito em 7 pacientes (14%), foraminal esquerdo em 15 pacientes (30%), central em 9 pacientes (18%), e difuso em 19 pacientes (38%); dor radicular: esquerda em 25 pacientes (50%), direita em 11 pacientes (22%), e bilateral em 14 pacientes (28%); escala visual analógica (EVA) pré-operatório: 9,5 ± 0,91, pós-operatório: 2,5 ± 1,79; tempo cirúrgico: 100 ± 31,36 minutos; e acompanhamento de 8,4 ± 6,7 meses. Foi registrada menos dor ciática pós-operatória nos grupos Modic 2 versus Modic 1 (p< 0,05). Não houve diferença na dor radicular pós-operatória entre os grupos Pfirrmann (IV versus V). Conclusão Embora não exista diferença clínica entre os grupos, em estágios avançados da degeneração discal, a discectomia transforaminal endoscópica mostrou-se eficaz na redução da dor radicular em pacientes com hérnia de disco lombar.


Subject(s)
Humans , Male , Female , Sciatica , Intervertebral Disc Degeneration , Intervertebral Disc Displacement , Lumbosacral Region
2.
Rev. SOBECC (Online) ; v26(n4): 230-237, 31-12-2021.
Article in Portuguese | LILACS, BDENF | ID: biblio-1366143

ABSTRACT

Objetivo: Avaliar a intensidade da dor musculoesquelética e as regiões anatômicas comprometidas referidas por profissionais de enfermagem atuantes em um centro cirúrgico hospitalar. Método: Estudo transversal, descritivo e quantitativo, desenvolvido com profissionais de enfermagem que atuam no centro cirúrgico de um hospital geral. A coleta de dados ocorreu entre dezembro de 2019 e março de 2020, mediante aplicação de questio-nário sociodemográfico, laboral e clínico, Questionário Nórdico de Sintomas Osteomusculares e Escala Numérica de Avaliação da Dor. Resultados:Participaram do estudo 25 profissionais de enfermagem. A maioria é mulher, na faixa etária de 31 a 40 anos, casada e com filhos. As regiões anatômicas mais acometidas pela dor musculoesquelética no último ano foram lombar, tornozelos e pés, ombros e pescoço, e, nos últimos sete dias, o maior per-centual de dor foi na região lombar. Apenas pequena parcela dos trabalhadores referiu não sentir dor nos últimos dias. Conclusão: A dor referida pelos participantes compromete suas atividades laborais. A intensidade da dor expressa sofrimento profissional, com risco de cronificação e desencadeamento de outras patologias, até mesmo autoimunes.


Objective: To assess the intensity of musculoskeletal pain and the affected anatomical regions reported by nursing professionals working in a hospital surgical center. Method: This is a quantitative, descriptive, cross-sectional study carried out with nursing professionals working in the surgi-cal center of a general hospital. Data were collected between December 2019 and March 2020 by administering a sociodemographic, labor, and clinical questionnaire, the Nordic Musculoskeletal Questionnaire, and the Numeric Pain Rating Scale. Results: Twenty-five nursing professionals participated in the study. Most were women, aged 31 to 40 years, married, and with children. The anatomical regions most affected by musculoskeletal pain in the previous year were the low back, ankles and feet, shoulders, and neck; in the previous seven days, the lumbar region was responsible for the highest per-centage of pain. Only a small part of workers declared not feeling pain in recent days. Conclusions: The pain reported by the participants compromises their work activities. Pain intensity reveals professional suffering, with the risk of chronicity and of triggering other diseases, even autoimmune ones.


Objetivo: Evaluar la intensidad del dolor musculoesquelético y regiones anatómicas comprometidas reportadas por profesionales de enferme-ría que laboran en el quirófano de un hospital. Método: Estudio transversal, descriptivo y cuantitativo, desarrollado con profesionales de enfermería que laboran en el quirófano de un hospital general. La recolección de datos se realizó entre diciembre de 2019 y marzo de 2020, mediante la aplicación del cuestionario sociodemográfico, laboral y clínico, Cuestionario Nórdico de Síntomas Musculoesqueléticos y Escala Numérica de Evaluación del Dolor. Resultados: Participaron del estudio veinticinco profesionales de enfermería. La mayoría son mujeres, de entre 31 y 40 años, casadas y con hijos. Las regiones anatómicas más afectadas por el dolor musculoesquelético en el último año fueron la zona lumbar, tobillos y pies, hombros y cuello y, en los últimos siete días, el mayor porcentaje de dolor fue en la región lumbar. Solo una pequeña parte de los trabajadores informó no haber sentido dolor en los últimos días. Conclusión: El dolor informado por los participantes compromete sus actividades laborales. La intensidad del dolor expresa sufrimiento profesional, con riesgo de cronicidad y desencadenamiento de otras patologías, incluidas las autoinmunes.


Subject(s)
Humans , Surgicenters , Musculoskeletal Pain , Nurse Practitioners , Women , Lumbosacral Region , Ankle
3.
Rev. habanera cienc. méd ; 20(5): e3706, 2021. graf
Article in English | LILACS, CUMED | ID: biblio-1352076

ABSTRACT

Introduction: Lumbar hernia (LH) is rarely found in teenager patients. There is an increased incidence of traumatic etiology of LH related to new diagnostic methods. LH has been frequently misdiagnosed as other surgical entities. A case of acquired primary superior lumbar hernia in a teenager patient with no previous history of surgical diseases is presented. Objective: To specify the keys for the diagnosis of acquired Grynfeltt-Lesshaft hernia in a teenager patient. Case Presentation: A 14-year-old African-American male patient who complained of an occasionally painful swelling over the left side of the lumbar region was clinically diagnosed with a Grynfelt-Lesshaft hernia which was confirmed by CT scan. The patient was operated on with a transverse incision over the tumour for the lumpectomy. The contents were reduced, and the 1cm x 1cm ring with no sac was closed and reinforced with a polyester fibre prosthetic mesh. No immediate complications were observed. The patient was discharged from the health care center five days after the procedure. Conclusions: The Grynfelt-Lesshaft hernia is an uncommon surgical condition related to a congenital or acquired etiology. The available advances in the diagnostic methods allow us to easily identify a Grynfelt-Lesshaft hernia in younger patients(AU)


Introducción: La hernia lumbar (HL) es una hernia que raramente se encuentra en pacientes adolescentes. Existe una mayor incidencia de etiología traumática de la HL relacionada con los nuevos métodos de diagnóstico. La HL suele ser mal diagnosticada como otras entidades quirúrgicas. Se presenta un caso de HL primaria superior adquirida en un paciente adolescente sin antecedentes de afecciones quirúrgicas. Objetivo: Precisar las claves diagnosticas de la Hernia de Grynfelt-Lesshaft adquirida en paciente adolescente. Presentación del caso: Paciente varón de raza negra, con 14 años de edad que presentó un incremento de volumen ocasionalmente doloroso en el lado izquierdo de la región lumbar, fue diagnosticado clínicamente con una hernia de Grynfelt-Lesshaft. El diagnóstico se confirmó por una tomografía computarizada. El paciente fue intervenido quirúrgicamente con una incisión de lumpectomía transversal sobre el tumor. Se redujo el contenido y se cerró el anillo de 1cm x 1cm sin saco y se reforzó con una malla protésica de fibra de poliéster. No se observaron complicaciones inmediatas y el paciente fue dado de alta de la institución cinco días después del procedimiento. Conclusiones: La hernia de Grynfelt-Lesshaft es una condición quirúrgica poco común relacionada con una etiología congénita o adquirida. Los avances en los métodos de diagnóstico disponibles permiten identificar sin dificultades una hernia de Grynfelt-Lesshaft en pacientes jóvenes(AU)


Subject(s)
Humans , Male , Adolescent , Herniorrhaphy/methods , Lumbosacral Region
4.
Rev. Pesqui. Fisioter ; 11(3): 549-560, ago.2021. ilus
Article in English, Portuguese | LILACS | ID: biblio-1292211

ABSTRACT

INTRODUÇÃO: A estenose do canal lombar (ECL) é conhecida como a razão bem estabelecida de dor e capacidade de marcha reduzida em pacientes com manifestações de parestesia e dor na parte inferior das costas, região glútea, coxa posterior e pernas, denominadas 'Claudicação Neurogênica' (NC). A terapia manual combinada com exercícios de alargamento do canal e fisioterapia convencional pode ser considerada na erradicação dos sintomas de dor e NC, melhorando assim a qualidade de vida. MÉTODOS E MATERIAIS: Pacientes com LCS com canal de diâmetro de 8-12 mm no nível de L 4 e abaixo serão recrutados para este estudo por meio do método de randomização em Bloco. Eles serão randomizados em dois grupos de intervenção: grupos Terapia Manual e Alargamento dos Canais (MTCE) (n = 16) e Fisioterapia Convencional (Cp) (n = 16). O grupo MTCE receberá terapia manual e exercícios de alargamento do canal, enquanto o grupo Cp receberá apenas fisioterapia convencional. Ambos os grupos de intervenção receberão 3 dias de tratamento por semana durante 4 semanas. O questionário de deficiência de Oswestry modificado (MODI), diâmetro do canal ântero-posterior (AP), escala numérica de dor (NPRS) e distância de claudicação (CD) serão usados para a avaliação. O índice de deficiência de Oswestry modificado, diâmetro do canal AP, NPRS, distância de claudicação e SLR serão medidos no início e após a intervenção. DISCUSSÃO: Os resultados desta pesquisa ditarão a aplicabilidade da terapia manual com um protocolo de exercícios de alargamento do canal na dor e incapacidade funcional em pacientes com SCL.


INTRODUCTION: Lumbar Canal Stenosis (LCS) is known as the well-established reason for pain and depleted walking capacity in patients with manifestations of paresthesia and pain in the lower back, gluteal region, posterior thigh, and legs which are termed as 'Neurogenic Claudication' (NC). Manual therapy combined with canal enlargement exercises and conventional physiotherapy may be considered in eradicating pain and NC symptoms, hence improving the quality of life. METHODS AND MATERIALS: Patients with LCS with canal diameter 8-12 mm at the level of L4 and below will be recruited for this study. Through the Block randomization method, they will be randomized into two interventional groups: Manual Therapy & Canal Enlargement (MTCE) (n=16) and Conventional Physiotherapy (Cp) (n=16) groups. MTCE group will receive manual therapy and canal enlargement exercises, while the Cp group will receive only conventional physiotherapy. Both interventional groups will receive 3 days of treatment per week for 4 weeks. Modified Oswestry Disability questionnaire (MODI), AnteroPosterior (AP) canal diameter, Numeric Pain Rating Scale (NPRS), and Claudication Distance (CD) will be used for the evaluation. In addition, modified Oswestry Disability Index, AP canal Diameter, NPRS, Claudication distance, an SLR will be measured at baseline and post-intervention. DISCUSSION: The results of this research will dictate the applicability of manual therapy with an exercise protocol of canal enlargement exercises on pain and functional disability in patients with LCS.


Subject(s)
Musculoskeletal Manipulations , Physical Therapy Modalities , Lumbosacral Region
5.
Rev. Col. Bras. Cir ; 48: e20213029, 2021. graf
Article in English | LILACS | ID: biblio-1287883

ABSTRACT

ABSTRACT Lumbar and para-iliac hernias are rare and occur after removal of an iliac bone graft, nephrectomies, retroperitoneal aortic surgery, or after blunt trauma to the abdomen. The incidence of hernia after the removal of these grafts ranges from 0.5 to 10%. These hernias are a problem that surgeons will face, since bone grafts from the iliac crest are being used more routinely. The goal of this article was to report the technique to correct these complex hernias, using the technique of fixing the propylene mesh to the iliac bone and the result of this approach. In the period of 5 years, 165 patients were treated at the complex hernia service, 10 (6%) with hernia in the supra-iliac and lumbar region, managed with the technique of fixing the mesh to the iliac bone with correction of the failure. During the mean follow-up of 33 months (minimum of 2 and maximum of 48 months), there was no recurrence of the hernias.


RESUMO Hérnias lombares e para-ilíacas são raras e ocorrem após a retirada de enxerto ósseo ilíaco, nefrectomias, cirurgia aórtica retroperitoneal, ou ainda, após traumas contusos sobre o abdômen. A incidência de hérnia após a retirada destes enxertos varia de 0,5 a 10%. Essas hérnias constituem um problema com o qual os cirurgiões irão se defrontar, uma vez que os enxertos ósseos da crista ilíaca estão sendo usados mais rotineiramente. O objetivo desse artigo foi relatar a técnica para correção dessas hérnias, consideradas complexas, utilizando-se a técnica de fixação de tela de propileno ao osso ilíaco e o resultado dessa abordagem. No período de 5 anos, 165 pacientes foram atendidos no serviço de hérnias complexas, 10 (6%) com hérnia da região suprailíaca e lombar, manejados com a técnica de fixação de tela ao osso ilíaco corrigindo a falha. Durante o seguimento médio de 33 meses (mínimo de 2 e máximo de 48 meses), não houve recidiva das hérnias.


Subject(s)
Humans , Ilium , Lumbosacral Region , Surgical Mesh , Herniorrhaphy , Hernia
6.
Pesqui. vet. bras ; 41: e06672, 2021. tab, graf
Article in English | LILACS, VETINDEX | ID: biblio-1279529

ABSTRACT

The purpose of this study was to evaluate the effects of lumbar myelography on subarachnoid pressure, cardiorespiratory parameters and pressure-volume index in sheep. Eight sheep were evaluated. The animals were submitted to puncture of the cisterna magna for monitoring of subarachnoid pressure (SaP). Lumbar myelography was performed through applying Iohexol (0.4mL/kg). ToC, PAS, PAD, MAP, InspISO, FeISO, SaP and CPP were recorded immediately after anesthetic stabilization (M0), during lumbar puncture (M1), and two, four and six minutes after contrast application (M2, M3 and M4, respectively). Blood pressure initially increased, then decreased, returning to basal level, similarly observed for InspISo and FeISo. The SaP rose initially thereafter remaining stable. Despite of the effect on subarachnoid pressure, lumbar myelography can be considered safe in sheep.(AU)


O objetivo foi avaliar os efeitos da mielografia lombar na pressão subaracnóidea, parâmetros cardiorrespiratórios e índice pressão-volume em ovinos. Oito ovelhas foram avaliadas. Os animais foram submetidos à punção da cisterna magna para monitoramento da pressão subaracnoidea (SaP). A mielografia lombar foi realizada com a aplicação de Iohexol (0,4mL/kg). Os momentos estudados foram: imediatamente após a estabilização anestésica (M0), durante a punção lombar (M1), dois, quatro e seis minutos após a aplicação do contraste (M2, M3 e M4, respectivamente), para avaliar as seguintes variáveis: ToC, PAS, PAD, MAP, InspISO, FeISO, Sap e CPP. A pressão arterial aumentou inicialmente, depois diminuiu, retornando aos valores iniciais, padrão também observado para o InspISo e o FeISo. O SaP subiu inicialmente, posteriormente, permanecendo estável. A mielografia lombar, apesar de influenciar a pressão subaracnoidea, pode ser considerada segura em ovinos.(AU)


Subject(s)
Animals , Female , Blood Pressure , Sheep , Myelography/adverse effects , Intracranial Pressure , Lumbosacral Region
7.
Article in Chinese | WPRIM | ID: wpr-879454

ABSTRACT

OBJECTIVE@#To compare clinical effects of different postoperative rehabilitation modes on lumbar degenerative diseases, and explore influence of rehabilitation mode and other factors on postoperative effect.@*METHODS@#From June 2013 to July 2016, totally 900 patients were admitted from nine tertiary hospitals in Beijing to perform single segment bone grafting and internal fixation due to lumbar degenerative diseases were prospectively analyzed. There were 428 males and 472 females, the age of patient over 18 years old, with an average of (51.42±12.41) years old;according to patients' subjective wishes and actual residence conditions, all patients were divided into three groups, named as observation group 1 (performed integrated rehabilitation approach and orthopedic treatment model intervention), observation group 2 (performed integrated rehabilitation approach and orthopedic treatment, classified rehabilitation model intervention), and control group(performed routine rehabilitation model intervention). Visual analogue scale(VAS), Oswestry Disability Index(ODI) and Japanese Orthopaedic Association (JOA) were used to evaluate postoperative efficacy among three groups at 24 weeks. Possible factors affecting the postoperative efficacy including age, age grouping, gender, body mass index (BMI), BMI grouping, education level, visiting hospital, payment method of medical expenses, preoperative complications, preoperative JOA score, clinical diagnosis, surgery section, operative method, intraoperative bleeding volume, postoperative complications and rehabilitation mode were listed as independent variables, and postoperative ODI score at 24 weeks as dependent variables. Univariate analysis was used to analyze relationship between influencing factors and postoperative efficacy. Multiple linear regression was used to analyze relationship between influencing factors, rehabilitation mode and postoperative ODI score at 24 weeks, in further to find out the main reasons which affect postoperative efficacy, and to analyze impact of rehabilitation mode on postoperative efficacy.@*RESULTS@#All patients were followed up for 24 weeks after operation. All incisions healed at stage I with stable internal fixation. (1)Evaluation of postoperative efficacy:① There were no statistical differences in preoperative VAS and ODI among three groups(@*CONCLUSION@#Preoperative JOA score, gender, age could predict postoperative clinical effects of lumbar degenerative diseases in varying degrees treated with single level bone graft fusion and internal fixation. Different rehabilitation modes could improve clinical effects. Intergrated rehabilitation orthopedic treatment model and integrated rehabilitation approach and orthopedic treatment with classifiedrehabilitation model are superior to conventional rehabilitation model in improving patients' postoperative function and relieving pain, which is worthy of promoting in clinical.


Subject(s)
Adolescent , Adult , Aged , Female , Humans , Infant , Lumbar Vertebrae/surgery , Lumbosacral Region , Male , Middle Aged , Retrospective Studies , Spinal Fusion , Treatment Outcome
8.
Article in Chinese | WPRIM | ID: wpr-879440

ABSTRACT

OBJECTIVE@#To investigate the efficacy and safety of ultrasound-guided selective nerve branch blockage in the treatment of lumbar spinal nerve posterior branch syndrome.@*METHODS@#A total of 40 patients with lumbar spinal nerve posterior branch syndrome treated by Pain Clinic from May 2017 to December 2018 were selected. According to the method used in locating site for nerve blockage, the patients were divided into ultrasound-guided group and anatomical positioning group, with 20 cases in each group. In anatomical positioning group, there were 7 males and 13 females, aged (63.42±7.71) years old, weighted (63.65±10.72) kg, numerical rating scale (NRS) was (6.61±1.52) scores, course of disease was (16.55±4.68) months. Pain sites:4 cases at L@*RESULTS@#There were no statistically significant differences in gender, age, weight, NRS, course of disease and pain segment distribution between two groups (@*CONCLUSION@#Comparedwith anatomicalpositioning, ultrasound-guided selective nerve branch block for the treatment of posterior branch of the lumbar spinal cord syndrome can reduce the number of treatments and maintain a longer therapeutic effect, but it is also necessary to pay attention to the time of each treatment to avoid dizziness and other adverse reactions.


Subject(s)
Aged , Female , Humans , Lumbosacral Region , Male , Middle Aged , Nerve Block , Spinal Nerves/diagnostic imaging , Ultrasonography , Ultrasonography, Interventional
9.
Article in Chinese | WPRIM | ID: wpr-879435

ABSTRACT

OBJECTIVE@#To explore the dynamic changes of lumbosacral sagittal parameters after real-time three-dimensional navigation assisted minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and traditional open TLIF for treatment of lumbar degenerative disease.@*METHODS@#The clinical data of 61 patients with lumbar degenerative disease underwent single-segment surgery from September 2017 to September 2019 were retrospectively analyzed. Among them, 31 cases underwent MIS-TLIF with 3D navigation techniques (MIS-TLIF group) and another 30 cases underwent conventional open TLIF (traditional open TLIF group). The basic information, operative time and intraoperative blood loss were collected. The sagittal radiologic parameters were measured before surgery and 3 months after surgery, including lumbar lordosis (LL), segmental lordosis (SL), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), anterior disc height (ADH), posterior disc height(PDH).And the average disc height(DH) and pelvic incidence to lumbar lordosis mismatch (PI-LL) were calculated.@*RESULTS@#Operative time and intraoperative blood loss in MIS-TLIF group were significantly less than in traditional open TLIF group(@*CONCLUSION@#Real-time navigation-assisted MIS-TLIF and traditional open TLIF can recover DH in a short term for lumbar degenerative diseases, improve LL and PI-LL, and make the arrangement of the sagittal plane of the lumbosacral region more coordinated after surgery. But only the navigation assisted MIS -TLIF can significantly improve SL. Compared with traditional open TLIF, real-time navigation assisted MIS-TLIF in the treatment of degenerative lumbar diseases has the advantages of short operation time and less intraoperative bleeding.


Subject(s)
Humans , Lumbar Vertebrae/surgery , Lumbosacral Region , Minimally Invasive Surgical Procedures , Retrospective Studies , Spinal Fusion , Treatment Outcome
10.
Article in Chinese | WPRIM | ID: wpr-921925

ABSTRACT

OBJECTIVE@#To observe the effect of Qiang Jin exercises on the muscle strength and activity of lumbar spine in patients with lumbar disc herniation.@*METHODS@#From March 2016 to September 2017, at the Department of Orthopaedics, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, a total of 110 subjects were enrolled, and 98 eligible subjects were screened. The subjects were randomized by stratified randomization and divided into experimental group and control group, 49 cases in each group, 25 males and 24 females in the experimental group, 25 males and 24 females in the control group. The experimental group exercised with Qiang Jin exercises, one time each morning and evening, each time10 sets were made;the control group used classic rehabilitation training, training twice a week, and three months was a course of treatment. After 12 weeks of training, the muscle strength and activity of the lumbar spine were evaluated and compared with the muscle strength and activity of the lumbar spine before training.@*RESULTS@#The experimental group and the control group had different muscle strength and activity of the lumbar spine before and after treatment (@*CONCLUSION@#Qiang Jin exercises can effectively improve the muscle strength and activity of the lumbar spine and improve the daily living ability of patients.


Subject(s)
China , Female , Humans , Intervertebral Disc Degeneration , Intervertebral Disc Displacement , Lumbar Vertebrae , Lumbosacral Region , Male , Treatment Outcome
11.
Coluna/Columna ; 19(4): 262-265, Oct.-Dec. 2020. tab
Article in English | LILACS | ID: biblio-1133600

ABSTRACT

ABSTRACT Objective To evaluate facet joint degeneration following surgical treatment in patients with lumbar disc herniation, seeking to correlate it with possible determining factors. Methods Cross-sectional observational study, which analyzed medical records, radiographs and magnetic resonance images of 287 patients with lumbar disc herniation treated surgically at the Spine Surgery Service of the Hospital Ortopédico de Passo Fundo. Information about age and sex was collected. In the imaging exams, the following variables were evaluated: facet joint angulation and its tropism, measured by the Karacan method, sacral slope and lumbar lordosis, measured by the Cobb method, arthrosis of the interfacetary joints, measured by the Weishaupt classification, and intervertebral disc degeneration, measured by the Pfirrmann classification. Results A statistically significant relationship was observed between facet joint degeneration and age (p = 0.002), and also between facet joint degeneration and sacral slope (p = 0.038). No correlation was found between facet joint degeneration and lumbar lordosis (p = 0.934). It was found that the most degenerated facet joints were those that had the greatest facet joint asymmetry (tropism). However, the mean degree of facet tropism did not increase homogeneously with the progression of the joint degeneration score (p = 0.380). Conclusion It was verified that there are, in fact, a multiplicity of factors related to the degree of facet joint degeneration in the low lumbar spine. Additional studies, correlated with the asymmetry of the facet joints, would be important to elucidate better preventive management of this degeneration, aiming to avert secondary low back pain and sciatica with advancing age. Level of evidence II; Retrospective study.


RESUMO Objetivo Avaliar a degeneração facetária em pacientes com hérnia de disco lombar tratados cirurgicamente, procurando correlacioná-la com possíveis fatores determinantes. Métodos Estudo observacional do tipo transversal, que analisou prontuários, radiografias e ressonâncias magnéticas de 287 pacientes com hérnia de disco lombar, tratados cirurgicamente no Serviço de Cirurgia da Coluna do Hospital Ortopédico de Passo Fundo. Foram coletadas informações sobre idade e sexo. Nos exames de imagem, foram avaliadas as seguintes variáveis: angulação facetária e seu tropismo, mensurada pelo método de Karacan, inclinação sacral e lordose lombar, medidas pelo método de Cobb, artrose das articulações interfacetárias, pela classificação de Weishaupt e degeneração do disco intervertebral, pela classificação de Pfirrmann. Resultados Foi verificada relação estatisticamente significativa entre degeneração facetária e idade (p = 0,002), assim como entre degeneração facetária e inclinação sacral (p = 0,038). Não foi encontrada correlação entre degeneração facetária e lordose lombar (p = 0,934). Constatou-se que as articulações facetárias mais degeneradas eram as que tinham maior assimetria facetária (tropismo). Porém, a média do grau de tropismo facetário não aumentou de forma homogênea com a progressão do escore de degeneração da articulação (p = 0,380). Conclusões Verificou-se que há, de fato, uma multiplicidade de fatores relacionados com o grau de degeneração facetária da coluna lombar baixa. Estudos adicionais correlacionados com a assimetria das referidas articulações seriam importantes para elucidarmos uma conduta preventiva melhor para a referida degeneração, objetivando evitar lombalgia e ciatalgia secundárias à medida que a idade avança. Nível de evidência II; Estudo retrospectivo .


RESUMEN Objetivo Evaluar la degeneración facetaria en pacientes con hernia de disco lumbar tratados quirúrgicamente, buscando correlacionarla con posibles factores determinantes. Métodos Estudio observacional del tipo transversal, que analizó historiales, radiografías y resonancias magnéticas de 287 pacientes con hernia de disco lumbar, tratados quirúrgicamente en el Servicio de Cirugía de la Columna del Hospital Ortopédico de Passo Fundo. Fueron colectadas informaciones sobre edad y sexo. En los exámenes de imagen, se evaluaron las siguientes variables: angulación facetaria y su tropismo, medida por el método de Karacan, inclinación sacral y lordosis lumbar, medidas por el método de Cobb, artrosis de las articulaciones interfacetarias, por la clasificación de Weishaupt, y degeneración del disco intervertebral, por medio de la clasificación de Pfirrmann. Resultados Se verificó relación estadísticamente significativa entre degeneración facetaria y edad (p = 0,002), así como entre degeneración facetaria e inclinación sacral (p = 0,038). No se encontró correlación entre degeneración facetaria y lordosis lumbar (p = 0,934). Se constató que las articulaciones facetarias más degeneradas eran las que tenían mayor asimetría facetaria (tropismo). Sin embargo, el promedio del grado de tropismo facetario no aumentó de forma homogénea con la progresión del score de degeneración de la articulación (p = 0,380). Conclusiones Se verificó que hay, de hecho, una multiplicidad de factores relacionados con el grado de degeneración facetaria de la columna lumbar baja. Estudios adicionales correlacionados con la asimetría de las referidas articulaciones serían importantes para que elucidemos una mejor conducta preventiva para la referida degeneración, con el objetivo de evitar lumbalgia e ciatalgia secundarias, a medida que la edad avanza. Nivel de evidencia II; Estudio retrospectivo.


Subject(s)
Humans , Intervertebral Disc Degeneration , Low Back Pain , Hernia , Lumbosacral Region
12.
Coluna/Columna ; 19(4): 258-261, Oct.-Dec. 2020. tab, graf
Article in English | LILACS | ID: biblio-1133589

ABSTRACT

ABSTRACT Objective To evaluate the intra- and interobserver reliability of the Lee et al. classification for migrated lumbar disc herniations. Methods In 2018, Ahn Y. et al. demonstrated the accuracy of this classification for radiologists. However, magnetic resonance images are often interpreted by orthopedists. Thus, a cross-sectional study was conducted by evaluating the magnetic resonance images of 82 patients diagnosed with lumbar disc herniation. The images were evaluated by 4 physicians, 3 of whom were spinal orthopedic specialists and 1 of whom was a radiologist. The intra- and interobserver analysis was conducted using the percentage of concordance and the Kappa method. Results The report of the classifications used by the four observers had a higher proportion of "zone 3" and "zone 4" type classifications in both evaluation moments. The most affected anatomical levels were L5-S1 (48.2%) and L4-L5 (41.4%). The intra- and interobserver concordance, when comparing both moments evaluation of the complementary examinations of the participants involved, was classified as moderate and very good. Conclusions Lee's classification presented moderate to very good intra- and interobserver reliability for the evaluation of migrated lumbar disc herniation. Level of evidence II; Retrospective Study.


RESUMO Objetivo Avaliar a confiabilidade intra e interobservador da classificação de Lee et al. para hérnias migradas de disco lombar. Métodos Ahn Y et al., em 2018, demonstraram a acurácia dessa classificação para radiologistas. Entretanto, as imagens de ressonância magnética são muitas vezes interpretadas por ortopedistas. Sendo assim, foi realizado um estudo transversal por meio da avaliação de exames de ressonância magnética de 82 casos diagnosticados com hérnia de disco lombar. As imagens foram avaliadas por quatro médicos, sendo três ortopedistas especialistas em cirurgia da coluna e um radiologista. Foi realizada a análise de confiabilidade intra e interobservador com o uso de porcentagem de concordância e do método Kappa. Resultados A relação das classificações utilizadas pelos quatro avaliadores tiveram, em sua maior proporção, as classificações tipo "zona 3" e "zona 4" em ambos os momentos de avaliação. Os níveis anatômicos mais acometidos foram L5-S1 (48,8%) e L4-L5 (41,4%). A concordância intra e interobservador, que comparou os dois momentos de avaliação dos exames complementares dos participantes envolvidos, obteve classificações de moderada a muito boa. Conclusões A classificação de Lee apresentou confiabilidade intra e interobservador moderada a muito boa para a avaliação de hérnia migrada de disco lombar. Nível de evidência II; Estudo Retrospectivo.


RESUMEN Objetivo Evaluar la confiabilidad intra e interobservador de la clasificación de Lee et al. para hernias migradas de disco lumbar. Métodos Ahn Y et al. en 2018, demostraron la exactitud de esa clasificación para los radiólogos. Entretanto, las imágenes de resonancia magnética son a menudo interpretadas por ortopedistas. Siendo así, fue realizado un estudio transversal a través de la evaluación de exámenes de resonancia magnética de 82 casos diagnosticados con hernia de disco lumbar. Las imágenes fueron evaluadas por cuatro médicos, siendo tres ortopedistas especialistas en cirugía de la columna y un radiólogo. Se realizó el análisis de confiabilidad intra e interobservador con el uso de porcentaje de concordancia y Método Kappa. Resultados La relación de las clasificaciones utilizadas por los cuatro evaluadores tuvieron, en su mayor proporción, las clasificaciones tipo "zona 3" y "zona 4" en ambos momentos de evaluación. Los niveles anatómicos más acometidos fueron L5-S1 (48,8%) y L4-L5 (41,4%). La concordancia intra e interobservador, que comparó los dos momentos de evaluación de los exámenes complementarios de los participantes involucrados, obtuvo clasificaciones de moderada a muy buena. Conclusiones La clasificación de Lee presentó confiabilidad intra e interobservador moderada a muy buena para la evaluación de hernia migrada discal lumbar. Nivel de evidencia II; Estudio Retrospectivo.


Subject(s)
Humans , Lumbosacral Region , Magnetic Resonance Spectroscopy , Intervertebral Disc Displacement , Lumbar Vertebrae
13.
Int. j. morphol ; 38(6): 1597-1605, Dec. 2020. tab, graf
Article in English | LILACS | ID: biblio-1134485

ABSTRACT

SUMMARY: Lumbar disc herniation is considered to be the main pathological factor for the common clinical disease of low back pain. Biomechanical factor is an important cause of lumbar disc herniation, so it is urgent to analyze the stress/strain behavior of intervertebral disc under different loading condition. Slow repetitive loading is considered to be an important factor of spine and disc injuries, and the effect of fatigue load on internal displacement in the intervertebral disc was investigated by applying the optimized digital image correlation technique in this study. The first finding was that fatigue load had a significant effect on the displacement distribution in the intervertebral disc under compression. Superficial AF exhibited the largest axial displacements before fatigue load, while it exhibited the smallest axial displacements after fatigue load. Inner AF exhibited slightly smaller radial displacements than outer AF before fatigue load, while it exhibited significantly greater radial displacements than outer AF displacements after fatigue load. The second finding was that fatigue load had a certain effect on the internal displacement distribution in the flexed intervertebral disc under compression. Middle AF exhibited the smallest axial displacements before fatigue load, while deep AF exhibited the smallest axial displacements after fatigue load. The radial displacement distribution did not change before and after fatigue load, as the radial displacement in outer AF was the smallest, while the radial displacement in inner AF was the largest. The third finding was that with the increase in fatigue time and amplitude, the Young's modulus of the intervertebral disc increased significantly. This study can provide the basis for clinical intervertebral disc disease prevention and treatment? and is important for mechanical function evaluation of artificial intervertebral disc as well.


RESUMEN: La hernia de disco lumbar se considera el principal factor patológico para la enfermedad clínica común del dolor lumbar. El factor biomecánico es una causa importante de hernia de disco lumbar, por lo que es urgente analizar el comportamiento de esfuerzo / tensión del disco intervertebral bajo diferentes condiciones de carga. La carga repetitiva lenta se considera un factor importante de lesiones de columna y disco, y en este estudio el efecto de la carga de fatiga sobre el desplazamiento interno en el disco intervertebral se investigó mediante la aplicación de la técnica de correlación de imagen digital optimizada. El primer hallazgo fue que la carga de fatiga tuvo un efecto significativo en la distribución del desplazamiento en el disco intervertebral bajo compresión. El AF superficial exhibió los desplazamientos axiales más grandes antes de la carga de fatiga, mientras que exhibió los desplazamientos axiales más pequeños después de la carga de fatiga. El AF interno exhibió desplazamientos radiales ligeramente más pequeños que el AF externo antes de la carga de fatiga, mientras que exhibió desplazamientos radiales significativamente mayores que los desplazamientos AF externos después de la carga de fatiga. El segundo hallazgo fue que la carga de fatiga tenía un cierto efecto sobre la distribución del desplazamiento interno en el disco intervertebral flexionado bajo compresión. El AF medio exhibió los desplazamientos axiales más pequeños antes de la carga de fatiga, mientras que el AF profundo exhibió los desplazamientos axiales más pequeños después de la carga de fatiga. La distribución del desplazamiento radial no cambió antes ni después de la carga de fatiga, ya que el desplazamiento radial en la FA externa fue el más pequeño, mientras que el desplazamiento radial en la FA interna fue el más grande. El tercer hallazgo fue que con el aumento del tiempo de fatiga y la amplitud, el módulo de Young del disco intervertebral aumentó significativamente. Este estudio puede proporcionar la base para la prevención y el tratamiento clínico de la enfermedad del disco intervertebral, y también es importante para la evaluación de la función mecánica del disco intervertebral artificial.


Subject(s)
Humans , Intervertebral Disc Displacement/etiology , Intervertebral Disc Displacement/pathology , Biomechanical Phenomena , Compressive Strength , Fatigue , Flexural Strength , Intervertebral Disc/pathology , Lumbar Vertebrae/pathology , Lumbosacral Region
14.
Arq. bras. med. vet. zootec. (Online) ; 72(4): 1397-1402, July-Aug. 2020. ilus
Article in English | LILACS, VETINDEX | ID: biblio-1131506

ABSTRACT

A captive adult male bush dog (Speothos venaticus) was referred to our Veterinary Medical Teaching Hospital from a local zoo due to a two-week history of progressive hind limb gait impairment and ataxia, non-responsive to clinical management. Computed tomography revealed decreased disc space at L3 - L4 level, with probable disc extrusion narrowing the right side of the spinal canal, compressing the spinal cord. We opted to surgically remove the disc material using both fenestration and right lateral pediculectomy (mini-hemilaminectomy) techniques. Twelve days after surgery there was mild residual proprioceptive ataxia. Gait was fully regained with remission of the neurological deficits around the 30th postoperative day. This is - to the best of our knowledge - the first successful report of a lumbar intervertebral disc extrusion in a bush dog (Speothos venaticus) surgically treated by pediculectomy and disc fenestration.(AU)


Um cachorro-vinagre (Speothos venaticus), macho, adulto, mantido em cativeiro, foi encaminhado ao Hospital Veterinário Universitário pelo zoológico local com histórico de duas semanas de comprometimento progressivo da marcha dos membros posteriores e ataxia, que não responderam ao tratamento clínico. Tomografia computadorizada revelou diminuição do espaço em disco no nível L3 - L4, com provável extrusão de disco estreitando o lado direito do canal vertebral, comprimindo a medula espinhal. Optamos por remover cirurgicamente esse material do disco usando técnicas de fenestração e pediculectomia lateral direita (mini-hemilaminectomia). Doze dias após a cirurgia, houve melhora na deambulação, com ataxia proprioceptiva residual leve. A marcha foi totalmente recuperada com remissão dos déficits neurológicos por volta do trigésimo dia de pós-operatório. Este é - até onde sabemos - o primeiro relato bem-sucedido de uma extrusão de disco intervertebral lombar em um cachorro-vinagre (Speothos venaticus) tratado cirurgicamente por pediculectomia e fenestração de disco.(AU)


Subject(s)
Animals , Male , Ataxia/veterinary , Canidae/injuries , Intervertebral Disc/pathology , Lumbosacral Region/surgery , Tomography, X-Ray Computed/veterinary , Animals, Zoo
15.
Prensa méd. argent ; 106(5): 339-341, 20200000. fig
Article in English | LILACS, BINACIS | ID: biblio-1367951

ABSTRACT

Venous varicose of epidura is considered a rare cause of nerve root and thecal sac compression and impingement that leads to lower limb radiculopathy. The purpose of this study is to draw attention to this problem during operation. It also aims to focus shed a light on using magnetic resonance imaging (MRI) before the operation. This research also attempts to evaluate the outcome of the surgery. Symptoms of epidural varicose with radiculopathy are rare and the diagnosis is often inaccurate by preoperative clinical examination and radiology investigations. Thus, in many cases the diagnosis is made intra- operatively. The case was a 40 years old female who consulted our outpatient clinic complaining from acute radicular pain in the lower back and down of her right lower limb. MRI was done for her and showed paracentral disc herniation. Intra operatively, an abnormal dilatation of epidural vein impingement on L4 nerve root with no foraminal stenosis was seen. We initiated a thermo coagulation of the epidural vein from proximal to distal ends at disc level and used gel foam patch to control bleeding that was removed all at the end of operation. Then, coagulation ablation was performed. The operation resulted in relief of symptoms and neurologic recovery occurred during follow up period. According to our case and previously published case reports, the outcome is good with recovery of neurological signs and symptoms that can be obtained by coagulation ablation of epidural varicose vein.


Subject(s)
Humans , Female , Adult , Radiculopathy/therapy , Varicose Veins/therapy , Magnetic Resonance Spectroscopy , Outcome Assessment, Health Care , Minimally Invasive Surgical Procedures , Anesthesia, Epidural , Lumbosacral Region
16.
Pesqui. vet. bras ; 40(7): 546-553, July 2020. tab, graf
Article in English | LILACS, VETINDEX | ID: biblio-1135656

ABSTRACT

Several surgical procedures aim to decompress and/or stabilize the lumbosacral (LS) joint of dogs; however, the lumbar interbody fusion technique, by using a cage combined with a bone graft, is the most indicated and used in human medicine. No specific implant is available for application to the canine lumbosacral joint. Thus, this study measured lumbosacral discs in large dogs, determined whether a human cage model could fit the dogs' L7-S1 intervertebral space, and developed a LS cage prototype for dogs. Ten cadaveric lumbosacral spines from adult dog weighing 20-35kg were used. The dogs had died for reasons unrelated to this study. The vertebral body dimensions and the L7-S1 intervertebral space occupied by the intervertebral disc were measured by lateral and ventrodorsal radiographs and by computed tomography in the dorsal, sagittal, and transverse views. Measurements were also taken of the anatomical specimens in the sagittal and transverse planes. After measuring the intervertebral discs, the following mean measures were obtained for L7-S1 discs: height 12.23mm, dorsal thickness 3.3mm, central thickness 4mm, ventral thickness 5.5mm, and width 24.74mm. The human lumbar cage models from brands LDR, Baumer Orthopedics, Stryker, Synthes, and Vertebral Technologies, Inc. and cervical stabilization cages from the brands B-Braun and Stryker were evaluated and were found to be unsuitable for large dogs. Cervical human cages had measurements similar to those found in this study; however, due to their quadrangular shape, the possibility of being introduced surgically through the surgical accesses available for the articulation between L7-S1 in dogs without injuring the cauda equina or the L7 root is small. A cage model was then developed using 3D modelling software. It was designed for insertion via dorsal laminectomy in the lateral portions of the intervertebral space. To avoid cauda equina lesion, the implant model was developed to be placed laterally to the midline. The cage surface is serrated to prevent using the locking screw to fix it, thus avoiding further injury to nerve structures. The serrated surfaces are also designed to avoid cage migration and promote stability. The prototype allows graft placement in the surrounding intervertebral space, which is fundamental for fusion through integration between the cage and the endplates as well as for bone growth between and around the cage. It was also considered studies on humans showing that the lateral regions of the endplates support a more considerable load. Biomechanical and in vivo studies on the developed model are necessary to evaluate the actual degree of distraction, mobility and the long-term rate of fusion between L7 and S1 and its possible impact on the adjacent motor units, combined or not with dorsal fixation techniques.(AU)


Vários procedimentos cirúrgicos visam descomprimir e/ou estabilizar a articulação lombossacra (LS) de cães; no entanto, a técnica de fusão lombar, usando um cage intersomático combinado com um enxerto ósseo, é a mais indicada e utilizada na medicina humana. Não há implante específico disponível para aplicação na articulação lombossacra canina. Assim, neste estudo foi realizada a mensuração do espaço do disco intervertebral lombossacro de cães de raças grandes, para verificar se algum modelo de cage usado na medicina humana poderia ser usado no espaço intervertebral L7-S1 de cães. O segundo objetivo foi desenvolver um protótipo de cage lombossacro para cães. Foram utilizadas dez colunas lombossacras provenientes de cadáveres de cães adultos com peso entre 20 e 35kg. Os cães vieram a óbito por razões não relacionadas a este estudo. As dimensões do corpo vertebral e o espaço intervertebral L7-S1 ocupado pelo disco intervertebral foram medidos por radiografias laterais e ventrodorsais e por tomografia computadorizada nos cortes dorsal, sagital e transversal. Também foram realizadas mensurações das peças anatômicas nos planos sagital e transversal. Após a mensuração dos discos intervertebrais, foram obtidas as seguintes medidas médias dos discos L7-S1: altura 12,23mm, espessura dorsal 3,3mm, espessura central 4mm, espessura ventral 5,5mm e largura 24,74mm. Os modelos de cage lombar humano das marcas LDR, Baumer Orthopaedics, Stryker, Synthes e Vertebral Technologies, Inc. não possuíam dimensões adequadas para os cães. Cages de estabilização cervical das marcas B-Braun e Stryker também foram avaliados e apresentaram medidas semelhantes às encontradas neste estudo; no entanto, devido à sua forma quadrangular, a possibilidade de serem introduzidos cirurgicamente através das abordagens disponíveis para a articulação entre L7-S1 em cães sem lesionar a cauda equina ou a raiz L7 é pequena. Um modelo de cage foi então desenvolvido usando-se o software de modelagem 3D. Foi projetado para inserção via laminectomia dorsal nas porções laterais do espaço intervertebral. Para evitar a lesão da cauda equina, o modelo de implante foi desenvolvido para ser colocado lateralmente à linha média. A superfície do cage é serrilhada para evitar o uso do parafuso de travamento, evitando-se lesões adicionais às estruturas nervosas. As superfícies serrilhadas também foram projetadas para evitar a migração do cage e promover estabilidade. O protótipo permite a colocação do enxerto no espaço intervertebral circundante, fundamental para a fusão através da integração entre o cage e as placas vertebrais terminais, bem como para o crescimento ósseo entre e ao redor do implante. Também foram considerados estudos em seres humanos que mostraram que as regiões laterais das placas vertebrais terminais suportam uma carga maior. São necessários estudos biomecânicos e in vivo do modelo desenvolvido para avaliar o grau real de distração, mobilidade e a taxa de fusão a longo prazo entre L7 e S1 e seu possível impacto nas unidades motoras adjacentes, quando combinado ou não com técnicas de fixação dorsal.(AU)


Subject(s)
Animals , Dogs , Dog Diseases/surgery , Intervertebral Disc Degeneration/veterinary , Cauda Equina Syndrome/rehabilitation , Cauda Equina Syndrome/veterinary , Lumbosacral Region/surgery , Chronic Disease/veterinary
17.
Coluna/Columna ; 19(2): 116-119, Apr.-June 2020. tab, graf
Article in English | LILACS | ID: biblio-1133569

ABSTRACT

ABSTRACT Objective This study aims to analyze the characteristics of patients with acute lumbar/sciatic disc herniation who underwent conservative, pain block procedures and surgical treatment, in order to better understand the natural history of herniations and their surgical indications, as well as the impact of hernia volume. Methods We analyzed 150 patients with a diagnosis of acute lumbar disc herniation. The treatments considered were: conservative, infiltration/pain block procedures and microdiscectomy. For seven patients who were surgically treated, the lumbar sequestrectomy volume was submitted to pathological analysis. Results Of the 150 patients, 80% were treated conservatively; 15.31% were treated with pain block procedures and 4.66% underwent microdiscectomy. The mean age of the surgical group was 42.5 years, and 57.1% of the patients were men. Most of the hernias were at L5-S1 (55.5%), and 77.7% were on the left side. All patients had presented significant lumbar pain or sciatica for a long period prior to the surgery. The Lasègue sign was present in all patients. Of the total number of patients, 85.7% presented hypoesthesia and 42.8% presented focal motor deficits, among other findings. The mean hernia volume was 9.6 cm3. Conclusions Unresponsiveness to conservative treatment is an important indication for surgery. The clinical manifestations in patients with a lumbar/sciatic hernia can be very diverse, as can the disc herniation volume, so these are not good indicators for surgery. Level of evidence IV; Case series


RESUMO Objetivo O presente estudo tem como objetivo analisar as características dos pacientes com hérnia de disco lombar/ciática aguda que passaram por procedimentos conservadores, procedimentos de bloqueio de dor e tratamento cirúrgico, a fim de melhor entender a história natural das hérnias e suas indicações cirúrgicas, assim como o impacto do volume da hérnia. Métodos Analisamos 150 pacientes diagnosticados com hérnia de disco lombar aguda. Os tratamentos considerados foram: tratamento conservador, procedimentos para bloqueio da dor/infiltração e microdiscectomia. Para sete pacientes tratados cirurgicamente, o volume de sequestrectomia lombar foi enviado para análise patológica. Resultados Dos 150 pacientes analisados, 80% foram tratados de modo conservador, 15,31% com procedimentos de bloqueio da dor e 4,66% com microdiscectomia. A idade média do grupo submetido à cirurgia foi 42,5 anos, sendo que 57,1% dos pacientes eram homens. A maior parte das hérnias estavam localizadas em L5-S1 (55,5%) e 77,7% das hérnias estavam no lado esquerdo. Todos os pacientes apresentaram significativa dor lombar ou ciática por um longo período antes da cirurgia. O sinal de Lasègue estava presente em todos pacientes. Do número total de pacientes, 85,7% apresentaram hipoestesia e 42,8% apresentaram déficits motores focais, entre outros achados. O volume médio das hérnias foi 9,6 cm3. Conclusões A falta de resposta ao tratamento conservador é uma importante indicação para cirurgia. As manifestações clínicas dos pacientes com hérnia lombar/ciática podem ser muito diversas, assim como o volume da hérnia de disco, portanto, esses não são bons indicadores para cirurgia. Nível de evidência IV; Série de casos.


RESUMEN Objetivo El presente estudio tiene como objetivo analizar las características de los pacientes con hernia de disco lumbar/ciática aguda que pasaron por procedimientos conservadores, procedimientos de bloqueo de dolor y tratamiento quirúrgico, a fin de entender mejor la historia natural de las hernias y sus indicaciones quirúrgicas, así como el impacto del volumen de la hernia. Métodos Analizamos a 150 pacientes diagnosticados con hernia de disco lumbar aguda. Los tratamientos considerados fueron: conservador, procedimientos para bloqueo de dolor/infiltraci ón y microdiscectom ía . Para siete pacientes tratados quirúrgicamente, el volumen de secuestrectomía lumbar fue enviado para análisis patológico. Resultados De los 150 pacientes analizados, 80% fue tratado de modo conservador, 15,31% con procedimientos de bloqueo de dolor y 4,66% con microdiscectomía. La edad promedio del grupo sometido a cirugía fue de 42,5 años, siendo que 57,1% de los pacientes eran hombres. La mayor parte de las hernias estaban localizadas en L5-S1 (55,5%) y 77,7% de las hernias estaban en el lado izquierdo. Todos los pacientes presentaron dolor lumbar o ciático significativo por un largo período antes de la cirugía. La señal de Lasègue estaba presente en todos los pacientes. Del número total de pacientes, 85,7% de los pacientes present ó hipostesia y 42,8% present ó déficit s motores focales, entre otros hallazgos. El volumen promedio de las hernias fue de 9,6 cm3. Conclusiones La falta de respuesta al tratamiento conservador es una importante indicación para la cirugía. Las manifestaciones clínicas de los pacientes con hernia lumbar/ciática pueden ser muy diversas, así como el volumen de la hernia de disco, por lo tanto, é stos no son buenos indicadores para cirugía. Nivel de evidencia IV; Serie de casos.


Subject(s)
Humans , Intervertebral Disc , Epidemiology , Natural History , Hernia , Lumbosacral Region
18.
Rev. medica electron ; 42(3): 1928-1936, mayo.-jun. 2020. graf
Article in Spanish | LILACS, CUMED | ID: biblio-1127053

ABSTRACT

RESUMEN La hernia lumbar del espacio de Grynfelt, pese a que es la más frecuente de los dos tipos de hernias lumbares, es un defecto raro de la pared abdominal posterior. Su diagnóstico se hace difícil por su relativa poca frecuencia. Los médicos no piensan seriamente en esta variedad de hernia, aunque constituye una patología en la que el diagnóstico, al igual que el resto de las hernias de la pared abdominal, es esencialmente clínico. Se presentó un caso tipo de hernia poco frecuente. Una paciente de 32 años con antecedentes de salud, que hacía 3 meses comenzó a quejarse de dolor en la región lumbar y notó la presencia de una masa pequeña en esa misma región. Acudió a la consulta de Cirugía por este motivo y posterior a los estudios correspondientes se le realizó hernioplastia lumbar (AU).


ABSTRACT Lumbar hernia of the Grynfelt space, although it is the most frequent of the two kinds of lumbar hernias, is a rare posterior abdominal wall defect. Its diagnosis is difficult because of its low frequency. Doctors do not think about this illness because it is very infrequent, though it is a disease that, like the rest of abdominal wall hernia, is mainly clinically diagnosed. The authors presented a typically infrequent case of hernia. A female patient, aged 32 years, with health antecedents, referred that three months ago she began to feel pain in the lumbar region and noticed the presence of a little mass in that region. For that reason she assisted the consultation of Surgery and, after being correspondently studied, she underwent a lumbar hernioplasty (AU).


Subject(s)
Humans , Female , Adult , Low Back Pain/diagnosis , Hernia, Abdominal/diagnosis , Lumbosacral Region/pathology , Hernia, Abdominal/surgery , Hernia, Abdominal/diagnostic imaging , Herniorrhaphy
20.
Coluna/Columna ; 19(1): 71-74, Jan.-Mar. 2020. graf
Article in English | LILACS | ID: biblio-1089641

ABSTRACT

ABSTRACT The objective of this paper is to report a case of atypical evolution after a classic case of dengue confirmed by serology, in which the formation of an epidural hematoma with low back pain and radiculopathy was observed. The article is a qualitative and descriptive case report. Data were collected from the medical records of the hospital where the patient was treated. In conclusion, the diagnostic correlation of dengue with this rare condition was possible due to radiological comparisons before and after the formation of the extradural hematoma. Level of evidence V; Expert Opinion.


RESUMO O presente trabalho tem como objetivo relatar um caso de evolução atípica após quadro clássico de dengue, confirmada por sorologia, em que foi observada a formação de um hematoma extradural, com dor lombar baixa e radiculopatia. O artigo é tipo relato de caso, qualitativo e descritivo. Os dados foram coletados no prontuário do hospital onde o doente foi atendido. Como conclusão, a correlação diagnóstica da dengue com essa afecção rara foi possível devido a comparações radiológicas pré- e pós-formação do hematoma extradural. Nível de evidência V; Opinião de Especialista.


RESUMEN El presente trabajo tiene como objetivo relatar un caso de evolución atípica después de un cuadro clásico de dengue, confirmado por serología, en el que se observó la formación de un hematoma extradural, con dolor lumbar bajo y radiculopatía. El artículo es tipo relato de caso, cualitativo y descriptivo. Los datos fueron recolectados en el prontuario del hospital en donde el enfermo fue atendido. Como conclusión, la correlación diagnóstica del dengue con esta afección fue posible debido a las comparaciones radiológicas pre y post formación del hematoma extradural. Nivel de evidencia V; Opinión de Especialista.


Subject(s)
Humans , Dengue , Hematoma, Epidural, Spinal , Lumbosacral Region
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