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1.
Medisan ; 26(3)jun. 2022.
Article in Spanish | LILACS-Express | LILACS, CUMED | ID: biblio-1405814

ABSTRACT

Se describen los casos clínicos de dos féminas que habían padecido lumbociatalgias durante varios meses, por lo cual acudieron al Hospital Provincial Docente Dr. Joaquín Castillo Duany de Santiago de Cuba, donde se les diagnosticó hernia discal lumbar y recibieron seguimiento médico en la consulta de Neurocirugía por más de un año. Ante la negativa de ser intervenidas quirúrgicamente, se prescribieron esquemas terapéuticos convencionales y alternativos, así como fisioterapia. En ambas pacientes se evidenció regresión espontánea de la discopatía, lo que se confirmó mediante estudios evolutivos de resonancia magnética. Dicha correlación entre la mejoría clínica y la recuperación imagenológica del disco intervertebral no siempre sucede en la evolución de estos casos.


The case reports of two women that had suffered from lumbar sciatic pain during several months are described, reason why they went to Dr. Joaquín Castillo Duany Teaching Provincial Hospital in Santiago de Cuba, where they were diagnosed lumbar herniated disk and received medical follow up in the Neurosurgery Service for more than a year. Before the negative of being surgically intervened, conservative and alternative therapeutic outlines were prescribed, as well as physiotherapy. In both patients spontaneous regression of the lumbar herniated disk was evidenced, which was confirmed by means of evolutionary studies of magnetic resonance. This correlation between the clinical improvement and the imaging recovery of the intervertebral disk doesn't always happen in the clinical course of these cases.


Subject(s)
Radiculopathy , Low Back Pain , Intervertebral Disc Displacement , Intervertebral Disc
2.
Article in English | WPRIM | ID: wpr-939778

ABSTRACT

OBJECTIVE@#To compare the analgesic effects of two types of spinal manipulation (SM) in acute lumbar radiculopathy (ALR) model rats induced by self-transplantation of autologous nucleus pulposus (ANP), and clarify the therapeutic mechanism.@*METHODS@#Totally 108 male Sprague-Dawley rats were randomly divided into 6 groups by a random number table (18 rats in each group), including a blank group with no interference, a sham operation group with a surgery by making a local soft tissue incision on the left side of L5-6 vertebral segment, a model group with ALR of L5 extraforaminal nerve by ANP self-transplantation without other interference, a sham manipulation (SMA) group with simulating physical rotation, as well as a mobilization (MOB) group with simulating low-velocity and variable-amplitude rotation and a manipulation (MAN) group with simulating high-velocity and low-amplitude rotation. The interventions in SMA, MOB, and MAN groups started 1 day after modeling followed by another 5 treatments at days 3, 5, 8, 10 and 12. Rats in the other 3 groups did not receive any special intervention. Behavioral pain tests of 50% mechanical pain withdrawal threshold (50% PWT) and paw withdrawal latency (PWL) were conducted 1 day before operation followed by another 10 tests on days 1-7, 10, 12 and 14. Immunohistochemical expression of nitric oxide synthase (NOS) was investigated on days 5 and 12 after operation.@*RESULTS@#After 3 experimental SM interventions, 50% PWT and PWL were higher in the MAN group than the SMA group on days 6 and 7, and higher on days 10, 12 and 14 postoperatively (P<0.05 or P<0.01), while the same indices were significantly higher in the MOB group than MAN group on days 1-4 (P<0.05 or P<0.01). The expression of NOS was lower in the MAN and MOB groups than SMA group on day 12 postoperatively (P<0.01).@*CONCLUSIONS@#Both manipulation and mobilization produced better results than sham interference in relieving pain by reducing neuroinflammation possibly. At the early period, compared with manipulation, mobilization presented less sensitive response to pain until later visit. SM may inhibit the overexpression of NOS, thereby alleviating severe radiculopathy.


Subject(s)
Analgesia/methods , Animals , Male , Manipulation, Spinal , Nucleus Pulposus/transplantation , Pain , Radiculopathy/therapy , Rats , Rats, Sprague-Dawley , Transplantation, Autologous
3.
Article in Chinese | WPRIM | ID: wpr-928289

ABSTRACT

OBJECTIVE@#To explore the clinical efficacy and safety of manual therapy combined with posterior percutaneous endoscopic cervical decompression(PECD) in the treatment of intractable cervical spondylotic radiculopathy.@*METHODS@#From May 2016 to May 2018, 23 CSR patients who responded poorly to conservative treatment for at least 6 weeks underwent the combination management. Firstly, the patients received the posterior percutaneous endoscopic cervical decompression routine care for the following 4 weeks and manual therapy for another 4 weeks. A total of 23 patients were followed up, including 14 males and 9 females, the age ranged from 29 to 78 years old with an average of (50.30±12.28) years, the course of disease was 3 to 24 months with an average of (9.74±5.76) months. The lesion segment involved C4,5 in 4 cases, C5,6 in 13 cases, C6,7 in 6 cases. The visual analogue scale (VAS), neck disability index (NDI), changes of cervical physiological curvature and interbody stability, adverse events were observed before and after operation. The follow-up time points were before operation, 1 day after operation and 1, 3 and 6 months after operation.@*RESULTS@#All patients successfully completed the operation and manual treatment for 4 to 8 times. Among the 29 cases, 23 patients were followed up for more than 6 months. There was no spinal cord and nerve root injury during the treatment and follow-up. Operation time was from 80 to 120 min with a median of 90 min;intraoperative blood loss was from 35 to 80 ml with a median of 50 ml. NDI, VAS of neck, shoulder and arm each period after operation were significantly lower than those before PECD(P<0.05), while there were no significant improvement in cervical physiological curvature and target segment intervertebral space height(P>0.05);there was no significant change in interbody stability (P>0.05). After received the manual therapy, NDI significantly decreased (P<0.05), however, there was no significant difference in VAS of neck, shoulder and arm, physiological curvature of cervical spine and intervertebral space height of target segment compared with that before manual treatment (P>0.05);there was no significant change in interbody stability (P>0.05).@*CONCLUSION@#Manual therapy combined with PECD in the treatment of intractable cervical spondylotic radiculopathy can not only quickly improve the symptoms, but also alleviate the residual symptoms after PECD safely and effectively, and can not cause obvious signs of accelerated instability of cervical adjacent segments in the short term.


Subject(s)
Cervical Vertebrae/surgery , Child , Child, Preschool , Decompression/adverse effects , Female , Humans , Male , Musculoskeletal Manipulations , Radiculopathy/surgery , Retrospective Studies , Spondylosis/surgery , Treatment Outcome
4.
Article in Chinese | WPRIM | ID: wpr-927419

ABSTRACT

OBJECTIVE@#To observe the effect of wheat-grain moxibustion at "Dazhui" (GV 14) on the expressions of Beclin-1 and GRP78 in spinal dorsal horn in rats with cervical spondylotic radiculopathy (CSR), and to explore the possible analgesic mechanism of wheat-grain moxibustion for CSR.@*METHODS@#A total of 48 SD rats were randomly divided into a sham operation group, a model group, a wheat-grain moxibustion group and a wheat-grain moxibustion+3-MA group, 12 rats in each group. The CSR model was prepared by spinal cord insertion method. Three days after modeling, the rats in the model group were intraperitoneally injected with 1 mL of 0.9% sodium chloride solution; the rats in the wheat-grain moxibustion group were treated with wheat-grain moxibustion at "Dazhui" (GV 14, 6 cones per time) on the basis of the model group; the rats in the wheat-grain moxibustion+3-MA group were intraperitoneally injected with 3-MA solution and wheat-grain moxibustion at "Dazhui" (GV 14, 6 cones per time). The three groups were intervened for 7 days, once a day. The gait score and mechanical pain threshold were observed before treatment and 7 days into treatment; after the treatment, the expressions of mRNA and protein of Beclin-1 in spinal dorsal horn were detected by real-time fluorescence quantitative PCR and immunohistochemistry; the expression of GRP78 protein in spinal dorsal horn was detected by Western blot method; the autophagosomes and ultrastructure in spinal dorsal horn neurons were observed by electron microscope.@*RESULTS@#After the treatment, compared with the sham operation group, in the model group, the gait score was increased and the mechanical pain threshold was decreased (P<0.01), and the expression of GRP78 protein in spinal dorsal horn was increased (P<0.01). Compared with the model group and the wheat-grain moxibustion+3-MA group, in the wheat-grain moxibustion group, the gait score was decreased and mechanical pain threshold was increased (P<0.01), and the expression of GRP78 protein in spinal dorsal horn was decreased, and the expressions of mRNA and protein of Beclin-1 were increased (P<0.01). Under electron microscope, the ultrastructure of spinal dorsal horn neurons in the wheat-grain moxibustion group was not significantly damaged, and its structure was basically close to normal, and the number of autophagosomes was more than the other three groups.@*CONCLUSION@#Wheat-grain moxibustion at "Dazhui" (GV 14) has analgesic effect on CSR rats. The mechanism may be related to moderately up-regulate the expression of Beclin-1, enhance autophagy and reduce endoplasmic reticulum stress.


Subject(s)
Animals , Beclin-1/genetics , Endoplasmic Reticulum Chaperone BiP , Moxibustion , RNA, Messenger , Radiculopathy/therapy , Rats , Rats, Sprague-Dawley , Spinal Cord , Spinal Cord Dorsal Horn , Spondylosis , Triticum/genetics
5.
Rev. bras. ortop ; 56(6): 761-765, Nov.-Dec. 2021. tab
Article in English | LILACS | ID: biblio-1357148

ABSTRACT

Abstract Objective To show the accuracy of the most used maneuvers in the clinical diagnosis of lumbosciatalgia, the slump test and the Laségue sign. Methods In order to perform the present study, 101 patients with magnetic resonance imaging (MRI) discopathy (gold standard) were selected and had their medical records reviewed to identify which had the positive maneuvers on the initial physical examination. Results The sensitivity found for the slump test and the Laségue sign in the diagnosis of disc herniation was 55.3% and 18.1%, respectively. Nonetheless, when they were compared with each other for the diagnosis of disc bulging, the sensitivity obtained was of 85.7% for the slump test and of 28.6% for the Laségue sign. Conclusion Comparing both clinical exams with MRI, it was found that the slump test presents superior sensitivity compared with the Laségue sign for both the diagnosis of hernia and disc bulging, and should be more present in clinical practice.


Resumo Objetivo Mostrar a acurácia das manobras mais usadas no diagnóstico clínico da lombociatalgia, a manobra de slump ea de Laségue. Métodos Para a realização do presente estudo, foram selecionados 101 pacientes com discopatia na ressonância magnética (RM) (padrão ouro), sendo posteriormente realizada a revisão dos prontuários para identificar quais tiveram as manobras positivas no exame físico inicial. Resultados A sensibilidade encontrada para as manobras de slump e Laségue no diagnóstico de hérnia discal foi respectivamente 55,3% e 18,1%. Já quando comparamos as manobras para o diagnóstico de abaulamento discal, a sensibilidade obtida foi de 85,7% para a manobra de slump e de 28,6% para a manobra de Laségue. Conclusão Foi constatado que a manobra de slump apresenta sensibilidade superior à da manobra de Laségue tanto para o diagnóstico de hérnia quanto para o de abaulamento discal quando comparadas a RM, e deveria estar mais presente na prática clínica.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Radiculopathy , Magnetic Resonance Imaging , Clinical Diagnosis , Medical Records , Sensitivity and Specificity , Low Back Pain , Hernia , Intervertebral Disc Displacement
6.
Arq. neuropsiquiatr ; 79(10): 900-903, Oct. 2021. graf
Article in English | LILACS, SES-SP, CONASS, SESSP-ILSLPROD, SES-SP, SESSP-ILSLACERVO, SES-SP | ID: biblio-1345316

ABSTRACT

Abstract Background: Pruritus is a common complaint in dermatology. Wartenberg, in 1943, associated pruritus with neuropathy, relating it to the "posterior antebrachial cutaneous nerve neuropathy". In 1968, Waisman described patients with frequent pruritus complaints in the upper limb during the summer, which he named "brachioradial summer pruritus". Currently, this pruritus is named brachioradial pruritus (BRP). BRP is characterized by a chronic pruritus, usually localized, with a long duration, and without apparent cutaneous abnormalities. Neurological disorders both from the central and peripheral nervous systems, including multiple sclerosis, are associated with pruritus. Objective: To investigate correlations between symptomatic dermatomes and alterations in the myotomes, as evidenced by electroneuromyography (ENMG). Methods: Forty-six patients with BRP dermatological diagnoses were subjected to upper limb ENMG. Results: Among 46 patients with C5 to C8 dermatomal pruritus, we evaluated 113 symptomatic dermatomal areas. Overall, 39 (85%) patients had radicular involvement and 28 (60%) had agreement between complaint and the ENMG findings (p=0.015). A total of 80% of the patients with complaints at C7 and 47% at C6 had radicular involvement at the same level. Conclusions: Among the patients who presented complaints, 47 and 80%, respectively, had ENMG alterations in the C6 and C7 myotomes. We conclude that peripheral nervous system involvement is associated with BRP.


RESUMO Antecedentes: O prurido constitui queixa frequente e desafiadora na prática dermatológica. O primeiro estudo a relacionar prurido com neuropatia foi de Wartenberg, em 1943, que associou à "neuropatia do nervo cutâneo antebraquial posterior". Em 1968, Waisman descreveu pacientes com queixas recorrentes de prurido em membros superiores no verão, sendo denominado, então, "brachioradial summer pruritus". Atualmente, esse prurido é denominado como prurido braquiorradial (PBR). O PBR é caracterizado por prurido crônico, geralmente bem localizado, de longa duração e sem anormalidades cutâneas aparentes. Doenças neurológicas, tanto centrais, esclerose múltipla ou acidente vascular cerebral como do sistema nervoso periférico, estão associadas a prurido. Objetivo: Investigar os dermátomos sintomáticos pela eletroneuromiografia (ENMG). Métodos: Foram estudados 46 pacientes com diagnóstico dermatológico de PBR com a eletroneuromiografia dos membros superiores. Resultado: Foram avaliados 46 pacientes com queixa dermatológica de C5 a C8 somando 113 áreas dermatoméricas sintomáticas. Observou-se que 39 (85%) pacientes apresentavam comprometimento radicular, sendo que em 28 (60%) houve concordância plena entre as queixas e os achados da ENMG (p=0,015), e que 80% dos pacientes com queixa em território de C7 e 47% em C6 apresentavam comprometimento radicular no mesmo nível. Conclusões: As queixas mais frequentes foram as correspondentes aos territórios de C6 e C7, sendo que 47 e 80%, respectivamente, apresentaram alteração na ENMG nesses miótomos. Dessa forma, evidenciou-se correlação entre comprometimento do sistema nervoso periférico (i.e., radicular) com PBR.


Subject(s)
Humans , Pruritus , Peripheral Nervous System , Arm , Radiculopathy , Electromyography , Muscles , Nervous System Diseases
8.
Article in Chinese | WPRIM | ID: wpr-879402

ABSTRACT

OBJECTIVE@#To explore the short-term clinical efficacy of single-stage cervical spondylotic radiculopathy (CSR) between the minimally invasive Key-hole technique and anterior cervical Zero profile intervertebral fusion system (Zero-P).@*METHODS@#A retrospective analysis was performed on 45 patients who underwent surgical treatment for CSR from January 2017 to January 2020, including 21 in Key hole group (12 males and 9 females), followed up for 10-22(13.2±2.3) months;24 cases in Zero-P group (14 males and 10 females), and the follow up period was 10 to 23(12.7±1.9) months. Perioperative conditions (incision length, intraoperative blood loss, operation time, length of hospital stay, and complications) were compared between two groups, and X-rays of cervical spine before and after surgery and at the final follow-up were taken to analyzed curvature of the cervical spine, visual analogue scale(VAS) of pain before and after surgery, Oswestry Disability Index(ODI) and Japanese Orthopaedic Association (JOA) score of cervical spine were recorded to evaluate clinical efficacy.@*RESULTS@#In Key-hole group and Zero-P group, the surgical incision length, intraoperative blood loss, operation time, final follow-up Cobb angle and immediate postoperative VAS score respectively were (1.2±0.2) cm, (5.3±0.3) cm;(35.3±9.7) ml, (120.2±13.5) ml;(56.4±11.3) min, (90.6±12.6) min;(3.2±3.9)°, (7.3±3.8)°;(2.8±1.2)points, (3.8±1.1) points;the Zero-P group was larger than the Key hole group, with statistical significance(@*CONCLUSION@#The cervical spine Key-hole technology is similar to the anterior cervical Zero-P system in the treatment of CSR. The Key-hole technique has certain advantages in incision length, intraoperative blood loss, and operation time. It is a safe, effective and can be widely used cervical spine surgery method.


Subject(s)
Case-Control Studies , Cervical Vertebrae/surgery , Female , Humans , Male , Radiculopathy/surgery , Retrospective Studies , Spinal Fusion , Spondylosis/surgery , Treatment Outcome
9.
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
10.
Chinese Acupuncture & Moxibustion ; (12): 1259-1262, 2020.
Article in Chinese | WPRIM | ID: wpr-877596

ABSTRACT

OBJECTIVE@#To analyze the rules of acupoint selection in the acupuncture treatment of cervical spondylotic radiculopathy by data mining.@*METHODS@#The randomized controlled trials (RCTs) regarding acupuncture for cervical spondylotic radiculopathy published from July 15 of 2009 to July 15 of 2019 were retrieved from databases of CNKI, VIP, Wanfang, SinoMed, PubMed and EMbase. A database was established with Microsoft Excel 2016. The frequency and total effective rate of high-frequency acupoints, meridians and acupoint combinations were analyzed, and the association rules of acupoints and meridians were analyzed by Apriori algorithm.@*RESULTS@#A total of 87 RCTs were included, involving 104 acupoints with a total frequency of 921. Among them, the high-frequency acupoints were cervical Jiaji (EX-B 2, 87 times), Fengchi (GB 20, 70 times), Houxi (SI 3, 54 times), etc. The frequently-used acupoints were mainly distributed in the hand @*CONCLUSION@#It is feasible to explore the acupoint selection and compatibility rules of acupuncture for cervical spondylotic radiculopathy by data mining. This study could provide corresponding reference for clinical treatment.


Subject(s)
Acupuncture Points , Acupuncture Therapy , Data Mining , Humans , Meridians , Radiculopathy/therapy
11.
Article in Chinese | WPRIM | ID: wpr-828283

ABSTRACT

OBJECTIVE@#To explore the clinical efficacy and safety of posterior intervertebral foraminal discectomy via Delta channel for cervical spondylotic radiculopathy in the early phase.@*METHODS@#From September 2017 to July 2018, 10 patients with cervical spondylotic radiculopathy underwent posterior intervertebral foraminal discectomy via Delta channel. There were 6 males and 4 females, aged from 30 to 62 years old with an average of (41.5±4.3) years old. All of them had unilateral symptoms caused by cervical nerve root compression, including 2 cases of C, 5 cases of C and 3 cases of C. CT and MRI examination of all the patients did not show ossification of posterior longitudinal ligament or calcification of ligamentum flavum, and no cervical spine instability was present in dynamic radiographs. The clinical outcome was poor after more than 6 weeks of systematic non-surgical treatment. The VAS score, JOA score, NDI score, the cervical spine physiological curvature, and the height and stability of the compressed cervical vertebrae were measured before operation and at the latest follow-up.@*RESULTS@#All patients successfully completed the surgeries without any spinal cord, nerve root or major blood vessel injury. The operation time was 70 to 120 min with an average of 90 min. Intraoperative blood loss ranged from 30 to 90 ml with an average of 40 ml. All the 10 patients were followed up for 6 to 14 months with an average of 9 months. Postoperative nerve root pain got relievd and nerve function was improved in all patients. VAS score decreased from 7.15±2.01 before surgery to 1.59±0.83 at the latest follow-up;JOA score increased from 12.57±1.24 before surgery to 16.42±0.58 at the latest follow-up;NDI score increased from 41.82±4.71 before surgery to 9.59±3.52 at the latest follow-up. All the results above presented significant difference between latest follow-up and preoperative (0.05). At the latest follow-up, no cervical instability was observed on dynamic radiographs.@*CONCLUSION@#Treatment of cervical spondylotic radiculopathy by posterior intervertebral foraminal discectomy via Delta channel can obtain a satisfactory clinical outcome without affecting the stability of cervical vertebra. The surgery is safe, reliable and worthy of clinical application.


Subject(s)
Adult , Cervical Vertebrae , Diskectomy , Female , Humans , Male , Middle Aged , Radiculopathy , Retrospective Studies , Spinal Cord Diseases , Spinal Fusion , Spondylosis , Treatment Outcome
12.
Article in Chinese | WPRIM | ID: wpr-828278

ABSTRACT

OBJECTIVE@#To explore the safety, effectiveness and consistency of "Zoning Method" foraminotomy in posterior cervical endoscopic surgery.@*METHODS@#From March 2016 to October 2018, 21 patients with cervical spondylotic radiculopathy were enrolled. Endoscopic foraminotomy and nucleus pulposus enucleation were performed in the patients. There were 13 males and 8 females, aged from 35 to 56 years old with an average of (47.3±5.1) years. The surgical segment of 6 cases were C, 10 cases were C and 5 cases were C. The "Zoning Method" was proposed and used to complete the foraminotomy under endoscope, and then to perform nucleus pulposus removal and nerve root decompression. The operation length, intraoperative bleeding volume and complications were recorded, and NDI, VAS were evaluated before operation, 1 day after the operation and 1 week after the operation.@*RESULTS@#All the operations were successful. The operation length was(46.10±26.39) min, intraoperative bleeding volume was (50.10±18.25) ml, and there were no complications such as nerve injury, dural tear or vertebral artery injury. All 21 patients were followed up for 3 to 9 months, with a median of 6 months. Postoperative VAS and NDI were obvious improved (0.05).@*CONCLUSION@#Endoscopic foraminotomy with "Zoning Method" is safe clinically significant, and consistent.


Subject(s)
Adult , Cervical Vertebrae , Decompression, Surgical , Female , Foraminotomy , Humans , Male , Middle Aged , Neuroendoscopy , Radiculopathy , Spondylosis , Treatment Outcome
13.
Article in Chinese | WPRIM | ID: wpr-828088

ABSTRACT

Xiaoxuming Decoction is an ancient classic herbal formula for the treatment of stroke. In ancient times, the connotation of stroke was very extensive, including facial neuritis, acute cerebral infarction, acute cerebral hemorrhage, sequelae of cerebral hemorrhage, unexplained weakness of limbs, cervical spondylosis, acute myelitis, acute radiculitis, Guillain Barre syndrome, multiple sclerosis, myasthenia gravis, motor neuron disease, dermatomyositis, hypokalemic paralysis peripheral neuritis. It has been identified that: ①Xiaoxuming Decoction is very common in the treatment of cerebrovascular diseases, such as cerebral infarction, cerebral hemorrhage and other cerebrovascular diseases, facial neuritis, acute myelitis, acute radiculitis, Guillain Barre syndrome, unexplained limb weakness, multiple sclerosis, motor neuron disease, myasthenia gravis, and rheumatic and immune system diseases, such as dermatomyositis, and can not only alleviate symptoms, but also improve prognosis and the long-term survival rate. ②Sudden limb failure, facial paralysis, and hypoalgesia without heat syndrome are the key indications of Xiaoxuming Decoction. ③This is a special prescription for the treatment of acute facial neuritis, and can cure in one week in the combination with moxibustion. ④In the treatment of facial neuritis complicated with hypertension or acute cerebrovascular disease, Xiaoxuming Decoction generally has a certain antihypertensive effect, without any hypertensive effect, which reflected its two-way regulatory effect for blood pressure. ⑤In the treatment of unknown limb weakness, acute myelitis, acute radiculitis, Guillain Barre syndrome, Xiaoxuming Decoction can rapidly alleviate the symptoms. ⑥This is the basic formula for multiple sclerosis and motor neuron disease. Long term use of Xiaoxuming Decoction can alleviate the symptom of limb weakness, reduce the occurrence of complications and delay the progress of the disease, but with a poor long-term prognosis. ⑦In the treatment of myasthenia gravis, Xiaoxuming Decoction can significantly improve muscle strength, and gradually help stop hormone reduction. After thymoma surgery, Xiaoxuming Decoction is also applicable to some patients with recurrent myasthenia gravis. ⑧Xiaoxuming Decoction also plays a role in the treatment of dermatomyositis and cervical spondylopathy. ⑨Raw ephedra is the monarch drug of Xiaoxuming Decoction, which is the key to the effect. The dosage starts with 6 g is titrated in a small dose and increases gradually. In addition, this formula is forbidden for those with red face, fast heart rate, high blood pressure, blocked stool, red tongue, yellow fur, wiry and rapid pulse or powerful pulse, and spout pulse.


Subject(s)
Dermatomyositis , Facial Nerve Diseases , Guillain-Barre Syndrome , Humans , Motor Neuron Disease , Multiple Sclerosis , Myasthenia Gravis , Myelitis , Radiculopathy , Spondylosis
14.
Article in Chinese | WPRIM | ID: wpr-827241

ABSTRACT

OBJECTIVE@#To explore the biomechanical characteristics of "three-dimensional balanced manipulation" for the treatment of cervical spondylotic radiculopathy(CSR).@*METHODS@#A CSR patient was treated with "three-dimensional balanced manipulation", and the mechanical changes during the manipulation were monitored by mechanical testing system. Using spiral CT to scan the neck of the patient to obtain DICOM data. The three-dimensional finite element model of cervical spondylotic radiculopathy was established by using Mimics software, Geographic Studio software. The "three-dimensional balance manipulation" was simulated and loaded, and the mechanical parameters of each part were replaced into the finite element model, and the finite element analysis was carried out by using ANSYS software to study the internal stress changes and displacement deformation of vertebral body and intervertebral disc under the action of "three-dimensional balance manipulation".@*RESULTS@#The established C-C finite element model of the CSR patient consisted of 5 vertebrae, 4 intervertebral discs and 3 ligaments, involving 153 471 nodes and 64 978 units. The stress of C-C vertebral body was mainly located in anterior and root of C spinous processes, arch, vertebral arch and the combination of the two after full loading of manipulation, and the maximum stress was 17.781 MPa. The deformation sites were mainly concentrated in articular processes and anterior transverse processes of C, superior articular processes and transverse processes of C, articular processes of C. The stress of C-C intervertebral disc mainly distributed in the anterior part of C intervertebral disc and the nucleus pulposus of C and C. The displace mentextended to the middle and posterior part of C nucleus pulposus, around the nucleus of C and C and anterior part of cervical intervertebral disc.@*CONCLUSION@#The establishment of three-dimensional finite element model of C-C cervical spondylotic radiculopathy can simulate the geometry and material properties of cervical spine, and also accurately reflects the biomechanical characteristics of cervical spine, verifys the internal mechanism of "three-dimensional balanced manipulation" on CSR, proves the safety and effectiveness of treatment, guides more standardized manipulation, and avoids medical accidents.


Subject(s)
Biomechanical Phenomena , Cervical Vertebrae , Finite Element Analysis , Humans , Intervertebral Disc , Radiculopathy , Range of Motion, Articular , Spondylosis
15.
Article in Chinese | WPRIM | ID: wpr-880800

ABSTRACT

OBJECTIVE@#To evaluate the efficacy of lumbar transforaminal epidural block (LTEB) for treatment of low back pain with radicular pain.@*METHODS@#We retrospectively analyzed the clinical data of 78 patients with low back pain and radicular pain admitted to the Department of Orthopedics of Beijing Chuiyangliu Hospital from March, 2017 to April, 2019. Thirty-three of the patients received treatment with LTEB (LTEB group), and 45 received comprehensive conservative treatment including traction, massage, acupuncture and physiotherapy (control group). The demographic and clinical data of the two groups were compared. The patients were followed up for 3 to 24 months, and numerical rating scale (NRS) and Oswestry disability index (ODI) scores of the patients were evaluated before the treatment and at 2 weeks, 1 month and 3 months after discharge to assess the efficacy of the treatment.@*RESULTS@#The mean operation time of LTEB was 25.7 7.5 min (15-45 min). After the operation, 5 patients developed weakness of the lower limbs but all recovered within 24-72 h. The patients receiving LTEB all showed significantly decreased NRS scores for low back and radicular pain and ODI scores after the operation (@*CONCLUSIONS@#As a minimally invasive approach, LTEB is effective for treatment of low back pain with radicular pain and can produce good short-term effects of pain relief and functional improvement.


Subject(s)
Humans , Injections, Epidural , Low Back Pain/drug therapy , Lumbar Vertebrae , Radiculopathy/drug therapy , Retrospective Studies , Treatment Outcome
16.
Article in English | WPRIM | ID: wpr-811122

ABSTRACT

BACKGROUND: Previous studies have reported what patients value while choosing their surgeon, but there are no studies exploring the patterns of referral to spine surgeons among primary care physicians (PCPs). This study aims to identify any trends in PCPs' referral to orthopedic surgery versus neurosurgery for spinal pathology.METHODS: In total, 450 internal medicine, family medicine, emergency medicine, neurology, and pain management physicians who practice at one of three locations (suburban community hospital, urban academic university hospital, and urban private practice) were asked to participate in the study. Consenting physicians completed our 24-question survey addressing their beliefs according to pathologies, locations of pathologies, and surgical interventions.RESULTS: Overall, 108 physicians (24%) completed our survey. Fifty-seven physicians (52.8%) felt that neurosurgeons would provide better long-term comprehensive spinal care. Overall, 66.7% of physicians would refer to neurosurgery for cervical spine radiculopathy; 52.8%, to neurosurgery for thoracic spine radiculopathy; and 56.5%, to orthopedics for lumbar spine radiculopathy. Most physicians would refer all spine fractures to orthopedics for treatment except cervical spine fractures (56.5% to neurosurgeons). Most physicians would refer to neurosurgery for extradural tumors (91.7%) and intradural tumors (96.3%). Most would refer to orthopedic surgeons for chronic pain. Finally, physicians would refer to orthopedics for spine fusion (61.1%) and discectomy (58.3%) and to neurosurgery for minimally invasive surgery (59.3%).CONCLUSIONS: Even though both orthopedic surgeons and neurosurgeons are intensively trained to treat a similar breath of spinal pathology, physicians vary in their referring patterns according to spinal pathology, location of pathology, and intended surgery. Education on the role of spine surgeons among PCPs is essential in ensuring unbiased referral patterns.


Subject(s)
Chronic Pain , Diskectomy , Education , Emergency Medicine , Hospitals, Community , Humans , Internal Medicine , Minimally Invasive Surgical Procedures , Neurology , Neurosurgeons , Neurosurgery , Orthopedics , Pain Management , Pathology , Physicians, Primary Care , Radiculopathy , Referral and Consultation , Spine , Surgeons
17.
Rev. Soc. Bras. Med. Trop ; 52: e20180335, 2019. graf
Article in English | LILACS | ID: biblio-1003134

ABSTRACT

Abstract The most common neurological impairments related to schistosomiasis involve the lower portions of the medulla and the cauda equina. A 22-year-old woman, with no history, signs, or symptoms of hepatointestinal schistosomiasis, presented with lumbar pain associated with acute paresthesia and paresis of the right lower limb. Spinal schistosomiasis was suspected based on the disease progression and radiological findings, and the diagnosis was confirmed after cerebrospinal fluid analysis. The authors emphasize this pathology as important as a differential diagnosis in similar clinical scenarios, especially in endemic areas, because both early diagnosis and treatment are essential to avoid permanent sequelae.


Subject(s)
Humans , Female , Young Adult , Radiculopathy/diagnosis , Neuroschistosomiasis/diagnosis , Radiculopathy/cerebrospinal fluid , Spinal Cord Diseases/diagnosis , Spinal Cord Diseases/cerebrospinal fluid , Magnetic Resonance Imaging , Neuroschistosomiasis/cerebrospinal fluid , Diagnosis, Differential
18.
The Korean Journal of Pain ; : 280-285, 2019.
Article in English | WPRIM | ID: wpr-761711

ABSTRACT

BACKGROUND: Pulsed radiofrequency (PRF) is a treatment modality that alleviates radicular pain by intermittently applying high-frequency currents adjacent to the dorsal root ganglion. There has been no comparative study on analgesic effect according to the position of the needle tip in PRF treatment. The objective of this study is to evaluate the clinical outcomes of PRF according to the needle tip position. METHODS: Patients were classified into 2 groups (group IP [group inside of pedicle] and group OP [group outside of pedicle]) based on needle tip position in the anteroposterior view of fluoroscopy. In the anteroposterior view, the needle tip was advanced medially further than the lateral aspect of the corresponding pedicle in group IP; however, in group OP, the needle tip was not advanced. The treatment outcomes and pain scores were evaluated at 4, 8, and 12 weeks after applying PRF. RESULTS: At 4, 8, and 12 weeks, there were no significant differences between the successful response rate and numerical rating scale score ratio. CONCLUSIONS: The analgesic efficacy of PRF treatment did not differ with the needle tip position.


Subject(s)
Analgesics , Fluoroscopy , Ganglia, Spinal , Humans , Low Back Pain , Lumbosacral Region , Needles , Observational Study , Pulsed Radiofrequency Treatment , Radiculopathy , Retrospective Studies , Spinal Nerve Roots
19.
The Korean Journal of Pain ; : 147-159, 2019.
Article in English | WPRIM | ID: wpr-761703

ABSTRACT

Lumbar foraminal pathology causing entrapment of neurovascular contents and radicular symptoms are commonly associated with foraminal stenosis. Foraminal neuropathy can also be derived from inflammation of the neighboring lateral recess or extraforaminal spaces. Conservative and interventional therapies have been used for the treatment of foraminal inflammation, fibrotic adhesion, and pain. This update reviews the anatomy, pathophysiology, clinical presentation, diagnosis, and current treatment options of foraminal neuropathy.


Subject(s)
Constriction, Pathologic , Decompression , Diagnosis , Electric Stimulation , Fibrosis , Foraminotomy , Ganglia, Spinal , Inflammation , Lumbosacral Region , Pain Management , Pathology , Radiculopathy , Spinal Nerve Roots
20.
The Korean Journal of Pain ; : 196-205, 2019.
Article in English | WPRIM | ID: wpr-761698

ABSTRACT

BACKGROUND: Hypertonic saline (HS) injections for decompressive neuroplasty (DN) can cause pain. We assessed whether a continuous infusion of HS through an infusion pump would reduce injection-related pain compared with repeated bolus administrations. METHODS: Fifty patients scheduled for DN were randomized to either the bolus injection or the continuous infusion group. After appropriately placing the epidural catheter, 4 mL of 5% NaCl was injected as four boluses of 1 mL each at 15-minute intervals or infused over 1 hour using an infusion pump. The severity of pain induced by HS injection, as measured by the 11-point numerical rating scale (NRS), was the primary outcome. The severity of low back or lower extremity pain, as measured by the 11-point NRS and Oswestry Disability Index (ODI), 3 months following the procedure, was the secondary outcome. RESULTS: Data from 21 patients in the bolus group and 23 in the continuous infusion group were analyzed. No statistically significant difference in injection-related pain was identified between the two groups during the initial HS administration (P = 0.846). However, there was a statistically significant reduction in injection-related pain in the continuous infusion group compared to the bolus injection group from the second assessment onwards (P = 0.001, < 0.001, and < 0.001, respectively). No significant between-group differences in the NRS and ODI scores 3 months post-procedure were noted (P = 0.614 and 0.949, respectively). CONCLUSIONS: Our study suggests that administering HS through a continuous infusion is a useful modality for reducing HS injection-related pain during DN.


Subject(s)
Catheters , Chronic Pain , Humans , Infusion Pumps , Injections, Epidural , Low Back Pain , Lower Extremity , Radiculopathy , Saline Solution, Hypertonic , Spinal Stenosis
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