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1.
Prensa méd. argent ; 107(8): 412-417, 20210000. tab
Article in Spanish | LILACS, BINACIS | ID: biblio-1358664

ABSTRACT

El dolor lumbar bajo y el dolor cervical con o sin irradiación son causas muy comunes de consulta a los médicos generalistas en los países desarrollados. La discopatía aguda y el dolor por estenosis del canal espinal son los diagnósticos más frecuentes. La postura tradicional ha sido la de administrar antiinflamatorios no esteroideos (AINES) para estas lumbalgias o cervicalgias agudas. Cuando existe irradiación neural por compresión radicular es usual asociar al AINE un corticoide a baja dosis, así como un antineurítico, para lograr un mejor resultado. Con el objeto de documentar la utilidad de esta práctica habitual, efectuamos en 142 pacientes ambulatorios un estudio multicéntrico randomizado que compara la efectividad y la tolerancia de una asociación a dosis fija de diclofenac, betametasona y cianocobalamina administrada por vía oral versus la administración de diclofenac como monofármaco en el tratamiento de la patología dolorosa de la columna lumbar y cervical asociada a compresión neural. La asociación demostró ser más eficaz en controlar el dolor y mejorar la funcionalidad de los pacientes que la administración de diclofenac en forma aislada y se asoció a escasos efectos colaterales, principalmente digestivos


Low back pain and neck pain with or without radiation are very common causes of consultation with general practitioners in developed countries. Acute discopathy and pain due to spinal canal stenosis are the most frequent diagnoses. The traditional approach has been to administer non-steroidal antiinflammatory drugs (NSAIDs) for these acute low back or cervical pain. When there is neural radiation due to root compression, it is usual to associate a low-dose corticosteroid with the NSAID, as well as an antineuritic, to achieve a better result. In order to document the usefulness of this routine practice, we conducted a randomized multicenter study in 142 outpatients that compared the effectiveness and tolerance of a fixed-dose combination of diclofenac, betamethasone, and cyanocobalamin administered orally versus the administration of diclofenac as Monopharmaceutical in the treatment of painful pathology of the lumbar and cervical spine associated with neural compression. The association proved to be more effective in controlling pain and improving the functionality of patients than the administration of diclofenac in isolation and was associated with few side effects, mainly digestive


Subject(s)
Humans , Adult , Middle Aged , Cats , Spinal Stenosis/therapy , Vitamin B 12/administration & dosage , Randomized Controlled Trials as Topic , Diclofenac/administration & dosage , Administration, Oral , Treatment Outcome , Low Back Pain/drug therapy , Neck Pain/drug therapy , Drug Combinations , Drug Evaluation
2.
Coluna/Columna ; 20(3): 189-191, July-Sept. 2021.
Article in English | LILACS | ID: biblio-1339740

ABSTRACT

ABSTRACT Objective To study the role of epidural steroid injection (ESI) in patients with lumbar disc herniation (LDH) and lumbar canal stenosis (LCS). ESIs are regularly used to support non-operative treatment for LBP, and our anecdotal impression is that a considerable proportion of patients report substantial pain relief after ESI. Methods One thousand consecutive patients (645 patients with LDH and 355 patients with LCS) who required ESI from January-August 2018 were included. All were given the same ESI, prepared with triamcinolone (80 mg), bupivacaine (0.25%, 4 ml) and normal saline (4 ml). Patients were evaluated using the numerical rating scale (NRS) immediately after the injection, after 7 days, and after 3 months. Results The mean NRS back-pain score of the LDH-group was reduced from 5 (range: 4-8) to 4 (range: 2-7) immediately after injection, 2 (range: 1-7) after 7 days and 2 (range: 1-7) after 3 months (p-value<0.001). The mean NRS back-pain score of the LCS-group was reduced from 5 (range: 4-8) to 4 (range: 2-7) immediately after injection, 2 (range: 1-7) after 7 days and 3 (range: 1-7) after 3 months (p-value <0.001). The mean NRS leg-pain score of the LDH group was reduced from 5 (range: 4-9) to 3 (range: 3-7) immediately after injection, 1 (range: 1-6) after 7 days and 2 (range: 1-7) after 3 months (p-value <0.001). The mean NRS leg-pain score of the LCS group was reduced from 5 (range: 4-9) to 4 (range: 3-7) immediately after injection, 3 (range: 1-7) after 7 days and 2 (range 1-6) after 3 months (p-value <0.001). Conclusion ESI causes statistically significant improvement in back and leg pain in patients with LDH and LCS. However, the short and medium-term efficacy of ESI in the LCS group was lower than in the LDH group. Level of evidence IV; Prospective hospital-based study.


RESUMO Objetivo Estudar o papel da injeção epidural de esteroides (IEE) em pacientes com hérnia de disco lombar (HDL) e estenose do canal lombar (ECL). As IEEs são usadas regularmente para dar suporte ao tratamento não cirúrgico da dor lombar e nossa impressão empírica é que uma proporção considerável de pacientes relata alívio substancial da dor depois da IEE. Métodos Foram incluídos mil pacientes consecutivos (645 pacientes com HDL e 355 pacientes com ECL) que precisaram de IEE de janeiro a agosto de 2018. Todos receberam a mesmo IEE preparada com triamcinolona (80 mg), bupivacaína (0,25% 4 ml) e solução salina normal (4 ml). Os pacientes foram avaliados pela Escala de Estimativa Numérica (NRS, Numeric Rating Scale) imediatamente, 7 dias e 3 meses depois. Resultados O escore médio de dor nas costas da NRS no grupo HDL foi reduzida de 5 (intervalo: 4-8) para 4 (intervalo: 2-7) imediatamente após a injeção, para 2 (intervalo: 1-7) após 7 dias e para 2 (intervalo: 1-7) após 3 meses (valor de p < 0,001). O escore médio de dor nas costas do NRS do grupo ECL foi reduzida de 5 (intervalo: 4-8) para 4 (intervalo: 2-7) imediatamente após a injeção, para 2 (intervalo: 1-7) após 7 dias e para 3 (intervalo: 1- 7) após 3 meses (valor de p <0,001). O escore médio de dor na perna da NRS do grupo HDL foi reduzida de 5 (intervalo: 4-9) para 3 (intervalo: 3-7) imediatamente após a injeção, para 1 (intervalo: 1-6) após 7 dias e para 2 (intervalo: 1-7) após 3 meses (valor de p < 0,001). O escore médio de dor na perna da NRS do grupo ECL foi reduzida de 5 (intervalo: 4-9) para 4 (intervalo: 3-7) imediatamente após a injeção, para 3 (intervalo: 1-7) após 7 dias e para 2 (intervalo 1-6) após 3 meses (valor de p < 0,001). Conclusão A IEE causa melhora estatisticamente significativa das dores nas costas e nas pernas em pacientes com HDL e ECL. No entanto, a eficácia a curto e médio prazo da IEE na ECL foi menor do que a da HDL. Nível de evidência IV; Estudo prospectivo baseado em hospital.


RESUMEN Objetivo Estudiar el papel de la inyección epidural de esteroides (IEE) en pacientes con hernia de disco lumbar (HDL) y estenosis del canal lumbar (ECL). Las IEE se utilizan regularmente para respaldar el tratamiento no quirúrgico del dolor lumbar y nuestra impresión empírica es que una proporción considerable de pacientes informa alivio sustancial del dolor después de la IEE. Métodos Se incluyeron mil pacientes consecutivos (645 pacientes con HDL y 355 pacientes con ECL) que necesitaron IEE de enero a agosto de 2018. A todos se les administró la misma IEE preparada con triamcinolona (80 mg), bupivacaina (0,25% 4 ml) y solución salina normal (4 ml). Los pacientes fueron evaluados usando una Escala de Valoración Numérica (NRS, Numeric Rating Scale) inmediatamente, 7 días y de 3 meses después. Resultados La puntuación media de dolor de espalda de la NRS del grupo HDL se redujo de 5 (rango: 4-8) a 4 (rango: 2-7) inmediatamente después de la inyección, a 2 (rango: 1-7) después de 7 días y a 2 (rango: 1-7) después de 3 meses (valor de p < 0,001). La puntuación media de dolor de espalda de la NRS del grupo ECL se redujo de 5 (rango: 4-8) a 4 (rango: 2-7) inmediatamente después de la inyección, a 2 (rango: 1-7) después de 7 días y a 3 (rango: 1- 7) después de 3 meses (valor de p < 0,001). La puntuación media de dolor de pierna de la NRS del grupo HDL se redujo de 5 (rango: 4-9) a 3 (rango: 3-7) inmediatamente después de la inyección, a 1 (rango: 1-6) después de 7 días y a 2 (rango: 1-7) después de 3 meses (valor p < 0,001). La puntuación media de dolor de pierna de la NRS del grupo ECL se redujo de 5 (rango: 4-9) a 4 (rango: 3-7) inmediatamente después de la inyección, a 3 (rango: 1-7) después de 7 días y a 2 (rango 1-6) después de 3 meses (valor p < 0,001). Conclusión IEE causa una mejoría estadísticamente significativa en el dolor de espalda y piernas en pacientes con HDL y ECL. Sin embargo, la eficacia a corto y medio plazo de la IEE en la ECL fue menor que la de HDL. Nivel de evidencia IV;Estudio prospectivo basado en hospitales.


Subject(s)
Humans , Spinal Stenosis , Back Pain , Hernia
3.
Coluna/Columna ; 20(1): 50-54, Jan.-Mar. 2021. tab, graf
Article in English | LILACS | ID: biblio-1154020

ABSTRACT

ABSTRACT Objective: To verify the effectiveness of indirect decompression after lateral access fusion in patients with high pelvic incidence. Methods: A retrospective, non-comparative, non-randomized analysis of 22 patients with high pelvic incidence who underwent lateral access fusion, 11 of whom were male and 11 female, with a mean age of 63 years (52-74), was conducted. Magnetic resonance exams were performed within one year after surgery. The cross-sectional area of the thecal sac, anterior and posterior disc heights, and bilateral foramen heights, measured pre- and postoperatively in axial and sagittal magnetic resonance images, were analyzed. The sagittal alignment parameters were measured using simple radiographs. The clinical results were evaluated using the ODI and VAS (back and lower limbs) questionnaires. Results: In all cases, the technique was performed successfully without neural complications. The mean cross-sectional area increased from 126.5 mm preoperatively to 174.3 mm postoperatively. The mean anterior disc height increased from 9.4 mm preoperatively to 12.8 mm postoperatively, while the posterior disc height increased from 6.3 mm preoperatively to 8.1 mm postoperatively. The mean height of the right foramen increased from 157.3 mm in the preoperative period to 171.2 mm in the postoperative period and that of the left foramen increased from 139.3 mm in the preoperative to 158.9 mm in the postoperative. Conclusions: This technique is capable of correcting misalignment in spinal deformity, achieving fusion and promoting the decompression of neural elements. Level of evidence III; Retrospective study.


RESUMO Objetivo: Verificar a eficácia da descompressão indireta depois de fusão por acesso lateral em pacientes com alta incidência pélvica. Métodos: Análise retrospectiva, não comparativa, não randomizada de 22 pacientes com alta incidência pélvica submetidos à fusão por acesso lateral; 11 do sexo masculino e 11 do sexo feminino, com média de idade de 63 anos (52 a 74). Os exames de ressonância magnética foram realizados até um ano depois da cirurgia. Foram analisadas: área da seção transversal do saco tecal, altura discal anterior e posterior, altura dos forames bilaterais, medidas no pré e pós-operatório em imagens de ressonância magnética axial e sagital. Os parâmetros do alinhamento sagital foram medidos a partir de radiografia simples. Os resultados clínicos foram avaliados com os questionários ODI e EVA (costas e membros inferiores). Resultados: Em todos os casos, a técnica foi realizada com sucesso, sem complicações neurais. A área da secção transversal média aumentou de 126,5 mm no pré-operatório para 174,3 mm no pós-operatório. A média da altura anterior do disco aumentou de 9,4 mm no pré-operatório para 12,8 mm no pós-operatório, enquanto a altura posterior do disco aumentou de 6,3 mm no pré-operatório para 8,1 mm no pós-operatório. A média da altura do forame direito aumentou de 157,3 mm no pré-operatório para 171,2 mm no pós-operatório e a do forame esquerdo aumentou de 139,3 mm no pré-operatório para 158,9 mm no pós-operatório. Conclusões: Essa técnica é capaz de corrigir o desalinhamento na deformidade da coluna vertebral, alcançando a fusão e promovendo a descompressão dos elementos neurais. Nível de evidência III; Estudo Retrospectivo.


RESUMEN Objetivo: Verificar la eficacia de la descompresión indirecta después de fusión por acceso lateral en pacientes con alta incidencia pélvica. Métodos: Análisis retrospectivo, no comparativo, no aleatorizado de 22 pacientes con alta incidencia pélvica sometidos a fusión por acceso lateral; 11 del sexo masculino y 11 del sexo femenino, con promedio de edad de 63 años (52 a 74). Los exámenes de resonancia magnética fueron realizados hasta un año después de la cirugía. Fueron analizadas: área de la sección transversal del saco dural, altura discal anterior y posterior, altura de los for ámenes bilaterales, medidas en el pre y posoperatorio en imágenes de resonancia magnética axial y sagital. Los parámetros de la alineación sagital fueron medidos a partir de una radiografía simple. Los resultados clínicos fueron evaluados con los cuestionarios ODI y EVA (espalda y miembros inferiores). Resultados: En todos los casos, la técnica fue realizada con éxito, sin complicaciones neurales. El área de la sección transversal promedio aumentó de 126,5 mm en el preoperatorio para 174,3 mm en el postoperatorio. El promedio de altura anterior del disco aumentó de 9,4 mm en el preoperatorio para 12,8 mm en el postoperatorio, mientras que la altura posterior del disco aumentó de 6,3 mm en el preoperatorio para 8,1 mm en el postoperatorio. El promedio de altura del foramen derecho aumentó de 157,3 mm en el preoperatorio para 171,2 mm en el postoperatorio y la del foramen izquierdo aumentó de 139,3 mm en el preoperatorio para 158,9 mm en el postoperatorio. Conclusiones: Esta técnica es capaz de corregir la desalineación en la deformidad de la columna vertebral, alcanzando la fusión y promoviendo la descompresión de los elementos neurales. Nivel de evidencia III; Estudio retrospectivo.


Subject(s)
Humans , Arthrodesis , Spinal Stenosis , Decompression
4.
Rev. bras. ortop ; 56(1): 9-17, Jan.-Feb. 2021. graf
Article in English | LILACS | ID: biblio-1288652

ABSTRACT

Abstract Degenerative lumbar spinal stenosis is the most frequent cause of low back pain and/or sciatica in the elderly patient. Epidemiology, pathophysiology, clinical manifestations and testing are reviewed in a wide current bibliographic investigation. The importance of the relationship between clinical presentation and imaging study, especially magnetic resonance imaging (MRI), is emphasized. Prior to treatment indication, it is necessary to identify the precise location of pain, as well as the differential diagnosis between neurological and vascular lameness. Conservative treatment combining medications with various physical therapy techniques solves the problem in most cases, while therapeutic testing with injections, whether epidural, foraminal or facetary, is performed when pain does not subside with conservative treatment and before surgery is indicated. Injections usually perform better results in relieving sciatica symptoms and less in neurological lameness. Equine tail and/or root decompression associated or not with fusion is the gold standard when surgical intervention is required. Fusion after decompression is necessary in cases with segmental instability, such as degenerative spondylolisthesis. When canal stenosis occurs at multiple levels and is accompanied by axis deviation, whether coronal and/or sagittal, correction of axis deviations should be performed in addition to decompression and fusion, especially of the sagittal axis, in which a lumbar lordosis correction is required with techniques that correct the rectified lordosis to values close to the pelvic incidence.


Resumo A estenose degenerativa do canal vertebral lombar é a causa mais frequente de dor lombar e/ou ciática no paciente idoso; sua epidemiologia, fisiopatogenia, manifestações e testes clínicos são revistos em ampla investigação bibliográfica atual. A importância da relação entre a clínica e o estudo por imagens, principalmente a ressonância magnética (RM), é ressaltada. Antes da indicação do tratamento, é necessário identificar a localização precisa da dor, bem como o diagnóstico diferencial entre a claudicação neurogênica e a vascular. O tratamento conservador associando medicações com as diversas técnicas fisioterápicas resolve o problema na maioria dos casos, já o teste terapêutico com os bloqueios, seja epidural, foraminal ou facetário, é realizado quando as dores não cedem com o tratamento conservador e antes da indicação da cirurgia. Os bloqueios costumam dar melhores resultados no alívio dos sintomas de ciatalgia e menos no quadro de claudicação neurogênica. A descompressão da cauda equina e/ou radicular associada ou não à artrodese é o padrão ouro quando a intervenção cirúrgica é necessária. A artrodese após a descompressão é necessária nos casos com instabilidade segmentar, como na espondilolistese degenerativa. Quando a estenose de canal acontece em múltiplos níveis e vem acompanhada de desvio de eixo, seja coronal e/ou sagital, deve ser realizada, além das descompressões e artrodese, a correção dos desvios de eixo, principalmente o eixo sagital, quando a correção da lordose lombar se impõe com técnicas que corrigem a lordose retificada para valores próximos à incidência pélvica.


Subject(s)
Humans , Pain , Arthrodesis , Spinal Stenosis , Magnetic Resonance Spectroscopy , Low Back Pain , Constriction, Pathologic , Decompression , Diagnosis, Differential , Intermittent Claudication
5.
Article in Spanish | LILACS, BINACIS | ID: biblio-1353908

ABSTRACT

Introducción: La laminectomía unilateral para descompresión bilateral por abordaje único ha tomado relevancia en pacientes con estenosis multinivel. Cuando se realiza en más de un nivel por un abordaje único, de manera alterna y de forma cruzada, al abordaje anterior es conocida como técnica de "slalom". Elobjetivode este artículo es presentar una serie de casos tratados con la técnica de "slalom" con asistencia endoscópica y microscópica bilateral, simultánea, en pacientes con estenosis de canal lumbar multinivel.materiales y métodos: Análisis retrospectivo de pacientes tratados de forma simultánea, entre enero de 2017 y enero de 2018, todos operados por el mismo equipo quirúrgico con separadores tubulares, y asistencia endoscópica y micros-cópica simultánea.Resultados: Se incluyó a 4 hombres, con una edad promedio de 73.5 años y patología lumbar multinivel. Se descomprimieron 10 segmentos (2,5 media de niveles por paciente), con un tiempo quirúrgico promedio de 107 minutos. No hubo complicaciones asociadas y los pacientes recibieron el alta hospitalaria el día de la cirugía.Conclusiones:La técnica de "slalom" mínimamente invasiva resulta ser un procedimiento muy eficaz para resolver síntomas de estenosis multinivel asociada a una técnica combinada bilateral con dos equipos quirúrgicos para el tratamiento de este tipo de pacientes. Nivel de Evidencia: IV


Introduction: Unilateral laminectomy for bilateral decompression (ULBD) by single approach has become relevant in patients with multilevel stenosis, when it is performed at more than one level with single approach, alternately and crosswise to the previous approach is known as a slalom technique.The objective of the following work is to present a series of cases treated with the slalom technique with bilateral endoscopic and microscopic assistance, simultaneous in patients with multilevel lumbar canal stenosis. Materials and Methods: Retrospective analysis of patients treated simultaneously between the months of January 2017 to January 2018, all operated by the same surgical team with tubular separators and simultaneous endoscopic and microscopic assistance. Results: Four patients, all male, with an average age of 73.5 years with multilevel lumbar pathology, were included. In total 10 segments were decompressed (2.5 average level for patients), with an average surgery of 107 minutes. No associated complications, with hospital discharge within the day of surgery. Conclusions: The minimally invasive Slalom technique turns out to be a very effective procedure to resolve symptoms of multilevel stenosis associated with a bilateral combined technique with two surgical teams, resulting in a viable option for the treatment of this type of patient. Level of Evidence: IV


Subject(s)
Aged , Spinal Stenosis , Minimally Invasive Surgical Procedures , Decompression, Surgical , Lumbar Vertebrae
6.
Article in Chinese | WPRIM | ID: wpr-921920

ABSTRACT

OBJECTIVE@#To evaluate the effect of degenerative scoliosis on the difficulty and efficacy of minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF) in the treatment of lumbar spinal stenosis.@*METHODS@#From September 2016 to September 2019, 52 patients with lumbar spinal stenosis treated by MIS-TLIF were retrospectively analyzed, including 16 males and 36 females, aged from 42 to 71(63.44±5.96) years old, the course of disease from 1.5 to 6.5 years, with an average of (3.69±1.10) years. All patients had lower extremity root pain or numbness, 41 patients had intermittent claudication. There were 31 cases of L@*RESULTS@#All patients were followed up for 12 to 36 months, with an average of (19.58±5.33) months. The operation time and intraoperative bleeding in stenosis group were better than those in scoliosis group (@*CONCLUSION@#For patients with lumbar spinal stenosis undergoing MIS-TLIF, degenerative scoliosis can lead to prolonged operation time and increased bleeding. However, it has no significant effect on therelief of postoperative symptoms, postoperative complications and the recovery of lumbar function.


Subject(s)
Adult , Aged , Female , Humans , Lumbar Vertebrae/surgery , Male , Middle Aged , Minimally Invasive Surgical Procedures , Retrospective Studies , Scoliosis/surgery , Spinal Fusion , Spinal Stenosis/surgery , Treatment Outcome
7.
Article in Chinese | WPRIM | ID: wpr-879439

ABSTRACT

OBJECTIVE@#To explore the clinical effect of modified interlaminar approach for the treatment of single-segment lumbar spinal stenosis.@*METHODS@#From February 2015 to August 2017, 80 patients with single-segment lumbar spinal stenosis planned to undergo endoscopic surgery were selected, including 38 males and 42 females;aged 33 to 69 (47.6±9.5) years old. Using random number table method, the patients were divided into study group and traditional group, 40 cases in each group, and underwent surgical treatment through modified translaminar approach and traditional approach respectively. The operation time, intraoperative blood loss, and hospital stay were recorded;visual analogue scale (VAS) and Oswestry Disability Index (ODI) before and after operation were compared between two groups;spinal canal arca, spinal canal diameter, disc yellow space and surgical complications were observed.@*RESULTS@#All 80 patients were followed up for at least 3 months. Two patients had incision infection, both of them were in traditional group;there was no significant difference in operation time between two groups(@*CONCLUSION@#Compared with the traditional approach, the modified interlaminar approach has advantages of less trauma, faster recovery and better postoperative spinal space recovery in the treatment of single-segment lumbar spinal stenosis.


Subject(s)
Adult , Aged , Case-Control Studies , Female , Humans , Lumbar Vertebrae/surgery , Male , Middle Aged , Retrospective Studies , Spinal Fusion , Spinal Stenosis/surgery , Treatment Outcome
8.
Article in Chinese | WPRIM | ID: wpr-879424

ABSTRACT

OBJECTIVE@#To observe the clinical effect of transforaminal endoscopy combined with interspinous fusion in the treatment of lumbar spinal stenosis with instability in the elderly.@*METHODS@#From February 2018 to February 2019, 82 elderly patients with lumbar spinal stenosis and instability were divided into control group and observation group. In the control group, there were 23 males and 18 females;the age was (68.9±4.1) years;the course of disease was (14.1±5.7) months;there were 5 cases of single segment lesions and 36 cases of multi segment lesions;simple bacfuse interspinous fusion was used. In the observation group, there were 22 males and 19 females;the age was (69.1±4.0) years;the course of diseasewas (14.4±5.5) months;there were 6 cases of single segment lesions and 35 cases of multi segment lesions;they were treated with transforaminal endoscopic surgery combined with Bacfuse interspinous fusion. The clinical efficacy, visual analogue scale (VAS), Japanese Orthopaedic Association scores (JOA), Oswestry disability index (ODI), Lehmann lumbar function score, posterior disc height and intervertebral foramen height, complication rate and recurrence rate of the two groups were compared.@*RESULTS@#The clinical efficacy of the observation group was better than that of the control group;the VAS score of the observation group was lower than that of the control group, the JOA score was higher than that of the control group, and the ODI index at 3 months after operation and at the last follow-up was lower than that of the control group, the Lehmann lumbar function score was higher than that of the control group;the posterior edge height of intervertebral disc and intervertebral foramen height were higher than those of the controlgroup;the incidence of complications and recurrence rate (4.9% and 0.0%) of the observation group were lower than those of the control group (19.5%, 9.8%), the difference was statistically significant (@*CONCLUSION@#The clinical effect of transforaminal endoscopy combined with interspinous process fusion in the treatment of lumbar spinal stenosis with instability in the elderly is ideal. It can reduce postoperative pain, improve lumbar function, improve the height of posterior edge of intervertebral disc and intervertebral foramen, and reduce the incidence and recurrence rate. It is worthy of clinical promotion.


Subject(s)
Aged , Endoscopy , Female , Humans , Intervertebral Disc Degeneration , Lumbar Vertebrae/surgery , Male , Middle Aged , Retrospective Studies , Spinal Fusion , Spinal Stenosis/surgery , Treatment Outcome
9.
Article in Chinese | WPRIM | ID: wpr-879398

ABSTRACT

OBJECTIVE@#To evaluate clinical effect of unilateral approach and bilateral decompression via large channel endoscopic system for the treatment of lumbar spinal stenosis.@*METHODS@#The clinical data of 32 patients with lumbar spinal tenosis treated by unilateral approach and bilateral decompression via large channel endoscopy from February 2018 to February 2019 were retrospectively analyzed. There were 18 males and 14 females, aged 65 to 84 years old with an average of (70.6± 8.4) years. The course of disease was from 1 to 12 years. All 32 cases were accompanied by numbness or pain in the lower limbs, of which 28 cases were accompanied by intermittent claudication. Narrow segments were L@*RESULTS@#All the patients were followed up for 12-24 (17.68±2.43) months and all operations were successfully completed with the operation time of 70-160(85.64±11.94) min. Spinal dural tear occurred in 1 case during the operation, and sensory disturbance in the other side of lower limb in a short period of time occurred in 2 cases, all improved after corresponding treatment. Postoperative imaging showed that the spinal canal was significantly enlarged and the nerve root was fully released. Before operation and 3 days, 3 months, 1 year after operation, VAS scores of low back pain were 4.62 ±1.41, 2.73 ±1.35, 1.21 ±1.17, 1.11 ±0.34, respectively;VAS scores of leg pain were 6.83 ± 1.71, 3.10±1.50, 1.08±0.19, 0.89±0.24, respectively. VAS scores of low back pain and leg pain each time point after operation were obvious improved (@*CONCLUSION@#It is a safe and effective way to treat lumbar spinal stenosis with unilateral approach and bilateral decompression via large channel endoscopic system. It has the advantages of sufficient decompression, less trauma, fast recovery, high safety and low incidence of postoperative complications. It can minimize the damage to the stable structure of the lumbar spine and is an ideal minimally invasive operation for the treatment of lumbar spinal stenosis.


Subject(s)
Aged , Aged, 80 and over , Decompression, Surgical , Endoscopy , Female , Humans , Lumbar Vertebrae/surgery , Male , Retrospective Studies , Spinal Stenosis/surgery , Treatment Outcome
10.
Rev. Méd. Clín. Condes ; 31(5/6): 441-447, sept.-dic. 2020. tab
Article in Spanish | LILACS | ID: biblio-1224137

ABSTRACT

La estenorraquis lumbar es la disminución del volumen del canal raquídeo en la columna. Es la causa más frecuente de dolor lumbociático y lumbocrural en población mayor de 60 años. Existen múltiples causas. La más común es la degenerativa que consiste en una disminución del canal secundario a varios factores como protrusión del disco intervertebral, hipertrofia y abombamiento del ligamento amarillo, engrosamiento de la capsula articular y por osteofitos. Los síntomas principales son el dolor lumbar irradiado a extremidades inferiores tipo lumbociática o lumbocruralgia y la claudicación neural intermitente. Generalmente no hay déficit motor ni sensitivo. La resonancia magnética es el estudio de elección para el diagnóstico, pero debe complementarse con radiografías y con frecuencia con tac para una mejor valoración de la patología. El tratamiento inicial siempre es conservador, que incluye uso de antiinflamatorios, analgésicos, relajantes musculares, kinesioterapia e infiltraciones de columna (epidurales o radiculares). La mayoría de los pacientes responden satisfactoriamente a este manejo. El tratamiento quirúrgico está indicado a los pacientes que presentan un dolor intenso, que afecta su calidad de vida y que no mejora con el tratamiento conservador. Consiste en la descompresión quirúrgica de las raíces lumbares a través de laminectomía. En ocasiones se recomienda complementar la descompresión con artrodesis específicamente cuando la estenorraquis se asocia a otras condiciones como espondilolistesis degenerativa, escoliosis, desbalance sagital o coronal, inestabilidad segmentaria y en enfermedad del segmento adyacente.


Spinal lumbar stenosis is a narrowing of the spinal canal in the lumbar spine. Is the most frequent cause of sciatic pain or cruralgia in the elderly population over 60 years old. Exist many etiologies. The most common is degenerative caused by many factors including bulging disc, hypertrophy of flavum ligament as well as facet capsule thickening and by osteophytes formation. The main symptoms of spinal stenosis are radicular pain and neurogenic claudication. Lumbar flexion usually improves the symptom and deambulation often worsens the pain. Most of the time neurologic examination is normal. The gold standard study is mri but is necessary to complement with x rays and ct to obtain a better evaluation. Initial treatment is always conservative and consists in nsaid's, muscle relaxants, physical therapy and steroid spinal injections. Most of the patients respond well to this treatment. Surgical treatment is indicated when the patient has a severe pain, quality of life is miserable and conservative treatment fails. Decompression is the gold standard surgical treatment. The addition of an arthrodesis or spinal fusion is recommended in degenerative spondylolisthesis, scoliosis, sagital or coronal imbalance, deformity correction, recurrent spinal stenosis and in cases of adjacent level disease problem.


Subject(s)
Humans , Spinal Stenosis/diagnosis , Spinal Stenosis/therapy , Spinal Stenosis/classification , Spinal Stenosis/pathology
11.
Coluna/Columna ; 19(2): 154-159, Apr.-June 2020. tab, graf
Article in English | LILACS | ID: biblio-1133562

ABSTRACT

ABSTRACT Objective Observational studies and register data provide researchers with ample opportunities to obtain answers to questions that randomized controlled trials cannot answer for organizational or ethical reasons. One of the most common tools for solving this problem is the use of propensity score matching (PSM) methods. The purposes of our study were to compare various models and algorithms for selecting PSM parameters, using retrospective clinical data, and to compare the results obtained using the PSM method with those of prospective studies. Methods The results of two studies (randomized prospective and retrospective) conducted at the Novosibirsk Research Institute of Traumatology and Orthopedics were used for comparative analysis. The trials aimed to study the effectiveness and safety of surgical treatment of degenerative dystrophic lesions in the lumbar spine. We compared the results using the recommended PSM parameters (caliper=0.2 and 0.6) the propensity score is the probability of assignment to one treatment conditional on a subject's measured baseline covariates. Propensity-score matching is increasingly being used to estimate the effects of exposures using observational data. In the most common implementation of propensity-score matching, pairs of treated and untreated subjects are formed whose propensity scores differ by at most a pre-specified amount (the caliper widthand the caliper values often used in real-life studies (0.05, 0.1, 0.25, 0.5, and 0.8) with the those obtained in a similar prospective study. Results After eliminating systematic selection bias, the results of the retrospective and randomized prospective studies were qualitatively comparable. Conclusion The results of this study provide recommendations for the use of PSM: when evaluating efficacy scores in neurosurgical studies (with a sample size < 150 patients), we recommend matching on the logit of the propensity score using calipers of width equal to 0.6 of the standard deviation of the logit of the propensity score. Level of evidence V; Type of study is expert opinion.


RESUMO Objetivos Estudos observacionais e dados de registro fornecem aos pesquisadores amplas oportunidades de obter respostas às perguntas que os estudos clínicos randomizados não podem responder por razões institucionais ou éticas. Uma das ferramentas mais comuns para resolver esse problema é o uso dos métodos de Propensity Score Matching (PSM, pareamento de escore de propensão). O objetivo do nosso estudo foi comparar vários modelos e algoritmos para a seleção de parâmetros de PSM, usando os dados clínicos retrospectivos e comparar os resultados obtidos com esse método com os de estudos prospectivos. Métodos Os resultados de dois estudos (randomizado prospectivo e retrospectivo), realizados no Instituto de Pesquisa de Traumatologia e Ortopedia de Novosibirsk, foram utilizados para análise comparativa. Os estudos visaram estudar a eficácia e a segurança do tratamento cirúrgico de lesões distróficas degenerativas na coluna lombar. Comparamos os resultados usando os parâmetros recomendados pelo PSM, isto é calibração (caliper) de 0,2 e 0,6 e os valores de calibração usados com frequência em estudos da vida real (0,05, 0,1, 0,25, 0,5 e 0,8) com os obtidos em um estudo prospectivo semelhante. Resultados Depois de eliminar o viés sistemático de seleção, os resultados de estudos randomizados prospectivos e retrospectivos foram qualitativamente comparáveis. Conclusões Os resultados deste estudo fornecem recomendações para o uso do PSM: ao avaliar os escores de eficácia em estudos neurocirúrgicos (com tamanho de amostra < 150 pacientes), recomendamos a correspondência do logit do escore de propensão com calibração de largura de 0,6 do desvio padrão do logit do escore de propensão. Nível de evidência V; Opinião do especialista.


RESUMEN Objetivos Los estudios de observación y los datos de registro brindan a los investigadores amplias oportunidades para obtener respuestas a preguntas que los estudios clínicos aleatorizados no pueden responder por razones institucionales o éticas. Una de las herramientas más comunes para resolver este problema es el uso de los métodos de Propensity Score Matching (PSM, emparejamiento de puntaje de propensión). El objetivo de nuestro estudio fue comparar varios modelos y algoritmos para la selección de parámetros de PSM, utilizando los datos clínicos retrospectivos y comparar los resultados obtenidos con ese método con los de estudios prospectivos. Métodos Los resultados de dos estudios (prospectivo aleatorizado y retrospectivo) realizados en el Instituto de Investigación de Traumatología y Ortopedia de Novosibirsk se utilizaron para el análisis comparativo. Los estudios tuvieron como objetivo estudiar la eficacia y seguridad del tratamiento quirúrgico de las lesiones distróficas degenerativas en la columna lumbar. Comparamos los resultados usando los parámetros recomendados por el PSM, esto es, calibración (caliper) de 0,2 y 0,6 y los valores de calibración usados con frecuencia en estudios de la vida real (0,05, 0,1, 0,25, 0,5 y 0,8) con los obtenidos en un estudio prospectivo semejante. Resultados Después de eliminar el sesgo sistemático de selección, los resultados de estudios prospectivos aleatorizados y retrospectivos fueron cualitativamente comparables. Conclusiones Los resultados de este estudio proporcionan recomendaciones para el uso del PSM: al evaluar los puntajes de eficacia en estudios neuroquirúrgicos (con tamaño de muestra <150 pacientes), recomendamos la correspondencia del logit del puntaje de propensión con calibración de ancho de 0.6 de la desviación estándar del logit de puntaje de propensión. Nivel de evidencia V; Opinión del especialista.


Subject(s)
Humans , Neurosurgery , Spinal Fusion , Spinal Stenosis , Bias , Statistical Analysis
12.
Article in Chinese | WPRIM | ID: wpr-828282

ABSTRACT

OBJECTIVE@#To investigate the clinical efficacy and advantages of the full endoscopic I See technique for the single-segment degenerative lumbar spinal stenosis.@*METHODS@#The clinical data of 38 patients with the single-segment degenerative lumbar spinal stenosis treated by full endoscopic I See technique from January 2017 to March 2018 were analyzed retrospectively. There were 16 males and 22 females, aged from 35 to 79 years with an average of(53.45±12.56) years. Five cases were L, 23 cases were L, 10 cases were LS. The clinical efficacy was evaluated by VAS, ODI and Macnab scores.@*RESULTS@#All the patients were followed up for more than 12 months after operation. The length of operation was from 55 to130 (86.0± 17.5) min. Intraoperative blood loss was ranging from 10 to 50 (17±6) ml, and the hospitalization length was from 3 to 7 days with an average of 4.6 days. The VAS scores of low back pain assessed before operation, and 3 d, 3 months, 12 months post operation were 6.67 ±1.25, 3.87 ±1.35, 2.55 ±1.21, 2.05 ±0.97, respectively, and the differences were statistically significant (P < 0.05);VAS scores of leg pain at these time points were 7.85±2.62, 3.31±1.42, 2.02±1.13, 1.85±0.86, respectively, and the differences were statistically significant (<0.05);ODI scores were 40.32±5.38, 25.76±4.81, 12.66±4.64, 9.32±2.91, respectively, and the differences were statistically significant (<0.05). Tevaluate the lumbar vertebrae function according to the Macnab criteria, 15 cases obtained excellent results, 19 cases were good, and 4 cases were fair.@*CONCLUSION@#Full endoscopic I See technique is effective in the treatment of single-segment degenerative lumbar spinal stenosis, with the advantages of less trauma, shorter hospital stay, and faster recovery.


Subject(s)
Adult , Aged , Decompression, Surgical , Female , Humans , Lumbar Vertebrae , Male , Middle Aged , Retrospective Studies , Spinal Fusion , Spinal Stenosis , Treatment Outcome
13.
Article in Chinese | WPRIM | ID: wpr-828279

ABSTRACT

OBJECTIVE@#To evaluate the clinical effects of percutaneous endoscopic foraminoplasty for simple lumbar spinal lateral exit zone stenosis.@*METHODS@#A total of 36 patients with simple lumbar spinal lateral exit zone stenosis were admitted to our hospital from January 2013 to June 2018, and received selective nerve root canal radiography and radicular block. According to the symptoms and patients' personal wills, 22 cases underwent the one-stage percutaneous foraminal surgery(the one-stage operation group), and the other 14 patients were re-admitted to the hospital for operation(the delayed operation group) because of the recurrence of symptoms after discharge. The visual analogue scale (VAS) and Oswestry Disability Index (ODI) were used to evaluate the clinical effects before therapy, 1 day after the radicular block, and 1 day, 3 months and 6 months after the operation.@*RESULTS@#VAS and ODI of all 36 cases were obviously improved (0.05), but when compared with its own pretherapy andbefore readmission results, the difference was significant (<0.05). There was no nerve injury in all cases. Only 2 cases were presented with the outlet root stimulation symptoms, and the symptoms relieved after short term conservative treatment.@*CONCLUSION@#The clinical effects of radicular block may be unsustainable for patients with simple lumbar spinal lateral exit zone stenosis. Instead, percutaneous endoscopic foraminoplasty was simple, safe and effective.


Subject(s)
Constriction, Pathologic , Decompression, Surgical , Humans , Lumbar Vertebrae , Neuroendoscopy , Retrospective Studies , Spinal Stenosis , General Surgery , Treatment Outcome
14.
Coluna/Columna ; 18(4): 322-326, Oct.-Dec. 2019. tab, graf
Article in English | LILACS | ID: biblio-1055992

ABSTRACT

ABSTRACT Objective: The number of revision surgical interventions for degenerative spine disorders has increased steadily. However, the formation of adhesions is one of the more serious conditions accompanying this type of surgery. There are some generally accepted options for its prevention, such as delicate surgical technique, preserving the integrity of spinal canal, and the use of different synthetic materials in the form of gels, plates and membranes to delimit the dural sac from the surrounding soft tissues. The main disadvantages of the described methods are their high cost and the need for a large volume of material in prolonged surgical interventions. Therefore, the development of new methods for prevention of adhesions formations is of paramount importance. The use of titanium mesh is, potentially, an effective and relatively cheap method of preventing the formation of adhesions in spinal surgeries. Methods: We have prospectively analyzed the outcomes of treatment of 40 patients suffering from degenerative spine disease who underwent surgical intervention with titanium mesh implantation in our department between October 2017 and December 2017. Conclusion: The results of our study led us to conclude that the use of titanium mesh enables the surgeon to delimit the dural sac in multilevel spinal decompression surgeries, contributing to closure of the defect in spinal canal and significantly reducing treatment costs. Level of evidence III; Control Case Study.


RESUMO Objetivo: O número de intervenções cirúrgicas de revisão dos distúrbios degenerativos da coluna está aumentando constantemente. Entretanto, a formação de aderências é uma das condições mais graves que acompanha esse tipo de cirurgia. Existem algumas opções geralmente aceitas para sua prevenção, como uma técnica cirúrgica delicada, a preservação da integridade do canal espinhal e o uso de diferentes materiais sintéticos na forma de géis, placas e membranas para delimitar o saco dural dos tecidos moles adjacentes. As principais desvantagens dos métodos descritos são o alto custo e a necessidade de um grande volume de material em intervenções cirúrgicas prolongadas. Portanto, o desenvolvimento de novos métodos para a prevenção de formações de aderências é de suma importância. O uso da malha de titânio é, potencialmente, um método efetivo e relativamente barato de prevenir a formação de aderências nas cirurgias da coluna. Métodos: Analisamos prospectivamente os desfechos do tratamento de 40 pacientes com doença degenerativa da coluna vertebral e que passaram por uma intervenção cirúrgica com implante de malha de titânio no nosso departamento entre outubro de 2017 e dezembro de 2017. Conclusão: Os resultados do nosso estudo levaram-nos a concluir que o uso da malha de titânio permite que o cirurgião delimite o saco dural em cirurgias de descompressão da coluna em multiníveis, contribuindo para o fechamento do defeito no canal espinhal e, significativamente, reduzindo o custo do tratamento. Nível de Evidência III; Estudo de Caso Controle.


RESUMEN Objetivo: El número de intervenciones quirúrgicas de revisión de los procesos degenerativos de la columna está aumentando constantemente. Entretanto, la formación de adherencias es una de las condiciones más graves que acompañan a este tipo de cirugía. Existen algunas opciones generalmente aceptadas para su prevención, como una técnica quirúrgica delicada, la preservación de la integridad del canal espinal y el uso de diferentes materiales sintéticos en forma de geles, placas y membranas para delimitar el saco dural de los tejidos blandos adyacentes. Las principales desventajas de los métodos descritos son el alto costo y la necesidad de un gran volumen de material en intervenciones quirúrgicas prolongadas. Por lo tanto, el desarrollo de nuevos métodos para la prevención de formaciones de adherencias es de suma importancia. El uso de la malla de titanio es, potencialmente, un método efectivo y relativamente barato de prevención para la formación de adherencias en las cirugías de columna. Métodos: Hemos analizado prospectivamente los resultados del tratamiento de 40 pacientes con enfermedad degenerativa de la columna vertebral y que pasaron por una intervención quirúrgica con implante de malla de titanio en nuestro departamento entre octubre de 2017 y diciembre de 2017. Conclusión: Los resultados de nuestro estudio nos llevaron a concluir que el uso de la malla de titanio permite que el cirujano delimite el saco dural en cirugías de descompresión de la columna en multiniveles, contribuyendo para el cierre del defecto en el canal espinal y, significativamente, reduciendo el costo del tratamiento. Nivel de Evidencia III; Estudio de caso de control.


Subject(s)
Humans , Spinal Stenosis , Spine , Surgical Mesh , Titanium
15.
Coluna/Columna ; 18(4): 294-300, Oct.-Dec. 2019. tab, graf
Article in English | LILACS | ID: biblio-1055984

ABSTRACT

ABSTRACT Objective: To conduct a multicenter analysis of the effectiveness of surgical tactics for treating patients with symptomatic tandem stenosis of the cervical and lumbar spine, based on a differentiated clinical-instrumental algorithm. Methods: The study included 97 patients with symptomatic tandem stenosis of the cervical and lumbar spine. The patients were allocated into 2 groups. The main prospective follow-up group (Group I) consisted of patients (n=46) who had undergone staged decompression/stabilization surgery according to the surgical tactics developed based on the differential clinical-instrumental algorithm. The clinical comparison group (Group II) (n=51) consisted of retrospectively recruited patients who, depending on the prevailing clinical condition, underwent primary surgery at the cervical level (29 cases) or at the lumbar level (22 cases). Results: The comparative analysis in Group I revealed significantly better parameters in the clinical and instrumental data. The total rates of postoperative surgical complications in the cervical and lumbar spine were 15% in Group I and 68% in Group II (p=0.0014). Conclusion: The multicenter analysis of the clinical-instrumental algorithm based on differential application of decompression/stabilization techniques enabled more rational and radical surgery, with less adverse outcomes, leading to earlier start of rehabilitation in the prospective group of patients (Group I), and an objective improvement in long-term clinical and functional outcomes. Level of Evidence II; Prognostic Studies - Investigating the Effect of a Patient Characteristic on Disease Outcome.


RESUMO Objetivo: Realizar uma análise multicêntrica da eficácia das táticas cirúrgicas no tratamento de pacientes com estenose sintomática em tandem da coluna cervical e lombar com base em um algoritmo clínico-instrumental diferenciado. Métodos: O estudo incluiu 97 pacientes com estenose sintomática em tandem da coluna cervical e lombar. Os pacientes foram divididos em 2 grupos. O grupo de acompanhamento prospectivo principal (Grupo 1) incluiu pacientes (n = 46) submetidos à cirurgia de descompressão/estabilização estagiada de acordo com as táticas cirúrgicas desenvolvidas com base no algoritmo clínico-instrumental diferencial. O grupo de comparação clínica (Grupo II) (n = 51) incluiu pacientes recrutados retrospectivamente que, dependendo do quadro clínico vigente, foram submetidos à cirurgia primária em nível cervical (29 casos) ou em nível lombar (22 casos). Resultados: A análise comparativa no Grupo I revelou parâmetros significativamente melhores nos dados clínicos e instrumentais. As taxas totais de complicações cirúrgicas pós-operatórias na coluna cervical e lombar foram de 15% no Grupo I e 68% no Grupo II (p = 0,0014). Conclusão: A análise multicêntrica do algoritmo clínico-instrumental baseada na aplicação diferencial das técnicas de descompressão/estabilização permitiu uma cirurgia mais racional e radical com menos desfechos adversos, levando a um início mais precoce de reabilitação no grupo prospectivo de pacientes (Grupo I) e uma melhora concreta nos desfechos clínicos e funcionais a longo prazo. Nível de Evidência II; Estudos prognósticos - Investigação do efeito de característica de um paciente sobre o desfecho da doença.


RESUMEN Objetivo: Realizar un análisis multicéntrico de la eficacia de las tácticas quirúrgicas en el tratamiento de pacientes con estenosis sintomática en tándem de la columna cervical y lumbar con base en un algoritmo clínico-instrumental diferenciado. Métodos: El estudio incluyó a 97 pacientes con estenosis sintomática en tándem de la columna cervical y lumbar. Los pacientes fueron divididos en 2 grupos. El grupo de acompañamiento prospectivo principal (Grupo I) incluyó a pacientes (n = 46) sometidos a cirugía de descompresión/estabilización por etapas de acuerdo con las tácticas quirúrgicas desarrolladas basadas en el algoritmo clínico-instrumental diferencial. El grupo de comparación clínica (Grupo II) (n = 51) incluyó a pacientes reclutados retrospectivamente que, dependiendo del cuadro clínico vigente, fueron sometidos a cirugía primaria en nivel cervical (29 casos) o en nivel lumbar (22 casos). Resultados: El análisis comparativo en el Grupo I reveló parámetros significativamente mejores en los datos clínicos e instrumentales. Las tasas totales de complicaciones quirúrgicas postoperatorias en la columna cervical y lumbar fueron de 15% en el Grupo I y 68% en el Grupo II (p = 0,0014). Conclusión: El análisis multicéntrico del algoritmo clínico-instrumental basado en la aplicación diferencial de las técnicas de descompresión/estabilización permitió una cirugía más racional y radical con menos resultados adversos, llevando a un inicio más precoz de rehabilitación en el grupo prospectivo de pacientes (Grupo I), y una mejora concreta en los resultados clínicos y funcionales a largo plazo. Nivel de Evidencia II; Estudios pronósticos - Investigación del efecto de característica de un paciente sobre el desenlace de la enfermedad.


Subject(s)
Humans , Spinal Fusion , Spinal Stenosis , Chronic Disease , Decompression , Diagnosis
16.
Acta ortop. mex ; 33(5): 308-313, sep.-oct. 2019. tab, graf
Article in English | LILACS | ID: biblio-1284962

ABSTRACT

Abstract: Introduction: Changes in ligamentum flavum (LF) related to degeneration are secondary to either the aging process or mechanical instability. Previous studies have indicated that LF with aging shows elastic fiber loss and increased collagen content, loss of elasticity may cause LF to fold into the spinal canal, which may further narrow of the canal. Material and methods: A total of 67 patients operated with the surgical indications of lumbar spinal stenosis (LSS), lumbar disc herniation (LDH) and lumbar degenerative spondylolisthesis (LDS) were included. LF samples were obtained from patients who had LSS (39), LDH (22) and LDS (6). Specimens were examined with regard to chondroid metaplasia, calcification, fragmentation of collagen fibers, cystic degeneration, fibrillar appearence, and hypercellularity. Results: The most frequent histopathological changes were hyalinization and fragmentation of collagen fibers occur in 34%, neovascularization in 40.3% and irregular arrangement of elastic fibers is the most prevalent change with 56.7% of the total samples. There is a difference in the presence of certain changes in the LF according to the diagnosis, being statistically significant for fragmentation of collagen fibers (p = 0.045), cystic degeneration (p = 0.001), fibrillar appearance (p = 0.007) and hypercellularity (p = 0.005) all of these, being more prevalent in LDS group. LHD group presented fragmentation of collagen fibers in 45.5% (p = 0.045) and fibrillar appearance in 4.5% (p = 0.009). Conclusions: There is not evidence of cellular hyperthophy in the histhopatological analyses, thickening of the LF can be seen by bulking of LF followed by collapse of motion segment.


Resumen: Introducción: Los cambios en el ligamento flavum (LF) relacionados con la degeneración son secundarios al proceso de envejecimiento o a la inestabilidad mecánica. Estudios anteriores han indicado que LF con envejecimiento muestra pérdida de fibras elásticas y aumento del contenido de colágeno, la pérdida de elasticidad puede hacer que el LF se pliegue en el canal espinal, disminuyendo su espacio. Material y métodos: Se incluyeron 67 pacientes operados de estenosis lumbar espinal (LSS), hernia de disco lumbar (LDH) y espondilolistesis degenerativa (LDS). Se obtuvieron muestras de LF de pacientes que tenían LSS (39), LDH (22) y LDS (6). Se examinaron especímenes con respecto a metaplasia condroide, calcificación, fragmentación de fibras de colágeno, degeneración quística, apariencia fibrilar e hipercelularidad. Resultados: Los cambios histopatológicos más frecuentes fueron la hialinización y la fragmentación de las fibras de colágeno (34%), neovascularización en 40.3%, y la disposición irregular de las fibras elásticas es el cambio más frecuente con 56.7% del total de muestras. Existe una diferencia en la presencia de cambios en el LF, de acuerdo con el diagnóstico, siendo estadísticamente significativo para la fragmentación de las fibras de colágeno (p = 0.045), la degeneración quística (p = 0.001), la apariencia fibrilar (p = 0.007) y la hipercelularidad (p = 0.005) todos ellos, siendo más frecuentes en el grupo LDS. El grupo LHD presentó fragmentación de las fibras de colágeno en 45.5% (p = 0.045) y la apariencia fibrilar en 4.5% (p = 0.009). Conclusiones: No hay evidencia de hipertrofia celular en los análisis histopatológicos, el engrosamiento del LF se puede ver por abultamiento del mismo, seguido de colapso del segmento de movimiento.


Subject(s)
Humans , Spinal Stenosis/surgery , Spondylolisthesis , Ligamentum Flavum , Hernia
17.
Int. j. morphol ; 37(3): 867-871, Sept. 2019. tab, graf
Article in English | LILACS | ID: biblio-1012367

ABSTRACT

Anatomical orientation of the termination level of Conus Medullaris (CM) has imperative role clinically for anesthetists and neurosurgeons which is considered as an objective guide to perform spinal anesthesia and spinal punctures circumspectly with less chance to have serious injuries. The current retrospective study was carried on to determine the location of the CM and how its termination level can be influenced by age, sex, height and lumber stenosis spine disease. The study included 462 participants that consisted of 199 men and 263 women range from 21 to 80 years of age and height range between 150-190 cm. Also, it included 150 lumber stenosis patients. The location of the CM was imaged using a series of magnetic resonance images (MRI) for the lumbosacral spine at different levels including, T12, T12-L1, L1, L1-L2, and L2. The measurements revealed inconsiderable differences in the CM termination level in relation to age, sex and height in a healthy study population. Moreover, the results showed insignificant differences in the CM termination level between men and women whether they are healthy or having lumbar spinal stenosis. In conclusion, the most common level of CM termination is at L1 followed by L1-L2. It is safe to perform a lumbar neuraxial procedures at the level of L3-L4.


La orientación anatómica del nivel de terminación del Conus medullaris (CM) tiene un importante papel clínico para los anestesistas y neurocirujanos, que se considera una guía objetiva para realizar la anestesia espinal y las punciones de la columna circunspectivamente con menos posibilidades de provocar lesiones graves. Se llevó a cabo un estudio retrospectivo para determinar la ubicación del CM y cómo su nivel de terminación puede verse afectado por la edad, el sexo, la altura y una patología de la columna vertebral, la estenosis lumbar. El estudio incluyó 462 participantes que consistían en 199 hombres y 263 mujeres de 21 a 80 años de edad y una altura de entre 150-190 cm. Además, se incluyeron 150 pacientes con estenosis lumbar. La ubicación del CM se determinó mediante una serie de imágenes de resonancia magnética (RM) de la columna lumbosacra a diferentes niveles, incluidos T12, T12-L1, L1, L1-L2 y L2. Las mediciones revelaron diferencias considerables en el nivel de terminación de CM en relación con la edad, el sexo o la altura en una población de estudio saludable. Además, los resultados mostraron diferencias poco significativas en el nivel de terminación de CM entre hombres y mujeres, sanos o con estenosis espinal lumbar. En conclusión, se encontró que el nivel más común de terminación del CM es L1 seguido de L1-L2, considerándose seguro realizar procedimientos neuroaxiales lumbares a nivel de L3-L4.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Spinal Cord/diagnostic imaging , Spinal Stenosis/diagnostic imaging , Magnetic Resonance Imaging , Spinal Cord/pathology , Spinal Stenosis/pathology , Sex Factors , Retrospective Studies , Age Factors
18.
Coluna/Columna ; 18(3): 231-235, July-Sept. 2019. tab, graf
Article in English | LILACS | ID: biblio-1019772

ABSTRACT

ABSTRACT Objective Considering that the technique of spinous process splitting has been advocated as a less invasive treatment of lumbar stenosis, the objective of this study was to evaluate the preliminary results of this technique in the surgical treatment of lumbar canal stenosis. Methods Twenty patients with lumbar spinal canal stenosis who underwent surgical treatment for lumbar canal decompression with the spinous process splitting technique were assessed in the preoperative period and on postoperative days 1, 7 and 30 for VAS for lower back and lower limbs pain and radiographic evaluation of the operated segment. Results The mean visual analogue scale score for lumbar pain in the preoperative assessment was 4.2 ± 3.37 and 0.85 ± 0.88, 1.05 ± 1.19 and 1.15 ± 1.04 after 1, 7 and 30 postoperative days, respectively. The mean VAS score for lower limb pain was 8 ± 1.72 preoperatively, and 0.7 ± 1.13, 0.85 ± 1.04, and 1.05 ± 1 after 1, 7, and 30 postoperative days, respectively. There were no radiographic signs of instability of the vertebral segment operated in the radiographic evaluation. Conclusions Decompression of the lumbar canal through the spinous process splitting technique in patients with lumbar canal stenosis had good immediate and short-term results in relation to low back and lower limbs pain. Level of evidence IV; Therapeutic Study.


RESUMO Objetivo A técnica da separação do processo espinhoso tem sido preconizada como técnica menos invasiva para o tratamento da estenose lombar. Objetivo é avaliar os resultados preliminares dessa técnica no tratamento cirúrgico da estenose do canal lombar. Métodos Vinte pacientes portadores de estenose do canal vertebral lombar e submetidos ao tratamento cirúrgico para descompressão do canal lombar, por meio da técnica da separação do processo espinhoso, foram avaliados no período pré-operatório, um, sete e trinta dias de pós-operatório, por meio da escala visual de avaliação da dor lombar e dor nos membros inferiores e avaliação radiográfica do segmento operado. Resultados O escore médio da escala visual analógica da dor lombar na avaliação pré-operatória foi 4,2 ± 3,37 e, respectivamente, 0,85 ± 0,88; 1,05 ± 1,19 e 1,15 ± 1,04 após um, sete e trinta dias de pós-operatório. O escore médio da escala visual analógica da dor nos membros inferiores foi 8 ± 1,72 no pré-operatório e, respectivamente, 0,7 ± 1,13; 0,85 ± 1,04 e 1,05 ± ١ após um, sete e trinta dias de pós-operatório. Não foram observados sinais radiográficos de instabilidade do segmento vertebral operado na avaliação radiográfica. Conclusão A descompressão do canal lombar por meio da técnica da separação do processo espinhoso nos pacientes com estenose do canal lombar apresentou bons resultados imediatos e a curto prazo, em relação à dor lombar e dor nos membros inferiores . Nível de evidência IV; Estudo Terapêutico.


RESUMEN Objetivo Teniendo en cuenta que la técnica de separación del proceso espinoso ha sido recomendada para el tratamiento menos invasivo de la estenosis lumbar, el objetivo de este estudio fue evaluar los resultados preliminares de esta técnica en el tratamiento quirúrgico de la estenosis del canal lumbar. Métodos Veinte pacientes con estenosis del canal espinal lumbar que se sometieron a tratamiento quirúrgico para descompresión del canal lumbar con la técnica de separación del proceso espinoso se evaluaron en el período preoperatorio y en los días 1, 7 y 30 postoperatorios mediante EVA para del dolor lumbar y de los miembros inferiores y evaluación radiográfica del segmento operado. Resultados La puntuación promedio de la escala visual analógica del dolor lumbar en la evaluación preoperatoria fue de 4,2 ± 3,37 y 0,85 ± 0,88; 1,05 ± 1,19 y 1,15 ± 1,04 después de 1, 7 y 30 días postoperatorios. La puntuación promedio de la EVA para el dolor de las extremidades inferiores fue 8 ± 1,72 en el preoperatorio y de 0,7 ± 1,13; 0,85 ± 1,04 y 1,05 ± 1 después de 1, 7 y 30 días postoperatorios, respectivamente. No se observaron signos radiográficos de inestabilidad del segmento vertebral operado en la evaluación radiográfica. Conclusiones La descompresión del canal lumbar por medio de la técnica de separación del proceso espinoso en pacientes con estenosis del canal lumbar tuvo buenos resultados inmediatos y a corto plazo con relación al dolor lumbar y las extremidades inferiores. Nivel de evidencia IV; Estudio Terapéutico.


Subject(s)
Humans , Spinal Stenosis , Low Back Pain , Laminectomy
19.
Coluna/Columna ; 18(3): 209-213, July-Sept. 2019. tab, graf
Article in English | LILACS | ID: biblio-1019785

ABSTRACT

ABSTRACT Objective To compare the sagittal alignment (SA) parameters in individuals with LCS and surgical indication with a control group and to study the correlations between SA parameters and ODI, VAS and EQ-5D in individuals with LCS and surgical indication. Methods In this multicenter cross-sectional case-control study, the individuals were allocated as follows. A stenosis group (SG) composed by patients with LCS confirmed by magnetic resonance imaging with surgical indication, treated between July 2010 and August 2016 and a control group (CG), without LCS. All subjects underwent anamnesis, completed the Health-related Quality of Life (HRQoL) and total spine radiographs were taken. Clinical data, HRQoL and radiographic parameters were correlated. Results Sixty-four individuals formed the SG and 14 the CG. The SG had higher values of mean age, coronal imbalance, sagittal vertical axis (SVA), pelvic tilt (PT), sacrofemoral distance (SFD), overhang (OH), PI-LL mismatch, Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) for pain and smaller thoracic kyphosis (TK), total (TLPL) and regional lumbopelvic lordosis (RLPL) in all vertebrae, sagittal offset (SO) in all evaluated vertebrae and EuroQol-5D (EQ-5D) with p <0.05. In the SG, the only significant correlations (p <0.05) were between TK and ODI and EQ-5D; all the other sagittal parameters did not correlated with VAS, ODI or EQ-5D. Conclusion SG had SA parameters altered in relation to CG. There was a direct correlation between decrease in TK and worsening of ODI and EQ-5D in SG. Level of evidence: III; Case Control Study.


RESUMO Objetivo Comparar parâmetros do AS em indivíduos portadores de EDL com indicação cirúrgica aos de uma população controle; estudar a correlação entre os questionários ODI, VAS e EQ-5D a parâmetros do AS nos portadores de EDL com indicação cirúrgica. Métodos Estudo transversal multicêntrico tipo caso-controle. Grupo estenose (GE) composto por portadores de EDL, confirmada por Ressonância Nuclear Magnética, com indicação cirúrgica, atendidos entre Julho de 2010 a agosto de 2016. Grupo controle (GC) sem EDL. Todos os indivíduos realizaram anamnese, responderam questionários de qualidade de vida e realizaram radiografias de coluna total. Dados clínicos, questionários e parâmetros radiográficos foram correlacionados. Resultados 64 indivíduos formaram o GE e 14 o GC. GE apresentou valores maiores de idade média, desequilíbrio coronal, sagital vertical index (SVA), pelvic tilt (PT), sacrofemoral distance (SFD), overhang (OH), missmatch PI - LL, Owestry Disability Index (ODI), Visual Analogic Scale (VAS) e valores menores de cifose torácica, lordose lombopélvica total e regional em todas as vértebras, offset sagital em todas as vértebras avaliadas e EuroQol-5D (EQ-5D), com p < 0,05. No GE, houve correlações significativas (p < 0,05) apenas entre TK e ODI e EQ-5D, sendo que todos os outros parâmetros sagitais não apresentaram correlação significativa com os questionários de qualidade de vida. Conclusão GE apresentou perda dos parâmetros de AS em relação ao GC. Houve correlação direta entre diminuição da TK e piora do ODI e EQ-5D no GE. Nível de Evidência III; Estudo de Caso Controle.


RESUMEN Objetivo Comparar los parámetros del alineamiento sagital (AS) en individuos con ECL e indicación quirúrgica con un grupo control y estudiar las correlaciones entre los parámetros de SA y ODI, EVA y EQ-5D en pacientes con ECL e indicación quirúrgica. Métodos En este estudio multicéntrico de casos y controles, los individuos fueron asignados como sigue. Un grupo estenosis (GE) compuesto por pacientes con ECL confirmada por imágenes de resonancia magnética con indicación quirúrgica, tratados entre julio de 2010 y agosto de 2016 y un grupo control (GC) sin ECL. Todos los individuos se sometieron a una anamnesis, respondieron el cuestionario de Calidad de Vida Relacionada con la Salud (HRQoL) y se tomaran radiografías totales de la columna. Se relacionaron datos clínicos, HRQoL y parámetros radiográficos. Resultados Sesenta y cuatro individuos formaron el GE y 14 el GC. El GE tenía valores más altos de edad promedio, desequilibrio coronal, eje sagital vertical (ESV), inclinación pélvica (IP), distancia sacrofemoral (DSF), protuberancia (P), falta de emparejamiento IP -LL, Índice de Discapacidad de Oswestry (ODI), Escala Visual Analógica (VAS) para el dolor y menos cifosis torácica (CT), lordosis lumbopélvica total (LLPT) y regional (LLPR) en todas las vértebras, offset sagital (OS) en todas las vértebras evaluadas y EuroQol-5D (EQ-5D), con p < 0,05. En el GE, las únicas correlaciones significativas (p < 0,05) fueron entre TC y ODI y EQ-5D; todos los demás parámetros sagitales no se correlacionaron con EVA, ODI o EQ-5D. Conclusión El GE tuvo parámetros de AS alterados en relación con el GC. Hubo correlación directa entre la disminución de TC y el agravamiento del ODI y EQ-5D en el GE. Nivel de evidencia III; Estudio de Caso Controle.


Subject(s)
Humans , Quality of Life , Spinal Stenosis , Spine , Radiography , Natural History
20.
Rev. argent. neurocir ; 33(2): 52-55, jun. 2019. graf, tab
Article in Spanish | LILACS, BINACIS | ID: biblio-1177648

ABSTRACT

Introducción: La Estenosis de Canal Lumbar (ECL) refiere al estrechamiento central del canal raquídeo, recesos laterales o agujeros de conjunción. Comúnmente, causa lumbalgia crónica en quienes la padecen afectando gravemente su calidad de vida. Sin embargo, su pronóstico, incidencia sigue siendo incierta en nuestra región. Objetivo: El presente trabajo tiene como propósito, determinar la frecuencia local de la ECL y su relación con distintos parámetros morfométricos, comorbilidades y el cuestionario CSI. Material y Método: Se realizó un estudio prospectivo, analítico, asociativo y de corte transversal de las consultas atendidas por el servicio de Neurocirugía del Hospital Enrique Vera Barros de la ciudad de La Rioja Capital, Argentina durante el período agosto-diciembre 2018. Se aplicó el cuestionario "Central Sensitization Inventory" (CSI). Resultados: La ECL fue diagnosticada en 42.9% de hombres que consultaron por lumbalgia y en el 33.3% en el caso de las mujeres. La media de la edad de los pacientes con ECL fue 57 años. El 100% de pacientes presentaron comorbilidades, siendo la más prevalente la artrosis. La dorsopatía más asociada fue la Hernia de Disco Lumbar (27.3%). La intensidad del dolor y los diámetros antero-posterior (DAP) y laterales (DL), fueron inversamente significativos (DAP= -,813 p=0,09; DL= -,967 p=0,007). El puntaje en el CSI fue significativamente mayor en pacientes con ECL (37 vs. 24,62 pts.) (p=,028). Finalmente, la correlación entre los DAP y DL con el puntaje del CSI mostró una correlación inversa (DAP= -,733 p>0,05; DL= -,639 p>0,05). Conclusión: En nuestro estudio encontramos que la prevalencia de ECL es más alta en hombres de edad media y que presentan comorbilidades asociadas, además el análisis morfométrico del canal raquídeo se asocia con la intensidad del dolor y el puntaje en el CSI. Por lo cual estas variables podrían ser utilidad clínica al momento de decidir el manejo adecuado para pacientes con ECL.


Introduction: Lumbar Spinal Stenosis (LSS) anatomically can involve the central canal, lateral recess, neural foramen or any combination of these locations. Although, LSS has been consider a common cause of chronic low back pain. Only few studies had explored the prevalence, incidence and associated variables in non-Caucasian populations. Therefore, the aim of this study is to determine the local frequency of LSS and its relationship with different morphometric parameters, comorbidities and the Central Sensitization Inventory (CSI). Methods: A prospective, analytical, associative and cross-sectional study of patients With LSS by single academic center was carried out. Diagnoses were done by clinical and MRI assessment. Results: LSS was diagnosed in 42.9% of males and 33.3% of females who consulted for low back pain. The average age of the patients with LSS was 57 years. 100% of LSS patients presented comorbidities, the most prevalent being osteoarthritis. Lumbar Disc Hernia was associated in 27.3% of patients with LSS. Pain intensity was inversely correlated (AP= -,813 p=0,09; L= -,967 p=0,007) with anteroposterior (AP), and lateral (L) diameters. The score in the CSI was significantly higher in patients with LSS (37 vs. 24,62 pts.) (p=,028). Finally, the correlation between the AP and L diameters with the CSI score was inverse (AP= -,733 58 p>0,05; L= -,639 p>0,05). Conclusions: In our study, we found that the prevalence of LSS is higher in middle-aged men with associated comorbidities. In addition, morphometric analysis of the spinal canal is associated with pain intensity and CSI scores. Therefore, these variables could be clinical applicable when deciding the appropriate management for patients with LSS.


Subject(s)
Low Back Pain , Pain , Quality of Life , Spinal Stenosis , Constriction, Pathologic
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