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ABSTRACT Objective To evaluate whether vertebral endplate signal changes (VESCs) influence the prognosis of patients submitted to conservative or surgical treatment for low back pain and lumbosciatica. Methods Study with 241 patients who underwent conservative treatment, infiltration or surgery with 12 months of follow-up. They were evaluated for pain by the Visual Analog Scale for Pain (VAS), for function by the Roland Morris questionnaire and for quality of life by the EuroQoI5 (EQ-5D). Results The VESCs did not have a significant effect on the treatment responses for the VAS (F = 0.03; P = 0.97), Roland Morris (F = 0.51; P = 0.60) and EQ-5D (F = 2.67; P = 0.07) variables, nor was there any interaction between VESC and treatment for VAS (F = 2.15; P = 0.08), Roland Morris (F = 1.55; P = 0.19) and EQ-5D (F = 2.15; P = 0.08). There was a significant effect for all treatments, however, the effect of the surgical procedure was superior when compared to the others (P <0.001). The VESC frequency was 48.33% for type 0, 29.17% for type I and 22.50% for type II. Conclusions The presence of VESC and its different types is not associated with a worse prognosis, nor was a higher prevalence of VESC observed in the patients with low back pain and lumbosciatica. Level of Evidence II; Retrospective cohort study.
RESUMO Objetivo Avaliar se as alterações de sinal do platô vertebral (ASPV) influenciam o prognóstico de pacientes submetidos ao tratamento conservador ou cirúrgico em lombalgia e lombociatalgia. Métodos Estudo com 241 pacientes submetidos ao tratamento conservador, infiltração ou cirurgia, com acompanhamento de 12 meses. Foram avaliados pela Escala Visual Analógica (EVA) da Dor, quanto à função, pelo questionário Roland Morris e quanto à qualidade de vida, pelo questionário EuroQoI5 (EQ-5D). Resultados As ASPV não tiveram efeito significante nas respostas do tratamento para as variáveis EVA (F = 0,03; P = 0,97), Roland Morris (F = 0,51; P = 0,60) e EQ-5D (F = 2,67; P = 0,07), bem como não houve interação de ASPV e tratamento para EVA (F = 2,15; P = 0,08), Roland Morris (F = 1,55; P = 0,19) e EQ-5D (F = 2,15; P = 0,08). Houve efeito significante para todos os tratamentos; entretanto, o efeito do procedimento cirúrgico foi superior quando comparado aos demais (P < 0,001). A frequência de ASPV tipo 0 foi 48,33%, tipo I foi 29,17% e tipo II foi 22,50%. Conclusões A presença de ASPV e seus diferentes tipos não estão associados a prognóstico pior, bem como não se demonstrou maior prevalência de ASPV nos pacientes com lombalgia e lombociatalgia. Nível de Evidência II; Estudo de coorte retrospectivo.
RESUMEN Objetivo Evaluar si las alteraciones de señal de la meseta vertebral (ASMV) influyen en el pronóstico de los pacientes sometidos a tratamiento conservador o quirúrgico en lumbalgia y lumbociatalgia. Métodos Estudio con 241 pacientes sometidos al tratamiento conservador, infiltración o cirugía, con acompañamiento de 12 meses. Se evaluaron a través de la Escala Visual Analógica del Dolor (EVA), cuanto a la función, por el cuestionario Roland Morris y cuanto a la calidad de vida por el cuestionario EuroQoI5 (EQ-5D). Resultados Las ASMV no tuvieron efecto significativo en las respuestas del tratamiento para las variables EVA (F = 0,03; P = 0,97), Roland Morris (F = 0,51; P = 0,60) y EQ-5D (F = 2,67; P = 0,07), así como no hubo interacción de ASMV y tratamiento para EVA (F = 2,15; P = 0,08), Roland Morris (F = 1,55; P = 0,19) y EQ-5D (F = 2,15; P = 0,08). Hubo efecto significativo para todos los procedimientos, entretanto, el efecto del procedimiento quirúrgico fue superior cuando comparado a los demás (P <0,001). La frecuencia de ASMV para el tipo 0 fue 48,33%, tipo I 29,17% y tipo II 22,50%. Conclusiones La presencia de ASMV y sus diferentes tipos no están asociados a pronóstico peor, bien como no se demostró mayor prevalencia de ASMV en los pacientes con lumbalgia y lumbociatalgia. Nivel de Evidencia II; Estudio de cohorte retrospectivo.
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Humanos , Dolor de la Región Lumbar , Ciática , Cirugía General , Tratamiento ConservadorRESUMEN
Objective To investigate the effects of intervertebral bridging ossifications in patients of osteoporotic vertebral compression fracture (OVCF) on bone fracture healing.Methods A total of 170 patients of thoracolumbar vertebral endplate fracture who were admitted into our hospital were selected.Divided these patients into the observation group,namely 60 patients with nonunion of vertebral endplate after 3 months of conservative treatment,and the control group, including 110 patients with well healed vertebra after 3 months of conservative treatment.Compared the distribution of intervertebral bridging ossifications of the two groups 3 weeks after injury.Results The incidence of bridging ossification at levels of T9 to T10,T10to T11,T11to T12 in the observation group were significantly higher than that in the control group.And it showed a significantly higher incidence of bridging ossification at the second proximal intervertebral segment in the observation group than that of the control group.There was a significantly greater sagittal wedge angle in the observation group compared with the control group.Conclusion Conservative treatment may increase the risk of nonunion of osteoporotic vertebral compression fractures when there is a bridging ossification at the second proximal intervertebral level or the sagittal wedge angle was greater than 14.2°in a fresh osteoporotic vertebral compression fracture.It should be a careful choose whether to take conservative treatment or surgical intervention.
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Objective: To investigate the prevalence and clinical significance of Modic changes in endplates of cervical vertebral body in patients with cervical spondylotic myelopathy(CSM). Methods: The T1-weight and T2-weight sagittal MRI scans of 136 CSM patients undergoing anterior operation were retrospectively reviewed. The patients' age, gender, prevalence, precise vertebral levels and specific type of Modic changes were recorded, and the association of axial pain with Modic changes was analyzed. Results: Modic changes were observed in 23 patients (16.9%), including 17(17.7%) male and 6(15%) female. The most frequent cervical spinal levels of Modic changes was C5-6. Of all the patients, 4.4% had type I Modic change, 7.4% had type II, and 5.1% had type III. The incidence of axial pain was 56.5% in Modic change groups and 20.4% in non-Modic change groups; there was significant difference between the two groups (P0.05). The pre-operation incidences of axial pain in patients with type I, type II and type III Modic change were 83.3%, 60% and 28.6%, respectively; and the post-operation pain-relieving rates were 100%, 66.7% and 50%, respectively. Conclusion: The most common Modic change is type II in the cervical spine, with the C5-6 level being the most frequently involved. The incidence of axial pain is high in patients with Modic change, especially those with type I.