ABSTRACT
The study of Biomechanics of the lumbar spine with clinical approach allows the physician related to locomotive sciences, to have a better interpretation of the clinical and radiological findings in order to carry out a treatment or a prediction of a medical problem with greater scientific foundation. The lumbar vertebral segment is studied from a biomechanical point of view in an integrated way, correlating with other body regions. The structures analyzed are the vertebrae, the intervertebral disks, the ligament and muscular system. The method of study goes from the static of the column to the dynamic, which includes the kinetic and kinematic aspects. The contradiction in the study of the lumbar spine is that the disorders of this body region are of the most frequent in the general and specialized medical consultation and, however, is not enough provided to the financial funds to carry out research.
El estudio de la biomecánica de la columna lumbar con enfoque clínico permite al médico especialista, relacionado con ciencias del aparato locomotor, tener una mejor interpretación de los hallazgos clínicos y radiológicos, para así poder realizar un tratamiento o una predicción de un problema médico con mayor fundamento científico. El segmento vertebral lumbar se estudia desde el punto de vista biomecánico de manera integrada, correlacionándolo con las demás estructuras corporales. Las estructuras analizadas son las vértebras, los discos intervertebrales, el sistema ligamentario y muscular. El método de estudio va desde la estática de la columna hasta la dinámica, que incluye los aspectos cinéticos y cinemáticos. La contradicción del estudio de la columna lumbar estriba en que los trastornos de esta región corporal son de los más frecuentes en la consulta médica general y especializada y, sin embargo, no está proporcionada con los fondos financieros para realizar investigación.
Subject(s)
Intervertebral Disc , Lumbar Vertebrae , Biomechanical Phenomena , HumansABSTRACT
PURPOSE: We report the results of surgery in 520 patients with clinically localized carcinoma of the prostate (CaP) who received preoperative neoadjuvant hormonal therapy (NHT) for 3 to 11(+) months. METHODS: The results in the NHT patients were compared with those in 1,413 men having surgery without NHT at our institution during the same time period. In the group without pretreatment, the median and mean follow-up was 36 and 21 months, respectively. In the patients receiving NHT, the median follow-up was 33 months and the mean 41 months. RESULTS: The overall disease-free survival (DFS) rate (serum prostate specific antigen [PSA] concentration < or = 0.2 ng/mL) was 75% at 5 years and 50% at 10 years. There was no statistically significant difference in overall DFS rate between men who had NHT and those who did not. No DFS advantage could be demonstrated for those patients with a presenting PSA >20 ng/mL who received NHT compared with patients with the same PSA concentration who did not receive NHT. Despite our previous experience indicating improved survival with NHT in men with a presenting PSA of > 10 ng/mL, we could find no advantage to NHT in enhancing DFS. At a median survival of 35 months (mean 41 months) in 201 men with an initial PSA > or = 10 ng/mL, 70% had an undetectable PSA concentration at 5 years compared with 72% at the same time point in men presenting with PSA <10 ng/mL. In the group expected to have the best surgical result; i.e. those men whose preoperative PSA was < or = 7 ng/mL, there was no DFS difference in men given NHT compared with those having no hormonal manipulation. Patients presenting with stage T(1) disease had a significantly better DFS than those with either T(2) or T(3) CaP. However, within each stage, the addition of NHT to surgery did not result in a higher DFS rate. The 5- and 10-year DFS rates for stage T(1) were 80% and 64%, for T2 disease 78% and 50%, and for T3 disease 67% and 50%. There was a statistically significant difference (P < or = 0.003) in survival between stage T(1) and stage T(2) disease, but no significant difference in DFS was noted in patients presenting with stage T(2) compared with T3 cancer (P = 0.431). Gleason score was not a significant predictor of durable DFS, and the addition of NHT did not improve the DFS within groups of patients with similar Gleason scores. Men with only one or two positive biopsy cores did significantly better than those with more than three positive cores (P = 0.06). There was a significant difference in DFS between men who had organ-confined disease and those with disease outside the gland (P = 0.0003). However, NHT did not improve DFS. The presence of positive surgical margins was a negative prognostic factor (P = 0. 001). Men who received NHT had a statistically lower positive margin rate (P = 0.001), but NHT did not increase the likelihood of a durable DFS (P = 0.175). The duration of NHT did not affect the DFS (P = 0.100 for <3 v >3 months). CONCLUSION: There appears to be no subset of men undergoing radical prostatectomy in whom the routine administration of NHT is beneficial despite the statistically significant improvement in the pathologic findings.
