ABSTRACT
The aim of this present clinical trial is to evaluate the effectiveness of a multicomponent prehabilitation programme administered through educational videos versus another programme based on written exercise recommendations, in patients scheduled for lumbar radiculopathy surgery. This study will be a multicentre, controlled, randomised, parallel clinical trial. One hundred participants undergoing lumbar radiculopathy surgery who meet the established inclusion criteria will be recruited at different Spanish hospitals. The experimental group will follow a 4-week prehabilitation programme combining therapeutic exercise, back care education, and pain neuroscience education delivered through videos designed for consumption at home. The control group will be provided with written instructions to perform therapeutic exercises during the same prehabilitation time period. The primary outcome of the study will be disability, assessed using the Spanish version of the Oswestry Disability Index. The secondary outcomes will be pain perception, health-related quality of life, fear avoidance, kinesiophobia, catastrophising, anxiety, depression, physical activity, and the treatment satisfaction of the patients. This study will provide evidence for the effectiveness of a home-based multicomponent prehabilitation programme that addresses some already identified barriers to patient attendance in face-to-face programmes. Understanding the medium and long-term effects of pre-surgery lumbar muscle training and pain neuroscience education administered via instructional videos watched by patients at home, will help improve the design of prehabilitation programmes in this population while also improving the cost-effectiveness of such interventions.
Subject(s)
Patient Education as Topic , Radiculopathy , Humans , Radiculopathy/surgery , Radiculopathy/therapy , Radiculopathy/rehabilitation , Patient Education as Topic/methods , Exercise Therapy/methods , Preoperative Exercise , Female , Male , Quality of Life , Randomized Controlled Trials as Topic , Low Back Pain/therapy , Low Back Pain/surgery , Adult , Middle Aged , Treatment Outcome , Neurosciences , Pain Management/methodsABSTRACT
Thoracic disc herniation is one of the most therapeutically challenging spine conditions. A myriad of surgical approaches have been described in the literature, including posterior, anterior, and combined techniques. However, transthoracic and retropleural approaches are currently deemed the most effective techniques to successfully obtain anterior decompression. Herein the authors describe a 65-year-old female patient who underwent a transthoracic endoscopic approach to remove a calcified herniated thoracic disc that caused spinal cord compression. Despite having a long learning curve, the surgical technique described herein can be even used in patients with complex and calcified thoracic disc herniations. The video can be found here: https://stream.cadmore.media/r10.3171/2022.3.FOCVID221.
ABSTRACT
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Subject(s)
Humans , Male , Middle Aged , Hematoma, Epidural, Spinal/complications , Hematoma, Epidural, Spinal/diagnostic imaging , Chest Pain/etiology , Risk Factors , Spinal Cord Compression/diagnostic imaging , Indicators of Morbidity and Mortality , Chest Pain/drug therapy , ST Elevation Myocardial Infarction/complications , Nitroglycerin/therapeutic use , Radiography, Thoracic , Magnetic Resonance Spectroscopy/methodsABSTRACT
Introducción. El glioblastoma multiforme es el tumor maligno más frecuente del sistema nervioso central, y su incidencia es del 80% en los mayores de 50 años. En los últimos tiempos se ha producido un aumento en la esperanza de vida de la población, y el análisis de las complicaciones posquirúrgicas en pacientes de edad avanzada resulta de gran relevancia para una correcta indicación quirúrgica. Objetivo. Analizar factores relacionados con las complicaciones posquirúrgicas en pacientes de edad avanzada. Pacientes y métodos. Se analizan retrospectivamente 88 pacientes diagnosticados de glioblastoma multiforme entre 31 y 78 años. Las variables estudiadas son: antecedentes personales, edad, estado funcional, estado preanestésico, características tumorales, tipo de cirugía y complicaciones posquirúrgicas. Resultados. Se observa una influencia de la edad en las complicaciones quirúrgicas locales (p = 0,006) y sistémicas (p = 0,034) y en la escala de Clavien-Dindo (p = 0,001). Las personas con peor estado funcional y riesgo cardiovascular presentaron más complicaciones sistémicas (p = 0,006 y 0,044) y peor graduación en dicha escala (p = 0,024 y 0,025). Asimismo, hallamos más complicaciones locales en las cirugías de exéresis que en las biopsias (p = 0,027). El estado preanestésico y los tratamientos antihemostáticos no se relacionaron con dichos eventos. Conclusiones. Los pacientes mayores de 65 años presentan una mayor incidencia de antecedentes patológicos y peor estado funcional prequirúrgico. La edad, el riesgo cardiovascular, el estado funcional y el tipo de cirugía han aumentado de manera significativa las complicaciones posquirúrgicas (AU)
Introduction. Glioblastoma multiforme is the most frequent malignant tumour of the central nervous system, and its incidence reaches 80% in those over 50 years of age. Life expectancy has increased in the population in recent times and an analysis of the post-surgical complications affecting elderly patients is of great importance for a correct surgical indication. Aims. To analyse the factors related with post-surgical complications in elderly patients. Patients and methods. A sample of 88 patients diagnosed with glioblastoma multiforme between 31 and 78 years of age was analysed retrospectively. The variables taken into consideration in the study were: personal medical history, age, functional status, pre-anaesthetic status, tumour characteristics, type of surgery and post-surgical complications. Results. Age was observed to have an influence on local (p = 0.006) and systemic surgical complications (p = 0.034), and on the Clavien-Dindo scale (p = 0.001). Persons with a poorer functional status and cardiovascular risk presented more systemic complications (p = 0.006 and 0.044) and a lower score on the Clavien-Dindo scale (p = 0.024 and 0.025) respectively. Likewise, more local complications are found in the case of excisional procedures than in biopsies (p = 0.027). The pre-anaesthetic status and anti-haemostatic treatments were not related with such events. Conclusions. Patients over 65 years of age present a higher incidence of pathological antecedents and a poorer presurgical functional status. Age, cardiovascular risk, functional status and the type of surgical procedure have significantly increased the occurrence of post-surgical complications (AU)
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Glioblastoma/complications , Glioblastoma/epidemiology , Glioblastoma/surgery , Postoperative Complications/epidemiology , Postoperative Complications/surgery , Brain Neoplasms/complications , Brain Neoplasms/surgery , Risk Factors , Retrospective Studies , Longitudinal StudiesABSTRACT
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