Efectividad analgésica del tapentadol en el dolor neuropático secundario al síndrome postlaminectomía / Analgesic effectiveness of tapentadol in neuropathic pain secondary to post-laminectomy syndrome

Objetivo: El objetivo del presente estudio es evaluar la eficacia y seguridad de tapentadol de liberación a 100 o 200 mg vía oral cada 24 horas, de acción prolongada, para el tratamiento del síndrome postlaminectomía (SPL) en una serie de pacientes con dolor neuropático en tratamiento analgésico inefectivo. Material y métodos: Se realizó un estudio unicéntrico, longitudinal, prospectivo y observacional, en el que se reclutaron 30 pacientes a la clínica de dolor de un centro de referencia de tercer nivel que sufrían de SPL y que cumplían con todos los criterios de inclusión; a quienes se les aplicó el cuestionario Brief Pain Inventory en su versión en español y el test de Lanss antes y después de iniciar tratamiento con tapentadol, y se aplicó una t de Student para comparar la efectividad global del tratamiento del dolor neuropático. Resultado: Se analizaron datos de 30 pacientes, de los cuales 19 fueron mujeres (63,3 %) y 11 hombres (36,6 %) con diagnóstico de SPL confirmado y con características de dolor de tipo neuropático, quienes fueron divididos en dos grupos: el primer grupo de 13 pacientes (43,3 %) recibió tapentadol a 100 mg vía oral cada 24 horas y el segundo de 17 pacientes (56,6 %) recibió 200 mg vía oral cada 24 horas por cuatro semanas. Se les dio un seguimiento de 4 semanas y se encontró una disminución estadísticamente significativa (valor de p = 0,05) del dolor neuropático en la consulta subsecuente de la clínica del SPL.(AU)

Objective: The objective of this study is to eva­luate the efficacy and safety of long-acting tapentadol 100 or 200 mg orally every 24 hours for the treatment of Postlaminectomy Syndrome (SPL) in a series of patients with pain neuropathic in ineffective analgesic treatment. Material and methods: A single-center, longitudinal, prospective and observational study was conducted, in which 30 patients were recruited to the pain clinic of a third-level reference center who suffered from SPL and who met all the inclusion criteria; To whom the Brief Pain Inventory questionnaire in its Spanish version and the Lanss Test were applied before and after starting treatment with tapentadol and a student's t was applied to compare the overall effectiveness of the treatment of neuropathic pain. Results: Data from 30 patients were analyzed, of which 19 were women (63.3 %) and 11 were men (36.6 %) with a diagnosis of confirmed SPL and the presentation of neuropathic pain, who were divided into two groups. The first group of 13 patients (43.3 %) received tapentadol at 100 mg orally every 24 hours, and the second group of 17 patients (56.6 %) received 200 mg orally every 24 hours for four weeks. They were followed up for 4 weeks and statistically significant improvement (p value = 0.05) was found in the SPL clinic.(AU)

Change in quality of life, disability, and well-being after decompressive surgery: results from a longitudinal study.

The aim of this study is to evaluate quality of life (QoL), disability, and psychological well-being (PWB) in patients with disc herniation and stenosis before and after decompressive surgery and to investigate factors associated with an improvement in the postoperative disability level. An observational longitudinal study was carried out to collect preoperative and postoperative data on QoL, disability, and PWB using European Health Interview Survey-Quality of Life (EUROHIS-QoL), WHO Disability Assessment Schedule, second version (WHODAS-II), and Psychological General Well-Being Index-Short (PGWB-S) questionnaires. Friedman's analysis of variance was performed to compare preoperative and postoperative test scores, whereas a one-sample t-test was calculated to compare the mean test scores with the general population. A hierarchical logistic regression was developed to investigate the association between the change in the disability level after surgery, sociodemographic and clinical characteristics, and preoperative test scores. Complete data were available for 55 patients. PGWB-S and WHODAS-II scores improved significantly (P=0.004 and 0.003), even if the disability level remained high after surgery. The logistic regression showed that patients with worse preoperative WHODAS-II scores had higher odds achieving improvement in their disability level after surgery. This study showed that disability and PWB improve significantly after surgery, but further treatment and a healthy lifestyle are expected and recommended as the disability level remains high. In addition, more severe preoperative disability was a predictor of better clinical outcome.

Is rehabilitation intervention during hospitalization enough for functional improvements in patients undergoing lumbar decompression surgery? A prospective randomized controlled study.

OBJECTIVE: Rehabilitation has been reported to improve pain and disability for patients after lumbar surgery. However, studies to investigate the rehabilitation intervention for lumbar decompression surgery during hospitalization are scarce. The aim of this study was to examine outcomes of perioperative rehabilitation intervention for patients who underwent lumbar decompression surgery (LDS). METHODS: Patients aged 18-65 years old who received their first LDS were randomized into the perioperative rehabilitation group (PG) or control group (CG). The PG received rehabilitation intervention during hospitalization for lumbar decompression surgery. Pain, functional capacity, Roland-Morris Disability Questionnaire (RMDQ), and Short-Form Health Survey (SF-12) were assessed on admission, at discharge, and at follow-ups one month, three months, and six months after surgery. Two-way repeated measures ANOVAs were used for statistical analysis. RESULTS: A total of 60 patients scheduled for decompression surgery for lumbar stenosis were enrolled into the study. After surgery, the PG showed significant pain relief and improvement of disability as well as quality of life, but there were no significant functional improvements compared with the CG. CONCLUSIONS: The findings of this study indicate that the rehabilitation intervention during hospitalization improves pain intensity as well as disability and quality of life, yet has limited effects on the functional performance over time up to six months post-surgery in patients who received LDS. The study suggest that rehabilitation interventions during hospitalization must include regular support for patient adherence to the intervention program and focus on task-oriented programs for lower extremities such as closed-chain exercises in functional postures.

Predicting discharge placement and health care needs after lumbar spine laminectomy.

OBJECTIVE: To explore factors associated with discharge placement (DP) and need for skilled assistance after patients are discharged from hospital following lumbar laminectomy. METHODS: A retrospective analysis of 339 patients who underwent lumbar laminectomy was conducted. We used multivariable logistic regression analysis to identify significant covariates and to construct two regression models: a primary model to predict DP, home vs inpatient rehabilitation/skilled nursing facility (IR/SNF), and a secondary model to predict the need for skilled assistance once patients are discharged to home. RESULTS: The sample included 48.7% females, 68.2% married, 56.3% independent in daily activities, and 85.2% discharged to home. Subjects were a mean 56.06 ± 12.75 years old and had a BMI of 31.35 ± 6.2. Of those discharged to home, 17.7% needed skilled assistance. Patients stayed 4.41 ± 3.55 days in the hospital and walked 203.38 ± 144.87 ft during hospital stay. Age, distance walked during hospital stay, and length of hospital stay (LOS) were significant positive predictors for discharge to home vs IR/SNF, whereas single living status, diminished prior level of function, and longer LOS were predictors of need for skilled assistance after discharge to home. CONCLUSION: Age, mobility, marital status, prior level of function, and LOS are key variables in determining healthcare needs following lumbar laminectomy.

Rehabilitation after lumbar disc surgery.

BACKGROUND: Several rehabilitation programmes are available for individuals after lumbar disc surgery. OBJECTIVES: To determine whether active rehabilitation after lumbar disc surgery is more effective than no treatment, and to describe which type of active rehabilitation is most effective. This is the second update of a Cochrane Review first published in 2002.First, we clustered treatments according to the start of treatment.1. Active rehabilitation that starts immediately postsurgery.2. Active rehabilitation that starts four to six weeks postsurgery.3. Active rehabilitation that starts longer than 12 months postsurgery.For every cluster, the following comparisons were investigated.A. Active rehabilitation versus no treatment, placebo or waiting list control.B. Active rehabilitation versus other kinds of active rehabilitation.C. Specific intervention in addition to active rehabilitation versus active rehabilitation alone. SEARCH METHODS: We searched CENTRAL (2013, Issue 4) and MEDLINE, EMBASE, CINAHL, PEDro and PsycINFO to May 2013. SELECTION CRITERIA: We included only randomised controlled trials (RCTs). DATA COLLECTION AND ANALYSIS: Pairs of review authors independently assessed studies for eligibility and risk of bias. Meta-analyses were performed if studies were clinically homogeneous. The GRADE approach was used to determine the overall quality of evidence. MAIN RESULTS: In this update, we identified eight new studies, thereby including a total of 22 trials (2503 participants), 10 of which had a low risk of bias. Most rehabilitation programmes were assessed in only one study. Both men and women were included, and overall mean age was 41.4 years. All participants had received standard discectomy, microdiscectomy and in one study standard laminectomy and (micro)discectomy. Mean duration of the rehabilitation intervention was 12 weeks; eight studies assessed six to eight-week exercise programmes, and eight studies assessed 12 to 13-week exercise programmes. Programmes were provided in primary and secondary care facilities and were started immediately after surgery (n = 4) or four to six weeks (n = 16) or one year after surgery (n = 2). In general, the overall quality of the evidence is low to very low. Rehabilitation programmes that started immediately after surgery were not more effective than their control interventions, which included exercise. Low- to very low-quality evidence suggests that there were no differences between specific rehabilitation programmes (multidisciplinary care, behavioural graded activity, strength and stretching) that started four to six weeks postsurgery and their comparators, which included some form of exercise. Low-quality evidence shows that physiotherapy from four to six weeks postsurgery onward led to better function than no treatment or education only, and that multidisciplinary rehabilitation co-ordinated by medical advisors led to faster return to work than usual care. Statistical pooling was performed only for three comparisons in which the rehabilitation programmes started four to six weeks postsurgery: exercise programmes versus no treatment, high- versus low-intensity exercise programmes and supervised versus home exercise programmes. Very low-quality evidence (five RCTs, N = 272) shows that exercises are more effective than no treatment for pain at short-term follow-up (standard mean difference (SMD) -0.90; 95% confidence interval (CI) -1.55 to -0.24), and low-quality evidence (four RCTs, N = 252) suggests that exercises are more effective for functional status on short-term follow-up (SMD -0.67; 95% CI -1.22 to -0.12) and that no difference in functional status was noted on long-term follow-up (three RCTs, N = 226; SMD -0.22; 95% CI -0.49 to 0.04). None of these studies reported that exercise increased the reoperation rate. Very low-quality evidence (two RCTs, N = 103) shows that high-intensity exercise programmes are more effective than low-intensity exercise programmes for pain in the short term (weighted mean difference (WMD) -10.67; 95% CI -17.04 to -4.30), and low-quality evidence (two RCTs, N = 103) shows that they are more effective for functional status in the short term (SMD -0.77; 95% CI -1.17 to -0.36). Very low-quality evidence (four RCTs, N = 154) suggests no significant differences between supervised and home exercise programmes for short-term pain relief (SMD -0.76;  95% CI -2.04 to 0.53) or functional status (four RCTs, N = 154; SMD -0.36; 95% CI -0.88 to 0.15). AUTHORS' CONCLUSIONS: Considerable variation was noted in the content, duration and intensity of the rehabilitation programmes included in this review, and for none of them was high- or moderate-quality evidence identified. Exercise programmes starting four to six weeks postsurgery seem to lead to a faster decrease in pain and disability than no treatment, with small to medium effect sizes, and high-intensity exercise programmes seem to lead to a slightly faster decrease in pain and disability than is seen with low-intensity programmes, but the overall quality of the evidence is only low to very low. No significant differences were noted between supervised and home exercise programmes for pain relief, disability or global perceived effect. None of the trials reported an increase in reoperation rate after first-time lumbar surgery. High-quality randomised controlled trials are strongly needed.

A rare presentation of subacute progressive ascending myelopathy secondary to cement leakage in percutaneous vertebroplasty.

Percutaneous vertebroplasty is used to manage osteoporotic vertebral body compression fractures. Although it is relatively safe, complications after vertebroplasty ranging from minor to devastatingly major ones have been described. Cement leakage into the spinal canal is one such complication. Subacute progressive ascending myelopathy is an infrequent neurologic complication after spinal cord injury, typically presenting as ascending neurologic deficit within weeks after the initial insult. The precise cause of subacute progressive ascending myelopathy still remains an enigma, considering the rarity of this disorder. The authors present the case of a 62-yr-old woman with osteoporotic vertebral fracture who underwent percutaneous vertebroplasty and developed T6 complete paraplegia because of cement leakage. A few weeks later, the neurologic level ascended to higher cervical level (C3). To date, no case of subacute progressive ascending myelopathy secondary to cement leakage after percutaneous vertebroplasty has been reported. Literature is reviewed regarding subacute progressive ascending myelopathy, and the rehabilitation challenges in the management of this patient are discussed.

Life dissatisfaction burden is associated with a poor surgical outcome among lumbar spinal stenosis patients: a 5-year follow-up study.

Dissatisfaction with life has been found to be associated with somatic health and the short-term surgery outcome in lumbar spinal stenosis (LSS) patients. This study investigated the effects of the long-term life dissatisfaction burden on the surgery outcome in LSS patients with a 5-year follow-up. This was a prospective clinical study. Altogether, 102 patients who underwent decompressive surgery completed a set of questionnaires preoperatively, 3 and 6 months, and 1, 2 and 5 years after the surgery. The final study population at the 5-year follow-up included 67 patients. The mean age of the patients was 67 years and 35% of the patients were men. Life satisfaction was evaluated using a four-item Life Satisfaction Scale. The life dissatisfaction burden was the sum of all six life satisfaction scores recorded during the follow-up. The outcome of surgery was evaluated using the Oswestry Disability Index (ODI), pain evaluation (Visual Analogue Scale; VAS), overall satisfaction with the surgery and self-reported walking capacity. In linear regression, the long-term life dissatisfaction burden was associated with the 5-year ODI, even after adjusting for age, sex, marital status, preoperative ODI and the 5-year VAS. It was not associated with the 5-year VAS score. Monitoring the life satisfaction of surgically treated LSS patients may enable detection of those at risk of a poorer surgery outcome.

Lesiones del ganglio dorsal por radiofrecuencia pulsada a través del espacio epidural / No disponible

No disponible

Administración de alphaB cristalina como nueva terapia para promover recuperación funcional en lesiones agudas de la médula espinal / Administration of alphaB crystallin as a new therapy to promote functional recovery after acute spinal cord injury

Objetivo: Caracterizar la expresión y función de alphaB cristalina en la lesión medular. Material y método: En un modelo animal murino -mus musculus (ratón) de la cepa C57/Bl6- se realizó lesión medular mediante contusión, y los segmentos medulares fueron extraídos a los 1, 3, 7, 14, 21 y 28 días postlesión. Se valoraron los niveles de ARNm de alpaB cristalina. Asimismo, se administró alphaB cristalina recombinante humana tras la lesión medular y se valoró su efecto sobre la recuperación funcional. Resultados: Los niveles de expresión de alphaB cristalina no se incrementan hasta los 21 días post-lesión. La administración de dicha proteína promueve recuperación funcional tras la lesión medular. Conclusión: La administración de alphaB cristalina podría ser una nueva terapia para tratar las lesiones agudas de la médula espinal (AU)

Objective: Characterize the expression and role of alphaB crystallin in spinal cord injury Material and method: In a murine animal model (mus musculus (C57/Bl6 mouse) spinal cord injury was induced by contusion and the spinal cord segment corresponding to the injury site was extracted at day 1, 3, 7, 14, 21, 28 post-injury and alphaB crystallin mRNA levels were assessed. In addition, the effects of the administration of the human alphaB crystallin recombinant protein after spinal cord injury was evaluated. Results: alphaB crystallin mRNA levels did not increase until day 21 following spinal cord injury. Administration of alphaB crystallin resulted in increased functional recovery after lesion. Conclusion: Administration of alphaB crystallin could therefore be valuable for the treatment of acute spinal cord injury (AU)

Fifteen pressure ulcers presenting in a known paediatric case of histiocytoma of the spine.

Patients with profound sensorimotor deficits following spinal trauma/post spinal surgery are vulnerable to develop pressure ulceration. Here we present an unusual case of multiple pressure ulcers in an 11-year-old paraplegic child, with histiocytoma of the spine at the T1-T3 level. Although multiplicity of ulcers is not uncommon, this was the first case, in our institute, in which such a large number of pressure ulcers were encountered in a child. Successful management, using a multidisciplinary approach, led to improved quality of life and, at follow-up of more than 1 year, the child has not developed any new pressure ulcers, and neither is there any recurrence.

Human Dental Pulp Cells: A New Source of Cell Therapy in a Mouse Model of Compressive Spinal Cord Injury

Strategies aimed at improving spinal cord regeneration after trauma are still challenging neurologists andneuroscientists throughout the world. Many cell-based therapies have been tested, with limited success in termsof functional outcome. In this study, we investigated the effects of human dental pulp cells (HDPCs) in a mousemodel of compressive spinal cord injury (SCI). These cells present some advantages, such as the ease of theextraction process, and expression of trophic factors and embryonic markers from both ecto-mesenchymal andmesenchymal components. Young adult female C57/BL6 mice were subjected to laminectomy at T9 andcompression of the spinal cord with a vascular clip for 1 min. The cells were transplanted 7 days or 28 days afterthe lesion, in order to compare the recovery when treatment is applied in a subacute or chronic phase. Weperformed quantitative analyses of white-matter preservation, trophic-factor expression and quantification, andultrastructural and functional analysis. Our results for the HDPC-transplanted animals showed better whitematterpreservation than the DMEM groups, higher levels of trophic-factor expression in the tissue, better tissueorganization, and the presence of many axons being myelinated by either Schwann cells or oligodendrocytes, inaddition to the presence of some healthy-appearing intact neurons with synapse contacts on their cell bodies. Wealso demonstrated that HDPCs were able to express some glial markers such as GFAP and S-100. The functionalanalysis also showed locomotor improvement in these animals. Based on these findings, we propose that HDPCsmay be feasible candidates for therapeutic intervention after SCI and central nervous system disorders inhumans.

Nurse experts jump-start clinical simulation in rehabilitation nursing: supporting new graduate transition to competence.

This article outlines a high-fidelity simulation project developed and implemented by expert staff nurses at a specialty rehabilitation hospital. The project is designed to educate new graduate nurses on appropriate care for patients after a rare spinal cord surgical procedure. Due to the complicated nature of the surgery, patients are highly acute and may present with specific complications that need to be addressed for positive patient outcomes. Expert staff nurses imparted their knowledge in developing a scenario emphasizing common and unusual postsurgery patient presentations. The scenario was implemented as a teaching exercise for new graduate nurses, with experienced staff nurses as facilitators of learning in a safe, nonthreatening environment. New graduate nurses were overwhelmingly positive in the postsimulation debriefing, reporting increased confidence and knowledge necessary to care for these patients. Future endeavors include expanding involvement of staff nurses in simulation education and researching new graduate transition through simulation.

Return to golf after spine surgery.

OBJECT: no published evidence indicates when patients can resume golfing after spine surgery. The objective of this study is to provide data from surveys sent to spine surgeons. METHODS: a survey of North American Spine Society members was undertaken querying the suggested timing of return to golf. Of 1000 spine surgeons surveyed, 523 responded (52.3%). The timing of recommended return to golf and the reasons were questioned for college/professional athletes and avid and recreational golfers of both sexes. Responses were tallied for lumbar laminectomy, lumbar microdiscectomy, lumbar fusion, and anterior cervical discectomy with fusion. RESULTS: the most common recommended time for return to golf was 4-8 weeks after lumbar laminectomy and lumbar microdiscectomy, 2-3 months after anterior cervical fusion, and 6 months after lumbar fusion. The results showed a statistically significant increase in the recommended time to resume golf after lumbar fusion than after cervical fusion in all patients (p < 0.01). The same holds true for the return to play after cervical fusion compared with either lumbar laminectomy or lumbar microdiscectomy for all golfer types (p < 0.01). There was a statistically significant shorter recommended time for professional and college golfers compared with noncompetitive golfers after lumbar fusion (p < 0.01), anterior cervical discectomy and fusion (p < 0.01), and lumbar microdiscectomy (p < 0.01). CONCLUSIONS: the return to golf after spine surgery depends on many variables, including the general well-being of patients in terms of pain control and comfort when golfing. This survey serves as a guide that can assist medical practitioners in telling patients the average times recommended by surgeons across North America regarding return to golf after spine surgery.

Herniación transdural espontánea de la médula espinal con recidiva temprana / Spontaneous transdural spinal cord herniation with early relapse

La herniación transdural idiopática de la médula espinal (HTIME) es una entidad muy poco conocida que suele cursar con una clínica de mielopatía progresiva de largo tiempo de evolución cuyas manifestaciones radiológicas mediante resonancia magnética (RM) previo a la cirugía son diagnósticas. Presentamos un caso de una paciente de 61 años de edad con una clínica de mielopatía espástica (síndrome de Brown-Séquard) cuyo diagnóstico de HTIME en RM fue concluyente. Se intervino quirúrgicamente mediante reducción y cierre del defecto dural, con mejoría clínica aunque quedando una paraplejia con nivel metamérico D5 (ASIA D). Sin embargo, posteriormente, la paciente refirió un nuevo episodio de empeoramiento clínico progresivo estableciéndose el diagnóstico de recidiva de la hernia, confirmada mediante RM. Se intervino por segunda vez a los 6 meses de la intervención inicial, cubriendo la sutura dural con un parche sintético. Aunque es habitual la persistencia de déficits neurológicos residuales tras la cirugía, la recidiva de la hernia medular transdural espontánea resulta extraordinariamente rara y hay que considerarla, como un posible diagnóstico diferencial, en caso de empeoramiento progresivo tras una evolución inicial favorable(AU)

Idiopathic transdural spinal cord herniation (ITSCH) is a little-known medical condition that causes large duration progressive myelopathy that can be diagnosed based on the radiological manifestations on magnetic resonance imaging (MRI) prior to surgery. We present the case of a 61-year-old woman with spastic myelopathy (Brown-Sequard syndrome) and conclusive diagnosis of ITSCH by MRI. Surgery was carried out with reduction of the spinal cord and repair of the dural defect with clinical improvement but paraplegia at the metameric D5 level (ASIA D). However, six months after surgery a new progressive neurologic worsening was present with recurrent spinal cord herniation diagnosis confirmed with MRI. A second surgery was carried out, covering the dural defect with synthetic patch. Although persistence of neurologic deficits after spinal surgery is common, recurrence of spinal cord herniation is extremely rare. It must be considered as a possible differential diagnosis in case of progressive neurologic deterioration after an initial favorable course(AU)

Teratoma inmaduro intramedular infantil / Immature childhood intramedullary teratoma

Los teratomas en la infancia son generalmente benignos; siendo los inmaduros los menos frecuentes. Son tumores intradurales; lo que supone el 10% de los tumores raquimedulares en el niño. Presentamos el caso clínico de un paciente varón afecto de lesión medular diagnosticada a los 2 años de edad sin déficit sensoriomotor. Tras extirpar la lesión quedaron secuelas que requirieron tratamiento neurorehabilitador: vejiga neurógena, paresia de extremidades inferiores. El estudio anatomopatológico diagnostica la lesión de teratoma inmaduro grado II/III de localización D11-L3. Existe además una recidiva de las lesiones intradurales; a pesar de lo cual la evolución es satisfactoria. Se realiza búsqueda bibliográfica sin encontrar ningún caso publicado con las características de nuestro paciente. Mediante este caso se demuestra la importancia de un seguimiento y tratamiento multidisciplinar para el tratamiento de estas lesiones; de modo que el papel del médico rehabilitador es actuar de forma precoz para minimizar las secuelas y conseguir el mayor grado de independencia posible(AU)

Teratomas in childhood are usually benign, the immature ones being the least frequent. They are intradural tumors, which account for 10% of all the spinal tumors in children. We present a case of a male whose lesion was detected when he was 2 years old with no sensory-motor deficit. Following the tumor excision, some sequels remained that required rehabilitation treatment: neurogenic bladder and lower limb paresis. The anatomy-pathology diagnosed an immature teratoma grade II/III located in D11-L3. There was also recurrence of the intradural lesions in spite of which the evolution was good. A bibliographic search was performed, without finding any case similar to our patient. The importance of a follow-up and multidisciplinary treatment for those lesions is demonstrated by this case. Thus, the role of the rehabilitation doctor is to act early to minimize the sequels and to the highest independence possible(AU)

The effects of different rehabilitation strategies on the functional recovery of spinal cord injured rats: an experimental study.

STUDY DESIGN: An experimental study. OBJECTIVE: To investigate the effects of different rehabilitation strategies on functional recovery of partial spinal cord of injured rats. SUMMARY OF BACKGROUND DATA: Activity-based rehabilitation is promising strategy for improving functional recovery following spinal cord injury (SCI). METHODS: Twenty-four female Sprague-Dawley rats weighing 180 to 220 g were anesthetized with chloral hydrate (450 mg kg⁻¹) by intraperitoneal injection, and laminectomy was performed at T7-T8 level, leaving the dura intact. A compression plate (2.2 × 5.0 mm) loaded with weight of 35 g was placed on the exposed cord for 5 minutes to create partial SCI. Animals were divided into 3 groups of 8 rats each. Group 1 served as control (SCI + without treadmill and swimming training). Whereas rats in Groups 2 and 3 were subjected to SCI as mentioned previously and received swimming training 5 minutes for Group 2 and treadmill training 5 minutes for Group 3 each day, which occurred beginning 14 days postsurgery and continued for 14 days. The spontaneous coordinate activity (SCA), Basso, Beattie, and Bresnahan (BBB), and Tarlov locomotor scores were used to assess functional recovery of spinal cord injured rats. RESULTS: Day 1 (baseline, 14 days after the surgery), there was no significant difference among the means for SCA, BBB, and Tarlov scores of all groups. After day 1, Groups 1, 2, and 3 showed continuous improvement in their BBB, Tarlov, and SCA scores. This improvement was maintained throughout the duration of the study with different levels for each group. By the end of the study, trained Groups 2 and 3 showed statistically significant improvement in their SCA, BBB, and Tarlov scores compared with Group 1 (P < 0.05). CONCLUSION: These results suggest that 2 weeks of treadmill locomotor training and swimming training may have positive effects on functional recovery after partial SCI.

Gait analysis for evaluating the relationship between increased signal intensity on t2-weighted magnetic resonance imaging and gait function in cervical spondylotic myelopathy.

OBJECTIVE: To determine relationships between increased signal intensity (ISI) on T2-weighted cervical spine magnetic resonance imaging (MRI) and parameters of gait analysis in patients with cervical spondylotic myelopathy (CSM). DESIGN: Retrospective comparative study. SETTING: Gait analysis laboratory. PARTICIPANTS: Patients (N=36) who undertook cervical laminectomy or laminoplasty because of CSM. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Subjects were evaluated by using the modified Japanese Orthopaedic Association (JOA) scale, the Nurick scale, cervical spine MRI, and gait analysis. Two radiologists classified patients into 3 groups: intense, faint, and no ISI. RESULTS: Relative to patients without ISI, those with ISI showed significantly slower gait speed, longer step time, decreased single-limb support time, increased double-limb support time, and limited range of motion of knee and ankle (P<.05). Increased intensity tended to correlate with poor gait function including slower gait speed, longer step time, decreased single-limb support time, and increased double-limb support time. The modified JOA and Nurick scale did not correlate with ISI. CONCLUSIONS: In patients with CSM who received surgical treatment, more intense ISI on T2-weighted MRI correlated preoperatively with increased difficulties in gait function. Gait analysis may be a useful tool for evaluating gait functions in cervical myelopathy.

Correlación clinicorradiográfica de la fibrosis epidural en el síndrome poslaminectomía mediante epidurografía / Clinical/radiography correlation of epidural fibrosis in postlaminectomy syndrome by epidurography

Introducción. La epidurografía es un recurso invasivo que evalúa deformidades y eventual ocupación del espacio epidural, además de ser un estudio fácilmente realizable, confiable, económico y que forma parte del algoritmo de manejo del síndrome poslaminectomía. Objetivo. Verificar si la localización y la extensión de la fibrosis epidural se correlacionan con el cuadro clínico presente en los pacientes con síndrome poslaminectomía. Material y métodos. Se incluyó a 30 pacientes con diagnóstico de síndrome poslaminectomía lumbar divididos en dos grupos: grupo A (n=15) pacientes con lumbalgia y dolor neuropático del miembro pélvico unilateral y grupo B (n=15) pacientes con lumbalgia con dolor neuropático bilateral. En todos los pacientes se realizó el abordaje caudal bajo control fluoroscópico en decúbito prono con aguja Tuohy ♯17. La epidurografía se realizó inyectando medio de contraste ioversol al 63%, acetato de metilprednisolona y lidocaína al 2%. Se relacionó la localización de la fibrosis con el cuadro clínico además de valorar la intensidad del dolor utilizando la escala visual analógica previa al procedimiento a las 2 y a las 4 semanas de realizado este. Resultados. Del total de la población, el 53,3% (16) tuvo correlación clinicorradiográfica, lo cual no se considera estadísticamente significativo (p=0,259). En relación con la evaluación de la escala visual analógica inicial se observó disminución significativa a las 2 semanas de realizado el procedimiento (p=0,0001). Conclusión. La epidurografía diagnóstica no tiene utilidad al momento de intentar correlacionar el sitio de fibrosis epidural con la presentación clínica en los pacientes con síndrome poslaminectomía (AU)

Introduction. Epidurography is an invasive technique that evaluates deformities and eventual occupation of the epidural space, besides being easy to perform, reliable and inexpensive, is part of the management algorithm of post laminectomy syndrome. Objective. To verify whether the location of epidural fibrosis correlates with the clinical picture present in patients with post-laminectomy syndrome. Material and methods. We included 30 patients with a diagnosis of lumbar post-laminectomy syndrome, divided into two groups: Group A (n=15) patients with low back pain and neuropathic unilateral pelvic limb pain, Group B (n=15) patients with low back and bilateral neuropathic pain. The procedure was performed in prone position by fluoroscopic caudal approach. The epidurography was performed by injecting contrast medium Ioversol 63%, methylprednisolone acetate and lidocaine 2%. We associated the location of the fibrosis with the clinical picture and assessed pain intensity using a visual analogue scale (VAS) before the procedure, at 2 and 4 weeks afterwards. Results. Of the total population, 53.3% (16) correlated the clinical/radiographic picture, this was not statistically significant (p=0.259). In relation to the initial VAS, there was a significant decrease at 2 weeks of performing the procedure (p=0.0001). Conclusion. The diagnostic epidurography was not useful when attempting to correlate the site of epidural fibrosis with the clinical presentation in patients with post-laminectomy syndrome (AU)

Tratamiento con acupuntura y moxibustión del síndrome poslaminectomía. Caso clínico / Treatment of post-laminectomy syndrome with acupuncture and moxibustion: a clinical case

El síndrome de la cirugía fallida de espalda es una complicación frecuente posquirúrgica que cursa con lumbalgia crónica con gran repercusión clínica y económica. Las posibilidades de tratamiento abarcan una gran variedad de técnicas y fármacos, siendo pese a ello una de las principales causas de dolor lumbar de más difícil tratamiento. Cada vez hay más pruebas sólidas de que la acupuntura puede ser un complemento útil al tratamiento convencional para el tratamiento de la lumbalgia. Se presenta el caso de un paciente de 37 años intervenido hace 2 años de artrodesis L4-L5,con reintervención posterior hace 1 año de retirada del material de osteosíntesis persistiendo con síndrome poslaminectomía no controlado con cicatriz disestésica pese a tratamiento con opiáceos débiles y anticonvulsivantes que se trató adecuadamente con sesiones de acupuntura y moxibustión. Como pruebas complementarias tenía una resonancia magnética en la que se aprecian además de cambios postquirúrgicos en la región lumbar posterior, deshidratación discal en L5-S1 y cambios degenerativos artrósicos de las pequeñas articulaciones interapofisarias a nivel de los últimos niveles lumbares, un estudio electroneurofisiológico en el que se observa una alteración en los potenciales evocados somestésicos realizados en el nervio fémorocutáneo lateral izquierdo, compatible con una neuropatía axonal de dicho nervio. El tratamiento se realizó en 10 sesiones durante 5 semanas, en cada una de las sesiones se hizo un tratamiento bifásico de 40min, tratando en primer lugar la zona cicatricial y a continuación la lumbalgia, en ambos se realizó moxibustión con puro de Artemisa con técnica de picoteo. El dolor fue controlándose pasando de una escala EAV inicial de 8 a una escala EAV al final del tratamiento de 0. Tras pasar revisión a los 6 meses continua con una escala EAV de 0 (AU)

Failed back surgery syndrome is a common post-surgical complication which leads to chronic low back pain with great clinical and financial repercussions. The treatment possibilities include a great variety of techniques and drugs, despite this being one of the main causes of a very difficult to treat lumbar pain. There is increasing solid evidence that acupuncture may be a useful complement to conventional treatment for treating low back pain. A case is presented of a 37 year-old patient surgically intervened 2 years ago for L4-L5 arthrodesis, with subsequent intervention 1 year ago to remove the osteosynthesis material. There was a persistent uncontrolled post-laminectomy syndrome with a dysesthetic scar despite treatment with weak opiates and anticonvulsants, which was treated adequately with sessions of acupuncture and moxibustion. A magnetic resonance imaging scan was performed as a complementary test, in which post-surgical changes could also be seen in the posterior lumbar region, disc dehydration in L5-S1, and degenerative arthrosis of the small interapophyseal lumbar joints. An electro-neurophysiological study showed a change in the somesthetic evoked potentials performed in the left lateral femoral-cutaneous nerve, compatible with an axonal neuropathy of that nerve. Treatment was given in 10 sessions over 5 weeks, in with a biphasic treatment of 40min being performed in each of them. The scar area was treated first and then the low back pain, moxibustion was performed on both with Artemis smoke and a pecking technique. The pain was controlled, going from a initial VAS score of 8 to 0 at the end of treatment. At the follow-up review at 6 months it was still 0 on the VAS scale (AU)

Treatment of acute neurological deficit after cervical laminectomy with lumbar cerebrospinal fluid drainage.

Spinal cord ischaemia is a rare, but reported cause of acute deterioration following cervical laminectomies. Various adjuncts have been reported to protect against and treat cord ischaemia, including CSF diversion. We present a case of a patient who experienced an acute neurological deterioration following cervical laminectomies that improved following CSF drainage.