Impact of demonstration in a realistic simulation environment as a postoperative education in patients' experience.

OBJECTIVE: To evaluate the impact of training in the Practical Life Room on patients experience during hospitalization. METHODS: Subjects submitted to orthopedic surgeries were randomized to two groups (Control and Intervention) in the postoperative period. The Control Group received only the printed guidelines regarding the postoperative period, and the Intervention Group received the printed guidelines and a demonstration and training session with a physical therapist, in an environment created to simulate a house and its rooms (living room, bedroom, kitchen, laundry and bathroom). The participants of both groups answered the questionnaire Hospital Consumer Assessment of Healthcare Providers and Systems on the day of discharge. RESULTS: Sixty-eight subjects were included in the study, 30 (44.1%) in the Control Group and 38 (55.9%) in the Intervention Group. The Hospital Consumer Assessment of Healthcare Providers and Systems questionnaire score showed no significant difference between the groups (p=0.496). CONCLUSION: There was no influence of the proposed intervention on the results of the Hospital Consumer Assessment of Healthcare Providers and Systems questionnaire, perhaps because of the limitation of the instrument or due to the fact it was employed when patients were still hospitalized. However, by reports from patients in the Intervention Group about felling better prepared and safer for performing daily activities, it is believed that patient education approaches through demonstration should be included as part of the process to prepare for discharge, whenever possible.

Impact of demonstration in a realistic simulation environment as a postoperative education in patients' experience / Impacto do uso de técnicas de demonstração em ambiente de simulação realística como forma de educação pós-operatória na experiência do paciente internado

ABSTRACT Objective To evaluate the impact of training in the Practical Life Room on patients experience during hospitalization. Methods Subjects submitted to orthopedic surgeries were randomized to two groups (Control and Intervention) in the postoperative period. The Control Group received only the printed guidelines regarding the postoperative period, and the Intervention Group received the printed guidelines and a demonstration and training session with a physical therapist, in an environment created to simulate a house and its rooms (living room, bedroom, kitchen, laundry and bathroom). The participants of both groups answered the questionnaire Hospital Consumer Assessment of Healthcare Providers and Systems on the day of discharge. Results Sixty-eight subjects were included in the study, 30 (44.1%) in the Control Group and 38 (55.9%) in the Intervention Group. The Hospital Consumer Assessment of Healthcare Providers and Systems questionnaire score showed no significant difference between the groups (p=0.496). Conclusion There was no influence of the proposed intervention on the results of the Hospital Consumer Assessment of Healthcare Providers and Systems questionnaire, perhaps because of the limitation of the instrument or due to the fact it was employed when patients were still hospitalized. However, by reports from patients in the Intervention Group about felling better prepared and safer for performing daily activities, it is believed that patient education approaches through demonstration should be included as part of the process to prepare for discharge, whenever possible.

RESUMO Objetivo Avaliar o impacto do treinamento no Ambiente Vida Prática na experiência do paciente durante a internação. Métodos Pacientes em pós-operatório de cirurgias ortopédicas foram randomizados em dois grupos (Controle e Intervenção). O Grupo Controle recebeu orientações por escrito quanto ao pós-operatório, e o Grupo Intervenção recebeu adicionalmente uma sessão de demonstração e treinamento em um ambiente criado para simular uma casa e seus cômodos (sala, quarto, cozinha, lavanderia e banheiro) com profissional fisioterapeuta. Os participantes de ambos os grupos responderam o Questionário de Avaliação do Paciente Internado Relativo aos Sistemas e Prestadores de Cuidados de Saúde no dia da alta hospitalar. Resultados Foram analisados 68 indivíduos, sendo 30 (44,1%) do Grupo Controle e 38 (55,9%) do Grupo Intervenção. O escore do Questionário de Avaliação do Paciente Internado Relativo aos Sistemas e Prestadores de Cuidados de Saúde foi semelhante entre os dois grupos (p=0,496). Conclusão Não houve influência da intervenção proposta nos resultados do Questionário de Avaliação do Paciente Internado Relativo aos Sistemas e Prestadores de Cuidados de Saúde, talvez por limitação do instrumento ou por sua aplicação com o paciente ainda internado. Entretanto, por relatos dos pacientes do Grupo Intervenção sobre maior preparo e segurança para a execução das atividades do cotidiano, acredita-se que abordagens de educação do paciente por meio de demonstração devam ser inseridas como parte do processo de preparação para a alta, sempre que possível.

Clinical Course of Motor Deficits from Lumbosacral Radiculopathy Due to Disk Herniation.

BACKGROUND: The clinical course of motor deficits from lumbosacral radiculopathy appears to improve with or without surgery. Strength measurements have been confined to manual muscle testing (MMT) and have not been extensively followed and quantified in prior studies. OBJECTIVE: To determine if motor weakness and patient-reported outcomes related to lumbosacral radiculopathy improve without surgical intervention over the course of 12 months. DESIGN: Prospective observational cohort. SETTING: Outpatient academic spine practice. PARTICIPANTS: Adults with acute radicular weakness due to disk herniation. METHODS: Forty patients with radiculopathy and strength deficit were followed over a 12-month period. Objective strength and performance tests as well as survey-based measurements were collected at baseline and then every 3 months. Patients underwent comprehensive pain management and rehabilitation and/or surgical approaches as determined in coordination with the treating specialist. This study was approved by the institutional review board of Colorado. MAIN OUTCOME MEASUREMENTS: Testing of strength was through MMT, handheld dynamometer, and performance-based testing. Furthermore, visual analog scale, modified Oswestry Disability Index, and 36-Item Short Form Health Survey (SF-36) were used to measure pain and disability outcomes. RESULTS: Of the 40 patients, 33 (82.5%) did not have surgery; 7 (17.5%) had surgery. Twenty-four of the 33 patients (60%) did not undergo surgery and were followed for 12 months (Comprehensive Pain Management and Rehabilitation, Complete [CPM&R-C]), and 9 (22%) did not have surgery and lacked at least one follow-up evaluation (Comprehensive Pain Management and Rehabilitation, Incomplete [CPM&R-I]). No statistically significant differences were found on baseline measures of strength deficits and SF-36 domains between the CPM&R-C, Surgery, and CPM&R-I groups. Pain and disability scores in the Surgery group were significantly higher than in the CPM&R-C at baseline. There were statistically significant improvements in all areas of strength, pain, and function when comparing measurements at the 12-month follow-up to baseline in the CPM&R-C group. CONCLUSIONS: Individuals with motor deficits due to lumbosacral radiculopathy improve over time regardless of treatment choice. Most did not choose surgery, and almost all of these patients regained full strength at 1 year. Strength recovery typically occurred in the first 3 months, but there was ongoing recovery over the course of a year. LEVEL OF EVIDENCE: II.

Método Tres Escuadras en pacientes deportistas con hernia de disco lumbar en ámbito hospitalario. Trabajo prospectivo / Three Squares method in athletes with lumbar disc herniation. Prospective study

Se realizó un ensayo clínico controlado, prospectivo, no cegado y no randomizado en pacientes deportistas con hernia de disco lumbar (HDL) con o sin irradiación, tratados con medicación y con el Método de Reeducación postural MTE, Método Tres Escuadras. Objetivo: Determinar la existencia y magnitud de la diferencia entre el VAS final e inicial, la flexibilidad lumbar final e inicial y la funcionalidad final e inicial en cada uno de los grupos. Material y Método: Este estudio fue realizado desde abril de 2009 hasta abril de 2014, en pacientes deportistas que presentaban hernia de disco lumbar diagnosticada por resonancia magnética nuclear. La N inicial fue de 126 pacientes, de los cuáles 26 fueron eliminados, N final: 100 pacientes; con un grupo etario de 18 a 65 años. Todos los pacientes realizaban deporte. Se subdividieron en tres grupos según edad, deporte y nivel de competencia. Las variables analizadas fueron el VAS, el Schoeber lumbar, el Schoeber total y el test de Owestry. Se evaluaron en la sesión 1 y en la 10. Los pacientes fueron atendidos con 1 sesión semanal con el Método Tres Escuadras. Resultados: Se evidenció una disminución en el VAS del 83,33% post intervención con respecto al valor basal. Se evidenció un aumento en la maniobra de Schoeber lumbar del 3,57% con respecto al valor basal. Se evidenció un aumento en la maniobra de Schoeber total del 28,57% con respecto al valor basal. Se determinó una disminución en el Owestry del 20% con respecto al valor inicial. Conclusión: Hay una diferencia estadísticamente significativa para el VAS, Schoeber lumbar, Schoeber total y test de Owestry, pre y post-intervención (valor p= <0,001)...

Tratamiento postquirúrgico de hernia discal lumbar en rehabilitación: Revisión sistemática / Postoperative treatment for lumbar disc herniation during rehabilitation: Systematic review

Existen diversos programas e intervenciones para la rehabilitación de pacientes postoperados por hernia discal lumbar (HDL) sintomática. Para determinar el valor de las diferentes intervenciones de rehabilitación dentro del tratamiento postoperatorio de pacientes con HDL sintomática. Material y métodos: Revisión Sistemática. Búsqueda en bases de datos electrónicas desde Enero del 2000 hasta Octubre del 2012. Dos revisores independientes certificados para el uso de la escala PEDro evaluaron los ensayos clínicos incluidos en la revisión final; se incluyeron únicamente aquéllos con alta calidad metodológica; un tercer evaluador fungió de árbitro en caso de discrepancia entre los revisores. Hubo cegamiento de autores, instituciones y revistas para mejorar la precisión de calificaciones y validez interevaluador. Resultados: Se consideraron 15 ensayos clínicos para ser revisados por los evaluadores; 8 (53.3%) se consideraron de alta calidad metodológica (promedio 7.7 de 10 puntos). Se aleatorizaron 1099 participantes a diferentes grupos de tratamiento. No fue posible realizar un metaanálisis con los datos de los ensayos debido a las múltiples intervenciones y variables de desenlace utilizadas. Conclusiones: Se recomienda un programa de rehabilitación inmediata en pacientes postoperados por primera vez de microdisectomía. La intervención cognitiva con reforzamiento positivo aunado al ejercicio es un tratamiento eficaz; incluso se considera alternativo a la fusión vertebral en pacientes postoperados por HDL con recurrencia de síntomas posterior a una primera intervención. Los resultados de la actividad postquirúrgica temprana son generalmente excelentes y sin complicaciones. Se requiere aumentar el número y calidad metodológica de ensayos clínicos enfocados al tema para sustentar la utilidad de estas intervenciones en la práctica clínica diaria.

Various programs and interventions are available for the rehabilitation of patients who have undergone surgery for symptomatic lumbar disc herniation (LDH). Our aim is to determine the value of the different rehabilitation interventions included in the postoperative treatment of patients with symptomatic LDH. Material and methods: Systematic review. Search in electronic data bases from January 2000 to October 2012. Two independent reviewers certified in the use of the PEDro (Physiotherapy Evidence Data Base) scale assessed the clinical trials included in the final version; only those with high methodological quality were included. A third reviewer acted as arbitrator in case of discrepancy between reviewers. The reviewers were blinded to the authors, institutions and journals to increase the precision of their ratings and the inter-reviewer validity. Results: Fifteen clinical trials were reviewed by the reviewers; 8 (53.3%) were considered as having a high methodological quality (average of 7.7/10). Were randomized 1099 participants to different treatment groups. It was not possible to conduct a meta-analysis with the clinical trial data due to the multiple interventions and outcome measures used. Conclusions: An immediate rehabilitation program is recommended in patients undergoing micro-diskectomy for the first time. Cognitive intervention with positive reinforcement together with exercise is an effective treatment. It is even considered as an alternative to vertebral fusion in patients who underwent LDH surgery with symptom recurrence after the first surgery. The results of early postoperative activity are usually excellent and involve no complications. The number and the methodological quality of the clinical trials on this topic need to be increased to justify the usefulness of these interventions in the daily clinical practice.

[Postoperative treatment for lumbar disc herniation during rehabilitation. Systematic review]. / Tratamiento postquirúrgico de hernia discal lumbar en rehabilitación. Revisión sistemática.

UNLABELLED: Various programs and interventions are available for the rehabilitation of patients who have undergone surgery for symptomatic lumbar disc herniation (LDH). Our aim is to determine the value of the different rehabilitation interventions included in the postoperative treatment of patients with symptomatic LDH. MATERIAL AND METHODS: Systematic review. Search in electronic data bases--from January 2000 to October 2012. Two independent reviewers certified in the use of the PEDro (Physiotherapy Evidence Data Base) scale assessed the clinical trials included in the final version; only those with high methodological quality were included. A third reviewer acted as arbitrator in case of discrepancy between reviewers. The reviewers were blinded to the authors, institutions and journals to increase the precision of their ratings and the inter-reviewer validity. RESULTS: Fifteen clinical trials were reviewed by the reviewers; 8 (53.3%) were considered as having a high methodological quality (average of 7.7/10). Were randomized 1099 participants to different treatment groups. It was not possible to conduct a meta-analysis with the clinical trial data due to the multiple interventions and outcome measures used. CONCLUSIONS: An immediate rehabilitation program is recommended in patients undergoing microiskectomy for the first time. Cognitive intervention with positive reinforcement together with exercise is an effective treatment. It is even considered as an alternative to vertebral fusion in patients who underwent LDH surgery with symptom recurrence after the first surgery. The results of early postoperative activity are usually excellent and involve no complications. The number and the methodological quality of the clinical trials on this topic need to be increased to justify the usefulness of these interventions in the daily clinical practice.

Eficacia del masaje tuina y los ejercicios de Williams como terapia en la hernia discal lumbar / Effectiveness of the massage tuina and the Williams exercise like therapy in the

Se conoce la elevada incidencia de la hernia discal lumbar en personas relativamente jóvenes. Se realizó un estudio prospectivo, longitudinal, explicativo y aplicable en el Hospital Provincial de Rehabilitación Faustino Pérez de Sancti Spiritus, entre abril de 2007 y septiembre de 2008 con el objetivo de determinar la eficacia de esta terapia en 40 pacientes que presentaban dolor lumbar secundario a hernia discal lumbar. Veinte enfermos recibieron masaje y ejercicios, mientras a los veinte restantes se les aplicó masaje Tuina, siendo instruidos en un grupo de cuidados posturales. La investigación denotó una mayor frecuencia de pacientes con edad entre 30 y 39 años y sexo masculino que realizaban trabajo pesado o intermedio. Se redujo la frecuencia e intensidad del dolor y las restricciones para realizar actividades, en los dos grupos, al evaluar los cuatro momentos, predominó la evaluación terapéutica muy buena (50 porciento) seguida de la excelente (32.5 porciento). El masaje Tuina resulta una terapia eficaz para aliviar el dolor e incrementar la actividad de los pacientes con hernia discal lumbar, tanto al ser usado solo o asociado a ejercicios de Williams, de esta última forma se obtienen mejores resultados(AU)

The high incidence of the hernia lumbar discal is known in relatively young people. It was carried out a prospective, longitudinal, explaratory and applicable study in the Provincial Hospital of Rehabilitation Faustino Pérez of Sancti Spiritus, between April of 2007 and September of 2008 with the objective of determining the effectiveness of this therapy in 40 patients that presented lumbar pain secondary to hernia lumbar discal. Twenty sick persons received massage and exercises, while at the twenty remaining were applied massage Tuina, being instructed in a group of postural care. The investigation denoted a bigger frequency of patient among 30 and 39 years and masculine sex that they carried out heavy work or intermediate. Decreased the frequency and intensity of the pain and the restrictions to carry out activities, in the two groups, when evaluating four moments, the very good therapeutic evaluation prevailed (50 percent) followed by the excellent one (32.5 percent). The massage Tuina is an effective therapy to alleviate pain and to increase activity of the patients with hernia lumbar discal, mainly when it is used alone or associated to Williams exercises, from the last one better results are obtained(AU)

Análisis de los resultados de la Cinesioterapia en el tratamiento fisioterapéutico de la Hernia Discal Cervical. Hospital Psiquiátrico de la Habana. 2011 / Analysis of the Kinesiotherapy in the Physiotherapeutic treatment of herniated cervical disk. Psychiatric Hospital of Havana, 2011

La Terapia Física repercute de manera significativa en el tratamiento de la hernia discal. Personas jóvenes socialmente activas se ven incapacitadas de realizar una vida normal por los síntomas que provoca esta lesión del disco intervertebral. El presente trabajo pretende describir los efectos del tratamiento rehabilitador cinesiológico en pacientes con hernia discal cervical operados y no operados. Para ello se realizó un estudio descriptivo y retrospectivo del año 2010 en el Hospital Psiquiátrico de la Habana tomando como muestra a los 21 pacientes con diagnóstico de hernia discal cervical operada y no operada. Los pacientes fueron en su mayoría del sexo masculino y predominó la cervicalgia baja, con localizaciones topográficas en C5-C6 y C6-C7. El 85 por ciento de los enfermos tuvieron síntomas por más de un año. En todos los pacientes se realizó Radiología simple y TAC con resultados positivos. La Electroterapia se aplicó en todos, constituyendo la base del tratamiento con agentes físicos. Hubo tendencia al mayor empleo de la Cinesioterapia en los no operados, lo cual indica que los pacientes operados fueron tratados más conservadoramente. Aunque un 81 por ciento de los pacientes tuvo alivio del dolor, las dos terceras partes tienen pérdida de fuerza, y una cantidad notable aqueja pérdida de sensibilidad y mareos, persistiendo el cuadro en 19 por ciento de los enfermos. Los datos muestran que la evolución de muchos pacientes no es óptima, sin diferencia notable entre operados y no operados, y que el protocolo de tratamiento empleado, basado en la aplicación de agentes físicos más que en la cinesioterapia, no resultó totalmente efectivo(AU)

The physical therapy results significantly on the treatment of herniated disk. Young person socially active are disable to carried out a normal life due to the symptoms provoked by this inter vertebral disk. The actual paper describes the effects of the kinesiology rehabilitating treatment on patients that has undergone a surgery and on patients that do not and suffering from herniated cervical disk. The majority were masculine patients and was significant the low cerviacalgy with topographic locations on C5-C6 and C6- C7. The 85 percent of the patients presented symptoms for more than a year. In all the patients it was done simple x ray and CAT with positive results. Electrotherapy was applied on all the patients being the base of the treatment with physical agents. There was a greater tendency to apply Kinesiotherapy in patients that did not have a surgery and this indicates that patients with a surgery were treated in a more traditional way. Even though a 85 percent of the patients presented pain relief, the two third parts present lack of strength and a significant amount of patients suffer from lack of sensitive and has dizziness, and the symptoms continue present in 19 percent of the patients. Data show that evolution in most of the patients is not ideal, without notable difference between patients that undergone a surgery and the ones that did not and the used treatment based on the use of physical agents more than Kinesiotherapy did not result totally effective(AU)

Hernia discal lumbar. Resultados del tratamiento quirúrgico. Hospital Celia Sánchez Manduley / Lumbar disc herniation. Surgical treatment results. Celia Sanchez Manduley Hospital

Se realizó un estudio descriptivo, retrospectivo, transversal en el Hospital Clínico Quirúrgico Celia Sánchez Manduley de Manzanillo, en 48 pacientes con el diagnóstico de Hernia Discal Lumbar, los cuales se intervinieron quirúrgicamente por la técnica convencional, en los años 1999-2003 observándose un predominio en aquellos pacientes cuyas edades oscilaba entre 25 y 44 años. En la etapa preoperatorio, en la totalidad de los enfermos se presentó el dolor lumbar irradiado a miembros inferiores, mientras que las parestesias incidieron en un 84,41 por ciento de los casos. El nivel de herniación más significativo fue el 5to espacio (43,75 por ciento). Del universo estudiado, un 47,92 por ciento evolucionó satisfactoriamente, rehabilitándose totalmente el 62,50 por ciento de los pacientes intervenidos quirúrgicamente, estando así en correspondencia con la literatura revisada respecto a la serie de otros autores.(AU)

It was performed a descriptive, retrospective and transverse research at Celia Sanchez Manduley Clinical Surgical Hospital in Manzanillo with 48 patients presenting Lumbar Disc Herniation. They were surgically assisted by the conventional technique during the years 1999-2003, and it was observed prevalence in the patients whose ages ranged between 25 and 44 years old. During this pre–operatory stage a lumbar pain irradiated to the lower members and it was presented in the greatest amount of patients, while the paresthesias influenced in 84.81 per cent of the cases. The most outstanding level of herniation was the 5th stage (43.75 per cent). From the universe, 47.92 per cent made a satisfactory progress and there were rehabilitated 62.50 per cent of the patients surgically assisted, according to the revision of literature.(EU)

O tratamento de pacientes com fibrose epidural pela reeducação postural global - RPG / Treatment of patients with epidural fibrosis withglobal postural reeducation - GPR

Muitos pacientes têm convivido com a fibrose epidural no pós-operatório de hérnia de disco lombar, doença que pode contribuir para o afastamento destes pacientes de suas atividades da vida profissional, além de interferir em outros aspectos de suas vidas, impossibilitando-as de desenvolver suas atividades habituais, em decorrência do desconforto produzido pela dor. Este trabalho teve como objetivo esclarecer a importância da fisioterapia no tratamento desta doença e mostrar a eficácia da Reeducação Postural Global (RPG), para amenizar a dor, propiciando uma melhor qualidade de vida para estes pacientes. Este trabalho foi realizado no Instituto de Neurologia Deolindo Couto da UFRJ, no ambulatório de fisioterapia. Fizeram parte deste estudo 18 pacientes de ambos os sexos, com fibrose epidural comprovada por ressonância magnética (RM). Todos os pacientes responderam ao Questionário de Dor e Incapacidade Lombar de Roland-Morris, e foram avaliados por uma Escala Visual Analógica (EVA). Essas medidas de avaliação de dor foram utilizadas sempre no momento inicial do tratamento, durante as sessões de RPG. Foram realizadas 15 sessões de RPG. Todos os pacientes envolvidos no trabalho concordaram em participar do programa proposto mediante préinformação e livre consentimento. Após o término do tratamento os pacientes foram reavaliados em um período de três e seis meses.

Many patients have been living with epidural fibrosis during the postoperative of lumbar disc hernia, a kind of disorder that take the patients away from their professional activities, and also away from other aspects of their lives. It impairs their daily activities due to the discomfort produced by the pain. This work has an objective of clarifying the importance of the Physiotherapy for the treatment of this disorder, and to show the efficacy of the Global Postural Reeducation (GPR) to diminish the pain, giving to these patients a better quality of life. This work was performed in Deolindo Couto Neurology Institute û UFRJ, at the Physiotherapy Clinic. Eighteen patients, of both sexes, were included in this study, with epidural fibrosis seen by Magnetic Resonance. All patients answered to the Questionnaire of Pain and Lumbar Incapacity of Roland-Morris, and were also evaluated by a Visual Analog Scale (VAS). These methods of pain evaluation were always used on the time of initial treatment, during GPR sessions. All patients involved in the work agreed in participating of the program, by preinformation and free assent. After the treatment, the patients were reevaluated after a three and six month's period.

Escore funcional e de dor após cirurgia de hérnia de disco lombar e fisioterapia precoce / Funcional and pain score after lumbar disc surgery snd early physiotherapy

Objetivos: Avaliar o efeito da intervenção fisioterapeutica no escore funcional e de dor dos pacientes submetidos à cirurgia de hérnia de disoc lombar (HDL). Métodos: Estudo randomizado, controlado e cego , avaliando pacientes que internaram no hospital São Lucas da PUCRS, no período de outubro de 2003 a maio de 2004, para realizar cirurgia de HDL. Amostra: 20 pacientes, 10 do grupo de intervenção (cirurgia e fisioterapia no pós-operatório). Intervenção fisioterapêutica): alongamento neural do ciático, alongamentos de Williams e uso da estimulação elétrica trascutânea três vezes ao dia, do primeiro dia pós-operatório até a alta hospitalar. Instrumentos para avaliar o escore de dor e de função, respectivamente: escala análogo-visual de dor e Roland Morris Questionnaire. Escores avaliados antes da cirurgia, pós-operatório imediato e dois meses após os procedimentos. Resultados: Houve significância estatística na diferença do escore funcional (P=0,009) e na redução da intensidade da dor (P=0,028) dos pacientes no segundo mês pós-operatório, favorecendo o grupo com intervenção fisioterapêutica

Reabilitação precoce de atletas utilizando hidroterapia após o tratamento cirúrgico de hérnia discal lombar: relato preliminar de 3 casos / Early rehabilitation of athletes using hydrotherapy after surgical treatment of lumbar disc herniation: preliminary report of three cases

Os autores avaliaram três atletas do sexo masculino, submetidos a tratamento cirúrgico de hérnia discal lombar, com o objetivo de avaliar os resultados, após serem submetidos a um protocolo de reabilitação com base em hidroterapia. Este método permitiu a reabilitação precoce dos atletas, iniciando-se na primeira semana após a cirurgia. Os atletas foram avaliados em 5 ocasiões: pré-operatório e nos 4 meses seguintes. Houve melhora completa da dor em dois atletas. O terceiro caso apresentou no 4º mês 1,3 por cento da intensidade máxima. As atividades de vida diária no período pré-operatório em média apresentaram-se com 21,6 por cento da freqüência máxima, chegando a 99,3 por cento no 4º mês. A freqüência de prática esportiva teve em média 10 por cento da intensidade no pré-operatório, no 4º mês os atletas já praticavam a atividade esportiva com uma freqüência de 84,6 por cento do normal. O nível de atividade esportiva foi relatado em média como 10 por cento daquele estabelecido pelos atletas antes do início dos sintomas, atingindo 88,3 por cento no 4º mês. Concluímos que os atletas apresentaram melhora evolutiva em todos os parâmetros analisados, especialmente em relação a dor. Portanto, a hidroterapia mostrou-se um método eficaz e bem tolerado na reabilitação precoce da cirurgia de hérnia discal em atletas.

Nucleotomía lumbar percutánea automatizada. Informe de 20 casos / Automated percutaneous lumbar discectomy. Report of 20 cases

La disquectomía lumbar percutánea automatizada (DLPA) es un nuevo procedimiento para el tratamiento de un disco lumbar herniado, usando anestesia local y la ayuda de un intensificador de imágenes como guía. Una cánula especialmente diseñada (nucleotomo) con un diámetro de 2 mm es colocada dentro del disco y éste es estraído por corte y aspiración en lugar de la cirugía convencional bajo anestesia general. A partir del mes de junio de 1989, en el Hospital de Traumatología y Ortopedia de Lomas Verdes del IMSS se ha iniciado su utilización en los casos considerados adecuados para ello. Comunicamos la experiencia obtenida con los primeros 20 casos de su aplicación que fueron 12 para L4 y ocho para L5. El seguimiento fue de tres a ocho meses con promedio de seis. El resultado fue satisfactorio en 15 pacientes y en cinco no satisfactorio. En dos de ellos se diagnosticó hernia extrusa y en otro un fragmento de disco libre subligamentario mediante discografía-TAC. Los tres sometieron a hemilaminectomía, comprobado el diagnóstico. Los dos restantes rehusaron todo estudio y tratamiento complementario.