RESUMEN
BACKGROUND: Epiduroscopy is a percutaneous endoscopic technique with an interesting diagnostic and therapeutic potential. AIM: The study was aimed to evaluate the effectiveness of this modern minimally invasive method in treating pain together with the accompanying neurological symptoms of patients with a failed back surgery syndrome (FBSS). RESULTS: In the retrospective multicentre clinical study, we monitored the effect of epiduroscopic performance in 40 patients with FBSS before epiduroscopy and after 6 and 12 months. The results of the study indicated a significant improvement in back pain after 6 months, at p<0.05. At the same time, a significant improvement was observed in pain radiating to the lower limbs after 6 and 12 months at p<0.05, as well as a significant improvement in the Oswestry Disability Index of the limbs after 6 months and after 12 months (p<0.05). CONCLUSION: The current summarised results indicate a significant positive effect of epiduroscopy in the treatment of chronic back pain with a reduction in radiating pain to the lower extremities and an increase in patients' quality of life after the procedure (Tab. 2, Fig. 1, Ref. 23).
Asunto(s)
Endoscopía , Síndrome de Fracaso de la Cirugía Espinal Lumbar , Manejo del Dolor , Síndrome de Fracaso de la Cirugía Espinal Lumbar/terapia , Humanos , Inyecciones Epidurales , Calidad de Vida , Estudios RetrospectivosRESUMEN
OBJECTIVE: Prospective observational multicentre two-arm parallel study describing clinical outcome after endoscopic discectomy provided via transforaminal and interlaminar approach. BACKGROUND: Endoscopic lumbar discectomy (ELD) is a percutaneous minimally invasive procedure for the treatment of herniated lumbar discs. Herniations at lumbar intervertebral disc levels of L1/2, L2/3, L3/4 and L4/5 are mostly accessed by the transforaminal (TF) approach. However, due to the anatomic position of the iliac crest, the L5/S1 level might not be reachable by the transforaminal approach, while the interlaminar (IL) percutaneous approach should be a suitable alternative. METHODS: In a prospective observational multicentre clinical trial NCT0274311, we compared the clinical outcomes of two groups of patients who underwent ELD via IL (83) and TF (103) approach. The subjects were followed for 12 months via planned examinations by pain physicians. The levels of leg pain and back pain intensity were assessed by an 11-point numerical ratings scale (NRS). Patient's functional disability was assessed by the Oswestry Disability Index (ODI). RESULTS: Study subjects showed a significant decrease in ODI scores in both groups (p<0.001) The values of mean preoperative ODI in TF and IL groups were 39.1±15.7 and 43.4±16, respectively. Postoperative values in the latter groups were 14.8±14.9 and 17.5±14.3, respectively. Significantly lower pain scores for leg pain (p<0.001) and back pain (p<0.001) were also recorded at 12-month follow-ups. CONCLUSION: Because both procedures are strictly percutaneous; they are now more commonly performed by interventional pain physicians as a safe and effective alternative to open surgical spine procedures (Tab.â 3, Fig. 7, Ref. 19).
Asunto(s)
Discectomía Percutánea , Discectomía , Endoscopía , Desplazamiento del Disco Intervertebral , Discectomía/métodos , Humanos , Desplazamiento del Disco Intervertebral/cirugía , Vértebras Lumbares , Dimensión del Dolor , Estudios Prospectivos , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
AIM: Our clinical experience with high - frequency SCS for FBSS in patients with predominant low back pain is presented. MATERIAL AND METHODS: After a trial period, 100 % (21 out of 21) of patients with FBSS with predominant low back pain reported a significant improvement in visual analog scale (VAS) pain score and underwent permanent implantation of the high - frequency SCS system. SCS trials lasted 7-14 days (median 9 days). SCS leads were mostly positioned at the T8-10 or T8-12 vertebral levels . We used both single and dual lead placement. VAS, patient satisfaction, patient performance status, opioid consumption and complication rate were assessed for the period of 12 months. RESULTS: The mean VAS score before implantation (8.7) compared to VAS 12 months after implantation (4.0) was significantly lower (CI95[3.9-5.4], p < 0.001). There was a significant improvement in performance status when comparing PS before implantation (3.0) and 12 months after implantation (1.8) (CI95[0.9-1.6], p < 0.001). The mean patient satisfaction scores (PSS) did not differ throughout the whole one year follow-up period. CONCLUSION: Our group of 21 patients with implanted high - frequency SCS systems reported significant low back pain and leg pain relief within the period of 12 months as well as significant improvement in their performance status. We had a special subgroup of 5 patients with regular change of frequencies between high frequency and conventional frequency (with paresthesia) also with significant leg and low back pain relief (Tab. 2, Fig. 1, Ref. 8). Text in PDF www.elis.sk.
Asunto(s)
Síndrome de Fracaso de la Cirugía Espinal Lumbar/terapia , Dolor de la Región Lumbar/terapia , Satisfacción del Paciente , Estimulación de la Médula Espinal/métodos , Adulto , Analgésicos Opioides/uso terapéutico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Médula Espinal/fisiología , Resultado del TratamientoRESUMEN
Mixed cellular (MC) type of Hodgkin disease was studied in a group of 92 bioptic cases diagnosed before the start of treatment. A precise histological analysis showed one subtype with lower malignancy (MC 1) and a second one with higher malignancy (MC 2). Subtype MC 1 comprised 61 cases (66 per cent), subtype MC 2 31 cases (34 per cent). Histomorphological subtyping was brought into correlation with clinical data of survival available in 65 cases (44 cases of subtype MC 1,21 cases of subtype MC 2). Different survival in both subtypes had statistical significance and prognostic relevance. Suggested subtyping is simple, based on common histological slides, without need of special additional investigation.