RESUMEN
Discogenic low back pain is a common musculoskeletal complaint in patients presenting to orthopaedic surgeons. In addition to surgical options, there are several nonsurgical intradiscal treatments that have gained interest, ranging from biologic, nonbiologic, cell-based, and molecular therapies. However, there is limited evidence for many of these techniques, and some are still in the clinical trial stage. We describe a broad overview of these intradiscal therapies, the mechanism of action, and the evidence behind them.
Asunto(s)
Degeneración del Disco Intervertebral , Desplazamiento del Disco Intervertebral , Dolor de la Región Lumbar , Humanos , Degeneración del Disco Intervertebral/terapia , Desplazamiento del Disco Intervertebral/cirugía , Dolor de la Región Lumbar/etiología , Dolor de la Región Lumbar/cirugía , Vértebras Lumbares , Resultado del TratamientoRESUMEN
INTRODUCTION: lumbar spine pain affects a high percentage of the population and has a significant socioeconomic impact. Lumbar facet syndrome has a prevalence between 15-31% with lifetime incidence of up to 52% in some series. Due to the use of different types of treatment and different patient selection criteria, the success rate varies in the literature. OBJECTIVE: to compare results of treatment with rhizolysis applying pulsed radiofrequency versus cryoablation in patients diagnosed with lumbar facet syndrome. MATERIAL AND METHODS: from January 2019 to November 2019, eight patients were randomly divided into two groups: group A treated with pulsed radiofrequency and group B treated with cryoablation. Pain was assessed with the visual analogue scale and the Oswestry low back pain disability index at four weeks, in addition to three and six months. RESULTS: follow-up was six months. Immediately the eight patients (100%) reported improvement in symptoms and pain. Of the four patients who were in intense functional limitation, one of them became without functional limitation, and two of them went to minimum functional limitation and one to moderate functional limitation at the first month, statistically significant differences were reported. CONCLUSIONS: both treatments control pain in the short term; there is also an improvement in physical abilities. The morbidity accompanying neurolysis either radiofrequency or cryoablation is very low.
INTRODUCCIÓN: el dolor en columna lumbar afecta a un alto porcentaje de la población y presenta un significativo impacto socioeconómico. El síndrome facetario lumbar tiene una prevalencia entre 15-31% con incidencia a lo largo de la vida de hasta 52% en algunas series. Debido al empleo de distintos tipos de tratamiento y diversos criterios de selección de los pacientes, la tasa de éxito varía en la literatura. OBJETIVO: comparar resultados de tratamiento con rizólisis aplicando radiofrecuencia pulsada versus crioablación en pacientes con diagnóstico de síndrome facetario lumbar. MATERIAL Y MÉTODOS: de Enero de 2019 a Noviembre de 2019, ocho pacientes fueron divididos aleatoriamente en dos grupos: el grupo A tratados con radiofrecuencia pulsada y el grupo B tratados con crioablación. Se evaluó el dolor con la escala visual análoga y el índice de discapacidad de dolor lumbar de Oswestry a las cuatro semanas, además de tres y seis meses. RESULTADOS: el seguimiento fue de seis meses. De forma inmediata los ocho pacientes (100%) refirieron mejoría de los síntomas y del dolor. De los cuatro pacientes que se encontraban en limitación funcional intensa, uno pasó a estar sin limitación funcional, dos de ellos pasaron a limitación funcional mínima y uno a limitación funcional moderada al primer mes; se reportaron diferencias estadísticamente significativas. CONCLUSIONES: ambos tratamientos controlan el dolor en el corto plazo; también hay una mejoría de las capacidades físicas. La morbilidad que acompaña a la neurólisis, ya sea radiofrecuencia o crioablación, es muy baja.
Asunto(s)
Criocirugía , Dolor de la Región Lumbar , Humanos , Dolor de la Región Lumbar/cirugía , Dimensión del Dolor , Examen FísicoRESUMEN
ABSTRACT Objectives To evaluate pain intensity and functional status before and 30 days following percutaneous lumbar endoscopic discectomy. Methods A retrospective cohort study that included patients who underwent percutaneous endoscopic discectomy from January 2019 to October 2020 at the Irmandade Santa Casa de Misericórdia Hospital, in Porto Alegre. The data were collected from the electronic medical records of the patients by two independent physicians. Clinical outcomes were assessed using visual analog scale (VAS) and Oswestry Disability Index (ODI) scores. Results Forty-six patients with a mean age of 52.6 ± 15.8 years, 27 of whom (58.7%) were male, were evaluated. Regarding clinical outcomes, a statistically significant improvement was observed in the comparison between the pre- and 30-day postoperative VAS and ODI scores, with no significant difference in relation to sex. No peri- or postoperative complications were observed. All patients successfully completed surgery and were discharged after recovery from anesthesia. Conclusion There was a significant improvement in pain and functional status 30 days after percutaneous endoscopic discectomy performed to correct lumbar disc herniation, with no difference in relation to sex. In addition, no peri- or postoperative complications were observed. Future studies, with longer follow-up times, comparing clinical outcomes from the various techniques of percutaneous endoscopic discectomy are necessary. Level of evidence III; Retrospective comparative study.
RESUMO Objetivos Avaliar a intensidade da dor e o estado funcional antes da cirurgia e em 30 dias de pós-operatório de discectomia endoscópica lombar percutânea. Métodos Estudo de coorte retrospectivo. Foram incluídos pacientes tratados com discectomia endoscópica percutânea, de janeiro de 2019 a outubro de 2020, no complexo hospitalar Irmandade Santa Casa de Misericórdia de Porto Alegre. Os dados foram coletados do prontuário eletrônico dos pacientes por dois médicos independentes. Os desfechos clínicos foram avaliados pela pontuação da Escala Visual Analógica (EVA) e do Índice de Incapacidade Oswestry (ODI). Resultados Foram incluídos 46 pacientes no estudo, com média de idade de 52,6 ± 15,8 anos, sendo 27 (58,7%), do sexo masculino. Quanto aos desfechos clínicos, observou-se melhora estatisticamente significativa com relação às escalas de EVA e ODI na comparação entre pré-operatório e 30 dias depois da cirurgia, sem diferença significativa com relação ao sexo. Não foram observadas complicações peri e pós-operatórias. Todos os pacientes completaram a cirurgia com sucesso e receberam alta após recuperação da anestesia. Conclusão Observou-se melhora significativa da dor e do estado funcional 30 dias depois da discectomia endoscópica percutânea realizada para correção da hérnia de disco lombar, sem diferença com relação ao sexo. Além disso, não foram observadas complicações peri e pós-operatórias, assim como não houve necessidade de internação hospitalar. Futuros estudos, com maior tempo de seguimento, que comparem os desfechos clínicos através das diversas técnicas de discectomia endoscópica percutânea fazem-se necessários. Nível de evidência III; Estudo retrospectivo comparativo
RESUMEN Objetivo Evaluar la intensidad del dolor y el estado funcional antes de la cirugía y 30 días después de la discectomía endoscópica lumbar percutánea. Métodos Estudio de cohorte retrospectivo. Se incluyeron pacientes tratados mediante discectomía endoscópica percutánea, de enero de 2019 a octubre de 2020, en el complejo hospitalario Hermandad Santa Casa de Misericordia de Porto Alegre. Los datos fueron recolectados de los registros médicos electrónicos de los pacientes por dos médicos independientes. Los resultados clínicos se evaluaron mediante la puntuación de la Escala Visual Analógica (EVA) y del Índice de Discapacidad de Oswestry (ODI). Resultados Se incluyeron 46 pacientes en el estudio, con una edad promedio de 52,6 ± 15,8 años, de los cuales 27 (58,7%) eran del sexo masculino. En cuanto a los resultados clínicos, hubo una mejoría estadísticamente significativa en relación a las escalas EVA y ODI al comparar el preoperatorio y 30 días después de la cirugía sin diferencia significativa en cuanto al sexo. No se observaron complicaciones perioperatorias y postoperatorias. Todos los pacientes completaron con éxito la cirugía e fueron dados de alta después de recuperarse de la anestesia, sin casos de reingreso hospitalario. Conclusión Hubo una mejoría significativa del dolor y del estado funcional luego de 30 días de discectomía endoscópica percutánea, realizada para corregir la hernia de disco lumbar, sin diferencias en cuanto al sexo. Además, no hubo complicaciones perioperatorias y postoperatorias, así como tampoco hubo necesidad de hospitalización. Son necesarios estudios futuros, con un período de seguimiento más largo, que comparen los resultados clínicos a través de las diferentes técnicas de discectomía endoscópica percutánea. Nivel de evidencia III; Estudio comparativo retrospectivo.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Dolor Postoperatorio , Columna Vertebral/cirugía , Dolor de la Región Lumbar/cirugía , Discectomía Percutánea/métodos , Endoscopía/métodos , Región Lumbosacra/cirugía , Estudios Retrospectivos , Recuperación de la Función , HerniorrafiaRESUMEN
BACKGROUND: Interventional radiofrequency (RF) ablation techniques are indicated when an adequate effect is not obtained with conservative measures. OBJECTIVES: The primary objective of this study was to evaluate pain relief after RF denervation of the sacroiliac joint. The secondary objective was to evaluate pain intensity and relief duration. STUDY DESIGN: The study was retrospective. SETTING: The study was conducted at Vera Cruz Hospital, Campinas, Brazil. METHODS: Data were collected from the medical records of patients undergoing RF denervation for low back pain originating in the sacroiliac joint, from January 2015 to December 2017. There were 78 patients studied, between 18 and 65 years old, of both genders, ASA I or II, who underwent knee arthroscopic meniscectomy. The patients were submitted to denervation of sacroiliac joint by 3 types of RF (conventional, pulsed, and cooled). The following parameters were evaluated, number of patients who obtained ? 50% pain relief; pain intensity, measured using the visual analog scale (before the procedure and 15, 30, 90 and 180 days after, performed by the same evaluator); and the use of complementary analgesic for 2 weeks. RESULTS: Of the 78 included patients, 56 (71.8%) underwent conventional RF, 9 (11.5%) underwent pulsed RF, and 13 (16.7%) underwent cooled RF. There were losses to follow-up including 40 patients who underwent conventional RF, 5 who underwent pulsed RF, and 12 who underwent cooled RF, who were retained for 6 months. There was significant pain relief with the three types of RF for up to 6 months of follow-up, with no difference among the types. After 6 months, 90.2% of patients who underwent conventional RF, 100% who underwent pulsed RF, and 91.7% who underwent cooled RF maintained ≥ 50% pain relief. Complementary analgesics were used by 95% of the patients who underwent conventional RF, 80% who underwent pulsed RF, and 91% who underwent cooled RF 2 weeks after the procedure. There were mild adverse effects, such as edema, hematoma, and local pain, without complications. LIMITATIONS: As for limitations, the number of pulsed and cooled RF is low and in a retrospective study some data may be missing, especially from follow-up. CONCLUSIONS: RF denervation of the sacroiliac joint is effective and promotes a long-lasting analgesic effect.
Asunto(s)
Dolor de la Región Lumbar , Articulación Sacroiliaca , Adolescente , Adulto , Anciano , Desnervación , Femenino , Humanos , Dolor de la Región Lumbar/cirugía , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Estudios Retrospectivos , Articulación Sacroiliaca/cirugía , Resultado del Tratamiento , Adulto JovenRESUMEN
ABSTRACT: Cohort study.This study aimed to determine the effectiveness of the universal approach of full endoscopy and percutaneous transpedicular fixation via a medial central approach (ACM) performed to surgically treat patients with lumbar degenerative surgical pathologies.Alternatives to interventionist treatments available to patients with lumbar degenerative surgical pathologies are related to recovery from minimally invasive surgery. Considering this, full endoscopic spinal decompression (full endoscopy) and percutaneous transpedicular fixation via an ACM represent advances in neurosurgical procedures, in particular, spinal surgery. Thus, the introduction of endoscopic and minimally invasive surgeries for the lumbar region has become 1 of the most important advances in modern surgery.A cohort of 79 patients undergoing full endoscopy and percutaneous transpedicular fixation was evaluated 6 times in 1âyear. Pain intensity was measured using the visual analog scale (VAS), and lumbar functionality was measured using the Oswestry Disability Index (ODI). Six evaluations were performed: before surgery and on discharge after surgery as well as at 1, 3, 6, and 12âmonths after surgery.Before the ACM was applied, the VAS pain score was 8.52. At 11âhours post-surgery, the pain score reduced to 2.59 points (a difference of 5.73 points; Pâ=â0.001). Of the 10 ODI domains evaluated, a difference was found between the period prior to surgery and 1âmonth later (Pâ<â0.01).The universal approach to full endoscopy and lumbar percutaneous transpedicular fixation via an ACM is highly effective for patients with lumbar surgical degenerative pathologies.
Asunto(s)
Descompresión Quirúrgica , Endoscopía , Degeneración del Disco Intervertebral/cirugía , Laminectomía , Dolor de la Región Lumbar , Vértebras Lumbares , Fusión Vertebral , Descompresión Quirúrgica/efectos adversos , Descompresión Quirúrgica/métodos , Endoscopía/efectos adversos , Endoscopía/métodos , Femenino , Humanos , Degeneración del Disco Intervertebral/diagnóstico , Laminectomía/efectos adversos , Laminectomía/métodos , Dolor de la Región Lumbar/diagnóstico , Dolor de la Región Lumbar/etiología , Dolor de la Región Lumbar/cirugía , Vértebras Lumbares/patología , Vértebras Lumbares/cirugía , Masculino , México , Persona de Mediana Edad , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Evaluación de Procesos y Resultados en Atención de Salud , Dimensión del Dolor/métodos , Periodo Perioperatorio/métodos , Recuperación de la Función , Fusión Vertebral/efectos adversos , Fusión Vertebral/métodosRESUMEN
INTRODUCCIÓN ; El presente documento de evaluación de tecnología sanitaria (ETS) expone la evaluación de la eficacia y seguridad del procedimiento de adhesiólisis percutánea con el uso de catéter epidural direccionable de neuroplastía (CEDN), en comparación con el catéter epidural convencional de neuroplastía (CECN), en pacientes adultos con dolor lumbar crónico (DLC) por compresión de nervios debido a cicatrices o adherencias epidurales. El dolor lumbar es una de las condiciones más prevalentes e incapacitantes en el mundo. Esta patología presenta una tendencia al incremento de su incidencia, principalmente en países en desarrollo. El Institute for Health Metrics and Evaluation (IHME) señala que en el Perú, el dolor lumbar fue la primera causa de años de vida vividos con discapacidad (AVD) y la tercera causa de años de vida perdidos por enfermedad, discapacidad o muerte prematura; medido según los años de vida ajustados por discapacidad (AVAD) en el año 2017. Por lo general, el dolor lumbar es de causa desconocida y suele remitir sin tratamiento en días o semanas. Sin embargo, los casos de dolor lumbar crónico (DLC) comúnmente son causados por la presencia de estenosis espinal, síndrome de cirugía de espalda fallida y/o hernias discales. Todas estas causas, se caracterizan por la presencia de cicatrices o adherencias en el espacio epidural que generan dolor debido al estiramiento o compresión de las raíces nerviosas contra las adherencias durante el movimiento. El procedimiento de adhesiólisis percutánea permite eliminar las adherencias causantes de DLC mediante la lisis mecánica y la administración de soluciones y fármacos (para la analgesia y desinflamación) directamente en las zonas afectadas. En EsSalud, existe una situación de vacío terapéutico para los pacientes con DLC debido a adherencias epidurales, pues no se dispone de tecnologías aprobadas para realizar adhesiólisis percutánea. Debido a ello, para realizar este procedimiento en algunos pacientes, algunos especialistas utilizan un "catéter epidural" fuera de etiqueta. Por ello, los especialistas del Hospital Nacional Guillermo Almenara Irigoyen (HNGAI) han sugerido la inclusión de la tecnología "catéter epidural direccionable de neuroplastía" (CEDN) al petitorio de EsSalud. Según los solicitantes, el catéter empleado actualmente en EsSalud no cuenta con las características técnicas (rigidez y direccionalidad de la punta) para realizar adhesiólisis percutánea, lo que impide alcanzar zonas de adherencias de difícil acceso disminuyendo la eficacia del tratamiento. Por otro lado, mencionan que el CEDN presenta un cuerpo rígido y la punta direccionable, lo que podría otorgar una buena maniobrabilidad y precisión durante los procedimientos, y por ende una mayor eficacia en la disminución del dolor. METODOLOGÍA: Se realizó una búsqueda sistemática de información con el objetivo e identificar la mejor evidencia disponible a la fecha (abril 2021) sobre la eficacia y seguridad de la adhesiólisis percutánea con CEDN, en comparación con CECN. Se realizó una búsqueda bibliográfica avanzada en las bases de datos PubMed, Cochrane Library y LILACS (Literatura Latinoamericana y del Caribe en Ciencias de la Salud). La búsqueda sistemática fue suplementada con una búsqueda manual en la lista de referencias bibliográficas de los estudios incluidos en la ETS. Además, se realizó una búsqueda manual en Google, a fin de poder identificar GPC y ETS de relevancia que pudiesen haber sido omitidas por la estrategia de búsqueda o que no hayan sido publicadas en las bases de datos consideradas. Asimismo, se realizó una búsqueda dentro de bases de datos pertenecientes a grupos que realizan ETS y GPC, incluyendo, el National Institute for Health and Care Excellence (NICE), la Canadian Agency for Drugs and Technologies in Health (CADTH), la Haute Autorité de Santé (HAS), el Institut für Qualitátund Wirtschaftlichkeitim Gesundheitswesen (IQWiG), además de la Base Regional de Informes de Evaluación de Tecnologías en Salud de las Américas (BRISA) y páginas web de sociedades especializadas en el manejo del dolor lumbar crónico. Por último, se realizó una búsqueda de estudios clínicos en ejecución o aún no terminados en: ClinicalTrials.gov International Clinical Trial Registry Platform (ICTRP). RESULTADOS: Se identificaron 279 estudios a partir de la búsqueda bibliográfica, de los cuales 250 estudios fueron elegibles para tamizaje por título y resumen, luego de eliminar duplicados. La selección de estudios por título y resumen se realizó mediante una evaluación por pares empleando el aplicativo web Rayyan. Como resultado, se obtuvieron 27 estudios elegibles para la evaluación a texto completo (21 como resultado de la búsqueda sistemática, y seis de la búsqueda manual), de los cuales, cuatro fueron considerados elegibles para incluirse en la presente ETS.
Asunto(s)
Humanos , Radiculopatía/fisiopatología , Dolor de la Región Lumbar/cirugía , Procedimientos Neuroquirúrgicos/métodos , Catéteres , Eficacia , Análisis Costo-BeneficioRESUMEN
OBJECTIVE: To determine the effect of dual tasking on trunk muscle endurance in patients after lumbar diskectomy. DESIGN: Cross-sectional study. SETTING: Rehabilitation hospital setting. PARTICIPANTS: Individuals (N=14) undergoing primary lumbar diskectomy. INTERVENTION: Using a randomized design on 2 separate days, muscle endurance was evaluated during prone bridging and Biering-Sorensen tests. Each test was randomly performed under 2 cognitive conditions: single task without cognitive condition and self-regulated dual task (ie, mathematical task). MAIN OUTCOME MEASURES: The primary outcomes were time to failure and pain assessed by the visual analog scale from 0 to 100 mm. The secondary outcomes were kinesiophobia assessed by the Tampa Scale and disability assessed by the Oswestry Disability Index. Associations were tested using a repeated measures analysis of variance with relevant interaction test. RESULTS: A significant interaction between condition, endurance tests, and kinesiophobia (P=.005) was found. The post hoc comparison showed positive effects between cognitive conditions in both endurance tests (prone bridging test: mean difference, 15.7s; 95% confidence interval [CI], 7.5-24s; P=.001; Biering-Sorensen test: mean difference, 7.9s; 95% CI, 1.9-14s; P=.014). The linear regression analysis between the Tampa Scale for Kinesiophobia and the difference of time to failure between cognitive conditions showed a positive correlation only during the Biering-Sorensen test (r=0.80; P=.001). CONCLUSIONS: A self-regulated dual task increases trunk muscle endurance in patients after lumbar diskectomy. The results suggest that the difference observed in time to failure between the single task and dual task is associated with fear avoidance, especially during back extension. This strategy seems especially relevant for patients with high levels of fear avoidance and may be used to improve trunk muscle endurance.
Asunto(s)
Terapia por Ejercicio/métodos , Dolor de la Región Lumbar/fisiopatología , Dolor de la Región Lumbar/rehabilitación , Debilidad Muscular/fisiopatología , Debilidad Muscular/rehabilitación , Resistencia Física/fisiología , Torso/fisiopatología , Adulto , Estudios Transversales , Evaluación de la Discapacidad , Discectomía , Femenino , Humanos , Dolor de la Región Lumbar/cirugía , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Adulto JovenRESUMEN
Lumbar radiofrequency ablation is indicated for the treatment of chronic axial low back pain that is mediated by facet arthropathy which has failed more conservative treatment options. This article details proper equipment and medications, patient positioning and setup, step-by-step instructions for multiplanar fluoroscopic visualization, cannula placement, and postoperative management. Pearls and pitfalls are also discussed. In addition, an instructional procedure video (Supplemental Digital Content 1, http://links.lww.com/CLINSPINE/A90) accompanies this paper.
Asunto(s)
Artropatías/cirugía , Dolor de la Región Lumbar/cirugía , Vértebras Lumbares/cirugía , Ablación por Radiofrecuencia/métodos , Articulación Cigapofisaria/cirugía , Dolor Crónico/etiología , Dolor Crónico/cirugía , Humanos , Artropatías/complicaciones , Artropatías/diagnóstico , Dolor de la Región Lumbar/etiología , Posicionamiento del PacienteRESUMEN
SUMMARY Lumbar herniated disc are common manifestations of degenerative spine diseases, the main cause of radiated lower back pain. This guideline followed standard of a systematic review with recovery of evidence based on the movement of evidence-based medicine. We used the structured method for formulating the question synthesized by the acronym p.I.C.O., In which the p corresponds to the lumbar herniated disc, i to the treatment intervention with percutaneous hydrodiscectomy, c comparing with other treatment modalities, o the outcome of clinical evolution and complications. From the structured question, we identify the descriptors which constituted the evidence search base in the medline-pubmed databases (636 papers) and therefore, after the eligibility criteria (inclusion and exclusion), eight papers were selected to answer to clinical question. The details of the methodology and the results of this guideline are exposed in annex i.
RESUMO Hérnias discais lombares são manifestações comuns das doenças degenerativas da coluna, sendo a principal causa de dor lombar irradiada. Esta diretriz seguiu padrão de uma revisão sistemática com recuperação de evidências com base no movimento da Medicina Baseada em Evidências. Utilizamos a forma estruturada de formular a pergunta sintetizada pelo acrônimo P.I.C.O., em que o P corresponde à Hérnia de disco lombar, I à intervenção Tratamento com hidrodiscectomia percutânea, C comparando com Outras modalidades de tratamento, O de desfecho de Evolução clínica e complicações. A partir da pergunta estruturada, identificamos os descritores que constituíram a base da busca da evidência nas bases de dados Medline-PubMed (636 trabalhos) e, assim, após os critérios de elegibilidade (inclusão e exclusão), oito trabalhos foram selecionados para responder à dúvida clínica. Os detalhes da metodologia e dos resultados desta diretriz estão expostos no Anexo I.
Asunto(s)
Humanos , Discectomía Percutánea/métodos , Degeneración del Disco Intervertebral/cirugía , Desplazamiento del Disco Intervertebral/cirugía , Dolor de la Región Lumbar/cirugía , Medicina Basada en la Evidencia , Vértebras Lumbares/cirugíaRESUMEN
Extradural lumbar spinal canal cavernous hemangiomas (or cavernomas) are rare lesions that can induce intense back pain and neurological deficit. We present a case report of a patient with a pure radicular lombar extradural cavernoma resembling a benign neurological tumor in imaging exams and a successful surgical resection.
Os hemangiomas cavernosos do canal vertebral lombar extradural (ou cavernomas) são lesões raras que podem induzir dor intensa no dorso e déficit neurológico. Apresentamos um relato de caso de um paciente com um cavernoma extradural lombar radicular puro assemelhando-se a um tumor neurológico benigno em exames de imagem e uma ressecção cirúrgica bem-sucedida.
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Dolor de la Región Lumbar/cirugía , Hemangioma Cavernoso/cirugía , Hemangioma Cavernoso/complicaciones , Hemangioma Cavernoso/diagnóstico , Imagen por Resonancia Magnética/métodos , Dolor de la Región Lumbar/etiología , Región LumbosacraRESUMEN
Lumbar herniated disc are common manifestations of degenerative spine diseases, the main cause of radiated lower back pain. This guideline followed standard of a systematic review with recovery of evidence based on the movement of evidence-based medicine. We used the structured method for formulating the question synthesized by the acronym p.I.C.O., In which the p corresponds to the lumbar herniated disc, i to the treatment intervention with percutaneous hydrodiscectomy, c comparing with other treatment modalities, o the outcome of clinical evolution and complications. From the structured question, we identify the descriptors which constituted the evidence search base in the medline-pubmed databases (636 papers) and therefore, after the eligibility criteria (inclusion and exclusion), eight papers were selected to answer to clinical question. The details of the methodology and the results of this guideline are exposed in annex i.
Asunto(s)
Discectomía Percutánea/métodos , Degeneración del Disco Intervertebral/cirugía , Desplazamiento del Disco Intervertebral/cirugía , Medicina Basada en la Evidencia , Humanos , Dolor de la Región Lumbar/cirugía , Vértebras Lumbares/cirugíaRESUMEN
La lumbociatalgia es un problema clínico común, que en la mayoría de los casos se autolimita y se puede tratar en forma conservadora, usando medidas no farmacológicas y analgésicos como paracetamol o los antiinflamatorios no esteroi-deos. Otro medicamento muy utilizado en nuestro medio es la pregabalina, a pesar de que no se encuentra aprobada para dicha indicación. En este trabajo, el autor se pregunta acerca de la utilidad clínica de la pregabalina y luego de hacer una búsqueda bibliográfica sobre la evidencia más actualizada y de mejor calidad acerca del tema, concluye que no es efectiva para lumbociatalgia y que se acompaña de efectos adversos significativos. Esto coincide con las recomenda-ciones de las guías internacionales, que en su mayoría desaconsejan el uso de anticonvulsivantes para la lumbalgia. (AU)
Sciatica is a common clinical situation, in most cases self-limited and which can be managed conservatively with nonpharmaco-logic treatment and analgesics, such as paracetamol or nonsteroidal anti-inflammatory drugs. Pregabalin is also commonly used, despite not being approved for this indication. In this article, the author queries about the clinical usefulness of pregabalin, and after carrying out a bibliographic search of the most recent and best-quality evidence, concludes that it is not effective in sciatica while it causes significant adverse effects. This is in line with the recommendations of most international guidelines,that do not recommend the use of anticonvulsivants drugs for the treatment of lumbalgia. (AU)
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Adulto Joven , Ciática/tratamiento farmacológico , Dolor de la Región Lumbar/tratamiento farmacológico , Práctica Clínica Basada en la Evidencia/tendencias , Pregabalina/efectos adversos , Anticonvulsivantes/efectos adversos , Ciática/cirugía , Ciática/terapia , Antiinflamatorios no Esteroideos/uso terapéutico , Dolor de la Región Lumbar/cirugía , Dolor de la Región Lumbar/terapia , Pregabalina/administración & dosificación , Pregabalina/uso terapéutico , Analgésicos/uso terapéutico , Bloqueo Nervioso/tendenciasRESUMEN
Lumbar pain is a common and frequent chronic condition. It is estimated that facet joint pain represents 15-31% of all consultations for low back pain. In suspected facet joint pain, it is recommended to perform nerve blocks to establish the diagnosis. Percutaneous continuous radiofrequency is the most effective treatment to date. We describe the current evidence on the minimally invasive treatment of lumbar facet syndrome and our experience with image guidance with CT and fluoroscopy by means of rhizolysis of the medial branch of the dorsal primary ramus of the spinal nerve.
El dolor lumbar es una entidad común y frecuente crónica. Se estima que el dolor de causa articular facetaria representa el 15-31% de todas las consultas por dolor lumbar. En sospecha de dolor articular facetario se recomienda realización de bloqueos nerviosos para establecer el diagnóstico. La radiofrecuencia continua percutánea es el tratamiento más efectivo hasta la fecha. Se describe la evidencia actual en el tratamiento mínimamente invasivo del síndrome facetario lumbar y nuestra experiencia con las guías de imagen con TC y fluoroscopía mediante rizolisis de la rama medial del ramo primario dorsal del nervio espinal.
Asunto(s)
Humanos , Desnervación/métodos , Dolor de la Región Lumbar/cirugía , Tratamiento de Radiofrecuencia Pulsada/métodos , Articulación Cigapofisaria , SíndromeRESUMEN
La psicología de la salud está al servicio de la medicina y busca evaluar, estudiar e intervenir en los factores psicológicos que influyen en el proceso de salud y enfermedad. a raíz del aumento de las cirugías y su calidad de evento estresor, que genera comprensivamente ansiedad en cualquier paciente, es aún más relevante el estudio de dichos factores.el presente trabajo tiene como objetivo dar a conocer en una revisión teórica las estrategias de afrontamiento, que son uno de los factores cognitivos-conductuales más importantes. Esta revisión se realizará según el modelo transaccional de estrés y afrontamiento de Lazarus & Folkman en pacientes quirúrgicos bariátricos, lumbares y plásticos.
The psychology of health is at the service of medicine and seeks to evaluate, study and intervene on the psychological factors that influence the health and disease process. as a result of the increase in surgeries, and its quality as a stressor event, which comprehensively generates anxiety in any patient, the study of these factors is even more relevant. The present work aims to present in a theoretical review the coping strategies, which are one of the most important cognitive-behavioral factors. this review will be performed according to the Lazarus & Folkman transactional stress and coping model in bariatric, lumbar and plastic surgical patients.
Asunto(s)
Humanos , Estrés Psicológico/terapia , Cirugía Plástica/psicología , Adaptación Psicológica , Cirugía Bariátrica/psicología , Manejo del Dolor/métodos , Dolor/psicología , Dolor de la Región Lumbar/cirugía , Modelos TeóricosRESUMEN
OBJECTIVES: Hydrodiscectomy is a new technique used for percutaneous spinal discectomy that employs a high-intensity stream of water for herniated disc ablation and tissue aspiration. No previous clinical study has examined the effects of percutaneous hydrodiscectomy. The aim of this study is to evaluate the outcomes of hydrodiscectomy compared to open microdiscectomy regarding pain, function, satisfaction, complications and recurrence rates. METHODS: In this randomized clinical trial, patients referred to our tertiary hospital for lumbar back pain were recruited and included in the study if they had disc protrusion or small herniation in only one level, without neurological deficits and with no resolution after six weeks of conservative treatment. One group underwent open microdiscectomy, and the other group underwent percutaneous microdiscectomy via hydrosurgery. Function was evaluated using the Oswestry Disability Index and pain was assessed using a visual analog scale. Evaluations were performed preoperatively, and then during the first week and at one, three, six and twelve months postoperatively. Personal satisfaction was verified. Clinicaltrials.gov: NCT01367860. RESULTS: During the study period, 20 patients were included in each arm and 39 completed one-year of follow-up (one patient died of unrelated causes). Both groups exhibited equal improvement on the visual analog scale and Oswestry evaluations after treatment, without any significant differences. The improvement in the lumbar visual analog scale score was not significant in the hydrodiscectomy group (p=0.138). The rates of infection, pain, recurrence and satisfaction were similar between the two groups. CONCLUSION: Percutaneous hydrodiscectomy was demonstrated to be as effective as open microdiscectomy for reducing pain. The rates of complications and recurrence of herniation were similar between groups. Patient satisfaction with the treatment was also similar between groups.
Asunto(s)
Discectomía Percutánea/métodos , Discectomía/métodos , Desplazamiento del Disco Intervertebral/cirugía , Dolor de la Región Lumbar/cirugía , Adulto , Evaluación de la Discapacidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dolor Postoperatorio/clasificación , Satisfacción del Paciente , Periodo Posoperatorio , Método Simple Ciego , Resultado del TratamientoRESUMEN
OBJECTIVES: Hydrodiscectomy is a new technique used for percutaneous spinal discectomy that employs a high-intensity stream of water for herniated disc ablation and tissue aspiration. No previous clinical study has examined the effects of percutaneous hydrodiscectomy. The aim of this study is to evaluate the outcomes of hydrodiscectomy compared to open microdiscectomy regarding pain, function, satisfaction, complications and recurrence rates. METHODS: In this randomized clinical trial, patients referred to our tertiary hospital for lumbar back pain were recruited and included in the study if they had disc protrusion or small herniation in only one level, without neurological deficits and with no resolution after six weeks of conservative treatment. One group underwent open microdiscectomy, and the other group underwent percutaneous microdiscectomy via hydrosurgery. Function was evaluated using the Oswestry Disability Index and pain was assessed using a visual analog scale. Evaluations were performed preoperatively, and then during the first week and at one, three, six and twelve months postoperatively. Personal satisfaction was verified. Clinicaltrials.gov: NCT01367860. RESULTS: During the study period, 20 patients were included in each arm and 39 completed one-year of follow-up (one patient died of unrelated causes). Both groups exhibited equal improvement on the visual analog scale and Oswestry evaluations after treatment, without any significant differences. The improvement in the lumbar visual analog scale score was not significant in the hydrodiscectomy group (p=0.138). The rates of infection, pain, recurrence and satisfaction were similar between the two groups. CONCLUSION: Percutaneous hydrodiscectomy was demonstrated to be as effective as open microdiscectomy for reducing pain. The rates of complications and recurrence of herniation were similar between groups. Patient satisfaction with the treatment was also similar between groups.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Discectomía Percutánea/métodos , Discectomía/métodos , Desplazamiento del Disco Intervertebral/cirugía , Dolor de la Región Lumbar/cirugía , Evaluación de la Discapacidad , Dolor Postoperatorio/clasificación , Satisfacción del Paciente , Periodo Posoperatorio , Método Simple Ciego , Resultado del TratamientoRESUMEN
BACKGROUND: Zygapophysial joint arthrosis is a pathology related with axial lumbar pain. The most accepted treatment, after failure of medical management, is the thermal denervation of the medial branch. Nonetheless, the placement of the heat probe remains a challenge to surgeons, even when using the fluoroscope. Using a variation of Shealy's and Bogduk's original techniques, which includes ablation of the medial branch and the nerves present in the joint capsule, we hypothesize that we can obtain similar outcomes to those found in the literature. OBJECTIVE: To present the results attained over the last 8 years in the treatment of axial lumbar pain from zygapophysial joints degeneration, by employing a variation of the lumbar medial branch neurotomy technique, called 360-degree facet rhizotomy with radiofrequency. STUDY DESIGN: Retrospective evaluation. SETTING: Spine Center - Minimally Invasive Surgery in Bogotá, Colombia. METHODS: A medical chart review was conducted for patients diagnosed with axial lumbar pain from zygapophysial joint arthrosis and treated with 360-degree facet rhizolysis with a high frequency radiofrequency energy source between 2008 and 2014. Data were evaluated under modified MacNab and pre- and postoperative visual analog scale (VAS) criteria. RESULTS: We obtained a total of 73 patients. The average population age was 58.6 years. The preoperative VAS obtained was 7.3, which changed to 1.7 one year after the procedure. The MacNab criteria 12 months after the surgery gave satisfactory outcomes (excellent and good) from 91.7% of the patients. LIMITATIONS: This retrospective study includes inherent limitations and only offers one year follow-up data. CONCLUSIONS: Thermal therapy for zygapophysial joint arthrosis constitutes a safe and effective technique. The one year follow-up data presented here show that the ablation of the medial branch and nerves present in the joint capsule leads to satisfactory results in a high percentage of patients.
Asunto(s)
Ablación por Catéter/métodos , Dolor de la Región Lumbar/cirugía , Vértebras Lumbares/cirugía , Manejo del Dolor/métodos , Articulación Cigapofisaria/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Desnervación/métodos , Femenino , Estudios de Seguimiento , Humanos , Dolor de la Región Lumbar/diagnóstico , Masculino , Persona de Mediana Edad , Dimensión del Dolor/métodos , Estudios Retrospectivos , Articulación Cigapofisaria/patologíaRESUMEN
Sacroiliac joint (SIJ) pain is responsible for up to 40% of all cases of lumbar back pain. Objective Report the long-term efficacy of radiofrequency denervation for sacroiliac joint pain at six, twelve and eighteen months.Method Third-two adults' patients with sacroiliac join pain diagnosis were included for a prospective study. Primary outcome measure was pain intensity on the Numeric Rating Scale (NRS). Secondary outcome measure was Patient Global Impression of Change Scale (PGIC).Results Short-term pain relief was observed, with the mean NRS pain score decreasing from 7.7 ± 1.8 at baseline to 2.8 ± 1.2 at one month and to 3.1 ± 1.9 at six months post-procedure (p < 0.001). Long-term pain relief was sustained at twelve and eighteen months post-procedure, with NRS pain remaining at 3.4 ± 2.1 and 4.0 ± 2.7, respectively.Conclusion Radiofrequency denervation of the SIJ can significantly reduce pain in selected patients with sacroiliac syndrome.