RESUMEN
STUDY DESIGN: Retrospective cohort study. OBJECTIVE: The goal of the present study was to determine whether neck pain responds differently to anterior cervical discectomy and fusion (ACDF) between patients with cervical radiculopathy and/or cervical myelopathy. SUMMARY OF BACKGROUND DATA: Many patients who undergo ACDF because of radiculopathy/myelopathy also complain of neck pain. However, no studies have compared the response of significant neck pain to ACDF. METHODS: Patients undergoing one to three-level primary ACDF for radiculopathy and/or myelopathy with significant (Visual Analogue Scale [VAS] ≥ 3) neck pain and a minimum of 1-year follow-up were included. Based on preoperative symptoms patients were split into groups for analysis: radiculopathy (R group), myelopathy (M group), or both (MR group). Groups were compared for differences in Health Related Quality of Life outcomes: Physical Component Score-12, Mental Component Score (MCS)-12, Neck Disability Index, VAS neck, and VAS arm pain. RESULTS: Two hundred thirty-five patients met inclusion criteria. There were 117 patients in the R group, 53 in the M group, and 65 in the MR group. Preoperative VAS neck pain was found to be significantly higher in the R group versus M group (6.5 vs. 5.5; Pâ=â0.046). Postoperatively, all cohorts experienced significant (Pâ<â0.001) reduction in VAS neck pain, (ΔVAS neck; R group: -2.9, M: -2.5, MR: -2.5) with no significant differences between groups. However, myelopathic patients showed greater improvement in absolute MCS-12 scores (Pâ=â0.011), RR (Pâ=â0.006), and % minimum clinically important difference (Pâ=â0.013) when compared with radiculopathy patients. This greater improvement remained following regression analysis (Pâ=â0.025). CONCLUSION: Patients with substantial preoperative neck pain experienced significant reduction in their neck pain, disability, and physical function following ACDF, whether treated for radiculopathy or myelopathy. However, in this study, only myelopathy patients had significant improvements in their mental function as represented by MCS improvements. LEVEL OF EVIDENCE: 3.
Asunto(s)
Vértebras Cervicales/cirugía , Discectomía/tendencias , Dolor de Cuello/cirugía , Radiculopatía/cirugía , Enfermedades de la Médula Espinal/cirugía , Fusión Vertebral/tendencias , Adulto , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Dolor de Cuello/diagnóstico , Dolor de Cuello/etiología , Dimensión del Dolor/métodos , Dimensión del Dolor/tendencias , Radiculopatía/complicaciones , Radiculopatía/diagnóstico , Estudios Retrospectivos , Enfermedades de la Médula Espinal/complicaciones , Enfermedades de la Médula Espinal/diagnóstico , Resultado del TratamientoRESUMEN
The most common neurological impairments related to schistosomiasis involve the lower portions of the medulla and the cauda equina. A 22-year-old woman, with no history, signs, or symptoms of hepatointestinal schistosomiasis, presented with lumbar pain associated with acute paresthesia and paresis of the right lower limb. Spinal schistosomiasis was suspected based on the disease progression and radiological findings, and the diagnosis was confirmed after cerebrospinal fluid analysis. The authors emphasize this pathology as important as a differential diagnosis in similar clinical scenarios, especially in endemic areas, because both early diagnosis and treatment are essential to avoid permanent sequelae.
Asunto(s)
Neuroesquistosomiasis/diagnóstico , Radiculopatía/diagnóstico , Enfermedades de la Médula Espinal/diagnóstico , Diagnóstico Diferencial , Femenino , Humanos , Imagen por Resonancia Magnética , Neuroesquistosomiasis/líquido cefalorraquídeo , Radiculopatía/líquido cefalorraquídeo , Enfermedades de la Médula Espinal/líquido cefalorraquídeo , Adulto JovenRESUMEN
Abstract The most common neurological impairments related to schistosomiasis involve the lower portions of the medulla and the cauda equina. A 22-year-old woman, with no history, signs, or symptoms of hepatointestinal schistosomiasis, presented with lumbar pain associated with acute paresthesia and paresis of the right lower limb. Spinal schistosomiasis was suspected based on the disease progression and radiological findings, and the diagnosis was confirmed after cerebrospinal fluid analysis. The authors emphasize this pathology as important as a differential diagnosis in similar clinical scenarios, especially in endemic areas, because both early diagnosis and treatment are essential to avoid permanent sequelae.
Asunto(s)
Humanos , Femenino , Adulto Joven , Radiculopatía/diagnóstico , Neuroesquistosomiasis/diagnóstico , Radiculopatía/líquido cefalorraquídeo , Enfermedades de la Médula Espinal/diagnóstico , Enfermedades de la Médula Espinal/líquido cefalorraquídeo , Imagen por Resonancia Magnética , Neuroesquistosomiasis/líquido cefalorraquídeo , Diagnóstico DiferencialRESUMEN
PURPOSE: To report the distribution of the different patterns of stretch brachial plexus injuries (BPIs) in a retrospective cohort of patients operated at our institution during an 11-year period. METHODS: From September 2002 to June 2012, we evaluated and operated on 565 patients with traction injuries of the brachial plexus. Average age was 26.8 years (SD ±9.3 years); the interval between the injury and surgery was 5.4 months (SD ±2.8 months). The pattern of injury was defined based on data obtained from a standardized clinical examination, preoperative helical computed tomography myelography after intradural contrast injection, surgical findings, and intraoperative electric stimulation. RESULTS: Supraclavicular injuries accounted for 91% of all cases (N = 512) whereas 9% of injuries were infraclavicular. Within the supraclavicular injuries, 50% of cases involved the entire plexus and in 12% there was avulsion of all 5 roots. Among them, 94% involved the upper plexus (C5 to C6 ± C7 ± C8), and 6% the lower plexus (C8 to T1 ± C7). C5 to C6 injuries accounted for 23% of partial BPI, C5 to C7 19%, C5 to C8 52%, C7 to T1 4%, and C8 to T1 2%. CONCLUSIONS: The most relevant findings of this study were that most panplexal BPIs showed at least one graftable root, there was a high prevalence of C5 to C8 BPI, C7 to T1 root injury was the most common pattern of lower type of injury, and infraclavicular BPI was uncommon. TYPE OF STUDY/LEVEL OF EVIDENCE: Diagnostic IV.
Asunto(s)
Neuropatías del Plexo Braquial/etiología , Neuropatías del Plexo Braquial/cirugía , Plexo Braquial/lesiones , Parálisis/etiología , Parálisis/cirugía , Adulto , Neuropatías del Plexo Braquial/diagnóstico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Parálisis/diagnóstico , Estudios Prospectivos , Radiculopatía/complicaciones , Radiculopatía/diagnóstico , Radiculopatía/cirugía , Recuperación de la Función , Estudios Retrospectivos , Resultado del Tratamiento , Adulto JovenRESUMEN
Introducción: la Radiculopatía Lumbosacra es una enfermedad con tendencia a la cronicidad y causante de discapacidad de los pacientes que la padecen. Para su adecuado tratamiento es importante la aplicación de estudios neurofisiológicos que tienen una alta sensibilidad para su diagnóstico, evolución y pronóstico. Objetivo: determinar el comportamiento electromiográfico de las afecciones radiculares lumbosacras en adultos mayores. Método: estudio caso-control de los pacientes cuyo motivo de ingreso fue dolor lumbar y fueron diagnosticados con hernia discal en el servicio de neurocirugía del Hospital General Carlos M. Céspedes, en el período de enero de 2006 hasta enero 2011. El estudio comprendió 293 casos, que presentaron dolor en la región lumbosacra, quedando como muestra 25 pacientes diagnosticados electromiográficamente con radiculopatía lumbosacra por hernia discal y el grupo control lo constituyeron 75 ancianos supuestamente sanos que asistieron a las consultas de ortopedia, neurología, neurocirugía y neurofisiología por otras causas. Resultados: en los pacientes con hernia discal predominó el patrón de contracción aislado con un 72 por ciento, así como los potenciales de fibrilación (24 por ciento), las ondas agudas positivas con un 12 por ciento y potenciales de acción de unidad motora polifásico (88 por ciento). El 52 por ciento de los casos presentó daño mielínico. Conclusiones: En todos los pacientes de la muestra estudiada la electromiografía evidenció algún grado de afectación radicular a diferencia de los controles(AU)
Introduction: the lumbosacral radiculopathy is a disease that tends to be chronic and it causes disability in patients who suffer from it. For a proper treatment, it is important the implementation of neurophysiologic studies because they are highly adequated to get to a diagnosis, improvement and prognosis. Objective: to determine the electromyography behaviours in the lumbosacral radicular complaints in elderly persons. Method: A case-control study was carried out in the patients admitted due to low back pain and diagnosed with an herniated disk in the neurosurgery department of Carlos Manuel de Céspedes Hospital from January, 2006 to January, 2011. The study included 293 cases who were complaining of low back pain, a sample of 25 patients were diagnosed electromiographically with lumbosacral radiculopathy due to an herniated disk and a control group of 75 elderly persons apparently healthy who were assisted for other causes in the consultation of orthopaedic, neurology, neurosurgery and neurophysiology. Results: In the patients suffering from a herniated disk, the isolate contraction pattern was predominant in a 72 percent, as well as the fibrillation potentials in a 24 percent, the acute positive waves in a 12 percent and potentials of action in the poliphasic motor unit (88 percent). The myelinated harm was predominant in the 52 percent of the cases. Conclusions: The electromyography showed radicular complaints to a certain degree in all the patients of the sample and it was not thesame in the control groups(EU)
Asunto(s)
Humanos , Desplazamiento del Disco Intervertebral/diagnóstico , Dolor de la Región Lumbar/terapia , Radiculopatía/diagnóstico , ElectromiografíaRESUMEN
Introducción: la radiculopatía por hernia de disco lumbar es la mayor causa de morbilidad que enfrentan los cirujanos espinales. Existen múltiples estrategias de tratamiento para esta afección, sin consenso actual entre secuestrectomía y discectomía, y sobre la necesidad de fusionar el segmento. Objetivo: mostrar nuestros resultados a los 4 años de seguimiento, en el tratamiento quirúrgico de la hernia discal lumbar mediante discectomía foraminal. Método: estudio descriptivo prospectivo en pacientes diagnosticados con hernias discales lumbares y tratados quirúrgicamente mediante discectomía foraminal simple y evaluados 4 años después. Resultados: muestra constituida por 67 pacientes, la mayoría (62,69 por ciento) del sexo masculino; edad media cercana a los 40 años en ambos sexos. Se confirmó el diagnóstico en el 85,3 por ciento de los casos mediante IRM. Predominó la localización L5-S1 y L4-L5, con 16 por ciento de más de un segmento. El índice de Oswestry y la Escala Visual Analógica del dolor mostraron significativa mejoría a los 4 años de operados. Conclusiones: el tratamiento quirúrgico de las hernias de disco mediante discectomía foraminal simple, según nuestra experiencia, produce buenos resultados; a los 4 años de efectuada la operación se constató disminución del dolor y mejoría de la función(AU)
Introduction: Radiculopathy by lumbar disc herniation is a major cause of morbidity faced by spinal surgeons. There are many treatment strategies for this condition, and no current consensus among sequestrectomy and discectomy, and the need to merge the segment. Objective: Show our results at 4 years of follow-up in the surgical treatment of lumbar disc herniation by foraminal discectomy. Method: A prospective study was conducted in patients diagnosed with lumbar disc herniation and foraminal surgically treated by simple discectomy and assessed four years later. Results: The sample consisted of 67 patients, the majority (62.69 percent) was male; average age of nearly 40 years in both sexes. The diagnosis was confirmed in 85.3 percent of cases by MRI. L5-S1 and L4-L5 locations predominated, with 16 percent of more than one segment. Oswestry index and the Visual Analog Scale for pain showed significant improvement after four years of surgery.Conclusions: The surgical treatment of herniated discs by simple foraminal discectomy, in our experience, has good results; at four years of operation pain decrease and improvement in function was found(AU)
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Desplazamiento del Disco Intervertebral/cirugía , Desplazamiento del Disco Intervertebral/terapia , Radiculopatía/diagnóstico , Discectomía/métodos , Medicina Física y Rehabilitación/métodos , Epidemiología Descriptiva , Estudios ProspectivosRESUMEN
INTRODUCCIÓN: la radiculopatía por hernia de disco lumbar es la mayor causa de morbilidad que enfrentan los cirujanos espinales. Existen múltiples estrategias de tratamiento para esta afección, sin consenso actual entre secuestrectomía y discectomía, y sobre la necesidad de fusionar el segmento. OBJETIVO: mostrar nuestros resultados a los 4 años de seguimiento, en el tratamiento quirúrgico de la hernia discal lumbar mediante discectomía foraminal. MÉTODO: estudio descriptivo prospectivo en pacientes diagnosticados con hernias discales lumbares y tratados quirúrgicamente mediante discectomía foraminal simple y evaluados 4 años después RESULTADOS: muestra constituida por 67 pacientes, la mayoría (62,69 %) del sexo masculino; edad media cercana a los 40 años en ambos sexos. Se confirmó el diagnóstico en el 85,3 % de los casos mediante IRM. Predominó la localización L5-S1 y L4-L5, con 16 % de más de un segmento. El índice de Oswestry y la Escala Visual Analógica del dolor mostraron significativa mejoría a los 4 años de operados. CONCLUSIONES: el tratamiento quirúrgico de las hernias de disco mediante discectomía foraminal simple, según nuestra experiencia, produce buenos resultados; a los 4 años de efectuada la operación se constató disminución del dolor y mejoría de la función.
INTRODUCTION: Radiculopathy by lumbar disc herniation is a major cause of morbidity faced by spinal surgeons. There are many treatment strategies for this condition, and no current consensus among sequestrectomy and discectomy, and the need to merge the segment. OBJECTIVE: Show our results at 4 years of follow-up in the surgical treatment of lumbar disc herniation by foraminal discectomy. METHOD: A prospective study was conducted in patients diagnosed with lumbar disc herniation and foraminal surgically treated by simple discectomy and assessed four years later. RESULTS: The sample consisted of 67 patients, the majority (62.69%) was male; average age of nearly 40 years in both sexes. The diagnosis was confirmed in 85.3% of cases by MRI. L5-S1 and L4-L5 locations predominated, with 16% of more than one segment. Oswestry index and the Visual Analog Scale for pain showed significant improvement after four years of surgery. CONCLUSIONS: The surgical treatment of herniated discs by simple foraminal discectomy, in our experience, has good results; at four years of operation pain decrease and improvement in function was found
INTRODUCTION: La radiculopathie par hernie discale lombaire est la cause de morbidité la plus souvent traitée par les chirurgiens spécialisés en moelle épinière. Il y a plusieurs stratégies de traitement pour cette affection, mais aujourd'hui il n'y a pas de consensus ni entre la séquestrectomie et la discectomie ni sur la nécessité de fusionner le segment. OBJECTIF: Le but de ce travail est de montrer, après 4 ans de suivi, nos résultats à propos du traitement chirurgical d'une hernie discale lombaire par décompression foraminale. MÉTHODE: Une étude descriptive et prospective de patients diagnostiqués de hernie discale lombaire, traités chirurgicalement par décompression foraminale simple et évalués quatre ans après, a été réalisée. RÉSULTATS: Dans un échantillon de 67 patients, dont la plupart étaient du sexe masculin (62,69 %) et avaient un moyen d'âge de 40 ans environ chez tous les deux sexes, on a confirmé le diagnostic par IRM dans 85,3 % des cas. Les hernies ont été souvent localisées aux niveaux L5-S1 et L4-L5, dont 16 % correspondait à plus d'un segment. Quatre ans après l'opération, l'indice d'Oswestry et l'échelle visuelle analogique de douleur ont montré une amélioration significative. CONCLUSIONS: D'après notre expérience, le traitement chirurgical des hernies discales lombaires par décompression foraminale simple a montré de très bons résultats. Quatre ans après l'opération, on a constaté une diminution de la douleur et une amélioration de la fonction.
Asunto(s)
Humanos , Masculino , Femenino , Medicina Física y Rehabilitación/métodos , Radiculopatía/diagnóstico , Discectomía/métodos , Desplazamiento del Disco Intervertebral/cirugía , Desplazamiento del Disco Intervertebral/terapia , Epidemiología Descriptiva , Estudios ProspectivosRESUMEN
Chikungunya virus (CHIKV) is a mosquito-borne alphavirus that is endemic to parts of Africa, South and Southeast Asia, and more recently the Caribbean. Patients typically present with fever, rash, and arthralgias, though neurologic symptoms, primarily encephalitis, have been described. We report the case of a 47-year-old woman who was clinically diagnosed with CHIKV while traveling in the Dominican Republic and presented 10 days later with left lower extremity weakness, a corresponding enhancing thoracic spinal cord lesion, and positive CHIKV serologies. She initially responded to corticosteroids, followed by relapsing symptoms and gradual clinical improvement. The time lapse between acute CHIKV infection and the onset of myelopathic sequelae suggests an immune-mediated phenomenon rather than direct activity of the virus itself. Chikungunya virus should be considered in the differential diagnosis of myelopathy in endemic areas. The progression of symptoms despite corticosteroid administration suggests more aggressive immunomodulatory therapies may be warranted at disease onset.
Asunto(s)
Fiebre Chikungunya/diagnóstico , Neuralgia/diagnóstico , Radiculopatía/diagnóstico , Enfermedades de la Médula Espinal/diagnóstico , Corticoesteroides/uso terapéutico , Fiebre Chikungunya/complicaciones , Fiebre Chikungunya/tratamiento farmacológico , Fiebre Chikungunya/fisiopatología , Virus Chikungunya/patogenicidad , Virus Chikungunya/fisiología , República Dominicana , Femenino , Humanos , Metilprednisolona/uso terapéutico , Persona de Mediana Edad , Neuralgia/complicaciones , Neuralgia/tratamiento farmacológico , Neuralgia/fisiopatología , Radiculopatía/complicaciones , Radiculopatía/tratamiento farmacológico , Radiculopatía/fisiopatología , Médula Espinal/efectos de los fármacos , Médula Espinal/fisiopatología , Médula Espinal/virología , Enfermedades de la Médula Espinal/complicaciones , Enfermedades de la Médula Espinal/tratamiento farmacológico , Enfermedades de la Médula Espinal/fisiopatología , Viaje , Estados UnidosRESUMEN
Cervical radiculopathy is a relatively common neurological disorder resulting from nerve root dysfunction, which is often due to mechanical compression; however, inflammatory cytokines released from damaged intervertebral disks can also result in symptoms. Cervical radiculopathy can often be diagnosed with a thorough history and physical examination, but an magnetic resonance imaging or computed tomographic myelogram should be used to confirm the diagnosis. Because of the ubiquity of degenerative changes found on these imaging modalities, the patient's symptoms must correlate with pathology for a successful diagnosis. In the absence of myelopathy or significant muscle weakness all patients should be treated conservatively for at least 6 weeks. Conservative treatments consist of immobilization, anti-inflammatory medications, physical therapy, cervical traction, and epidural steroid injections. Cervical radiculopathy typically is self-limiting with 75%-90% of patients achieving symptomatic improvement with nonoperative care. For patients who are persistently symptomatic despite conservative treatment, or those who have a significant functional deficit surgical treatment is appropriate. Surgical options include anterior cervical decompression and fusion, cervical disk arthroplasty, and posterior foraminotomy. Patient selection is critical to optimize outcome.
Asunto(s)
Vértebras Cervicales , Radiculopatía/terapia , Antiinflamatorios no Esteroideos/uso terapéutico , Descompresión Quirúrgica , Humanos , Procedimientos Ortopédicos , Radiculopatía/diagnóstico , Radiculopatía/epidemiología , Radiculopatía/etiologíaRESUMEN
Objetivo: Determinar la relación entre las anormalidades electrodiagnósticas y las características clínicas encontrados en pacientes con diagnóstico de radiculopatía lumbar. Material y Métodos: Se realizó un estudio descriptivo, retrospectivo donde se estableció una correlación clínico-electro fisiológica en 140 pacientes atendidos en el Departamento de Investigación y Ayuda al Diagnóstico del Instituto Nacional de Rehabilitación en el periodo Enero-Diciembre 2012. Resultados: La edad promedio fue de 54.59 (rango de 32 a 84) años; observándose predominio en el sexo femenino (53.6 por ciento); la mayoría presentó dolor lumbar irradiado (87.1 por ciento). La raíz espinal más afectada fue la combinación L5-S1 (25 por ciento). El 62.1 por ciento de los pacientes estudiados presentó evidencia electromiográfica de radiculopatía. Se encontró que el signo de Lasegue es el que presenta mayor asociación significativa a alteraciones electrodiagnósticas. El dolor lumbar irradiado no presentó asociación significativa con el examen electrodiagnóstico. Conclusiones: La sintomatología: parestesias, dolor lumbar irradiado, no se halla relacionada a alteraciones electrofisiológicas. La presencia de signo Lasegue está asociada de manera significativa con las anormalidades electrodiagnósticas encontradas, y en menor proporción la debilidad y alteraciones de la sensibilidad.
Objective: To determine correlation between clinical and electrophysiological abnormalities in patients diagnosed with lumbar radiculopathy. Material and Methods: We made a descriptive, retrospective study to established clinical-electrophysiological correlation in 140 patients treated at the Department of Research and Diagnosis Assistance of Instituto National of Rehabilitation, period January to December 2012. Results: Mean age was 54.59 years (range 32-85); with female predominance (53.6 per cent), most of them presented low back pain referred to the extremity (87.1 per cent) the most affected spinal rootles was the couple L5-S1 (25 per cent), 62.1 per cent of patients had EMG evidence of radiculopathy. It was found that Lasegues sign is having a more significant association to electrodiagnostic abnormalities. Low back pain radiating present no significant association with electrodiagnostic examination. Conclusions: The symptoms (numbness, low back pain radiating, weakness) are not related to electrodiagnostic abnormalities. The presence of Tinel or Phalen sign is significantly associated with electrophysiological abnormalities found. Lasegues sign is associated significantly with electrodiagnostic abnormalities found, and to a lesser extent the weakness and altered sensitivity.
Asunto(s)
Masculino , Femenino , Humanos , Adolescente , Adulto Joven , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Electrodiagnóstico , Radiculopatía/diagnóstico , Estudios Observacionales como Asunto , Estudios RetrospectivosRESUMEN
OBJECTIVE: To ascertain the value ascribed by Brazilian rheumatologists to ultrasonography (US) for diagnosing tendinitis and to electromyography (EMG) for diagnosing peripheral neuropathy and upper limb radiculopathy. MATERIAL AND METHODS: In total, 165 rheumatologists answered an anonymous survey (sent via the internet) concerning the two exams, with respect to the following characteristics: reliability, diagnostic accuracy, the importance and necessity of these tests for diagnostic RESULTS: The study revealed that most of the rheumatologists recognised that these exams are operator-dependent, that clinicians do not rely entirely on the results, that these exams are not mandatory for the diagnoses listed, and that professionals who perform these exams should be better trained to provide reliable results. CONCLUSIONS: The Brazilian rheumatologists believe the following: the results of these exams should be interpreted with caution and are not definitive for diagnosis; musculoskeletal US and EMG should be performed by trained professionals; and there must be better preparation of the professionals who perform these exams.
Asunto(s)
Electromiografía , Enfermedades del Sistema Nervioso Periférico/diagnóstico , Pautas de la Práctica en Medicina , Reumatología , Tendinopatía/diagnóstico por imagen , Brazo , Humanos , Radiculopatía/diagnóstico , Encuestas y Cuestionarios , UltrasonografíaRESUMEN
OBJETIVO: Averiguar o valor que os reumatologistas brasileiros conferem ao exame de ultrassonografia para o diagnóstico de tendinite e ao exame de eletroneuromiografia para o diagnóstico da neuropatia periférica e da radiculopatia dos membros superiores. MATERIAL E MÉTODOS: No total, 165 reumatologistas responderam a uma pesquisa de opinião anônima (enviada pela internet), sobre diversas situações relativas aos dois exames, no que diz respeito aos seguintes questionamentos: confiabilidade, precisão no diagnóstico, importância e necessidade desses exames para confirmação diagnóstica e credibilidade e treinamento dos profissionais que executam os exames. RESULTADOS: O estudo revelou que a maioria dos reumatologistas reconhece que esses exames são operador-dependentes, que não confia integralmente nos resultados observados, que tais exames não são imperativos para os diagnósticos elencados, e que os profissionais que executam esses exames deveriam ser mais bem treinados para fornecer resultados mais confiantes. CONCLUSÃO: Para os reumatologistas brasileiros, os resultados desses exames devem ser interpretados com cautela e não são definitivos para o diagnóstico; a ultrassonografia musculoesquelética e a eletroneuromiografia devem ser realizadas por profissionais capacitados; deve haver melhor preparo dos executores desses exames em nosso meio.
OBJECTIVE: To ascertain the value ascribed by Brazilian rheumatologists to ultrasonography (US) for diagnosing tendinitis and to electromyography (EMG) for diagnosing peripheral neuropathy and upper limb radiculopathy. MATERIAL AND METHODS: In total, 165 rheumatologists answered an anonymous survey (sent via the internet) concerning the two exams, with respect to the following characteristics: reliability, diagnostic accuracy, the importance and necessity of these tests for diagnostic RESULTS: The study revealed that most of the rheumatologists recognised that these exams are operator-dependent, that clinicians do not rely entirely on the results, that these exams are not mandatory for the diagnoses listed, and that professionals who perform these exams should be better trained to provide reliable results. CONCLUSIONS: The Brazilian rheumatologists believe the following: the results of these exams should be interpreted with caution and are not definitive for diagnosis; musculoskeletal US and EMG should be performed by trained professionals; and there must be better preparation of the professionals who perform these exams.
Asunto(s)
Humanos , Electromiografía , Pautas de la Práctica en Medicina , Enfermedades del Sistema Nervioso Periférico/diagnóstico , Reumatología , Tendinopatía , Brazo , Radiculopatía/diagnóstico , Encuestas y CuestionariosRESUMEN
Navigated posterior cervical microforaminotomy (PCM) is a promising minimally invasive technique for treating radiculopathy caused by lateral disc herniations and foraminal stenosis. Between December 2009 and October 2010, 14 patients with unilateral foraminal disc herniations or foraminal stenosis at the C6-7 or C7-T1 level underwent PCM assisted by O-arm navigation using the METRx tubular retractor. The main symptoms were radicular arm pain with no significant neck pain. Successful relief of radicular pain was achieved in all 14 patients. Two of the patients were lost during follow-up, and three had to undergo further decompression due to remnant foraminal stenosis being discovered on intraoperative O-arm images. There were no cases of instability or recurrence, and the only complication observed was a dural tear in one patient, which was adequately treated with fibrin glue and bed rest. The duration of symptoms was 4.5 months on average. The mean operation time was 136 minutes, with the additional time required for the image guided surgery assisted by O-arm-based navigation being approximately 28 minutes on average. There were no other complications during the surgical procedure or in the immediate postoperative period. Posterior cervical microforaminotomy assisted by O-arm-based navigation is a safe, effective and minimally invasive procedure for the treatment of lateral disc herniations and foraminal stenosis of the lower cervical spine and C-T junction, offering the possibility of an accurate decompression with a reduced risk of segmental instability.
Asunto(s)
Vértebras Cervicales/cirugía , Descompresión Quirúrgica/métodos , Desplazamiento del Disco Intervertebral/complicaciones , Microcirugia/métodos , Procedimientos Neuroquirúrgicos/métodos , Radiculopatía/cirugía , Cirugía Asistida por Computador/instrumentación , Adulto , Anciano , Diseño de Equipo , Femenino , Estudios de Seguimiento , Humanos , Desplazamiento del Disco Intervertebral/diagnóstico , Desplazamiento del Disco Intervertebral/cirugía , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Radiculopatía/diagnóstico , Radiculopatía/etiología , Estudios Retrospectivos , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
Varicella-zoster virus (VZV) meningoencephalomyelitis is a rare but severe neurological complication of VZV reactivation in immunocompromised patients. We report the case of an HIV-infected individual who developed an acute and severe meningoencephalomyelitis accompanied by a disseminated cutaneous eruption due to VZV. The presence of VZV DNA in cerebrospinal fluid was confirmed by polymerase chain reaction (PCR) technique. The patient started undergoing an intravenous acyclovir therapy with a mild recovery of neurological manifestations. Varicella-zoster virus should be included as a cause of acute meningoencephalomyelitis in patients with AIDS. Early diagnosis followed by specific therapy should modify the rapid and fulminant course for this kind of patients.
A meningoencefalomielite pelo vírus varicela-zoster (VVZ) é uma complicação neurológica rara mas grave da reativação do VVZ em pacientes imunocomprometidos. Nós relatamos o caso de um indivíduo infectado por HIV que desenvolveu uma meningoencefalomielite aguda e grave acompanhada por uma erupção cutânea por causa do VVZ. A presença do DNA do VVZ no líquor foi confirmada pela técnica de reação em cadeia da polimerase (PCR). O paciente iniciou uma terapia intravenosa com aciclovir com uma leve recuperação das manifestações neurológicas. O vírus varicela-zoster deve ser incluído como uma causa de meningoencefalomielite nos pacientes com AIDS. O diagnóstico precoce seguido por terapia específica pode modificar o curso rápido e fulminante deste tipo de pacientes.
Asunto(s)
Humanos , Masculino , Adulto Joven , Infecciones Oportunistas Relacionadas con el SIDA/diagnóstico , Encefalitis por Varicela Zóster/diagnóstico , Encefalomielitis/diagnóstico , /aislamiento & purificación , Radiculopatía/diagnóstico , Enfermedad Aguda , Infecciones Oportunistas Relacionadas con el SIDA/virología , Encefalomielitis/virología , Radiculopatía/virologíaRESUMEN
Varicella-zoster virus (VZV) meningoencephalomyelitis is a rare but severe neurological complication of VZV reactivation in immunocompromised patients. We report the case of an HIV-infected individual who developed an acute and severe meningoencephalomyelitis accompanied by a disseminated cutaneous eruption due to VZV. The presence of VZV DNA in cerebrospinal fluid was confirmed by polymerase chain reaction (PCR) technique. The patient started undergoing an intravenous acyclovir therapy with a mild recovery of neurological manifestations. Varicella-zoster virus should be included as a cause of acute meningoencephalomyelitis in patients with AIDS. Early diagnosis followed by specific therapy should modify the rapid and fulminant course for this kind of patients.
Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/diagnóstico , Encefalitis por Varicela Zóster/diagnóstico , Encefalomielitis/diagnóstico , Herpesvirus Humano 3/aislamiento & purificación , Radiculopatía/diagnóstico , Infecciones Oportunistas Relacionadas con el SIDA/virología , Enfermedad Aguda , Encefalomielitis/virología , Humanos , Masculino , Radiculopatía/virología , Adulto JovenRESUMEN
El presente estudio muestra experiencia en la realización de bloqueos facetarios periarticulares y radiculares lumbares guiados Por Toomografía Axial Computada (TAC), en pacientes con dolor lumbar, o lumbociático provocado por estenosis foraminales de diversas causas, especialmente las secundarias a hernias discales foraminales sin manifestaciones de déficit motor y artrosis facetarias, en estos casos, la causa del dolor se supone se debe ala isquemia que afecta directamente las raíces nerviosas y produce sìntomas. Se realizó la evaluaciòn de 55 pacientes a los que se les efectuó este procedimiento entre los años 2007-2010 con diagnóstico de radiculopatía lumbar provocados por estenosis foraminales secundarias a hernias discales foraminales sin manifestaciones de deficít motor y artrosis facetarias y que no mejorarón con tratamiento médico - kinésico en 4 a 6 semana. 40 Hombres y 15 mujeres con edades entre 35 y 84 años. se realizaron 45 bloqueos de raíces nerviosas, a 10 pacientes se le realizó en dos espacios simultáneo en forma homolateral, y 10 facetarios periarticulares, 8 en forma bilateral. el 90% de los pacientes y refirió mejoría inmediata después del procedimiento, con resultados variables a largo plazo. la duración de la mejoría del dolor fue variable y osciló en un rango de 15 días hasta en forma permanente en el 80% de los casos. Los procedimientos en su mayoría se realizaron con internación de 24 horas. No se presentaron complicaciones técnicas ni posteriores a la inyección. En nuestra experiencia los mejores resultados se encuentran en el dolor radicular con el diagnóstico de hernia discal foraminal. Se concluye con los bloqueos facetarios y radiculares constituyen un método diagnóstico y terapéutico que puede realizarse con mucha precisión y seguridad utilizando la ayuda de imágenes diagnósticas, especialmente la TAC siendo útiles para la localización del origen del dolor y para decidir un eventual tratamiento definitivo...
SUMMARY: The following study shows our experience doing TAC-guided lumbar facet periarticular and radicular blockades in patients with lumbar or lumbociatic pain caused by foraminal stenosis due to different causes, specially those secondary to foraminal disc herniantions without motor impairment and facetary arthrosis (in these cases, the cause of the pain is supposed to be due to ischemia affecting the nerve roots which causes the symptoms). We evaluated patients to whom the procedure was performed between 2007 and 2010, with diagnosis of lumbar radiculopathy caused by foraminal stenosis secondary to foraminal disc herniations without evidence of motor impairment and facetary arthrosis, whichdidn' t improve with kinesic medical treatment in 4 to 6 weeks. 55 patients were incluided, 40 men and 15 women, between 35 and 84 years. 45 nerve root blockades, in 10 patients it was done homolaterally in two space simultaneously, and 10 periarticular facetary blockades were performed, 8 bilateral, 90% of the patients refered immediate improvement of the symptoms after the procedure, with variable long-term results. The duration of the pain relief was variable and ranged from 15 days to permanent in 80% of the cases. In most of the cases the procedure was done with 24-hour hospital stay. There were no complications, neither technical nor following the injections. In our experience the best results are achieved in the treatment of radicular pain with the diagnosis of foraminal disc herniation. In conclusion, facetary and radicular blockades represent highly precise and safe, both therapeutic and diagnostic methods, that could be used with the aid of diagnostic images, specially TAC, to localize the origin of the pain as well as to decide an eventual definitive treatment.
Asunto(s)
Humanos , Masculino , Adulto , Femenino , Adulto Joven , Anciano , Anciano de 80 o más Años , Columna Vertebral/patología , Desplazamiento del Disco Intervertebral , Osteoartritis de la Columna Vertebral , Radiculopatía/diagnóstico , Dolor de la Región Lumbar/terapiaRESUMEN
A eletroneuromiografia (ENMG) é empregada como método de diagnóstico complementar no diagnóstico de radiculopatia desde 1950, contribuindo com importantes informações para o esclarecimento diagnóstico, planejamento do tratamento e acompanhamento evolutivo dos pacientes. A presente revisão baseada em evidências buscou referências com ênfase na indicação, sensibilidade, especificidade, reprodutibilidade e limitações do uso desse exame na avaliação das radiculopatias cervicais e lombossacrais. As referências apontam a ENMG como um exame bastante útil tanto na triagem quanto no diagnóstico diferencial na suspeita de radiculopatia cervical ou lombossacra, bem como na avaliação do grau e extensão da lesão, quando respeitadas as limitações da técnica.
Electromyography (EMG) has been employed as a complementary method in the diagnosis of radiculopathy since 1950, contributing important information for diagnostic clarification, treatment planning and patient follow-up. This evidence based review sought references with emphasis on the recommendation, sensibility, specificity, reproducibility and limitations of the use of this test in the evaluation of cervical and lumbosacral radiculopathy. The references point to EMG as being an extremely useful test both in the screening and in the differential diagnosis in the suspicion of cervical or lumbosacral radiculopathy, as well as in the evaluation of the degree and extent of the injury, when the limitations of the technique are considered.