RESUMO
Se realiza estudio prospectivo para demostrar que la nucleolisis percutánea, más el bloqueo peridural y foraminal con ozonoterapia es efectiva y muy segura para disminuir el dolor producido por síndrome de espalda fallida. Material y método: previo consentimiento informado, a 45 pacientes con síndrome de espalda fallida, se les realizó un total de 45 nucleolisis percutáneas, más bloqueo peridural y foraminal con ozonoterapia, durante un periodo comprendido entre mayo 2012 a mayo del 2013. Todas las nucleolisis se realizaron bajo control fluoroscopio con medidas de asepsia y antisepsia estrictas, y sedación consciente. A todos los pacientes, se les administró ozono en disco, peridural y foraminal (5-10 ml) a 10ug/ml, más procaina al 2% y 1cc de 40mg de cristales esteroideos; en todos los casos se administró 1gr. de cefacidal como profilaxis. Discusión: La eficacia del tratamiento, se basa en el control del dolor según la escala visual analógica basal (EVA 0), a los 30 días (EVA 1), a los seis meses (EVA 3) y a los 12 meses (EVA 6). Se aplicó el test de oswestry, antes del tratamiento y al final del estudio; a todos los pacientes se les realizo encuesta en la primera consulta, y luego al final del tratamiento con una respuesta satisfactoria(AU)
This prospective study is to demonstrate that percutaneous nucleolisys and epidural, foraminal block with oxygen-ozone is effective and very safe to decrease the pain from failed back syndrome. Materials and Methods: previous reported 45 patients with failed back syndrome consent to a total of 45 percutaneous nucleolisys more and foraminal Epidural blockade with ozone therapy was conducted over a period from May 2012 to May 2013 all nucleolisys were performed under fluoroscopic control measures strict asepsis and antisepsis, conscious sedation. All patients were administered ozone in disk, epidural and foraminal (5-10 ml) at 10 ug / ml over 2% procaine more steroidal 1cc 40mg of crystals, in all cases of cefaolin sodium 1grs administered prophylactically. Discution: The effectiveness of treatment is based on pain control by baseline visual analog scale (EVA 0), 30 days (EVA 1), six (EVA 3) and 12 months (EVA 6). By oswestry test evaluated before treatment and at study end; all patients were conducted survey in the first query and then at the end of treatment with satisfactory response
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Dor Lombar/fisiopatologia , Lesões nas Costas/complicações , Hérnia/diagnóstico , Disco Intervertebral/cirurgia , Ozônio , TerapêuticaRESUMO
BACKGROUND: High prevalence and high costs in the treatment of spine injuries make a cost study necessary. The objective of this paper is to analyze, from the economic point of view, the behavior of traumatic and non-traumatic spinal pathologies in relation to hospital stay. METHODS: Analysis of economic cost per hospital stay (January 2000 to May 2010). RESULTS: 4,173 cases studied, 45% women and 55% men, predominantly elderly and a mean age of 48.9, standard deviation 16.8 years, with a notable increase in hospital expenses in prevalence and peak months: January, February and April; and a decrease in July, October and December. Total expenses for hospital stay were estimated as $85,565,288.00. Traumatic entities consumed $40,404,477.00, and degenerative $21,866,815.00. The months of highest spending were: April, $11,072,683.00, December, $8,423,773.00 and February $8,154,152.00; whereas July showed the lowest spending: $4,874,261.00. Inflation up to July 2011 remained at 3.55% on average, down 2.98 percentage points from 2008 figures. DISCUSSION: there is a clear increase in spending connected with spine condition treatment at hospitals, in particular those resulting from traumatic events. The definition of risk groups for preventive measures is also reflected in the spending records. Spending on hospital treatment of spinal conditions of the elderly reflects an increment in degenerative conditions. CONCLUSION: It is necessary to plan a timely resource distribution by month and year in order to achieve a better and more efficient scheme for health services. The epidemiological basis for the reorientation of the current models is now clear.
Assuntos
Traumatismos da Medula Espinal/economia , Academias e Institutos/economia , Adolescente , Adulto , Fatores Etários , Lesões nas Costas/complicações , Lesões nas Costas/economia , Feminino , Gastos em Saúde , Custos Hospitalares , Humanos , Tempo de Internação/economia , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Estudos Retrospectivos , Previdência Social/economia , Traumatismos da Medula Espinal/epidemiologia , Traumatismos da Medula Espinal/etiologia , Doenças da Coluna Vertebral/complicações , Doenças da Coluna Vertebral/economia , Neoplasias da Coluna Vertebral/complicações , Neoplasias da Coluna Vertebral/economia , Espondilite/complicações , Espondilite/economia , Adulto JovemRESUMO
BACKGROUND: The objective of this study was to describe the most prevalent physically disabling conditions for insured workers belonging to the Mexican Social Security Institute (IMSS) in the Valley of Mexico and to identify risk factors for disabling spondyloarthrosis. METHODS: Retrospective cases and prevalent controls from IMSS clinics in the Mexico City metropolitan area were studied. Eighty cases were IMSS workers reporting disability due to spondyloarthrosis; 80 controls were active workers at the same workplace and shared the economic activity of the cases. The 1995 IMSS Disability Report was reviewed. From this report congenital conditions of the musculoskeletal system, obesity, history of trauma, and sociodemographic patient characteristics were assessed. RESULTS: The most important risk factors were a history of spina bifida (odds ratio [OR] = 29.3, 95% confidence interval [95% CI] = 5.3-161; p = 0.0009), supernumerary vertebrae (OR = 21.3, 95% CI = 5.3-95; p = 0.0001), history of low back (lumbar) trauma (OR = 3.9, 95% CI = 1.9-8.3; p = 0.0004), flatfoot (OR = 11.7, 95% CI = 1.9-69, p = 0.02), and obesity (OR = 2.0, 95% CI = 1.06-4.03; p = 0.04). CONCLUSIONS: A history of congenital deformity of the musculoskeletal system, spinal column trauma, and obesity were risk factors most associated with work disability due to spondyloarthrosis.
Assuntos
Lesões nas Costas/diagnóstico , Dor nas Costas/diagnóstico , Adulto , Idoso , Lesões nas Costas/complicações , Lesões nas Costas/epidemiologia , Dor nas Costas/epidemiologia , Estudos de Casos e Controles , Pé Chato/complicações , Humanos , Masculino , México , Pessoa de Meia-Idade , Obesidade/complicações , Estudos Retrospectivos , Fatores de Risco , Disrafismo Espinal/complicações , Coluna Vertebral/anormalidadesRESUMO
Eleven patients with paralysis of muscle groups in the upper or lower extremity were clinically diagnosed after previous proximal direct trauma to the corresponding peripheral nerves, without complete nerve disruption. Patients were seen within an average of 8 months after trauma (minimum 3 months and maximum 2 years after). Nerve lesions were caused either by gunshot, motor-vehicle accident, and other direct trauma or, in one case, after tumor excision. All patients presented with complete sensory and motor loss distal to the trauma site, but demonstrated a positive Tinel sign and pain on testing over the "classic" (distal) anatomic nerve entrapment sites only. After surgical release through decompression of the nerve compression site distal to the trauma, a recovery of sensory function was achieved after surgery in all cases. Good-to-excellent restoration of motor function (M4/M5) was achieved in 63 percent of all cases. Twenty-five percent had no or only poor improvement in motor function, despite a good sensory recovery. Those patients in whom nerve compression sites were surgically released before 6 months after trauma had an improvement in almost all neural functions, compared to those patients who underwent surgery later than 9 months post trauma. A possible explanation of traumatically caused neurogenic paralysis with subsequent distal nerve compressions is provided, using the "double crush syndrome" hypothesis.