Herniated lumbar discs are a common cause of low back pain, which can negatively impact the quality of life of working-age individuals. This study aimed to evaluate changes in the quality of life in patients with sciatica who underwent endoscopic discectomy, a minimally invasive surgical procedure. The study (ClinicalTrials.gov NCT02742311) included 470 patients who underwent transforaminal, interlaminar, or translaminar endoscopic discectomy. Quality of life and pain perception were evaluated by comparing statistically weighted values of EQ-5D-5L, EQ-VAS, Oswestry disability index, and numerical pain scales for lower limb and back pain before and 12 months after the endoscopic procedure. After the procedure, there was a significant improvement in the reduction of back and lower limb pain, as well as in all monitored questionnaires (P < .001), which persisted 12 months after the endoscopy. All evaluated dimensions of the EQ-5D-5L questionnaire indicated a significant improvement in the assessed quality of life (P < .001). The study showed that percutaneous endoscopic lumbar discectomy is an effective pain-treating intervention that can improve the quality of life. There was no observed difference in the percentage of complications or re-herniations when comparing the transforaminal and interlaminar, approaches.
- MeSH
- bederní obratle chirurgie MeSH
- diskektomie MeSH
- endoskopie MeSH
- kvalita života MeSH
- lidé MeSH
- lumbalgie * etiologie chirurgie MeSH
- meziobratlová ploténka * MeSH
- perkutánní diskektomie * MeSH
- výhřez meziobratlové ploténky * chirurgie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- klinické zkoušky MeSH
Radiofrequency denervation of the zygapophysial (facet) joints is a frequently performed procedure for chronic low back pain. However, cryoablation represents a novel therapeutic approach for this condition. We observed and analyzed 3 cases with confirmed positive lumbar facet joint syndrome. Our results show a significant improvement in the clinical state of the patients in the first and third months after the procedure. The 6-month follow-up examination demonstrates a recurrence of pain and a gradual deterioration in the quality of life with a lasting partial pain-relief effect. Thermal radiofrequency denervation and cryoablation of the lumbar zygapophysial joints represent an effective, albeit temporary treatment option for lumbar facet joint syndrome patients, resulting from the pathophysiology of sensory nerve regeneration after destructive procedures. This type of treatment can be used repeatedly in the case of a positive response.
- Publikační typ
- kazuistiky MeSH
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. 3, Fig. 7, Ref. 19).
- Klíčová slova
- transforaminální metoda, interlaminární metoda,
- MeSH
- degenerace meziobratlové ploténky chirurgie MeSH
- interpretace statistických dat MeSH
- ischialgie chirurgie etiologie MeSH
- lidé MeSH
- měření bolesti metody MeSH
- meziobratlová ploténka patofyziologie MeSH
- obnova funkce MeSH
- perkutánní diskektomie * metody MeSH
- prospektivní studie MeSH
- radikulopatie chirurgie etiologie MeSH
- výhřez meziobratlové ploténky * chirurgie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- multicentrická studie MeSH
- pozorovací studie MeSH
BACKGROUND: Epiduroscopy is a well-established diagnostic and to certain level therapeutic tool in complex situations, where conventional methods such as magnetic resonance imaging (MRI) lack power or resolution to detect pathological changes. Such a situation is primarily failed back surgery syndrome (FBSS) but also radicular pain without surgery. The aim of this study was to determine the effectiveness of epiduroscopic treatment in patients with FBSS. METHODS: A total of 79 patients with FBSS were randomized into 2 groups. The first group underwent epiduroscopy and received mechanical lysis of adhesions only, the second group received also medication into the epidural space (methylprednisolone and hyaluronidase). Patients were subsequently followed for 12 months, with evaluation also after 6 months post-epiduroscopy. Patients were checked in terms of mobility, self-care, usual activities, pain/discomfort and anxiety/depression as defined in the 5‑dimensional EQ-5D-5L questionnaire and to asses suitability of this questionnaire in chronic pain states. Data were collected using EQ-5D-5L questionnaire and also quality of life (QoL) questionnaire. RESULTS: In the terms of ability to walk (dimension mobility) and also ability to do housework, study or leisure activities (dimension usual activity) patients improved in both groups after 6 and 12 months after epiduroscopy. In pain dimension there was improvement mainly after 6 months which correlated also with self-care dimension and quality of life self-assessment. Results in anxiety/depression dimension were mixed. CONCLUSION: Epiduroscopy appears to be a beneficial procedure for both patient groups, especially after 6 months, with some benefit remaining after 12 months. The EQ-5D-5L questionnaire seems to be a suitable and comprehensive way to assess patient health in chronic pain states.
Bolesť chrbta sa stáva obrovským socio-ekonomickým spoločenským problémom. Okrem výdavkov na liečbu je problémom i samotná dlhodobá disabilita pacientov a s ňou spojené aj ekonomické straty na úrovni rodiny a v konečnom dôsledku aj spoločnosti. Radikulárna bolesť je zapríčinená najčastejšie herniáciou intervertebrálnej platničky. Bolesť sa šíri prevažne z driekovej oblasti chrbtice v dermatóme postihnutého koreňa nervu vo väčšine prípadov pod koleno, resp. až do akrálnych častí končatiny. Incidencia radikulopatií v hrudnej a krčnej oblasti je markantne nižšia, preto sa v článku venujeme prevažne bolesti v lumbo-sakrálnej oblasti s vyžarovaním do dolných končatín. Príčinou je ruptúra anulus fibrosus intervertebrálneho disku (IVD) a okrem samotného mechanického útlaku na nervové štruktúry dochádza k spusteniu zložitých procesov na bunkovej a molekulárnej úrovni, ktoré stále nie sú plne objasnené. Terapia sa v prvom rade opiera o konzervatívne postupy a farmakoterapiu bolesti. Do liečebných postupov sa stále vo väčšej miere integrujú intervenčné procedúry. U pacientov, kde tieto metódy zlyhávajú a pretrváva intenzívna bolesť, resp. trvá viac ako 3 mesiace a bráni v bežných činnostiach, je indikovaná diskektómia. Alternatívou ku konvenčnej diskektómii je perkutánna endoskopická diskektómia, ktorá minimalizuje poškodenie tkaniva, tvorbu adhézií, skracuje dobu rekonvalescencie, a veľkou výhodou pre pacientov je aj vyhnutie sa celkovej anestézii a komplikáciám s ňou súvisiacim.
Back pain is becoming a huge socio-economic social problem. In addition to treatment costs, long-term disability of patients is also a problem, and economic losses at family level and, ultimately, in society. Radicular pain is most often caused by herniation of the intervertebral disc. Pain running predominantly from the lumbo-sacral back of the spine area in the dermatome of the affected nerve root in most cases under the knee or, up to the acral parts of the limb. The incidence of radiculopathy in the thoracic and cervical area is markedly lower, therefore, the article is mostly about pain in the lumbo-sacral area with radiotherapy in the lower limbs. The rupture of the annulus fibrosus intervertebral disc (IVD) is the cause, and apart from the mechanical oppression on the nervous structures, complex processes at the cellular and molecular level are triggered, which are still not fully elucidated. Therapy is primarily based on conservative procedures and pain therapy, where intervention procedures are increasingly being integrated. In patients where these methods fail and persist severe pain, which lasts more than 3 months and prevents the usual discectomy. An alternative to conventional discectomy is percutaneous endoscopic discectomy that minimizes tissue damage, adhesion formation, reduces recovery time, and great benefit for patients is also the avoidance of overall anesthesia and complications associated with it.
- MeSH
- bolesti zad * diagnóza etiologie terapie MeSH
- diagnostické zobrazování metody MeSH
- lidé MeSH
- radikulopatie diagnóza terapie MeSH
- výhřez meziobratlové ploténky patofyziologie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
Fyzická záťaž, ktorá má priamy vplyv na excesívne zvyšovanie intradiskálneho tlaku, môže byť jedným z hlavných rizikových faktorov pre vznik degeneratívnych zmien medzistavcovej platničky. Rekreačné aj vrcholové športové aktivity znamenajú opakované zvyšovanie vnútroplatničkového tlaku, čo môže iniciovať degeneratívne zmeny medzistavcovej platničky. Rozličné typy športov vytvárajú aj rozličné pôsobenie priamych síl na platničkové štruktúry. Na druhej strane sa šport a športový tréning v populácii všeobecne považuje za zdraviu prospešný. Mnohí lekári pokladajú športový tréning za formu prevencie proti poškodeniu chrbtice. Autori v nasledujúcom texte analyzujú viaceré športové aktivity s rozličným typom pôsobenia priamych síl na chrbticu. Cieľom je informovať o realistických vedeckých faktoch týchto športových aktivít na degeneráciu medzistavcovej platničky a zároveň aj o dostupných faktoch, ktoré potvrdzujú pozitívny efekt určitého typu športovej záťaže v rámci prevencie poškodenia medzistavcovej platničky.
Physical strain, which has a direct influence on the excessive increase of intra-discal pressure, is possibly one of the main risk factors in the for-mation of degenerative changes of the intervertebral discs. Recreational and professional sport activities cause repetitive increase of intra-discal pressure, which can initiate degenerative changes of the intervertebral disc. Different types of sport create various effects of direct forces on the disc structures. On the other hand, sport and exercise is in general regarded as beneficial for our health. Many physicians also regard sport and exercise as a form of prevention against back injuries. The authors analyse numerous sport activities with different types of direct forces acting on the spine, with the goal to inform about realistic scientific facts regarding the impact of these activities on the degeneration of the intervertebral disc. Moreover, they inform about the available facts, which confirm the positive effects of certain types of exercise load in the prevention of intervertebral disc damage.
- MeSH
- degenerace meziobratlové ploténky * epidemiologie patofyziologie patologie MeSH
- lidé MeSH
- lyžování MeSH
- meziobratlová ploténka * patofyziologie patologie MeSH
- nemoci páteře MeSH
- páteř patofyziologie patologie MeSH
- plavání MeSH
- sporty * MeSH
- vzpírání MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
