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.
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
Perkutánne endoskopické techniky sú moderné miniinvazívne metódy, ktoré umožňujú efektívne riešiť bolesť a sprievodné neurologické symptómy u pacientov s vyklenutím medzistavcovej platničky a/alebo s inou epidurálnou patológiou. Dostupné dôkazy podporujú ich efektivitu a bezpečnosť, a preto si zaslúžene získavajú stabilné miesto v riešení špecifických typov spinálnej patológie. Vhodnou diagnostickou a terapeutickou metódou pri chronických stavoch spojených s bolesťou dolnej časti chrbta v kombinácii s radikulárnou symptomatológiou je epiduroskopia. V článku sa venujeme jej princípom a indikačným kritériám a technike uskutočnenia výkonu. Ďalšou účinnou endoskopickou metódou je endoskopická diskektómia. Je to moderná, ale zároveň štúdiami overená efektívna liečba hernie disku s akútnym radikulárnym syndrómom. Naše skúsenosti overené klinickými štúdiami poukazujú na účinný liečebný a diagnostický potenciál perkutánnych endoskopických techník v manažmente akútnej a chronickej bolesti.
Percutaneous endoscopic techniques are modern minimally-invasive methods that enable effective treatment of pain and accompanying neurological symptoms in patients with an intervertebral disc herniation and/or other epidural pathologies. Available evidence supports their efficacy and safety therefore, they deserve a stable position in addressing specific types of spinal pathologies. Epiduroscopy is a suitable diagnostic and therapeutic method for chronic conditions associated with back pain in the lower parts of the spine in combination with radicular symptomatology. In this article, we deal with the principles, indication criteria and the performance technique. Another effective endoscopic method is endoscopic discectomy. It is a modern, yet well-proven effective treatment method for disc herniations with a radicular syndrome. Our experience confirmed with clinical studies points to the effective therapeutic and diagnostic potential of percutaneous endoscopic techniques in the management of acute chronic pain.
- Klíčová slova
- epiduroskopie, endoskopická diskektomie,
- MeSH
- artroskopie metody MeSH
- bolesti zad chirurgie terapie MeSH
- endoskopie metody MeSH
- epidurální prostor chirurgie MeSH
- lidé MeSH
- miniinvazivní chirurgické výkony metody MeSH
- perkutánní diskektomie metody MeSH
- radikulopatie * chirurgie terapie MeSH
- výhřez meziobratlové ploténky chirurgie terapie MeSH
- Check Tag
- lidé MeSH
Kvalitný indikačný proces pred implantáciou miechového stimulátora je jedným z najdôležitejších faktorov pre jeho úspešné fungovanie. Vzhľadom na fakt, že použitie miechovej stimulácie je finančne náročná terapia, pokladáme za dôležité, aby selekcia pacienta pre tento druh výkonu mala čo najvyššiu kvalitu. V našom príspevku prezentujeme aktuálny algoritmus nášho pracoviska, ktorý zahŕňa využitie najmodernejších postupov v diagnostike a liečbe bolestí chrbta. V článku sa zameriavame na časť intervenčnej diagnostiky a liečby, ktorá prebieha na našom pracovisku. Samozrejmou súčasťou indikačného procesu sú aj psychologické, psychiatrické, neurologické a neurochirurgické vyšetrenia, ktorým sa v našom príspevku nevenujeme. V stručnosti sa snažíme o zhrnutie nami používaných diagnostických intervencií na miešnych štruktúrach, ktoré slúžia na potvrdenie, respektíve vylúčenie generátorov bolesti u pacienta s komplikovanou bolesťou chrbta. Následne popisujeme nami používané terapeutické spinálne intervencie, ktoré nadväzujú na pozitívne výsledky intervenčnej diagnostiky.
A high quality indicational process before the implantation of a spinal stimulator is one of the most important factors for its successful functioning. Due to the fact that the use of spinal stimulation is a financially challenging therapy, we consider it important to have the selection of the patients for this procedure of the highest quality possible. In our article we present an up-to-date algorithm of our workplace, that includes the application of the most advanced methods in the diagnostics and treatment of back pain. We focus on the part of interventional diagnostics and treatment that we perform at our clinic. By definition, a part of the indication process includes psychological, psychiatric, neurological and neurosurgical examinations, which we do not focus on in our review. Briefly, we are aiming for a summary of the diagnostic interventions of the spinal structures that are used to confirm or exclude the generators of pain in a patient with a complicated back pain which we apply in our workplace. Subsequently, we describe the therapeutical spinal interventions performed by us, that pick up on the positive results of interventional diagnostic procedures
- Klíčová slova
- neuromodulace,
- MeSH
- algoritmy MeSH
- failed back surgery syndrom terapie MeSH
- klinické protokoly * MeSH
- lidé MeSH
- míšní stimulace * MeSH
- výběr pacientů * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
