1. vydání 126 stran : barevné ilustrace ; 20 cm
Příručka se zaměřuje na různé rehabilitační cviky, které pomáhají léčit bolesti zad, zejména spojené s páteří a ploténkami. Určeno široké veřejnosti.
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
Previously, we proposed the hypothesis that similarities in the inflammatory response observed in acne vulgaris and degenerative disc disease (DDD), especially the central role of interleukin (IL)-1β, may be further evidence of the role of the anaerobic bacterium Cutibacterium (previously Propionibacterium) acnes in the underlying aetiology of disc degeneration. To investigate this, we examined the upregulation of IL-1β, and other known IL-1β-induced inflammatory markers and neurotrophic factors, from nucleus-pulposus-derived disc cells infected in vitro with C. acnes for up to 48 h. Upon infection, significant upregulation of IL-1β, alongside IL-6, IL-8, chemokine (C-C motif) ligand 3 (CCL3), chemokine (C-C motif) ligand 4 (CCL4), nerve growth factor (NGF) and brain-derived neurotrophic factor (BDNF), was observed with cells isolated from the degenerative discs of eight patients versus non-infected controls. Expression levels did, however, depend on gene target, multiplicity and period of infection and, notably, donor response. Pre-treatment of cells with clindamycin prior to infection significantly reduced the production of pro-inflammatory mediators. This study confirms that C. acnes can stimulate the expression of IL-1β and other host molecules previously associated with pathological changes in disc tissue, including neo-innervation. While still controversial, the role of C. acnes in DDD remains biologically credible, and its ability to cause disease likely reflects a combination of factors, particularly individualised response to infection.
- MeSH
- degenerace meziobratlové ploténky genetika mikrobiologie MeSH
- dospělí MeSH
- interakce hostitele a patogenu MeSH
- interleukin-1beta genetika MeSH
- kultivované buňky MeSH
- lidé středního věku MeSH
- lidé MeSH
- meziobratlová ploténka metabolismus mikrobiologie MeSH
- neurotrofní faktory genetika MeSH
- Propionibacterium acnes fyziologie MeSH
- upregulace MeSH
- zánět genetika mikrobiologie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články 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 AND OBJECTIVE: We present a fully automatic system based on learning approaches, which aims to localization and identification (labeling) of vertebrae in 3D computed tomography (CT) scans of possibly incomplete spines in patients with bone metastases and vertebral compressions. METHODS: The framework combines a set of 3D algorithms for i) spine detection using a convolution neural network (CNN) ii) spinal cord tracking based on combination of a CNN and a novel growing sphere method with a population optimization, iii) intervertebral discs localization using a novel approach of spatially variant filtering of intensity profiles and iv) vertebra labeling using a CNN-based classification combined with global dynamic optimization. RESULTS: The proposed algorithm has been validated in testing databases, including also a publicly available dataset. The mean error of intervertebral discs localization is 4.4 mm, and for vertebra labeling, the average rate of correctly identified vertebrae is 87.1%, which can be considered a good result with respect to the large share of highly distorted spines and incomplete spine scans. CONCLUSIONS: The proposed framework, which combines several advanced methods including also three CNNs, works fully automatically even with incomplete spine scans and with distorted pathological cases. The achieved results allow including the presented algorithms as the first phase to the fully automated computer-aided diagnosis (CAD) system for automatic spine-bone lesion analysis in oncological patients.
- MeSH
- algoritmy MeSH
- databáze faktografické MeSH
- diagnóza počítačová MeSH
- lidé MeSH
- metastázy nádorů MeSH
- meziobratlová ploténka diagnostické zobrazování patologie MeSH
- nádory kostí diagnostické zobrazování patologie MeSH
- nemoci páteře diagnostické zobrazování MeSH
- neuronové sítě (počítačové) MeSH
- páteř diagnostické zobrazování patologie MeSH
- počítačová rentgenová tomografie * MeSH
- počítačové zpracování obrazu MeSH
- reprodukovatelnost výsledků MeSH
- rozpoznávání automatizované MeSH
- software MeSH
- zobrazování trojrozměrné metody MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
Impedančná terapia ponúka nové postupy v liečbe degeneratívnych ochorení chrbtice s objektívnou kontrolou štrukturálnych/degeneratívnych zmien. Cieľom práce bolo zistiť vplyv inovatívnej metódy Impedančnej terapie (IT) na zmenu zdravotného stavu v rehabilitačnej starostlivosti pacientov s degeneratívnym ochorením chrbtice (DDD). Overiť účinky IT v liečbe degeneratívneho ochorenia chrbtice potvrdením prítomnosti "Disc grow up" (DGU fenoménu). Súbor klinickej randomizovanej štúdie (RCT) tvorilo 55 pacientov s priemerným vekom 51,3 roka. Súbor bol rozdelený do dvoch skupín. Sledovaná skupina pacientov podstúpila rehabilitáciu s IT so špecifickým elektrickým impulzom (SEI), druhá (kontrolná) skupina pacientov podstúpila taký istý rehabilitačný plán s tým, že namiesto SEI sa aplikovala klasická elektroliečba v skladbe 10 terapií cyklicky opakujúcich sa počas celého rehabilitačného plánu. V sledovanej skupine pacientov s DDD, ktorým bola aplikovaná IT, sa zaznamenal DGU fenomén s úspešnosťou 76 %, so štatisticky významným nárastom objemu medzistavcovej platničky. V kontrolnej skupine pacientov, ktorým bola podávaná štandardná elektroliečba, DGU fenomén nebol zaznamenaný. Na základe vplyvu metódy impedančnej terapie na zmenu objemu medzistavcovej platničky môžeme považovať degeneratívne ochorenie chrbtice ako civilizačné ochorenie za liečiteľné.
Impedance therapy offer new procedures in the therapy of degenerative changes of the spine by objective control of structural and degenerative changes. The paper investigated the influence of an innovative Impedance therapy (IT) on changes in the health state in the rehabilitation care of patients suffering from degenerative disease of the spine (DDD). The authors verified the influence of IT in the therapy of degenerative disease of the spine by confirming the"Disc grow up" (DGU) phenomenon. The cohort in the clinically randomized study (RCT) was formed by 55 patients at the average age of 51.3 years. The cohort was divided in two groups. The observed group of patients underwent rehabilitation with IT by a specific electric impulse (SEI) and the second (control) group underwent the same rehabilitation plan, while, instead of SEI, a classical electrotherapy constituted of 10 therapies which were applied in cycles which were repeated during the whole rehabilitation plan. In the observed group of patients (DDD), who were applied IT, the DGU phenomenon was observed with 76% successfulness, with statistically significant I crease od intervertebral discs. In the control group of patients, who underwent the standard electrotherapy, the DGU phenomenon was not observed. Based on the observed influence of the method of impedance therapy on the changes of intervertebral disc volume, the degenerative disease of the spine may be considered curable as a civilization disease.
- Klíčová slova
- impedanční terapie,
- MeSH
- elektrická impedance * terapeutické užití MeSH
- elektrická stimulace přístrojové vybavení MeSH
- elektrostimulační terapie MeSH
- interpretace statistických dat MeSH
- kyselina mléčná krev MeSH
- lidé MeSH
- magnetická rezonanční tomografie MeSH
- meziobratlová ploténka MeSH
- nemoci páteře * rehabilitace MeSH
- nerandomizované kontrolované studie jako téma MeSH
- rehabilitace metody MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
PURPOSE: The presence of Propionibacterium acnes in a substantial component of resected disc specimens obtained from patients undergoing discectomy or microdiscectomy has led to the suggestion that this prominent human skin and oral commensal may exacerbate the pathology of degenerative disc disease. This hypothesis, therefore, raises the exciting possibility that antibiotics could play an important role in treating this debilitating condition. To date, however, little information about antibiotic penetration into the intervertebral disc is available. METHODS: Intervertebral disc tissue obtained from 54 microdiscectomy patients given prophylactic cefazolin (n = 25), clindamycin (n = 17) or vancomycin (n = 12) was assayed by high-performance liquid chromatography, with cefaclor as an internal standard, to determine the concentration of antibiotic penetrating into the disc tissue. RESULTS: Intervertebral disc tissues from patients receiving the positively charged antibiotic clindamycin contained a significantly greater percentage of the antibacterial dose than the tissue from patients receiving negatively charged cefazolin (P < 0.0001) and vancomycin, which has a slight positive charge (P < 0.0001). CONCLUSION: Positively charged antibiotics appear more appropriate for future studies investigating potential options for the treatment of low-virulence disc infections. These slides can be retrieved under Electronic Supplementary Material.
- MeSH
- antibakteriální látky farmakokinetika terapeutické užití MeSH
- cefazolin farmakokinetika terapeutické užití MeSH
- degenerace meziobratlové ploténky chirurgie MeSH
- dospělí MeSH
- grampozitivní bakteriální infekce prevence a kontrola MeSH
- klindamycin farmakokinetika terapeutické užití MeSH
- lidé MeSH
- meziobratlová ploténka metabolismus MeSH
- Propionibacterium acnes * MeSH
- vankomycin farmakokinetika terapeutické užití MeSH
- výhřez meziobratlové ploténky chirurgie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
Iatrogenní poranění velkých břišních cév během operace meziobratlových plotének je vzácnou, přesto obávanou komplikací těchto výkonů. Krvácení během operačního výkonu je důvodem pro cílené vyšetření zobrazovacími metodami i v případě, že je pacient po operaci asymptomatický. Při progresi arteriovenózního zkratu může následně dospět až do stadia srdečního selhání. V období mezi lety 2009-2019 byli na našem pracovišti endovaskulárně léčeni tři pacienti. Všichni tři byli v době intervence oběhově stabilní. Endovaskulární výkon s implantací stentgraftu a v jednom případě i spirál byl u všech pacientů technicky i klinicky úspěšný s pooperačním průběhem bez komplikací. Naše zkušenosti s endovaskulární léčbou těchto poranění potvrzují, že je vhodnou metodou ošetření u hemodynamicky stabilizovaných nemocných.
An iatrogenic injury of the major abdominal blood vessels is a rare yet feared complication of intervertebral disc surgery. Presence of bleeding during the surgery is a reason for targeted examination with imaging methods, even if the patient is asymptomatic after surgery. If arteriovenous fistula is present, the patient can later develop heart failure due to fistula progression. Between years 2012-2019, three patients were endovascularly treated in our department. All three were hemodynamically stable. An endovascular procedure with implantation of stentgrafts, and in one case with addition of coils, was technically and clinically successful, with no complications postoperatively. Our experiences with endovascular treatment of such injuries confirm, that it is an appropriate method of treatment in hemodynamically stable patients.
- MeSH
- arteria iliaca * chirurgie zranění MeSH
- arteriovenózní píštěl chirurgie MeSH
- cévní protézy MeSH
- CT angiografie MeSH
- dospělí MeSH
- endovaskulární výkony * metody MeSH
- iatrogenní nemoci * MeSH
- lidé MeSH
- meziobratlová ploténka chirurgie MeSH
- senioři MeSH
- terapeutická embolizace MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
Cieľ: Cieľom práce je určiť, ktorý spôsob chirurgickej liečby intervertebrálneho disku v krčnej chrbtici má väčší efekt na dizabilitu, funkčný stav a kvalitu života pacientov. Súbor a metodika: V tejto prospektívnej, konzekutívnej, klinickej štúdii sa porovnávala dizabilita, funkčný stav a kvalita života u skupiny 48 pacientov, ktorí podstúpili prednú cervikálnu discektómiu a implantáciu klietky – anterior cervical discectomy and fusion (ACDF) so skupinou 40 pacientov, ktorí podstúpili prednú cervikálnu discektómiu a implantáciu dynamickej náhrady - dynamic cervical implant (DCI). Dysfunkcia krčnej chrbtice bola hodnotená prostredníctvom testu Neck Disability Index (NDI). Funkčný stav pacientov bol hodnotený pomocou Pulses Profilu a kvalita života bola hodnotená testom kvality života podľa Spitzera. Výsledky: Štatistickým vyhodnotením výsledkov dotazníka (NDI, Pulses a Spitzer) medzi porovnávanými skupinami pacientov sa nezistili žiadne významné rozdiely (p> 0,05). Dvanásť mesiacov po operácii skupina pacientov s ACDF a pacientov s DCI vykazovali signifikantne nižšiu mieru dizability, zvýšenie funkčného stavu a zlepšenie kvality života. Medzi týmito skupinami ale neboli štatisticky významné rozdiely. Záver: Obidve metódy chirurgickej liečby (ACDF a DCI) vykazujú po uplynutí dvanástich mesiacov od operácie porovnateľne pozitívny vplyv na dizabilitu, funkčný stav a kvalitu života pacientov, ktorí sa podrobili operácii medzistavcovej platničky krčnej chrbtice.
Objective: The purpose of this paper is to determine which surgical treatment method of intervertebral disc in the cervical spine has better effect on disability, functional status and quality of life of patients. Sample and methods: In this prospective, consecutive, clinical study, we compare disability, functional status, and quality of life in a group of 48 patients who underwent anterior cervical discectomy and implantation of a Anterior Cervical Discectomy and Fusion Cage (ACDF), and a group of 40 patients who underwent anterior cervical discectomy and Dynamic Cervical Implant (DCI) arthroplasty. Dysfunction of the cervical spine was assessed according to the Neck Disability Index (NDI). Functional status of patients was evaluated by Pulses Profile and quality of life was evaluated by the Test of Quality of Life according to Spitzer. Results: Statistical evaluation of the questionnaire results (NDI, Pulses and Spitzer) between the compared groups of patients found no significant differences (p>0.05). Twelve months post-surgery the group of ACDF patients and the patients with DCI displayed reduced disability, increased functional status, and improved quality of life. However, there were no significant differences between these groups. Conclusion: The use of both methods of the surgical treatment (ACDF and DCI) for the period of twelve months show comparably positive effect on disability, functional status, and quality of life in patients who underwent intervertebral disc surgery in the cervical spine.
- Klíčová slova
- umělá náhrada ploténky,
- MeSH
- artroplastika metody MeSH
- biokompatibilní materiály terapeutické užití MeSH
- diskektomie metody MeSH
- dospělí MeSH
- krční obratle chirurgie MeSH
- lidé středního věku MeSH
- lidé MeSH
- meziobratlová ploténka * chirurgie MeSH
- neurochirurgické výkony * metody MeSH
- páteř chirurgie MeSH
- prospektivní studie MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
