OBJECTIVE: To compare the effect of epidural steroid injections (ESI) in patients with discogenic sciatica (Sci) versus patients with lumbar canal stenosis (LSS), not controlled by conservative treatment. MATERIALS AND METHODS: In our study, 80 patients with Sci and 66 with LSS were included. A single ESI (10 mg dexamethasone in 3 cc 0.25% bupivacaine) was applied under fluoroscopic control: one level above the highest stenotic level, in the posterior epidural space, via interlaminar approach in LSS and at the prolapse level, in the anterior epidural space, via transforaminal route in Sci. Pain intensity was assessed by VAS at baseline and on days 1, 15 and 30 after intervention. RESULTS: The procedure was successful in 78 Sci and 63 LSS patients. Patients with Sci responded significantly better. At one month, pain reduction over 50% was achieved in 63% (52.3-73.7% at p = 0.95) of Sci but only in 35% (23.2-46.8%) of LSS (p = 0.03). Return to pre-intervention level happened in 47% (34.7-59.3%) of LSS versus 14% (6.3-21.7%) of Sci patients (p = 0.01). In 5 patients the procedure failed, without resulting morbidity. CONCLUSION: ESI are more effective in patients with Sci than in single level LSS. In multiple level LSS, results are disappointing.

• Klíčová slova
• chronic pain, epidural steroid injections, intervertebral disc disease, low back pain, lumbar spinal stenosis, neuropathic pain, sciatica,
• MeSH
• anestetika lokální aplikace a dávkování   MeSH
• antiflogistika aplikace a dávkování   MeSH
• bederní obratle MeSH
• bupivakain aplikace a dávkování   MeSH
• časové faktory MeSH
• degenerace meziobratlové ploténky komplikace   MeSH
• dexamethason aplikace a dávkování   MeSH
• dospělí MeSH
• epidurální analgezie MeSH
• fluoroskopie MeSH
• ischialgie farmakoterapie   etiologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• lumbalgie farmakoterapie   etiologie   MeSH
• měření bolesti MeSH
• prospektivní studie MeSH
• senioři MeSH
• spinální stenóza komplikace   MeSH
• studie případů a kontrol MeSH
• výhřez meziobratlové ploténky komplikace   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• anestetika lokální MeSH
• antiflogistika MeSH
• bupivakain MeSH
• dexamethason MeSH

Cervical total disc replacement (CTDR) aims to decrease the incidence of adjacent segment disease through motion preservation in the operated disc space. Ongoing data collection and increasing number of studies describing heterotopic ossification (HO) resulting in decreased mobility of implants, forced us to carefully evaluate our long-term clinical and morphological results of patients with CTDR. We present the first 54 consecutive patients treated with 65 ProdiscC prostheses during a 12-month period (2/2004-3/2005). All patients signed an informed consent and were included in prospective long-term study approved by hospital ethical committee. The 1- and 2-year follow-up analysis were available for all patients included and 4-year results for 50 patients (60 implants). Clinical (neck disability index-NDI, visual analog scale-VAS) and radiological follow-up was conducted at 1-, 2- and 4-years after the procedure. The Mehren/Suchomel modification of McAfee scale was used to classify the appearance of HO. Mean preoperative NDI was 34.5%, VAS for neck pain intensity 4.6 and VAS for arm pain intensity 5.0. At 1-, 2- and 4-year follow-up, the mean NDI was 30.7, 27.2, and 30.4, mean VAS for neck pain intensity 2.5, 2.1 and 2.9 and mean VAS for arm pain intensity pain 2.2, 1.9 and 2.3, respectively. Significant HO (grade III) was present in 45% of implants and segmental ankylosis (grade IV) in another 18% 4 years after intervention. This finding had no clinical consequences and 92% of patients would undergo the same surgery again. Our clinical results (NDI, VAS) are comparable with fusion techniques. Although, advanced non-fusion technology is used, a significant frequency of HO formation and spontaneous fusion in cervical disc replacement surgery must be anticipated during long-term follow-up.

• MeSH
• ankylóza etiologie   patologie   patofyziologie   MeSH
• bolest krku etiologie   patologie   patofyziologie   MeSH
• čas MeSH
• časové faktory MeSH
• diskektomie škodlivé účinky   MeSH
• dospělí MeSH
• fúze páteře škodlivé účinky   MeSH
• heterotopická osifikace etiologie   patologie   patofyziologie   MeSH
• hlava - pohyby fyziologie   MeSH
• interní fixátory škodlivé účinky   MeSH
• krční obratle patologie   chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mechanický stres MeSH
• měření bolesti MeSH
• následné studie MeSH
• pooperační komplikace etiologie   patologie   patofyziologie   MeSH
• posuzování pracovní neschopnosti MeSH
• recidiva MeSH
• rozsah kloubních pohybů fyziologie   MeSH
• výhřez meziobratlové ploténky komplikace   patologie   chirurgie   MeSH
• zatížení muskuloskeletálního systému fyziologie   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

PURPOSE OF THE STUDY: Each dynamic stabilisation should preserve motion at the operated segment as well as reduce a load on the disc and intervertebral joints. One of the methods to achieve this is the implantation of interspinous spacers between lumbar spinous processes. In this study, the patients treated with the DIAM interspinous spacer (Medtronic, USA) were prospective- ly followed up with the aim to evaluate clinical outcomes and post-operative complications. MATERIAL: Patients with a degenerative disease of the lumbosacral spine were indicated for the operation. They suffered from axial pain with signs of nerve root involvement due to disc hernia, foraminal stenosis or disc herniation recurrence A total of 68 patients aged 23 to 75 (average age, 50.01) years, including 39 men (average age, 50.44) and 29 women (average age, 49.45), were followed up for 1 to 3 years and evaluated. METHODS: All patients underwent a standard pre-operative clinical and neurological examination. Each patient assessed pain intensity using a Visual Analogue Scale (VAS) and, with an Oswestry Disability Index (ODI) questionnaire, evaluated their functional state. In the case of disc hernia or disc herniation recurrence, a sequester was removed; for foraminal stenosis, foraminotomy and partial medial facetectomy was performed. After this decompression of nerve structures, a spacer was implanted. Follow-up included clinical and neurological examination at 6 weeks, 6 months and 1 - 3 years post-operative- ly. At 6 months and between 1 and 3 years after surgery, pain intensity and functional outcome using VAS and ODI assessments were measured by the patients, and antero-posterior and lateral skiagrams of the lumbosacral spine were made. The X-ray examination was made to reveal a potential implant dislocation. The VAS and ODI values at 1-3 post-operative years were compared with those before surgery and the results were statistically analysed. The surgeon evaluated the outcomes at 1-3 years of follow-up according to the Odom criteria. RESULTS: The average ODI of the group was 60.44 % before and 21.85 % after surgery, which showed an improvement by 63.85%. The average VAS was 7.18 points before and 2.10 points after surgery, showing an improvement by 70.75 %. A comparison of the pre- and post-operative results showed, in the average ODI differences of 38.24 % and 39.44 % in women and men, respectively; and in the average VAS value, 5.00 in women and 5.19 in men. The results evaluated according to indication for surgery were as follows: in patients with disc hernia, the difference in ODI was 39.62 % on average, and in VAS it was 5.42 points on average. In patients with disc herniation recurrence, the differences between pre- and post-operative average values were 41.50 % for ODI and 5.00 points for VAS. In patients treated for foraminal stenosis, these differences were 39.79 % for ODI and 5.18 points for VAS. The results for the level treated showed that at L5/S1 the average difference for ODI was 46.75 % and 4.50 points for VAS ; at L4/5 it was 35.52 % for ODI and 5.12 for VAS; at L3/4 it was 48.00 % for ODI and 5.78 for VAS; and at L2/3 it was 39.00 % for ODI and 4.50 for VAS.The results related to the method of nerve root decompression included the average differences of 40.00 % in ODI and 5.17 in VAS for removal of a disc sequester; and average differences of 32.89 % in ODI and 4.78 in VAS for foraminotomy and partial medial facetectomy. The results evaluated for the duration of pre-operative complaints were as follows: surgery by 3 months, average ODI, 44, 53 % and average VAS, 5.25; surgery between 3 and 6 months, average ODI, 37.65 % and average VAS, 4.71; and surgery after 6 months, average ODI, 35.60 % and average VAS, 5.28. The Odom criteria showed results as excellent in 41 %, good in 51.5 % and fair in 7.5 % of the patients. No poor result was recorded. There were no early complications such as haematoma, wound seroma or deep subfascial infection, and no implant dis- location. One patient had to undergo repeat surgery for subcutaneous infection without affecting the implant. Until the end of the study, no signs of herniation recurrence at the segment stabilised with a Diam interspinous spacer had been found. DISCUSSION: The fact that none of the patients in this study required revision surgery or had a recurrence of disc herniation provides evidence for the effectiveness of the DIAM interspinous spacer.This also suggests that the implant protects the whole operated spinal segment, i.e., both intervertebral joints and discs, from being overloaded. Lesser mechanical stress applied to intervertebral facets may slow down degenerative processes and reduce their signs. CONCLUSIONS: The implantation of a DIAM interspinous spacer is a less invasive and safe method of dynamic stabilisation of the spi- ne without intra- or post-operative complications that is well tolerated by the patient. At 3-year follow-up the patients reported improvement in their functional state, as measured with an ODI, by 64 % on the average. Their axial and nerve root pain was reduced by 71 % on the average. All patients showed improved clinical conditions and the outcomes were evaluated as excellent in 41 %, good in 51 % and fair in 7.5 % of the patients. The results of implantation were not significantly related to age, gender, operative indications, operated lumbosacral level, method of nerve root decompression or duration of pre-operative problems. No patient treated by the DIAM spacer had any recurrence of disc herniation.

• MeSH
• bederní obratle chirurgie   MeSH
• dospělí MeSH
• křížová kost chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• protézy a implantáty * MeSH
• senioři MeSH
• spinální stenóza komplikace   chirurgie   MeSH
• výhřez meziobratlové ploténky komplikace   chirurgie   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH

STUDY DESIGN: Clinical, radiologic, and neurophysiologic description of 2 cases. OBJECTIVE: To describe 2 cases with spontaneous deep unilateral abdominal pain as the first symptom of thoracic disc herniation at a low thoracic vertebral level, further manifested by unilateral partial paresis of the obliquus abdominis muscle. SUMMARY OF BACKGROUND DATA: Clinical manifestation of lateral thoracic disc herniation with electrophysiologic results and conservative therapy as treatment of choice when spinal cord functions are preserved. METHODS: Magnetic resonance imaging revealed bilateral paramedian disc protrusions at T12-L1 in Patient 1 and foraminal herniation at T10-T11 and paramedian herniation at T11-T12 in Patient 2. Electromyography (EMG) and evoked potentials were investigated in the acute stage and after 6 months. RESULTS: Spontaneous activity on needle EMG confirmed axonal root impairment. Somatosensory and motor-evoked potentials were within normal limits and excluded spinal cord involvement. Nonsteroidal anti-inflammatory drugs and periradicular injection of steroids and local anesthetics rendered both patients pain-free. Normalization of muscle strength within 3 to 6 months was accompanied by EMG findings of reinnervation. CONCLUSION: Lateral disc herniation causing compression of a thoracic root associated with unilateral segmental paresis of the abdominal wall is a rare condition. Despite EMG documentation of axonal root lesion, however, a purely conservative therapeutic approach may be considered treatment of choice in cases without spinal cord involvement.

• MeSH
• antiflogistika nesteroidní terapeutické užití   MeSH
• bolesti břicha etiologie   patologie   patofyziologie   MeSH
• břišní svaly inervace   patofyziologie   MeSH
• dospělí MeSH
• elektromyografie MeSH
• evokované potenciály fyziologie   MeSH
• hrudní obratle patologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• magnetická rezonanční tomografie MeSH
• míšní kořeny účinky léků   patologie   patofyziologie   MeSH
• obnova funkce účinky léků   fyziologie   MeSH
• paréza etiologie   patologie   patofyziologie   MeSH
• steroidy terapeutické užití   MeSH
• svalová síla účinky léků   fyziologie   MeSH
• výhřez meziobratlové ploténky komplikace   patologie   patofyziologie   MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH
• práce podpořená grantem MeSH
• Názvy látek
• antiflogistika nesteroidní MeSH
• steroidy MeSH

Prolapse of an intervertebral disc and neurologically important spondylosis of the thoracic vertebrae are not a frequent finding--in the wide spectrum of surgical treatment of degenerative diseases of the spine the numbers of operations in the thoracic section account only for a few percent. The authors give an account of 12 patients treated surgically during the 5-year period 1997-2001 at the Neurosurgical Department of the First Medical Faculty Charles University and Institute for Postgraduate Training in Prague-Stresovice. They describe the establishment of the neurological finding from the differential diagnostic aspect, the algorithm of radiological examination and selected treatment. In the group of surgically treated patients were two with spinal and radicular symptoms, 8 patients had only spinal and 2 patients had only root symptoms. Laminectomy was performed in one female patient, in 9 patients discectomy was performed from a transpedicular approach and in two patients discectomy from costotransversectomy. Complete normalization of clinical complaints was recorded in 2 patients, in 8 the condition improved and 2 patients did not improve. In 2 patients a revision was made and extension of the approach on account of persisting clinical complaints, in one patient after revision complete normalization of the clinical finding occurred, the second patient did not improve after revision. Selection and results of the surgical approach--in all instances different types of posterior approach were involved--are discussed. In the discussion also a brief review, indications and illustrations of posterior approaches are given. The discussion deals also with the advantages and disadvantages of the method as compared with the anterior approach or endoscopic technique. The authors emphasize the advantages of the microsurgical technique--the open posterior approach still holds an irreplaceable place in the spectrum of surgical therapeutic methods despite the onset of endoscopic methods.

• MeSH
• dospělí MeSH
• hrudní obratle chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• osteofytóza páteře komplikace   chirurgie   MeSH
• senioři MeSH
• výhřez meziobratlové ploténky komplikace   chirurgie   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH

The objective of the submitted work was to draw attention to some problems associated with the diagnosis and treatment of prolapse of sequestra of thoracic intervertebral discs. The investigated group comprised 9 subjects (4 women, 5 men) aged 33 to 67 years operated upon at the Neurosurgical Clinic in Kosice between Jan. 1 1982 and June 30 2001 on account of compression of nervous structures in the thoracic portion of the spine by sequestra of intervertebral discs. This was manifested by back pain, a sensation of stiffening of the muscles of the lower extremities, altered sensitivity and in all by impaired gait. Only one female patient developed urinary retention, another one painless paraparesis of the lower extremities, therefore the condition was evaluated as a demyelinisation process. In three patients as the only imaging examination method perimyelography was used, in another two it was supplemented by CT. Four patients were examined by MRI. This graphic method proved to be the most suitable. In all subjects of the investigated group the clinical picture and examination methods indicated a unilateral predominance of the affection. In five subjects it proved possible to remove the sequestream of the intervertebral disc via laminectomy, in another four a transpedicular approach into the spinal canal was used successfully. In all patients the condition improved after surgery.

• MeSH
• dospělí MeSH
• hrudní obratle * MeSH
• komprese míchy diagnóza   etiologie   chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• senioři MeSH
• výhřez meziobratlové ploténky komplikace   diagnóza   chirurgie   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH

Lumbar disc operations have been performed in Brno since 1952 and from the very beginning they are performed under regional anaesthesia. Since 1965 until 1999 about 16,000 operations for herniated discs have been performed here. The number of operations doubled with the foundation of the second neurosurgical department in Brno in 1992. Lumbar disc surgery represents 25% of the operation spectrum in our department. Epidural anaesthesia is advantageous for less risk of some complications compared with general anaesthesia and enables communication between the surgeon and the patient. Other advantages are: less visible bleeding in the operative field due to the lateral position and the fact that the surgeon can sit during the operation. On a long-term basis we found 4-5% had further surgery for reccurent problems. Objective neurological evaluation 6 weeks after the operation showed improvement in 92% of patients. The patients themselves consider their status as very good or satisfactory in 82% (median 3 years after the operation). Besides a correctly performed operation we emphesize also the role of correct diagnosis (good correlation between the patient's problems and CT scan finding) for a good treatment result.

• MeSH
• bederní obratle diagnostické zobrazování   chirurgie   MeSH
• časové faktory MeSH
• chirurgická dekomprese MeSH
• dospělí MeSH
• epidurální anestezie * MeSH
• lidé středního věku MeSH
• lidé MeSH
• radikulopatie diagnostické zobrazování   etiologie   chirurgie   MeSH
• radiografie MeSH
• recidiva MeSH
• reoperace MeSH
• senioři MeSH
• spokojenost pacientů MeSH
• výhřez meziobratlové ploténky komplikace   diagnostické zobrazování   chirurgie   MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika MeSH

• MeSH
• flaviny * MeSH
• klinické zkoušky jako téma MeSH
• lidé středního věku MeSH
• lidé MeSH
• míšní kořeny * MeSH
• úžinové syndromy farmakoterapie   etiologie   MeSH
• vazodilatancia terapeutické užití   MeSH
• výhřez meziobratlové ploténky komplikace   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• klinické zkoušky MeSH
• Názvy látek
• flaviny * MeSH
• nicoflavin MeSH Prohlížeč
• vazodilatancia MeSH

• MeSH
• bederní obratle * MeSH
• bolesti zad etiologie   MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• nervus peroneus MeSH
• paralýza etiologie   MeSH
• senioři MeSH
• syndrom MeSH
• výhřez meziobratlové ploténky komplikace   chirurgie   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

• MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• míšní kořeny MeSH
• pooperační komplikace chirurgie   MeSH
• úžinové syndromy etiologie   MeSH
• výhřez meziobratlové ploténky komplikace   chirurgie   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH