quarta-feira, 27 de maio de 2015

DORES NAS HÉRNIA DE DISCO: FORTALEZA INOVA COM TÉCNICAS MENOS AGRESSIVAS E MAIS EFICAZES



O tratamento das hérnias de disco tem evoluído bastante nos últimos anos. Das grandes cirurgias, passamos para as técnicas mini-invasivas e intervencionistas, e, agora, com o desenvolvimento de novos medicamentos para controle dos componentes neurais da dor, podemos associar técnicas infiltrativas guiadas por imagem a tratamentos clínico altamente eficazes.

Na Unidade Intervencionista do CENTRO MÉDICO DA COLUNA VERTEBRAL você pode ter acesso aos maiores avanços desta área, sendo tratado com excelência e resolutividade.

Associado a toda esta tecnologia, você dispõe, ainda, de uma equipe multidisciplinar com médicos, psicólogos, educadores físicos e fisioterapeutas especializados em um tratamento personalizado e feito para você, na medida certa, sob coordenação de um especialista altamente qualificado.

Visite nosso site: http://www.centromedicodacoluna.com.br/

Centro Médico da Coluna Vertebral
Torre Saúde São Mateus
Av. Santos Dumont, 5753, Sala 206
Fortaleza - Ceará - Brasil
Fone/Fax: (85) 3265 8300 e (85) 3242 9263

HÉRNIA DE DISCO E DORES NA COLUNA: EXPERIÊNCIA E EFICÁCIA DE UM TRATAMENTO SEM CORTES


CIRURGIA PRA QUÊ? AS HÉRNIAS DESAPARECEM NATURALMENTE!

Spontaneous regression of posterior epidural migrated lumbar disc fragments: case series 

  • Kiyoshi TarukadoMDab
  • Ko IkutaMDa
  • Yoshiaki FukutokuMDa
  • Osamu TonoMDb
  • Toshio DoiMDb
  • Abstract

    Background context

    Posterior epidural migrated lumbar disc fragments is an extremely rare disorder. Surgical treatment was performed in all reported cases. To the best of our knowledge, there are no reported cases of the use of conservative treatment for posterior epidural migrated lumbar disc fragments.

    Purpose

    To report the possibility of a spontaneous regression of posterior epidural migrated lumbar disc fragments.

    Study design

    Case series.

    Methods

    Four patients with posterior epidural migrated lumbar disc fragments were treated at Karatsu Red Cross Hospital between April 2008 and August 2010. Spontaneous regression of the posterior epidural migrated lumbar disc fragments with relief of symptoms was observed on magnetic resonance imaging (MRI) in three cases. Another patient underwent surgical treatment. The present and previously reported cases of posterior epidural migrated lumbar disc fragments were analyzed with respect to patient age, imaging features on MRI, the level of the lesion, clinical symptoms, treatment, and outcomes.

    Results

    Conservative treatment was successful, and spontaneous lesion regression was seen on MRI with symptom relief in three cases.

    Conclusions

    Although posterior epidural migrated lumbar disc fragment cases are generally treated surgically, the condition can regress spontaneously over time, as do sequestrated disc fragments. Spontaneous regression of lumbar disc herniations is a widely accepted observation at present. Posterior epidural migrated lumbar disc fragments fall under the sequestrated type of disc herniation. In fact, the course of treatment for posterior epidural migrated lumbar disc fragments should be determined based on the symptoms and examination findings, as in cases of ordinary herniation. However, providing early surgical treatment is important if the patient has acute cauda equina syndrome or the neurologic symptoms worsen over time.

DIABETES NÃO REPRESENTA RISCO DE REOPERAÇÃO EM FUSÃO DA COLUNA MAS REPRESENTA EM CASOS DE DESCOMPRESSÃO

The relationship between diabetes and the reoperation rate after lumbar spinal surgery: a nationwide cohort study

Abstract

Background context

Diabetes is present in 5% to 20% of patients undergoing spine surgeries and is a known risk factor for reoperation. Considering the chronicity of diabetes, its influence on the reoperation rate may differ over time.

Purpose

To present the relationship between diabetes and the reoperation rate over time.

Study design/setting

Retrospective cohort study.

Patient sample

A national health insurance database was used to identify a cohort of patients who underwent an initial surgery for lumbar degenerative disease in 2003 (n=34,918).

Outcome measures

The primary end point was any type of second lumbar surgery after fusion surgery (n=4,792) or decompression surgery (n=30,126) during the early (0–postoperative 90 days), short-term (91–365 days), and midterm (1–6 years) periods.

Methods

All patients were followed up until December 2008. Cox proportional hazards regression modeling was used to assess the adjusted reoperation rates in the diabetic patients.

Results

The incidence of diabetes in the present cohort was 24.5% in the fusion group and 16.9% in the decompression group. Overall, reoperation was performed in 13.2% (631 of 4,792) of the patients after fusion surgery and in 14.0% (4,214 of 30,126) of the patients after decompression surgery. After fusion surgery, diabetes did not make a significant difference in the reoperation rate during the entire follow-up period. After decompression surgery, the reoperation rate was not different during Postoperative Month 3, but diabetic patients showed a 1.2 to 1.4 times higher reoperation rate during postoperative 3 months to 5 years (p<.01).

Conclusions

The study did not find a relationship between diabetes at the time of surgery and the reoperation rate during the early postoperative period. Thereafter, the reoperation rate was not higher after fusion surgery in diabetic patients, but it was higher after decompression surgery.

CIÁTICA: MEDICAMENTOS, INFILTRAÇOES E CIRURGIAS SÃO EFICAZES; REPOUSO, EXERCÍCIOS E TRAÇÃO SÃO INEFICAZES

Comparative clinical effectiveness of management strategies for sciatica: systematic review and network meta-analyses 

  • Ruth A. LewisBSc (hons), MSca,
  • Nefyn H. WilliamsPhD, FRCGP, FLCOMab
  • Alex J. Sutton,PhDc
  • Kim BurtonPhD, DO, EurEngd
  • Nafees Ud DinMSc, MFDS, RCSa
  • Hosam E. MatarBSc, MBBSe
  • Maggie HendryBA (hons)a
  • Ceri J. PhillipsPhDf
  • Sadia NafeesMSca
  • Deborah Fitzsimmons,PhDd
  • Ian Rickardg
  • Clare WilkinsonMD, FRCGPa
  • Abstract

    Background

    There are numerous treatment approaches for sciatica. Previous systematic reviews have not compared all these strategies together.

    Purpose

    To compare the clinical effectiveness of different treatment strategies for sciatica simultaneously.

    Study design

    Systematic review and network meta-analysis.

    Methods

    We searched 28 electronic databases and online trial registries, along with bibliographies of previous reviews for comparative studies evaluating any intervention to treat sciatica in adults, with outcome data on global effect or pain intensity. Network meta-analysis methods were used to simultaneously compare all treatment strategies and allow indirect comparisons of treatments between studies. The study was funded by the UK National Institute for Health Research Health Technology Assessment program; there are no potential conflict of interests.

    Results

    We identified 122 relevant studies; 90 were randomized controlled trials (RCTs) or quasi-RCTs. Interventions were grouped into 21 treatment strategies. Internal and external validity of included studies was very low. For overall recovery as the outcome, compared with inactive control or conventional care, there was a statistically significant improvement following disc surgery, epidural injections, nonopioid analgesia, manipulation, and acupuncture. Traction, percutaneous discectomy, and exercise therapy were significantly inferior to epidural injections or surgery. For pain as the outcome, epidural injections and biological agents were significantly better than inactive control, but similar findings for disc surgery were not statistically significant. Biological agents were significantly better for pain reduction than bed rest, nonopioids, and opioids. Opioids, education/advice alone, bed rest, and percutaneous discectomy were inferior to most other treatment strategies; although these findings represented large effects, they were statistically equivocal.

    Conclusions

    For the first time, many different treatment strategies for sciatica have been compared in the same systematic review and meta-analysis. This approach has provided new data to assist shared decision-making. The findings support the effectiveness of nonopioid medication, epidural injections, and disc surgery. They also suggest that spinal manipulation, acupuncture, and experimental treatments, such as anti-inflammatory biological agents, may be considered. The findings do not provide support for the effectiveness of opioid analgesia, bed rest, exercise therapy, education/advice (when used alone), percutaneous discectomy, or traction. The issue of how best to estimate the effectiveness of treatment approaches according to their order within a sequential treatment pathway remains an important challenge.

segunda-feira, 5 de janeiro de 2015

CASOS DE DESAPARECIMENTO ESPONTÂNEO DE HÉRNIA DE DISCO

O QUADRO DE DESAPARECIMENTO ESPONTÂNEO DE HÉRNIA É FATO COMUM, O QUE NOS LEVA A EVITAR AS CIRURGIAS DE HÉRNIAS NA GRANDE MAIORIA DAS VEZES.

VEJA ALGUMAS FOTOS ANTES E DEPOIS DO DESAPARECIMENTO ESPONTÂNEO DE UMA HÉRNIA LOMBAR:



O PROBLEMA A SER REALMENTE A SER TRATADO NÃO É A HÉRNIA MAS O QUE O QUADRO INFLAMATÓRIO CONSEQUENTE PODE CAUSAR NOS NERVOS DA REGIÃO.