Case presentation: The interdisciplinary and rehabilitation treatment of lumbar disc hernia on a patient with corticoterapy dependency and history of lymph node TB

Introduction. Disc herniation means the movement of an intervertebral disc. Lumbar disc herniation is an evolutionary phase of lumbar vertebral discopathy , by de Seze classification: phase I (low back pain), phase II (lumbar pain and paravertebral contracture), phase III (discal hernia, with three stages , radicular pain, paresthesias and motor deficiency). Materials and Methods. We are presenting the situation of a female patient, aged 62, from the urban area, with confirmed vices of smoking and sedentary lifestyle, which presented in Emergency Room in Constanta for lumbosciatalgias and paresthesias, impaired walking and presence of antalgic positions that required hospitalization in Neurosurgery section. The patient has a 15 points Glasgow score, with medical history of Hypertension, Rheumatoid Arthritis with corticotherapy, minor stroke and lymph node Tuberculosis. The muscular and osteoarticular system: apparently integral, with difficulty for active movements. The magnetic rezonance examination reveals 2 lumbar disc hernias at level L4. The neurosurgical treatment was applied: discectomy in the L4 disc herniation bilaterally with the removal of the disc fragments. Subsequently, the patient was transferred to the medical rehabilitation department from Techirghiol Sanatorium. The patient was evaluated clinically, functionally in dynamics to track the effectiveness of the neuromotor rehabilitation program. Results. Through the program of early rehabilitation established, the therapeutic yield was significant with the improvement of the clinical symptomatology as well as the marked increase of the functional parameters, assuring the patient a high degree of mobility, of autonomy, but also of reintegration in the social and family life. Conclusions. The peculiarity of this case was the critical condition of the patient at the hospitalization, corticodependence, which makes the surgery but also the medical rehabilitation much complicated by functional osteoporosis and low bone consistency. Neurosurgery together with medical rehabilitation have sounded excellent together with in many cases, with ability to restore strength, functionality as well as better health of patients, which creates an indispensability between the two specializations. Keywords: corticodependency, lumbar disc herniation, rehabilitation, neurosurgery,

Rehabilitation in Osteoporosis - therapeutic chalenge?

Introduction. Osteoporosis is a disease of the entire skeleton, characterized by decrease bone mass and microarhitectural alterations of bone tissue, which result in increased bone fragility and predisposition to bone fractures. Materials and methods. Accesing standard medical databases: Medline, Embase, Database, Pubmed and the Cochrane Register of Controled Studies to review new pharmacological studies and non-pharmacological terapies in osteoporosis. Statistical analysis performed from the data extracted from the observation sheets from June 2019 to December 2019 by Dr. Liliana Stanciu. Results and discussions. The complex balneo-physical-kinetic treatment is an important link in the treatment of the disabling pathology for the patient, with an important clinical resonance. Conclusion. Osteoporosis is a pathology that decreases the patient’s quality of life. There are complementary therapies to pharmacological treatment with immediate and long lasting results. Keywords: mud, osteoporosis, balneal, hormones,

Effects of balneotherapy and spa therapy on levels of cortisol as a stress biomarker: a systematic review

Balneotherapy and spa therapy are well-known practices, even though limited evidence has been produced about their biological effects. This systematic review primarily aims at assessing if balneotherapy, mud/peloid therapy, and spa therapy may influence cortisol levels. Secondarily, it aims at understanding if these interventions may improve stress resilience. PubMed/Medline, Embase, and Cochrane Library were searched for relevant articles in English or Italian about studies involving healthy and sub-healthy subjects or patients with a diagnosed disease about effects of balneotherapy, mud/peloid therapy, and spa therapy on serum and salivary cortisol levels. Fifteen studies involving 684 subjects were included. Five studies investigated biological effects of balneotherapy alone. Two of them reported significant changes of cortisol levels in healthy participants. The other three studies reported no significant variations in patients with rheumatic conditions. No studies investigated biological effects of mud/peloid therapy alone. Ten studies investigated biological effects of spa therapy with or without included mud/peloid therapy, and in all but two studies, significant variations of cortisol levels were reported. Our main findings suggest that balneotherapy may have the potential to influence cortisol levels in healthy subjects, in such a way as to improve stress resilience. Spa therapy with or without included mud/peloid therapy demonstrated the same potential to influence cortisol levels also in sub-healthy subjects and in patients with a diagnosed disease. Therefore, balneotherapy and spa therapy may be considered as useful interventions for the management of stress conditions. Further investigation is needed because of limited available data.