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Méndez-Gutiérrez A, Marín Navas F, Acevedo-González JC. Frequency of use of discography findings for the diagnosis of low back pain of discogenic origin. Systematic review of the literature. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024; 68:209-222. [PMID: 36906136 DOI: 10.1016/j.recot.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 02/28/2023] [Accepted: 03/05/2023] [Indexed: 03/12/2023] Open
Abstract
INTRODUCTION There are different techniques and interpretations of discography findings to determine it positive for the diagnosis of discogenic pain. This study aims to evaluate the frequency of use of discography findings for the diagnosis of low back pain of discogenic origin. MATERIAL AND METHODS A systematic review of the literature of the last 17 years was performed in MEDLINE and BIREME. A total of 625 articles were identified, 555 were excluded for duplicates, title and abstract. We obtained 70 full texts of which 36 were included in the analysis after excluding 34 for not meeting the inclusion criteria. RESULTS Among the criteria in discography to determine it as positive, 8 studies used only the pain response to the procedure, 28 studies used more than one criterion during discography to consider it as positive, the evaluation of at least one adjacent intervertebral disc with a negative result was necessary in 26 studies to consider a discography as positive. Five studies formally expressed the use of the technique described by SIS/IASP to determine a discography as positive. CONCLUSIONS Pain in response to contrast medium injection, assessed with the visual analog pain scale≥6, was the most used criterion in the studies included in this review. Although there are already criteria to determine a discography as positive, the use of different techniques and interpretations of discography findings to determine a positive discography for low back pain of discogenic origin persists.
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Affiliation(s)
- A Méndez-Gutiérrez
- Pontificia Universidad Javeriana, Hospital Universitario San Ignacio, Bogotá, Colombia.
| | - F Marín Navas
- Semillero de Neurocirugía y Neurología, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - J C Acevedo-González
- Pontificia Universidad Javeriana, Hospital Universitario San Ignacio, Bogotá, Colombia
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Méndez-Gutiérrez A, Marín Navas F, Acevedo-González JC. [Translated article] Frequency of use of discography findings for the diagnosis of low back pain of discogenic origin. Systematic review of the literature. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024; 68:T209-T222. [PMID: 38508378 DOI: 10.1016/j.recot.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 02/28/2023] [Accepted: 03/05/2023] [Indexed: 03/22/2024] Open
Abstract
INTRODUCTION There are different techniques and interpretations of discography findings to determine it positive for the diagnosis of discogenic pain. This study aims to evaluate the frequency of use of discography findings for the diagnosis of low back pain of discogenic origin. MATERIAL AND METHODS A systematic review of the literature of the last 17 years was performed in MEDLINE and BIREME. A total of 625 articles were identified, 555 were excluded for duplicates, title and abstract. We obtained 70 full texts of which 36 were included in the analysis after excluding 34 for not meeting the inclusion criteria. RESULTS Among the criteria in discography to determine it as positive, 8 studies used only the pain response to the procedure, 28 studies used more than one criterion during discography to consider it as positive, the evaluation of at least one adjacent intervertebral disc with a negative result was necessary in 26 studies to consider a discography as positive. Five studies formally expressed the use of the technique described by SIS/IASP to determine a discography as positive. CONCLUSIONS Pain in response to contrast medium injection, assessed with the visual analogue pain scale ≥6, was the most used criterion in the studies included in this review. Although there are already criteria to determine a discography as positive, the use of different techniques and interpretations of discography findings to determine a positive discography for low back pain of discogenic origin persists.
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Affiliation(s)
- A Méndez-Gutiérrez
- Pontificia Universidad Javeriana, Hospital Universitario San Ignacio, Bogotá, Colombia.
| | - F Marín Navas
- Semillero de Neurocirugía y Neurología, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - J C Acevedo-González
- Pontificia Universidad Javeriana, Hospital Universitario San Ignacio, Bogotá, Colombia
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Martel Villagrán J, Martínez-Sánchez RT, Cebada-Chaparro E, Bueno Horcajadas AL, Pérez-Fernández E. Diagnostic accuracy of lumbar CT and MRI in the evaluation of chronic low back pain without red flag symptoms. Radiologia (Engl Ed) 2023; 65 Suppl 2:S59-S70. [PMID: 37858354 DOI: 10.1016/j.rxeng.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 02/01/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND Low back pain (LBP) is one of the most frequent reasons for medical consultation. Most of the patients will have nonspecific LBP, which usually are self-limited episodes. It is unclear which of the diagnostic imaging pathways is most effective and costeffective and how the imaging impacts on patient treatment. Imaging techniques are usually indicated if symptoms remain after 6 weeks. Magnetic resonance imaging (MRI) is the diagnostic imaging examination of choice in lumbar spine evaluation of low back pain; however, availability of MRI is limited. OBJECTIVES To evaluate the diagnostic accuracy of computed tomography (CT) with MRI (as standard of reference) in the evaluation of chronic low back pain (LBP) without red flags symptoms. To compare the results obtained by two radiologists with different grades of experience. MATERIALS AND METHODS Patients with chronic low back pain without red flags symptoms were retrospectively reviewed by two observers with different level of experience. Patients included had undergone a lumbar or abdominal CT and an MRI within a year. Once the radiological information was collected, it was then statistically reviewed. The aim of the statistical analysis is to identify the equivalence between both diagnostic techniques. To this end, sensitivity, specificity and validity index were calculated. In addition, intra and inter-observer reliability were measured by Cohen's kappa values and also using the McNemar test. RESULTS 340 lumbar levels were evaluated from 68 adult patients with chronic low back pain or sciatica. 63.2% of them were women, with an average age of 60.3 years (SD 14.7). CT shows high values of sensitivity and specificity (>80%) in most of the items evaluated, but sensitivity was low for the evaluation of density of the disc (40%) and for the detection of disc herniation (55%). Moreover, agreement between MRI and CT in most of these items was substantial or almost perfect (Cohen's kappa-coefficient > 0'8), excluding Modic changes (kappa = 0.497), degenerative changes (kappa0.688), signal of the disc (kappa = 0.327) and disc herniation (kappa = 0.639). Finally, agreement between both observers is mostly high (kappa > 0.8). Foraminal stenosis, canal stenosis and the grade of the canal stenosis were overdiagnosed by the inexperienced observer in the evaluation of CT images. CONCLUSIONS AND SIGNIFICANCE CT is as sensitive as lumbar MRI in the evaluation of most of the items analysed, excluding Modic changes, degenerative changes, signal of the disc and disc herniation. In addition, these results are obtained regardless the experience of the radiologist. The rising use of diagnostic medical imaging and the improvement of image quality brings the opportunity of making a second look of abdominal CT in search of causes of LBP. Thereby, inappropriate medical imaging could be avoided (2). In addition, it would allow to reduce MRI waiting list and prioritize other patients with more severe pathology than LBP.
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Affiliation(s)
- J Martel Villagrán
- Radiología musculoesquelética, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | | | - E Cebada-Chaparro
- Radiología musculoesquelética, Hospital Universitario de Cáceres, Cáceres, Spain
| | - A L Bueno Horcajadas
- Radiología musculoesquelética, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - E Pérez-Fernández
- Metodología de la Investigación, Hospital Universitario Fundación Alcorcón, Madrid, Spain
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Clark P, Contreras D, Ríos-Blancas MJ, Steinmetz JD, Ong L, Culbreth GT, Lenox H, Mendoza CF, Razo C. Analysis of musculoskeletal disorders-associated disability in Mexico from 1990 to 2021. GAC MED MEX 2023; 159:502-511. [PMID: 38386887 DOI: 10.24875/gmm.m24000831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 10/23/2023] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Musculoskeletal disorders (MSD) affect 1.71 billion people worldwide and are the leading cause of disability. OBJECTIVE To analyze the years lived with disability (YLD) attributed to MSD in Mexico between 1990 and 2021. MATERIAL AND METHODS With estimates from the Global Burden of Disease 2021 study, the YLDs due to MSD and their six categories were analyzed, including osteoarthritis, rheumatoid arthritis, gout, neck pain, low back pain, as well as other MSDs. Patterns and trends in the number, crude rate, and YLD age-standardized rate were evaluated at the national and state levels, as well as by age group and gender. RESULTS MSDs were the main cause of YLDs in Mexico between 1990 and 2021, with an increase of 57.3%, going from 1,458.4 to 2,293.7 per 100,000 population. Low back pain (840.6 YLD) showed the highest rate in 2021, while osteoarthritis had the largest increase. MSDs increased with age and, and except for gout, affected women more often. CONCLUSIONS From 1990 to 2021, MSDs were the main cause of YLDs in Mexico, with a higher impact on adults and women. MSDs can appear early in life, hence the need for continuous interventions in order to preserve quality of life.
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Affiliation(s)
- Patricia Clark
- Clinical Epidemiology Unit. Hospital Infantil de México "Federico Gómez", Mexico City, Mexico
- Faculty of Medicine, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Daniela Contreras
- Faculty of Medicine, Universidad Nacional Autónoma de México, Mexico City, Mexico
- Tecnológico de Monterrey, School of Medicine and Health Sciences, Monterrey, Nuevo León, Mexico
| | - María J Ríos-Blancas
- Nutrition and Health Research Center, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico
- Fundación "Carlos Slim", Mexico City, Mexico
| | - Jaimie D Steinmetz
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, United States of America
| | - Liane Ong
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, United States of America
| | - Garland T Culbreth
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, United States of America
| | - Hailey Lenox
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, United States of America
| | - Carlos F Mendoza
- Faculty of Medicine, Universidad Nacional Autónoma de México, Mexico City, Mexico
- Program for Medical, Dentistry and Health Sciences Master's Degree and PHD, Universidad Nacional Autónoma de Mexico City, Mexico
| | - Christian Razo
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, United States of America
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Yamada AS, Simon D, Antunes FTT, Say KG, Souza AHD. Psychosocial factors associated with disability in patients with non-specific chronic low back pain: A cross-sectional study. Rehabilitacion (Madr) 2022; 57:100750. [PMID: 35868884 DOI: 10.1016/j.rh.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 06/03/2022] [Accepted: 06/09/2022] [Indexed: 10/17/2022]
Abstract
INTRODUCTION AND OBJECTIVES Chronic low back pain is the main cause of disability worldwide, generating high costs for society. To evaluate the prevalence of disability in patients with non-specific chronic low back pain and associated factors, including the impacts of low back pain and psychosocial factors linked to kinesiophobia, catastrophism, anxiety, and depression. PATIENTS A cross-sectional study was carried out with 108 adult individuals who had non-specific chronic low back pain. The patients answered previously validated questionnaires, namely the Brief Pain Inventory, the Roland-Morris Disability Questionnaire, the Pain Catastrophizing Scale, the Tampa Kinesiophobia Scale, and the Hospital Anxiety and Depression Scale. RESULTS The prevalence of disability observed was 65.7%, with the mean disability score being 15.7±5.3 points in the Roland-Morris Disability Questionnaire. Although pain intensity and other domains of the Brief Pain Inventory, like anxiety, depression, and severe kinesiophobia were significant in the bivariate analyses, they were not associated with disability in the multivariate analysis. Only catastrophic thoughts (prevalence ratio [PR]=1.19; 95% confidence interval [CI]: 1.07-1.32), and the 'walking' domain (PR=1.08; 95% CI: 1.03-1.14) remained statistically associated with disability. CONCLUSION Pain catastrophization and impact on gait were associated with disability in individuals with non-specific chronic low back pain. Motor control thoughts and behaviors during functional activities were considered to be relevant aspects for the better assessment and treatment of these patients.
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Affiliation(s)
- A S Yamada
- Graduate Program in Molecular and Cellular Biology Applied to Health, Lutheran University of Brazil, Canoas, Rio Grande do Sul, Brazil.
| | - D Simon
- Graduate Program in Molecular and Cellular Biology Applied to Health, Lutheran University of Brazil, Canoas, Rio Grande do Sul, Brazil
| | - F T T Antunes
- Graduate Program in Molecular and Cellular Biology Applied to Health, Lutheran University of Brazil, Canoas, Rio Grande do Sul, Brazil
| | - K G Say
- Department of Gerontology at the Federal University of São Carlos, São Carlos, São Paulo, Brazil
| | - A H D Souza
- PhD in Biochemical and Molecular Pharmacology from the Federal University of Minas Gerais, Brazil
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Melo Cruz MC, Santeularia Verges MT, Rius Llorens C, Gich Saladich IJ, Català Puigbó E. Influence of comorbidities on pain intensity in patients with chronic low back pain. Med Clin (Barc) 2021; 159:73-77. [PMID: 34879972 DOI: 10.1016/j.medcli.2021.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 08/30/2021] [Accepted: 09/02/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Chronic pain is a complex process that can vary depending on factors such as time evolution, mood, or even previous experiences. Our objective is to describe patient's characteristics from those who were referred with a diagnosis of low back pain in their first Pain Unit (PU) visit, and identify those factors that may interfere with their pain perception. METHODS Inferential analysis was carried out from data recorded in the PU database of the Hospital de la Santa Creu y Sant Pau in Barcelona, from November 2012 to November 2018. The average pain intensity during the last 24 hours (EVN24) was quantified using data from the BPI (Brief Pain Inventory) questionnaire. Using multiple linear regression, the independent predictive factors related to pain intensity (EVN24) were assessed. RESULTS Mood disorders (Degree of depresión acording HAD_D level) was the variable with the highest impact in pain perception. Using binary logistic regression for multivariate analysis, a model of variables related to pain intensity (EVN24) was obtained (R = 0.354, P < 0.001). CONCLUSIONS The specialized treatment of low back pain in PUs must take into account the patient's profile and especially the affective disorders and associated comorbidities since they predict a greater intensity of pain. Consequently, the associated comorbidity not only affects the greater intensity of pain, but the physical characteristics that accompany the patient throughout the process can influence or even compromise treatment.
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Affiliation(s)
- Martha Cristina Melo Cruz
- Servicio de Anestesiología y Reanimación. Unidad del Dolor Hospital de la Santa Creu i Sant Pau. Servicio de Epidemiología Clínica y Salud Pública del Hospital de la Santa Creu i Sant Pau , Barcelona, España.
| | - Maria Teresa Santeularia Verges
- Servicio de Anestesiología y Reanimación. Unidad del Dolor Hospital de la Santa Creu i Sant Pau. Servicio de Epidemiología Clínica y Salud Pública del Hospital de la Santa Creu i Sant Pau , Barcelona, España
| | - Carme Rius Llorens
- Servicio de Anestesiología y Reanimación. Unidad del Dolor Hospital de la Santa Creu i Sant Pau. Servicio de Epidemiología Clínica y Salud Pública del Hospital de la Santa Creu i Sant Pau , Barcelona, España
| | - Ignasi J Gich Saladich
- Servicio de Anestesiología y Reanimación. Unidad del Dolor Hospital de la Santa Creu i Sant Pau. Servicio de Epidemiología Clínica y Salud Pública del Hospital de la Santa Creu i Sant Pau , Barcelona, España
| | - Elena Català Puigbó
- Servicio de Anestesiología y Reanimación. Unidad del Dolor Hospital de la Santa Creu i Sant Pau. Servicio de Epidemiología Clínica y Salud Pública del Hospital de la Santa Creu i Sant Pau , Barcelona, España
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García-Macero RA, Balbuena Domínguez JC, Fernández-Castañón Martínez E, Herbello Rodríguez A. [Low back pain and abdominal aortic aneurysm: Red flags]. Rehabilitacion (Madr) 2021:S0048-7120(21)00076-1. [PMID: 34503841 DOI: 10.1016/j.rh.2021.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 07/25/2021] [Accepted: 07/29/2021] [Indexed: 11/23/2022]
Abstract
Approximately 70% of adults will experience low back pain at some point in their life. Most of the cases cannot be identified a cause, being nonspecific pains. The clinical guidelines on the management of low back pain indicate suspecting the presence of serious processes by means of the so-called red flags. Abdominal aortic aneurysm in 91% of cases is accompanied by low back pain, hence its importance of including it as a differential diagnosis. We present the case of a 75-year-old man with low back pain, without improvement with conservative treatment, referred to a rehabilitation consultation 3months after the onset of symptoms, and in the event of warning signs, imaging studies are requested that show abdominal aortic aneurysm and mass right kidney. We must bear in mind the red flags in patients with low back pain, and thus avoid outcomes that can put their lives at risk.
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Martínez Núñez P, Ruiz Alonso ME, Pérez González M. [Copeman nodules, a frequent but little known cause of low back pain; case report]. Rehabilitacion (Madr) 2020; 55:157-160. [PMID: 33066978 DOI: 10.1016/j.rh.2020.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 05/02/2020] [Accepted: 05/27/2020] [Indexed: 10/23/2022]
Abstract
Copeman nodules or episacral lipomas are a very prevalent entity in the general population. They consist of subfascial fat herniations at the episacral region, through weakened areas of the overlying thoracodorsal fascia. They are usually bilateral and symmetric. Only in rare cases they are the cause of clinical manifestations. We present the case of a 63-year-old woman who presents with lumbar pain refractory to conventional treatments. Ultrasound examination suggests the diagnosis of Copeman nodules. The treatment of the patient is approached from a multidisciplinary perspective, finally deciding to operate the patient. After the intervention, the symptoms remitted shortly, allowing the patient to continue a normal life without discomfort or analgesic treatment.
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Puerto-Vázquez MG, Vicario-Espinosa C, Criado-Álvarez JJ, Marco-Martínez F. Development of a calculator to establish indications to refer patients with lumbar degenerative disease for spinal surgery consultation. Rev Esp Cir Ortop Traumatol (Engl Ed) 2020; 64:177-184. [PMID: 32171672 DOI: 10.1016/j.recot.2019.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 10/16/2019] [Accepted: 12/21/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND AIM Low-back pain remains a common pathological entity in the Western population. We have found no data in the literature that assess whether, with correct physical examination and evaluation of simple x-rays of the spine, it is possible to diagnose patients who are highly likely to be candidates for lumbar spine surgery and thus reduce the care burden and resource consumption that this disorder entails. The aim of the study was to develop a user-friendly calculator that allows only patients who are strong candidates for surgical treatment to be referred for spinal surgery consultation. MATERIAL AND METHOD An observational and retrospective study that included all adult patients from the healthcare area of Talavera de la Reina (Toledo, Spain) with a clinical and/or radiological diagnosis of degenerative lumbar spine disease referred by other specialists over one calendar year to the spinal surgery unit to assess whether surgery was indicated after unsuccessful conservative treatment. All the patients were assessed under the same protocol with a follow-up of 6years, at the end of which we performed a check of those who had undergone lumber spine surgery. RESULTS A total of 201 patients were studied and at the end of the 6-year follow-up, a total of 77 patients had been operated. Concordance of 70% was found between the indication for surgical treatment and the treatment received at the end of the follow-up. Therefore a logistic regression was performed in an attempt to predict the patients that could be referred to the spinal surgery units and from that a calculator was generated, which included the plain x-ray variable as an essential item, and which showed as statistically significant (P<.05): age, Waddell's non-organic signs, Lasegue's sign and plain x-ray assessment. Once this tool had been obtained, the likelihood of undergoing surgery was calculated for all patients who were proposed surgical treatment, obtaining results above 62% as the cut-off point when using the calculator. CONCLUSIONS The use of the calculator predicts the possibility of being a candidate for surgical treatment with 70% reliability. Therefore, patients with a result in the calculator of above 62% should be referred for spinal surgery consultation for assessment by a specialist.
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Affiliation(s)
| | - C Vicario-Espinosa
- Hospital General Nuestra Señora del Prado, Talavera de la Reina, Toledo, España
| | - J J Criado-Álvarez
- Centro de Salud de La Pueblanueva, Gerencia de Atención Integrada de Talavera de la Reina, SESCAM, San Bartolomé de las Abiertas, Toledo, España
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Reyes-Sánchez A, Reyes-Ayala C, García-Ramos CL, Obil-Chavarría C, Alpizar-Aguirre A, Rosales-Olivares L. [Results in the surgical treatment of lumbar disc hernia, report of seven years follow up]. Acta Ortop Mex 2019; 33:319-324. [PMID: 32253855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Low back pain by herniated disc is caused by abnormal intersomatic movement, considering this as an etiological factor of disc herniation and the surgical indication. MATERIAL AND METHODS A prospective, descriptive, observational, longitudinal study design, in a period from January 2000 to December 2006. Initial sample of 195 patients, with inclusion criteria in 20 patients at seven years follow up. Demographic, dependent and independent variables were taken into account. Descriptive statistical analysis was conducted comparing preoperative with evolution to seven years. RESULTS Two groups were compared: dynamic interspinous stabilization and lumbar arthroplasty, with 10 patients for each procedure. Using T and 2 test, statistical significance was observed when comparing the results of pain and Oswestry scale with parameters of imaging according to Pfirrmann pre surgical against final follow-up in patients undergoing dynamic stabilization. And for Arthroplasty was statistically meaningful comparison of results of pain with VAS (visual analogue scale) and function with Oswestry scale, with a p 0.05. CONCLUSION With this work we can see that there was statistical significance to compare clinical outcomes of both procedures, observing a minimum percentage of complications in patients who underwent dynamic stabilization compared with arthroplasty; therefore we suggest to perform the latter only in cases in all criteria, to meet adequately to be equal to the anticipated clinical and functional outcomes.
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Affiliation(s)
- A Reyes-Sánchez
- División Cirugía de Columna, Instituto Nacional de Rehabilitación «Dr. Luis Guillermo Ibarra Ibarra». Av. México-Xochimilco 289, C.P. 14389. Ciudad de México. México
| | | | - C L García-Ramos
- Servicio de Cirugía de Columna. Instituto Nacional de Rehabilitación «Dr. Luis Guillermo Ibarra Ibarra». Av. México-Xochimilco 289, C.P. 14389. Ciudad de México. México
| | | | - A Alpizar-Aguirre
- Servicio de Cirugía de Columna. Instituto Nacional de Rehabilitación «Dr. Luis Guillermo Ibarra Ibarra». Av. México-Xochimilco 289, C.P. 14389. Ciudad de México. México
| | - L Rosales-Olivares
- Servicio de Cirugía de Columna. Instituto Nacional de Rehabilitación «Dr. Luis Guillermo Ibarra Ibarra». Av. México-Xochimilco 289, C.P. 14389. Ciudad de México. México
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Jiménez-Ávila JM, Rubio-Flores EN, González-Cisneros AC, Guzmán-Pantoja JE, Gutiérrez-Román EA. Guidelines on the application of the clinical practice guideline on low back pain. ACTA ACUST UNITED AC 2019; 86:24-32. [PMID: 30951045 DOI: 10.24875/cirue.m18000004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Low back pain is defined as pain in the upper portion of T12 and below the crease of the buttocks and functional limitation. The prevalence of low back pain gradually increases 11.4% per year. In Mexico, the clinical practice guidelines are not followed in handling low back pain, so it is important to systematize medical care more efficient, since resources are scarce. The first level doctor must meet the benchmarks according to patient need, an incomplete anamnesis is performed, inadequate physical examination, misinterpretation of clinical studies, misdiagnosis, ineffective management, and reference to second or third level not justified. Objective To provide recommendations for the implementation of syndromic diagnosis, management of adult carriers of low back pain, and correct reference. Implementation of clinical practice guidelines for low back pain syndrome consists of an assessment of the patient by way of "verification", which evaluates certain signs of symptoms, with a total of 37 items for rating, including the sections of clinical symptomatology, AP X-ray, lateral X-ray, sagittal (optional) and axial magnetic resonance imaging (optional), and pain type. Oriented data quickly and easily, from first contact to a syndromic diagnosis in patients with low back pain.
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Affiliation(s)
- José María Jiménez-Ávila
- Centro Médico Nacional de Occidente Hospital, Instituto Mexicano del Seguro Social. Guadalajara, Jal., Mexico
| | - Erik Noe Rubio-Flores
- Centro Médico Nacional de Occidente Hospital, Instituto Mexicano del Seguro Social. Guadalajara, Jal., Mexico
| | | | | | - Elsa Armida Gutiérrez-Román
- Centro Médico Nacional de Occidente Hospital, Instituto Mexicano del Seguro Social. Guadalajara, Jal., Mexico
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de Andrés Ares J, Gilsanz F. Diagnostic nerve blocks in the management of low back pain secondary to facet joint syndrome. Rev Esp Anestesiol Reanim (Engl Ed) 2019; 66:213-221. [PMID: 30683428 DOI: 10.1016/j.redar.2018.11.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 11/12/2018] [Accepted: 11/13/2018] [Indexed: 06/09/2023]
Abstract
Low back pain is currently one of the main public health problems. Among the multiple causes, pain in the zygapophysial joints, also called facets or posterior vertebral joints, are an important cause, usually secondary to osteoarthritis. The source of low back pain is often difficult to find, making the therapeutic approach to the patient sub-optimal. Diagnostic blocks are a very important tool in establishing an adequate treatment for patients with low back pain, as long as they are performed accurately, with an adequate local anaesthetic volume, with a suitable image and fluoroscopic projection and its result are precisely interpreted. In this article a review is presented on the importance of diagnostic blocks, as well as how they should be performed in order to obtain the maximum information and the greatest therapeutic benefit.
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Affiliation(s)
- J de Andrés Ares
- Servicio de Anestesiología-Unidad del Dolor, Hospital Universitario La Paz, Madrid, España.
| | - F Gilsanz
- Servicio de Anestesiología-Unidad del Dolor, Hospital Universitario La Paz, Madrid, España
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Delgado-López PD, Rodríguez-Salazar A. Abandoned techniques in spine surgery. Neurocirugia (Astur) 2020; 31:37-41. [PMID: 30792110 DOI: 10.1016/j.neucir.2019.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 01/05/2019] [Indexed: 11/20/2022]
Abstract
In spine surgery, certain surgical techniques and devices are currently in marked decline or have been completely abandoned. Although used in thousands of patients, such treatments failed to demonstrate durable and sound effectiveness, and sometimes associate inacceptable morbidity. Chemopapain injections, percutaneous discectomy, laser discectomy or antiadhesion gels are examples of abandoned therapies. Some other techniques are in frank decline like implantation of interspinous devices or lumbar disc prosthesis. In general, a technique is abandoned due to inefficacy, excessive associated morbidity, substituted by another more efficacious and less aggressive technique, end of commercialization, or usage prohibition. In the last decades, a great commercial pressure plus an increasing social demand have managed to convince many spine surgeons to indicate treatments not sufficiently supported by scientific evidence nor consolidated over time, many of which are eventually abandoned.
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Jiménez-Ávila JM, Rubio-Flores EN, González-Cisneros AC, Guzmán-Pantoja JE, Gutiérrez-Román EA. Guidelines on the application of the clinical practice guideline on low back pain. CIR CIR 2018; 86:29-37. [PMID: 29681630 DOI: 10.24875/ciru.m18000013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Low back pain is defined as pain in the upper portion of T12 and below the crease of the buttocks and functional limitation. The prevalence of low back pain gradually increases 11.4% per year. In Mexico, the clinical practice guidelines are not followed in handling low back pain, so it is important to systematize medical care more efficient, since resources are scarce. The first level doctor must meet the benchmarks according to patient need, an incomplete anamnesis is performed, inadequate physical examination, misinterpretation of clinical studies, misdiagnosis, ineffective management, and reference to second or third level not justified. Objective To provide recommendations for the implementation of syndromic diagnosis, management of adult carriers of low back pain, and correct reference. Implementation of clinical practice guidelines for low back pain syndrome consists of an assessment of the patient by way of "verification", which evaluates certain signs of symptoms, with a total of 37 items for rating, including the sections of clinical symptomatology, AP X-ray, lateral X-ray, sagittal (optional) and axial magnetic resonance imaging (optional), and pain type. Oriented data quickly and easily, from first contact to a syndromic diagnosis in patients with low back pain.
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Affiliation(s)
| | - Erik Noe Rubio-Flores
- Centro Médico Nacional de Occidente Hospital, Instituto Mexicano del Seguro Social, México
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Díaz-Cerrillo JL, Rondón-Ramos A, Clavero-Cano S, Pérez-González R, Martinez-Calderon J, Luque-Suarez A. [Clinical-demographic factors associated with fear-avoidance in subjects with non-specific chronic low back pain in Primary Care: secondary analysis of intervention study]. Aten Primaria 2019; 51:3-10. [PMID: 29395123 DOI: 10.1016/j.aprim.2017.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 06/30/2017] [Accepted: 07/27/2017] [Indexed: 12/19/2022] Open
Abstract
Objetivo Describir algunas características sociodemográficas y clínicas de los sujetos con lumbalgia crónica inespecífica (LCI) atendidos habitualmente en atención primaria (AP), así como investigar su asociación con el miedo-evitación (ME). Diseño Descriptivo transversal. Análisis secundario de estudio de intervención. Emplazamiento Zonas Básicas de Salud del Distrito Sanitario de AP Costa del Sol (Málaga). Participantes Un total de 147 sujetos con LCI extraídos de la base de datos de un estudio de intervención previo en fisioterapia de AP. Características: edad, 18-65 años; comprensión del idioma español; ausencia de deterioro cognitivo, ausencia de fibromialgia, ausencia de cirugía dorsolumbar, y tolerancia al ejercicio físico. Mediciones principales La variable principal fue el ME (FABQ y subescalas FABQ-PA y FABQ-W); las variables clínicas incluyeron: dolor (NRPS-11), discapacidad (RMQ), tiempo de evolución, tratamientos previos y diagnósticos de imagen; las variables sociodemográficas incluyeron: sexo, edad, nivel educativo y situación laboral. Resultados El 51,7% de los sujetos presentaron elevado ME con la escala FABQ-PA. Incapacidad temporal (IT) [β = 24,45 (p = 0,009*); β = 13,03 (p = 0,016*); β = 14,04 (p = 0,011*) para FABQ, FABQ-PA y FABQ-W, respectivamente]; estudios primarios [β = 15,09 (p = 0,01*); β = 9,73 (p = 0,01*) para FABQ y FABQ-PA], y discapacidad [β = 1,45 (p < 0,001); β = 0,61 (p < 0,001); β = 0,68 (p < 0,001) para FABQ, FABQ-PA y FABQ-W, respectivamente] aparecieron asociados al ME cuando fueron modelados por regresión multivariante. Conclusiones Algunos rasgos sociodemográficos y clínicos de la población con LCI son presentados. Las pruebas de imagen (81,63%) y los tratamientos previos pasivos (55,78%) podrían reflejar problemas de adherencia a las recomendaciones de las GPC. IT, estudios primarios y discapacidad se asociaron al ME. Los hallazgos deben ser interpretados a la luz de las posibles limitaciones. Algunas sugerencias para la práctica clínica son aportadas.
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Altun I, Yuksel KZ. Impact of Position on Efficacy of Caudal Epidural Injection for Low Back Pain and Radicular Leg Pain Due to Central Spinal Stenosis and Lumbar Disc Hernia. J Korean Neurosurg Soc 2017; 60:205-210. [PMID: 28264241 PMCID: PMC5365291 DOI: 10.3340/jkns.2016.0405.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 12/05/2016] [Accepted: 12/09/2016] [Indexed: 11/27/2022] Open
Abstract
Objective This study was performed to evaluate and compare the efficacies of caudal epidural injections performed at prone and lateral decubitus positions. Methods A total of 120 patients suffering from low back pain and radicular leg pain were included and patients were randomly distributed into 2 groups according to the position during injection. In Group 1 (n=60; 32 women, 28 men), caudal epidural injection was performed at prone position, whereas it was implemented at lateral decubitus position in Group 2 (n=60; 33 women, 27 men). Visual analogue scale, Oswestry Disability Index (ODI), walking tolerance (WT) and standing tolerance (ST) were compared in 2 groups before and after injection. Results In Group 1, ODI values were higher at 30th minute (p=0.007), 3rd week (p=0.043) and 6th month (p=0.013). In Group 1, ODI, VAS and ST values were improved significantly at all follow-up periods compared to initial values. In Group 1, WT scores were better than initial values at 30th minute, 3rd week and 3rd month. In Group 2, ODI scores at 30th minute, 3rd week, 3rd month and 6th month were improved while VAS and ST scores were improved at all periods after injection. WT scores were better at 30th minute, 3rd week and 3rd month compared to initial WT scores. Conclusion Our results indicated that application of injection procedure at lateral decubitus position allowing a more concentrated local distribution may provide better relief of pain.
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Affiliation(s)
- Idiris Altun
- Department of Neurosurgery, Kahramanmaras Sutcu Imam University Medical Faculty, Kahramanmaras, Turkey
| | - Kasım Zafer Yuksel
- Department of Neurosurgery, Kahramanmaras Sutcu Imam University Medical Faculty, Kahramanmaras, Turkey
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Kovacs FM, Arana E. Degenerative disease of the lumbar spine. Radiologia 2016; 58 Suppl 1:26-34. [PMID: 26872873 DOI: 10.1016/j.rx.2015.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Revised: 12/07/2015] [Accepted: 12/16/2015] [Indexed: 11/20/2022]
Abstract
In the last 25 years, scientific research has brought about drastic changes in the concept of low back pain and its management. Most imaging findings, including degenerative changes, reflect anatomic peculiarities or the normal aging process and turn out to be clinically irrelevant; imaging tests have proven useful only when systemic disease is suspected or when surgery is indicated for persistent spinal cord or nerve root compression. The radiologic report should indicate the key points of nerve compression, bypassing inconsequential findings. Many treatments have proven inefficacious, and some have proven counterproductive, but they continue to be prescribed because patients want them and there are financial incentives for doing them. Following the guidelines that have proven effective for clinical management improves clinical outcomes, reduces iatrogenic complications, and decreases unjustified and wasteful healthcare expenditures.
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Díaz-Cerrillo JL, Rondón-Ramos A, Pérez-González R, Clavero-Cano S. [Non-randomised trial of an educational intervention based on cognitive-behavioural principles for patients with chronic low back pain attended in Primary Care Physiotherapy]. Aten Primaria 2016; 48:440-8. [PMID: 26724987 PMCID: PMC6877809 DOI: 10.1016/j.aprim.2015.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 10/06/2015] [Accepted: 10/17/2015] [Indexed: 11/07/2022] Open
Abstract
Objetivo Valorar la influencia de una intervención educativa en la reducción del «miedo-evitación» (ME) y del «catastrofismo al dolor» (CAT) en población con lumbalgia crónica inespecífica (LCI) atendida en fisioterapia de atención primaria (AP). Diseño Estudio cuasiexperimental. Emplazamiento Centros de salud (CS) del Distrito Sanitario Costa del Sol. Participantes Pacientes con LCI entre 18-65 años con comprensión del idioma español; ausencia de intervenciones educativas paralelas; ausencia de banderas rojas; ausencia de deterioro cognitivo y/o fibromialgia; ausencia de cirugía dorsolumbar, y tolerancia al ejercicio físico. Intervenciones El grupo control recibió la EdE grupal habitual. El experimental recibió, además, un instrumento escrito para lectura domiciliaria, más la posterior puesta en común, aclaración de dudas y reestructuración de creencias y metas durante el desarrollo de las sesiones. Ambas intervenciones duraron unos 280 min (7 sesiones de 40 min). Resultados Las variables principales incluyeron ME y CAT. Secundariamente se valoraron dolor y discapacidad. Algunas variables «sociodemográficas» y «relacionadas con el trastorno» fueron tenidas en cuenta en el análisis. Se observaron diferencias estadísticamente significativas en el grupo experimental versus control en la variación del ME −14 (−25,5; 0) vs −4 (−13; 0) (p = 0,009), y del CAT −9 (−18; −4) vs −4,5 (−8,25; 0) (p = 0,000). Igualmente se observaron diferencias en discapacidad (p = 0,046), pero no en dolor (p = 0,280). Conclusiones Los resultados deben ser considerados a la luz de las posibles limitaciones que plantea el estudio. Su naturaleza pragmática permitiría una potencial transferencia a la dinámica asistencial habitual.
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Affiliation(s)
- Juan Luis Díaz-Cerrillo
- Distrito Sanitario Costa del Sol, Servicio Andaluz de Salud, Junta de Andalucía, Málaga, España.
| | - Antonio Rondón-Ramos
- U.G.C. Las Lagunas, Unidad de Fisioterapia, Distrito Sanitario Costa del Sol, Servicio Andaluz de Salud, Junta de Andalucía, Mijas-Costa, Málaga, España; Área de conocimiento de Fisioterapia, Departamento de Psiquiatría y Fisioterapia, Facultad de Ciencias de la Salud, Universidad de Málaga, Málaga, España
| | | | - Susana Clavero-Cano
- U.G.C. Las Albarizas, Unidad de Fisioterapia, Distrito Sanitario Costa del Sol, Servicio Andaluz de Salud, Junta de Andalucía, Mijas-Costa, Málaga, España
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Gallo-Padilla D, Gallo-Padilla C, Gallo-Vallejo FJ, Gallo-Vallejo JL. [Low back pain during pregnancy. Multidisciplinary approach]. Semergen 2015; 42:e59-64. [PMID: 26239672 DOI: 10.1016/j.semerg.2015.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 06/12/2015] [Accepted: 06/17/2015] [Indexed: 01/14/2023]
Abstract
After explaining that low back pain is considered the most common pregnancy complication, its pathogenesis, risk factors and the clinical characteristics of the very painful symptoms of this condition are described. As for its approach, it is stressed that it must be multidisciplinary, introducing very important preventive measures, including proper postural hygiene. For its treatment, the methods may be based on non-surgical or pharmacological interventions of a conservative non-invasive nature. Thus, physiotherapy, osteopathic manipulation, multimodal intervention (exercise and education), exercises performed in water environment, acupuncture, etc., have proven to be effective. Finally, it is emphasised that given the significant impact on their quality of life, different health professionals must be proactive and treat the lumbar disease in pregnant women.
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Affiliation(s)
- D Gallo-Padilla
- Servicio de Traumatología y Cirugía Ortopédica, Complejo Hospitalario Universitario de Granada, Granada, España
| | | | | | - J L Gallo-Vallejo
- Servicio de Obstetricia y Ginecología, Complejo Hospitalario Universitario de Granada, Granada, España.
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Romero-Vargas S, Obil-Chavarria C, Zárate-Kalfopolus B, Rosales-Olivares LM, Alpizar-Aguirre A, Reyes-Sánchez AA. [Profile of the patient with failed back surgery syndrome in the National Institute of Rehabilitation. Comparative analysis]. CIR CIR 2015; 83:117-23. [PMID: 25986977 DOI: 10.1016/j.circir.2015.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 10/31/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND Failed back surgery syndrome is a complication of spine surgery that leads to chronic pain and disability, often with disastrous emotional consequences to the patient. AIM To compare the profile of patients whose first surgery was performed in our hospital versus a group that underwent first spine surgery in a different centre. METHODS Retrospective study with 65 patients; 18 formed group I (first spine surgery performed in our institution), and 47 patients in group II (first surgery performed in another hospital). Background, demographic, clinical features and functional status were compared. In group I the majority of the cases had a previous diagnosis of lumbar stenosis (group I 44.4% vs group II 25.5% p = 0.22), whereas disk herniation was the main diagnosis in group II (group I 22.2% vs group II 61.7% p = 0.001). The main cause of the syndrome in group I was technical error during surgery (61.1%), while in group II this cause represented only 6.3% (p=.001). Among the patients of this latter group, misdiagnosis was highly prevalent (57.4%), against no cases in group I (p=.001). The preoperative functional status between both groups and their recovery in the immediate postoperative period was similar (p = 0.68). CONCLUSIONS This study suggests that the diagnostic and treatment standards are different between healthcare centres, specifically between academic centres vs. private practice.
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Díaz-Cerrillo JL, Rondón-Ramos A. [Design of an educational tool for Primary Care patients with chronic non-specific low back pain]. Aten Primaria 2014; 47:117-23. [PMID: 25159025 PMCID: PMC6985600 DOI: 10.1016/j.aprim.2014.03.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Revised: 02/16/2014] [Accepted: 03/18/2014] [Indexed: 12/14/2022] Open
Abstract
Evidencias científicas actuales sobre el manejo de la lumbalgia crónica inespecífica ponen de relieve los beneficios del ejercicio físico. Este objetivo es frecuentemente minado por déficits educativos en materias relacionadas con la naturaleza multifactorial y benigna del dolor lumbar inespecífico, los cuales constituyen auténticos factores de riesgo psicosocial para la cronificación. Su perversa influencia podría interferir no solo con la decisión individual de adoptar conductas de afrontamiento más adaptativas, sino también, con los mecanismos endógenos de neuromodulación del dolor. Así, las estrategias educativas y el control de dichos factores se han convertido en objetivos relevantes a incorporar en el manejo del trastorno y en las directrices de investigación. Este trabajo presenta los modelos teóricos y las bases científicas sobre los que se ha sustentado el diseño de un instrumento educativo para pacientes con lumbalgia crónica inespecífica atendidos en Fisioterapia de Atención Primaria. Su estructuración, contenido y objetivos también son presentados.
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Affiliation(s)
- Juan Luis Díaz-Cerrillo
- Unidad de Gestión Clínica Las Lagunas, Distrito Sanitario Costa del Sol, Sistema Sanitario Público de Andalucía, Mijas-Costa, Málaga, España.
| | - Antonio Rondón-Ramos
- Unidad de Gestión Clínica Las Lagunas, Distrito Sanitario Costa del Sol, Sistema Sanitario Público de Andalucía, Mijas-Costa, Málaga, España
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Aso Escario J, Martínez Quiñones JV, Aso Vizán A, Arregui Calvo R, Bernal Lafuente M, Alcázar Crevillén A. Simulation in spinal diseases. ACTA ACUST UNITED AC 2014; 10:396-405. [PMID: 24913963 DOI: 10.1016/j.reuma.2014.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 03/10/2014] [Accepted: 03/16/2014] [Indexed: 12/17/2022]
Abstract
Simulation is frequent in spinal disease, resulting in problems for specialists like Orthopedic Surgeons, Neurosurgeons, Reumathologists, etc. Simulation requires demonstration of the intentional production of false or exaggerated symptoms following an external incentive. The clinician has difficulties in demonstrating these criteria, resulting in misdiagnosis of simulation or misinterpretation of the normal patient as a simulator, with the possibility of iatrogenic distress and litigation. We review simulation-related problems in spine, proposing a terminological, as well as a diagnostic strategy including clinical and complementary diagnosis, as a way to avoid misinterpretation and minimize the iatrogenic distress and liability Based on the clinical-Forensic author's expertise, the literature is analyzed and the terminology readdressed to develop new terms (inconsistences, incongruences, discrepancies and contradictions). Clinical semiology and complementary test are adapted to the new scenario. Diagnostic strategy relies on anamnesis, clinical and complementary tests, adapting them to a uniform terminology with clear meaning of signs and symptoms.
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Affiliation(s)
- José Aso Escario
- Servicio de Neurocirugía, Hospital de la Mutua de Accidentes de Zaragoza, Zaragoza, España; Facultad de Ciencias de la Salud, Universidad San Jorge, Zaragoza, España.
| | | | - Alberto Aso Vizán
- Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario Miguel Servet, Zaragoza, España
| | - Ricardo Arregui Calvo
- Servicio de Neurocirugía, Hospital de la Mutua de Accidentes de Zaragoza, Zaragoza, España
| | - Marta Bernal Lafuente
- Servicio de Valoración, Hospital de la Mutua de Accidentes de Zaragoza, Zaragoza, España
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Zúñiga Cedó E, Vico Besó L. [Chronic low back pain and abdominal aortic aneurysm]. Semergen 2013; 39:e47-9. [PMID: 24095169 DOI: 10.1016/j.semerg.2012.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Revised: 06/28/2012] [Accepted: 07/01/2012] [Indexed: 11/22/2022]
Abstract
Abdominal aortic aneurysm has a population prevalence of 2-5% and mortality in case of rupture of 80%. Up to 91% of cases is accompanied with low back pain, so it is important to include aortic aneurysm in the differential diagnosis of chronic low back pain. Low back pain is one of the most frequent reasons for consultions in Services Emergency Hospital Emergency and Primary Care Services, with an estimated 80% of population having spinal pain at some point in their lives, with 90% of them having a benign course.
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Menéndez P, García A, Peláez R. [Paravertebral and intra-abdominal abscess due to oxygen-ozone therapy for lower back pain]. Rev Esp Cir Ortop Traumatol (Engl Ed) 2013; 58:125-7. [PMID: 24071048 DOI: 10.1016/j.recot.2013.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2013] [Revised: 06/10/2013] [Accepted: 06/16/2013] [Indexed: 11/25/2022] Open
Abstract
Complications secondary to oxygen-ozone therapy are rare, but they have been described in medical literature. There are only two cases of infectious complications after oxygen-ozone therapy. Our aim is to describe a rare case of purulent complication that was secondary to oxygen-ozone therapy for the treatment of lower back pain. We report the clinical improvement with conservative treatment for a local complication after percutaneous oxygen-ozone treatment. According to the clinical improvement of our patient, conservative treatment should be considered before any aggressive surgery.
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Affiliation(s)
- P Menéndez
- Servicio de Cirugía General, Hospital Gutiérrez Ortega, Valdepeñas, Ciudad Real, España.
| | - A García
- Servicio de Cirugía General, Hospital Gutiérrez Ortega, Valdepeñas, Ciudad Real, España
| | - R Peláez
- Servicio de Cirugía General, Hospital Gutiérrez Ortega, Valdepeñas, Ciudad Real, España
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Abstract
OBJECTIVE To determine the incidence of spondylolysis and spondylolisthesis among female gymnasts, and to correlate these with lumbar pain, history of trauma and training load. METHOD Eighteen competitive-level Olympic-style gymnasts aged 8-17 years, with an average age of 11.3 years, were evaluated on a voluntary basis. The gymnasts answered a questionnaire about their sports activities and underwent a clinical examination and lumbar spine radiography. RESULTS The radiographs were analyzed by orthopedists specializing in surgery of the vertebral column. The prevalence of spondylolysis was 5.56%, while no cases of spondylolisthesis were found. CONCLUSION The incidence of the radiographic abnormalities identified was similar to what has been reported in the literature for non-athletic individuals, and the lumbalgia reported by these athletes did not show any direct relationship with spondylolysis and spondylolisthesis.
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Affiliation(s)
- Rafael Mohriak
- Resident Physician in the Department of Orthopedics and Traumatology, Escola Paulista de Medicina, Unifesp, São Paulo, Brazil
| | - Pedro Debieux Vargas Silva
- Attending Physician in the Spine Group, Department of Orthopedics and Traumatology, Escola Paulista de Medicina, Unifesp, São Paulo, Brazil
| | - Miguel Trandafilov
- Attending Physician in the Spine Group, Department of Orthopedics and Traumatology, Escola Paulista de Medicina, Unifesp, São Paulo, Brazil
| | - Délio Eulálio Martins
- Attending Physician in the Spine Group, Department of Orthopedics and Traumatology, Escola Paulista de Medicina, Unifesp, São Paulo, Brazil
| | - Marcelo Wajchenberg
- Attending Physician in the Spine Group, Department of Orthopedics and Traumatology, Escola Paulista de Medicina, Unifesp, São Paulo, Brazil
| | - Moisés Cohen
- Full Adjunct Professor and Head of the Sports Traumatology Center, Department of Orthopedics and Traumatology, Escola Paulista de Medicina, Unifesp, São Paulo, Brazil
| | - Eduardo Barros Puertas
- Full Adjunct Professor and Head of the Spine Group, Department of Orthopedics and Traumatology, Escola Paulista de Medicina, Unifesp, São Paulo, Brazil
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