discectomía mínimamente invasiva asociada con mayores tasas de recurrencia / Minimally invasive discectomy associated with higher recurrence rates

Este artículo es originalmente publicado en:
http://www.ncbi.nlm.nih.gov/pubmed/24722785
http://nblo.gs/11XrX9

De:

Int Orthop. 2014 Jun;38(6):1225-34. doi: 10.1007/s00264-014-2331-0. Epub 2014 Apr 11.

The safety and efficacy of minimally invasive discectomy: a meta-analysis of prospective randomised controlled trials.

Chang X1, Chen B, Li HY, Han XB, Zhou Y, Li CQ.

Author information

Abstract

PURPOSE:

The objective of this study was to compare the safety and efficacy of minimally invasive discectomy (MID) with standard discectomy (SD) and determine whether the use of the MID technique could decrease the recurrence of lumbar disc herniation (LDH) after the surgery.

PROPÓSITO:
El objetivo de este estudio fue comparar la seguridad y eficacia de la discectomíamínimamente invasiva (MID) con discectomía estándar (SD) y determinar si el uso de la técnica MID podría disminuir la recurrencia de la hernia de disco lumbar (LDH) después de la cirugía.

METHODS:

In February 2014, a comprehensive search was performed in PubMed, EMBASE, Web of Science, Cochrane Library and the Chinese Biological Medicine Database. Only randomised controlled trials (RCT) that compared MID with SD for the surgical management of LDH were included. These trials were carefully picked out following the inclusion and exclusion criteria. Using the Cochrane Collaboration guidelines, two authors independently extracted data and assessed these trials' quality. The age of the patients, size of incision, surgical time, blood loss, visual analogue scale (VAS) score after the surgery, hospital stay, disc herniation recurrence, X-ray exposure and surgical costs in these studies were abstracted and synthesised by a meta-analysis with RevMan 5.2.0 software, and the main results (VAS score after the surgery and disc herniation recurrence) of publication bias were examined by Stata 12.0.

RESULTS:

Overall, 16 trials involving 2,139 patients meeting our criteria were included and analysed. Comparing MID and SD, the former was more likely to increase disc herniation recurrence [relative risk (RR) = 1.95, 95 % confidence interval (CI) 1.19-3.19, p = 0.008], and it involved a smaller size of incision [mean difference (MD) = -1.91, 95 % CI -3.33 to -0.50, p = 0.008], shorter hospital stay, longer operating time (MD = 11.03, 95 %C I 6.62-15.44, p < 0.00001) and less blood loss (MD = -13.56, 95 % CI -22.26 to -4.87, p = 0.002), while no statistical difference appeared with regard to the age of the patients, VAS score after the surgery, X-ray exposure, hospital stay and surgical costs.

CONCLUSIONS:

Based on available evidence, MID results in less suffering for patients during the hospital course with a similar clinical efficacy compared to SD. This makes MID a promising procedure for patients with LDH; however, to popularise it greater effort is required to reduce disc herniation recurrence.

Comment in

• Comment on Chang et al.: the safety and efficacy of minimally invasive discectomy: a meta-analysis of prospective randomised controlled trials.[Int Orthop. 2014]

PMID:

 

24722785

 

[PubMed - in process] 

PMCID:

 

PMC4037525

 [Available on 2015/6/1]

Acerca de los nervios pinzados / About Pinched Nerves

Este artículo es publicado originalmente en:
http://blog.bonati.com/about-pinched-nerves/

About Pinched Nerves

Pinched nerve is a general term that is used to describe the compression of individual nerves or groups of nerves. Pinched nerves are caused by compression or pressure applied to the surrounding tissue, bones, cartilage, muscles or tendons to the nerves along the spinal cord causing neck and back pain. While pinched nerves can occur throughout the body, they are most common in the back. More than 90% of pinched nerves occur in the lower (lumbar) back.

Pinched nerve in spine.

CAUSES

There are numerous possible causes of pinched nerves, including:

• Exercise and sports
• Injuries
• Poor posture
• Obestity
• Genetics

SYMPTOMS

Bulging or herniated discs are a common cause of pinched nerves between the vertebrae of the spine. The discs that are most prone to hernias are those in the cervical spine and the lumbar spine because these are the most flexible vertebrae.

Lumbar disc hernias occur most often between L4/L5 and L5/S1. Hernias at these levels compress the L5 nerve and the S1 nerve. Pinching of the L5 nerve can cause numbness, pain, burning and tingling sensations to radiate out from the affected area down the inner thigh and leg to the big toe. Pinching of the S1 nerve can cause radiating pain down the outer leg to the ankle and the sole and side of the foot.

Cervical disc hernias occur less frequently than lumbar disc hernias because less force is exerted on the cervical spine. Compressed nerve roots in the cervical spine can result in pain that radiates into the arms. If the sensory nerves between the first and second or second and third cervical levels are pinched, severe, chronic headaches can result.

A thoracic herniated disc may lead to myelopathy (spinal cord dysfunction), progressive neurological deficits, or intolerable pain. Typically, these symptoms occur following an acute traumatic disc herniation with myelopathy.

TREATMENT

• The Bonati Spine Procedures – Foraminotomy, which increases the space of the foramen, or the opening where the nerves exit the spine, to relieve pressure on the spinal cord.
• The Bonati Spine Procedures – Laminectomy, in which the lamina, or the bony arch of the vertebrae covering the nerves of the spine, is completely removed, to widen the spinal canal and relieve pressure on the spinal cord.
• The Bonati Spine Procedures – Laminotomy, in which a portion of the bony arch of the vertebrae (lamina) covering the nerves of the spine is removed, thus widening the spinal canal and relieving pressure on the spinal cord.

Acerca de los nervios pinzados

El pinzamiento de un nervio es un término general que se utiliza para describir la compresión de los nervios o grupos de nervios individuales. Nervios perforados son causados por compresión o presión aplicada a los tejidos circundantes, huesos, cartílagos, músculos o tendones a los nervios de la médula espinal, causando dolor de cuello y espalda. Aunque pueden ocurrir los nervios pinzados por todo el cuerpo, que son más comunes en la parte de atrás. Más del 90% de los nervios pinzados se produce en la parte inferior (lumbar) de nuevo.

Los nervios en la columna lumbar
Pinzamiento del nervio en la columna vertebral.

CAUSAS

Existen numerosas causas posibles de los nervios pellizcados, incluyendo:

Ejercicios y deportes
Lesiones
La mala postura
Obestity
genética
SÍNTOMAS

Discos abultados o herniados son una causa común de la compresión de los nerviosentre las vértebras de la columna vertebral. Los discos que son más propensos a herniasson aquellos en la columna cervical y lumbar de la columna vertebral debido a que estosson las vértebras más flexible.

Las hernias de disco lumbares ocurren con mayor frecuencia entre L4 / L5 y L5 / S1. Las hernias en estos niveles comprimen el nervio L5 y el nervio S1. Pellizcos del nervio L5puede causar entumecimiento, dolor, ardor y sensación de hormigueo a irradiar hacia fuera de la zona afectada por la parte interna del muslo y la pierna al dedo gordo.Pellizcos del nervio S1 puede causar dolor que se irradia hacia la pierna exterior hasta el tobillo y la suela y parte lateral del pie.

Las hernias de disco cervical se producen con menos frecuencia que las hernias de disco lumbar, ya que menos fuerza se ejerce sobre la columna cervical. Raíces nerviosascomprimidas en la columna cervical puede resultar en dolor que irradia hacia los brazos.Si se pellizcan los nervios sensoriales entre los primero y segundo o segundo y terceroniveles cervicales, dolores de cabeza severos, crónicas pueden resultar.

Una hernia discal torácica puede conducir a mielopatía (disfunción de la médula espinal),déficits neurológicos progresivos o dolor intolerable. Por lo general, estos síntomas se producen a raíz de una hernia discal traumática aguda con mielopatía.

TRATAMIENTO

Los Procedimientos Bonati Spine - Foraminotomía, lo que aumenta el espacio del agujero, o la apertura por donde los nervios salen de la columna vertebral, para aliviar la presión sobre la médula espinal.
Los procedimientos Bonati Spine - laminectomía, en el que la lámina o el arco óseo de las vértebras que cubre los nervios de la columna vertebral, se elimina por completo, para ampliar el canal espinal y aliviar la presión sobre la médula espinal.
La Columna Vertebral Procedimientos Bonati - Laminotomía, en el cual se extrae unaporción del arco óseo de las vértebras (lámina) que cubre los nervios de la columna vertebral, ampliando así el canal espinal y aliviar la presión sobre la médula espinal.

¿Qué señal está presente? ¿Qué condición representa? / What sign is present? What condition does it represent?

una publicación de Radiopaedia.org.

¿Su teléfono celular está matando a tu espalda? Is Your Cell Phone Killing Your Back?

Este artículo se publico originalmente en:
http://cirugiavertebral.blogspot.mx/2014/12/su-telefono-celular-esta-matando-tu.html ¿Su teléfono celular está matando a tu espalda? Is Your Cell Phone Killing Your Back? http://www.spineuniverse.com/wellness/ergonomics/your-cell-phone-killing-your-back

Is Your Cell Phone Killing Your Back? http://t.co/zZ735psTlq vía @SpineUniverse
— Victor Ravens (@bibliomanazteca) diciembre 6, 2014

¿Es un aparato ortopédico necesario para la curación de la fractura vertebral? / Is a brace necessary for spinal fracture healing?

Este artículo es originalmente publicado en:

http://newsroom.aaos.org/media-resources/Press-releases/is-a-brace-necessary-for-spinal-fracture-healing.htm

una publicación de American Academy of Orthopaedic Surgeons.

Spine Surgeons’ Role in Preventing Failed Back Syndrome

Este artículo es originalmente publicado en:
http://www.spineuniverse.com/treatments/surgery/spine-surgeons-role-preventing-failed-back-syndrome

Do all roads lead back to the operating room when it comes to failed back surgery?

Written by Ralph F Rashbaum, MD

SpineUniverse: Do all roads lead back to the operating room when it comes to failed back surgery?

Dr. Rashbaum:
A failed back surgery implies that the patient had surgery, and then following that surgery, they come back with a situation where their symptoms persist or have gotten worse.

So here’s the question:
Is it from a surgical misadventure; in other words, was the nerve root brutalized or beaten in an effort to get the root out of the way to take the herniation out? This can happen at times, but let’s not forget that these roots were sensitized by virtue of the process of herniating the disc. The nerve roots swell and become hypersensitive.

If you bang your tibia, it becomes real sensitive; you don’t want to touch it. Nerve roots respond in exactly the same way. Or, is failed back surgery brought on because a fragment of the disc that should have been removed wasn’t? In other words, is surgeon error to blame?

Lea la entrevista completa aquí

A Young Mother Shares Her Spine Surgery Experience with Spine-health: Part 1

Este artículo es originalmente publicado en:
http://www.spine-health.com/blog/young-mother-shares-her-spine-surgery-experience-spine-health

una publicación de Spine-health.