Indications à la laminectomie : adéquation et nécessité

[Table des matières] I. Objectifs du projet. II. Méthode. III. Résultats et réalisations. IV. Evaluation. V. Utilisations possibles et mise en garde. VI. Conclusions et recommendations. VII. Membres du panel d'experts. VIII. Revue de la littérature médicale sur efficacité de l'opération pour hernie discale. IX. Définitions utilisées pour les scénarios cliniques. X. Notes sur la lecture des tableaux d'adéquation "appropriateness". XI. Tableaux des scénarios d'adéquation, évalués par les experts. XII. Tableaux des scénarios de nécessité, évalués par les experts. XIII. Résumé du projet d'étude soumis au Fonds national (Dr F. Porchet). XIV. Résumé du projet d'étude soumis au Fonds national (Dr J.P. Vader). XV. Evaluation du processus par les experts. XVI. Extraits de pages du site WWW "Aide à la décision médicale"

Barnes Hospital Bulletin

https://digitalcommons.wustl.edu/bjc_barnes_bulletin/1206/thumbnail.jp

LETTER TO EDITOR: Role of Oxygen-Ozone (O2-O3) Injection in Discogenic Pain

Medical ozone is a mixture of oxygen-ozone (O2-O3) which can be used for several medical applications. Ozone chemonucleolysis by injecting mixture of oxygen-ozone is a minimally invasive technique to treat discogenic pain. Considering invasiveness and possible morbidity with surgery for discogenic pain, minimal invasive techniques are preferred. Ozone chemonucleolysis is currently available such technique which has shown promising result in recent years. It involves injection of ozone gas into the intervertebral disc under fluoroscopic guidance. This article deals with mechanism of action, indications, procedure and side effects of this technique in detail

An investigation into the effectiveness of collagenase for the percutaneous discolysis of thoracolumbar intervertebral discs in the dog : a thesis presented in partial fulfilment of the requirements for the degree of Master of Veterinary Science at Massey University

This investigation compared the effectiveness of chemonucleolysis with 500 units of collagenase, to lateral fenestration of the thoracolumbar intervertebral discs of the non-chondrodystrophoid dog. Effectiveness was based on the amount of nuclear material removed from the disc and the associated modifications to intervertebral disc structure, as determined by histological examination. The object was to determine whether the percutaneous injection of collagenase enzyme could be an alternative to fenestration as a prophylaxis against herniation of a degenerate intervertebral disc. Eight one year old, non-chondrodystrophoid mongrel dogs were used in the experiment. Apart from two dogs which remained untreated, the remaining six dogs were from two litters which had been sired by the same animal. Two of these dogs had six intervertebral discs (T10/11 to L2/3) injected with 500 units of collagnease VIIs delivered percutaneously. Another two dogs had their equivalent discs surgically fenestrated by the lateral approach as described by Flo and Brinker. The remaining two dogs were subjected to a placebo injection of physiological saline. The animals were examined clinically, neurologically and radiologically before treatment and at regular intervals following treatment. Six months following treatment, the dogs were euthanased. The results showed that collagenase caused almost complete removal of normal nuclear material from within the disc. The centre of the disc was replaced by a variable combination of fibrocartilage and hyaline cartilage, which appeared to develop from the collapsed inner lamellae of the annulus fibrosus. Complications were recorded in only one dog, who suffered a transient hind limb paralysis in the two days immediately following injection. A massive dorsal extrusion of nuclear material was observed in one disc at post-mortem in this dog and was believed to be the cause of the paralysis. The dog recovered without treatment and remained normal on clinical, neurological and radiological examination six months after injection. The annulus fibrosus, dorsal and ventral longitudinal ligaments remained intact in all other dogs. Fenestration was found to cause a variable disruption to the normal architecture of the nucleus pulposus. In most discs, cellular aggregations from the normal nucleus pulposus were undergoing a transformation to fibrocartilage. These cell groups were separated by an increased amount of amorphous matrix material which stained moderately with alcian blue. In the remaining discs (3/12), an increased fibrosus of the nucleus pulposus was seen, but no other disruption to the normal architecture was recorded. No complications occurred in these dogs. The injection of the discs with physiological saline caused remarkably similar histological effects to the disc as did fenestration. The investigators concluded that collagenase appeared to be an attractive alternative to fenestration for the prophylaxis of intervertebral disc herniation, on the basis of its completeness of removal of nuclear tissue, and its simplicity, cheapness, non-invasiveness and the lack of medium and short term complications. Since intervertebral disc protrusions occur more commonly in chondrodystrophoid breeds of dog, the effect of collagenase should be studied in degenerate disc of these breeds before it can be recommended for clinical use

Factores pronósticos del resultado de la quimionucleosis

Los resultados exitosos de la quimionucleosis dependen íntimamente de una estricta selección de los pacientes. En el presente trabajo se revisa la influencia de diferentes factores preoperatorios, clínicos y radiológicos, sobre el resultado de la quimionucleosis a los dos años de evolución, a través de un estudio estadístico de los casos. Los autores destacan como factores de mal pronóstico, en su casuística, las lumbalgias aisladas o prolongadas y el régimen laboral autónomo. Ni el tamaño ni la localizatción, central o lateral, de la imagen herniaria influyeron de manera estadística significativa en el resultado de la discolisis. Tampoco el número de discos explorados o inyectados, ni la presencia de signos radiológicos o tomodensitométricos asociados a la hernia discal sintomática.Successful results of chemonucleolysis depend specially on a strict patient selection. In this paper the influence of different preoperative, clinical and radiologic factors on the results two years after chemonucleolysis, is reviewed through the statistical analysis of the cases. The author s hav e observed the isolated or persistent low back pain (rather than sciatica), and being an autonomous worke r as poor prognosis factors in their environment. Size and site, either midline or lateral, of the disc herniation did not influence the results of chemonucleolysis with statistical significance; nor did the number of discs explored or injected, neither the presence of radiologic or tomodensitometric findings associated with symptomatic disc herniation

Do neurosurgeons subscribe to the guideline lumbosacral radicular syndrome?

Background: This study presents a survey of the opinion of neurosurgeons on the multidisciplinary clinical guideline 'lumbosacral radicular syndrome'. The aim was to describe to what extent neurosurgeons in the Netherlands endorse the content of this guideline. The guideline was issued in 1996 by the Netherlands Institute of Quality Health Care and this is the first attempt to evaluate the implementation of this guideline. Methods: All active neurosurgeons (n=92) in the Netherlands were invited to complete a questionnaire investigating to what extent they agree with the 26 recommendations in the guideline 'lumbosacral radicular syndrome'. The results are represented in frequencies (%) in order to express the magnitude of their consent or dissent with the recommendations. Results: Overall, 75% of the neurosurgeons responded and, of these, 94% agreed (at least partially) with the content of the guideline. Of the 26 recommendations in the guideline, seven were not fully endorsed by the neurosurgeons. Three of these seven recommendations may need revision based on newly published data. Conclusion: This survey shows that almost all neurosurgeons subscribed (at least partially) to the multidisciplinary LRS guideline. Therefore, one important aspect of the implementation process has been fulfilled, i.e. acceptance of the content of the guideline

Reduced inclination of cervical spine in a novel notebook screen system : implications for rehabilitation

Background: Professional working at computer notebooks is associated with high requirements on the body posture in the seated position. By the high continuous static muscle stress resulting from this position at notebooks, professionals frequently working at notebooks for long hours are exposed to an increased risk of musculoskeletal complaints. Especially in subjects with back pain, new notebooks should be evaluated with a focus on rehabilitative issues. Methods: In a field study a new notebook design with adjustable screen was analyzed and compared to standard notebook position. Results: There are highly significant differences in the visual axis of individuals who are seated in the novel notebook position in comparison to the standard position. Also, differences are present between further alternative notebook positions. Testing of gender and glasses did not reveal influences. Conclusion: This study demonstrates that notebooks with adjustable screen may be used to improve the posture. Future studies may focus on patients with musculoskeletal diseases

Translation, adaptation and validation of the Roland-Morris questionnaire - Brazil Roland-Morris

The purpose of the present study was to translate the Roland-Morris (RM) questionnaire into Brazilian-Portuguese and adapt and validate it. First 3 English teachers independently translated the original questionnaire into Brazilian-Portuguese and a consensus version was generated. Later, 3 other translators, blind to the original questionnaire, performed a back translation. This version was then compared with the original English questionnaire. Discrepancies were discussed and solved by a panel of 3 rheumatologists and the final Brazilian version was established (Brazil-RM). This version was then pretested on 30 chronic low back pain patients consecutively selected from the spine disorders outpatient clinic. In addition to the traditional clinical outcome measures, the Brazil-RM, a 6-point pain scale (from no pain to unbearable pain), and its numerical pain rating scale (PS) (0 to 5) and a visual analog scale (VAS) (0 to 10) were administered twice by one interviewer (1 week apart) and once by one independent interviewer. Spearman's correlation coefficient (SCC) and intraclass correlation coefficient (ICC) were computed to assess test-retest and interobserver reliability. Cross-sectional construct validity was evaluated using the SCC. In the pretesting session, all questions were well understood by the patients. The mean time of questionnaire administration was 4 min and 53 s. The SCC and ICC were 0.88 (P<0.01) and 0.94, respectively, for the test-retest reliability and 0.86 (P<0.01) and 0.95, respectively, for interobserver reliability. The correlation coefficient was 0.80 (P<0.01) between the PS and Brazil-RM score and 0.79 (P<0.01) between the VAS and Brazil-RM score. We conclude that the Brazil-RM was successfully translated and adapted for application to Brazilian patients, with satisfactory reliability and cross-sectional construct validity.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Disciplina de ReumatologiaUNIFESP, EPM, Disciplina de ReumatologiaSciEL

3-D pain drawings-mobile data collection using a PDA

A large number of the adult population suffers from some kind of back pain during their lifetime. Part of the process of diagnosing and treating such back pain is for a clinician to collect information as to the type and location of the pain that is being suffered.Traditional approaches to gathering and visualizing this pain data have relied on simple 2-D representations of the human body, where different types of sensation are recorded with various monochrome symbols. Although patients have been shown to prefer such drawings to traditional questionnaires, these pain drawings can be limited in their ability to accurately record pain. The work described in this paper proposes an alternative that uses a 3-D representation of the human body, which can be marked in color to visualize and record the pain data. This study has shown that the new approach is a promising development in this area of medical practice and has been positively received by patients and clinicians alike

A Quantitative Study of Intervertebral Disc Morphologic Changes Following Plasma‐Mediated Percutaneous Discectomy

Objective To quantitatively evaluate interval magnetic resonance imaging ( MRI ) changes in disc morphology following plasma‐mediated percutaneous discectomy. Design/Setting A retrospective comparison of pretreatment and posttreatment MRIs at a single university spine clinic. Subjects From a group of 60 consecutively treated patients, 15 met the study inclusion and exclusion criteria. All had either failed treatment or had other clinical reasons for a posttreatment MRI . Methods Two independent physicians electronically measured disc protrusion size and disc height at the treatment discs and adjacent discs on pre‐ and posttreatment MRI scans. Additionally, images were compared for gross anatomic changes including disc degeneration by P firrman classification, new disc herniations, high intensity zone ( HIZ ), vertebral endplate changes, post‐contrast enhancement, and changes in segmental alignment. P earson r correlation was used to determine interobserver reliability between the two physicians' MRI measurements. Paired t ‐tests were calculated for comparisons of pre‐ and posttreatment MRI measurements, and an ANOVA was performed for comparison of pre‐ to posttreatment changes in disc height measurements at treatment levels relative to adjacent levels. Results Correlation was high for measurement of disc height change ( r  = 0.89; P  < 0.0001) and good for anteroposterior protrusion size change ( r  = 0.51; P  = 0.0512). Disc height at treated discs demonstrated a small but statistically significant mean interval reduction of 0.48 mm ( P  = 0.0018). This remained significant when compared with the adjacent control discs ( P  < 0.0001). Pretreatment mean disc protrusion size (4.74 mm; range 3.75–6.55 mm) did not differ significantly ( P  = 0.1145) from posttreatment protrusion size (4.42 mm; range 2.55–7.95 mm). Gross anatomic changes at treatment levels included reduced disc protrusion size (N = 6), enlarged protrusion (N = 3), resolution of HIZ (N = 3), and improvement in endplate signal changes (N = 1). Also, 11/15 posttreatment MRIs included post‐contrast images that showed epidural fibrosis (N = 1), rim enhancement (N = 2), and enhancement of the posterior annulus (N = 4). Conclusions Based on MRI examinations, subtle anatomic changes may occur following plasma‐mediated percutaneous discectomy. Further study is required to determine the clinical relevance of these changes.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/109360/1/pme12525.pd