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Artykuły w czasopismach na temat "Intradiscal Complications"
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Cohen, Steven P., Daniel Wenzell, Robert W. Hurley, Connie Kurihara, Chester C. Buckenmaier, Scott Griffith, Thomas M. Larkin, Erik Dahl i Bennie J. Morlando. "A Double-blind, Placebo-controlled, Dose–Response Pilot Study Evaluating Intradiscal Etanercept in Patients with Chronic Discogenic Low Back Pain or Lumbosacral Radiculopathy". Anesthesiology 107, nr 1 (1.07.2007): 99–105. http://dx.doi.org/10.1097/01.anes.0000267518.20363.0d.
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Abstract Background: In recent years, convincing evidence has emerged implicating tumor necrosis factor α as a causative factor in radiculopathy and discogenic back pain. But although preliminary open-label studies demonstrated promising results for the treatment of low back pain with tumor necrosis factor-α inhibitors, early optimism has been tainted by a controlled study showing no significant benefit in sciatica. To determine whether outcomes might be improved by a more direct route of administration, the authors evaluated escalating doses of intradiscal etanercept in 36 patients with chronic lumbosacral radiculopathy or discogenic low back pain. Methods: A double-blind, placebo-controlled pilot study was conducted whereby six patients received 0.1, 0.25, 0.5, 0.75, 1.0, or 1.5 mg etanercept intradiscally in each pain-generating disc. In each escalating dose group of six patients, one received placebo. A neurologic examination and postprocedure leukocyte counts were performed in all patients at 1-month follow-up visits. In patients who experienced significant improvement in pain scores and function, follow-up visits were conducted 3 and 6 months after the procedure. Results: At 1-month follow-up, no differences were found for pain scores or disability scores between or within groups for any dose range or subgroup of patients. Only eight patients remained in the study after 1 month and elected to forego further treatment. No complications were reported, and no differences were noted between preprocedure and postprocedure leukocyte counts. Conclusions: Although no serious side effects were observed in this small study, a single low dose of intradiscal etanercept does not seem to be an effective treatment for chronic radicular or discogenic low back pain.
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Cohen, Steven P., Thomas Larkin, Salahadin Abdi, Audrey Chang i Milan Stojanovic. "Risk Factors for Failure and Complications of Intradiscal Electrothermal Therapy: A Pilot Study". Spine 28, nr 11 (czerwiec 2003): 1142–47. http://dx.doi.org/10.1097/01.brs.0000067269.31377.6a.
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Wegener, Bernd. "Experimental Evaluation of the Risk of Extradiscal Thermal Damage in Intradiscal Electrothermal Therapy (IDET)". Pain Physician 1;15, nr 1;1 (14.01.2012): E99—E106. http://dx.doi.org/10.36076/ppj.2012/15/e99.
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Background: In 2000 the intradiscal electrothermal therapy (IDET) procedure for the treatment of discogenic pain was introduced. The technique involves the positioning of an intradiscal catheter with a temperature-controlled thermal resistive heating coil at the inner posterior annulus. The therapeutic mechanism of IDET combines the thermocoagulation of native nociceptors and in-grown nonmyelinated nerve fibers with collagen shrinkage, stabilizing annular fissures. Thermal nerve root injuries were described with IDET. The temperature in relation to the distance from the catheter tip was investigated. The intradiscal temperature distribution during treatment with IDET was also described. Objective: To examine the temperature distribution outside the disc near neural structures and the risk of thermal damage to nerve tissue during a correctly performed IDET procedure. Study Design: Experimental study. Setting: Biomechanical laboratory of an academic orthopedic surgery department. Methods: Testing was performed on cadaveric human lumbar spines with 10 intact intervertebral discs in a circulating water bath. Five thermocouples were attached to different locations on the disc. The temperature was recorded for 26 minutes. In addition, surface temperatures were recorded using an infrared camera. For the application of IDET, we used the Electrothermal 20S Spine System by Smith & Nephew and the standard clinical protocol. Results: The shape of the recorded temperature curves was quite heterogeneous. Inside the spinal canal, temperatures as high as 45.2°C were recorded for a very short time. Temperature monitoring with the infrared camera demonstrated a change in temperature clearly restricted to the nucleus of the disc. Limitations: The temperature distribution depends on the exact position of the IDET probe, which will never be 100% identical between individual experiments. Conclusion: This study shows that temperatures generated within the spinal canal during IDET do not appear to be high enough to cause nerve damage. Key words: IDET, thermal nerve damage, thermal complications, intradiscal electrothermal therapy
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Hosseini, Pooria, Gregory M. Mundis, Robert K. Eastlack, Ramin Bagheri, Enrique Vargas, Stacie Tran i Behrooz A. Akbarnia. "Preliminary results of anterior lumbar interbody fusion, anterior column realignment for the treatment of sagittal malalignment". Neurosurgical Focus 43, nr 6 (grudzień 2017): E6. http://dx.doi.org/10.3171/2017.8.focus17423.
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OBJECTIVESagittal malalignment decreases patients’ quality of life and may require surgical correction to achieve realignment goals. High-risk posterior-based osteotomy techniques are the current standard treatment for addressing sagittal malalignment. More recently, anterior lumbar interbody fusion, anterior column realignment (ALIF ACR) has been introduced as an alternative for correction of sagittal deformity. The objective of this paper was to report clinical and radiographic results for patients treated using the ALIF-ACR technique.METHODSA retrospective study of 39 patients treated with ALIF ACR was performed. Patient demographics, operative details, radiographic parameters, neurological assessments, outcome measures, and preoperative, postoperative, and mean 1-year follow-up complications were studied.RESULTSThe patient population comprised 39 patients (27 females and 12 males) with a mean follow-up of 13.3 ± 4.7 months, mean age of 66.1 ± 11.6 years, and mean body mass index of 27.3 ± 6.2 kg/m2. The mean number of ALIF levels treated was 1.5 ± 0.5. Thirty-three (84.6%) of 39 patients underwent posterior spinal fixation and 33 (84.6%) of 39 underwent posterior column osteotomy, of which 20 (60.6%) of 33 procedures were performed at the level of the ALIF ACR. Pelvic tilt, sacral slope, and pelvic incidence were not statistically significantly different between the preoperative and postoperative periods and between the preoperative and 1-year follow-up periods (except for PT between the preoperative and 1-year follow-up, p = 0.018). Sagittal vertical axis, T-1 spinopelvic inclination, lumbar lordosis, pelvic incidence–lumbar lordosis mismatch, intradiscal angle, and motion segment angle all improved from the preoperative to postoperative period and the preoperative to 1-year follow-up (p < 0.05). The changes in motion segment angle and intradiscal angle achieved in the ALIF-ACR group without osteotomy compared with the ALIF-ACR group with osteotomy at the level of ACR were not statistically significant. Total visual analog score, Oswestry Disability Index, and Scoliosis Research Society–22 scores all improved from preoperative to postoperative and preoperative to 1-year follow-up. Fourteen patients (35.9%) experienced 26 complications (15 major and 11 minor). Eleven patients required reoperation. The most common complication was proximal junctional kyphosis (6/26 complications, 23%) followed by vertebral body/endplate fracture (3/26, 12%).CONCLUSIONSThis study showed satisfactory radiographic and clinical outcomes at the 1-year follow-up. Proximal junctional kyphosis was the most common complication followed by fracture, complications that are commonly associated with sagittal realignment surgery and may not be mitigated by the anterior approach.
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Theron, J., H. Huet i O. Coskun. "Cervical Automated Discectomy". Interventional Neuroradiology 2, nr 1 (marzec 1996): 35–44. http://dx.doi.org/10.1177/159101999600200104.
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The lumbar automated discectomy system described by Onik has been used in the treatment of cervical disk herniations whose symptomatology resisted medical treatment. Experience on 150 patients is reported showing a 74.5% success rate. This series performed in most cases on an outpatient basis had no complications. Up to 1992 failure cases were treated by intradiscal injections of triamcinolone with 62% of success. This complementary technique was abandonned after the description of epidural calcifications secondary to this type of injections in the lumbar area. Since 1992, failure cases have been managed differently with injections of steroids in the cervical joints, especially when a hypertrophy of the ligamentum flavum supposedly a sign of an inflammatory posterior component of the pain was demonstrated on the CT. Nine patients received intradiscal injections of microdoses (600 IU) of chymopapaine with excellent results. No patient has had open surgery since 1992. It is concluded that percutaneous automated discectomy is a very promising and safe technique which can be used as a first choice technique for most cervical disk herniations resisting medical treatment.
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Giurazza, Francesco, Gianluigi Guarnieri, Kieran J. Murphy i Mario Muto. "Intradiscal O2O3: Rationale, Injection Technique, Short- and Long-term Outcomes for the Treatment of Low Back Pain Due to Disc Herniation". Canadian Association of Radiologists Journal 68, nr 2 (maj 2017): 171–77. http://dx.doi.org/10.1016/j.carj.2016.12.007.
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The management of low back pain should always start with a conservative approach; however, when it fails, intervention is required and at that moment the most appropriate choice remains unclear. Before invasive surgery, minimally invasive techniques can be adopted. In European trials and in a trans-Canadian clinical trial 03 ozone has been used successfully. In total over 50,000 patients have been treated safely. Ozone is a gas normally present in the atmosphere with potent oxidizing power; it has been used for percutaneous intradiscal injection combined with oxygen (O2O3) at very low concentrations for 15 years in Europe. The main indication is back pain with or without radicular pain but without motor deficits, which is refractory to 4-6 weeks of conservative therapies. Its mechanism of action on the disc is mechanical (volume reduction by subtle dehydration of the nucleus pulposis) and antinflammatory. The intradiscal ozone injection is performed with a thin needle (18-22 gauge) image guided by computed tomography or angiofluoroscopy and is usually complimented by periganglionic injection of corticosteroids and anesthetics. This combination gives immediate pain relief and allows time for the ozone to act. It is a cost-effective procedure that presents a very low complication rate (0.1%). The radicular pain is resolved before the back pain does, as is seen with microdiscectomy. Peer-reviewed publications of large randomized trials, case series, and meta analysis from large samples of patients have demonstrated the procedure to be safe and effective in the short and the long terms, with benefits recognized up to 10 years after treatment. We aim to review the principles of action of O2O3 and report the injection techniques, complications, and short- and long-term outcomes.
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Beyaz, Serbülent Gökhan. "Six-Month Results of Cervical Intradiscal Oxygen-Ozone Mixture Therapy on Patients with Neck Pain: Preliminary Findings". January 2018 1, nr 21;1 (15.07.2018): E499—E456. http://dx.doi.org/10.36076/ppj.2018.4.e449.
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Background: Numerous techniques have been developed for the treatment of disc herniation. Oxygen-ozone (O2 -O3 ) mixture therapy is a minimally invasive percutaneous treatment for disc herniation. Objective: The aim of the study is to investigate the 6-month efficacy and safety of O2 -O3 mixture therapy in patients with cervical disc herniation (CDH) and chronic neck pain. Study Design: This is a cross-sectional, single-center study. Setting: The study was conducted from January 2012 to May 2016 on patients visiting Sakarya University Training and Research Hospital’s pain clinic. Methods: Each patient was evaluated before the procedure (baseline) and at 2 weeks (W2), 6 weeks (W6), and 6 months (M6) after the procedure using the visual analog scale (VAS) and the Oswestry Disability Index scores. Results: A total of 44 patients with CDH underwent the same treatment with an O2 -O3 mixture. Significant pain relief was observed compared with preoperative pain at W2, W6, and M6 according to patient self-evaluation (P = 0.01). The mean VAS score was 7.89 ± 1.13 before the procedure, 4.22 ± 1.62 at W2, 3.03 ± 1.66 at W6, and 2.27 ± 1.25 at the end of M6. No significant complications or side effects were reported during or after the procedure. Limitations: Our study was conducted retrospectively, which resulted in problems obtaining follow-up data. In addition, this study was performed in a small patient group. Conclusion: Based on our results, intradiscal injection of an O2 -O3 mixture treatment showed a beneficial long-term effect. Key words: Cervical disc herniation, chemonucleolysis, injection, intradiscal, oxygen-ozone mixture, percutaneous treatment
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Muto, M., i F. Avella. "Percutaneous Treatment of Herniated Lumbar Disc by Intradiscal Oxygen-Ozone Injection". Interventional Neuroradiology 4, nr 4 (grudzień 1998): 279–86. http://dx.doi.org/10.1177/159101999800400403.
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We report our experience of treating lumbar herniated disc by intradiscal injection of an oxygen-ozone mixture. Ozone (03, MW = 48) is a triatomic molecule, having antiviral, disinfectant and antiseptic properties. Several mechanisms of action have been proposed to explain the efficacy of the treatment: analgesic action; anti-inflammatory action; oxidant action on the proteoglycan in the nucleus pulposus. We treated 93 patients (50 women, 43 men) aged from 24 to 45 yrs (average age 38 yrs) from June 1996 to April 1998. All patients presented sciatica and/or low back pain, lasting two or more months; patients had in the mean time received both medical and physical therapy with mild or no benefit. Diagnostic tests in all patients included plain film x-ray, CT and/or MR at the level of the lumbar spine disclasing a herniated or protruded disc with nerve root or thecal sac compression. We divided patients to be treated in to two groups: the first one group included 35 patients already selected for surgery who presented herniated or protruded disc with radicular pain with associated neurological deficit (hypoesthesia and partial loss of reflex). Those patients had already had medical and physical therapy for two or more months and agreed to try the percutaneous treatment before surgery. CT or MR in this group demonstrated the presence of intraforaminal, extra or sub-ligamentary and sequestrated herniated disc. The second group included 58 patients with radicular pain but without neurological deficit; patients in this group had received medical and/or physical therapy for two or more months and CT showed the presence of a small subligamentary herniated or protruded disc. We considered the results according to the modified MacNab method. In the first group we had “failure” in all patients; in seven cases the symptoms improved for one month, but recurred later on. In the second group 45 patients had “success” showing complete clinical recovery within five to six days after treatment, all remained without symptoms up to six months or more of follow-up. The remaining 13 patients presented the same symptoms again within three months after a temporary clinical recovery. The goal of this study was to present this new technique that can also be compared with a previous study of different percutaneous treatment. Clinical and neuroradiological indications and the contraindications are well known, and must be followed to achieve good results and avoid complications.
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Gao, Chang, Min Zong, Wen-tao Wang, Lei Xu, Da Cao i Yue-fen Zou. "Analysis of risk factors causing short-term cement leakages and long-term complications after percutaneous kyphoplasty for osteoporotic vertebral compression fractures". Acta Radiologica 59, nr 5 (7.08.2017): 577–85. http://dx.doi.org/10.1177/0284185117725368.
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Background Percutaneous kyphoplasty (PKP) is a common treatment modality for painful osteoporotic vertebral compression fractures (OVCFs). Pre- and postoperative identification of risk factors for cement leakage and follow-up complications would therefore be helpful but has not been systematically investigated. Purpose To evaluate pre- and postoperative risk factors for the occurrence of short-term cement leakages and long-term complications after PKP for OVCFs. Material and Methods A total of 283 vertebrae with PKP in 239 patients were investigated. Possible risk factors causing cement leakage and complications during follow-up periods were retrospectively assessed using multivariate analysis. Cement leakage in general, three fundamental leakage types, and complications during follow-up period were directly identified through postoperative computed tomography (CT). Results Generally, the presence of cortical disruption ( P = 0.001), large volume of cement ( P = 0.012), and low bone mineral density (BMD) ( P = 0.002) were three strong predictors for cement leakage. While the presence of intravertebral cleft and Schmorl nodes ( P = 0.045 and 0.025, respectively) were respectively identified as additional risk factors for paravertebral and intradiscal subtype of cortical (C-type) leakages. In terms of follow-up complications, occurrence of cortical leakage was a strong risk factor both for new VCFs ( P = 0.043) and for recompression ( P = 0.004). Conclusion The presence of cortical disruption, large volume of cement, and low BMD of treated level are general but strong predictors for cement leakage. The presence of intravertebral cleft and Schmorl nodes are additional risk factors for cortical leakage. During follow-up, the occurrence of C-type leakage is a strong risk factor, for both new VCFs and recompression.
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Azulay, N., M. Forgerit, E. G. Alava, A. Deplas, R. Vialle, S. Ragot i J. P. Tasu. "A novel radiofrequency thermocoagulation method for treatment of lower back pain: thermal conduction after instillation of saline solution into the nucleus pulposus—preliminary results". Acta Radiologica 49, nr 8 (październik 2008): 934–39. http://dx.doi.org/10.1080/02841850802247681.
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Background: Radiofrequency heating of the intervertebral disc has been proposed for the treatment of chronic low back pain using two methods: a flexible needle inserted into the annulus fibrosus achieving a full 360° penetration, or a rigid needle inserted into the nucleus pulposus. The first technique is effective on pain, but the clinical benefit of the second is uncertain. Purpose: To evaluate a technique for radiofrequency heating of the lumbar intervertebral disc by a needle placed into the nucleus pulposus. Material and Methods: The method was tested in 17 patients according to the criteria used in previous intradiscal radiofrequency studies. Before and after treatment, disability was assessed by the Oswestry disability score. A pain reduction of at least 50% was considered a success. Results: Fifteen patients were responders at 1 month (88%), nine at 3 months (53%), and 12 at 6 months (70.6%). No complications were observed. Conclusion: A new method of providing discal radiofrequency treatment for lower back pain had a substantial clinical benefit in 71% of the observed patients. A prospective study comparing this new method with placebo should be conducted to confirm these initial results.
Rozprawy doktorskie na temat "Intradiscal Complications"
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Fraser, Robert D. "Discitis after discography and chemonucleolysis /". Title page, table of contents and abstract only, 1986. http://web4.library.adelaide.edu.au/theses/09MD/09mdf842.pdf.
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Fraser, Robert D. (Robert David). "Discitis after discography and chemonucleolysis". 1986. http://web4.library.adelaide.edu.au/theses/09MD/09mdf842.pdf.
Pełny tekst źródłaKsiążki na temat "Intradiscal Complications"
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Kapural, Leonardo. Lumbar Disc Procedures: Fluoroscopy. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199908004.003.0023.
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Discogenic lumbar pain is a frequent cause of prolonged disability. Currently, there are few effective minimally invasive therapeutic options to treat diseased discs and provide a long-term pain relief. Intradiscal biacuplasty improves functional capacity and affords pain relief in properly selected patients. Provocative discography is a relatively invasive intradiscal technique that has been used as a diagnostic tool to help to detect painful discs and associated morphological changes. One of the effective therapeutic approaches to control discogenic pain is to use an ablative radiofrequency intradiscal procedure, like biacuplasty. Intradiscal electrothermal therapy (IDET) is currently in limited use. Serious complications of intradiscal procedures are rather rare.
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Patel, Vikram B. Basics of Fluoroscopy. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199908004.003.0001.
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This chapter reviews the basics of fluoroscopy, including its safe use and the dangers of radiation. Although various interventions have been used to treat pain for decades, use of fluoroscopy has been more prevalent since the mid-1990s. Several studies have shown that using any form of guidance is superior to “blind” procedures, providing better outcomes while reducing the rate of complications. Ultrasound may be safer than fluoroscopy for certain procedures such as joint injections near and around blood vessels. Ultrasound avoids the harmful radiation to the patient, the treating physician, and staff, and also helps significantly by allowing the physician to visualize blood and fluid flow. Nevertheless, fluoroscopy may never be replaced for certain procedures that require full view of osseous structures or for open but minimally invasive surgical procedures such as implantable devices and intradiscal procedures.
Części książek na temat "Intradiscal Complications"
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McJunkin, Tory L., Paul J. Lynch i Christi Makas. "Complications of Therapeutic Minimally Invasive Intradiscal Procedures". W Reducing Risks and Complications of Interventional Pain Procedures, 41–54. Elsevier, 2012. http://dx.doi.org/10.1016/b978-1-4377-2220-8.00006-4.
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Saal, Joel S., i Jeffrey Saal. "Complications Associated with Intradiscal Electrothermal Therapy (IDET)". W Complications in Regional Anesthesia & Pain Medicine, 267–72. Elsevier, 2007. http://dx.doi.org/10.1016/b978-1-4160-2392-0.50031-5.
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"Complications of Minimally Invasive Spinal Procedures and Surgery—Part IV: Percutaneous and Intradiscal Techniques". W Complications of Pediatric and Adult Spinal Surgery, 565–90. CRC Press, 2004. http://dx.doi.org/10.1201/b14827-38.
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