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Zhongguo Xiu Fu Chong Jian Wai Ke Za... Oct 2022To analyze the early effectiveness of unilateral biportal endoscopic discectomy (UBED) combined with annulus fibrosus suture in the treatment of lumbar disc herniation...
OBJECTIVE
To analyze the early effectiveness of unilateral biportal endoscopic discectomy (UBED) combined with annulus fibrosus suture in the treatment of lumbar disc herniation (LDH).
METHODS
The clinical data of 19 patients with LDH treated with UBED and annulus fibrosus suture between October 2020 and October 2021 were retrospectively analyzed. There were 12 males and 7 females with an average age of 39.1 years (range, 26-59 years). The operative segment was L in 13 cases, and L , S in 6 cases. The mean disease duration was 6.7 months (range, 3-15 months). Preoperative neurological examination showed that muscle strength, sensation, and tendon reflex weakened or disappeared in varying degrees. Single annulus fibrosus suture (14 cases) or anchor assisted annulus fibrosus suture (5 cases) was selected according to the location of annulus fibrosus tears. Visual analogue scale (VAS) score was used to assess the low back and leg pain before operation and at 3 days, 3 months, and 6 months after operation. Oswestry disability index (ODI) was used to evaluate the function recovery of lumbar spine before operation and at 3 days, 3 months, and 6 months after operation. At 3 days and 3 months after operation, MRI was used to examine the removal of nucleus pulposus and decompression of nerve root. MacNab criteria was used to evaluate the effectiveness at 6 months after operation and the recovery of nerve root function was recorded.
RESULTS
All operations were successfully completed with a mean operation time of 52.7 minutes (range, 40-75 minutes). There was no complication such as nerve injury, spinal cord hypertension syndrome, or dural sac tear during operation, and no complication such as infection, aggravation of nerve damage, or cerebrospinal fluid leakage after operation. All the patients were followed up 6-10 months (mean, 8.2 months). Postoperative MRI showed that the herniated disc was completely removed and nerve roots were fully decompressed. During the follow-up, there was no recurrence of disc herniation. The VAS scores of low back pain and leg pain and ODI at each time point after operation significantly improved when compared with those before operation, and those at 6 months after operation further improved than those at 3 days and 3 months after operation, all showing significant differences ( <0.05). At 6 months after operation, MacNab standard was used to evaluate the effectiveness, and the results were excellent in 14 cases, good in 4 cases, and fair in 1 case, with an excellent and good rate of 94.7%. Neurological examination showed that the sensation and muscle strength of the affected nerve root innervated area recovered significantly when compared with those before operation ( <0.05); the recovery of tendon reflex was not obvious, showing no significant difference when compared with that before operation ( >0.05).
CONCLUSION
UBED combined with annulus fibrosus suture is a safe and effective technique for LDH and early effectiveness is satisfactory.
Topics: Male; Female; Humans; Adult; Intervertebral Disc Displacement; Annulus Fibrosus; Retrospective Studies; Treatment Outcome; Diskectomy; Endoscopy; Lumbar Vertebrae; Low Back Pain; Sutures; Diskectomy, Percutaneous
PubMed: 36310453
DOI: 10.7507/1002-1892.202205095 -
Cureus Jul 2022Segmental zoster paresis (SZP) is a rare complication of herpes zoster (HZ) that results in focal weakness of the extremity in the myotome that corresponds to dermatomal...
Segmental zoster paresis (SZP) is a rare complication of herpes zoster (HZ) that results in focal weakness of the extremity in the myotome that corresponds to dermatomal involvement.We present a case of an 80-year-old female with a resolving HZ rash on her left leg and buttocks that presented with left leg weakness for two weeks. The patient's rash preceded the left leg weakness by two weeks. The exam revealed erythematous macular and crusting lesions in the left L3/L4 distribution. The left thigh was flaccid with 1/5 knee extension strength with an absent patellar reflex. Lumbar spine magnetic resonance imaging (MRI) revealed enhancement of the left L4 roots, suggestive of inflammation or neuropathy. The patient was discharged on gabapentin, amitriptyline, and a two-week prednisone taper. In this case study, we present SZP, a rare complication that occurs in approximately 3% of HZ patients. The majority of SZP cases occur on the face or upper extremity, whereas our patient had SZP of the lower extremity. This case emphasizes the importance of maintaining a comprehensive differential diagnosis and highlights that SZP should be considered in patients who present with acute weakness in an extremity.
PubMed: 36039221
DOI: 10.7759/cureus.27261 -
Journal of Clinical Medicine Aug 2022Magnetic stimulation is a safe, non-invasive diagnostic tool and promising treatment strategy for neurological and psychiatric disorders. Although most studies address...
Magnetic stimulation is a safe, non-invasive diagnostic tool and promising treatment strategy for neurological and psychiatric disorders. Although most studies address transcranial magnetic stimulation, transspinal magnetic stimulation (TsMS) has received recent attention since trials involving invasive spinal cord stimulation showed encouraging results for pain, spasticity, and Parkinson's disease. While the effects of TsMS on spinal roots is well understood, its mechanism of action on the spinal cord is still controversial. Despite unclear mechanisms of action, clinical benefits of TsMS have been reported, including improvements in scales of spasticity, hyperreflexia, and bladder and bowel symptoms, and even supraspinal gait disorders such as freezing and camptocormia. In the present study, a critical review on the application of TsMS in neurology was conducted, along with an exploratory trial involving TsMS in three patients with hereditary spastic paraplegia. The goal was to understand the mechanism of action of TsMS through H-reflex measurement at the unstimulated lumbosacral level. Although limited by studies with a small sample size and a low to moderate effect size, TsMS is safe and tolerable and presents consistent clinical and neurophysiological benefits that support its use in clinical practice.
PubMed: 36012986
DOI: 10.3390/jcm11164748 -
Journal of Medical Case Reports Aug 2022Owing to the aging population, fragility fractures of the pelvis are occurring more frequently. Fixation of the fracture and stabilization of the pelvic ring usually...
BACKGROUND
Owing to the aging population, fragility fractures of the pelvis are occurring more frequently. Fixation of the fracture and stabilization of the pelvic ring usually provide good clinical results. A case of distal sacral nerve roots severed by a fragility fracture of the sacrum is presented.
CASE PRESENTATION
A 62-year-old Japanese woman with schizophrenia with low back pain, gait disorder, dysuria, and fecal incontinence presented to an emergency department, and plain X-rays showed no findings. She also complained of dysuria, and neurogenic bladder and cystitis were diagnosed. One month later, she was admitted to a psychiatric hospital for exacerbation of schizophrenia. In hospital, she had a urethral catheter inserted and spent 3 months in bed. She was referred to our orthopedic department because a gait disorder was discovered after her mental condition improved and she was permitted to walk. On examination, she could not walk and had decreased sensation from the buttocks to both posterior thighs and around the anus and perineum. Manual muscle testing of her lower limbs showed mild weakness of about 4 in bilateral flexor hallucis longus and gastrocnemius, and bilateral Achilles tendon reflexes were lost. Her anal sphincter did not contract, and urinary retention continued after urethral catheter removal. Imaging examinations showed an H-shaped sacral fracture consisting of a transverse fracture with displacement of the third sacral vertebra and vertical fractures of the bilateral sacral wings, with severe stenosis of the spinal canal at the site of the transverse fracture. The patient was diagnosed as having bladder and rectal dysfunction due to a displaced, unstable sacral fracture. First to third sacral laminectomy and alar-iliac fixation using percutaneous pedicle screws and sacral alar-iliac screws were then performed. The bilateral distal sacral nerve roots (S3, S4, S5) were completely severed at the second to third sacral levels, but bilateral second sacral nerve roots were not compressed from the bifurcation to the sacral foramen. Postoperatively, bladder and rectal dysfunction remained, but the low back pain was alleviated. Two weeks postoperatively, she could walk with a walker and was discharged. Three months after the operation, bone fusion of the fracture was observed.
CONCLUSIONS
In cases of bladder-rectal dysfunction with low back pain, the possibility of sacral fracture should be considered, and computed tomography, magnetic resonance imaging, and X-ray examinations should be performed. Even sacral fractures without displacement require attention because they can cause serious injury in the event of a nerve root being severed if not diagnosed early and given appropriate treatment.
Topics: Aged; Dysuria; Female; Fracture Fixation, Internal; Fractures, Bone; Humans; Low Back Pain; Middle Aged; Pelvis; Sacrum; Spinal Fractures
PubMed: 35996162
DOI: 10.1186/s13256-022-03551-z -
Child Neurology Open 2022We present a case of a 3-year-old girl who rapidly developed bilateral facial palsy, dysphagia, dysphonia, areflexia, and ataxia soon after receiving an influenza...
We present a case of a 3-year-old girl who rapidly developed bilateral facial palsy, dysphagia, dysphonia, areflexia, and ataxia soon after receiving an influenza vaccine. Brain and spine Magnetic resonance imaging (MRI) scans with and without contrast showed enhancement of cranial nerves III, V, VII, and X, as well as the anterior and posterior cervical spinal and cauda equina roots. cerebrospinal fluid (CSF) studies showed white blood cell count of 19 cells/cm, glucose 81 mg/dL, and protein 116 mg/dL, with negative infectious and autoimmune labs. Serum IgM and IgG antibodies against GM1, GD1a, GD1b, GM2, GT1A, GQ1b were negative. The patient was treated with intravenous immunoglobulin, which led to a full recovery. Upon three-month follow-up, her neurologic examination demonstrated normal cranial nerves, reflexes, and gait. Her presentation was most consistent with the acute bulbar palsy plus (ABPp) variant of Guillain-Barré syndrome (GBS), a rare and challenging diagnosis especially in her age group.
PubMed: 35936111
DOI: 10.1177/2329048X221115476 -
Swiss Medical Weekly Jun 2022The complex care needs of people with chronic illnesses and multimorbidity pose a significant challenge to the Swiss primary care system. Ensuring efficient,...
Integration of an advanced practice nurse into a primary care practice: a qualitative analysis of experiences with changes in general practitioner professional roles in a Swiss multiprofessional primary care practice.
BACKGROUND
The complex care needs of people with chronic illnesses and multimorbidity pose a significant challenge to the Swiss primary care system. Ensuring efficient, high-quality care will require new care models. Internationally, the integration of advanced practice nurses (APNs) into primary care models has shown promising results. The current study investigates how general practitioners (GPs) in Switzerland experience the integration of APNs into their primary care teams with respect to their own professional roles.
METHODS
We used a qualitative, social-constructivist approach, focusing on six individual interviews with general practitioners within the frame of a larger study including GPs and APNs in a Swiss multiprofessional primary care practice. Data were analysed following Braun and Clarke's approach for reflexive thematic analysis.
SETTING AND PARTICIPANTS
The study took place between August 2019 and February 2020 in a Swiss multiprofessional primary care practice that had been working with APNs for nine years. Participants included six general practitioners.
RESULTS
We identified three main themes characterising Swiss GPs' experiences with the integration of APNs into their primary care team: (1) trust as foundation for collaboration with APNs; (2) build-up of the APN role by delegation, teaching, and supervision, investing time particularly at the beginning of their collaboration with the APN - a time investment that declined significantly as the APNs' competencies grew - and (3) synergies of partnership-based collaboration with APNs. Physicians who were experienced teachers and supervisors, and who delegated tasks based on who would be able to fulfil them most efficiently and effectively, experienced not only a broad range of synergies, but also possibilities to further develop the range of their own activities. Comprehensive, high-quality patient care was perceived as a particular added value.
CONCLUSION
Our analysis revealed that GPs experienced interprofessional synergies when working collaboratively with APNs. These were rooted in trust and relied on abilities in teaching, supervision and delegation to achieve maximum impact. Capitalising on the integration of APNs into primary care, this new care model can be adapted to diverse individual settings. We conclude this article by highlighting the potential of working collaboratively with APNs, who play increasingly important roles in the primary care of polymorbid patients with complex needs.
Topics: Advanced Practice Nursing; General Practitioners; Humans; Primary Health Care; Professional Role; Qualitative Research; Switzerland
PubMed: 35816630
DOI: 10.4414/smw.2022.w30199 -
Developmental Medicine and Child... Jan 2023To explore - through intraoperative neurophysiology mapping and recordings - the comparative distribution of the reflexive excitability of the L2 to S2...
AIM
To explore - through intraoperative neurophysiology mapping and recordings - the comparative distribution of the reflexive excitability of the L2 to S2 radiculo-metameric segments of the spinal cord in a series of children with bilateral spastic cerebral palsy (CP) who underwent selective dorsal rhizotomy (SDR).
METHOD
Our series included 46 consecutive children (36 males, 10 females; aged 5-16 years, mean 8 years) who underwent SDR, using keyhole interlaminar dorsal rhizotomy. The procedure allowed access to all L2 to S2 roots independently, while preserving the posterior architecture of the lumbar spine. Dorsal roots were stimulated selectively to test reflexive excitability of the corresponding radiculo-metameric levels. Stimulation parameters were identical for all roots for optimal comparison between root levels, with an intensity just above threshold to avoid excessive diffusion. The responses in the main muscular groups in each lower limb were clinically observed and electromyograms recorded. Degrees of excitability were quantified according to Fasano's scale.
RESULTS
The difference between root levels was highly significant. Median values of excitability were 1, 2, 3, 3, 3, and 3 for the L2, L3, L4, L5, S1, and S2 levels respectively. Lower root levels exhibited significantly more excitability.
INTERPRETATION
In addition to insight into the spasticity of children with CP, the profile of segmental excitability can be useful in establishing surgical planning when programming SDR.
WHAT THIS PAPER ADDS
Keyhole interlaminar dorsal rhizotomy modality allowed selective stimulation of all L2-S2 dorsal roots for testing excitability. There were significant differences in reflexive excitability of L2-S2 radiculo-medullary segments. Lower segments of L2-S2 medullary levels have higher excitability. Interindividual variability in excitability of lumbosacral segments justifies intraoperative neurophysiology. This original article is commented on by Young on pages 9-10 of this issue.
Topics: Child; Male; Female; Humans; Rhizotomy; Cerebral Palsy; Neurophysiology; Muscle Spasticity; Spinal Nerve Roots; Treatment Outcome
PubMed: 35698904
DOI: 10.1111/dmcn.15315 -
Experimental Neurobiology Apr 2022Spontaneous interneuron activity plays a critical role in developing neuronal networks. Discharges conducted antidromically along the dorsal root (DR) precede those from...
Spontaneous interneuron activity plays a critical role in developing neuronal networks. Discharges conducted antidromically along the dorsal root (DR) precede those from the ventral root's (VR) motoneurons. This work studied whether spinal interneurons project axons into the neonate's dorsal roots. Experiments were carried out in postnatal Swiss-Webster mice. We utilized a staining technique and found that interneurons in the spinal cord's dorsal horn send axons through the dorsal roots. In vitro electrophysiological recordings showed antidromic action potentials (dorsal root reflex; DRR) produced by depolarizing the primary afferent terminals. These reflexes appeared by stimulating the adjacent dorsal roots. We found that bicuculline reduced the DRR evoked by L5 dorsal root stimulation when recording from the L4 dorsal root. Simultaneously, the monosynaptic reflex (MR) in the L5 ventral root was not affected; nevertheless, a long-lasting after-discharge appeared. The addition of 2-amino-5 phosphonovaleric acid (AP5), an NMDA receptor antagonist, abolished the MR without changing the after-discharge. The absence of DRR and MR facilitated single action potentials in the dorsal and ventral roots that persisted even in low Ca2+ concentrations. The results suggest that firing interneurons could send their axons through the dorsal roots. These interneurons could activate motoneurons producing individual spikes recorded in the ventral roots. Identifying these interneurons and the persistence of their neuronal connectivity in adulthood remains to be established.
PubMed: 35673998
DOI: 10.5607/en21019