Introduction: Cervical radiculopathy (CR) is one of the diseases that most affect the cervical spine, causing radicular symptoms in the ipsilateral limb. Conservative treatment aim recover of both mechanical and physiological functions through neural mobilization techniques, along with the activation of the deep neck flexors with cervical segmental stabilization, combining techniques of joint mobilization and manipulation, which seeks mobility improvement of crucial areas of the cervical spine. The objective of this study was to evaluate a multimodal treatment to enhance the outcomes of conservative care in patients diagnosed with CR. Methods: The sample consisted of 11 patients with CR, between 21 and 59 years old, 3 female and 8 male. It was recorded the Visual Analogue Scale (VAS) for pain, the Functional Development of the Neck Pain and Disability Scale (NPDS) and the goniometry during shoulder abduction. The intervention plan was composed by neural mobilization, intermittent cervical traction, pompages, stretching, myofascial inhibition techniques, manipulative techniques and cervical segmental stabilization exercises. After 12 weeks of treatment, subjects underwent a new evaluation process. Results: Before the treatment, subjects reported an average pain of 7 (± 1.48) in VAS, whose dropped to average 1.18 (± 1.99) (p < 0.01). Functional disability evaluated in NPDS was 36 (± 10.95) before treatment decreasing to 11.45 (± 9.8) (p < 0.01) after the treatment. Range of motion of the ipsilateral upper limb was restores by increasing from 9.2° (± 8.2) to 137° (± 24.4) (p < 0.01). Conclusion: The proposed treatment approach was effective, significantly improving the results of analgesia and functional disability a series of cases of patients diagnosed with cervical radiculopathy. {#}
ResumoObjetivo Avaliar o déficit motor decorrente do acesso através do músculo psoas na técnica XLIF. Métodos Estudo prospectivo, não randomizado, controlado, único centro. Sessenta pacientes com média de 61,8 anos. Todos os participantes passaram por fusão intersomática lombar por acesso lateral retroperitoneal com monitoração eletroneuromiográfica. Foram operados de 1 a 3 níveis nesses casos (média de 1,4; 63% eram de apenas um nível; 68% incluíram L4-L5). A força de flexão isométrica do quadril em posição sentada foi determinada bilateralmente com um dinamômetro de mão. As médias das medidas de 3 picos de força (N) foram calculadas. Testes isométricos padronizados foram realizados antes e em 10 dias, 6 semanas, 3 e 6 meses após a cirurgia. Resultados A força de flexão do quadril no lado ipsilateral diminuiu (p < 0,001) no pós-operatório imediato, mas em 6 semanas atingiu os valores pré-operatórios. As médias de pré-operatório, 10 dias, 6 semanas, 3 meses e 6 meses para flexão de quadril medidos foram: (Ipsilateral) 13 N;9,7 N;13,7 N; 14,4 N; 16 N; (Contralateral) 13,3 N;13,4 N; 15,3 N; 15,9 N; 16,1 N. Nem o nível ou o número de níveis tratados tiveram clara associação com sintomas na coxa, mas a fraqueza de flexão de quadril foi o sintoma mais encontrado. Conclusões O pós-operatório imediato do acesso transpsoas apresentou fraqueza de flexão de quadril após a cirurgia. Entretanto, essa ocorrência é transiente, e o uso da eletroneuromiografia é essencial no acesso transpsoas. Somado a isso, a educação do paciente deve ser amplamente aplicada para alertar sobre a possibilidade de fraqueza de flexão de quadril com o intuito de prevenir quedas no período pós-operatório imediato. AbstractObjective This work evaluated the motor deficit following the access through the psoas muscle in the XLIF approach.
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