Muvaffaqiyatsiz orqa sindromi - Failed back syndrome

Muvaffaqiyatsiz orqa sindromi yoki post-laminektomiya sindromi bilan tavsiflangan shartdir surunkali og'riq quyidagi orqa jarrohlik operatsiyalari.[1][2][3][ishonchsiz tibbiy manbami? ] FBSning paydo bo'lishi yoki rivojlanishiga ko'plab omillar, shu jumladan qoldiq yoki takroriy ta'sir ko'rsatishi mumkin o'murtqa disk churrasi, o'murtqa asabga operatsiyadan keyingi doimiy bosim, qo'shma harakatchanlikning o'zgarishi, qo'shma gipermobilitivlik beqarorlik bilan, chandiq to'qimasi (fibroz ), depressiya, tashvish, uyqusizlik, orqa miya mushaklari tozalash va hatto Kutibakterium aknalari infektsiya.[4] Kabi tizimli kasalliklar tufayli shaxs FBS rivojlanishiga moyil bo'lishi mumkin diabet, otoimmun kasallik va periferik qon tomirlari (qon tomirlari) kasalligi.

FBS bilan bog'liq keng tarqalgan alomatlar orasida orqa yoki oyoqlarda tarqalgan tarqoq, xiralashgan va og'riqli og'riqlar mavjud. G'ayritabiiy sezuvchanlik ekstremitalarda o'tkir, tirnoqli va pichoqli og'riqlarni o'z ichiga olishi mumkin. "Post-laminektomiya sindromi" atamasi ba'zi shifokorlar tomonidan muvaffaqiyatsiz bel sindromi holatini ko'rsatish uchun ishlatiladi.

Post-laminektomiya sindromining davolash usullari fizik davolanishni, kam kuchga xos chiropraktik parvarishni o'z ichiga oladi[iqtibos kerak ], mikro-oqim elektr-nerv-mushak stimulyatori,[5] kichik asab bloklari, teri osti elektr asab stimulyatsiyasi (TENS), xulq-atvor tibbiyoti, steroid bo'lmagan yallig'lanishga qarshi (NSAID) dori vositalari, membrana stabilizatorlari, antidepressantlar, orqa miya stimulyatsiyasi va intratekal morfin pompasi. Ba'zi hollarda epidural steroid in'ektsiyalaridan foydalanish minimal darajada foydali bo'lishi mumkin. Yallig'lanishga qarshi kuchli TNF terapevtik vositalaridan maqsadli anatomik foydalanish tekshirilmoqda.

Orqa miya operatsiyalari soni dunyo bo'ylab turlicha. Qo'shma Shtatlar va Niderlandiya umurtqa pog'onalarini eng ko'p operatsiya qilishgan, Buyuk Britaniya va Shvetsiya esa eng kam operatsiyani qayd etishgan. So'nggi paytlarda Evropada ko'proq agressiv jarrohlik davolanishga chaqiriqlar mavjud. Orqa miya jarrohligining muvaffaqiyat darajasi ko'plab sabablarga ko'ra farq qiladi.[6][7]

Sababi

Bemorning orqa qismida operatsiya qiluvchi o'murtqa jarrohlar.

Bel umurtqasida bir yoki bir nechta operatsiyani boshdan kechirgan va keyinchalik og'riqni boshdan kechirishni davom ettiradigan bemorlarni ikki guruhga bo'lish mumkin. Birinchi guruhga operatsiya aslida ko'rsatilmagan yoki o'tkazilgan jarrohlik kerakli natijaga erisha olmaydiganlar va jarrohlik ko'rsatilgan, ammo texnik jihatdan mo'ljallangan natijaga erishmaganlar kiradi.[8] Og'riqqa shikoyat qiladigan bemorlar a radikulyar tabiatning og'riqli shikoyati orqadagi og'riq bilan cheklanganlarga qaraganda yaxshi natijalarga erishish uchun ko'proq imkoniyatga ega.

Ikkinchi guruhga operatsiyalarni to'liq yoki etarli darajada o'tkazilmagan bemorlar kiradi. Bel o'murtqa stenoz e'tibordan chetda qolishi mumkin, ayniqsa, bu diskning chiqib ketishi yoki churrasi bilan bog'liq bo'lsa. Diskni olib tashlash, stenozning mavjudligini ko'rib chiqmasa ham, umidsiz natijalarga olib kelishi mumkin.[9] Ba'zida noto'g'ri darajada ishlash, shuningdek, ekstrudirovka qilingan yoki ajratilgan disk parchasini tanib bo'lmaslik kabi holatlar yuz beradi. Noto'g'ri yoki noo'rin jarrohlik ta'sir qilish, asosiy patologiyaga kirmaslikda boshqa muammolarga olib kelishi mumkin. Xakelius 3% asab tomirlarining jiddiy zararlanish holatlarini qayd etdi.[10]

1992 yilda Tyorner va boshq. o'murtqa stenoz uchun dekompressiyadan keyingi natijalar haqida xabar bergan 74 ta jurnal maqolalari bo'yicha so'rovnomani e'lon qildi. Bemorlarning 64% o'rtacha va yaxshi natijalarga erishganligi haqida xabar berishdi. Shu bilan birga, natijalarning keng o'zgarishi qayd etildi. Degenerativ spondilolistez bo'lgan bemorlarda yaxshi natija bor edi.[11] Mardjekto va boshqalarning xuddi shunday ishlab chiqilgan tadqiqotlari. Birgalikda o'murtqa artrodezi (termoyadroviy) ko'proq muvaffaqiyatga erishganligini aniqladi.[12] Herron va Trippi 24 bemorni baholashdi, ularning barchasi degenerativ spondilolistez bilan faqat laminektomiya bilan davolangan. Jarrohlikdan keyingi 18 dan 71 oygacha davom etadigan kuzatuvda 24 bemorning 20 tasi yaxshi natijani qayd etdi.[13] Epstein 25 yil davomida davolangan 290 bemor haqida xabar berdi. A'lo natijalar 69% da, yaxshi natijalar 13% da olingan.[14] Ushbu nekbin hisobotlar "raqobatbardosh ish joyiga qaytish" stavkalari bilan o'zaro bog'liq emas, aksariyat hollarda o'murtqa jarrohlik operatsiyalarining aksariyati yomon.[iqtibos kerak ]

So'nggi yigirma yil ichida AQShda termoyadroviy jarrohlik amaliyotining keskin o'sishi kuzatildi: 2001 yilda 122000 dan ortiq bel sintezi amalga oshirildi, 100000 aholiga 1990 yilga nisbatan termoyadroviy 22% ga o'sdi, 2003 yilda bu ko'rsatkich 250000 ga etdi va 500000 2006 yilda.[15][16][17] 2003 yilda faqat termoyadroviy uchun uskunalar uchun milliy hisob-kitob yiliga 2,5 milliard dollarga ko'tarildi.[16][18]Jarrohlikdan so'ng og'riqni davom ettiradigan, yuqoridagi asoratlar yoki holatlarga bog'liq bo'lmagan bemorlar uchun interventsion og'riq shifokorlari "og'riq generatorini", ya'ni bemorning og'rig'iga javob beradigan anatomik tuzilmani aniqlash zarurligi haqida gapirishadi. Samarali bo'lish uchun jarroh to'g'ri anatomik tuzilishda operatsiya qilishi kerak, ammo og'riq manbasini aniqlashning iloji yo'q.[19][20] Buning sababi shundaki, ko'plab bemorlar surunkali og'riq ko'pincha o'murtqa darajadagi diskda shish paydo bo'ladi va fizik tekshiruv va tasvirlash ishlari og'riq manbasini aniqlay olmaydi.[19] Bunga qo'chimcha, o'murtqa sintez o'zi, ayniqsa bir nechta o'murtqa darajasida operatsiya qilingan bo'lsa, "qo'shni segment degeneratsiyasi" ga olib kelishi mumkin.[21] Buning sababi shundaki, eritilgan segmentlar burilishni kuchaytirishi va kuchlanish kuchlarini kuchayishiga olib kelishi mumkin intervertebral disklar birlashtirilgan umurtqalarning yuqorisida va ostida joylashgan.[21] Ushbu patologiya - termoyadroviy jarrohlikning mumkin bo'lgan alternativasi sifatida sun'iy disklarning rivojlanishining bir sababi. Ammo termoyadroviy jarrohlar buni ta'kidlaydilar o'murtqa sintez ko'proq vaqt sinovidan o'tgan va sun'iy disklar tarkibida metall buyumlar mavjud bo'lib, ular biologik material singari umurtqa pog'onasida metall parchalarini tashlab ketmasdan davom etishi mumkin emas. Ular boshqacha fikr maktablari. (Diskni almashtirish bo'yicha munozaraga qarang.)

"Kimyoviy radikulit" ning avlodda ahamiyati tobora ortib borayotgani bu juda dolzarb masalalardan biri orqa og'riq.[22] Jarrohlikning asosiy yo'nalishi "bosimni" olib tashlash yoki asabiy elementga mexanik siqishni kamaytirishdir: yoki orqa miya yoki a asab ildizi. Ammo tobora kuchayib bormoqda, faqat siqilish tufayli emas, balki orqa miya og'rig'i butunlay asab ildizining kimyoviy yallig'lanishiga bog'liq bo'lishi mumkin. Bir necha o'n yillar davomida ma'lumki, disk churralari bog'langan asab ildizining massiv yallig'lanishiga olib keladi.[22][23][24][25] So'nggi besh yil ichida ko'payib borayotgan dalillar ushbu og'riqning o'ziga xos yallig'lanish vositachisini ko'rsatdi.[26][27] Ushbu yallig'lanish molekulasi deb ataladi o'sma nekrozi omil-alfa (TNF), nafaqat churra yoki chiqadigan disk tomonidan, balki diskning yirtilishi (halqasimon yirtilish) holatlarida, faset bo'g'imlari va o'murtqa stenoz.[22][28][29][30] Og'riq va yallig'lanishni keltirib chiqarishdan tashqari, TNF diskning degeneratsiyasiga ham hissa qo'shishi mumkin.[31] Agar og'riqning sababi siqilish emas, balki yallig'lanish TNF vositachiligida bo'lsa, unda bu nima uchun operatsiya og'riqni engillashtirmasligi va hatto uni kuchaytirishi, natijada FBSSga olib kelishi mumkin.

Roli sakroiliak qo'shma (SIJ) bel og'rig'i (LBP)

Koen tomonidan 2005 yilda o'tkazilgan tekshiruvda "SI qo'shilishi eksenel LBP bilan og'rigan bemorlarning 15% dan 25% gacha bo'lgan haqiqiy, ammo baholanmagan og'riq generatoridir" degan xulosaga keldi.[32] Ha va boshqalarning tadqiqotlari shuni ko'rsatadiki, post-lomber termoyadroviy jarrohlik operatsiyasida SI qo'shma degeneratsiyasining paydo bo'lishi, operatsiyadan keyingi 5 yil davomida tasvirga asoslangan holda 75% ni tashkil qiladi.[33] DePalma va Liliang va boshqalarning tadqiqotlari shuni ko'rsatadiki, post-lumbar termoyadroviy bemorlarning 40-61% diagnostika bloklari asosida SI qo'shma disfunktsiyasi uchun simptomatik bo'lgan.[34][35]

Chekish

KT tekshiruvi sezilarli darajada qalinlashganligini ko'rsatmoqda ligamentum flavum (sariq ligament) sabab bo'ladi o'murtqa stenoz bel umurtqasida.

Yaqinda o'tkazilgan tadqiqotlar shuni ko'rsatdiki, sigaret chekuvchilar umurtqa pog'onasidagi barcha operatsiyalarni muntazam ravishda uddalay olmaydilar, agar bu operatsiya maqsadi og'riqni kamaytirish va zaiflashish bo'lsa. Ko'pgina jarrohlar chekishni mutlaq deb bilishadi kontrendikatsiya orqa miya jarrohligiga. Nikotin induktsiya orqali suyak almashinuviga xalaqit beradi kaltsitonin qarshilik va osteoblastik funktsiyani pasayishi. Shuningdek, u qon tomirlari diametrini cheklab qo'yishi mumkin, bu esa chandiq hosil bo'lishining kuchayishiga olib keladi.[36][37][38][39][40][41][42]

Sigaret chekish, bel og'rig'i va barcha turdagi surunkali og'riq sindromlari o'rtasida bog'liqlik mavjud.[43][44][37][45][46]

Daniyadagi 426 umurtqa pog'onasi bilan kasallangan bemorlarning hisobotida chekish termoyadroviy va umumiy bemorning qoniqish ta'siriga salbiy ta'sir ko'rsatdi, ammo funktsional natijalarga o'lchovli ta'sir ko'rsatmadi.[47]

Operatsiyadan keyingi gipotetik taxminni tasdiqlash mavjud chekishni tashlash sigareta chekishni o'murtqa sintezdan keyingi natijalarga ta'sirini qaytarishga yordam beradi. Agar operatsiyadan keyingi davrda bemorlar sigareta chekishni to'xtatsalar, muvaffaqiyatga ijobiy ta'sir ko'rsatadi.[48]

O'smirlik davrida muntazam ravishda chekish yosh kattalardagi bel og'rig'i bilan bog'liq edi. Paket yillari chekish qizlar o'rtasida ta'sirga javob munosabatlarini ko'rsatdi.[49]

Yaqinda o'tkazilgan bir tadqiqot shuni ko'rsatdiki, sigareta chekish sarumga salbiy ta'sir qiladi gidrokodon darajalar. Shifokorlarni tayinlash ba'zi sigaret chekuvchilarda sarum gidrokodon miqdorini aniqlash mumkin emasligini bilishlari kerak.[50]

Daniyadan adabiyotdagi ko'plab hisobotlarni ko'rib chiqqan holda, chekishni belning og'rig'i emas, balki zaif xavf belgisi deb hisoblash kerak degan xulosaga kelishdi. Ko'pgina epidemiologik tadqiqotlar davomida chekish va bel og'rig'i o'rtasidagi bog'liqlik qayd etilgan, ammo yondashuv va o'rganish natijalarining o'zgarishi ushbu adabiyotni yarashtirishni qiyinlashtiradi.[51] Milliy umurtqa pog'onasi tarmog'idan lomber o'murtqa jarrohlik amaliyotini o'tkazadigan 3482 bemorni ommaviy ravishda o'rganish paytida (1) chekish, (2) kompensatsiya, (3) o'z-o'zini umumiy sog'lig'i yomonlashganligi va (4) oldindan mavjud bo'lgan psixologik omillar qobiliyatsizligi yuqori xavfi. Followup operatsiyadan 3 oy va bir yil o'tgach amalga oshirildi. Operatsiyadan oldingi depressiya kasalliklari yaxshi natija bermadi.[52]

Chekish operatsiyadan keyingi infektsiyani ko'paytiradi va birlashish tezligini pasaytiradi. Bir tadqiqot shuni ko'rsatdiki, operatsiyadan keyingi infektsiyalarning 90% sigaret chekuvchilarda, shuningdek yara atrofidagi myonekroz (mushaklarning yo'q qilinishi).[53][54]

Patologiya

KT tekshiruvi paydo bo'lishidan oldin, muvaffaqiyatsiz orqa sindromidagi patologiyani tushunish qiyin edi. Kompyuterlashtirilgan tomografiya 1960 va 1970-yillarning oxirlarida metrizamid miyelografiyasi bilan birgalikda operatsiyadan keyingi nosozliklar bilan bog'liq mexanizmlarni bevosita kuzatishga imkon berdi. Olti xil patologik holat aniqlandi:

  • Takroriy yoki doimiy disk churrasi
  • Orqa miya stenozi
  • Operatsiyadan keyingi infektsiya
  • Operatsiyadan keyingi epidural fibroz
  • Yopishqoq araxnoidit
  • Asab shikastlanishi

Takroriy yoki doimiy disk churrasi

Bel umurtqasidagi katta churrali diskning tomografiya tasviri.

Bir darajadagi diskni olib tashlash, keyinchalik boshqa darajadagi disk churrasini keltirib chiqarishi mumkin. Diskning eng to'liq jarrohlik eksizatsiyasi ham diskning 30-40 foizini qoldiradi, uni xavfsiz olib tashlash mumkin emas. Ushbu saqlangan disk operatsiyadan keyin bir muncha vaqt o'tgach qayta churraga aylanishi mumkin. Qorin bo'shlig'idagi va orqa retroperitoneal bo'shliqning deyarli har qanday asosiy tuzilishi, bir muncha vaqt, orqa laminektomiya / diskektomiya jarrohlik muolajalari yordamida disklarni olib tashlash orqali jarohatlangan. Ularning eng ko'zga ko'ringan tomoni - bu diskning old qismiga yaqin joylashgan chap ichki yonbosh venasining yorilishi.[55][56] Ba'zi tadkikotlarda bir xil radikulyar naqshdagi yoki boshqa naqshdagi takrorlanadigan og'riq diskdagi operatsiyadan keyin 50% gacha bo'lishi mumkin.[57][58] Ko'pgina kuzatuvchilar ta'kidlashlaricha, muvaffaqiyatsizlikka uchragan bel sindromining eng keng tarqalgan sababi, dastlab operatsiya qilingan bir xil darajadagi diskning churrasi. Ikkinchi operatsiyani tezda olib tashlash davolovchi bo'lishi mumkin. Qaytalanadigan disk churrasi klinik ko'rinishi odatda sezilarli og'riqsiz oraliqni o'z ichiga oladi. Biroq, jismoniy topilmalar etishmayotgan bo'lishi mumkin va yaxshi tarixga ehtiyoj bor.[59][60][61][62] Yangi alomatlar paydo bo'lishi uchun vaqt qisqa yoki uzoq bo'lishi mumkin. Kabi diagnostik belgilar to'g'ri oyoq ko'tarish haqiqiy patologiya mavjud bo'lsa ham, test salbiy bo'lishi mumkin.[58][63] Ijobiy miyelogramning mavjudligi yangi disk churrasini ko'rsatishi mumkin, ammo operatsiyadan keyingi chandiq holatini shunchaki yangi diskka taqlid qilishi mumkin. MRTni ko'rishning yangi usullari ushbu dilemmani biroz aniqlab berdi.[59][60][64][65][66][67] Aksincha, takroriy diskni post op skarlasma mavjud bo'lganda aniqlash qiyin bo'lishi mumkin. Miyelografiya bemorni takrorlanadigan disk kasalligi uchun to'liq baholash uchun etarli emas va KT yoki MRI skanerlash zarur. To'qimalarning zichligini o'lchash foydali bo'lishi mumkin.[9][64][68][69][70]

Disk churrasi uchun laminektomiyaning asoratlari sezilarli bo'lishi mumkin bo'lsa ham, minglab bemorlarni qamrab olgan so'nggi tadqiqotlar seriyasi homiyligida nashr etilgan Dartmut tibbiyot maktabi to'rt yillik kuzatuvda, bel disklari churrasi bo'yicha operatsiya qilinganlar, ish holatidan tashqari barcha birlamchi va ikkinchi darajali natijalarda operatsiyasiz davolangan bemorlarga qaraganda ancha yaxshilanishga erishdilar.[71]

Orqa miya stenozi

Yangi stenozni keltirib chiqaradigan chandiq hosil bo'lishini ko'rsatadigan (qizil rang bilan ko'rsatilgan) laminektomiyaning KT tekshiruvi.

Orqa miya stenozi disk churrasi uchun laminektomiyadan so'ng yoki o'murtqa stenozning asosiy patologik holatida operatsiya o'tkazilganda kech tug'ruq bo'lishi mumkin.[9][72][73] Meyn tadqiqotida, bel o'murtqa stenozi bo'lgan bemorlar orasida 8 yildan 10 yilgacha kuzatuvni yakunlagan, bel og'rig'ini engillashtirgan, simptomlarning ustunlashuvi va hozirgi holatdan qoniqish dastlab jarrohlik yoki jarrohlik usulida davolanmagan bemorlarda o'xshash edi. Shu bilan birga, oyoq og'rig'ini yo'qotish va orqaga bog'liq funktsional holat, dastlab jarrohlik muolajasini olganlarga yordam berishda davom etdi.[74]

Finlyandiya tomonidan olib borilgan o'murtqa stenoz bo'yicha katta tadqiqotlar natijasida operatsiyadan keyin ishlash qobiliyatining prognostik omillari jarrohlikdan oldin ishlash qobiliyati, 50 yoshga to'lmaganligi va oldingi operatsiyaning yo'qligi aniqlandi. Juda uzoq muddatli natija (o'rtacha kuzatuv davri 12,4 yil) bemorlarning 68 foizida (59 foiz ayollar va 73 foiz erkaklar) yaxshi natijalarga erishdi. Bundan tashqari, bo'ylama kuzatishda natija 1985-1991 yillarda yaxshilandi. Ushbu juda uzoq muddatli kuzatuv vaqtida hech qanday maxsus asoratlar kuzatilmadi. Operatsiyadan oldingi miyelografiyada total yoki subtotal bloklangan bemorlar eng yaxshi natijaga erishishdi. Bundan tashqari, blok stenozi bo'lgan bemorlar uzunlamasına kuzatishda o'z natijalarini sezilarli darajada yaxshilashdi. Kompyuter tomografiyasida ko'rilgan operatsiyadan keyingi stenoz 90 bemorning 65 foizida kuzatilgan va 23 bemorda (25 foiz) og'ir bo'lgan. Biroq, ushbu muvaffaqiyatli yoki muvaffaqiyatsiz jarrohlik dekompressiyasi bemorlarning sub'ektiv nogironligi, yurish qobiliyati yoki og'riqning zo'ravonligi bilan bog'liq emas. Oldingi orqa jarrohlik jarrohlik natijalariga kuchli yomonlashuv ta'sirini ko'rsatdi. Operatsiyadan oldingi miyelografiyada umumiy blok bo'lgan bemorlarda bu ta'sir juda aniq edi. Oldingi orqa jarrohlik operatsiyalari bilan og'rigan bemorning jarrohlik natijasi, oldingi ikki operatsiya orasidagi vaqt oralig'i 18 oydan ortiq bo'lganida, oldingi orqa jarrohlik amaliyotisiz bemorga o'xshardi.[75]

Operatsiyadan keyingi stenozning MRG natijalari bemorlar boshdan kechirgan alomatlarga nisbatan cheklangan qiymatga ega. Bemorlarning yaxshilanishni idrok etishi operatsiyadan keyingi magnit-rezonans tomografiyada ko'rilgan strukturaviy topilmalarga qaraganda uzoq muddatli jarrohlik natijalari bilan ancha kuchli bog'liqlikka ega edi. Degenerativ topilmalar bemorlarning yurish qobiliyatiga stenotik topilmalarga qaraganda ko'proq ta'sir ko'rsatdi.[76][77]

Operatsiyadan keyingi rentgenologik stenoz lomber o'murtqa stenozi bilan operatsiya qilingan bemorlarda juda keng tarqalgan, ammo bu klinik natijalar bilan bog'liq emas. Klinisyen belning o'murtqa stenozi bilan operatsiya qilingan bemorlarda operatsiyadan keyingi kompyuter tomografiya natijalari bilan klinik alomatlar va belgilarni moslashtirishda ehtiyotkor bo'lishi kerak.[78]

Jorjtaun universiteti tomonidan olib borilgan tadqiqotlar shuni ko'rsatdiki, 1980-1985 yillarda lomber stenoz uchun dekompressiv operatsiyani boshdan kechirgan yuzta bemor haqida. Postfuzion stenozli to'rtta bemor kiritilgan. 88 bemorda 5 yillik kuzatuv davriga erishildi. O'rtacha yosh 67 yoshni tashkil etdi va 80% 60 yoshdan oshgan. Birgalikda tibbiy kasalliklarning yuqori darajasi bor edi, ammo asosiy nogironlik nevrologik ishtirok bilan bel stenozi edi. Dastlab muvaffaqiyatga erishishning yuqori darajasi bor edi, ammo nevrologik ishtirokning qaytalanishi va bel og'rig'ining davom etishi muvaffaqiyatsizliklar sonining ko'payishiga olib keldi. 5 yilga kelib bu raqam mavjud bo'lgan aholi havzasining 27 foiziga etdi, demak, aksariyat bemorlarning taxmin qilingan umr ko'rish davomiyligi darajasida muvaffaqiyatsizlik darajasi 50 foizga yetishi mumkin. 26 ta muvaffaqiyatsizlikdan 16 tasi sakkiztasida stenozning yangi darajalarida va sakkiztasida operativ darajadagi stenozning takrorlanishida yuzaga kelgan yangilangan nevrologik ishtirok etish uchun ikkinchi darajali edi. Ushbu 16 bemorning 12tasida reoperatsiya muvaffaqiyatli o'tdi, ammo ikkitasi uchinchi operatsiyani talab qildi. Hodisa spondilolistez 5 yoshida jarrohlik muvaffaqiyatsizlikka qaraganda (26 bemorning 12 tasi) jarrohlik yutuqlariga qaraganda (64 ning 16 tasi) yuqori bo'lgan. Spondilolistetik stenoz dekompressiyadan keyingi bir necha yil ichida qaytalanishga moyil edi. Yoshi va unga bog'liq kasalliklar tufayli bu guruhda birlashishga erishish qiyin bo'lishi mumkin.[79]

Operatsiyadan keyingi infektsiya

Lomber jarrohlik bemorlarning ozchilik qismi operatsiyadan keyingi infektsiyani rivojlantiradi. Ko'pgina hollarda, bu yomon asorat bo'lib, oxir-oqibat yaxshilanishi yoki kelajakda ish bilan ta'minlanishi uchun yaxshi sabab bo'lmaydi. Jarrohlik adabiyotidan olingan hisobotlarda infektsiya darajasi 0% dan deyarli 12% gacha.[80][81][82][83][84][85][86][87][88][89][90][91][92][93][94][95] Jarayonning murakkabligi va ish vaqti oshgani sayin infektsiya tezligi oshib boradi. Metall implantlardan foydalanish (asbobsozlik) infektsiya xavfini oshiradi. Infektsiyani kuchayishi bilan bog'liq omillar orasida diabet mellitus, semirish, to'yib ovqatlanmaslik, chekish, avvalgi infektsiya, revmatoid artrit va immunitet tanqisligi mavjud.[96][97][98][99][100][101]Oldingi yara infektsiyasini o'murtqa jarrohlik amaliyotiga qarshi ko'rsatma deb hisoblash kerak, chunki bunday bemorlarni ko'proq jarrohlik operatsiyalari bilan yaxshilash ehtimoli kam.[102][103][104][105][106][107]Antimikrobiyal profilaktika (infektsiya boshlangunga qadar operatsiya paytida yoki undan keyin antibiotiklar berish) umurtqa pog'onasidagi jarrohlik operatsiyasida jarrohlik joyini yuqtirish darajasini pasaytiradi, ammo uning qo'llanilishida juda ko'p farqlar mavjud. Yapon tadqiqotida Kasalliklarni nazorat qilish markazlari antibiotiklarning profilaktikasi bo'yicha tavsiyalar, umumiy infektsiya darajasi 0,7% qayd etilgan, bitta dozali antibiotik guruhi 0,4% infektsiyaga va ko'p dozali antibiotiklar infektsiyasi 0,8% ga teng. Mualliflar ilgari operatsiyadan keyingi 5-7 kun davomida profilaktik antibiotiklardan foydalanganlar. Kasalliklarni nazorat qilish va oldini olish markazlari ko'rsatmasi asosida ularning antibiotiklar profilaktikasi faqat operatsiya qilingan kunga o'zgartirildi. Ikki xil antibiotik protokollari o'rtasida infektsiya darajasida statistik farq yo'q degan xulosaga kelishdi. CDC yo'riqnomasiga asoslanib, profilaktik antibiotikning bitta dozasi o'murtqa operatsiyalarda infektsiyani oldini olish uchun samarali ekanligi isbotlandi.[108]

Operatsiyadan keyingi epidural fibroz

Diskni olib tashlash uchun laminektomiyadan so'ng epidural chandiq takrorlanadigan siyatik yoki radikulopatiya uchun qayta ishlashda keng tarqalgan xususiyatdir.[59] Skarlar disk churrasi va / yoki qaytalanuvchi o'murtqa stenoz bilan bog'liq bo'lsa, bu nisbatan keng tarqalgan bo'lib, 60% dan ortiq hollarda uchraydi. Bir muncha vaqt davomida yog 'payvandini dural ustiga qo'yish operatsiyadan keyingi chandiq paydo bo'lishiga to'sqinlik qilishi mumkin edi. Biroq, so'nggi yillarda dastlabki g'ayrat susaymoqda.[109][110][111][112][113] 2 yoki undan ortiq umurtqani o'z ichiga olgan keng laminektomiyada operatsiyadan keyingi chandiq norma hisoblanadi. Ko'pincha L5 va S1 nerv ildizlari atrofida uchraydi.[114][115][116]

Yopishqoq araxnoidit

Bel umurtqasida araxnoiditning odatiy topilmalarini ko'rsatadigan miyelogramma.

Fibröz chandiq ham subaraknoid bo'shliqda asorat bo'lishi mumkin. Uni aniqlash va baholash juda qiyin. Rivojlanishidan oldin magnit-rezonans tomografiya, mavjudligini aniqlashning yagona usuli araxnoidit durani ochish bilan edi. Kunlarida KT skanerlash va Pantopak va keyinroq, Metrizamid miyelografiya, araxnoidit borligi rentgenografik topilmalar asosida taxmin qilinishi mumkin. Ko'pincha Metrizamid kiritilgunga qadar miyelografiya araxnoiditning sababi bo'lgan. Bunga qattiq disk churrasi yoki o'murtqa stenoz bilan olib kelingan uzoq muddatli bosim sabab bo'lishi mumkin.[60][59][117][118][62] Xuddi shu bemorda epidural yara izlari va araxnoiditning mavjudligi ehtimol juda keng tarqalgan. Araxnoidit - bu miya yarim kortekslari va subaraknoid bo'shliqning yallig'lanishini bildiruvchi keng atama. Yuqumli, yallig'lanishli va neoplastik jarayonlarni o'z ichiga olgan turli sabablar mavjud, yuqumli sabablarga bakterial, virusli, qo'ziqorin va parazitlar kiradi. Yuqumli bo'lmagan yallig'lanish jarayonlariga jarrohlik, intratekal qon ketish va intellektual vositalarni kiritish (dural kanal ichkarisida) miyelografik kontrast vositalar, anestezikalar (masalan.) Kiradi. xloroprokain ) va steroidlar (masalan, Depo-Medrol, Kenalog). So'nggi paytlarda yatrogenik araxnoidit tasodifan intratekal ravishda yuborilganda noto'g'ri joylashtirilgan Epidural steroid in'ektsiya terapiyasiga sabab bo'ldi. Barcha steroidli in'ektsiyalarda mavjud bo'lgan konservantlar va suspenzion vositalar, bu AQShning oziq-ovqat va farmatsevtika idorasi tomonidan araxnoidit, falaj va o'lim kabi og'ir noxush hodisalar tufayli kelib chiqqanligi sababli epidural administratsiya qilish uchun ko'rsatilmagan. kimyoviy menenjitning dastlabki bosqichidan keyingi kasallik.[119][120][121][122] Neoplaziya tizimli o'smalarning gematogen tarqalishini o'z ichiga oladi, masalan, ko'krak va o'pka karsinomasi, melanoma va Xodkin bo'lmagan lenfoma. Neoplaziya, shuningdek, markaziy asab tizimining (CNS) o'smalaridan miya omurilik suyuqligini (CSF) to'g'ridan-to'g'ri urug'lantirishni o'z ichiga oladi. glioblastoma multiforme, medulloblastoma, ependimoma va koroid pleksus karsinomasi. Qisqacha aytganda, muvaffaqiyatsiz bel sindromidagi araxnoiditning eng keng tarqalgan sababi yuqumli yoki saraton kasalligidan kelib chiqmaydi. Bu jarrohlik yoki asosiy patologiyaning ikkinchi darajali o'ziga xos bo'lmagan chandiqlari bilan bog'liq. [123][124][125][126][127][128][129][130]

Asab jarohati

Nerv ildizining yorilishi yoki ehtiyotkorlik yoki tortishish natijasida shikastlanish surunkali og'riqlarga olib kelishi mumkin, ammo buni aniqlash qiyin bo'lishi mumkin. Disk, suyak (osteofit) yoki chandiq kabi doimiy agent tomonidan asab ildizining surunkali siqilishi ham asab ildiziga doimiy zarar etkazishi mumkin. Dastlabki patologiyadan kelib chiqadigan yoki jarrohlik amaliyotidan so'ng paydo bo'ladigan epidural chandiqlar ham asabning buzilishiga olib kelishi mumkin. Muvaffaqiyatsiz orqa bemorlarning bir tadqiqotida patologiyaning mavjudligi 57% hollarda o'tkazilgan jarrohlik darajasi bilan bir xil joyda ekanligi qayd etilgan. Qolgan holatlar patologiyani boshqa darajada yoki teskari tomonda rivojlantirdi, ammo jarrohlik amaliyoti bilan bir xil darajada. Nazariy jihatdan, barcha muvaffaqiyatsizlikka uchragan bemorlarda asab shikastlanishi yoki shikastlanishi bor, bu esa oqilona davolanish vaqtidan keyin simptomlarning davomiyligiga olib keladi.[57][58][131]

Tashxis

Post-laminektomiya / laminotomiya sindromidan saqlanish

Suyakni olib tashlamaydigan kichik protseduralar (masalan, endoskopik transforaminal lomber diskektomiya va rekonfiguratsiya) laminektomiya / laminotomiya sindromiga sabab bo'lmaydi.[132]

Menejment

Muvaffaqiyatsiz orqa sindromi (FBS) - bu bel umurtqasi jarrohligining taniqli asoratidir. Buning natijasida surunkali og'riq va nogironlik paydo bo'lishi mumkin, ko'pincha bemorga ruhiy va moliyaviy oqibatlarga olib keladi. Ko'pgina bemorlar an'anaviy ravishda "o'murtqa nogironlar" deb tasniflangan va uzoq muddat davolanishga imkon bermaydigan uzoq muddatli giyohvandlik bilan shug'ullanishadi. So'nggi yillarda keng ko'lamli ishlarga qaramay, FBS qiyin va qimmatbaho tartibsizlik bo'lib qolmoqda.[133]

Opioidlar

Surunkali og'riqli bemorlarni o'rganish Viskonsin universiteti buni topdi metadon opioidga qaramlikni davolashda ishlatilishi bilan eng keng tarqalgan, ammo metadon ham samarali analjeziya beradi. Boshqa opioidlar bilan og'riqni etarli darajada kamaytirmaslik yoki chidab bo'lmas nojo'ya ta'sirlarni boshdan kechirgan yoki neyropatik og'riq bilan og'rigan bemorlar metadonga og'riq qoldiruvchi vosita sifatida o'tishdan foyda ko'rishlari mumkin. Yomon ta'sirlar, xususan, nafas olish tizimidagi tushkunlik va o'lim metadonni surunkali og'riqli bemor uchun analjezik terapiya deb hisoblaydigan provayder uchun muhim bo'lgan farmakologik xususiyatlari to'g'risida bilimga ega.[134]

Bemorni tanlash

Bemorlar siyatik og'riq (orqa tarafdagi og'riq, dumg'aza oyog'iga nur sochish) va churraga aylangan disk natijasida aniqlanadigan radikulyar nervlarning yo'qolishining aniq klinik xulosalari operatsiyadan keyingi kursga shunchaki bel og'rig'i bo'lganlarga qaraganda yaxshiroq bo'ladi. Agar asab ildiziga bosim o'tkazadigan diskning aniq churrasini aniqlash mumkin bo'lmasa, operatsiya natijalari umidsizlikka uchraydi. Ishchining tovon puli, sud protsessi yoki boshqa kompensatsiya tizimlarida ishtirok etgan bemorlar operatsiyadan keyin yomonroq harakat qilishadi. Orqa miya stenozi bo'yicha operatsiya odatda yaxshi natijalarga olib keladi, agar operatsiya keng ko'lamda amalga oshirilsa va simptomlar paydo bo'lganidan keyin birinchi yil ichida amalga oshirilsa.[9][58][135][136][137]

Oaklander va Shimoliy "Fail Back" sindromini umurtqa pog'onasiga bir yoki bir nechta jarrohlik amaliyotidan so'ng surunkali og'riqli bemor deb ta'riflaydi. Ular bemor va jarroh o'rtasidagi munosabatlarning ushbu xususiyatlarini ajratib ko'rsatdilar:

  1. Bemor jarrohga og'riqni kamaytirish uchun tobora ortib borayotgan talablarni qo'yadi. Jarroh kerakli maqsadlarga erishmaganida, jarroh davo vositasi bilan ta'minlashda katta mas'uliyatni his qilishi mumkin.
  2. Bemor muvaffaqiyatsizlikka tobora ko'proq g'azablanib, sudga tortilishi mumkin.
  3. Odatiylashtiradigan yoki o'ziga qaram qilib qo'yadigan og'riqli dorilarning kuchayishi mavjud.
  4. Muvaffaqiyatsiz bo'lishi mumkin bo'lgan qimmatbaho konservativ davolarga qaramay, jarroh keyingi operatsiyani bajarishga ishontiriladi, garchi bu ham muvaffaqiyatsiz bo'lsa.
  5. Nogironlik davomiyligi oshgani sayin daromadli ishga qaytish ehtimoli kamayadi.
  6. Nogiron bo'lib qolishni moddiy rag'batlantirish tiklanish uchun rag'batdan ustunroq deb qabul qilinishi mumkin.[138]

Nogironlik yoki ishchining tovon puli uchun moliyaviy manbalar mavjud bo'lmaganda, boshqa psixologik xususiyatlar bemorning operatsiyadan tiklanish imkoniyatlarini cheklashi mumkin. Ba'zi bemorlar shunchaki baxtsiz bo'lib, sog'ayishni istashlariga va ularni parvarish qilishda ishtirok etgan shifokorlarning barcha sa'y-harakatlariga qaramay, "surunkali og'riq" toifasiga kiradi.[139][140][141][142][143][144][145][146][147][148][149] Jarrohlikning kamroq invaziv shakllari ham bir xilda muvaffaqiyatli bo'lmaydi; taxminan 30,000–40,000[qo'shimcha tushuntirish kerak ] laminektomiya bemorlar simptomatologiyani yengillashtirmaydi yoki simptomlarning qaytalanishini oladi.[150] Orqa miya jarrohligining yana bir kamroq invaziv shakli, teri osti diskida operatsiya, reviziya stavkalari 65% gacha bo'lganligi haqida xabar berdi.[151] Shuning uchun FBSS tibbiy va jarrohlik jamoalari tomonidan keyingi tadqiqotlar va e'tiborga loyiq bo'lgan muhim tibbiy muammo ekanligi ajablanarli emas.[19][20]

Jami diskni almashtirish

Lomber diskni to'liq almashtirish dastlab lomber artrodezga (termoyadroviy) alternativ sifatida ishlab chiqilgan. Ushbu protsedura Qo'shma Shtatlarda ham, Evropada ham katta hayajon bilan kutib olindi. 2004 yil oxirida diskni birinchi marta almashtirish disk raskadrovka oldi AQSh oziq-ovqat va farmatsevtika idorasi (FDA). Evropada ko'proq tajriba mavjud edi. O'shandan beri dastlabki hayajon shubha va xavotirga yo'l ochdi.[152][153][154][155][156][157][158] Diskni to'liq almashtirishni qayta ko'rib chiqish uchun turli xil nosozliklar va strategiyalar haqida xabar berilgan.[159]

Orqa miya kasalliklarini davolashda diskni sun'iy yoki to'liq almashtirishning roli aniqlanmagan va noaniq bo'lib qolmoqda.[160] Har qanday yangi texnikani baholash qiyin yoki imkonsiz, chunki shifokor tajribasi minimal yoki etishmasligi mumkin. Bemorlarning taxminlari buzilgan bo'lishi mumkin.[161][162] Diskni sun'iy ravishda almashtirish uchun aniq ko'rsatkichlarni aniqlash qiyin bo'ldi. Bu almashtirish protsedurasi yoki termoyadroviy alternativasi bo'lmasligi mumkin, chunki so'nggi tadqiqotlar shuni ko'rsatdiki, termoyadroviy bemorlarning 100% diskni almashtirishga qarshi bir yoki bir nechta kontrendikatsiyaga ega.[163][164][165] Diskni almashtirishning roli bugungi adabiyotda aniqlanmagan yangi ko'rsatmalar yoki mavjud bo'lgan kontrendikatsiyalarni yumshatishi kerak.[160]

Regan tomonidan olib borilgan tadqiqot [166] almashtirish natijasi L4-5 va L5-S1 da CHARITE disk bilan bir xil bo'lganligini aniqladi. Biroq, ProDisc II L5-S1 bilan taqqoslaganda L4-5da yanada qulay natijalarga ega edi.[167]

Yoshlik bir necha tadkikotlarda yaxshi natijalarni bashorat qilgan.[157][168][169] Boshqalarda bu salbiy bashorat qiluvchi yoki bashorat qiluvchi ahamiyatga ega emasligi aniqlandi.[170][171][172][173][174] Keksa bemorlarda ko'proq asoratlar bo'lishi mumkin.[173]

Oldingi o'murtqa operatsiya diskni almashtirishga aralash ta'sir ko'rsatdi. Bir nechta tadkikotlarda salbiy bo'lganligi haqida xabar berilgan.[170][175][176][177][174][178] Boshqa tadqiqotlarda hech qanday ta'siri yo'qligi haqida xabar berilgan.[179][168][172][177][180][157] Ko'pgina tadqiqotlar natijasizdir.[170] Mavjud dalillar hozirgi vaqtda diskni almashtirish holati to'g'risida aniq xulosalar chiqarishga imkon bermaydi.[160]

Elektr stimulyatsiyasi

Ko'plab muvaffaqiyatsizlikka uchragan bemorlar orqa va oyoqlarda surunkali og'riq tufayli sezilarli darajada buziladi. Ularning aksariyati elektr stimulyatsiyasi bilan davolanadi. Bu ham bo'lishi mumkin teri osti elektr asab stimulyatsiyasi orqa tomondan teriga joylashtirilgan asbob yoki orqa miyaga orqa miyaga to'g'ridan-to'g'ri tegib turadigan elektr zondlar bilan implantatsiya qilingan asab stimulyatori. Bundan tashqari, ba'zi surunkali og'riqli bemorlar foydalanadilar fentanil yoki narkotik yamalar. Ushbu bemorlar odatda jiddiy buzilgan va neyropstimulyatsiyani qo'llash ushbu buzilishni kamaytiradi degan xulosaga kelish haqiqiy emas. Masalan, neyrostimulyatsiya bemorni raqobatbardosh ishga qaytish uchun etarlicha yaxshilashi shubhali. Neyropstimulyatsiya palliativ. TENS birliklari Melzak va Uollning og'riq nazariyasida ta'riflanganidek, neyrotranslyatsiyani blokirovka qilish orqali ishlaydi.[181] Implantatsiya qilingan neyrostimulyatsiya uchun muvaffaqiyat darajasi 25% dan 55% gacha bo'lganligi haqida xabar berilgan. Muvaffaqiyat og'riqning nisbatan pasayishi deb ta'riflanadi.[182]

Chiropraktik

Bir nechta tadqiqotlar natijalari shiropraktik parvarish bilan boshqariladigan muvaffaqiyatsiz orqa jarrohligi bo'lgan bemorlar uchun sezilarli yaxshilanishlarni ko'rsatdi.[183][184]

Prognoz

Qo'shma Shtatlarning II va XVI unvonlari tomonidan e'lon qilingan qoidalarga muvofiq Ijtimoiy ta'minot to'g'risidagi qonun, surunkali radikulopatiya, araxnoidit va o'murtqa stenoz 1,04 A (radikulopatiya), 1,04 B (araxnoidit) va 1,04 S (o'murtqa stenoz) ro'yxatiga muvofiq nogiron sharoit sifatida tan olinadi. [185][186]

Ishga qaytish

Operatsiyadan keyingi skarlasma va araxnoiditni ko'rsatadigan tomografiya.

Kanadalik yangi tadqiqotda Vaddell va boshq.[187] takroriy operatsiyaning qiymati va ishchining tovon puli bilan ishiga qaytishi to'g'risida xabar berdi. Ularning xulosasiga ko'ra, umurtqa pog'onasini operatsiya qiladigan ishchilar o'z ishlariga qaytish uchun ko'proq vaqt talab qiladilar. Ikkita o'murtqa jarrohlik amaliyoti o'tkazilgandan so'ng, kamdan-kam hollarda har qanday turdagi foydali ishga qaytish mumkin. Ikki o'murtqa operatsiyadan so'ng, ishchilarning kompakt tizimidagi ko'pchilik odamlar ko'proq jarrohlik yo'li bilan yaxshilanmaydi. Ko'pchilik uchinchi operatsiyadan keyin yomonroq bo'ladi.

Ishchining tovon puli sharoitida ish jarohati bilan bog'liq bo'lgan bel og'rig'i epizodlari odatda qisqa muddatli bo'ladi. Bunday epizodlarning taxminan 10% oddiy bo'lmaydi va hatto jarrohlik amaliyoti o'tkazilmasa ham surunkali va nogiron bel kasalliklariga aylanadi.[188][189]

Ishdan qoniqmaslik va jismoniy talablarni individual ravishda qabul qilish tiklanish vaqtining ko'payishi yoki umuman tiklanmaslik xavfining ortishi bilan bog'liq degan faraz qilingan.[190] Shaxsiy psixologik va ijtimoiy ish omillari, shuningdek ishchilar va ish beruvchilar o'rtasidagi munosabatlar tiklanish vaqti va darajasi bilan bog'liq bo'lishi mumkin.[191][192][193]

Finlyandiya bemorlari bilan ishlashga qaytishni o'rganish o'murtqa stenoz jarrohlik yo'li bilan davolanganligi quyidagilarni aniqladi: (1) operatsiyadan oldin nafaqaga chiqqan bemorlarning hech biri keyinchalik ish joyiga qaytmagan. (2) Operatsiyadan keyingi ayollar uchun ishlash qobiliyatini taxmin qiladigan o'zgaruvchilar quyidagilar: operatsiya vaqtida ishlashga yaroqli bo'lish, operatsiya vaqtida <50 yosh va bel umurtqasi stenozi belgilari <2 yil. (3) Erkaklar uchun ushbu o'zgaruvchilar quyidagilar edi: operatsiya vaqtida ishlashga yaroqli bo'lish, operatsiya paytida <50 yosh, oldindan operatsiya qilinmaganligi va jarrohlik muolajasining hajmi birga teng yoki undan kam. laminektomiya. Lomber o'murtqa stenoz operatsiyasidan keyin ayollar va erkaklar ish qobiliyati farq qilmaydi. Agar maqsad ish qobiliyatini maksimal darajaga ko'tarish bo'lsa, unda umurtqa pog'onasi stenozi operatsiyasi ko'rsatilganda, uni kechiktirmasdan bajarish kerak. Lomber o'murtqa stenozi> 50 yoshga to'lgan va kasallik ta'tilida bo'lgan bemorlarda ularning ish joyiga qaytishini kutish haqiqatga to'g'ri kelmaydi. Therefore, after such an extensive surgical procedure, re-education of patients for lighter jobs could improve the chances of these patients returning to work.[194]

In a related Finnish study, a total of 439 patients operated on for lumbar spinal stenosis during the period 1974–1987 was re-examined and evaluated for working and functional capacity approximately 4 years after the decompressive surgery. The ability to work before or after the operation and a history of no prior back surgery were variables predictive of a good outcome. Before the operation 86 patients were working, 223 patients were on sick leave, and 130 patients were retired. After the operation 52 of the employed patients and 70 of the unemployed patients returned to work. None of the retired patients returned to work. Ability to work preoperatively, age under 50 years at the time of operation and the absence of prior back surgery predicted a postoperative ability to work.[195]

A report from Belgium noted that patients reportedly return to work an average of 12 to 16 weeks after surgery for lumbar disc herniation. However, there are studies that lend credence to the value of an earlier stimulation for return to work and performance of normal activities after a limited discectomy. At follow-up assessment, it was found that no patient had changed employment because of back or leg pain.The sooner the recommendation is made to return to work and perform normal activities, the more likely the patient is to comply. Patients with ongoing disabling back conditions have a low priority for return to work. The probability of return to work decreases as time off work increases. This is especially true in Belgium, where 20% of individuals did not resume work activities after surgery for a disc herniation of the lumbar spine.

In Belgium, the medical advisers of sickness funds have an important role legally in the assessment of working capacity and medical rehabilitation measures for employees whose fitness for work is jeopardized or diminished for health reasons. The measures are laid down in the sickness and invalidity legislation. They are in accordance with the principle of preventing long-term disability. It is apparent from the authors' experience that these measures are not adapted consistently in medical practice. Most of the medical advisers are focusing purely on evaluation of corporal damage, leaving little or no time for rehabilitation efforts. In many other countries, the evaluation of work capacity is done by social security doctors with a comparable task.[196]

In a comprehensive set of studies carried out by the Vashington universiteti tibbiyot maktabi, it was determined that the outcome of lumbar fusion performed on injured workers was worse than reported in most published case series. They found 68% of lumbar fusion patients still unable to return to work two years after surgery. This was in stark contrast to reports of 68% post-op satisfaction in many series.[197][141] In a follow-up study it was found that the use of intervertebral fusion devices rose rapidly after their introduction in 1996. This increase in metal usage was associated with a greater risk of complication without improving disability or re-operation rates.[198][199][200][201]

Tadqiqot

Identifikatsiyasi o'sma nekrozi omil-alfa (TNF) as a central cause of inflammatory spinal pain now suggests the possibility of an entirely new approach to selected patients with FBSS. Specific and potent inhibitors of TNF became available in the U.S. in 1998, and were demonstrated to be potentially effective for treating siyatik in experimental models beginning in 2001.[202][203][204] Targeted anatomic administration of one of these anti-TNF agents, etanercept, a patented treatment method,[205] has been suggested in published pilot studies to be effective for treating selected patients with chronic disc-related pain and FBSS.[206][207] The scientific basis for pain relief in these patients is supported by the many current review articles.[208][209] In the future new imaging methods may allow non-invasive identification of sites of neuronal inflammation, thereby enabling more accurate localization of the "pain generators" responsible for symptom production. These treatments are still experimental.

If chronic pain in FBSS has a chemical component producing inflammatory pain, then prior to additional surgery it may make sense to use an anti-inflammatory approach. Often this is first attempted with non-steroidal anti-inflammatory medications, but the long-term use of Steroid bo'lmagan yallig'lanishga qarshi dorilar (NSAIDS) for patients with persistent back pain is complicated by their possible cardiovascular and gastrointestinal toxicity; and NSAIDs have limited value to intervene in TNF-mediated processes.[20] An alternative often employed is the injection of cortisone into the spine adjacent to the suspected pain generator, a technique known as "epidural steroid injection".[210] Although this technique began more than a decade ago for FBSS, the efficacy of epidural steroid injections is now generally thought to be limited to short term pain relief in selected patients only.[211] In addition, epidural steroid injections, in certain settings, may result in serious complications.[212] Fortunately there are now emerging new methods that directly target TNF.[206] These TNF-targeted methods represent a highly promising new approach for patients with chronic severe spinal pain, such as those with FBSS.[206] Ancillary approaches, such as rehabilitation, fizioterapiya, antidepressantlar, and, in particular, graduated exercise programs, may all be useful adjuncts to anti-inflammatory approaches.[20] In addition, more invasive modalities, such as spinal cord stimulation, may offer relief for certain patients with FBSS, but these modalities, although often referred to as "minimally invasive", require additional surgery, and have complications of their own.[213][214]

Dunyo bo'ylab istiqbol

CT scan showing two views of L4-5 disc herniation

A report from Spain noted that the investigation and development of new techniques for instrumented surgery of the spine is not free from conflicts of interest. The influence of financial forces in the development of new technologies and its immediate application to spine surgery, shows the relationship between the published results and the industry support. Authors who have developed and defended fusion techniques have also published new articles praising new spinal technologies. The author calls spinal surgery the "American Stock and Exchange" and "the bubble of spine surgery". The scientific literature doesn't show clear evidence in the cost-benefit studies of most instrumented surgical interventions of the spine compared with the conservative treatments. It has not been yet demonstrated that fusion surgery and disc replacement are better options than the conservative treatment. It's necessary to point out that at present "there are relationships between the industry and back pain, and there is also an industry of the back pain". Nonetheless, the "market of the spine surgery" is growing because patients are demanding solutions for their back problems. The tide of scientific evidence seems to go against the spinal fusions in the degenerative disc disease, discogenic pain and in specific back pain. After decades of advances in this field, the results of spinal fusions are mediocre. New epidemiological studies show that "spinal fusion must be accepted as a non proved or experimental method for the treatment of back pain". The surgical literature on spinal fusion published in the last 20 years establishes that instrumentation seems to slightly increase the fusion rate and that instrumentation doesn't improve the clinical results in general. We still are in need of randomized studies to compare the surgical results with the natural history of the disease, the placebo effect, or conservative treatment. The European Guidelines for lumbar chronic pain management show "strong evidence" indicating that complex and demanding spine surgery where different instrumentation is used, is not more effective than a simple, safer and cheaper posterolateral fusion without instrumentation. Recently, the literature published in this field is sending a message to use "minimally invasive techniques"; – the abandonment of transpedicular fusions. Surgery in general, and usage of metal fixation should be discarded in most cases.[215]

In Sweden, the national registry of lumbar spine surgery reported in the year 2000 that 15% of patients with spinal stenosis surgery underwent a concomitant fusion.[216] Despite the traditionally conservative approach to spinal surgery in Sweden, there have been calls from that country for a more aggressive approach to lumbar procedures in recent years.

Cherkin et al.,[217] evaluated worldwide surgical attitudes. There were twice the number of surgeons per capita in the United States compared to the United Kingdom. Numbers were similar to Sweden. Despite having very few spinal surgeons, the Netherlands proved to be quite aggressive in surgery. Sweden, despite having a large number of surgeons was conservative and produced relatively few surgeries. The most surgeries were done in the United States. In the UK, more than a third of non-urgent patients waited over a year to see a spinal surgeon. In Wales, more than half waited over three months for consult. Lower rates of referrals in the United Kingdom was found to discourage surgery in general. Fee for service and easy access to care was thought to encourage spinal surgery in the United States, whereas salaried position and a conservative philosophy led to less surgery in the United Kingdom. There were more spinal surgeons in Sweden than in the United States. However, it was speculated that the Swedish surgeons being limited to compensation of 40–48 hours a week might lead to a conservative philosophy. There have been calls for a more aggressive approach to lumbar surgery in both the United Kingdom and Sweden in recent years.[70][218][219]

Adabiyotlar

  1. ^ Long DM (Oct 1991). "Failed back surgery syndrome". Neyroxirurg. Klinika. N. Am. 2 (4): 899–919. doi:10.1016/S1042-3680(18)30709-5. PMID  1840393.
  2. ^ Fritsch EW, Heisel J, Rupp S (Mar 1996). "The failed back surgery syndrome: reasons, intraoperative findings, and long-term results: a report of 182 operative treatments". Orqa miya. 21 (5): 626–33. doi:10.1097/00007632-199603010-00017. PMID  8852320.
  3. ^ "Conditions of the Spine - Post Laminectomy Syndrome". 2010. Arxivlangan asl nusxasi 2014-09-10. Olingan 10 sentyabr 2014.
  4. ^ Capoor, Manu N.; Ruzicka, Filip; Shmitz, Jonatan E.; Jeyms, Gart A.; Machakova, Tana; Yancalek, Radim; Smrcka, Martin; Lipina, Radim; Ahmed, Faxad S. (2017-04-03). "Propionibacterium acnes biofilm mikrodisektomiya qilingan bemorlarning intervertebral disklarida mavjud". PLOS ONE. 12 (4): e0174518. Bibcode:2017PLoSO..1274518C. doi:10.1371 / journal.pone.0174518. ISSN  1932-6203. PMC  5378350. PMID  28369127.
  5. ^ Lee PB, Kim YC, Lim YJ, et al. (2006). "Efficacy of pulsed electromagnetic therapy for chronic lower back pain: a randomized, double-blind, placebo-controlled study". J. Int. Med. Res. 34 (2): 160–7. doi:10.1177/147323000603400205. PMID  16749411.
  6. ^ Slipman CW, Shin CH, Patel RK, et al. (Sep 2002). "Etiologies of failed back surgery syndrome". Og'riq Med. 3 (3): 200–14, discussion 214–7. doi:10.1046/j.1526-4637.2002.02033.x. PMID  15099254.
  7. ^ Taylor VM, Deyo RA, Cherkin DC, Kreuter W (Jun 1994). "Low back pain hospitalization. Recent United States trends and regional variations". Orqa miya. 19 (11): 1207–12, discussion 13. doi:10.1097/00007632-199405310-00002. PMID  8073311.
  8. ^ Fager C. A.; Freiberg S. R. (1980). "Analysis of failures and poor results of lumbar spine surgery". Orqa miya. 5 (1): 87–94. doi:10.1097/00007632-198001000-00015. PMID  7361201.
  9. ^ a b v d Burton CV, Kirkaldy-Willis WH, Yong-Hing K, Heithoff KB (June 1981). "Causes of failure of surgery on the lumbar spine". Klinika. Orthop. Relat. Res. (157): 191–9. doi:10.1097/00003086-198106000-00032. PMID  7249453.
  10. ^ Hakelius A (1970). "Prognosis in sciatica. A clinical follow-up of surgical and non-surgical treatment". Acta Orthop. Skandal. Qo'shimcha. 129: 1–76. doi:10.3109/ort.1970.41.suppl-129.01. PMID  5269867.
  11. ^ Turner J, et al. (1992). "Surgery for lumbar spinal stenosis. Attempted meta-analysis of the literature". Orqa miya. 17 (1): 1–8. doi:10.1097/00007632-199201000-00001. PMID  1531550.
  12. ^ Mardjetko SM, Connolly PJ, Shott S (October 1994). "Degenerative lumbar spondylolisthesis. A meta-analysis of literature 1970–1993". Orqa miya. 19 (20 Suppl): 2256S–2265S. doi:10.1097/00007632-199410151-00002. PMID  7817240.
  13. ^ Herron L. D.; Trippi A. C. (1989). "L4-5 degenerative spondylolisthesis. The results of treatment by decompressive laminectomy without fusion". Orqa miya. 14 (5): 534–538. doi:10.1097/00007632-198905000-00013. PMID  2727798.
  14. ^ Epstein N. E. (1998). "Decompression in the surgical management of degenerative spondylolisthesis: advantages of a conservative approach in 290 patients". J. Spinal Disord. 11 (2): 116–122. doi:10.1097/00002517-199804000-00004. PMID  9588467.
  15. ^ Deyo RA, Gray DT, Kreuter W, Mirza S, Martin BI (Jun 2005). "United States trends in lumbar fusion surgery for degenerative conditions". Orqa miya. 30 (12): 1441–5, discussion 1446–7. doi:10.1097/01.brs.0000166503.37969.8a. PMID  15959375.
  16. ^ a b Abelson R, Petersen M (December 31, 2003). "An operation to ease back pain bolsters the bottom line, too". Nyu-York Tayms. Olingan 8 yanvar, 2011.
  17. ^ Abelson R (December 30, 2006). "Surgeons invest in makers of hardware". Nyu-York Tayms. Olingan 8 yanvar, 2011.
  18. ^ Guyer RD, Patterson M, Ohnmeiss DD (Sep 2006). "Failed back surgery syndrome: diagnostic evaluation". J. Am. Akad. Orthop. Surg. 14 (9): 534–43. doi:10.5435/00124635-200609000-00003. PMID  16959891.
  19. ^ a b v Deyo RA (Jul 2002). "Diagnostic evaluation of LBP: reaching a specific diagnosis is often impossible". Arch Intern Med. 162 (13): 1444–7, discussion 1447–8. doi:10.1001/archinte.162.13.1444. PMID  12090877.
  20. ^ a b v d Carragee EJ (May 2005). "Clinical practice. Persistent low back pain". N. Engl. J. Med. 352 (18): 1891–8. doi:10.1056/NEJMcp042054. PMID  15872204.
  21. ^ a b Levin DA, Hale JJ, Bendo JA (2007). "Adjacent segment degeneration following spinal fusion for degenerative disc disease". Bulletin of the NYU Hospistal for Joint Disease. 65 (1): 29–36. PMID  17539759. Arxivlandi asl nusxasi 2009-02-19.
  22. ^ a b v Peng B, Vu V, Li Z, Guo J, Vang X (2007 yil yanvar). "Kimyoviy radikulit". Og'riq. 127 (1–2): 11–6. doi:10.1016 / j.pain.2006.06.034. PMID  16963186.
  23. ^ Marshall LL, Trethewie ER (avgust 1973). "Disk prolapsasida asab-ildizning kimyoviy tirnash xususiyati". Lanset. 2 (7824): 320. doi:10.1016 / S0140-6736 (73) 90818-0. PMID  4124797.
  24. ^ Makkarron RF, Vimpe MW, Xadkins PG, Laros GS (oktyabr 1987). "Pulposus yadrosining yallig'lanish ta'siri. Bel og'rig'i patogenezida mumkin bo'lgan element". Orqa miya. 12 (8): 760–4. doi:10.1097/00007632-198710000-00009. PMID  2961088.
  25. ^ Takahashi H, Suguro T, Okazima Y, Motegi M, Okada Y, Kakiuchi T (Yanvar 1996). "Bel o'murtqa churrasi diskida yallig'lanishli sitokinlar". Orqa miya. 21 (2): 218–24. doi:10.1097/00007632-199601150-00011. PMID  8720407.
  26. ^ Igarashi T, Kikuchi S, Shubayev V, Myers RR (Dekabr 2000). "2000 yilgi Volvo mukofotining asosiy ilmiy tadqiqotlari g'olibi: ekzogen o'sma nekrozi faktor-alfa yadro pulposus tomonidan kelib chiqadigan neyropatologiyani taqlid qiladi. Sichqonlarda molekulyar, gistologik va xulq-atvor taqqoslashlari". Orqa miya. 25 (23): 2975–80. doi:10.1097/00007632-200012010-00003. PMID  11145807.
  27. ^ Sommer C, Schafers M (Dec 2004). "Neyropatik og'riq mexanizmlari: sitokinlarning roli". Bugungi kunda giyohvand moddalarni kashf qilish: kasallik mexanizmlari. 1 (4): 441–8. doi:10.1016 / j.ddmec.2004.11.018.
  28. ^ Igarashi A, Kikuchi S, Konno S, Olmarker K (2004 yil oktyabr). "Lomber o'murtqa degenerativ buzilishlarida faset qo'shma to'qimalaridan ajralib chiqadigan yallig'lanishli sitokinlar". Orqa miya. 29 (19): 2091–5. doi:10.1097 / 01.brs.0000141265.55411.30. PMID  15454697.
  29. ^ Sakuma Y, Ohtori S, Miyagi M va boshq. (2007 yil avgust). "Kalamushlarda lomber faset qo'shma shikastlanishidan so'ng dorsal ildiz ganglionlari neyronlarida p55 TNF alfa-retseptorlari regulyatsiyasi". Yevro. Spine J. 16 (8): 1273–8. doi:10.1007 / s00586-007-0365-3. PMC  2200776. PMID  17468886.
  30. ^ Sekiguchi M, Kikuchi S, Myers RR (may 2004). "Eksperimental o'murtqa stenoz: kauda equina siqilish darajasi, nevropatologiya va og'riq o'rtasidagi bog'liqlik". Orqa miya. 29 (10): 1105–11. doi:10.1097/00007632-200405150-00011. PMID  15131438.
  31. ^ Seguin CA, Pilliar RM, Roughley PJ, Kandel RA (sentyabr 2005). "Shish nekrozi faktor-alfa matrisi ishlab chiqarish va yadro pulposus to'qimalarida katabolizmni modulyatsiya qiladi". Orqa miya. 30 (17): 1940–8. doi:10.1097 / 01.brs.0000176188.40263.f9. PMID  16135983.
  32. ^ Cohen Steven P (2005). "Sacroiliac Joint Pain: a Comprehensive Review of Anatomy, Diagnosis, and Treatment". Anesth. Analg. 101 (5): 1440–1453. doi:10.1213/01.ane.0000180831.60169.ea. PMID  16244008.
  33. ^ Ha, Kee-Yong, Jun-Seok Lee, and Ki-Won Kim. "Degeneration of Sacroiliac Joint After Instrumented Lumbar or Lumbosacral Fusion: a Prospective Cohort Study over Five-year Follow-up." Orqa miya 33, yo'q. 11 (May 15, 2008) 1192–1198.
  34. ^ DePalma MJ, Ketchum JM, Saullo TR (May 2011). "Etiology of chronic low back pain in patients having undergone lumbar fusion". Og'riq dori. 12 (5): 732–9. doi:10.1111/j.1526-4637.2011.01098.x. PMID  21481166.
  35. ^ Liliang, Po-Chou, Kang Lu, Cheng-Loong Liang, Yu-Duan Tsai, Kuo-Wei Wang, and Han-Jung Chen. "Sacroiliac Joint Pain After Lumbar and Lumbosacral Fusion: Findings Using Dual Sacroiliac Joint Blocks." Pain Medicine (Malden, Mass.) 12, no. 4 (April 2011) 565–570.
  36. ^ Frymoyer J. W.; va boshq. (1983). "Risk factors in low-back pain. An epidemiological survey" (PDF). J. Bone Joint Surg. 65A (2): 213–218. doi:10.2106/00004623-198365020-00010. PMID  6218171.
  37. ^ a b Deyo R. A.; Bass J. E. (1989). "Lifestyle and low-back pain. The influence of smoking and obesity". Orqa miya. 14 (5): 501–506. doi:10.1097/00007632-198905000-00005. PMID  2524888.
  38. ^ Svensson H. O.; va boshq. (1983). "Low-back pain in relation to other diseases and cardiovascular risk factors". Orqa miya. 8 (3): 277–285. doi:10.1097/00007632-198304000-00008. PMID  6226118.
  39. ^ De Vernejoul M.C.; va boshq. (1989). "Evidence for defective osteoblastic function. A role for alcohol and tobacco consumption in osteoporosis in middle-aged men". Klinika. Orthop. Relat. Res. 179 (1): 107–115. doi:10.1097/00003086-198310000-00016. PMID  6617002.
  40. ^ An H. S.; va boshq. (1994). "Comparison of smoking habits between patients with surgically confirmed herniated lumbar and cervical disc disease and controls". J. Spinal Disord. 7 (5): 369–373. doi:10.1097/00002517-199410000-00001. PMID  7819635.
  41. ^ Hollo I, Gergely I, Boross M (June 1977). "Smoking results in calcitonin resistance". JAMA. 237 (23): 2470. doi:10.1001/jama.1977.03270500022008. PMID  576955.
  42. ^ Iwahashi M, et al. (2002). "Mechanism of intervertebral disc degeneration caused by nicotine in rabbits to explicate intervertebral disc disorders caused by smoking". Orqa miya. 27 (13): 1396–1401. doi:10.1097/00007632-200207010-00005. PMID  12131735.
  43. ^ Biering-Sorensen F.; Thomsen C. (1986). "Medical, social and occupational history as risk indicators for low-back trouble in a general population". Orqa miya. 11 (7): 720–5. doi:10.1097/00007632-198609000-00011. PMID  2947336.
  44. ^ Boshuizen H, et al. (1993). "Do smokers get more back pain?". Orqa miya. 18 (1): 35–40. doi:10.1097/00007632-199301000-00007. PMID  8434323.
  45. ^ Heliovaara M, et al. (1991). "Determinants of sciatica and low-back pain". Orqa miya. 16 (6): 608–14. doi:10.1097/00007632-199106000-00002. PMID  1830689.
  46. ^ Heliovaara M, et al. (1989). "Risk factors for low back pain and sciatica". Ann. Med. 21 (4): 257–64. doi:10.3109/07853898909149202. PMID  2528971.
  47. ^ Andersen T, et al. (2001). "Smoking as a Predictor of Negative Outcome in Lumbar Spinal Fusion". Orqa miya. 26 (23): 2623–28. doi:10.1097/00007632-200112010-00018. PMID  11725245.
  48. ^ Glassman S. D.; va boshq. (2000). "The Effect of Cigarette Smoking and Smoking Cessation on Spinal Fusion". Orqa miya. 25 (20): 2608–15. doi:10.1097/00007632-200010150-00011. PMID  11034645.
  49. ^ Mikkonen P, et al. (2008). "Is smoking a risk factor for low back pain in adolescents? A prospective cohort study". Orqa miya. 33 (5): 527–32. doi:10.1097/BRS.0b013e3181657d3c. PMID  18317198.
  50. ^ Ackerman W. E.; Ahmad M. (2007). "Effect of cigarette smoking on serum hydrocodone levels in chronic pain patients". J. Ark. Med. Soc. 104 (1): 19–21. PMID  17663288.
  51. ^ Leboeuf-Yde C. (1999). "Smoking and low back pain. A systematic literature review of 41 journal articles reporting 47 epidemiologic studies". Orqa miya. 24 (14): 1463–70. doi:10.1097/00007632-199907150-00012. PMID  10423792.
  52. ^ Slover J, et al. (2006). "The Impact of Comorbidities on the Change in Short-Form 36 and Oswestry Scores Following Lumbar Spine Surgery". Orqa miya. 31 (17): 1974–1988. doi:10.1097/01.brs.0000229252.30903.b9. PMID  16924216.
  53. ^ Porter SE, Hanley EN (2001). "The musculoskeletal effects of smoking". J Am Acad Orthop Surg. 9 (1): 9–17. doi:10.5435/00124635-200101000-00002. PMID  11174159.
  54. ^ Thalgott J. S.; va boshq. (1991). "Postoperative infections in spinal implants. Classification and analysis--a multicenter study". Orqa miya. 16 (8): 981–984. doi:10.1097/00007632-199108000-00020. PMID  1948385.
  55. ^ Linton R. R.; White P. D. (1945). "Arteriovenous Fistula Between The Right Common Iliac Artery And The Inferior Vena Cava". Arch. Surg. 50 (1): 6–13. doi:10.1001/archsurg.1945.01230030009002.
  56. ^ Epps C. H. (1978). Complications in Orthopedic Surgery. Philadelphia: Lippincott and Co. pp. 1009–1037. ISBN  978-0-397-50382-7.
  57. ^ a b Cauchoix J, Ficat C, Girard B (1978). "Repeat Surgery After Disc Excision". Orqa miya. 3 (3): 256–59. doi:10.1097/00007632-197809000-00011. PMID  152469.
  58. ^ a b v d Weir B.K.A.; Jacobs G. A. (1980). "Reoperation rate following lumbar discectomy. An analysis of 662 lumbar discectomies". Orqa miya. 5 (4): 366–70. doi:10.1097/00007632-198007000-00010. PMID  7455766.
  59. ^ a b v d Benoist M, et al. (1980). "Postoperative Lumbar Epiduro-Arachnoiditis". Orqa miya. 5 (5): 432–35. doi:10.1097/00007632-198009000-00007. PMID  6450453.
  60. ^ a b v Benner B.; Ehni G. (1978). "Spinal arachnoiditis. The postoperative variety in particular". Orqa miya. 3 (1): 40–44. doi:10.1097/00007632-197803000-00009. PMID  644391.
  61. ^ Rothman R (1975). "Orthopedic Clinics of North America". Orthop. Klinika. N. Am. 6: 305–310. ISSN  0030-5898.
  62. ^ a b Quiles M, Marchisello PJ, Tsairis P (March 1978). "Lumbar adhesive arachnoiditis. Etiologic and pathologic aspects". Orqa miya. 3 (1): 45–50. doi:10.1097/00007632-197803000-00010. PMID  644392.
  63. ^ Spangfort EV (1972). "The lumbar disc herniation. A computer-aided analysis of 2,504 operations". Acta Orthop. Skandal. Qo'shimcha. 142: 1–95. doi:10.3109/ort.1972.43.suppl-142.01. PMID  4516334.
  64. ^ a b Byrd S. E.; va boshq. (1985). "The radiographic evaluation of the symptomatic postoperative lumbar spine patient". Orqa miya. 10 (7): 652–61. doi:10.1097/00007632-198509000-00011. PMID  2933827.
  65. ^ Deburge A.; Badelon O. (1982). "Failure of the surgical treatment of common non-paralyzing disk sciaticas. A symposium" [Failure of the surgical treatment of common non-paralyzing disk sciaticas. A symposium]. Vahiy Chir. Orthop (frantsuz tilida). 68 (4): 249–54. PMID  6217514.
  66. ^ Irstam L (1984). "Differential diagnosis of recurrent lumbar disc herniation and postoperative deformation by myelography. An impossible task". Orqa miya. 9 (7): 759–63. doi:10.1097/00007632-198410000-00019. PMID  6505846.
  67. ^ Thibierge M.; Metzger J. (1982). "Failure of the surgical treatment of common non-paralyzing disk sciaticas. A symposium" [Failure of the surgical treatment of common non-paralyzing disk sciaticas. A symposium]. Vahiy Chir. Orthop. (frantsuz tilida). 68 (4): 230–33. PMID  6217514.
  68. ^ Massare C (1982). "Failure of the surgical treatment of common non-paralyzing disk sciaticas. A symposium" [Failure of the surgical treatment of common non-paralyzing disk sciaticas. A symposium]. Vahiy Chir. Orthop. 68 (4): 233–46. PMID  6217514.
  69. ^ Teplik J. G.; Haskin M. E. (1984). "Intravenous contrast-enhanced CT of the postoperative lumbar spine: improved identification of recurrent disk herniation, scar, arachnoiditis, and diskitis". AJR. Amerika Roentgenologiya jurnali. 143 (4): 845–55. doi:10.2214/ajr.143.4.845. PMID  6332496.
  70. ^ a b Deyo RA, Nachemson A, Mirza SK (Feb 2004). "Spinal-fusion surgery – the case for restraint". N. Engl. J. Med. 350 (7): 722–6. doi:10.1056/NEJMsb031771. PMID  14960750.
  71. ^ Weinstein J. N.; va boshq. (2008). "Surgical versus nonoperative treatment for lumbar disc herniation: four-year results for the Spine Patient Outcomes Research Trial (SPORT)". Orqa miya. 33 (25): 2789–2800. doi:10.1097/BRS.0b013e31818ed8f4. PMC  2756172. PMID  19018250.
  72. ^ Crock H. V. (1976). "Observations on the management of failed spinal operations". J. Bone Joint Surg. 58B (2): 193–199. doi:10.1302/0301-620X.58B2.932081. PMID  932081.
  73. ^ Crock, H. V. Practice of Spinal Surgery, Vienna/New York; Springer Verlag, 1983
  74. ^ Atlas S. J.; va boshq. (2005). "The Efficacy of Corticosteroids in Periradicular Infiltration for Chronic Radicular Pain". Orqa miya. 30 (8): 857–9. doi:10.1097/01.brs.0000158878.93445.a0. PMID  15834326.
  75. ^ Herno A (1995). "Surgical results of lumbar spinal stenosis". Ann Chir Gynaecol Suppl. 210: 1–969. PMID  8546434.
  76. ^ Herno A, et al. (1999). "Long-term clinical and magnetic resonance imaging follow-up assessment of patients with lumbar spinal stenosis after laminectomy". Orqa miya. 24 (15): 1533–7. doi:10.1097/00007632-199908010-00006. PMID  10457572.
  77. ^ Herno A, et al. (1999). "The degree of decompressive relief and its relation to clinical outcome in patients undergoing surgery for lumbar spinal stenosis". Orqa miya. 24 (10): 1010–4. doi:10.1097/00007632-199905150-00015. PMID  10332794.
  78. ^ Herno A, et al. (1999). "Computed tomography findings 4 years after surgical management of lumbar spinal stenosis. No correlation with clinical outcome". Orqa miya. 24 (21): 2234–9. doi:10.1097/00007632-199911010-00011. PMID  10562990.
  79. ^ Caputy A. J.; Luessenhop A. J. (1992). "Long-term evaluation of decompressive surgery for degenerative lumbar stenosis". J. neyrosurg. 77 (5): 669–76. doi:10.3171/jns.1992.77.5.0669. PMID  1403105.
  80. ^ Sponseller P. D.; va boshq. (2000). "Deep wound infections after neuromuscular scoliosis surgery: a multicenter study of risk factors and treatment outcomes". Orqa miya. 25 (19): 2461–2466. doi:10.1097/00007632-200010010-00007. PMID  11013497.
  81. ^ Weinstein M. A.; va boshq. (2000). "Postoperative spinal wound infection: a review of 2,391 consecutive index procedures". J. Spinal Disord. 13 (5): 422–426. doi:10.1097/00002517-200010000-00009. PMID  11052352.
  82. ^ Massie JB, Heller JG, Abitbol JJ, McPherson D, Garfin SR (November 1992). "Postoperative posterior spinal wound infections". Klinika. Orthop. Relat. Res. (284): 99–108. doi:10.1097/00003086-199211000-00013. PMID  1395319.
  83. ^ Rechtine G. R.; va boshq. (2001). "Postoperative Wound Infection after Instrumentation of Thoracic and Lumbar Fractures". J Orthop travması. 15 (8): 566–569. doi:10.1097/00005131-200111000-00006. PMID  11733673.
  84. ^ Eck KR, Bridwell KH, Ungacta FF, et al. (2001 yil may). "Complications and results of long adult deformity fusions down to l4, l5, and the sacrum". Orqa miya. 26 (9): E182–92. doi:10.1097/00007632-200105010-00012. PMID  11337635.
  85. ^ Capen D. A.; va boshq. (1996). "Perioperative risk factors for wound infections after lower back fusions". Orthop. Klinika. N. Am. 27 (1): 83–86. PMID  8539055.
  86. ^ Hee H. T.; va boshq. (2001). "Anterior/posterior lumbar fusion versus transforaminal lumbar interbody fusion: analysis of complications and predictive factors". J. Spinal Disord. 14 (6): 533–540. doi:10.1097/00002517-200112000-00013. PMID  11723406.
  87. ^ Aydinli U, et al. (1999). "Postoperative deep wound infection in instrumented spinal surgery". Acta Orthopaedica Belg. 65 (2): 182–187. PMID  10427800.
  88. ^ Wimmer C, et al. (1998). "Influence of antibiotics on infection in spinal surgery: a prospective study of 110 patients". J. Spinal Disord. 11 (6): 498–500. doi:10.1097/00002517-199812000-00008. PMID  9884294.
  89. ^ Wimmer C, Gluch H, Franzreb M, Ogon M (April 1998). "Predisposing factors for infection in spine surgery: a survey of 850 spinal procedures". J. Spinal Disord. 11 (2): 124–8. doi:10.1097/00002517-199804000-00006. PMID  9588468.
  90. ^ Hodges SD, Humphreys SC, Eck JC, Covington LA, Kurzynske NG (December 1998). "Low postoperative infection rates with instrumented lumbar fusion". Janubiy. Med. J. 91 (12): 1132–6. doi:10.1097/00007611-199812000-00007. PMID  9853725.
  91. ^ Perry J. W.; va boshq. (1997). "Wound infections following spinal fusion with posterior segmental spinal instrumentation". Klinika. Yuqtirish. Dis. 24 (4): 558–561. doi:10.1093/clind/24.4.558. PMID  9145726.
  92. ^ Abbey D. M.; va boshq. (1995). "Treatment of postoperative wound infections following spinal fusion with instrumentation". J. Spinal Disord. 8 (4): 278–283. doi:10.1097/00002517-199508040-00003. PMID  8547767.
  93. ^ West J. L.; va boshq. (1991). "Complications of the variable screw plate pedicle screw fixation". Orqa miya. 16 (5): 576–579. doi:10.1097/00007632-199105000-00016. PMID  2053001.
  94. ^ Esses SI, Sachs BL, Dreyzin V (November 1993). "Complications associated with the technique of pedicle screw fixation. A selected survey of ABS members". Orqa miya. 18 (15): 2231–8, discussion 2238–9. doi:10.1097/00007632-199311000-00015. PMID  8278838.
  95. ^ Dave S. H.; Meyers D. L. (1992). "Complications of Lumbar Spinal Fusion with Transpedicular Instrumentation". Orqa miya. 17 (Suppl 6): S184–189. doi:10.1097/00007632-199206001-00021. PMID  1631716.
  96. ^ Andreshak T. G.; va boshq. (1997). "Lumbar spine surgery in the obese patient". J. Spinal Disord. 10 (5): 376–379. doi:10.1097/00002517-199710000-00003. PMID  9355052.
  97. ^ Viola R. W.; va boshq. (1997). "Point of View: Delayed Infection After Elective Spinal Instrumentation and Fusion". Orqa miya. 22 (20): 2450–2451. doi:10.1097/00007632-199710150-00024.
  98. ^ Klein J. D.; va boshq. (1996). "Perioperative nutrition and postoperative complications in patients undergoing spinal surgery". Orqa miya. 21 (22): 2676–2682. doi:10.1097/00007632-199611150-00018. PMID  8961455.
  99. ^ Swank S.M.; va boshq. (1981). "Surgical treatment of adult scoliosis. A review of two hundred and twenty-two cases". J. Bone Jt. Surg. 63 (2): 268–87. doi:10.2106/00004623-198163020-00013. PMID  6450768.
  100. ^ Klein J. D.; Garfin S. R. (1996). "Nutritional status in the patient with spinal infection". Orthop. Klinika. N. Am. 27 (1): 33–36. PMID  8539050.
  101. ^ Heary R. F.; va boshq. (1994). "HIV status does not affect microbiologic spectrum or neurologic outcome in spinal infections". Surg. Neyrol. 42 (5): 417–423. doi:10.1016/0090-3019(94)90350-6. PMID  7974148.
  102. ^ Bertrand G (January 1975). "The "battered" root problem". Orthop. Klinika. N. Am. 6 (1): 305–10. PMID  1113977.
  103. ^ Depalma and Rothman, The Intervertebral Disc, Philadelphia, W. B. Saunders, 1970
  104. ^ Finnegan W.; Rothman R.; va boshq. (1975). "The American Academy of Orthopaedic Surgeons" (PDF). J. Bone Jt. Surg. 57A (7): 1022–1035 [1034].
  105. ^ Ghormley RK (1957). "The problem of multiple operations on the back". Instr kursi ma'ruzasi. 14: 56–63. PMID  13524946.
  106. ^ Greenwood J; McGuire Th; Kimbell F (January 1952). "A study of the causes of failure in the herniated intervertebral disc operation; an analysis of sixty-seven reoperated cases". J. neyrosurg. 9 (1): 15–20. doi:10.3171/jns.1952.9.1.0015. PMID  14908634.
  107. ^ Hirsch C (1965). "Efficiency Of Surgery In Low-back Disorders. Pathoanatomical, Experimental, And Clinical Studies". J. Bone Joint Surg. 47A (5): 991–1004. doi:10.2106/00004623-196547050-00009. PMID  14318637.
  108. ^ Kanayama M, et al. (2007). "Effective prevention of surgical site infection using a Centers for Disease Control and Prevention guideline-based antimicrobial prophylaxis in lumbar spine surgery". J. neyrosurg. Orqa miya. 6 (4): 327–9. doi:10.3171/spi.2007.6.4.7. PMID  17436921.
  109. ^ Langenskold A.; Valle M. (1976). "Prevention of epidural scar formation after operations on the lumbar spine by means of free fat transplants. A preliminary report". Klinika. Orthop. Relat. Res. 115 (115): 92–95. doi:10.1097/00003086-197603000-00015. PMID  1253503.
  110. ^ La Rocca H.; Macnab I. (1974). "The laminectomy membrane. Studies in its evolution, characteristics, effects and prophylaxis in dogs". Suyak va qo'shma jarrohlik jurnali. 56B (3): 545–50. PMID  4421702.
  111. ^ Law J. D.; va boshq. (1978). "Reoperation after lumbar intervertebral disc surgery". J. neyrosurg. 48 (2): 259–63. doi:10.3171/jns.1978.48.2.0259. PMID  146731.
  112. ^ Lee C. K.; Alexander H. (1984). "Prevention of postlaminectomy scar formation". Orqa miya. 9 (3): 305–12. doi:10.1097/00007632-198404000-00016. PMID  6729595.
  113. ^ Lehmann TR, LaRocca HS (1981). "Repeat lumbar surgery. A review of patients with failure from previous lumbar surgery treated by spinal canal exploration and lumbar spinal fusion". Orqa miya. 6 (6): 615–9. doi:10.1097/00007632-198111000-00014. PMID  6461073.
  114. ^ Lähde S, Puranen J (August 1985). "Disk-space hypodensity in CT: the first radiological sign of postoperative diskitis". Eur J Radiol. 5 (3): 190–2. PMID  4029155.
  115. ^ Hinton JL, Warejcka DJ, Mei Y, et al. (1995). "Inhibition of epidural scar formation after lumbar laminectomy in the rat". Orqa miya. 20 (5): 564–570. doi:10.1097/00007632-199503010-00011. PMID  7604326.
  116. ^ Fischgrund J. S. (2000). "Perspectives on modern orthopaedics: use of Adcon-L for epidural scar prevention". J. Am. Akad. Orthop. Surg. 8 (6): 339–343. doi:10.5435/00124635-200011000-00001. PMID  11104397.
  117. ^ Brodsky A. E. (1978). "Chronic spinal arachnoiditis. A postoperative syndrome that may signal its onset". Orqa miya. 3 (1): 88–91. doi:10.1097/00007632-197803000-00017. PMID  644396.
  118. ^ Burton C. V. (1978). "Lumbosacral arachnoiditis". Orqa miya. 3 (1): 24–30. doi:10.1097/00007632-197803000-00006. PMID  148106.
  119. ^ US/FDA DepoMedrol DataSheet 2010
  120. ^ Dermot R. Fitzgibbon, MD | ASA Closed Claims Project | Anesthesiology | year = 2004
  121. ^ Lima, Navarro, "et al." Clinical And Histological Effects of Intrathecal Administration of MPA in Dogs | year = 2010 | Og'riq shifokori
  122. ^ authors = D A Nelson, W M Landau | Neurol Neurosurgery Psychiatry | year = 2001 | Intraspinal Steroids: History, Efficacy, Accidentality, and Controversy with Review of United States Food & Drug Administration Reports
  123. ^ Brammah TB, Jayson MI (November 1994). "Syringomyelia as a complication of spinal arachnoiditis". Orqa miya. 19 (22): 2603–5. doi:10.1097/00007632-199411001-00019. PMID  7855688.
  124. ^ Georgy B. A.; va boshq. (1996). "MR imaging of spinal nerve roots: techniques, enhancement patterns, and imaging findings". Am. J. Rentgenol. 166 (1): 173–9. doi:10.2214/ajr.166.1.8571871. PMID  8571871.
  125. ^ Gero B, et al. (1991). "MR imaging of intradural inflammatory diseases of the spine". AJNR Am J Neuroradiol. 12 (5): 1009–19. PMID  1950896.
  126. ^ Gupta R. K.; va boshq. (1994). "MRI in intraspinal tuberculosis". Neyroadiologiya. 36 (1): 39–43. doi:10.1007/BF00599194. PMID  8107996.
  127. ^ Johnson CE, Sze G (1990). "Benign lumbar arachnoiditis: MR imaging with gadopentetate dimeglumine". AJNR Am J Neuroradiol. 11 (4): 763–70. PMID  2114765.
  128. ^ Muñoz A, Hinojosa J, Esparza J (May 2007). "Cisternography and ventriculography gadopentate dimeglumine-enhanced MR imaging in pediatric patients: preliminary report". AJNR Am J Neuroradiol. 28 (5): 889–94. PMID  17494664.
  129. ^ Sharma A, et al. (1997). "MR imaging of tubercular spinal arachnoiditis". Am. J. Rentgenol. 168 (3): 807–12. doi:10.2214/ajr.168.3.9057539. PMID  9057539.
  130. ^ Tali E. T.; va boshq. (2002). "Intrathecal gadolinium (gadopentetate dimeglumine) enhanced magnetic resonance myelography and cisternography: results of a multicenter study". Investitsiya. Radiol. 37 (3): 152–9. doi:10.1097/00004424-200203000-00008. PMID  11882795.
  131. ^ Yong H. K.; va boshq. (1980). "Prevention of nerve root adhesions after laminectomy". Orqa miya. 5 (1): 59–64. doi:10.1097/00007632-198001000-00011. PMID  7361199.
  132. ^ Endoscopic transforaminal lumbar discectomy and reconfiguration: a postero-lateral approach into the spinal canalDA Ditsworth – Surgical neurology, 1998 – Elsevier
  133. ^ Onesti S. T. (2004). "Failed back syndrome". Nevrolog. 10 (5): 259–64. doi:10.1097/01.nrl.0000138733.09406.39. PMID  15335443.
  134. ^ Brown R, et al. (2004). "Methadone: applied pharmacology and use as adjunctive treatment in chronic pain". Postgrad. Med. J. 80 (949): 654–9. doi:10.1136/pgmj.2004.022988. PMC  1743125. PMID  15537850.
  135. ^ Spengler D. M.; va boshq. (1980). "Low-back pain following multiple lumbar spine procedures. Failure of initial selection?". Orqa miya. 5 (4): 356–60. doi:10.1097/00007632-198007000-00008. PMID  6450449.
  136. ^ Wiltse LL, Rocchio PD (1975). "Preoperative psychological tests as predictors of success of chemonucleolysis in the treatment of the low-back syndrome" (PDF). J. Bone Joint Surg. 57A (4): 478–83. doi:10.2106/00004623-197557040-00006. PMID  124736.
  137. ^ Weir BK (March 1979). "Prospective study of 100 lumbosacral discectomies". J. neyrosurg. 50 (3): 283–9. doi:10.3171/jns.1979.50.3.0283. PMID  422980.
  138. ^ Oaklnader, A. L., and North, R. B. "Failed back surgery syndrome" In Loeser, J. D., et al., eds. Bonica's Management of Pain, Philadelphia, Lippincott Williams & Wilkins, 2001
  139. ^ Haider TT, Kishino ND, Gray TP, Tomlin MA, Daubert HB (1998). "Functional restoration: Comparison of surgical and nonsurgical spine patients". J. okkup. Qayta tiklash. 8 (4): 247–253. ISSN  1053-0487.
  140. ^ Tandon V; Campbell, F; Ross, ER (1999). "Posterior lumbar interbody fusion. Association between disability and psychological disturbance in noncompensation patients". Orqa miya. 24 (17): 1833–1838. doi:10.1097/00007632-199909010-00013. PMID  10488514.
  141. ^ a b Turner JA, Ersek M, Herron L, et al. (1992 yil avgust). "Patient outcomes after lumbar spinal fusions". JAMA. 268 (7): 907–11. doi:10.1001/jama.268.7.907. PMID  1640622.
  142. ^ Malter A. D.; va boshq. (1996). "Cost-effectiveness of lumbar discectomy for the treatment of herniated intervertebral disc". Orqa miya. 21 (9): 1048–1055. doi:10.1097/00007632-199605010-00011. PMID  8724089.
  143. ^ Dvorak J, et al. (1988). "The outcome of surgery for lumbar disc herniation. I. A 4-17 years' follow-up with emphasis on somatic aspects". Orqa miya. 13 (12): 1418–1422. doi:10.1097/00007632-198812000-00015. PMID  3212575.
  144. ^ Deyo R, et al. (1992). "Morbidity and mortality in association with operations on the lumbar spine. The influence of age, diagnosis, and procedure". J. Bone Joint Surg. 74A (4): 536–543. doi:10.2106/00004623-199274040-00009. PMID  1583048.
  145. ^ Gervitz R. N.; va boshq. (1996). "Psychophysiologic treatment of chronic lower back pain". Prof. Psychol. Res. Amaliyot. 27 (6): 561–566. doi:10.1037/0735-7028.27.6.561.
  146. ^ Graver V, Haaland AK, Magnaes B, Loeb M (April 1999). "Seven-year clinical follow-up after lumbar disc surgery: results and predictors of outcome". Br. J. neyrosurg. 13 (2): 178–84. doi:10.1080/02688699943952. PMID  10616588.
  147. ^ De Groot K. I.; va boshq. (1997). "The influence of psychological variables on postoperative anxiety and physical complaints in patients undergoing lumbar surgery". Og'riq. 69 (1–2): 19–25. doi:10.1016/S0304-3959(96)03228-9. PMID  9060008.
  148. ^ Schade V, et al. (1999). "The impact of clinical, morphological, psychosocial and work-related factors on the outcome of lumbar discectomy". Og'riq. 80 (1–2): 239–249. doi:10.1016/S0304-3959(98)00210-3. PMID  10204736.
  149. ^ Rosenstiel A.; Keefe F. (1983). "The use of coping strategies in chronic low back pain patients: Relationship to patient characteristics and current adjustment". Og'riq. 17 (1): 33–40. doi:10.1016/0304-3959(83)90125-2. PMID  6226916.
  150. ^ Keane GP (1997). "Failed low back surgery syndrome". In Herring SA, Cole AJ (eds.). The low back pain handbook: a practical guide for the primary care clinician. Filadelfiya: Xanli va Belfus. pp. 269–81. ISBN  978-1-56053-152-4.
  151. ^ Chatterjee S, Foy PM, Findlay GF (Mar 1995). "Report of a controlled clinical trial comparing automated percutaneous lumbar discectomy and microdiscectomy in the treatment of contained lumbar disc herniation". Orqa miya. 20 (6): 734–8. doi:10.1097/00007632-199503150-00016. PMID  7604351.
  152. ^ Fritzell P, et al. (2001). "2001 Volvo Award Winner in Clinical Studies: Lumbar fusion versus nonsurgical treatment for chronic low back pain: a multicenter randomized controlled trial from the Swedish Lumbar Spine Study Group". Orqa miya. 26 (23): 2521–32. doi:10.1097/00007632-200112010-00002. PMID  11725230.
  153. ^ LeHuec J. C.; va boshq. (2005). "Clinical results of Maverick lumbar total disc replacement: two-year prospective follow-up". Orthop. Klinika. N. Am. 36 (3): 315–22. doi:10.1016/j.ocl.2005.02.001. PMID  15950691.
  154. ^ Guyer RD, McAfee PC, Hochschuler SH, et al. (2004). "Prospective randomized study of the Charite artificial disc: data from two investigational centers". Spine J. 4 (6 Suppl): 252S–259S. doi:10.1016/j.spinee.2004.07.019. PMID  15541674.
  155. ^ Blumenthal S, McAfee PC, Guyer RD, et al. (2005 yil iyul). "A prospective, randomized, multicenter Food and Drug Administration investigational device exemptions study of lumbar total disc replacement with the CHARITE artificial disc versus lumbar fusion: part I: evaluation of clinical outcomes". Orqa miya. 30 (14): 1565–75, discussion E387–91. doi:10.1097/01.brs.0000170587.32676.0e. PMID  16025024.
  156. ^ McAfee PC, Cunningham B, Holsapple G, et al. (2005 yil iyul). "A prospective, randomized, multicenter Food and Drug Administration investigational device exemption study of lumbar total disc replacement with the CHARITE artificial disc versus lumbar fusion: part II: evaluation of radiographic outcomes and correlation of surgical technique accuracy with clinical outcomes". Orqa miya. 30 (14): 1576–83, discussion E388–90. doi:10.1097/01.brs.0000170561.25636.1c. PMID  16025025.
  157. ^ a b v Zeegers W. S.; va boshq. (1999). "Artificial disc replacement with the modular type SB Charité III: 2-year results in 50 prospectively studied patients". Yevro. Spine J. 8 (3): 210–17. doi:10.1007/s005860050160. PMC  3611160. PMID  10413347.
  158. ^ Putzier M, Funk JF, Schneider SV, et al. (2006 yil fevral). "Charité total disc replacement—clinical and radiographical results after an average follow-up of 17 years". Yevro. Spine J. 15 (2): 183–95. doi:10.1007/s00586-005-1022-3. PMC  3489410. PMID  16254716.
  159. ^ Patel A. A.; va boshq. (2008). "Revision strategies in lumbar total disc arthroplasty". Orqa miya. 33 (11): 1276–1283. doi:10.1097/BRS.0b013e3181714a1d. PMID  18469704.
  160. ^ a b v Zindrick M. R.; va boshq. (2008). "An evidence-based medicine approach in determining factors that may affect outcome in lumbar total disc replacement". Orqa miya. 33 (11): 1262–1269. doi:10.1097/BRS.0b013e318171454c. PMID  18469702.
  161. ^ Straus, S., et al. "Evidence Based Medicine, 3rd ed." London; Elsevier Cherchill Livingstone, 2005 yil
  162. ^ Sackett, D. L., et al., "Evidence-Based Medicine. How to Practice and Teach EBM", New York:: Churchill Livingstone, 2000
  163. ^ Lemaire J. P.; va boshq. (2005). "Clinical and radiological outcomes with the Charité artificial disc: a 10-year minimum follow-up". J. Spinal Disord. Texnik. 18 (4): 353–9. doi:10.1097/01.bsd.0000172361.07479.6b. PMID  16021017.
  164. ^ Huang R. C.; va boshq. (2004). "The prevalence of contraindications to total disc replacement in a cohort of lumbar surgical patients". Orqa miya. 29 (22): 2538–41. doi:10.1097/01.brs.0000144829.57885.20. PMID  15543070.
  165. ^ Wong D. A.; va boshq. (2007). "Incidence of contraindications to total disc arthroplasty: a retrospective review of 100 consecutive fusion patients with a specific analysis of facet arthrosis". Spine J. 7 (1): 5–11. doi:10.1016/j.spinee.2006.04.012. PMID  17197326.
  166. ^ Regan J. J. (2005). "Clinical results of charité lumbar total disc replacement". Orthop. Klinika. N. Am. 36 (3): 323–40. doi:10.1016/j.ocl.2005.03.005. PMID  15950692.
  167. ^ Siepe C. J.; va boshq. (2007). "Total lumbar disc replacement: different results for different levels". Orqa miya. 32 (7): 782–90. doi:10.1097/01.brs.0000259071.64027.04. PMID  17414914.
  168. ^ a b Siepe CJ, Mayer HM, Wiechert K, Korge A (August 2006). "Clinical results of total lumbar disc replacement with ProDisc II: three-year results for different indications". Orqa miya. 31 (17): 1923–32. doi:10.1097/01.brs.0000228780.06569.e8. PMID  16924209.
  169. ^ Le Huec JC, Basso Y, Aunoble S, Friesem T, Bruno MB (June 2005). "Influence of facet and posterior muscle degeneration on clinical results of lumbar total disc replacement: two-year follow-up". J. Spinal Disord. Texnik. 18 (3): 219–23. PMID  15905763.
  170. ^ a b v Tropiano P, et al. (2005). "Lumbar Total Disc Replacement. Seven to Eleven-Year Follow-Up". J. Bone Joint Surg. 87A (3): 490–6. doi:10.2106/JBJS.C.01345. PMID  15741612.
  171. ^ Sott A. H.; Harrison D. J. (2000). "Increasing age does not affect good outcome after lumbar disc replacement". Int. Orthop. 24 (1): 50–3. doi:10.1007/s002640050013. PMC  3619853. PMID  10774864.
  172. ^ a b Chung S. S.; va boshq. (2006). "Lumbar total disc replacement using ProDisc II: a prospective study with a 2-year minimum follow-up". J. Spinal. Tartibsizlik. Texnik. 19 (6): 411–5. doi:10.1097/00024720-200608000-00007. PMID  16891976.
  173. ^ a b Bertagnoli R, et al. (2006). "Lumbar total disc arthroplasty in patients older than 60 years of age: a prospective study of the ProDisc prosthesis with 2-year minimum follow-up period". J. neyrosurg. Orqa miya. 4 (2): 85–90. doi:10.3171/spi.2006.4.2.85. PMID  16506473.
  174. ^ a b Tropiano P, et al. (2003). "Lumbar disc replacement: preliminary results with ProDisc II after a minimum follow-up period of 1 year". J. Spinal Disord. Texnik. 16 (4): 362–8. doi:10.1097/00024720-200308000-00008. PMID  12902952.
  175. ^ David T (2007). "Long-term results of one-level lumbar arthroplasty: minimum 10-year follow-up of the CHARITE artificial disc in 106 patients". Orqa miya. 32 (6): 661–6. doi:10.1097/01.brs.0000257554.67505.45. PMID  17413471.
  176. ^ Cinotti G, et al. (1996). "Results of disc prosthesis after a minimum follow-up period of 2 years". Orqa miya. 21 (8): 995–1000. doi:10.1097/00007632-199604150-00015. PMID  8726204.
  177. ^ a b Bertagnoli R, Yue JJ, Shah RV, et al. (2005 yil oktyabr). "The treatment of disabling multilevel lumbar discogenic low back pain with total disc arthroplasty utilizing the ProDisc prosthesis: a prospective study with 2-year minimum follow-up". Orqa miya. 30 (19): 2192–9. doi:10.1097/01.brs.0000181061.43194.18. PMID  16205346.
  178. ^ Le Huec J. C. (2005). "Influence of facet and posterior muscle degeneration on clinical results of lumbar total disc replacement: two-year follow-up". J. Spinal Disord. Texnik. 18 (3): 219–23. PMID  15905763.
  179. ^ Lemaire J. P.; va boshq. (1997). "Intervertebral Disc Prosthesis: Results and Prospects for the Year 2000". Klinika. Orthop. Relat. Res. 337 (337): 64–76. doi:10.1097/00003086-199704000-00009. PMID  9137178.
  180. ^ Mayer H. M.; va boshq. (2002). "Diskni minimal invaziv ravishda almashtirish: jarrohlik texnikasi va dastlabki klinik natijalar". Yevro. Orqa miya J. 11 (Qo'shimcha 2): S124-30. doi:10.1007 / s00586-002-0446-2. PMC  3611566. PMID  12384733.
  181. ^ Vang JK (1976 yil yanvar). "Stimulyatsiya natijasida ishlab chiqarilgan analjeziya". Mayo klinikasi. Proc. 51 (1): 28–30. PMID  765636.
  182. ^ de la Porte C, Zigfrid J (sentyabr 1983). "Lumbosakral o'murtqa fibroz (o'murtqa araxnoidit). Uning diagnostikasi va umurtqa pog'onasini stimulyatsiya qilish yo'li bilan davolash". Orqa miya. 8 (6): 593–603. doi:10.1097/00007632-198309000-00005. PMID  6228017.
  183. ^ Kruse, RA (2011). "Jarrohlikdan keyingi lomber orqa miya og'rig'ini chiropraktik boshqarish: 32 holatni retrospektiv o'rganish". Manipulyatsion va fiziologik terapiya jurnali. 34 (6): 408–12. doi:10.1016 / j.jmpt.2011.05.011. PMID  21807265.
  184. ^ Erik Chu CP (2017). "Postlaminektomiya sindromining chiropraktik parvarishi: 2 ta holat haqida hisobot". Xalqaro tibbiyot va sog'liqni saqlash fanlari jurnali. 6 (3): 185–7.
  185. ^ Ijtimoiy Havfsizlik; "Ijtimoiy ta'minot sharoitida nogironlikni baholash", 2006 yil iyun
  186. ^ "Arxivlangan nusxa" (PDF). Arxivlandi asl nusxasi (PDF) 2011-01-01 da. Olingan 2010-12-26.CS1 maint: nom sifatida arxivlangan nusxa (havola)
  187. ^ Vaddell G va boshq. (1979). "Ishlab chiqarish jarohatlaridan so'ng bel disklari operatsiyasi va takroriy operatsiya". Suyak va qo'shma jarrohlik jurnali. 61A (2): 201–206. doi:10.2106/00004623-197961020-00007. PMID  422604.
  188. ^ Vaddell G. (1998). Orqa og'riq inqilobi (1-nashr). London: Cherchill Livingstone. ISBN  978-0-443-06039-7.[sahifa kerak ]
  189. ^ Litton S.; van Tulder M. (2001). "Rasm ming so'zga arziydi". Orqa miya. 26 (4): 339–44. doi:10.1097/00007632-200102150-00007.
  190. ^ Mielenz T. J.; va boshq. (2008). "Bel og'rig'i natijalari bilan psixologik ijtimoiy ish xususiyatlarining assotsiatsiyasi". Orqa miya. 33 (11): 1270–1275. doi:10.1097 / BRS.0b013e31817144c3. PMID  18469703.
  191. ^ Hoogendoorn V. E.; va boshq. (2000). "Ishdagi va shaxsiy hayotdagi psixosotsial omillarni tizimli ravishda qayta ko'rib chiqish, bel og'rig'i uchun xavf omillari" (PDF). Orqa miya. 25 (16): 2114–25. doi:10.1097/00007632-200008150-00017. PMID  10954644.
  192. ^ Devis K.; Heaney C. (2000). "Psixosotsial ish xususiyatlari va bel og'rig'i o'rtasidagi munosabatlar: asosiy metodologik muammolar". Klinika. Biomech. 15 (6): 389–406. doi:10.1016 / S0268-0033 (99) 00101-1. PMID  10771118.
  193. ^ Linton S va boshq. (1994). "Sog'liqni saqlash, bel og'rig'i va funktsiya buzilishi bilan bog'liq psixologik omillar". J. okkup. Qayta tiklash. 4 (1): 1–10. doi:10.1007 / BF02109992. PMID  24234259.
  194. ^ Herno A va boshq. (1996). "Operatsiyadan oldingi va keyingi omillar bel umurtqasi stenozi bo'yicha operatsiyadan keyin ishiga qaytish bilan bog'liq". Am. J. Ind. Med. 30 (4): 473–8. doi:10.1002 / (SICI) 1097-0274 (199610) 30: 4 <473 :: AID-AJIM13> 3.0.CO; 2-1. PMID  8892553.
  195. ^ Airaksinen O va boshq. (1994). "Lomber orqa miya stenozini jarrohlik yo'li bilan davolash: bemorlarning operatsiyadan keyingi nogironligi va mehnat qobiliyati". Yevro. Orqa miya J. 3 (5): 261–4. doi:10.1007 / BF02226576. PMID  7866848.
  196. ^ Donceel P, Du Bois M, Lahaye D (1999 yil may). "Lomber disk churrasi bo'yicha operatsiyadan keyin ishingizga qaytish. Sug'urta tibbiyotida reabilitatsiya yo'naltirilgan yondashuv". Orqa miya. 24 (9): 872–6. doi:10.1097/00007632-199905010-00007. PMID  10327508.
  197. ^ Franklin GM, Haug J, Heyer NJ, McKeefrey SP, Picciano JF (sentyabr 1994). "Vashington shtati ishchilarining tovon puli bilan belning birlashishi natijasi". Orqa miya. 19 (17): 1897-903, munozara 1904. doi:10.1097/00007632-199409000-00005. PMID  7997921.
  198. ^ Maghout-Juratli S va boshqalar. (2006). "Vashington shtati ishchilariga tovon puli to'lashida lomber sintez natijalari". Orqa miya. 31 (23): 2715–2723. doi:10.1097 / 01.brs.0000244589.13674.11. PMID  17077741.
  199. ^ Romano P. S .; va boshq. (2002). "Operatsiyadan keyingi klinik jihatdan asoratlarni aniqlash uchun ma'muriy ma'lumotlar ishlatilishi mumkinmi?". Am. J. Med. Sifatli. 17 (4): 145–54. doi:10.1177/106286060201700404. PMID  12153067.
  200. ^ Merfi P. L.; Volinn E. (1999). "Kasbiy bel og'rig'i ko'paymoqda?". Orqa miya. 24 (7): 691–7. doi:10.1097/00007632-199904010-00015. PMID  10209800.
  201. ^ Greenough C. G.; Fraser R. D. (1989). "Belning shikastlanishini tiklashda kompensatsiyaning ta'siri". Orqa miya. 14 (9): 947–55. doi:10.1097/00007632-198909000-00006. PMID  2528824.
  202. ^ Sommer C, Schäfers M, Marziniak M, Toyka KV (iyun 2001). "Etanercept eksperimental og'riqli neyropatiyada giperaljeziyani pasaytiradi". J. Perifer. Asab. Syst. 6 (2): 67–72. doi:10.1111 / j.1529-8027.2001.01010.x. PMID  11446385.
  203. ^ Olmarker K, Rydevik B (2001 yil aprel). "O'simta nekrozining omil-alfa bilan selektiv inhibatsiyasi yadro pulposusiga bog'liq tromb hosil bo'lishining oldini oladi, intranaural shish va asab o'tkazuvchanligi tezligini pasaytiradi: siyatikani kelajakdagi farmakologik davolash strategiyalari uchun mumkin bo'lgan ta'sirlar". Orqa miya. 26 (8): 863–9. doi:10.1097/00007632-200104150-00007. PMID  11317106.
  204. ^ Murata Y, Onda A, Rydevik B, Takahashi K, Olmarker K (2004 yil noyabr). "O'simta nekrozining faktor-alfa bilan selektiv inhibisyoni dorsal ildiz ganglionidagi pulposus yadrosidagi gistologik o'zgarishlarning oldini oladi". Orqa miya. 29 (22): 2477–84. doi:10.1097 / 01.brs.0000144406.17512.ea. PMID  15543058.
  205. ^ AQSh Patenti 6 537 549 va boshqalar
  206. ^ a b v Tobinik EL, Britschgi-Davoodifar S (2003 yil mart). "Diskogen og'riq uchun perispinal TNF-alfa inhibatsiyasi". Shveytsariyalik Med Wkly. 133 (11–12): 170–7. PMID  12715286.
  207. ^ Tobinik E, Dovudifar S (2004 yil iyul). "Eteranseptning perispinal administratsiyasi orqali surunkali bel va / yoki bo'yin disklari bilan bog'liq og'riqlar uchun yuborilishi: 143 bemorda klinik kuzatuvlarni o'rganish". Curr. Med. Res. Opin. 20 (7): 1075–85. doi:10.1185/030079903125004286. PMID  15265252.
  208. ^ Myers RR, Campana WM, Shubayev VI (2006 yil yanvar). "Neyropatik og'riqda neyroinflamatsiyaning roli: mexanizmlari va terapevtik maqsadlari". Giyohvand moddalar Discov. Bugun. 11 (1–2): 8–20. doi:10.1016 / S1359-6446 (05) 03637-8. PMID  16478686.
  209. ^ Uceyler N, Sommer C (2007). "Sitokin bilan bog'liq og'riq: asosiy fan va klinik ta'sirlar". Analjezikadagi sharhlar. 9 (2): 87–103. doi:10.3727/000000007783992807.
  210. ^ Fredman B, Nun MB, Zohar E va boshq. (1999 yil fevral). "" Muvaffaqiyatsiz orqa jarrohlik sindromi "ni davolash uchun epidural steroidlar: fluoroskopiya haqiqatan ham kerakmi?". Anesth. Analg. 88 (2): 367–72. doi:10.1097/00000539-199902000-00027. PMID  9972758.
  211. ^ Landau WM, Nelson DA, Armon C, Argoff CE, Samuels J, Backonja MM (Avgust 2007). "Baholash: radikulyar lumbosakral og'riqni davolash uchun epidural steroid in'ektsiyasidan foydalanish: Amerika Nevrologiya Akademiyasining Terapevtikasi va Texnologiyalarini baholash bo'yicha kichik qo'mitasining ma'ruzasi". Nevrologiya. 69 (6): 614, muallifning javobi 614-5. doi:10.1212 / 01.wnl.0000278878.51713.c8. PMID  17679685.
  212. ^ Abbasi A, Malxotra G, Malanga G, Elovic E.P., Kan S (2007 yil sentyabr). "Interlaminar servikal epidural steroid in'ektsiyalarining asoratlari: adabiyotni ko'rib chiqish". Orqa miya. 32 (19): 2144–51. doi:10.1097 / BRS.0b013e318145a360. PMID  17762818.
  213. ^ Bell GK, Kidd D, Shimoliy RB (1997 yil may). "Muvaffaqiyatsiz orqa jarrohlik sindromini davolashda orqa miya stimulyatsiyasining iqtisodiy samaradorligini tahlil qilish". J Og'riq alomatlarini boshqarish. 13 (5): 286–95. doi:10.1016 / S0885-3924 (96) 00323-5. PMID  9185434.
  214. ^ Kumar K, Teylor RS, Jak L va boshq. (2007 yil noyabr). "Neyropatik og'riqlar uchun an'anaviy tibbiy davolanishga qarshi orqa miya stimulyatsiyasi: muvaffaqiyatsiz orqa jarrohlik sindromi bo'lgan bemorlarda ko'p markazli randomizatsiyalangan tekshiruv". Og'riq. 132 (1–2): 179–88. doi:10.1016 / j.pain.2007.07.028. PMID  17845835.
  215. ^ Robaina-Padron FJ (2007 yil oktyabr). "Munozaralar de la cirugía instrumentada y el tratamiento del dolor lumbar por enfermedad degenerativa. Resultados de la evidencia científica" [Instrumental jarrohlik va degenerativ bel umurtqasi og'rig'ida og'riqni kamaytirish haqida tortishuvlar. Ilmiy dalillar natijalari] (PDF). Neyrokirugiya (Astur) (ispan tilida). 18 (5): 406–13. doi:10.4321 / s1130-14732007000500004. PMID  18008014.
  216. ^ Stromquist B va boshq. (2001). "Bel umurtqasi jarrohligi bo'yicha Shvetsiya milliy reestri: umurtqa jarrohligi bo'yicha Shvetsiya jamiyati". Acta Orthop. Skandal. 72 (2): 99–106. doi:10.1080/000164701317323327. PMID  11372956.
  217. ^ Cherkin D. C .; va boshq. (1994). "Orqa jarrohlik stavkalarini xalqaro taqqoslash". Orqa miya. 19 (11): 1201–1206. doi:10.1097/00007632-199405310-00001. PMID  8073310.
  218. ^ Bunker J. P. (1970). "Jarrohlik ishchi kuchi. Qo'shma Shtatlardagi va Angliya va Uelsdagi operatsiyalar va jarrohlarni taqqoslash". N. Engl. J. Med. 282 (3): 135–144. doi:10.1056 / NEJM197001152820306. PMID  5409538.
  219. ^ Lyuis C. E. (1969). "Jarrohlik holatining o'zgarishi". N. Engl. J. Med. 281 (16): 880–994. doi:10.1056 / NEJM196910162811606. PMID  5812257.

Tashqi havolalar

Tasnifi