AIMS: Multiple studies have shown that arthrocentesis is an effective treatment for internal derangement of the temporomandibular joint. However, it is not known which patient groups will respond to this procedure. It is often difficult for surgeons to preoperatively the outcome of athrocentesis. This had led some researchers to analyze and evaluate specific variables which could possibly be used as prognostic factors to predict the outcome of arthrocentesis. None of those studies used the amount of disc displacement as a prognostic factor to assess the treatment outcome of arthrocentesis. Therefore, our study objective was to evaluate the amount of disc displacement as a prognostic factor for the outcome of arthrocentesis in patients with Internal derangement of the tempromandibular joint. MATERIALS AND METHODS: The study involved a retrospective review of the treatment records of 46 patients who underwent arthrocentesis of the TMJ by a single surgeon between 2010 and 2013. A prognostic factor evaluated for its effect on the treatment outcome of TMJ arthrocentesis in this study was the degree of disc displacement. For study purposes, patients were divided into two groups: 1) Success group, and, 2) Failure group. Patients were categorized as successful if they met the success criteria prescribed by the American Association of Oral and Maxillofacial Surgeons in 1995. MRI of TMJ was performed in two steps. Initially, oblique parasagittal sections were scanned with a 1.5 T MRI machine. The amount of disc displacement was analyzed from sagittal oblique views of the MRI scans in closed mouth positions by measuring the angle between the posterior band of the articular disc and the center of the condylar head. The disc is considered to be in its normal position when the thicker portion of its posterior band lies within ±10° on the 12 o'clock position. First, the condylar head was identified, and a circle was established to describe the outline of the anterior, posterior, and superior surfaces of the condylar head; this allowed separation of the condylar head from the neck region. Second, the center of the circle was identified and a vertical line was drawn from the center of the circle. The last step was to measure the degree of displacement from this vertical line to the posterior band of the disc. Findings were compared for patients in the two groups for the following variables: age (continuous), disc displacement (continuous), and gender (female or male). P-value were calculated for differences in continuous or categorical variables using a T-test or Pearson's chi-squared test, respectively. The mean MMO, pain and diet scores were also reported in the preoperative group and 12 months postoperative group by outcome status. Statistical significance was set at p < .05 based on a two-tailed test. SPSS was used for all statistical analyses (SPSS Inc, Chicago, IL, 1997). RESULTS: 46 patients with 46 joints were evaluated in the present study. Average age of patients was 31 years with arrange of 24 to 46 years. 35 cases (76.1%) were classified as successful and 11 cases (23.9%) were classified as unsuccessful based on the criteria described earlier. In the successful group, the mean MMO score was found to be greater at the 12 months postoperative interval when compared to the preoperative examination. In the unsuccessful group, the mean MMO score was also greater than preoperatively at the 12 months postoperative group but to a lesser extent than seen in the successful group. Pain level improved more in the successful group compared to the unsuccessful group. Diet scores showed improvement in chewing ability in the successful group but remain unchanged in the unsuccessful group There was a statistically significant difference between the two groups in the degree of anteriorly disc displacement. CONCLUSION: In summary, it has been shown that the degree of disc displacement, preoperative pain level, diet score, and MMO can be used as prognostic factors for the outcome of TMJ arthrocentesis. Future investigations should more carefully evaluate the validity of other variables. Identifying prognostic factors for the outcome on arthrocentesis will help with guiding surgeons in the planned evaluation of TMJ cases. More specifically, clinicians will be able to create tailored treatment modalities based upon prognostic factors.

The purpose of this retrospective study was to examine the predictive value of quantitative MRI disc displacement for changes of TMD signs and symptoms in a pre-orthodontic adolescent patient sample. The sample consisted of fifty-five adolescent patients who had baseline temporomandibular joint MRI and longitudinal clinical records of TMD signs and symptoms. Thirty-eight were females and seventeen were males. The mean age was 12.9 ±1.6 years (range 7.4-16.6). Our analysis revealed that MRI right disc displacement has significant association with changes of ipsilateral joint locking. However, predictive value of disc displacement for changes of joint locking could not be analyzed due to small sample size. Nevertheless, MRI right disc displacement can distinguish subjects with persistent ipsilateral clicking from those who were persistently free of clicking from T1 to T2. These findings indicate that clinical assessment of right joint clicking is consistent with MRI determination of disc displacement.

No description available.

Propósito: Analizar si la adición de un espaciador interespinoso o la fusión intersomática ofrece ventajas en relación con la microdiscetomía aislada en el tratamiento de la hernia discal lumbar. Métodos: Pacientes con hernia de disco lumbar que iban a someterse a cirugía fueron elegidos para participar. En este estudio de cohorte los pacientes se dividieron en 3 grupos; Microdiscectomía sola (MD), microdiscectomía más espaciador interespinoso (IS) y fusión intersomática lumbar posterior (PLIF). La medida de resultado primaria fue la eficacia clínica mediante el índice de discapacidad de Oswestry (ODI). También evaluamos varios otros parámetros de resultado, entre los que se incluyeron: escala analógica visual para el dolor (EVA) de espalda y piernas, duración de la estancia, coste desde el ingreso hasta el alta hospitalaria, tasa de complicaciones de 90 días y tasa de reoperación tras 1 año. Resultados: Se incluyeron un total de 103 pacientes cuya edad media fue de 39,1 (± 8,5) años. En los 3 grupos se detectó una mejora significativa de la puntuación inicial del dolor de espalda y piernas con ODI y EVA. Las puntuaciones del ODI cambiaron de 62.66 a 13.77 en el grupo MD, 62.93 a 13.50 en el grupo IS, y 59.62 a 17.62 en el grupo PLIF (p <0.001). Después de 1 año, no se encontraron diferencias significativas en el ODI, ni en la EVA de espalda y piernas entre los 3 grupos. Hubo un aumento del 169% en el coste hospitalario en el grupo IS y del 287% en el grupo PLIF, en relación con la MD (p <0,001). La duración de la estancia fue un 86% mayor en el grupo IS y un 384% más en el grupo PLIF en comparación con MD (p <0,001). Las tasas de reoperación a 1 año fueron de 5,6%, 10% y 16,2% (p = 0,33) en los grupos MD, IS y PLIF respectivamente. Conclusión: La mejoría clínica parece deberse a la microdiscectomía, sin que el implante (interespinoso o fusión) agregue ningún beneficio. La adición de espaciador interespinoso o fusión no protegió contra la reoperación, y aumentó la duración de la estancia hospitalaria y los gastos quirúrgicos.

Submitted by Irene Nascimento (irene.kessia@ufpe.br) on 2017-02-02T16:47:10Z No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) GEISA GUIMARAES DE ALENCAR.pdf: 2551073 bytes, checksum: 0cec34009ffa04010ce2175cb58b6606 (MD5) / Made available in DSpace on 2017-02-02T16:47:10Z (GMT). No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) GEISA GUIMARAES DE ALENCAR.pdf: 2551073 bytes, checksum: 0cec34009ffa04010ce2175cb58b6606 (MD5) Previous issue date: 2016-07-12 / O objetivo deste estudo foi analisar a efetividade da Facilitação Neuromuscular Proprioceptiva (FNP) e da Estabilização Segmentar Vertebral (ESV) na redução da dor, assim como no aumento nas dimensões dos multífidos e transverso do abdome em indivíduos com hérnia de disco lombar. A pesquisa foi do tipo intervencional, comparativo e controlado, aprovada pelo Comitê de Ética em Pesquisa da Universidade Federal de Pernambuco. Participaram indivíduos com idade entre 25 e 50 anos e com hérnia de disco lombar com localização entre L4-L5 e/ou L5-S1, desde que comprovada por ressonância magnética e atestada por um médico. O estudo foi constituído por dois grupos: grupo FNP composto por nove participantes e o grupo de ESV com 12 participantes. Os indivíduos foram submetidos a um exame antropométrico (peso, altura e IMC) e a avaliação da intensidade da dor pela Escala Analógica Visual (EVA) e posteriormente a um exame ultrassonográfico para avaliação do trofismo dos multifidos e do transverso do abdome, através de ultrassom da marca ALOKA 500® e com transdutores de5 MHz e de 7,5 MHz, respectivamente. Cada grupo totalizou 15 atendimentos, sendo realizado por três vezes na semana, com tempo médio de 60 minutos para cada atendimento. No grupo de ESV, a técnica foi executada em três fases: cognitiva, a associativa e a de automatismo. No grupo FNP utilizou-se os padrões: escapular nas diagonais de antero-elevação-póstero-depressão e póstero-elevação-antero-depressão; pélvico na diagonal antero-elevação-póstero-depressão; e de tronco nos movimentos de flexão e extensão, através das técnicas de iniciação rítmica, combinação de isotônicas e reversão dinâmica. Ao final dos 15 atendimentos, todos os instrumentos usados na avaliação foram reutilizados na reavaliação. Nos resultados verificou-se redução da intensidade da dor em todos os participantes, não havendo diferenças entre os grupos após as intervenções (p=0,20), sendo a EVA no final de 1,4 + 1,2 para grupo de ESV e de 2,4 + 2,3 para o grupo FNP. Houve um maior trofismo do transverso do abdome para o grupo ESV (0,9 + 0,1 cm) após a intervenção, quando comparado ao FNP (0,8 + 0,3cm), p=0,02; e uma maior espessura do multífido para o grupo FNP (4,7 + 0,4 cm²) quando comparado ao ESV (3,3 + 0,3 cm), p=0,007. Sendo assim, o estudo mostrou que os dois protocolos são efetivos para a melhora da dor e para o aumento das dimensões dos músculos estabilizadores lombares, porém a ESV se mostrou mais efetiva para o recrutamento do transverso do abdome e a FNP para os multífidos. No entanto, esse resultado precisa ser melhor investigado em relação a persistência a longo prazo. / The objective of this study was to analyze the effectiveness of Neuromuscular Facilitation (PNF) and stabilization Segmental Vertebral (ESV) in reducing pain, as well as increasing the size of the multifidus and transversus abdominis in patients with lumbar disc herniation. The research was the interventional type, comparative and controlled, approved by the Ethics Committee of the Federal University of Pernambuco. Participated in individuals aged between 25 and 50 years and with lumbar disc herniation with location between L4-L5 and / or L5-S1, since confirmed by MRI and certified by a doctor. The study consisted of two groups: FNP group of nine participants and the ESV group with 12 participants. The subjects underwent an anthropometric examination (height, weight and BMI) and the assessment of pain intensity by the Visual Analog Scale (VAS) and later to a ultrasonography examination for tropism assessment of the multifidus and transversus abdominis through ultrasound the ALOKA 500® brand and transducers de5 MHz and 7.5 MHz, respectively. Each group totaled 15 sessions, being held three times a week, with an average time of 60 minutes for each service. In the ESV group, the technique was performed in three phases: cognitive, associative and the automatism. In the PNF group standards were used: scapular on the diagonals of anterior-elevation-depression posterolateral and posteromedial high-anterior-depression; pelvic diagonal high-anterior-posterior-depression; and the trunk flexion and extension, through the rhythmic initiation techniques, isotonic and dynamic combination of reversal. At the end of the 15 sessions, all instruments used in the evaluation were reused in the revaluation. These results indicate a reduction in pain intensity for all participants, with no differences between groups after the intervention (p = 0.20), the EVA being at the end of 1.4 + 1.2 for ESV group and 2.4 + 2.3 for the FNP group. There was a higher tropism of the transversus abdominis to the ESV group (0.9 + 0.1 cm) after the intervention compared to the FNP (0.8 + 0.3 cm), p = 0.02; and a thickness greater multifidus for FNP group (4.7 ± 0.4 cm²) compared to ESV (3.3 + 0.3 cm) p = 0.007. Thus, the study showed that the two protocols are effective for improving pain and the increase in the size of the lumbar stabilizer muscles, but the ESV was more effective for the transversus abdominis recruitment and PNF for the multifidus. However, this result must be further investigated with regard to long-term persistence.

Submitted by isabela.moljf@hotmail.com (isabela.moljf@hotmail.com) on 2017-05-17T12:11:32Z No. of bitstreams: 1 glauciaarleudasilva.pdf: 3423860 bytes, checksum: 769aaed9184977e90b0c5f5446d55722 (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2017-05-17T16:16:18Z (GMT) No. of bitstreams: 1 glauciaarleudasilva.pdf: 3423860 bytes, checksum: 769aaed9184977e90b0c5f5446d55722 (MD5) / Made available in DSpace on 2017-05-17T16:16:18Z (GMT). No. of bitstreams: 1 glauciaarleudasilva.pdf: 3423860 bytes, checksum: 769aaed9184977e90b0c5f5446d55722 (MD5) Previous issue date: 2010-07-30 / O objetivo deste trabalho foi avaliar a acurácia dos Critérios de Diagnóstico para Pesquisa das Desordens Temporomandibulares (RDC/DTM), a partir da comparação com o exame de imagem por ressonância magnética (IRM) no diagnóstico dos deslocamentos de disco da articulação temporomandibular em pacientes que buscaram tratamento para desordem temporomandibular. Vinte pacientes foram avaliados, totalizando 40 articulações examinadas. Para detectar anormalidades na posição do disco clinicamente foi empregado o uso do RDC/DTM, por um único examinador calibrado, “cego” para os exames de IRM. O diagnóstico das IRM obtidas dos pacientes foi realizadas por dois especialistas em radiologia odontológica, “cegos” para o exame clínico. Com base na estatística Kappa, foram observados níveis aceitáveis de confiabilidade intra-examinador na aplicação do RDC/DTM, e intra e interexaminador na avaliação das IRM. Os valores de kappa para a concordância entre o RDC/DTM e IMR foram melhores nos diagnósticos de deslocamento de disco do lado direito (k=0,913). Neste estudo, o RDC/DTM mostrou-se válido para diagnosticar deslocamentos de disco articular da ATM, com acurácia de 95% para a avaliação das ATM do lado direito e 75% do lado esquerdo, evidenciando a necessidade de um exame padronizado realizado por investigadores treinados na avaliação de pacientes com DTM. / The aim of this study was to evaluate the accuracy of the Research Diagnostic Criteria to Temporomandibular Disorders (RDC/TMD), from the comparison with magnetic resonance imaging (MRI) findings in the diagnosis of disc displacements of the temporomandibular joint in patients seeking treatment for temporomandibular disorders. Twenty patients were evaluated in a total of 40 joints examined. To detect abnormalities in disc position was employed clinically using the RDC/TMD, by a single calibrated examiner, “blinded” to the MRI scans. The diagnosis of MRI was obtained from patients performed by two specialists in oral radiology, “blinded” to the clinical examination. Based on the Kappa value, were found acceptable levels of reliability intra examiner in the application of RDC/TM, and intra e inter examiner in the evaluation of MRI. Kappa values for agreement between RDC/TMD and MRI were better in the diagnosis of disc displacement on the right side (k = 0.913). In this study, the RDC/TMD was valid for diagnosing disc displacement of the TMJ, with 95% accuracy for the evaluation of ATM on the right side and 75% of the left side, suggesting the need for a standardized examination conducted by trained investigators in the evaluation of patients with TMD.

Submitted by Jean Medeiros (jeanletras@uepb.edu.br) on 2016-04-26T14:22:16Z No. of bitstreams: 1 PDF - Júlio César Queiroz.pdf: 1732660 bytes, checksum: eac0e047f8642390b521fbea380c66e3 (MD5) / Approved for entry into archive by Secta BC (secta.csu.bc@uepb.edu.br) on 2016-07-25T19:28:43Z (GMT) No. of bitstreams: 1 PDF - Júlio César Queiroz.pdf: 1732660 bytes, checksum: eac0e047f8642390b521fbea380c66e3 (MD5) / Approved for entry into archive by Secta BC (secta.csu.bc@uepb.edu.br) on 2016-07-25T19:32:18Z (GMT) No. of bitstreams: 1 PDF - Júlio César Queiroz.pdf: 1732660 bytes, checksum: eac0e047f8642390b521fbea380c66e3 (MD5) / Made available in DSpace on 2016-07-25T19:32:18Z (GMT). No. of bitstreams: 1 PDF - Júlio César Queiroz.pdf: 1732660 bytes, checksum: eac0e047f8642390b521fbea380c66e3 (MD5) Previous issue date: 2015-07-21 / Temporomandibular jointcan be affected by musculoskeletal disorders, which result in temporomandibular joint dysfunction characterized by signs and symptoms such as oral-facial pain, clicks, crackles, among others. Temporomandibular jointinternal derangement causes such symptoms and it is generally characterized by disc displacement followed by disc- condyle irregular relation, jaw- temple‟s articular componentsjoint morphological changes, as well as effusion and degenerative changes in that joint. This study aims to evaluate the association between displacement, function, disc position and condylar excursion in jaw- temple joint symptomatology by using magnetic resonance imaging. The sample consisted of 140 jaw-temple joints.Displacement, function and disc position were analyzed.Clock hours and condylar excursion were used as criterion. There were used bivariate and multivariate logistic regressions for statistical analysis, in order to verify those variables association with the following signs and symptoms: presence of pain, clicks, crackles, jerky and mouth opening limitation. Results showed positive association between displacement with reduction andhypoexcursion with pain (p = 0.05), between displacement with reduction and clicks (p = 0.05), between disc position lower than 10 hours, displacement without reducing and hypoexcursion with irregular movement and opening limitation (p <0.05). It was also observed that only the lower position than 10 hours showed a correlation with symptoms, suggesting normal position comprising the range of 10 hours to 1 hour. Displacements with and without reduction showed associations with some signs and symptoms as regards disc function.About condylar excursion, only hypoexcursion was associated with symptoms.It was concluded that there was association of temporomandibular jointdisordersymptoms with disc function and position, as well as with condylar excursion. / A articulação temporomandibular (ATM) pode ser acometida por desordens musculoesqueléticas, que resultam na disfunção temporomandibular (DTM), caracterizada por sinais e sintomas, como dor orofacial, estalidos, crepitações, dentre outros. O desarranjo interno da ATM que provoca essa sintomatologia se caracteriza geralmente pelo deslocamento do disco e consequente relação disco-côndilo irregular, pelas alterações morfológicas dos componentes articulares da ATM, pela presença de efusão e de alterações degenerativas nessa articulação.O objetivo deste estudo foi avaliar a associação do deslocamento, função, posição do disco e da excursão condilar na sintomatologia da ATM, através de imagens de ressonância magnética. A amostra foi composta por 140 ATMs e foram analisados o deslocamento, função, posição do disco conforme critério das horas de um relógio e excursão condilar. Para a análise estatística, foram utilizadas regressão logística bivariada e multivariada, a fim de verificar a associação destas variáveis com os seguintes sinais e sintomas: presença de dor, estalidos, crepitações, movimento irregular e limitação de abertura de boca. Os resultados demonstraram associações positivas entre deslocamento com redução e hipoexcursão com presença de dor (p≤0,05), entre deslocamento com redução e estalidos (p=0,05), entre posição do disco menor que 10 horas, deslocamento sem redução e hipoexcursão com movimento irregular e limitação de abertura (p<0,05). Observou-se que apenas a posição menor que 10 horas demonstrou associação com a sintomatologia, o que sugere normalidade das posições que compreendem o intervalo de 10 horas a 1 hora. Quanto à função do disco, os deslocamentos com e sem redução apresentaram associações com alguns sinais e sintomas e no que se refere à excursão condilar, apenas a hipoexcursão esteve associada à sintomatologia.Concluiu-seque houve associação da sintomatologia da ATM com a função e posição do disco, como também com a excursão condilar.

Submitted by isabela.moljf@hotmail.com (isabela.moljf@hotmail.com) on 2017-08-30T11:31:00Z No. of bitstreams: 1 isabelamaddalenadias.pdf: 1933858 bytes, checksum: dd1558f677feb5cfa8ac31d154731a13 (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2017-08-30T11:44:47Z (GMT) No. of bitstreams: 1 isabelamaddalenadias.pdf: 1933858 bytes, checksum: dd1558f677feb5cfa8ac31d154731a13 (MD5) / Made available in DSpace on 2017-08-30T11:44:47Z (GMT). No. of bitstreams: 1 isabelamaddalenadias.pdf: 1933858 bytes, checksum: dd1558f677feb5cfa8ac31d154731a13 (MD5) Previous issue date: 2011-03-28 / O presente estudo teve como objetivo avaliar por meio de imagens de ressonância magnética a prevalência e os tipos de deslocamentos de disco e alterações ósseas degenerativas que podem acometer a articulação temporomandibular (ATM) de indivíduos adultos portadores de sinais e sintomas de desordens temporomandibulares (DTM), verificando a correlação entre estes achados. Foram avaliadas 224 articulações de112 pacientes, de ambos os gêneros, com indicação para o exame de ressonância magnética. A possibilidade de visualizar simultaneamente o disco articular e estruturas de tecido duro da ATM por meio de um único exame permitiu verificar estas condições e a correlação entre ambas. Para isso um examinador calibrado avaliou as imagens atribuindo escores em relação ao deslocamento do disco articular e alterações ósseas degenerativas. O deslocamento do disco articular foi verificado em 58,42% das ATM avaliadas no corte sagital. O deslocamento anterior de disco com redução foi o mais frequente, ocorrendo em 67,18% dos casos de articulações com deslocamento do disco. Nos cortes coronais, o deslocamento do disco articular foi verificado em 56,65% das ATM avaliadas, sendo o deslocamento medial visto em 96% dos casos. Com relação às alterações ósseas degenerativas as mesmas foram verificadas em 53,94% das ATM analisadas. Houve correlação significativa entre o deslocamento de disco com redução e o aplainamento condilar; deslocamento de disco sem redução e o aplainamento condilar; deslocamento de disco sem redução e alterações degenerativas associadas (aplainamento e erosão; aplainamento, osteófito e erosão; aplainamento e osteófito; erosão e esclerose, aplainamento e esclerose; aplainamento, osteófito e esclerose) e deslocamento lateral do disco articular e osteófitos. A associação entre casos avançados de deslocamento de disco e a ocorrência de alterações degenerativas, enfatizam a importância das imagens por ressonância magnética tanto para um diagnóstico preciso e elaboração de um correto plano de tratamento, quanto para fins prognósticos, nos casos que o exame clínico não é suficiente para estes objetivos. / The aim of this study is evaluate by means of magnetic resonance images the prevalence and types of disc displacements and degenerative bone changes that can affect the temporomandibular joint (TMJ) of patients with signs and symptoms of temporomandibular disorders (TMD),checking the correlation between these findings. Two hundred twenty-for temporomandibular joints of 112 patients of both genders, with an indication for MRI, were evaluated The possibility to simultaneously view the disc and hard tissue structures of the TMJ by a single examination has shown these conditions and the correlation between them. For this purpose a calibrated examiner evaluated the images by assigning scores in relation to the disc displacement and degenerative bone changes. The disc displacement was found in 58.42% of TMJ evaluated on sagittal sections. The anterior displacement of the disc with reduction was the most common, occurring in 67.18% of cases of joints with disc displacement. In coronal sections, disc displacement was observed in 56.65% of TMJ evaluated, and the medial displacement seen in 96% of cases. With respect to degenerative bone changes, the same were observed in 53.94% of TMJ analyzed. There was significant correlation between disc displacement with reduction and condylar flattening, disc displacement without reduction and condylar flattening, disc displacement without reduction and degenerative changes associated (flattening and erosion, flattening, osteophyte and erosion; flattening and osteophytes, erosion and sclerosis, flattening and sclerosis, flattening, osteophytes and sclerosis) and lateral displacement of the disc and osteophytes. The association between advanced cases of disc displacement and the occurrence of degenerative changes, emphasize the importance of magnetic resonance imaging to an accurate diagnosis and development of an appropriate treatment plan, and for prognosis in cases than clinical examination is not sufficient for these purposes.

INTRODUÇÃO: A hérnia de disco lombar (HDL) acomete cerca de 5% dos pacientes com de dor lombar e o tratamento cirúrgico nestes casos é cada vez menos indicado, optando-se, na maior parte dos casos, pelo conservador. Embora o método estabilização lombar (EL) e a estimulação elétrica nervosa transcutânea (TENS) tenham mostrado bons resultados em indivíduos portadores de dor lombar inespecífica, há escassa literatura que tenha verificado a eficácia destes tratamentos isoladamente em sujeitos acometidos por hérnia de disco lombar. OBJETIVO: Comparar a eficácia dos exercícios de estabilização lombar e da TENS na dor, incapacidade funcional, e capacidade de ativação do músculo transverso do abdome (TrA) de indivíduos com hérnia de disco lombar. METODOLOGIA: Participaram da pesquisa 40 indivíduos com idade variando de 25 a 58 anos com dor lombar e hérnia de disco, e foram randomizados em dois grupos: Grupo estabilização lombar (EL) (exercícios específicos para os músculos TrA e multífido lombar(ML)) (n=20) e Grupo TENS (GT) (n=20) que receberam atendimento com corrente de estimulação elétrica nervosa transcutânea. Foram avaliados quanto à dor (Escala Visual Analógica e Questionário McGill de Dor), incapacidade funcional (Índice de Incapacidade de Oswestry), e capacidade de recrutamento do TrA (Unidade de Biofeedback Pressórico-UBP). Os grupos foram tratados em duas sessões semanais com duração de 60 minutos por oito semanas. Cada indivíduo foi avaliado antes e após o tratamento. O nível de significância estabelecido foi de alfa=0,05. RESULTADOS: Após oito semanas, o grupo estabilização lombar mostrou melhora significativa na dor (p < 0,001), incapacidade funcional (p < 0,001), e capacidade de ativação do TrA (p < 0,001). O grupo TENS apresentou diferença estatisticamente significante apenas na dor (p < 0,012). A estabilização foi superior à TENS na melhora na dor (p < 0,001), incapacidade funcional (p < 0,001), e capacidade de ativação do TrA (p < 0,001). CONCLUSÃO: Os resultados indicam que a estabilização é efetiva na melhora da dor, incapacidade funcional, e capacidade da ativação do TrA, e a TENS apenas na dor. A estabilização foi superior à TENS em todas as variáveis / INTRODUCTION: Lumbar disc herniation (LDH) affects about 5% of low back pain (LBP) patients. Surgical treatment in these cases is increasingly less suitable, opting, in most cases, for the conservative. Although lumbar stabilization method and transcutaneous electric nerve stimulation (TENS) have shown good results in patients with nonspecific low back pain, there is scarce literature that has verified the effectiveness of these treatments alone in subjects suffering from lumbar disc herniation.OBJECTIVE: To compare the effectiveness of lumbar stabilization exercises and transcutaneous electrical nerve stimulation (TENS), on pain, functional disability and activation of the transversus abdominis muscle (TrA), in individuals with lumbar disc herniation (LDH). METHODS: This study involved 40 patients (age range 25-58 years) with lumbar disc herniation randomized into two groups: Stabilization group (SG: n=20); which received of stabilization exercises (transversus abdominis and lumbar multifidus muscles) and TENS group (TG: n=20), which received electrotherapy. The following instruments were used: visual analogue pain scale and McGill Pain Questionnaire for pain, Oswestry Disability Index for functional disability, and pressure biofeedback unit (PBU) for ability to contract the TrA. Analyses within and between groups were performed after treatment. Groups underwent 16 sessions, for 60 minutes, twice a week and they were evaluated before and after eight weeks. Significance level was set at alfa= 0.05. RESULTS: After eight weeks, lumbar stabilization group showed significant improvements in pain (p < 0.001), functional disability (p < 0.001), and the ability to contract the TrA (p < 0.001). There were no significant differences in TENS group in terms of disability (p < 0.264) or ability to contract the TrA muscle (p < 0.181), however, improvement in pain was demonstrated (p < 0.012). The stabilization was superior to TENS in terms of improvements in pain (p < 0.001), functional disability (p < 0.001), and ability to contract the TrA (p < 0.001). CONCLUSION: The results indicate that stabilization is effective in improving pain, functional disability, and the ability to contract the TrA in individuals with LDH. In the TENS group, the only improvement after treatment was in terms of pain. Stabilization was superior to TENS in all outcomes

Introdução: A microdiscectomia para tratamento de hérnia de disco lombar, mesmo apresentando ótimos resultados, pode resultar em danos consequentes à lesão tecidual local. As cirurgias endoscópicas já são consideradas padrão ouro em outras áreas da medicina devido ao mínimo dano colateral causado e consequente melhora dos resultados. Autores internacionais demonstraram a eficácia e segurança da técnica, mas ainda não existem estudos na América Latina que validem esses estudos. Objetivo: Comparar os resultados cirúrgicos da abordagem endoscópica e convencional para tratamento da hérnia de disco lombar quanto à melhora da dor, da incapacidade e suas complicações. Métodos: Estudo prospectivo randomizado envolvendo pacientes com hérnia de disco lombar, submetidos a tratamento cirúrgico. Quarenta e sete pacientes foram randomizados prospectivamente em dois grupos, discectomia endoscópica e microdiscectomia, e foram acompanhados ao longo de 12 meses. Questionário de incapacidade de Oswestry validado para o português e escala analógica de dor foram aplicados durante o seguimento. Os eventos adversos também foram recordados. Resultados: Após a cirurgia os pacientes tiveram melhoras significativas da dor irradiada (68%), mas sem diferença entre os grupos estudados e apresentaram significativa melhora da incapacidade. Quanto a dor lombar, a discectomia endoscópica resultou em menor dor lombar pós-operatória nas avaliações de uma semana, um e três meses quando comparada a microdiscectomia. Entretanto não se observou diferença entre os grupos no sexto e décimo segundo mês de seguimento. Não foram evidenciadas diferenças estatísticas quanto a recidiva, infecções e cirurgias subsequentes. Conclusão: Os resultados clínicos da discectomia endoscópica são semelhantes aos da microdiscectomia quanto à melhora da dor irradiada e da incapacidade, mas oferecem uma vantagem quanto à dor lombar pós-operatória até o terceiro mês. A discectomia endoscópica consiste em uma técnica segura e eficaz representando uma alternativa ao tratamento padrão ouro representado pela microdiscectomia / Introduction: Microdiscectomy, despite the good results, may result in damages to the local tissue. In other fields, endoscopic surgeries are considered the gold standard due to the minimal collateral damage. There aren\'t studies comparing both methods performed in Latin America. Objective: Compare the traditional microdiscectomy and percutaneous endoscopic lumbar discectomy for the treatment of disc herniation regarding pain, disability and complications. Methods: Prospective randomized trial with patients with sciatica due to lumbar disc herniation comparing two different surgical techniques. Forty-seven patients were divided in two groups and monitored for twelve months. Oswestry disability index and visual analog scale for pain were recorded. Results: After surgery the leg pain and disability improved significantly, but without significant difference between the groups. There was significantly less back pain after surgery until the third month. After that the groups were statistically the same. There were no statistical differences regarding recurrence, infection and subsequent surgeries. Conclusion: Endoscopic discectomy results are similar than conventional microdiscectomy according to pain and disability improvement, however, lumbar pain are less during the first three months. Endoscopic discectomy consists in a safe and efficient alternative to microdiscectomy