A dor lombar acomete a humanidade desde tempos remotos, tendo seus primeiros relatos descritos no \"Papiro de Edwin Smith\" (1500 a.C.). Acredita-se que durante a vida até 90% da população terá pelo menos um episódio de dor lombar, sendo tal patologia uma das principais causas de afastamento do trabalho, acarretando em vultosos prejuízos financeiros anuais. Cinco a 10% dos pacientes que possuem lombalgia também apresentam dor irradiada para o membro inferior (ciatalgia) e esta última, 85% das vezes é secundária à hérnia de disco lombar (HDL), cuja prevalência anual na população geral é estimada em 2.2%. O objetivo deste estudo foi avaliar a eficácia da aplicação do laser diodo de 980 nm intradiscal no tratamento da ciatalgia em pacientes portadores de hérnias lombares contidas em comparação com o grupo controle. Vinte e cinco pacientes (30 discos intervertebrais) com HDL e dor neuropática de distribuição metamérica foram randomizados, 12 no grupo controle e treze no grupo laser. No grupo controle foi feita injeção de dexametasona, clonidina e lidocaína intradiscais e no grupo laser aplicada média de 900 J de energia intradiscal, além das mesmas medicações. Os grupos foram avaliados nos tempos antes, imediatamente após, um mês, dois, três, seis e 12 meses decorridos do procedimento quanto aos parâmetros: dor, pela Escala Numérico Visual (ENV), uso de medicações para o controle desse sintoma e efeitos colaterais. Os resultados demonstraram queda nas médias das ENVs e necessidade de medicações para controle da dor em ambos os grupos logo após o tratamento (p<0,05), que perdurou no grupo laser onde houve média de redução de 80,73% nas ENVs, e de 75,51% na necessidade de medicação em um ano de seguimento (p<0,05). Já no grupo controle, as ENVs e as necessidades de analgésicos voltaram a ser semelhantes aos valores anteriores ao tratamento a partir do segundo mês de avaliação (p>0,05). Foi verificada predominância da doença no sexo masculino (68%), com faixa etária média de 44 anos, e baixa incidência de efeitos colaterais semelhantemente a dados anteriormente relatados. O laser diodo de 980 nm é eficaz na redução da ciatalgia secundária à herniação discal contida e superior à injeção intradiscal de clonidina, dexametasona e lidocaína, no que se refere à duração da redução das ENVs e da necessidade de medicações analgésicas. / Lumbar pain affects mankind from earliest times having its first descriptions in the \"Edwin Smith Papyrus\" (1500 BC). It is believed that during life up to 90% of the population will have at least one episode of low back pain, being such pathology one of the main causes of work withdrawal with huge annual financial losses. Five to 10% of patients with low back pain also have lower-limb pain (sciatica), and the latter, 85% of the time, is secondary to lumbar disc herniation (LDH), whose annual prevalence in the general population is estimated at 2.2%. The objective of this study was to evaluate the efficacy of intradiscal diode laser 980 nm wavelength in comparison with a control group on sciatica treatment in patients with contained lumbar disc herniations. A total of 25 patients (30 intervertebral discs) with LDH and neuropathic pain of metameric distribution were randomized, 12 patients in the control group and 13 patients in the laser group. In the control group, intradiscal injection of dexamethasone, clonidine and lidocaine was performed and in the laser group an average of 900 J of intradiscal energy was delivered, in addition to the same medications. The groups were evaluated at the time before, immediately after, 1, 2, 3, 6, and 12 months after the procedure for the parameters: pain measured by Visual Numerical Scale (VNS), medication use to control this symptom and side effects. The results showed a decrease in VNS and the need for pain control medications in both groups after treatment (p<0.05) that lasted in the laser group which demonstrated an average in VNSs reduction of 80,73% and in pain analgesic needs of 75,51% after 1 year (p<0,05). In the control group, VNSs and analgesic needs were again similar to pre-treatment values from the second month of evaluation (p>0.05). The predominance of the disease was found in males (68%), with a mean age of 44 years and a low incidence of side effects similar to the data reported before. The 980 nm diode laser is effective in reducing sciatica due to contained LDH and superior to intradiscal injection of clonidine, dexamethasone and lidocaine for the duration of the reduction of VNS and need for analgesic medications.

Psychosocial factors have been advanced as an explanation for the development of chronic disability in 20 to 30% of patients treated by lumbar disc surgery. Aims: The overall aim of this thesis was to study the role of psychosocial factors in patients undergoing first-time lumbar disc surgery in relation to the outcome of both surgery and subsequent physiotherapy. Methods: Sixty-nine patients with lumbar disc herniation undergoing first-time disc surgery participated in the studies; in addition, Study I included 162 knee patients for comparison. Psychosocial factors were assessed preoperatively, as was the activation of the physiological stress response system. Pain, disabil-ity and quality of life were assessed before, and 3 and 12 months after surgery. Coping and kinesiophobia were analysed before and one year after surgery. The results of two different postoperative training programmes were compared. Results: There were no differences between disc and knee patients regarding the presence of psychosocial stress factors preoperatively (Study I). Disc patients with low diurnal cortisol variability had lower physical function, perceived fewer possibilities to influence their pain and were more prone to catastrophise than patients with high diurnal cortisol variability (Study II). The results of clinic-based physiotherapy and home training did not differ regarding postoperative disability and pain 3 months after surgery. The home-based group had less pain and higher quality of life in comparison to the clinic-based group 12 months after surgery (Study III). Patients’ expectations of returning to work could best predict pain, disability, quality of life and sick leave one year after surgery (Study IV). Psychosocial factors were only weakly asso-ciated to pain, disability, quality of life and sick leave preoperatively. However, these associations were stronger in patients with residual pain one year after surgery. Conclusion: Psychosocial factors and, in particular, patients’ expectations regarding outcome are associated with the results of lumbar disc surgery. Assessing psychosocial factors preoperatively and developing an active home training programme after surgery could create options leading to better results for these patients.

Tyrimo tikslas – įvertinti liemens raumenų izometrinės jėgos, simetriškumo ir gyvenimo pilnatvės kaitą po taikytos stuburo stabilizavimo ir laikysenos korekcijos programos asmenims, kuriems diagnozuota juosmeninės stuburo dalies išvarža bei vargina lėtinis apatinės nugaros dalies skausmas. Uždaviniai: 1. Įvertinti vyrų ir moterų, kuriuos vargina lėtinis apatinės nugaros dalies skausmas, nugaros, pilvo bei liemens šoninių raumenų izometrinės jėgos kaitą po taikytos kineziterapijos; 2. Įvertinti vyrų ir moterų nugaros-pilvo bei liemens šoninių raumenų izometrinės jėgos santykio kaitą po taikytos kineziterapijos; 3. Įvertinti vyrų ir moterų liemens raumenų statinės ištvermės, juosmens judesių amplitudės kaitą po taikytos kineziterapijos; 4. Nustatyti nugaros bei pilvo raumenų izometrinės jėgos ir apatinės nugaros dalies skausmo sąsajas prieš ir po taikytos kineziterapijos; 5. Įvertinti vyrų ir moterų apatinės nugaros dalies ir kojos skausmo, funkcinės negalios, gyvenimo pilnatvės bei bendros sveikatos būklės kaitą po taikytos kineziterapijos. Tyrime dalyvavo 17 darbingo amžiaus asmenų, 8 moterys ir 9 vyrai. Jiems radiologiškai diagnozuota juosmeninės stuburo dalies išvarža. Taikyta stuburo stabilizavimo ir laikysenos korekcijos pratimų programa 9 k., 3 k. per sav., po 45 min., individualiai. Vertinta: liemens raumenų maksimali izometrinė jėga (dr. Wolff „Back-check“ dinamometras), statinė ištvermė (sekundėmis), apatinės nugaros dalies ir kojos skausmas (SAS), funkcinė negalia... [toliau žr. visą tekstą] / The aim of the investigation – to evaluate changes in trunk muscles isometric strength, symmetry and quality of life under the impact of spine stabilization and posture correction exercises in patients with diagnosed intervertebral disk herniation and low back pain. The tasks of investigation: 1. To evaluate changes in back, abdominal and waist side muscles isometric strength after physical therapy applied in women and men with low back pain; 2. To evaluate changes in symmetry of the back-abdominal and waist side muscles isometric strength after physical therapy applied; 3. To evaluate changes in the muscles static endurance, lumbar movement amplitude after physical therapy applied; 4. To determine the correlation between back, abdominal muscles isometric strength and low back pain before and after physical therapy. 5. To evaluate changes of low back and leg pain, functional impairment, quality of life and common health condition of the patients after physical therapy applied in women and men. Methods and materials. There took part 17 working-age persons (8 women and 9 men) diagnosed with lumbar intervertebral disk herniation and low back pain in the investigation. They were applied spine stabilization and posture correction exercises program to - 9 times altogether, 3 times a week individually, 45 min. each. There were evaluated: trunk muscles isometric strength (Dr. Wolff “Back-check”), low back and leg pain (SAS), static endurance (in sec.), functional impairment... [to full text]