Lombosciatica - mituri i greeli n practica medical

Szatmri Szabolcs

UMF Tg. Mure

Deyo R.A. Low-Back Pain.

Scientific American. 1998;279:2933.

Mituri:

1. hernia de disc trebuie operat

2. rtg, CT sau IRM identific cauza ntotdeauna

3. lombosciatic pacientul s rmn inactiv

4. cauza: traume, efort

5. cauzeaz incapacitate de munc

6. fiecare pacient necesit imagistic

7. esena tratamentului este repausul

Investigator: Disc bombat Disc protruzionat Disc prolabat Disc patologic

Jensen et al. 52% 27% 1% 64%

Boos et al.* 63% 13%

Greenberg et

al. 39% 18% 57%

Weishaupt et

al. 24% 40% 18%

Wood et al * 53% 37% 63%

Prevalena herniei de disc la subieci asimptomatici

IRM lombar cu rezultate fals? pozitive

http://www.chirogeek.com/000_MRI-Abnormalities_Asymptomatic-Pats.htm

MRI

indicaii:

pacient

MF

specialist

interpretare:

radiolog

specialist

MF

pacient

efecte:

ncetinete vindecarea

iatrogenii:

paralizie

uureaz indicaia operatorie

indicaia operatorie:

tulburrile sfincteriene

pareza

indicaia operatorie: tulburrile sfincteriene

pareza

atenie!

peste 50 ani

scdere ponderal

durere n timpul repausului

traume, neoplazie, droguri, alcool, diabet, corticoterapie, osteoporoz, SIDA

febr

n anul 2011 la Cl. Neurologie II:

1600 pacieni

300 (20%) lumbago i/sau sciatic

4 transferai la Neurochirurgie