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Query: UMLS:C0030552 (paresis)
 5,831 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In a double-bind investigation of the effect phenylbutazone (initially injected + Butazolidin Alka p.o.) was compared with that of placebo in 36 patients with acute lumbago-sciatica without root involvement in the form of paresis. The investigation showed that the effect of phenylbutazone was significantly better than that of placebo. The side-effects of the drug were mild.
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PMID:Phenylbutazone in treatment of acute lumbago-sciatica. 12 37

Disturbances of bladder, function often occur in cases of sciatica due to intervertebral disc lesions, although other clinical signs of sacral root compression are absent. In 32 patients, operated upon because of lumbar disc diseases without cauda equina syndrome, micturition symptoms were registered, and bladder function was investigated. Intravesical pressure/volume relations (water cystometry) and simultaneous intravesical pressure/urinary flow relations (urodynamic examination) were recorded preoperatively together with anal sphincter surface EMG. In almost half of the patients cystometry revealed bladder hyposensibility (late first sensation), and a quarter voided mainly by straining (detrusor paresis). These findings were unrelated to the neurosurgical pathology. Pronounced micturition symptoms or abnormal preoperative urodynamic examinations indicated evaluation two months after lumbar disc operation. Two-thirds tended towards recovery, one third remained unchanged.
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PMID:Bladder neuropathy in lumbar disc disease. 46 3

A prospective study was carried out in 280 patients suffering from sciatica caused by myelographically verified disc prolapse. The patients were divided into three groups according to the following criteria: 1. The doubtful group, selected at random. Patients with doubtful indications for surgery. Treated operatively or not--by drawing lots. 2. Non-operated group. Patients with moderate symptoms and/or continued improvement. 3. Operated group. Patients with imperative indications for surgery. The muscle strength of the lower limbs was measured during maximal isometric voluntary contractions in all the patients 2 weeks after admission. Approximately 50 per cent had paresis. Control examinations of these patients 1 year later showed that operative treatment gave no better prognosis than conservative treatment with regard to the motor function, neither in the group chosen at random nor in the selected groups. The causative factors are discussed.
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PMID:The effect of delayed disc surgery on muscular paresis. 118 24

Among 120 patients with lumbar disk prolapse treated conservatively over a seven-year period, 72 patients were submitted to follow-up examination, and questionnaires completed by 92 patients were evaluated. Some 23.8% of the patients reported freedom from pain following treatment in hospital. Sciatica cleared up in 43.2%. After discharge from hospital, the average working time lost in 54 patients was 11.1 weeks. Ninety-five percent of the patients reported a return to work within one year. Eighty percent were able to return to their original workplaces. Some 73.8% of the patients surveyed were satisfied or very satisfied with the results of treatment. With respect to sensory disorders 37%, and with respect to paresis 32%, of the patients, reported improvement. Overall, the general and local symptoms, such as changes in gait and posture, percussion pain and tenderness, all showed an appreciably greater tendency to regress than did the neurological deficits.
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PMID:[Lumbar intervertebral disk displacement. Results of conservative treatment]. 137 9

Among 2983 patients operated upon for herniated lumbar disks from 1981 through 1985 193 were between 65 and 84 years of age. Many of them had long-standing histories of recurrent sciatica. Most patients presented with unilateral or bilateral radicular pain, motor weakness or paresis and typical sensory changes. The usual type of conservative treatment had been tried in all patients before operation was recommended. Although our patients were, due to their advanced age and medical problems less than optimal surgical risks, we did not encounter a single perioperative mortality and postoperative complications were limited. The mean duration of hospitalisation was 15.1 days. Surgical results were quite encouraging, since 80.3% of the patients reported satisfactory resolution of their preoperative pain, motor weakness and sensory changes. Since most patients can achieve relief of their preoperative pain, it is not justified to restrict operative treatment only because of advanced age despite a number of preoperative risk factors.
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PMID:[Results of intervertebral disk surgery in advanced age]. 232 Jan 99

Low back pain and lumbo-ischialgia are symptoms of degeneration of the intervertebral disc with protrusion. The possible invalidity in these patients is difficult to assess. Several factors do influence the outcome of conservative and/or neurosurgical treatment: Some patients are treated as out-patients only instead of the necessary in-patient treatment. Only in case of a paresis or disturbances of the urine bladder function, operation must be done without pretreatment. The quality of the postoperative treatment decides on the later result! The clinical assessment of a patient is not possible without examination and intensive questions about the circumstances of daily life, holiday activities, hobbies and so on. Discrepancies between the result of examination and the answers to these questions give a signal to a very critical evaluation of this patient.
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PMID:[Backache--risk of disability?]. 252 32

Based on statistical analysis of 97 chronic low back patients, a pelvic list model has been proposed explaining the correlation between leg length discrepancies (LLD) and sciatica. This model suggests that asymmetrical pronation patterns (one pedal arch dropping more than the contralateral pedal arch) initiates a forward downward rotation within the sacroiliac joint. Entrapment of the sciatic nerve between the piriformis muscle and sacrospinous ligament occurs. Clinically, paresis is observed: numbness, weakness and eventually paralysis of the affected limb. Based on this work, the authors have comprised a classification dividing LLD into two main categories: functional and anatomical. Functional LLD have been subdivided into two types of lists: static and dynamic. Treatment based on a combination of chiropractic and podiatric therapy is presented with a 6-month follow-up. Analysis of the success in this tandem approach is very promising. Concurrently, a chondromalacia model is proposed explaining the pathomechanical events associated with oblique tracking patellar syndrome. The authors suggest that excessive pronation is the causative factor directing asynchronous rotation between the shank and femur. This forces the patella out of its normal tracking groove, which, in turn, generates erosion between the inferior margin of the patella and femoral epicondyles.
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PMID:Excessive pronation: a major biomechanical determinant in the development of chondromalacia and pelvic lists. 297 5

Epidural application of local anesthetics or opiates is commonly used for treatment of severe pain or arterial obstruction. We discuss two cases of complications following peridural anesthesia. As an acute complication, a lumbar epidural hematoma developed hours after placement of the catheter and caused sciatic pain and nearly complete paraplegia. The hemorrhage might have been promoted by heparinization. After decompressive hemilaminectomy the patient recovered but was disabled by a persistent paresis. The second patient suffered from renal failure, arterial obstruction, and phantom limb pain. A peridural catheter was kept in place for 6 weeks. Five months later the patient developed severe sciatica. Spinal computed tomography showed compression of the cauda at the L4/5 level (Fig.4) caused by an abscess that was opened and drained. After insertion of a gentamicin - PMMA - chain (Septopal), the wound healed primarily but the patient suffered from persistent pain. The incidence of vessel puncture after insertion of a peridural catheter is about 1%-10%. The risk of hemorrhage, perforation of the dura, and nerve root irritation is increased in scoliotic or elderly patients with a narrow spinal canal. Persistent pain after removal of the catheter is the most important sign. Although paraplegias following peridural catheterization can occur without anticoagulants, even low-dose heparinization is potentially dangerous. The risk of infectious complications after long-term peridural catheterization may be up to 20%. Hematogenous metastatic infection is more common in patients with malignancies or multiple risk factors than continuous immigration of bacteria. Epidural hematomas and spinal abscesses can cause disability and persistent neurological deficit in spite of aggressive surgical and antibiotic therapy.
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PMID:[Lumbar epidural hematoma and spinal abscess following peridural anesthesia]. 368 76

Two cases of postoperative extradural arachnoid cyst in the lumbar region were reported. The symptoms such as lumbago, sciatica and paresis of foot which were perfectly cured at discharge relapsed after several months of daily business. The two patients were readmitted and reexamined by myelography and computer assisted tomography. In the two patients a cystic pooling of metrizamide having a connection with the subarachnoid space was noted in the same way. At the second operation a small dural tear and an extradural arachnoid cyst were recognized similarly. Burres and coworkers reported that an extradural arachnoid cyst would easily grow through a small dural defect in the lumbar region, because the hydrostatic pressure is higher than that of the cervical level. Our two cases might well coincident with their theory. In consequence of the experience of the two postoperative extradural arachnoid cyst, we give emphasis that even though the dural tear would be small, especially in the lumbar region, it should not be overlooked and be closed carefully with fine sutures.
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PMID:[Postoperative lumbar extradural arachnoid cyst. Report of two cases and review of the literature]. 623 58

As far as medical decision making is based on weighing up individual risks and chances of a certain patient receiving a certain treatment, some knowledge is required about signs and symptoms which are associated with a certain outcome: they are called risk factors, or predictive factors. In lumbar intervertebral disc surgery, the most frequent undesired effect of the treatment is unsuccessfulness. Reviewing the literature about risk factors for unsuccessfulness, one recognizes a lot of unconfirmed or even contradictory findings. This inconsistency can possibly be attributed to the common use of a very simplified, unidimensional definition of the target variable "success of treatment". That is why we performed a prospective observational trial on 109 patients in whom the success of lumbar intervertebral disc microsurgery was assessed after half a year using six different target variables. The rate of treatment success varied considerably, from 44% (when "return to previous occupation" served as the target variable) to 91% (with regard to "subjective contentedness"). Further target variables were intensity of sciatica, intensity of low back pain, activities of daily living, and postoperative paresis, giving intermediate success rates. We were able to identify some risk factors (for instance, duration of sick leave and of the recent pain episode, preoperative paresis, intensity of psychosomatic complaints), each of them being relevant to some of the target variables, but none of them associated with all of the target variables. We conclude that the multidimensional rating of treatment successes seems to promote risk research in multidimensional diseases.
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PMID:[Predictors of treatment success after microsurgical operation of lumbar intervertebral disk displacement]. 781 Feb 52


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