Sažetak. Prevalencija stenoze spinalnog kanala slabinske regije u stalnom je porastu zbog starenja pučanstva. Naime, unatoč etiološkoj raznovrsnosti, ona najčešće nastaje kao posljedica ...degenerativnih promjena na kralježnici. Nema općeprihvaćene klasifikacije stenoze spinalnog kanala slabinske regije. Za postavljanje dijagnoze potrebno je povezati nalaze iz anamneze, kliničkog statusa i slikovnih metoda zajedno s elektrofiziološkim nalazima. Liječenje bolesnika sa stenozom spinalnog kanala slabinske regije može biti konzervativno (farmakološko i nefarmakološko) i kirurško, s tim da se u potonjem u posljednje vrijeme preferiraju minimalno invazivne tehnike. U ovom radu dajemo sveobuhvatni suvremeni pogled na stenozu spinalnog kanala slabinske regije.
. Low-back pain is one of the most common causes of physical disability, most often originating from intervertebral disc degeneration. Lack of pinpointing the exact source of pain is the limiting ...factor in more efficient prevention and treatment. New findings, especially in the fields of genetics and mass spectometry based protein analysis, shed a new light to the understanding of etiopathogenesis of disc degenerative disease. New imaging methods like chemical exchange saturation transfer (CEST)MRI or apparent diffusion coefficient (ADC)MRI can detect early degenerative changes. Advances have been made regarding elucidating the role of physical load, as well as the type of exercise that can have an impact on the development and treatment of patients with degenerative disc disease. Finally, a significant progress has been made in the surgical treatment ecouraging of these patients, with an emphasis on minimally invasive techniques. Other surgical modalities have also shown improvement, like total disc replacement and mesenchymal stem cells treatments. These, and other novelties in the diagnosis and treatment of degenerative disc disease of lumbar spine are discussed in this article.
Vratobolja je jedna od najčešćih mišićnokoštanih bolesti koja rezultira značajnom boli i nesposobnosti te ima velik utjecaj na individualnoj razini, kao i na zdravstveni sustav i društvo u cjelini. ...Uzroci vratobolje su različiti, a etiološki prevladavaju oni mehanički povezani s degenerativnim promjenama vratne kralježnice. Svjedočimo raznim dijagnostičkim i terapijskim pristupima za ove bolesnike. Hrvatsko vertebrološko društvo Hrvatskoga liječničkog zbora predstavlja sveobuhvatni narativni pregled i smjernice za dijagnozu i liječenje bolesnika s vratoboljom, s naglaskom na najčešće uzroke. Smjernice su rezultat konsenzusa stručnjaka različitih specijalnosti, a temelje se na najboljim dokazima. Prvi dio se odnosi na dijagnostiku, a drugi, njemu komplementarni dio odnosi se na terapiju. Dijagnostički dio smjernica (1. dio) obuhvaća: klinička obilježja i evaluaciju (uključivo strukturirane upitnike), laboratorijsku dijagnostiku, slikovne metode, neurofiziološko testiranje i minimalno invazivne dijagnostičke procedure. Dio smjernica o liječenju (2. dio) uključuje: farmakološko liječenje, tjelesne medicinske vježbe, trakciju, manualnu terapiju, metode fizikalne terapije, primjenu ortoza, minimalno invazivne terapijske intervencije, kirurško liječenje, rehabilitaciju nakon kirurških zahvata i psihijatrijski pristup. Ovo su prve hrvatske smjernice za vratobolju primarno namijenjene liječničkoj profesionalnoj zajednici.
Neck pain is one of the most prevalent musculoskeletal diseases which results in considerable pain and disability, and has a great impact on individual level, as well as on health-care system, and ...overall society. Causes of neck pain are different, and prevailing aetiology are mechanical reasons associated with degenerative changes of cervical spine. We are witnessing various diagnostic and therapeutic approaches for these patients. The Croatian Society for Vertebrology of the Croatian Medical Association is presenting a comprehensive narrative review and guidelines for the diagnosis and treatment of neck pain, focusing on the most prevalent causes. The guidelines are the result of consensus of experts of different background, based on the best available evidence. Part 1 relates to diagnosis, while the complementary Part 2 relates to treatment. For the diagnostic part (Part 1) the guidelines encompass: clinical features and evaluation (including questionnaires), laboratory tests, imaging, neurophysiology tests, and minimally invasive diagnostic procedures. The management part (Part 2) includes: pharmacology treatment, physical exercise, traction, manual therapies, physical therapy modalities, orthotics, minimally invasive therapeutic interventions, surgical treatment, rehabilitation after surgical procedures, and psychiatric approach. These are the first Croatian guidelines for neck pain intended in the first place for the physicians’ professional community.
Neck pain is one of the most prevalent musculoskeletal diseases which results in considerable pain and disability, and has a great impact on individual level, as well as on health-care system, and ...overall society. Causes of neck pain are different, and prevailing aetiology are mechanical reasons associated with degenerative changes of cervical spine. We are witnessing various diagnostic and therapeutic approaches for these patients. The Croatian Society for Vertebrology of the Croatian Medical Association is presenting a comprehensive narrative review and guidelines for the diagnosis and treatment of neck pain, focusing on the most prevalent causes. The guidelines are the result of consensus of experts of different background, based on the best available evidence. This part (Part 1) relates to diagnosis, while the complementary part (Part 2) relates to treatment. For the diagnostic part (Part 1) the guidelines encompass: clinical features and evaluation (including questionnaires), laboratory tests, imaging, neurophysiology tests, and minimally invasive diagnostic procedures. The management part (Part 2) includes: pharmacology treatment, physical exercise, traction, manual therapies, physical therapy modalities, orthotics, minimally invasive therapeutic interventions, surgical treatment, rehabilitation after surgical procedures, and psychiatric approach. These are the first Croatian guidelines for neck pain intended in the first place for the physicians’ professional community.
Križobolja je jedan od najčešćih uzroka fizičke nesposobnosti, čije je najčešće izvorište degeneracija intervertebralnog diska. Nemogućnost točnog utvrđivanja potjecišta boli jest ograničavajući ...čimbenik u učinkovitijoj prevenciji i liječenju. Nova saznanja, napose u područjima genetike i analize proteina primjenom spektrometrije masa, bacaju novo svjetlo u razumijevanju etiopatogeneze degenerativne bolesti diska. Novim slikovnim metodama kao što je CEST magnetska rezonancija ili ADC magnetska rezonancija mogu se detektirati rane degenerativne promjene. Napredak je ostvaren glede razjašnjenja uloge fizičkog opterećenja, kao i tipa vježbi koje mogu imati utjecaj kako na razvoj tako i na liječenje bolesnika s degenerativnim promjenama diska. Na kraju, značajan napredak je ostvaren u kirurškom liječenju tih bolesnika, s naglaskom na minimalno invazivne tehnike. Ostali kirurški modaliteti liječenja su pokazali napredak koji ohrabruje, kao što su totalna zamjena diska i liječenje mezenhimalnim matičnim stanicama. Uz navedeno, i ostale novosti u dijagnostici i liječenju degenerativne bolesti vertebralnog diska raspravljene su u ovom članku.
Vratobolja je jedna od najčešćih mišićnokoštanih bolesti koja rezultira značajnom boli i nesposobnosti te ima velik utjecaj na individualnoj razini, kao i na zdravstveni sustav i društvo u cjelini. ...Uzroci vratobolje su različiti, a etiološki prevladavaju oni mehanički povezani s degenerativnim promjenama vratne kralješnice. Svjedočimo raznim dijagnostičkim i terapijskim pristupima za ove bolesnike. Hrvatsko vertebrološko društvo Hrvatskoga liječničkog zbora predstavlja sveobuhvatni narativni pregled i smjernice za dijagnozu i liječenje bolesnika s vratoboljom, s naglaskom na najčešće uzroke. Smjernice su rezultat konsenzusa stručnjaka različitih specijalnosti, a temelje se na najboljim dokazima. Ovaj prvi dio odnosi se na dijagnostiku, a drugi njemu komplementarni dio odnosi se na terapiju. Dijagnostički dio smjernica (1. dio) obuhvaća: klinička obilježja i evaluaciju (uključivo strukturirane upitnike), laboratorijsku dijagnostiku, slikovne metode, neurofiziološko testiranje i minimalno invazivne dijagnostičke postupke. Dio smjernica o liječenju (2. dio) uključuje: farmakološko liječenje, tjelesne medicinske vježbe, trakciju, manualnu terapiju, metode fizikalne terapije, primjenu ortoza, minimalno invazivne terapijske intervencije, kirurško liječenje, rehabilitaciju nakon kirurških zahvata i psihijatrijski pristup. Ovo su prve hrvatske smjernice za vratobolju primarno namijenjene liječničkoj profesionalnoj zajednici.
Pain syndromes originating from cervical and thoracic spine remain to be a major public health problem. Medical expenses in general and surgical procedures associated with overall care for the neck ...and thoracic pain are high and growing. Furthermore, these two chronic pain conditions are also leading causes for missed workdays. Chronic pain syndromes originating from cervical spine are most commonly caused by degenerative changes of the facet joints. Cervi- cobrachial syndrome is most commonly caused by herniated discs. Diagnostic controlled blocks, performed in order to identify, the source of pain, often predetermine patient for further therapeutic minimally invasive interventions. If the chronic pain syndromes of the cervical and thoracic spine are caused by degenerative facet joints, patient can be offered neuroablative procedures using radiofrequency. In patients suffering from chronic cervical and thoracic pain caused by painful intervertebral disc minimally invasive intradiscal decompression procedures can be performed. In cases where the neck pain and radicular pain are caused by the central and foraminal spinal stenosis patients are advised epidural steroid injections. The purpose of above advised procedures, using steroids, local anesthetics and RF current, is to relieve patients' pain, allow optimal physical therapy, and improved functional capacity, consequently providing a better quality of life.
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