1
|
Cao Y, Chen H, Sun Y, Fan Z, Cheng H. Quercetin inhibits fibroblasts proliferation and reduces surgery-induced epidural fibrosis via the autophagy-mediated PI3K/Akt/mTOR pathway. Bioengineered 2022; 13:9973-9986. [PMID: 35412948 PMCID: PMC9161887 DOI: 10.1080/21655979.2022.2062530] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Epidural fibrosis (EF) is a serious complication when the patients suffer from operations of lumbar laminectomy. It is reported that quercetin plays a positive role in the prevention of various fibrotic diseases. However, the role of quercetin in the prevention of epidural fibrosis (EF) and its possible mechanism are unclear. Fibroblast proliferation is considered to be the main cause of epidural fibrosis.Autophagy is a lysosomal degradation pathway that is essential for survival, differentiation, development, and homeostasis.Although autophagy has been associated with fibrosis of different tissues, the effect of autophagy on epidural fibrosis is still unknown.The aim of this study was to investigate the function and mechanism of autophagy induced by quercetin, a polyphenol derived from plants. In vivo, the effect of quercetin on reducing epidural fibrosis was confirmed via histological staining and immunohistochemical analysis. The results showed that quercetin had significant suppressive effects on epidural fibrosis following laminectomy in rats.In vitro,, cell counting kit-8 (CCK-8), Western blot analysis, immunofluorescence and Edu staining, TUNEL staining and transmission electron microscopy were used to detect the effects of quercetin on the proliferation and apoptosis of fibroblasts and explore the possible signal transduction pathway. Results indicated that quercetin could induce autophagy and inhibit proliferation in fibroblasts. In conclusion, Quercetin could regulate fibroblast proliferation, apoptosis, migration and other biological behaviors through autophagy, thereby preventing epidural fibrosis. The specific corresponding pathway may be the PI3K/Akt/mTOR signaling pathway.
Collapse
Affiliation(s)
- Yile Cao
- Department of Clinical Medicine, School of Medicine, Yangzhou University, Jiangsu, Yangzhou, China
| | - Hui Chen
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Yangzhou, Jiangsu, China
| | - Yu Sun
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Yangzhou, Jiangsu, China
| | - Zhehao Fan
- School of Medicine, Yangzhou University, Jiangsu, Yangzhou, China
| | - Hong Cheng
- Yangzhou University Medical College, Jiangsu Key Laboratory of Experimental & Translational Non-coding RNA Research, China Institute of Translational Medicine, Yangzhou University, Jiangsu, Yangzhou, China
| |
Collapse
|
2
|
Fang Y, Hu X, Liu S, Zou Y, Wang Z, Chu Y. The clinical significance and function of miR-146 in the promotion of epidural fibrosis. Genet Mol Biol 2021; 44:e20200447. [PMID: 33999095 PMCID: PMC8127721 DOI: 10.1590/1678-4685-gmb-2020-0447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 02/08/2021] [Indexed: 11/30/2022] Open
Abstract
Epidural fibrosis is the main cause of failed back surgery syndrome. To
investigate the role of miR-146 in the diagnosis and development of epidural
fibrosis. Lumbar disc tissues were collected from 72 lumbar disc herniation
patients (45 developed epidural fibrosis and 27 did not). The expression of
miR-146 in collected tissues and isolated epidural fibroblasts was detected by
RT-qPCR. The relative levels of pro-inflammatory cytokines were analyzed by
ELISA. The effect of miR-146 on the proliferation of fibroblasts was evaluated
by MTT assay. miR-146 was significantly upregulated in epidural fibrosis
patients compared with control patients. The expression of miR-146 was closely
associated with the location, lower limb symptom and duration of disease of
epidural fibrosis patients, and was positively correlated with the relative
levels of pro-inflammatory cytokines. Moreover, miR-146 could discriminate
epidural fibrosis patients from control patients. In isolated epidural
fibroblasts, the overexpression of miR-146 dramatically enhanced its
proliferation and the inflammatory response. miR-146 serves as a diagnostic
biomarker for the early detection of epidural fibrosis. The upregulation of
miR-146 enhanced the fibroblasts proliferation and inflammatory response in
epidural fibrosis. This study provides a novel potential therapeutic target for
epidural fibrosis.
Collapse
Affiliation(s)
- Yuan Fang
- The Affiliated Hospital of Qingdao University, Department of Joint Surgery, Qingdao, Shandong, China
| | - Xiaoli Hu
- Women and Children's Hospital of Linyi City, Department of Obstetrics and Gynecology, Linyi, Shandong, China
| | - Shuzhen Liu
- Medical Department of the Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Yunwen Zou
- The Affiliated Hospital of Qingdao University, Department of Spinal Surgery, Qingdao, Shandong, China
| | - Zhijie Wang
- The Affiliated Hospital of Qingdao University, Department of Spinal Surgery, Qingdao, Shandong, China
| | - Yanchen Chu
- The Affiliated Hospital of Qingdao University, Department of Spinal Surgery, Qingdao, Shandong, China
| |
Collapse
|
3
|
Hegmann KT, Travis R, Andersson GBJ, Belcourt RM, Carragee EJ, Eskay-Auerbach M, Galper J, Goertz M, Haldeman S, Hooper PD, Lessenger JE, Mayer T, Mueller KL, Murphy DR, Tellin WG, Thiese MS, Weiss MS, Harris JS. Invasive Treatments for Low Back Disorders. J Occup Environ Med 2021; 63:e215-e241. [PMID: 33769405 DOI: 10.1097/jom.0000000000001983] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE This abbreviated version of the American College of Occupational and Environmental Medicine's Low Back Disorders guideline reviews the evidence and recommendations developed for invasive treatments used to manage low back disorders. METHODS Comprehensive systematic literature reviews were accomplished with article abstraction, critiquing, grading, evidence table compilation, and guideline finalization by a multidisciplinary expert panel and extensive peer-review to develop evidence-based guidance. Consensus recommendations were formulated when evidence was lacking and often relied on analogy to other disorders for which evidence exists. A total of 47 high-quality and 321 moderate-quality trials were identified for invasive management of low back disorders. RESULTS Guidance has been developed for the invasive management of acute, subacute, and chronic low back disorders and rehabilitation. This includes 49 specific recommendations. CONCLUSION Quality evidence should guide invasive treatment for all phases of managing low back disorders.
Collapse
Affiliation(s)
- Kurt T Hegmann
- American College of Occupational and Environmental Medicine, Elk Grove Village, Illinois
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
4
|
Kim JY, Lee YH, Yoo S, Kim JY, Joo M, Park HJ. Factors Predicting the Success of Adhesiolysis Using a Steerable Catheter in Lumbar Failed Back Surgery Syndrome: A Retrospective Study. J Clin Med 2021; 10:jcm10050913. [PMID: 33652702 PMCID: PMC7956797 DOI: 10.3390/jcm10050913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 02/09/2021] [Accepted: 02/22/2021] [Indexed: 01/02/2023] Open
Abstract
Failed back surgery syndrome (FBSS) is a commonly encountered disease after lumbar surgery. There are many cases where it is difficult to choose a treatment because no specific cause can be found. Nevertheless, according to recent reports, adhesiolysis has shown reasonable evidence. However, considering its poor cost-effectiveness, adhesiolysis cannot be used as the first line of treatment. FBSS patients often suffer from chronic pain; accordingly, they become frustrated when this treatment produces a poor response. Therefore, before the procedure, the target group must be selected carefully. We sought to identify the pre-procedure factors predicting the effect of adhesiolysis in FBSS. A total of 150 patients were evaluated and analyzed retrospectively. Of these 150 patients, 69 were classified as responders three months after the procedure (46%). The outer diameter of the catheter during the procedure and grade of foraminal stenosis were correlated with the procedure effect. In conclusion, of the 2.1 mm diameter of the catheter, 1.7 mm of it was used during the procedure, and the milder the foraminal stenosis, the greater the pain reduction effect was three months after the procedure.
Collapse
|
5
|
Demirel C, Turkoz D, Yazicioglu IM, Cokluk C. The Preventive Effect of Curcumin on the Experimental Rat Epidural Fibrosis Model. World Neurosurg 2020; 145:e141-e148. [PMID: 33010510 DOI: 10.1016/j.wneu.2020.09.140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/25/2020] [Accepted: 09/26/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The aim of the study was to evaluate the effect of systemically administrated curcumin on the prevention of peridural fibrotic tissue and adhesion formation in a rat laminectomy model. METHODS Thirty-two Wistar albino rats were randomly selected and equally divided into 4 groups as follows: negative control group (group I) did not undergo operation; positive control group (group II) underwent laminectomy without treatment; group III (low-dose curcumin; 100 mg/kg); and group IV (high-dose curcumin; 200 mg/kg). Curcumin was administered intraperitoneally per day for 7 days after surgery starting from day 0. Twenty-eight days after surgery, T12 and L4 vertebral columns, paraspinal tissues, and epidural scar tissue were dissected en bloc and prepared for histopathologic examinations. All specimens were examined for inflammation, epidural fibrosis (EF), foreign body reaction, medulla spinalis retraction, granulation tissue, and arachnoid involvement. A Kruskal-Wallis test followed by a Dunn multiple comparison test were used for statistical analysis, and a P value <0.05 was considered as statistically significant. RESULTS Curcumin treatment significantly reduced inflammation, foreign body reaction, granulation tissue formation, medulla spinalis retraction, and EF formation compared with positive control group (P < 0.05); however, no significant differences were found between the 2 groups that received different doses of curcumin. CONCLUSIONS The results of the present study showed that systemic administration of curcumin was effective in reducing EF formation, inflammation, granulation tissue formation, medulla spinalis retraction, and foreign body reaction in the laminectomy area. Our results suggest that antiinflammatory activities of curcumin are beneficial for attenuation of EF formation.
Collapse
Affiliation(s)
- Cem Demirel
- Department of Neurosurgery, University of Health Sciences, Samsun Education and Research Hospital, Samsun, Turkey.
| | - Dursun Turkoz
- Department of Neurosurgery, University of Health Sciences, Samsun Education and Research Hospital, Samsun, Turkey
| | - Irem Melike Yazicioglu
- Department of Pathology, University of Health Sciences, Samsun Education and Research Hospital, Samsun, Turkey
| | - Cengiz Cokluk
- Department of Neurosurgery, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| |
Collapse
|
6
|
Yang L, Gao Q, Lv F, Guo M, Zhao D. miR‑519d‑3p promotes TGFβ/Smad mediated postoperative epidural scar formation via suppression of BAMBI. Mol Med Rep 2019; 20:3901-3909. [PMID: 31485673 DOI: 10.3892/mmr.2019.10630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Accepted: 03/13/2018] [Indexed: 11/05/2022] Open
Abstract
To investigate the role of microRNA (miR)‑519d‑3p in postoperative epidural scar formation and its regulation of the bone morphogenetic protein and activin membrane‑bound inhibitor (BAMBI), miR‑519d‑3p and BAMBI expression levels in the lumbar disc of patients who had undergone laminectomy were detected with reverse transcription‑quantitative polymerase chain reaction and western blotting. The results demonstrated that miR‑519d‑3p expression was significantly increased, whereas BAMBI expression was sharply reduced in the lumbar discs of patients suffering from epidural scars. Subsequently, the miR‑519d‑3p mimic was transfected into primary fibroblasts isolated from epidural scar tissues. Flow cytometric and Cell Countin Kit‑8 analyses indicated that overexpression of miR‑519d‑3p promoted the proliferation of fibroblasts, the production of tumor necrosis factor‑α and interleukin (IL)‑1α, and the expression of type I collagen (col I), α‑smooth muscle actin (α‑SMA) and fibronectin (FN). Downregulation of miR‑519d‑3p by the miR‑519d‑3p antagomir transfection had the opposite effect. Bioinformatics and luciferase reporter gene analyses demonstrated that BAMBI is a target gene of miR‑519d‑3p: miR‑519d‑3p directly binds to the 3'‑untranslated region of BAMBI mRNA and suppressed BAMBI protein expression. Finally, the pcDNA‑BAMBI vector and BAMBI small interfering RNA were respectively transfected into primary fibroblasts to overexpress and knockdown the BAMBI gene. It was demonstrated that BAMBI overexpression suppressed fibroblast proliferation, TNF‑α and IL‑1α production, and the expression of col I, α‑SMA and FN proteins, whereas, BAMBI knockdown had the opposite effect. In conclusion, it was noted that BAMBI is a target of miR‑519d‑3p and miR‑519d‑3p promotes transforming growth factor β/mothers against decapentaplegic homolog 9‑mediated postoperative epidural scar formation via suppression of BAMBI.
Collapse
Affiliation(s)
- Longbiao Yang
- Department of Orthopaedics, Central Hospital of Zibo Mining Refco Group Ltd., Zibo, Shandong 255120, P.R. China
| | - Qingyuan Gao
- Department of Orthopaedics, Central Hospital of Zibo Mining Refco Group Ltd., Zibo, Shandong 255120, P.R. China
| | - Feng Lv
- Department of Orthopaedics, Central Hospital of Zibo Mining Refco Group Ltd., Zibo, Shandong 255120, P.R. China
| | - Min Guo
- Department of Geriatrics, Central Hospital of Zibo Mining Refco Group Ltd., Zibo, Shandong 255120, P.R. China
| | - Dong Zhao
- Department of Orthopaedics, Central Hospital of Zibo Mining Refco Group Ltd., Zibo, Shandong 255120, P.R. China
| |
Collapse
|
7
|
Abstract
Cervical vertebral compressive myelopathy (CVCM) represents the most significant disease of the spinal cord in horses for which surgical treatment is described. Current surgical methods used include ventral interbody fusion with kerf cut cylinders and dorsal laminectomy. Polyaxial pedicle screw and rod constructs and ventral locking compression plating have been introduced in the treatment of equine CVCM and present promising alternative approaches to achieve ventral interbody fusion. Advancements in diagnostic imaging and endoscopy of the cervical vertebral canal may improve reliable preoperative identification of the exact locations of spinal cord compression in horses with CVCM to improve postoperative outcomes.
Collapse
Affiliation(s)
- Lynn Pezzanite
- Translational Medicine Institute, Department of Clinical Sciences, Colorado State University, 300 W Drake Road, Fort Collins, CO 80523, USA
| | - Jeremiah Easley
- Preclinical Surgical Research Laboratory, Department of Clinical Sciences, Colorado State University, 300 W Drake Road, Fort Collins, CO 80523, USA.
| |
Collapse
|
8
|
|
9
|
Shrauner B, Blikslager A, Davis J, Campbell N, Law M, Lustgarten M, Prange T. Feasibility and safety of lumbosacral epiduroscopy in the standing horse. Equine Vet J 2016; 49:322-328. [DOI: 10.1111/evj.12591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 05/09/2016] [Indexed: 12/13/2022]
Affiliation(s)
- B. Shrauner
- College of Veterinary Medicine; North Carolina State University; Raleigh USA
| | - A. Blikslager
- College of Veterinary Medicine; North Carolina State University; Raleigh USA
| | - J. Davis
- College of Veterinary Medicine; North Carolina State University; Raleigh USA
| | - N. Campbell
- College of Veterinary Medicine; North Carolina State University; Raleigh USA
| | - M. Law
- College of Veterinary Medicine; North Carolina State University; Raleigh USA
| | - M. Lustgarten
- College of Veterinary Medicine; North Carolina State University; Raleigh USA
| | - T. Prange
- College of Veterinary Medicine; North Carolina State University; Raleigh USA
| |
Collapse
|
10
|
Yörükoğlu AG, Tahta A, Akçakaya MO, Sabancı PA, Aras Y, Aydoseli A, Dolgun M, Sencer A, Hepgül K. Percutaneous Fully Endoscopic İnterlaminar Approach to the Filum Terminale: A Cadaveric Study. World Neurosurg 2016; 92:402-406. [PMID: 27241095 DOI: 10.1016/j.wneu.2016.05.055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Revised: 05/18/2016] [Accepted: 05/19/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To investigate the utility, safety, and feasibility of a novel endoscopic technique for the visualization and surgical manipulation of the filum terminale in fresh postmortem adult human cadavers. METHODS The filums from 18 fresh postmortem adult human cadavers were explored with a percutaneous fully endoscopic interlaminar approach. After the filum was identified and the nerve roots were dissected away from it, the filum was cut. A specimen was sent for histopathologic examination. RESULTS In 15 of 18 (83%) cadavers, the filum terminale could be visualized. A specimen for histopathologic examination was obtained from 11 of 15 (73%) visualized filums. Histopathologic examination revealed that 2 of them were fatty filums, 7 were normal filums, and 2 were peripheral nerves. CONCLUSIONS We have described a successful and feasible percutaneous fully endoscopic interlaminar approach to the filum terminale. This technique provides a smaller skin incision, narrow durotomy, and minimal tissue damage. Animal studies are necessary to prove the feasibility and safety of our method before clinical use.
Collapse
Affiliation(s)
| | - Alican Tahta
- Department of Neurosurgery, Iğdır State Hospital, Iğdır, Turkey
| | | | - Pulat Akın Sabancı
- Department of Neurosurgery, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
| | - Yavuz Aras
- Department of Neurosurgery, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
| | - Aydın Aydoseli
- Department of Neurosurgery, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
| | - Müge Dolgun
- Department of Neurosurgery, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
| | - Altay Sencer
- Department of Neurosurgery, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
| | - Kemal Hepgül
- Department of Neurosurgery, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
| |
Collapse
|
11
|
Javier de Andrés A, Juan Pablo Acuña B, Alicia Olivares S. Dolor en el paciente de la tercera edad. REVISTA MÉDICA CLÍNICA LAS CONDES 2014. [DOI: 10.1016/s0716-8640(14)70089-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
|
12
|
Abstract
STUDY DESIGN Retrospective analysis of a population-based insurance claims data set. OBJECTIVE To evaluate the use of spinal cord stimulation (SCS) and lumbar reoperation for the treatment of failed back surgery syndrome (FBSS), and examine their associated complications and health care costs. SUMMARY OF BACKGROUND DATA FBSS is a major source of chronic neuropathic pain and affects up to 40% of patients who undergo lumbosacral spine surgery for back pain. Thus far, few economic analyses have been performed comparing the various treatments for FBSS, with these studies involving small sample sizes. In addition, the nationwide practices in the use of SCS for FBSS are unknown. METHODS The MarketScan data set was used to analyze patients with FBSS who underwent SCS or spinal reoperation between 2000 and 2009. Propensity score methods were used to match patients who underwent SCS with those who underwent lumbar reoperation to examine health care resource utilization. Postoperative complications were analyzed with multivariate logistic regression. Health care use was analyzed using negative binomial and general linear models. RESULTS The study cohort included 16,455 patients with FBSS, with 395 undergoing SCS implantation (2.4%). Complication rates at 90 days were significantly lower for SCS than spinal reoperation (P < 0.0001). Also in the matched cohort, hospital stay (P < 0.0001) and associated charges (P = 0.016) were lower for patients with SCS. However outpatient, emergency room, and medication charges were similar between the 2 groups. Overall cost totaling $82,586 at 2 years was slightly higher in the lumbar reoperation group than in the SCS group with total cost of $80,669 (P = 0.88). CONCLUSION Although previous studies have demonstrated superior efficacy for the treatment of FBSS, SCS remains underused. Despite no significant decreases in overall health care cost with SCS implantation, because it is associated with decreased complications and improved outcomes, this technology warrants closer consideration for the management of chronic pain in patients with FBSS.
Collapse
|
13
|
Murai K, Suzuki H, Igarashi T, Kawanishi M, Naiki R, Seo N, Sato T, Namiki Y, Hanaoka K, Ogawa S. Epiduroscopy for intractable low back pain or sciatica in operated and non-operated back patients: results from The Japan Society of Epiduroscopy. ACTA ACUST UNITED AC 2013. [DOI: 10.1179/016911107x376891] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
|
14
|
Consoletti L, Cotoia A, Cinnella G, Dambrosio M. Transient global amnesia after epiduroscopy in a failed back surgery syndrome patient: Case report. Health (London) 2013. [DOI: 10.4236/health.2013.511a1002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
15
|
Chern JJ, Gordon AS, Naftel RP, Tubbs RS, Oakes WJ, Wellons JC. Intradural spinal endoscopy in children. J Neurosurg Pediatr 2011; 8:107-11. [PMID: 21721897 DOI: 10.3171/2011.4.peds10533] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Intracranial endoscopy in the treatment of hydrocephalus, arachnoid cysts, or brain tumors has gained wide acceptance, but the use of endoscopy for intradural navigation in the pediatric spine has received much less attention. The aim of the authors' present study was to analyze their experience in using spinal endoscopy to treat various pathologies of the spinal canal. The authors performed a retrospective review of intradural spinal endoscopic cases at their institution. They describe 4 representative cases, including an arachnoid cyst, intrinsic spinal cord tumor, holocord syrinx, and split cord malformation. Intradural spinal endoscopy was useful in treating the aforementioned lesions. It resulted in a more limited laminectomy and myelotomy, and it assisted in identifying a residual spinal cord tumor. It was also useful in the fenestration of a multilevel arachnoid cyst and in confirming communication of fluid spaces in the setting of a complex holocord syrinx. Endoscopy aided in the visualization of the spinal cord to ensure the absence of tethering in the case of a long-length Type II split spinal cord malformation. Conclusions Based on their experience, the authors found intradural endoscopy to be a useful surgical adjunct and one that helped to decrease morbidity through reduced laminectomy and myelotomy. With advances in technology, the authors believe that intradural endoscopy will begin to be used by more neurosurgeons for treating diseases of this anatomical region.
Collapse
Affiliation(s)
- Joshua J Chern
- Pediatric Neurosurgery, Children's Hospital, Birmingham, Alabama 35233, USA
| | | | | | | | | | | |
Collapse
|
16
|
Affiliation(s)
- Chin-wern Chan
- Wasser Pain Management Center, Mount Sinai Hospital, Toronto, Ontario, Canada
| | | |
Collapse
|
17
|
Prange T, Derksen FJ, Stick JA, Garcia-Pereira FL, Carr EA. Cervical vertebral canal endoscopy in the horse: intra- and post operative observations. Equine Vet J 2011; 43:404-11. [PMID: 21496080 DOI: 10.1111/j.2042-3306.2010.00310.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
REASONS FOR PERFORMING STUDY Despite modern medical diagnostic imaging, it is not possible to identify reliably the exact location of spinal cord compression in horses with cervical vertebral stenotic myelopathy (CVSM). Vertebral canal endoscopy has been successfully used in man and a technique for cervical vertebral canal endoscopy (CVCE) has been described in equine cadavers. OBJECTIVE To determine the feasibility and safety of CVCE in healthy mature horses. METHODS Six healthy mature horses were anaesthetised. A flexible videoendoscope was subsequently introduced via the atlanto-occipital space into the epidural space (epiduroscopy, Horses 1-3) or the subarachnoid space (myeloscopy, Horses 4-6) and advanced to the 8th cervical nerve. Neurological examinations were performed after surgery and lumbosacral cerebrospinal fluid (CSF) analysed in horses that had undergone myeloscopy. RESULTS All procedures were completed successfully and all horses recovered from anaesthesia. Anatomical structures in the epidural space (including the dura mater, nerve roots, fat and blood vessels) and subarachnoid space (including the spinal cord, blood vessels, arachnoid trabeculations, nerve roots and the external branch of the accessory nerve) were identified. During epiduroscopy, a significant increase in mean arterial pressure was recognised, when repeated injections of electrolyte solution into the epidural space were performed. In one horse of the myeloscopy group, subarachnoid haemorrhage and air occurred, resulting in transient post operative ataxia and muscle fasciculations. No complications during or after myeloscopy were observed in the other horses. CSF analysis indicated mild inflammation on Day 7 with values approaching normal 21 days after surgery. CONCLUSIONS Endoscopic examination of the epidural and subarachnoid space from the atlanto-occipital space to the 8th cervical nerve is possible and can be safely performed in healthy horses. POTENTIAL RELEVANCE Cervical vertebral canal endoscopy might allow accurate identification of the compression site in horses with CVSM and aid diagnosis of other lesions within the cervical vertebral canal.
Collapse
Affiliation(s)
- T Prange
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, MI, USA.
| | | | | | | | | |
Collapse
|
18
|
The effectiveness of endoscopic epidurolysis in treatment of degenerative chronic low back pain: a prospective analysis and follow-up at 48 months. ACTA NEUROCHIRURGICA. SUPPLEMENT 2011; 108:67-73. [PMID: 21107940 DOI: 10.1007/978-3-211-99370-5_11] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The aim of this prospective study was to evaluate the efficacy of endoscopic epidurolysis in the treatment of degenerative chronic low back pain.Two hundred and thirty four patients affected by chronic low back pain, with VAS ≥ 5 and Oswestry Low Back Pain Disability Index (ODI) from 0 to 60% (0-20%, group A; 20-40%, group B; 40-60%, group C) were enrolled and treated prospectively with endoscopic epidurolysis by means of a flexible fiberoptic endoscope introduced into the caudal epidural space and by the intermittent instillation of saline solution added with 150 UI hyaluronidase. Targeted application of ozone (8 ml; 38 γ/ml) and 50 mg ciprofloxacin close to the abnormal areas was also performed. Short and long term efficacy (1 week, 3 months, 6, 12, 24, 36 and 48 months) was prospectively evaluated. VAS score <5 and ODI <40% were considered as a positive outcome.The treatment significantly reduced VAS score in all three groups of patients starting from the first week and throughout the entire follow-up period (P < 0.001). Disability Index (ODI) too showed encouraging results (P < 0.001) that was particularly evident at 3 months and maintained up to long-term follow-up intervals.Epiduroscopy by mechanical adhesiolysis and administration on targeted areas of ciprofloxacin and ozone seems to be, in this prospective study, an effective technique to provide a sensible and persisting pain relief and act of improving ODI in chronic low back pain.
Collapse
|
19
|
Di Donato A, Fontana C, Alemanno D, Di Giacomo A. Epiduroscopy in treatment of degenerative chronic low back pain: A prospective analysis and follow-up at 60 months. ACTA ACUST UNITED AC 2010. [DOI: 10.3109/10601333.2010.485317] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
20
|
North RB, Kidd D, Shipley J, Taylor RS. Spinal Cord Stimulation versus Reoperation for Failed Back Surgery Syndrome: A Cost Effectiveness and Cost Utility Analysis Based on a Randomized, Controlled Trial. Neurosurgery 2007; 61:361-8; discussion 368-9. [PMID: 17762749 DOI: 10.1227/01.neu.0000255522.42579.ea] [Citation(s) in RCA: 173] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
OBJECTIVE:
We analyzed the cost-effectiveness and cost–utility of treating failed back–surgery syndrome using spinal cord stimulation (SCS) versus reoperation.
MATERIALS AND METHODS
A disinterested third party collected charge data for the first 42 patients in a randomized controlled crossover trial. We computed the difference in cost with regard to success (cost–effectiveness) and mean quality–adjusted life years (cost–utility). We analyzed the patient–charge data with respect to intention to treat (costs and outcomes as a randomized group), treated as intended (costs as randomized; crossover failure assigned to a randomized group), and final treatment costs and outcomes.
RESULTS:
By our mean 3.1–year follow–up, 13 of 21 patients (62%) crossed to reoperation versus 5 of 19 patients (26%) who crossed to SCS (P < 0.025). The mean cost per success was US $117,901 for crossovers to SCS. No crossovers to reoperation achieved success despite a mean per-patient expenditure of US $260,584. The mean per-patient costs were US $31,530 for SCS versus US $38,160 for reoperation (intention to treat), US $48,357 for SCS versus US $105,928 for reoperation (treated as intended), and US $34,371 for SCS versus US $36,341 for reoperation (final treatment). SCS was dominant (more effective and less expensive) in the incremental cost–effectiveness ratios and incremental cost–utility ratios. A bootstrapped simulation for incremental costs and quality–adjusted life years confirmed SCS's dominance, with approximately 72% of the cost results occurring below US policymakers' “maximum willingness to pay” threshold.
CONCLUSION:
SCS was less expensive and more effective than reoperation in selected failed back–surgery syndrome patients, and should be the initial therapy of choice. SCS is most cost–effective when patients forego repeat operation. Should SCS fail, reoperation is unlikely to succeed.
Collapse
Affiliation(s)
- Richard B North
- Department of Neurosurgery, The Johns Hopkins University, Baltimore, Maryland 21287, USA.
| | | | | | | |
Collapse
|
21
|
Manchikanti L. Safety of epidural catheterization in interventional pain management. JOURNAL OF SPINAL DISORDERS & TECHNIQUES 2006; 19:305. [PMID: 16778670 DOI: 10.1097/01.bsd.0000177958.11603.b8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
|
22
|
Baron EM, Levene HB, Heller JE, Jallo JI, Loftus CM, Dominique DA. Neuroendoscopy for spinal disorders: a brief review. Neurosurg Focus 2005; 19:E5. [PMID: 16398482 DOI: 10.3171/foc.2005.19.6.6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Neuroendoscopy has grown rapidly in the last 20 years as a therapeutic modality for treating a variety of spinal disorders. Spinal endoscopy has been widely used to treat patients with cervical, thoracic, and lumbosacral disorders safely and effectively. Although it is most commonly used with minimally invasive lumbar spine surgery, endoscopy has gained widespread acceptance for the treatment of thoracic disc herniations and for anterior release and rod implantation in the correction of thoracic spinal deformity. The authors review the use of endoscopy in spine surgery and in the treatment of spinal disorders as well as in the treatment of intrathoracic nonspinal lesions. Endoscopy has some significant advantages over open or other minimally invasive techniques in that it can allow for better visualization of the lesion, smaller incision sizes with reduced morbidity and mortality, reduced hospital stays, and ultimately lower cost. In addition, spinal endoscopy allows observers and operating room staff to be more involved in each case and fosters education. Spinal endoscopy, like any novel modality, carries with it additional risks and the surgeon must always be prepared to convert to an open procedure. The learning curve for spinal endoscopy is steep and the procedure should not be attempted alone by a novice surgeon. Nevertheless, with training and experience, the spine surgeon can achieve better outcomes, reduced morbidity, and better cosmesis with spinal endoscopy, and the operating times are comparable to open procedures. As technology evolves and more experience is obtained, neuroendoscopy will likely achieve further roles as a mainstay in spine surgery.
Collapse
Affiliation(s)
- Eli M Baron
- Department of Neurosurgery, Temple University Hospital, Philadelphia, Pennsylvania 19140, USA
| | | | | | | | | | | |
Collapse
|
23
|
Manchikanti L, Boswell MV, Rivera JJ, Pampati VS, Damron KS, McManus CD, Brandon DE, Wilson SR. [ISRCTN 16558617] A randomized, controlled trial of spinal endoscopic adhesiolysis in chronic refractory low back and lower extremity pain. BMC Anesthesiol 2005; 5:10. [PMID: 16000173 PMCID: PMC1187869 DOI: 10.1186/1471-2253-5-10] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2004] [Accepted: 07/06/2005] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Postoperative epidural fibrosis may contribute to between 5% to 60% of the poor surgical outcomes following decompressive surgery. Correlations have been reported between epidural scarring and radicular pain, poor surgical outcomes, and a lack of any form of surgical treatment. The use of spinal endoscopic adhesiolysis in recent years in the management of chronic refractory low back and lower extremity pain has been described. METHODS A prospective, randomized, double-blind trial was conducted to determine the outcome of spinal endoscopic adhesiolysis to reduce pain and improve function and psychological status in patients with chronic refractory low back and lower extremity pain. A total of 83 patients were evaluated, with 33 patients in Group I and 50 patients in Group II. Group I served as the control, with endoscopy into the sacral level without adhesiolysis, followed by injection of local anesthetic and steroid. Group II received spinal endoscopic adhesiolysis, followed by injection of local anesthetic and steroid. RESULTS Among the 50 patients in the treatment group receiving spinal endoscopic adhesiolysis, significant improvement without adverse effects was shown in 80% at 3 months, 56% at 6 months, and 48% at 12 months. The control group showed improvement in 33% of the patients at one month and none thereafter. Based on the definition that less than 6 months of relief is considered short-term and longer than 6 months of relief is considered long-term, a significant number of patients obtained long-term relief with improvement in pain, functional status, and psychological status. CONCLUSION Spinal endoscopic adhesiolysis with targeted delivery of local anesthetic and steroid is an effective treatment in a significant number of patients with chronic low back and lower extremity pain without major adverse effects.
Collapse
Affiliation(s)
- Laxmaiah Manchikanti
- Pain Management Center of Paducah, 2831 Lone Oak Road, Paducah, Kentucky, 42003, USA
| | - Mark V Boswell
- Case University School of Medicine, University Hospitals of Cleveland, 11100 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Jose J Rivera
- Pain Management Center of Paducah, 2831 Lone Oak Road, Paducah, Kentucky, 42003, USA
| | - Vidya Sagar Pampati
- Pain Management Center of Paducah, 2831 Lone Oak Road, Paducah, Kentucky, 42003, USA
| | - Kim S Damron
- Pain Management Center of Paducah, 2831 Lone Oak Road, Paducah, Kentucky, 42003, USA
| | - Carla D McManus
- Pain Management Center of Paducah, 2831 Lone Oak Road, Paducah, Kentucky, 42003, USA
| | - Doris E Brandon
- Pain Management Center of Paducah, 2831 Lone Oak Road, Paducah, Kentucky, 42003, USA
| | - Sue R Wilson
- Pain Management Center of Paducah, 2831 Lone Oak Road, Paducah, Kentucky, 42003, USA
| |
Collapse
|
24
|
Abstract
BACKGROUND Failed back syndrome (FBS) is a well-recognized complication of surgery of the lumbar spine. It can result in chronic pain and disability, often with disastrous emotional and financial consequences to the patient. Many patients have traditionally been classified as "spinal cripples" and are consigned to a life of long-term narcotic treatment with little chance of recovery. Recent progress in our understanding of this complex condition, as well as advances in surgical and medical treatment, have offered hope for improved outcomes and quality of life for these patients. REVIEW SUMMARY This study explores the complex and multifactorial etiology of FBS, including reasons for surgical failure, indications for surgical revision, and adjunctive treatments such as pain management procedures. CONCLUSIONS Despite extensive work in recent years, FBS remains a challenging and costly disorder. Recent advances in surgical reconstruction, rehabilitation, and pain management technique offer hope for patients with this painful and disabling condition.
Collapse
Affiliation(s)
- Stephen T Onesti
- Department of Neurosurgery, SUNY Downstate Medical Center, Brooklyn, New York 11203, USA.
| |
Collapse
|
25
|
|