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Chang MC, Choo YJ, Denis I, Mares C, Majdalani C, Yang S. Effectiveness of intradiscal ozone injections for treating pain following herniated lumbar disc: A systematic review and meta-analysis. J Back Musculoskelet Rehabil 2024:BMR240024. [PMID: 38905033 DOI: 10.3233/bmr-240024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/23/2024]
Abstract
BACKGROUND Low back pain and sciatica caused by herniated lumbar discs (HLDs) are common complaints among patients visiting pain clinics. Among the various therapeutic methods, intradiscal ozone injections have emerged as an effective alternative or additional treatment option for HLDs. OBJECTIVE This meta-analysis aimed to investigate the effectiveness of intradiscal ozone injections in the treatment of HLDs. METHODS We searched the PubMed, Embase, Cochrane Library, and Scopus databases for relevant studies published until January 25, 2024. We included studies that investigated the efficacy of intradiscal ozone injections in patients with HLDs. We evaluated the methodological quality of individual studies using the Cochrane Collaboration tool. RESULTS At ⩾ 6 months after treatment, the therapeutic effect of intradiscal ozone injections in patients with HLDs was greater than that of steroid injections (treatment success rate, 6 months: odds ratio = 3.95, 95% confidence interval [CI] [2.44, 6.39], P< 0.01) or conventional medications (changes in the Visual Analog Scale [VAS], 6 months: standardized mean difference [SMD] = 1.65, 95% CI [1.08, 2.22], P< 0.01; 12 months: SMD = 1.52, 95% CI [0.96, 2.08], P< 0.01) but similar to that of microdiscectomy (changes in VAS, 18 months: SMD =-0.05, 95% CI [-0.67, 0.57], P= 0.87). At < 6 months after treatment, the reduction in the VAS score after intradiscal ozone injections was higher than that after steroid injections (changes in VAS, 1 month: SMD = 2.53, 95% CI [1.84, 3.21], P< 0.01). CONCLUSION Intradiscal ozone injections may be a useful therapeutic tool in patients with HLDs. Compared with other conventional treatment methods such as steroid injections and oral medications, intradiscal ozone injection has great long-term (⩾ 6 months) effectiveness.
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Affiliation(s)
- Min Cheol Chang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Taegu, Korea
| | - Yoo Jin Choo
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Taegu, Korea
| | - Isabelle Denis
- Department of Physical Medicine and Rehabilitation, Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | - Christopher Mares
- Department of Physical Medicine and Rehabilitation, Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | - Carl Majdalani
- Department of Physical Medicine and Rehabilitation, Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | - Seoyon Yang
- Department of Rehabilitation Medicine, School of Medicine, Ewha Woman's University Seoul Hospital, Seoul, Korea
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Lee JH, Lee YJ, Chang MC, Lee JH. Clinical Effectiveness of Artificial Disc Replacement in Comparison With Anterior Cervical Discectomy and Fusion in the Patients With Cervical Myelopathy: Systematic Review and Meta-analysis. Neurospine 2023; 20:1047-1060. [PMID: 37798997 PMCID: PMC10562247 DOI: 10.14245/ns.2346498.249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 07/12/2023] [Accepted: 07/15/2023] [Indexed: 10/07/2023] Open
Abstract
OBJECTIVE Cervical myelopathy (CM) describes the compressive cervical spinal cord state, often accompanied by serious clinical condition, by herniated disc or hypertrophied spurs or ligament. Anterior cervical discectomy and fusion (ACDF) has been frequently employed as conventional surgical solution for this CM despite its inherent biomechanical handicap. Alternatively, an artificial disc replacement (ADR) preserves cervical motion while still decompressing the spinal canal and neural foramen. This analysis elaborated to clarify the potential benefits of ADR application to CM over ACDF from the conglomerated results of the past references. METHODS A literature search was performed using MEDLINE, Embase, Cochrane review, and KMbase databases from the studies published until March 2023. Six studies (3 randomized controlled study [RCTs] and 3 non-RCTs) were included in a qualitative and quantitative synthesis. Data were extracted and analyzed using a random effects model to obtain effect size and its statistical significance. Quality assessment and evidence level were established in accordance with the GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology. RESULTS Among 6 studies, 2 studies showed that ADR group achieved significantly better clinical improvement than the ACDF group, while the rest 4 studies revealed no significant difference. A meta-analysis showed better clinical outcomes with or without statistical significance. The level of evidence was low because of inconsistency and imprecision. CONCLUSION ADR was superior or at least, not inferior to ACDF in terms of functional recovery. However, its application to the CM patients is merely empowered with weak strength due to low level of evidence.
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Affiliation(s)
- Jung Hwan Lee
- Department of Rehabilitation Medicine, Namdarun Rehabilitation Clinic, Yongin, Korea
| | | | - Min Cheol Chang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu, Korea
| | - Jun Ho Lee
- Department of Neurosurgery, Kyung Hee University Medical Center, Seoul, Korea
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MRI of difficult discs. Clin Radiol 2023; 78:201-208. [PMID: 36535826 DOI: 10.1016/j.crad.2022.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 11/12/2022] [Accepted: 11/21/2022] [Indexed: 12/23/2022]
Abstract
Diagnosis of disc herniation is a daily task for radiologists. Although diagnosis is usually straightforward, it may become more difficult due to disc location. Disc herniations in the neural foramen or lateral to it can be overlooked if sagittal images are not obtained far enough laterally, and are often best seen on coronal images. Intradural disc herniations should be recognised preoperatively by their distinctive shape; recognition prepares the surgeon for the need to perform a durotomy and dural repair. Sequestered discs are often lentiform and inconspicuous on sagittal images. They can be missed if axial images are obtained only through the level of the intervertebral disc. Mimics of disc herniation must also be kept in mind when reviewing magnetic resonance imaging (MRI) studies: these include disc osteophyte complex, epidural haematoma, facet joint cyst, and tumours such as meningioma, nerve sheath tumours, and metastases.
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Lee JH, Lee JH, Chang MC. Transforaminal Epidural Steroid Injection for Patients with Lumbosacral Disc Herniation in the Absence of Spine Magnetic Resonance Imaging - Is Better Really the Enemy of the Best? J Pain Res 2023; 16:1477-1485. [PMID: 37168846 PMCID: PMC10166140 DOI: 10.2147/jpr.s402405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 05/02/2023] [Indexed: 05/13/2023] Open
Abstract
Purpose This study aimed to evaluate the effect of transforaminal epidural steroid injection (TFESI) in patients with lumbosacral disc herniation by comparing its effect between those diagnosed by clinical evaluation and plain radiography only (X-ray group) and those by additional magnetic resonance imaging (MRI) (MRI group). Additionally, we investigated the accuracy of the preliminary clinical assumption in the X-ray group using confirmative post-injection MRI. Patients and Methods We retrospectively recruited 367 patients with back and radicular pain due to lumbosacral disc herniation from a single pain clinic. Among them, 201 and 166 patients were categorized into the X-ray and MRI groups, respectively. In the X-ray group, the pathological level assumed initially by clinical evaluation and plain radiography concurred with that confirmed later on post-injection MRI in 139 patients (corresponding group); the remaining 62 patients lacked this concurrence (non-corresponding group). The NRS scores and Macnab criteria results were compared between the X-ray and MRI groups as well as the corresponding and non-corresponding groups. Results Both the X-ray and MRI groups showed significant reductions in the NRS scores at 2 and 10 weeks post-injection when compared with the pretreatment scores. However, no significant difference was noted between the groups in terms of the magnitude of clinical improvement assessed by successful reduction in the NRS or Macnab scores. Furthermore, similar results were obtained in the comparison between the corresponding and non-corresponding groups of the X-ray group. Conclusion TFESI guarantees favorable clinical outcomes even in the absence of confirmative MRI in patients with back and radicular pain. The preemptive application of this procedure could be prioritized and justified in patients suspected of lumbosacral disc herniation based on clinical evaluation and plain radiography only without the preceding MRI verification.
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Affiliation(s)
- Jung Hwan Lee
- Namdarun Rehabilitation Clinic, Yongin-City, Gyeonggi-Do, South Korea
| | - Jun Ho Lee
- Department of Neurosurgery, Kyung Hee University Medical Center, Seoul, 02447, South Korea
| | - Min Cheol Chang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu, 705-717, Republic of Korea
- Correspondence: Min Cheol Chang, Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, 317-1, Daemyungdong, Namku, Daegu, 705-717, Republic of Korea, Tel +82-53-620-4862, Email
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de Castro JPS, Brock RS, Teixeira MJ, Figueiredo EG. Ultrasound-Guided In-Plane Interlaminar Lumbar Endoscopic Approach with Smartphone and Portable Light Source: Description of a New Surgical Technique. ARQUIVOS BRASILEIROS DE NEUROCIRURGIA: BRAZILIAN NEUROSURGERY 2022. [DOI: 10.1055/s-0042-1756459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Introduction Endoscopic spine surgery enables the minimally invasive treatment of pathologies affecting the spinal cord and roots. Herein we describe an unprecedented technique Ultrasound-Guided in-plane interlaminar lumbar endoscopic approach with a smartphone and portable light source.
Methods The interlaminar approach was performed in a cadaveric specimen at L4 to 5 and L5 to S1 bilaterally. A curvilinear 2 to 5 MHz ultrasound probe was employed, the puncture was performed with the needle, a guide wire was inserted until the flavum ligament, followed by the dilator and working cannula. A 30° spinal endoscope, with an optical adapter of the endoscope camera for smartphone and portable endoscope lighting was inserted, the flavum ligament was visualized, and an opening in this site was performed with the scissors. Open dissection of the specimen was subsequently performed by identifying the puncture site in the interlaminar window.
Results The four interlaminar punctures were successfully guided by ultrasound; the opening of the ligamentum flavum was performed in the most lateral part of the interlaminar space, near the junction of the superior and inferior articular processes of the corresponding vertebrae in all the punctures.
Discussion The ultrasound makes possible to identify facets, foramina, transverse processes, and the interlaminar space. It is possible to minimize the use of radioscopy and its associated risks, both for patients and health professionals.
Conclusions The ultrasound-guided, in-plane, interlaminar, lumbar endoscopic approach with smartphone-adapted endoscope and portable light source is feasible and practical, minimizing radiation risks and making it possible to perform endoscopic spinal surgery.
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Affiliation(s)
| | - Roger Schmidt Brock
- Departament of Neurology, Hospital das Clínicas da Universidade de São Paulo, São Paulo – SP, Brazil
| | - Manoel Jacobsen Teixeira
- Departament of Neurology, Hospital das Clínicas da Universidade de São Paulo, São Paulo – SP, Brazil
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Gokyar A, Tonga F. Clinical experience on intertransverse extraforaminal approach for far lateral disc herniations: 132 cases. Niger J Clin Pract 2022; 25:630-635. [PMID: 35593605 DOI: 10.4103/njcp.njcp_1588_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Far lateral disc herniations attract many spine surgeons for their type of onset, degree of pain, risk of neurological deficit, and increasing incidence. Today, a direct approach to the region by miminally invasive techniques is preferred. Aims We aimed to present the results of the cases that were operated via intertransverse extraforaminal approach through a midline incision. Patients and Methods One hundred thirty-two patients who were operated for far lateral disc herniation by extraforaminal approach between January 2010 and December 2017 were retrospectively evaluated. The demographical data, level of disc herniations, examination findings, preoperative and postoperative VAS scores, and postoperative long-term MacNab satisfaction rates were recorded. Results Sixty-nine of the patients were male. The mean age was 58.1 years. Acute onset pain was a dominant complaint in 75% of the cases. The mean preoperative VAS score of 8.24 decreased to 2.08 at one month postoperatively. Based on a mean follow-up of 34.4 months, the long-term satisfaction rates according to Macnab criteria were 74% excellent-good, 20% moderate, and 6% poor. Conclusion Intertransverse extraforaminal approach is an effective and safe technique for far lateral disc herniations. However, considering the anatomical restrictions and the unfamiliarity of the surgeons with the region, it is important that the surgeons perform the surgery with the technique they know best to increase the success of the surgery.
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Affiliation(s)
- A Gokyar
- Department of Neurosurgery, Medical Faculty of Amasya, Turkey
| | - F Tonga
- Department of Neurosurgery, Medical Faculty of Amasya, Turkey
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Two Cases of Iatrogenic Lumbar Foraminal Disc Herniations. Case Rep Orthop 2022; 2021:5546530. [PMID: 34976423 PMCID: PMC8720017 DOI: 10.1155/2021/5546530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 12/03/2021] [Indexed: 12/05/2022] Open
Abstract
Objective We report two cases of iatrogenic deterioration of lumbar foraminal disc herniations following lumbar disc injections. Summary of Background Data. Complications associated with discography were reported. However, only a few reports have thus far referred to the iatrogenic deterioration of lumbar foraminal disc herniations. Cases 60-year-old and 74-year-old men were treated with MR images of L4-5 foraminal disc herniations without fragment in the spinal canal. The patients underwent discography and disc block for its diagnosis and treatment. After disc injections, both patients complained of deterioration of L4 radiculopathy. Results On disco-CT or reexamined MR images after disc injections, herniated fragment was migrated from neural foramen to cranial central spinal canal with was not shown in previous MR images. The herniated fragments were extirpated by means of osteoplastic laminoplasty or transforaminal lumbar interbody fusion with facetectomy. The herniated fragments were migrated from neural foramen to cranial central spinal canal. Conclusions The injection of liquid medicine into the nucleus led the intradiscal pressure increased, and the disc fragment might prolapsed through the raptured region of annulus fibrosus and migrated to cranial central spinal canal by anatomical reason. The disc injection may have a risk for deterioration of foraminal disc herniation. Our report is instructive for the management of discography for the diagnosis of foraminal disc herniations.
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Funayama T, Mataki K, Murakami K, Mataki Y, Noguchi H, Miura K, Shibao Y, Eto F, Kono M, Abe T, Takahashi H, Koda M, Yamazaki M. Two Cases of Lateral Lumbar Disc Herniation Successfully Treated with Intradiscal Condoliase Injection. Spine Surg Relat Res 2020; 5:437-441. [PMID: 34966872 PMCID: PMC8668223 DOI: 10.22603/ssrr.2020-0127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 08/12/2020] [Indexed: 12/11/2022] Open
Affiliation(s)
- Toru Funayama
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Kentaro Mataki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Kohei Murakami
- Department of Orthopaedic Surgery and Sports Medicine, Tsukuba University Hospital Mito Clinical Education and Training Center, Mito Kyodo General Hospital, Mito, Japan
| | - Yuki Mataki
- Department of Orthopaedic Surgery, Ibaraki Prefectural University of Health Sciences, Ami, Japan
| | - Hiroshi Noguchi
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Kousei Miura
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yosuke Shibao
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Fumihiko Eto
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Mamoru Kono
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Tetsuya Abe
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hiroshi Takahashi
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Masao Koda
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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Torkian P, Daneshvar K, Taherian E, Rezaeifar Y, Akhlaghpoor S. Fibrin sealants in lumbar annuloplasty after endoscopic discectomy as a method to prevent recurrent lumbar disc herniation. Eur J Transl Myol 2020; 30:8748. [PMID: 32782757 PMCID: PMC7385697 DOI: 10.4081/ejtm.2019.8748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 01/24/2020] [Indexed: 11/23/2022] Open
Abstract
Fibrin sealant as a promising agent for providing scaffold and efficient hemostasis is widely accepted in several specialties. However, the outcome of Fibrin sealants in lumbar annuloplasty after endoscopic discectomy has not been evaluated in patients with disc herniation. The goal of this study was to evaluate the efficacy, response, and probability of future recurrence rates in herniated nucleus pulposus (HNP) with the use of fibrin sealant in conjunction with endoscopic disc surgery. A total of 35 patients (28 men, 7women) were evaluated, including 18 patients who underwent endoscopic discectomy alone and 17 patients that received fibrin sealant at the site of annulus tear and endoscopic discectomy. All patients were followed through both clinical and imaging methods for an average of 10.5 months. Primary outcome measure was defined as lumbar decompression approved by imaging and symptom alleviation after endoscopic spinal discectomy with Visual Analogue Scale (VAS) score ≤ 4 (cut-off point). Median size of annular tearing was significantly lower in the endoscopic discectomy group (median, 3) (minimum, 2; maximum, 5); however, the corresponding factor in the endoscopic discectomy plus fibrin sealant group was significantly larger (median, 6) (minimum, 5; maximum, 10), with P <0.001. Only one patient in the endoscopic discectomy group had an HNP recurrence during follow-up compared to two patients in the endoscopic discectomy plus fibrin sealant group. Due to the temporary effects of fibrin sealant in preventing disc herniation and the observed recurrence rate in both the case and control groups, the results of this study suggest a role of fibrin sealants combined with endoscopic discectomy to prevent early HNP recurrence rate.
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Affiliation(s)
- Pooya Torkian
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Keivan Daneshvar
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Yasaman Rezaeifar
- Department of Psychology, Faculty of Health, York University, Toronto, Ontario, Canada
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Torkian P, Daneshvar K, Taherian E, Rezaeifar Y, Akhlaghpoor S. Fibrin sealants in lumbar annuloplasty after endoscopic discectomy as a method to prevent recurrent lumbar disc herniation. Eur J Transl Myol 2020. [DOI: 10.4081/ejtm.2020.8748] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Fibrin sealant as a promising agent for providing scaffold and efficient hemostasis is widely accepted in several specialties. However, the outcome of Fibrin sealants in lumbar annuloplasty after endoscopic discectomy has not been evaluated in patients with disc herniation. The goal of this study was to evaluate the efficacy, response, and probability of future recurrence rates in herniated nucleus pulposus (HNP) with the use of fibrin sealant in conjunction with endoscopic disc surgery. A total of 35 patients (28 men, 7women) were evaluated, including 18 patients who underwent endoscopic discectomy alone and 17 patients that received fibrin sealant at the site of annulus tear and endoscopic discectomy. All patients were followed through both clinical and imaging methods for an average of 10.5 months. Primary outcome measure was defined as lumbar decompression approved by imaging and symptom alleviation after endoscopic spinal discectomy with Visual Analogue Scale (VAS) score ≤ 4 (cut-off point). Median size of annular tearing was significantly lower in the endoscopic discectomy group (median, 3) (minimum, 2; maximum, 5); however, the corresponding factor in the endoscopic discectomy plus fibrin sealant group was significantly larger (median, 6) (minimum, 5; maximum, 10), with P <0.001. Only one patient in the endoscopic discectomy group had an HNP recurrence during follow-up compared to two patients in the endoscopic discectomy plus fibrin sealant group. Due to the temporary effects of fibrin sealant in preventing disc herniation and the observed recurrence rate in both the case and control groups, the results of this study suggest a role of fibrin sealants combined with endoscopic discectomy to prevent early HNP recurrence rate.
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A comparison of sciatica in young subjects and elderly person. J Clin Orthop Trauma 2020; 11:889-890. [PMID: 32879576 PMCID: PMC7452267 DOI: 10.1016/j.jcot.2019.07.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 07/20/2019] [Accepted: 07/23/2019] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Sciatica is a common symptom for many people with degenerative lumbar spine diseases. It is by far the most common symptom of disc herniation. However, disc herniation is not the only cause of sciatica. Other degenerative lumbar spine diseases can provoke Sciatica. To date, few studies have analysed the cause of sciatica in particularly in elderly patients. MATERIAL AND METHODS We analysed retrospectively records of patients aged between 35 and 55 (first group) and between 65 and 85 (second group) visited in our departments for sciatica between December 2009 and November 2018. RESULTS In elderly patients, disc herniation from upper levels (L2-L3 and L3-L4) is more common than younger people. Sciatica as a result of exclusive disc herniation reduces with age. Foramen stenosis produces sciatica in elderly patients more than twice as high in younger patients. Statistically, more patients needed to surgery in elderly patients in comparison with younger population. CONCLUSION Sciatica in elderly patients takes a different clinical aspect in comparison with younger population. The clinical picture associates pain less severe but more persistent, more resistant to treatment. It is caused in less than 50% by disc herniation.
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Bergen TA, Mesropyan NA, Smagina AV. [Magnetic-resonance imaging under degenerative changes in lumbar spine: state of the art]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2019; 83:104-112. [PMID: 31577276 DOI: 10.17116/neiro201983041104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Magnetic resonance imaging (MRI) of lumbar spine is a very frequent examination in any computer tomography unit. However, there are still no scan standards or standards for scan interpretation in the world's medical community. In this article based on our experience we describe common problems encountered by a radiologist during MRI examination of lumbar spine and its subsequent description. The literature survey and analysis are presented with a summary of current recommendations. We examined routine sequences, which could be included in MRI protocol, discussed common terminology, and showed the incidence of different pathologies. The special emphasis is made on assessing lumbar canal stenosis. In this article we focus on qualitative and quantitative criteria of lumbar spinal stenosis.
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Affiliation(s)
| | | | - A V Smagina
- Federal State Budgetary Educational Institution of Higher Education Novosibirsk State Medical University of the RF Ministry of Health, Novosibirsk, Russia
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Khan JM, McKinney D, Basques BA, Louie PK, Carroll D, Paul J, Varthi A, Iyer S, An HS. Clinical Presentation and Outcomes of Patients With a Lumbar Far Lateral Herniated Nucleus Pulposus as Compared to Those With a Central or Paracentral Herniation. Global Spine J 2019; 9:480-486. [PMID: 31431869 PMCID: PMC6686375 DOI: 10.1177/2192568218800055] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES Examine pre- and postoperative outcomes between patients presenting with a central/paracentral versus a far lateral herniated nucleus pulposus (HNP) and assess whether significantly worse postoperative outcomes, assessed via patient self-reported survey, are associated with far lateral disc herniations. METHODS We performed a retrospective cohort analysis of patients who underwent primary lumbar decompression between January 2008 and December 2015. Groups were divided based on herniation type, central/paracentral or far lateral. Patients with 3 months, or longer, of follow-up were included. Variables analyzed included demographics, American Society of Anesthesiologists (ASA) Score, Charleston Comorbidity Index (CCI), Oswestry Disability Index (ODI) scores, Visual Analog Scales (VAS) scores for the back and leg, 12-Item Short Form Mental and Physical Survey (SF-12) scores, and Veterans RAND 12-Item Mental and Physical Survey (VR-12) scores. RESULTS A total of 100 patients met the inclusion criteria. Postoperative ODI scores for central/paracentral HNP were significantly lower compared to far lateral HNP. Patients with a far lateral disc herniation presented with significantly lower preoperative SF-12 and VR-12 scores. The improvement in ODI score from preoperative to final was significantly lower in the patients presenting with a far lateral HNP. CONCLUSIONS Although patients with far lateral HNP present with worse preoperative outcome scores, they can expect similar symptom improvement to central or paracentral herniations following discectomy. This information can be used for future surgeons when weighing conservative versus surgical treatment of far lateral herniations.
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Affiliation(s)
| | | | | | - Philip K. Louie
- Rush University Medical Center, Chicago, IL, USA,Philip K. Louie, Department of Orthopaedic Surgery, Rush University Medical Center, 1611 West Harrison Street, Suite 300, Chicago, IL 60612, USA.
| | | | | | | | | | - Howard S. An
- Rush University Medical Center, Chicago, IL, USA
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Clemente M, Roero C, Perlo V, Peila E, De Luca A. A Novel Application of an Adjustable Catheter in Acute Radicular Pain Management. Pain Ther 2019; 8:141-150. [PMID: 30617904 PMCID: PMC6513925 DOI: 10.1007/s40122-018-0110-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Indexed: 11/26/2022] Open
Abstract
Introduction Acute lumbosacral radicular syndrome is often a medical disorder of difficult management. Epidural steroid injection is a useful approach for the herniated disc and radiculitis. The transforaminal approach is usually considered more effective and target-specific, but it can be associated with permanent lower extremity paralysis. A caudal approach with an adjustable catheter has been widely used in adhesiolysis in chronic low back pain, but there are no reports of its application in acute radicular pain. The aim of this study is to assess the clinical effectiveness of epidural steroid injection by caudal approach with an adjustable catheter in patients with severe acute radicular pain. Methods Fifty-five patients with severe acute radiculopathy were treated with epidural steroid injection by an epidural catheter whose tip can be directed laterally on the selected site. Numerical rating scale (NRS), pain relief, and analgesic consumption were observed after 1, 3, 6, and 12 months. Analgesic consumption (AC) and functional recovery (FR) have been considered secondary outcomes. Results We observed a significant reduction of NRS score that was constant every 12 months. Pain relief was good after 1 month and improved further after 3 months. Only a few patients perceived poor pain relief and only three patients relapsed. More than 70% of the patients were drug-free at the 12th month. Conclusions The caudal approach with adjustable catheter showed similar but more lasting effects on the acute severe radicular pain when compared to other epidural injections techniques; it is extremely target-specific and thus allows the use of small doses of corticosteroids; moreover, the adjustable catheter makes the procedure free from the risk of major complications. Funding No funding or sponsorship was received for this study. Sponsorship for article publication fees were funded by TSS Medical SRL.
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Affiliation(s)
- Maria Clemente
- Pain Clinic and Palliative Care Unit, A.O.U. Città della Salute e della Scienza, Corso Bramante 88, 10131, Turin, Italy.
| | - Carla Roero
- Pain Clinic and Palliative Care Unit, A.O.U. Città della Salute e della Scienza, Corso Bramante 88, 10131, Turin, Italy
| | - Veronica Perlo
- Pain Clinic and Palliative Care Unit, A.O.U. Città della Salute e della Scienza, Corso Bramante 88, 10131, Turin, Italy
| | - Elena Peila
- Pain Clinic and Palliative Care Unit, A.O.U. Città della Salute e della Scienza, Corso Bramante 88, 10131, Turin, Italy
| | - Anna De Luca
- Pain Clinic and Palliative Care Unit, A.O.U. Città della Salute e della Scienza, Corso Bramante 88, 10131, Turin, Italy
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15
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Domenico C, Pasquale C, Domenico M, Francesco S. Discrepancy between clinical-neurophysiological-neuroimaging examinations in lumbar spine degenerative disease: To the neurosurgeon the choice. INTERDISCIPLINARY NEUROSURGERY 2018. [DOI: 10.1016/j.inat.2018.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Tschugg A, Lener S, Hartmann S, Fink V, Neururer S, Wildauer M, Löscher WN, Thome C. Extraforaminal Lumbar Disk Herniations Lead To Neuroplastic Changes: a Study Using Quantitative Sensory Testing. Muscle Nerve 2018; 58:676-680. [DOI: 10.1002/mus.26184] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 05/24/2018] [Accepted: 05/24/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Anja Tschugg
- Department of Neurosurgery; Innsbruck Medical University; Anichstrasse 35, A-6020 Innsbruck Austria
| | - Sara Lener
- Department of Neurosurgery; Innsbruck Medical University; Anichstrasse 35, A-6020 Innsbruck Austria
| | - Sebastian Hartmann
- Department of Neurosurgery; Innsbruck Medical University; Anichstrasse 35, A-6020 Innsbruck Austria
| | - Valentin Fink
- Department of Neurosurgery; Innsbruck Medical University; Anichstrasse 35, A-6020 Innsbruck Austria
| | - Sabrina Neururer
- Department of Medical Statistics and Health Economics; Innsbruck Medical University; Innsbruck Austria
| | - Matthias Wildauer
- Department of Neuroradiology; Innsbruck Medical University; Innsbruck Austria
| | | | - Claudius Thome
- Department of Neurosurgery; Innsbruck Medical University; Anichstrasse 35, A-6020 Innsbruck Austria
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17
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Chirchiglia D, Chirchiglia P, Murrone D, Signorelli F. Clinical-neurophysiological-neuroradiological discordance in lumbar degenerative disc disease: should the neurosurgeon have the last word? J Neurosurg Sci 2018; 64:307-308. [PMID: 29905431 DOI: 10.23736/s0390-5616.18.04508-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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18
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Farshad M, Sutter R, Hoch A. Severity of foraminal lumbar stenosis and the relation to clinical symptoms and response to periradicular infiltration-introduction of the "melting sign". Spine J 2018; 18:294-299. [PMID: 28739476 DOI: 10.1016/j.spinee.2017.07.176] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 06/25/2017] [Accepted: 07/17/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND CONTEXT Nerve root compression causing symptomatic radiculopathy can occur within the intervertebral foramen. Sagittal magnetic resonance imaging (MRI) sequences are reliable in detection of nerve root contact to intraforaminal disc material, but a clinically relevant classification of degree of contact is lacking. PURPOSE This study aimed to investigate a potential relation of amount of contact between intraforaminal disc material and nerve root to clinical findings and response after periradicular corticosteroid infiltration. STUDY DESIGN A post hoc analysis of a prospective cohort was carried out. PATIENT SAMPLE Patients who underwent computed tomography (CT)-guided periradicular corticosteroid infiltration (L1-L5) at our institution (January 2014 to May 2016) were included. OUTCOME MEASURES The medical records and radiographic imaging were reviewed. METHODS T2-weighted MRI of the lumbar spine of patients with single-level symptomatic radiculopathy with (responders, n=28) or without (non-responders, n=14) pain relief after periradicular infiltration with corticosteroids were measured and compared by two independent readers to determine the amount of intraforaminal nerve root contact with the intervertebral disc ("melting" of the T2-hypointense signal). Pain relief was defined with a pain level decrease of >50% on a visual analogue scale and lack of pain relief with a pain level decrease of <25%, respectively. The amount of T2-hypointensity melting of disc and nerve root was categorized to 0%, 1%-25%, and over 25%. RESULTS Reader one identified 0% T2-melting in none of the responders, 1%-25% melting in 13 patients (46.4%), 26%-50% in 15 of the 28 patients (53.6%) with pain relief after periradicular corticosteroid infiltration (responders), with a mean amount of T2-melting of 5.9±2.1 mm, whereas the non-responder group had 0% T2-melting in 2 patients (14.3%), 1%-25% T2-melting in 11 patients (78.6%), and 26%-50% in 1 patient (7.1%), with a mean amount of T2-melting of 2.6±1.9 mm (p<.05). Reader two identified 0% T2-melting in none, 1%-25% T2-melting in 15 (53.6%) patients, and 26%-50% in 13 of the 28 responders (46.4%), with mean amount of 6.3±1.9 mm. In the non-responder group 0% T2-melting was seen in 3 patients (21.4%), 1%-25% T2-melting in 10 patients (71.4%), and 26%-50% in 1 patient (7.1%), with a mean amount of T2-melting of 2.7±1.9 mm (p<.05). None of the MRI showed T2-melting in over 50% of the circumference of the intraforaminal nerve root. A T2-melting of >25% had a high specificity of 93% but a sensitivity of 50%, thus a positive likelihood ratio of 7.5, to identify those with a pain relief of more than 50% after infiltration. CONCLUSION The amount of T2-melting of disc material and nerve root on sagittal MRI (>25%) predicts the amount of pain relief by periradicular infiltration in patients with intraforaminal nerve root irritation.
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Affiliation(s)
- Mazda Farshad
- Division of Spine Surgery and Radiology, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008 Zürich, Switzerland.
| | - Reto Sutter
- Division of Spine Surgery and Radiology, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008 Zürich, Switzerland
| | - Armando Hoch
- Division of Spine Surgery and Radiology, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008 Zürich, Switzerland
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Wang Y, Sun H, Qin S. Clinical efficacy of lumbar interbody fusion using a channel system combined with ozone therapy for the treatment of central-type L3-L4 lumbar disc herniation. Exp Ther Med 2017; 13:619-623. [PMID: 28352340 PMCID: PMC5348654 DOI: 10.3892/etm.2016.4009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 12/19/2016] [Indexed: 12/15/2022] Open
Abstract
The clinical efficacy of minimally invasive lumbar interbody fusion via the intervertebral foramen combined with ozone (O3) therapy for the treatment of L3-L4 central-type lumbar disc herniation was explored. We recruited patients with sciatica who attended our hospital between July 2013 and October 2015 and underwent lumbar X-ray (anteroposterior and lateral view), lumbar flexion-extension radiographs, computed tomography, and magnetic resonance imaging after admission. Seventy-four patients with central-type lumbar disc herniation but no other complications were randomly selected and divided into the observation and control groups. The observation group comprised 37 patients treated with lumbar fusion using a channel system combined with O3 therapy, whereas the control group comprised 37 patients treated with lumbar fusion alone. The effects of the two therapies were evaluated using visual analog scale, Japanese Orthopaedic Association, and MacNab scores. There was no significant difference in scores between the two groups before surgery (P>0.05). The scores of the observation group after treatment were significantly lower than those before surgery and those of the control group (P<0.05). One patient in the observation group experienced no obvious improvement in symptoms after surgery, and two patients in the control group experienced postoperative recurrence; these three patients subsequently underwent laminectomy combined with planted bone fusion and internal fixation. There was no significant difference in total efficacy rates between the two groups (P>0.05). Lumbar fusion using a channel system combined with O3 therapy for the treatment of L3-L4 central-type lumbar disc herniation is safe and effective. It has the advantages of reduced trauma, fewer complications, and rapid pain relief, and it promotes the recovery of lumbar function. Strict mastery of the surgical indications is key to the success of the procedure; however, it is worth expanding its use in the clinical setting.
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Affiliation(s)
- Yu Wang
- Department of Orthopedics, Rizhao Hospital of Traditional Chinese Medicine, Rizhao, Shandong 276800, P.R. China
| | - Hong Sun
- Department of Anesthesiology, People's Hospital of Rizhao, Rizhao, Shandong 276800, P.R. China
| | - Shuzhen Qin
- Operating Room, Rizhao Hospital of Traditional Chinese Medicine, Rizhao, Shandong 276800, P.R. China
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