No correlation identified between the proportional size of a prolapsed intravertebral disc with disability or leg pain

AIMS

The aim of the study was to determine if there was a direct correlation between the pain and disability experienced by patients and size of their disc prolapse, measured by the disc's cross-sectional area on T2 axial MRI scans.

METHODS

Patients were asked to prospectively complete visual analogue scale (VAS) and Oswestry Disability Index (ODI) scores on the day of their MRI scan. All patients with primary disc herniation were included. Exclusion criteria included recurrent disc herniation, cauda equina syndrome, or any other associated spinal pathology. T2 weighted MRI scans were reviewed on picture archiving and communications software. The T2 axial image showing the disc protrusion with the largest cross sectional area was used for measurements. The area of the disc and canal were measured at this level. The size of the disc was measured as a percentage of the cross-sectional area of the spinal canal on the chosen image. The VAS leg pain and ODI scores were each correlated with the size of the disc using the Pearson correlation coefficient (PCC). Intraobserver reliability for MRI measurement was assessed using the interclass correlation coefficient (ICC). We assessed if the position of the disc prolapse (central, lateral recess, or foraminal) altered the symptoms described by the patient. The VAS and ODI scores from central and lateral recess disc prolapses were compared.

RESULTS

A total of 56 patients (mean age 41.1 years (22.8 to 70.3)) were included. A high degree of intraobserver reliability was observed for MRI measurement: single measure ICC was 0.99 (95% confidence interval (CI) from 0.97 to 0.99 (p < 0.001)). The PCC comparing VAS leg scores with canal occupancy for herniated disc was 0.056. The PCC comparing ODI for herniated disc was 0.070. We found 13 disc prolapses centrally and 43 lateral recess prolapses. There were no foraminal prolapses in this group. The position of the prolapse was not found to be related to the mean VAS score or ODI experienced by the patients (VAS, p = 0.251; ODI, p = 0.093).

CONCLUSION

The results of the statistical analysis show that there is no direct correlation between the size or position of the disc prolapse and a patient's symptoms. The symptoms experienced by patients should be the primary concern in deciding to perform discectomy. Cite this article: Bone Joint J 2022;104-B(6):715-720.

The History of Endoscopic Posterior Lumbar Surgery

Throughout its evolution, spine surgery has migrated toward less invasiveness. For posterior lumbar surgery, percutaneous techniques together with endoscopic visualization allow for the smallest surgical corridor. Initially, this approach utilized the natural entry point into the spinal canal via the transforaminal approach via Kamin's triangle. The interlaminar endoscopic technique was subsequently developed to address central disc herniations at L5-S1, where the transforaminal approach can be challenging to reach the surgical pathology. More recently, the dual portal posterior lumbar endoscopic technique provides for yet another method of performing posterior lumbar surgery, expanding its versatility, including the treatment of spinal stenosis. In addition to treating disc pathology, percutaneous endoscopic lumbar interbody fusions are now performed in select patients in the ambulatory surgery setting. Despite the dramatic advantages of advanced minimally invasive procedures, the adoption of endoscopic spine surgery in everyday practice has lagged. The main obstacle to adoption appears to be the difficult learning curve of endoscopic surgery combined with the fact that traditional microdiscectomy surgery remains one of the most successful operations in our treatment armamentarium. The successful future of endoscopic spine surgery will depend on our ability to address the learning curve problem. In the future, this problem may be addressed through the use to computer-assisted navigation, robotic assistance, and an integrated operating room suite that improves the efficiencies and ergonomics of increasingly complex surgical treatment strategies.

Efficacy and durability of radiopaque gelified ethanol in management of herniated discs

Background

Percutaneous image-guided intradiscal injection of gelified ethanol was introduced to treat herniated disc disease lately. The aim of the study was to assess clinical efficacy and durability over a 36 months’ period.

Patients and methods

Eighty-three patients (47 males, 36 females, mean age 48.9 years (18–79 years) were treated between May 2014 and December 2015 for 16 cervical and 67 lumbar chronical contained disc herniations. For pain assessment evaluation, the visual analog scale (VAS) was used. Physical activity, the use of analgesics, patients’ satisfaction with the treatment results and patient’s willingness to repeat the treatment were also evaluated.

Results

Fifty-nine patients responded to questionnaire. 89.8% had significant reduction in VAS after 1 month (p < 0.001); 76.9% of patients with cervical symptoms and 93.5% of patients with lumbar symptoms. In cervical group it remained stable, while in lumbar group VAS decreased even more during 36 months (p = 0.012). Single patient had spinal surgery. Moderate and severe physical disability prior to treatment (96.6%) was reduced to less than 30% after 12 months. The majority of active patients returned to their regular job (71.1%); 78% needed less analgesics. Only 5.1% patients were not satisfied with the treatment and 10.2% would not repeat the treatment if needed.

Conclusions

Percutaneous image-guided intradiscal injection of gelified ethanol is safe, effective and durable therapy for chronic contained cervical and lumbar herniations. Due to minimal invasiveness and long-lasting benefits, this kind of treatment should be proposed to designated group of patients as first-line therapy.

Magnetic resonance imaging analysis of work-related chronic low back pain: comparisons of different lumbar disc patterns

Background

Currently, there is a lack of comparative research about different lumbar disc patterns in patients with work-related chronic low back pain (CLBP) based on magnetic resonance imaging (MRI) analysis. Therefore, this study, on different patterns of lumbar disc degeneration or herniation in patients with CLBP, is valuable. In this study, we retrospectively investigated lumbar degenerative changes in patients with CLBP by using MRI analysis.

Materials and methods

Two hundred and eighty-three patients (110 women and 173 men) with work-related CLBP were enrolled and divided into four groups based on intervertebral disc morphology from MRI analysis, including normal discs (ND) group, degenerative discs (DD) group, bulging discs (BD) group, and herniated discs (HD) group. Demographic characteristics, occupational information, Visual Analog Scale (VAS) scores, and Oswestry Disability Index (ODI) scores were analyzed. Moreover, multiple parameters were investigated in the MRI analysis.

Results

The mean age of all 283 patients was 41.8±12.0 years (range, 18-80) and the mean duration of CLBP for all patients was 24.5±24.9 months. There were no significant differences in the patients' BMI, history of smoking, and education level (P>0.05). The three most common occupational types were manual worker, desk worker, and technician. The VAS and ODI scores of patients with CLBP in the DD, BD, and HD groups were significantly higher than those of patients in the ND group (P<0.05). The degrees of degeneration of L4/5 and L5/S1 were significantly higher than those of other intervertebral discs (P<0.05). The disc heights of L4/5 in the BD and HD groups were significantly lower than those of the ND group (P<0.05) and the disc height of L5/S1 in the HD group was significantly lower than that of the ND group (P<0.05). At the neutral position, the distances of L3/4, L4/5, and L5/S1 discs' bulge/herniation in the BD and HD groups were significantly higher than those in the ND and DD groups (P<0.05).

Conclusion

In summary, more severe degenerative changes of lower lumbar discs (L4/5 and L5/S1) such as higher degree of degeneration of disc, lower disc height, and significant displacement of disc were found in patients with work-related CLBP based on MRI analysis.

Analysis of crucial molecules involved in herniated discs and degenerative disc disease

OBJECTIVES

Herniated discs and degenerative disc disease are major health problems worldwide. However, their pathogenesis remains obscure. This study aimed to explore the molecular mechanisms of these ailments and to identify underlying therapeutic targets.

MATERIAL AND METHODS

Using the GSE23130 microarray datasets downloaded from the Gene Expression Omnibus database, differentially co-expressed genes and links were identified using the differentially co-expressed gene and link method with a false discovery rate ,0.25 as a significant threshold. Subsequently, the underlying molecular mechanisms of the differential co-expression of these genes were investigated using Kyoto Encyclopedia of Genes and Genomes pathway enrichment analysis. In addition, the transcriptional regulatory relationship was also investigated.

RESULTS

Through the analysis of the gene expression profiles of different specimens from patients with these diseases, 539 differentially co-expressed genes were identified for these ailments. The ten most significant signaling pathways involving the differentially co-expressed genes were identified by enrichment analysis. Among these pathways, apoptosis and extracellular matrix-receptor interaction pathways have been reported to be related to these diseases. A total of 62 pairs of regulatory relationships between transcription factors and their target genes were identified as critical for the pathogenesis of these diseases.

CONCLUSION

The results of our study will help to identify the mechanisms responsible for herniated discs and degenerative disc disease and provides a theoretical basis for further therapeutic study.