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Poot-Franco JA, Mena-Balan A, Perez-Navarrete A, Huchim O, Azcorra-Perez H, Mendez-Dominguez N. Association between the Thickness of Lumbar Subcutaneous Fat Tissue and the Presence of Hernias in Adults with Persistent, Non-Traumatic Low Back Pain. Tomography 2024; 10:277-285. [PMID: 38393290 PMCID: PMC10892227 DOI: 10.3390/tomography10020022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/22/2024] [Accepted: 01/29/2024] [Indexed: 02/25/2024] Open
Abstract
We aimed to analyze the association between the average lumbar subcutaneous fat tissue thickness (LSFTT) at each intervertebral level and the presence of hernias in patients with low back pain from an insurance network hospital in Mexico. This observational prospective study included 174 patients with non-traumatic lumbago who underwent magnetic resonance imaging with a 1.5T resonator. Two independent radiologists made the diagnosis, and a third specialist provided a quality vote when needed. The sample size was calculated with a 95% confidence interval using random order selection. Anonymized secondary information was used. Percentages and means with confidence intervals were tabulated. The area under the curve, specificity, and sensitivity of LSFTT were calculated. A regression analysis was performed to analyze the presence of hernias with LSFTT using each intervertebral level as a predictor. The odds of herniation at any intervertebral level increased directly with LSFTT. The average LSFTT predicted the overall presence of hernias; however, the LSFTT at each intervertebral level better predicted hernias for each intervertebral space. The area under the curve for LSFTT in predicting hernias was 68%. In conclusion, the average LSFTT was associated with the overall presence of hernias; patients with more hernias had higher LSFTT values.
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Affiliation(s)
- Jorge Adolfo Poot-Franco
- Facultad de Medicina, Universidad Autónoma de Yucatán, Merida 97000, Mexico;
- Hospital Regional de Alta Especialidad de la Peninsula de Yucatán, IMSS-BIENESTAR, Merida 97300, Mexico
| | | | - Adrian Perez-Navarrete
- Hospital Regional de Alta Especialidad de la Peninsula de Yucatán, IMSS-BIENESTAR, Merida 97300, Mexico
| | - Osvaldo Huchim
- Escuela de Medicina, Universidad Anahuac, Naucalpan 52786, Mexico;
| | - Hugo Azcorra-Perez
- Centro de investigaciones Silvio Zavala, Universidad Modelo, Merida 97305, Mexico;
| | - Nina Mendez-Dominguez
- Hospital Regional de Alta Especialidad de la Peninsula de Yucatán, IMSS-BIENESTAR, Merida 97300, Mexico
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Çetin T, Kahraman S, Kızılgöz V, Aydın S. The Comparison between Herniated and Non-Herniated Disc Levels Regarding Intervertebral Disc Space Height and Disc Degeneration, A Magnetic Resonance Study. Diagnostics (Basel) 2023; 13:3190. [PMID: 37892011 PMCID: PMC10605841 DOI: 10.3390/diagnostics13203190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 09/26/2023] [Accepted: 10/04/2023] [Indexed: 10/29/2023] Open
Abstract
PURPOSE The main purpose of this study was to evaluate the intervertebral disc height and intervertebral disc degeneration between the normal group and the group with disc herniation at the level of the L4-L5 intervertebral disc by MRI using the Pfirrmann grading system. MATERIALS AND METHODS 385 patients were included in this study. MRI images were reevaluated and intervertebral disc heights were measured from the anterior, middle and posterior segments. Researchers divided disc pathologies into two groups. In the non-herniated group; normal or bulging ones; in the herniated group, they included those with protrusion or extrusion. RESULTS 385 lumbar MRI examinations meeting the study criteria were included in study. There were 56.9% (219/385) females and 43.1% (166/385) males in the study. For the whole patients in the study group, the intervertebral disc height values at the L4-5 level were measured as 12.34 mm, 11.58 mm, and 7.60 mm in the anterior, middle, and posterior localizations, respectively. CONCLUSIONS At the L4-5 level, the height of the disc distances in the herniated group was lower than in the normal group. The Pfirrman score was found to be higher in the herniated group in terms of disc degeneration compared to the normal group.
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Affiliation(s)
- Türkhun Çetin
- Department of Radiology, Faculty of Medicine, Erzincan Binali Yıldırım University, 24100 Erzincan, Turkey; (S.K.); (V.K.); (S.A.)
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Kim D, Kim ES, Lee YJ, Lee JY, Park KS, Jung SY, Yang C, Han CH, Ha IH. A Pilot Study for Effectiveness of Non-Pharmacological versus Pharmacological Treatment Strategies for Lumbar Disc Herniation: A Pragmatic Randomized Controlled Trial. J Pain Res 2023; 16:3197-3216. [PMID: 37744184 PMCID: PMC10516209 DOI: 10.2147/jpr.s421148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 08/12/2023] [Indexed: 09/26/2023] Open
Abstract
Purpose We aimed to compare the efficacy, safety, and cost-effectiveness of non-pharmacological- and pharmacological treatment strategies for Lumbar disc herniation (LDH) in pragmatic clinical settings. Patients and Methods This study was a pilot, two-armed, parallel pragmatic randomized controlled trial. Thirty patients aged 19-70 years with a numeric rating scale (NRS) score ≥5 for sciatica and confirmed LDH on magnetic resonance imaging (MRI) were included. Participants were assigned in a 1:1 ratio to non-pharmacological (non-Phm) or pharmacological (Phm) treatment group. They were treated for 8 weeks and a total follow-up period was 26 weeks after randomization. Non-Phm treatment included acupuncture, spinal manual therapy, etc., Phm included medication, injection, nerve block, etc., The primary outcome was a numeric rating scale (NRS) of radiating leg pain. NRS for low back pain, Oswestry disability index, visual analog scale, Fear-Avoidance Beliefs Questionnaire, patient global impression of change, Short Form-12 Health Survey, version 2, 5-level European Quality of Life-5 dimensions (EQ-5D) were also measured. Linear mixed model was used to evaluated the difference in change of outcomes from baseline between two groups. An economic evaluation was conducted using incremental cost-effectiveness ratios. Results There was no significant difference between the two groups in the intervention period, but non-Phm group showed significantly greater degree of improvement in follow-up of Week 14. Difference in the NRS for sciatica and ODI were 1.65 (95% CI 0.59 to 2.71, p=0.003) and 8.67 (95% CI 1.37 to 15.98, p=0.21), respectively in Week 14. The quality-adjusted life year (QALY) value calculated by EQ-5D and Short Form-6 Dimension were 0.006 (95% CI -0.012 to 0.024, p=0.472) and 0.015 (95% CI -0.008 to 0.038, p=0.195) higher in non-Phm group than in Phm group. The cost was lower in non-Phm group than in Phm group (Difference: -682, 95% CI -3349 to 1699, p=0.563). Conclusion We confirmed that the non-Phm treatment could be more cost-effective treatments than Phm treatments and feasibility of a large-scale of main study in future.
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Affiliation(s)
- Doori Kim
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, 06110, Republic of Korea
| | - Eun-San Kim
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, 06110, Republic of Korea
| | - Yoon Jae Lee
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, 06110, Republic of Korea
| | - Jee Young Lee
- Department of Korean Internal Medicine, Integrative Cancer Center, Cha Ilsan Medical Center, Goyang-si, Gyeonggi-do, Republic of Korea
| | - Kyong Sun Park
- Jaseng Hospital of Korean Medicine, Seoul, 06110, Republic of Korea
| | - So Young Jung
- Clinical Research Coordinating Team, Korea Institute of Oriental Medicine, Daejeon, 34054, Republic of Korea
| | - Changsop Yang
- Clinical Medicine Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Chang-Hyun Han
- Korean Convergence Medical Science, University of Science & Technology (UST), School of Korea Institute of Oriental Medicine, Daejeon, 34054, Republic of Korea
- KM Science Research Division, Korea Institute of Oriental Medicine, Daejeon, 34054, Republic of Korea
| | - In-Hyuk Ha
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, 06110, Republic of Korea
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Chu ECP, Trager RJ, Lee WT, Cheong BKC, Hei SYM. Lung Cancer With Vertebral Metastases Presenting as Low Back Pain in the Chiropractic Office: A Case Report. Cureus 2023; 15:e34821. [PMID: 36919062 PMCID: PMC10008126 DOI: 10.7759/cureus.34821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2023] [Indexed: 02/11/2023] Open
Abstract
Lung cancer commonly metastasizes to the skeletal system, and when affecting the spine, it may initially be mistaken for a typical musculoskeletal source of back pain. We report a previously healthy 52-year-old male non-smoker with an eight-week history of low back pain that radiated into his left thigh and recent weight loss, yet no respiratory symptoms. Initially, the patient visited his primary care physician, who suspected a musculoskeletal condition and prescribed a nonsteroidal anti-inflammatory drug and muscle relaxant, then referred the patient to the chiropractor. Based on the patient's pain pattern, limited mobility, and other features, the chiropractor suspected a lumbar disc herniation. However, the patient's condition worsened during a one-week trial of care, so the chiropractor ordered magnetic resonance imaging (MRI) and, as the findings suggested vertebral metastasis, promptly referred the patient to an oncologist, who confirmed a diagnosis of lung adenocarcinoma via positron emission tomography (PET)/computed tomography and biopsy. Chiropractors should be aware of warning signs of malignancy, such as unexplained weight loss or progressive worsening despite treatment. If providers suspect spinal metastasis, they should order advanced imaging such as an MRI and refer patients to an oncologist for timely care.
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Affiliation(s)
- Eric Chun-Pu Chu
- New York Chiropractic and Physiotherapy Centre, New York Medical Group, Kowloon, HKG
| | - Robert J Trager
- Chiropractic, Connor Whole Health, University Hospitals Cleveland Medical Center, Cleveland, USA
| | - Wai Ting Lee
- New York Chiropractic and Physiotherapy Centre, New York Medical Group, Kowloon, HKG
| | | | - Steve Yun Ming Hei
- New York Chiropractic and Physiotherapy Centre, New York Medical Group, Kowloon, HKG
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Yazici A, Yerlikaya T, Oniz A. Evaluation of the degeneration of the multifidus and erector spinae muscles in patients with low back pain and healthy individuals. J Back Musculoskelet Rehabil 2023; 36:637-650. [PMID: 36776035 DOI: 10.3233/bmr-220055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
BACKGROUND Although several studies have been conducted to determine the cause of low back pain (LBP), a sufficient correlation has not been found between research findings and symptoms. Therefore there seems to be a need for studies to explain the relationship between pain and morphological changes in the paraspinal muscles of patients with LBP through comparisons with healthy control subjects. OBJECTIVE The aim of this study was to examine degeneration in the lumbar musculus multifidus (LMF) and lumbar musculus erector spinae (LES) muscles in patients with chronic LBP with non-radiculopathy lumbar disc herniation (LDH), patients with mechanical LBP, and healthy individuals. METHODS The study included 35 patients with mechanical LBP, 38 patients with non-radiculopathy LDH, and a control group of 36 healthy participants. In all patients and the control group, evaluations were made on axial magnetic resonance imaging slices at L3-S1 level of the LMF and LES cross-sectional areas (CSA), total CSA (TCSA = LMF+LES), fat infiltrations and asymmetries. RESULTS The mean CSA values of the right and left LMF and LES showed significant differences between the groups (p< 0.001, p= 0.002, p= 0.002, p= 0.010, respectively). Fat infiltrations showed a difference between the right-left LMF and left LES groups (p= 0.007, p< 0.001, p= 0.026, respectively). Asymmetry was not observed between the CSA and TCSA of the right and left sides. CONCLUSION A correlation was found between fat infiltration in the LMF and mechanical LBP and LDH. However, no significant correlation was determined between LBP and the CSA and TCSA of the LMF and LES. This was thought to be due to an incorrect result of CSA and TCSA in the evaluation of muscle mass. Therefore, for a more accurate evaluation of muscle mass, it can be considered necessary to measure muscle atrophy associated with fat infiltration or functional CSA.
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Affiliation(s)
- Alikemal Yazici
- Orthopedics and Traumatology Department, Faculty of Medicine, Near East University, Nicosia, Cyprus.,Orthopedics and Traumatology Department, Buyuk Anadolu Hospital, Samsun, Turke
| | - Tuba Yerlikaya
- Physiotherapy and Rehabilitation Department, Faculty of Health Sciences, Near East University, Nicosia, Cyprus
| | - Adile Oniz
- Faculty of Health Sciences, Near East University, Nicosia, Cyprus.,Institute of Graduate Studies, Department of Biophysics, Near East University, Nicosia, Cyprus
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Meng S, Han J, Xu D, Wang Y, Han S, Zhu K, Lin A, Su K, Li Y, Han X, Ma X, Zhou C. Fully endoscopic transforaminal discectomy for thoracolumbar junction disc herniation with or without calcification under general anesthesia: Technical notes and preliminary outcomes. Front Surg 2023; 9:1067775. [PMID: 36684323 PMCID: PMC9852773 DOI: 10.3389/fsurg.2022.1067775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 11/21/2022] [Indexed: 01/09/2023] Open
Abstract
Objective To evaluate the feasibility, safety, and outcomes of percutaneous endoscopic transforaminal discectomy (PETD) for thoracolumbar junction disc herniation (TLDH) with or without calcification. Methods This study included 12 patients diagnosed with TLDH with or without calcification who met the inclusion criteria and underwent surgery for PETD from January 2019 to December 2021. The mean patient age, operation time, hospitalization time, time in bed, and complications were recorded. Patients were followed up for at least 9 months. Visual analog scale (VAS) scores for low-back and leg or thoracic radicular pain and modified Japanese Orthopedic Association score (m-JOA) scores were preoperatively evaluated, at 1 day and 3, 6, and 12 months postoperatively or at last follow-up. The modified MacNab criteria were used to evaluate clinical efficacy at 12 months postoperatively or at last follow-up. Results The mean patient age, operation time, hospitalization time, and time in bed were 53 ± 13.9 years, 101.3 ± 9.2 min, 4.5 ± 1.3 days, and 18.0 ± 7.0 h, respectively. The mean VAS scores of low-back and leg or thoracic radicular pain improved from 5.8 ± 1.5 and 6.5 ± 1.4 to 2.0 ± 0.9 and 1.3 ± 0.5, respectively (P < 0.05). The m-JOA score improved from 7.5 ± 1.2 to 10.0 ± 0.7 (P < 0.05). The overall excellent-good rate of the modified MacNab criteria was 83.3%. No severe complications occurred. Conclusion Fully endoscopic transforaminal discectomy and ventral decompression under general anesthesia is a safe, feasible, effective, and minimally invasive method for treating herniated discs with or without calcification at thoracolumbar junction zone.
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Affiliation(s)
- Shengwei Meng
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jialuo Han
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Derong Xu
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yan Wang
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Shuo Han
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Kai Zhu
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Antao Lin
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Kunpeng Su
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yaxiong Li
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xing Han
- Operating Room, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xuexiao Ma
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China,Correspondence: Chuanli Zhou Xuexiao Ma
| | - Chuanli Zhou
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China,Correspondence: Chuanli Zhou Xuexiao Ma
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Sayin Gülensoy E, Gülensoy B. A 9-year retrospective cohort of patients with lumbar disc herniation: Comparison of patient characteristics and recurrence frequency by smoking status. Medicine (Baltimore) 2022; 101:e32462. [PMID: 36595869 PMCID: PMC9794230 DOI: 10.1097/md.0000000000032462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
To evaluate the association between smoking status and patient characteristics and to identify risk factors associated with recurrence in patients who underwent surgery for lumbar disc herniation (LDH). This retrospective study was carried out at Lokman Hekim University, Ankara, Turkey between January 1, 2021 and January 1, 2022. The medical data of patients who underwent microsurgical discectomy for LDH were retrospectively recorded. Patients with any reemergence of LDH within a 6-month period after surgery were defined as having recurrent LDH. A total of 1109 patients were included in the study and mean age was 50.7 ± 14.3 years. The frequency of hernia at L2-L3 and L3-L4 levels was higher in the nonsmoker group (P < .001). The frequency of cases with Pfirrmann Grade 4 degeneration was higher in the nonsmoker group than in smokers and ex-smokers (P < .001). Protrusion-type hernias were more common in nonsmokers (P = .014), whereas paracentral hernias were more common in smokers (P < .001). The overall frequency of recurrence was 20.4%, and was higher in smokers than in non-smokers and ex-smokers (P < .001). Multivariable logistic regression revealed that current smoking (OR: 2.778, 95% CI [confidence interval]: 1.939-3.980, P < .001), presence of Pfirrmann Grade 4&5 disc degeneration (OR: 4.217, 95% CI: 2.966-5.996, P < .001), and paracentral herniation (OR: 5.040, 95% CI: 2.266-11,207, P < .001) were associated with higher risk of recurrence, whereas presence of sequestrated disc was associated with lower risk of recurrence (OR: 2.262, 95% CI:0.272-0.717, P = .001). Taken together, our data show that smoking, increased degree of degeneration and paracentral hernia increase the risk of LDH recurrence, while sequestrated disc appears to decrease risk. Taking steps to combat smoking in individuals followed for LDH may reduce the risk of recurrence in LDH patients.
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Affiliation(s)
- Esen Sayin Gülensoy
- Ufuk University, Faculty of Medicine, Department of Chest Diseases, Ankara, Turkey
- * Correspondence: Esen Sayin Gülensoy, Ufuk University, Faculty of Medicine, Department of Chest Diseases, Mevlana Bulvari 86/88 Balgat, Ankara 06520, Turkey (e-mail: )
| | - Bülent Gülensoy
- Lokman HekimUniversity, Faculty of Medicine, Department of Neurosurgery, Ankara, Turkey
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Gil HY, Seo W, Choi GB, Ha E, Kim T, Ryu J, Kim JH, Choi JB. A New Role for Epidurography: A Simple Method for Assessing the Adequacy of Decompression during Percutaneous Plasma Disc Decompression. J Clin Med 2022; 11:jcm11237144. [PMID: 36498718 PMCID: PMC9741216 DOI: 10.3390/jcm11237144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/29/2022] [Accepted: 11/29/2022] [Indexed: 12/02/2022] Open
Abstract
Percutaneous plasma disc decompression (PPDD) is a minimally invasive treatment for discogenic low back pain and herniated disc-related symptoms. However, there are no known outcome predictive variables during the procedure. The purpose of this study was to evaluate and validate epidurography as an intra-procedure outcome predictor. We retrospectively enrolled 60 consecutive patients who did not respond to conventional treatments. In the next stage of treatment, PPDD was performed, and the epidurography was conducted before and after the PPDD. We analyzed the relationship between epidurographic improvement and the success rate. The Numerical Rating Scale and the Oswestry Disability Index were used to assess pain and functional capacity, respectively, before the procedure and 1 month after the procedure. The pain reduction and the success rate in the epidurographic improvement group were significantly higher than in the epidurographic non-improvement group. Both the Numerical Rating Scale and the Oswestry Disability Index scores were significantly reduced in both groups, but there was no significant difference in Oswestry Disability Index scores. This study's results showed that PPDD is an effective treatment method. We also suggested that epidurography may be a potential outcome predictor for ensuring successful outcomes and determining the endpoint of the procedure.
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Affiliation(s)
- Ho Young Gil
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon 16499, Republic of Korea
| | - Wonseok Seo
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon 16499, Republic of Korea
| | - Gyu Bin Choi
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon 16499, Republic of Korea
| | - Eunji Ha
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon 16499, Republic of Korea
| | - Taekwang Kim
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon 16499, Republic of Korea
| | - Jungyul Ryu
- Department of Anesthesiology and Pain Medicine, Dongtan Sacred Heart Hospital, Hallym University School of Medicine, Hwaseong 18450, Republic of Korea
| | - Jae Hyung Kim
- Department of Anesthesiology and Pain Medicine, Dongtan Sacred Heart Hospital, Hallym University School of Medicine, Hwaseong 18450, Republic of Korea
| | - Jong Bum Choi
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon 16499, Republic of Korea
- Correspondence: ; Tel.: +82-31-219-5571
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Noh SH, Ndraha E, Shin DA, Cho PG, Kim KN, Kim SH. Immediate postoperative lumbar spine magnetic resonance imaging: Correlation with postoperative pain in lumbar microdiscectomy. Medicine (Baltimore) 2022; 101:e31287. [PMID: 36316946 PMCID: PMC9622618 DOI: 10.1097/md.0000000000031287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Magnetic resonance imaging (MRI) has been extensively used in the management of patients with a herniated lumbar disc. Nevertheless, immediate postoperative MRI has not become a standard procedure, with limited research suggesting that the findings are often similar to preoperative MRI in both symptomatic and asymptomatic patients. This study aimed to determine the benefits of immediate postoperative MRI in patients with or without postoperative symptoms and its correlation with these symptoms. A total of 172 patients who underwent lumbar spine microdiscectomy at our institution between 2014 and 2021 were included. Patients who had previous spinal surgery and lumbar fusion were excluded. Patient data were collected from medical records. MRI was performed 3 days after surgery and assessed by 2 neurosurgeons to minimize bias. Immediate postoperative MRI results showed dural sac compression or foraminal stenosis in 29 patients (16.86%), of which 10 had postoperative pain and 19 were pain free. Among the 143 patients (83.14%) without these findings on MR imaging, 38 had postoperative pain. Immediate postoperative MRI did not correlate with postoperative pain (P = .421/.357). Intraoperative bleeding and the Charlson comorbidity index (CCI) showed significant correlations with postoperative pain (P = .018 and .002, respectively). In a multivariate analysis, intraoperative blood loss and CCI independently correlated with postoperative pain (P = .001 and .001, respectively). Based on our findings, intraoperative blood loss and CCI appear to be the factors that may predict the persistence of postoperative pain, despite normal findings on MRI.
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Affiliation(s)
- Sung Hyun Noh
- Department of Neurosurgery, Ajou University School of Medicine, Suwon, Republic of Korea
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eveline Ndraha
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dong Ah Shin
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Pyung Goo Cho
- Department of Neurosurgery, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Keung Nyun Kim
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sang Hyun Kim
- Department of Neurosurgery, Ajou University School of Medicine, Suwon, Republic of Korea
- *Correspondence: Sang Hyun Kim, Department of Neurosurgery, Ajou University Hospital, Ajou University School of Medicine, Suwon 164, Republic of Korea (e-mail: )
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Meng S, Xu D, Han S, Li G, Wang Y, Shen Y, Zhu K, Lin A, Wang R, Ma X, Zhou C. Fully Endoscopic 360° Decompression for Central Lumbar Spinal Stenosis Combined with Disc Herniation: Technical Note and Preliminary Outcomes of 39 Cases. J Pain Res 2022; 15:2867-2878. [PMID: 36124038 PMCID: PMC9482463 DOI: 10.2147/jpr.s379431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 09/02/2022] [Indexed: 11/24/2022] Open
Abstract
Purpose To evaluate the outcomes, feasibility, and safety of endoscopic unilateral laminectomy, bilateral decompression and discectomy (Endo-ULBDD) for central lumbar spinal stenosis (CLSS) combined with disc herniation (DH). Methods This study includes 39 patients diagnosed with CLSS combined with DH who met the inclusion criteria and underwent surgery for Endo-ULBDD from April 2020 to March 2021. The mean age of the patients, operation time, hospitalization time, time in bed, and complications were recorded. Patients were followed up for at least 12 months. Visual analog scale (VAS) scores for low-back and lower-limb pain and Oswestry Disability Index (ODI) scores were evaluated preoperatively, before discharge, and at 3, 6, and 12 months postoperatively. To evaluate clinical effectiveness 12 months postoperatively, the modified MacNab criteria were used. Results The mean age of the patients was 59.9 years, the mean operation time was 82.1 minutes, the mean hospitalization time was 3.7 days, and the mean time in bed was 20.9 hours. The mean VAS scores of low-back and lower-limb pain improved from 5.9 and 7.2 to 2.0 and 1.6, respectively (P < 0.05). The ODI score improved from 56.0 to 16.7 (P < 0.05). The overall excellent-good rate of the modified MacNab criteria was 89.7%. Two kinds of complications occurred in 4 patients (10.3%), including 1 patient whose inferior articular process was excessively removed and 3 patients who suffered from postoperative dysesthesia. No other severe complications were noted. Conclusion Endo-ULBDD is a safe, feasible, efficient, and minimally invasive approach to treating CLSS combined with DH.
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Affiliation(s)
- Shengwei Meng
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, People's Republic of China
| | - Derong Xu
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, People's Republic of China
| | - Shuo Han
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, People's Republic of China
| | - Guanghui Li
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, People's Republic of China
| | - Yan Wang
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, People's Republic of China
| | - Yanqing Shen
- Operating Room, Affiliated Hospital of Qingdao University, Qingdao, Shandong, People's Republic of China
| | - Kai Zhu
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, People's Republic of China
| | - Antao Lin
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, People's Republic of China
| | - Ruiting Wang
- Medical Insurance Audit Department, Affiliated Hospital of Qingdao University, Qingdao, Shandong, People's Republic of China
| | - Xuexiao Ma
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, People's Republic of China
| | - Chuanli Zhou
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, People's Republic of China
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11
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QIN Q, CHEN Z, FAN W, LI J, LIAO L, LI Y. Hyperpolarization-activated cyclic nucleotide-gated 2 contributes to electroacupuncture analgesia on lumbar disc herniation-induced radicular pain through activation of microglia in spinal dorsal horn. J TRADIT CHIN MED 2022; 42:372-378. [PMID: 35610006 PMCID: PMC9924730 DOI: 10.19852/j.cnki.jtcm.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
OBJECTIVE To explore the mechanisms of dorsal root ganglia and spinal microglia cascade cross in electroacupuncture (EA) analgesia in the treatment of lumbar disc herniation. METHODS A rat model of lumbar disc herniation (LDH) was established, EA was administered at Huantiao (GB30) acupoint 30 min once a day, for 3 d. Before and after modeling, and after EA, mechanical allodynia thresholds were detected. Hyperpolarization-activated cyclic nucleotide-gated 2 (HCN2) in dorsal root ganglia was detected by quantitative polymerase chain reaction (qPCR) and Western blot. C-X3-C motif chemokine ligand 1 (CX3CL1) and activity of microglia in spinal cord was observed separately qPCR and immunofluorescence staining. RESULTS The mechanical allodynia threshold of the right planta of model rats was significantly reduced ( < 0.01), EA increased the mechanical pain threshold of rats ( < 0.01), and decreased HCN2 mRNA, and protein expression, reduced the expression of CX3CL1 and the activation of microglia. ZD7288 (a blocker of HCN channel) reduced the analgesic effect of EA from 1.83 ± 0.84 to 0.74 ± 0.20 ( < 0.05), and the expression of CX3CL1 in the spinal cord decreased from 0.52 ± 0.11 to 0.15 ± 0.05 ( < 0.01). CONCLUSION EA analgesia on the radicular pain of LDH is definite. EA reduced the expression of HCN2 channel in the dorsal root ganglion, thereby decreasing the noxious stimulation entered to microglia in spinal dorsal horn. Our work supports EA is an effective treatment for radicular pain of LDH.
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Affiliation(s)
- Qingguang QIN
- School of Traditional Chinese Medicine, Southern Medical University, Guangzhou 510515, China
| | - Zujiang CHEN
- School of Traditional Chinese Medicine, Southern Medical University, Guangzhou 510515, China
| | - Weimin FAN
- School of Traditional Chinese Medicine, Southern Medical University, Guangzhou 510515, China
| | - Junhua LI
- School of Traditional Chinese Medicine, Southern Medical University, Guangzhou 510515, China
| | - Liqing LIAO
- School of Traditional Chinese Medicine, Southern Medical University, Guangzhou 510515, China
| | - Yikai LI
- LI Yikai, School of Traditional Chinese Medicine, Southern Medical University, Guangzhou 510515, China. ,Telephone: +86-20-61648455
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Ayyappan Unnithan AK. A Review of the Diagnostic Features of Posteriorly Migrated Lumbar Discs with Reports of Two Cases. Neurol India 2022; 70:1213-1216. [PMID: 35864669 DOI: 10.4103/0028-3886.349665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND The radiological features of posteriorly migrated intervertebral discs mimic tumors, hematoma, and abscess. OBJECTIVE The aim is to analyze two cases of posteriorly migrated lumbar discs. CASES Two males had features of cauda equina syndrome. Both had posterior lesions at L4/5 level in magnetic resonance imaging. The mass of the 41-year-old man had peripheral rim enhancement with gadolinium. The epidural mass was excised. The histopathology showed fibrocartilaginous disc. The 67-year-old man had mass with moderate enhancement. The mass had thinned the dura to appear as intradural tumor. The histopathology showed a fibrocartilaginous disc. Immunohistochemistry was negative for neoplasm. CONCLUSION A migrated disc should be considered in the case of a posterior extramedullary mass. The granulation tissue around the disc produces peripheral enhancement with gadolinium. Thin enhancement is common. Thick enhancement is also reported. Neoplasms have intense enhancement and inflammatory changes are seen in abscess.
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Xu Q, Tian X, Bao X, Liu D, Zeng F, Sun Q. Nonsurgical spinal decompression system traction combined with electroacupuncture in the treatment of multi-segmental cervical disc herniation: A case report. Medicine (Baltimore) 2022; 101:e28540. [PMID: 35060512 PMCID: PMC8772752 DOI: 10.1097/md.0000000000028540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 12/21/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE With the spread of computers and mobile phones, cervical spondylosis has become a common occupational disease in clinics, which seriously affects the quality of life of patients. We used a nonsurgical spinal decompression system (SDS) combined with physical therapy electroacupuncture (EA) to treat a case of mixed cervical spondylosis caused by multi-level cervical disc herniation, and we achieved satisfactory results. PATIENT CONCERNS A 44-year-old Caucasian Asian woman presented with neck pain and numbness on the left side of the limb. MRI showed the patient's C3-C7 segment cervical disc herniation, and the flexion arch of the cervical spine was reversed. DIAGNOSIS The patient was diagnosed with a mixed cervical spondylosis. INTERVENTIONS The patient received a month of physical therapy (SDS traction combined with EA). OUTCOMES Before and after treatment: VAS score of neck pain decreased from 8 to 0; Cervical spine mobility returned to normal; The grip strength of left hand increased from 7.5 kg to 19.2 kg; Cervical curvature index changed from -16.04% to -3.50%; the physiological curvature of the cervical spine was significantly restored. There was no dizziness or neck discomfort at 6 month and 1 year follow-up. LESSONS SUBSETIONS SDS traction combined with EA is effective for the treatment of cervical disc herniation and can help restore and rebuild the biomechanical balance of the cervical spine.
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Affiliation(s)
- Qing Xu
- Department of Rehabilitation Medicine, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Department of Rehabilitation Medicine, Shandong Sports Rehabilitation Research Center, Jinan, Shandong, China
| | - Xuewen Tian
- Shandong Sport University, Jinan, Shandong Province, China
| | - Xintong Bao
- Department of Sports Medicine, Shandong Sports Rehabilitation Research Center, Jinan, Shandong, China
| | - Dongren Liu
- Medical Imaging Department, Shandong Sports Rehabilitation Research Center, Jinan, Shandong, China
| | - Fanshuo Zeng
- Department of Rehabilitation Medicine, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Qiangsan Sun
- Department of Rehabilitation Medicine, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
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Echt M, Holland R, Mowrey W, Cezayirli P, Ramos RDLG, Hamad M, Gelfand Y, Longo M, Kinon MD, Yanamadala V, Chaudhary S, Cho SK, Yassari R. Surgical Outcomes for Upper Lumbar Disc Herniations: A Systematic Review and Meta-analysis. Global Spine J 2021; 11:802-813. [PMID: 32744112 PMCID: PMC8165931 DOI: 10.1177/2192568220941815] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
STUDY DESIGN Systematic review and meta-analysis. OBJECTIVE To conduct a literature review on outcomes of discectomy for upper lumbar disc herniations (ULDH), estimate pooled rates of satisfactory outcomes, compare open laminectomy/microdiscectomy (OLM) versus minimally invasive surgical (MIS) techniques, and compare results of disc herniations at L1-3 versus L3-4. METHODS A systematic review of articles reporting outcomes of nonfusion surgical treatment of L1-2, L2-3, and/or L3-4 disc herniations was performed. The inclusion and exclusion of studies was performed according to the latest version of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. RESULTS A total of 20 articles were included in the quantitative meta-analysis. Pooled proportion of satisfactory outcome (95% CI) was 0.77 (0.70, 0.83) for MIS and 0.82 (0.78, 0.84) for OLM. There was no significant improvement with MIS techniques compared with standard OLM, odds ratio (OR) = 0.86, 95% CI (0.42, 1.74), P = .66. Separating results by levels revealed a trend of higher satisfaction with L3-4 versus L1-3 with OLM surgery, OR = 0.46, 95% CI (0.19, 1.12), P = .08. CONCLUSION Our analysis reveals that discectomy for ULDH has an overall success rate of approximately 80% and has not improved with MIS. Discectomy for herniations at L3-4 trends toward better outcomes compared with L1-2 and L2-3, but was not significant.
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Affiliation(s)
- Murray Echt
- Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
,Icahn School of Medicine at Mount Sinai, New York, NY, USA,Murray Echt, Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, 439 Calhoun Avenue, Bronx, NY 10467, USA.
| | - Ryan Holland
- Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Wenzhu Mowrey
- Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Phillip Cezayirli
- Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Mousa Hamad
- Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Yaroslav Gelfand
- Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Michael Longo
- Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Merritt D. Kinon
- Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Vijay Yanamadala
- Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Saad Chaudhary
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Samuel K. Cho
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Reza Yassari
- Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
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Ding Y, Lv S, Dong S, Cui J, Cao Z, Chen Y. Relationship between Scheuermann disease and symptomatic thoracic spinal stenosis: A retrospective study. Acta Orthop Traumatol Turc 2021; 55:253-257. [PMID: 34100367 PMCID: PMC10566354 DOI: 10.5152/j.aott.2021.20022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 03/28/2020] [Accepted: 10/05/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study aimed to investigate the possible relationship between Scheuermann disease (SD) and the pathophysiological factors of thoracic spinal stenosis (TSS), including ossification of the ligamentum flavum (OLF), ossification of the posterior longitudinal ligament (OPLL), and thoracic disc herniation (TDH) in patients with symptomatic TSS. METHODS Demographic and radiological data from 66 consecutive patients diagnosed with symptomatic TSS from 2013 to 2018 were retrospectively collected and divided into 3 groups depending on the underlying pathomechanism of TSS: TDH group (18 patients; 6 women; mean age ± standard deviation [Sd] = 59.89 ± 11.34), OPLL group (12 patients; 8 women; mean age ± Sd = 56.08 ± 14.74), and OLF group (36 patients; 20 women; mean age ± Sd = 58.69 ± 9.77). A total of 41 age-matched healthy individuals (19 women; mean age ± Sd = 54.88 ± 13.63) were designated as the control group. In each group, both typical and atypical SD criteria were radiologically examined. The demographic data and presence of SD between the control group and 3 subgroups of TSS pathomechanisms were evaluated. RESULTS SD characteristics were identified in 83.33% (15/18) of patients in the TDH group, 44.44% (16/36) in the OLF group, 25% (3/12) in the OPLL group, and 17.07% (7/41) of the control individuals. When analyzed by the chi-squared test and logistic regression analysis, the presence of SD was significantly associated with TDH (P < 0.01) and OLF (P < 0.05) but not OPLL (P > 0.05). Patients with TDH and OLF showed peak involvement of T10/11, and patients with OPLL did not. Furthermore, we determined that age, sex, body-mass index, and smoking status were not the risk factors for TDH, OPLL, and OLF (P > 0.05). SD was found to be a risk factor for TDH (P < 0.01) and OLF (P < 0.05) but not for OPLL (P > 0.05). CONCLUSION Evidence from this study indicated that SD might be a risk factor for OLF and TDH but not for OPLL.
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Affiliation(s)
- Yan Ding
- Department of Spine, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan,
China
- Department of Orthopaedics, Yantaishan Hospital, Yantai,
China
| | - Shiqiao Lv
- Department of Orthopaedics, Yantaishan Hospital, Yantai,
China
| | - Shengjie Dong
- Department of Orthopaedics, Yantaishan Hospital, Yantai,
China
| | - Jinpeng Cui
- Clinical Laboratory, Yantaishan Hospital, Yantai,
China
| | - Zhilin Cao
- Department of Orthopaedics, Yantaishan Hospital, Yantai,
China
| | - Yunzhen Chen
- Department of Spine, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan,
China
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16
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Son S, Ahn Y, Lee SG, Kim WK, Yoo BR, Jung JM, Cho J. Learning curve of percutaneous endoscopic transforaminal lumbar discectomy by a single surgeon. Medicine (Baltimore) 2021; 100:e24346. [PMID: 33530228 PMCID: PMC7850775 DOI: 10.1097/md.0000000000024346] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 12/28/2020] [Indexed: 01/05/2023] Open
Abstract
To evaluate the learning curve of percutaneous endoscopic transforaminal lumbar discectomy (PETLD) from the novice stage to the proficient stage, we performed retrospective study for patients with lumbar disc herniation who underwent PETLD performed by a single surgeon and evaluated the surgeon's learning curve and the effect of surgical proficiency on outcomes.A total of 48 patients who underwent PETLD at the lower lumbar level (L3-S1) with a minimum 1-year follow-up were enrolled. The learning curve of the surgeon was assessed using cumulative study of operation time and linear regression analyses to reveal the correlation between operation time and case series number.Because the cutoff of familiarity was 25 cases according to the cumulative study of operation time, the patients were allocated into two groups: early group (n = 25) and late group (n = 23). The clinical, surgical, and radiological outcomes were retrospectively evaluated and compared between the two groups.According to linear regression analyses, the operation time was obtained using the following formula: operation time (minutes) = 69.925-(0.503 × [case number]) (P < .001).As expected, the operation time was significantly different between the two groups (mean 66.00 ± 11.37 min in the early group vs 50.43 ± 7.52 min in the late group, P < .001). No differences were found between the two groups in demographic data and baseline characteristics. Almost all clinical outcomes (including pain improvement and patient satisfaction), surgical outcomes (including failure, recurrence, and additional procedure rates), and radiological outcomes (including change of disc height and sagittal angles) did not differ between the two groups.However, the late group demonstrated a more favorable postoperative volume index of the remnant disc (362.91 mm3 [95% confidence interval, 272.81-453.02] in the early group vs 161.14 mm3 [95% confidence interval, 124.31-197.97] in the late group, P < .001), and a lower complication rate related to exiting nerve root (16.0% in the early group vs 0% in the late group, P = .045).The learning curve of PETLD is not as difficult as that of other minimally invasive spine surgery technique. Although the overall outcomes were not different between the groups, the risks of incomplete decompression and exiting root injury-related complication were higher in the novice stage.
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Affiliation(s)
- Seong Son
- Department of Neurosurgery, Gil Medical Center, Gachon University College of Medicine, Seongnam-si, Gyeonggi-do
| | - Yong Ahn
- Department of Neurosurgery, Gil Medical Center, Gachon University College of Medicine, Seongnam-si, Gyeonggi-do
| | - Sang Gu Lee
- Department of Neurosurgery, Gil Medical Center, Gachon University College of Medicine, Seongnam-si, Gyeonggi-do
| | - Woo Kyung Kim
- Department of Neurosurgery, Gil Medical Center, Gachon University College of Medicine, Seongnam-si, Gyeonggi-do
| | - Byung Rhae Yoo
- Department of Neurosurgery, Gil Medical Center, Gachon University College of Medicine, Seongnam-si, Gyeonggi-do
| | - Jong Myung Jung
- Department of Neurosurgery, Gil Medical Center, Gachon University College of Medicine, Seongnam-si, Gyeonggi-do
| | - Joon Cho
- Department of Neurosurgery, Konkuk University Medical Center, Gwangjin-gu, Seoul South Korea
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Yaşa ME, Ün Yıldırım N, Demir P. The effects of a 6-Week balance training in addition to conventional physiotherapy on pain, postural control, and balance confidence in patients with cervical disc herniation: a randomized controlled trial. Somatosens Mot Res 2020; 38:60-67. [PMID: 33172321 DOI: 10.1080/08990220.2020.1845136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE Impaired postural control and fear of falling are common symptoms in patients with neck disorders, but the effects of balance training have not yet been sufficiently investigated. The aim of this study was to determine the effects of balance training on neck pain, postural control, and balance confidence in patients with cervical disc herniation (CDH). MATERIALS AND METHODS Thirty patients (21 females and 9 males) aged 18-55 years were randomly assigned into two groups and followed up for 6 weeks, with a 3-day weekly treatment program. Both groups received hot pack therapy, interferential current, and myofascial relaxation and cervical dynamic isometric exercises. The training group also received additional balance training on a force platform with the visual feedback technique. All patients were evaluated using the visual analogue scale for pain intensity, activity specific balance confidence scale (ABC) for balance confidence, centre of pressure with eyes closed-eyes open (CoP-EO/CoP-EC), and the limits of stability tests (LoS) for postural control with a monoaxial bipodal stabilometric force platform pre- and post-intervention. RESULTS The pain intensity was significantly reduced in both groups (p = 0.01). CoP-EO/CoP-EC and LoS results improved in the training group (p = 0.036, p = 0.020, p = 0.23, respectively), whereas no effects were observed in the control group (p = 0.955, p = 0.307, p = 0.363, respectively). Although ABC scores increased significantly in both groups (p = 0.001, p = 0.009, respectively), the increase in the training group was significantly higher than that of the control group (p = 0.003). CONCLUSIONS The results of our study revealed that balance training added to the treatment protocol of CDH may have positive results in the treatment of neck problems. Accordingly, balance training in the treatment of chronic neck problems should also be considered for a comprehensive management of CDH.
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Affiliation(s)
| | - Necmiye Ün Yıldırım
- Faculty of Health Sciences, University of Health Sciences Turkey, Ankara, Turkey
| | - Pervin Demir
- Faculty of Medicine, Ankara Yıldırım Beyazıt University, Ankara, Turkey
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18
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Lee YJ, Kim J, Kim MR, Kim J, Kim MY, Cho HW, Lee SH, Ha I. Observational study on effectiveness and safety of integrative Korean medicine treatment for inpatients with sciatica due to lumbar intervertebral disc herniation. Medicine (Baltimore) 2020; 99:e20083. [PMID: 32481274 PMCID: PMC7249894 DOI: 10.1097/md.0000000000020083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
We developed a protocol for a prospective registry to prove the effectiveness and safety of integrative Korean medicine treatment for inpatients with sciatica due to lumbar intervertebral disc herniation. We plan on recruiting 1000 inpatients receiving integrative Korean medicine treatment for lumbar intervertebral disc herniation at four spine specialized Korean medical hospitals. Patients enrolled in the registry will be evaluated at the time of hospitalization, 2 weeks after hospitalization, at discharge, and 6 months after hospitalization on predefined outcome variables such as intensity of back and leg pain, Oswestry Disability Index, quality of life, Patient Global Impression of Change, and adverse effects. The protocol of this study was registered in CRIS (KCT0003709) and Clinical trial gov (NCT03750591). This study is significant in that it cannot only be a basis for safety-related evidence of complementary alternative medicine, which has been lacking, but it also gives clear evidence on the effectiveness and validity of treatment effects such as accompaniment of stenosis, sex, age, and type of disc herniation.
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Affiliation(s)
- Yoon Jae Lee
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation
| | - Jongho Kim
- Jaseng Hospital of Korean Medicine, Seoul
| | | | - Joowon Kim
- Bucheon Jaseng Hospital of Korean Medicine, Gyeonggi-do
| | | | - Hyun-Woo Cho
- Haeundae Jaseng Hospital of Korean Medicine, Busan, Republic of Korea
| | - Sook-Hyun Lee
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation
| | - Inhyuk Ha
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation
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Meyer G, DA Rocha ID, Cristante AF, Marcon RM, Coutinho TP, Torelli AG, Petersen PA, Letaif OB, DE Barros Filho TEP. Percutaneous Endoscopic Lumbar Discectomy Versus Microdiscectomy for the Treatment of Lumbar Disc Herniation: Pain, Disability, and Complication Rate-A Randomized Clinical Trial. Int J Spine Surg 2020; 14:72-78. [PMID: 32128306 DOI: 10.14444/7010] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Purpose The objective was to compare the traditional microdiscectomy with percutaneous endoscopic lumbar discectomy for the treatment of disc herniations regarding pain, disability, and complications. Methods Randomized clinical trial with 47 patients with disc herniations treated with 2 different surgical techniques: traditional microdiscectomy or percutaneous endoscopic lumbar discectomy. Forty-seven patients were divided into 2 groups and monitored for 12 months. Irradiated and low back pain were evaluated with the visual analog scale. Surgery complications were recorded. Results After surgery, the sciatica and disability improved significantly but without significant differences between the groups. Improvements in back pain were significant until the third month. There were no statistical differences between groups regarding recurrence, infection, and the need for reoperation. Conclusions Endoscopic discectomy results are similar to those of conventional microdiscectomy regarding pain and disability improvement. Postoperative lumbar pain is less intense with endoscopic discectomy than conventional microdiscectomy only during the first 3 months. Endoscopic discectomy is a safe and efficient alternative to microdiscectomy. Clinical Trials Trial protocol registration number: RBR-5symrd (http://www.ensaiosclinicos.gov.br).
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Affiliation(s)
- Guilherme Meyer
- Spine Surgery Division, Instituto de Ortopedia e Traumatologia da Faculdade de Medicina da Universidade de São Paulo, FMUSP, São Paulo, Brazil.,Spine Surgery Division, Instituto Vita, São Paulo, Brazil
| | - Ivan Dias DA Rocha
- Spine Surgery Division, Instituto de Ortopedia e Traumatologia da Faculdade de Medicina da Universidade de São Paulo, FMUSP, São Paulo, Brazil
| | - Alexandre Fogaça Cristante
- Spine Surgery Division, Instituto de Ortopedia e Traumatologia da Faculdade de Medicina da Universidade de São Paulo, FMUSP, São Paulo, Brazil
| | - Raphael Martus Marcon
- Spine Surgery Division, Instituto de Ortopedia e Traumatologia da Faculdade de Medicina da Universidade de São Paulo, FMUSP, São Paulo, Brazil
| | - Thiago Pereira Coutinho
- Spine Surgery Division, Instituto de Ortopedia e Traumatologia da Faculdade de Medicina da Universidade de São Paulo, FMUSP, São Paulo, Brazil
| | - Alessandro Gonzalez Torelli
- Spine Surgery Division, Instituto de Ortopedia e Traumatologia da Faculdade de Medicina da Universidade de São Paulo, FMUSP, São Paulo, Brazil
| | - Pedro Araujo Petersen
- Spine Surgery Division, Instituto de Ortopedia e Traumatologia da Faculdade de Medicina da Universidade de São Paulo, FMUSP, São Paulo, Brazil
| | - Olavo Biraghi Letaif
- Spine Surgery Division, Instituto de Ortopedia e Traumatologia da Faculdade de Medicina da Universidade de São Paulo, FMUSP, São Paulo, Brazil
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Asano LYJ, Bergamaschi JPM, Dowling Á, Rodrigues LMR. Transforaminal Endoscopic Lumbar Discectomy: Clinical Outcomes and Complications. Rev Bras Ortop 2020; 55:48-53. [PMID: 32123445 PMCID: PMC7048575 DOI: 10.1055/s-0039-1700822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 01/22/2019] [Indexed: 02/06/2023] Open
Abstract
Objective To evaluate the clinical and functional results of transforaminal endoscopic lumbar discectomy. Materials and Methods From August 2015 to January 2017, 101 patients with lumbar disc hernia refractory to clinical treatment underwent endoscopic discectomy. Through clinical evaluation by the Visual Analogue Scale and functional evaluation by the Oswestry Disability Index questionnaire, the patients were analyzed in the preoperative period, the immediate postoperative period, at 1 month, 3 months, 6 months and 1 year after surgery. Results The mean age of the participants was 48.1 years. The most affected disc levels were L4-L5 and L5-S1. A total of 29 patients were treated at 2 disc levels. After 1 month of postoperative follow-up, the mean scores on the questionnaires (VAS and ODI) decreased significantly ( p < 0.001). Conclusion Transforaminal endoscopic Lumbar discectomy has been shown to be a safe, effective and minimally-invasive alternative for the treatment of lumbar disc herniation. The procedure has advantages, such as short hospital stay, surgery performed under local anesthesia and sedation, early return to daily activities, and low rate of complications.
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Abstract
Lumbar disc herniation is common and may be symptomatic. The magnetic resonance imaging (MRI) scan is an appropriate tool to confirm the diagnosis and affected level of the spine. While a disc herniation is usually associated with ipsilateral symptoms, a few cases have been reported to present with contralateral symptoms. We report a unique case of left lumbar disc herniation at L5/S1 who presented with contralateral symptoms and was successfully treated with a right L5/S1 foraminal block. However, the patient developed concordant ipsilateral symptoms 6 weeks later and was treated with left L5/S1 microdiscectomy.
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Affiliation(s)
- Zhi Sheng Darren Koh
- University Orthopaedics, Hand and Reconstructive Microsurgery Cluster (UOHC), National University Health System, Singapore
| | - Shuxun Lin
- University Orthopaedics, Hand and Reconstructive Microsurgery Cluster (UOHC), National University Health System, Singapore
| | - Hwee Weng Dennis Hey
- University Orthopaedics, Hand and Reconstructive Microsurgery Cluster (UOHC), National University Health System, Singapore
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22
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Thoreson O, Kovac P, Swärd A, Agnvall C, Todd C, Baranto A. Back pain and MRI changes in the thoraco-lumbar spine of young elite Mogul skiers. Scand J Med Sci Sports 2016; 27:983-989. [PMID: 27367529 DOI: 10.1111/sms.12710] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2016] [Indexed: 11/30/2022]
Abstract
Athletes have a higher prevalence of LBP and spinal abnormalities on Magnetic Resonance Imaging (MRI) compared to non-athletes. The objective of this study was to investigate the amount of spinal MRI abnormalities and the lifetime prevalence of low back pain (LBP) in 16 young elite Mogul skiers compared to 28 non-athletes in the corresponding age in a cross-sectional design. LBP was assessed by a questionnaire consisting of a part regarding previous or present back pain, the Oswestry disability index, and the EuroQol questionnaire. MRI examinations from Th5 to sacrum were conducted to evaluate spinal pathologies. The Mogul skiers had significantly more MRI abnormalities (like disc degeneration) in mean (7.25 vs 3.78, P < 0.023) compared to the controls. No significant difference was seen regarding the lifetime LBP prevalence between the groups (50% vs 42%, P = 0.555). No correlation could be found between disc degeneration and back pain in this study. Young elite Mogul skiers, compared to an age-matched control group of non-athletes, have an increased risk of developing spinal abnormalities potentially due to the different high loads that they are subjected to in their sport. Future relationship between the MRI abnormalities and LBP cannot be verified by this study design.
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Affiliation(s)
- O Thoreson
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - P Kovac
- Radiology, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - A Swärd
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden.,Sportsmedicine Åre and Åre Ski High School, Åre, Sweden
| | - C Agnvall
- Sportsmedicine Åre and Åre Ski High School, Åre, Sweden
| | - C Todd
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden.,The Carl Todd Clinic, Corsham, UK
| | - A Baranto
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
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23
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Abstract
Intradural or intraradicular lumbar disc herniation (IDH) is a relatively rare condition often diagnosed intraoperatively. We encountered an extreme variant of IDH - a transradicular herniation as the disc material extruded through the lumbar nerve root through a split essentially transecting the nerve root. While failure to recognize intradural and intraradicular disc herniation can lead to failed back surgery, the variant described in the present case could lead to iatrogenic injury and complication if not recognized. A unique case of transradicular lumbar disc herniation in a 25-year-old patient is presented with the depiction of intraoperative images supplementing the text.
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Affiliation(s)
- Manish K Kasliwal
- Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA 22901, USA,Address for correspondence: Dr. Manish K Kasliwal, Department of Neurosurgery, RUSH University Medical Center, 1725 W Harrison Street, Suite 855, Chicago, IL 60612, USA. E-mail:
| | - Adam L Shimer
- Department of Orthopedics, University of Virginia Medical Center, Charlottesville, VA 22901, USA
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24
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Rasouli MR, Rahimi‐Movaghar V, Shokraneh F, Moradi‐Lakeh M, Chou R. Minimally invasive discectomy versus microdiscectomy/open discectomy for symptomatic lumbar disc herniation. Cochrane Database Syst Rev 2014; 2014:CD010328. [PMID: 25184502 PMCID: PMC10961733 DOI: 10.1002/14651858.cd010328.pub2] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Microdiscectomy or open discectomy (MD/OD) are the standard procedures for symptomatic lumbar disc herniation and they involve removal of the portion of the intervertebral disc compressing the nerve root or spinal cord (or both) with or without the aid of a headlight loupe or microscope magnification. Potential advantages of newer minimally invasive discectomy (MID) procedures over standard MD/OD include less blood loss, less postoperative pain, shorter hospitalisation and earlier return to work. OBJECTIVES To compare the benefits and harms of MID versus MD/OD for management of lumbar intervertebral discopathy. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (November 2013), MEDLINE (1946 to November 2013) and EMBASE (1974 to November 2013) and applied no language restrictions. We also contacted experts in the field for additional studies and reviewed reference lists of relevant studies. SELECTION CRITERIA We selected randomised controlled trials (RCTs) and quasi-randomised controlled trials (QRCTs) that compared MD/OD with a MID (percutaneous endoscopic interlaminar or transforaminal lumbar discectomy, transmuscular tubular microdiscectomy and automated percutaneous lumbar discectomy) for treatment of adults with lumbar radiculopathy secondary to discopathy. We evaluated the following primary outcomes: pain related to sciatica or low back pain (LBP) as measured by a visual analogue scale, sciatic specific outcomes such as neurological deficit of lower extremity or bowel/urinary incontinence and functional outcomes (including daily activity or return to work). We also evaluated the following secondary outcomes: complications of surgery, duration of hospital stay, postoperative opioid use, quality of life and overall participant satisfaction. Two authors checked data abstractions and articles for inclusion. We resolved discrepancies by consensus. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by The Cochrane Collaboration. We used pre-developed forms to extract data and two authors independently assessed risk of bias. For statistical analysis, we used risk ratio (RR) for dichotomous outcomes and mean difference (MD) for continuous outcomes with 95% confidence intervals (CI) for each outcome. MAIN RESULTS We identified 11 studies (1172 participants). We assessed seven out of 11 studies as having high overall risk of bias. There was low-quality evidence that MID was associated with worse leg pain than MD/OD at follow-up ranging from six months to two years (e.g. at one year: MD 0.13, 95% CI 0.09 to 0.16), but differences were small (less than 0.5 points on a 0 to 10 scale) and did not meet standard thresholds for clinically meaningful differences. There was low-quality evidence that MID was associated with worse LBP than MD/OD at six-month follow-up (MD 0.35, 95% CI 0.19 to 0.51) and at two years (MD 0.54, 95% CI 0.29 to 0.79). There was no significant difference at one year (0 to 10 scale: MD 0.19, 95% CI -0.22 to 0.59). Statistical heterogeneity was small to high (I(2) statistic = 35% at six months, 90% at one year and 65% at two years). There were no clear differences between MID techniques and MD/OD on other primary outcomes related to functional disability (Oswestry Disability Index greater than six months postoperatively) and persistence of motor and sensory neurological deficits, though evidence on neurological deficits was limited by the small numbers of participants in the trials with neurological deficits at baseline. There was just one study for each of the sciatica-specific outcomes including the Sciatica Bothersomeness Index and the Sciatica Frequency Index, which did not need further analysis. For secondary outcomes, MID was associated with lower risk of surgical site and other infections, but higher risk of re-hospitalisation due to recurrent disc herniation. In addition, MID was associated with slightly lower quality of life (less than 5 points on a 100-point scale) on some measures of quality of life, such as some physical subclasses of the 36-item Short Form. Some trials found MID to be associated with shorter duration of hospitalisation than MD/OD, but results were inconsistent. AUTHORS' CONCLUSIONS MID may be inferior in terms of relief of leg pain, LBP and re-hospitalisation; however, differences in pain relief appeared to be small and may not be clinically important. Potential advantages of MID are lower risk of surgical site and other infections. MID may be associated with shorter hospital stay but the evidence was inconsistent. Given these potential advantages, more research is needed to define appropriate indications for MID as an alternative to standard MD/OD.
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Affiliation(s)
- Mohammad R Rasouli
- Thomas Jefferson University HospitalRothman Institute at Jefferson925 Chestnut Street, 5th FloorPhiladelphiaPAUSA19107‐4216
| | - Vafa Rahimi‐Movaghar
- Tehran University of Medical SciencesSina Trauma and Surgery Research Center, Sina HospitalHassan‐Abad Square, Imam Khomeini AveTehranTehranIran11365‐3876
| | - Farhad Shokraneh
- The Institute of Mental Health, a partnership between the University of Nottingham and Nottinghamshire Healthcare NHS TrustCochrane Schizophrenia GroupJubilee CampusNottinghamUKNG7 2TU
| | - Maziar Moradi‐Lakeh
- Iran University of Medical SciencesDepartment of Community MedicineTehranTehranIran
| | - Roger Chou
- Oregon Health & Science UniversityDepartment of Medical Informatics & Clinical Epidemiology3181 SW Sam Jackson Park Rd.Mail Code: BICCPortlandOregonUSA97239
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25
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Abstract
The aim of this study was to assess the associations of overweight and obesity with lumbar radicular pain and sciatica using a meta-analysis. We searched the PubMed, Embase, Scopus, and Web of Science databases from 1966 to July 2013. We performed a random-effects meta-analysis and assessed publication bias. We included 26 (8 cross-sectional, 7 case-control, and 11 cohort) studies. Both overweight (pooled odds ratio (OR) = 1.23, 95% confidence interval (CI): 1.14, 1.33; n = 19,165) and obesity (OR = 1.40, 95% CI: 1.27, 1.55; n = 19,165) were associated with lumbar radicular pain. The pooled odds ratio for physician-diagnosed sciatica was 1.12 (95% CI: 1.04, 1.20; n = 109,724) for overweight and 1.31 (95% CI: 1.07, 1.62; n = 115,661) for obesity. Overweight (OR = 1.16, 95% CI: 1.09, 1.24; n = 358,328) and obesity (OR = 1.38, 95% CI: 1.23, 1.54; n = 358,328) were associated with increased risk of hospitalization for sciatica, and overweight/obesity was associated with increased risk of surgery for lumbar disc herniation (OR = 1.89, 95% CI: 1.25, 2.86; n = 73,982). Associations were similar for men and women and were independent of the design and quality of included studies. There was no evidence of publication bias. Our findings consistently showed that both overweight and obesity are risk factors for lumbar radicular pain and sciatica in men and women, with a dose-response relationship.
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26
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Abstract
Discal cyst is an intraspinal cyst with a distinct communication with the corresponding intervertebral disc. It is a rare condition and could present with radiculopathy similar to that caused by lumbar disc herniation. We present a patient with a large discal cyst in the ventrolateral epidural space of the 5th lumbar vertebral (L5) level that communicated with the adjacent 4th lumbar and 5th lumbar intervertebral disc, causing L5 radiculopathy. We alleviated the radiating pain with selective transforaminal epidural blocks.
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Affiliation(s)
- Sae Young Kim
- Department of Anesthesiology and Pain Medicine, Keimyung University School of Medicine, Daegu, Korea
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27
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Deukmedjian AJ, Jason Cutright ST, Augusto Cianciabella PAC, Deukmedjian A. Deuk Laser Disc Repair(®) is a safe and effective treatment for symptomatic cervical disc disease. Surg Neurol Int 2013; 4:68. [PMID: 23776754 PMCID: PMC3683169 DOI: 10.4103/2152-7806.112610] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Accepted: 02/08/2013] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Deuk Laser Disc Repair(®) is a new full-endoscopic surgical procedure to repair symptomatic cervical disc disease. METHODS A prospective cohort of 66 consecutive patients underwent cervical Deuk Laser Disc Repair(®) for one (n = 21) or two adjacent (n = 45) symptomatic levels of cervical disc disease and were evaluated postoperatively for resolution of headache, neck pain, arm pain, and radicular symptoms. All patients were candidates for anterior cervical discectomy and fusion (ACDF) or arthroplasty. The Mann-Whitney Wilcoxon test was used to calculate P values. RESULTS All patients (n = 66) had significant improvement in preoperative symptoms with an average symptom resolution of 94.6%. Fifty percent (n = 33) had 100% resolution of all preoperative cervicogenic symptoms. Only 4.5% (n = 3) had less than 80% resolution of preoperative symptoms. Visual analog scale (VAS) significantly improved from 8.7 preoperatively to 0.5 postoperatively (P < 0.001) for the cohort. Average operative and recovery times were 57 and 52 minutes, respectively. There were no perioperative complications. Recurrent disc herniation occurred in one patient (1.5%). Average postoperative follow-up was 94 days and no significant intergroup difference in outcomes was observed (P = 0.111) in patients with <90 days (n = 52) or >90 days (n = 14, mean 319 days) follow-up. No significant difference in outcomes was observed (P = 0.774) for patients undergoing one or two level Deuk Laser Disc Repair(®). Patients diagnosed with postoperative cervical facet syndrome did significantly worse (P < 0.001). CONCLUSION Deuk Laser Disc Repair(®) is a safe and effective alternative to ACDF or arthroplasty for the treatment of one or two adjacent symptomatic cervical disc herniations with an overall success rate of 94.6%.
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28
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Deukmedjian AJ, Cianciabella A, Cutright J, Deukmedjian A. Cervical Deuk Laser Disc Repair(®): A novel, full-endoscopic surgical technique for the treatment of symptomatic cervical disc disease. Surg Neurol Int 2012; 3:142. [PMID: 23230523 PMCID: PMC3515925 DOI: 10.4103/2152-7806.103884] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Accepted: 08/13/2012] [Indexed: 11/25/2022] Open
Abstract
Background: Cervical Deuk Laser Disc Repair® is a novel full-endoscopic, anterior cervical, trans-discal, motion preserving, laser assisted, nonfusion, outpatient surgical procedure to safely treat symptomatic cervical disc diseases including herniation, spondylosis, stenosis, and annular tears. Here we describe a new endoscopic approach to cervical disc disease that allows direct visualization of the posterior longitudinal ligament, posterior vertebral endplates, annulus, neuroforamina, and herniated disc fragments. All patients treated with Deuk Laser Disc Repair were also candidates for anterior cervical discectomy and fusion (ACDF). Methods: A total of 142 consecutive adult patients with symptomatic cervical disc disease underwent Deuk Laser Disc Repair during a 4-year period. This novel procedure incorporates a full-endoscopic selective partial decompressive discectomy, foraminoplasty, and posterior annular debridement. Postoperative complications and average volume of herniated disc fragments removed are reported. Results: All patients were successfully treated with cervical Deuk Laser Disc Repair. There were no postoperative complications. Average volume of herniated disc material removed was 0.09 ml. Conclusions: Potential benefits of Deuk Laser Disc Repair for symptomatic cervical disc disease include lower cost, smaller incision, nonfusion, preservation of segmental motion, outpatient, faster recovery, less postoperative analgesic use, fewer complications, no hardware failure, no pseudoarthrosis, no postoperative dysphagia, and no increased risk of adjacent segment disease as seen with fusion.
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29
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Roberts S, Evans H, Menage J, Urban JPG, Bayliss MT, Eisenstein SM, Rugg MS, Milner CM, Griffin S, Day AJ. TNFalpha-stimulated gene product (TSG-6) and its binding protein, IalphaI, in the human intervertebral disc: new molecules for the disc. Eur Spine J 2005; 14:36-42. [PMID: 15549486 PMCID: PMC3476674 DOI: 10.1007/s00586-004-0798-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2003] [Revised: 08/04/2004] [Accepted: 08/20/2004] [Indexed: 01/27/2023]
Abstract
Inflammation and irritation of the nerve roots has been indicated as an important factor in the pain associated with symptomatic disc herniations. Tumour necrosis factor alpha (TNFalpha) is now believed to be involved in this pathway. TNFalpha causes connective tissue cells in culture to synthesise a glycoprotein, TNFalpha-stimulated gene-6 (TSG-6). TSG-6 is found in inflammatory diseases of related connective tissues, such as articular cartilage in rheumatoid arthritis, but is not present in unaffected individuals. In order to determine if TSG-6 occurred in intervertebral disc (and cartilage endplate), we have investigated the presence of TSG-6 and its binding protein, inter-alpha-inhibitor (IalphaI), in 58 herniated and 15 non-herniated discs. Immunostaining for the cytokines, IL-1alpha, IL-1beta and TNFalpha, has also been carried out. We have demonstrated that both TSG-6 and IalphaI occur commonly in human intervertebral disc matrix with at least some TSG-6 in 98% of discs studied and IalphaI in all of them. Staining for TSG-6 was greatest in herniated discs, particularly close to blood vessels. IalphaI immunostaining was frequently widespread throughout the disc but there was little in the cartilage endplate. It has been proposed that these molecules have widespread effects, including extracellular matrix stabilisation, down-regulation of the protease network and reduction of inflammation. Hence, the occurrence of TSG-6 and IalphaI in disc tissue could have implications in the aetiopathogenesis and future therapeutics of intervertebral disc disease.
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Affiliation(s)
- Sally Roberts
- Centre for Spinal Studies, Robert Jones and Agnes Hunt Orthopaedic Hospital and Keele University, Oswestry, Shropshire, SY10 7AG, UK.
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