Asymptomatic Disc Research Articles

Use of minimally invasive ultrasound transducer during tubular microdiscectomy.

Minimally invasive ultrasound during tubular microdiscectomy is novel. The authors report the technique during surgery for L5-S1 herniated disc. Ultrasound provided real-time visualization of the pathology and neural elements. After discectomy and tactile assessment, ultrasound showed decompression of the thecal sac and traversing nerve root. The patient tolerated the procedure well, with resolution of preoperative pain and strength improvement. Postoperative MRI revealed a residual asymptomatic disc fragment that was retrospectively identified on ultrasonography. Minimally invasive ultrasound could become a useful supplement to direct visual and tactile assessment during tubular microdiscectomy, but further experience with surgical anatomy on ultrasound is required. The video can be found here: https://stream.cadmore.media/r10.3171/2024.1.FOCVID23206.

Teaching NeuroImages: Linear Radial Periventricular Enhancement in Glial Fibrillary Acidic Protein Astrocytopathy

A 48-year-old woman presented with asymptomatic painless optic disc swelling, seizures, cognitive decline, and weakness over 3 months. She had an upper motor neuron pattern of grade 4/5 weakness in all 4 limbs. Brain MRI revealed striking linear radial perivascular enhancement in the deep white matter1,2 (figure, A and B); MRI spine revealed longitudinally extensive C3-to-conus cord T2 hyperintensity and T1 enhancement2 (figure, C and D). CSF demonstrated glial fibrillary acidic protein (GFAP) pattern by indirect immunofluorescence with GFAPα specificity confirmed by cell-based assay. The patient improved clinically (figure, E and F) with steroid treatment. Linear/radial perivascular enhancement in the deep white matter prompts consideration of a corticosteroid-responsive meningoencephalomyelitis termed autoimmune GFAP astrocytopathy.1

Unilateral asymptomatic optic disc edema: do not forget sinusitis

Background: Optic disc edema is a pathological condition with various causes. Cases of optic disc swelling should be dealt with a multidisciplinary approach to rule out those causes. Unilateral optic disc edema is seen in papillitis, non-arteritic anterior ischemic optic neuropathy, retinal vein occlusion, and infection or inflammation of the contiguous sinus or orbit. Here, we report a rare case of unilateral asymptomatic optic disc edema due to posterior ethmoid sinusitis. 
 Case Presentation: A 53-year-old man presented for a routine 3-monthly follow-up after an uneventful cataract surgery of the right eye. All examinations were unremarkable, except for the right eye optic disc edema on fundus examination, consistent with an enlarged blind spot in the visual field test. Contrast-enhanced magnetic resonance imaging revealed mucosal thickening with muco-inflammatory exudates of the posterior ethmoidal sinus overriding the optic disc on the right side, leading to optic disc edema of the right eye. The patient was diagnosed with unilateral asymptomatic optic disc edema in the right eye due to posterior ethmoid sinusitis and referred to an otorhinolaryngologist for the management. The otorhinolaryngologist performed functional endoscopic sinus surgery and prescribed antibiotics and anti-histamines for 6 weeks. At the final examination, his visual acuity was 6/6, and the fundus examination revealed no optic disc edema.
 Conclusions: We reported a rare case of unilateral optic nerve edema and visual field loss with a treatable cause. Contemporary imaging provided the accurate diagnosis. Therefore, in cases of disc edema, sinusitis of the adjacent paranasal sinuses should be ruled out as a possible cause of compressive optic neuropathy or inflammation overriding the optic nerve.

Should adjacent asymptomatic lumbar disc herniation of L5-S1 isthmic spondylolisthesis be simultaneously rectified? Evaluation of postoperative spino-pelvic sagittal balance and functional outcomes

BackgroundThis study aimed to analyze the efficacy of the simultaneous rectification of adjacent asymptomatic lumbar disc herniation (asLDH) of L5-S1 isthmic spondylolisthesis (IS).MethodsOne hundred and forty-eight patients with L5-S1 IS, and simultaneous L4-5 asLDH, were recruited between January 2012 and December 2017, for this study. Group A: seventy-two patients received PLIF at L5-S1. Group B: seventy-six patients received PLIF at L4-S1. The radiographic outcomes were assessed via the lumbar lordosis (LL), segmental lordosis (SL), sacral slope (SS), pelvic incidence (PI), pelvic tilt (PT), PI-LL and slip degree (SD). The functional outcomes were evaluated via the visual analog scale (VAS), Oswestry disability index (ODI), and reoperation rate. The potential risk hazards for reoperation were identified using both uni- and multivariate logistic regression analyses.ResultsThe postoperative LL, SL, PT, SS, SD, VAS, and ODI exhibited vast improvements (P < 0.05). Relative to Group A, Group B exhibited markedly better LL, SL, PT, PI-LL,VAS and ODI scores at the final follow-up (P < 0.05). Group B also achieved better SD values post surgery than Group A (P < 0.05). The reoperation rate was remarkably elevated in Group A, compared to Group B (P < 0.05). The multivariate logistic regression analysis showed the L4-5 asLDH grade was a stand-alone risk hazard for reoperation, whereas, pre-SL and pre-LL offered protection against reoperation (P < 0.05).ConclusionsL4-S1 PLIF is recommended to correct asLDH in L5-S1 IS patients, with high-grade disc herniation and abnormal sagittal alignment.

Diffusion properties of asymptomatic lumbar intervertebral discs in a pediatric cohort: a preliminary study of apparent diffusion coefficient.

To explore the apparent diffusion coefficients of intervertebral discs in an asymptomatic pediatric cohort. We conducted a prospective MRI study of the lumbar spine from below the thoracolumbar junction to the lumbosacral junction on 12 subjects (mean age 13 y.o.) with no spinal pathology or spinal posture disorder. MRI was carried out using a 1.5T machine with acquisitions realized both in sagittal and coronal planes. First, disc hydration was determined, and then, diffusion-weighted images were obtained using an SE single-shot echo-planar sequence. Apparent diffusion coefficients (ADC) of anterior annulus fibrosus (AAF), nucleus pulposus (NP) and posterior annulus fibrosus (PAF) were measured in the sagittal plane. Averaged hydration of 0.27 SD 0.03 confirmed the asymptomatic nature of discs. Average scaled values of ADC were 0.46 SD 0.01, 0.22 SD 0.09 and 0.18 SD 0.03 for NP, AAF and PAF, respectively. ADC of NP were almost constant along the spine; PAF values show a slight increase in the thorax-sacrum direction, while AAF values showed a pronounced decrease. Locally, ADC of AAF was higher compared to ADC PAF values below the thoracolumbar junction and it reversed for subjacent discs. In our knowledge, our study provided the first diffusive properties of asymptomatic intervertebral discs in an adolescent cohort. ADC of NP was slightly higher than adults'. ADC evolutions of AAF were correlated with lordosis concavity which pointed out the role of compressive strain on fluid transport properties. This study could furnish information about segment homeostasis for exploration of pediatric spinal pathologies.

Venous congestion as a central mechanism of radiculopathies.

Compression of roots/nerves can disrupt some of their functions, but does not necessarily cause pain. This is illustrated by the frequency of nearly asymptomatic spinal stenosis or disc herniations. In fact, pain of radiculopathies (and nerve entrapments) may mostly be the consequence of intraneural oedema induced by microscopical venous stasis around roots/spinal ganglia (or nerves) not or poorly shown by imaging. This narrative review first lists arguments for a role of congestion of vasa-nervorum in the pathophysiology of radiculopathies, including those induced by disc herniation and spinal stenosis, but also other sources of overpressures in spinal venous plexuses (pregnancy, vena cava atresia and thrombosis, portal hypertension, epidural varices, arterio-venous fistula, vertebral hemangioma or hemangioblastoma). It also details sources of venous congestion around nerves outside the spine, from pelvis (May-Thurner syndrome, Nut-cracker syndrome) to buttocks (superior and inferior gluteal veins), and even thighs and legs. A better recognition of a preeminent role of venous congestion in radiculopathies, plexopathies, and nerve entrapments, should have major consequences: (i) discard the dogma that compression is mandatory to induce root/nerve suffering, since root/nerve adherences in two locations can impair blood flow in vasa-nervorum through root/nerve stretching; (ii) implementation of sensitive techniques to visualise impingement of blood flow around or within roots and nerves; (iii) better prevention of roots/nerves adherence, or arachnoiditis induced by extravascular fibrin deposition secondary to venous stasis.; (iv) optimizing treatments dampening clot formation and/or extravascular fibrin leakage in the intradural/peridural spaces, or around roots/nerves, like guided injection of tissue plasminogen activator.

Ossification of Ligamentum Flavum – Beckoning Surgeon’s Knife!

Ossification of ligamentum flavum (OLF) is well known but rare entity causing slow progressive thoracic myelopathy. It affects especially lower thoracic spine and is relatively common in the East Asian population particularly in Japan. Posterior decompression in the form of extensive laminectomy with or without instrumented fusion is the treatment of choice. Decompression itself can be very challenging since the flavum is fused with the laminae above and below and it becomes very difficult for the surgeon to insert Kerrison roungers in inter-laminar space. Seven cases of recurrence of OLF at same intervertebral level reported till now but no case of adjacent level OLF in thoracic spine reported yet. We report the case of a 37-year-old male with D6-7-8 ossified ligamentum flavum with coexisting asymptomatic L1-2 disc prolapse and previously operated for D8-9 OLF. Pre-operative counseling of patients should be done regarding possibility of reoperation due to new adjacent segment or same level OLF. Keywords: Ossified ligamentum flavum, Thoracic myelopathy, Posterior decompression.

Evaluation of asymptomatic lumbar disc herniation and endplate failure in general population and their significance in development of low backache

Introduction: Despite being the most common cause of low back pain, there are wide variations in the pathogenesis and management of lumbar disc herniation (LDH). Previously the nucleus pulposus was being implicated for most of the symptoms, but recent papers propose the endplate failure (EPF) as the most important component of symptomatic LDH. However considering the abundance of the asymptomatic LDH in normal population, it is important to study the association of endplate failure in general population to understand it’s contribution in symptomatic LDH.Aim: To evaluate the incidence of asymptomatic LDH and EPF in normal population and note development of any low back pain in them. Material and Methods: Adult patients presenting outdoor with complains other than present or past history of low backache were evaluated clinically and radiologically [x-ray, CT scan, MRI scan including the fat suppressed 3D fast spoiled gradient sequences (3DFSPGR)] to note status of lumbar disc and endplate. They were then, prospectively followed up for 3 years for any occurrence of backache.Results: Twenty volunteers (13 males, 7 females) were studies from age 19-50 years (mean 33.6±10.3). Six volunteers (30%) had desiccation of one or more lumbar disc and 8 volunteers (40%) had LDH at one or more levels. However all of the LDH were broad based disc bulge. Three volunteers had cartilaginous EPF and 1 had bony EPF. None of the EPFs were associated with disc desiccation, but 2 were associated with LDH. The presence of disc desiccations and LDH were significantly correlated to the increasing age but the EPF had no such age correlation. Subsequently 2 volunteers developed low backache.Conclusion: Asymptomatic disc desiccation and lumbar disc bulge is fairly common. Their mere presence may not be the cause of the low backache and should be carefully considered for any surgical planning. However presence bony EPF is rare and may have some significance in development of symptomatic LDH

Asymptomatic optic disc edema as ophthalmological incidental finding

Asymptomatic optic disc edema as ophthalmological incidental finding

Biomechanical changes in the lumbar spine following spaceflight and factors associated with postspaceflight disc herniation

For chronic low back pain, the causal mechanisms between pathological features from imaging and patient symptoms are unclear. For instance, disc herniations can often be present without symptoms. There remains a need for improved knowledge of the pathophysiological mechanisms that explore spinal tissue damage and clinical manifestations of pain and disability. Spaceflight and astronaut health provides a rare opportunity to study potential low back pain mechanisms longitudinally. Spaceflight disrupts diurnal loading on the spine and several lines of evidence indicate that astronauts are at a heightened risk for low back pain and disc herniation following spaceflight.To examine the relationship between prolonged exposure to microgravity and the elevated incidence of postflight disc herniation, we conducted a longitudinal study to track the spinal health of twelve NASA astronauts before and after approximately 6 months in space. We hypothesize that the incidence of postflight disc herniation and low back complaints associates with spaceflight-included muscle atrophy and pre-existing spinal pathology.This is a prospective longitudinal study.Our sample included a cohort of twelve astronaut crewmembers.From 3T MRI, we quantified disc water content (ms), disc degeneration (Pfirrmann grade), vertebral endplate irregularities, facet arthropathy and/ fluid, high intensity zones, disc herniation, multifidus total cross-sectional area (cm2), multifidus lean muscle cross-sectional area (cm2), and muscle quality/composition (%). From quantitative fluoroscopy we quantified, maximum flexion-extension ROM (°), maximum lateral bending ROM (°), and maximum translation (%). Lastly, patient outcomes and clinical notes were used for identifying postflight symptoms associated with disc herniations from 3T MRI.Advanced imaging data from 3T MRI were collected at three separate time points in relation to spending six months in space: (1) within a year before launch ("pre-flight"), (2) within a week after return to Earth ("post-flight"), and (3) between 1 and 2 months after return to Earth ("recovery"). Fluoroscopy of segmental kinematics was collected at preflight and postflight timepoints. We assessed the effect of spaceflight and postflight recovery on longitudinal changes in spinal structure and function, as well as differences between crew members who did and did not present a symptomatic disc herniation following spaceflight.Half of our astronauts (n=6) experienced new symptoms associated with a new or previously asymptomatic lumbar disc protrusion or extrusion following spaceflight. We observed decreased multifidus muscle quality following spaceflight in the lower lumbar spine, with a reduced percentage of lean muscle at L4L5 (-6.2%, p=.009) and L5S1 (-7.0%, p=.006) associated with the incidence of new disc herniation. Additionally, we observed reduced lumbar segment flexion-extension ROM for L2L3 (-17.2%, p=.006) and L3L4 (-20.5%, p=.02) following spaceflight, and furthermore that reduced ROM among the upper three lumbar segments (-24.1%, p=.01) associated with the incidence of disc herniation. Existing endplate pathology was most prevalent in the upper lumbar spine and associated with reduced segmental ROM (-20.5%, p=.02).In conclusion from a 10-year study investigating the effects of spaceflight on the lumbar spine and risk for disc herniation, we found the incidence of lumbar disc herniation following spaceflight associates with compromised multifidus muscle quality and spinal segment kinematics, as well as pre-existing spinal endplate irregularities. These findings suggest differential effects of spinal stiffness and muscle loss in the upper versus lower lumbar spine regions that may specifically provoke risk for symptomatic disc herniation in the lower lumbar spine following spaceflight. Results from this study provide a unique longitudinal assessment of mechanisms and possible risk factors for developing disc herniations and related low back pain. Furthermore, these findings will help inform physiologic countermeasures to maintain spinal health in astronauts during long-duration missions in space.

Validation and demonstration of a pericarp disc system for studying blossom-end rot of tomatoes

BackgroundBlossom-end rot in tomatoes is often used as a model system to study fruit calcium deficiency. The study of blossom-end rot development in tomatoes has been greatly impeded by the difficulty of directly studying and applying treatments to the affected cells. This manuscript presents a novel method for studying blossom-end rot development after harvest in immature whole fruit and in pericarp discs.ResultsPericarp discs removed from the bottom pericarp of immature healthy fruit developed blossom-end rot like symptoms, corresponding to a decrease in L* value and an increase in a* value. Symptoms also developed in columella tissue, but not in stem-end pericarp tissue, similar to patterns observed during blossom-end rot development on the plant. Ascorbate oxidase and peroxidase activity, which are elevated in blossom-end rot affected fruit compared to healthy fruit, were both correlated with colorimetric measures of tissue darkening in discs. Respiration rate was higher in discs that later developed blossom-end rot symptoms, with increased respiration in asymptomatic discs on day 1 of storage being associated with symptom development on day 2. Calcium chloride and ascorbic acid treatments inhibited symptom development, demonstrating the potential of this method to provide causal evidence.ConclusionsResults indicate that symptom development in this system is consistent with blossom-end rot development with regards to location, color change, and the activity of key enzymes. This system has the potential to be used to elucidate the cause of fruit calcium deficiency and improve knowledge of the biological basis for calcium’s diverse effects on fruit.

Optic Disc Pits: A Case Report and Review

Background: Congenital optic disc pits (ODP) are a rare clinical finding affecting approximately 1 in 11,000 people. Affected individuals are generally asymptomatic unless fluid accumulates in the macula resulting in severe vision loss. The management of ODPs depends mostly on clinical findings and can range from observation to surgery. Optometrists need to be aware of clinical presentations and possible complications of ODPs. Case Report: This report will review a case of an asymptomatic optic disc pit and discuss the potential treatment options if complications arise. Conclusion: Although rare, congenital optic disc pits need to be accurately assessed and diagnosed. Symptoms can range from none to severe vision loss. Proper observation and management may lead to improved visual outcomes.

Should adjacent asymptomatic lumbar disc herniation be simultaneously rectified? A retrospective cohort study of 371 cases that received an open fusion or endoscopic discectomy only on symptomatic segments

BACKGROUND CONTEXTIn the treatment of multiple disc herniations, the decision of whether to include the presumed asymptomatic lumbar disc herniation (asLDH) at adjacent segments remains uncertain. On the one hand, the untouched asLDH might soon become symptomatic and require treatment. On the other hand, additional surgery involving more segments will introduce greater risk, complications, and cost. PURPOSETo investigate the prognosis of untreated asLDH after open fusion or percutaneous endoscopic lumbar discectomy (PELD) on symptomatic lumbar disc herniation (LDHs) in patients. STUDY DESIGNThis is a retrospective cohort study. PATIENT SAMPLEA total of 371 patients with multiple disc herniations who underwent open discectomy and fusion or PELD only for symptomatic levels from January 2012 to July 2018 were included. OUTCOME MEASURESThe primary outcome of interest was the development of symptomatic LDH at the previous asLDH of both groups that required reoperation. A second analysis was performed to compare the reoperation rate due to deterioration of asLDH among different severity grades of herniation. Reoperation rates of the original surgery at the symptomatic segment in both fusion and PELD groups were also reviewed. METHODSThe patients were divided into two groups based on the surgical procedure, with 264 patients undergoing fusion surgery and 107 patients undergoing PELD. Clinical and imaging follow-ups were performed at routine intervals for more than 3 years. The reoperation rates due to deterioration of previously asLDH and failure of original surgery were investigated and compared between the two groups, as well as among the different severity grades of herniation. RESULTSThe follow-up times were 48.2±24.2 and 41.1±17.5 months for the fusion and the PELD groups, respectively. The overall reoperation rate at the previous adjacent asLDH was 6.7% (25/317). According to the severity of the asLDH, a higher grade of asymptomatic herniation yielded a significantly higher rate of reoperation rate in both groups. If the nerve root was displaced by disc material prominently (nG2), the reoperation rate of asLDHs was 42.9% (3/7) in the fusion group and 20% (3/15) in the PELD group. Twenty out of 264 patients (7.6%) in the fusion group and 5 out of 107 patients (4.7%) in the PELD group required reoperation due to deterioration of asLDH. Reoperation rates due to failure of the original surgery were 7.6% (20/264) in the fusion group and 8.4% (9/107) in the PELD group. CONCLUSIONSWith multilevel LDHs, if the asLDH is left untreated, the reoperation rate is closely related to the degree of herniation. When confronting an asLDH graded as G2, a high possibility of reoperation should be clearly discussed with the patient, regardless of open fusion or PELD techniques. Considering that fusion and minimally invasive nonfusion techniques did not yield significantly different overall reoperation rates, ongoing degeneration seemed to have a greater contribution in terms of the deterioration of asLDH.

Intervertebral Disc Diseases PART 2: A Review of the Current Diagnostic and Treatment Strategies for Intervertebral Disc Disease.

With an aging population, there is a proportional increase in the prevalence of intervertebral disc diseases. Intervertebral disc diseases are the leading cause of lower back pain and disability. With a high prevalence of asymptomatic intervertebral disc diseases, there is a need for accurate diagnosis, which is key to management. A thorough understanding of the pathophysiology and clinical manifestation aids in understanding the natural history of these conditions. Recent developments in radiological and biomarker investigations have potential to provide noninvasive alternatives to the gold standard, invasive discogram. There is a large volume of literature on the management of intervertebral disc diseases, which we categorized into five headings: (a) Relief of pain by conservative management, (b) restorative treatment by molecular therapy, (c) reconstructive treatment by percutaneous intervertebral disc techniques, (d) relieving compression and replacement surgery, and (e) rigid fusion surgery. This review article aims to provide an overview on various current diagnostic and treatment options and discuss the interplay between each arms of these scientific and treatment advancements, hence providing an outlook of their potential future developments and collaborations in the management of intervertebral disc diseases.

Cervical disc degeneration and neck pain.

Cervical intervertebral disc has long been considered a common source of neck pain. However, the pain caused by the disc itself has not been clearly defined so far, and its diagnosis and treatment has always been controversial. Degenerative cervical disc has a rich supply of nerve fibers, is prone to inflammatory reactions, and is susceptible to pain that can be provoked by disc stimulation or distention, and can be eliminated by block. Overwhelming clinical evidence demonstrates that neck pain in patients with degenerative cervical radiculopathy or myelopathy can be subsided rapidly by anterior cervical surgery, further indicating that this neck pain stems from the pathology of cervical disc itself. Cervical discography is advocated as the only test that connects disease to symptoms, but the procedure remains controversial. If strict criteria and technique are maintained, discography can discriminate painful, symptomatic discs from nonpainful, asymptomatic discs. Discogenic neck pain alone without cervical disc herniation or cervical spondylosis accounts for a large proportion of chronic neck pain. For these patients who continue to have refractory neck pain and fail to respond to conservative treatment, anterior cervical fusion surgery or artificial cervical disc replacement may be a better choice, and preoperative cervical discography can guarantee the excellent surgical results. Existing basic and clinical studies have scientifically shown that cervical intervertebral disc degeneration can lead to neck pain.

Radiculopathy Contralateral to the Side of Disc Herniation -Microendoscopic Observation.

Introduction There are patients with lumbar disc herniation (LDH) having contralateral sciatic symptoms although the mechanisms of this clinical feature are still not well understood. The purpose of this study was to investigate these mechanisms by microendoscopic findings. Methods Patients were performed microendoscopic surgery using over-the-top approach (ME-OTT), with laminoplasty, extirpation of herniation, and observation of the contralateral nerve root. The over-the-top approach was applied through the same incision from the herniation side. Clinical results were assessed according to the clinical scoring system established by the Japanese Orthopedic Association (JOA) score. Results This study consisted of five patients, with the average age of 55.6 years old. The mean preoperative JOA score was 13 points. Three cases were Grade II and two were Grade III degrees of disc herniation. Levels of herniation were one at L3-4 and four at L4-5. Remission of sciatic symptoms was obtained in all cases after surgery. The average and percent improvements (%IP) of JOA scores at 2 months after surgery were 27.8 points and 92%, respectively. By the approach from the herniation side using ME-OTT, image around the contralateral nerve root was obtained without radical intervention. By ME-OTT, redness of the nerve root and fibrosis around the symptomatic nerve root were identified, whereas inflammatory changes were not apparent on the ipsilateral nerve root. Conclusions Operative treatment of LDH with contralateral symptoms by ME-OTT was a useful procedure for decompression and observation of the affected nerve root. Asymptomatic disc herniation, “silent disc herniation,” was considered at the herniation side since there were less inflammatory changes around the ipsilateral nerve root. In contrast, compression of dura toward the opposite side by disc herniation could have led to mechanical stress against the contralateral nerve root and triggered inflammation at lateral recess, resulting in radicular pain.

What are the possibilities of spontaneous resorption of a thoracic disc herniation occupying more than 20% of the spinal canal in the asymptomatic subject? Comparative study

Thoracic disc herniation is a rare pathology for which surgical treatment is difficult. The discovery of asymptomatic or only slightly symptomatic lesions can be problematic, especially in cases of marked canal stenosis. The possibility of spontaneous resorption has been documented by a few case reports but there is no study on this subject. Our objective was to compare the clinical and radiological data for two groups of patients with significant thoracic herniation (occupying more than 20% of the spinal canal): one showing spontaneous resorption (group 1) and the other persistence of the lesion during follow up (group 2). The physiological processes of thoracic herniation are also discussed. We present a retrospective study of our database of patients with thoracic hernia. Only subjects who initially showed signs of slight or absent myelopathy (Frankel D or E) were included. Group 1 and 2 are composed of 12 and 17 patients respectively. The clinical and radiological data are compared. The two groups were not different for the following parameters: age, sex ratio, disc calcification, size, trajectory, side, hernia level. Other parameters were evaluated and were not associated with a higher rate of resorption: disc calcification, intramedullary hypersignal in T2 sequence, calcification of the posterior common vertebral ligament, calcification of another disc and Scheuerman’s disease. Asymptomatic thoracic disc herniation is a condition that can disappear spontaneously, even in the case of a large lesion. To date, there are no clinical or radiological data that can predict such an evolution.

Lumbar Disc Herniation Presented with Contralateral Symptoms.

ObjectiveThis study aimed to unravel the putative mechanism underlying the neurologic deficits contralateral to the side with lumbar disc herniation (LDH) and to elucidate the treatment for this condition.MethodsFrom January 2009 to June 2015, 8 patients with LDH with predominantly contralateral neurologic deficits underwent surgical treatment on the side with LDH with or without decompressing the symptomatic side. A retrospective review of charts and radiological records of these 8 patients was performed. The putative mechanisms underlying the associated contralateral neurological deficits, magnetic resonance imaging (MRI), electromyography (EMG), and the adequate surgical approach are discussed here.ResultsMRI revealed a similar laterally skewed paramedian disc herniation, with the apex deviated from the symptomatic side rather than directly compressing the nerve root; this condition may generate a contralateral traction force. EMG revealed radiculopathies in both sides of 6 patients and in the herniated side of 2 patients. Based on EMG findings and the existence of suspicious lateral recess stenosis of the symptomatic side, 6 patients underwent bilateral decompression of nerve roots and 2 were subjected to a microscopic discectomy to treat the asymptomatic disc herniation. No specific conditions such as venous congestion, nerve root anomaly or epidural lipomatosis were observed, which may be considered the putative pathomechanism causing the contralateral neurological deficits. The symptoms resolved significantly after surgery.ConclusionThe traction force generated on the contralateral side and lateral recess stenosis, rather than direct compression, may cause the contralateral neurologic deficits observed in LDH.

In-vivo T2-relaxation times of asymptomatic cervical intervertebral discs.

Limited research exists on T2-mapping techniques for cervical intervertebral discs and its potential clinical utility. The objective of this research was to investigate the in-vivo T2-relaxation times of cervical discs, including C2-C3 through C7-T1. Ten asymptomatic subjects were imaged using a 3.0T MR scanner and a sagittal multi-slice multi-echo sequence. Using the mid-sagittal image, intervertebral discs were divided into five regions-of-interest (ROIs), centered along the mid-line of the disc. Average T2 relaxation time values were calculated for each ROI using a mono-exponential fit. Differences in T2 values between disc levels and across ROIs of the same disc were examined. For a given ROI, the results showed a trend of increasing relaxation times moving down the spinal column, particularly in the middle regions (ROIs 2, 3 and 4). The C6-C7 and C7-T1 discs had significantly greater T2 values compared to superior discs (discs between C2 and C6). The results also showed spatial homogeneity of T2 values in the C3-C4, C4-C5, and C5-C6 discs, while C2-C3, C6-C7, and C7-T1 showed significant differences between ROIs. The findings indicate there may be inherent differences in T2-relaxation time properties between different cervical discs. Clinical evaluations utilizing T2-mapping techniques in the cervical spine may need to be level-dependent.

Prevalence and Characteristics of Discogenic Pain in Tertiary Practice: 223 Consecutive Cases Utilizing Lumbar Discography.

Between 26% and 42% of chronic low back pain is attributed to internal disc disruption of lumbar intervertebral discs. These prevalence estimates and data characterizing discogenic pain originate largely from research at elite practices, conducted 20 years ago. With few studies since, their concordance with rates in community practice has rarely been addressed. To assess the prevalence and key features of discogenic pain within community-based tertiary practice, and to evaluate the accuracy and clinical utility of discography. This prospective, three-year study of 223 consecutive cases of chronic low back pain used image-guided lumbar discography to identify symptomatic and flanking asymptomatic discs. A subset of patients (n = 195) had previously undergone posterior column blocks to investigate spinal facet and/or sacroiliac joints as contributing pain sources. A total of 644 discs were tested without infection or complication. Positive discograms were recorded in 74% of patients, with 22.9% negative and 3.1% assessed as indeterminate. Among patients receiving both discography and diagnostic blocks, 63% had proven discogenic pain, 18% had pain of mixed etiology and 14% remained undiagnosed. Taking into account all low back pain cases during this study (n = 756), discogenic pain prevalence was 21.8% (95% CI: 17-26%). The prevalence of discogenic pain in this community practice is below the range, but within confidence intervals, previously reported. Prevalence is considerably elevated, however, among well-selected patients and discography enabled a firm diagnosis in most such cases. These findings are broadly in keeping with those reached in key publications and support the clinical utility of discography.