Cervical Herniation Research Articles

The Effects of Scapular Stabilization Exercise Program on the Neck Disability Index, Range of Motion and Myofunction for Patients with Cervical Herniation of Intervertebral Disc

The Effects of Scapular Stabilization Exercise Program on the Neck Disability Index, Range of Motion and Myofunction for Patients with Cervical Herniation of Intervertebral Disc

A Good Result of Cardiopulmonary Resuscitation Following Colonic Segment Interposition with Vascular Supercharge

A 70-year-old man who underwent surgical excision of an esophageal leiomyoma developed esophageal leak and underwent esophagectomy. Colonic segment interposition was performed to address the esophageal defect. Cardiopulmonary resuscitation (CPR) was subsequently performed for desaturation due to pulmonary atelectasis; spontaneous circulation resumed without indication of contrast leakage or necrosis. Redundancy of the esophagus in the neck occurred due to migration of the colon segment during CPR. We shortened the colonic segment, which improved swallowing function. Here we report the first case of a positive outcome of cervical herniation of a colon graft due to CPR after a colonic interposition procedure.

Association of COL11A1 C4603T polymorphism with the risk of cervical and lumbar disc herniation

Aim. To evaluate the association of COL11A1 gene C4603T polymorphism with the risk of cervical and lumbar disc herniation among Ukrainian people. Materials and methods. In total, 97 patients (48 women and 49 men with a mean age of 34.49 ± 6.75 years) with lumbar and cervical disc herniation and 60 (30 women and 30 men with a mean of 35.00 ± 6.51 years) control subjects were included in the study. All participants underwent T2-weighted magnetic resonance imaging (MRI). Single nucleotide polymorphism С4603Т (rs1676486) of COL11A1 gene was detected by real-time polymerase chain reaction using Tag Man Universal PCR Master Mix (Applied Biosystems, USA) and Tag Man SNP Genotyping Assays (Applied Biosystems, USA). Results. The study revealed the association of the COL11A1 gene C4603T polymorphism with a risk of lumbar L5-S1 herniation in the dominant (OR = 3.20; 95 % CI (1.34–7.50); P < 0.008) and multiplicative models (OR = 2.82; 95 % CI (1.34–5.93); P < 0.006). A statistical association of the polymorphism with lumbar L4-L5 herniation was not found. Carriers of the 4603Т allele had a four-fold higher risk of cervical herniation in the dominant model (OR =4.00; 95 % CI (1.37–11.79); P < 0.01), and three-fold higher – in the multiplicative model (OR = 3.12; 95 % CI (1.26–7.69); P < 0.05). Conclusions. The study has shown the statistically significant association of the COL11A1 C4603T polymorphism with cervical and lumbar disc herniation among Ukrainian people. The 4603T allele presence should be considered when a sports career planning or occupational choice related to a heavy load on the cervical or lumbar spine.

Cervical Herniation of Apical Pulmonary Bulla in a Patient With Marfan Syndrome

Cervical Herniation of Apical Pulmonary Bulla in a Patient With Marfan Syndrome

Clinical Improvement of Cervical Disc Herniation 24 hours after a Single Oxygen-Ozone Injection

Oxygen-ozone therapy is a minimally invasive treatment for disc herniation, compared to surgery, which uses the beneficial biochemical properties of a gas mixture of ozone and oxygen. A satisfactory efficacy is usually obtained within one month after the injection. We assessed the therapeutic outcome of a single injection of oxygen-ozone in a symptomatic patient with C5-C6 cervical discal herniation with compression of the nerve roots. He experienced immediate pain relief seconds after the injection, and neuro-imaging improvement 24 hours afterwards. To our knowledge this is the fastest improvement ever reported in literature.

8주간의 등허리부 저항성 운동이 목뼈 척추원반 탈출증 여성 환자의 목 장애지수와 척추 정렬, 정적 균형 능력에 미치는 영향

The purpose of this study was to investigate the effects of 8-week thoracolumbar resistance exercise program on neck disability index(NDI), spinal alignment and static balance ability in patients with cervical herniation of intervertebral disc. The exercise program performed thoracolumbar exercise 3times a week for 8-weeks and consisted of a total of 60minutes. The subjects of this study were 20 middle-aged women patients diagnosed with cervical herniation intervertebral disc. The results of this study were as follows. NDI was significantly decreased in both groups after exercise, and it was more significantly improved in TRG than in CG(p<.001). As for spinal alignment, the cranial vertebra angle (CVA), cranial rotation angle (CRA), and lumbar vertebrae angle (LLA) were significantly changed only in TRG after exercise, and TRG was significantly improved than CG(p<.001). Static balance ability was significantly changed only in TRG after exercise, and TRG was significantly improved than CG(p<.001). These results indicated that thoracolumbar resistance exercise program in patients with cervical herniation of intervertebral disc have the positive effect on changed in NDI, spinal alignment, and static balance ability. Therefore, thoracolumbar resistance exercise is considered to be an effects as exercise therapy program for improvement of cervical herniation of intervertebral disc patients.

Bariatric surgery diminishes spinal diagnoses in a morbidly obese population: A 2-year survivorship analysis of cervical and lumbar pathologies

The effects of bariatric surgery on diminishing spinal diagnoses have yet to be elucidated in the literature. The purpose of this study was to assess the rate in which various spinal diagnoses diminish after bariatric surgery. This was a retrospective analysis of the NYSID years 2004–2013. Patient linkage codes allow identification of multiple and return inpatient stays within the time-frame analyzed (720 days). Time from bariatric surgery until the patient’s respective spinal diagnosis was no longer present was considered a loss of previous spinal diagnosis (LOD). Included: 4,351 bariatric surgery pts with a pre-op spinal diagnosis. Cumulative LOD rates at 90-day, 180-day, 360-day, and 720-day f/u were as follows: lumbar stenosis (48%,67.6%,79%,91%), lumbar herniation (61%,77%,86%,93%), lumbar spondylosis (47%,65%,80%,93%), lumbar spondylolisthesis (37%,58%,70%,87%), lumbar degeneration (37%,56%,72%,86%). By cervical region: cervical stenosis (48%,70%,84%,94%), cervical herniation (39%,58%,74%,87%), cervical spondylosis (46%, 70%,83%, 94%), cervical degeneration (44%,64%,78%,89%). Lumbar herniation pts saw significantly higher 90d-LOD than cervical herniation pts (p < 0.001). Cervical vs lumbar degeneration LOD rates did not differ @90d (p = 0.058), but did @180d (p = 0.034). Cervical and lumbar stenosis LOD was similar @90d & 180d, but cervical showed greater LOD by 1Y (p = 0.036). In conclusion, over 50% of bariatric patients diagnosed with a cervical or lumbar pathology before weight-loss surgery no longer sought inpatient care for their respective spinal diagnosis by 180 days post-op. Lumbar herniation had significantly higher LOD than cervical herniation by 90d, whereas cervical degeneration and stenosis resolved at higher rates than corresponding lumbar pathologies by 180d and 1Y f/u, respectively.

Effects on pain of percutaneous treatment of cervical disc herniations using DiscoGel: A retrospective analysis.

Cervical discogenic pain originates from degenerated intervertebral discs and is a common condition in the middle-aged population. Cervical discs may herniate and give compressions to cervical nerves, with pain and functional limitation of the arms. DiscoGel is a device that can be useful in the treatment of cervical disc herniation, with very short operating time and low radiation dose. Between March 2018 and April 2019 we performed this procedure on 38 patients with non-fissurated cervical herniation using 0.3-0.4 mL of DiscoGel injected under fluoroscopic guidance. The most common discs affected were C5-C6, C6-C7 and C4-C5. Outcomes were evaluated with Visual Analogue Scale (VAS) and Neuropathic Pain Symptom Inventory (NPSI) scores at 3, 6 and 12 months follow-up. A magnetic resonance imaging (MRI) scan of the cervical spine was performed 3 months after the procedure. Postoperative examinations showed: VAS 2.15 ± 1.34 and NPSI 2.29 ± 0.71.Postoperative MRI performed 3 months after the procedure showed a good improvement of cervical disc herniation or bulging or protrusion. The mean dose area product (DAP) was 2803 mGy/cm2 with a mean fluoroscopy time of 4 minutes 22 seconds.Conclusion DiscoGel is a suitable approach for non-fissurated cervical disc herniations, especially in patients that are not suitable for open surgery, with excellent postoperative results, fast recovery and a low radiation dose.

Correlation between loss of cervical lordosis and the degree of cervical disc herniation

Background: Chronic neck pain is a common health problem and is increasingly relevant in health-related quality of life, not only in industrialized countries. The etiology of neck pain is very complex and may be associated with disc herniation, facet joints, muscles, and ligaments that cervical stability will gradually decrease and can cause damage and lead to loss of cervical lordosis. However, studies rarely report the correlation between cervical lordosis and cervical herniation in patients with neck pain. The purpose of this study was to determine the profile of cervical lordosis curves in patients with chronic neck pain and prove the correlation between the degree of cervical disc herniation with loss of cervical lordosis.Method: This study was designed as an analytic study with a retrospective cross-sectional approach. Cervical lordosis curves are measured from mid sagittal cervical MRI while the degree of cervical disc herniation is evaluated using a herniation score. The Spearman correlation test and a simple linear regression test were performed to assess the relationship between loss of cervical lordosis and cervical herniation severity. Multivariate analysis was performed to adjust for the effect of confounding variables.Result: A total of 67 study samples, 64.2% male and 35.8% female, with an average age of 54.7 ± 12.5. Cervical lordosis angle was found not normal (86.6%), most are in the form of hypolordosis (41.8%) and kyphosis (43.3%). The most herniation was in protrusion stage (47.8%). There was a significant correlation between the loss of the cervical lordosis and the degree of disc herniation (r -0.259, and p-value 0.034), each increase of one cervical disc herniation score affects the angle of the lordosis curve by -1.9 degrees, with a coefficient value of B = -1,914 (95% CI, p = 0.026). Conclusion: there is a significant correlation between loss of cervical lordosis and cervical disc herniation (p &lt;0.05).Â

Spinal pathologies and management strategies associated with cervical angina (pseudoangina): a systematic review.

Cervical angina, or pseudoangina pectoris, is a noncardiac syndrome of chest pain that often mimics angina pectoris but is a disease of the spine. Diagnosis of cervical angina can be difficult and is often overlooked, although once identified, it can be successfully managed through conservative therapies and/or a variety of surgical interventions. Ultimately, cervical angina is an important component of the list of differential diagnoses in noncardiac chest pain. In the present study, the authors report the first comprehensive systematic review of the range of cervical and thoracic pathologies associated with cervical angina, as well as the different treatment methods used to manage this condition. A systematic review was performed according to PRISMA guidelines and using PubMed, Web of Science, and Cochrane databases from database inception to April 29, 2020, to identify studies describing spinal pathologies related to cervical angina. The following Boolean search was performed: ("cervical" OR "thoracic") AND ("angina" OR "chest pain") AND ("herniation" OR "OPLL"). Variables extracted included patient demographics, cervical angina pain location, pathology and duration of symptoms, treatment and/or management method, and posttreatment pain relief. Upon careful screening, 22 articles published between 1976 and 2020 met the study's inclusion/exclusion criteria, including 5 case series, 12 case reports, and 5 retrospective cohort studies. These studies featured a total of 1100 patients, of which 95 met inclusion criteria (mean patient age 51.7 years, age range 24-86 years; 53.6% male). Collectively, symptom durations ranged from 1.5 days to 90 months. Cervical herniation (72.6%) accounted for the majority of cervical angina cases, and surgical interventions (84.4%) predominated over physical therapy (13.0%) and medical management strategies (9.1%). Every patient assessed at follow-up reported relief from symptoms related to cervical angina. Cervical angina is a noncardiac syndrome of chest pain associated with a broad range of cervical and thoracic spinal pathologies, the most common of which is cervical disc herniation. Although difficult to diagnose, it can be successfully treated when identified through first-line conservative management or surgical interventions in refractory cases.

82. Bariatric surgery diminishes spinal symptoms in a morbidly obese population: a 2-year survivorship analysis of cervical and lumbar pathologies

BACKGROUND CONTEXT Bariatric surgery for morbid obesity helps to address common comorbidity burdens, including decreasing rates of myocardial infarction and stroke. The increased mechanical stresses on the spine caused by morbid obesity predispose patients to various spinal pathologies and are concerning for spinal surgeons, with previous studies suggesting poorer outcomes than the general population. The effects of bariatric surgery on diminishing spinal complaints or symptoms have yet to be elucidated in the literature. PURPOSE To assess the rate in which various spinal symptoms diminish after bariatric surgery. STUDY DESIGN/SETTING Retrospective analysis of the prospectively collected New York State Inpatient Database (NYSID) years (2004-2013). PATIENT SAMPLE A total of 4,351 patients who underwent bariatric surgery with at least one identified spinal diagnosis present before bariatric surgery. OUTCOME MEASURES Time from bariatric surgery until disappearance of specific spinal complaint, percentage of unresolved spinal complaints with 2-year follow-up. METHODS Retrospective analysis of the prospectively collected (NYSID) years 2004-2013. Patient linkage codes allow identification of multiple and return inpatient stays within the time frame analyzed (720 days). Inclusion criteria were bariatrics surgery patients with one or more visits prior to and after bariatric procedure (excluding pts with RESULTS A total of 4,351 bariatric surgery pts with a preop spinal diagnosis by ICD-9 were analyzed. Lumbar pts: 1,049 had stenosis, 774 spondylosis, 648 degeneration, 249 spondylolisthesis, 72 disc herniation. Cervical pts: 581 disc herniation, 376 had stenosis, 366 spondylosis, 236 degeneration. Cumulative resolution rates at 90-day, 180-day, 360-day, and 720-day follow-up were as follows: lumbar stenosis (48%,67.6%,79%,91%), lumbar herniation (61%,77%,86%,93%), lumbar spondylosis (47%,65%,80%,93%), lumbar spondylolisthesis (37%,58%,70%,87%), lumbar degeneration (37%,56%,72%,86%). By cervical region: cervical stenosis (48%,70%,84%,94%), cervical herniation (39%,58%,74%,87%), cervical spondylosis (46%, 70%,83%, 94%), cervical degeneration (44%,64%,78%,89%). Lumbar herniation pts saw significantly higher 90d-resolution than cervical herniation pts (p CONCLUSIONS Over 50% of bariatric patients diagnosed with a cervical or lumbar pathology before weight-loss surgery no longer sought inpatient care for their respective spinal diagnosis by 180 days postop. Lumbar herniation had significantly higher resolution than cervical herniation by 90d, whereas cervical degeneration and stenosis resolved at higher rates than corresponding lumbar pathologies by 180d and 1-year follow-up, respectively. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Long-Term Results of Multiple Anterior Cervical Discectomy with Cage Fusion Technique: Results of Multiple Centre Study.

BACKGROUND:Cervical herniation is commonly treated by anterior cervical discectomy and fusion (ACDF) if conservative management has failed in relief of the patient’s symptoms. Disc fusion is needed after ACDF as anterior longitudinal ligament will be absent after doing the operation, especially if multiple levels are needed. The occurrence of complications as cage subsidence and adjacent segment failure related to the length of follow up as they are increasing in percentage is directly proportional to the length of follow up.AIM:Analysis of the results for patients who underwent 3 levels of ACDF with cage fusion for short term and long term follow up in multiple centres as the visual analogue score for neck pain & brachialgia.METHODS:This retrospective cohort series of 68 patients selected out of 136 patients suffering from 3 levels of degenerative cervical disc disease who were unresponsive to adequate conservative therapy. All cases were treated at one of the neurosurgery departments of 3 different hospitals (Naser institute for research and treatment hospital, Haram hospital for research and treatment and Misr university for science and technology) by the same surgical team in the period from February 2012 to February 2017.RESULTS:We found in this study;68 patients fulfilling the inclusion criteria, of the 29 patients underwent 3 levels of ACDF starting from C3-4 (42.65%) and 39 patients who underwent 3 levels of ACDF starting from C4-5 (57.35%). Clinical assessment for VAS pain score for both neck pain and radiculopathy were done before the surgery and immediately post-operative and during each time follow up visit and we found statistically significant immediate postoperative improvement. (P < 0.05)CONCLUSION:Stand-alone three levels of an anterior cervical discectomy with cage fusion technique improved the clinical outcomes on long term follow up.

Percutaneous plasma laser disc coagulation and navigable ablation decompression in the treatment of cervical disc herniation: a single center experience

Background/aim We aimed to compare the effectivity of percutaneous disc coagulation therapy (PDCT) and navigable ablation decompression treatment (L-DISQ) in patients who were diagnosed with cervical disc herniation. Materials and methods Visual analog scale (VAS) and Neck Pain Index (NPI) scores were recorded initially and at the 1st, 3rd, 6th, and 12th months after the procedures. Patient Satisfaction Scale (PSS) scores were recorded 12 months after the procedures.Results Mean VAS scores were 7.55 and 3.1 points in the PDCT group and 7.6 and 3.00 points in the L-DISQ group; mean NPI scores were 34.2 and 20.75 points in the PDCT group and and 34.1 and 20.4 points in the L-DISQ group initially and at the 12th month. When compared between months, there was a significant decrease in time-dependent VAS and NPI scores in both PDCT and L-DISQ groups (P = 0.001). Some complications included esophageal, vascular, and neural injuries; hoarseness; Horner syndrome; infections; dural puncture; and muscle spasm. The only difference between groups was the rate of cervical spasm within 1 month after the procedure: 75% in the PDCT group and 15% in the L-DISQ group.Conclusion The diameter of the canal of the cervical vertebrae is narrower than of the lumbar and thoracic regions; therefore, the smaller part of the disc may be sufficient to create clinical signs. The response to decompression therapies is faster in the case of cervical percutaneous procedures that are performed correctly. Proper patient selection and practitioner’s experience are important in the treatment success.

Repeat epidural steroid injections for radicular pain due to lumbar or cervical disc herniation

The aim of this study was to determine the efficacy of repeat epidural steroid injections as a form of treatment for patients with insufficiently controlled or recurrent radicular pain due to a lumbar or cervical disc herniation. A cohort of 102 patients was prospectively followed, after an epidural steroid injection for radicular symptoms due to lumbar disc herniation, in 57 patients, and cervical disc herniation, in 45 patients. Those patients with persistent pain who requested a second injection were prospectively followed for one year. Radicular and local pain were assessed on a visual analogue scale (VAS), functional outcome with the Oswestry Disability Index (ODI) or the Neck Pain and Disability Index (NPAD), as well as health-related quality of life (HRQoL) using the 12-Item Short-Form Health Survey questionnaire (SF-12). A second injection was performed in 17 patients (29.8%) with lumbar herniation and seven (15.6%) with cervical herniation at a mean of 65.3 days (sd 46.5) and 47 days (sd 37.2), respectively, after the initial injection. All but one patient, who underwent lumbar microdiscectomy, responded satisfactorily with a mean VAS for leg pain of 8.8 mm (sd 10.3) and a mean VAS for arm pain of 6.3 mm (sd 9) one year after the second injection, respectively. Similarly, functional outcome and HRQoL were improved significantly from the baseline scores: mean ODI, 12.3 (sd 12.4; p < 0.001); mean NPAD, 19.3 (sd 24.3; p = 0.041); mean SF-12 physical component summary (PCS) in lumbar herniation, 46.8 (sd 7.7; p < 0.001); mean SF-12 PCS in cervical herniation, 43 (sd 6.8; p = 0.103). Repeat steroid injections are a justifiable form of treatment in symptomatic patients with lumbar or cervical disc herniation whose symptoms are not satisfactorily relieved after the first injection. Cite this article: Bone Joint J 2018;100-B:1364-71.

Paraplegia by Acute Cervical Disc Herniation after Shoulder Arthroscopic Surgery in Beach-Chair Position

Paraplegia after non-cervical spine surgery under general anesthesia is a rare devastating postoperative complication [1]. A patient with shoulder pain was scheduled for shoulder arthroscopy due to rotator cuff repair. Arthroscopic shoulder surgery was performed with the patient in the beach-chair. Postoperatively, patients complained the weakness of both lower leg and marked numbness and tingling in the both arms. MRI showed a herniated intervertebral disc between C6 and C7 with spinal cord compression. Despite urgent discectomy, the patient remained dysesthesia of both upper extremities for 6 months. The purpose of this report is to introduce our case with a paraplegia observed after arthroscopic shoulder surgery in beach-chair position because of acute cervical herniation.

The relation between cervical and thoracal disc herniations and multiple sclerosis plaques: a retrospective review

The aim of the study is the evaluation cervical and thoracal disc herniations are predisposant factor to the formation and activation of plaques formation of relapsing remitting (R-R ) type multiple sclerosis (MS) patients. We performed a retrospective study on R-R type MS diagnosed patients who also had cervical and thoracal disc herniations. 185 cervical and 136 thoracic in total 321 MR images of 104 (42 men, 62 women) MS patients with R-R type were evaluated retrogradly. When we evaluate the association between cervical or thoracal disc herniation and MS plaques we determined the same localization of cervical herniation and MS plaques was statistically significant. In conclusion, cervical and thoracic disc herniations may contribute to distrupion of blood brain barrier by generating microtraumas and this may lead to MS plaque formation. Therefore, early and effective treatment of MS patients having disc compression is crucial for preventing from sequels and for providing a better life quality.

The level of pain intensity vs sleep quality and functioning of patients with cervical and lumbar disc disease

Discopathy have wide variety of clinical symptoms. The main issue, destabilizing patients’ life is pain, especially when sleep quality is influenced. The aim of the study was to assess the influence of pain severity on sleep and everyday life quality in patients with cervical and lumbar discopathy. The study was performed on 52 cervical herniation and 59 lumbar herniation patients qualified to surgical intervention. In the study, Athens Insomnia Scale, Oswestra Questionnaire, NRS were used. The majority of patients (70,3%) experienced constant pain and it’s severity what is higher in group of patients with lumbar herniation (Me: 8 vs 7; p=0,036). In a 41% of patients pain lasted for more than two years. Analgesics were applayed by patients (73%) most temporarily, when the level of pain was 8 (relief of pain Me: 5). The pain intensity is correlated with insomnia (r=0,32; p=0,000) and degree of disability (r=0,60; p=0,000). Patients with lumbar herniation have significantly higher degree of disability in comparison to patients with cervical herniation (49,9% vs 37,4%; p=0,000). In majority of patients experienced pain was constant and its intensity was high. Moreover pain was responsible for lowering the quality of sleep and everyday life regardless of the patient’s age. Patients with lumbar herniation experienced significantly higher pain intensity and had higher degree of disability. The pain treatment was not effective enough however it’s effectiveness can be modified by many factors, not by disease process itself.

Assessment of the Radiation Exposure of Surgeons and Patients During a Lumbar Microdiskectomy and a Cervical Microdiskectomy: A French Prospective Multicenter Study

Cervical and lumbar disk herniations are the most frequently carried out procedures in spinal surgery. Often, a few snapshots during the procedure are necessary to validate the level or to position the implant. The objective of this study is to quantitatively estimate the radiation received by a spine surgeon and patient during a low-dose radiation procedure. We conducted a prospective multicenter study in France from November 2014 to April 2015. Four spine centers were monitored for radiation received by surgeons during interventions for lumbar disk herniation and cervical disk herniation. A total of 134 patients were included. For lumbar disk herniation, the average exposure for the surgeon was 0.584 μSv on the chest, 5.291 μSv on the lens, and 9.295 μSv on the hands per procedure. For these procedures, the dose area product (DAP) was 94.2 ± 198.4 cGy·cm(2), and the fluoroscopic time was 10.2 ± 16.9 seconds. For a herniated cervical disk, the average exposure for the surgeon was 0.122 μSv on the chest, 3.106 μSv on the lens, and 7.143 μSv on the hands per procedure. For these procedures, the DAP was 35.7 ± 72.1 cGy·cm(2), and the fluoroscopic time was 19.7 ± 13.7 seconds. Exposure to x-rays for surgeons and patients during surgery for lumbar disk herniation is higher than during surgery for cervical herniation disk. Our results show that radiation exposure to the spine surgeon is still far below the annual dose limits.

Three-level cervical disc herniation

Abstract Multilevel cervical degenerative disc disease is well known in the cervical spine pathology, with radicular syndromes or cervical myelopathy. One or two level cervical herniated disc is common in adult and multilevel cervical degenerative disc herniation is common in the elderly, with spinal stenosis, and have the same cause: the gradual degeneration of the disc. We report the case of a patient with two level cervical disc herniation (C4 – C5 and C5 – C6) treated by anterior cervical microdiscectomy both levels and fusion at C5 – C6; after five years the patient returned with left C7 radiculopathy and MRI provided the image of a left C6 – C7 disc herniation, he underwent an anterior microsurgical discectomy with rapid relief of symptoms. Three-level cervical herniated disc are rare in adults, and the anterior microdiscectomy with or without fusion solve this pathology.

4:18 PM Abstract No. 58 - Percutaneous treatment of lumbar and cervical intervertebral disc herniations with radiopaque gelified ethanol (RGE): clinical and morphostructural changes in our experience

Purpose To demonstrate the safety and efficacy of injection of RGE in the percutaneuos treatment of lumbar and cervical disc herniations. Furthermore, intervertebral disc morfostructural changes has been evaluated by three dimensional compute tomography (3D-CT). Materials and Methods Between September 2010 and April 2012, 47 symptomatic patients (21 females, 26 males, age range at treatment: 33-75 years) have been treated for 54 lumbar intervertebral disc herniations in L2-L3 (n: 3), L4-L5 (n: 25), and L5-S1 (n: 26) levels, and 7 cervical intervertebral discs in C4-C5 (n: 2), C5-C6 (n: 3), C6-C7 (n: 1), and C7-D1 (n: 1) levels by percutaneous intradiscal injection of RGE (DISOGEL by Gelscom SAS Caen France). All treatments were performed under fluoroscopic guidance with biplanar 3D rotational angiographic system using 18 G needle for lumbar and 21 G for cervical. All patients received local anesthesia and a “short term” antibiotic therapy. In 14 patients, the treatment was performed in 2 levels in the same session. In 5 cases large extruded and migrated herniations have been treated. All patients underwent clinical evaluation, including VAS scale before treatment, soon after treatment, 3 and 6 months later. Low dose three-dimensional computed tomography (3D-CT) was obtained after treatment and 3 months later. Results All the procedures have been well tolerated. There were no allergic complications. 34 patients (85%) with lumbar disc herniations and 4 of 5 patients with cervical herniations obtained improvement in symptoms. In these patients, VAS scale showed a significant score reduction (p Conclusion These results show the efficacy and innocuity RGE. RGE does not produce any intervertebral disc morphostructural change.