Calcified Disc Research Articles

FGF4L2 retrogene copy number is associated with intervertebral disc calcification and vertebral geometry in Nova Scotia Duck Tolling Retrievers

To evaluate the effects of the chondrodystrophy-associated FGF4L2 retrogene on intervertebral disc (IVD) calcification and vertebral geometry. 22 Nova Scotia Duck Tolling Retrievers (NSDTR) with no FGF4L2 retrogene (n = 7, wild-type dogs), 1 retrogene copy (8, heterozygous dogs), or 2 retrogene copies (7, homozygous dogs). Computed tomography (CT) scans of the vertebral column were analyzed using computer-aided design (CAD) software. IVD calcification, vertebral column length, and vertebral geometry of the third cervical (C3), 13th thoracic (T13), and first lumbar (L1) vertebrae were compared. IVD calcification was not found in wild-type dogs. IVD calcification was more frequent in homozygous dogs than heterozygous (P = .008) or wild-type dogs (P < .001) and in heterozygous dogs compared to wild-type dogs (P < .001). Four IVDs were subclinically herniated in 3 dogs (2 homozygous, 1 heterozygous). Calcified IVD had a greater volume and surface area in heterozygous dogs than homozygous dogs. C3 vertebral canal height-to-width ratio was greater in homozygous dogs than heterozygous dogs (P = .044) and wild-type dogs (P = .010). IVD calcification and vertebral geometry can be analyzed using CAD software. The presence of 1 or 2 FGF4L2 copies in the absence of the FGF4L1 retrogene has an additive effect on the number of calcified IVD and a minor effect on vertebral geometry in NSDTR dogs. Data support the use of FGF4L2 phenotyping to reduce clinical disease in segregating breeds and to monitor the introduction of wild-type alleles into fixed breed populations.

Acromegalic Arthropathy and Ossification of the Yellow Ligament Treated with an Interlaminar Full-Endoscopic Approach: A Case Report

Introduction: Acromegalic arthropathy is a cause of morbidity and functional disability, affecting large peripheral joint, especially the spine. Affected patients can suffer from lumbar and sciatic pain, with or without radiculopathy. Due to the severe arthrosis, stenosis with ossification of the ligamentum flavum can often occur. Patient history: This study presents a 57-year-old patient with acromegalic arthropathy resulting from a growth hormone secreting pituitary macroadenoma. He was previously submitted to transsphenoidal surgery and present a history of L4-L5 decompression due to disc herniation and bilateral knee arthroplasty. The condition evolved to an acute left lumbar sciatic pain and the patient was refractory to clinical and physical therapy treatment. Surgical procedure: Decompression and discectomy were performed through an interlaminar endoscopic approach. Cutting and diamond burs and Keirrinson-type forceps were used for decompression. Diamond burs were used in the calcified yellow ligament and in the intervertebral disc to remove the protruding disc.Imaging exams: Preoperative exams showed calcified disc herniation and stenosis, with ossification of the posterior longitudinal ligament. Postoperative exams showed good decompression, removal of the calcified disc herniation and ossification of the posterior longitudinal ligament.Patient follow-up: Immediate resolution of sciatica pain and neurological deficit, with a negative nerve stretching test. At one-year follow-up, the patient had no return of radicular symptoms.Conclusion: Endoscopic surgery can be a reliable treatment option in approaching patients with severe stenosis of the spinal canal associated with calcified disc hernias and ossification of the ligamentum flavum, even when submitted to previous surgeries. This approach also presents benefits of a minimally invasive surgery.

Surgical treatment of calcified thoracic herniated disc disease via transthoracic approach with use of intraoperative computed tomography (ICT) and microscope-based augmented reality (AR)

Surgical treatment of calcified thoracic herniated disc disease via transthoracic approach with use of intraoperative computed tomography (ICT) and microscope-based augmented reality (AR)

Kawasaki disease with intervertebral disc calcification and torticollis.

Pediatrics InternationalAccepted Articles e15537 CLINICAL NOTE Kawasaki disease with intervertebral disc calcification and torticollis Keiichi Koizumi, Corresponding Author Keiichi Koizumi koizumi72ac@gmail.com orcid.org/0000-0003-2519-3868 Department of Pediatrics, Fujiyoshida Municipal Hospital, Yamanashi, Japan Correspondence Keiichi Koizumi, Department of Pediatrics, Fujiyoshida Municipal Hospital, 7-11-1 Kamiyoshidahigashi, Fujiyoshida City, Yamanashi, 403-0032, Japan. Tel: +81-555-22-4111; fax: +81-555-22-6995. Email: koizumi72ac@gmail.comSearch for more papers by this authorHiroyuki Fujihara, Hiroyuki Fujihara Department of Pediatrics, Fujiyoshida Municipal Hospital, Yamanashi, Japan Department of Pediatrics, University of Yamanashi, Yamanashi, JapanSearch for more papers by this authorKoichi Makino, Koichi Makino Department of Pediatrics, Fujiyoshida Municipal Hospital, Yamanashi, JapanSearch for more papers by this authorJin Yamamoto, Jin Yamamoto Department of Radiology, Fujiyoshida Municipal Hospital, Yamanashi, JapanSearch for more papers by this authorNagakazu Watanabe, Nagakazu Watanabe Department of Orthopedic Surgery, Fujiyoshida Municipal Hospital, Yamanashi, JapanSearch for more papers by this authorMakoto Nakamura, Makoto Nakamura Department of Pediatrics, Fujiyoshida Municipal Hospital, Yamanashi, JapanSearch for more papers by this author Keiichi Koizumi, Corresponding Author Keiichi Koizumi koizumi72ac@gmail.com orcid.org/0000-0003-2519-3868 Department of Pediatrics, Fujiyoshida Municipal Hospital, Yamanashi, Japan Correspondence Keiichi Koizumi, Department of Pediatrics, Fujiyoshida Municipal Hospital, 7-11-1 Kamiyoshidahigashi, Fujiyoshida City, Yamanashi, 403-0032, Japan. Tel: +81-555-22-4111; fax: +81-555-22-6995. Email: koizumi72ac@gmail.comSearch for more papers by this authorHiroyuki Fujihara, Hiroyuki Fujihara Department of Pediatrics, Fujiyoshida Municipal Hospital, Yamanashi, Japan Department of Pediatrics, University of Yamanashi, Yamanashi, JapanSearch for more papers by this authorKoichi Makino, Koichi Makino Department of Pediatrics, Fujiyoshida Municipal Hospital, Yamanashi, JapanSearch for more papers by this authorJin Yamamoto, Jin Yamamoto Department of Radiology, Fujiyoshida Municipal Hospital, Yamanashi, JapanSearch for more papers by this authorNagakazu Watanabe, Nagakazu Watanabe Department of Orthopedic Surgery, Fujiyoshida Municipal Hospital, Yamanashi, JapanSearch for more papers by this authorMakoto Nakamura, Makoto Nakamura Department of Pediatrics, Fujiyoshida Municipal Hospital, Yamanashi, JapanSearch for more papers by this author First published: 25 March 2023 https://doi.org/10.1111/ped.15537 This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi:10.1111/ped.15537. AboutPDF ToolsExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Accepted ArticlesAccepted, unedited articles published online and citable. The final edited and typeset version of record will appear in the future.e15537 RelatedInformation

Predictive Factors for Poor Outcome following Chemonucleolysis with Condoliase in Lumbar Disc Herniation.

Background and Objectives: Condoliase, a chondroitin sulfate ABC endolyase, is a novel and minimally invasive chemonucleolytic drug for lumbar disc herniation. Despite the growing number of treatments for lumbar disc herniation, the predicting factors for poor outcomes following treatment remain unclear. The aim of this study was to determine the predictive factors for unsuccessful clinical outcome following condoliase therapy. Material and Methods: We performed a retrospective single-center analysis of 101 patients who underwent chemonucleolysis with condoliase from January 2019 to December 2021. Patients were divided into good outcome (i.e., favorable outcome) and poor outcome (i.e., requiring additional surgical treatment) groups. Patient demographics and imaging findings were collected. Clinical outcomes were evaluated using the numerical rating scale and Japanese Orthopaedic Association scores at baseline and at 1- and 3-month follow-up. Pretreatment indicators for additional surgery were compared between the 2 groups. Results: There was a significant difference in baseline leg numbness between the good outcome and poor outcome groups (6.27 ± 1.90 vs. 4.42 ± 2.90, respectively; p = 0.033). Of the 101 included patients, 32 received a preoperative computed tomography scan. In those patients, the presence of calcification or ossification in disc hernia occurred more often in the poor outcome group (61.5% vs. 5.3%, respectively; p < 0.001; odds ratio = 22.242; p = 0.014). Receiver-operating characteristics curve analysis for accompanying calcification or ossification showed an area under the curve of 0.858 (95% confidence interval, 0.715−1.000; p = 0.001). Conclusions: Calcified or ossified disc herniation may be useful predictors of unsuccessful treatment in patients with condoliase administration.

Long-term operative outcome of giant calcified thoracic disc herniation - A retrospective analysis of 24 patients.

Thoracic disc herniations (TDHs) are rare (0.15-4%) and often cause significant myelopathy (70-95%). They are defined as "Giant" if they occupy >40% of the spinal canal. Further, they are ossified/calcified in 42% of cases, with a 70% incidence of intradural extension. Here, we reviewed our experience resecting 24 giant thoracic discs utilizing a posterolateral surgical approach. Over a 2-year period, we evaluated the outcomes for 24 patients averaging 40 years of age undergoing posterolateral resections of giant ossified/calcified TDH. We evaluated multiple clinical and radiographic parameters; demographics, Frankel grades, surgical time, perioperative complications, and number of levels involved. In addition, utilizing magnetic resonance/computed tomography studies, we documented that the most commonly involved level was T11-T12, and the average canal occupancy ratio (i.e., degree of canal encroachment) was 58.2 ± 7.72%. Neurological improvement was seen in 22 of the 24 patients; none experienced neurological deterioration over the average 2-year post-operative period. Six complications occurred; three dural tears and three suture site infections. The posterolateral approach proved to be safe and effectively for resecting 24 giant ossified/calcified TDH with minimum complications.

Disc calcifications: Think of ochronosis.

Disc calcifications: Think of ochronosis.

Is conservative treatment a good choice for pediatric intervertebral disc calcification in children?

Paediatric intervertebral disc calcification (PIDC) is a rare disease, and its aetiology remains unknown. This study aimed to analyse the characteristics and clinical outcomes of patients with PIDC. After applying the exclusion and inclusion criteria, 159 children diagnosed with PIDC were analysed at our hospital between January 2010 and November 2020. Patients' demographic and clinical data were collected, such as sex, pain, duration time, physical examination, white blood cell count, erythrocyte sedimentation rate, C-reactive protein, and radiography, computed tomography, and magnetic resonance imaging findings. Patients were followed up for at least 6months, and radiography or symptoms were evaluated. Fisher's exact test or χ2-test was used for statistical analyses. One hundred and fifty-nine patients were ultimately followed up with for about 12.5 ± 5.8months. There were 103 male and 56 female, with an average age of 6.08 ± 2.62years (2months to 12years). A total of 109 patients had only one PIDC, 29 patients had two PIDCs, and 21 patients had multiple PIDCs. Thirty patients were found incidentally and were asymptomatic. A total of 106 patients had neck torticollis. Sixteen patients had IDC herniations, fifteen patients had posterior longitudinal ligament calcification, two patients had anterior longitudinal ligament calcification, and 17 patients had herniation of the vertebral canal. All patients underwent conservative treatment, and none underwent surgery. All patients' symptoms resolved after either collar fixation or neck traction. PIDC can be treated conservatively, even when accompanied by herniation, longitudinal ligament calcification, or clinical neck symptoms. IV.

Image-guided transthoracic transpedicular microdiscectomy for a giant thoracic disc herniation: patient series

BACKGROUNDThis case series reports on five consecutive patients who underwent image-guided transpedicular transthoracic microdiscectomy. The authors retrospectively reviewed five patients who had undergone Stealth image-guided transpedicular transthoracic microdiscectomy between 2015 and 2021.OBSERVATIONSImage guidance with O-arm verified critical anatomical landmarks in the setting of large central calcified and/or soft tissue disc prolapse. This allowed limited rib head resection, pedicle removal, and corpectomy to give adequate access and not require interbody fusion. The authors performed a partial posterior corpectomy anterior to the affected disc prolapse and microsurgical delivery of the affected disc anteriorly into the corpectomy cave away from the thecal sac. Electronic and radiographic records were analyzed at their initial presentation and at follow-up. The median patient age was 51 years (range, 44–56 years), with 80% of the patients being males. Four of five patients had significant improvement of their presenting clinical symptoms. One patient had a complicated postoperative recovery with a pneumothorax and subsequent bilateral pneumonia requiring intensive care. Another patient developed delayed postoperative worsening of paraparesis.LESSONSThe use of Stealth image guidance with O-arm for transthoracic microdiscectomy for complex calcified thoracic disc herniation is an effective operative technical adjunct to verify anatomical landmarks and limit the microsurgical procedure.

Angled Ultrasonic Bone Curette-Assisted Circumferential Decompression for Thoracic Myelopathy Caused by Severely Anterior Ossification.

ObjectiveThoracic myelopathy caused by severe anterior ossification is often progressive and fails to respond to conservative treatment. Removal of the compressing ossification is the most effective method but is hard to operate. In this study, we describe a novel one‐stage posterior circumferential decompressive procedure assisted by an angled ultrasonic bone curette (UBC) for thoracic myelopathy caused by severe anterior ossification and evaluate its safety and efficacy.MethodsThe current study enrolled 15 consecutive patients (five men and 10 women) with thoracic myelopathy caused by severely anterior ossification between January 2017 and December 2019. All patients underwent posterior circumferential decompression assisted by angled UBC and segmental instrumentation with interbody fusion. At the time of surgery, the average age was 58.6 ± 6.3 years (47–70 years). Before and after surgery, the patient data, clinical manifestation, operative levels, blood loss, operative time, perioperative complications, Japanese Orthopaedic Association (JOA) score were recorded and analyzed retrospectively.ResultsAll patients had successful one‐stage posterior circumferential decompression to remove anterior ossifications directly. There were 12 cases of OPLL, two cases of a calcified giant herniated disc, and one case of osteophyte. The average operation time was 153.4 ± 53.4 min (77–242 min), with a mean blood loss of 463.5 ± 155.8 mL (240–780 mL). The average length of stay in the hospital was 14.3 ± 4.7 days (9–25 days) and the mean follow‐up duration was 20.8 ± 8.8 months (12–39 months). Almost all patients had subjective improvement in motor power and gait. The average preoperative JOA score was 4.5 ± 1.6, which improved to 9.0 ± 1.8 at the final follow‐up. Postoperative differences in the overall JOA scores showed significant improvement (F = 105.446, p < 0.01). The overall recovery rate at the final examination scored 70.9% ± 25.0%. According to Hirabayashi's classification, eight cases were rated as excellent, four as good, two as fair, and one as unchanged. No patient was graded as deteriorated. Two patients (13.3%) experienced intraoperative cerebrospinal fluid leakage, while two cases (13.3%) experienced unilateral intercostal neuralgia, and only one (6.7%) encountered acute neurological deterioration. All these patients were treated conservatively and their neurological function improved significantly. At the follow‐up, there was no evidence of neurological deterioration.ConclusionCircumferential decompression assisted by angled UBC can preserve more posterior elements of the involved levels, maintaining an intact pleura and reducing the operation time and blood loss for thoracic myelopathy caused by severe anterior ossification. It is a safe, effective, and technically feasible method to provide surgeons with a new option for thoracic spinal circumferential decompression.

Enhanced magnetic resonance imaging manifestations of paediatric intervertebral disc calcification combined with ossification of the posterior longitudinal ligament: case report and literature review

BackgroundSince the first description of paediatric intervertebral disc calcification (IDC) by Báron in 1924, only approximately 400 cases have been reported in the literature. Paediatric IDC combined with ossification of the posterior longitudinal ligament (OPLL) is an even rarer condition, with only 8 cases described in detail to date. In this paper, we present a review of the disease characteristics described in the relevant English language literature and discuss the possible mechanisms of lesion enhancement in contrast-enhanced magnetic resonance imaging (MRI).Case presentationIn May 2020, a 6-year-old Han nationality girl presented with the chief complaint of neck pain that had lasted for a week. She did not report a history of trauma or a past illness. On admission, there was no personal and family history, congenital diseases, or non-specific infections such as tuberculosis, among others. Further physical examination revealed that the movement of her cervical spine was limited. Computed tomography (CT) and MRI revealed ossification of the intervertebral discs and posterior longitudinal ligament (PLL) at the C4/5 levels and an absence of obvious spinal cord compression. When contrast-enhanced MRI was performed, significant enhancement was observed in the intervertebral discs and PLL at the C4/5 level. We adopted a non-interventional approach and performed an imaging re-examination 8 months later. Both the plain and contrast-enhanced MRI scans indicated swelling in the C4/5 intervertebral discs and disappearance of the previously observed enhancement in the nucleus pulposus (NP) and PLL at the corresponding levels; CT examination revealed that the ossified lesions had been completely resorbed.ConclusionObvious lesion enhancement in contrast-enhanced MRI is an extremely rare manifestation of paediatric IDC combined with OPLL. However, the exact mechanisms of this phenomenon remain unclear. We surmise that it may be caused by a series of biophysical changes related to vertebral endplate injury and repair, but further research will be required for in-depth investigation.

Antero-lateral transthoracic endoscopic approach for a calcified thoracic disc herniation.

Thoracic disc herniation is one of the most therapeutically challenging spine conditions. A myriad of surgical approaches have been described in the literature, including posterior, anterior, and combined techniques. However, transthoracic and retropleural approaches are currently deemed the most effective techniques to successfully obtain anterior decompression. Herein the authors describe a 65-year-old female patient who underwent a transthoracic endoscopic approach to remove a calcified herniated thoracic disc that caused spinal cord compression. Despite having a long learning curve, the surgical technique described herein can be even used in patients with complex and calcified thoracic disc herniations.The video can be found here: https://stream.cadmore.media/r10.3171/2022.3.FOCVID221

Optic Disc Drusen

Fundus photographs of a 75-year-old man showed a pale left optic disc with irregular margins and several pearl-like nodules (Fig A). Autofluorescence demonstrated diffuse hyperreflectivity indicating calcified optic disc drusen (ODD, Fig B). High-resolution enhanced depth imaging OCT (Fig C and D, Heidelberg Spectralis) using the ODD consortium protocol revealed multiple ODDs (yellow arrows) with hyperreflective margins and hyporeflective cores. Blood vessels (white asterisks) were observed with shadowing (white arrowhead), horizontal hyperreflective lines (halo arrow), and a torus shaped peripapillary hyperreflective ovoid mass-like structure (blue arrow) indicating axoplasmic stasis in the optic nerve head (Magnified version of Fig A-D is available online at www.aaojournal.org).

Ochronose : une observation

IntroductionOchronosis, also known as alkaptonuria, is a rare autosomal recessive disease. It is caused by a lack of homogentisic acid oxidase, which causes homogentisic acid deposition in the tissues. Case reportWe report a 69-year-old patient who presented with chronic mechanical low back and radicular pain. The clinical examination revealed lumbar lordosis loss, lumbar spinal stiffness, and knee joint limitations of range of motion. On an extra-articular level, the pavilions of the ears and the internal angles of the eyes had a bluish color. Extensive lumbar disc calcifications, vacuum discal phenomenon and osteophytic bridges were demonstrated on standard radiographs of the spine. Clinical and radiographic criteria were used to make the diagnosis of ochronosis. ConclusionAlkaptonuria is a degenerative arthropathy that leads to reduction of functional ability. The use of molecular analysis and genetic research is useful.

Treatment of Calcified Lumbar Disc Herniation by Intervertebral Foramen Remolding: A Retrospective Study.

PurposeThis study aimed to investigate the use of the percutaneous intervertebral foramen lens technology for secondary molding of the intervertebral foramen in the treatment of calcified lumbar discs.MethodsThe study included 104 patients who were divided into two groups. Group A comprised 50 patients with calcified lumbar disc herniation and group B comprised 54 patients with non-calcified lumbar disc herniation diagnosed by computed tomography and magnetic resonance imaging. Patients underwent a percutaneous endoscopic lumbar discectomy at our hospital from January 1, 2017, to December 31, 2019. Demographic characteristics before the surgery and perioperative outcomes were retrospectively reviewed. The treatment outcome was analyzed using the numerical rating scale (NRS) score, Oswestry Disability Index (ODI) score, and modified Macnab criteria.ResultsPatients in groups A and B showed significant improvement in both the NRS and ODI scores after the surgery and maintained relatively low ODI and NRS scores during subsequent follow-ups. According to the evaluation under the modified MacNab standard, the good–excellent rate of clinical efficacy was 94% in group A and 92.6% in group B at the 3 month follow-up. In group A, one patient developed neck pain during the surgery, which was diagnosed as spinal hypertension syndrome, and the surgery was suspended until the patient’s condition improved. No similar complications occurred in group B. In both the groups, no patient reported any dural leak, infection, or other related complications.ConclusionThe use of transforaminal remolding technology can significantly improve the symptoms and dysfunction of patients with calcified and non calcified lumbar disc herniation. There are few intraoperative and postoperative complications and have little impact on vertebral stability. It can provide a reference for the treatment of special types of lumbar disc herniation.

Foot drop as the initial symptom caused by thoracic disc herniation.

Foot drop is a syndrome resulting from weakness or paralysis of the tibialis anterior muscle. Some patients with thoracic disc herniation seek medical help complain of foot drop as the initial symptom. The study investigated the clinical characteristics of these patients and clarified the clinical efficacy after treatment. A total of 13 patients with foot drop as the initial symptom arising from thoracic disc herniation were collected from January 2015 to December 2020. The average follow-up period was 20.5months. We recorded neurological functions, the tibialis anterior muscle strength, Japanese Orthopedic Association score (JOA), location of the lesion, and occupation rate of herniation in the spinal canal preoperatively and at the final follow-up. None pathological reflex was found in the patients. Surgical treatment was performed in 12 of the 13 patients, and tibialis anterior functional recovery was observed in 83.4% (10/12) of the cases, with an average recovery rate of 52.8 ± 18.5%. The mean JOA score increased from 6.8 ± 1.9 points preoperatively to 8.9 ± 1.3 points postoperatively (p < 0.05), achieving a mean recovery rate of 52.3 ± 13.1%. The MRI showed the conus medullaris was obviously compressed at the level of T11-L1, and the occupation rate of herniation was more than 40% in all patients, with an average of 65.4 ± 16.3%. CT indicated that 84.6% of the cases had calcification in intervertebral discs. Foot drop can be the initial symptom caused by thoracic disc herniation at the T11-L1 level, especially for the calcified disc herniation. A satisfactory recovery rate can be achieved by surgical decompression with fixation.

Mechanisms and clinical implications of intervertebral disc calcification.

Low back pain is a leading cause of disability worldwide. Intervertebral disc (IVD) degeneration is often associated with low back pain but is sometimes asymptomatic. IVD calcification is an often overlooked disc phenotype that might have considerable clinical impact. IVD calcification is not a rare finding in ageing or in degenerative and scoliotic spinal conditions, but is often ignored and under-reported. IVD calcification may lead to stiffer IVDs and altered segmental biomechanics, more severe IVD degeneration, inflammation and low back pain. Calcification is not restricted to the IVD but is also observed in the degeneration of other cartilaginous tissues, such as joint cartilage, and is involved in the tissue inflammatory process. Furthermore, IVD calcification may also affect the vertebral endplate, leading to Modic changes (non-neoplastic subchondral vertebral bone marrow lesions) and the generation of pain. Such effects in the spine might develop in similar ways to the development of subchondral marrow lesions of the knee, which are associated with osteoarthritis-related pain. We propose that IVD calcification is a phenotypic biomarker of clinically relevant disc degeneration and endplate changes. As IVD calcification has implications for the management and prognosis of degenerative spinal changes and could affect targeted therapeutics and regenerative approaches for the spine, awareness of IVD calcification should be raised in the spine community.

Machine Learning Predicts Recurrent Lumbar Disc Herniation Following Percutaneous Endoscopic Lumbar Discectomy.

Retrospective study. To develop machine learning (ML) models to predict recurrent lumbar disc herniation (rLDH) following percutaneous endoscopic lumbar discectomy (PELD). We retrospectively analyzed 1159 patients who had undergone single-level PELD for lumbar disc herniation (LDH) between July 2014 to December 2019 at our institution. Various preoperative imaging variables and demographic metrics were brought in analysis. Student's t test and Chi-squared test were applied for univariate analysis, which were feature selection for ML models. We established ML models to predict rLDH: Artificial neural networks (ANN), Extreme Gradient Boost classifier (XGBoost), KNeighborsClassifier (KNN), Decision tree classifier (Decision Tree), Random forest classifier (Random Forest), and support vector classifier (SVC). A total 130 patients (11.22%) were diagnosed as rLDH in 1159 patients. Recurrence occurred within 10.25 ± 11.05 months. Body mass index (BMI) (P = .027), facet orientation (FO) (P < .001), herniation type (P = .012), Modic changes (P = .004), and disc calcification (P = .013) are significant factors in univariate analysis (P < .05). Extreme Gradient Boost classifier, Random Forest, ANN showed fine area under the curve, .9315, .9220, and .8814 respectively. We developed a deep learning and 2 ensemble models with fine performance in prediction of rLDH following PELD. Predicting re-herniation before surgery has the potential to optimize decision-making and meaningfully decrease the rates of rLDH following PELD. Our ML model identified higher BMI, lower FO, Modic changes, disc calcification in a non-protrusive region, and herniation type (noncontained herniation) as significant features for predicting rLDH.

Only Surgical Decompression Is Sufficient for Multilevel Lumbar Spinal Stenosis with Calcified Disc Protrusion and Vacuum Disc: Case Reports

The purpose of this report was to share our successful cases of only surgical decompression for symptomatic multilevel lumbar spinal stenosis, by assessing treatment outcomes and perioperative complications. Two patients who had only surgical decompression for symptomatic multilevel lumbar spinal stenosis in March and May 2021 were investigated. They were preoperatively diagnosed with the calcified disc protrusion and vacuum disc in the intervertebral space by magnetic resonance imaging (MRI) and computed tomography (CT). The chief complaints were severe low back pain and bilateral sciatica 2 or 3 months ago. The patients reported also reported difficulty walking due to sciatica, for which they were admitted to Daegu Wooridul Spine Hospital. Under general anesthesia unilateral laminotomy for bilateral decompression (ULBD) was performed and discectomy was not done on the stenosis levels. Treatment outcomes were analyzed by preoperative and postoperative visual analog scale (VAS) for low back pain and sciatica (Back VAS and Leg VAS), improvement in walking, and postoperative MRI. Treatment outcomes were favorable: Low back pain and bilateral sciatica showed a VAS score improvement (Back VAS=3, Leg VAS=3), the patient’s walking was improved, and on a postoperative MRI of the two patients, the thecal sac was released sufficiently. The patients developed no perioperative complications. Only surgical decompression is an effective method for symptomatic multilevel lumbar spinal stenosis with calcified disc protrusion and vacuum disc in not the spinal canal but the intervertebral space.

Surgical management of giant calcified thoracic disc herniation and the role of neuromonitoring. The outcome of large mono centric series

PurposeGiant thoracic disc herniations (GTDH) are considered a subgroup of TDHs with worse functional outcomes, a high calcification rate, and a considerable risk of complications. We aimed to determine whether there is a relationship between the extent of calcification of GTDH and outcomes concerning the risk of complications, the surgical technique, and changes in neuromonitoring signals. MethodsWe present a retrospective analysis of 76 patients undergoing surgery for calcific GTDH. We introduced and defined a radiological definition of the calcified disc into“fully calcified” and “partially calcified.” We performed a statistical analysis between clinical and radiological variables, type of surgical procedure, the extent of excision, neuro-monitoring signals, and outcome, comparing a group of 58 “fully-calcified TDH” patients and 18 “partially-calcified TDH” patients. ResultsFully calcified TDHs, compared with partially calcified TDHs, do not have significant differences in outcome (worse outcome 4/58–6.9% versus 0/18, p = 0.25) and complications (10/58–17.24% versus 4/18–22.2%, p = 0.63); Fully calcified TDH is associated with a higher risk of alterations in neurophysiological potentials (14/58–24.1% versus 0/18, p = 0.02) and subtotal excision (18/58–31% versus 2/18–11%, p = 0.15), without significant differences between the approaches used. ConclusionFully calcified TDH group has a similar outcome and complication rate as the partially calcified TDH group, but they are associated with higher intraoperative neuromonitoring signal changes. We introduced a new classificationsystem that guides the approach and helps tocounsel the patients.