Disc Extrusion Research Articles

Magnetic resonance imaging versus computed tomography to plan hemilaminectomies in chondrodystrophic dogs with intervertebral disc extrusion.

To determine the influence of preoperative computed tomography (CT) versus magnetic resonance (MR) on hemilaminectomies planned to treat thoracolumbar (TL) intervertebral disc (IVD) extrusions in chondrodystrophic dogs. Prospective clinical study. Forty chondrodystrophic dogs with TL IVD extrusion and preoperative CT and MR studies. MR and CT images were randomized and reviewed by 4 observers masked to the dog's identity and corresponding imaging studies. Observers planned the location along the spine, side, and extent (number of articular facets to be removed) based on individual reviews of CT and MR studies. Intra-observer agreement was determined between overall surgical plan, location, side, and size of the hemilaminectomy planned on CT versus MR of the same dog. Similar surgical plans were developed based on MR versus CT in 43.5%-66.6% of dogs, depending on the observer. Intra-observer agreement in location, side, and size of the planned hemilaminectomy based on CT versus MR ranged between 48.7%-66.6%, 87%-92%, and 51.2%-71.7% of dogs, respectively. Observers tended to plan larger laminectomy defects based on MR versus CT of the same dog. Findings from this study indicated considerable differences in hemilaminectomies planned on preoperative MR versus CT imaging. Surgical location and size varied the most; the side of planned hemilaminectomies was most consistent between imaging modalities.

Percutaneous endoscopic lumbar discectomy: minimally invasive technique for multiple episodes of lumbar disc herniation

BackgroundsAlthough open lumbar discectomy is a gold standard surgical technique for lumbar disc herniation (LDH), surgery-induced tissue injury may actually become a source of postsurgical pain. Percutaneous endoscopic lumbar discectomy (PELD) is introduced as a minimal invasive spinal technique for LDH. The PELD has gained popularity and shown successful results. The authors report the clinical usefulness of the PELD technique in two patients with the serial multilevel LDHs.Case presentationsA 32-year-old man suffered from radicular pain at the L5 dermatome due to the down migrated soft LDH at the L4–5 level. The PELD was performed to remove the ruptured fragments, yielding a complete decompression of the L5 nerve root. Four years later, he visited the clinic because of right leg radiating pain along the S1 dermatome. An MRI scan revealed the LDH at the L5-S1 level. The PELD with foraminoplasty was also performed successfully at the L5-S1 level. Two months after the second PELD, he visited the clinic again because of severe pain along the left L4 dermatome; consequently, the PELD was also performed at the L3–4 level without any complications. A 34-year-old man presented with radiating pain in the back and both legs at the L5 dermatome. The MR images show a disc extrusion at the L4–5. The patient underwent the PELD at the L4–5 via the left approach. After the PELD, the back and leg pain both improved. One year later, the patient suffered from severe pain in the back and the left anterior thigh. The MR images show a left paramedian LDH at the L2–3. After the PELD was performed at the L2–3, the pain was relieved. The final MR images show no signs of any aggravated degeneration of the intervertebral discs or the facet joints at all of the treated levels.ConclusionWhen multiple episodes of LDH occur in a patient’s life span, PELD could be considered as an alternative good technique to treat LDH in each step by preserving normal anatomic structures.

MRI Evaluation of Lumbar Disc Degenerative Disease

Aim of the work: lumbar disc degenerative disease is most leading cause of back pain, it is the most common cause of disability at age above 45 years and 2nd most common reason for primary care physician visit. Magnetic Resonance Imaging (MRI) is the standard imaging modality for detecting disc pathology due to its advantage of lack of radiation, multi planar imaging capability, excellent spinal soft-tissue contrast and precise localization of intervertebral discs’ changes. this study aimed to evaluate the characterization, extent and changes associated with the degenerative lumbar disc disease by Magnetic Resonance Imaging. Study Design: cross-sectional and observational study. Study Sample: forty consecutive and clinically examined patients with lower back pain suggestive of lumbar disc disease. Material and Methods: 40 patients with age group between 17 and 80 years with low back pain were diagnosed on 1.5 Tesla MRI machine. The following MRI findings were noted: lumbar lordosis preserved or not, ligamentum flavum hypertrophy, facet joint arthrosis or osteophytes formation and Endplate (modic) changes, decreased disc height as compared to the upper and lower vertebral levels and loss of signals, disc bulge at different levels, Disc protrusion and disc extrusion was observed. Result: most of patient showed lossof lumbar lordosis, facet joint arthrosis, ligamentum flavum hypertrophy, Endplate (modic) changes, and osteophytes formation. Disc dehydration which is one of the earliest features of aging and disc degeneration was present in (42%) patients with the most dehydrated disc seen at L4/L5 and L5/S1. Patients with degenerative disc disease had the following disc contour abnormalities. Disc bulges (26.5%) and herniations (10.5%). Herniations were further reported as broad based herniations (9.5%), extrusions (19.0%) and the protrusions (71.4%). The most common site for bulges and herniations was L4/L5 (33.6%) and (57.1%) respectively. The most common complication of bulges and herniations was impingement of exiting nerve roots (40%) and compression of exiting nerve roots and cauda equina (47.6%) respectively. Conclusion: lumbar disc degeneration is the most common cause of low back pain. It is the most common cause of disability at age above 45 years. Plain radiograph can be helpful, but MRI is the standard imaging modality for detecting disc pathology due to its advantage of lack of radiation, multi planar imaging capability, excellent spinal soft-tissue contrast and precise localization of intervertebral discs changes.

Right Shoulder Pain

HISTORY: A 48 year-old right-handed AAF with no significant PMH presented with right shoulder weakness and pain for 2 weeks. There was no inciting event or recent changes in activity. Her symptoms began 2 weeks after a viral URI. She works as a network manager and started developing acute pain for a few days, which was followed with stiffness, weakness and numbness on the lateral side of her arm. The pain then become constant and the numbness and tingling were intermittent and radiating into her hand. Her symptoms had been worsening over the prior week specifically with overhead activity. She had been using NSAID’s, ice/heat and massage with no relief PHYSICAL EXAMINATION: Winging of the right scapula was noticed as well as tenderness over the deltoid. Passive ROM was normal with decreased active ROM; forward flexion and abduction 0-120 degrees, abduction external rotation 0-60 degrees. Supraspinatus, infraspinatus and triceps strength 3/5 with normal deltoid and trapezius strength. Hawkin’s, Neer’s, Empty can, and Impingement tests are all positive. Obrien’s, Yergason’s and Crossover tests negative. DIFFERENTIAL DIAGNOSIS: Parsonage-Turner syndrome, Cervical disk disease, Shoulder impingement syndrome, Neoplastic brachial plexopathy, Supraspinatus tendinopathy TESTS AND RESULTS: Xray were obtained; no fracture, arthritis or soft tissue abnormalities were seen. Patient was sent for cervical and plexus MRI as well as EMG and nerve conduction studies. MRI results were without infiltrating process or extrinsic compression on the brachial plexus. Cervical spine MRI revealed a small right central disc extrusion without impingement. Nerve conduction studies demonstrated significant differences between the right and left Median and Ulnar nerves. The right Median and Ulnar nerves F-wave latency showed no response compared to 20.3 msc on the left side, which is consistent with a proximal injury as at the level of the plexus. FINAL WORKING DIAGNOSIS: Parsonage-Turner syndrome OUTCOME: Patient was given Toradol and Depomedrol IM as well as Medrol dose pack and Amitriptyline. She was also referred to PT. RETURN TO ACTIVITY AND FOLLOW UP: 7 weeks after the initiation of the treatment patient reported almost complete resolution of her symptoms. She was instructed to follow up as needed if not complete resolution within 8 weeks.

Evaluation of T2-weighted versus short-tau inversion recovery sagittal sequences in the identification and localization of canine intervertebral disc extrusion with low-field magnetic resonance imaging.

Sagittal T2-weighted sequences (T2-SAG) are the foundation of spinal protocols when screening for the presence of intervertebral disc extrusion. We often utilize sagittal short-tau inversion recovery sequences (STIR-SAG) as an adjunctive screening series, and experience suggests that this combined approach provides superior detection rates. We hypothesized that STIR-SAG would provide higher sensitivity than T2-SAG in the identification and localization of intervertebral disc extrusion. We further hypothesized that the parallel evaluation of paired T2-SAG and STIR-SAG series would provide a higher sensitivity than could be achieved with either independent sagittal series when viewed in isolation. This retrospective diagnostic accuracy study blindly reviewed T2-SAG and STIR-SAG sequences from dogs (n = 110) with surgically confirmed intervertebral disc extrusion. A consensus between two radiologists found no significant difference in sensitivity between T2-SAG and STIR-SAG during the identification of intervertebral disc extrusion (T2-SAG: 92.7%, STIR-SAG: 94.5%, P = 0.752). Nevertheless, STIR-SAG accurately identified intervertebral disc extrusion in 66.7% of cases where the evaluation of T2-SAG in isolation had provided a false negative diagnosis. Additionally, one radiologist found that the parallel evaluation of paired T2-SAG and STIR-SAG series provided a significantly higher sensitivity than T2-SAG in isolation, during the identification of intervertebral disc extrusion (T2-SAG: 78.2%, paired T2-SAG, and STIR-SAG: 90.9%, P = 0.017). A similar nonsignificant trend was observed when the consensus of both radiologists was taken into consideration (T2-SAG: 92.7%, paired T2-SAG, and STIR-SAG= 97.3%, P = 0.392). We therefore conclude that STIR-SAG is capable of identifying intervertebral disc extrusion that is inconspicuous in T2-SAG, and that STIR-SAG should be considered a useful adjunctive sequence during preliminary sagittal screening for intervertebral disc extrusion in low-field magnetic resonance.

Frozen shoulder: evaluation of intraarticular corticosteroids injection versus suprascapular nerve block “A prospective clinical study”

Introduction: Adhesive capsulitis (frozen shoulder) has an incidence of 3-5% in the general population. This disorder is one of the most common musculoskeletal problem seen in orthopaedics. Aims and objectives 1. The study was designed to assess the effectiveness of suprascapular nerve block (SSNB) and intra articular steroid (IAS) to relieve pain and improve range of motion. 2. To assess which one had better results in terms of simple pain score and SPADI (shoulder pain and disability index) score along with range of movement at shoulder joint. 3. To record any adverse effects and complications. Materials and methods: The study was conducted in department of orthopaedics, S.M.S. Medical college and attached group of hospitals, Jaipur, with due permission from institutional ethical committee and review board after taking informed and written consent from the patient from 1.4.2015 to 1.4.2016 Study design: hospital based, prospective, randomized, comparative study. Sample size: Sample size was calculated to be 23 subjects in each of 2 groups. Inclusion criteria 1. Patients with history of chronic shoulder pain and decreased range of motion (active and passive) of shoulder. 2. Age group 40-70 years. 3. Either sex. 4. Patients with pain and stiffness for atleast 4 weeks. 5. Who have been on conservative management like pain killers, physiotherapy etc. 6. Patients who give consent to participate in study. 7. Diabetic patients whose HbA1c is less than 6.5% and fasting blood sugar levels are less than 126 mg/dl. Exclusion criteria 1. Patients with intrinsic pathologies of the shoulder such as a) rotator cuff tears b) biceps tendinitis c) Calcific tendinosis. d) History of fracture and dislocation. e) Arthritis of glenohumeral or acromioclavicular joint. f) Sympathetic dystrophy. 2. Patients with extrinsic problems such as a) Neuromuscular disorders (Parkinsonism). b) Referred pain from associated conditions- extrusion of a cervical disc with radiculopathy. c) History of previous surgery of affected shoulder. 3. Patients who refuse to participate in study Results: In early follow ups there was significant improvement in abduction in IAS group than SSNB group, but at final follow up almost normal range of motion was achieved in both the groups. The average improvement in abduction in SSNB group was 86.92º and 68.46º in IAS group. Both groups achieved almost normal range of ER movement at final follow up. The average improvement in ER was 25.19º (SSNB- 32.3º & IAS – 18.08º).All groups achieved significant improvement in pain and restriction of movement and achieved almost normal day to day activity at final follow up. Overall good to excellent results were seen in both the groups.

Residual Spinal Cord Compression Following Hemilaminectomy and Mini-Hemilaminectomy in Dogs: A Prospective Randomized Study.

The aim of this study was to compare the reduction of spinal cord compression after surgical treatment of dogs with acute thoracolumbar intervertebral disc (IVD) extrusion achieved using hemilaminectomy versus mini-hemilaminectomy techniques. This was a prospective randomized study with client-owned dogs presented with acute IVD extrusion that were allocated to surgical treatment using hemilaminectomy (n = 15) or mini-hemilaminectomy (n = 15) techniques. Plain and intravenous-contrast computed tomography was performed pre- and postoperatively. The preoperative minimal cross-sectional dimension of the spinal cord (MDSCpre) and the postoperative minimal cross-sectional dimension of the spinal cord (MDSCpost) were measured at the level of greatest compression. The minimal diameter of the uncompressed spinal cord was measured in a similar way both pre- (MDUSCpre) and postoperatively (MDUSCpost). Dogs in the mini-hemilaminectomy group had significantly greater reduction of compression (RC) (p < 0.01) after surgery compared to dogs in the hemilaminectomy group. The mean RC in the hemilaminectomy group was 34.6% and in the mini-hemilaminectomy group 62.6%. Our results showed a significantly greater reduction of spinal cord compression for mini-hemilaminectomy compared to hemilaminectomy. Additionally, mini-hemilaminectomy could be a preferred method due to its minimal invasiveness and easier access to lateral fenestration.

Associations Between Anesthetic Variables and Functional Outcome in Dogs With Thoracolumbar Intervertebral Disk Extrusion Undergoing Decompressive Hemilaminectomy.

BackgroundOutcome of acute experimental spinal cord injury is strongly associated with tissue perfusion and oxygenation. Cardiopulmonary depression could affect outcome in dogs undergoing general anesthesia for surgical treatment of thoracolumbar intervertebral disk extrusion (IVDE).Hypothesis/ObjectivesTo evaluate the effects of general anesthesia on functional outcome in dogs undergoing surgery to treat thoracolumbar IVDE.AnimalsEighty‐four client‐owned dogs with acute thoracolumbar IVDE treated by decompressive hemilaminectomy.MethodsExploratory, retrospective observational study. Medical records were reviewed for clinical presentation and anesthetic monitoring variables, including duration of anesthesia and surgery, hypotension, bradycardia, temperature, and respiratory parameters. Multivariable regression tree analysis was performed to explore associations between anesthetic variables and functional outcome scores after 6 weeks, as well as return to ambulatory status.ResultsEpisodes of bradycardia (69%) and hypotension (57%) were frequent. Across all outcome measures, regression tree analysis highlighted functional grade at presentation as the primary determining factor, and among pain perception negative dogs, there was a possible association between increased duration of surgery and poorer outcome. In dogs with intact pain perception, duration of bradycardia, mean body temperature, and mean end‐tidal carbon dioxide were highlighted.Conclusions and Clinical ImportanceExploratory statistical methods can facilitate hypothesis‐generating studies to inform prospective investigations in veterinary medicine. Although the mechanism is uncertain, increased duration of surgery might be associated with poorer outcome in pain perception negative dogs with thoracolumbar IVDE.

Postoperative pain in dogs undergoing hemilaminectomy: Comparison of the analgesic activity of buprenorphine and tramadol

Abstract The objective of this study was to compare the analgesic activity of buprenorphine and tramadol for the management of postoperative pain after hemilaminectomy because of acute intervertebral disc extrusion in dogs. This is a randomized, blinded, and prospective clinical trial. The study was carried out on 50 dogs undergoing hemilaminectomy. After diagnosis, the dogs were divided randomly into 2 groups: group A (n = 25 dogs) received 3 mg/kg −1 of tramadol intramuscularly and group B (n = 25 dogs) received 0.02 mg/kg −1 of buprenorphine intramuscularly 10-15 minutes before the end of surgery and, then, every 8 and 6 hours, respectively, for 48 hours. Using the short form of the Glasgow Composite Pain Scale at 4 time points (before and 2, 12, and 24 hours after surgery), the dogs were clinically monitored and scored by the same operator who was blinded to the treatment. Data were analyzed using Mann-Whitney U tests. Significance was set at P

Long-Term Course to Lumbar Disc Resorption Patients and Predictive Factors Associated with Disc Resorption.

The long-term course to lumbar intervertebral disc herniation (LDH) patients receiving integrative Korean medicine treatment and predictive factors associated with disc resorption were investigated. LDH patients who received integrative Korean medicine treatment from February 2012 to December 2015 and were registered in the “longitudinal project for LDH on MRI” were included. Disc resorption amount was measured 3-dimensionally with disc degeneration and modic change levels on baseline and follow-up MRIs. Patient characteristics, Korean medicine use, pain, symptom recurrence, and satisfaction were assessed through medical records and phone surveys. Of 505 participants, 19 did not show disc resorption, while 486 did. A total of 220 displayed resorption rates of ≥50%. LDH volume at baseline was 1399.82 ± 594.96 mm3, and that on follow-up MRI was 734.37 ± 303.33 mm3, indicating a 47.5% decrease (p < 0.0001). Predictive factors for disc resorption were disc extrusion, Komori migration classification, and LDH amount. Approximately 68.4% did not experience symptom recurrence over the 51.86 ± 19.07-month follow-up, and 90.3% were satisfied with Korean medicine treatment. The majority of LDH patients who improved after integrative Korean medicine treatment showed disc resorption within 1 year with favorable long-term outcomes. Predictive factors for disc resorption should be duly considered for informed decision-making. This trial is registered with ClinicalTrials.gov NCT02841163.

Pattern of lumbosacral magnetic resonance imaging findings in diagnosed cases of disc degenerative disease among Nigerian adults with low back pain

Background: Lumbar spine disc degenerative disease (DDD) has been proven to be the most common cause of low back pain which causes musculoskeletal disability. Magnetic resonance imaging (MRI) allows detailed evaluation of all components of the lumbar spine and assesses abnormalities that may be associated with disc degeneration. Objective: To document the frequency of lumbosacral MRI findings in DDD with correlation to age, gender, and lumbar disc level. Methodology: Two hundred and eighty-one out of three hundred archived magnetic resonance images of patients aged 18 years and above investigated for low back pain at Memfys Hospital for Neurosurgery were enrolled into the study. Axial and sagittal magnetic resonance images were acquired at 5 mm slice thickness with 1 mm gap using spin echo pulse sequence. Results: The mean age of the study population was 55.11 years with a range of 18-91 years. Highest frequency of disc degenerative changes fell within 50-59 years age group and L4/L5 level with male preponderance. Positive findings were disc bulge 51.2%, disc protrusion 87.5%, disc extrusion 19.6%, disc sequestration 1.78%, Modic endplate changes 47.4%, Modic I 10.7%, Modic II 15.3%, and Modic III 21.4%. Logistic regression analysis showed that only posterior disc protrusion and disc bulge were significant. Odd ratio 0.062 and 0.015, respectively, while the beta values are −4.190 and −2.780, respectively. Conclusion: The most common lumbosacral MRI findings in diagnosed cases of DDD among patients with low back pain in this study were posterior disc protrusion, posterior disc bulge, and endplate changes.

Extraforaminal Extrusion of Intervertebral Disc Misdiagnosed as Neurogenic Tumor: a Case Report

Extraforaminal Extrusion of Intervertebral Disc Misdiagnosed as Neurogenic Tumor: a Case Report

Postoperative computed tomography and low-field magnetic resonance imaging findings in dogs with degenerative lumbosacral stenosis treated by dorsal laminectomy.

To describe postoperative computed tomography (CT) and magnetic resonance imaging (MRI) findings in dogs with degenerative lumbosacral stenosis (DLSS) treated by dorsal laminectomy and partial discectomy. Prospective clinical case study of dogs diagnosed with and treated for DLSS. Surgical and clinical findings were described. Computed tomography and low field MRI findings pre- and postoperatively were described and graded. Clinical, CT and MRI examinations were performed four to 18 months after surgery. Eleven of 13 dogs were clinically improved and two dogs had unchanged clinical status postoperatively despite imaging signs of neural compression. Vacuum phenomenon, spondylosis, sclerosis of the seventh lumbar (L7) and first sacral (S1) vertebrae endplates and lumbosacral intervertebral joint osteoarthritis became more frequent in postoperative CT images. Postoperative MRI showed mild disc extrusions in five cases, and in all cases contrast enhancing non-discal tissue was present. All cases showed contrast enhancement of the L7 spinal nerves both pre- and postoperatively and seven had contrast enhancement of the lumbosacral intervertebral joints and paraspinal tissue postoperatively. Articular process fractures or fissures were noted in four dogs. The study indicates that imaging signs of neural compression are common after DLSS surgery, even in dogs that have clinical improvement. Contrast enhancement of spinal nerves and soft tissues around the region of disc herniation is common both pre- and postoperatively and thus are unreliable criteria for identifying complications of the DLSS surgery.

Molecular effects of chondroguard in osteoarthritis and herniated discs

Chondroitin sulfates (CS) are a building material for the cartilage and have anti-inflammatory and antioxidant effects. The paper gives the results of analyzing the pharmaceutical composition of chondroguard and its pharmaceutical substance CS-BIOACTIVE (CS-BIOACTIVE©Bioiberika S.A.U., Spain). It discusses the molecular-physiological mechanisms of action of CS in intervertebral disc extrusions and protrusions.

Proportion recovery and times to ambulation for non-ambulatory dogs with thoracolumbar disc extrusions treated with hemilaminectomy or conservative treatment: A systematic review and meta-analysis of case-series studies

Thoracolumbar intervertebral disc extrusion is a common cause of spinal cord dysfunction in dogs. Peer-reviewed studies reporting treatment of predominantly chondrodystrophic dogs with disc extrusion with loss of ambulation with either hemilaminectomy or conservative treatment (rest, analgesics and anti-inflammatories) were evaluated in a systematic review of the literature.Generally, the level of evidence available was low with no controlled studies and only case series available. In the meta-analysis, there was a clear trend to a greater proportion of dogs recovering and returning faster to ambulation for dogs treated with hemilaminectomy than for conservatively treated dogs. The mean proportions that recovered for neurological grades 3, 4 and 5 were 93, 93 and 61% for those treated with hemilaminectomy, and 79, 62 and 10% for those treated conservatively (Grade 3 – non-ambulatory paraparetic dogs; grade 4 – paraplegic dogs with intact deep pain perception; grade 5 – paraplegic dogs without intact deep pain perception). Due to the use of case series, these results represent between-study comparisons, thereby increasing the risk of selection bias and other biases. Data presented in this review support the current recommendations for surgical management of non-ambulatory dogs with disc-extrusion, but controlled clinical studies comparing outcomes are necessary to confirm these findings.

The Significance of Foraminotomy in Lumbar Herniated Disc Surgery

Introduction: Spinal column represents a strong and flexible body axis. It is consisted of vertebrae which are connected by the intervertebral disk and solid fibrous joints. Aim of the Study: To ascertain whether or not and to what extent foraminotomy affects the final outcome of lumbar herniated disc surgery. Patients and Methods: This retrospective study analyzed 71 patients who were operated at the Clinic of Neurosurgery in Banja Luka, in the period from 2009 to 2016. Extirpation of disc was performed in 41 respondents, while in 30 patients, a nerve root was further alleviated, along with the extirpation of disc. All patients were operated under the same conditions. Results: There was no statistically significant difference in the age of women and men who underwent classical discectomy and foraminotomy. There was a statistically significant difference in the disc protrusion and extrusion in patients who underwent conventional discectomy and those who underwent foraminotomy, along with conventional discectomy. There was no statistically significant difference in diagnosis in respondents who underwent conventional discectomy and those who underwent foraminotomy, along with conventional discectomy. There was statistically significant difference in the severity of pain in patients who underwent conventional discectomy and those who underwent foraminotomy, along with conventional discectomy. There was a statistically significant difference in clinical recovery, where the findings were in favor of the respondents who underwent foraminotomy, compared to the respondents who did not. Discussion: The treatment of this syndrome is complex, multidisciplinary and with problematic success, and in cases when the operation is performed, the results are not as good as in the primary operation. Conclusion: The results of this study show that the patients who underwent foraminotomy during the operation of prolapsed lumbar disc have a clinically better result.

MRI of the Psoas Major Muscle: Origin, Attachment, Anatomical Variants and Correlation with the Lumbar Disc Extrusion

MRI of the Psoas Major Muscle: Origin, Attachment, Anatomical Variants and Correlation with the Lumbar Disc Extrusion

92 - Can MRI Detect Ruptured Posterior Longitudinal Ligament in Patients Having Nontraumatic Cervical Disc Extrusion and Sequestration?

92 - Can MRI Detect Ruptured Posterior Longitudinal Ligament in Patients Having Nontraumatic Cervical Disc Extrusion and Sequestration?

Association between clinically diagnosed lumbar intervertebral disc prolapse and magnetic resonance image findings

There are contradictory reports on the findings of magnetic resonance image (MRI) in lumbar intervertebral disc prolapse. A study was conducted on 54 patients using 3 of 4 clinical criteria (low back pain with radiation down to the lower limbs, radicular pain along specific dermatomes, positive straight leg raising test, presence of neurological symptoms and signs e.g. motor or sensory deficit and MRI of lumbosacral spine of the respondent). Evaluation of MRI of lumbosacral spine was done based on extent of disc prolapse, disc degeneration, nerve root compression neural foramen compromise. The logistic regression analysis between the findings of MRI and the clinical features show that there was a significant association in the neural foramen or lateral recess (Odd's ratio 7.106, p&lt;0.05), the root compression (p&lt;0.01) as well as the disc extrusion (p&lt;0.05). There was no statistical association between clinical levels and other MRI findings like disc protrusion and disc bulge (p value 0.21 and 0.14, respectively). The strength of agreement between clinical and MRI diagnosis level of disc prolapse was calculated using kappa statistics (k-value). The test revealed a very good agreement for L3/4 (k-value = 0.812) and good agreement for L4/5 and L5/SI level (k-value 0.75 and 0.75 respectively) between these two procedures, suggesting that level of disc prolapse could be correctly diagnosed without MRI findings. In conclusion, clinically diagnosed levels associate well with MRI levels, but all MRI abnormalities do not have any clinical significance.

Transpedicular Lumbar Endoscopic Surgery for Highly Migrated Disk Extrusions: Preliminary Series and Surgical Technique

Endoscopic surgery for highly migrated lumbar disk extrusions is a challenge even for spine surgeons who are familiar with using endoscopic techniques. Because of the anatomic constraints involved in transforaminal access in endoscopic surgery, an incomplete removal of a highly migrated disk extrusion can result in some cases. Here the authors describe a new technique for accessing extruded lumbar disks that have migrated into the canal directly through a transpedicular approach. A technique for the endoscopic treatment of highly migrated lumbar disk extrusions is presented. Retrospectively, we reviewed a series of 21 consecutive patients operated on with lumbar 3-4, lumbar 4-5, and lumbar 5-sacral 1 highly migrated disk extrusions: preoperative and postoperative clinical data with 1-year follow-up. A preliminary series of 11 male and 10 female patients with an average age of 56.9 years (from 33-78 years old) who underwent transpedicular endoscopic retrieval of an extruded lumbar disk between 2012 and 2015 is presented. Two patients required revision to transforaminal access, 1 at the same sitting and the other 4 weeks later. The mean visual analog scale score for radicular pain improved from an average pain score before surgery of 8.1-1.7 one year after surgery. No pedicle fractures were encountered. Transpedicular endoscopic access to highly migrated lumbar herniated disk extrusions is presented as a unique minimally invasive approach to extruded lumbar herniated disks, especially at L3-4, L4-5, and L5-S1.