Disc Protrusion Research Articles

Phase I Study to Assess the Safety and Immunogenicity of an Intradermal COVID-19 DNA Vaccine Administered Using a Pyro-Drive Jet Injector in Healthy Adults

We conducted a nonrandomized, open-label phase I study to assess the safety and immunogenicity of an intradermal coronavirus disease 2019 (COVID-19) DNA vaccine (AG0302-COVID-19) administered using a pyro-drive jet injector at Osaka University Hospital between Yanagida November 2020 and December 2021. Twenty healthy volunteers, male or female, were enrolled in the low-dose (0.2 mg) or high-dose (0.4 mg) groups and administered AG0302-COVID19 twice at a 2-week interval. There were no adverse events that led to discontinuation of the study drug vaccination schedule. A serious adverse event (disc protrusion) was reported in one patient in the high-dose group, but the individual recovered, and the adverse event was not causally related to the study drug. In the analysis of the humoral immune response, the geometric mean titer (GMT) of serum anti-SARS-CoV-2 spike glycoprotein-specific antibody was low in both the low-dose and high-dose groups (246.2 (95% CI 176.2 to 344.1, 348.2 (95% CI 181.3 to 668.9)) at the 8 weeks after first vaccination. Regarding the analysis of the cellular immune, the number of IFN-γ-producing cells responsive to the SARS-CoV-2 spike glycoprotein increased with individual differences after the first dose and was sustained for several months. Overall, no notable safety issues were observed with the intradermal inoculations of AG0302-COVID19. Regarding immunogenicity, a cellular immune response was observed in some subjects after AG0302-COVID19 intradermal inoculation, but no significant antibody production was observed.

Complete tracheal obstruction during anaesthesia for ventral slot decompression surgery in a dog

AbstractAn 8‐year‐old, female Yorkshire terrier presented to the neurology department with a 3‐month history of progressive ambulatory tetraparesis. A diagnosis of intervertebral disc protrusions at the levels of C3–C4 and C6–C7 was made using magnetic resonance imaging. Ventral slot decompressive surgery was carried out at both sites. When accessing the C6–C7 disc space, placement of Gelpi retractors resulted in complete tracheal obstruction, characterised by an absence of end tidal carbon dioxide measurement. This occurred in conjunction with the cessation of abdominal and thoracic respiratory movement despite the use of positive pressure ventilation. Removal of the Gelpi retractors resolved the tracheal occlusion and permitted the resumption of ventilatory support. To facilitate this surgical approach, the trachea was reintubated with a longer endotracheal tube to protect the patency of the airway. To the authors’ knowledge, this is the first report of tracheal obstruction as a complication of a ventral slot procedure.

Evaluation of the Diagnostic Utility of Spinal Magnetic Resonance Imaging in Low Back Pain Patients

Introduction: Low back pain secondary to degenerative disc disease is a condition that affects young to middle-aged persons with peak incidence at approximately 30-39 years. Magnetic Resonance Imaging (MRI) is the standard modality for detecting disc pathology. This study is being conducted to review the pattern of spinal degenerative diseases in patients referred to our institution. Methods: A retrospective study was conducted at Gandaki Medical College Teaching Hospital & Research Centre (GMCTHRC) from January 2018 to April 2018 with approval from the Institutional Review Committee of Gandaki Medical College Teaching Hospital and Research Centre. The MRI findings were noted i.e. disc desiccation, disc bulge (diffuse, symmetrical and asymmetrical), disc protrusion, neural foramen narrowing, traversing nerve root compression, exiting nerve root compression and posterior annular ligament tear. Results: Out of 98 patients enrolled in the study mean age being 41 years. Disc bulge as most common finding seen in 89 (90.8%) followed by protrusion 50 (51.1%) neural foraminal narrowing (NFN) 72 (73.4%) traversing nerve roots (TNR) compression 58 (59.1%) and exiting nerve root (ENR) compression 22 (22.4%). Conclusions: The study shows that degenerative disc diseases remain the cause of morbidity in the most productive years of life (30-40 years). Large volumes of MRIs performed for this condition represent a significant economic and healthcare burden in a developing country like Nepal.

36-YEARS-OLD MALE WITH CERVICAL DISC PROTRUSION AND POSTURAL DEVIATIONS

Structures around the cervical spine are a common source of neck pain and have numerous aetiologies. One of the aetiologies considered here is the sustained abnormal posture; this type of presentation can be seen in the population which works tirelessly in the same position for hours like the patient in our case who works as a technician. Patient’s main concerns were pain in right shoulder radiating till the elbow, the severity of the pain kept the patient awake for nights. Clinical findings include severely restricted extension of neck and reduced lateral flexion and rotation of the affected side; Spurling’s test positive for the affected side and distraction test positive. MRI revealed cervical intervertebral disc protrusion at multiple levels (C3-C4, C4-C5, C5-C6, and C6-C7). This case report concluded that poor cervical posture responsible for overloading on cervical spine leads to disc protrusion in people who work for long hours in abnormal posture.

Frequency of lumbar magnetic resonance imaging findings in patients with low back pain

<p class="abstract"><strong>Background:</strong> Back pain is one of the main causes of disability and has been the most common cause of disability in the last decade. MRI imaging is able to identify soft tissues, including the intervertebral disc, nerves, and muscles, that are potential sources of back pain; it should be noted, however, that in some cases MRI is not able to identify the source of low back pain.</p><p class="abstract"><strong>Methods: </strong>This cross-sectional study was done on 256 patients who referred to the imaging ward of Ardabil city hospital for lumbar MRI from September 2020 and September 2021. These patients in terms of gender, age, type of insurance, disc dehydration, disc protrusion, disc extrusion, disc sequestration, disc dehydration, spondylolisthesis, retrolysis, presence of Taylor cyst, hemangioma, vertebral fracture, spinal abnormality, spinal abnormality Bone marrow SG, spinal canal stenosis, furaminal stenosis, modic changes and the presence of scoliosis were evaluated.</p><p class="abstract"><strong>Results:</strong> The mean age of patients was 45.10 with a standard deviation of 14.28 years. 152 patients (59.4%) were male. 240 patients (93.7%) had health insurance.55 patients (21.5%) had normal MRI. The most common MRI findings in the present study were: extrusion (67.6%), intervertebral disc dehydration (59.4%), protrusion (40.2%), spinal canal stenosis (29.7%) furaminal stenosis (24.2%), retrolysis (19.5%), lumbar scoliosis (14.7%), modic changes in the lumbar vertebrae (14.5%), scoliosis (13.7%), hemangioma (10.5%), spondylolisthesis (9.4%), sequestration (3.1%), spinal abnormalities (2%) and bone marrow SG (1.6%).</p><p class="abstract"><strong>Conclusions: </strong>Based on the results, the most common abnormal findings in MRI of patients with low back pain were: extrusion, protrusion and dehydration of the intervertebral disc. Also, most of these changes were in the lower levels of the lumbar vertebrae.</p>

Diagnostic imaging of the equine cervical spine – Are radiographs enough?

Diagnostic imaging of the equine cervical spine – Are radiographs enough?

Association between Occupation and Cervical Disc Degeneration in 1211 Asymptomatic Subjects.

Magnetic resonance imaging (MRI) system has frequently observed degenerative changes in the cervical discs of healthy subjects. Although there are concerns regarding the link between an individual’s occupation and intervertebral disc degeneration (IDD) in the cervical spine, whether the occupation affects IDD is still not clear. This study aimed to evaluate the occupation and IDD interplay using cervical spine MRI among a cohort of healthy individuals, and to evaluate any association between the type of labor and IDD. Using MRI, we prospectively measured at every level, the anteroposterior (AP) intervertebral disc diameter and disc height, in a cohort of 1211 healthy volunteers (606 (50%) male; mean age, 49.5 years). Using a minimum of 100 male and female each from the third to eighth decades of age (20–79 years), IDD was evaluated based on the modified Pfirrmann classification system to derive a disc degeneration score (DDS). We also measured the AP diameters of disc protrusion and of the dural sac as well as the spinal cord. The overall DDS and number of disc protrusions increased with age. Among 11 occupations, there were no significant differences in AP diameter of the dural sac as well as the spinal cord. For the four labor types (heavy object handling, same position maintenance, cervical extension position, and cervical flexion position), there were no significant differences in overall DDS and number of disc protrusions, with or without work. Also, among the four labor types, there were no significant differences in the AP diameter of the dural sac as well as the spinal cord. In this cross-sectional survey of cervical spine MRI data among healthy adult volunteers, occupation and type of labor might have no effect on IDD in the cervical spine.

Evaluation of lumbar spine using MRI in patients with chronic low back pain

Aim: We compared the prevalence of MR imaging features of lumbar spine degeneration in adults and with self-reported low back pain. Evaluating the patient based on the degree of disc bulge correlating findings on MRI study aimed in establishing the role of MRI in prompt diagnosis to assess the degree of disc herniation. Material and Methods : Patients were evaluated each for the following outcomes : degree of disc bulge, disc degeneration, disc extrusion, disc protrusion, annular fissures, Modic changes, central canal stenosis, spondylolisthesis and spondylolysis, RESULTS : 52 self reported cases of low back pain. 40 of them (80%) met the inclusion criteria, 12 patients had a normal MRI, disc bulge (50%), spondylolysis (20%), disc extrusion (5%), MODIC 1 changes (10%), disc protrusion (5%) and disc degeneration (10%) the degree of disc bulge in the upper lumbar levels showed significant radicular symptoms in symptomatic low back pain patients associated with degenerative changes more in older population with a greater pain scale.

No correlation identified between the proportional size of a prolapsed intravertebral disc with disability or leg pain.

The aim of the study was to determine if there was a direct correlation between the pain and disability experienced by patients and size of their disc prolapse, measured by the disc's cross-sectional area on T2 axial MRI scans. Patients were asked to prospectively complete visual analogue scale (VAS) and Oswestry Disability Index (ODI) scores on the day of their MRI scan. All patients with primary disc herniation were included. Exclusion criteria included recurrent disc herniation, cauda equina syndrome, or any other associated spinal pathology. T2 weighted MRI scans were reviewed on picture archiving and communications software. The T2 axial image showing the disc protrusion with the largest cross sectional area was used for measurements. The area of the disc and canal were measured at this level. The size of the disc was measured as a percentage of the cross-sectional area of the spinal canal on the chosen image. The VAS leg pain and ODI scores were each correlated with the size of the disc using the Pearson correlation coefficient (PCC). Intraobserver reliability for MRI measurement was assessed using the interclass correlation coefficient (ICC). We assessed if the position of the disc prolapse (central, lateral recess, or foraminal) altered the symptoms described by the patient. The VAS and ODI scores from central and lateral recess disc prolapses were compared. A total of 56 patients (mean age 41.1 years (22.8 to 70.3)) were included. A high degree of intraobserver reliability was observed for MRI measurement: single measure ICC was 0.99 (95% confidence interval (CI) from 0.97 to 0.99 (p < 0.001)). The PCC comparing VAS leg scores with canal occupancy for herniated disc was 0.056. The PCC comparing ODI for herniated disc was 0.070. We found 13 disc prolapses centrally and 43 lateral recess prolapses. There were no foraminal prolapses in this group. The position of the prolapse was not found to be related to the mean VAS score or ODI experienced by the patients (VAS, p = 0.251; ODI, p = 0.093). The results of the statistical analysis show that there is no direct correlation between the size or position of the disc prolapse and a patient's symptoms. The symptoms experienced by patients should be the primary concern in deciding to perform discectomy. Cite this article: Bone Joint J2022;104-B(6):715-720.

Biomaterials for Interbody Fusion in Bone Tissue Engineering.

In recent years, interbody fusion cages have played an important role in interbody fusion surgery for treating diseases like disc protrusion and spondylolisthesis. However, traditional cages cannot achieve satisfactory results due to their unreasonable design, poor material biocompatibility, and induced osteogenesis ability, limiting their application. There are currently 3 ways to improve the fusion effect, as follows. First, the interbody fusion cage is designed to facilitate bone ingrowth through the preliminary design. Second, choose interbody fusion cages made of different materials to meet the variable needs of interbody fusion. Finally, complete post-processing steps, such as coating the designed cage, to achieve a suitable osseointegration microstructure, and add other bioactive materials to achieve the most suitable biological microenvironment of bone tissue and improve the fusion effect. The focus of this review is on the design methods of interbody fusion cages, a comparison of the advantages and disadvantages of various materials, the influence of post-processing techniques and additional materials on interbody fusion, and the prospects for the future development of interbody fusion cages.

Effects of Complex Rehabilitation Program on Reducing Pain and Disability in Patients with Lumbar Disc Protrusion—Is Early Intervention the Best Recommendation?

(1) Background: Due to its frequency and possible complications, low back pain (LBP) has a high social impact, it is a common problem of the active population and the second reason for visiting a physician. In patients with lumbar disc protrusion (LDP), one of the most common causes of LBP, the nucleus pulposus bulges against the disc and then protrudes into the spinal cord, but the annulus fibrosus remains intact; (2) Objectives: The primary objective of this study was to determine the efficacy of a rehabilitation treatment (RT) comprising electrotherapy (ET), hydrotherapy (HT) and individualized physical therapy (PT) versus ET alone in patients with LDP. The second objective was to investigate whether there is a correlation between early RT and the symptomatology of patients with LDP; (3) Methods: The research was conducted between July 2021 and January 2022 at the Ceres Hotel Treatment Centre from Baile 1 Mai, Romania, and all the study subjects signed an informed consent form. For this study, the block randomization method was used to randomize subjects into groups that resulted in equal sample size, in order to maintain a reasonably good balance among groups. Therefore, the two groups had the same number of subjects (30 subjects) and the randomization was made taking into account the patient’s motivation or the subject’s willingness to receive not only electrotherapy treatment, but also the physical exercises and hydrotherapy. The eligibility criteria were: low back pain for more than three months, an MRI confirmed diagnosis of LDP (without dural compression), and ability to perform a PT program. The control group received only a classical ET program. In addition, the patients in the experimental group received a complex individualized PT program associated with HT and ET. To achieve these objectives, the study subjects were monitored for spinal mobility (lateral lumbar flexion—LLF, index fingers-ground—IFG, lumbar Schober tests for flexion—LS, Inverted Schober test for extension—ILS), trunk flexor and extensor muscle strength (LF strength, LE strength), level of pain (Short Form McGill Pain Questionnaire—SF-MPQ, Visual Analogue Scale—VAS), and the degree of limitation in activities of daily living (Oswestry Disability Index—ODI); (4) Results: Comparing the evolution of the subjects, using the One-Way ANOVA between groups, we observed a significant improvement in all variables [SF-MPQ (95% CI, 7.996/11.671), VAS (95% CI, 1.965/3.169), mobility FTF (95% CI, −7.687/−3.940), LS (95% CI, 2.272/2.963), LE strength (95% CI, −5.676/−3.324), LF strength (95% CI, −5.970/−3.630), disability (95% CI, 8.026/10.441) after six months of treatment for the experimental group subjects. A clear correlation was found, using the Bravis–Pearson test, between the earliest possible initiation of RT and improvement of patients’ symptoms; (5) Conclusion: The current study proves the importance of combining ET with HT and PT. The earlier the RT is implemented, the lower the pain perception and level of disability associated with the lumbar disease.

Clinical Effect of the Treatment of Lumbar Intervertebral Disc Protrusion.

Compared with traditional acupuncture, it is urgently needed for more effective method for the disease to serve the clinical treatment. This paper combines acupuncture and massage to treat lumbar intervertebral disc protrusion, uses a controlled trial to study the clinical effects of acupuncture combined with massage for the treatment of lumbar intervertebral disc protrusion, combines mathematical statistics to test the data, and compares and analyzes the statistical object parameters. Through experimental research, it is known that in the treatment of lumbar intervertebral disc protrusion, in order to obtain a faster and better effect, traditional acupuncture treatment should be combined with massage therapy. On the basis of fully eliminating the pathological factors, the intervertebral disc is reset by mechanical treatment, which makes the patient more likely to heal. Therefore, it is a comprehensive treatment plan that is worth adopting.

Endoscope-Assisted Retroperitoneal Prepsoas Approach to Lumbar Intervertebral Disk Decompression. Technical Note.

Increasingly there is an impetus on the part of surgeons to find more minimally invasive approaches to treat spinal pathologies. Retroperitoneal prepsoas and transpsoas approaches to the lumbar spine are one such example gaining increased attention. Endoscope-assisted approaches may help further reduce soft tissue dissection. To describe an endoscope-assisted lateral retroperitoneal prepsoas approach for lumbar diskectomy. Two fresh-frozen thoracolumbar cadaveric specimens were obtained and placed in the right lateral decubitus position. Using a left-sided, retroperitoneal prepsoas approach to the lumbar spine and under endoscopic visualization, diskectomies were performed at the L2/3, L3/4, L4/5, and L5/S1 intervertebral spaces. Qualitative assessment of the extent of central and contralateral foraminal decompression was performed. The endoscope was found to provide effective visualization at all disk spaces and combined with the anterior retroperitoneal prepsoas approach allowed for effective decompression of all explored disk spaces. Both operators noted difficulty obtaining visualization of the ipsilateral foramen, but adequate central and contralateral foraminal decompression was achievable for central, paracentral, and contralateral far lateral disk protrusions. Endoscope assistance may improve visualization of the lumbar intervertebral disk spaces during retroperitoneal prepsoas approaches and thereby help to expand the surgical indication for anterior and oblique lumbar interbody fusion.

Low-dose mesenchymal stem cell therapy for discogenic pain: safety and efficacy results from a 1-year feasibility study.

Aim:To evaluate safety and efficacy of low dose autologous adipose-derived mesenchymal stem cells (ADMSCs) for treatment of disc degeneration resulting in low back pain (LBP).Methods:Nine participants with chronic LBP originating from single-level lumbar disc disease underwent intradiscal injection of 10 million ADMSCs with optional repetition after 6 months.Results:No unexpected or serious adverse events were recorded. Seven (78%) of participants reported reductions in pain 12 months after treatment. Five (56%) reported increased work capacity. Three (33%) reduced analgesic medication. Improvements in EQ-5D and Oswestry disability index results were observed. MRI demonstrated no further disc degeneration and improvements to annular fissures and disc protrusions.Conclusion:This study provides initial evidence of safety and efficacy of ADMSCs for discogenic LBP.

Case Report Tuberculous Spondylitis in Elderly with Polyneuropathy

Background Tuberculous (TB) spondylitis or Pott’s Disease is a manifestation of extrapulmonary tuberculosis infection caused by the hematogenous and lymphomatous spread of Mycobacterium Tuberculosis, causing infection in the vertebral bones. Approximately 10% of extrapulmonary TB cases are TB spondylitis. Pulmonary and extrapulmonary tuberculosis cases are considerable cases in developing countries. Indonesia is a country with the third-highest prevalence of TB in the world after China and India.Objective The aim of this study was to report a case of TB spondylitis in a 66 years old woman with polyneuropathy at Bethesda Hospital Yogyakarta.Case description A 66 years old female patient presented with complaints of pain and difficulty in moving the left lower limb 3 months ago. The patient had a history of hypertension 5 years ago, while the family history was not specific. The patient was generally in pain with full awareness and cooperation. Vital sign examination showed blood pressure 140/80 mmHg, pulse 82 beats per minute, and respiratory rate of 22 breaths per minute. The lumbosacral-MRI examination was performed without contrast material and L2-L5 TB Spondylitis, with L2-L3 Disc protrusion, was found.Conclusion Tuberculous spondylitis (TB) may cause paradiscal inflammation, edema, and progressive bone destruction due to lysis of anterior bone tissue and secondary ischemia which will lead to collapse. Pain, difficulty moving, and local swelling are the most common complaints. Abnormalities in the curvature, misalignment of the vertebrae, deformity and bone destruction might be found in MRI radiological imaging. Treatment of TB spondylitis prioritizes administering of anti-TB drugs combined with immobilization using a girdle. The prognosis for TB spondylitis varies depending on the clinical manifestations.

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.

Risk Factors for Poor Outcomes Following Minimally Invasive Discectomy: A Post Hoc Subgroup Analysis of 2-Year Follow-up Prospective Data.

ObjectiveA post hoc subgroup analysis of prospectively collected data from a randomized controlled trial was conducted to identify risk factors related to poor outcomes in patients who underwent minimally invasive discectomy. MethodsPatients were divided into satisfied and dissatisfied subgroups based on Oswestry Disability Index (ODI), visual analogue scale (VAS) back pain score (VAS-back) and leg pain score (VAS-leg) at short-term and midterm follow-up according to the patient acceptable symptom state threshold. Demographic characteristics, radiographic parameters, and clinical outcomes between the satisfied and dissatisfied subgroups were compared using univariate and multivariate analysis. ResultsA total of 222 patients (92.1%) completed 2-year follow-up, and the postoperative ODI, VAS-back, and VAS-leg were significantly improved after surgery as compared to preoperatively. Multivariate analysis indicated older age (p=0.026), lateral recess stenosis (p=0.046), and lower baseline ODI (p=0.027) were related to poor short-term functional improvement. Higher baseline VAS-back (p=0.048) was associated with poor short-term relief of back pain, while absence of decreased sensation (p=0.019) and far-lateral disc herniation (p=0.004) were associated with poorer short-term relief of leg pain. Lumbar facet joint osteoarthritis was identified as a risk factor for poor functional improvement (p=0.003) and relief of back pain (p=0.031). Disc protrusion (p=0.036) predicted poorer relief of back pain at midterm follow-up. ConclusionIn this study, several factors were identified to be predictive of poor surgical outcomes following minimally invasive discectomy. (ClinicalTrials.gov number: NCT01997086).

Treatment of lumbar osteochondrosis by intercuteneous laser diskectomy

Fifteen patients with lumbar osteochondrosis complicated by L4-L5 and L5-S1 disk protrusion treated by interosseous laser diskectomy are reviewed. Early and long-term results are given. In 14 patients (93%) good results were achieved, 1 patients (7%) had satisfactory outcome. Indications for intercutaneous laser diskectomy are the following: low back pain irradiating to lower extremity, and persistent over 3 months, failed conservative treatment, absence of neurologic complications, such as paresis, disturbance of pelvic organs function as well as disk protrusion (size up to 6 mm) confirmed by CT, MRI. This method does not damage soft tissues and allows to achieve persistent release of pain syndrome.

Transforaminal Endoscopic Lumbar Discectomy with versus without Platelet-Rich Plasma Injection for Lumbar Disc Herniation: A Prospective Cohort Study.

Objective Transforaminal endoscopic lumbar discectomy (TELD) is an effective treatment for patients with lumbar disc herniation (LDH) with failure of conservative treatment. However, defects in the annulus fibrosus after TELD usually lead to a recurrence of LDH. Platelet-rich plasma (PRP) injection has shown promising potential for the repair of injured tissues. The combination of TELD and PRP injection has rarely been reported. Hence, this study aimed to evaluate the effectiveness, disc remodeling, and recurrence rate of LDH in TELD with or without PRP in LDH treatment. Methods A total of 108 consecutive patients who underwent TELD were prospectively registered between July 2018 and December 2019 (https://clinicaltrials.gov/ct2/show/ChiCTR1800017228). Fifty-one and fifty-seven patients underwent TELD with PRP injections and TELD only, respectively. The visual analog scale (VAS) score for back and leg pain, Oswestry Disability Index (ODI), and MacNab criteria were evaluated, and perioperative complications were documented. The disc protrusion, spinal cross-sectional area (SCSA), and disc height were measured on MRI and evaluated preoperatively, postoperatively, and at regular follow-up. Results All patients were followed up. Clinical improvement was noted in both groups. There were statistical differences in the VAS scores of back and leg pain and ODI between the two groups at 3 months, 6 months, and 1 year follow-up (P < 0.05); the improvement in the PRP group was significant. The disc protrusion and SCSA on MRI in the PRP group showed better improvement, with lower recurrence rate, than that in the control group at the final follow-up (P < 0.05). No adverse events were reported in our study following PRP injection. Conclusion Our study showed that TELD with PRP injection was a safe and effective treatment for patients with LDH in the medium and long-term follow-up. PRP injection was beneficial for disc remodeling after endoscopic discectomy and decreased the recurrence of LDH.

Brachioradial Pruritus: Clinical, Electromyographic, and Cervical MRI Features in Nine Patients.

BackgroundBrachioradial pruritus (BRP) is a neuropathic dysesthesia manifesting as pruritus over the dorsolateral forearm. While the etiology is unknown, intensive sun exposure and cervical spine disease have been proposed. This study describes the clinical, electrodiagnostic (EDX), and cervical MRI findings in nine patients diagnosed with BRP.Materials and methodsAll patients underwent EDX and cervical MRIs. Numerous metrics were documented including presenting symptoms, neurological examination, EDX findings, and cervical MRI features.ResultsAll nine patients experienced pruritus of the arms/forearms, typical of BRP, which was unilateral in eight (89%) cases. Decreased pinprick sensation was noted in the arms/forearms (five [56%] patients) or of the thumbs, index, and/or middle fingers (four [44%] patients). Four (44%) patients had either decreased or absent biceps and brachioradialis deep tendon reflexes (DTRs), while one (11%) patient had decreased triceps and brachioradialis DTRs. The EDX revealed abnormalities in eight (89%) patients. Increased polyphasic units, decreased motor units, and/or denervation changes were recorded by needle electromyography (EMG) in eight (89%) patients: the biceps in seven (88%) and both the brachioradialis and triceps in four (50%) patients. The EMG abnormalities indicated chronic radiculopathy involving C6 in six patients and C5 and C6 in one patient. All nine patients had cervical spine disease, encompassing disc protrusions, spondylosis, spinal stenosis, and/or foraminal stenosis.ConclusionsBRP in this series of patients was accompanied by chronic cervical radiculopathy involving predominantly C6 and C5. EDX and cervical spine MR imaging should be considered essential investigations in the evaluation of patients with BRP.