Removal Of Disc Research Articles

Platelet Rich Plasma in the Management of Recurrent Lumbar Disc Surgery; A Study of Ten Cases

Low back pain (LBP) is a very common entity, now regarded as the first cause of disability worldwide. Intervertebral disc (IVD) degeneration leads to posterior rupture annulus fibrosus (AF) with extrusion of Central Nucleus pulposus (NP) through the injured area which has little potential to repair as it has no blood supply and causes mechanical pressure and inflammatory changes in the nerve root causing LBP. Autologous platelet rich plasma (PRP) contain concentrate blood that contain a natural concentration of autologous growth factors and cytokines and currently widely used in the clinical setting for tissue regeneration and repair. PRP had great potential to stimulate cell proliferation and metabolic activity of IVD effectively restoring structural change, improving matrix integrity, IVD regeneration, reducing discogenic back pain. Our Study of 10 cases, where repeat or re-exploration surgery (after primary PLID Surgery, fenestration and discectomy) was done, where removal of recurrent disc 5, release of epidural fibrosis and perineural scarring 4 and surgical debridement for discitis 1 was done. In addition, PRP was given in the disc space & around the nerve root which provides lots of growth factor, cytokines which helps in disc regeneration and prevent adhesion & fibrosis. These dual actions enhance symptomatic recovery of all cases. Large scale studies may be required to confirm the clinical evidence of PRP for the treatment of discogenic LBP Bang. J Neurosurgery 2024; 13(2): 70-74

RhBMP-2-loaded hydroxyapatite/beta-tricalcium phosphate microsphere/hydrogel composite promotes bone regeneration in a novel rat femoral nonunion model.

Nonunion following fracture treatment remains a significant clinical challenge, adversely affecting the patient's quality of life and imposing a substantial economic burden. The emergence of bone morphogenetic protein 2 (BMP-2) for bone regeneration represents a promising avenue, albeit limited by side effects such as inflammatory reactions primarily due to suboptimal drug delivery systems. This study focuses on NOVOSIS putty (NP), a novel biomaterial designed for the sustained release of BMP-2, aiming to mitigate these limitations and enhance bone healing. This research aimed to evaluate the effectiveness of NP, a hydroxyapatite granules/β-tricalcium phosphate hydrogel composite (HA/β-TCP/hydrogel), as a BMP-2 carrier for promoting bone regeneration in a new rat nonunion model of long bone. Using Sprague Dawley rats, a 2-mm silicone disk was interposed at the femoral fracture site, and intramedullary fixation with K-wire was performed to create a nonunion with a 2-mm bone defect. After 3weeks, internal fixation with a plate, removal of the silicon disk, and refreshing the nonunion site were performed by implanting three different materials into the nonunion sites: allogenic iliac bone (IB), collagen sponge (CS) containing 10μg of BMP-2, or NP containing 10μg of BMP-2. Bone healing was evaluated weekly using micro-computed tomography (CT); ex vivo micro-Ct and histological evaluation were conducted at 6weeks. At 6weeks, NP demonstrated a significantly higher bone union rate (76.5%) compared with the CS group (35.3%, p = 0.037), and the IB group (6.3%, p < 0.0001). Bone mineral density (BMD) and bone volume/tissue volume (BV/TV) were also significantly higher in the NP group compared with the CS group (BMD, p < 0.0001; BV/TV, p = 0.031). Histological analysis showed the fracture gap in the NP group was filled with more trabecular bone and less fibrous tissue compared with the CS group. The study confirms NP is a highly effective BMP-2 carrier, significantly improving bone union rates and new bone formation in nonunion fractures. The sustained release of BMP-2 from the hydrogel component reduced inflammatory responses and enhanced bone regeneration. NP can be a promising alternative to collagen-based BMP-2 delivery systems.

Regional differences in reimbursement rates from Medicare, Medicaid, and FAIR Health across common procedures for neurological surgeons.

FAIR Health-a nonprofit, state-funded database-was created as an independent repository of healthcare claims paid data to address allegations of price fixing. Many insurers have forced physicians to negotiate payments based on Medicare rates, rather than utilizing FAIR Health. The authors' objective was to provide an overview of regional differences in reimbursement rates per several sample neurosurgical Current Procedural Terminology (CPT) codes and to compare Medicare, Medicaid, and usual, customary, and reasonable rates via FAIR Health rate estimates. The authors compared FAIR Health rates for three common neurosurgical CPT codes: 61510 (removal of bone from skull for removal of upper brain tumor), 22630 (fusion of lower spine bones with removal of disc, posterior approach, single interspace), and 62223 (creation of a brain fluid drainage shunt, ventriculoperitoneal, ventriculopleural, or other terminus), with Medicare and Medicaid reimbursement to evaluate differences in five different regions in the US. Medicare and Medicaid reimbursement rates were consistently and significantly lower than FAIR Health in-network rates across all three CPT codes evaluated (p < 0.001 for all). Significant regional differences exist per census data in median age, median income, employment rates, and degree of health coverage (p < 0.001, p = 0.002, p = 0.002, and p = 0.001, respectively). Reimbursement estimates were found to have regional variation: Medicare/Medicaid rates were significantly lower than FAIR Health in-network rates for all codes across regions with a region-based interaction for reimbursement for code 62223 (p = 0.020). Medicare and Medicaid rates did not significantly vary across regions. Inherent differences exist between cities and states, including median income, employment rates, and health coverage. Despite geographic cost practice indices for Medicare and state-specific production of Medicaid, Medicaid/Medicare reimbursement rates did not vary across regions but were consistently and significantly lower than FAIR Health estimates throughout the US. Locale-specific variation in FAIR Health may further indicate a better accounting of regional differences in cost of practice.

Expectations in patients undergoing spine surgery are high and unmet

BACKGROUND CONTEXTDefining success in spine surgery lacks a standardized approach, and all existing concepts are based on registrations after surgery. PURPOSETo examine patients’ expectations before spine surgery assessed by a modified Oswestry Disability Index (ODI) and Numeric Rating Scale (NRS). The authors asked: how do the expectations align with actual outcomes and can a patient's individual expectations be used as a success criterion in itself? STUDY DESIGN /SETTINGProspective single-center study. PATIENT SAMPLEPatients scheduled for spine surgery at Akershus University Hospital (AHUS) were included in the study. They underwent 1 of 3 procedures: decompression for spinal stenosis, disc removal for lumbar disc herniation, or spinal fusion for degenerative disc disease. OUTCOME MEASURESModified and standard version of ODI and NRS (back and leg pain). METHODSPreoperatively, the patients were given a modified ODI and NRS questionnaire in which they were asked to register the minimum acceptable functional impairment and pain they anticipated to have postsurgery. The patients’ expectations were compared with 3-and 12-month follow-up data from the Norwegian Registry for Spine Surgery (NORspine) with ODI, NRS and Global Perceived Effect (GPE) scale. We used simple descriptive statistics. RESULTSA total of 93 patients completed the pre-op questionnaire. Of these, 65 responded to the 3-month follow-up and 53 at 12-month follow-up. The mean (95%CI) ODI before surgery was 38.3 (34.2–42.3), the mean (95% CI) preoperative NRS back pain was 6.34 (5.81–6.88), and leg pain was 6.67 (6.08–7.26). The patients expected a mean (95% CI) ODI of 10.5 (7.5–13.5), mean (95%CI) NRS back pain of 2.5 (2.1–3.0), and NRS leg pain of 1.8 (1.5–2.2). The actual clinical outcome after 12 months were a mean (95% CI) ODI of 21.7 (17.0–26.5), NRS back pain of 3.4 (2.8–4.1), and leg pain of 2.8 (2.0–3.5). Only 12 (30.8%) patients achieved their expected ODI, while 26 (65.0%) classified themselves as significantly better according to GPE. CONCLUSIONSPatients seem to have high expectations before spine surgery, and the expectations may exceed the clinical outcome. Only 30.8% had their ODI expectations met, but perceived benefit was higher. High expectations may be due to inadequate preoperative information and/or the unsuitability of ODI for capturing expectations.

Biomechanical Effects of Titanium Alloy Based Single versus Dual Cage Fusion Devices

Degenerative disc disease is an increasing problematic complication following lumbar fusion surgeries. Posterior lumbar interbody fusion (PLIF) is a well-established surgical method for spine stability following intervertebral disc removal. The position and number of titanium cages in PLIF are remain contingent on individual surgeon experience. Thus, a systemic investigation of the efficacy of titanium single mega cage versus two cages in treating degenerative lumbar spinal diseases is imperative. A biomechanical study was aimed to compare the stability achieved in PLIF through interbody reconstruction using a single mega cage (32 mm) Vs. a dual cage (22 mm). Normal intact finite element model of L3–L4 was developed based on computed tomography images from a healthy 27-year-old male volunteer. The study tested the intact model (Model A) and its surgically operated counterparts using four PLIF implantation methods: single transverse cage (Model B), single transverse cage with bone graft (Model C), dual transverse cage (Model D), and dual transverse cage with bone graft (Model E). Combined loads simulating physiological motions—flexion, extension, axial rotation, and lateral bending —were applied across all loading directions. The assessment includes all model range of motion (ROM), micromotion between the cage and endplate, and stress on the cage and internal fixation system (screw and rod). The ROM between Models B, C, D and E were consistently reduced by over 71% compared to intact Model A under all motion scenarios. Model D exhibited the highest peak stress of 115 MPa on the cage during flexion, surpassing Model C and E (Flexion) by fourfold. Model E demonstrated the lowest cage stress (20 MPa) during extension, outperforming the other models. Notably, Model E exhibited minimal endplate stress (2 MPa), cage stress (21 MPa), micromotion (13 µm) during extension, and screw-rod stress (56 MPa) during flexion, making it superior to other implantation methods. In the context of PLIF, Model E showed enhanced biomechanical stability, reducing ROM, stress on the endplates, cage, screw-rod system and micromotion. Alternatively, Model C may be a viable alternative in standard PLIF, especially in cases with limited intervertebral space, providing efficient clinical outcomes with shorter operative times and reduced costs and ease of implantation. Also, this computational study provides valuable understandings into optimizing cage implantation strategies for improved outcomes during PLIF.

Rotational Latissimus Dorsi Flap for Lateral Repair of Thoracic Cerebrospinal Fluid-Pleural Fistula: Case Report.

Giant calcified thoracic discs are challenging surgical pathologies that tend to be more centrally located and calcified. This complicates the removal process and potentiates the formation of dural defects, resulting in persistent cerebrospinal fluid (CSF) leaks and the formation of pleural fistulas. The typical intervention for this is CSF diversion through external ventricular drain or lumbar drain placement, followed by direct repair. However, if all these measures fail, subsequent salvage techniques have not been described previously. A 45-year-old man with past medical history of obesity (body mass index: 58), hypertension, and type 2 diabetes mellitus presented to the emergency department with thoracic myelopathy symptoms. MR demonstrated a giant calcified thoracic discs at T7-T8 with severe spinal cord compression. Intraoperatively, the disc was found fused to the dura and removal caused a large ventrolateral dural dehiscence. CSF diversion and direct repair were attempted unsuccessfully, so a salvage procedure with a rotational pedicled latissimus dorsi flap was performed. The patient's latissimus dorsi was exposed and resected from attachments, maintaining thoracodorsal blood supply, while removing thoracodorsal innervation. The flap was then rotated into the previous corpectomy site. The dural defect was repaired with a sealant patch, overlayed with a parietal pleural flap and the latissimus dorsi flap. By the patient's last follow-up, he had full functional independence at home. We present a surgical case highlighting the challenges of managing postoperative CSF-pleural fistula occurring after giant calcified thoracic disc removal and the successful use of a novel rotational latissimus dorsi flap to definitively repair the fistula after unsuccessful primary interventions.

Limited discectomy versus aggressive discectomy by spinal endoscopy with the transforaminal approach for lumbar disc herniation: a retrospective study

ObjectiveTo compare the clinical and radiological outcomes of limited discectomy (LD) and aggressive discectomy (AD) performed via spinal endoscopy using the transforaminal approach in patients with lumbar disc herniation(LDH)MethodsWe conducted a retrospective review of patients who underwent percutaneous endoscopic transforaminal discectomy (PETD) at the L4-L5 lumbar spine segments in our department from January 2017 to December 2020. The follow-up period extended to 24 months postoperatively. Patients were categorized into the LD and AD groups based on the extent of intraoperative disc removal. We retrospectively collected and analyzed clinical and radiological data.ResultsThe study followed 65 patients, with 36 in the LD group and 29 in the AD group. No statistically significant differences were noted in recurrence rates, the excellent and good Macnab rates, preoperative Disc Height Index (DHI), and preoperative Modic changes between the groups (P >0.05). However, significant differences were observed in operation duration, postoperative DHI and postoperative Modic change (P<0.05). No significant differences in Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) scores were detected between the groups preoperatively, or one and two years postoperatively (P>0.05). Nevertheless, notable differences in VAS and ODI scores were present one month postoperatively (P<0.05).ConclusionAs a conventional surgical method for treating LDH, PETD can achieve satisfactory clinical results in both LD and AD, with no significant variance in recurrence rates. However, AD is associated with longer operation times, and greater postoperative reductions in DHI and greater postoperative Modic changes compared to LD.

Management Considerations for Cervical Corpectomy: Updated Indications and Future Directions.

Together, lower back and neck pain are among the leading causes of acquired disability worldwide and have experienced a marked increase over the past 25 years. Paralleled with the increasing aging population and the rise in chronic disease, this trend is only predicted to contribute to the growing global burden. In the context of cervical neck pain, this symptom is most often a manifestation of cervical degenerative disc disease (DDD). Traditionally, multilevel neck pain related to DDD that is recalcitrant to both physical and medical therapy can be treated with a procedure known as cervical corpectomy. Presently, there are many flavors of cervical corpectomy; however, the overarching goal is the removal of the pain-generating disc via the employment of the modern anterior approach. In this review, we will briefly detail the pathophysiological mechanism behind DDD, overview the development of the anterior approach, and discuss the current state of treatment options for said pathology. Furthermore, this review will also add to the current body of literature surrounding updated indications, surgical techniques, and patient outcomes related to cervical corpectomy. Finally, our discussion ends with highlighting the future direction of cervical corpectomy through the introduction of the "skip corpectomy" and distractable mesh cages.

Cloward Procedure Outcome using Hashmi Cage for Anterior Cervical Discectomy and Fusion Experience in Pakistan

Abstract: Background: We aim to focus on ACDF patients treated with Hashimi cage filled with autologous bone. We will assess the safety of this approach based on the specific surgical level and its outcome. Objective: Study aims to evaluate the results of the Hashmi cage used in the Cloward Procedure while using odom’s based criteria for the outcome. Materials and Methods: This was a descriptive study researched at the Neuro Spinal Cancer Care Institute in Karachi, time duration from 16 June 2016 to 31 June 2022. The study included patients with a single-level prolapsed intervertebral cervical disc. During the surgery. Bony Fusion was assessed using movement ≤ 1 mm in flexion and extension cervical X-rays, was required. Result: We had 162 patients; among them males were 102 (62.96%) and female patient were 60 (37.03%). The median range for the age was from 23 to 63 years with mean 48 years ± 3.6 age. Clinically the patients presented with radiculopathy, commonly of the C6 level which was patients (63.73%). Odom’s based criteria were used to evaluate the results of the procedure. Among the patients, 92.84% showed excellent outcomes, 4.9% had good results, 1.8% had fair outcomes, and 1.23% had a poor outcome. Conclusion: ACDF with the Hashmi cage and plate application is a highly effective treatment option. This approach not only ensures better removal of the problematic discs but also significantly increases the likelihood of successful fusion and better radiological outcomes.

Combining 3D Printing and Cryostructuring to Tackle Infection and Spine Fusion

AbstractLow back pain is among the main issues in vertebral orthopaedics. Intervertebral disk degeneration can be severe, up to requiring the replacement of the damaged disk by substitutes to achieve spine fusion. Disk removal results in critical size defects, so fusion does not occur naturally, but synthetic bone grafts are needed. Since the surgical procedure is time‐consuming, high infection rates occur. Hence, in spine fusion, bone regeneration enhancement and infection prevention are needed. Here, a new dual‐component system is proposed, to tackle both issues at one time. To enable spine fusion, 3D extrusion‐based printing is employed to develop coherent custom magnesium phosphate (CaMgP)‐based cages. The 3D‐printed scaffolds are hardened, and the structural properties are evaluated to be within the ranges of physiological bone. To prevent infection, an in‐house ice‐templating device is employed in combination with a 3D‐printed ceramic scaffold, to develop tailored porous alginate structures loaded with vancomycin. Results show that CaMgP can be printed into complex geometries and that the geometry influences the pore orientation during ice‐templating. These structures loaded with vancomycin have antibacterial properties against Escherichia coli (E. coli) and Staphylococcus aureus (S. aureus) strains.

REACTIVATION OF THE NUCLEUS PULPOUS CELLS BY PLATELET DERIVATIVES AS A NEW TOOL IN INTERVERTEBRAL DISC REGENERATION

Degenerative disc disease, associated to low back pain, afflicts more than 50% of humans, and represents a major healthcare problem, especially for the pathology initiation. Current treatments range from conservative strategies to more invasive surgical techniques, such as disc removal and vertebral fusion. In the Intervertebral Disease (IVD) the nucleus pulposus (NP) degeneration is a key factor for the pathology initiation. Several tissue engineering approaches aiming to restore the appropriate NP cell (NPCs) and matrix content, were attempted by using adult stromal cells either from bone marrow or adipose tissue, chondrocytes, notochordal cells and more recently also pluripotent stem cells. However, none was fully satisfactory since the NP acid and a-vascularized environment appeared averse to the implanted heterologous cells. Several studies demonstrated the efficacy of platelet derivatives such as platelet rich plasma (PRP) in promoting the regeneration of connective tissues. We investigated the efficacy of PRP on NPCs proliferation and differentiation with the goal to propose the direct stimulation of resident cells (stimulation of endogenous cells – less invasive surgical procedure) or the implantation of NPCs expanded in vitro in the presence of PRP as therapeutic agents in IVD degeneration.NPCs were isolated from small fragments of NP explants, cultivated in medium supplemented with PRP or FCS (standard condition control) and characterized by FACS analysis for the expression of the typical mesenchymal stem cells markers CD34, CD44, CD45, CD73, CD90 and CD105. NPCs cultured in PL showed a phenotypic profile like the cells cultured in FCS. However, compared to NPCs expanded in the presence of FCS, NPCs expanded in PRP showed a much better proliferation and differentiation capacity. NPCs differentiation was evaluated by the cell ability to produce an organized metachromatic cartilaginous matrix, confirmed by the positive immunohistochemical staining for chondrogenic markers.

A New Technique for Arthroscopic Discectomy of the Temporomandibular Joint Disc Perforation: A Technical Note

Disc perforation represents the result of the degenerative process in joint structures that may lead to pain, joint noise, restricted mouth opening, osteoarthritis, and even dentofacial anomalies. Even though discectomy has proven benefits, with promising outcomes reported, it is mainly described using an open approach. While some arthroscopic techniques have been published, they are limited to managing perforation, edge widening, and inflammation treatment and do not describe complete disc removal. We describe a novel step-by-step arthroscopic discectomy technique (ADT) utilizing two operative cannulas that completely remove non-functional cartilaginous tissue.

Comparative Analysis of the Clinical Effects of General Anesthesia and Intraspinal Anesthesia in Percutaneous Endoscopic Foraminal Disc Removal

Comparative Analysis of the Clinical Effects of General Anesthesia and Intraspinal Anesthesia in Percutaneous Endoscopic Foraminal Disc Removal

Traumatic Anterior Cervical Disc Herniation Presenting as Severe Dysphagia.

Due to the anatomical characteristics of the cervical spine, few cases of traumatic anterior cervical disc herniation have been reported in the literature. Here, we present a rare case of a traumatic anterior cervical disc herniation presenting as severe dysphagia. A 75-year-old male patient presented with severe dysphagia following an accident three days prior when he fell from a height of stairs. Cervical magnetic resonance (MR) imaging revealed a 1.3 × 1.0 cm extruded disc in the anterior aspect of the C4 level with the base at the C3-4 disc, which displaced the esophagus anteriorly. Esophagography revealed an extrinsic esophageal lesion that was considered to be responsible for the obstruction of the airway at the same level. He underwent a ruptured disc removal via the anterior approach. Preoperative dysphagia was resolved gradually after surgery, and he remained asymptomatic six months after surgery.

Biomechanical Finite Element Analysis of Percutaneous Endoscopic Lumbar Discectomy via a Transforaminal Approach

Based on the previously established 3-dimensional model, this study uses the finite element analytical method to observe the effects of superior articular process resection and intervertebral discectomy on the stress of the surgical segment under different motion states. A validated L3-S1 finite element model was modified for simulation. And on the basis of the normal lumbar spine model, the superior articular process and discs of different parts of L4-L5 were simulated for resection. The resection models were divided into 6 groups, and the stress characteristics of articular process and discs of the lumbar spine under different postoperative motion conditions were examined under the same loading conditions. Simultaneous resection of the tip and base of the superior articular process increased the stress on the facet joint under various motion states compared with separate resections. In addition, the fewer herniated discs that are removed, the smaller the increase in facet joint stress. excision of the tip of the superior articular process caused a smaller stress increase in the facet joint than excision of the base under the forward bending and right-lateral flexion, and the opposite results were found under left-lateral flexion, posterior extension, and rotation. Resection of the tip of the superior articular process increases disc stress more than resection of the base of the superior articular process. Select resection of the superior articular process base as much as possible to expose the target of the disc. And minimize annulus damage and disc removal.

Risk Factors for Short-Term and Long-Term Low Back Pain After Transforaminal Endoscopic Lumbar Discectomy.

Low back pain following transforaminal endoscopic lumbar discectomy (TELD) is prevalent (15-25% incidence). Modifying TELD techniques to avoid excessive disc removal has been suggested to reduce such pain. Facet injury, re-herniation, and disc space collapse might contribute. This retrospective study aimed to explore factors linked to post-TELD low back pain. A total of 351 patients with L3/4, L4/5, and L5/S1 intervertebral lumbar disc herniations, who underwent TELD at two spine centers, were included. Patients were followed for one year. Low back and leg pain visual analogue scale (VAS) scores, Oswestry Disability Index (ODI), Pfirrmann grade, and disc height were measured at 3 months and 1 year. Correlation analyses examined links between postoperative low back pain VAS scores, age, sex, disc/vertebrae height ratio (D/V H ratio), Pfirrmann grade, cannula position grade, re-herniation grade, high-intensity zone (HIZ), disc calcification, surgical grade, and other factors. Significant variables were identified using partial least square tests, with variable importance in projection (VIP) values quantifying their impact on low back pain. Univariate analysis indicated that surgical grade correlated with long-term postoperative low back pain (P = 0.023), while re-herniation (P = 0.008, P = 0.000), disc height (P = 0.001, P = 0.034), and sex (P = 0.025, P = 0.003) correlated with both short- and long-term postoperative low back pain. Trephine/cannula position is correlated with short-term low back pain (P = 0.036). Worsening low back pain was associated with female sex, improper trephine/cannula position, re-herniation, and post-surgical disc space collapse. Intradiscal irrigation was linked to decreased low back pain. This study highlights factors influencing low back pain after TELD. Loss of disc height, extent of re-herniation, quality of trephine/cannula position, and sex were associated with low back pain at both 3 months and 1-year post-TELD. Proper techniques, like minimizing disc height loss and re-herniation, may help mitigate postoperative low back pain.

Benchtop impaction device replicates cadaveric loading conditions of the transforaminal lumbar interbody fusion (TLIF) procedure

Background contextLumbar spine disc pathologies often necessitate removal of the intervertebral disc and implantation of a lumbar interbody fusion (LIF) device. Herein, the objective was to measure use condition forces while simulating intra-operative loading conditions of transforaminal lumbar interbody fusion (TLIF) procedures. MethodsIn this work, we developed a transferable method to measure impact forces in a cadaveric intra-operative setting and designed a drop weight benchtop device equipped with force and displacement sensors to replicate cadaveric impact conditions, including number of strikes required for interbody device insertion, peak force, initial slope of the impact waveform, impact duration, and area under the force-time curve (impulse). Following cadaveric testing, a benchtop biomechanical study varying interbody device height, drop height, and drop weight was performed to evaluate the utility of the benchtop device to replicate impact loading conditions which occurred in the cadaveric model. ResultsSeveral benchtop test groups replicated the cadaver group in number of strikes required for device insertion. The average cadaveric peak force, 13.03 kN, was replicated by three benchtop groups: 12 mm device height, 60 cm drop height, 0.75 lb drop weight; 12 mm device height, 60 cm drop height, 1.0 lb drop weight; and 14 mm device height, 60 cm drop height, 0.50 lb drop weight. The initial slope of the impact waveform was replicated best by 12 mm devices. Both the impact duration and impulse were lower in all benchtop groups than in cadaver testing. ConclusionsThis work validated the outfitting of an impact force sensor onto an interbody device insertion instrument as a reproducible, quantifiable method for collecting impact loading data in a cadaveric model. This benchtop device and methodology will aid in testing interbody devices relative to anticipated use conditions, enhance interbody device designs, and accelerate surgical technique refinement.

Surgical techniques and perioperative surgical outcomes after discectomy for calcified lumbar disc herniation: a review and meta-analysis.

Calcified lumbar disc herniation (CLDH) poses surgical challenges due to longstanding disease and adherence of herniated disc to the surrounding neural structures. The data regarding outcomes after surgery for CLDH are limited. This review was conducted to analyse the surgical techniques, perioperative findings and the postoperative clinical outcomes after surgery for CLDH. PRISMA guidelines were followed whilst conducting this systematic review and meta-analysis. The literature review was conducted on 3 databases (PubMed, EMBASE, and CINAHL). After thorough screening of all search results, 9 studies were shortlisted from which data were extracted and statistical analysis was done. Pooled analysis was done to ascertain the perioperative and postoperative outcomes after surgery for CLDH. Additional comparative analysis was done compared to CLDH with non-calcified lumbar disc herniation (NCLDH) cases. We included 9 studies published between 2016 and 2022 in our review, 8 of these were retrospective. A total of 356 cases of CLDH were evaluated in these studies with a male preponderance (56.4%). Mean operative time was significantly lower in NCLDH cases compared to CLDH cases. The mean estimated blood loss showed a negative correlation with the percentage of males. Satisfactory clinical outcomes were observed in majority of patients. The risk of bias of the included studies was moderate to high. Surgical difficulties in CLDH cases leads to increase in operative time compared to NCLDH. Good clinical outcomes can be obtained with careful planning; the focus of surgery should be on decompression of the neural structures rather than disc removal.

A hybrid approach for diagnosing diabetic retinopathy from fundus image exploiting deep features

One of the major causes of blindness in human beings is the diabetic retinopathy (DR). To prevent blindness, early detection of DR is therefore necessary. In this paper, a hybrid model is proposed for diagnosing DR from fundus images. A combination of morphological image processing and Inception v3 deep learning techniques are exploited to detect DR as well as to classify healthy, mild non-proliferative DR (NPDR), moderate NPDR, severe NPDR, and proliferative DR (PDR). The proposed algorithm was carried out in several steps such as segmentation of blood vessels, localization and removal of optic disc, and macula, abnormal features detection (microaneurysms, hemorrhages, and neovascularization), and classification. Microaneurysms and hemorrhages that appear in the retina are the early signs of DR. In this work, we have detected microaneurysms and hemorrhages by applying dynamic contrast limited adaptive histogram equalization and threshold value on overlapping patched images. An overall accuracy of 96.83% is obtained to classify DR into five different stages. The better performance demonstrates the effectiveness and novelty of the proposed work as compared to the recent reported work.

Atypical extravertebral ventral cervical disc extrusion in a dog

AbstractA 6‐year‐old cocker spaniel dog was investigated by computed tomography for a marked neck pain more evident on ventroflexion. Cervical disc extrusion of mineralised nucleus pulposus material was identified in the vertebral canal dorsally to the C4–C5 intervertebral space, with spinal cord compression. Another mineralised material was also identified at an unusual location, ventrally to the C2–C3 intervertebral space. Ventral slot at C4–C5 intervertebral disc allowed surgical removal of the compressive disc, and longus colli muscles dissection at C2–C3 level allowed removal of the identified material, confirmed histologically as degenerated (mineralised) nucleus pulposus. Ventral paravertebral disc extrusion of degenerated nucleus pulposus extrusion is rarely described in human medicine. This case report illustrates the anatomical and imaging key points that support the diagnostic approach to a previously undescribed presentation of disc extrusion in dog.