Disc Surgery Research Articles

TMJ disc repositioning associated with orthognathic surgery for the treatment of severe retrognathism

Introduction: Orthognathic surgery associated with temporomandibular disc reposition is a modality of surgical treatment for dentofacial deformities associated with temporomandibular disorders that has been shown to be a stable and predictable alternative for such situations. However, there is still no consensus in the literature regarding the treatment modality in these cases. Several studies have been developed looking for more stable and predictable results in favor of the best patient treatment. Case Report: Patient with a class II facial pattern and temporomandibular dysfunction, submitted to bilateral repositioning of the articular disc and orthognathic surgery with counterclockwise rotation of the maxillomandibular complex, with improvement of the symptoms and of the functionality of the stomatognathic system, and satisfaction with facial aesthetics. Conclusion: Although there are controversies about the surgical repositioning of chronic articular disc displacements in retrognathism, this treatment modality has demonstrated long-term stability and reduction or resolution of joint symptoms.

Comparison of Extubation of Patients in Prone versus Supine Position in workers Undergoing Lumbar Disc Surgery

Introduction: This study compared the extubation of patients in prone versus supine positions in patients undergoing lumbar disc surgery.
 Material and Methods: In this single-blind clinical trial, 60 patients who were candidates for elective lumbar disc surgery were selected and randomly assigned into two groups of 30 patients. All patients primarily underwent surgery in the prone position. After surgery and discontinuation of anesthesia gases (T0), patients were assigned into two groups, prone and supine. From T0 to extubation time, heart rate, systolic and diastolic blood pressure, mean arterial pressure, Spo2, cough severity, and secondary complications after extubation such as laryngospasm and shortness of breath were measured and recorded in both groups. 
 Results: The results showed that in all the variables under study, the supine group had higher values than the prone group. There was a significant difference in oxygen pressure between the two groups, and the prone group had a more suitable status than the supine group (P=0.02). The incidence of cough was higher in the supine group compared to the prone group, and the observed difference was significant (P=0.001).
 Conclusion: Based on the findings of this study, maintaining the prone position after lumbar disc surgery for extubation causes the patient to be less affected by the change of position and is in a superior status in terms of coughing and oxygen pressure.

P131. Long term effectiveness of full endoscopic versus open microdiscectomy for sciatica: a 24-month RCT

<h3>BACKGROUND CONTEXT</h3> Open microdiscectomy (OM) is the current standard procedure to treat sciatica caused by lumbar disk herniation. Percutaneous transforaminal endoscopic discectomy (PTED) is an alternative procedure which is performed under local anesthesia. Here we report the long-term results. <h3>PURPOSE</h3> To assess long-term effectiveness of PTED vs OM at 24 months. <h3>STUDY DESIGN/SETTING</h3> A pragmatic, multicenter, non-inferiority, randomized controlled trial. <h3>PATIENT SAMPLE</h3> A total of 613 were randomized to either PTED (n=304) or OM (n=309). <h3>OUTCOME MEASURES</h3> The primary outcome is self-reported leg pain measured by the 0-100 Visual Analogue Scale (VAS) with a noninferiority margin of 5. Secondary outcomes include self-reported ODI, back pain, health-related quality of life and self-perceived recovery. <h3>METHODS</h3> A pragmatic, multicenter, non-inferiority, randomized controlled trial was conducted in which patients were randomized between PTED or OM in a 1:1 ratio. The primary outcome is self-reported leg pain measured by the 0-100 visual analogue scale (VAS) with a noninferiority margin of 5. Secondary outcomes include self-reported ODI, back pain, health-related quality of life and self-perceived recovery. Outcomes were measured the day following surgery, at 2, 4, and 6 weeks, and at 3, 6, 9,12 and 24 months. <h3>RESULTS</h3> At 24 months, 92% of the patients had followup data available. At 24 months, the adjusted between group difference of the VAS leg pain was 7.3 in favor of PTED (17.0 ± 22.4 vs 24.3 ± 26.5;). There was no difference in back pain at 24 months between both groups. All other secondary patient-reported outcomes showed small but statistically more favorable results for the PTED-group. Complications rates and rate of recurrent disc surgery appear similar between both groups. <h3>CONCLUSIONS</h3> At long-term, PTED remains noninferior to OM in the treatment of sciatica at 24 months of followup and clinical outcomes appear to be more favorable for PTED, albeit not exceeding established MCIDs. Therefore, based on these study results, implementation of PTED as a treatment option for sciatica is warranted. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

A 50-step walking test for analysis of recovery after decompressive surgery for thoracolumbar disc herniation in dogs.

BackgroundDespite its importance, there is no agreed definition of recovery of ambulation in dogs with spinal cord injury.ObjectivesTo validate a new walking test in dogs recovering from thoracolumbar spinal cord injury.AnimalsTwo hundred twenty‐four dogs weighing <20 kg: 120 normally ambulatory dogs, plus 104 dogs undergoing decompressive surgery for acute thoracolumbar intervertebral disc herniation.MethodsProspective cohort studies. The distance each freely‐ambulatory dog walked during 50 step cycles was regressed on ulna length. For each postsurgical dog, we recorded when the calculated 50‐step distance was completed without falling, or their inability to complete this distance by 4 months or more after surgery. Bayesian analysis compared outcomes for presurgical neurologic categories; association of recovery with several preoperative variables was explored using logistic and time‐to‐event regression.ResultsFor control dogs, 50‐step distance (m) = 1.384 × ulnar length (cm) + 2.773. In postsurgical dogs, the 50‐step test provided decisive evidence that deep pain‐negative dogs were less likely to recover ambulation than dogs with intact pain perception (12/29 recovered vs 71/75; Bayes factor [BF] = 5.9 × 106) and, if they did recover, it took much longer (median 91 days vs median 14 days; BF = 1.5 × 103). Exploratory analysis suggested that presurgical neurologic status (subhazard ratio [SHR] = 0.022; P < .001) and duration of presurgical anesthesia (SHR = 0.740; P = .04) were associated with rapidity of recovery.Conclusions and Clinical ImportanceThis straightforward 50‐step walking test provides robust data on ambulatory recovery well‐suited to large scale pragmatic trials on treatment of thoracolumbar spinal cord injury in dogs.

Randomized clinical trial comparing outcomes after fentanyl or ketamine-dexmedetomidine analgesia in thoracolumbar spinal surgery in dogs.

BackgroundOpioids are widely used for perioperative pain control in dogs undergoing spinal surgery, but alternatives may be required because data suggest that opioids exacerbate inflammation in the injured spinal cord and veterinary access to opioids may become more restricted in the future.ObjectivesTo compare recovery of ambulation and other functions between spinal cord‐injured dogs receiving peri‐operative fentanyl and those receiving a ketamine‐dexmedetomidine combination.AnimalsA total of 102 client‐owned dogs undergoing decompressive surgery for thoracolumbar intervertebral disc herniation.MethodsRandomized clinical trial. Dogs were randomized 1:1 to fentanyl or a ketamine‐dexmedetomidine combination for intra and postoperative analgesia. Primary outcome was time to recovery of ambulation; secondary outcomes were the postoperative Colorado Acute Pain Scale, the short‐form Glasgow Composite Measure Pain Scale, time to recovery of voluntary urination and time to unassisted eating.ResultsNo difference was found in time to recovery of ambulation between groups (adjusted sub‐hazard ratio, 0.83; 95% confidence interval [CI], 0.55‐1.24; P = .36) or in pain scores (Colorado: χ 2 = 14.74; P = .32; Glasgow: χ 2 = 6.61; P = .76). Differences in time to recovery of eating and urination were small but favored ketamine‐dexmedetomidine (adjusted odds ratios, 3.31; 95% CI, 1.53‐7.16; P = .002 and 2.43; 95% CI, 1.00‐5.96; P = .05, respectively).Conclusions and Clinical ImportanceThere was no evidence that, at the doses used, fentanyl impaired ambulatory outcome after surgery for thoracolumbar intervertebral disc herniation in dogs. Pain control appeared similar between groups. Secondary outcomes suggested minor benefits associated with ketamine‐dexmedetomidine. The ketamine‐dexmedetomidine combination appears to be a reasonable alternative to peri‐operative opioids.

Analysis of Long-Term Results of Lumbar Discectomy With and Without an Interspinous Device.

Discectomy is the surgical treatment of choice for disc herniation. However, discectomy can lead to disc degeneration and vertebral instability over time. Interspinous devices (ISDs), added to conventional surgery, constitute a low-invasive alternative that attempts to prevent these complications. The aim of this study is to compare the long-term clinical and functional outcomes of patients undergoing conventional discectomy with those who had an ISD added during surgery. This analytical-descriptive, retrospective, and transversal studyinvestigated outcomes of 114 patients who underwent surgery for a lumbar disc herniation between 2008 and 2011. The results were evaluated with a minimum follow-up of 8 years (mean, 10 years) by means of different questionnaires: visual analog scale (VAS), Oswestry Disability Index (ODI), consumption of analgesic medication, work status, degree of satisfaction, and complications and reinterventions during the follow-up period. At the end of the follow-up, an overall improvement of VAS of 5 points (71%) and ODI of 36 points (77%) was observed, with a degree of satisfaction of 76% with disc surgery. The analysis between both groups showed a better behavior in VAS and ODI in the implant group, with a pre- and postsurgery difference of 73% and 79% compared to 66% and 77% in the control group, respectively, though this finding was not statistically significant. The current analgesic consumption and the degree of satisfaction were also better in the group with an implant. Compared with the non-implant group, the number of reinterventions at the end of the follow-up was lower (7% vs 15.5%) and the time until the second intervention was higher (81.5 vs 41 months) in the group with an implant, but the differences were not statistically significant. Lumbar discectomy proved to be a safe technique for the treatment of disc herniation, and results are maintained over time. The additional gesture of adding an ISD to conventional discectomy improves clinical outcomes overall, but not in a statistically significant way. The lower number of reinterventions and the longer period without surgery being required may mean a certain protective effect of the ISD on the intervertebral disc being operated on.

The effect of intraoperative epidural levobupivacaine administration in lumbar disc surgery for postoperative pain

Aim: Postoperative pain is an essential problem that affects morbidity in surgical cases. We aimed to provide maximal benefits with minimal side effects, facilitate the recovery period, accelerate mobilization, and provide patient safety and comfort through the usage of the drug and method of our choice to provide postoperative analgesia.Material and Method: Our study included 60 elective or urgent lumbar disc surgery cases. The patients were randomly divided into two groups; (a) The Group S; patients receiving general anesthesia and intraoperative epidural saline injection, and (b) The Group L; patients receiving general anesthesia and intraoperative epidural 2.5 mg/mL levobupivacaine 10 mL injection. The patient’s hemodynamic parameters were monitored perioperatively. To all patients, in case of necessity, patient-controlled analgesia with IV morphine was administered. The pain assessment was done using a numeric pain rating scale and visual analog scale. In addition, morphine usage during the 24 hours, pain scores, mobilization time, patient satisfaction, and side effects were evaluated.Results: In the levobupivacaine group, the pain scores were lower during the whole trial, the morphine consumption in the 24 hour period was lower, the first time of mobilization was shorter, the patient satisfaction was more remarkable, and this group was more clinically significant considering side effects.Conclusion: The usage of epidural bupivacaine combined with IV morphine instead of IV morphine alone for postoperative analgesia is more beneficial for early mobilization, reducing complications, and better patient satisfaction

Full-endoscopic lumbar disc surgery: the new gold standard? (PhD Academy Award)

Full-endoscopic lumbar disc surgery: the new gold standard? (PhD Academy Award)

Additional operations after surgery for lumbar disc prolapse : indications, type of surgery, and long-term follow-up of primary operations performed from 2007 to 2008.

Lumbar disc prolapse is a frequent indication for surgery. The few available long-term follow-up studies focus mainly on repeated surgery for recurrent disease. The aim of this study was to analyze all reasons for additional surgery for patients operated on for a primary lumbar disc prolapse. We retrieved data from the Swedish spine register about 3,291 patients who underwent primary surgery for a lumbar disc prolapse between January 2007 and December 2008. These patients were followed until December 2020 to record all additional lumbar spine operations and the reason for them. In total, 681 of the 3,291 patients (21%) needed one or more additional operations. More than three additional operations was uncommon (2%; 15/906). Overall, 906 additional operations were identified during the time period, with a mean time to the first of these of 3.7 years (SD 3.6). The most common reason for an additional operation was recurrent disc prolapse (47%; 426/906), followed by spinal stenosis or degenerative spondylolisthesis (19%; 176/906), and segmental pain (16%; 145/906). The most common surgical procedures were revision discectomy (43%; 385/906) and instrumented fusion (22%; 200/906). Degenerative spinal conditions other than disc prolapse became a more common reason for additional surgery with increasing length of follow-up. Most patients achieved the minimally important change (MIC) for the patient-reported outcomes after the index surgery. After the third additional spinal operation, only 20% (5/25) achieved the MIC in terms of leg pain, and 29% (7/24) in terms of the EuroQol five-dimension index questionnaire visual analogue scale. More than one in five patients operated on for a lumbar disc prolapse underwent further surgery during the 13-year follow-up period. Recurrent disc prolapse was the most common reason for additional surgery, followed by spinal stenosis and segmental pain. This study shows that additional operations after primary disc surgery are needed more frequently than previously reported, and that the outcome profoundly deteriorates after the second additional operation. The findings from this study can be used in the shared decision-making process. Cite this article: Bone Joint J2022;104-B(5):627-632.

Bilateral ultrasound-guided erector spinae plane block for postoperative persistent low back pain in lumbar disc surgery.

Persistent low back pain is an important disability after lumbar disc surgery. Erector spinae plane block (ESPB) is highly effective in providing post-surgical pain control, but its effectiveness in long-term persistent low back pain has not been investigated. The aim of this randomized controlled trial was to investigate the effect of ESPB on the reduction of persistent low back pain after surgery. 162 patients who were operated for lumbar disc herniation under spinal anaesthesia were divided into two groups according to the following criteria; ESPB block group (Group A); applied before surgery and 1month after surgery and non-ESPB block group (Group B). The preoperative and postoperative 6th month Visual Analogue Scale (VAS), Oswestry Low Back Pain Disability Questionnaire (ODI) and Japan Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) scores of the patients were evaluated, and it was examined whether there was a difference. In two groups with similar patient characteristics and no significant difference in preoperative pain scores, a significant improvement was observed in pain scores in Group A compared to Group B at the end of the 6th month. ESPB, which has a low risk of complications and is simple to perform, has been found useful in the treatment of persistent low back pain after disc surgery.

Usefulness of 3D CT/MRI Fusion Imaging for the Evaluation of Lumbar Disc Herniation and Kambin's Triangle.

Study design: Prospective study. Objective: The aim of this study is to visualize the morphology of a lumbar herniated disc and Kambin’s triangle in three dimensions (3D) based on preoperative CT/MRI fusion images. Methods: CT/MRI fusion images of 23 patients (10 males and 13 females; mean age 58.2 years) were used to evaluate Kambin’s triangle, which is created between the superior articular process (SAP), exiting nerve root (ENR), inferiorly by the superior endplate of the lower lumbar vertebra and dural canal medially at 60 degree and 45 degree endoscopic approach angles. The percentage of the safe usage of transforaminal endoscopic approach was evaluated to utilize a 5 mm dilater without partial facet resection in the fusion image. The 3D lumbar nerve root sleeve angulation (3DNRA), which is the angle between the axis of the thecal sac and the nerve root sleeve, was calculated. The herniated discs were also visualized in the CT/MRI fusion image. Results: The 3DNRA became smaller from L2 to S1. The L2 3DNRA was statistically larger than those of the other root, and the S1 3DNRA was significantly smaller than the others (p < 0.05). (L2, 41.0°; L3, 35.6°; L4, 36.4°; L5, 33.9°; and S1, 23.2°). The SAP-ENR distance at 60° was greatest at L4/5 (5.9 mm). Possible needle passages at 60° to each disc level were 89.1% at L2/3, 87.0% at L3/4 and 84.8% at L4/5. However, the safe 5 mm dilater passage at 60° without bony resection to each disc level were 8.7% at L2/3, 28.3% at L3/4 and 37.0% at L4/5. The 60° corridor at L2/3 was the narrowest (p < 0.01). All herniated discs were visualized in the fusion image and the root compression site was clearly demonstrated especially with foraminal/extraforaminal herniations. Conclusion: The 3D lumbar CT/MRI fusion image enabled a combined nerve-bony assessment of Kambin’s triangle and herniated disc. A fully endoscopic 5 mm dilater may retract the exiting nerve root in more than 60% of total cases. This new imaging technique could prove to be very useful for the safety of endoscopic lumbar disc surgery.

The Pain Control Efficacy of Zolpidem versus Melatonin after Intervertebral Disc Herniation Surgery under General Anaesthesia: A Randomised Clinical Trial.

Background:Postoperative pain management has been linked with multiple clinically relevant complications such as thromboembolism, myocardial ischaemia, and cardiac arrhythmias.Objectives:The present study moves towards an evidence-based approach to the therapeutic efficacy of zolpidem and melatonin in a better clinically meaningful pain relief following intervertebral disc herniation surgery under general anaesthesia.Materials and Methods:Undertaking a randomised, parallel-group, double-blind, clinical trial, 60 patients meeting eligibility (mean age ≈ 39, 50% female and 50% men) were offered intervertebral disc surgery at the Arak-based Valiasr Hospital and stratified into two interventional arms by block randomisation. Data including (i) pain (visual analog scale) and sedation (Ramsay sedation scale) scores during recovery and at all five initial 24-h time points (two, four, six, 12, 24); (ii) adverse events inclusive of mild nausea and dizziness, pethidine consumption; and (iii) ongoing haemodynamic parameters, including heart rate, blood pressure, and oxygen saturation were collected. Data were analysed at a significance level of P = 0.05 (SPSS 20.0, IBM Corp).Results:Our results showed no perceived statistically significant between-arm difference in three functional haemodynamic parameters, duration of surgery, and adverse events, as well as in sedation and pain scores (P < 0.05). Our results showed no between-arm difference in analgesia and sedation, haemodynamic changes, and postoperative adverse events.Conclusion:The findings taken together lent a strong support for the highly encouraging efficacy of both drugs in affording adequate analgesia at 24 postoperative hours without any adverse events needing to be thought of. Therefore, both zolpidem and melatonin were promising postoperative pain relievers, while no drug is demonstrably superior to the other.

Magnetic Resonance Imaging Documentation of Approach Trauma With Lumbar Endoscopic Interlaminar, Translaminar, Compared to Open Microsurgical Discectomy.

Endoscopic spine surgery is associated with less approach trauma than conventional open translaminar surgery. However, objective evidence to corroborate this empiric observation is scarce. Preservation of the anatomic attachment and sensory function of multifidus muscles have been stipulated to be critical to maintaining the normal function of the lumbar spinal motion segment. The authors were interested in comparing the postoperative approach trauma between traditional open translaminar microsurgical and interlaminar endoscopic discectomy. The approach trauma to the paraspinal muscles due to interlaminar or open microsurgical discectomy was evaluated on T2-weighted axial magnetic resonance imaging (MRI) images of 39 consecutive patients who underwent lumbar disc surgery. Postoperative MRI images taken at 4 days and within 1 year after surgery were analyzed. Eleven patients underwent conventional open translaminar microdiscectomy surgery. Endoscopic discectomy was performed on 17 patients via the interlaminar and on another 11 patients via the transforaminal approach. The immediate surgical approach trauma was estimated as the defect zone by measuring the normalized relative cross-sectional area (rCSA) of muscle disruption in the surgical corridor 4 days postoperatively. The long-term effect of surgical approach trauma was assessed by measuring the area of the paraspinal muscles that had been replaced by fatty tissue 1 year postoperatively. The rCSA data showed diminished approach trauma with a smaller surgical defect zone in the interlaminar endoscopy group (17.6%) was smaller than in the microsurgical group 4 days postoperatively (41.2%). At 1 year postoperatively, the mean fatty replacement of the paraspinal muscles was 23.6% after microsurgery and 2.1% after the interlaminar endoscopy. Muscle recovery was substantially reduced in the interlaminar endoscopic group, with the muscle zone reducing from 20.3% to 2.1% when analyzed 1 year postoperatively. In the microsurgery group, the muscle damage by atrophy increased from 41.2% to 62.9% at 1 year postoperatively (P < 0.001). Fatty replacement of the multifidus muscle was seen on the ipsilateral and contralateral approach side. There was a negligible change in the muscle zone with the transforaminal approach. Tissue trauma was significantly reduced with endoscopic surgery techniques compared with the traditional translaminar microdiscectomy approach. There was a minor postoperative tissue trauma and hardly any long-term replacement of the multifidus and paraspinal muscles by fatty tissue 1 year postoperatively with the endoscopic technique. The transforaminal approach has the least effect on the paraspinal muscles of the surgical motion segment. Further study is needed to investigate whether these findings translate into decreased postoperative instability or low back pain following endoscopic discectomy surgery. MRI analysis of multifidus atrophy following various lumbar translaminar and transforaminal decompression techniques.

Comparison of Patient Satisfaction between Spinal versus General Anaesthesia for Lumbar Disc Surgery

Background: Lumbar discectomy is most commonly performed under general anaesthesia, which can be associated with several perioperative morbidities including nausea, vomiting, atelectasis, pulmonary aspiration, and prolonged post-anaesthesia recovery. It is possible that fewer complications may occur if the procedure is performed under spinal anesthesia. Objective: To assess the Patient Satisfaction between Spinal versus General Anaesthesia in Patients for Prolapse Lumbar Intervertebral Disc (PLID) Surgery. Methods: A Comparative study was carried out at the Dept. of Anesthesia, Abdul Malek Ukil Medical College &amp; Hospital, Noakhali, Bangladesh from January 2018 to December 2020. One hundred (100) healthy and co-operative patients ASA I-II were recruited and randomized into two equal groups, with half of these patients receiving spinal anaesthesia (n-50) and the remainder general anaesthesia (n-50). A comprehensive postoperative evaluation was carried out documenting any anaesthetic complications, pace of physiological and functional recovery and patient satisfaction. Variables were recorded as pain level using a visual analogue scale (VAS) at 1, 6, 12 and 24 hours; patient level of satisfaction during the stay on the ward using verbal rating scale (VRS) as it was detected by A p-value &lt; 0.05 were considered as significant. Results: In our study Spinal anaesthesia patients achieved the milestones of physiological and functional recovery more rapidly and reported less postoperative pain. Perioperative hypotension in 26% of patients and none was hypertensive in spinal group and in G/A Group 06% of patients was hypotensive and 20% were hypertensive. Postoperative pain intensity more in G/A group than spinal group. Patient satisfaction in spinal group was more comparative to G/A group. Conclusion: In conclusion, Spinal anesthesia is a reasonable alternative to general anesthesia for the patients with ASA grade I/II and preferably single level pathology in the lumbar .....

Reparative effects of chronic intermittent hypobaric hypoxia pre‑treatment on intervertebral disc degeneration in rats.

Previous studies have indicated that chronic intermittent hypobaric hypoxia (CIHH) preconditioning can inhibit TNF-α and other related inflammatory cytokines and exerts protective effect on intervertebral disc degeneration disease (IDD) in rats; however, the mechanism is still unclear. The present study aimed to explore the repair mechanisms of CIHH on IDD in rats. In the experiment, 48 adult Sprague-Dawley rats were selected and randomly divided into an experimental group (CIHH-IDD), a degenerative group (IDD) and a control group (CON). The CIHH-IDD group of rats (n=16) were treated with CIHH (simulated 3000 m altitude, 5 h per day, 28 days; PO2=108.8 mmHg) before disc degeneration surgery. The IDD group of rats (n=16) underwent tail-vertebral intervertebral disc surgery to establish a model of intervertebral disc degeneration. The CON group of rats (n=16) did not receive any treatments. After surgery, the disc height index was calculated using X-ray analysis of rat tail vertebrae, the degeneration process was observed and repair was evaluated by chemically staining degenerative intervertebral disc tissue slices. The expression levels of basic fibroblast growth factor (bFGF), TGFβ1, Collagen I and Collagen II were measured in the intervertebral disc tissue using western blotting; while the expression levels of bFGF, TGFβ1 and hypoxia-inducible factor 1-α (HIF-1α) were measured in rat serum using ELISA. The results demonstrated that: i) The degree of intervertebral disc height degeneration in CIHH-IDD rats was significantly lower compared with that in IDD rats (P<0.05); ii) the expression levels of bFGF, TGFβ1 and HIF-1α were higher in CIHH-IDD rat serum compared with those in IDD rat serum (P<0.05); iii) optical microscopy revealed that the degree of disc degeneration was relatively mild in CIHH-IDD rats; and iv) the protein expression levels of bFGF, TGFβ1 and collagen II were increased in CIHH-IDD rat intervertebral disc tissues compared with those of IDD rats, while the overexpression of collagen I protein was inhibited. Overall, after CIHH pre-treatment, the expression levels of bFGF and TGFβ1 were up-regulated, which play notable roles in repairing degenerative intervertebral discs in rats.

Iatrogenic aortocaval shunt treated by stent graft placement into the inferior vena cava

Fifty six year old male sustained an injury to the abdominal aorta during his 1992 lumbar disc surgery with subsequent aortocaval shunt formation. In order to close the shunt, his abdominal aorta and both common iliac arteries were ligated and bilateral aortoiliac bypass was implanted. Postoperatively the patient remained asymptomatic for several years. Subsequently he developed arterial hypertension, his exercise capacity diminished and he complained of exertional dyspnea. Intraarterial DSA demonstrated filling of the occluded aortic segment from intercostal and lumbar arteries as well and a shunt between this segment and the inferior vena cava. The hemodynamic significance of the shunt was confirmed using catheterization. Attempted reduction of the shunt flow by intercostal arteries embolization was not successful. We were successful in closing the fistula using a custom-made stent graft. CTA performed 18 years after the procedure confirmed absence of the shunt and patent inferior vena cava. The patient is now asymptomatic 23 years after the original surgery.

Clinical outcomes and satisfaction in patients after lumbar microdiscectomy

Introduction: Lumbar disc herniation is a common cause of low back and radicular pain. Microdiscectomy is the recommended surgical technique for herniated lumbar discs at the moment. It has great success rates and little postoperative morbidity. We aimed to assess the clinical result and patient satisfaction of micro-discectomy in lumbar disc herniation patients. Methodology: This is a prospective observational hospital-based research of 26 patients who had micro-discectomy at the Regional Clinical Center of Neurosurgery and Neurology in Uzhhorod, Ukraine, during August and September 2021. The research excluded patients with recurrent prolapsed intervertebral discs, multiple level herniated discs, and disc surgery requiring stability. During surgery, the kind of prolapsed intervertebral disc, its level, and the duration of the procedure were recorded. Additionally, we recorded the duration of the patient's hospital stay and any complications. The visual analogue scale (VAS), the Oswestry Disability Index (ODI), and the MacNab score questionnaires were used to measure pain, disability, and patient satisfaction, respectively. Result: All procedures were performed on a single level using micro-discectomy. The mean age of the study population was 45.69 years. Micro-discectomy surgeries were performed in less than an hour in 69.2% of cases. The most often seen lumbar prolapsed intervertebral disc occurred at the L4-L5 level (57.7%). The most often seen kinds of prolapse were disc extrusion (30.8%) and disc sequestration (26.9%). The mean length of stay in the hospital was 3.96 days. After surgery, 57.7% of patients received an excellent rating on the Macnab's scale. There was a statistically significant difference between pre- and postoperative VAS and ODI scores (p&lt;0.05). Conclusion: Overall 65.4% of patients had no postoperative complications. In these instances, a proper surgical technique might help avoid problems. Our findings demand additional investigation with bigger sample sizes and longer follow-up periods.

Evaluating Intervertebral Foramen Measurements for Patients with Anterior Cervical Disc Surgery in Oblique CT

Objective: It is particularly difficult to determine the level of radiculopathy pain. Because radicular pain usually doesn't fit the dermatomal map. unlike the foramen lumbar vertebrae, where the cervical nerve root is exerted, it has a slope of approximately 45 degrees to the vertebrae in the axical plane and 10-15 degrees in the horizontal plane. Due to this structure of cervical foremen, the evaluation of conventional ct results in incorrect or incomplete diagnosis. In our study, we compared the change in cervical foramen patients with anterior cervical discectomy and cage (fusion) to oblique ct reconstructive and preop and postop. Methods: CT images were acquired in a 64 slice CT system (60–80 mAs, 120 kVp, FC86 reconstruction core and 2.0 mm slice thickness at 2.0 mm intervals). Oblique sagittal images were created with OsiriX Lite v. 12.0.1 version and measurements were performed. For each level, the area has been measured in addition to the short and long axle length of the neural foramens from the pre-op and post-op oblique sagittal images.Results: In our study, 98 cervical intervertebral foramen oblique CT de preop-postop, long axle, short axle and field measurements were evaluated with 43 patients from 16/01/2019 to 03/02/2020, 3 patients with two levels of anterior ceral discectomy + interbody cage. Right side, long axle, short axle, and area respectively; 13,37%, 5,99%, 16,87% increase. Left side, long axle, short axle, and area respectively, increased by 14,27%, 7,11%, 23,20%Conclusion: The cage, which is placed on the intervertebral level, will increase the area of the foramen, increase the space of the foramen, and allow the nerve to decompression. This is why it is necessary to insert the material with the highest height of the intervertebral disk level that can be placed during surgery.

Routine Procedure Getting Complicated: Iliac Artery Injury during Herniated Disc Surgery.

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Role of Dexamethasone for Pain Management in Intervertebral Disc Surgery

Intervertebral disc operations are already among the most common and their frequency is increasing. The pain associated with these operations is one of the most common postoperative discomforts, has a significant impact on psychosocial aspects, and should therefore be treated effectively. Therefore, we present the importance of dexamethasone for multimodal pain management after intervertebral disc surgery.