Herniated Disc Material Research Articles

Thoracolumbar hydrated nucleus pulposus extrusion and intervertebral disc extrusion in dogs: Comparison of clinical presentation and magnetic resonance imaging findings

Thoracolumbar hydrated nucleus pulposus extrusion (TL-HNPE) is an increasingly recognised pathology with a substantial lack of literature describing its features. The aim of this retrospective case-control study was to analyse the clinical and magnetic resonance imaging (MRI) features of dogs with TL-HNPE compared to dogs affected with thoracolumbar intervertebral disc extrusion (TL-IVDE). Data from dogs diagnosed with TL-HNPE and TL-IVDE via MRI at two referral hospitals, were retrospectively collected and compared in terms of clinical signs and MRI features. Cases diagnosed with TL-IVDE were deemed controls. The MRI features of the affected IVD space, herniated IVD material, affected overlying spinal cord and local epaxial musculature were evaluated for each group. Fifty-one cases with TL-HNPE and 105 randomly selected cases of TL-IVDE were included. Several signalment and neurological signs were identified as statistically distinct between groups in univariate analysis. Multivariate analysis identified that dogs affected with TL-HNPE were typically older, less likely to be chondrodystrophic (62.2 % vs. 91 %), more frequently experiencing a peracute onset (90.2 % vs. 61.9 %) often attributed to a suspected trauma linked with exercise (37.3 % vs. 10.5 %), being less frequently progressive (41.2 % vs. 86.5 %) and with herniated disc material less frequently lateralised (72.6 % vs. 89.5 %) than cases with TL-IVDE. MRI-identifiable intervertebral disc degeneration was found in every TL-IVDE case but only in 60 % of TL-HNPE cases. TL-HNPEs were associated to significantly less spinal cord compression and less hyperalgesia than TL-IVDE.

A novel repair strategy using knotless squeeze anchors for lumbar disc herniation with endplate junction lesions under biportal endoscopic spinal surgery.

Annulus fibrosus-endplate (AF-EP) junction lesions are important determinants for lumbar disc herniation (LDH). Utilizing biportal endoscopic spinal surgery (BESS), we introduce a novel repair method using bioabsorbable PushLock anchors with suture fibers to stretch disconnected AF tissues to the vertebral cortex. The viewing and working portals are established to excise herniated disc materials causing radiculopathy. Through the working portal, a suture strand is passed through the intact AF tissue near the lesion and retrieved using the Suture Crossing Device. Then, the knotless suture limbs are secured into the cortical bone socket of the vertebral body with a PushLock anchor. The procedure is a simple, safe, and feasible knotless suturing technique for the treatment of LDH with AF-EP junction lesions.

Physiotherapy Intervention for Cervical Radiculopathy: A Case Report

Introduction: The objective of this study is to determine the efficacy of physiotherapy on pain and quality of life in cervical radiculopathy. Cervical Radiculopathy is characterised by compression of the nerves by either arthritic bone spurs or herniated disc material. Usually, this impingement causes motor dysfunction in the upper extremities and neck, as well as sensory impairments, numbness, or discomfort extending to the arms. Pathologies affecting the nerve roots might result in cervical radiculopathy. Case Report: This case report focuses on a 31-year-old female patient who has been diagnosed with cervical radiculopathy. She had tingling and numbness in her hands, particularly in right arm of physiotherapy on pain and quality of life in cervical radiculopathy. Cervical Radiculopathy is characterised by compression of the nerves by either arthritic bone spurs or herniated disc material. Usually, this impingement causes motor dysfunction in the upper extremities and neck, as well as sensory impairments, numbness, or discomfort extending to the arms. Pathologies affecting the nerve roots might result in cervical radiculopathy. Case Report: This case report focuses on a 31-year-old female patient who has been diagnosed with cervical radiculopathy. She had tingling and numbness in her hands, particularly in right arm shows (median nerve distribution). Patient was recruited on the basis of special test: Spurling Test, Distraction Test, and Upper Limb Tension Test. After 2 week of intervention significant improvement was shown by using- Numeric pain Rating scale for pain, Neck Disability Index for Disability, and SF_12 for quality of life, patient reported less symptomatic and symptoms reduction during work and exercise. This case report demonstrates an effective, evidence based approach to physical therapy treatment for patients in cervical radiculopathy.

Unilateral Biportal Endoscopy for Lumbar Spinal Stenosis and Lumbar Disc Herniation.

Unilateral Biportal Endoscopy for Lumbar Spinal Stenosis and Lumbar Disc Herniation.

Use of Cannulated Reamers to Facilitate Thoracic Diskectomy Using a Minimally Invasive Retropleural Thoracotomy Approach-Surgical Technique.

The surgical treatment of symptomatic thoracic disk herniations is technically challenging. In the past decade, a minimally invasive retropleural thoracotomy approach has become more popular to treat this pathology. However, efficient bone removal to safely perform the diskectomy and spinal cord decompression is difficult with this technique because of the small incision size and long working distance in the thoracic cavity and the proximity of the compressed thoracic cord. To describe a novel surgical technique for performing a thoracic diskectomy using a minimally invasive lateral approach using cannulated reamers to facilitate bone removal. This technique was used in 7 consecutive patients who presented with thoracic myelopathy from a thoracic disk herniation. First, a standard lateral minimally invasive retropleural approach to the thoracic spine was performed. Partially threaded guide wires were placed in the posterior aspect of the vertebral bodies adjacent to the affected disk space, and sequential cannulated reamers were passed over the guidewires to perform partial corpectomies. The posterior annulus, posterior longitudinal ligament, and herniated disk material were then resected using Penfield dissectors and Kerrison rongeurs to complete the decompression. All 7 patients who underwent thoracic diskectomy using this approach had stable or improved neurologic function postoperatively. There were no complications related to the use of the cannulated reamer technique. The use of cannulated reamers provides a simple and efficient method for safe bone removal to facilitate minimally invasive thoracic diskectomy using a lateral approach. This is an easily reproducible technique using commonly available equipment.

Usefulness of Source Images of Magnetic Resonance Myelograms and Partial Laminectomy for Interlaminar Endoscopic Lumbar Discectomy at L5-S1: A Technical Note and Preliminary Clinical Results.

The primary objective of this study was to assess the clinical and radiologic outcomes and introduce the technical notes from 10 patients who underwent interlaminar endoscopic lumbar discectomy (IELD) at L5-S1 using the source images of magnetic resonance (MR) myelograms and performing partial laminectomy. A biportal endoscopic system was used to perform partial laminectomy, followed by fragmentectomy and subtotal discectomy using a uniportal endoscopic system. The source images of MR myelograms were used to identify the anatomical relationship between the herniated disc material, L5 and S1 nerve roots, the thecal sac, and L5 lamina. Preoperative leg and back visual analog scale scores were greatly improved immediately and after 3 months and 6 months postoperatively. Fragmentectomy and subtotal discectomy became easier after performing a partial laminectomy in all IELD cases at L5-S1. The source images of MR myelograms and partial laminectomy is useful for IELD at L5-S1. Level IV.

Comparison of Surgical Outcomes Associated With Compression Secondary to Hemorrhage and Intervertebral Disk Extrusions in Dogs.

Acute intervertebral disk extrusion (IVDE) is one of the most commonly reported neurologic disorders seen in veterinary practice. There is a recognized subset of IVDE cases that have a hemorrhagic inflammatory reaction within the epidural space that causes compression in addition to compression from herniated disk material. Previous reports have been conflicting in the outcomes of these cases. The goals of this retrospective case-control cross-sectional study are to (1) compare the success rate of routine surgical decompression in dogs with DEEH compression compared to Modified Frankel Score (MFS) matched dogs with non-hemorrhagic disk extrusions; (2) evaluate the extent of spinal cord compression on MRI compared to final patient outcomes in DEEH compression and (3) determine the surgical compression to decompression ratio and its relation to patient outcomes in cases of DEEH compression. A total of 143 dogs were included in this study and divided into two groups: DEEH compression dogs (n = 78) and non-hemorrhagic IVDE dogs (n = 65). Outcomes were assigned for each patient [0 = deceased, 1 = alive and non-ambulatory (MFS 0–3), 2 = alive and ambulatory (MFS 4 or 5)] in both groups. Outcomes of DEEH and non-hemorrhagic IVDE did not differ when taken to surgery with comparable success rates when stratified by MFS. Similarly, outcomes did not differ between DEEH and non-hemorrhagic IVDE dogs when assessed by compression to decompression ratio. Dogs with DEEH compression had more compressed sites than dogs with non-hemorrhagic IVDE (P = 0.001) and had more sites decompressed surgically than dogs with non-hemorrhagic IVDE (P < 0.001). Consequently, the compression to decompression ratio did not differ between the two groups (P = 0.52). Our results support the finding that when a similar level of surgical decompression is achieved, dogs with DEEH compression have similar outcomes to dogs with non-hemorrhagic IVDE for similar degrees of neurological dysfunction.

Comparison Of the Effectiveness of Maitland Manipulation of Thoracic Spine Versus Grade I And II Maitland Mobilization of Cervical Spine on Pain Intensity and Functional Status in Patients of Cervical Radiculopathy

Cervical radiculopathy (CR) is a most reported pathological problem mainly due to herniated disc material causing nerve compression or the formation of osteophytes. This impingement specifically causes cervical pain radiating to arm, numbness, and sensory deficit. It also affects the motor function of the neck and upper extremities. Objectives: To evaluate the comparative effectiveness of Maitland manipulation of thoracic spine versus grade I and II Maitland mobilization of cervical spine on Pain, intensity, and functional status in patients of cervical radiculopathy. Methods: Total 32 patients suffering from cervical radiculopathy were randomly assigned to receive Maitland manipulation on thoracic spine along with Conventional Physiotherapy (intermittent cervical traction, strengthening exercises) in Group A(n=16) and Maitland mobilization on cervical spines along with Conventional Physiotherapy in Group B (n=16). Total treatment sessions given to each group was 9 (3 sessions per week). To measure outcome numeric pain rating scale (NPRS) and neck disability index (NDI) questionnaire was used. Data collection was done at the beginning and post-treatment. Results: The study revealed that the mean age of patients was 47.59 with a range minimum of 27 years to a maximum of 59 years. Comparison of post-treatment of both groups showed mean NPRS score in group A (Maitland thoracic spine manipulation) was 4.56± 1.031 and group B (Maitland cervical spine mobilization) was 6.12± 0.50, while post-treatment NDI score group A was 22.44± 10.09 and group B was 36.88± 8.437 with p=0.000 that was p&lt;0.05. Conclusion: The study concluded that both Maitland thoracic spine manipulation and Maitland cervical spine mobilization techniques have similar effects in reducing cervical radiculopathy and increasing active range of motion. However, Maitland thoracic spine manipulation showed better results in neck pain reduction and improved functional status on the comparison.

Lumbosacral intervertebral disk extrusions in 13 dogs

To describe the clinical presentation, magnetic resonance imaging (MRI) findings, and outcome of dogs treated surgically for lumbosacral intervertebral disk extrusion (IVDE). Retrospective study. Thirteen dogs. Records and MRI studies of dogs with intraoperatively confirmed lumbosacral IVDE were reviewed. MRI features of thoracolumbar IVDE were applied to all cases. Postoperative outcome was subjectively assessed as excellent, good, or poor. All dogs had an acute or subacute onset of lumbosacral pain and nerve root signature. Seven dogs had neurological deficits. MRI revealed lateralized herniated disk material and partial to complete disk degeneration in all cases; the extradural material extended cranial and/or caudally from the disk space in 10 cases. All dogs underwent L7-S1 dorsal laminectomy and removal of extruded disk material. In six dogs, surgery was complicated by inflammatory changes, including one case of epidural steatitis. On reexamination 4-6 weeks postsurgery, outcome was judged as excellent in 11 dogs and poor in the remaining 2 due to contralateral nerve root signature in one case and nonambulatory paraparesis and urinary incontinence in the case with steatitis. Lumbosacral IVDE in dogs was characterized by acute/subacute onset of lumbosacral pain and nerve root signature and lateralized and often dispersed extradural material over a degenerated L7-S1 intervertebral disk on MRI. Early decompressive dorsal laminectomy generally resulted in excellent clinical outcome. Observation of these clinical and imaging features in dogs should prompt clinical suspicion of lumbosacral IVDE.

Early surgery determines recovery of motor deficits in lumbar disc herniations\u2014a prospective single-center study

BackgroundPatients with intervertebral disc herniation undergo surgical removal of herniated disc material in cases of persisting symptoms and/or neurologic deficits. While motor deficits often prompt surgery, little is known about the optimal timing of surgery in these cases. The aim of this study was to prospectively evaluate the impact of timing of disc surgery on motor recovery. Does postponing surgical treatment worsen outcome?MethodIn total, 120 patients with sciatica and/or sensorimotor deficits due to a lumbar disc herniation were surgically treated at the authors’ center within a 3-month period. In 60 patients, motor deficits were present at the time of admission. Motor function was assessed using manual muscle testing and subdivided according to the Medical Research Council (MRC) scale. Patient demographics, neurologic deficits, duration of motor deficits, treatment characteristics, and outcome were assessed. At a minimum follow-up of 1 year, functional recovery and complications were collated. Patients were subdivided into groups according to the severity of the paresis (MRC ≤ 3/5 vs. MRC 4/5). Intra-group differences were compared based on the duration of the neurologic deficits.ResultsPatients with moderate and severe paresis (MRC ≤ 3/5) benefit from treatment within 72 h as they were shown to have a significantly higher complete recovery rate at 1-year follow-up (75% vs. 0%; p < 0.001).ConclusionImmediate surgery should be offered to patients with moderate and severe motor deficits to increase the likelihood of neurologic recovery. This prospective data may have an impact on emergency triage in these patients.

Full endoscopic interlaminar discectomy (FEID) for recurrent lumbar disc herniation: surgical technique, clinical outcome, and prognostic factors.

The objective of this study is to determine the effectiveness and prognostic factors of revisional full endoscopic interlaminar discectomy (FEID) for recurrent herniation after conventional open disc surgery. The major concerns of the repeated discectomy for recurrent lumbar disc herniation (RLDH) are the epidural scar and postoperative segmental instability. Compared to open discectomy, endoscopic method has advantages of less tissue traumatization, clearer visualization and better tissue identification. With the improvement of endoscopic technique and instrument, the problems related to adhesive scar tissues or postoperative instability could be overcome. From June 2014 to December 2016, FEID was performed in consecutive 24 patients for RLDH. The age ranged from 25 to 60 years (mean 44.6 years). The level operated was L5-S1 in 16 cases and L4-5 in 8 cases. To avoid injury to the neural tissue, we started with the bony structure. A small part of facet or lamina might be resected in severe stenotic or adhesive condition. Aggressive separation of the scar from the neural tissue might lead to dural tear and should be avoided. The herniated disc material was removed after neural tissue had been clearly identified and protected. The follow-up period was at least 24 months. The visual analog scale (VAS) for leg pain and back pain, and Oswestry disability index (ODI) showed significant improvement after treatment. Excellent or good outcome by the modified Macnab's criteria was obtained in 22 of 24 patients at two years follow-up. Excellent outcome was noted in 100 percent patients younger than 50 years. Small durotomy occurred in 2 patients and no visible cerebrospinal fluid (CSF) leakage was detected despite repair was not performed. Two additional surgery was performed including one repeated FEID for re-recurrence of disc herniation and one fusion surgery for postoperative back pain. FEID is a safe and effective alternative for recurrent disc herniation. The successful rate was greater than 90 percent, especially in the younger patients with the advantages of early recovery and no need for fusion.

Modified Full-Endoscopic Interlaminar Discectomy via an Inferior Endplate Approach for Lumbar Disc Herniation: Retrospective 3-Year Results from 321 Patients

Percutaneous endoscopic interlaminar discectomy (PEID) is a widely used minimally invasive procedure that shows satisfying outcomes for the treatment of L5-S1 and even L4-5 disc herniation. PEID can be divided into direct and indirect approaches according to the established method of the working channel. The direct approach mainly uses the puncture needle directly through the intervertebral space into the intervertebral disc under indirect vision and insertion of the guidewire into the puncture needle to guide the dilator and into the working channel to retract the ligamentum flavum, dural sac, and nerve roots. This approach requires a skilled puncture technique, given the high risk of damage to the nerve roots and dural sac. Therefore, we improved this interlaminar access procedure, placing the puncture target at the inferior endplate and performing preoperative epidurography to expose the spinal nerve roots and dural sac after the puncture needle was passed through the ligamentum flavum. We then positioned the puncture needle at the posterior edge of the superior centrum. Finally, we inserted the working sleeve for the operation. This approach is convenient and effectively reduces the learning curve andintraoperative complications. Here we introduce theprocedure and report the safety and efficacy of full-endoscopic interlaminar discectomy via an inferior endplate approach for the treatment of lumbar disc herniation. We performed full-endoscopic interlaminar discectomy via the inferior endplate approach in 321 patients who met our inclusion criteria between May 2014 and May 2017. All operations were completed under local anesthesia. Under fluoroscopic guidance, we performed epidurography to expose the spinal nerve roots and dural sac. The working sleeve and endoscope were then introduced into the inferior endplate of the superior centrum. Herniated disc material was removed using forceps and a laser under clear endoscopic visualization. We retrospectively evaluated the 321 patients with more than 30 months (range, 12-48 months) of follow-up. The therapeutic effects were assessed using scores of the visual analog scale (VAS), Oswestry disability index (ODI), Macnab standard, and infrared thermal imaging. The mean VAS score for radicular pain improved from 6.3 ± 1.01 preoperatively to 1.01 ± 0.35 at the final follow-up (P < 0.01). The mean ODI score improved from 85.5 ± 12 preoperatively to 12.4 ± 3.7 at the final follow-up (P < 0.01). According to the MacNab standard, the excellent and good outcome scores were 96.5%. The infrared thermal imaging scores indicated significantly improved skin temperature of both lower extremities at 1 week after surgery compared with the preoperation temperature (P < 0.01). The inferior endplate approach for percutaneous endoscopic interlaminar discectomy provides a safe and effective alternative for the treatment of lumbar disc herniation.

Stand-Alone Open Disectomy versus Fixation in Management of Recurrent Lumbar Disc Prolapse

Abstract Background The strict definition of recurrent disc herniation is the presence of herniated disc material at the same level, ipsi- or contralateral, in a patient who had experienced a pain-free interval of at least 6 months following discectomy. Objective The main objective of the systematic review was to compare the outcome of repeated surgery after these two techniques. Methods In the present systematic review, we evaluated 655 patients from 9 studies undergoing surgery for RLDH. Both procedures stand-alone open discectomy and discectomy with fusion were found to cause significant improvement in symptoms and disability following revision of different surgical techniques used in the primary surgery. These were open surgery. All patients showed no improvement or unsatisfactory outcome after a variable periods of proper conservative treatment. Results From the results of this systematic review concerning the recurrent lumbar disc: Recurrent lumbar disc herniation was common in males due to higher physical stress and activity. Both procedures were found to cause significant improvement in symptoms and disability following revision surgery. Fusion was found to be associated with longer operative time (70 min on average), higher intraoperative EBL (220 ml on average) and delayed hospital discharge (an average of 3 days). No significant differences were found with regards to functional outcomes, reoperation rates and dural tears between the two cohorts. Repeat discectomy alone may cause or exacerbate lumbar instability. Sciatica was the first presenting symptoms in all cases while back pain was present significantly more in patient done discectomy alone. There was no significant difference between the two approaches regarding the sensory deficit or muscle weakness. Treatment options for recurrent disc herniation include observation and aggressive medical management or operative intervention, in this systematic review all patients were managed surgically, after failure of conservative management. The optimal surgical approach for recurrent disc herniation remains a subject of controversy. Discectomy with fusion has several theoretical advantages. Dural tear was the main immediate intraoperative complication. The surgical treatment was successful with excellent or good outcome in the majority of cases with no significant difference between the two approaches and it is widely accepted that the results after repeated surgery are comparable to those of the first surgery. There was no significant factor influencing the outcome of surgery including age, sex, diabetes, duration of symptoms or pain-free interval and level or side of recurrence. Conclusion Surgery for recurrent lumbar disc herniation can be very successful and may approach the success rate for initial operations provided proper patient selection, good and thorough examination and investigations and proper surgical technique. Available evidence shows that in treating recurrent lumbar discs herniation, repeat discectomy and fusion are associated with comparable reoperation rates, incidence of dural tears, functional outcomes as well as satisfaction with surgical treatment at last follow-up. The findings should be viewed within the context of variable length of follow-up in the included studies; as such, the true long term implications of fusion as compared to repeat discectomy remain to be elucidated. Longitudinal randomized controlled trials are needed to provide firm evidence in this field.

Are viruses associated with disc herniation? A clinical case series

BackgroundThere is some limited evidence for the presence of viruses in herniated disc material including a previous case series that claimed to provide “unequivocal evidence of the presence of herpes virus DNA in intervertebral disc specimens of patients with lumbar disc herniation suggesting the potential role of herpes viruses as a contributing factor to the pathogenesis of degenerative disc disease”. This study has not been replicated. The objective of our study was to determine if viruses were present in herniated disc fragments in participants with a prior history of back pain.MethodsWe recruited fifteen participants with a history of prior low-back pain prior to undergoing disc herniation surgery in the lumbar spine. Harvested disc samples were subject to next generation sequencing for detection of both RNA and DNA viral pathogens. Additionally, samples were analysed by a broadly reactive PCR targeting herpesviral DNA. Ethics approval was granted by the Human Research Ethics Committees of both Murdoch University, and St John of God Hospital, Western Australia.ResultsOf the fifteen research participants, 8 were female. Mean age was 49.4 years (SD 14.5 yrs) with a range of 24–70 years. All participants had prior back pain with mean time since first ever attack being 8.8 years (SD 8.8 yrs). No samples contained significant DNA sequences relating to known human viral agents. Inconsequential retroviral sequences were commonly found and were a mixture of putative animal and human retroviral protein coding segments. All samples were negative for herpesvirus DNA when analysed by pan-herpesvirus PCR.ConclusionsThis study found no viral pathogens in any intervertebral disc fragments of patients who had previous back pain and underwent discectomy for disc herniation and thus it is unlikely that viruses are associated with disc herniation, however given the contradiction between key studies enhanced replication of this experiment is recommended.

Results Following Posterior Cervical Microforaminotomy and Discectomy using McCulloch Retractors for Cervical Radiculopathy

Cervical radiculopathy frequently occurs secondary to degeneration of cervical disc and cervical spondylosis. The herniated disc material and the osteophytes compress the spinal cord and the nerve roots, resulting in clinical symptoms. Severe pain and neurological deficits often requires surgical intervention. Surgical management for radiculopathy of the cervical spine includes Anterior Cervical Discectomy with Fusion (ACDF), cervical foraminotomy via an anterior (ACF) or posterior approach, and Anterior Cervical Decompression and Arthroplasty (ACDA). Surgeons tend to choose the surgical method that is appropriate to the patient’s needs, the pathological characteristic of the case, and the surgeon’s skill.

WITHDRAWN: Modified Full-Endoscopic Interlaminar Diskectomy via an Inferior End Plate Approach for Lumbar Disk Herniation: Retrospective 3-Year Results from 321 Patients

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Posterior Percutaneous Endoscopic Technique Through Bilateral Translaminar Osseous Channels for Thoracic Spinal Stenosis Caused by Ossification of the Ligamentum Flavum Combined with Disk Herniation at the T10–11 Level: A Technical Note

The occurrence rate of thoracic spinal stenosis caused by ossification of the ligamentum flavum combined with disk herniation is lower than that of ossified ligamentum flavum in the thoracic spine, and the treatment method has rarely been reported. In this paper, we applied an endoscopic technique to a patient with thoracic spinal stenosis caused by ossification of the ligamentum flavum combined with disk herniation at the T10-11 level. We performed surgical decompression of the thoracic spinal cord for a patient diagnosed with thoracic spinal stenosis at the T10-11 level caused by ossification of the ligamentum flavum combined with disk herniation using percutaneous endoscopic surgery via the bilateral translaminar osseous channel approach. Pre- and postoperative computed tomography (CT) scan and magnetic resonance imaging (MRI) examinations were performed, and pre- and postoperative neurologic status was evaluated using the Modified Japanese Orthopaedic Association and visual analog scale scores. The ossified ligamentum flavum and herniated disk material were removed through this osseous channel. Postoperative CT and MRI scanning revealed adequate decompression of the spinal cord at the T10-11 level. The patient was discharged home on postoperative day 3. At 6-month postoperative follow-up, the patient experienced complete resolution of T12 dermatomal numbness. The strength in her bilateral lower extremities improved slightly to grade5. We have applied percutaneous endoscopic surgery via bilateral translaminar osseous channels for the treatment of thoracic spinal stenosis caused by ossification of the ligamentum flavum combined with disk herniation. This surgery could provide sufficient decompression for thoracic spinal cord with minimum trauma.

Structural Analysis of Experimentally Induced Disc Herniation-Like Changes in the Rat

Introduction A disc herniation has traditionally been considered as disc tissue that has slipped out from an intervertebral disc. However, it was recently suggested that the disc herniation mass is a product of bioactive substances from the disc and that the disc hernia would more likely be scar tissue than herniated disc material. In this study, we aimed to analyze the structural components of experimentally induced disc herniations and compare with scar tissue and nucleus pulposus, in the rat. Methods Twenty-eight rats had their L4-5 discs punctured. After three weeks, the nodule that had been formed over the puncture site, scar tissue from the spine musculature, and normal nucleus pulposus were harvested and processed for further analysis. Results Proteomics analysis demonstrated that the formed nodule was more similar to scar tissue than to nucleus pulposus. Gene expression analysis showed that there was no resemblance between any tissues when looking at inflammatory genes but that, there was a clear resemblance between the nodule and scar tissue when analyzing extracellular matrix-related genes. Analysis of the GAG and polysaccharide size distribution revealed that only the nodule and scar tissue contained the shorter versions, potentially short chain hyaluronic acid that is known to induce inflammatory responses. The hematoxylin and eosin stained sections of the nodule, disc tissue, and scar tissue indicated that the morphology of the nodule and scar tissue was very similar. Conclusions The nodule formed after experimental disc puncture, and that resembles a disc hernia, has a more structural resemblance to scar tissue than disc tissue. The nodule is, therefore, more likely to be induced by disc-derived bioactive substances than being formed by herniated disc material.

Design of Compliant Three-Dimensional Printed Surgical End-Effectors for Robotic Lumbar Discectomy

In this paper, the design of compliant three-dimensional (3D) printed surgical end-effectors for robotic lumbar discectomy is presented. Discectomy is the surgery to remove the herniated disk material that is pressing on a nerve root or spinal cord. This surgery is performed to relieve pain or numbness caused by the pressure on the nerve. The limited workspace of the spine (&lt;27 cm3) results in challenging design requirements for surgical instruments. We propose a new cannula-based robotic lumbar discectomy procedure that can accommodate multiple articulated tools in the workspace at the same time and can be controlled teleoperatively by the surgeon. We present designs for two instruments for this proposed system: an articulated nerve retractor and an articulated grasper. The end-effectors of each are 3D printed with multiple materials, with flexible links acting as joints of the mechanism. These flexible links are actuated by cables which provide sufficient articulation and manipulation forces in the surgical workspace. The end-effector's articulated flexible joint kinematics is modeled and tested for range of motion capabilities. The retraction forces for the nerve retractor and the grasping force for the grasper are also experimentally tested and verified to meet all the design requirements. Additionally, fatigue testing of the flexible joint is presented and teleoperated control for the instruments is demonstrated. Finally, conceptual designs for new actuation systems are presented that will enable feasible surgical operations with the enhanced attributes of the designed end-effectors.

Precisão do sinal do beijo na RM da coluna lombar em casos de hérnia do disco axial e a correlação cirúrgica: um estudo multicêntrico indiano

ObjectivesMagnetic resonance imaging has proven to be a valuable tool in the assessment of disc abnormalities. Two types of disc extrusion can be described according to the direction of herniated disc material: shoulder type and axillary type. Axillary disc herniation is described when the extruded disc fragment lies in the recess between the lateral border of cauda equina and medial to the nerve roots, while in the shoulder type the disc lies lateral to the nerve roots. It is very important to describe the type of disc herniation, as the surgical approach differs in each type. To the best of the authors’ knowledge, no definite signs have been described in literature to date. This study aimed to address the accuracy of the kissing sign on MRI for he diagnosis of axillary disc herniation. MethodsThe MRIs of 72 patients undergoing spinal surgery were prospectively evaluated for axillary disc herniation by a senior radiologist and experienced spinal surgeon using the kissing sign on MRI. The kissing sign was considered positive when the herniated disc material was in direct contact with the lamina and/or ligamentum flavum on axial images. Subsequently, all surgeries were performed by two independent surgeons and the actual type of disc herniation was documented. The accuracy of the results was statistically assessed. ResultsThe kissing sign on MRI was found to be 66.66% sensitive, 92.59% specific, and 76.38% accurate in detecting axillary disc herniation with significant correlation with the surgical findings. ConclusionThe type of disc herniation is an important parameter for patient selection in different surgical approaches. The kissing sign on MRI can be considered as an important tool for diagnosing axillary disc herniation due to its high specificity and accuracy.