Intervertebral Disc Herniation Research Articles

Can transcription factors in the intervertebral disc of lopinavir/ritonavir prevent degeneration in the nucleus pulposus by mediating the regulation of inflammation through signaling pathways?

This study was conducted to examine whether lopinavir/ritonavir (Lop/r), an HIV protease inhibitor, can improve disc physiology and slow down intervertebral disc (IVD) degeneration through in vitro experimental methods, as well as whether it can suppress inflammation with interleukin-1 beta (IL-1β) and sex-determining region Y (SRY) protein-related high-mobility group box genes-9 (SOX9) through hypoxia-inducible factor 1-alpha (HIF-1α) and the nuclear factor kappa B (NF-κB) signaling pathway. The aim was to investigate whether Lop/r application is toxic to IVD cells and the microenvironment simultaneously. Human primary cell cultures were prepared using herniated IVD tissues obtained from patients with lumbar disc hernia who were unresponsive toconservative and medical treatment, and thereby, were operated on. The untreated culture samples served as control group, and the samples treated with Lop/r served as study group. Microscopic evaluations were performed simultaneously using fluorescent and supravital dyes in all groups. In addition to cell viability, toxicity, and proliferation analysis through a commercial kit, IL-1β, SOX9, HIF-1α, and NF-κB protein expressions were evaluated using Western blotting. In the statistical comparison of the obtained data, an alpha value less than 0.05 was considered significant. Cell proliferation decreased in the Lop/r group, but no cell death was observed (p < 0.05). Moreover, at the end of 72 hours after Lop/r application, IL-1β and NF-kB protein expressions decreased by 40% and 52%, respectively, while HIF-1α and SOX9 protein expressions increased by 4% and 59%, respectively (p< 0.05). Although these data were obtained from an in vitro experimental study, it is believed that these findings could make significant contributions to the pharmaco-regenerative treatment modalities of IVD degeneration. Lop/r suppresses the IL-1β and NF-κB and induces SOX9 and HIF-1α, since these signaling pathways may be related to human IVD degeneration.

Letter to the Editor Regarding Comments on "The Correlation Between Facet Tropism and Intervertebral Disk Herniation in the Subaxial Cervical Spine" by Wang et al.

TO THE EDITOR: Letter to the Editor Regarding Comments on “The Correlation Between Facet Tropism and Intervertebral Disk Herniation in the Subaxial Cervical Spine” by Wang et al The article entitled “The correlation between facet tropism and intervertebral disk herniation in the subaxial cervical spine” written by Wang et al1 caught us with great interest. The authors performed a retrospective case-control study and found that the facet tropism on the sagittal, axial, and coronal planes are all associated with cervical disk herniation in the subaxial cervical spine. In addition, the side of greater facet angle did not affect the side of herniation. The manuscript is well organized. We appreciate their contribution to this important topic while we would like to communicate with the authors to address some concerns related to the methodology. The cervical facet joints play important roles in the spine motion and load transmission with complex anatomical structure.2 The shape and inclination of the facet joints are not regular and the surfaces are not genuinely planar.3,4 Thus, it may be difficult to describe the three-dimensional orientation of the facet joint planes accurately by drawing lines on two-dimensional images, especially considering the oblique position of the cervical facet joints.5 For all participants, the authors measured the facet angles on axial, sagittal, and coronal planes of computed tomography images. The facet angle was defined as the angle downward between the facet line and midsagittal line in the axial or coronal plane and the closed angle between the facet line and the endplate line in the sagittal plane. According to the definition, the two lines of the facet angle in the coronal and sagittal planes are in two different planes. Although this method is simple, it could be inaccurate. Given the anatomical feature of the facet joints, the orientation would be different if measured on different positions.4 As shown in Figure 1 (Supplemental Digital Content 1, https://links.lww.com/BRS/B916), the measurements are taken from three different positions on the reconstructed computed tomography scan images of the same facet joints. In the sagittal plane, the facet orientation is 58.63° (Figure 1B, Supplemental Digital Content 1, https://links.lww.com/BRS/B916), 51.74° (Figure 1C, Supplemental Digital Content 1, https://links.lww.com/BRS/B916), and 47.65° (Figure 1D, Supplemental Digital Content 1, https://links.lww.com/BRS/B916) in three consecutive images; in the axial plane, the facet orientation is 101.05° (Figure 1F, Supplemental Digital Content 1, https://links.lww.com/BRS/B916), 102.33° (Figure 1G, Supplemental Digital Content 1, https://links.lww.com/BRS/B916), and 100.35° (Figure 1H, Supplemental Digital Content 1, https://links.lww.com/BRS/B916) in three consecutive images; in the coronal plane, the facet orientation is 73.08° (Figure 1J, Supplemental Digital Content 1, https://links.lww.com/BRS/B916), 78.78° (Figure 1K, Supplemental Digital Content 1, https://links.lww.com/BRS/B916), and 80.25° (Figure 1L, Supplemental Digital Content 1, https://links.lww.com/BRS/B916) in three consecutive images. Our previous study4 adopted a three-dimensional method to calculate the facet orientation. The space vector was obtained after the reconstruction the three-dimensional model. Then, the facet angle was calculated by the formula of vector and cosine function. Accurately measuring the facet joint angle is clinically significant in elucidating the relationship between facet orientation and cervical spine degeneration. Hence, a more precise and comprehensive measurement is needed to avoid possible measurement bias. We analyzed the data from a cohort of 100 patients with cervical spondylosis.6 The preliminary results showed no significant relationship between facet tropism and cervical disk degeneration. Many factors might contribute to the degeneration of the intervertebral disk. We suspect the facet tropism might play a role in disk degeneration, but not in a significant way. A prospective cohort study might be a better way to elucidate the cause-and-effect relationship between facet tropism and disk degeneration. We are expecting to further interesting and instructive research about the cervical facet joints from the authors in the future.

Study on Nursing Effect of Moxibustion Combined with Cupping on Patients with Lumbar Intervertebral Disc Herniation of Qi Stagnation and Blood Stasis

Study on Nursing Effect of Moxibustion Combined with Cupping on Patients with Lumbar Intervertebral Disc Herniation of Qi Stagnation and Blood Stasis

Cervical spine and muscle adaptation after spaceflight and relationship to herniation risk: protocol from ‘Cervical in Space’ trial

BackgroundAstronauts have a higher risk of cervical intervertebral disc herniation. Several mechanisms have been attributed as causative factors for this increased risk. However, most of the previous studies have examined potential causal factors for lumbar intervertebral disc herniation only. Hence, we aim to conduct a study to identify the various changes in the cervical spine that lead to an increased risk of cervical disc herniation after spaceflight.MethodsA cohort study with astronauts will be conducted. The data collection will involve four main components: a) Magnetic resonance imaging (MRI); b) cervical 3D kinematics; c) an Integrated Protocol consisting of maximal and submaximal voluntary contractions of the neck muscles, endurance testing of the neck muscles, neck muscle fatigue testing and questionnaires; and d) dual energy X-ray absorptiometry (DXA) examination. Measurements will be conducted at several time points before and after astronauts visit the International Space Station. The main outcomes of interest are adaptations in the cervical discs, muscles and bones.DiscussionAstronauts are at higher risk of cervical disc herniation, but contributing factors remain unclear. The results of this study will inform future preventive measures for astronauts and will also contribute to the understanding of intervertebral disc herniation risk in the cervical spine for people on Earth. In addition, we anticipate deeper insight into the aetiology of neck pain with this research project.Trial registrationGerman Clinical Trials Register, DRKS00026777. Registered on 08 October 2021.

Overview of the Current Literature on the Most Common Neurological Diseases in Dogs with a Particular Focus on Rehabilitation.

Simple SummaryThis paper aims to report an overview of the most common neurological diseases (intervertebral disc herniation, degenerative myelopathy, fibrocartilaginous embolism, and polyradiculoneuritis), with a main focus on rehabilitative options and outcomes, reported in recent veterinary literature. Literature seems to be positively oriented on the efficacy of the rehabilitation approach, reporting a careful and prudent choice of the protocol to be applied for the correct recovery of the patient. However, blinded, controlled, prospective studies are still necessary, above all for degenerative myelopathy, fibrocartilaginous embolism, and polyradiculoneuritis.Intervertebral disc herniation, degenerative myelopathy, fibrocartilaginous embolism and polyradiculoneuritis often affect dogs; and physiotherapy may improve the patient’s quality of life and/or reduce recovery times. The aim of this review was to evaluate the current scientific outcomes on these four neurological diseases and on their physiotherapy approaches. From the analysis of the published articles, it emerged that intervertebral disc herniation can be treated, with different rates of success, through a conservative or a surgical approach followed by physiotherapy. The literature is generally oriented toward the efficacy of the rehabilitation approach in this specific canine disease, often proposing intensive post-surgery physiotherapy for the most severe conditions with the absence of deep pain perception. When degenerative myelopathy, fibrocartilaginous embolism or polyradiculoneuritis occur, the existing literature supports the use of a physiotherapeutic approach: allowing a delay in the onset and worsening of the clinical signs in degenerative myelopathy, physical improvement, and, sometimes, complete remission during fibrocartilaginous embolism or acute idiopathic polyradiculoneuritis. However, papers on rehabilitation in dogs affected by polyradiculoneuritis are currently limited to single clinical cases and further blinded, controlled, prospective studies are still advisable for all four neurological diseases.

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.

Follow-up MRI appearance of the surgical site in dogs treated for thoracolumbar intervertebral disc herniation and showing ongoing or recurrent neurological symptoms.

Reherniation and reoperation rates of 4.5%-36% are reported in canine patients treated for intervertebral disc herniation (IVDH). Decision-making for surgical reintervention can prove challenging, especially since common postoperative changes are poorly described on MRI. The purpose of this single-center, retrospective, descriptive study was to describe the MRI characteristics ofthe surgical site in dogs treated for thoracolumbar IVDH and presenting for ongoing or recurrent neurological signs. Twenty-one patients were included for a total of 42 MRI studies. Chondrodystrophic breeds, specifically Dachshunds, were overrepresented. Mean number of days between surgery and second MRI was335(range 2-1367). Metallic susceptibility artifacts were seen in seven of 21cases(33%), but these were limited in extent, spanning on average 1.3 vertebral bodies. In 11 cases, spinal cord compression suspected to be clinically significant was found at the surgical site; the extradural compressive material consisted of intervertebral disc material only, or a combination of intervertebral disc material and hematoma or inflammatory changes in 10 cases, and a displaced articular process and fibrous tissue in one case. The latter is a newly described complication of mini-hemilaminectomies. Paravertebral soft tissue changes and vertebral new bone formation varied according to the postoperative stage at which the patients were imaged. The results of this study supported the use of MRI as a diagnostic modality for spinal imaging following IVDH surgery, and showed that the presence of extradural disc material at a spinal surgical site is common along with various vertebral and paravertebral changes.

Effectiveness and Functional Outcome of Fenestration and Discectomy by Mini-Incision for the Prolapsed Lumbar Intervertebral Disc

Background: Lumbar intervertebral disc herniation is a common health problem in our country. Majority of the surgeries of the spine are done due to disc herniation in Bangladesh. Discectomy can be limited to partial discectomy where only extruded and sequestrated portion is removed, subtotal discectomy where the whole of nucleus pulpous is removed and total discectomy where the entire intervertebral disc of the affected level is removed. Aim of the study: To find out the effectiveness and functional outcome of fenestration and discectomy by mini-incision for the prolapsed lumbar intervertebral disc in our context. Material &amp; Methods: This prospective observational study was conducted at National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR), Dhaka, Bangladesh during July 2015 to June 2017. A total of 31 patients with prolapsed lumbar intervertebral disc were included for the study according to inclusion and exclusion criteria. Results: The mean age was 35.98 ± 8.50 years with the range from 17 to 50 years. In this study, the most common muscle weakness in EHL. Out of 31 patients, 22 (70.96 %) patients were in this group. 08 (25.80%) cases had weakness in FHL and another group 01 (3.22%) had both muscle weakness. Out of 31 patients, 30 (96.78%) patients had preoperative sensory deficit and 03 (09.67%) patients had postoperative sensory deficit, which is statistically significant. In preoperative period, moderate pain in 27 (83.87%) patients, severe pain in 04 (12.90%) patients. In postoperative period had no pain in 22 (70.96%) patients, mild pain was noted in 08 (25.08%) patients, moderate pain in 01 (03.22%) patient. 20 (64.51%) patients had para spinal muscle spasm in the preoperative period, whereas no patient had any spasm in 3 months postoperatively. The success rate was 100% and the result was statistically significant. In this present series, functional outcome was assessed according to Macnab criteria. 08 (25.80%) cases were excellent, ...

Update on Interventional Radiology of the Spine.

Interventional radiologists now perform spinal interventions routinely for diagnostic and therapeutic purposes. New technologies for the management of spine pathologies have emerged with promising results in terms of safety and efficacy. Interventional radiology techniques in the spine include percutaneous biopsy and therapies for intervertebral disk herniation or spinal stenosis, facet and sacroiliac joint pathologies, vertebral and sacral fractures, and metastases. These techniques can also be easily combined one with the other or to further therapeutic approaches including systemic therapies, surgical approaches, and radiotherapy. This review provides a comprehensive overview of current percutaneous imaging-guided interventional radiology techniques in the spine. It will help readers become familiar with the most common indications, learn about different technical considerations during performance, and review the available evidence. Controversies concerning new products and technical approaches are also addressed.

Clinical Studies of Bee Venom Acupuncture for Lower Back Pain in the Korean Literature.

This study aimed to identify all of the characteristics of bee venom acupuncture (BVA) for the treatment of lower back pain (LBP) that are described in the Korean literature, and to provide English-speaking researchers with bibliometrics. Six Korean electronic databases and sixteen Korean journals on BVA treatment for back pain were searched up to February 2022. This report included and analyzed 64 clinical studies on BVA interventions for back pain and 1297 patients with LBP. The most common disease in patients with back pain was lumbar herniated intervertebral discs (HIVD) of the lumbar spine (L-spine). All studies used bee venom (BV) diluted with distilled water. The concentration of BVA for HIVD of L-spine patients with LBP ranged from 0.01 to 5.0 mg/mL; the dosage per treatment was 0.02–2.0 mL, and for a total session was 0.3–40.0 mL. The most used outcome measure was the visual analogue scale for back pain (n = 45, 70.3%), and most of the papers reported that each outcome measure had a positive effect. Korean clinical studies were typically omitted from the review research, resulting in potential language bias. This study provides clinical cases in Korea for future development and standardization of BVA treatment for back pain.

Hui Medicine Moxibustion Promotes the Absorption of Lumbar Disc Herniation and the Recovery of Motor Function in Rats through Fas/FasL Signaling Pathway.

Objectives To study the resorption of the herniated lumbar disc (RHLD) and its mechanism in the SD rats of lumbar intervertebral disc herniation treated with Hui medicine moxibustion (HMM). Methods Forty SD rats were randomly divided into four groups, normal group, lumbar disc herniation (LDH) group, HMM group, and antagonist (HMM+Met12) group, with 10 rats in each group. The rat model of LDH was prepared with the method of lumbar epidural emplacement of the caudal intervertebral disc. In the HMM group and HMM+Met12 groups, 4 weeks after modeling, HMM therapy was performed in the lumbar spine for 3 months with 1 time per day and 20 min each time, the samples were collected 8 weeks after the treatment. The histological degeneration was observed through HE staining, and the neovascularization of intervertebral disc tissues was detected by the expression of CD34 and vascular endothelial growth factor (VEGF). The apoptosis of nucleus pulpous cells was detected by TUNEL assay, and the activity of caspase-3, -8, and -9 and extracellular matrix enzymes was detected by western blotting. Results HMM treatment significantly improved the behavioral ability of rats with LDH surgery. The morphological structure was obviously destroyed in the LDH group, but disc structure was significantly repaired in the HMM group, and mild structure alterations were observed in the HMM+Met12 group. Higher levels of CD34 and VEGF were detected in the HMM group indicating that neovascularization is formed. The expression level of FasL was significantly increased in the HMM group. The protein expression levels of cleaved-caspase-3, cleaved-caspase-8, and cleaved-caspase-9 in nucleus pulposus (NP) tissues were also elevated when treated with HMM, and the TUNEL staining showed the same results. The protein expression levels of matrix metalloproteinases- (MMP-) 1, MMP-2, MMP-3, MMP-13, and ADAMTS-4 were markedly promoted in the HMM group. Met12, a small peptide antagonist of FasL, significantly reduced the effects of HMM. Conclusion HMM can promote the formation of neovascularization of lumbar intervertebral disc, support the apoptosis of NP cells through Fas/FasL signaling, and regulate the degradation of extracellular matrix enzyme, which then accelerates the absorption of lumbar intervertebral disc herniation and the recovery of motor function in rats.

Nonsurgical Rehabilitation in Dachshunds With T3-L3 Myelopathy: Prognosis and Rates of Recurrence.

Dachshunds are at significant risk of experiencing thoracolumbar intervertebral disk herniation (IVDH) during their lifetimes. Standard of care includes advanced imaging, surgical intervention, and postoperative rehabilitation. Conservative management is commonly recommended for cases where the standard of care is declined, and little is known about the prognosis of treatment with conservative management and rehabilitation (nonsurgical rehabilitation). This retrospective cohort study assessed 12-week functional outcome and recurrence of clinical signs in 40 dachshunds with T3-L3 myelopathy presumed to be due to Hansen's Type I disc herniation, treated with nonsurgical rehabilitation. The overall prognosis was good with 34 of 40 (85.0%, 95% CI 70.2–94.2) dachshunds achieving functional pet status by 12 weeks postinjury. Modified Frankel Score at presentation was significantly (p < 0.001) higher in dogs with a positive 12-week outcome compared to dogs that did not recover by 12 weeks. All 27 dogs with motor function at presentation had a positive outcome. Of the 9 dogs exhibiting paraplegia with intact deep nociception at presentation, 7 dogs (77.8%) had achieved a positive outcome by 12 weeks. None of the 4 dogs persistently lacking deep nociception had a positive outcome. Among 27 dogs with a positive outcome for whom follow-up records were available, the 1- and 2-year recurrence rates for T3-L3 myelopathy were 5 and 11%, respectively. Nonsurgical rehabilitation should be considered in dachshunds with mild to moderate T3-L3 myelopathy or in severe cases when advanced imaging and surgical intervention are not possible.

Comparison of interlaminar and transforaminal epidural steroid injection for lumbosacral radiculopathy

Background: Low back pain due to Intervertebral disc herniation, intervertebral disc degeneration without disc herniation are the most common diagnosis of chronic persistent low back and lower extremity symptoms. Epidural steroid injections (ESI) are one of the most common interventional techniques for managing low back pain with or without lower extremity radiation Aims and objectives: Comparison of the effectiveness of lumbar Interlaminar and Transforaminal epidural steroid injections in managing various types of chronic low back pain. Material and methods: A total of 60 patients with history of lumbosacral radicular pain (≥3 months with VAS score ≥50) and magnetic resonance imaging (MRI) of the lumbar spine showing the exact disc level protrusion, who met the inclusion criteria were selected. With simple purposive sampling techniques, all patients were randomly divided into two groups. Group I Received 4 ml of 0.25% bupivacaine with 8mg dexamethasone through fluoroscopy guided interlaminar epidural route and Group T Received 2ml of 0.25% bupivacaine with 4mg dexamethasone through transforaminal route. Baseline assessment was completed just before the randomization and then follow up SLRT and VAS score recordings were taken - post 1 week, 1 month and 3 months after the procedure.

Dysphagia as a Postoperative Complication of Anterior Cervical Discectomy and Fusion.

Anterior cervical discectomy and fusion (ACDF), despite its possible complications, remains the gold standard for the surgical treatment of patients with radiculopathy and/or myelopathy caused by cervical intervertebral disc herniation or spondylosis. Despite its high rate of incidence, postoperative dysphagia following ACDF is still poorly understood; its pathogenesis remains relatively unknown, and its risk factors are still a subject of debate.The aim of this study is to review the incidence, pathogenesis, diagnosis, and methods of prevention of dysphagia in ACDF patients. To this end, a literature review was conducted based on the PubMed internet database. Article titles were searched by using the following keywords: “dysphagia” and “anterior cervical discectomy and fusion” or “ACDF”. The search was limited to prospective clinical studies evaluating dysphagia after ACDF surgery. Studies published in non-English languages, retrospective studies, cadaveric studies, reviews, case reports, study protocols, and commentary studies were excluded.Initially, 335 studies were identified after a primary search. After the application of the exclusion criteria, 73 studies remained for the final analysis. This literature review focused on identifying the rate of dysphagia and the various risk factors leading to this complication by comparing and evaluating the current literature with a wide spectrum of heterogeneity concerning patients, surgeons, and surgical techniques. A mean dysphagia rate of 19.4% (95% CI: 9.6%-29.1%) based on the findings of the included studies correlating dysphagia directly with ACDF procedures was calculated. Various established risk factors leading to dysphagia include the female sex, smoking, the surgical approach, rhBMP-2 use, and multilevel surgery, while zero-profile devices seem to reduce dysphagia risk. The diagnosis is based on clinical and radiological findings, especially prevertebral soft-tissue swelling. However, videofluoroscopic and endoscopic studies have been recently used for the evaluation of dysphagia. The role of local administration of steroids in the prevention of dysphagia has not yet been clarified. This review underscores the prevailing rudimentary understanding of the problem of dysphagia after ACDF procedures and highlights the need for more sensitive, factor-specific studies for understanding the impact of various risk factors on the incidence rate of dysphagia.

Targeting Oxidative Stress and Inflammation in Intervertebral Disc Degeneration: Therapeutic Perspectives of Phytochemicals.

Low back pain is a major cause of disability worldwide that declines the quality of life; it poses a substantial economic burden for the patient and society. Intervertebral disc (IVD) degeneration (IDD) is the main cause of low back pain, and it is also the pathological basis of several spinal degenerative diseases, such as intervertebral disc herniation and spinal stenosis. The current clinical drug treatment of IDD focuses on the symptoms and not their pathogenesis, which results in frequent recurrence and gradual aggravation. Moreover, the side effects associated with the long-term use of these drugs further limit their use. The pathological mechanism of IDD is complex, and oxidative stress and inflammation play an important role in promoting IDD. They induce the destruction of the extracellular matrix in IVD and reduce the number of living cells and functional cells, thereby destroying the function of IVD and promoting the occurrence and development of IDD. Phytochemicals from fruits, vegetables, grains, and other herbs play a protective role in the treatment of IDD as they have anti-inflammatory and antioxidant properties. This article reviews the protective effects of phytochemicals on IDD and their regulatory effects on different molecular pathways related to the pathogenesis of IDD. Moreover, the therapeutic limitations and future prospects of IDD treatment have also been reviewed. Phytochemicals are promising candidates for further development and research on IDD treatment.

Effect of Intraoperative Warming on Postoperative Anesthesia Recovery Time of Patients with Intervertebral Disc Herniation Undergoing UBE Double-channel Surgery

Effect of Intraoperative Warming on Postoperative Anesthesia Recovery Time of Patients with Intervertebral Disc Herniation Undergoing UBE Double-channel Surgery

Fluoroscopic lumbar transforaminal epidural steroid injections for recurrent herniated intervertebral disc after discectomy: Effectiveness and outcome predictors.

BackgroundDespite transforaminal epidural steroid injection (ESI) being the first choice in patient with recurrent herniated intervertebral disc (HIVD), efficacy of ESI in those patients are not well established. Herein, we evaluate the effectiveness and outcome predictors of fluoroscopic transforaminal ESI for recurrent HIVD.MethodsSeventy-seven patients (48 male; mean age, 51.3 years) with recurrent lumbar HIVD were included and divided into three groups according to initial treatment: conservative treatment, transforaminal ESI, and immediate surgery. ESI effectiveness was evaluated by operation rates, injection numbers in 6 months, and pain reduction (visual analog scale (VAS) scores). Clinical and MRI variables were analyzed as possible outcome predictors. Each subject in the transforaminal ESI group was individually matched to two patients with initial HIVD (control group).ResultsIn the transforaminal ESI group (n = 37), 20 patients (54.1%) did not undergo reoperation. The initial and follow-up VAS scores were significantly higher in the reoperation group (p = 0.014, p = 0.019, respectively). Patients with either paresthesia or motor weakness (12/19, 63.2%) had a significantly higher reoperation rate than patients with only pain (5/18, 27.8%; p = 0.031). Extruded disc ratios ≥2.0 were significantly higher in the reoperation group (10/17, 58.8%; p = 0.048). The reoperation rate in the transforaminal ESI group (17/37, 45.9%) was higher than the operation rate in the control group (6/73, 8.2%; p<0.001).ConclusionTransforaminal ESI was effective in reducing radicular pain in patients with recurrent HIVD. Approximately 54% of patients did not undergo reoperation. An extruded disc ratio ≥2.0 and paresthesia or motor weakness were poor outcome predictors.

MRI diffusion tensor imaging scalar values in dogs with intervertebral disc herniation: A comparison between manual and semiautomated region of interest methods.

Magnetic resonance imaging (MRI) diffusion tensor imaging (DTI) measures have been described as methods for quantifying spinal cord injury and predicting outcome in dogs with intervertebral disc herniation (IVDH); however, studies comparing methods for selecting regions of interest (ROIs) are currently lacking. The aims of this retrospective, methods comparison, observational study were to compare DTI measurements acquired using manual (mROI) versus semiautomated ROI (sROI) methods and to compare DTI measurements with patient outcomes. Magnetic resonance imaging scans that included DTI pulse sequences were retrieved for 65 dogs with confirmed IVDH. Regions of interest were placed at one vertebral length cranial and caudal to the region of spinal cord compression (RSCC) using the mROI and sROI methods. Scalar values based on the mROI and sROI methods were compared. There was a significant difference for all DTI measures (P<0.0001), where fractional anisotropy was higher (95% confidence interval [CI]: 0.15, 0.19) and mean diffusivity (MD; CI: -0.41, -0.35), axial diffusivity (AD; CI: -0.47, -0.36) and radial diffusivity (RD; CI: -0.36, -0.27) were lower for the mROI than for the sROI. For both the mROI and sROI, MD, AD, and RD were significantly lower (p<0.05) at the RSCC in paraplegic dogs that did not regain motor function. The findings indicated that DTI methods for quantifying SCI using open source software and ROI were feasible for use in dogs with IVDH; however, values based on sROI methods differed from values based on mROI methods. Some DTI measures based on both the mROI and sROI methods were predictive of poor patient outcome.

Rehabilitation and health aspects of the joseph pilates system

Joseph Pilates's exercise system is related to mental fitness and aims to improve the musculoskeletal system, cardiovascular and lymphatic systems, strengthen the stabilizing muscles that hold the spine, improve the sense of balance and your body in space, coordination, strength and muscular endurance, teaches to move gracefully and beautifully. Purpose: to determine the rehabilitation and health aspects of the Pilates system. Methods of work: the methods of theoretical level of research were used in the work: analysis, comparison, induction, deduction, systematization and generalization of scientific and methodological literature and information resources of the Internet on the application of Pilates. Results: According to the results of experimental studies, the effectiveness of Pilates classes to increase the adaptive potential of functionality, reduce blood pressure, heart rate, body weight in women of all ages. The main advantage of the Joseph Pilates system is the complex load, which includes the factor of healing and unloading the spine, eliminating pain, correcting posture defects and improving well-being in osteochondrosis and intervertebral disc herniation. Researchers who implement Pilates in their teaching practice, note that such classes are performed with low intensity and in sitting or lying down, it allows to easily use this system in people with diseases of the visual organs, cardiovascular system, in patients with breast cancer. Conclusions: Joseph Pilates system allows you to develop a balanced body, intensify metabolic processes, relieve stress, increase muscle endurance, improve the appearance and health of women of all ages.

Transforaminal Endoscopic Lumbar Discectomy for Lumbosacral Junction Adolescent Lumbar Disc Herniation with High Iliac Crests.

ObjectiveTo investigate the clinical results of transforaminal endoscopic lumbar discectomy for lumbosacral junction adolescent lumbar disc herniation with high iliac crest.MethodsFrom February 2014 to September 2020, a retrospective analysis of 96 patients less than 21 years old with intervertebral disc herniation was carried out. We enrolled 44 patients diagnosed with lumbosacral junction disc herniation with high iliac crest who required transforaminal endoscopic lumbar discectomy. Pain in the back and the lower extremity was scored on Numeric Rating Scales (NRS) scores. Patient outcomes were graded as excellent, good, fair, and poor using modified MacNab criteria. The NRS scores before and after the operation were compared using the Wilcoxon two‐sample test.ResultsThere were 30 male patients and 14 females. One patient underwent repeat surgery for an intervertebral disc pseudocyst. The NRS scores decreased significantly in both early and late follow‐up evaluations (p < 0.05). At the last follow‐up, 42 patients (95.45%) had an excellent outcome, one patient (2.27%) had a good outcome, and one patient (2.27%) had a fair outcome. The overall success rate was 97.7%.ConclusionThis study's data suggest that targeted individualized foraminoplasty can effectively overcome the lumbosacral anatomical obstacles, and transforaminal endoscopic lumbar discectomy is an effective and valid option for lumbosacral junction adolescent lumbar disc herniation with high iliac crest.