Including Disc Herniation Research Articles

Paper on role of cervical disc replacement surgery in cervical pivd patients in both elderly and young population and it’s comparison with anterior cervical dissectomy and fusion

For more than fifty years, anterior cervical discectomy and fusion (ACDF) has been a widely accepted operation for cervical spine degenerative diseases, including disc herniation and spondylosis, that are refractory to medical management. The high rates of success and patients’ satisfaction with ACDF has made the operation a standard of care in common neurosurgical practice, however, the advantages of cervical disc arthroplasty (CDA) over fusion including maintaining normal neck motion and reducing degeneration of adjacent segments of the cervical spineTo study the role of cervical disc replacement surgery in cervical pivd patients in both elderly and young population and it’s comparison with anterior cervical dissectomy and fusion with age variability taken into consideration. The inclusion and exclusion criteria used, The operative procedure for both ACDF and CDA, The further follow up studies considering clinical as well as radiological outcome The most commonly indexed levels of CDA were C4–5 and C5–6, accounting for 85%of the entire series.The clinical outcomes, including VAS of neck and arm pain, NDI, and JOA scores were all similarly satisfactory after the surgery, during the follow-up. CDAs has been demonstrated to preserve segmental motion at long-term followup and to decrease the incidence of adjacent-level surgery, as compared to ACDF. Cervical global alignment and the segmental angle at rest improves after cervical arthroplasty

Minimally Invasive Transforaminal Lumbar Interbody Fusion (MI-TLIF): A Video Technique Guide.

Minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) has been established as an excellent alternative to the traditional open approach for the treatment of degenerative conditions of the lumbar spine1-3. The procedure is performed with the patient under general anesthesia and on a radiolucent table in order to allow for intraoperative fluoroscopy. The procedure is performed through small incisions made over the vertebral levels of interest, typically utilizing either a fixed or expandable type of tubular dilator, which is eventually seated against the facet joint complex4. A laminectomy and/or facetectomy is performed in order to expose the disc space, and the ipsilateral neural elements are visualized5. The end plates are prepared, and an interbody device is placed after the disc is removed. Pedicle screws and rods are then placed for posterior fixation. Nonoperative alternatives include physical therapy and corticosteroid injections. Other operative techniques include open TLIF or other types of lumbar fusion approaches, such as posterior lumbar interbody fusion (PLIF), anterior lumbar interbody fusion, lateral or extreme lateral interbody fusion, or oblique lumbar interbody fusion. Open TLIF was developed in order to obtain a more lateral approach to the lumbar disc space than was previously possible with PLIF. The goal of this was to minimize the amount of thecal-sac and nerve-root retraction required during PLIF4. Additionally, as the number of patients who required revision after PLIF increased, the need arose for an approach to the lumbar spine that circumvented the posterior midline scarring from previous PLIF surgical sites6. MI-TLIF was introduced to reduce the approach-related paraspinal muscle damage of open TLIF5. Indications for MI-TLIF include most degenerative pathology of the lumbar spine, including disc herniation, low-grade spondylolisthesis, and spinal and foraminal stenosis7. However, MI-TLIF allows for less robust correction of deformity than other minimally invasive approaches; therefore, MI-TLIF may not be as effective in cases of substantial spinal deformity or high-grade spondylolisthesis8. MI-TLIF results in significantly less blood loss, postoperative pain, and hospital length of stay compared with open TLIF1-3. Although some studies have suggested increased operative time for MI-TLIF9,10, meta-analyses have shown comparable operative times between the 2 techniques1-3. It is thought that the discrepancy in reported operative times is the result of a learning curve and that, once that is overcome, the difference in operative time between the 2 techniques becomes minimal11,12. One disadvantage of MI-TLIF that has remained constant in the literature is its increased intraoperative fluoroscopy time compared with open TLIF3,13. The complication rate has largely been found to be equivalent between open and MI-TLIF1-3 or slightly lower with MI-TLIF14, especially in the hands of an experienced surgeon15. Finally, the fusion rate and improvement in patient outcome scores have also been found to be largely equivalent1-3. We suggest placing the ipsilateral pedicle screw after the interbody cage has been inserted.Fully visualize the Kambin triangle16 prior to performing the facetectomy. Protect the exiting and traversing nerve roots by placing small cottonoids around them and retracting delicately.Bone removed during facetectomy can be utilized as autograft for the interbody cage.Avoid removing pedicle bone during decompression.If central stenosis is present, the neural decompression should be extended medial to the epidural fat so that the dura mater can be visualized all of the way to the contralateral pedicle.Perform an adequate end plate preparation prior to interbody insertion while being mindful to avoid injuring the end plate, to minimize the risk of future cage subsidence.Confirm correct placement of the interbody device on intraoperative fluoroscopy.If bone morphogenic protein is utilized, be careful not to pack too much posteriorly as this may cause nerve irritation. TLIF = transforaminal lumbar interbody fusionMI-TLIF = minimally invasive TLIFPLIF = posterior lumbar interbody fusionALIF = anterior lumbar interbody fusionLLIF = lateral lumbar interbody fusionXLIF = extreme lateral interbody fusionOLIF = oblique lumbar interbody fusionDLIF = direct lateral interbody fusionMRI = magnetic resonance imagingA/P = anteroposteriorEMG = electromyographicBMP = bone morphogenic proteinXR = x-ray (radiograph)OTC = over the counterDVT = deep vein thrombosisPE = pulmonary embolismMI = myocardial infarctionMIS = minimally invasive surgeryOR = operating roomLOS = length of stayVAS = visual analog scaleODI = Oswestry Disability IndexM-H = Mantel-HaenszelRR = risk ratioCI = confidence intervalNSAIDs = nonsteroidal anti-inflammatory drugs.

Proximal Chain Strength and Coordination Concepts to Maximize Injury Protection and Transfer of Training Effects for Competitive Baseball Players

ABSTRACT Proximal injuries involving the core, intercostal musculature, and spine are the third leading cause of playing time loss in professional baseball. Long seasons and rotational unilaterality from hitting, throwing, and pitching exposes athletes to overuse risks, including disc herniation, spondyloses, spondylosis, facet joint syndromes, and pars lumbar fractures. This article describes injury epidemiology, rotational biomechanics including energy transfer dynamics, and offers injury prevention insights with minimal equipment. Ultimately, the goal of this article is to provide concepts to improve strength and coordination in training to offer greater injury protection and performance in baseball. For a video abstract of this article, see Supplemental Digital Content 1, http://links.lww.com/SCJ/A382.

EFFECT OF MODIC CHANGE ON CLINICAL OUTCOME OF CERVICAL DISC HERNIATION PATIENTS UNDERGOING ANTERIOR CERVICAL DISCECTOMY AND FUSION

Highlights The presence of preoperative Modic changes tends not to affect clinical outcomes after ACDF due to degenerative pathology, including disc herniation. Preoperative Modic changes are correlated with a worse preoperative picture. Abstract Background: Modic Change (MC) is a phenomenon that can be found in Magnetic Resonance Imaging (MRI) of patients with degenerative spinal diseases and in the cervical region. The effect of Modic change on the clinical outcome of postoperative patients has not been fully established. Anterior Cervical Discectomy and Fusion (ACDF) is a procedure that has become the gold standard in treating cervical disc herniation because it is able to eliminate pathological lesions and prevent the recurrence of nerve compression. Objective: This study aimed to determine the effect of MC on the clinical outcome of patients undergoing ACDF therapy due to degenerative disc pathology, including cervical disc herniation. Material and Method: This was a systematic review using filtered literature based on PICOs. The variables examined in this study were "modic change", "ACDF", and "clinical outcome". Data were collected from three databases, which were then screened based on eligibility criteria, assessed for study quality, and reviewed using a qualitative descriptive method. Result: A total of six articles published between 2017 and 2021 were included in this study. This study was an observational study with a retrospective cohort method. Preoperative Modic changes tend not to affect clinical outcomes after ACDF. Conclusion: The presence of preoperative Modic changes tends not to affect clinical outcomes after ACDF due to degenerative disc pathology, including disc herniation, but remains a risk factor for postoperative disability and provides a worse preoperative picture.

Children and adolescents seen at a medical unit – A retrospective review of patient records from the Spine Center of Southern Denmark

ABSTRACT Background Spinal pain in children and adolescents is common and limits their daily In the Region of Southern Denmark, the Spine Center of Southern Denmark provides care for patients with spinal pain who have not improved through primary care. Limited information exists about children and adolescents seen in medical hospital settings. Method A retrospective review of clinical encounters with patients under the age of 18 from January 2018 to December 2021. Data were collected on demographic factors, clinical characteristics, functional impairments, and diagnostic codes (International Classification of Disease (ICD-10)). Results Patients ranged from age 9 to 17, and 60% were female. Most were in primary school, and physically active. The primary complaint was persistent ongoing lumbar pain without nerve root affection and of non-traumatic origin. Mostly used ICD-10 codes were categorized as non-specific spinal pain. However, one-fourth had specific diagnoses, includingdisk herniation, spondylolysis and -listhese, specific spinal-related and non-spinal complaints. Advanced imaging was common, both before referral or at the initial assessment. Approximately 20% were referred to other hospital departments, mostly pediatric departments. Functional impairment varied widely. Conclusion Children and adolescents with spinal pain seen at an outpatient spine center predominantly received non-specific pain diagnoses. However, approximately 20% did have a specific cause for their pain. Patients demonstrated high variability in how much their pain affected them; a large proportion had received imaging either before the initial assessment or with a referral from the spine center.

Injectable bioorthogonal hydrogel (BIOGEL) accelerates tissue regeneration in degenerated intervertebral discs.

Intervertebral disc (IVD) degeneration is a leading cause of back pain and precursor to more severe conditions, including disc herniation and spinal stenosis. While traditional growth factor therapies (e.g., TGFβ) are effective at transiently reversing degenerated disc by stimulation of matrix synthesis, it is increasingly accepted that bioscaffolds are required for sustained, complete IVD regeneration. Current scaffolds (e.g., metal/polymer composites, non-mammalian biopolymers) can be improved in one or more IVD regeneration demands: biodegradability, noninvasive injection, recapitulated healthy IVD biomechanics, predictable crosslinking, and matrix repair induction. To meet these demands, tetrazine-norbornene bioorthogonal ligation was combined with gelatin to create an injectable bioorthogonal hydrogel (BIOGEL). The liquid hydrogel precursors remain free-flowing across a wide range of temperatures and crosslink into a robust hydrogel after 5-10min, allowing a human operator to easily inject the therapeutic constructs into degenerated IVD. Moreover, BIOGEL encapsulation of TGFβ potentiated histological repair (e.g., tissue architecture and matrix synthesis) and functional recovery (e.g., high water retention by promoting the matrix synthesis and reduced pain) in an in vivo rat IVD degeneration/nucleotomy model. This BIOGEL procedure readily integrates into existing nucleotomy procedures, indicating that clinical adoption should proceed with minimal difficulty. Since bioorthogonal crosslinking is essentially non-reactive towards biomolecules, our developed material platform can be extended to other payloads and degenerative injuries.

446 Accurate Localization of Back Pain by Radiomic Assessment of Sigma-1 Receptor Expression

INTRODUCTION: The current diagnostic tools that we have for back pain have low sensitivity and poor accuracy which leads to ineffective and unnecessary treatments, resulting in high health care costs and unwanted outcomes. Sigma-1 receptor (s1R) is broadly implicated in nociceptive signaling and peripheral pain sensation. METHODS: Specific patient selection for full body ([18F]FTC-146) PET/MRI scan was done after clinical and radiological review by a neurosurgeon specializing in spinal surgery. Six patients with various etiologies of back pain were included. For all the study participants, we recorded all relevant clinical details and reviewed prior diagnostic tests. All PET/MRI scans were completed at our institution’s facilities and images were reviewed and correlated by a musculoskeletal radiologist to identify lesions that may be causing patient’s symptoms. RESULTS: Our study results strongly support the likelihood of achieving enhanced diagnostic sensitivity to sources of back pain with the proposed s1r imaging approach. PET/MRI imaging matched the clinical diagnosis in all cases, including disc herniation, nerve compression, stenosis, and arthropathy. Additionally, it offered benefit over traditional MRI by identifying additional “functional” findings both within and outside the spine. This additional functional detail, was useful for patients with either no or multiple structural abnormalities on MRI to pinpoint the true cause of pain demonstrating the synergistic utility of this imaging modality. Such functional detail guided successful interventions including surgery, therapy, and injections in our patient cohort that successfully addressed the pain. CONCLUSIONS: Early results show promise for improved confidence and sensitivity in detecting sources of pain using full body ([18F]FTC-146) PET/MRI scan which can potentially improve patient management and outcomes.

The Effect of Amniotic Tissue on Spinal Interventions: A Systematic Review.

Amniotic membrane tissue has been thought to potentiate healing in many soft tissue conditions. Specifically, recent studies have shown its therapeutic potential for treatment in the setting of spinal pathologies. The purpose of this study is to thoroughly review the existing scientific literature and evidence concerning the clinical use of amniotic membrane-derived biologic agents on postoperative outcomes following spinal surgery. A systematic review was conducted following preferred reporting items for systematic reviews and meta-analyses guidelines using PubMed, Embase, and Cochrane databases up to December 2020 to identify animal and clinical studies examining the therapeutic potential for amniotic membrane tissue in the setting of spinal pathologies (including disc herniation, prevention of epidural fibrosis, and spinal fusion). Studies were broken down into 2 categories: experimental model type and the type of amnion product being analyzed. A total of 12 studies (4 clinical studies and 8 studies utilizing animal models) met inclusion criteria. Additionally, the major types of amnion product were divided into cryopreserved/freeze-dried amniotic membrane, human amniotic fluid, human amniotic membrane, cross-linked amniotic membrane, and amnion-derived epithelial cells. While heterogeneity of study design precludes definitive specific results reporting, most studies showed positive benefits on healing/outcomes with amniotic augmentation. Specifically, amnion products have shown promising effects in reducing epidural adhesions and scar tissue after spine surgery, improving spinal fusion rate and postoperative pain scores, and promoting better functional outcomes after spine surgery. A review of the limited number of reported studies revealed a wide variety of amniotic membrane preparations, treatment regimens, and indications, which limit definitive conclusions. To date, while there is no definitive clinical proof that amniotic tissues enhance tissue repair or regeneration, the aggregate results demonstrate promising basic science and outcomes potential in spinal surgery. Further study is warranted to determine whether this application is appropriate in the clinical setting. This systematic review provides a summary of the existing literature regarding the use of amniotic membrane preparations, treatment regimens, and indications within spinal surgery. With the growing popularity and utilization of biologic agents such as amniotic membrane-derived products in orthopedic and neurologic surgery, this systematic review gives physicians a concise summary on the outcomes and indications associated with amniotic membrane products.

Diffuse Spinal Hyperostosis Causing Severe Spinal Stenosis and Thoracic Myelopathy.

Spinal stenosis has a wide range of causes including disc herniation, facet hypertrophy, degenerative spondylosis, facet cyst, ossification of the ligamentum flavum (OLF) and ossification of the posterior longitudinal ligament (OPLL). We present three cases of diffuse spinal hyperostosis causing severe spinal stenosis and myelopathy, which demonstrate a unique association between obesity and a novel syndrome of hyperostosis. This report describes 3 morbidly obese patients with diffuse spinal hyperostosis causing critical thoracic stenosis. Their presenting complaints focus on lower extremity weakness and the CT/MRI imaging is striking for diffuse hyper-ossification at thoracic levels. Two patients were subsequently managed with spinal decompression, and one patient was managed non-operatively. Metabolic changes associated with obesity may result in diffuse hyperostosis with ligament ossification and spinal stenosis. Pre-operative imaging is essential to identify the degree of ossification and potential dural involvement as this may complicate management.

Cauda Equina Compression an Ayurvedic management w.r.s to Gridrasi and Pakwasaya Gata Vata

Cauda equina compression at the level of L4/L5 or L5/S1 level is a surgical emergency with potentially significant consequences, including motor and sensory dysfunction. The causes include disc herniation, spinal stenosis, cancer, trauma, epidural abscess. The common cause is usually a disc herniation which is most commonly due to trauma, age, connective tissue disorders and congenital disorders. Cauda equina syndrome a disorder caused by compression of the nerve roots in the cauda equina region. This can cause permanent loss of bladder and bowel control if not treated within time. The incidence of a herniated disc is about 5 to 20 cases per 1000 adults annually and is most common in people in their third to the fifth decade of life with a male to female ratio 2:1. If decompressive surgery is delayed, there can be catastrophic consequences for the patient in terms of bladder, bowel and sexual function. In the present case study, a 36 year old female patient who was diagnosed as a case of Cauda Equina compression due to an extruded L4-L5 disc refused to undergo surgery and opted for Ayurvedic treatment. She was admitted in the Kayachikitsa IPD for 45 days. She was treated with the principle of Gridrasi along with Pakwasayagata vata. Deepana pachana and Vasti or Sodhana is the main treatment choice. Rooksha and Snigdha swedas were done which also help to reduce the stiffness and pain. After the management her physical condition and quality of life improved.

Revisiting the Role of Intraoperative Ultrasound in Spine Surgery for Extradural Pathologies: Review and Clinical Usage

This case series looks at the role of intraoperative ultrasound in spine surgery for extradural pathologies. Ten cases of different pathologies were included. Following posterior laminectomy, intraoperative ultrasound was used to determine the adequacy of decompression. The surgical approach and extent of surgery was then determined on the basis of ultrasound observations. Postoperative magnetic resonance imaging was done to correlate the ultrasound findings. We found intraoperative ultrasound to be a useful tool that is easy to use and interpret in spine surgery. The adequacy of decompression was well visualized. The finding also correlated with the decompression achieved on a postsurgery magnetic resonance imaging scan. Intraoperative ultrasound is a useful tool in routine spine surgery. It is effective and easy to read to determine decompression for various pathologies including disk herniation, epidural abscess, tumors, and deformity and reconstructive surgeries. This simple tool can help plan surgeries.

Endoscopic Spinal Decompression: A Retrospective Review of Pain Outcomes at an Academic Medical Center.

Introduction: Spinal stenosis is a chronic, debilitating condition that is expected to affect an increasing number of people as the population ages. Symptomatic spinal stenosis, like other spine pathologies, including disc herniation and degenerative disc disease, traditionally required an open decompressive surgical approach if more conservative approaches failed. An emerging alternative has been developed to address the needs of this population of patients in the form of endoscopic spine surgery (ESS). Advantages of ESS include minimal tissue trauma, decreased risk of damage to the neurovascular structures, minimal epidural fibrosis/scarring, reduced hospital stay, early functional recovery, and improved cosmetic outcomes. The purpose of this study was to review the outcomes of patients undergoing transforaminal endoscopic spinal decompression at an academic pain program.Methods: We conducted a retrospective review of electronic medical records with approval from the University of Florida Institutional Review Board (IRB #202001529). Twenty patients underwent successful transforaminal endoscopic lumbar spinal decompression surgery at UF Health Pain Medicine from July 1, 2019, to June 1, 2020. The majority of cases were performed at L4-5 (n = 14), followed by an equal number (n = 3) of cases at L3-4 and L5-S1. Preoperative and postoperative visual analog scale (VAS) pain scores from patients' pain clinic appointments were obtained from the electronic health records system to assess the intervention as a pain relief strategy.Results: Patients had an average pain reduction of 82% (SD = 31%), resulting in an average postoperative pain score of 1.8 (SD = 2.8) on a 10-point VAS.Conclusion: This study highlights the benefits of endoscopic spine surgery for patients, including pain reduction and reduced scarring.

Pre-operative Assessment of the Size of the Herniated Lumbar Disc on MRI as Apredictor of Surgical Outcome

Background: Lumbar intervertebral disc herniation (LDH) are the most common source of lumbar radiculopathy. Magnetic Resonance Imaging (MRI) is considered the diagnostic imaging procedure of choice for LDH as it can provide exquisite morphologic detail of the disc abnormality. The aim of this study was to determine if baseline MRI findings including disc herniation size is associated with differential surgical treatment effect. Method: This study was conducted on Benha university hospitals on 36 patients who underwent lumbar discectomy to estimate the role of MRI as a predictor of surgical outcome (by comparison between Preoperative and postoperative leg and back pain scores, as well as functional status measured using the modified oswestry disability index (MODI). Results: The age of patients was (21-51) years, mean 36 and 22 patients (61.1 %) were males and 14 patients (38.9 %) were female, all patients suffered from Back and leg pain, 69.44% of them with lower extremity pain , Sciatica with 77.78% of them hypoesthesia and/or leg weakness was reported in 36.11% of cases. Conclusion: It can be concluded that MRI finding espicially disc size and disc height can predict the surgcail outcome. Patients with larger disc herniations, on average, may have a higher likelihood of experiencing superior clinical outcomes following discectomy. Additional findings seem to support that a patient’s preoperative functional score has the strongest influence on postoperative clinical outcome.

Transforaminal lumbar interbody fusion in degenerative spondylolisthesis

Introduction Spinal fusion surgery is a common technique used to treat degenerative lumbar pathologies including disc herniation with instability, spinal stenosis, and degenerative spondylolisthesis (DS). Minimally invasive transforaminal lumbar interbody fusion (TLIF) is a common surgical procedure for treatment of DS. Aim We aimed to assess the outcomes of TLIF in DS. Patients and methods This study was conducted on 15 patients treated for DS treated with TLIF. A written informed consent was taken from all participants after proper explanation of the study. The study assessed perioperative results related to the operative procedure such as blood loss, operation time, hospital stay, and complications. Oswestry Disability Index (ODI) questionnaire was filled for functional evaluation, and the visual analog scale was used to assess pain preoperatively and postoperatively. Result A total of 15 cases were included. The mean age of the included cases was 53.67 years, the mean BMI was 26.73, 53.3% of cases were female, and 33.3% of patients were smokers. There was a significant decrease in visual analog scale ODI after operation. Regarding complications, 73.3% had no early complications but 13.3% had wound infection and 6.7% had positioning neuropathy and postoperative hematoma. Late complications were founded in 33.3% in the form of adjacent segment disease in 13.3%, arthrodesis in 13.3%, and fusion failure in 6.7%. Conclusion This study shows that TLIF is an effective procedure in surgical management of DS. The TLIF gives better results regarding reduction of low back pain and leg pain, as well as reduction in ODI score in early follow-ups and similar results in late follow-ups.

Serious adverse events following lumbar spine mobilization or manipulation and potential associated factors: a systematic review protocol.

The objectives of this review are to describe the serious adverse events reported in the literature following lumbopelvic mobilization and manipulation, and identify patient, provider, and/or treatment factors that may be associated with serious adverse events after these interventions. Spinal mobilization and manipulation are types of conservative care commonly used to treat people with low back pain and other musculoskeletal conditions of the lumbar spine and pelvis. Although most adverse events following these interventions are benign and transient, serious adverse events have been reported mostly following spinal manipulative therapy. Given the significant impact serious adverse events can have on patients' lives, identifying factors that may be associated with serious adverse events following spinal mobilization and manipulation of the low back and pelvis would allow for a more specific pre-treatment screening, potentially reducing the occurrence of serious adverse events following these popular interventions and contributing to a safer treatment delivery. This review will consider interventional and observational studies that report serious adverse events following lumbopelvic spinal mobilization or manipulation experienced by people of any age. Examples of serious adverse events include disc herniation, cauda equina syndrome, and vertebral fracture. MEDLINE, Embase, CINAHL, PubMed, The Cochrane Database of Systematic Reviews/Central Register of Controlled Trials, and Index to Chiropractic Literature (ICL) databases will be searched as well as OpenGrey and ProQuest Dissertations and Theses. Two independent reviewers will screen titles and abstracts of identified references as well as the full text of identified studies, and extract data following a standardized data extraction form. Data will be summarized, categorized, and a comprehensive narrative summary will be presented. PROSPERO CRD42019122339.

A randomised controlled trial comparing the effectiveness of surgical and nonsurgical treatment for cervical radiculopathy

BackgroundCervical radiculopathy is usually caused by disc herniation or spondylosis. The prognosis is expected to be good in most patients, but there is limited scientific evidence on the indications for nonsurgical and surgical treatments. The aim of the present study is to evaluate and compare the effectiveness of surgical and nonsurgical treatment in two trials – including disc herniation and spondylosis, respectively, and to evaluate factors that contribute to better decision making.Methods/designPatients with disabling radicular arm pain and MRI-proven cervical disc herniation or spondylosis will be randomised to receive nonsurgical or surgical treatment. The follow-up period is one year and the sample size is estimated to be 50 for each arm in the two trials, giving a total of 200 patients. The primary outcomes are the Neck Disability Index and arm pain. Secondary outcomes include neck pain; EQ-5D and costs to evaluate cost-effectiveness; prognostic factors; CT and MRI scans, to estimate intervertebral foraminal area and nerve root compression; and the expected minimal improvement for willingness to undergo treatment.DiscussionThe outcomes of this study will contribute to better decision making in the treatment of cervical radiculopathy.Trial registrationThis study has been registered at ClinicalTrials.gov as NCT03674619, on September 17, 2018.

Transforaminal Endoscopic Discectomy and Foraminoplasty for Treating Central Lumbar Stenosis.

ObjectiveLumbar spinal stenosis is a medical condition characterized by the narrowing of the spinal canal as a consequence of bone and soft tissue degeneration, including disc herniation, facet and ligamentum flavum hypertrophy, and osteophyte formation. The percutaneous transforaminal endoscopic discectomy (PTED) technique is one of the emerging surgical alternatives for treating central lumbar stenosis. The present study aims to describe the present techniques of PTED and foraminoplasty for central lumbar stenosis, and discuss the feasibility and advantages of this technique.MethodsA total of 55 patients with an average age of 50 years were recruited in this study. They were operated on between August 2017 and June 2018 by a single surgeon for symptomatic lumbar stenosis using the PTED and foraminoplasty technique, along with a detailed description of the present technique. The retrospective analysis of 55 patients operated between August 2017 and June 2018 by a single surgeon for symptomatic lumbar stenosis using the PTED and foraminoplasty techniques, and the detailed description of the present technique were the focus of the present study. For all patients, the PTED and foraminoplasty procedure was performed under local anesthesia in the lateral position on a radiolucent table using C‐arm fluoroscopy. The retrospective analysis evaluated the outcomes of symptoms through follow‐up interviews at six weeks, six months, and one year after surgery. The analyzed parameters included surgery time, intraoperative blood loss, postoperative complications, visual analog scale (VAS) score, Japan Orthopedic Association (JOA) score, and the Oswestry Disability Index (ODI). The modified MacNab criteria were adopted.ResultsThe average duration of symptoms was 15.6 weeks. The mean operative time was 161 minutes. The mean volume of intraoperative blood loss was 21 mL. The mean follow‐up period was 14.6 months. The average preoperative VAS score for leg pain and low back pain was 6.8 and 5.5, respectively. The preoperative ODI and JOA score was 49.2 and 14.6, respectively. At the final follow‐up, all 55 patients had an average VAS score of 1.1 for leg pain and 0.5 for low back pain. At the same time, the average ODI and JOA score was seven and 24.5, respectively. The statistical analysis showed that the VAS score, ODI value, and JOA score were significantly lower in all time‐points at post‐operation, when compared to those at pre‐operation. For the modified MacNab criteria, the final outcome results were excellent in 39 patients (70.9%), good in nine patients (16.4%), fair in four patients (7.3%), and poor in two patients (3.6%), and the overall success rate was 89.1%. Two patients underwent a second operation during the follow‐up period, and their symptoms were released after the reoperation.ConclusionPTED and foraminoplasty technique showed promising outcomes in the treatment of central lumbar stenosis in a 1‐year follow‐up period. It suggested that PTED and foraminoplasty might be applied as a safe and effective therapeutic option for patients with lumbar stenosis.

Minimally Invasive Lateral Approach to Thoracic and Lumbar Spine: For Discectomy and Corpectomy for Trauma, Tumor, Infection, and Deformity

Anterior access to the spinal column is a powerful tool in the armamentarium of spine surgeons. Direct decompression of anteriorly based compressive pathology is expedient at the level of the spinal cord, conus medullaris, and cauda equina. Anterior column reconstruction provides ideal restoration of alignment and provides robust stability and longevity of the fusion construct. Traditional transthoracic, thoracoabdominal, and retroperitoneal approaches to the spine involve large incisions and considerable morbidity. Minimally invasive surgical approaches to the thoracic and lumbar spine are safe and effective with potentially decreased morbidity. This chapter discusses the indications, technique, and outcomes of minimally invasive surgical lateral approach to the thoracolumbar spine for the treatment of disk and vertebral level pathologies including disk herniation, fracture, infection, tumor, and deformity.

Lumbar Spinal Stenosis in Older Adults.

Lumbar spinal stenosis (LSS) is a frequent cause of low back pain among adults, caused by a narrowing impinging on the spinal cord or nerve roots. Several conditions cause LSS, including disc herniation, spondylolisthesis, tumor, fractures, and other degenerative changes. Back pain is frequently experienced. MRI is the radiologic modality of choice. Radiographic evidence of LSS may not correlate well with symptoms. An increase in utilization of surgery has been noted. However, surgery has no significant benefit over more conservative options. An appropriate risk/benefit discussion between the patient and an interdisciplinary medical team is optimal.

Cervical radiculopathy and cervical myelopathy: diagnosis and management in primary care.

It is important in primary care to be able to differentiate between cervical spine disease that can be managed conservatively and that associated with neurological symptoms suggestive of more serious disease, which may require urgent surgery. This article will cover key points in the history, examination, and management of patients with neck and neurological symptoms, with particular reference to cervical myelopathy and radiculopathy. The prevalence of neck pain in the general population is high: it has been estimated that 30–50% of adults will experience neck pain in any given year,1 with the average GP estimated to consult with seven people per week for neck or upper extremity symptoms.2 Neck pain with abnormal neurology (usually cervical radiculopathy) is much less common: it has been estimated to affect around 100 per 100 000 males and 60 per 100 000 females.3 Cervical myelopathy is even rarer but is worthy of discussion given that it requires urgent management and needs to be identified from among the many cases of neck and neurological symptoms that a GP sees on a regular basis — the incidence of cervical myelopathy is poorly quantified but studies have estimated it to be around 4 per 100 000.4 Cervical radiculopathy is due to compression or irritation of either or both of the dorsal (sensory) and ventral (motor) roots of a cervical nerve at one or more vertebral levels. Compression can result from intervertebral disc herniation, osteophyte formation, or other mass effects near the exit foramen of the cervical spine. This results in lower motor neurone symptoms and often presents with arm pain, weakness, and/or sensory loss, with or without associated neck pain. Cervical myelopathy is spinal cord dysfunction due to compression caused by narrowing of the spinal canal. Common causes include disc herniation, spondylosis, and congenital …