Intervertebral Disc Herniation Research Articles

Current Status and Challenges of the Evidence for Cupping Therapy in Clinical Practice Guidelines in Korea

Clinical practice guidelines (CPGs) published in Korea were reviewed to evaluate up-to-date evidence and the recommendations for cupping therapy (CT) to inform clinicians and researchers for future studies. There were 14 CPGs (allergic rhinitis, ankle sprain, cervical pain, chronic low back pain, cold hands and feet, facial nerve palsy, Hwabyung, knee osteoarthritis, lumbar herniated intervertebral disk, migraine, osteoporosis, postoperative syndrome, shoulder pain, and traffic accident injury) with 29 recommendations for CT determined from “low” to “moderate” rated evidence. The levels of evidence were mostly downgraded due to the risk of bias and imprecision. The majority of recommendations for CT were graded as B or C. This comprehensive analysis underscores the imperative need for robust clinical research, including randomized controlled trials and observational studies using real-world data to enhance the quality of the evidence for CT. In addition, recommendations providing definite phases or scope of the target conditions/diseases and treatment regimens should be employed. This work lays a foundational step towards integrating CT into evidence-based clinical practice, emphasizing strategic directions for future research to bridge the gap between evidence and practice.

Three-dimensional finite element analysis of lumbar disc herniation under different body positions

To campare biomechanical effects of different postural compression techniques on three-dimensional model of lumbar disc herniation (LDH) by finite element analysis. Lumbar CT image of a 48-year-old female patient with LDH (heighted 163 cm, weighted 53 kg) was collected. Mimics 20.0, Geomagic Studio, Solidwords and other software were used to establish three-dimensional finite element model of LDH on L4,5 segments. Compression techniques under horizontal position, 30° forward bending and 10° backward extension were simulated respectively. After applying the pressure, the effects of compression techniques under different positions on stress, strain and displacement of various tissues of intervertebral disc and nerve root were observed. L4, 5 segment finite element model was successfully established, and the model was validated. When compression manipulation was performed on the horizontal position, 30° flexion and 10° extension, the annular stress were 0.732, 5.929, 1.286 MPa, the nucleus pulposus stress were 0.190, 1.527, 0.295 MPa, and the annular strain were 0.097, 0.922 and 0.424, the strain sizes of nucleus pulposus were 0.153, 1.222 and 0.282, respectively. The overall displacement distance of intervertebral disc on Y direction were -3.707, -18.990, -4.171 mm, and displacement distance of nerve root on Y direction were +7.836, +5.341, +3.859 mm, respectively. The relative displacement distances of nerve root and intervertebral disc on Y direction were 11.543, 24.331 and 8.030 mm, respectively. Compression manipulation could make herniated intervertebral disc produce contraction and retraction trend, by increasing the distance between herniated intervertebral disc and nerve root, to reduce symptoms of nerve compression, to achieve purpose of treatment for patients with LDH, in which the compression manipulation is more effective when the forward flexion is 30°.

Therapeutic Efficacy of Ultrasound-Guided Selective Nerve Block on Chronic Cervical Radiculopathy.

Background and Objectives: Cervical radiculopathy (CR) manifests as pain and sensorimotor disturbances in the upper extremities, often resulting from nerve root compression due to intervertebral disc herniation, degenerative changes, or trauma. While conservative treatments are initially preferred, persistent or severe cases may require surgical intervention. Ultrasound-guided selective nerve root block (SNRB) has emerged as a promising intervention for alleviating symptoms and potentially obviating the need for surgery. This study evaluates the therapeutic efficacy of ultrasound-guided SNRB in managing chronic CR, aiming to determine its potential in symptom relief and delaying or avoiding surgical procedures. Materials and Methods: A retrospective analysis was conducted on 720 outpatients treated for CR between October 2019 and March 2022. After excluding patients with traumatic CR, previous surgeries, malignancies, progressive neurological symptoms requiring immediate surgery, or inadequate conservative treatment, 92 patients who had experienced cervical radicular pain for more than three months and had failed to improve after more than six weeks of conservative treatment with VAS scores ≥ 5 were included. The patients underwent single or multiple ultrasound-guided SNRB procedures, involving the injection of dexamethasone and lidocaine under real-time ultrasound guidance. Symptom severity was assessed at the baseline, and at 4, 8, and 12 weeks post-procedure using the Visual Analog Scale (VAS). The data collected included age, sex, presence of neck and/or radicular pain, physical examination findings, recurrence of symptoms, improvement in symptoms, and whether surgical intervention was ultimately required. Statistical analyses were performed to identify the factors associated with symptom improvement or recurrence. Results: Significant symptom improvement was observed in 69 (75.0%) participants post-SNRB, with 55 (79.7%) showing improvement at 4 weeks, 11 (15.9%) at 8 weeks, and 3 (4.4%) at 12 weeks. Symptom recurrence, defined by an increase in VAS score accompanied by a pain flare lasting at least 24 h after a pain-free interval of at least one month, was noted in 48 (52.2%) patients. The presence of combined neck and radicular pain was a significant predictor of recurrence (p = 0.008). No significant associations were found between symptom relief and factors such as age, gender, initial pain severity, or MRI findings. Conclusions: Ultrasound-guided SNRB effectively manages chronic CR, providing substantial symptom relief and potentially reducing the need for surgical intervention. This technique offers a promising conservative treatment option, especially given its real-time visualization advantages and minimal radiation exposure.

Mechanical consequences to the annulus fibrosus following rapid internal pressurization and endplate fracture under restrained-expansion conditions

Intervertebral disc herniation is not a common injury in the adolescent population, but the correlation between trauma and herniation warrants concern. Previous research demonstrated the capacity for rapid internal pressurization to reduce the mechanical integrity of the intervertebral disc's annulus fibrosus, even in the absence of fracture. The purpose of this study was to modify previous internal pressurization procedures towards a more transferable injury model, then investigate the capacity for these procedures to damage the mechanical integrity of the annulus fibrosus. Porcine cervical motion segments with intact facet joints were confined between a vice and force plate under 300 N of static compression, then a single, manual, rapid internal pressurization was delivered. Posterolateral annulus samples were extracted and situated in a 180° peel test configuration, exposing the interlamellar matrix of samples to separations of 0.5 mm/s, until complete separation of the sample occurred. Multilayer tensile testing was performed on superficial and mid-span samples of annulus by applying uniaxial tension of 1 %/s to 50 % strain. Compared to unpressurized controls, rapid pressurization causing fracture resulted in reduced lamellar adhesion and increased toe-region stress and strain properties in the annulus. Morphological assessment reported similar fracture patterns between endplate fractures achieved in the present experiment and endplate fractures documented in human patients. Mechanical plus morphological results suggest that rapid internal pressurization resulting in endplate fracture may represent a potent mechanism for subsequent damage to the intervertebral disc.

The Effect of Gray Ramus Communicans Nerve Block on Radicular Pain in Patients With Lumbosacral Radicular Pain Who Underwent Transforaminal Epidural Block

Lumbosacral radicular pain (LRP) is usually caused by herniation of intervertebral discs and is characterized by pain arising in the back and radiating to the lower extremities. The current study evaluated the efficacy of gray ramus communicans nerve block (GRCNB) in decreasing LRP in patients with intervertebral disc herniation who underwent transforaminal epidural block. Thirty patients with magnetic resonance imaging indicating a disc herniation on the L4-L5 level participated in this study. All patients were randomly divided into two groups: one whose members underwent GRCNB (n=15) after transforaminal epidural block, and a second group (n=15) whose members underwent only transforaminal epidural block on L4-L5 on the affected side. Follow-up after the procedure ran for a period ranging from 6 to 10 months (mean=8.2±2.1 months) for radicular pain score and the need for analgesics. The mean age of the patients was 54.8±18.4 years (range: 30-65 years). LRP duration in all patients before the procedure was 6-24 months (mean: 12±10.9 months), and there was no significant difference between the two groups. A greater reduction in the numerical rating scale (NRS) one week, 1, and 6 months after the procedure was observed in the group with GRCNB compared to the other group. The reduction in need for analgesics one week, 1, and 6 months after the procedure was statistically significant in the group with GRCNB compared to the group without GRCNB. No major complications were observed in any of the patients in either group. GRCNB is effective in reducing radicular pain and the need for analgesics in patients with lumbosacral radicular pain.

Lumbar disc herniation diagnosis using deep learning on MRI

ObjectiveIn recent years, artificial intelligence deep learning has gradually become a research hotspot in diagnosing and treating cervical and lumbar degenerative diseases, represented by cervical spondylosis and lumbar disc herniation. MethodsRetrospective inclusion of 590 patients with lumbar disc herniation, randomly divided into a training group (n = 456) and a testing group (n = 134), labeled with intervertebral disc herniation areas on lumbar MR images (1157 in the training group and 395 in the testing group). Construct a deep learning model based on Unet to segment and detect intervertebral disc herniation areas in sagittal and transverse planes and evaluate the model's lesion detection efficiency and accuracy in lesion segmentation. ResultsThe model has good detection performance on the test group data. The F1 values in the sagittal and transverse positions are 0.971 (95% CI: 0.951–0.987) and 0.903 (95% CI: 0.870–0.935). In the segmentation of prominent areas, the Dice values in the sagittal and transverse planes are 0.774 ± 0.193 and 0.647 ± 0.261 (2D plane), 0.777 ± 0.148 and 0.655 ± 0.180 (3D plane), respectively. ConclusionThe deep learning model based on U-net can accurately identify and segment the intervertebral disc herniation area in lumbar MR images, which helps to assist clinical diagnosis.

Treatment of lumbar intervertebral disc herniation using open spinal endoscopy: Techniques and clinical outcomes

Treatment of lumbar intervertebral disc herniation using open spinal endoscopy: Techniques and clinical outcomes

Vertebral Bone Density Variations in Scoliotic vs. Non-Scoliotic Juveniles, and Its Implications for Schmorl’s Node Development: A CT-Based Analysis Using the New Mexico Decedent Image Database

Scoliosis, characterized by an abnormal lateral curvature of the spine, is predominantly idiopathic, underscoring the need to delve into its underlying causes for effective treatment and preventive strategies. This study investigates a potential correlation between scoliosis and Schmorl’s nodes (intervertebral disc herniations) influenced by Wolff’s law, which posits that bones adapt to external pressures. We analyzed CT scans from 108 juvenile decedents, including 56 with scoliosis and 52 without. After running multiple statistical tests, there was no significance between the mean bone density when compared to having scoliosis. An independent t-test provided a t-value of 0.041, which, when compared to the original significance level of 0.05, is statistically significant, although weak. When compared to the Bonferroni correction level of 0.008, it throws out the significance to give a result of not being statistically significant. It was the same in the cases of L3 (t = 0.103), L2 (t = 0.084), and L1 (t = 0.053). If compared to the regular significance level of 0.05, T12 (t = 0.012) and T11 (t = 0.042) had weak significance, but that was then excluded when the Bonferroni correction was applied. When looking at any significance of densities in different vertebral regions, the results from a one-way ANOVA (p-value = 0.213) suggest that it is likely that the results are due to random variability or chance, and that there is no statistical significance. With a value of 0.273 from a Chi-squared (χ2)/Fisher’s exact test, it suggests that there is no statistically significant correlation or difference between the variables of scoliosis and Schmorl’s nodes. The general pattern seems to follow that as the spine ascends, the density increases, and this is true in both scoliotic and non-scoliotic individuals. As a whole, it is evident that those with scoliosis have a lower vertebral density than those without, in all of the vertebral regions. There is, however, a weak negative linear relationship between bone density and age in both scoliotic and non-scoliotic individuals. A p-value of −0.229 obtained from a Pearson correlation coefficient analysis in non-scoliotic individuals, as well as a p-value of −0.069 in scoliotic individuals, was obtained. Overall, the findings of this study are comparable to some existing studies on similar topics, but there are few results that hold statistical significance and so this would be interesting to research further, potentially using a different dataset or a larger sample size that is more representative.

Progress of researches on mechanisms of acupuncture therapy in the treatment of lumbar disc herniation.

Lumbar intervertebral disc herniation (LDH) is a common and frequently-occurring disease, which usually causes lumbar and leg pain. Studies have shown that acupuncture can improve the symptoms of LDH patients. In the present paper, we summarize the progress of researches on the mechanisms of acupuncture underlying improvement of symptoms of LDH in recent 10 years from 1) delaying the intervertibral disc degeneration (by down-regulating the expressions of matrix metalloproteinase ［MMP］-3 and MMP-4, up-regulating the expressions of diosaccharides and polyglycoprotein, inhibiting apoptosis and promoting mitochondrial autophagy of nucleus pulposus cells, etc.), 2) maintaining spinal column stability (by relieving rachiasmus and improving lumbar flexor and extensor muscle strength, lowering the degree of polyfidus edema and fat infiltration, and restoring the biomechanics of the spine), 3) regulating inflammation (by inhibiting the production of proinflammatory factors and increasing the production of anti-inflammatory factors, etc.), 4) regulating immune response (by promoting the activity of T cells and other immune cells, lowering serum levels of MMP-3, transforming growth factor-β1 and prostaglandin E2, raising serum levels of IgA, IgG and IgM to improve immune function ), 5) modulating neural structure and function (by promoting myelin regeneration of sciatic nerve fibers, and reducing the edema of Schwann cells' cytoplasm and mitochondria, and improving neural ultrastructure, and sensory and motor functions of peripheral nerves, etc.), 6) relieving lumbar pain (by down-regulating expression of Ca2+/calmodulin-dependent protein kinase and activation of lumbar spinal cord glial cells, blocking nociceptive signal conduction, regulating the levels of pain-related factors, etc.), and 7) improving local microcirculation. These results may provide scientific evidence for acupuncture treatment of LDH.

Genetic factors in the etiology of intervertebral disc herniation and protrusion

Genetic factors in the etiology of intervertebral disc herniation and protrusion

The use of acupuncture in the treatment of lumbar intervertebral disc herniation (сlinical case)

Abstract. The effectiveness of acupuncture in the treatment of discogenic compression radiculopathy has been proven in many scientific works. Acupuncture has a positive effect not only on the course of radiculopathy, but also on the size of the hernias and protrusions of the intervertebral discs themselves. Purpose. To study the effectiveness of acupuncture in the treatment of intervertebral disc herniation in the lumbar region. Material and methods. Before and after treatment (after 3 and 6 months), the patient was assessed: neurological status, results of an electrokymographic study of peripheral nerves of the lower extremities, MRI of the spine. Acupuncture was carried out at acupuncture points of the meridian of the stomach, bladder, gallbladder, colon, for a course of 40 procedures. Results. A 40‑year-old patient suffered from prolonged pain for 8 months. Conservative treatment with drug therapy and physical therapy did not provide satisfactory improvement in symptoms. On MRI of the PC department, the IVD herniation at the L4 — L5 level was 12 mm. When using acupuncture, the pain syndrome decreased clearly after the first sessions. Sensory disturbances and motor deficits gradually regressed. After 40 sessions over 3 months, electromyographic indicators of the affected right peroneal nerve improved. An unexpected result was a reduction in the size of the IVD hernia by 50 % to 6 mm.

The Epidemiology of Spinal Neurosurgery in Nigeria: A Systematic Review and Patient-Level Analysis

Spinal pathologies are prevalent in Nigeria, though epidemiological data remains sparse. This systematic review used pooled patient-level data from across the country to generate a standardized epidemiological reference. Four research databases and gray literature sources were searched. Risk of bias assessment was conducted using Risk of Bias in Non-Randomised Studies - of Interventions and Cochrane's risk of bias tool. We descriptively analyzed all article metrics and statistically analyzed relevant data variables via paired t-test and χ2 independence tests (α=0.05). One hundred twenty-seven articles, comprising a patient cohort of 8425 patients, were analyzed. Most were retrospective cohort studies (46.5%) and case reports/series (31.5%), with an overall moderate-high risk of bias. Most studies were published in the last 20years. Most patients were male (∼2.5 males per female), with an average age of 43.2years (±16.4). Clinical diagnoses spanned the breadth of spinal neurosurgery. Approximately 45.0% of patients had complete spinal impairment. Pain (41.7%) was the most reported presenting feature. X-ray (45.1%) was the most common investigation used. Intervertebral disc herniation (18.9%) was the most prevalent imaging finding on MRI. Most patients were managed nonoperatively (57.8%), with a favorable outcome in 27.4% of patients. Posttreatment complications included pressure sores, infection, and motor deficits. This systematic review and pooled analysis provide an epidemiological overview of spinal neurosurgery in Nigeria over the last 60years and serves as a useful reference to direct future global research in this arena.

Exploring the Dual Components and Mechanism of Panax notoginseng-Eucommia ulmoides for Managing Osteoporosis-Associated Lumbar Disc Herniation Using Network Pharmacology

Osteoporosis (OP) combined with lumbar intervertebral disc herniation (LDH) is a complex disease that exhibits limited efficacy in drug treatment, physical therapy, and surgical intervention, while also carrying potential side effects and risks. Traditional Chinese medicine treatment of OP combined with LDH primarily aims to address deficiencies and regulate the body. Several active ingredients found in Panax notoginseng and Eucommia ulmoides, such as quercetin and beta-sitosterol, have demonstrated the ability to enhance osteoblast proliferation and bone matrix synthesis. While historical literature contains mechanistic studies on individual herbs, there is a conspicuous dearth of comprehensive and systematic research on their mechanisms of action. By utilizing network pharmacology method, we identified 35 active ingredients present in Panax notoginseng and Eucommia ulmoides, along with 98 potential targets associated with the treatment of OP combined with LDH using Panax notoginseng-Eucommia ulmoides. Through protein-protein interaction network analysis, we identified 5 essential active ingredients (Quercetin, Beta-carotene, Kaempferol, Beta-sitosterol, and Notoginsenoside Fe) and 5 core targets (Nuclear factor kappa-B 3 [RELA], hypoxia-induciblefactor-1A [HIF-1A], Myelocytomatosis Viral Oncogene homolog [MYC], Transcription Factor AP-1 [JUN], and Estrogen Receptor 1 [ESR1]). The potential targets primarily involve IL-17, AGEs-RAGE, the TNF signaling pathway, and other pathways through which they exert therapeutic effects. The key active ingredient was docked with the core target molecule, resulting in all molecules exhibiting binding energies ≤-5 kcal/mol. This study provides preliminary evidence that treatment with Panax notoginseng-Eucommia ulmoides for OP combined with LDH may lead to improvements in inflammation, oxidative stress, cell proliferation, differentiation, and apoptosis, and cytokine regulation.

Risk factors for reoperation after discectomy of lumbar herniated intervertebral disc disease.

Discectomy is the most common surgery for lumbar herniated intervertebral disc (HIVD) disease. However, 5%-24% of patients undergo a second surgery due to recurrent disc herniation. This study was aimed to identify the risk factors for reoperation after discectomy of lumbar HIVD and recommend treatment for patients with a high risk of reoperation. We recruited patients diagnosed as having single-level lumbar HIVD who underwent open discectomy from January 1, 2000, to December 31, 2012 in our hospital. We used a survival curve to inspect the survival time and reoperation rate after surgery. We discussed the correlation of reoperation rate with discectomy level, body mass index, heavy lifting after surgery, sex, and age. Furthermore, we investigated the correlation between the experience of a surgeon and the reoperation rate. A total of 619 patients were enrolled in our study. Most patients were 40-60 years old (48.8%), and most of them had herniation at L4/5 level (48.9%). The 8-year survival rate was 92%. Weight lifting after surgery may increase the reoperation rate by 115 and 18 times for those >60 years and <40 years, respectively. In addition, less experience of the surgeon and female sex had a high reoperation rate. Postoperative working modification may be very important for preventing patients from recurrent HIVD. For elderly people with HIVD, a more conservative therapy could be selected. If patients with lumbar spine hypermobility or severe degeneration require wide laminectomy, primary fusion should be considered.

Comparison of histopathologic findings of initial and recurrent lumbar disc herniation

Objective: Recurrent lumbar disc hernia (RLDH) is a common and challenging complication after an initial discectomy. This study aimed to investigate the relationship between the histopathologic outcomes of the initial and recurrent disc tissues. Methods: This study investigated 70 patients who underwent a microdiscectomy and subsequently developed same-level same-side lumbar disc herniation (LDH) recurrence. The clinic, western blot, and immunohistochemical evaluations of patients with initial LDH and RLDH were conducted and statistically analyzed. Results: The effect of inflammation and apoptosis in the degenerative changes of intervertebral disc hernia and increased histopathologic findings in RLDH was demonstrated. The degeneration of the hernia disc tissue is a major pathological process, which is characterized by cellular apoptosis, inflammation, and reduced synthesis of extracellular matrix. Currently, there is no clinical therapy targeting the reversal of disc degeneration. Conclusions: This, therefore, stay away from factors that increase inflammation in the intervention of intervertebral disc hernia, applying to reduce inflammation the medicines, could allow reducing disc collagen degeneration, and more successful outcomes. These findings might shed some new lights on the mechanism of disc degeneration and provide new strategies for the treatments of initial and recurrent LDH.

Characterization and modulation of the pro-inflammatory effects of immune cells in the canine intervertebral disk.

Intervertebral disk (IVD) degeneration affects both humans and canines and is a major cause of low back pain (LBP). Mast cell (MC) and macrophage (MØ) infiltration has been identified in the pathogenesis of IVD degeneration (IVDD) in the human and rodent model but remains understudied in the canine. MC degranulation in the IVD leads to a pro-inflammatory cascade and activates protease activated receptor 2 (PAR2) on IVD cells. The objectives of the present study are to: (1) highlight the pathophysiological changes observed in the degenerate canine IVD, (2) further characterize the inflammatory effect of MCs co-cultured with canine nucleus pulposus (NP) cells, (3) evaluate the effect of construct stiffness on NP and MCs, and (4) identify potential therapeutics to mitigate pathologic changes in the IVD microenvironment. Canine IVD tissue was isolated from healthy autopsy research dogs (beagle) and pet dogs undergoing laminectomy for IVD herniation. Morphology, protein content, and inflammatory markers were assessed. NP cells isolated from healthy autopsy (Mongrel hounds) tissue were co-cultured with canine MCs within agarose constructs and treated with cromolyn sodium (CS) and PAR2 antagonist (PAR2A). Gene expression, sulfated glycosaminoglycan content, and stiffness of constructs were assessed. CD 31+ blood vessels, mast cell tryptase, and macrophage CD 163+ were increased in the degenerate surgical canine tissue compared to healthy autopsy. Pro-inflammatory genes were upregulated when canine NP cells were co-cultured with MCs and the stiffer microenvironment enhanced these effects. Treatment with CS and PAR2 inhibitors mediated key pro-inflammatory markers in canine NP cells. There is increased MC, MØs, and vascular ingrowth in the degenerate canine IVD tissue, similar to observations in the clinical population with IVDD and LBP. MCs co-cultured with canine NP cells drive inflammation, and CS and PAR2A are potential therapeutics that may mitigate the pathophysiology of IVDD in vitro.

ПОПЕРЕКОВА ДИСКЕКТОМІЯ З ДЕКОМПРЕСІЄЮ КАНАЛУ ЗА СИСТЕМОЮ DESTANDAU ENDOSPINE

Lumbar disc herniation is a common disease. There is severe pain in the buttock and leg, which may persist for more than 6 weeks even after conservative treatment. Currently, there are several surgical techniques for the treatment of lumbar disc herniation, ranging from laminectomy to microdiscectomy. The main advantages of endoscopic discectomy include: cosmetic appeal, minimally invasive nature, better visualization, shorter hospital stay and faster recovery. Objective. This article reviews discusses the management of patients with degenerative diseases of the lumbar spine by Destandau Endospine system. The authors shares his experience of the surgical technique and the results of percutaneous endoscopic discectomy using the Destandau system during the treatment of 51 patients with herniated disc and canal stenosis in the lumbar spine. The main advantages of the Destandau endoscopic system are a small skin incision and minimal damage to soft tissues. This is a minimally invasive intervention, which is applied through a skin incision 1.5–2 cm long. In order to ensure the accuracy and safety of the patient both before and during the operation, fluoroscopy is used. Under the control of an endoscope, the herniated intervertebral disc, free fragments of the disc are removed and the pinched nerve is released. Thus, rapid recovery is achieved during postoperative rehabilitation. Conclusions. The endoscopic system can be used to treat all types of intervertebral disc herniations and associated canal stenosis. It is a relatively safe procedure, provided proper preoperative planning and an experienced team of doctors. Most lumbar pathologies that are not related to instability can be successfully resolved with its help. The two main advantages of the Destandau endospinal system include minimally invasive surgery with minimal iatrogenic damage and excellent efficacy. In the case of its successful application, the recovery process is significantly shortened, without any restrictions for returning to everyday life.

Results of routine thoracic radiographic examinations rarely impact the plan to proceed with anesthetic procedures in dogs with presumed acute intervertebral disc herniation.

Acute thoracolumbar intervertebral disc herniation (IVDH) constitutes an emergency because associated neurological clinical signs can be progressive, with prognosis dependent on preoperative presence of deep pain perception. Pre-anesthetic thoracic radiographs are routinely performed to evaluate for potential pathology that could result in increased risk or change in overall prognosis. However, due to the emergent nature of this disease, the weight of thoracic radiographic findings on treatment plans for these dogs in unknown. The objective of this study was to investigate the clinical benefit of thoracic radiographs prior to advanced spinal imaging and surgery for acute non-ambulatory dogs with suspected T3-L3 myelopathy. Consecutive dogs presented with presumed acute IVDH between July 2020-July 2022 were identified, and medical records were reviewed retrospectively. Age, body weight, and alteration of treatment plan were compared between the dogs with positive thoracic pathology identified on thoracic radiographs and those with negative thoracic pathology. Only 2/105 dogs had their diagnostic and treatment plans changed due to thoracic radiographic findings. Dogs with radiographic pathology diagnosed (2/16) were more likely to have their treatment plans changed than dogs with no radiographic pathology (0/89) (p = 0.014). The odds of radiographic thoracic pathology were 4.6 times higher in dogs aged 12 years or older [OR 4.6 (95%CI 1.2-17, p = 0.026]. Performing routine thoracic radiography prior to advanced (anesthetized) diagnostic spinal imaging in presumed IVDH cases rarely resulted in a change to the treatment plan, thought eh practice may be clinically relevant in dogs 12 years of age or older.

Utilization of Bone-Anchored Annular Defect Closure to Prevent Reherniation Following Lumbar Discectomy: Overcoming Barriers to Clinical Adoption and Market Access.

While achieving premarket approval from the US Food and Drug Administration represents a significant milestone in the development and commercialization of a Class III medical device, the aftermath endeavor of gaining market access can be daunting. This article provides a case study of the Barricaid annular closure device (Barricaid), a reherniation reduction device, which has been demonstrated to decrease the risk of suffering a recurrent lumbar intervertebral disc herniation. Following Food and Drug Administration approval, clinical adoption has been slow due to barriers to market access, including the perception of low-quality clinical evidence, questionable significance of the medical necessity of the procedure, and imaging evidence of increased likelihood of vertebral endplate changes. The aim of this article is to provide appropriate examination, rationale, and rebuttal of these concerns. Weighing the compendium of evidence, we offer a definition of a separate and unique current procedural terminology code to delineate this procedure. Adoption of this code will help to streamline the processing of claims and support the conduct of research, the evaluation of health care utilization, and the development of appropriate medical guidelines.

Diagnostic and prognostic significance of miR-486-5p in patients who underwent minimally invasive surgery for lumbar spinal stenosis.

This study aimed to investigate the expression and clinical value of microRNA miR-486-5p in diagnosing lumbar spinal stenosis (LSS) patients and predicting the clinical outcomes after minimally invasive spinal surgery (MISS) in LSS patients, and the correlation of miR-486-5p with inflammatory responses in LSS patients. This study included 52 LSS patients, 46 patients with lumbar intervertebral disk herniation (LDH) and 42 healthy controls. Reverse transcription quantitative PCR was used to detect miR-486-5p expression. The ability of miR-486-5p to discriminate between different groups was evaluated by receiver-operating characteristic analysis. The visual analogue scale (VAS), Oswestry Disability Index (ODI) and Japanese Orthopaedic Association (JOA) scores at 6months postoperatively were used to reflect the clinical outcomes of LSS patients. Enzyme-linked immunosorbent assay was used to measure the levels of inflammatory factor [interleukin-1β (IL-1β) and tumor necrosis factor-α (TNF-α)]. The correlation of miR-486-5p with continuous variables in LSS patients was evaluated by the Pearson correlation coefficient. Expression of serum miR-486-5p was upregulated in LSS patients and had high diagnostic value to screen LSS patients. In addition, serum miR-486-5p could predict the 6-month clinical outcomes after MISS therapy in LSS patients. Moreover, serum miR-486-5p was found to be positively correlated with the levels of IL-1β and TNF-α in patients with LSS. miR-486-5p, increased in LSS patients, can function as an indicator to diagnose LSS and a predictive indicator for the clinical outcomes after MISS therapy in LSS patients. In addition, miR-486-5p may regulate LSS progression by modulating inflammatory responses.