Disc Prolapse Research Articles

A Randomized Comparative Trial to Study the effect of Preoperative single shot Epidural with Ropivacaine in Lumbar Laminectomy

Background: laminectomy surgeries are usually performed in cases of spinal canal stenosis, disc prolapse etc. It has been reported that the use of regional anesthesia techniques in combination to general anaesthesia has shown better heamodynamic stability intraoperatively, better pain scores and reduced intraoperative blood loss. The present study was conducted to evaluate the efficacy of fusion technique of combining epidural and general anaesthesia in patients undergoing lumbar laminectomies. Aim: To evaluate the efficacy of combined epidural general anesthesia for lumbar laminectomy surgeries with epidural ropivacaine. Materials and Methods: A prospective randomised study was conducted in 100 patients who are scheduled for lumbar laminectomy surgeries belonging to ASA Class I and II age between 40-60 years were randomly allocated into two groups (Group E and Group F) of 50 each. Group E: 12ml of 0.5% Ropivacaine and 50µg fentanyl epidurally. Group F:12ml of Normal Saline and 50µg fentanyl epidurally. The parameters recorded were intraoperative analgesia by heart rate and blood pressure, Rescue analgesia, Blood loss. Results: Intraoperatively requirement of general anesthetics, Heart rate, MBP, Blood loss, is lesser in Group E when compared with Group F. It was observed that longer time to rescue analgesia in group E than in group F. Conclusion: combined epidural general anesthesia with local anesthetic (ropivacaine) with narcotic (fentanyl) is a better technique for anesthetic management of patients posted for lumbar laminectomy. Thus from our study we conclude that combined epidural general anesthesia technique with epidural ropivacaine is a better alternative to general anesthesia providing stable hemodynamics, reducing dose of general anesthetics, less blood loss.

Experience with Rectangular Titanium Cages in Anterior Cervical Discectomy and Fusion in a Single Unit of a Tertiary Level Hospital, Dhaka.

Background: Anterior cervical discectomy is a common procedure for treating patients for cervical disc prolapse. This study was conducted to evaluate the surgical outcome and demographic characteristics of patients who were treated for anterior cervical disc prolapse. Methods: Study was conducted in the Department of Neurosurgery-spine, National Institute of Neurosciences and Hospital, Dhaka. Study interval was 5 years from January, 2014 to 31st December, 2019. Total numbers of patients were 215. Males were 183 (85.1%) and females were 32 (14.9%). All the patients had undergone the procedure of anterior cervical discectomy and fusion (ACDF) with RABEA Rectangular Titanium Cages (RTC). All the patients had plain MRI cervical spine done for diagnosis of anterior cervical disc prolapse. Surgical and Clinical preoperative evaluation and surgical outcomes were evaluated using pre- and postoperative Nurick, Visual Analog Scale (VAS), Neck Disability Index (NDI), for Myelopathy, overall Odoms outcome scores, postoperative surgical complications, and fusion and subsidence rates. Results: Total 215 patients underwent ACDF; the mean age of these patients was 44.66 years, and their preoperative VAS and NDI, scores were 8.09 and 35.38 respectively. Sixty seven percent of patients had one level, 25.1% had two-level, and 7.9% had three-level procedures. On preoperative Magnetic Resonance Imaging(MRI), foraminal stenosis was present in 68.4% of patients, whereas medullar stenosis was present in 43.7%. The rate of complications was 2.8%: two patients had postoperative implant migration (0.93%), three patients had postoperative transient dysphagia (1.4%) and one patients had temporary hoarseness of voice. Mean postoperative follow-up time was 6.7 months; postoperative VAS and NDI scores were 1.10 and 14.4, respectively. Postoperative fusion rate was 93.5%, and subsidence rate was 5.6%. Conclusion: Results with Rectangular Titanium Cages are expectedly good. Symptoms resolved and fusion rate was 93.5% at 1 year follow up. Bang. J Neurosurgery 2021; 10(2): 137-147

Anterior cervical discectomy and fusion using polyetheretherketone (PEEK) cage

Introduction:There are ways to operate for herniated cervical disc starting from simple discectomy to artificial disc replacement.
 Materials and Methods:This is a prospective study of anterior cervical discectomy and fusion with polyetheretherketone (PEEK) age device conducted from January 2016 till September 2019. Age, sex ratio, the level of disc prolapses, symptoms, complications of surgery and the outcome was assessed.Neurological assessment was done pre-and postoperative as defined by Odom’s criteria and Ranawat et al grading system. Check x ray was done at 3 and 6 months.
 Results: The total number of cases was 82, predominantly males (62%). Disc prolapse due to degenerative disease was the most common case (68%). C5-6 was the most often disc prolapse level (40%), followed by C6-7 level (38%) with multiple level disc prolapse in 12%. Applying Ranawat grading system of neurological deficit; at presentation, majority were in Grade II (54%), followed by Grade IIIA (19%). Postoperatively there was a reduction in weakness from 54% to 16% in Grade II and from 19% to 8% for Grade IIIA. Majority had excellent and good outcome based on Odom’s criteria. The continuity of the graft and the adjacent spinal curvature was also assessed and there was more than 96% fusion rate.
 Conclusion:Use of local autograft with a PEEK cage hasbenefit of working within the same operative window as the ACDF, thus reducing the infection, bleeding, and pain risks that may be encountered with a second incision. It is very safe to use in single level or multilevel cervical disc prolapse and also saves additional time of harvesting graft from donor site.

Quadriceps weakness due to disc protrusion causing nerve root compression. A case report and literature review

Most common presentation of spinal disc herniation is pain. Next common presentation is pain associated with neurological symptoms [1] . It is relatively unusual to present muscular weakness purely due to disc herniation in the absence of lower back or neuropathic pain and can be a diagnostic challenge. A male patient of 45 presented to his family physician with five days history of weakness in the left quadriceps. There was no pain in the back or leg or any sensory symptoms at this stage. There was no other significant past medical history apart of history of spontaneous disc prolapse when he was 26. (radiating pain to the left leg but no neurological symptoms at that time). Clinical examination revealed motor deficit of 4/5 in the left quadriceps and diminished knee reflex. There was no sensory deficit elicited at this stage. Patient was referred to neurologist (by this time patient had developed sensory deficit at medial lower leg) who arranged nerve conduction studies which revealed L4 radiculopathy. Patient was referred to spinal surgeon who after consultation arranged MRI of the lumbosacral spine which showed disc extrusion at L3-4 level causing root compression of L4 nerve root. Since the patient was active sportsman, it was decided to do discectomy. However, after case discussion in spinal team meeting, (and patient started to feel slight improvement in sensory symptoms after couple of weeks) it was decided to manage conservatively. Patient started physiotherapy for three months and gradually noticed complete resolution of sensory loss after a month and gradual improvement in motor weakness. Patient started light sporting activities after three months of orthopaedic consultation. Patient continued to recover and had complete resolution of motor symptoms within a year. Patient had a follow up MRI after about a year which showed subtle improvement of compression at the same level. Patient was discharged from outpatient follow up. This case illustrates diagnostic dilemma when symptoms are not typical. However, it is proven the ‘common things are common’ again. Conservative management seems to be way forward when neurological symptoms are mild especially in the absence of neuropathic pain, However, it needs to be decided on case-by-case basis

Efficacy of epidural injection of steroid in treatment of lumber disc prolapse: article review

"Chronic low back and lower extremity pain is mainly caused by lumbar disc herniation (LDH) and radiculitis. Various surgery and nonsurgical modalities, including epidural injections, have been used to treat LDH or radiculitis. Caudal epidural injection of local anesthetics with or without steroids is one of the most commonly used interventions in managing chronic low back and lower extremity pain. To describe the indications, rationale, techniques, alternatives, contraindications, complications, and efficacy of lumbar and caudal epidural corticosteroid injections. Interventions: Three reviewers with formal training and certification in evidence-based medicine searched the literature on non–image guided lumbar interlaminar epidural steroid injections. A larger team of seven reviewers independently assessed the methodology of studies found and appraised the quality of the evidence presented. A systematic literature search was performed, in the Medline Case reports and retrospective and prospective studies were extensively reviewed to provide detailed descriptions of the clinical features of lumbar and caudal epidural corticosteroid injections. Data sources included relevant literature of the English language identified through searches of PubMed and EMBASE , and manual searches of bibliographies of known primary and review articles. Epidural corticosteroid injections are commonly requested treatments for patients with various low-back or lower-extremity pain syndromes (or both). Most of the reports on the use of this type of treatment are retrospective and noncontrolled. These studies indicate benefit; however, the prospective controlled studies provide varied results about the efficacy of lumbar and caudal epidural corticosteroid injections. In conclusions: In patients with lumbar radicular pain secondary to disc herniation or neurogenic claudication due to spinal stenosis, interlaminar epidural steroid injections appear to have clinical effectiveness limited to short-term pain relief. Therefore, in a contemporary medical practice, these procedures should be restricted to the rare settings where fluoroscopy is not available."

Second ever reported case of central cause of unilateral foot drop due to cervical disc herniation: Case report and review of literature.

BackgroundFoot drop is defined as a weakness in the ankle and foot dorsiflexors. A disruption of the neural pathway starting from the motor prefrontal cortex and ending in the peroneal nerve can lead to foot drop. Foot drop due to lower motor neuron injury is well documented. However, foot drop due to a central cause of cervical disc prolapse is very rare.Case presentationA 55-year-old male presenting with neck pain, right and left arms radicular pain and numbness, and unilateral right foot drop following cervical disc prolapse. The patient presented with upper motor neuron lesion signs. MRI showed cervical disc prolapse at two levels, confirming central cause of foot drop. The patient underwent anterior cervical decompression and fusion surgery.DiscussionFollowing decompression and fusion of involved cervical spine disc pathology, the patient had complete recovery of his right foot drop.ConclusionsCentral causes, although rare, should be considered in the differential diagnosis of foot drop. Causes could be due to the compression effect of the cortico-spinal tract of the cervical spinal cord. Satisfactory results can be achieved upon correcting the causative lesion.

O71: INTRA-OPERATIVE SPINAL CORD MONITORING DURING SPINAL SURGERY: DOES IT HAVE ANY CLINICAL VALUE?

Abstract Introduction Spinal cord surgery is a technically challenging endeavour with potentially devastating complications for patients and surgeons. Spinal cord monitoring (SCM), is one method of preventing and identifying damage to the spinal cord. At present, indications for its use are based more on individual surgeon preference and for medico legal purposes. Our study aimed to determine SCM's utility as a clinical tool. Method This is a retrospective case series of 169 patients who underwent spinal surgery with SCM at two institutions between 2013 and 2018. Signal changes detected were recorded as well as the surgeon's response to these changes. Patients were followed up to one-year post-surgery using our institution's EVOLVE system. The main outcome measure in this study was new post-operative neurological signs and/or symptoms and what effect, if any, IONM and subsequent surgeon intervention had on these complications. Result Indications for SCM included cervical stenosis, cervical disc prolapse, unstable fractures and bony metastases. Signal changes were observed in 33% (n=55) of cases. 24 of these patients responded to re-positioning. There were 7 total complications with full resolution by 12 months. False negative rate was 2.4% (n=4). There was one true positive. The largest cohort of patients included those who experienced no signal changes and subsequently no post-operative deficits (n=124). Conclusion SCM is a non-invasive clinical tool that may be utilised for medicolegal reasons. Its use as a clinical tool is questionable given its relatively high false negative rate and low false positive rate. Take-home message Spinal cord monitoring may be used by spinal surgeons for medicolegal reasons if desired. Its use as a clinical tool is questionable at best.

Outcomes and technical issues of transcorporeal anterior cervical microforaminotomy in patients with cervical brachialgia

IntroductionTranscorporeal anterior cervical microforaminotomy is a motion-preserving surgery. It addresses directly to the prolapsed disc in contrast to posterior laminoforaminotomy and does not affect facet joints; in the transuncal approach, there is a chance of vertebral artery injury and it also decreases disc height; hence, may alter the motion of that segment. ObjectiveAim is to assess the outcome of surgery and its effectiveness. MethodsA total of 40 patients were observed retrospectively of which 33 were male and 7 were female. A single study of transcorporeal anterior cervical microforaminotomy was analyzed in a private hospital (Comfort Hospital), Dhaka, Bangladesh. Patients having pure brachialgia who were not relieved by conservative treatment over 6–8 weeks in cervical disc prolapse were included in the study. Patients having more than one level of disease, features of myelopathy, or instability were excluded from the study. ResultsAll patients were pain-free postoperatively, although after one to two months 2 out of 40 patients developed brachialgia and required anterior cervical discectomy and fusion. ConclusionTranscorporeal microforaminotomy for brachialgia is a safe and effective approach that is motion preserving and minimally invasive as well.

Effect of Huangqi Guizhi Wuwu Decoction on rats with prolapse of lumbar intervertebral disc

Purpose: This study aims to study the effect of Huangqi Guizhi Wuwu Decoction on the serum interleukin-β1 (TFG-β1) and tumor necrosis of experimental rats with lumbar disc herniation under the guidance of traditional Chinese medicine theory and modern scientific research methods. The influence of tumor necrosis factor -α (TNF-α) content. After establishing the rat lumbar disc herniation model, through 4 weeks of experimental intervention, the serum of various rats was collected, and the ELISA method was used to detect the content of TFG-β1 and TNF-α in the serum of each group of rats to obtain data Use statistical methods to analyze and process the data, explore the inflammatory factors that cause lumbar intervertebral disc herniation and the possible mechanism of action of Huangqi Guizhi Wuwu Decoction on the treatment of lumbar intervertebral disc herniation, and provide the prescription for the treatment of lumbar intervertebral disc herniation in the future Scientific experimental basis. Methods: The 48 SD male rats used in the experiment, weighing between 160-200g, were randomly divided into 4 groups, namely, A is the blank control group, B is the model, C is the Huangqi Guizhi Wuwu Decoction experimental group, and D It is the western medicine group of ibuprofen suspension, the blank group does not do any treatment, the other 3 groups of rats under aseptic conditions cut the skin (about 4cm in length) and subcutaneous tissue in the middle of the back, and bluntly separated the paravertebral tissue from the left spine Muscles, with bilateral iliac spine as anchor points, remove the spinous processes, left lamina and articular processes of the two vertebrae above the iliac spine. Expose the dura mater on the left side under an operating microscope to confirm the left spinal nerve. Take the jelly-like intervertebral disc nucleus pulposus from the excised tail of the mouse and place it gently around the dorsal side of the left nerve root. 3d intraperitoneal injection of penicillin sodium 2×105U/kg, once a day. Two weeks after modeling, imaging and histopathology showed obvious inflammatory cell infiltration. The infiltrating inflammatory cells were mainly neutrophils and macrophages. The nerve tissue was swollen and the nerve myelin sheath was swollen, ruptured, and axons. Swelling or disappearance, Schwann cells autolyzed and softened, and successfully established a rat lumbar disc herniation model. The administration was started on the first day after successful modeling. The frequency of administration in each group was once a day. The dosage was as follows: the blank group and the model group were given normal saline (1ml|100g) respectively, and the experimental group was given Huangqi Guizhi Wuwu Decoction was given by intragastric administration (1ml|100g), the western medicine group was given ibuprofen suspension (1ml|100g) by intragastric administration, and 1/4 animals were randomly sacrificed on the 7, 14, 21 and 28 days after intragastric administration. Three rats per group each time, blood was taken from the heart, centrifuged at 3000 r/min for 15 minutes, and the supernatant was drawn. The serum TFG-β1 and TNF-α contents of each group of rats were detected by ELISA. Results: 1. Changes in the level of TFG-β1 in serum: 7th, 14th, 21st, and 28th days after intragastric administration, the detection of serum TFG-β1 levels in each group showed that there was no significant change in TFG-β1 levels in group A; group B Compared with group A, the level of TFG-β1 increased abnormally; group C and group D decreased the level of TFG-β1, but group C dropped more significantly than group D, and the difference between the two groups was statistically significant (P<0.05). 2. Changes in serum TNF-α levels: There was no significant change in serum TNF-α levels in group A rats; serum TNF-α levels in group B rats were significantly increased, and serum TNF-α levels in group C and D rats Compared with group B, the levels of TNF-α in group C decreased more significantly than those in group D. The difference in serum TNF-α levels between the two groups of rats was statistically significant (P <0.05). Conclusions: 1. An animal model of rat lumbar disc herniation can be established by rat autologous nucleus pulposus transplantation;2. Before treatment, the serum TFG-β1/TNF-α content in rats in group C and D increased significantly, suggesting that the content of serum TFG-β1/TNF-α may be related to the incidence of lumbar disc herniation;3. Huangqi Guizhi Wuwu Decoction can significantly reduce the content of TFG-β1 and TNF-α in the serum of rats with lumbar disc herniation, and the effect is better than that of the western medicine group.Tabled 1Serum TFG-β1 levels (pg/ml) of rats in each group on 7, 14, 21, 28 days after gavageGroup7d14d21d28dB Group58.31±23.7959.60±24.5861.12±12.9363.17±13.38C Group43.11±22.8438.27±34.3226.35±11.9815.86±24.47*D Group57.26±13.1149.33±23.7435.46±23.0926.12±22.83* Open table in a new tab Tabled 1Serum levels of TNF-α (ng.L-1) in rats of each group at 7, 14, 21, 28 days after gavageGroup7d14d21d28dB Group89.67±28.8288.64±32.0890.32±22.3391.17±13.78C Group69.44±40.7957.73±32.8850.60±15.4339.25±21.58*D Group76.86±33.0165.23±33.4658.26±22.8947.52±26.13* Open table in a new tab

Spinal Subdural Hematoma With Paraplegia Mimicking Dorsolumbar Prolapsed Disc: A Case Report

Background and Importance: Spinal Subdural Hematoma (SSH) is a rare condition with an unknown incidence in the general population. Iatrogenic spinal subdural hematoma radiologically mimicking a prolapsed dorsolumbar disc has not been published in the literature. Case Presentation: A 65-year-old female presented with altered sensorium and generalized weakness for 3 days evaluated by a neurologist who diagnosed it as a metabolic encephalopathy with Syndrome of Inappropriate Antidiuretic Hormone secretion (SIADH) with severe anemia and hypothyroidism. She underwent a diagnostic lumbar puncture and following which, within 24 hours, she developed weakness of both the lower limbs. MRI of dorsolumbar spine was done which revealed D12-L1 extruded disc causing severe compression to the conus medullaris with D12-L2 subarachnoid lesion and cord edema. On opening the dura, a large organized hematoma on the anterior aspect of the conus was seen and evacuated. Conclusion: Spinal subdural hematoma presents with a spectrum of signs and symptoms. Although MRI is the investigation of choice but SSH presenting like a prolapsed intervertebral disc on MRI is one of its kinds and should be kept in mind since it carries a grave prognosis if not treated early with emergency decompression.

Endoscopic Discectomy versus Microscopic Discectomy

Objective: A randomized control trial was conducted to compare the outcome of an endoscopic discectomy with microdiscectomy in lumbar spine disc disease.&#x0D; Material and Methods: A randomized control trial was conducted at the Department of Neurosurgery, Punjab Institute of Neurosciences (PINS), Lahore. We included 80 patients of ages between 13 – 65 years, with low backache with radiation towards legs and prolapsed intervertebral disc at L5 – S1 and L4 – L5 levels on MRI were included in the study. Endoscopic/microscopic discectomy was done in a randomized manner under general anesthesia in a prone position with fluoro guidance. Postoperatively, all patients stayed in the recovery room for two hours for monitoring and then shifted to the ward. All patients followed-up-to one year clinically with the help of the Oswestry disability index (ODI).&#x0D; Results: There were 37 female and 43 male patients in the ages between 13 – 65 years. The mean age of patients was 53.5 years. The 53 patients were having prolapsed disc at L5 S1 levels and 27 patients with disc prolapse at L4 – 5 levels. A good improvement was observed in visual analog scores after surgery in both endoscopic and microscopic discectomy groups. But endoscopic discectomy group required a lesser hospital stay, early mobilization, and lesser postoperative analgesia requirements than the microscopic group.&#x0D; Conclusion: Endoscopic/microdiscectomy both are equally effective and safer techniques. They both can relief. However, the endoscopic discectomy was found better in terms of early mobilization and lesser postoperative pain.

OUTCOME OF ENDOSCOPIC LUMBAR DISCECTOMY FOR THE TREATMENT OF SCIATICA

Objective: To evaluate the outcome of endoscopic lumbar discectomy in patients having sciatica due to single level prolapsed disc. Methodology: This descriptive study was conducted in neurosurgery departments of Lady Reading Hospital and Hayatabad Medical Complex Peshawar from June 2017 to December 2019, after approval from the ethics com­mittee. All patients with straight leg raising (SLR) less than 60 degree, failed conservative treatment and with single level prolapsed disc were included while redo cases, cauda equine syndrome and traumatic disc prolapse asso­ciated with fractures were excluded. Per operative and post operative complications were documented. Patients were followed up for 3 months. Data was collected and analyzed with SPSS version 20. Results: One hundred and fifteen endoscopic lumbar discectomies were done. There were 75 (65.2%) male and 40 (34.8%) female patients. Age range was 17 to 63 years with mean age of 31.0±2.13 years. L5-S1 was involved in 67 (58.26%) cases, L4-5 in 42 (36.52%) cases and L3-4 in 6 (5.22%) cases. Procedure time ranged from 35 to 125 min with a mean of 62 minutes. Four cases were converted to open discectomies due to technical difficulties. Sciatica pain relief was achieved in 110 (95.65%) cases. Surgical site infection was observed in 2 (1.74%) cases. Conclusion: Endoscopic discectomy has acceptable rate of complications and good post-operative pain relief.

The role of altered glycosylation in human nucleus pulposus cells in inflammation and degeneration.

Intervertebral disc (IVD) degeneration causes low-back pain through disc compression, prolapse and herniation. Inflammation of the IVD and subsequent degeneration produce altered glycosylation profiles in several animal models of IVD injury and ageing, although the function of this altered glycosylation pattern in a human is unknown. Altered N-glycome, specifically sialylated and fucosylated N-glycosylation motif expression, might play a role in inflammation and disease progression. Healthy (foetal and adolescent idiopathic scoliosis) and degenerated (lumbar degeneration) human IVD glycosylation patterns were studied using lectin histochemistry. Small-molecule fluorinated sugar analogues (3Fax-Peracetyl Neu5Ac; 2F-Peracetyl-Fucose) were used to inhibit sialylation and fucosylation in an in vitro model of inflammation, to investigate their effects on the glycosignature, cell metabolism, extracellular matrix synthesis and cell migration. The effects of interleukin (IL)-1β, tumour necrosis factor (TNF)-α and IL-6 on glycosylation in human nucleus pulposus cells were investigated by lectin histochemistry, PCR and enzyme-linked immunosorbent assay (ELISA). In the in vitro model of IVD degeneration, cytokine-induced inflammation-induced hypersialylation was observed, as indicated by Sambucus nigra I binding. However, this modification was inhibited by the sialyltransferase inhibitor. Inhibition of sialylation and fucosylation modulates cell migration and protein translation of catabolic enzymes in response to inflammation. The altered patterns of glycosylation in human tissue in degeneration was consistent with previous IVD studies in murine, bovine and ovine models. The present study was the first functional investigation of glycosylation in human degenerated IVD, elucidating the role of the glycome in disease progression and identified potential therapeutic targets for future regenerative therapies.

The Value of Standing X-ray in Detecting Physiological Spondylolisthesis in Patients with Single Disc Prolapse with Normal Intensity MRI Findings

Background: A common spinal disease is lumbar disc herniation (LDH) accompanied by clinically relevant symptoms and it affects nearly one to 3 percent of general population. It has been inferred from long-term studies that approximately 15 percent of patients with spondylosis will have spondylolisthesis in addition. When adults are taken into consideration, 10% women and 5% of men are going to have lumbar spondylolisthesis that is not accompanied by a defect in the pars. Aim of the study: current study was carried out in order to highlight the association between physiologic spondylolisthesis and disc herniation. Patients and methods: current cross-sectional study was carried out at radiology unit, Al-Diwaniyah teaching hospital, Al-Diwaniyah province, Iraq. work with this study is dated back to March 2019 and lasted till April 2020. study included 100 patients with single disc prolapsed, who were randomly selected from the pool of patients referred by orthopedic unit to radiology unit. Those patients were investigated by MRI according to the routinely recommended examination done in the radiology unit for patients with single disc prolapse in addition to conventional plane x-ray in supine and standing positions (anteroposterior and lateral). Results: following results were found after data evaluation. Regarding the age interval of 20-40, 15 of them have disk prolapse with normal signal intensity, no one of them have spondylolisthesis, and 5 of them have abnormal signal intensity (dehydrated disk), one patient showing spondylolisthesis. Regarding the age interval of 41 to 60, 18 of them have disk prolapse with normal signal intensity, no one of them have spondylolisthesis, and 42 of them have abnormal signal intensity (dehydrated disk), 4 patient showing spondylolisthesis. With respect to the age above 60, one of them are have disk prolapsed with normal signal intensity, no one of them have spondylolisthesis, and 19 of them have abnormal signal intensity (dehydrated disk), one patient showing spondylolisthesis. Conclusion: standing position lateral X-ray must be performed for every patient with single disk prolapse having normal or abnormal signal intensity MRI to exclude physiological spondylolisthesis. How to Cite this Article Pubmed Style Hashim NA, Kadhim RJ. Value of Standing X-ray in Detecting Physiological Spondylolisthesis in Patients with Single Disc Prolapse with Normal Intensity MRI Findings. SRP. 2020; 11(9): 243-247. doi:10.31838/srp.2020.9.40 Web Style Hashim NA, Kadhim RJ. Value of Standing X-ray in Detecting Physiological Spondylolisthesis in Patients with Single Disc Prolapse with Normal Intensity MRI Findings. http://www.sysrevpharm.org/?mno=6438 [Access: March 30, 2021]. doi:10.31838/srp.2020.9.40 AMA (American Medical Association) Style Hashim NA, Kadhim RJ. Value of Standing X-ray in Detecting Physiological Spondylolisthesis in Patients with Single Disc Prolapse with Normal Intensity MRI Findings. SRP. 2020; 11(9): 243-247. doi:10.31838/srp.2020.9.40 Vancouver/ICMJE Style Hashim NA, Kadhim RJ. Value of Standing X-ray in Detecting Physiological Spondylolisthesis in Patients with Single Disc Prolapse with Normal Intensity MRI Findings. SRP. (2020), [cited March 30, 2021]; 11(9): 243-247. doi:10.31838/srp.2020.9.40 Harvard Style Hashim, N. A. & Kadhim, . R. J. (2020) Value of Standing X-ray in Detecting Physiological Spondylolisthesis in Patients with Single Disc Prolapse with Normal Intensity MRI Findings. SRP, 11 (9), 243-247. doi:10.31838/srp.2020.9.40 Turabian Style Hashim, Najat Adel, and Raad Jawad Kadhim. 2020. Value of Standing X-ray in Detecting Physiological Spondylolisthesis in Patients with Single Disc Prolapse with Normal Intensity MRI Reviews in Pharmacy, 11 (9), 243-247. doi:10.31838/srp.2020.9.40 Chicago Style Hashim, Najat Adel, and Raad Jawad Kadhim. The Value of Standing X-ray in Detecting Physiological Spondylolisthesis in Patients with Single Disc Prolapse with Normal Intensity MRI Findings. Systematic Reviews in Pharmacy 11 (2020), 243-247. doi:10.31838/srp.2020.9.40 MLA (The Modern Language Association) Style Hashim, Najat Adel, and Raad Jawad Kadhim. The Value of Standing X-ray in Detecting Physiological Spondylolisthesis in Patients with Single Disc Prolapse with Normal Intensity MRI Findings. Systematic Reviews in Pharmacy 11.9 (2020), 243-247. Print. doi:10.31838/srp.2020.9.40 APA (American Psychological Association) Style Hashim, N. A. & Kadhim, . R. J. (2020) Value of Standing X-ray in Detecting Physiological Spondylolisthesis in Patients with Single Disc Prolapse with Normal Intensity MRI Reviews in Pharmacy, 11 (9), 243-247. doi:10.31838/srp.2020.9.40

GRIDRASI: A CASE STUDY

In the present era, sedentary lifestyle is creating lot of problems in the human body. Gridrasi is a painful condition in which the person cannot sit and walk properly which in turn hampers his normal activity. Almost all signs and symptoms of Gridrasi resembles the condition Sciatica, as described in the modern texts. Sciatica is a very painful condition in which pain begins in lumbar region and radiates along the posterior lateral aspect of thigh and leg along with difficulty in walking. SLR, Slump test, Lasegue’s signs, Faber’s test is helpful not only to diagnose the sciatica but also to assess the progress of the therapy. A 49-year-old male patient working as a carpenter came to KVG Ayurveda Medical college KC, OPD complaining of low back pain radiating to posterior aspect of left lower limb for one month. Also, difficulty in walking and numbness in the left foot. He was diagnosed as a case of intervertebral disc prolapse at L4 - L5. According to symptoms it was diagnosed as Vata Kaphaja Gridrasi, treated with medicine like RasanaerandathiKashayam, Trayodasangguggulu, SarvangaChoornapindaswedam, Sarvangapathrapindasweda, Basthi, Sahacharadikashayam, Rasanadhiguggulu etc. After the treatment patient’s overall quality of life was significantly improved. The present case study is about the successful Ayurvedic management of Gridrasi.

Endoscopic lumbar discectomy using side viewing conical working tube

Objective: The paradigm of surgical therapy for spinal disease especially for lumbar disc herniation has gradually shifted from traditional open surgeries to minimally invasive spinal surgeries. Endoscopic discectomy has been performed widely using various devices and techniques. In this study, we present our experience of endoscopic discectomy using a unique device with separate side viewing channel.&#x0D; Methods: 26 patients of lumbar disc herniation treated between March 2015 to April 2018 using the unique conical working tube with separate side-viewing endoscopic channel have been retrospectively analysed. Their preoperative and postoperative Oswestry Disability Index (ODI) and Macnab scores were used to evaluate the outcome with a mean follow up of 37.04 months.&#x0D; Results: There were 18 males and 08 females with age ranging from 19-72 years (mean-38.4 years). The follow up ranged from 25 months to 60 months with a mean of 37.04 months. The mean preoperative ODI score was 72.4 which decreased to a mean of 7.6 and the outcome evaluated by Macnab criteria was 65.3% excellent, 19.2 % good, 11.5% fair, 3.8% poor. 1 patient underwent a second surgery. None of the patients had to change their occupation postoperatively. Complications occurred were dural tear in 1 patient and transient foot paresis in 1 which improved spontaneously.&#x0D; Conclusion: Endoscopic discectomy using conical working tube is a safe and effective technique for lumbar disc prolapse. The long term results are comparable to conventional techniques.

Extra-laminar microscopic-assisted percutaneous nucleotomy (EL-MAPN) for the treatment of foraminal lumbar disc prolapse, a modified minimally invasive approach

In this work, a modification of the percutaneous surgical approach for removing the lumbar foraminal disc prolapse is introduced. A prospective study was performed. The indication for surgery was foraminal disc prolapse presenting with acute motor or persistent sensory radiculopathy. MRI and X-ray of the lumbar spine were performed. VAS and ODI were recorded. The operation was done under general anesthesia. A needle was inserted for level-localization using C-arm. A 1.5cm para-median skin incision was performed. A gradual dilatation using trocars was followed by the insertion of a tubular system. Under direct vision using the operative microscope, the lateral edge of the lamina was identified. A small, hooked probe was inserted in the foramen, and its position was documented fluoroscopically. With the help of the microscope, the triad consisting of Pedicle, Nerve root, and Prolapse "PNP" was identified. The nerve root was mobilized, and the prolapsed disc was removed. The study included 50 patients, 26 females, and 24 males. The mean follow-up was 18months. The mean operative time was 65min. The mean blood loss was 105ml. The mean VAS improved from 7.8 ± 2.3 preoperatively to 0.8 ± 0.3 after one year (p = 0.001). Mean ODI improved from 28 ± 10.4 to 4 ± 2.3 after one year (p = 0.02). A recurrent disc occurred in 2 patients and was revised in the same technique. EL-MAPN represents a minimally invasive approach for foraminal disc prolapse removal under direct visual control avoiding injury to the facet joint or pars interarticularis.

Single Level Lumbar Disk Herniation: Conventional Discectomy versus Interbody Fusion with Bilateral Pedicular Fixation

OBJECTIVE: The objective of the study was to compare between the conventional discectomy and the interbody fusion with bilateral pedicular screw fixation in the management of single level lumbar disk herniation.&#x0D; METHODS: This is a prospective study done on 50 patients (25 in each group) at Cairo University Hospitals in the period between October 2018 and June 2019 fulfilling the inclusion criteria. Diagnosis was made clinically with history (low back pain and sciatica),examination (motor power assessment, straight leg raising test), and radiological findings (MRI, CT and X-ray lumbar spine). The pain status (VAS) was pre and postoperatively evaluated and followed up every 3 months for 1 year.&#x0D; RESULTS: The study included 50 patients (25 in each group) (mean age 40.4 years old) with slight female predominance. The most common clinical findings presented at diagnosis were low back pain followed by lower limb pain in the form of claudication and sciatica. L5-S1 disk prolapse was the most common level affected in both groups followed by L4-5 level. Regarding the clinical outcome, there was statistical significance in the VAS of low back pain at 9 months and 1-year follow-up favoring the fusion group with mean VAS 0.40 and 1.32 (p &lt; 0.05).&#x0D; CONCLUSION: Clinical outcome was excellent in both groups. However, the reduction in low back pain after surgery was greater in the fusion group (p &lt; 0.05). The rate of recurrent disk herniation at the surgical level in the nonfusion group was higher, but intraoperative blood loss, operation time, length of hospital stay, and total cost of procedure were all less in the patients undergoing discectomy alone. Although there is still controversy regarding the pros and cons of fusion in association with disk excision without instability, fusion results were highly favorable.

Spine surgery in pregnant women: a multicenter case series and proposition of treatment algorithm

PurposeSpinal diseases requiring urgent surgical treatment are rare during pregnancy. Evidence is sparse and data are only available in the form of case reports. Our aim is to provide a comprehensive guide for spinal surgery on pregnant patients and highlight diagnostic and therapeutic aspects.MethodsThe study included a cohort of consecutive pregnant patients who underwent spinal surgery at five high-volume neurosurgical centers between 2010 and 2017. Perioperative and perinatal clinical data were derived from medical records.ResultsTwenty-four pregnant patients were included. Three underwent a preoperative cesarean section. Twenty-one patients underwent surgery during pregnancy. Median maternal age was 33 years, and median gestational age was 13 completed weeks. Indications were: lumbar disk prolapse (n = 14; including cauda equina, severe motor deficits or acute pain), unstable spine injuries (n = 4); intramedullary tumor with paraparesis (n = 1), infection (n = 1) and Schwann cell nerve root tumor presenting with high-grade paresis (n = 1). Two patients suffered transient gestational diabetes and 1 patient presented with vaginal bleeding without any signs of fetal complications. No miscarriages, stillbirths, or severe obstetric complications occurred until delivery. All patients improved neurologically after the surgery.ConclusionSpinal surgical procedures during pregnancy seem to be safe. The indication for surgery has to be very strict and surgical procedures during pregnancy should be reserved for emergency cases. For pregnant patients, the surgical strategy should be individually tailored to the mother and the fetus.

Value of diffusion tensor imaging and tractography in unilateral lumbar disc prolapse

BackgroundConventional MR imaging is not enough for evaluation of symptomatic foraminal stenosis, because there is high incidence of false-positive results in asymptomatic elderly patients. Conventional MR cannot quantitatively assess the severity of the nerve lesion. DTI is a non-invasive way to effectively trace the nerve fiber bundle and quantitatively evaluate the nerve injury. DTI with fiber tracking may describe abnormalities beyond the resolution of conventional MR techniques. The aim of this work was to compare between the mean values of diffusion parameters such as fractional anisotropy and apparent diffusion coefficient of the compressed lumbar spinal nerve roots and of the contralateral normal nerve roots. Correlate these parameters with the severity of neurological symptoms. This is a prospective study that was conducted on 50 patients with symptomatic unilateral posterolateral lumbar disc prolapse at a university hospital. They were investigated with diffusion tensor imaging with tractography on a 1.5-T MR. The changes in the mean fractional anisotropy and apparent diffusion coefficient values of the compressed nerves and the relationship between these changes and the severity of the neurological side effects using Japanese Orthopedic Association score and visual analogue scale were investigated.ResultsThe mean fractional anisotropy values were significantly lower (p ≤ 0.001), and mean apparent diffusion coefficient values were significantly higher (p ≤ 0.001) in compressed nerves than in contralateral intact nerves. There were strong correlations between the DTI parameters and the severity of the neurological symptoms as assessed using the Japanese Orthopedic Association score and the visual analogue scale.ConclusionIn patients with lumbar disc prolapse, radicular diffusion parameters are affected in the compressed roots in comparison to the healthy roots and this affection is correlated with the degree of prolapse and with the severity of neurological symptoms. DTI with fiber tracking provide clinically relevant information and describe abnormalities beyond the resolution of conventional MR techniques.