Lateral Disc Research Articles

Clinical Results and Postoperative Complications in Patients with Lateral Lumbar Disc Herniation

Clinical Results and Postoperative Complications in Patients with Lateral Lumbar Disc Herniation

Effects of Lumbar Stabilization Exercise in Management of Pain and Restoration of Function in Patients with Postero Lateral Disc Herniation

Objective: Objective of this study was to assess the effectiveness of lumbar stabilization exercise in mana-gement of pain and restoration of function in patients with postero lateral disc herniation. Methodology: In this randomized controlled trial 100 patients were taken. Using non-probability conveni-ence sampling patients were divided into 2 groups, i.e. In Group A – patients were managed with lumbar sta-bilization exercises and in Group B patients were man-aged with conventional physical therapy. Final assess-ment was based on the following Oswestry scale. Results: Mean age of patients in Group – A was 35.66 ± 6.34 years and in Group-B mean age was 37.96 ± 4.25 years. Before treatment total assessment score in Group – A and in Group – B was 16.13 ± 3.42 and 18.80 ± 3.06. After treatment total assessment score in Group – A and in Group – B was 6.90 ± 2.68 and 13.53 ± 3.07 respectively. According to p-value significant difference was present in both groups. i.e. (p-value = 0.000). Conclusion: The Lumbar Stabilization exercises pro-vide significantly better results compared with conven-tional physical therapy regimen in patients with disc herniation. Lumber stabilization exercises were safe and easy to perform. Keywords: Postero lateral disc herniation, lumbar stabilization, conventional physical therapy.

Can Preoperative Radiographic Parameters Be Used to Predict Fusion in Non-instrumented Posterolateral Fusion for Degenerative Spondylolisthesis?

Prospective cohort. To determine whether preoperative radiographic parameters (translation, angular motion, and lateral disc height) can predict fusion status in patients with degenerative spondylolisthesis who underwent a single-level decompression and non-instrumented posterolateral fusion using autogenous iliac crest bone graft. Non-instrumented posterolateral fusion is sometimes considered in patients with degenerative spondylolisthesis who do not have radiographic evidence of instability. No previous study has attempted to determine whether preoperative radiographic parameters can be used to predict successful fusion. A prospective, randomized, controlled, multicenter clinical study was previously conducted to compare the outcomes of osteogenic protein 1 (BMP-7) putty to autogenous iliac crest bone graft for single-level non-instrumented posterolateral fusion for the treatment of symptomatic degenerative spondylolisthesis with spinal stenosis. A total of 90 patients who were randomized to the autograft group formed the basis of this study, 67 of whom had data on the 3 radiographic parameters. Preoperative and postoperative radiographs were evaluated by 2 independent observers. The spine was determined to be fused if there was presence of continuous bone bridging between the transverse processes, an angulation of ≤5°, and a translational movement of ≤3 mm on flexion/extension radiographs of the affected level. Forty-two (63%) of the 67 patients had a radiographic fusion. The mean preoperative translation in this group was 1.87 mm (range, 0.3-7.35 mm), the angular motion was 4.44° (range, 0.1°-12.1°), and the lateral disc height was 8.74 mm (range, 0.2-15.34 mm). Twenty-five (37%) of the 67 patients had a radiographic pseudarthrosis. The mean preoperative translation in the pseudarthrosis group was 1.20 mm (range, 0-3.55 mm), the angular motion was 4.66° (range, 1.1°-12.95°), and the lateral disc space height was 8.10 mm (range, 1.98-13.315 mm). There was no significant difference in these 3 parameters between the fusion and the pseudarthrosis group. These results indicate that preoperative radiographic parameters that may indicate the absence of gross instability in degenerative spondylolisthesis are not reliable in predicting radiographic fusion in a single-level non-instrumented fusion.

Minimally Invasive Posterior Cervical Discectomy for Cervical Radiculopathy

Retrospective analysis of data of all patients treated by minimally invasive posterior discectomy for cervical radiculopathy between January 2004 and February 2008. To describe our technique and report the outcome of minimally invasive posterior cervical discectomy using the MetRx tubular retractor system and surgical microscope. Although several studies have been published on posterior minimally invasive approaches to cervical radiculopathy, most have focused on decompression of the nerve root by laminoforaminotomy only without the removal of the offending disc. The hospital charts, magnetic resonance imaging studies, and follow-up records of all the patients were reviewed. Outcome was assessed by neurological status, visual analog scale (VAS) for neck and arm pain, and by the short form-36 health survey questionnaire. Thirty-two patients were included in this study. The follow-up time was 20 to 67 months (mean, 39 mo). Muscle weakness improved in all patients; sensory deficits resolved in 21 patients and improved in 7 patients. Analysis of the mean VAS for radicular pain, VAS for neck pain, and all 8 domains of the short form-36 health survey questionnaire showed significant improvement. Complications included 1 case of incidental dural tear without postoperative cerebrospinal fluid leakage and 1 case of longstanding neck pain. Minimally invasive posterior cervical discectomy is safe and effective in the management of lateral cervical disc herniation manifested by radiculopathy. In addition to eliminating some of the disadvantages of open surgical approaches, it may also have swifter symptoms resolution compared with laminoforaminotomy without discectomy.

Surgical Strategies in the Management of Cervical Degenerative Disorders

t seems to be agreeable for many of us that in a lateral or oraminal soft-disc protrusion causing cervical radiculopathy at he single level, posterior foraminotomy with removal of a equestrated disc fragment is as good as anterior microdiscecomy and probably less invasive because of fewer complications 6). However in the cases of the lateral discs associated with pondylosis or medial disc protrusion causing usually radiculomylopathy, posterior foraminotomy has a significant risk of surgical ailure and necessitates a second surgery in 8%-14% of the ases (3, 5). Postoperative instability and loss of lordosis after osterior foraminotomy also have been reported, and some ases needed the posterior fusion.

The lumbosacral plexus: anatomic considerations for minimally invasive retroperitoneal transpsoas approach

The minimally invasive transpsoas approach can be employed to treat various spinal disorders, such as disc degeneration, deformity, and lateral disc herniation. With this technique, visualization is limited in comparison with the open procedure and the proximity of the lumbar plexus to the surgical pathway is one limitation of this technique. Precise knowledge of the regional anatomy of the lumbar plexus is required for safe passage through the psoas muscle. The primary objective of this study was to determine the anatomic position of the lumbar plexus branches and sympathetic chain in relation to the intervertebral disc and to define a safe working zone. The second objective was to compare our observations with previous anatomical studies concerning the transpsoas approach. A total of 60 lumbar plexus in 8 fresh cadavers from the Department of Anatomy were analyzed in this study. Coronal and lateral X-Ray images were obtained before dissection in order to eliminate spine deformity or fracture. All cadavers were placed in a lateral decubitus position with a lateral bolster. Dissection of the lumbar plexus was performed. All nerve branches and sympathetic chain were identified. Intervertebral disc space from L1L2 to L4L5 was divided into four zones. Zone 1 being the anterior quarter of the disc, zone 2 being the middle anterior quarter, zone 3 the posterior middle quarter and zone 4 the posterior quarter. Crossing of each nervous branch with the disc was reported and a safe working zone was determined for L1L2 to L4L5 disc levels. A safe working zone was defined by the absence of crossing of a lumbar plexus branch. No anatomical variation was found during blunt dissection. As described previously, the lumbar plexus is composed of the ventral divisions of the first four lumbar nerves and from contributions of the sub costal nerve from T12. The safe working zone includes zones 2 and 3 at level L1L2, zone 3 at level L2L3, zone 3 at level L3L4, and zone 2 at level L4L5. No difference was observed between right and left sides as regards the relationships between the lumbar plexus and the intervertebral disc. We observed some differences concerning the safe working zone in comparison with other cadaveric studies. The small number of cadaveric specimens used in anatomical studies probably explains theses differences. The minimally invasive transpsoas lateral approach was initially developed to reduce the complications associated with the traditional procedure. The anatomical relationships between the lumbar plexus and the intervertebral disc make this technique particularly risky a L4L5. Alternative techniques, such as transforaminal interbody fusion (TLIF), posterior lumbar interbody fusion (PLIF) or anterior interbody fusion (ALIF) should be used at this level.

Risk of progression of degenerative lumbar scoliosis

In this paper the authors' goal was to determine the factors associated with the progression of degenerative lumbar scoliosis (DLS). Twenty-seven patients (3 men and 24 women; mean age 64.9 years) with more than 10° of lumbar scoliosis at baseline were monitored for a mean period of 10 years. The radiological evaluation included measurement of the scoliosis angle using the Cobb method, the direction of the scoliosis, the relationship between the intercrest line and the L-5 vertebra, lateral listhesis, segmental angle, distance from the center of the sacral line to the apical vertebra, degenerative listhesis anteriorly or posteriorly or both, and lordosis angle. In addition, the lateral osteophyte difference, disc index, and severity of osteoporosis were measured. The pain and disability outcomes were assessed using the visual analog scale and the Oswestry Disability Index (ODI) relative to severity of the angle of scoliosis. The mean initial and final scoliosis angles were 14° ± 5.4° and 25° ± 8.5°, respectively. The initial disc index at the L-3 vertebra (Spearman ρ = 0.7, p < 0.001), the sum of the segmental wedging angles above and below the L-3 vertebra (ρ = 0.6, p < 0.001), and the initial disc index at the apical vertebra (ρ = 0.6, p < 0.001) were correlated with the last follow-up angle of the scoliosis. By contrast, there was no statistically significant correlation between the initial segmental angles at L2-3 and L3-4 and the final follow-up scoliosis angle (ρ = 0.2, p = 0.67; and ρ = 0.1, p = 0.22; respectively). When the authors separated the patients into 3 groups according to the sum of the segmental angles above and below L-3 (< 5°, 5° to 10°, and > 10°), they found that 3 (42.9%) of 7, 8 (66.7%) of 12, and 6 (75.0%) of 8 patients in the 3 groups showed increases of greater than 10° in scoliosis angle. The mean distance from the center of the sacral line to the apical vertebra was 36.0 ± 9.7 mm, and the distance correlated with the measurement of the last follow-up angle of the scoliosis (ρ = 0.6, p < 0.001). The mean angle of the scoliosis was significantly greater when the intercrest line passed through the L-5 or L4-5 disc space than when the line passed through the L-4 vertebral body (31.4° ± 7.9° vs 21.8° ± 6.7°, p = 0.01). The ODI correlated with the measurement of the angle of the scoliosis (ρ = 0.6, p < 0.001). Age, sex, osteoporosis, the direction of the scoliosis, listhesis of coronal and sagittal planes, the lateral osteophyte difference, and the vertebral body index did not correlate with curve progression. The findings of this study demonstrated that the progression of DLS was affected by the relationship between the intercrest line and the L-5 vertebra. When L-5 was deep seated, progression of DLS was found. Asymmetrical change in the disc space above and below the L-3 or apical vertebra may also be an important predictor of curve progression.

Prediction of postoperative trunk imbalance after posterior spinal fusion with pedicle screw fixation for adolescent idiopathic scoliosis

The objective of this retrospective study was to explore, which radiographic parameters, immediately after posterior spinal fusion with pedicle screw fixation for adolescent idiopathic scoliosis (AIS), best correlate with subjacent disc wedging at a minimum of 2-year follow-up. Sixty-four consecutive AIS patients who underwent posterior pedicle screw-only instrumentation were studied. Preoperative and postoperative radiographs were obtained to measure various parameters regarding global coronal, shoulder, sagittal, and regional balance. Specific correlation of these parameters to selected 2-year postoperative disc wedging and lowest-instrumented vertebra (LIV) tilt and translation were analyzed. The average lateral disc opening changed from 4.59±4.75 preoperatively to 1.46±2.82 at 2 weeks and 2.81±6.43 at 2 years postoperatively. Two-year postoperative lateral disc opening significantly correlated with the 2-week postoperative lateral disc opening, C7 plumbline relative to the posterior-superior corner of the first sacral vertebra distance, and LIV-center sacral vertical line (CSVL) distance (r=0.7433, P<0.0001). The two-year postoperative LIV tilt significantly correlated with the 2-week postoperative LIV tilt, T12-LIV lordosis, LIV-CSVL distance, and C7-CSVL distance (r=0.8879, P<0.0001). Two-year postoperative LIV-CSVL significantly correlated with 2-week postoperative LIV-CSVL distance and lateral disc opening (r=0.6104, P<0.0001). Two-year postoperative disc wedging, LIV tilt, and LIV translation occurred most often when disc wedging and LIV deviation or obliquity existed immediately postoperatively. This study identified a potential indicator for AIS repair. Preoperative surgical planning and intraoperative correction are important for avoiding subjacent regional imbalance after scoliosis fusion.

Surgical management of multiple thoracic disc herniations via a transfacet approach: a report of 15 cases

Symptomatic thoracic disc herniations (TDHs) are rare, and multiple TDHs account for an even smaller percentage of symptomatic herniated discs. Most TDHs are found in the lower thoracic spine, with more than 75% occurring below T-8. The authors report a series of 15 patients with multiple symptomatic TDHs treated with a modified transfacet approach. Fifteen patients (9 women and 6 men) with a total of 32 symptomatic TDHs were treated surgically at the authors' institution between 1994 and 2010. The average patient age was 51.1 years. Thirteen patients had 2-level herniation and 2 patients had 3-level disease. The most commonly involved level was T7-8 (10 herniations), followed by T6-7 and T8-9 (6 herniations each). All patients had long-standing myelopathic and/or radicular complaints at the time of presentation. Each disc that exhibited radiographically confirmed compression of the spinal cord or nerve root was considered for resection. Only patients with lateral disc herniations were considered for the modified transfacet approach; patients with a centrally herniated disc underwent ventral or ventral-lateral procedures. The average follow-up time was 30 months. All patients had successful resection of their herniated discs. All patients with preoperative weakness demonstrated improved strength, and 11 of 12 patients with preoperative pain showed improvement in pain. Sensory loss was less consistently improved. The 2 patients who underwent posterior fixation and fusion achieved radiographically confirmed fusion by the 1-year follow-up. Nine of 10 patients who were working returned to their jobs. Eleven of 12 patients with preoperative back or radicular pain had drastic or complete pain resolution; 1 patient had no change in pain. All 7 patients with preoperative ambulatory difficulty had postoperative gait improvement. Complications were minimal. Multiple symptomatic herniated thoracic discs are rare causes of pain and disability, but should be treated surgically because good outcomes can be achieved with acceptably low morbidity.

고속 회전 유연 디스크 시스템에서 곡면 안정기에 가공된 모세관형 오리피스의 감쇠계수 해석

In the last couple of years, the flexible optical disk(FOD) system that consists of a thin polycarbonate(PC) film of 95 <TEX>${\mu}m$</TEX> thick, a rigid stabilizer, and a high speed spindle motor has been spot-lighted as the next-generation optical system for archival use of digital data. The air film between the rotating disk and stabilizer provides a means for damping out the lateral disk vibrations. However, its damping-capability drops significantly as the rotational speed of the disk exceeds a specific limit and, eventually, the disk vibration propagates inward causing the whole span of the disk exhibits large vibration amplitudes. Based on the numerical simulations as well as the experimental results, the present work aims to evaluate the damping coefficient of the air-film near the outer region of the disk where the capillary type orifices are applied to the edge of the curved stabilizer.

Safe working zones using the minimally invasive lateral retroperitoneal transpsoas approach: a morphometric study

The minimally invasive lateral retroperitoneal transpsoas approach is a recent technique developed for lumbar interbody fusion and discectomy. The proximity of the retroperitoneal vessels and ventral nerve roots to the surgical pathway increases the risk of injury to these anatomical structures. A precise knowledge of the regional anatomy of the lumbar plexus is required for safe passage through the psoas muscle. Preoperative examination of the axial MRI images will allow the surgeon to observe the neural structures at the operative levels and confirm that abdominal vessels do not obstruct the lateral disc space. The objective of this study was to determine the anatomic position of the ventral nerve roots and the retroperitoneal vessels in relation to the vertebral body in the degenerative spine and to delineate a safe working zone using magnetic resonance imaging (MRI). We retrospectively evaluated lumbar spine MRI in 78 patients (from L1-L2 to L4-L5). The total number of lumbar vertebrae measured was 304 levels. Sagittal MRI sections were used to measure disc height (anterior, middle, posterior). Axial MRI sections were used to measure the sagittal and transversal vertebral endplate diameters, the overlap between ventral nerve roots and the posterior border of the lower endplate of the vertebral body, and the overlap between the retroperitoneal vessels and the anterior border of the lower endplate of the vertebral body. The safe zone was subsequently calculated. It was defined as the relative lower endplate vertebral body sagittal diameter that is anterior to the nerve root and is posterior to the retroperitoneal vessels. The safe working zone was 75.3% of the lower endplate of the vertebral body sagittal diameter at L1-L2, 59.5% at L2-L3, 51.9% at L3-L4 and 37.8% at L4-L5 levels. This area significantly decreases from L1-L2 to L4-L5 (p<0.05). Compared with L1-L2, L2-L3 levels, the more anterior position of the nerve root and the more posterior position of the retroperitoneal vessels at the L4-L5 level causes a significant reduction of this area. Compared with the L3-L4 level, we observed that the safe zone decrease was simply secondary to the more anterior position of the nerve roots at the L4-L5 level. Preoperative planning and safe zone delineation are a simple method to assess the relative position of neural and vascular anatomic structures in relation to the surgical area. This method can help spine surgeons to prevent perioperative complications.

Submuskulärer Zugang zur Lendenwirbelsäule und extraforaminale Cage-Implantation

The posterior median approach to the lumbar spine may cause significant injury to the erector spinae muscles (ESM) which is minimized using the paralateral approach suggested by Ray. We have adopted this approach and have extended it into the disc space to allow cage implantation from outside the foramen (EPLIF - extraforaminal posterior lumbar interbody fusion). The initial exposure of the posterior vertebral elements between the ESM and the deep lumbar fascia is sufficient to attain the entry points of pedicle screws. The intervertebral foramen and posterior annulus fibrosus are then exposed after which distant lateral disc herniations may be removed, the foramen/lateral recess may be decompressed or an EPLIF performed following clearing and vertical distraction of the disc space. This is followed by ipsilateral transpedicular fixation (TpF), contralateral fixation (second approach) by TpF or translaminar screws. Indications are given for foraminal and extraforaminal disc herniation, stenosis of the foramen and/or of the lateral recess, posterolateral fusion, TpF and EPLIF. The submuscular approach and EPLIF have proven to be valuable alternatives to standard techniques.

Two new species of the subgenus Asteroporpa (Asteromoana) (Ophiuroidea: Euryalida: Gorgonocephalidae) from Japan

Two new species of the subgenus Asteroporpa (Asteromoana) (Echinodermata: Ophiuroidea: Euryalida: Gorgonocephalidae) are described from southwestern and southern Japan. A. (Asterom.) muricatopatella sp. nov. has only cone-shaped dermal ossicles with terminal projections on radial shields, only plate-shaped dermal ossicles on oral plates, and coneshaped dermal ossicles with relatively short terminal projections at the lateral interradial disc. A. (Asterom.) koyoae sp. nov. has both cone-shaped dermal ossicles with terminal projections and plate-shaped dermal ossicles on radial shields, cone-shaped dermal ossicles with terminal projections on oral plates, and cone-shaped dermal ossicles with relatively long terminal projections on the lateral interradial disc. A taxonomic key to all four species of the subgenus A. (Asteromoana) is provided.

Paraspinal-approach transforaminal lumbar interbody fusion for the treatment of lumbar foraminal stenosis

Foraminal stenosis is a common cause of lumbar radicular symptoms. Recognition of the dynamic pathology, as well as the static anatomical changes, is important to achieving successful surgical outcomes. Excessive facet and anulus removal leads to subsequent disc space narrowing and/or segmental instability, which can cause poor results after decompressive surgery. The objective of this study was to evaluate the efficacy of the paraspinal-approach transforaminal lumbar interbody fusion (TLIF) in the treatment of lumbar foraminal stenosis. Twenty levels of lumbar foraminal stenosis in 16 patients were treated using an instrumented paraspinal-approach TLIF. There were 12 single-level and 4 two-level cases. Pathologies included foraminal stenosis at 13 levels and lateral disc herniation with disc space narrowing at 7. In all patients, preoperative radicular symptoms and mechanical low-back pain were resolved immediately after the operation and leg weakness improved gradually. The recovery rate using the Japanese Orthopaedic Association score was 89.1%. Bony union was achieved within 6 months after the operation in all cases. Postoperative MR imaging showed minimal changes in the paraspinal muscles in the single-level cases. The paraspinal-approach TLIF is a minimally invasive, safe, and secure procedure for treating lumbar foraminal lesions. Direct visualization and decompression for the foraminal lesion, distraction of the collapsed disc space, and stabilization of the unstable segments can be achieved simultaneously through the paraspinal approach, which produces successful clinical and radiological results.

경피적 내시경 수핵제거술 후 운동유형이 체간근력 및 요통지수에 미치는 영향

This study looked at the effects on the trunk muscle strength and the oswestry disability index(ODI) of modes of waist-hip exercise (static stability, dynamic stability, weight), after a patient was operated by percutaneous endoscopic discectomy. Furthermore, this study was implemented to provide necessary supporting data for designing a desirable future rehabilitation and exercise program for the patient with the percutaneous endoscopic discectomy, reaching the conclusions as below. 1. Trunk Muscle Strength As for the changes in trunk muscle strength by angle when measuring with the Centaur, the differences between periods per group have shown that all the three groups - static stability exercise, dynamic stability exercise and weight exercise - the trunk muscle strength on both sides increased more significantly (p.001) after exercise than before exercise, while no significant differences were present between groups per period. 2. The Oswestry Disability Index(ODI) In the differences between periods per group, all the three groups - static stability exercise, dynamic stability exercise and weight exercise - turned out to show reduction, 4, 8 and 12 weeks after exercise, more significantly (p.001) than before exercise. In the differences between groups per period, on the other hand, the weight exercise group released a significantly lower figure(p.05) 12 weeks after exercise than both groups of static and dynamic stability exercise. As examined above, different exercise programs were implemented separately, which consequently showed that, after the percutaneous endoscopic discectomy applied to a patient with extreme lateral lumbar disc herniation, those programs - the static, dynamic stability exercise and the weight exercise program - had positive effects on DITI-based trunk muscle strength the passage of time. However, this study failed to provide the most effective exercise mode among the programs by exercise mode. Therefore, we see it necessary to apply continuing, systematic and objective exercise programs, and to add the realization of data standardization to use as objective clinical data, by designing multiple methods of measurement for the patients related.

TMJ Dysfunction: Conservative Management of Facial Pain

Shawky M. Elmorsy, MD Ass. Professor of Otolarynglogy, Mansoura University Egypt Phone: +20129485014 Fax: +20502267016 shawky_morsy2003@yahoo.com Objectives:The conservative treatment of tempromandibular disorder is recommended as a basic principle in management by using splint especially anterior disk displacement. Aim of the work:This study aimed to compare the effect of wearing anterior deprogramming devices (two types) and muscle relaxant on TMJ in patient with lateral pole anterior disc displacement Material and methods:In a prospective study from 2005-2009, 30 patients with lateral pole anterior disc displacement were evaluated in this study before and after wearing devices for six months. Magnetic resonance imaging (MRI) was used for evaluation in this study. Patients were randomly divided into three equal groups. In Group I, anterior deprogramming devices were used. Group II used anterior midline stop device and group III used muscle relaxant appliance for six months. Outcome assessment was done by MRI and clinical findings. Results:The results of this study revealed that anterior deprogramming devices were more rapid and effective in treatment of TMJ displacement than muscle relaxant appliance. Conclusion:It can be concluded that anterior deprogramming devices can be used for treatment lateral pole anterior disc displacement of TMJ. TMJ dysfunction: Conservative Management of Facial Pain

Dorsoventral organization of sensory nerves in the lumbar spine as indicated by double labeling of dorsal root ganglion neurons

BackgroundReferred pain due to lumbar disc disorders can be analyzed using the stereoscopic structure of the peripheral sensory nervous system. The rostrocaudal structure has been clarified. The dorsoventral structure of the lumbar spine would be useful for mapping areas of pain perception in spinal disorders. MethodsThe neurotracer 1,1-dioctadecyl-3,3,3,3-tetramethylindocarbocyanine perchlorate (DiI) was applied to the lateral portion of the L5/6 intervertebral disc in rats to examine the dorsoventral organization of the sensory nervous system in the lumbar spine and related tissues. Fluorogold (FG) was applied to reference sites located at the spinous process of the L5 vertebra, the L5/6 facet joint, the psoas muscle at the L5 level, or the rectus abdominis muscle at the pubic symphysis. FG was also applied to the lateral portion of the disc (DiI application site) at L5 or at the L5 level as controls for the double labeling. Labeled neurons were counted in dorsal root ganglia (DRGs) from L1 through L4. ResultsThe proportion of neurons double-labeled with DiI and FG in the total number of DiI-labeled and FG-labeled neurons was 32.9% in the control group; 0% in the spinous process, 0.6% in the facet joint, 2.3% in the psoas muscle, and 0.1% in the rectus abdominis muscle. DRG neurons with dichotomizing afferent fibers were most prevalent (2.3%) between the lateral disc and the psoas muscle at the groin; they were rare or absent between the disc and other reference sites. ConclusionsDorsoventral organization of the primary sensory system in the lumbar body trunk was suggested from the proportion of DRG neurons with dichotomizing afferent fibers innervating the lumbar disc and other tissues. The present findings provide a pathomechanism of groin referred pain in lumbar disc disorders.

Minimally Invasive Approach for Far Lateral Disc Herniations: Results from 20 Patients

Far lateral lumbar disc herniations, while infrequent, are a substantial cause of morbidity causing painful radicular syndromes often accompanied by a motor or sensory deficit. Surgical treatment can be challenging technically because of unfamiliar lateral anatomy and the importance of adjacent osseous structures, notably the pars interarticularis and facet joint. The traditional approach for a far lateral lumbar disc herniation involves a midline incision, wide lateral subperiosteal exposure and partial removal of these structures with the potential for iatrogenic instability. A paramedian approach to the lateral compartment of the disc space is advantageous because it directly targets the pathology. The use of recently developed minimally invasive retractor systems decreases tissue dissection and blood loss and improves postoperative recovery. We present a series of 20 patients who underwent far lateral discectomy using a minimally invasive muscle splitting approach.

Infliximab administration reduces neuronal apoptosis on the optic pathways in a rabbit hydrocephalus Model: A preliminary report

Object. This study was designed to explore the effects of infliximab on the optic pathway in kaolin induced hydrocephalus rabbit model. Methods. After injection of kaolin to the cisterna magna of 12 New Zealand rabbits for induction of hydrocephalus, animals were divided into 2 groups and received either infliximab or normal saline. The intracranial pressure measurement was performed 2 times; firstly, before kaolin injection and secondly, before decapitation to ensure that the rabbits had hydrocephalus. After 2 weeks, animals were decapitated. Results. Apoptotic cells in the lateral geniculate body, optic radiation, and optic disc were counted with TUNEL method. Apoptotic cell counts of the lateral geniculate body and the optic radiation were showed statistically significant difference between the infliximab group and the control group. Conclusions. This study suggests that infliximab may have a neuroprotective effect through its anti-apoptotic property on hydrocephalus induced optic pathways injury.

Hip And Buttock Pain - Runner

HISTORY: A 50-year-old female presents 10 days pre-marathon with gradually increasing right hip, back and buttock pain for 5-6 weeks, worsening to where she is hardly able to run. She has increased her weekly mileage to 30 miles, with her longest run 22 miles. She has pain in her right anterior and posterior thigh. Her hip pain radiates to her groin and antero-medial thigh. Her posterior thigh pain radiates from the buttock to the knee. She reports her pain is 20% back and 80% leg. She denies weakness, neurologic or systemic symptoms. PHYSICAL EXAMINATION: Gait is antalgic. Hop test positive for hip pain. Hip ROM is slightly restricted on right side. Quadrant test and log rolling of the hip mildly painful. No palpable tenderness. Straight leg raise reproduces her index posterior thigh pain. Power, sensation and reflexes were normal. DIFFERENTIAL DIAGNOSIS: Lumbar radiculopathy Sciatica Femoral stress fracture Hip osteoarthritis TEST AND RESULTS: Radiographs: Standing AP pelvis, supine frog leg: No evidence of femoral stress fracture or periosteal reaction. Slightly increased femoral neck offset consistent with FAI, and early degenerative changes. Standing AP, lateral of LS spine No acute bony abnormality. MRI pelvis and right hip were ordered, and performed 5 days later: No evidence of femoral neck or shaft stress fracture. Reactive edema of the proximal hamstring origin on the ischial tuberosity, consistent with grade 1 strain and partial avulsion. MRI lumbo-sacral-spine: Right-sided lateral L3-4 disc impinging on exiting L3 nerve root. FINAL / WORKING DIAGNOSIS: Hip pain secondary to L3 radiculopathy Posterior thigh pain secondary to hamstring insertional tendonitis TREATMENT AND OUTCOMES: Day-0: Advised to stop all impact activities until MRI results available. She was advised to do non-impact activities and pool running Day-5: Following the MRIs, fluoroscopy-guided selective right L3 nerve root block, provided significant relief of hip and anterior thigh pain. Day-6: ESWT to the hamstring origin on the ischial tuberosity provided immediate pain relief in her posterior thigh. Day-10: able to walk/run marathon without much difficulty. Day-13: Second ESWT provided additional pain relief in her posterior thigh. Day-14: Hop test negative. Normal nerve tension. Hip and anterior thigh pain improved.