Lumbar Intervertebral Disc Research Articles

Efficacy of a virtual reality-based basic and clinical fused curriculum for clinical education on the lumbar intervertebral disc.

Today, minimally invasive procedures have become mainstream surgical procedures. Percutaneous endoscopic transforaminal discectomy for lumbar disc herniation (LDH) requires profound knowledge of the laparoscopic lumbar anatomy. Immersive virtual reality (VR) provides three-dimensional patient-specific models to help in the process of preclinical surgical preparation. In this study, the authors investigated the efficacy of VR application in LDH for training orthopedic residents and postgraduates. VR images of the lumbar anatomy were created with immersive VR and mAnatomy software. The study was conducted among 60 residents and postgraduates. A questionnaire was developed to assess the effect of and satisfaction with this VR-based basic and clinical fused curriculum. The teaching effect was also evaluated through a postlecture test, and the results of the prelecture surgical examination were taken as baselines. All participants in the VR group agreed that VR-based education is practical, attractive, and easy to operate, compared to traditional teaching, and promotes better understanding of the anatomical structures involved in LDH. Learners in the VR group achieved higher scores on an anatomical and clinical fusion test than learners in the traditional group (84.67 ± 14.56 vs 76.00 ± 16.10, p < 0.05). An immersive VR-based basic and clinical fused curriculum can increase residents' and postgraduates' interest and support them in mastering the structural changes and complicated symptoms of LDH. However, a simplified operational process and more realistic haptics of the VR system are necessary for further surgical preparation and application.

Variation in spatial distance between the lumbar interlaminar window and intervertebral disc space during flexion-extension.

Knowledge of interlaminar space is important for undertaking percutaneous endoscopic discectomy via an interlaminar approach (PED-IL). However, dynamic changes in the lumbar interlaminar space and the spatial relationship between the interlaminar space and intervertebral disc space (IDS) are not clear. The aim of this study was to anatomically clarify the changes in interlaminar space height (ILH) and variation in distance between the two spaces during flexion-extension of the lumbar spine in vitro. First, we used a validated custom-made loading equipment to obtain neutral, flexion, and extension 3D models of eight lumbar specimens through 3D reconstruction software. Changes in ILH (ILH, IL-yH, IL-zH) and distances between the horizontal plane passing through the lowest edge of the lamina of the superior lumbar vertebrae and the horizontal plane passing through the lowest position of the trailing edge of the same-level IDS (DpLID) at L3/4, L4/5 and L5/S1 were examined on 3D lumbar models. We found that ILH was greater at L4/5 than at L3/4 and L5/S1 in the neutral position, but the difference was not significant. In the flexion position, ILH was significantly more than that in neutral and extension positions at L3/4, L4/5, and L5/S1. There were significantly more DpLID changes from neutral to flexion than that from neutral to extension at all levels (L3/4, L4/5, L5/S1). These findings demonstrated level-specific changes in ILH and DpLID during flexion-extension. The data may provide a better understanding of the spatial relationship between lumbar interlaminar space and IDS, and aid the development of segment-specific treatment for PED-IL.

Treatment of migrated lumbar intervertebral disc herniation by percutaneous spinal endoscopy through bone tunnel

To investigate the clinical effect of percutaneous endoscopic lumbar discectomy (PELD) through bone tunnel in the treatment of migrated lumbar intervertebral disc herniation. The clinical data of 42 patients with migrated lumbar intervertebral disc herniation treated through PELD techniques were retrospectively analyzed from October 2015 to December 2018. There were 26 males and 16 females, aged from 39 to 71 years old with a mean of(58.55±7.16) years. There were 7 cases where the affected segment was L3,4, 24 cases of L4,5, and 11 cases of L5S1. According to modified free nucleus pulposus classification, 3 cases of type A1, 6 cases of type A2, 8 cases of type B1, 8 cases of type B2, 6 cases of type C1, and 11 cases of C2. Among these 42 cases, 22 patients were treated with transpedicular approach (transpedicular approach group), 6 cases were type A2, 6 cases were type B2 and 10 cases were type C2, and 20 cases with translaminar approach(translaminar approach group), 3 cases were type A1, 8 cases were type B1, 6 cases were type C1, 2 cases were type B2 and 1 case was type C2. The operation time, intraoperative and postoperative complications of the two groups were recorded, and the pain visual analogue scale (VAS) and Oswestry Disability Index (ODI) were used to assess the improvement of the clinical symptoms before surgery, immediately after surgery, and 12 months after surgery, and the modified Macnab evaluation system was used to evaluate the clinical efficacy. The operative time was from 69 to 105 min with a mean of (88.29±9.85) min;and no intraoperative complications such as neurovascular injury or dural tear were occurredin all patients. One case in the transpedicular approach group was changed to general anesthesia and translaminar approach due to local anesthesia intolerance. All the patients were followed up from 13 to 34 months, with a mean of (13.71±3.56) months. VAS and ODI were significantly improved in two groups immediately after surgery and 12 months after surgery (P<0.05). According to modified Macnab criteria, 27 cases obtained excellent results, 11 good, 3 fair, and 1 poor. There were no postoperative complications such as lumbar fractures and postoperative infections in the follow-up patients. For migrated intervertebral disc herniation, the modified nucleus pulposus classification can be used to estimate the precise target before operation, and the reasonable bone tunnel approach can be selected to obtain good results.

Adjuvant surgical decision-making system for lumbar intervertebral disc herniation after percutaneous endoscopic lumber discectomy: a retrospective nonlinear multiple logistic regression prediction model based on a large sample

Lumbar disc herniation (LDH) is a common condition that can affects an individual' quality of life. In patients for whom conservative treatment is ineffective after 3 months, surgical treatment, such as percutaneous endoscopic lumbar discectomy (PELD), is recommended. Because PELD is minimally invasive and produces thorough nerve root decompression, both surgeons and patients often prefer it to other techniques. Surgeons find it challenging to prevent postoperative recurrent LDH (rLDH) when they use PELD. We created and verified a model for evaluating patients' recurrence risk factors before surgery so that surgeons can choose other surgical techniques when necessary. Retrospective study. One thousand eight hundred seven patients who underwent PELD at our hospital between 2012 and 2015 were enrolled. The main outcome measure was rLDH at any follow-up time point. Data were retrospectively analyzed for 1807 patients who underwent PELD at our hospital at some point between 2012 and 2015; all patients had been monitored for at least 5 years after surgery. They were divided into a recurrence group and a nonrecurrence group. Clinical and radiological risk factors were assessed over time to determine their correlations with recurrence and to exclude less important factors. A nonlinear multivariate logistic regression model was established to predict the recurrence rate before surgery. A total of 1706 patients were monitored after PELD; data were missing for 101 additional patients. The total recurrence rate was 10.38%, and the most common time from surgery to recurrence was 1 year. Ten risk factors were assessed and included in the analysis. Regarding clinical risk factors, patients with hypertension (p < .001; correlation coefficient R [R]=0.235; odds ratio [OR]=4.749), diabetes (p < .001; R=0.381; OR=16.797), a history of smoking (p < .001; R=0.347; OR=9.012), and a history of performing intense physical labor (p < .001; R=0.409; OR=19.592) had a higher recurrence rate. Regarding radiological risk factors, patients with disc degeneration (Pfirrmann grade III) (p < .001; R=0.228; OR=4.919), Modic changes (level 2) (p < .001; R=0.309; OR=7.934), herniation in the form of extrusion (p < .001; R=0.365; OR=12.228), a higher disc height index (DHI) (p < .001; R=0.336), and a larger segmental range of motion (p < .001; R=0.243) had a higher recurrence rate. When the lumbar motion angle was negative (p < .001; R=0.318; OR=13.680), the recurrence rate was high. The overall accuracy of the final model was 97.6% (1665 of 1706). The recognition rate for non-rLDH cases was 99.0% (1514 of 1529), and the rate for rLDH cases was 85.3% (151 of 177); the AUC was 0.9315. A simple model was used. For those patients with postoperative trauma (p < .001; R=0.382; OR=13.680), a comparison model was established, and the corresponding recurrence rate was 23.0% ± 25.0% (0-76%). A large cohort of patients underwent long-term monitoring, and 11 risk factors were verified for assessing each patient's risks before surgery to predict the postoperative recurrence of LDH following PELD. The risk of recurrence may be effectively reduced with the use of alternative surgical techniques in high risk cases.

EFFECT OF FLUID-STRUCTURE INTERACTION OF L4/L5 INTERVERTEBRAL DISC UNDER TRANSIENT LOADS

The spine manipulation of traditional Chinese medicine treats the degeneration of the lumbar intervertebral disc by applying transient distraction and rotation forces on the lumbar spine. In this paper, numerical simulation considering fluid-structure interaction is used to study the underlying biomechanical mechanisms. Through experimental measurement and literature research, reasonable parameters of distraction and rotation loads have been determined. A method is developed to build a detailed geometric model of lumbar spine, which uses data from computed tomography scans of human body and anatomical knowledge. Cancellous bones, endplates, and intervertebral discs are considered as poroelastic materials, while others are considered as linear elastic materials, in order to consider the effect of fluid-structure interaction in biological tissues considered here. Through numerical simulations, the stress, strain and fluid flow in the intervertebral disc under transient loads and their combination are obtained. It is found that the transient load generates fluid flow in the nucleus pulposus by changing the stress of the solid matrix of the L4/L5 intervertebral disc and producing pressure gradient across the nucleus pulposus. Distraction causes the fluid to flow out of the nucleus pulposus first and then flow into the nucleus pulposus to produce a change of water content. Under clockwise rotation, opposite flow processes occur on left and right sides of the nucleus pulposus. Water content on the right side of the nucleus pulposus changes greater than the left side. The method used in this research provides a new method for the study of the pathophysiological mechanism of human intervertebral disc degeneration related to the flow process. This method also provides a pathway to make the spine manipulation of traditional Chinese medicine scientific. An entry point is provided additionally for the related study of mechanical and biological coupling study, as well as the basic research of nucleus pulposus regeneration.

In vivo relationships between lumbar facet joint and intervertebral disc composition and diurnal deformation

BackgroundSpinal motion is facilitated by a “three joint complex”, two facet joints and one intervertebral disc at each spinal level. Both the intervertebral discs and facet joints are subject to natural age-related degeneration, and while these processes may be linked it is not clear how. As instability in the disc could underlie facet arthritis, we evaluated the hypothesis that the discs and facet joints are mechanically coupled. MethodsWe recruited young, asymptomatic volunteers (n = 10; age: mean 25, range 21–30 years; BMI: mean 23.1, range 19.1–29.0 kg/m2) and applied magnetic resonance imaging (MRI) and three-dimensional (3D) modeling to measure facet and disc composition (MRI T1rho relaxation time) and facet and disc function (diurnal changes in facet space width, disc height) in the lumbar spine. FindingsWe found that facet space width was positively associated with facet T1rho relaxation time (fluid content) and negatively associated with disc T1rho, and that facets adjacent to degenerated discs were significantly thicker and had significantly higher T1rho. Furthermore, the diurnal change in wedge angle was positively associated the diurnal change in facet space width, while disc degeneration, the diurnal change in disc height, and facet T1rho were not. InterpretationThese data demonstrate an interdependence between disc and facet health, but not between disc and facet mechanical function. Furthermore, the weak relationship between facet cartilage composition and in vivo function suggests that other factors, like spinal curvature, determine in vivo spine mechanics. Future work in symptomatic or aged populations are warranted to confirm these findings.

Lumbar Disc Prolapse: Microdiscectomy and its Clinical Outcomes

Background: Prolapse lumbar intervertebral disc (PLID) is a localized disc displacement outside its margins is the most common source of sciatica pain, involving 1%-5% of the population annually. Standard management includes conservative management initially for a period of around 6 weeks. In general, microdiscectomy (MD) is considered a standard procedure for symptomatic cases, with approximately 60%-80% of satisfactory results. In this study, we aimed in describing experience of MD in patients diagnosed with PLID. Methods: This retrospective study has been conducted at Dr. Ziauddin University hospital, Karachi; Pakistan. The medical records from 2018 to 2020, of microdiscectomy for prolapsed intervertebral lumbar disc were studied. All patients of 18 years or more admitted with symptomatic PLID, and proceeded to single level MD have been included. The regular pre-operative work-up, surgical technique and post-operative management was followed. Data collection was performed using a standard proforma. Utilizing SPSS version 23.0, all statistical analyses were carried out a p &lt;0.05 was considered statistically significant. Results: Mean age of patients was 43 to 42 years and Male: Female ratio was 1.6:1 and pre-operative neurological deficit was observed in 28 (42.4%) patients. Most common affected disc spaces were L4-L5 35(53%) and L5-S1 26 (39.4%). Left side disc Prolapse was found more affected as 39(59.1%) cases reported among the total. Visual analog scale (VAS) score dropped from more than 5 to no pain after surgery. Conclusion: Microdiscectomy is a safe treatment in prolapsed intervertebral lumbar disc for patients with failed conservative therapy and reported excellent outcomes with earlier surgical intervention. Keywords: Discectomy; Intervertebral Disc Displacement; Radiculopathy.

Selective Retention of Bone Marrow Stromal Cells with Gelatin Sponge for Repair of Intervertebral Disc Defects after Microendoscopic Discectomy: A Prospective Controlled Study and 2-Year Follow-Up.

Objective Discectomy remains the classic procedure for treating lumbar intervertebral disc (IVD) herniation, but the occurrence of defects after discectomy is thought to be an important cause generating recurrent and accelerated IVD degeneration. Previous studies attempted suture of the annulus fissure, but the validity of this technique on restraining the degenerative process is controversial. On the other hand, cell therapies have been shown in multiple clinical and basic studies. Our purpose was to investigate the effectiveness of selective retention of autologous Bone Marrow Stromal Cells (BMSCs) with gelatin sponge in combination with annulus fibrosus suture (AFS) for the repair of IVD defects following mobile microendoscopic discectomy (MMED). Methods This prospective, two-armed, and controlled clinical study was conducted from December 2016 to December 2018. Written informed consent was obtained from each patient. Forty-five patients with typical symptoms, positive signs of radiculopathy, and obvious lumbar disc herniation observed by MRI were enrolled. Patients were divided into 3 groups with different treating methods: MMED (n = 15), MMED+AFS (n = 15), and MMED+AFS+BMSCs (n = 15). A postoperative 2-year follow-up was performed to evaluate the patient-reported outcomes of VAS, ODI, and SF-36. The improvement rate of VAS and ODI was calculated as [(latest‐preoperative)/preoperative] to evaluate the therapeutic effect of the three groups. Assessment parameters included Pfirrmann grade, intervertebral disc height (IDH), and disc protrusion size (DPS), as measured by MRI to evaluate the morphological changes. Results All patients enrolled had a postoperative follow-up at 3, 6, 12, and 24 months. VAS and ODI scores were significantly improved compared to the preoperative status in all three groups with a mean DPS reduction rate over 50%. At the final follow-up, the improvement rate of the VAS score in the MMED+AFS+BMSCs group was significantly higher than the MMED+AFS and MMED groups (80.1% ± 7.6% vs. 71.3% ± 7.0% vs. 70.1% ± 7.8%), while ODI improvement showed a significant change (65.6% ± 8.8% vs. 59.9% ± 5.5% vs. 57.8% ± 8.1%). All participants showed significant improvement in SF-36 PCS and MCS; the differences between each group were not significant. The mean IDH loss rate of the MMED+AFS+BMSCs group was also significantly lower than other groups (−17.2% ± 1.3% vs. −27.6% ± 0.7% vs. −29.3% ± 2.2%). The Pfirrmann grade was aggravated in the MMED and MMED+AFS groups while maintained at the preoperative grade in the MMED+AFS+BMSCs group. No adverse events of cell transplantation or recurrence were found in all patients during the postoperative follow-up period. Conclusions It is feasible and effective to repair lumbar IVD defects using SCR-enriched BMSCs with gelatin sponges, which warrants further study and development as a cell-based therapy for IVD repair.

Effect of Rehabilitation Nursing of Traditional Chinese Medicine on Rehabilitation Effect and Satisfaction of Patients with Lumbar Intervertebral Disc Herniation

Effect of Rehabilitation Nursing of Traditional Chinese Medicine on Rehabilitation Effect and Satisfaction of Patients with Lumbar Intervertebral Disc Herniation

&lt;i&gt;In situ&lt;/i&gt; Tracking of Individual Collagen Fibre Bundles in Intact Loaded Intervertebral Discs Exposes Damage-Susceptible Collagen Organisations

Many soft tissues, such as the intervertebral disc (IVD), have a hierarchical fibrous composite structure which suffers from regional damage. We hypothesise that clinical injury patterns in these tissues occur in localised regions where there is an integrated requirement for both marked compliance and significant load transfer. Here we used synchrotron computed tomography (sCT) to resolve collagen fibre bundles (~5μm width) in 3D throughout an intact native rat lumbar IVD under increasing compressive load. Using intact samples meant that tissue boundaries (such as endplate-disc or nucleus-annulus) and residual strain were preserved; this is vital for characterising both the inherent structure and structural changes upon loading in tissue regions functioning in a near-native environment. Nano-scale displacement measurements along >10,000 individual fibres were tracked, and fibre orientation, curvature and strain changes were compared between the failure-prone posterior-lateral region and the more robust anterior region. These methods can be widely applied to other soft tissues, to identify fibre structures which cause tissue regions to be more susceptible to injury and degeneration. Our results demonstrate for the first time that highly-localised changes in fibre orientation, curvature and strain indicate differences in regional strain transfer and mechanical function (e.g. tissue compliance), correlating directly with locations clinically at risk of damage. This included decreased fibre reorientation at higher loads, specific tissue morphology which reduced capacity for flexibility and high strain at the disc-endplate boundary.

A microstructure-based model for a full lamellar-interlamellar displacement and shear strain mapping inside human intervertebral disc core

The determinant role of the annulus fibrosus interlamellar zones in the intervertebral disc transversal and volumetric responses and hence on their corresponding three-dimensional conducts have been only revealed and appreciated recently. Their consideration in disc modeling strategies has been proven to be essential for the reproduction of correct local strain and displacement fields inside the disc especially in the unconstrained directions of the disc. In addition, these zones are known to be the starting areas of annulus fibrosus circumferential tears and disc delamination failure mode, which is often judged as one of the most dangerous disc failure modes that could evolve with time leading to disc hernia. For this latter reason, the main goal of the current contribution is to incorporate physically for the first time, the interlamellar zones, at the scale of a complete human lumbar intervertebral disc, in order to allow a correct local vision and replication of the different lamellar-interlamellar interactions and an identification of the interlamellar critical zones. By means of a fully tridimensional chemo-viscoelastic constitutive model, which we implemented into a finite element code, the physical, mechanical and chemical contribution of the interlamellar zones is added to the disc. The chemical-induced volumetric response is accounted by the model for both the interlamellar zones and the lamellae using experimentally-based fluid kinetics. Computational simulations are performed and critically discussed upon different simple and complex physiological movements. The disc core and the interlamellar zones are numerically accessed, allowing the observation of the displacement and shear strain fields that are compared to direct MRI experiments from the literature. Important conclusions about the correct lamellar-interlamellar-nucleus interactions are provided thanks to the developed model. The critical interlamellar spots with the highest delamination potentials are defined, analyzed and related to the local kinetics and microstructure.

Functional outcome of discectomy in lumbar disc prolapse

Background: Sciatica resulting from a lumbar intervertebral disc prolapse is the most common cause of radicular leg pain in adult working population. It can be treated with both conservative and operative methods. In our study, we have chosen open discectomy as an appropriate mode of surgical treatment for lumbar intervertebral disc prolapse. We assessed the surgical outcomes of patients treated with discectomy in lumbar disc prolapse. Objectives: To compare pre and post-operative back pain and leg pain using Visual Analogue Scale (VAS) and functional outcome using modified Oswestry Disability Index (ODI). Methods: 30 patients were included in this study and were followed up for up to 6 months postoperatively. We assessed the functional outcome of each patient with ODI and VAS post-operatively and at 6 months. Results: We found that males had higher incidence (60%) of disc prolapse. Majority of the patients presented with left sided radiculopathy (60%) and most commonly involving L4-L5 level (76.7%). The mean ODI and VAS score pre-operatively were 59.40±6.07 and 8 respectively, which improved to 15.12±5.15 and 1, respectively at 6 months post-operative follow-up. These were statistically highly significant. Conclusions: Our study established that open discectomy has a satisfactory functional outcome and leads to a significant improvement in the patients’ quality of life.

LUMBAR RADICULOPATHY MANAGED WITH SPINAL MOBILIZATION WITH LEG MOVEMENT: A CASE STUDY

Purpose. This report describes the case of prolapsed lumbar intervertebral disc with radiating pain to leg managed with spinal mobilization with leg movement (SMWLM) combined with intermittent lumbar traction (ILT) and interferential therapy. Case presentation. Twelve treatment sessions carried out over 4 consecutive weeks thrice weekly consisting of spinal mobilization with leg movement, intermittent lumbar traction and interferential therapy. Outcome measures were documented by using Visual analog score (VAS), Oswestry disability index (ODI) and range of straight leg raise (SLR) score. After 4 weeks, VAS improved by 7 points and ODI score improved by 19 points. Range of straight leg raise also increased significantly from 46.30 to 68.40. Conclusions. Spinal mobilization with leg movement combined with intermittent lumbar traction and interferential therapy resulted in decrease in disability and pain as well as improvement in range of straight leg raise. Therefore, it may be used as a first line of treatment with massive disc prolapse before surgical intervention.

Exploratory clinical trial on the safety and capability of dMD-001 in lumbar disc herniation: Study protocol for a first-in-human pilot study

Herniated nucleus pulposus (NP), one of the most common diseases of the spine, is surgically treated by removing the sequestered NP. However, intervertebral disc (IVD) defects may remain after discectomy, leading to inadequate tissue healing and predisposing patients to IVD degeneration. An acellular, bioresorbable, ultra-purified alginate (UPAL) gel (dMD-001) implantation system can be used to fill any IVD defects in order to prevent IVD degeneration after discectomy. This first-in-human pilot study aims to determine the feasibility, safety, and perceived patient response to a combined treatment involving discectomy and UPAL gel implantation for herniated NP. We designed a one-arm, double-centre, open-label, pilot trial. The study started in November 2018 and will run until a sample of 40 suitable participants is established. Patients aged 20–49 years, diagnosed with isolated lumbar IVD herniation and scheduled for discectomy represent suitable candidates. All eligible participants who provide informed consent undergo standard discectomy followed by UPAL gel implantation. The primary outcomes of the trial will be the feasibility and safety of the procedure. Secondary outcomes will include self-assessed clinical scores and magnetic resonance imaging-based measures of morphological and compositional quality of the IVD tissue. Initial outcomes will be published at 24 weeks. Analysis of feasibility and safety will be performed using descriptive statistics. Both intention-to-treat and per-protocol analyses of treatment trends of effectiveness will be conducted.

Three-dimensional digital measurement of the facet joint in normal individual and lumbar intervertebral disc herniation patients aged 13 – 18 years

BackgroundLumbar facet joint is an important element of spinal “three-joint complex”. Whether there is a relationship between strange structure of facet joint and adolescent lumbar disc herniation (ALDH) is nonetheless controversial, and the current research is mainly centered on adults. ObjectiveTo find out the normal lumbar facet joints between 13 and 18 years old to provide anatomical basis for early diagnosis and therapy of lumbar disc herniation. MethodsCT imaging information of 32 sufferers with lumbar disc herniation aged from 13 to 18 years old in Inner Mongolia have been collected as the ALDH group, and 62 wholesome subjects in the equal period had been chosen as the normal group. Uncooked records of continuous scanning lumbar tomography pix were imported into MIMICS 21.0 for evaluation and size in DICOM format. The parameters include facet joint height, facet joint width, et al. Results1. The left and right transverse angle of L5S1 segment in the ALDH group were (52.41 ± 9.2) ° and (55.99 ± 10.91) ° (P < 0.05), and the differences were statistically significant. The right side is larger than the left side. 2. Facet joint thickness in L3-L5 segment of the normal group was significantly higher than that of male (1.63 ± 0.32) mm than that of female (1.38 ± 0.25) mm; In 16–18 years old group, comparison of facet joint cross-sectional area was statistically significant (22.1 ± 3.04) mm2 in male than (18.92 ± 3.71) mm2 in female. 3. In comparison between normal and ALDH group, there was significant difference in L3-4 transverse angle (P < 0.05), L4-5 facet joint height and facet joint thickness (P < 0.05), L5S1 facet joint thickness and transverse angle (P < 0.05). ConclusionWhen ALDH occurs in the L5S1 segment, there is a substantial difference between the left and right sides of the transverse angle, and there is a difference in the thickness and the facet joint cross-sectional area between males and females, which is generally larger in males than in females. Facet joint height is larger, transverse angle of left and right is asymmetric, inferior articular process is larger, and facet joint thickness is smaller can indicate that lumbar disc herniation is effortless to occur.

Long-term clinical and radiological outcomes after total lumbar disc replacement at the lumbosacral junction

The study objective is to analyze long-term clinical and radiological outcomes in patients after performing total lumbar disc replacement at the level of the lumbosacral junction.Materials and methods. A multicenter retrospective observational cohort study was performed. The study included medical records of patients who underwent total lumbar disc replacement at the level of the lumbosacral junction. Both clinical and instrumental parameters were assessed. According to the eligibility criteria, 93 patients were included in the study (38 men, 55 women, mean age 39.9 ± 7.5 years). The average postoperative observation period for the respondents was 33.4 ± 9.5 months.Results. The severity of pain in the lumbar spine on a visual analogue scale significantly decreased (from 7.3 ± 2.5 to 1.9 ± 2.2 cm, p &lt;0.001). The indicators of the quality of life according to the Oswestry Disability Index and according to the Short Form-36 scale (including the mental and physical components) of the studied group of respondents significantly improved (from 43.4 ± 17.6 to 18.9 ± 16.0 %, р &lt;0.001 and from 30.8 ± 8.5 to 52.3 ± 12.4 %, p &lt;0.001, respectively). From the 12th month of observation of the respondents, a significant decrease in the values of the range of motions of the operated segment was noted from 5.3 ± 3.2° to 4.1 ± 3.6° (p &lt;0.009). Also, from the 12th month of postoperative observation, a slight decrease in the values of the range of motions of the adjacent segment from 8.6 ± 4.1° to 7.8 ± 3.8° (p &gt;0.05) was verified. The value of global lumbar lordosis after the installation of a lumbar intervertebral disc prosthesis at the level of the lumbosacral junction significantly increased from 49.1 ± 4.8° to 55.6 ± 5.5° (p &lt;0.001). Intervertebral disc prostheses with a lordotic angle of 10° reliably positively correlate with an increase in the values of segmental lordosis, in contrast to implants with an angle of 6° (rS = 0.86, p = 0.04). The severity of pain in the lumbar spine according to visual analogue scale and the range of motion of the operated segment has a significant negative correlation in the late periods of postoperative follow-up (24 and 36 months, rS = -0.74, p = 0.015).Conclusion. The total lumbar disc replacement technique is an effective method of surgical treatment of patients with degenerative diseases of the intervertebral discs of the lumbosacral spine, including at the level of the lumbosacral junction.

Artificial intelligence predicts disk re-herniation following lumbar microdiscectomy: development of the "RAD" risk profile.

Surgical treatment of herniated lumbar intervertebral disks is a common procedure worldwide. However, recurrent herniated nucleus pulposus (re-HNP) may develop, complicating outcomes and patient management. The purpose of this study was to utilize machine-learning (ML) analytics to predict lumbar re-HNP, whereby a personalized risk prediction can be developed as a clinical tool. A retrospective, single center study was conducted of 2630 consecutive patients that underwent lumbar microdiscectomy (mean follow-up: 22-months). Various preoperative patient pain/disability/functional profiles, imaging parameters, and anthropomorphic/demographic metrics were noted. An Extreme Gradient Boost (XGBoost) classifier was implemented to develop a predictive model identifying patients at risk for re-HNP. The model was exported to a web application software for clinical utility. There were 1608 males and 1022 females, 114 of whom experienced re-HNP. Primary herniations were central (65.8%), paracentral (17.6%), and far lateral (17.1%). The XGBoost algorithm identified multiple re-HNP predictors and was incorporated into an open-access web application software, identifying patients at low or high risk for re-HNP. Preoperative VAS leg, disability, alignment parameters, elevated body mass index, symptom duration, and age were the strongest predictors. Our predictive modeling via an ML approach of our large-scale cohort is the first study, to our knowledge, that has identified significant risk factors for the development of re-HNP after initial lumbar decompression. We developed the re-herniation after decompression (RAD) profile index that has been translated into an online screening tool to identify low-high risk patients for re-HNP. Additional validation is needed for potential global implementation.

Application of Magnetic Resonance-Ultra Time Echo (MR-UTE) Imaging in the Analysis of the Degree of Degeneration of the Intervertebral Disc Cartilage Endplate

Magnetic resonance imaging (MRI) is the most widely used imaging method in clinical lumbar spine examination. Because of its advantages of non-radiation and good tissue contrast, magnetic resonance imaging provides rich and effective diagnostic information for clinic. The most commonly used sequence is type 2 (T2) sequence, which has a longer time (usually longer than 2000 ms). It shows well in long T2 tissues such as nucleus pulposus, cerebrospinal fluid and adipose tissue, showing moderator high signal in images, while for short T2 tissues such as cartilage endplate and anterior and posterior longitudinal zone, it is often no signal and low signal because of its short attenuation time, thus forming obvious tissue contrast. But at the same time, because the time is too long, for short T2 tissue, the signal has been attenuated to zero before sequence acquisition, so the complete structure can not be displayed directly. In this paper, the normal human lumbar intervertebral disc was studied by conventional magnetic resonance type 1 (T1), T2 and double-echo-UTE imaging techniques. Each part of lumbar intervertebral disc and the semi-quantitative analysis of anatomical structure in images were compared, and the advantages and characteristics of each sequence for each anatomical structure of lumbar intervertebral disc and the advantage of MR-UTE in intervertebral disc display were discussed. It has been found that UTE, as a new sequence which can effectively image short T2 tissue, is gradually applied from experiment to clinic in bone and joint system because of its shorter time. In the gross specimens of lumbar intervertebral disc, sequence can directly display the cartilage endplate and the short T2 tissue of the anterior and posterior longitudinal ligament.

Association between spinal alignment and biochemical composition of lumbar intervertebral discs assessed by quantitative magnetic resonance imaging.

To evaluate potential associations between spinopelvic parameters and the biochemical composition of lumbar intervertebral discs using quantitative magnetic resonance imaging in asymptomatic young adults. Our study group comprised 93 asymptomatic volunteers aged 20-40 years (49 women and 44 men). Lumbar spine T2-weighted images and T2 relaxometry were acquired on a 1.5T MRI scanner. Spinopelvic parameters including sacral slope, pelvic tilt, pelvic incidence, lumbar lordosis, thoracic kyphosis, thoracolumbar alignment, sagittal vertical axis, spinosacral angle, C2 pelvic angle, and T1S1 and L1S1 length were measured on panoramic spine radiographs. Lumbar lordosis decrease correlates with discrete dehydration of nucleus pulposus at all lumbar levels. Also low values of sacral slope, pelvic tilt, pelvic incidence, thoracic kyphosis and spinosacral angle were associated with decrease of T2 relaxation times on annulus fibrosus. In conclusion, spinopelvic parameters presented a discrete association with lumbar disc composition and water content.

Perioperative Nursing Observation of Plasma Radiofrequency Ablation for Treatment of Lumbar Intervertebral Disc Herniation

Objective: To observe and analyze the perioperative nursing effect of plasma radiofrequency ablation for treatment of lumbar disc herniation. Methods: A total of 100 patients with lumbar intervertebral disc herniation received from October 2017 to October 2020 were selected and randomly divided into two groups with 50 cases in each group. The control group received the conventional nursing model and the experimental group received the comprehensive nursing model. The two groups of nursing care were compared on satisfaction, SDS and SAS scores before and after treatment, VAS score and JOA score before and after treatment, and treatment effect. Results: The nursing satisfaction of the experimental group, SDS and SAS scores before and after treatment, VAS score and JOA score before and after treatment, and the treatment effect were better than those of the control group. The difference was statistically significant (P&lt;0.05). Conclusion: The comprehensive nursing model has a significant effect on the perioperative nursing of the treatment of lumbar intervertebral disc herniation by plasma radiofrequency ablation. More popularization and application will help improve the treatment effect.