Lumbosacral Disc Herniation Research Articles

Prevalence of presumed endplate junction failure at the lumbosacral intervertebral junction in dogs on computed tomography.

Lumbosacral intervertebral disc herniation (IVDH) is a common cause of lower back pain in dogs and humans. In humans, the vertebral endplate to annulus fibrosus (AF) attachment was implicated as an alternative failure site besides rupture through the dorsal AF (AFF). Endplate junction failure (EPJF) is characterized by IVDH, accompanied by endplate irregularities (type A), rim avulsions (type B), or larger bony avulsions on one (type C) or both endplates (type D), associated with an adjacent endplate defect. This retrospective study reports the CT prevalence of presumed EPJF in dogs and its associations with signalment and other lumbosacral CT abnormalities. CT scans, including the lumbosacral spine of dogs obtained at two institutions, were assessed, yielding 324 scans. Presumed EPJF was found in 69 dogs (21%) and AFF in 68 dogs (21%), commonly at the caudal endplate of the last lumbar vertebra (71%). The remaining 187 dogs did not show presumed EPJF or AFF. Presumed EPJF type A occurred in 49/69, type B in 19/69, and type C in 1/69 dogs. Univariable logistic regression showed that presumed EPJF was associated with significantly higher IVDH grades than AFF. In the multiple regression model, presumed EPJF and AFF remained associated with increasing age and spondylosis deformans. Presumed EPJF was associated with vertebral endplate sclerosis and AFF with zygapophyseal joint osteoarthritis. In conclusion, presumed EPJF was observed on CT in 21% of dogs with lumbosacral IVDH. Prospective studies correlating EPJF on CT with clinical, surgical, and histopathological findings are needed for a better understanding of the underlying pathology and clinical relevance.

Body Armor and Lumbar Disc Herniation in Young Military Veterans: A Case Series.

Soldiers on the battlefield are affected by heavy body armor and excessive march load. It is well known, but the long-term effects of this extra weight on the musculoskeletal system of military veterans, specifically the lumbar spine, are unclear. In Iraq and Afghanistan, most body armors weighed over 33 pounds (15 kg). These armors were 3 times heavier than those used in Vietnam. Chiropractors at the Fargo VA Hospital are seeing more young veterans with non-traumatic lower back pain. This article presents a perspective on the impact of body armor weight and excessive carry load on lumbosacral disc herniation with radicular pain in military veterans. This study is a retrospective case series. We used a convenient sampling method. We selected the first 10 military veterans who came to a Fargo VA chiropractor in late fall 2023. Each veteran filled out a VA Form 10-5345 to give us permission to access their electronic health records. All 10 veterans also completed a survey. The survey asked about their active combat status, the type and weight of their body armor, how long they wore the armor each day, how much weight they carried, and their opinion on the cause of their lower back pain (service related or not). The Fargo VA does not require an institutional review board for a case series. This study found that military veterans experience lower back pain at an average age of 35 years. This is at least 5 years earlier than non-service men. Lower back pain with disc herniation typically occurs at the L4-L5 and L5-S1 disc levels. All 10 veterans in the study believe that their lower back pain is related to their service. Sixty percent of the participants in the study have a service-connected disability because of back pain. For military veterans, onset of lower back pain from a disc herniation at a young age may be linked to carrying heavy body armor and loads. However, the small sample size of this case series limits causal relationship inferences.

Evaluation of Patients with Neurogenic Bladder Following Lumbar and Lumbosacral Disc Herniation Surgery: A Retrospective Cross-Sectional Study

Evaluation of Patients with Neurogenic Bladder Following Lumbar and Lumbosacral Disc Herniation Surgery: A Retrospective Cross-Sectional Study

Outcomes of surgically and conservatively managed thoracolumbar and lumbosacral intervertebral disc herniations in cats.

Limited information is available regarding intervertebral disc herniation (IVDH) and its treatment in cats. Describe outcomes after surgical or conservative treatment of cats with thoracolumbar and lumbosacral IVDH. Ninety-two cats from 2 referral populations (2012-2022) with compressive IVDH between the T3 and S1 vertebrae. Retrospective cohort study evaluating outcomes of surgical (49 cats) and conservative (36 cats) management of IVDH; 7 cats were euthanized at diagnosis. Outcome was assessed using hospital and referring veterinarian records and client questionnaires. Successful outcome was defined as regained or improved ambulation, urinary and fecal continence, and no requirement for analgesic medication. Incidence of IVDH during the study period was 0.44% (92/20849). Surgical treatment resulted in 62% (6 weeks) and 74% success (6 months). Conservative treatment resulted in 54% (6 weeks) and 65% success (6 months). Neurological grade at presentation was higher in cats treated surgically (median, 2; range, 1-5) than in those treated conservatively (median, 2; range, 0-4; P = .001). Regardless of treatment type, cats suffering trauma were more likely to have a successful outcome 6 weeks after treatment compared with those without history of trauma (odds ratio, 5.3; 95% confidence interval, 1.05-26.78; P = .04). Neurological deficits remained in the majority of cats for both treatment types (92%, conservative; 86%, surgical at 6 weeks). Acute-on-chronic IVDH with characteristics of both extrusion and protrusion were identified in 10% of cats. Conservative treatment could be as effective as surgical decompression in cats with thoracolumbar or lumbosacral IVDH.

Evaluation of erectile dysfunction in patients with lumbosacral disc herniation

Objectives: Survey on erectile dysfunction in patients with lumbosacral disc herniation and evaluation of their clinical improvement after surgical treatment of spinal canal stenosis due to herniated disc. Materials and Methods: 35 patients with lumbosacral were treated with discectomy with posterior intervertebral fusion (PLIF) surgery from 10/2021 - 4/2022 at the Department of Neurology, Hue University of Medicine and Pharmacy Hospital. Patients were evaluated for erectile dysfunction and postoperative improvement using the IIEF-5, CSFQ-14, DASS-21, Oswestry scales. Results: The mean age was 48.49 ± 9.15 years old. 51.4% of patients had the most severe hernia at the L4-L5 disc, 28.6% L3-L4 and 20% L5-S1. 100% of patients with herniated disc have erectile dysfunction. Of which 40% had mild-moderate disorders, 34.3% had moderate disorders, 14.3% had severe disorders and 11.4% had mild disorders. The CSFQ-14 and DASS-21 scales were correlated with erectile dysfunction (p < 0.05). Surgery significantly improved pain (VAS score), activity limitation (ODI and JOA), degree of erectile dysfunction, changes in sexual function, depression and anxiety, stress of the patient 1 month after surgery (p < 0.05). Conclusions: Patients with lumbosacral disc herniation had a 100% erectile dysfunction rate with a mean IIEF-5 score of 11.69 ± 3.77. The CSFQ-14 and DASS-21 scores have a strong positive correlation with erectile dysfunction. Surgical treatment of spinal canal stenosis due to lumbosacral disc herniation improves the clinical status of herniated disc as well as improves erectile dysfunction in these patients. Key words: Erectile dysfunction, IIEF-5 erectile dysfunction questionnaire, CSFQ-14 scale, DASS-21 scale, Oswestry scale, disc herniation.

Transforaminal Epidural Steroid Injection for Patients with Lumbosacral Disc Herniation in the Absence of Spine Magnetic Resonance Imaging - Is Better Really the Enemy of the Best?

This study aimed to evaluate the effect of transforaminal epidural steroid injection (TFESI) in patients with lumbosacral disc herniation by comparing its effect between those diagnosed by clinical evaluation and plain radiography only (X-ray group) and those by additional magnetic resonance imaging (MRI) (MRI group). Additionally, we investigated the accuracy of the preliminary clinical assumption in the X-ray group using confirmative post-injection MRI. We retrospectively recruited 367 patients with back and radicular pain due to lumbosacral disc herniation from a single pain clinic. Among them, 201 and 166 patients were categorized into the X-ray and MRI groups, respectively. In the X-ray group, the pathological level assumed initially by clinical evaluation and plain radiography concurred with that confirmed later on post-injection MRI in 139 patients (corresponding group); the remaining 62 patients lacked this concurrence (non-corresponding group). The NRS scores and Macnab criteria results were compared between the X-ray and MRI groups as well as the corresponding and non-corresponding groups. Both the X-ray and MRI groups showed significant reductions in the NRS scores at 2 and 10 weeks post-injection when compared with the pretreatment scores. However, no significant difference was noted between the groups in terms of the magnitude of clinical improvement assessed by successful reduction in the NRS or Macnab scores. Furthermore, similar results were obtained in the comparison between the corresponding and non-corresponding groups of the X-ray group. TFESI guarantees favorable clinical outcomes even in the absence of confirmative MRI in patients with back and radicular pain. The preemptive application of this procedure could be prioritized and justified in patients suspected of lumbosacral disc herniation based on clinical evaluation and plain radiography only without the preceding MRI verification.

Evaluation of Surgical Indications for Full Endoscopic Discectomy at Lumbosacral Disc Levels Using Three-Dimensional Magnetic Resonance/Computed Tomography Fusion Images Created with Artificial Intelligence.

Background and Objectives: Although full endoscopic lumbar discectomy with the transforaminal approach (FED-TF) is a minimally invasive spinal surgery for lumbar disc herniation, the lumbosacral levels present anatomical challenges when performing FED-TF surgery due to the presence of the iliac bone. Materials and Methods: In this study, we simulated whether FED-TF surgery could be safely performed on a total of 52 consecutive cases with L5-S1 or L5-L6 disc herniation using fused three-dimensional (3D) images of the lumbar nerve root on magnetic resonance imaging (MRI) created with artificial intelligence and of the lumbosacral spine and iliac on computed tomography (CT) images. Results: Thirteen of the fifty-two cases were deemed operable according to simulated FED-TF surgery without foraminoplasty using the 3D MRI/CT fusion images. All 13 cases underwent FED-TF surgery without neurological complications, and their clinical symptoms significantly improved. Conclusions: Three-dimensional simulation may allow for the assessment from multiple angles of the endoscope entry and path, as well as the insertion angle. FED-TF surgery simulation using 3D MRI/CT fusion images could be useful in determining the indications for full endoscopic surgery for lumbosacral disc herniation.

Predictors of reoperation in hispanic-americans with recurrent lumbosacral disc herniation following primary hemilaminectomy and discectomy surgery

BackgroundMultiple risk factors for recurrent lumbosacral disc herniation (rLDH) have been evaluated. However, it has been difficult to establish a consensus due to conflicting results. Therefore, the aim of our study was to evaluate the predictors of reoperation in Hispanic-Americans with rLDH following primary hemilaminectomy and discectomy surgery. MethodsA retrospective case-control study of 451 Hispanic-Americans with lumbosacral disc herniation (LDH) was conducted. The sample was divided into two groups: reoperated (cases) and non-reoperated (controls). Preoperative, operative, and postoperative variables of initial surgery were compared between the two groups. ResultsThe reoperation rate was 11.5%, with a mean interval between primary surgery and reoperation of 3.32 years ± 2.07. Analysis of preoperative variables identified a higher rate of reoperation in patients who were unemployed (cases: 48.1%, controls: 17.1%, p=0.001). A significant difference was also seen regarding the presence of gastrointestinal disease (cases: 11.5%, controls: 4.3%, p=0.038). However, there were no differences in the sociodemographic factors, preoperative physical exam, preoperative management, radiological parameters, or operative data. Those patients with persistent postoperative lower extremity pain, radiculopathy, low back pain, and buttock pain demonstrated a higher correlation with rLDH. Multivariable logistic regression analysis identified a significant difference only in work status (employed; OR and 95% CI [0.60 (0.55, 0.67)], p=0.002) and presence of postoperative low back pain (OR and 95% CI [2.17 (1.13, 4.29)], p=0.014). ConclusionsPatients who required reoperation due to rLDH were more frequently unemployed and/or suffered postoperative low back pain after primary hemilaminectomy and discectomy surgery.

Danlu tongdu tablets: Preclinical safety evaluation and mechanism of hepatotoxicity.

Danlu tongdu tablets (DLTD) is a listed Chinese patent medicine collected in the Pharmacopoeia of the People's Republic of China (version 2020). This prescription has been applied in clinics in China for lumbar spinal stenosis and lumbosacral disc herniations. The wide application of Danlu tongdu in therapy has raised some clinical adverse reactions, such as significant elevation of alanine transaminase (ALT) and aspartate transaminase (AST) in individual patients after use. The present study aimed to investigate the safety of Danlu tongdu and analyze its adverse effects on the liver. The maximum feasible dose (MFD) was used to carry out the acute toxicity tests. Mortality, adverse effects, body weight and food consumption were recorded for up to 14days post treatment. In the 6-month chronic toxicity test, sprague-dawley rats were randomly divided into four groups according body weight, the experimental groups were administrated to rats at the concentrations of 1.67, 3.34 and 6.67g/kg/day, whereas the control group was received the ultrapure water (vehicle) only, 10ml/kg, once a day. The animal's body weight, food consumption was monitored weekly. In addition, their hematological and biochemical parameters, body and organ weights and histopathology, were all measured at specific observation time points. Additionally, we further explored the adverse effects mechanism of Danlu tongdu on the liver through transcriptome analysis. No deaths or substance-relative toxicity were observed in the acute toxicity study or the 6-month chronic toxicity study with doses of 1.67g/kg and 3.34g/kg, respectively. We found that mild hypertrophy and hyperplasia of hepatic interlobular bile ducts were detected in some rats with doses of 6.67g/kg after repeated oral administration of Danlu tongdu for 13 and 26weeks, but the above changes in liver were reversible. The results of transcriptome sequencing showed that Danlu tongdu had a significant effect on cytochrome P450 enzymes in rat liver, especially cytochrome P450 1 (CYP1) subtype. Therefore, the toxic target organ of Danlu tongdu is the liver and the mechanism of mild liver injury is closely related to the up-regulation of cytochrome P450 1A1 (CYP1A1) and cytochrome P450 1A2 (CYP1A2) expression.

Applicative value of T2 mapping in evaluating lumbosacral nerve root injury induced by lumbosacral disc herniation.

To alleviate the damage caused by nerve root entrapment mediated by lumbosacral disc herniation (LDH), an imaging method that allows quantitative evaluation of the lumbosacral nerve injury is necessary. To investigate the diagnostic value of magnetic resonance (MR) T2 mapping in nerve root injury caused by LDH. A total of 70 patients with unilateral sciatic nerve pain and 35 healthy volunteers were divided into three groups: LDH with nerve root entrapment; LDH without nerve root entrapment; and 35 healthy volunteers. All participants underwent 3.0-T MR with T1-weighted (T1W) imaging, T2-weighted (T2W) imaging, and T2-mapping images. T2 was measured and observed with the left and right nerve roots of the L4-S1 segments in healthy volunteers; the differences between the three groups were compared. T2 and the relaxation rate of nerve root injury were analyzed. T2 showed significant differences among the three groups (F = 89.494; P = 0.000), receiver operating characteristic curve revealed that the T2 relaxation threshold was 79 ms, the area under curve (AUC) area was 0.86, sensitivity was 0.77, and specificity was 0.74; the T2 relaxation rate was 1.06, the AUC area was 0.88, sensitivity was 0.74, and specificity was 0.85. T2 mapping could quantitatively evaluate the nerve root injury with lumbar disc degeneration. Hence, it can be used for the clinical evaluation of nerve root entrapment caused by LDH.

Transforaminal Endoscopic Lumbar Discectomy for Lumbosacral Junction Adolescent Lumbar Disc Herniation with High Iliac Crests.

ObjectiveTo investigate the clinical results of transforaminal endoscopic lumbar discectomy for lumbosacral junction adolescent lumbar disc herniation with high iliac crest.MethodsFrom February 2014 to September 2020, a retrospective analysis of 96 patients less than 21 years old with intervertebral disc herniation was carried out. We enrolled 44 patients diagnosed with lumbosacral junction disc herniation with high iliac crest who required transforaminal endoscopic lumbar discectomy. Pain in the back and the lower extremity was scored on Numeric Rating Scales (NRS) scores. Patient outcomes were graded as excellent, good, fair, and poor using modified MacNab criteria. The NRS scores before and after the operation were compared using the Wilcoxon two‐sample test.ResultsThere were 30 male patients and 14 females. One patient underwent repeat surgery for an intervertebral disc pseudocyst. The NRS scores decreased significantly in both early and late follow‐up evaluations (p < 0.05). At the last follow‐up, 42 patients (95.45%) had an excellent outcome, one patient (2.27%) had a good outcome, and one patient (2.27%) had a fair outcome. The overall success rate was 97.7%.ConclusionThis study's data suggest that targeted individualized foraminoplasty can effectively overcome the lumbosacral anatomical obstacles, and transforaminal endoscopic lumbar discectomy is an effective and valid option for lumbosacral junction adolescent lumbar disc herniation with high iliac crest.

A Case of Painful Legs and Moving Toes Syndrome in a Young Woman

Painful legs and moving toes syndrome (PLMT) is a rare syndrome characterized by pain in the lower extremities and involuntary movements of single or multiple toes. A 29-year-old woman with lumbosacral intervertebral disc herniation complained of bilateral foot pain and involuntary toe movements for three months. This is the first case of PLMT in a young adult patient with a lumbosacral intervertebral disc herniation in Korea.

Evaluation of the relationship between the level of disc herniation and spinopelvic radiological parameters in patients with lumbosacral disc herniation

Evaluation of the relationship between the level of disc herniation and spinopelvic radiological parameters in patients with lumbosacral disc herniation

Effect of Yoga Therapy Module on Lumbosacral Radiculopathy

Lumbosacral (L-S) radiculopathy is one most common reasons for low back pain occurring due to etiologies of discopathies and lumbosacral disc herniation. The treatment which is used for radiculopathies is pain killers, physiotherapy, and spine surgeries. Many of the patients opt for conservative treatment and one of the better conservative treatments is through yoga therapy. The case study reveals electrodiagnostic findings before and after completion of yoga therapy module given for 3 weeks duration. Electrodiagnostic findings show improvement in the nerve conduction study parameters after the yoga therapy was given. The result of the case study reveals that yoga therapy module may be used as a complementary tool for conservative treatment purpose of L-S radiculopathy.

Efficacy of transforaminal epidural magnesium administration when combined with a local anaesthetic and steroid in the management of lower limb radicular pain.

Lower limb radicular pain resulting from a herniated intervertebral disc is a cause of functional disability and could lead to increased consumption of opioids. We evaluated the efficacy of epidural magnesium combined with a local anaesthetic and steroid in the management of this pain. This was a prospective, case-control, randomized, double-blind study. Fifty patients each received 2ml bupivacaine, 1ml (40mg) methylprednisolone and 1ml saline (0.9%) (group C) or magnesium (200mg) instead of saline (group M). The primary outcome measure was the improvement in the pain score (assessed using a visual analogue scale (VAS)), and the secondary outcome was the improvement in the functional ability (assessed using the Modified Oswestry Disability Questionnaire (MODQ)). The VAS and MODQ scores were assessed before and at 1day, 1week, 1month and 3months post-intervention. The VAS and MODQ scores were significantly better in group M compared to those in group C at all times post-injection (p-value<0.001). Comparisons within the same group showed that the VAS and MODQ scores were significantly better at all post-injection time points compared to the pre-injection scores in both group C and group M (p-values<0.0001). Adding magnesium to a local anaesthetic and steroid to be injected in the transforaminal epidural space could improve the pain and the quality of life in patients suffering from lower limb radicular pain due to lumbo-sacral disc herniation, and this improvement could last for up to 3months. Magnesium is efficient when added to local anaesthetics and steroids for management of lower limb radicular pain.

Disorders of the Cauda Equina.

Cauda equina dysfunction (often referred to as cauda equina syndrome) is caused by a diverse group of disorders that affect the lumbosacral nerve roots. It is important to recognize dysfunction of the cauda equina quickly to minimize diagnostic delay and lasting neurologic symptoms. This article describes cauda equina anatomy and the clinical features, differential diagnosis, and management of cauda equina disorders. The diagnosis of disorders of the cauda equina continues to be a challenge. If a compressive etiology is seen, urgent neurosurgical intervention is recommended. However, many people with clinical features of cauda equina dysfunction will have negative diagnostic studies. If the MRI is negative, it is important to understand the diagnostic evaluation and differential diagnosis so that less common etiologies are not missed. Cauda equina dysfunction most often occurs due to lumbosacral disk herniation. Nondiskogenic causes include vascular, infectious, inflammatory, traumatic, and neoplastic etiologies. Urgent evaluation and surgical intervention are recommended in most cases of compressive cauda equina syndrome. Other types of treatment may also be indicated depending on the etiology.

PECULIARITIES OF SURGICAL TREATMENT OF LUMBOSACRAL DISC HERNIATION

Introduction. In pediatric practice, herniated discs that require surgical treatment are quite rare (0.5% of all surgical interventions for degenerative spinal diseases). At the same time, there is a tendency to the increase in the number of diagnosed intervertebral disc extrusions in adolescents. Despite of good effectiveness of the standard microdiscectomy, new techniques for removing a herniated disc are being developed to improve results in the postoperative period. Material and methods. The paper presents outcomes of surgical treatment of 59 patients with herniated discs, including 22 children. A comparative characteristics of two techniques was made: traditional microdiscectomy where a hernial component is removed and advanced microdiscectomy where an additional foraminotomy is made under the control of endoscopic technique. The discussed modified surgical treatment was patented (patent for invention No. 2687020 dated 06.05.2019). The authors have compared the effectiveness of these techniques at immediate and long-term periods in all operated patients. Rezults. The number of excellent and good results for the proposed method was higher than 95%, than for the traditional method - 88,9% . Conclusion. The proposed technique improves outcomes of surgical treatment of a herniated disc by eliminating compression of the spinal nerve root in the initially narrow foraminal opening and by expanding the latter under the control of endoscopy with a minimal risk of postoperative complications.

Retrospective Analysis of Clinical Outcome of Intraoperative Epidural Steroid Injection Versus No Steroid Injection after Standard Lumbosacral Discectomy

Background: Despite operative decompression of neural structure with discectomy in the indicated cases of lumbosacral disc herniation, many patients continue to experience back pain and leg pain in the postoperative period. Use of intraoperative local epidural steroid injection has been in practice to reduce this complications but there are concern and controversies regarding its benefit and risk. So this study aims to analyze clinical outcome in terms of reduction in pain, hospital stay, postoperative use of analgesics and risk associated with the use of intraoperative epidural steroid locally and comparison to those who did not receive steroid.&#x0D; Methods: This was a retrospective analysis of total of 44 patients, 28 patients who received Epidural Steroid Injection (ESI) locally after lumbosacral standard discectomy and comparison of the outcome with results of 16 patients with standard lumbosacral discectomy who did not receive ESI. Outcome measurement was done between two groups in terms of postoperative pain VAS scale, use of analgesics, hospital stay and complications if any.&#x0D; Results: There were total of 44 cases (28 steroid group and 16 no steroid group) with mean age of 39.93 years, male 27 and female 17 who underwent standard discectomy and followed up for at least one year. Overall, preoperative mean VAS score for pain improved from 7.95 to 1.55 at 1 year after operation which was significant p&lt;0.05. On comparison of 24 hour postoperative VAS score and hospital stay between the groups with steroid and no steroid, it was mean of 5.32 versus 6 and 4.43 days versus 5.25 days (p&lt;0.05) respectively which was significant. All the patients in no steroid group needed both NSAID and opioids for the postoperative pain management whereas only 12 (42.8%) patient needed addition of opioids in steroid group. There was no difference in VAS score at 1week and 1 year. There was no complications in either of the group. &#x0D; Conclusions: Use of intraoperative ESI help to reduce early postoperative pain, hospital stay and use of opioids without adding further risk or complication.

Persistent genital arousal disorder: a special sense neuropathy.

Introduction:Persistent genital arousal (PGAD) is a syndrome of unprovoked sexual arousal/orgasm of uncertain cause primarily reported in female patients. Most patients are referred for mental-health treatment, but as research suggests associations with neurological symptoms and conditions, there is need to analyze cases comprehensively evaluated by neurologists.Methods:The IRB waived consent requirements for this retrospective university-hospital study. We extracted and analyzed neurological symptoms, test, and treatment results from all qualifying participants' records and recontacted some for details.Results:All 10 participants were female; their PGAD symptoms began between ages 11 to 70 years. Two patterns emerged: 80% reported daily out-of-context sexual arousal episodes (≤30/day) that usually included orgasm and 40% reported lesser, often longer-lasting, nonorgasmic arousals. Most also had symptoms consistent with sacral neuropathy—70% had urologic complaints and 60% had neuropathic perineal or buttock pain. In 90% of patients, diagnostic testing identified anatomically appropriate and plausibly causal neurological lesions. Sacral dorsal-root Tarlov cysts were most common (in 4), then sensory polyneuropathy (2). One had spina bifida occulta and another drug-withdrawal effect as apparently causal; lumbosacral disc herniation was suspected in another. Neurological treatments cured or significantly improved PGAD symptoms in 4/5 patients, including 2 cures.Conclusions:Although limited by small size and referral bias to neurologists, this series strengthens associations with Tarlov cysts and sensory polyneuropathy and suggests new ones. We hypothesize that many cases of PGAD are caused by unprovoked firing of C-fibers in the regional special sensory neurons that subserve sexual arousal. Some PGAD symptoms may share pathophysiologic mechanisms with neuropathic pain and itch.

Could the Splitting of the Annulus During Percutaneous Endoscopic Lumbar Diskectomy (PELD) Be a Culprit for Recurrent Disk Herniation?: An Analysis of the Reherniation Pattern After PELD

To explore which preoperative radiologic variables have propensity for reherniation and to evaluate whether the inherent annulus splitting procedure during percutaneous endoscopic lumbar diskectomy (PELD) could prompt reherniation, we assessed the correlation between the anatomic location of annular penetration and reherniation. Three hundred and fifty patients who underwent PELD for central or subarticular disk herniation through a transforaminal approach were followed-up for at least 24 months. Fifty-four subjects that were reoperated for recurrent herniation were allocated as the reherniation group and the other 296 subjects were allocated as the non-reherniation group. The numerical rating scale score, another lumbosacral disk herniation (LDH) lesion in addition to the PELD level (another LDH), location (central or subarticular) and severity of LDH (protrusion or extrusion), and tear of the posterior longitudinal ligament (PLL) were compared between the 2 groups to identify which variables could be predictive factors for reherniation. To assess the influences of PELD on reherniation, location and severity of reherniation were compared with those of initial herniation. The location at the subarticular region and the existence of a concomitant PLL tear during initial LDH were significantly related to subsequent reherniation. The location and severity of these reherniations were significantly retained when compared with those of primary herniation. PLL tear and subarticular herniation were significantly related to recurrent disk herniation. Reherniation patterns after PELD generally matched those of primary herniation. The annulus penetrating step during PELD did not increase the risk of reherniation.