Radicular Research Articles

A comparative and prospective study of surgical outcomes of cervical artificial disc to anterior cervical discectomy and fusion in the treatment of symptomatic degenerative disc disease of cervical spine in a tertiary care center of Eastern India

Background: Cervical disc degeneration is known to be a primary cause of neck pain and neurologic symptoms and can cause significant morbidity. Degeneration can be related to radiculopathy or myelopathy due to compression of spinal nerves and/or spinal cord. Disc pathology may manifest clinically as localized and radicular pain, myelopathy, and spinal joint instability. If severe, such as in degenerative disc disease, infections, and trauma, surgical methods are indicated. Some studies reported that compared to anterior cervical discectomy and fusion (ACDF), cervical artificial disc (CAD) could provide better neurological outcomes and reduce the rate of adjacent segment degeneration, whereas other studies reported no difference between the two procedures. Aims and Objectives: The aim of this study was to compare surgical outcomes of CAD to anterior cervical discectomy and fusion in the treatment of symptomatic degenerative disc disease in cervical spine. Materials and Methods: It was a comparative study with prospective design conducted among 40 symptomatic cervical disc degenerative disease patients (20 patients undergoing CAD and the remaining 20 anterior cervical discectomy and fusion) at the Department of Neurosurgery, Bangur Institute of Neurosciences, 1PGMER and SSKM Hospital, Kolkata, from January 2021 to December 2022. Respective surgical procedures were done. All patients were required to return for follow-up. Clinical and radiological evaluations were performed at 1 month, 3 months, 1 year, postoperatively, and last follow-up (more than 18 months). Clinical effectiveness was evaluated by the visual analog scale (VAS) score, Japanese Orthopedic Association (JOA) score (17 points system, 1994 revised edition), and neck disability index (NDI) score. Results: Improvement in NDI, VAS, and JOA index was found to be more in CAD as compared to ACDF group with a statistically significant difference as P<0.05. Subsequent surgical intervention was reported among four subjects, out of which one belonged to the CAD group while the rest three to ACDF. Overall success was found to be more in the CAD group (75%) as compared to the ACDF group (55%), though no significant difference was revealed as P>0.05. Conclusion: The findings of the present study support the superior longevity and better outcome of CDA, as compared with ACDF, with regard to need for subsequent surgical intervention and also support better improvement in symptoms in subsequent follow-up in patients undergoing CDA as compared to ACDF despite having comparable mean operative time and blood loss.

Radiographic characteristics-based classification system for percutaneous endoscopic lumbar discectomy surgical approach selection in patients with L5-S1 disc herniation: a hierarchical clustering analysis.

No classification system exists for aiding the selection of surgical approaches in L5-S1 disc herniation when undergoing percutaneous endoscopic lumbar discectomy (PELD). We aimed to identify radiographic subtypes to aid the selection of percutaneous endoscopic transforaminal discectomy (PETD) and percutaneous endoscopic interlaminar discectomy (PEID) in patients with L5-S1 disc herniation via unsupervised hierarchical clustering analysis. In this retrospective case-control study, we gathered 296 anteroposterior and lateral lumbar spine radiographs (dataset 1) from Tianjin Hospital between January 2016 and October 2021 for clustering analyses. Additionally, we analyzed 111 patients who underwent PEID or PETD for L5-S1 disc herniation at Tianjin Hospital from January 2016 to August 2022. We included patients with radicular leg pain or back pain associated with intra-canal disc herniation who failed in conservative treatments over 6 weeks. First, pair-wise Spearman correlation coefficients were calculated among plain radiographic metrics in dataset 1 to reveal the association among these radiographic metrics. Second, hierarchical clustering analysis was conducted to unsupervised cluster the plain films into several subtypes. Last, for each radiographic subtype, the intraoperative blood loss (IBL), operation time (OT), total operating room time (TORT) along with visual analogue scale (VAS) and Oswestry Disability Index (ODI) were compared between patients underwent PETD or PEID with age as covariates. This study yielded 3 main findings: (I) iliac height (IH) was negatively correlated with intervertebral foramen width (IFW), intervertebral foramen height (IFH), and intertransverse height (ITH) (R=-0.50, -0.42, and -0.46, all P<0.001), ITH was positively correlated with IFW and IFH (R=0.40 and 0.53, all P<0.001); (II) 2 lumbosacral radiographic subtypes were identified via hierarchical clustering analysis; (III) relative to subtype 1, the patients identified as subtype 2 exhibited lesser IBL, shorter OT, and shorter TORT following PETD (t=2.92, P=0.006; t=2.65, P=0.012; t=3.17, P=0.003). The morphology pattern of the lumbosacral region affect the ease of different PELD procedures when performing percutaneous discectomy at the segment of L5-S1. Without considering the type of disc herniation, this classification system might aid spine surgeons in the selection of an appropriate surgical approach.

The Fate of Pre-Existing L5-S1 Degeneration following Oblique Lumbar Interbody Fusion of L4-L5 and Above

Background: Previous studies have identified various risk factors for adjacent segment disease (ASD) at the L5-S1 level after fusion surgery, including preoperative sagittal imbalance, longer fusion, and preoperative disc degeneration. However, only a few studies have explored the risk factors for ASD at the L5-S1 level after oblique lumbar interbody fusion (OLIF) at the L4-L5 level and above. This study aimed to identify the risk factors for symptomatic ASD at the L5-S1 level in patients with pre-existing degeneration after OLIF at L4-L5 and above. Methods: We retrospectively reviewed the data of patients who underwent OLIF at L4-L5 and above, with a minimum follow-up period of 2 years. Patients with central stenosis or Lee grade 2 or 3 foraminal stenosis at L5-S1 preoperatively were excluded. Patients were divided into ASD and non-ASD groups based on the occurrence of new-onset L5 or S1 radicular pain requiring epidural steroid injection (ESI). The clinical and radiological factors were analyzed. Logistic regression was used to identify the risk factors for ASD of L5-S1. Results: A total of 191 patients with a mean age ± standard deviation of 68.6 ± 8.3 years were included. Thirty-four (21.7%) patients underwent ESI at the L5 root after OLIF. In the logistic regression analyses, severe disc degeneration (OR (95% confidence interval (CI)): 2.65 (1.16–6.09)), the presence of facet effusion (OR (95% CI): 2.55 (1.05–6.23)), and severe paraspinal muscle fatty degeneration (OR (95% CI): 4.47 (1.53–13.05)) were significant risk factors for ASD in L5-S1. Conclusions: In this study, the presence of facet effusion, severe disc degeneration, and severe paraspinal muscle fatty degeneration at the L5-S1 level were associated with the development of ASD at L5-S1 following OLIF at L4-L5 and above. For patients with these conditions, surgeons could consider including L5-S1 in the fusion when considering OLIF at the L4-L5 level and above.

Traumatic lumbar hematomyelia causing spinal shock: A case report

Background: Spinal cord hemorrhage or hematomyelia can arise from trauma or non-trauma causes, adverse effect of anticoagulation therapy and ruptured vascular malformation. Bleeding in epidural space is common and complications such as acute spinal cord syndrome can arise due to the compression and destruction of the spinal cord. Symptoms of hematomyelia might be varied depending on location of the lesion, often accompanied with acute radicular pain. In this case study, we reported a case of spinal shock after traumatic lumbar hematomyelia. Case: A 13-year-old girl presented to Dr. Moewardi General Hospital with inferior paraparesis, bladder and bowel incontinence, a day after falling on her gluteus. Physical examination revealed reduced motoric and sensory function below 12th thoracal dermatome, with no patellar and reduced Achilles reflexes. Conventional X-ray was unremarkable and further investigation with MRI showed a hematoma on thoracal 10 to 12 vertebrae. Motor and sensory functions were improved after 12 days administration of corticosteroids and further improvement was seen almost immediately after decompression surgery. Objective: To describe a case of spinal shock caused by traumatic lumbar hematomyelia Method: This is a case report study describing spinal shock which improved after administration of corticosteroid and decompression surgery. Conclusion: Spinal shock could be caused by traumatic lumbar hematomyelia, which is characterized by loss of motor, sensory, and bladder function, and decompression surgery improved the prognosis.

Modified Epidural Adhesiolysis Protocol for the Treatment of Refractory Low Back Pain - A Case Series

BACKGROUND: Scar tissue can form within the epidural space following surgical trauma, infection, annular tearing, hematoma formation, and disc herniation. When epidural fibrosis (EF) is present, it can render nerve roots more susceptible to entrapment, compression, and tension—each of which can potentially contribute to low back and radicular pain in the lower extremities. In the past, several different epidural adhesiolysis protocols have been described to treat such pain. CASE REPORT: Three patients with chronic low back and radicular pain, and evidence of EF underwent a modified epidural adhesiolysis protocol over a single visit. All 3 patients reported greater than 50% pain relief for at least 3 months following treatment with the modified epidural adhesiolysis protocol. CONCLUSION: These case results suggest that the proposed modified epidural adhesiolysis can provide significant relief of axial and radicular pain in a cost effective and accessible manner for this patient population. KEY WORDS: Back pain, adhesiolysis protocol, vertebrogenic pain, epidural fibrosis, failed back surgery syndrome, post laminectomy syndrome

An update on technical and safety practice patterns of interlaminar epidural steroid injections

IntroductionInterlaminar epidural steroid injections (ILESIs) are mainstay in the management of low back, neck and radicular pain and are a commonly performed pain management procedure in the United States. Our survey aims to provide an update in practice patterns of ILESIs among interventional pain physicians. MethodsWe distributed a 91-item survey nationwide to private and academic interventional pain physicians who perform epidural steroid injections (ESIs). The survey was distributed via REDCap with a series of questions inquiring about current practices in epidural steroid injections from March 2021 to March 2022. Cross sectional data from survey responses specific to ILESI-related practices were captured and synthesized. ResultsOf 103 complete survey responses, 96 physicians perform ILESIs (cervical, 87.5 %; thoracic, 82.3 %; lumbar 99 %). Nearly all surveyed physicians utilize fluoroscopy (98.1 %) over other modalities like MRI and ultrasound. For CIESIs, dexamethasone was the preferred steroid (52.4 %) over methylprednisolone (23.7 %); the converse was true for LIESIs in which methylprednisolone (44.2 %) was preferred over dexamethasone (32.6 %). The majority of providers performing ILESI's (91.7 %) preferred a Tuohy/Weiss needle while only a small fraction preferred the Quincke needle (7.2 %). Sedation practices were more varied with only about half of providers (47.6 %) offering medications. Furthermore, a great fraction of providers continue to use contrast for LIESIs (97.9 %) and CIESIs (89.6 %). DiscussionOur survey suggests that despite updated consensus recommendations, variability continues to exist in procedural practice patterns. Highlighting areas of variable adherence to current safety guidelines can assist with what is emphasized in the generation of future evidence-based guidelines. Though our survey was conducted in the context of the COVID-19 pandemic with resultant supply chain shortages, more research is needed to elucidate what variables may factor into why proceduralists may stray from guideline concordant care.

Herpez Zoster in Teens

Herpes Zoster (HZ) is a reactivation of the Varicella Zoster Virus (VVZ), which is characterized by an acute unilateral vesicular eruption grouped with radicular pain around the dermatome. The incidence of HZ increases with age and is rare in children. The prevalence of HZ in children can occur, if they have a history of primary intrauterine infection, are immunocompromised, and who are infected with varicella in the first year of life. One daughter, Ms. B, 15 years old, came to the Skin and Venereology Clinic, PKU Muhammadiyah Surakarta Hospital on December 28, 2022 with complaints of itching and heat, a lesion in the form of multiple clustered vesicles, round in shape, with a size of 0.3-0.5 cm above the skin, erythematous, unilateral, not crossing the midline, the age of the vesicles in one group is the same, but with other groups it is not the same, the skin between groups is normal. Treatment was given acyclovir 4x800 mg per day taken orally for 5 days, triamcinolone 4 mg/day, compressed NaCl 15 minutes 2x daily, caaladine lotion 2x daily on intact lesions and mupirocin calcium on open wounds

Efficacy of conditioned autologous serum therapy (Orthokine®) on the dorsal root ganglion in patients with chronic radiculalgia: study protocol for a prospective randomized placebo-controlled double-blind clinical trial (RADISAC trial)

BackgroundPulsed radiofrequency (PRF) treatment on the dorsal root ganglion (DRG) has been proposed as a good option for the treatment of persistent radicular pain based on its effect of neuromodulation on neuropathic pain. Autologous conditioned serum (ACS) therapy is a conservative treatment based on the patient’s own blood. The aim of this manuscript is to develop a study protocol using ACS on the DRG as a target for its molecular modulation.MethodsWe plan to conduct a randomized controlled study to compare the efficacy of PRF therapy plus ACS versus PRF therapy plus physiological saline 0.9% (PhS) on the DRG to reduce neuropathic pain in patients with persistent lower limb radiculalgia (LLR) and to contribute to the functional improvement and quality of life of these patients.Study participants will include patients who meet study the inclusion/exclusion criteria. Eligible patients will be randomized in a 1:1 ratio to one of treatment with PRF plus ACS (experimental group) or PRF plus PhS (placebo group). The study group will consist of 70 patients (35 per group) who have experienced radicular pain symptoms for ≥ 6 months’ duration who have failed to respond to any therapy. Both groups will receive PRF on the DRG treatment before the injection of the sample (control or placebo). Patient assessments will occur at baseline, 1 month, 3 months, 6 months, and 12 months after therapy.The primary efficacy outcome measure is Numeric Pain Rating Scale (NPRS) responders from baseline to 12 months of follow-up using validated minimal important change (MIC) thresholds. A reduction of ≥ 2 points in NPRS is considered a clinically significant pain relief.The secondary efficacy outcome measure is the proportion of Oswestry Low Back Pain Disability Scale (ODS) responders from baseline to 12 months of follow-up in the experimental group (PRF plus ACS) versus the placebo group (PRF plus PhS). ODS responders are defined as those patients achieving the validated MIC of ≥ 10-point improvement in ODS from baseline to 12 months of follow-up as a clinically significant efficacy threshold.DiscussionThis prospective, double-blind, randomized placebo-controlled study will provide level I evidence of the safety and effectiveness of ACS on neuropathic symptoms in LLR patients.Trial registration {2a}{2b}EUDRACT number: 2021–005124-38. Validation date: 13 November 2021. Protocol version {3}: This manuscript presents the 2nd protocol version.

Benefit of pain and function after cervical transforaminal epidural steroid injections, an observational study

ObjectiveTo evaluate the improvement of pain and function after cervical transforaminal epidural steroid injections (CTFESI) for radicular pain. DesignThis is a retrospective observational study of patients receiving fluoroscopically-guided cervical transforaminal epidural steroid injections under a single provider at a tertiary referral center from December 2013 to December 2020. Primary outcome measures were Numeric Rating Scale (NRS), patient reported percent of pain relief, the Patient Health Questionnaire, the Patient Reported Outcome Measurement Information System (PROMIS) Global Health Physical and Mental Health score, and the Pain Disability Questionnaire. ResultsA total of 219 individual patients underwent 261 CTFESI and were included in the analyses. The average subject age was 51.9 years (SD = 11.3) and 50.9 % were male. Following the intervention, average pain relief by NRS at 3 months, 6 months, 1 year, and 2 years was −4.07, −3.82, −4.20, and −4.45, respectively. The average functional improvement with PROMIS-GH physical at 3-months, 6-months, 1- year, and 2-years was 2.23, 2.35, 3.15, and 3.29, respectively. ConclusionsOur results suggest that patients with cervical radiculopathy report significant pain relief and functional improvement following CTFESI. They can also report clinically important improvement in their health-related quality of life.

Output Current and Efficacy of Pulsed Radiofrequency of the Lumbar Dorsal Root Ganglion in Patients With Lumbar Radiculopathy: A Prospective, Double-blind, Randomized Pilot Study

BACKGROUND: Lumbar radicular pain (LRP) is a common but challenging clinical symptom. Pulsed radiofrequency (PRF), a neuromodulation technique that uses short pulses of radiofrequency current, is effective in treating various pain disorders. However, few studies have been conducted on the effects of PRF and its modifying parameters. OBJECTIVES: Our study aimed to determine the intraoperative parameters of PRF of the lumbar dorsal root ganglion (DRG) that are related to clinical effects in patients with LRP unresponsive to transforaminal epidural steroid injections (TFESI). STUDY DESIGN: Prospective double-blind randomized controlled trial, pilot study. SETTING: Single medical center in the Republic of Korea. METHODS: Patients were allocated to one of 2 groups, high-voltage (60 V) or standard-voltage (45 V), according to the preset maximum voltage at which the active tip temperature does not exceed 42°C. Intraoperative parameters, such as output current, sensory threshold, and impedance, were measured. The primary outcomes were radicular pain intensity, physical functioning, global improvement and satisfaction with treatment, and adverse events. The assessments were performed up to 3 months postprocedure. RESULTS: The patients in the standard-voltage group showed significant improvements in the Numeric Rating Scale pain score (P = 0.007) and Oswestry Disability Index (ODI) (P = 0.008) scores at 3 months post-PRF; however, no difference was observed in the high-voltage group. Among the intraoperative parameters, the output current showed a significant negative linear relationship with analgesic efficacy. The output current also showed a significant association with pain intensity (P = 0.005, R2 = 0.422) and ODI score (P = 0.004, R2 = 0.427) at 3 months postprocedure in a multiple regression analysis. The optimal cut-off value of the output current to lower pain intensity after 3 months was 163.5 mA with a sensitivity of 87.5%, specificity of 100%, and an area under the receiver operating characteristic curve value of 0.92 (95% CI. 0.76 – 1.00). LIMITATIONS: Limitations of our study include an imbalance of baseline characteristics, small sample sizes, and short follow-up periods CONCLUSIONS: Lower output currents during PRF application to the lumbar DRG were associated with greater analgesic effects in patients who did not respond to therapeutic TFESI. KEY WORDS: Lumbar radicular pain, pulsed radiofrequency, dorsal root ganglion

1. Lumbosacral radicular pain.

Patients suffering lumbosacral radicular pain report radiating pain in one or more lumbar or sacral dermatomes. In the general population, low back pain with leg pain extending below the knee has an annual prevalence that varies from 9.9% to 25%. The literature on the diagnosis and treatment of lumbosacral radicular pain was reviewed and summarized. Although a patient's history, the pain distribution pattern, and clinical examination may yield a presumptive diagnosis of lumbosacral radicular pain, additional clinical tests may be required. Medical imaging studies can demonstrate or exclude specific underlying pathologies and identify nerve root irritation, while selective diagnostic nerve root blocks can be used to confirm the affected level(s). In subacute lumbosacral radicular pain, transforaminal corticosteroid administration provides short-term pain relief and improves mobility. In chronic lumbosacral radicular pain, pulsed radiofrequency (PRF) treatment adjacent to the spinal ganglion (DRG) can provide pain relief for a longer period in well-selected patients. In cases of refractory pain, epidural adhesiolysis and spinal cord stimulation can be considered in experienced centers. The diagnosis of lumbosacral radicular pain is based on a combination of history, clinical examination, and additional investigations. Epidural steroids can be considered for subacute lumbosacral radicular pain. In chronic lumbosacral radicular pain, PRF adjacent to the DRG is recommended. SCS and epidural adhesiolysis can be considered for cases of refractory pain in specialized centers.

Roles of Chemokines in Intervertebral Disk Degeneration.

Intervertebral disc degeneration is the primary etiology of low back pain and radicular pain. This review examines the roles of crucial chemokines in different stages of degenerative disc disease, along with interventions targeting chemokine function to mitigate disc degeneration. The release of chemokines from degenerated discs facilitates the infiltration and activation of immune cells, thereby intensifying the inflammatory cascade response. The migration of immune cells into the venous lumen is concomitant with the emergence of microvascular tissue and nerve fibers. Furthermore, the presence of neurogenic factors secreted by disc cells and immune cells stimulates the activation of pain-related cation channels in the dorsal root ganglion, potentially exacerbating discogenic and neurogenic pain and intensifying the degenerative cascade response mediated by chemokines. Gaining a deeper comprehension of the functions of chemokines and immune cells in these processes involving catabolism, angiogenesis, and injury detection could offer novel therapeutic avenues for managing symptomatic disc disease.

Pain is common in early onset Parkinson's disease and pain severity is associated with age and worsening of motor and non-motor symptoms

The consequences of pain in early onset Parkinson's disease (EOPD) remain under appreciated even though pain may exert an increasingly negative impact on patient quality of life as motor and non-motor symptoms worsen.In this prospective study, we investigate the prevalence and severity of pain in 135 Vietnamese patients with EOPD from three medical centers using the King's PD Pain Scale (KPPS), the Mini Mental Status Exam (MMSE), the Unified Parkinson's Disease Rating Scale (UPDRS) and the Non-Motor Symptoms Scale (NMSS).Pain was reported by 79.3%. The most common subtype of pain was musculoskeletal (70.1%), followed by nocturnal (43.9%), radicular (43.0%), chronic (42.1%), fluctuation-related (34.6%) and orofacial pain (16.8%). Most patients (74.8%) experienced more than one pain subtype. Fluctuation-related pain and orofacial pain were significantly more prevalent among patients with higher Hoehn & Yahr (H&Y) stages (3–5) versus lower H&Y stages (1–2). Pain subtype and severity were not significantly related to gender or age of PD onset.Patients with H&Y stages 3–5 had statistically significantly higher KPPS scores for fluctuation-related pain (p = 0.018) and radicular pain (p = 0.026). Independent associations were found between pain severity and age (p = 0.028), depression severity (p = 0.018), perceptual problems/hallucinations (p = 0.033) and sexual function (p = 0.024).Patients with depression and higher H&Y stages (3–5) had statistically significantly higher mean KPPS scores versus patients without depression and at lower H&Y stages (1–2).Pain may be more common and severe in EOPD patients than previously appreciated. Older age, depression, perceptual problems/hallucinations and sexual dysfunction were independently associated with higher pain severity.

Pro-Con Debate: Superior Versus Inferior Triangle Needle Placement in Transforaminal Epidural Injections.

Although transforaminal epidural injections have long been used for radicular pain, there is no universal standard injection approach to the neural foramen. The intervertebral foramen and its surrounding structures comprise an anatomically sensitive area that includes bone and joint structures, the intervertebral disk, blood vessels (in particular, the radicular arteries), the epidural sheath, and the spinal nerve root. Given the relatively high risk of inadvertent injury or injection to these nearby structures, image guidance for transforaminal epidural steroid injections (TFESIs) is standard of care. However, there is a lack of consensus regarding the optimal approach to the neural foramen: from the traditional superior ("safe") triangle or from the inferior (Kambin's) triangle. In this Pro-Con commentary article, we discuss the relative advantages and disadvantages of each approach for TFESIs.

NCMP-16. A CASE OF WIDESPREAD EXTRACRANIAL METASTASES FROM A GLIOSARCOMA

Abstract BACKGROUND: Glioblastoma (GBM) with sarcomatous features (gliosarcoma) accounts for 2-8% of all glioblastomas1,2, characterized by a biphasic histopathology pattern consisting of glial and sarcomatous components. While GBMs generally do not metastasize outside the central nervous system (CNS), GS has been associated with extracranial metastases in up to 11% of cases3. Case presentation: A 58-year-old right-handed woman with a GBM presented to our institution for a second opinion. She was initially diagnosed 18 months prior and had received radiotherapy with concurrent temozolomide. Her adjuvant temozolomide was discontinued due to rash, and she started on bevacizumab. Her tumor progressed and she sought additional treatment options. On her initial presentation, she was tachycardic with leukocytosis, prompting admission. A chest CT showed thoracic adenopathy, multiple bilateral pulmonary nodules, and a large left malignant pleural effusion. Bronchoscopy revealed spindle cell sarcomatoid neoplasm raising the possibility of metastasis from a CNS primary tumor. Additionally, the patient endorsed development of subacute radicular pain in her bilateral lower extremities as well as weakness. MRI of total spine revealed multilevel osseous and epidural lesions, infiltrating the paraspinal muscles and thickening of cauda roots with concern for leptomeningeal disease. A subsequent PET-CT showed increased FDG avidity in these lesions. Reevaluation of the initial CNS pathology confirmed the presence of mesenchymal/sarcomatous differentiation, consistent with a diagnosis of GS. As confirmed by autopsy, the patient eventually passed away due to widespread and metastatic disease. Discussion: While GBM rarely metastasizes outside the CNS, GBM with sarcomatous features are more likely to exhibit extracranial metastasis. Our patient had widespread involvement, including the lungs, heart, liver, omentum, and bone. Metastasis was thought most likely once EBUS of the lung returned with sarcomatous features. Clinicians should therefore maintain a high suspicion for metastases when dealing with patients diagnosed with GS.

Association of selected inflammatory markers and risk factors with pain in patients undergoing cervical or lumbar disc herniation

Introduction&#x0D; Studies have suggested that radicular pain following disc herniation may be associated with local or systemic inflammatory responses produced in the vicinity of the herniated disc rather than compression of the nerve. Present study assessed the association of serum interleukin-6 (IL-6) levels, high-sensitivity C-reactive protein (hs-CRP) and related risk factors in patients undergoing discectomy following cervical disc herniation (CDH) or lumbar disc herniation (LDH).&#x0D; Methods&#x0D; Study recruited 77 patients undergoing discectomy for LDH and CDH. An interviewer administered questionnaire was used to obtain sociodemographic, behavioral and occupational data. IL-6 and hs-CRP levels were measured in each individual. IL-6 was analyzed by ELISA method and hs-CRP was determined using auto analyzer. Results were analyzed by using SPSS version 25.0.&#x0D; &#x0D; Results&#x0D; Significant correlation was not found with serum IL-6 and hs-CRP levels (r=0.02, p˃0.05) for acute and chronic CDH and LDH. Patients with chronic neck or back pain showed significantly (p=0.043) higher IL-6 level compared to patients with acute neck or back pain. Serum hs-CRP level was significantly higher (p=0.048) in patients with acute neck or back pain compared to patients with chronic neck or back pain. Significant association was not observed between; level of physically demanding nature of occupation (p=0.542), duration of occupation (p=0.446), type of exercise (p=0.371), type of sports (p=0.339) and CDH or LDH.&#x0D; Conclusion&#x0D; Though significant correlation was not observed between inflammatory markers IL-6, hs-CRP and CDH or LDH. The mean IL-6 was higher in chronic back pain and neck pain patients with LDH and CDH whereas mean hs-CRP mean was higher in acute back pain and neck pain patients. Significant association was not reported between selected known risk factors (behavioral, occupational) and CDH or LDH.

Ultrasound-guided and CT-guided selective cervical nerve root injection for the treatment of cervical radicular pain: A retrospective clinical study.

To compare the clinical effects and safety of ultrasound (US)-guided selective cervical nerve root injection (SCNI) and computed tomography (CT)-guided SCNI for patients with cervical radicular pain (CRP). Forty-two CT-guided SCNI procedures (26 eligible patients) and forty-two US-guided SCNI procedures (25 eligible patients) performed to treat CRP were identified from the medical record system between October 2017 and July 2021 and enrolled in the study. The numeric rating scale was used to assess pre- and postprocedural pain levels, and the neck disability index was used to assess the level of function. All immediate and delayed clinical complications were also recorded. The cost of each procedure and the radiation dose of the CT procedure were documented. The follow-up data were obtained by telephone calls or outpatient visits. Five patients in the CT group and one patient in the US group were lost to follow-up at 1 year. No procedure-related complications were observed in either group. Significant pain relief and cervical function improvement were achieved after treatment in both the CT-guided SCNI and US-guided SCNI groups; however, there were no significant differences between the two groups. The average cost per CT-guided SCNI procedure was 133.2 USD, which was higher than the cost per US-guided SCNI procedure (42.2 USD). Meanwhile, the necessary radiation dose per patient in the CT group was 0.36 ± 0.08 mGy. US-guided SCNI and CT-guided SCNI have similar efficacy in treating CRP, but US-guided SCNI is radiation free and less costly than the CT-guided procedure.

Pain outcome of non-instrumented lumbar decompressive surgery for degenerative lumbar spine disease using patient-reported pain outcome instruments.

A clinical disorder known as degenerative lumbar spine disease (DLSD) is characterized by persistent low back pain (LBP) coupled with radiculopathy and other signs of neurologic impairment. Using patient-reported pain outcome assessment tools, this study evaluated the pain outcome of non-instrumented lumbar decompressive surgery for DLSD. A prospective longitudinal research was conducted. Using the metric visual analog scale (VAS) score and the Oswestry disability index (ODI), consenting patients who underwent non-instrumented lumbar decompressive surgery for symptomatic DLSD were evaluated for radicular pain and LBP. The evaluation was conducted both immediately before surgery and 6 months after surgery. Data generated by comparing the pre-operative and post-operative VAS and ODI scores were then analyzed using descriptive and inferential statistics. Sixty-seven patients in total completed the study. Thirty-six (54%) males and 31 (46%) females, with a mean age and body mass index of 55.28 years and 29.5 k/m2, respectively. At 6 months postoperatively, there was significant pain reduction from the pre-operative baseline VAS for LBP (67.12-32.74) with P < 0.001, VAS for radicular pain (75.39-32.75) with P < 0.001, and ODI (65.30-27.66) with P < 0.001. There was a greater decrease in radicular pain than in LBP following lumbar decompressive only surgery (P = 0.03). Patients with symptomatic DLSD and high pre-operative back pain scores without considerable listhesis should anticipate a significant reduction in radicular and back pain intensity, as well as pain-related functional disability, 6 months after non-instrumented lumbar decompressive surgery.

The Duration of Symptoms Influences Outcomes After Lumbar Microdiscectomies: A Michigan Spine Surgery Improvement Collaborative.

Retrospective Cohort. We investigate whether duration of symptoms a patient experiences prior to lumbar microdiscectomy affects pain, lifestyle, and return to work metrics after surgery. A retrospective review of patients with a diagnosis of lumbar radiculopathy undergoing microdiscectomy was conducted using a statewide registry. Patients were grouped based on self-reported duration of symptoms prior to surgical intervention (Group 1: symptoms less than 3months; Group 2: symptoms between 3months and 1year; and Group 3: symptoms greater than 1year). Radicular pain scores, PROMIS PF Physical Function measure (PROMIS PF), EQ-5D scores, and return to work rates at 90days, 1year, and 2years after surgery were compared using univariate and multivariate analysis. There were 2408 patients who underwent microdiscectomy for lumbar disc herniation for radiculopathy with 532, 910, and 955 in Groups 1, 2, and 3, respectively. Postoperative leg pain was lower for Group 1 at 90days, 1year, and 2years compared to Groups 2 and 3 (P < .05). Postoperative PROMIS PF and EQ-5D scores were higher for Group 1 at 90days, 1year, and 2years compared to Groups 2 and 3 (P < .05). Patients with prolonged symptoms prior to surgical intervention experience smaller improvements in postoperative leg pain, PROMIS PF, and EQ-5D than those who undergo surgery earlier. Patients undergoing surgery within 3months of symptom onset have the highest rates of return to work at 1year after surgery.

Effectiveness of a Nonoperative Tailored Treatment and Return to Sport of a Rugby Union Player After a Cervical Spine Disc Herniation: A Case Report

BACKGROUND: This case report aims to illustrate the nonoperative rehabilitation of a rugby union player following a cervical spine disc herniation with neck pain and radicular pain. CASE PRESENTATION: A 23-year-old male rugby player presented with neck pain and radicular pain and was evaluated using clinical and neck-motor control assessments, self-report questionnaires, neck-strength, and magnetic resonance imaging. OUTCOME AND FOLLOW-UP: A well-structured rehabilitation program was followed to ensure early recovery and optimal functional outcome. The player was able to participate in full rugby training sessions without limitation. He returned to his previous level of performance, playing in the first team. DISCUSSION: This is the first case report of a rugby union player with an isolated disc herniation managed with nonoperative treatment. The treatment objectives, interventions, and assessments are provided in detail. JOSPT Cases 2023;3(4):260-266. Epub 25 September 2023. doi:10.2519/josptcases.2023.11886