Root Compression Research Articles

Risk of Subsequent Fusion After Isolated Decompression of Lumbar Facet Cysts.

Lumbar facet cysts represent a potential source of nerve root compression in elderly patients. Isolated decompression without fusion has proven to be a reasonable treatment option in properly indicated patients. However, the risk of lumbar fusion after isolated decompression and facet cyst excision has yet to be elucidated. The PearlDiver database was reviewed for patients undergoing isolated laminectomy for lumbar facet cyst from January 2015 to December 2018 using Current Procedural Terminology coding. Patients undergoing concomitant fusion or additional decompression, as well as those diagnosed with preexisting spondylolisthesis or without a minimum of 5-year follow-up, were excluded. Rates of subsequent lumbar fusion and potential risk factors for subsequent fusion were identified. Statistical analysis included descriptive statistics, chi square test, and multivariate logistic regression. Results were considered significant at P < 0.05. In total, 10,707 patients were ultimately included for analysis. At 5-year follow-up, 727 (6.79%) of patients underwent subsequent lumbar fusion after initial isolated decompression. Of these, 301 (2.81% of total patients, 41.4% of fusion patients) underwent fusion within the first year after decompression. Multivariate analysis identified chronic kidney disease, hypertension, and osteoarthritis as risk factors for requiring subsequent lumbar fusion at 5 years following the index decompression procedure ( P < 0.033; all). Patients undergoing isolated decompression for lumbar facet cysts undergo subsequent lumbar fusion at a 5-year rate of 6.79%. Risk factors for subsequent decompression include chronic kidney disease, hypertension, and osteoarthritis. This study will assist spine surgeons in appropriately counseling patients on expected postoperative course and potential risks of isolated decompression.

Minimally Invasive Far Lateral Lumbar Discectomy With Modified Technique: Symptomatic Relief and Intersegmental Stability Study.

To evaluate the use of a modified minimally invasivesurgery (MIS) technique for far lateral lumbar discectomy (FLDH) that minimizes the degree of bony drilling required for nerve root decompression, increasing postoperative pain reduction rate with reduced risk of iatrogenic spinal instability. FLDH accounts for approximately 10% of all lumbar disc herniations and is increasingly recognized in the era of advanced imaging techniques. These disc herniations typically result in extra-foraminal nerve root compression. Minimally invasive spine techniques are increasingly performed with various degrees of foraminal and facet removal to decompress the affected nerve root. The study design involves a single institutional, retrospective cohort technical review. The review was completed of all patients undergoing MIS far lateral lumbar discectomy between 2010 and 2020. Cross-sectional, summary statistics were calculated for all variables.Counts and percentages were recorded for categorical variables and mean and standard deviations were calculated for continuous variables. A total of 48 patients underwent MIS far lateral lumbar discectomies (FLLD) from 2010 to 2020. The mean age was 63 ± 11.5 years (60.4% males), the mean BMI was 28.5 ± 5.5, and 20.8% smokers. The most common presenting complaint was both low back and radicular pain (79.2%) with 8.3% of patients suffering from motor weakness preoperatively. The mean follow-up time was 4.3 ± 2.7. The mean length of stay was 1.3 ± 1.4 days with 77.1% of patients discharged postoperative day one. Forty-three patients (93.5%) had improvement in their symptoms. Twenty-seven (58.7%) had complete resolution in 2.6 months on average. Six patients (13%) had immediate symptom resolution postoperatively. Our modified technique for FLLD allows MIS access to the extra-foraminal site of nerve root compression without the need for bony drilling. This minimizes postoperative pain and reduces the risk of iatrogenic spinal instability without sacrificing symptom resolution.

Real-Time Intraoperative Ultrasound Using a Minimally Invasive Transducer During Anterior Cervical Spine Surgery.

Intraoperative ultrasound (IOUS) during anterior cervical surgery is hindered by large transducer size and small operative corridor. We hypothesized that a linear (minimally invasive) transducer designed for transsphenoidal surgery can visualize the spinal cord, nerve roots, and surrounding structures during anterior cervical approaches, facilitating intraoperative assessment of central and foraminal decompression. IOUS was used to evaluate 26 levels in 17 patients (15 anterior cervical discectomy and fusion, 1 corpectomy, 1 arthroplasty) with a linear probe (7 × 6-mm end-fire transducer, 150-mm length, 12-15 MHz). After pin-based distraction, discectomy, and posterior longitudinal ligament resection, IOUS assessed adequacy of cord decompression and, following proximal foraminotomy or uncinectomy, nerve root decompression. If indicated, additional decompression was completed. Criteria for adequate central and foraminal decompression were visualization of subarachnoid space around the cord and cerebrospinal fluid pulsatility along the root sleeve/absence of nerve root compression distal to the root sleeve, respectively. IOUS successfully visualized the cord, nerve roots, and surrounding structures in all 26 levels and influenced management in 11 levels (42.3%). IOUS indicated persistent cord and nerve root compression in 2 and 7 levels, respectively. Planned uncinectomy was aborted in 2 levels after IOUS demonstrated adequate nerve root decompression with intervertebral distraction/proximal foraminotomy alone. IOUS identified persistent nerve root compression after initial proximal foraminotomy in 4 levels and uncinectomy in 2 levels. An unplanned uncinectomy was performed in 1 level after IOUS showed persistent nerve root compression after multiple iterations of proximal foraminotomy. At follow-up (mean 3.1 months), the mean improvement in Numeric Rating Scale neck and arm pain, Neck Disability Index, and modified Japanese Orthopedic Association was 4.0%, 3.2%, 3.7%, and 0.7%, respectively. The neural elements and their relationships to surrounding bone/soft tissue can be visualized using a minimally invasive IOUS transducer during anterior cervical surgery without having to remove pin-based distraction. This allows surgeons to intraoperatively verify the extent of central and foraminal decompression.

Comparison between Neural Mobilization and Mckenzie Approach in Reducing Pain, Improving Mobility and Functional Ability in Peoples with Lumbar Radiculopathy

Background: Lumbar radiculopathy is the compression of lumbar nerve root. The most common causes of nerveroot compression are intervertebral disc herniation and degenerative alterations. About 3% of cases, disc diseasecauses lumbar radiculopathy. Pain is the major symptom.Purpose: The study is to compare the effectiveness of neural mobilisation and McKenzie approach in reducingpain, improving mobility and functional ability for peoples with lumbar radiculopathy.Materials and Methods: A Experimental study which consists of 64 subjects who were selected based on inclusionand exclusion criteria from A.K.B physiotherapy during the period of November 2022 to April 2023. They weresplit into two groups , the Neural mobilisation group(n=32) and McKenzie group(n=32).The intervention wasgiven for 5 days a week for 4 weeks . The pre and post test values were measured using (NPRS), Modified Schober’smethod and (MODI).Results: With a p value of 0.0001, the mean of the Neural Mobilization at the post test was shown to be greaterthan the mean of McKenzie Exercise.Conclusion: This study concluded that Neural mobilisation was found to be more effective than McKenzie indecreasing pain , improving mobility and functional ability for peoples with lumbar radiculopathy.

Comparison Between Mckenzie Approach and Lumbar Core Stabilization Exercise in Improving Functional Activity and Reducing Pain for Lumbar Radiculopathy by Using Pain Rating Scale and Functional Scale as an Outcome Tool

Background: Lumbar radiculopathy, is a symptom of radiating pain in the lumbar nerve root distribution thatmay also include sensory and motor dysfunction. The most common causes of nerve root compression areintervertebral disc herniation and degenerative alterationsPurpose: To compare the effectiveness of McKenzie approach and core stabilization exercise in Lumbarradiculopathy by reducing pain and improving the functional activityMaterials and Methods: Total of 64 subjects will be selected by a convenient sampling method based on inclusionand exclusion criteria. The study was fully described to the participants, and their signed agreement was acquired.Numerical pain rating scale (NPRS), Roland-Morris Disability Questionnaire (RMDQ) was used to analyse thepain, and related disability.Results: With a p value of 0.0001, the mean of the core stabilization at the post test was shown to be greater thanthe mean of McKenzie Exercise.Conclusion: This study concluded that Neural mobilisation was found to be more effective than McKenzie indecreasing pain and functional ability for peoples with lumbar radiculopathy

Clinical and imaging findings in dogs with nerve root signature associated with cervical intervertebral disc herniation.

Intervertebral disc herniation (IVDH) is the most common spinal cord disease in dogs. Little information is available regarding the clinical presentation of nerve root signature (NRS) associated with cervical IVDH. To detail the clinical and magnetic resonance imaging (MRI) findings in dogs with NRS associated with cervical IVDH. Forty-seven client-owned dogs presenting with thoracic limb NRS and MRI confirmed IVDH. Medical records from 2010 to 2020 were retrospectively reviewed for dogs that met inclusion criteria. Imaging studies were evaluated by 2 individuals to characterize location and severity of neural tissue compression. Chondrodystrophoid dogs comprised the majority of the study cohort, with dachshund the most common breed (n = 10). Three-quarters of dogs were ≥7 years of age. Interobserver agreement was moderate or good for all of the imaging variables evaluated. The C6-C7 intervertebral disc space was significantly overrepresented (P = .01), comprising 32% (15/47) of the affected discs. However, 42% (20/47) of cases involved C2-C3 though C4-C5 disc sites. Disc material was more frequently located laterally compared to medially within the vertebral canal (P = .0005), and to be associated with compression of the nerve root at the level of the intervertebral foramen (P = .012). NRS is most commonly associated with lateralized or foraminal cervical disc herniations. It is most prevalent with C6-C7 intervertebral disc involvement, suggesting that there might be unique anatomic factors that contribute to development of NRS at this site, but can be a clinical manifestation of IVDH occurring anywhere along the cervical spine.

A Comparative Review of Two Major Topical Hemostasis Agents in Spine Surgery

Achieving adequate hemostasis in spine surgery is critical for both the patient and surgeon. Currently, there are two major topical hemostatic matrix agents used in spine surgery—Floseal (Baxter Healthcare, Deerfield, Illinois, USA) and Surgiflo (Ethicon Inc., Raritan, New Jersey, USA). While both products have been shown to be effective at achieving hemostasis, there is no consensus supporting the use of one agent over another in spine surgery. There are studies comparing outcomes and cost between Floseal and Surgiflo, but a significant portion of the studies have industry affiliations. Generally, existing literature reports low to moderate cost savings in favor of one agent or the other, with no clinically significant differences in other patient-based outcomes such as postoperative hematomas. Animal model studies also suggest unique complications, including epidural fibrosis and associated nerve root compression with use of a flowable topical hemostatic agent. Further non-industry-affiliated studies are warranted to compare efficacy, patient outcomes, cost analyses, and possible unique complications associated with the two hemostatic agents.

Diagnostic evaluation of deep learning accelerated lumbar spine MRI.

Deep learning (DL) accelerated MR techniques have emerged as a promising approach to accelerate routine MR exams. While prior studies explored DL acceleration for specific lumbar MRI sequences, a gap remains in comprehending the impact of a fully DL-based MRI protocol on scan time and diagnostic quality for routine lumbar spine MRI. To address this, we assessed the image quality and diagnostic performance of a DL-accelerated lumbar spine MRI protocol in comparison to a conventional protocol. We prospectively evaluated 36 consecutive outpatients undergoing non-contrast enhanced lumbar spine MRIs. Both protocols included sagittal T1, T2, STIR, and axial T2-weighted images. Two blinded neuroradiologists independently reviewed images for foraminal stenosis, spinal canal stenosis, nerve root compression, and facet arthropathy. Grading comparison employed the Wilcoxon signed rank test. For the head-to-head comparison, a 5-point Likert scale to assess image quality, considering artifacts, signal-to-noise ratio (SNR), anatomical structure visualization, and overall diagnostic quality. We applied a 15% noninferiority margin to determine whether the DL-accelerated protocol was noninferior. No significant differences existed between protocols when evaluating foraminal and spinal canal stenosis, nerve compression, or facet arthropathy (all p > .05). The DL-spine protocol was noninferior for overall diagnostic quality and visualization of the cord, CSF, intervertebral disc, and nerve roots. However, it exhibited reduced SNR and increased artifact perception. Interobserver reproducibility ranged from moderate to substantial (κ = 0.50-0.76). Our study indicates that DL reconstruction in spine imaging effectively reduces acquisition times while maintaining comparable diagnostic quality to conventional MRI.

Determination of Paraoxonase 1 Activity and Phenotype Distribution in Cervical Disk Herniation Patients

Determination of Paraoxonase 1 Activity and Phenotype Distribution in Cervical Disk Herniation Patients&#x0D; &#x0D; Abstract&#x0D; Objectives: Cervical disk herniation (CDH) is a common disease that usually develops as a result of intervertebral disk degeneration (IVDD) or trauma, which can cause pain or neurological deficiency by nevre root or spinal cord compression. Paraoxonase 1 (PON1) has antioxidant qualities, and its function may vary based on genetic variations and ethnic background. This study aims to compare PON1 activity and phenotype distribution in CDH patients and individuals without the condition.&#x0D; Materials and Methods: This study involved 70 CDH patients and 70 individuals in good health. Spectrophotometric tests were conducted to measure the serum PON1 and arylesterase (ARE) activities. The PON1 ratio, which indicates the salt-stimulated PON/ARE level, showed a three-peak distribution. This ratio was utilized to determine the various phenotypes; QQ, QR, and RR for each participant.&#x0D; Results: The PON1 activity was lower in CDH patients compared to the healthy individuals (p &lt; 0.05). CDH patients exhibited a statistically significant QQ phenotype in comparison to the healthy participants (p &lt; 0.05).&#x0D; Conclusion: Patients with CDH exhibited significantly reduced PON1 activity, indicating that low PON1 activity and the PON1 QQ phenotype could potentially be a risk factor for the development of CDH.&#x0D; Keywords: Cervical disk herniation, Paraoxonase, Phenotype, PON1

Assessment of sciatica pain awareness among adults in Makkah region, Saudi Arabia: A cross-sectional study

Abstract: Background: Sciatica is a common debilitating condition caused by compression of the sciatic nerve root (L4-S3), often due to narrowing of the vertebral canal or trauma such as vertebral disk protrusion or prolapse. Its peak incidence was in the fourth decade of life and had an annual incidence rate of 1-5%. In Saudi Arabia, with the increasing prevalence of musculoskeletal disorders, evaluating public awareness of sciatica is essential. This study aims to assess the level of awareness about sciatica pain among adults in the Makkah region. Methods: A web-based descriptive cross-sectional study was conducted among adults aged 18 years and above in the Makkah region, Saudi Arabia. The minimum calculated sample size was 385 participants, which was increased to 600 to enhance study robustness. Data were collected through an online questionnaire distributed via social media. The questionnaire included 15 questions across three sections: sociodemographic characteristics, personal and family history of sciatica, and awareness of sciatica using a three-point Likert scale. Results: The study included 601 participants, with males constituting 54%, individuals aged 20-40 years representing 60%, 50% were employed and 63% had pursued university education or beyond. Approximately 7.5% had a history of sciatica, 64% lacked a family history, and 41% lacked information on sciatica. The mean knowledge score was 9.79±2.16, with 56.7% demonstrating good knowledge. Significant factors influencing sciatica knowledge included age (p=0.013), and education (p=0.047). Higher knowledge levels were associated with personal (OR: 2.76, 95% CI: 1.23, 7.07) and family history of sciatica (OR: 2.07, 95% CI: 1.20, 3.64), and prior information about sciatica (OR: 3.02, 95% CI: 2.08, 4.42). Males had significantly lower knowledge of sciatica than females (OR: 0.46, 95% CI: 0.32, 0.66). Conclusion: The study reveals a moderate level of awareness about sciatica among adults in the Makkah region, with significant gaps influenced by gender, education, and personal or family history of the condition. Enhanced public health initiatives and educational programs are essential to address these gaps and improve patient outcomes.

Association Between Lumbar Spine Disorder and Genovarum: A Population-Based Cross-Sectional Study.

It is becoming increasingly important to study pathology at the knee and spine because of their role in causing pain and deformity in one another. Compression of the lumbar nerve root can disrupt innervation to the thigh muscles, cause an imbalance of muscle and result in varus deformity. In this study, we try to figure out the relation between lumbar spine disorders and genu varum and realize if lumbar spine disorders can cause varus deformity in a patient. In this cross-sectional study, the number of 53 patients with knee varus greater than 20 degrees who visited the orthopedic clinics of Rasoul Akram and Moheb Mehr hospitals affiliated to Iran University of Medical Sciences between 2020 and 2022 were investigated in terms of association with lumbar disorders. The demographic characteristics and clinical findings of the patients were recorded and collected using a checklist by referring to the patient's medical profiles. Radiographic findings were evaluated by referring to the imaging department and using the Pacs system. The diagnosis of the patients was based on the history and findings of the knee graph, which was measured with a goniometer to measure the knee angle. The frequency of lumbar disorders caused by pressure on the lumbar nerves in patients with genu varum deformity including canal stenosis, osteoarthritis, spondylolisthesis, and disc herniation was investigated. To investigate lumbar problems, patients' history and radiographic images as well as lumbosacral and knee MRI of patients were used. The mean age was 66.3 ± 7.66 years. 40 (75.5%) cases were female and 13 (24.5%) cases were male. Lumbar canal stenosis with 28(52.8%) and disc herniation with 32(60.4%) were the most common lumbar disorders in patients with knee varus more than 20 degrees. The mean age of patients with varus of more than 20 degrees with lumbar disorders was significantly higher than that of patients without lumbar disorders. (P: 0.001) There was no significant difference between gender distribution and lumbar disorders in patients with varus more than 20 degrees. Significant positive correlation between genu varum with lumbar canal stenosis (r: 0.53, P: 0.001), osteoarthritis (r: 0.38, P: 0.004), spondylolisthesis (r: 0.39, P: 0.002) and disc herniation (r: 0.46, P: 0.001) was reported2. An association between lumbar disorders and varus more than 20 degrees was found to be considerable.

Philosophies And Surgical Techniques for Ewing's Sarcoma of Spine with Review of Literature.

Ewing sarcoma (ES) is a malignant and aggressive bony tumor affecting the most common age group of 5-20 years. It constitutes 10%-15% of all bone sarcomas and is the second most common primary malignant bone tumor after osteosarcoma. It usually presents with pain, which is typically constant and progressive in nature. The primary source of pain is due to the instability of the spine to support the weight of the body, the vertebral body's expanding cortices due to the growing mass, compression of nerve roots due to tumour mass, pathologic fractures, spinal cord compression, and invasion of tissue by the tumour mass. We reviewed the literature on Ewing's Sarcoma of the spine to evaluate its etiology, clinical presentations, differential diagnosis, imaging modalities and management with chemotherapy, radiotherapy, and surgical management. PubMed, EMBASE, Google Scholar and Cochrane key articles were searched. Keywords like 'Ewing's Sarcoma,' 'Spine,' 'etiology,' 'treatment,' 'surgical management,' and 'en bloc resection' were used. The current management of Ewing's sarcoma of the spine usually involves three primary modalities: combination chemotherapy, surgery and/or radiotherapy. Recent improvements in combination chemotherapy (vincristine, doxorubicin, cyclophosphamide +/- Ifosfamide and etoposide) are among the most significant factors for improving survival. Also, recent advancements in radiotherapy, instrumentation, and fusion techniques in surgical management have been demonstrated to improve local disease control and overall survival. Primary Ewing sarcoma of the spine is a rare condition affecting the most common age group of 5-20 years, accounting for 1-3 cases/million/year. About 5 % of cases have spine involvement. Recent improvements in combination chemotherapy have improved the overall survival rates. Enbloc resection and/or radiotherapy have improved local control of the disease.

Surgical Treatment of Hemifacial Spasm via Microvascular Decompression of a Large, Ectatic Vertebral Artery.

Hemifacial spasm is a neuromuscular disorder caused by compression of the facial nerve at the nerve root entry zone, often due to ectatic or aberrant vasculature. Pathologic compression of the nerve-brainstem interface results in involuntary, paroxysmal contractions of ipsilateral facial muscles that may cause considerable impairments in quality of life. For those with severe symptoms, have positive imaging demonstrating vascular compression, or who fail other management modalities, 1 2 3 4 microvascular decompression offers potential definitive treatment. 5 6 Traditionally, nonabsorbable packing agent is used to pack between the nerve and offending vascular structure. However, for large and more complex arterial structures, simple nonabsorbable padding is often not sufficient. In this operative video, we demonstrate microvascular decompression for intractable hemifacial spasm in a 52-year-old female using a specialized sling tacked to the petrous dura for management of a large, ectatic vertebral artery. Following a standard left retrosigmoid craniotomy, an atheromatous ectatic vertebral artery was identified. We fashioned a bovine pericardium sling around the vessel and used a permanent aneurysm clip to secure it to an incision portion of petrous dura. We subsequently identified potential additional facial nerve root compression by anterior inferior cerebellar artery (AICA) and posterior inferior cerebellar artery (PICA) branches, which were elevated and secured using Teflon felt packing. Following elevation of all three vessels, the lateral spread response resolved. At 2 weeks postoperatively, the patient reported substantial relief in her hemifacial spasms and endorsed highly improved quality of life.

Management outcomes of cervical radiculopathy with conservative treatment, anterior cervical discectomy fusion (ACDF), and anterior cervical disc replacement (ACDR)—Retrospective single center matched cohort study

Abstract Background: Degenerative cervical radiculopathy results from nerve root compression in the cervical neural foramina, often due to a herniated disc, osteophyte, or facetal/ligamentum flavum hypertrophy. Typically, 80% of patients show improvement within the initial 12 weeks through nonoperative measures, with surgical intervention considered for non-responders. This study aimed to compare clinical and radiological outcomes in cervical radiculopathy patients undergoing prolonged conservative care, anterior cervical discectomy and fusion (ACDF), or anterior cervical disc replacement (ACDR) after a 1‐year follow‐up. Materials and Methods: Our study was a retrospective single‐center study involving 780 cervical radiculopathy patients from January 2012 to December 2021. About 80.12% found relief with conservative management within 12 weeks. Remaining 155 patients were offered surgery, with 73 opting for continued conservative care, and 82 undergoing surgery (55 with ACDF and 27 with ACDR). Evaluation was done using visual analogue scale (VAS), Neck Disability Index (NDI), and radiographic parameters. Results: The mean follow‐up was 11.58 ± 6.7 months. ACDR group: Mean age 43.38 ± 8.56, VAS 7.81 ± 1.04 preoperatively, improved significantly to 2.07 ± 1.34 (P &lt; 0.05) at 1‐year follow‐up. ACDF group: Mean age 44.85 ± 10.65, VAS 8.22 ± 1.21 preoperatively, improved significantly to 2.09 ± 1.01 (P &lt; 0.05) at 1‐year follow‐up. Conservative group: Mean age 45.04 ± 11.19, VAS 7.77 ± 1.86 preoperatively, improved significantly to 2.08 ± 1.40 (P &lt; 0.05) at 1‐year follow‐up. Radiographic parameters significantly improved in all groups at 1‐year follow‐up (P &lt; 0.05). Range of motion (ROM) changes varied across groups. Miyazaki’s grading and Kim’s score showed comparable results. Conclusion: Comparable clinical and radiological outcomes were observed among conservative, ACDF, and ACDR approaches. ACDR approach demonstrated a better NDI score outcome. Neck ROM was better maintained or improved in the ACDR approach, decreased in ACDF, and remained almost similar in the conservative group.

Quantum Molecular Resonance Radiofrequency Disc Decompression and Percutaneous Microdiscectomy for Lumbar Radiculopathy.

Within the practice of pain management, one of the most commonly encountered events is low back pain. Lumbar radiculopathy (LR) is a pain syndrome caused by the compression or irritation of the nerve roots in the lower back due to lumbar disc herniation, vertebra degeneration, or foramen narrowing. Symptoms of LR include low back pain that propagates toward the legs, numbness, weakness, and loss of reflexes. The aim of this study is to assess the long-term effectiveness of quantum molecular resonance disc decompression and its combination with a percutaneous microdiscectomy using Grasper© forceps (QMRG) in patients with persistent lumbar radiculopathy (LR) in relation to patient physical stress status. The main outcome measures of this prospective observational study were DN4, NRS, ODI, SF12, PGI, CGI, and MOS Sleep Scale. An improvement 12 months post-intervention was observed in patients without physical stress, presenting better overall results. The mean change was over the minimal clinically important difference in 64.3% of outcome measures studied for the whole sample. QMRG appears to be an effective treatment option for LR, but a reduction in physical stress is needed to ensure long-term effectiveness.

An Open Label Single Arm Clinical Study on Dashamooladi Yamaka Pratimarsha Nasya and Ashtavargam Kashaya in Vishwachi (Cervical Radiculopathy)

Background: Vishwachi is one among the 80 Vatavyadhi. Lakshana of Vishwachi are Bahu Cheshtapaharana, Bahu Karma Kshaya, Stambha, Ruja, Toda, Spandana, Tandra, Gourava and Arochaka. Cervical radiculopathy is a condition similar to Vishwachi, which results from compression of cervical nerve roots. This leads to neck pain radiating along the distribution of the affected nerve root, numbness, altered reflexes and weakness in the muscles of arm. Objectives: To evaluate the combined effectiveness of Dashamooladi Yamaka Pratimarsha Nasya and Ashtavargam Kashaya in Vishwachi (Cervical Radiculopathy). Materials and methods: 30 subjects fulfilling the inclusion criteria were administered with Dashamooladi Yamaka Pratimarsha Nasya in the dose of 2 Bindu twice daily after food and Ashtavargam Kashaya, 15ml thrice daily after food, for 14 days. Ruja, Toda, Spandana, Sthambha, Tandra, Gourava, Arochaka, Bahukarmakshya, Bahucheshtapaharana and Spurling test were assessed on 1 st day, 7th day and 15th day. Data were analyzed using appropriate statistical tests. Results and conclusion: Statistically significant (P &lt; 0.05) improvement was observed in symptoms such as Bahu Karmakshaya, Bahu Cheshtapaharana, Ruja, Toda, Spandana and range of cervical movement. Dashamooladi Yamaka Pratimarsha Nasya and Ashtavargam Kashaya were found to be effective in the management of Vishwachi.

Management of persistent genital arousal disorder: A case report

Persistent genital arousal disorder (PGAD) is a pathological condition characterized by intrusive, unwanted, and distressing symptoms related to spontaneous and prolonged sensations of genital arousal in the absence of sexual desire or stimulation that may compromise the individual&amp;rsquo;s quality of life. Here, we report the case of a woman who suffered from PGAD probably associated with multiple alterations in the spinal column and Tarlov cyst, which caused the compression of nerve roots and the abnormal sensitivity of the genital region.

Unilateral Biportal Endoscopy for the Treatment of Lumbar Disc Herniation.

Unilateral biportal endoscopy (UBE) is a minimally invasive spinal surgery technique increasingly employed in treating degenerative lumbar diseases, such as lumbar disc herniation, lumbar spinal stenosis, and spondylolisthesis. In UBE, two independent yet interconnected surgical channels are established-one for the endoscope and the other for surgical instruments-providing a broad and clear surgical field of view. UBE offers several advantages over traditional open surgery, including reduced tissue damage, shorter hospital stays, and faster recovery times. Additionally, it combines the benefits of microscopic surgery and interlaminar endoscopy, enhancing flexibility, accuracy, and reliability during the procedure. The learning curve for UBE is shorter than that for transforaminal endoscopy, as the surgical processes closely resemble those of conventional open surgery. Despite its favorable clinical outcomes, such as reduced blood loss and shorter hospitalization, UBE carries potential complications, including epidural hematoma, dural injury, and compression of the outlet nerve root. To mitigate these risks, it is crucial to ensure appropriate patient selection, apply the correct surgical technique, and engage in careful postoperative monitoring. This article provides a detailed summary of the step-by-step surgical techniques used in UBE for treating lumbar disc herniation. It serves as a comprehensive guide to enhance practitioners' understanding of UBE. The presentation also underscores the importance of rigorous training and expertise to ensure optimal patient outcomes.

Minimally invasive treatment of lumbar epidural lipomatosis with local administration of deoxycholic acid

Lumbar epidural lipomatosis (LEL) is a rare neurologic condition characterized by the accumulation of adipose tissue in the spinal canal, leading to nerve root or spinal cord compression and necessitating subsequent surgical decompression in severe cases. We hypothesize that minimally invasive injection of deoxycholic acid (DCA), a medication used for submental fat reduction, may reduce epidural adipose tissue burden, decompress the nerve roots and spinal cord, and reduce symptoms associated with LEL. We propose a phase 1 clinical trial to investigate the safety of DCA injections in patients with LEL. In support of the mechanism of our hypothesis, previous studies have demonstrated that DCA disrupts adipocyte cell membranes, promoting tissue remodeling and reducing adipose tissue volume. DCA injections may represent a viable alternative to surgical decompression, reducing procedural risks to patients as well as decreasing recovery times and healthcare utilization.

Diffusion tensor imaging reveals distributed white matter abnormalities in primary trigeminal neuralgia: Tract-based spatial statistics study

BackgroundPrimary trigeminal neuralgia (PTN) is a prevalent chronic pain disorder whose pathogenesis is not limited to the trigeminal system. Despite the significant advances in uncovering underlying mechanisms, there is a paucity of comprehensive and consistent data regarding the role of white matter throughout the entire brain in PTN. MethodsWe performed a prospective case-control study. Sixty patients with PTN and 28 age- and sex-matched healthy controls were evaluated using diffusion tensor imaging (DTI). A tract-based spatial statistical approach was performed to investigate white matter impairment in patients with PTN with several metrics, including fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD) and axial diffusivity (AD). Additionally, ROI-based analysis was performed for each white matter tract to compare FA values between groups with correction for patient age and sex. Correlations between DTI data and nerve root compression severity, as well as pain severity, were also evaluated in patients with PTN. ResultsOur analysis demonstrated a widespread and symmetrical reduction in FA values among TN patients when compared to the control group (p < 0.05). Specifically, this FA decrease was predominantly observed in regions such as the corona radiata, internal capsule, optic radiation, and thalami, as well as structures within the posterior fossa, notably the cerebellar peduncles. No statistically significant differences were found between patients and the control group during the MD, AD and RD map analyses. ROI-based analysis did not reveal statistically significant changes in FA values in white matter tracts (p > 0.05 in all comparisons, FDR-corrected); however, there were trends towards FA value decreases in the internal capsule (p = 0.08, FDR-corrected) and inferior fronto-occipital fasciculus (p = 0.09, FDR-corrected). ConclusionsOur findings indicate the presence of microstructural abnormalities in white matter among individuals with primary trigeminal neuralgia, which may potentially play a role in the development and progression of the condition.