Unilateral Radiculopathy Research Articles

Association of Abdominal Aortic Calcification and Clinical Outcomes in LDH Patients Treated with Endoscopic Lumbar Discectomy.

To determine any significant associations between abdominal aortic calcification (AAC) and clinical manifestations of pain symptoms following endoscopic lumbar discectomy. Patients sequentially presenting with a history of unilateral radiculopathy with or without back pain, and with magnetic resonance imaging (MRI)-confirmed diagnosis of posterolateral disc herniation between August 2021 and December 2023 were eligible for inclusion in the study. All patients underwent endoscopic discectomy at our center during the study period. AAC stages were classified based on the Kauppila classification system using lateral lumbar radiographs. Between August 2021 and December 2023 a total of 120 patients were included in the study for analysis, of whom 82 (68.3%) exhibited mild AAC and 38 (31.7%) had moderate-severe AAC. Analyses using the multivariate linear regression model revealed a significant correlation between AAC comorbidity and postoperative clinical outcomes. At 1 year post-surgery, the mean change in leg pain following endoscopic lumbar discectomy was significantly less for patients with moderate-severe AAC (5.0 points) than for patients with mild ACC (p < 0.001). Even after adjusting for relevant confounders, this difference remained significant. Similar results were also observed in the postoperative improvement of back pain, the Oswestry Disability Index score, and the physical functioning, role physical, and bodily pain components of the 36-item Short Form Health Survey questionnaire. There was no significant difference in the rate of repeat surgery or post-surgical new-onset back pain between patients with different levels of severity of AAC at 1 year post-surgery. There is a significant association between the severity of AAC and clinical outcomes among patients with lumbar disk herniation who underwent endoscopic lumbar discectomy. AAC may serve as a prognostic factor in predicting surgical outcomes and guiding management strategies for patients with lumbar disk herniation following endoscopic lumbar discectomy.

Neurophysiological Assessment of H-Reflex Alterations in Compressive Radiculopathy.

This study aimed to investigate changes in the H-reflex recruitment curve in compressive radiculopathy, specifically assessing differences between symptomatic and asymptomatic limbs in patients with unilateral S1 radiculopathy through derived parameters. A total of 24 volunteers (15 male and 9 female, aged between 22 and 60 years) with confirmed nerve root compression in the L5/S1 segment participated. Nerve root compression was verified through clinical MRI examination and attributed to disc protrusion, spinal canal stenosis, or isthmic spondylolisthesis of L5/S1. Analysis revealed no difference in M-wave threshold intensity between symptomatic and non-symptomatic limbs. However, the H-reflex exhibited a trend toward increased threshold intensity in the symptomatic limb. Notably, a significant decrease in the slope of the H-reflex was observed on the symptomatic side, and the maximal H-reflex amplitude proved to be markedly different between the two limbs. The Hmax/Mmax ratio demonstrated a significant decrease in the symptomatic limb, indicating reduced effectiveness of signal translation. In conclusion, our findings emphasize the importance of H-reflex parameters in evaluating altered recruitment curves, offering valuable insights for neurological examinations. The observed differences in maximal values of M-wave, H-reflex, and their ratio in affected and unaffected limbs can enhance the diagnostic process for lumbosacral unilateral radiculopathy and contribute to a standardized approach in clinical assessments.

Foot pressure transfers are altered in lumbar radiculopathy but reversible after surgery: a prospective, pedobarography study

BACKGROUND CONTEXTPatients with lower lumbar stenosis and disc herniation report disability in standing and ambulation, despite normal neurological examination. The L5 and S1 nerve roots support the entire motor and sensory function of the foot, and their radiculopathy can affect foot loading during standing and walking. This has not been quantified before. PURPOSETo quantify alterations in static and dynamic foot pressure transfers in patients with lower lumbar nerve root compression, and document any beneficial effects of surgical decompression. STUDY DESIGNProspective, case-control study. PATIENT SAMPLECases—Patients with unilateral radiculopathy (L5/S1) with normal neurology (n=50); Controls - Healthy volunteers (n=50). METHODSThe volunteers and patients underwent pedobarographic analysis during standing (static) and walking (dynamic), and fifteen (12 dynamic and three static) parameters were documented. The patient's preoperative values were compared with that of the healthy volunteers. All the 50 patients underwent surgical decompression, and clinical outcome measures (VAS/ODI at 3 months) were documented. Pedobarographic analysis was repeated in the postoperative period (48 hours) and 3-month follow-up and compared with the preoperative scores. RESULTSIn healthy controls, the mean values of all 15 parameters were comparable between the right and the left side (p>.05). When compared to controls, the patients had significantly lower maximum foot loads (p=.01) and average foot loads (p=.05) on the affected side during walking indicating lesser load transmission, in the preoperative period. Within the affected foot, the load transfer was higher on the first metatarsal/ medial arch while significantly less on the lateral metatarsals (p=.04). The percentage load on whole foot and forefoot was significantly less on standing (p=.01). Significant improvements were noted in the postoperative period, especially in the maximum foot surface area (p=.01), maximum and average foot loads, and improved weight transfers on lateral arch and forefoot (p=.02). The load on whole foot increased significantly from 46.1%±5.5% (preoperative) to 48.1%±5.5% (postoperative) and 49.9%±3.3% at follow-up (p=.01). CONCLUSIONThis is the first study using pedobarography to document altered foot pressure patterns during ambulation in patients with disc herniation and stenosis. Decreased load transfer, asymmetrical and unphysiological distribution of pressures on the affected foot were observed during weight bearing, which improved after surgical decompression.

Minimally invasive anterior cervical foraminotomy for unilateral radiculopathy.

Anterior cervical foraminotomy (ACF) is an alternative surgical option for the treatment of refractory unilateral radiculopathy due to disc herniation or spondylosis. The efficacy and adverse event rate in experienced practitioners are comparable to those of anterior cervical discectomy and fusion, total disc arthroplasty, and posterior foraminotomy. However, this technique has not been widely adopted, likely because of the proximity of the working zone and the vertebral artery. The authors present a detailed operative video of a patient successfully treated with an ACF. They also present a review of the ACF literature. The video can be found here: https://stream.cadmore.media/r10.3171/2024.1.FOCVID23196.

Perspective: Operate on lumbar synovial cysts and avoid ineffective percutaneous techniques.

Lumbar synovial cysts (LSC), best diagnosed on MR studies, may cause symptoms/signs ranging from unilateral radiculopathy to cauda equina compressive syndromes. Attempts at percutaneous treatment of LSC typically fail. Rather, greater safety/efficacy is associated with direct surgical resection with/without fusion. Treatment of LSC with percutaneous techniques, including cyst aspiration/perforation, injection (i.e., with/without steroids, saline/other), dilatation, and/or disruption/bursting, classically fail. This is because LSCs' tough, thickened, and adherent fibrous capsules cause extensive thecal sac/nerve root compression, and contain minimal central "fluid" (i.e., "crank-case" and non-aspirable). Multiple percutaneous attempts at decompression, therefore, typically cause several needle puncture sites risking dural tears (DT)/cerebrospinal fluid (CSF) leaks, direct root injuries, failure to decompress the thecal sac/nerve roots, infections, hematomas, and over the longer-term, adhesive arachnoiditis. Alternatively, many studies document the success of direct or even partial resection of LSC (i.e., partial removal with marked cyst/dural adhesions with shrinking down the remnant of capsular tissue). Surgical decompressions of LSC, ranging from focal laminotomies to laminectomies, may or may not warrant additional fusions. Symptomatic LSC are best managed with direct or even partial operative resection/decompression with/without fusion. The use of varying percutaneous techniques classically fails, and increases multiple perioperative risks.

Transforaminal Endoscopic Lumbar Lateral Recess Decompression for Octogenarian Patients.

The incidence of radiculopathy due to lumbar spinal stenosis has been on the increase in the aging population. However, patients aged ≥ 80 years hesitate to undergo conventional open surgery under general anesthesia because of the risk of postoperative morbidity and adverse events. Therefore, less invasive surgical alternatives are required for the elderly or medically handicapped patients. Transforaminal endoscopic lumbar lateral recess decompression (TELLRD) may be helpful for those patients. This study aimed to demonstrate the efficacy of TELLRD for treating radiculopathy in octogenarian patients. A total of 21 consecutive octogenarian patients with lumbar foraminal stenosis underwent TELLRD between January 2017 and January 2021. The inclusion criterion was unilateral radiculopathy, which stemmed from lumbar lateral recess stenosis. The pain source was verified using imaging studies and selective nerve blocks. Full-scale lateral canal decompression was performed using a percutaneous transforaminal endoscopic approach under local anesthesia. We found the pain scores and functional status improved significantly during the 24-month follow-up period. The clinical improvement rate was 95.24% (20 of 21 patients) with no systemic complication. In conclusion, endoscopic lateral recess decompression via the transforaminal approach is practical for octogenarian patients.

Does a Positive Response to Transforaminal Epidural Steroid Injection Identify Patients Who Can Avoid Surgery for Two Years?

Transforaminal epidural steroid injection (TFESI) is widely used to manage lumbar radiculopathy. In clinical settings, patients often undergo repeated transforaminal epidural injections with or without steroid administration. To examine whether a positive response to TFESI at the first month, can in clinical settings, identify patients with radiculopathy who can avoid surgery for two years. Study Design/Setting. This prospective observational study was conducted at an academic medical center. Individuals aged ≥20 years who had been referred to our pain center by spine surgeons were enrolled. All patients were assessed using the Numerical Rating Scale (NRS) at baseline and 1 month after the first TFESI. Patients were divided into two groups according to the NRS decrement: the positive response (PR) group achieved a ≥2.0 decrease on the NRS 1 month after the first TFESI compared to baseline and the no response (NR) group achieved a <2.0 decrease on the NRS. The incidence rates of surgery over two years were compared between the two groups. In addition, we calculated the hazard ratio of the PR group to the NR group regarding the incidence of surgery over two years using the Cox proportional hazard model, adjusting for baseline NRS. Seventy-six patients completed the two-year follow-up. In total, 8 and 68 patients had bilateral and unilateral radiculopathy, respectively. The PR and NR groups included 35 and 41 patients, respectively. The rate of surgery avoidance was 85.7% and 73.2% in the PR and NR groups, respectively. This difference was not statistically significant (p=0.26). After adjusting for baseline NRS, the hazard ratio of the PR group to the NR group regarding the incidence of surgery within two years was 0.35 (95% confidence interval: 0.11-1.11, p=0.08). A positive response to TFESI may not identify patients who can avoid surgery for two years.

Lumbar Disc Herniation with Contralateral Symptoms: A Case-Series of 11 Patients and Literature Review.

Lumbar disc herniation (LDH) is a common pathology that typically causes unilateral radiculopathy on the same side as herniation, while patients may occasionally present with contralateral symptoms. Owing to the rare incidence of LDH with contralateral symptoms, the pathological mechanism remains unclear and the optimal surgical strategy is a subject of debate. This study aimed to provide new insights into the pathological mechanism of contralateral symptoms and assess the efficacy of ipsilateral hemilaminectomy and discectomy surgery in this population. This study was a retrospective, single-center, clinical case series, including 11 LDH cases with exclusive contralateral symptoms. We searched for LDH cases that were presented at our institution between January 2011 and December 2020. Adult LDH Patients with contralateral radicular pains were included, while those with ipsilateral radiculopathy, lumbar stenosis, foraminal stenosis on the symptomatic side, multilevel disc herniations, scoliosis, and lumbar operation history were excluded. Visual Analog Scale (VAS), clinical features, radiographic images, and other data were collected from the study cohort of 11 cases for further analysis. We also reviewed LDH cases in English literature from 1978 to 2023 to analyze their clinical characteristics and treatment. The incidence rate of LDH with contralateral symptoms in single-level LDH cases was 0.32%. The average age of our 11 cases was 49.3 years old, and five of them were female (45.5%). All individuals had single-level lateral LDH, with six cases (54.5%) located at L4-5 and five cases (45.5%) located at L5-S1. Upon admission, patients presented with lower back pain (seven cases, 63.6%), radicular pain (seven cases, 63.6%), hypoesthesia (seven cases, 63.6%), and muscle weakness (one case, 9.1%) on the contralateral side alone. Each case experienced ipsilateral hemilaminectomy and discectomy, and no lateral recess stenosis, hypertrophy of facets or ligaments, and sequestrated discs were found during surgery. All of them have good pain relief with two cases reporting no pain and nine cases reporting only mild pain at the last follow-up. Based on the surgical findings of our 11 LDH cases with contralateral symptoms, we hypothesized that the contralateral symptoms might be produced when the nerve root on the contralateral symptomatic side was tightly pulled by the herniated disc via the dural mater. Ipsilateral hemilaminectomy and discectomy surgery effectively and efficiently relieve the symptoms without postoperative complications for these patients.

S1 Transforaminal Epidural Anesthesia in Percutaneous Transforaminal Endoscopic Discectomy: A Case-Series Study.

Percutaneous transforaminal endoscopic discectomy (PTED) has become popular over the years due to its safety and low invasiveness. This surgery can be performed with different anesthesia techniques; however, the extent to which the surgeon and patient are satisfied with the analgesia is debatable. This study investigated the efficiency of the S1 transforaminal epidural block. This retrospective study was conducted on 60 patients with L4 - L5 lumbar disc herniation who underwent PTED under the S1 transforaminal epidural block. All patients had clinical symptoms associated with unilateral radiculopathy and were candidates for surgery. Percutaneous transforaminal endoscopy and S1 epidural block were performed by a surgeon for all patients. Of the 60 evaluated cases, 61.7% and 38.3% were female and male, respectively, with a mean age of 42.98 ± 10.79 years. The mean pain score before surgery was 7.83 ± 0.69, which decreased to 2.58 ± 0.65 during surgery and 0.50 ± 0.50 48 hours after surgery (P < 0.001). The mean duration of operation in these patients was 58.58 ± 16.95 minutes, and the mean onset time was 10.08 ± 3.12 minutes. Moreover, the mean bleeding was 124.17 ± 25.20 cc. The PTED with S1 epidural anesthesia is a simple, safe, and effective method that causes good analgesia during the operation and cooperates well with the surgeon in neurological monitoring due to patient consciousness.

Comparison of Single-level Cervical Radiculopathy Outcomes Between Posterior Endoscopic Cervical Decompression and Anterior Cervical Discectomy and Fusion: Mid-term Results.

A retrospective cohort study. To investigate the mid-term results and technical possibilities of posterior endoscopic cervical decompression (PECD) in the treatment of cervical radiculopathy. PECD has been used in the treatment of cervical radiculopathy for the past decades; there is a paucity of studies directly comparing its outcomes with anterior cervical discectomy and fusion (ACDF) for patients with single-level cervical radiculopathy. From January 2016 to December 2018, clinical and radiologic data of 42 patients were collected. Patients were followed for a mean of 40.6 months (range: 30-54 mo) after surgery. Changes in cervical lordosis and degeneration of adjacent segments were analyzed. Dysphagia was assessed using the Bazaz score, and clinical outcomes were analyzed using the Neck Disability Index and visual analog scoring system. There were no significant differences in neurological outcomes between the two groups. Significant between-group differences in postoperative dysphagia were observed ( P < 0.05). There were significant differences in postoperative segmental Cobb angles and disc height between the two groups ( P < 0.05). Degenerative changes in the adjacent segments occurred in 5 patients in the ACDF group and 1 patient in the PECD group ( P < 0.05); no revision surgery was needed. Clinical outcomes of PECD for patients with unilateral radiculopathy were satisfactory. On the premise of a strict selection of indications, we consider this technique to be a safe supplement and alternative to ACDF for patients with unilateral cervical radiculopathy. Longer follow-up periods are required to confirm these observations.

Combined cervical laminoplasty and foraminotomy for coexistence of cervical myelopathy and unilateral radiculopathy: case series and preliminary results.

The clinical outcomes and radiographic changes of a one-stage procedure combining cervical laminoplasty and unilateral cervical foraminotomy for patients with coexisting cervical myelopathy and unilateral radiculopathy were evaluated. Seven patients (two females and five males) with coexisting cervical myelopathy and unilateral cervical radiculopathy were included in this study. The mean age was 58.4years (range 45-77years). Cervical laminoplasty and unilateral cervical foraminotomy were performed on the recruited patients in a single stage. The quantitative clinical changes between the preoperative and 6-month postoperative assessment were analyzed using the Japanese Orthopedic Association (JOA) score, the JOA Cervical Myelopathy Evaluation Questionnaire (JOA-CMEQ), visual analog scale (VAS), and Neck Disability Index (NDI). Moreover, the preoperative and 6-month postoperative radiographic changes were assessed using the C2-7 angle and range of motion (ROM) between flexion and extension angle. There were significant differences in QOL in the JOA-CMEQ between the groups. Furthermore, the postoperative VAS values in the arms and hands generally improved, although not significantly, between the groups. The aforementioned surgical procedure may be safe and efficient for patients with coexisting cervical myelopathy and radiculopathy.

Predictable factors for aggravation of cervical alignment after posterior cervical foraminotomy.

This study aimed to investigate the risk factors for aggravation of cervical alignment after posterior cervical foraminotomy (PCF) and to identify their relationships with kyphotic changes in cervical curvature. Ninety-eight patients who underwent PCF for unilateral radiculopathy and received follow-up for more than 2 years were retrospectively reviewed. Segmental Cobb angle (SA), cervical Cobb angle (CA), Pfirrmann grade, foraminal stenosis, and clinical outcomes including neck pain, arm pain, and Neck Disability Index scores were assessed. Radiological and clinical outcomes were compared between groups C (control group with kyphotic change in CA < 5°) and K (kyphotic group with kyphotic change in CA ≥ 5°). Multivariate regression analysis was performed to determine the risk factors for kyphotic change ≥ 5° after PCF. Group K was significantly older than group C (p = 0.002) and had a higher Pfirrmann grade (p = 0.025). In group K, neck pain had significantly increased at last follow-up (p < 0.001). Multivariate linear regression analysis revealed that kyphotic changes in CA were related to older age (p = 0.016, B = 0.420) and Pfirrmann grade of the operative levels (p = 0.032, B = 4.560). Preoperative hypolordosis was not an independent risk factor for kyphotic changes in CA. Receiver operating characteristic curve analysis showed that the cutoff value for kyphotic changes in patients with CA ≥ 5° was Pfirrmann grade 3.417 (p = 0.008). Contrary to previous studies, preoperative hypolordosis was not a risk factor for kyphotic changes in CA after PCF. Older patients with disc degeneration of Pfirrmann grade IV or greater for should be carefully considered.

Unilateral radiculopathy away from the puncture site due to adhesive arachnoiditis after spinal anesthesia for an emergent cesarean delivery: a case report

BackgroundAdhesive arachnoiditis has been described as a deteriorating neurological complication after neuraxial blockade; however, few pieces of literatures have reported minor cases that resemble peripheral neuropathy.Case presentationA 29-year-old nulliparous woman underwent an emergent cesarean delivery under spinal anesthesia at the second and third lumbar interspace (L2/3) without any specific concerns. Subsequently, she developed left L5 and sacral first (S1) radiculopathy that persisted for 2 months. Although the neurological findings more likely indicated peripheral neuropathy, magnetic resonance imaging revealed localized adhesive arachnoiditis at the left L5/S1 level. Her symptoms gradually improved and entirely disappeared within 2 months without any particular treatment.ConclusionThe neurological symptoms that show a clear tendency to improve spontaneously do not always undergo a detailed workup. Therefore, such minor adhesive arachnoiditis might have occurred more than expected. Imaging such cases might cumulatively further the understanding of its etiology.

Foraminal Stenosis at L5-S1 as an Overlooked Pathology of Bilateral Radiculopathy: A Case Series.

The classical symptom of foraminal stenosis is unilateral radiculopathy. Bilateral radiculopathy caused purely by foraminal stenosis is rare. Here, we report five cases of bilateral L5 radiculopathy caused purely by L5-S1 foraminal stenosis and describe the clinical and radiological features of these patients in detail. Among the five patients, two were men and three were women with an average age of 69 years. Four patients had undergone surgeries at L4-5 level, previously. All the patients showed an improvement in symptoms in the post-operative period. After a certain period, the patients complained of bilateral leg pain and numbness. An additional surgery was performed in two patients; however, there was no improvement in symptoms. One patient, who did not undergo surgery, was treated conservatively for 3 years. All the patients had been suffering from bilateral leg symptoms before their first visit to our hospital. The neurological findings in these patients were consistent with bilateral L5 radiculopathy. The average pre-operative Japanese Orthopedic Association (JOA) score was 13 out of 29 points. Bilateral foraminal stenosis at L5-S1 level was confirmed using a three-dimensional magnetic resonance imaging or computed tomography. Posterior lumbar interbody fusion was performed in one patient and bilateral lateral fenestration using Wiltse's approach was performed in four patients. The neurological symptoms recovered immediately after surgery. The average JOA score at 2-year follow-up was 25 points. Spine surgeons may overlook the pathology of foraminal stenosis, particularly in patients with bilateral radiculopathy. Familiarity with the clinical and radiological features of symptomatic lumbar foraminal stenosis is necessary to properly diagnose bilateral foraminal stenosis at L5-S1 level.

A series of transforaminal epidural steroid injections in acute lumbar disc herniation with unilateral radiculopathy

Objective: To evaluate functional outcomes of patients suffering from unilateral lower limb radiculopathy due to lumbar disc herniation conservatively treated with transforaminal epidural steroid injection (TFESI). Materials and Methods: It is a prospective study of 100 patients. We correlated clinical findings with magnetic resonance imaging. The patients are treated with dexamethasone injection through transforaminal epidural space under C-ARM guidance using Kambin's triangle approach with follow-up at 3 weeks, 6 weeks, 9 weeks, 12 weeks, and 24 weeks. Assessment of functional outcomes is done by visual analog scale (VAS) and modified Oswestry disability index (ODI). Results: Eighty-eight percent of patients significantly improved their radicular pain, according to the VAS scoring system and modified ODI. The mean modified ODI score of preinjection was found to be 64.18; it was reduced to 33.9 at 3 weeks, 30.82 at 6 weeks, 24.04 at 9 weeks, 22.04 at 12 weeks, and 19.38 at 6 months. The t = 18.49 and the P < 0.00001. Preinjection mean VAS was 8, 3.98 at 3 weeks, 3.28 at 6 weeks, 3.04 at 9 weeks, 2.72 at 12 weeks, and reduced to 2.14 at 24 weeks. The t = 19.83 and the P < 0.00001. There were no complications seen during our study. Conclusion: Our study justifies that unilateral lower limb radiculopathy due to lumbar disc herniation can be well managed by TFESI without any complication. It is very less invasive technique, safe, and effective for pain relief.

Does Unilateral Lumbosacral Radiculopathy Affect the Association between Lumbar Spinal Muscle Morphometry and Bone Mineral Density?

Age-related degenerative changes lead to a gradual decrease in bone mineral density (BMD) and muscle mass. We aimed to assess the effects of decreased BMD and lumbar denervation on lumbar spinal muscle morphometry and the relationship between BMD and lumbar spinal muscular morphometry, respectively. Eighty-one patients, aged 50–85 years, diagnosed with unilateral lumbosacral radiculopathy based on electrodiagnostic studies between January 2016 and April 2021 were enrolled. BMD T scores in the lumbar spine and hip were measured using dual-energy X-ray absorptiometry. The cross-sectional area (CSA) of the psoas, multifidus, and erector spinae located in the middle of the lumbar spine, between the L3 and L4 and between the L4 and L5 levels, respectively, was measured using axial MRI. Functional CSA (FCSA) was defined as the CSA of lean muscle mass. Pearson correlation analyses were performed to evaluate the association between BMD T scores and the CSA, FCSA, and the ratio of the FCSA to the CSA (functional ratio) for each side. The CSA of lumbar spinal muscles showed no significant correlation with lumbar BMD. The FCSA and functional ratio of lumbar spinal muscles were significantly correlated with lumbar BMD. There was no correlation between femur BMD and lumbar spinal muscle morphometry.

The reference intervals of intraoperative posterior tibial nerve somatosensory evoked potentials

BackgroundA reference interval exists for posterior tibial nerve somatosensory evoked potentials (PTN-SEPs) in awake. However, the reference interval for intraoperative- PTN-SEPs (I-PTN-SEPs) remains unclear. As a substitute for PTN-SEPs in awake, we considered I-PTN-SEPs can provide functional information about the dorsal somatosensory system. No report evaluated the physiologic and analytical issues in the measurement of I-PTN-SEPs. We investigated the sources of variation and reference intervals for I-PTN-SEPs. MethodsWe studied 143 patients with unilateral radiculopathy and without neurologic deficit who underwent surgery. Stimulation was delivered to the PTN at the ankle. The scalp recording electrode was placed at the Cz with a reference electrode located on the forehead at the Fz. SEPs were recorded from patients during electrical stimulation of the I-PTN. ResultsP1 and N1 latencies showed significant positive linear correlations with age (P1 latency = 36.52 + 0.0814 × age, P = 0.00003; N1 latency = 46.21 + 0.081 × age, P = 0.00022), and body height (P1 latency = 16.94 + 14.91 × body height, P = 0.00000; N1 latency = 25.42 + 15.64 × body height, P = 0.00002). In contrast, I-PTN-SEPs amplitude showed no correlation with age or body height. The 95% confidence interval for I-PTN-SEPs amplitude, or the reference interval, was determined as 0.31–5.91 μV. ConclusionsThe lower normal limit value was 0.31 μV, and this reference interval may be useful to evaluate function of the posterior funiculus, such that as during surgery for patients with intramedullary tumor.

Functional Outcome after Fenestration and Discectomy in Young Adults Presenting with Unilateral Radiculopathy

Introduction: Lumbar disc herniation is one of the common ailments in young adults. The common levels of L4-L5 and L5-S1 have been chosen for ours. The Evaluation was done based on the level of disc herniation and also with different types of disc herniation such as contained, extruded, or sequestrated disc herniations. The outcomes were evaluated using the Japanese Orthopedic Association (JOA) scoring system. Methods: Thirty-three patients with a single-level disc herniation at L4-L5 or L5-S1 who did not show significant improvement of radiculopathy even after a conservative trial were included in the study. All patients were consented and subjected to surgery-unilateral fenestration and fragment discectomy. Patients were evaluated based on their JOA Scoring which was done preoperatively and postoperatively on day 10 and at 1 month, 3 months, 6 months, and 1 year. The functional outcome in percentage was calculated using the “recovery rate” by the Hirabayashi index. Results: Following fenestration discectomy, the functional outcome of the patient was found to be good. O the 33 patients operated, males n = 20 and females n = 13. According to Hirabayashi's recovery rate, 48% (n = 16) patients were found to have an excellent result with recovery rate of &gt;80%. Good results were seen in 43% (n = 14) with recovery rates ranging between 70% and 80%. About 3% (n = 1) had a fair result with recovery rate of 56% and 6% (n = 2) had poor results with recovery rate &lt; 50% following surgery. Applying the paired t-test, P was calculated and was 0.0001 which is statistically significant. Complications included incidental durotomy, pseudomeningocele, recurrent disc herniation, and spondylodiscitis. Conclusion: Patients who underwent fenestration discectomy for single-level lumbar disc herniation at L4/5 or L5/S1 showed significant functional improvement as per JOA scoring and Hirabyashi's recovery rate. The results were comparable with newer techniques such as micro and endoscopic discectomy.

Clinical parameters predicting successful outcomes following transforaminal epidural selective nerve root blocks for acute lumbar disc herniation

Background: The lifetime prevalence of radiculopathy due to a herniated lumbar disc is estimated to be around 4% in females and 5% in males. The efficacy of SNRB in acute LDH has been quoted variedly in previous studies ranging from 30% to 80% [6]. There are only a few studies which identify the various clinical parameters that can predict successful outcomes in patients undergoing SNRB. Methods: The prospective study was conducted at Mahatma Gandhi Missions Hospital Navi Mumbai, between March 2019 and February 2020.During the study period, total 60 patients with documented LDH on magnetic resonance imaging (MRI), presenting with unilateral radiculopathy, with symptom duration of less than 3 months who had failed adequate conservative management of about 3 weeks duration were treated with transforaminal. Result: Out of the 60 patients which were included in the study, 50 patients had adequate pain relief for the study period of one year while 10 patients did not have sufficient relief of pain. Thus Transforaminal SNRB had an efficacy of 83.33% in our study. In our study out of the 60 patients 32 had right side involvement and 28 had left side involvement. Out of those having right side involvement 26 had successful and 6 had unsuccessful outcome while 28 had left side involvement in which 25 had successful outcome and 3 had unsuccessful outcome and the p value was insignificant for this clinical parameter. Conclusion: Transforaminal Selective Nerve Root Block had an efficacy of 83.33% in our study. It is an efficient technique which provides adequate pain relief for about one year.

Percutaneous uniportal versus biportal endoscopic posterior cervical foraminotomy for unilateral cervical radiculopathy with cervical foraminal disc disease

Percutaneous uniportal versus biportal endoscopic posterior cervical foraminotomy for unilateral cervical radiculopathy with cervical foraminal disc disease