Aims. The presence of facet tropism has been correlated with an elevated susceptibility to lumbar disc pathology. Our objective was to evaluate the impact of facet tropism on chronic lumbosacral discogenic pain through the analysis of clinical data and finite element modelling (FEM). Methods. Retrospective analysis was conducted on clinical data, with a specific focus on the spinal units displaying facet tropism, utilizing FEM analysis for motion simulation. We studied 318 intervertebral levels in 156 patients who had undergone provocation
The National Institute for Health and Care Excellence
has issued guidelines that state fusion for non-specific low back
pain should only be performed as part of a randomised controlled
trial, and that lumbar disc replacement should not be performed.
Thus, spinal fusion and disc replacement will no longer be routine
forms of treatment for patients with low back pain. This annotation
considers the evidence upon which these guidelines are based. Cite this article:
Introduction. Degenerative disc disease results from mechanical alteration of the intervertebral disc. Biochemical modifications of the nucleus matrix are also incriminated. Furthermore, genetic predispositions as well as vascular factors have been advocated in the process of disc degeneration. A relationship between sciatica and Propionibacterium acnes has been described. However, it remains unclear if the hypothesis of a subclinical spondylodiscitis might play a role in the pathophysiology of degenerative disc disease. The purpose of this study was to analyze the possible presence of bacteria in lumbar discs of patients with degenerative disc disease. Methods. We prospectively analyzed the presence of bacteria in 83 patients (34 males and 49 females, average age 41 years) treated by lumbar disc replacement at L3-L4, L4-L5 or L5-S1. An intraoperative biopsy and microbiological culture were performed for each disc to determine if intradiscal bacteria were present. Great care was taken to avoid any source of contamination during the conditioning process of the biopsy. Microbiological results were compared to the magnetic resonance stages of disc degeneration according to the Pfirrmann and Modic classifications. Possible sources of previous iatrogenic disc contamination after
Introduction. We report the outcomes of minimally invasive technique for posterior lumbar interbody fusion (PLIF) procedure using Hollow Modular Anchorage (HMA) screws supplemented by routine pedicle screw fixation (Dynesis). Patients and Methods. Seventy-nine patients, who had undergone PLIF procedure using HMA screws supplemented by pedicle screw fixation, were included. Patients deemed suitable for surgery following
The June 2012 Spine Roundup360 looks at: back pain; spinal fusion for tuberculosis; anatomical course of the recurrent laryngeal nerve; groin pain with normal imaging; the herniated intervertebral disc; obesity’s effect on the spine; the medicolegal risks of cauda equina syndrome; and intravenous lidocaine use and failed back surgery syndrome.
We conducted a prospective follow-up MRI study
of originally asymptomatic healthy subjects to clarify the development
of Modic changes in the cervical spine over a ten-year period and
to identify related factors. Previously, 497 asymptomatic healthy
volunteers with no history of cervical trauma or surgery underwent
MRI. Of these, 223 underwent a second MRI at a mean follow-up of
11.6 years (10 to 12.7). These 223 subjects comprised 133 men and 100
women with a mean age at second MRI of 50.5 years (23 to 83). Modic
changes were classified as not present and types 1 to 3. Changes
in Modic types over time and relationships between Modic changes
and progression of degeneration of the disc or clinical symptoms
were evaluated. A total of 31 subjects (13.9%) showed Modic changes at
follow-up: type 1 in nine, type 2 in 18, type 3 in two, and types In the cervical spine over a ten-year period
The management of discogenic pain continues to be controversial. The results for operative and non-operative management are variable. This study aims to look at the results of interbody fusion versus dynamic stabilisation in patients with discogenic pain. Diagnosis was made by use of MRI and provocative
To assess the effectiveness of dynamic stabilisation as a treatment for discogenic pain compared to standard treatment of interbody fusion. All patients were referred for a 2 year back-pain management programme. Patients with continued pain following conservative treatment underwent
Purpose. By systematic literature review, to quantify the association between vertebral endplate signal changes (VESC) and non-specific low back pain (NSLBP). Materials and methods. MEDLINE, EMBASE, and SveMED databases were searched for the period 1984 to June 2009. Articles were included which investigated the association between VESC and NSLBP and reported sufficient data to construct two-by-two tables. Articles on specific low back pain conditions were excluded. A standardised data collection and quality assessment were performed. To estimate the association between VESC and NSLBP, two-by-two tables were created and exact odds ratios were calculated with 95% confidence intervals (CI). Meta-analysis was performed on homogeneous studies. Results. Fourteen articles met the inclusion criteria. A statistically significant positive association between VESC and NSLBP was found in 10 of 14 studies from the general, working, and clinical populations with odds ratios ranging from 2.0 to 27.9. Two of the other four studies showed positive associations, one study a neutral association and the other a negative association but all these results were not statistically significant. Meta-analysis of the eight
Objective. To assess the effectiveness of dynamic stabilisation as a treatment for discogenic pain compared to standard treatment of interbody fusion. Study Design & Subjects. All patients were referred for a 2 year back-pain management programme. Patients with continued pain following conservative treatment underwent
Recurrence of back or leg pain after discectomy
is a well-recognised problem with an incidence of up to 28%. Once conservative
measures have failed, several surgical options are available and
have been tried with varying degrees of success. In this study,
42 patients with recurrent symptoms after discectomy underwent less
invasive posterior lumbar interbody fusion (LI-PLIF). Clinical outcome
was measured using the Oswestry Disability Index (ODI), Short Form
36 (SF-36) questionnaires and visual analogue scales for back (VAS-BP)
and leg pain (VAS-LP). There was a statistically significant improvement
in all outcome measures (p <
0.001). The debate around which
procedure is the most effective for these patients remains controversial. Our results show that LI-PLIF is as effective as any other surgical
procedure. However, given that it is less invasive, we feel that
it should be considered as the preferred option.
Purpose of the study: Indications for disc prosthesis is generally established on the basis of the MRI findings (MODIC classification) and the
Purpose: To report the clinical and radiographic prospective results of a consecutive series of patient with a minimum two year follow-up with the Charite Total Disc Arthroplasty (TDA). Method: Between 2001 and 2005, sixty patients underwent a Charite TDA (Depuy Spine, Raynham, MA) at either L4-5 or L5-S1. The primary indication for surgery was discogenic low back pain confirmed by provocative
Prospective match cohort study of disc degeneration progression over ten years with and without baseline
Coccydynia is a painful disorder characterised by coccygeal pain which is typically exaggerated by pressure. It remains an unsolved mystery because of the perceived unpredictability of the origin of the pain, some psychological traits that may be associated with the disorder, the presence of diverse treatment options, and varied outcomes. A more detailed classification based on the aetiology and pathoanatomy of coccydynia helps to identify patients who may benefit from conservative and surgical management. This review focuses on the pathoanatomy, aetiology, clinical features, radiology, treatment and outcome of coccydynia.
Background: Over several decades, investigators have been trying to identify the painful degenerate disc. Their work included two main methods. The first was to set criteria on the radiological investigations, mainly the MRI scan, to describe the severity of the degenerative disc disease (DDD); and the second was to perform