Aims. To identify the incidence and risk factors for five-year same-site recurrent
Aims. The aim of this study was to investigate whether the type of cervical
Aims. The aim of this study was to determine the efficacy of repeat epidural steroid injections as a form of treatment for patients with insufficiently controlled or recurrent radicular pain due to a lumbar or cervical
Multiple thoracic
Objective: To asses the outcome of hermivertebrectomy and fusion for symptomatic thoracic
Introduction and Aims: Recurrent
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 discography. Significant predictors of clinical findings were identified by univariate and multivariate analyses. Loading conditions were applied in FEM simulations to mimic biomechanical effects on intervertebral discs, focusing on maximal displacement and intradiscal pressures, gauged through alterations in disc morphology and physical stress. Results. A total of 144 discs were categorized as ‘positive’ and 174 discs as ‘negative’ by the results of provocation discography. The presence of defined facet tropism (OR 3.451, 95% CI 1.944 to 6.126) and higher Adams classification (OR 2.172, 95% CI 1.523 to 3.097) were important predictive parameters for discography-‘positive’ discs. FEM simulations showcased uneven stress distribution and significant disc displacement in tropism-affected discs, where loading exacerbated stress on facets with greater angles. During varied positions, notably increased stress and displacement were observed in discs with tropism compared to those with normal facet structure. Conclusion. Our findings indicate that facet tropism can contribute to
Background: Many studies have examined magnetic resonance images (MRI) with a view to the anatomy and signaling properties of the intervertebral disc and adjacent tissues in asymptomatic populations. In this study we have examined MRIs of a discrete population of patients undergoing surgery for symptomatic
Studies on recurrent
Background: The dermatomal drawings used in clinical practice are based on questionable experiments performed in the 1930s. Though widely used in the clinical practice to identify the level of nerve root irritation, this may not be a reliable practise. Purpose: To identify the pain distribution and overlap of single level L4, L5 and S1nerve root irritation. Methods: 187 patients with radicular pain to or below the knee made a precise drawing of their pain distribution and then underwent a MRI scan. Only patients identified as having a single level
Magnetic resonance imaging (MRI) was used to compare the appearance of the spine in 20 adolescents with proven symptomatic intervertebral disc herniations with that in 20 asymptomatic patients who acted as controls. Abnormality in the signal from the nucleus pulposus of one or more discs was present in all patients, while only four of the 20 controls had any abnormal signals. In all the patients the symptomatic disc produced an abnormal signal and in most a herniated fragment of the nucleus pulposus was identified. Fifteen of the 20 patients had multiple-disc abnormality: six had three abnormal discs and nine had two. This suggests there was an underlying diathesis in patients who later developed
The purpose of this study was to highlight uncommon and confusing clinical problem of unilateral prolapsed intervertebral disc (PIVD) producing contralateral symptoms based on case reports and literature review. Four cases of patients with disc prolapse contralateral to the symptomatic limb are presented. Two patients had cervical
The aim of this study was to assess whether the pro-lapsed disc fragment type was predictive of recurrent
Introduction: The purpose of this case report is to highlight an unusual presentation of a well-described but rare condition (idiopathic spinal epidural lipomatosis) in association with a commonly presenting problem (far-lateral disc herniation). Methods: Retrospective case report and review of the literature. Results: A 46-year-old Caucasian male presented with right L5 radiculopathy secondary to a far-lateral lumbosacral disc protrusion, confirmed on MRI scanning. Treatment consisted of a right L5 foraminal steroid injection with a 50% improvement in symptoms. This was soon followed by symptoms of spinal stenosis, and repeat MRI showed worsening of idiopathic spinal epidural lipomatosis seen on the initial scan. Over this period the patient had been unable to exercise regularly and had gained 10 kg of weight. Nonoperative treatment, including a supervised Xenical weight-reduction program (which was unsuccessful), failed to alleviate his symptoms so operative decompression was performed, with satisfactory resolution of the stenotic symptoms. Discussion: Spinal epidural lipomatosis may be idiopathic or secondary to excess steroids (endogenous or exogenous). It affects either the thoracic or lumbar spine. Treatment options are withdrawal of exogenous steroids, weight reduction or decompressive surgery. In this case, disability associated with a far-lateral
Thirteen patients with symptomatic
Aim: To investigate the effectiveness of Adcon-L in re-discectomy and/or surgical neurolysis compared to autologous fat graft. Methods: A total of 50 patients with recurrent
Introduction: Discectomy for herniation of the nucleus pulposus is an effective procedure when conservative treatment has failed. However, a number of patients rapidly progress to symptomatic instability after discectomy. Those most likely to develop instability have central and multi-regional herniations. Therefore, primary posterior lumbar interbody fusion (PLIF) may be a better option than discectomy alone in this group. This paper presents the clinical and radiological outcome of a consecutive group of such patients treated in one centre by PLIF, but recognises that newer technologies may make such destructive spinal surgery unnecessary in the future. Methods: Between June 1997 and December 2000, PLIF for central
INTRODUCTION: Discectomy for herniation of the nucleus pulposus is an effective procedure when conservative treatment has failed. However, a number of patients rapidly progress to symptomatic instability after discectomy. Those most likely to develop instability have central and multi-regional herniations. Therefore, primary posterior lumbar interbody fusion (PLIF) may be a better option than discectomy alone in this group. This paper presents the clinical and radiological outcome of a consecutive group of such patients treated in one centre by PLIF, but recognises that newer technologies may make such destructive spinal surgery unnecessary in the future. METHODS: Between June 1997 and December 2000, PLIF for central
We describe a rare herniation of the disc at the C2/C3 level in a 73-year-old woman. It caused hemicompression of the spinal cord and led to the Brown-Sequard syndrome. The condition was diagnosed clinically and by MRI six months after onset. Discectomy and fusion gave complete neurological resolution.