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.
We evaluated the nerve roots of the cauda equina by CT myelography in 36 patients aged from 11 to 19 years with lumbar disc herniation. On straight-leg-raising tests, six younger patients had isolated hamstring tightness with no sciatica (group A) and 30 had sciatic pain (group B). CT myelography showed that no patient in group A had associated nerve-root swelling, and that the roots were displaced posteriorly, but not compressed. In 21 of the group-B patients, swelling of the nerve roots was confirmed, with compression between the herniated disc and the superior articular process. Our findings suggest that hamstring tightness in these patients may be caused by a different mechanism from that which causes sciatic pain.
Despite the clinical relevance of back pain and intervertebral disc herniation, the lack of reliable models has strained their molecular understanding. We characterized the lumbar spinal phenotype of C57BL/6 and SM/J mice during aging. Interestingly, old SM/J lumbar discs evidenced accelerated degeneration, associated with high rates of
Aims. The aim of the study was to determine if there was a direct correlation between the pain and disability experienced by patients and size of their disc prolapse, measured by the disc’s cross-sectional area on T2 axial MRI scans. Methods. Patients were asked to prospectively complete visual analogue scale (VAS) and Oswestry Disability Index (ODI) scores on the day of their MRI scan. All patients with primary
Background. It has become increasingly important to conduct studies assessing clinical outcomes, reoperation rates, and revision rates to better define the indications and efficacy of lumbar spinal procedures and its association with symptomatic adjacent segment degeneration (sASD). Adjacent segment degeneration (ASD) is defined as the radiographic change in the intervertebral discs adjacent to the surgically treated spinal level. SASD represents adjacent segment degeneration which causes pain or numbness due to post-operative spinal instability or nerve compression at the same level. The most common reason for early reoperation and late operation is sASD, therefore is in our best interest to understand the causes of ASD and make steps to limit the occurrence. Method. A comprehensive literature search was performed selecting Randomized controlled trials (RCTs) and retrospective or prospective studies published up to December 2023. Meta-analysis was performed on 38 studies that met the inclusion criteria and included data of clinical outcomes of patients who had degenerative disc disease,
Abstract. Objectives. There is still controversy in the literature over whether Cervical Foraminotomy or Anterior Cervical discectomy and fusion (ACDF) is best for treating cervical Radiculopathy. Numerous studies have focused on the respective complication rates of these procedures and outcome measures with a lack of due consideration to preoperative MRI findings. Proximal foraminal stenosis can theoretically be accessed via either approach. We aimed to investigate whether patient reported outcome measures (PROMs) favoured one approach over the other in patients with proximal foraminal stenosis. Methods. A single centre retrospective review of patients undergoing either ACDF or Cervical foraminotomy over the period 2012 to 2022. VAS, Neck disability index (NDI), EQ5DL and Patient Satisfaction on a Five Point Likert scale were obtained. Patients who had both an ACDF and a Foraminotomy were excluded. Axial MRI images were analysed and the location of the worst clinically relevant
With the increase in the elderly population, there is a dramatic increase in the number of spinal fusions. Spinal fusion is usually performed in cases of primary instability. However it is also performed to prevent iatrogenic instability created during surgical treatment of spinal stenosis in most cases. In literature, up to 75% of adjacent segment disease (ASD) can be seen according to the follow-up time. 1. Although ASD manifests itself with pathologies such as instability, foraminal stenosis,
Background. FORECAST is a prospective longitudinal cohort study exploring mechanism-based prognostic factors for pain persistence in sciatica. Here, we share an update on this largest deeply-phenotyped primary care sciatica cohort. Methods/results. Our cohort includes 180 people with sciatica (score >4 on Stynes’ Sum Score), aged 18–85, within 3 months of symptom onset. Psychosocial factors, self-reported sensory profiling, clinical examination, quantitative sensory testing (QST), biological samples (blood and skin samples), and Magnetic Resonance Neurography of lumbar nerve roots were collected at baseline. Pain persistence was determined at three and twelve months with the Sciatica Bothersomeness Index (SBI) and a numeric pain rating scale (NRS) as primary outcomes. Recruitment nears completion, with 160 participants enrolled to date. 127 and 96 participants have completed 3 and 12 months follow-up respectively. Overall, 56% of our cohort are female, with a mean age (SD) of 54.14yrs (16.57). Ethnicity data approximates local populations. SBI at baseline was (median [IQR]) 13[10-17], and interim longitudinal data shows stepwise improvement at 3 and 12 months. Baseline ‘average’ pain intensity was 5.56 (2.15) for leg pain, and 4.14(2.82) for low back pain (LBP). Overall, pain scores decreased at 3 and 12 months, with greater reductions in leg pain than LBP at 12 months. However, around 55–80% and 40–65% of people reported persistent pain at 3 and 12 months respectively. Conclusion. Leg pain severity was moderate and higher than LBP at baseline. All primary outcome measures demonstrate improvement over time, however 40–65% of patients report persistent pain at 12 months. Conflicts of interest. LR: Paid facilitation of post-graduate courses internationally. SK, MT, FP, KM, WS, CP, CR, SC: No conflicts of interest. GC: Editor in Chief of Health Psychology Review. Director of board of directors, MentalCHealth Care setting NoordWestVlaanderen. JF: Copyright holder of ODI (Oswestry Disability Index). Served on a data monitoring committee for a clinical trial of 2 different surgical approaches to cervical
Aims. Patients may present with concurrent symptomatic osteoarthritis (OA) of the hip and degenerative disorders of the lumbar spine, with surgical treatment being indicated for both. Whether arthroplasty of the hip or spinal surgery should be performed first remains uncertain. Materials and Methods. Clinical scenarios were devised for a survey asking the preferred order of surgery and the rationale for this decision for five fictional patients with both OA of the hip and degenerative lumbar disorders. These were symptomatic OA of the hip and: 1) lumbar spinal stenosis with neurological claudication; 2) lumbar degenerative spondylolisthesis with leg pain; 3) lumbar disc herniation with leg weakness; 4) lumbar scoliosis with back pain; and 5) thoracolumbar
A 980 nm Diode (Biolitec AG) Laser energy introduced via a 21G needle under C-arm or CT-Scan guidance and local anesthesia, vaporizes a small amount of nucleous polposus with a disc shrinkage and a relief of pressure on nerve root. The procedure in the
Repetitive manual handling caused 31% of all work related musculoskeletal disorders in 2015, with the back being the site of injury 38% of the time. Despite its high resilience, studies have shown that intervertebral discs can be damaged during repetitive loading at physiological motions, causing cumulative damage and
Background. NICE guidance suggests that caudal epidural injections of steroid and local anaesthetic may be considered for acute and severe sciatica, however studies have demonstrated limited long-term benefit and impact on future surgery. This study aimed to investigate the use of caudal epidural injections in a district general hospital setting and the rate of subsequent operation. Methods. All patients undergoing caudal epidural injection between 1. st. January and 30. th. June 2015 were included. Records were reviewed to obtain diagnosis, pre- and post-epidural clinical findings, prior interventions, and subsequent operations. Results. A total of 141 patients underwent a caudal epidural, with a median age of 63 (18 – 90). 37 patients went on to surgical intervention within 3 years, resulting in a conversion rate of 26.1%. Amongst those not requiring surgery, 59 (56.19%) had
Endoscopic spine surgery is a promising and minimally invasive technique for the treatment of
Introduction. In degenerative lumbar spine, it seems possible that foraminal stenosis is over-diagnosed as axial scanning is not performed in the plane of the exiting nerve root. We carried out a two-part study to determine the true incidence of foraminal stenosis. Patients and Methods. Initially we performed a retrospective analysis of radiology reports of conventional Magnetic Resonance Imaging in 100 cases of definite spinal stenosis to determine the incidence of reported ‘foraminal stenosis’. Subsiquently we performed a prospective study of MRI including fine slice T2 and T2 STIR coronal sequences in 100 patients with suspected stenosis. Three surgeons and one radiologist independently compared the diagnoses on conventional axial and sagittal sequences with the coronal scans. Results. The retrospective analysis found that ‘foraminal stenosis’ was reported by radiologists in 46% using conventional axial and sagittal sequences. In the prospective study of 100 patients suspected of having stenosis, spinal stenosis was reported in 40; degenerative spondylolisthesis in 14; posterolateral
In a prospective, consecutive study we determined the frequency of common symptoms and signs in 300 patients with lumbar nerve-root compression syndromes. We compared 100 patients with
The volume of spinal procedures have increased over the last two decades (220% in lumbar region). A simultaneous increase in re-operation rates (up to 20%) has been reported. Our aim was to compare with literature the reoperation rates and complications for various spinal procedures from a peripheral unit and to provide this information to the patients. This was a retrospective study of all patients who underwent spinal surgery during the period 1995 to 2005 by one surgeon. Using ICDM-9 codes and private notes patients were identified and medical records were used to gather relevant data. The following information was extracted-demographics, diagnosis, ASA criteria, primary procedure, any complication/s, secondary procedures, duration of follow up and to secondary procedure. The index procedures were grouped into regional and according to indication. Both complications and reoperations were grouped into early (within three months) or delayed (after three months) from the index operation. Reoperation rates and complications were calculated and compared with literature. Four hundred and thirty-nine patients formed the study population. Five patients had inadequate data and were excluded. 23 patients have since died. Demographics showed 22% were smokers and 9% were either unemployed or sickness beneficiary. The commonest diagnosis in the lumbar spine was
Purposes of the study and background. The objective of this overview was to evaluate the available evidence from systematic reviews on the effectiveness of surgical interventions for sciatica due to
Spinal stenosis and
Summary: Twenty six consecutive patients with CSM were operated between Jan 2001–Dec 2004 with anterior corpectomy and reconstruction using strut graft/ lordotic cage and stabilization ACP. 10/26 were wheel chair bound/bought on stretcher. 16/26 had spastic lower limbs with myelopathic hands. Post operatively 20/26 had good gait improvement and are community ambulators. 3/26 house hold ambulators and 1 died. 18/26 had good improvement in hand function. Introduction: Cervical spondylotic myelopathy is a degenerative disease of old age. Patients present with severe disabiling symptoms of spastic gait/inability to walk and varied involvement in the hand. The degenerative spondylosis being the commonest cause, CSM is also caused by OPLL and soft
The aim of this study was to identify potential inflammatory mediators in herniated and non-herniated intervertebral disc. It has been suggested that inflammation of the nerve root is a pre-requisite for
Retrospective analysis of radiology reports of conventional MRI in 100 patients with definite spinal stenosis to determine the incidence of reported “foraminal stenosis”. Prospective study of MRI including T2 coronal and T2 STIR coronal sequences in 57 patients with suspected stenosis. Three surgeons and one radiologist independently compared the diagnoses on conventional and coronal scans. Patients with suspected spinal stenosis undergoing MRI. Incidence of “foraminal stenosis” on radiologists' reports. Diagnoses obtained by different scanning methods. Retrospective analysis: “foraminal stenosis” called by radiologists in 46% using conventional axial and sagittal sequences. Prospective study - 57 patients: conventional sequences diagnosed lateral recess stenosis well but also suggested foraminal stenosis in 33%. However, coronal sequences clearly showed no foraminal nerve compression. In degenerative spondylolisthesis conventional scans suggested foraminal stenosis in 8 of 11 cases. Coronals showed no foraminal stenosis. Excellent correlation was found in normal spines and in
Background. Recently, some studies have focused attention on the possibility that anaerobic pathogens of low virulence could constitute an etiological factor in
Introduction and Aims: Lower back and/or leg pain is a symptom of a number of pathological conditions involving lumbosacral nerve roots.
Purpose of the study: Conventional treatment for recurrent lumbar disc herniation is repeated discectomy. Other methods such as fusion, ligamentoplasty or implantation of a discal prosthesis are sometimes proposed but all increase morbidity. The purpose of this work was to ascertain the efficacy of isolated repeated radicular release for the treatment of recurrent
Massive
The belief that an intervertebral disc must degenerate
before it can herniate has clinical and medicolegal significance,
but lacks scientific validity. We hypothesised that tissue changes
in herniated discs differ from those in discs that degenerate without
herniation. Tissues were obtained at surgery from 21 herniated discs
and 11 non-herniated discs of similar degeneration as assessed by
the Pfirrmann grade. Thin sections were graded histologically, and
certain features were quantified using immunofluorescence combined
with confocal microscopy and image analysis. Herniated and degenerated
tissues were compared separately for each tissue type: nucleus, inner
annulus and outer annulus. Herniated tissues showed significantly greater proteoglycan loss
(outer annulus), neovascularisation (annulus), innervation (annulus),
cellularity/inflammation (annulus) and expression of matrix-degrading
enzymes (inner annulus) than degenerated discs. No significant differences
were seen in the nucleus tissue from herniated and degenerated discs.
Degenerative changes start in the nucleus, so it seems unlikely
that advanced degeneration caused herniation in 21 of these 32 discs.
On the contrary, specific changes in the annulus can be interpreted
as the consequences of herniation, when disruption allows local
swelling, proteoglycan loss, and the ingrowth of blood vessels,
nerves and inflammatory cells. In conclusion, it should not be assumed that degenerative changes
always precede
Purpose of study and background. The use of NRB (Nerve Root Block) in radicular pain caused by stenosis is considered controversial in some centres, whereas its indication in radiculitis caused by
Repeated lumbar spine surgery has been associated with inferior clinical outcomes. This study aimed to examine and quantify the impact of this association in a national clinical register cohort. This is a population-based study from the Norwegian Registry for Spine surgery (NORspine). We included 26,723 consecutive cases operated for lumbar spinal stenosis or lumbar disc herniation from January 2007 to December 2018. The primary outcome was the Oswestry Disability Index (ODI), presented as the proportions reaching a patient-acceptable symptom state (PASS; defined as an ODI raw score ≤ 22) and ODI raw and change scores at 12-month follow-up. Secondary outcomes were the Global Perceived Effect scale, the numerical rating scale for pain, the EuroQoL five-dimensions health questionnaire, occurrence of perioperative complications and wound infections, and working capability. Binary logistic regression analysis was conducted to examine how the number of previous operations influenced the odds of not reaching a PASS.Aims
Methods
The February 2014 Spine Roundup. 360 . looks at: single posterior approach for severe kyphosis; risk factors for recurrent
Background: To asses the safety and efficacy of the Wallis Stabilization System in degenerative disorders of the lumbar spine. Methods: A prospective international multicentre clinical and radiological outcome assessment study. The study is ongoing. The study group comprises 260 consecutive patients meeting inclusion and exclusion criteria with respect to diagnosis (and levels affected), age, medical conditions and prior surgery. 61% were male, 39% female and the mean age was 44 years. The principal diagnosis was massive
The number of patients undergoing surgery for degenerative cervical radiculopathy has increased. In many countries, public hospitals have limited capacity. This has resulted in long waiting times for elective treatment and a need for supplementary private healthcare. It is uncertain whether the management of patients and the outcome of treatment are equivalent in public and private hospitals. The aim of this study was to compare the management and patient-reported outcomes among patients who underwent surgery for degenerative cervical radiculopathy in public and private hospitals in Norway, and to assess whether the effectiveness of the treatment was equivalent. This was a comparative study using prospectively collected data from the Norwegian Registry for Spine Surgery. A total of 4,750 consecutive patients who underwent surgery for degenerative cervical radiculopathy and were followed for 12 months were included. Case-mix adjustment between those managed in public and private hospitals was performed using propensity score matching. The primary outcome measure was the change in the Neck Disability Index (NDI) between baseline and 12 months postoperatively. A mean difference in improvement of the NDI score between public and private hospitals of ≤ 15 points was considered equivalent. Secondary outcome measures were a numerical rating scale for neck and arm pain and the EuroQol five-dimension three-level health questionnaire. The duration of surgery, length of hospital stay, and complications were also recorded.Aims
Methods
Purpose of the Study. Assessment of long term results of Chemonucleolysis vs. surgery for soft
Assessment of long term results of Chemonucleolysis vs. surgical enucleation in soft
Introduction. In degenerative disorders of the spine such as
CRP is an acute-phase protein that is used as a biomarker to follow severity and progression in infectious and inflammatory diseases. Its pathophysiological mechanisms of action are still poorly defined. CRP in its pentameric form exhibits weak anti-inflammatory activity. The monomeric isoform (mCRP) exerts potent proinflammatory properties in chondrocytes, endothelial cells, and leucocytes. No data exist regarding mCRP effects in human intervertebral disc (IVD) cells. This work aimed to verify the pathophysiological relevance of mCRP in the aetiology and/or progression of IVD degeneration. We investigated the effects of mCRP and the signalling pathways that are involved in cultured human primary annulus fibrosus (AF) cells and in the human nucleus pulposus (NP) immortalized cell line HNPSV-1. We determined messenger RNA (mRNA) and protein levels of relevant factors involved in inflammatory responses, by quantitative real-time polymerase chain reaction (RT-qPCR) and western blot. We also studied the presence of mCRP in human AF and NP tissues by immunohistochemistry.Aims
Methods
Summary Statement. Repetitive loading of degenerated human intervertebral discs in combined axial compression, flexion and axial rotation, typical of manual handling lifing activities, causes: an increase in intradiscal maximum shear strains, circumferential annular tears and nuclear seperation from the endplate. Introduction. Chronic low back pain (LBP) is a crippling condition that affects quality of life and is a significant burden to the health care system and the workforce. The mechanisms of LBP are poorly understood, however it is well known that loss of intervertebral disc (disc) height due to degeneration is a common cause of chronic low back and referred pain. Gross disc injury such as herniation can be caused by sudden overload or by damage accumulation via repetitive loading, which is a cause of acute LBP and an accelerant of disc degeneration. The aim of this study was to determine for the first time the relationship between combined repetitive compression, flexion and axial rotation motion of degenerated cadaver lumbar spine segments, and the progression of three-dimensional (3D) internal disc strains that may lead to
Lumbar disc prolapse is a frequent indication for surgery. The few available long-term follow-up studies focus mainly on repeated surgery for recurrent disease. The aim of this study was to analyze all reasons for additional surgery for patients operated on for a primary lumbar disc prolapse. We retrieved data from the Swedish spine register about 3,291 patients who underwent primary surgery for a lumbar disc prolapse between January 2007 and December 2008. These patients were followed until December 2020 to record all additional lumbar spine operations and the reason for them.Aims
Methods
Aim: The aim of the study was to analyse the long-term follow-up of patients who were treated with chemonucleolysis for single level disc prolapse. Method: In our retrospective study we reviewed 112 cases that underwent chemonucleolysis for single level lumber
In a prospective, consecutive study 93 patients who had had previous lumbar spinal surgery underwent repeat decompression for persistent or recurrent back and leg pain. The previous operations had been discectomies in 65 patients and decompression for spinal stenosis in 28; two of the latter group had also had posterolateral fusion. At the repeat operation,
Two collagen type IX gene polymorphisms that introduce a tryptophan residue into the protein’s triple-helical domain have been linked to an increased risk of lumbar disc disease. To determine whether a particular subset of symptomatic lumbar disease is specifically associated with these polymorphisms, we performed a prospective case-control study of 107 patients who underwent surgery of the lumbar spine. Patients were assigned to one of five clinical categories (fracture, disc degeneration,
Cervical spine disorders represent a good proportion of the daily practice of many neurosurgeons. The rapidly increasing knowledge base on spinal conditions and the progressive complexity of surgical interventions appear to be generating a renewed interest in this evolving subspecialty among neurosurgical trainees. In order to assess the current level of spinal surgery training and conveyed competence in dealing with spinal disorders, a self assessment questionnaire was devised and distributed to the neurosurgical trainees attending the EANS (European Association of Neurosurgical Society) training courses. 126 questionnaires were returned with a return rate of 32%. The majority of trainees responding to the questionnaire were in their final (6th) year of training or had completed their training (60,3% of total) representing 25 European nations. A separate analysis of the data pertaining to cervical spine disorders revealed 80% of the trainees completing their training in University hospitals with cervical spine injuries predominantly managed by neurosurgeons (75%). In their practical skill assessment, 78% of the senior trainees were competent in the treatment of cervical
This article reviews the current knowledge of
the intervertebral disc (IVD) and its association with low back
pain (LBP). The normal IVD is a largely avascular and aneural structure
with a high water content, its nutrients mainly diffusing through
the end plates. IVD degeneration occurs when its cells die or become
dysfunctional, notably in an acidic environment. In the process
of degeneration, the IVD becomes dehydrated and vascularised, and
there is an ingrowth of nerves. Although not universally the case,
the altered physiology of the IVD is believed to precede or be associated
with many clinical symptoms or conditions including low back and/or
lower limb pain, paraesthesia, spinal stenosis and
Prospective match cohort study of disc degeneration progression over ten years with and without baseline discography. To compare progression of common degenerative findings between lumbar discs injected ten years earlier with those same disc levels in matched subjects not exposed to discography. Seventy-five subjects without serious low back pain illness underwent a protocol MRI and a L3/4, L4/5 and L5 S1 discography in 1997. A match group was enrolled at the same time and underwent the same protocol MRI examination. Subjects were followed for ten years. At 7 to 10 years after baseline assessment, eligible discography in controlled subjects underwent another protocol MRI. MRI graders, blind to group designation, scored both groups for qualitative findings. Well matched cohorts, including 50 discography subjects and 52 control subjects met eligibility criteria for follow up evaluation. In all graded or measured parameters, discs that had been exposed to puncture and injection had greater progression of degenerative findings compared to control (non-injected) discs: progression of disc degeneration, 54 discs (35%) in the discography group compared to 21 (14%) in the control group (p=0.03); 55 new
Aims: The aim of this study was to compare the results of Micro Endoscopic Discectomy (MED) toMicro Surgical Discectomy (MSD). Methods: 12 Patients were reviewed by an independent observer. This included the þrst 6 patients who underwent MED and 6 patients who underwent MSD selected randomly. There was no signiþcant difference between the two groups concerning age and sex distribution, occupation, preoper-ative time of work and clinical symptomatology. The
Revision discetomy is a procedure often assumed to give similar results to primary discectomy. There is no level one or level two evidence to support this view and no publications with pre and post surgical spine specific outcome measures. This aim of this study was to evaluate the surgical outcomes of revision discectomies using standard spine instruments and to identify factors which influence the outcome. A prospective cohort study was performed between 1996 and 2004. A revision discectomy was defined as surgery at the same lumbar level as a previous discectomy with a minimum three month interval from the index surgery. Outcome measures were available for all 20 patients from the index primary discectomy. Questionnaires were given to the patients preoperatively and at 2 year follow-up. Among the outcomes measures used were the Oswestry Disability Index (ODI), the Low Back Outcome(LBO), and a Visual Analogue Score(VAS). 20 revision discectomies were performed on 11 males and 9 females, 7 at L4/5 and 13 at L5/S1. The mean age was 41(30–56) and the mean follow-up was 27(24–36) months. The preoperative ODI, LBO and VAS at the index primary discectomy averaged 54(22–82), 19(7–42) and 8(5–10) respectively. The preoperative ODI, LBO and VAS at the revision discectomy averaged 63(34–82), 18(1–46) and 8(1–10) respectively. The ODI, LBO and VAS all improved significantly at follow-up. The ODI averaged 27(2–66) (p<
0.05), the LBO averaged 47 (14–70) (p<
0.05) and the VAS 4(3–9) (p<
0.05). The outcome of revision discectomies is favourable, in this series the average improvement in ODI was 36 points, a clinically significant change. The risk factors which influence the outcome are preoperative ODI, preoperative VAS and Age (p<
0.05). Sex, preoperative LBO, duration between recurrent
The detailed anatomy of interconnectivity of intervertebral disc annular fibre layers remains unclear and a structural survey of interlammellar connectivity is required to understand this anatomy and mechanical behavior. The subsequent failure modes of the annulus under hydrostatic loading require definition to understand genesis of annular tears and
Purpose and background. Lumbar spinal fusion (LSF) is frequently and increasingly used in lumbar degenerative disorders despite conflicting results and recommendations. Further understanding of patient outcomes after LSF is required to inform decisions regarding surgery and to improve post-surgery management. The objective was to evaluate the course of pain and disability in patients with degenerative disorders of the lumbar spine (spinal stenosis, spondylolisthesis,
Patients may present with concurrent symptomatic hip and spine problems, with surgical treatment indicated for both. Controversy exists over which procedure, total hip arthroplasty (THA) or lumbar spine procedure, should be performed first. Clinical scenarios were devised for 5 fictional patients with both symptomatic hip and lumbar spine disorders for which surgical treatment was indicated. An email with survey link was sent to 110 clinical members of the NA Hip Society requesting responses to: which procedure should be performed first; the rationale for the decision with comments, and the type of THA prosthesis if “THA first” was chosen. The clinical scenarios were painful hip osteoarthritis and (1) lumbar spinal stenosis with neurologic claudication; (2) lumbar degenerative spondylolisthesis with leg pain; (3) lumbar disc herniation with leg weakness; (4) lumbar scoliosis with back pain; and (5) thoracolumbar
Purpose of the study: Discal arthroplasty is warranted as a part of the treatment of discopathy to guarantee mobility after disc removal. Depending on the type of discopathy, the diseased disc can be classified into different categories: absence of herniation (H0),
Purpose: Calcified thoracic
Cervical radiculopathy is a significant cause of pain and morbidity. For patients with severe and poorly controlled symptoms who may not be candidates for surgical management, treatment with transforaminal epidural steroid injections (CTFESI) has gained widespread acceptance. However, a paucity of high-quality evidence supporting their use balanced against perceived high risks of the procedure potentially undermines the confidence of clinicians who use the technique. We undertook a systematic review of the available literature regarding CTFESI to assess the clinical efficacy and complication rates of the procedure. OVID, MEDLINE, and Embase database searches were performed independently by two authors who subsequently completed title, abstract, and full-text screening for inclusion against set criteria. Clinical outcomes and complication data were extracted, and a narrative synthesis presented.Aims
Methods
People with severe, persistent low back pain (LBP) may be offered lumbar spine fusion surgery if they have had insufficient benefit from recommended non-surgical treatments. However, National Institute for Health and Care Excellence (NICE) 2016 guidelines recommended not offering spinal fusion surgery for adults with LBP, except as part of a randomized clinical trial. This survey aims to describe UK clinicians’ views about the suitability of patients for such a future trial, along with their views regarding equipoise for randomizing patients in a future clinical trial comparing lumbar spine fusion surgery to best conservative care (BCC; the FORENSIC-UK trial). An online cross-sectional survey was piloted by the multidisciplinary research team, then shared with clinical professional groups in the UK who are involved in the management of adults with severe, persistent LBP. The survey had seven sections that covered the demographic details of the clinician, five hypothetical case vignettes of patients with varying presentations, a series of questions regarding the preferred management, and whether or not each clinician would be willing to recruit the example patients into future clinical trials.Aims
Methods
This is a study on the results of fifty consecutive patients who underwent endoscopic removal of herniated lumbar disc by interlaminar extra-dural approach. The indication for surgery was unrelenting, single level, unilateral sciatic pain not relieved by conservative treatment, with supportive evidence of
The escalating demand for medical resources to address spinal diseases as society ages is an issue that requires careful evaluation. However, few studies have examined trends in spinal surgery, especially unscheduled hospitalizations or surgeries performed after hours, through large databases. Our study aimed to determine national trends in the number of spine surgeries in Japan. We also aimed to identify trends in after-hours surgeries and unscheduled hospitalizations and their impact on complications and costs. We retrospectively investigated data extracted from the Diagnosis Procedure Combination database, a representative inpatient database in Japan. The data from April 2010 to March 2020 were used for this study. We included all patients who had undergone any combination of laminectomy, laminoplasty, discectomy, and/or spinal arthrodesis.Aims
Methods
Purpose. Patients may present with concurrent symptomatic hip and spine problems, with surgical treatment indicated for both. Controversy exists over which procedure, total hip arthroplasty (THA) or lumbar spine procedure, should be performed first, and does the surgeon's area of expertise influence the choice. Materials & Methods. Clinical scenarios were devised for 5 fictional patients with both symptomatic hip and lumbar spine disorders for which surgical treatment was indicated. An email with survey link was sent to 110 clinical members of the Hip Society and 101 experienced spine surgeons in the USA requesting responses to: which procedure should be performed first, and the rationale for the decision with comments. The clinical scenarios were painful hip osteoarthritis and (1) lumbar spinal stenosis with neurologic claudication; (2) lumbar degenerative spondylolisthesis with leg pain; (3) lumbar disc herniation with leg weakness; (4) lumbar scoliosis with back pain; and (5) thoracolumbar
Initial treatment of traumatic spinal cord injury remains as controversial in 2023 as it was in the early 19th century, when Sir Astley Cooper and Sir Charles Bell debated the merits or otherwise of surgery to relieve cord compression. There has been a lack of high-class evidence for early surgery, despite which expeditious intervention has become the surgical norm. This evidence deficit has been progressively addressed in the last decade and more modern statistical methods have been used to clarify some of the issues, which is demonstrated by the results of the SCI-POEM trial. However, there has never been a properly conducted trial of surgery versus active conservative care. As a result, it is still not known whether early surgery or active physiological management of the unstable injured spinal cord offers the better chance for recovery. Surgeons who care for patients with traumatic spinal cord injuries in the acute setting should be aware of the arguments on all sides of the debate, a summary of which this annotation presents. Cite this article:
Introduction Far lateral disc prolapse (also known as foraminal or extreme lateral prolapse) make up 10% of all
Purpose: In recent years, many reports have described spontaneous resorption of lumbar disc herniation evaluated with Gd-enhanced MRI. We also found retrospectively that sequestrated lumbar disc herniation with Gd-enhanced MRI would disappear, and that patient with this type of lumbar disc herniation would improve clinically. But there is a question that Gd-enhanced MRI is really needed to speculate the prognosis of sequestrated lumbar disc herniation. The purpose of this study is to clarify the prognostic value of Gd-enhanced MRI for sequestrated lumber
Purpose of the study: Discal herniation is an exceptional cause of lumbar canal stenosis. When surgery for this disorder was first performed in the sixties, discectomy was not exceptional because discal protrusions were frequent. It was rather rapidly observed however that these protrusions were actually osteoarthitic discal rims that do not cause root compression. Discectomy was thus almost completely abandoned for lumbar stenosis surgery. Consequently, the development of true
Introduction: This retrospective study examined the clinical characteristics, radiological findings, management, and functional outcome in 34 rehabilitated patients who presented with traumatic central cord syndrome. Methods: Between 1994 and 2004 a total of 34 patients with central cord syndrome were admitted to the National Spinal Injuries Unit. There were 29 men and 5 women. The mean age was 56.1 years (15 to 88). The mean follow up time was 4.9 years. Patients were divided into three groups by age, <
50 years (10 patients), 50–70 years (16 patients), and >
70 years (8 patients). The American Spinal Injury Association (ASIA) system recorded the motor and sensory scores, of upper and lower limbs, on admission, discharge and during rehabilitation. Patients underwent radiological investigation that included plain film, CT, and MRI of the cervical spine. Results: The mechanism of injury was a fall in 58.8%, road traffic accident in 35.2% and other in 6%. Alcohol was a contributing factor in 32.4% of cases. Seven patients had a spinal fracture. The cervical spine was involved in 5 cases with the remaining 2 cases involving the thoracic spine. Seventy percent of patients received intravenous steroids. Over half (53%) of the patients had some degree of cervical spondylosis while cord changes were seen in almost all of the patients (79.4%). In the majority of cases (70.4%) the affected level was C3/4.
The aim of this study was to determine the differences in spinal imaging characteristics between subjects with or without lumbar developmental spinal stenosis (DSS) in a population-based cohort. This was a radiological analysis of 2,387 participants who underwent L1-S1 MRI. Means and ranges were calculated for age, sex, BMI, and MRI measurements. Anteroposterior (AP) vertebral canal diameters were used to differentiate those with DSS from controls. Other imaging parameters included vertebral body dimensions, spinal canal dimensions, disc degeneration scores, and facet joint orientation. Mann-Whitney U and chi-squared tests were conducted to search for measurement differences between those with DSS and controls. In order to identify possible associations between DSS and MRI parameters, those who were statistically significant in the univariate binary logistic regression were included in a multivariate stepwise logistic regression after adjusting for demographics. Odds ratios (ORs) and 95% confidence intervals (CIs) were reported where appropriate.Aims
Methods
Introduction: While anterior cervical decompression and fusion has been shown to be clinically effective in cases of myelopathy or radiculopathy, several studies have suggested an increased risk of development of adjacent segment degeneration. The Bryan Cervical Disc Pros-thesis was developed to address this complication and was fi rst used clinically in Europe in January 2000. The author began to use the device in June of 2001 and since that time has implanted 30 prostheses in 22 patients. The present prospective study was commenced at the time (concurrently with an ASERNIPS study) with a view to examine the clinical efficacy and safety of this device. The results in the author’s first 14 patients are reported, all with a minimum follow-up of 12 months (mean 20 months). Methods: An observational audit of 14 consecutive patients with cervical radiculopathy (6 patients), myelopathy (6 patients) or discogenic neck pain (2 patients) operated upon between July 2001 and November 2002. Average age was 48 years (range 27 – 61 years). 5 patients underwent two level procedures. Operative / post-op complications and clinical / radiological outcomes were recorded at 6 weeks, 3, 6, 12 months and January 2004. Results: Follow-up data is available at >
12 months on 13 of the 14 patients at an average 23 months post op (Range: 14–30 months). The patient for whom data is not available is known to have had a poor clinical outcome. She developed an unusual symptom complex with complex regional pain syndrome and is very unhappy with the surgery. Of the other 13 patients, 12 consider their outcome to have been excellent and 1 fair. In the two patients who underwent surgery purely for discogenic neck pain, substantial relief was reported. In the 8 patients with pre-operative arm pain, 6 reported complete relief, 1 substantial relief and one partial relief. There were no intra-operative complications. Two patients developed dysphagia which resolved after several months, one has described a clicking sensation in his neck for which no cause has been identified and one experiences persistent ‘neural surges’. One patient required surgery for a
Purpose: Thoracoscopic spinal surgery may be less aggressive than classical open surgery. We relate our experience over the last five years, analysing complications observed. Material and methods: Between 1995 and 2000, 68 patients underwent thoracoscopic spinal surgery. There were 34 men and 34 women, mean age 30.2 years (13–69). We analysed indications, preoperative anaesthesia parameters, peroperative and postoperative parameters and pulmonary, vascular, neurological and instrumental complications. Results: Indications were: metastatic compression in three patients,
Cervical total disc replacement has been in practice for years now as a viable alternative to cervical fusion in suitable cases, aspiring to preserve spinal motion and prevent adjacent segment disease. Reports are rife that neck pain emerges as an annoying feature in the early postoperative period. The facet joint appears to be the most likely source of pain. 50 patients were prospectively followed up through 5 years after having received disc replacement surgery, indicated for symptomatic soft
To study the associations of lumbar developmental spinal stenosis (DSS) with low back pain (LBP), radicular leg pain, and disability. This was a cross-sectional study of 2,206 subjects along with L1-S1 axial and sagittal MRI. Clinical and radiological information regarding their demographics, workload, smoking habits, anteroposterior (AP) vertebral canal diameter, spondylolisthesis, and MRI changes were evaluated. Mann-Whitney U tests and chi-squared tests were conducted to search for differences between subjects with and without DSS. Associations of LBP and radicular pain reported within one month (30 days) and one year (365 days) of the MRI, with clinical and radiological information, were also investigated by utilizing univariate and multivariate logistic regressions.Aims
Methods
Introduction The concept of accelerated degeneration of adjacent disc levels as a consequence of increased stress caused by interbody fusion of the lumbar spine has been widely postulated. Total disc arthroplasty may offer the same clinical benefits as fusion while providing motion that may protect the adjacent level discs from the abnormal and undue stresses associated with fusion. The goal of this study was to prospectively analyse the results of the Maverick Lumbar Disc Prosthesis (Medtronic, USA) at 4 years follow-up. Methods We conducted a prospective analysis of the Maverick Lumbar Disc Prosthesis implanted in the first 50 consecutive patients for the treatment of degenerative disc disease of the lumbar spine resistant to conservative treatment for more than 1 year. 253 Maverick have been implanted in our spine unit and these 50 have the longest follow-up. The outcome data collected included the Oswestry Questionnaire and Visual Analog Scale (VAS) preoperatively and at routine scheduled follow-ups. Radiographic analysis included sagittal balance parameters on standing full length lateral radiographs of the spine and range of motion on flexion/extension dynamic radiographs. 3 European centres were included in the study. The offset on AP x-rays was calculated for all patients and correlated with clinical outcomes. Results There were 32 females and 28 males with an average age of 43, 4 years and average follow-up of 3.1 years (22 to 48 months). The Maverick was implanted at L5S1: 20 cases; L4L5: 17 cases; 3 patients had 2 levels arthroplasty and 10 had a fusion at L5S1 and a prosthesis at L4L5. Clinical success, defined by the FDA as improvement of at least 25% on the Oswestry, was 76% and 81%, at 6 months and 1 year follow-up respectively. The VAS showed an improvement in back pain from 7.1 (+/− 2, 1) pre-operatively to 3.0 (+/− 1.8) post-operatively. Leg pain was significantly higher according to VAS when patients have been previously operated for
Psychoeducative prehabilitation to optimize surgical outcomes is relatively novel in spinal fusion surgery and, like most rehabilitation treatments, they are rarely well specified. Spinal fusion patients experience anxieties perioperatively about pain and immobility, which might prolong hospital length of stay (LOS). The aim of this prospective cohort study was to determine if a Preoperative Spinal Education (POSE) programme, specified using the Rehabilitation Treatment Specification System (RTSS) and designed to normalize expectations and reduce anxieties, was safe and reduced LOS. POSE was offered to 150 prospective patients over ten months (December 2018 to November 2019) Some chose to attend (Attend-POSE) and some did not attend (DNA-POSE). A third independent retrospective group of 150 patients (mean age 57.9 years (SD 14.8), 50.6% female) received surgery prior to POSE (pre-POSE). POSE consisted of an in-person 60-minute education with accompanying literature, specified using the RTSS as psychoeducative treatment components designed to optimize cognitive/affective representations of thoughts/feelings, and normalize anxieties about surgery and its aftermath. Across-group age, sex, median LOS, perioperative complications, and readmission rates were assessed using appropriate statistical tests.Aims
Methods
Silicon nitride spinal fusion cages have been successfully used in the treatment or correction of stenosis,
Purposes of the study and background. The care and cure of patients with low back disorders is of a multidisciplinary nature. Cooperation and communication between the disciplines would improve standardized care delivery to the patient. We engaged to establish a national group of multidisciplinary spine specialists to promote research and education in the field of spinal disorders. Summary of the methods used and results. A multidisciplinary group of spine professionals, opinion leaders and research leaders in spinal disorders in the Netherlands were invited to participate in a national network (“Netwerk Wervelkolomaandoeningen”). The group consists of physiotherapists, family physicians, neurosurgeons, orthopedic surgeons, anesthesiologists, as well as clinical researchers and epidemiologists. Group meetings were organized in various locations in the country. Priorities were set and divided in research and education. Communication lines were established with a resource website and a linked-in page. The first educational series of symposia for primary care professionals on multidisciplinary approaches for
Background:. The reported prevalence of sciatica ranges from 1.2% to 43%. Epidural injections are the most commonly performed interventions for sciatica. Setting:. A provincial based spinal unit. Objective:. To evaluate the effectiveness of lumbar epidural injections with local anaesthetic and steroids, in patients with sciatica secondary to
Purpose of Study. Discecomy is a common operation peformed for back pain at our hospital. We analysed the theatre register looking at demographic and health data for our patients to shed more light on this cases. Description of Methods. Entries in the spinal unit theatre registers from 2000–2012 were reviewed, and all patients undergoing discectomy for
Introduction. Herniated disc tissue removed at surgery is mostly nucleus pulposus, with varying proportions of annulus fibrosus, cartilage endplate, and bone. Herniated nucleus swells and loses proteoglycans, and herniated annulus is invaded by blood vessels and inflammatory cells. However, little is known about the significance of endplate cartilage and bone within a herniation. Methods. Herniated tissue was removed surgically from 21 patients (10 with sciatica, 11 without). 5-μm sections were examined using H&E, Toluidine blue, Giemsa, and Masson-trichrome stains. Each tissue type in each specimen was scored for tears/fissures, neovascularisation, proteoglycan loss, cell clustering, and inflammatory cell invasion. Proportions of each tissue type were quantified using image analysis software. Results. Herniations from patients with sciatica had greater nerve and blood vessel invasion (P<0.05), and a greater proportion contained cartilage endplate (7/10 vs 3/11, p<0.05). Cartilage fragments were generally small (5–20% of herniated mass) and showed little swelling or proteoglycan loss, or inflammatory cell invasion, although chondrocytes often formed small clusters. Most cartilage endplate fragments had a straight edge where it had been stripped from bone. Two cartilage fragments showed some bone still attached, and three showed small defects that were filled with nucleus tissue, bone, or endothelial cells. Conclusion. More than 50% of
In recent years, machine learning (ML) and artificial neural networks (ANNs), a particular subset of ML, have been adopted by various areas of healthcare. A number of diagnostic and prognostic algorithms have been designed and implemented across a range of orthopaedic sub-specialties to date, with many positive results. However, the methodology of many of these studies is flawed, and few compare the use of ML with the current approach in clinical practice. Spinal surgery has advanced rapidly over the past three decades, particularly in the areas of implant technology, advanced surgical techniques, biologics, and enhanced recovery protocols. It is therefore regarded an innovative field. Inevitably, spinal surgeons will wish to incorporate ML into their practice should models prove effective in diagnostic or prognostic terms. The purpose of this article is to review published studies that describe the application of neural networks to spinal surgery and which actively compare ANN models to contemporary clinical standards allowing evaluation of their efficacy, accuracy, and relatability. It also explores some of the limitations of the technology, which act to constrain the widespread adoption of neural networks for diagnostic and prognostic use in spinal care. Finally, it describes the necessary considerations should institutions wish to incorporate ANNs into their practices. In doing so, the aim of this review is to provide a practical approach for spinal surgeons to understand the relevant aspects of neural networks. Cite this article:
Cauda equina syndrome (CES) can be associated with chronic severe lower back pain and long-term autonomic dysfunction. This study assesses the recently defined core outcome set for CES in a cohort of patients using validated questionnaires. Between January 2005 and December 2019, 82 patients underwent surgical decompression for acute CES secondary to massive lumbar disc prolapse at our hospital. After review of their records, patients were included if they presented with the clinical and radiological features of CES, then classified as CES incomplete (CESI) or with painless urinary retention (CESR) in accordance with guidelines published by the British Association of Spinal Surgeons. Patients provided written consent and completed a series of questionnaires.Aims
Methods
To identify the validity of the Straight leg raise and crossed straight leg raise in the diagnosis of Lumbar disc prolapse. Systematic review of the literature. The Medline database was used (1966-09) using the search terms Lumbar disc prolapse /