Background and Objective. In industrialized societies, the prevalence of radicular low back pain has exploded in recent years. Lumbar disc prolaps, protrusion, or extrusion account for less than 5% of all low back problems, but are the most common causes of nerve root pain and surgical interventions. The primary rationale for any form of surgery for disc prolaps is to relieve nerve root irritation or compression due to herniated disc material. The primary modality of surgical treatment continues to be either open or microdiscectomy, but several alternative techniques including. Nucleoplasty. It provokes ablation of the nucleus of the disk by a controlled thermal effect produced by radiofrequency. Nucleoplasty is minimally invasive treatment aimed at removing nuclear material and lowering intradiscal pressure and decompressing through coblation needle inserted percutaneously into the nucleus of intervertebral discs. This paper will show a 3 years experience with 110 cases with lumbar radicular pain secondary to a disc protrusion that underwent Nucleoplasty as their secondary therapy. Methods. Included in this series were 110 patients with significant lumbar radicular pain, resistant to interventional therapy done before hand like fluoroscopically guided spinal transforaminal epidural injections or sacral injections with steroids. These cases were done under local anaesthesia with short analgesia and stand by monitoring. Results. In the overall cohort, the average Visual Analogue Scale (VAS) pain score decreased. Conclusions. We conclude that with use of the present selection criteria, Nucleoplasty is very effective long-term treatment for lumbar radicular pain. We recommend modifying the criteria to include only those cases with lumbar radicular pain due to protrusion whose annular integrity is confirmed via MRI and by either selective nerve root blocks and to exclude cases with axial pain

Abstract: Objective of this study was to assess the adequacy of relief provided by Nerve Root Block for Lumbar Radicular pain. If successful, this treatment can obviate the need for surgery considering the favourable natural history of this pathology. We studied 64 patients who had this injection, from February 2000 to July 2001. These patients had clinical and radiographic confirmation of nerve root compression and were followed up at 2 and 6 weeks post injection and then at an average of 10 months by a questionnaire, which addressed patient satisfaction with injection treatment and pre-injection and present Low Back Outcome Score and Pain intensity on Visual Analogue Scale. Overall, out of 64 patients injected, at 10 months follow-up, 50% (n=32) were satisfied with the treatment, 42% (n=27) injections failed and 8% (n=5) had incomplete follow-up. Pain intensity as measured on Visual Analogue Scale decreased from pre-injection mean value of 9.1 to post injection value of 4.9 the difference being statistically significant (p< 0.01). The Low Back Outcome Score increased from mean of 43 to 61, again the difference being statistically significant (p< 0.01). Nerve Root Block is an effective therapeutic tool for Lumbar Radicular pain and should be recommended as the initial treatment of choice for this condition since it can provide persistent relief to the point that the patient does not require surgery

Northumbria Healthcare NHS Trust, Ashington, UK. To assess if a pain diary is useful in assessment and management of patients who undergo diagnostic nerve root block (NRB) for lumbar radicular pain. Prospective study. 23 patients who underwent diagnostic NRB for lumbar radicular pain were given a pain diary. They recorded their response to one of four options from Day 0 to Day 14 (good relief, partial satisfactory, partial unsatisfactory, and no relief of leg pain) and could also add additional comments. A Consultant Spinal Surgeon reviewed the diary with the patient at 6-week follow up appointment to formulate a management plan. Patient response, completion of the pain diary and final clinical outcome (surgical or non surgical treatment). The response rate was 91% (21/23). The pain diary was very useful in 43% (9/21), useful in 33% (7/21) and not useful in 24% (5/21) of patients in formulating further management. There was a tendency for patients with complex problems and poor response to add descriptive notes and comments (9/ 23). Patient compliance with pain diary was good and it has been valuable in making further management decisions. We found the pain diary to be a useful and inexpensive adjunct in the assessment of patients who underwent diagnostic NRB

Background and Aims. Transforaminal epidurals (TFEs) have been widely used as a treatment for lumbar radicular pain since its introduction by Krempen and Smith in 1974. 1. Originally used as a diagnostic tool, it is now becoming increasingly recognised as a definitive treatment. 2. This study investigates the use of TFEs by a single surgeon over 4 years. We hoped that the study would add to our understanding and the discussion of the actual benefit of therapeutic steroid and local anaesthetic injections by this route. 3. . Methods and Results. A total of 181 patients were identified. At injection 10mls 0.25% Marcaine and 40mg Depomedrone was injected under fluoroscopic guidance. Clinic notes and MRI reports for all patients were reviewed. Of the 176 patients included in the study, 127 showed a symptomatic improvement. Of these patients, 59 proceeded to surgical decompression. For 50 patients, TFE was the definitive treatment. 13 patients were offered but declined surgery. 5 patients were too frail to proceed to surgery. 49 patients showed no symptomatic improvement. Of this group, 34 were deemed unsuitable for surgical intervention. 15 patients did proceed to surgery. Conclusions and Discussion. These results are comparable to other similar case series. Vad et al. 3. demonstrated that 78% of patients studied were satisfied with the outcome of TFE. Riew et al. 2. showed that 53% of their study group avoided surgery due to positive long term effect of TFE. The operative notes of the 15 patients who proceeded to surgery despite a negative TFE outcome are being reviewed and will be presented. Conflicts of Interest. None. Source of Funding. None

A rat model of lumbar root constriction with an additional sympathectomy in some animals was used to assess whether the sympathetic nerves influenced radicular pain. Behavioural tests were undertaken before and after the operation.

On the 28th post-operative day, both dorsal root ganglia and the spinal roots of L4 and L5 were removed, frozen and sectioned on a cryostat (8 μm to 10 μm). Immunostaining was then performed with antibodies to tyrosine hydroxylase (TH) according to the Avidin Biotin Complex method. In order to quantify the presence of sympathetic nerve fibres, we counted TH-immunoreactive fibres in the dorsal root ganglia using a light microscope equipped with a micrometer graticule (10 x 10 squares, 500 mm x 500 mm). We counted the squares of the graticule which contained TH-immunoreactive fibres for each of five randomly-selected sections of the dorsal root ganglia.

The root constriction group showed mechanical allodynia and thermal hyperalgesia. In this group, TH-immunoreactive fibres were abundant in the ipsilateral dorsal root ganglia at L5 and L4 compared with the opposite side. In the sympathectomy group, mechanical hypersensitivity was attenuated significantly.

We consider that the sympathetic nervous system plays an important role in the generation of radicular pain.

Objectives. In order to elucidate the influence of sympathetic nerves on lumbar radiculopathy, we investigated whether sympathectomy attenuated pain behaviour and altered the electrical properties of the dorsal root ganglion (DRG) neurons in a rat model of lumbar root constriction. Methods. Sprague-Dawley rats were divided into three experimental groups. In the root constriction group, the left L5 spinal nerve root was ligated proximal to the DRG as a lumbar radiculopathy model. In the root constriction + sympathectomy group, sympathectomy was performed after the root constriction procedure. In the control group, no procedures were performed. In order to evaluate the pain relief effect of sympathectomy, behavioural analysis using mechanical and thermal stimulation was performed. In order to evaluate the excitability of the DRG neurons, we recorded action potentials of the isolated single DRG neuron by the whole-cell patch-clamp method. Results. In behavioural analysis, sympathectomy attenuated the mechanical allodynia and thermal hyperalgesia caused by lumbar root constriction. In electrophysiological analysis, single isolated DRG neurons with root constriction exhibited lower threshold current, more depolarised resting membrane potential, prolonged action potential duration, and more depolarisation frequency. These hyperexcitable alterations caused by root constriction were significantly attenuated in rats treated with surgical sympathectomy. Conclusion. The present results suggest that sympathectomy attenuates lumbar radicular pain resulting from root constriction by altering the electrical property of the DRG neuron itself. Thus, the sympathetic nervous system was closely associated with lumbar radicular pain, and suppressing the activity of the sympathetic nervous system may therefore lead to pain relief

Introduction: There is still controversy regarding the treatment of acute Lumbar Radicular pain. Most authorities recommend bed rest, anti-inflammatory medication and physical therapy (Riew et al JBJS 1982 and Tulder ET AL Spine 22–1997) Comparing the outcome of operative and conservative treatment in selected patients many authors (Weber et al, Hakelius et al) did not find any significant difference after first year and no difference after 4 years. However many patients treated conservatively complains of persistent pain and seek further intervention. Aim: We did a prospective study to determine the effectiveness of selective nerve root injection in relieving pain in patients with Lumbar radicular pain. Material and Methods: We included 27 consecutive patients in our study, who had selective nerve root block. Inclusion criteria were Degenerative Lumbar Radicular pain or spinal stenosis, MRI correlating with Lumbar radiculopathy and no benefit from 6 weeks Anti-inflammatory medication, Rest, Physical treatment and activity modification. Informed consent taken from all patients for this study. Each patient was given Low Back Pain outcome score questionnaire of Greenough and Fraser and Oswestry Disability index of Fairbank, to be filled pre and post injection in day ward and at regular intervals up to 3 months post-injection. Adcortyl 20mg with 1 ml of 1% Lignocaine were injected under image in theatre after confirming the site with radioculogram and pain replication. Results: From the total of 27 patients, 25 (92%) showed improvement in their symptoms in first week. Out of these 25 patients, 18(66%) had long-term improvement and 7(26%) showed short-term relief. Statistically significant improvement at every stage of assessment was observed. Conclusion: The selective nerve root block combined with careful history, physical examination and quality radiolographic studies, is an important tool in the diagnosis and treatment of patients with predominant Lumbar radicular symptoms. It gives acceptable results in form of pain relief in 3 months. It has a role in lumbar Radicular pain largely in patients where surgery is not appropriate for whatever reasons

Study Purpose. To examine the presence of radicular pain and its relationship to the degree of lumbar nerve root compression in patients with a degenerative lumbar spine condition about to undergo surgery for either lumbar disc prolapse or lumbar canal stenosis. Background. The pathophysiology underlying radicular pain is not completely understood but it is thought that nerve root compression is a key factor and from a surgical perspective, decompressing the nerve root is considered to be the key therapeutic step. However, despite often severe root compression in patients with lumbar stenosis, radicular pain is not a typical feature. Methods. Thirty-nine pre-surgical patients with either lumbar disc prolapse or lumbar canal stenosis were studied using the Standardised Evaluation of Pain (StEP), a clinical assessment tool known to predict with a high degree of sensitivity and specificity the presence or absence of lumbar radicular pain. A nerve root compression score was given from lumbar MRI for each patient by a neuroradiologist blinded to the patients history. Results. The StEP assessment tool was able to distinguish the presence or absence of radicular pain with high sensitivity and specificity. This correlated well with the pre-operative diagnosis of disc prolapse or canal stenosis. The relationship between radicular pain and nerve root compression was less clear and will be discussed. Conclusion. This study confirms StEP as a useful bedside tool for identifying the presence of radicular pain in patients with a degenerative lumbar spine condition. Nerve root compression per se does not necessarily produce radicular pain. Conflicts of Interest. None. Source of Funding. None. This study has not been published or presented at a previous meeting

Abstract: The importance of nerve root inflammation accompanying disc herniation and its contribution to symptomatology was first proposed in the 1950’s. This encouraged the widespread administration of (percutaneous) epidural steroid injections in the non-surgical treatment of acute and chronic lumbar Radicular pain. It also prompted the local application of steroid preparations directly onto the nerve root at the time of disc compression. The literature supporting this latter practice however, is scant and equivocal. A randomised double blind prospective study was therefore carried out to evaluate the benefits of epidural steroid application at the time of lumbar disc decompression. 50 consecutive patients undergoing elective lumbar discectomy were enrolled. Patients in the study group (n=25) received 20mg of tri-amcinolone acetonide, applied directly to the decompressed nerve root. The control group (n=25) received an equal volume of saline. Intraoperative analgesia was standardised and postoperative pain was measured by a 10cm visual analog pain scale at 2, 6, 12, 25 and 72 hours. Standardised post-operative analgesic protocols were established and the amounts of consumed analgesics were determined. Statistical analysis was performed using the Mann-Whitney test. No statistically significant difference was noted in either pain score, analgesic consumption at 24, 38 or 72 hours or length of hospital stay, between the steroid treatment or control groups. This suggests that local epidural steroid administration after lumbar disc decompression offers no therapeutic advantage over mechanical decompression alone

Purpose: The quality of the functional result for surgical treatment of lumbar stenosis has been the subject of much debate. The objectives of this retrospective review were to assess functional outcome ten years after surgical treatment of lumbar stenosis and determine the rate of revision in order to identify factors influencing outcome at last follow-up. Material and methods: One hundred forty-one patients underwent surgery for lumbar stenosis between January 1990 and December 1992. Mean follow-up was ten years. Functional outcome at last follow-up was assessed with a specific questionnaire with items for lumbar and radicular pain and signs of radicular ischemia and with a self-administered satisfaction questionnaire as well as two visual analogue scales (VAS) for lumbar and radicular pain. Other data noted were: epidemiological and morphological features, comorbidity, presence or not of objective signs of neurological involvement, the SF-36, and a self-assessed anxiety-depression score (GHQ28). Two types of analysis were performed. A descriptive analysis to determine the severity of functional signs observed at last follow-up, patient satisfaction and incidence and reasons for surgical revision. Multivariate analysis was designed to search for factors affecting the self-administered senosis score. Results: During the study period, fifteen patients underwent a revision procedure involving the lumbar spine. At last follow-up the overall satisfaction index was 71%. The best results were obtained for radiculalgia and intermittent neurogenic claudication. Residual lumbalgia was the main complaint at last follow-up. The patient’s psychological profile was the predominant factor affecting functional outcome. Other factors influencing functional outcome were revision surgery, persistent objective neurological disorders, and comorbidity. Conclusion: Surgical treatment of lumbar stenosis allows satisfactory long-term results in the majority of patients. At ten years, the risk of revision surgery was 10%. A review of the literature shows that these results are better than those obtained with medical treatment and that these surgical interventions enable quality-of-life similar to that observed in an age-matched population

Purpose of the study: Indications for disc prosthesis is generally established on the basis of the MRI findings (MODIC classification) and the discography. We considered that knowledge of the preoperative disc height is also important. We report a multicentric study of the results of lumbar arthroplasties as a function of preoperative height of the operated disc. Material and methods: A Mobidisc prosthesis was implanted in 93 patients and followed prospectively for at least one year (mean follow-up 5 years). Disc height was compared with the height of the suprajacent disc and divided into three groups: > 66% of height (GI) i.e. a subnormal disc height (n=30), 33–66% (GII) moderate impingement (n=36), < 33% (GIII) total impingement (n=27). A MODIC signal was found for 19% in GI, 42% in GII and 40% in GIII. Results: The lumbar VAS improved from 6.7 to 3.2 (GI), 6.2 to 2 (GII) and 6.2 to 1.5 (GIII). The radicular VAS improved from 4.8 to 3.1 (GI), 5.7 to 2.4 (GII) and 5.5 to 1.6 (GIII), respectively 69, 75 and 85.5% of the patients were satisfied or very satisfied for relief of the lumbar or radicular pain. The Oswestry score improved from 50 to 22% (GI), 49 to 20% (GII) and 46 to 12% (GIII). By MODIC, the lumbar VAS improved from 6.5 to 2.8 (MODIC 0) and from 6.6 to 2 (MODIC 1). The radicular VAS was improved from 5.5 to 2.9 (MODIC 0) and from 5.3 to 2.1 (MODIC 1). The Oswestry score was improved from 52 to 24% (MODIC 0) and from 48 to 15% (MODIC 1). Independently of MODIC, the VAS was always better for very tight discs and lower if the disc height was preserved. Discussion: An influence of the disc height was found for all parameters studied, irrespective of the type of disc disease as described by the MODIC classification. The presence of a tight preoperative disc height appeared as the essential prognostic factor for discal prostheses. For a MODIC 0 discopathy, without loss of disc height, only 67 and 61% of the operated patients were satisfied or very satisfied with relief of lumbar and radicular pain (VAS 3.6 and 3.4) for respectively 88 and 75% of the MODIC0 discopathies with discal impingement (VAS 1.5 and 1.5). Though it should not be formally ruled out, surgery for discopathy with a preserved disc height should be examined prudently before implanting a disc prosthesis

Purpose of the study: The theoretical advantage of a disc prosthesis compared with fusion is to preserve spinal mobility. The purpose of our study was to determine the relationship, at nine years follow-up, between range of motion and clinical outcome after lumbar disc replacement. Material and methods: This retrospective analysis concerned the clinical and radiographic outcome observed in 38 patients who had undergone one- or two-stage disc replacement surgery (51 implanted prostheses). Mean follow-up was 8.6 years (range 6.9–10.7). Clinical outcome was assessed with the Stauffer-Coventry modified score (SCM), the Oswestry score (ODQ) and a visual analog scale (VAS) for lumbar and radicular pain. Flexion-extension range of motion (ROM) was measured on the upright films (Cobb method) at last follow-up. Each clinical element was compared with the ROM (Spearman coefficient of correlation). Two groups of patients were distinguished: high (> 5°) and low ≤ 5°) ROM for comparison with the Mann-Whitney test. Results: The Spearman coefficient of correlation disclosed a weak to moderate but statistically significant association between ROM, lumbar VAS (r=−0.35, p=0.034), ODQ (r=−0.33, p=0.046), SCM (r=0.42, p=0.0095); but no significant correlation between ROM and radicular VAS (r=−0.12,p=0.48). Patients with greater ROM had better clinical results and ODQ (mean difference 6.3 points, p=0.031) and SCM (mean difference 2.2 points, p=0.017); but no significant difference between the preoperative characteristics in each group (age, sex, weight, surgical history, lumbar and radicular pain, ODQ and SCM). Discussion: There are no data in the literature comparing range of motion and clinical outcome after lumbar disc replacement. The present study demonstrated a weak to moderate but statistically significant relationship (r=0.35) between range of flexion-extension motion and clinical outcome at nine years. In addition, patients with lesser ROM (< 5°) have slightly less favorable results compared with those with greater ROM (> 5°). This study suggests the preservation of motion has a positive effect on mid-term clinical outcome. Conclusion: These results need to be confirmed with long-term prospective data comparing discal prosthesis with fusion and non-surgical treatment in order to demonstrate the usefulness of preserving motion on the quality of the clinical outcome

Purpose of the study: The purpose of this work was to analysis the clinical results of lumbar disc arthroplasty as a function of the type of degenerative discopathy in patients with MODIC 1 anomalies at the MRI. Material and methods: Sixty-five patients were included in this prospective study over a two-year period. Mean age was 43 years (range 23–59). All patients had a single level lumbar discopathy with MODIC 1 signs on the MRI. The discopathy was classed H0 for isolated degenerative disc disease, H1 for an associated disc overhang, H2 in the event of a recurrent disc hernia, and H3 if there was a post-discectomy syndrome. The clinical analysis was based on the VAS for lumbar and radicular pain and the Oswestry score noted preoperatively then at 3, 6, 12 and 24 months postoperatively. Results: In the 12 patients classed H0, a significant decrease in the lumbar and radicular VAS was noted at 24 months, similarly for the H1 patients (n=25), the H2 patients (n=12) and the H3 patients (n=16). The Oswestry score also improved significantly in the different groups: 25/50 preoperatively to 5/50 at last follow-up in H0, 25/50 to 7/50 in H1, 27/50 to 11/50 in H2, and 31/50 to 13/50 in H3. There was a statistically significant difference between the results in H0 and H3 and between H1 and H3 (p< 0.05). Discussion: In patients with degenerative discopathy with MODIC1 signs on the MRI, the results of disc arthroplasty are globally satisfactory with a significant clinical improvement. There are however statistically significant difference as a function of the type of discopathy. These preliminary data provide a base for reflection concerning the expected results and about information to give patients for whom a lumbar disc arthroplasty may be proposed

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), disc herniation (H1), recurrent disc herniation (H2), post discectomy syndrome (H3), or stenosis of a single unit (including grade 1 degenerative spondylolisthesis) (St-SPd). The purpose of this study was to compare clinical outcome after discal arthroplasty for these different clinical situations. Material and methods: This was a prospective study of 152 patients who underwent a single-stage operation for insertion of a lumbar disc prosthesis. Pain was assessed with a visual analog scale for the lumbar level (VAS-L), and for radicular pain (VAS-R) and the Oswestry index (ODI). Patients were classified as follows: 39 H0, 52 H1, 22 H2, 29 H3, 10 ST-SPd). Results: Outcome in patients in groups H0, H1, and St-SPd, i.e. first-intention surgery patients, presented equivalent results for lumbar and radicular pain and for function: VAS-L and VAS-R declined concomitantly. Results at three months postop were equivalent to those observed at 24 months. Patients in groups H2 and H3 who had had prior operation(s) for posterior discectomy experienced rapid relief of lumbar pain but radicular pain persisted postoperatively (6 to 12 m). Discussion: These data confirm the excellent results obtained with single-level disc replacement as assessed by VAS and ODI. The persistence of radiculalgia which then resolves several months later in patients with a history of discal surgery can be explained by the combination of chronic compression, postoperative adherences and restored disc height. In the present series, none of the patients required complementary surgery for posterior radicular release. Conclusion: Discal arthroplasty provides satisfactory results for the different stages of discal disease. The procedure should however be undertaken with prudence for patients who have had prior surgery. A perfect analysis of other factors involved should be helpful in chosing the most appropriate technique and avoid the development of postoperative radiculalgia. The present results could be usefully confirmed with a long-term randomized prospective study comparing discal prosthesis with fusion for the treatment of discal disease

Purpose: Eary results of a prospective study of a homogeneous group of 45 patients treated by electrical stimulation of the posterior cords for refractory chronic pain subsequent to postoperative fibrosis demonstrated good results (function and pain relief) in 77% of patients with a mean follow-up of 51 months. We further examined the technique treating certain cases of post-surgical refractory chronic lumbar radiculaglia using spinal cord neurostimulation and posterior spinal restabilisation during the same procedure. Material and methods: Results of a small series of eight patients, mean age 48 years were examined at a mean follow-up of 11 years. Five of the patients were manual labourers and five were occupational accident victims. All had a history of endocanal surgery (narrow lumbar canal, disc hernia). These eight patients had lumbar and radicular pain which were chronic and refractory to conservative treatment. The usual preoperative tests were: percutaneous epidural neurostimulation for radiculalgia by deafferentation and immobilisation test with a corset for lumbalgia. Chronic neurostimulation of the posterior cords was indicated if either test was positive. Metronic ITREL II or III was used. Posterior restabilisation was performed by arthrodesis with a posteriolateral graft, or for more recent patients, by dynamic lumbar neutralisation (Dynesys). Neurostimulation and posterior stabilisation were performed during the same operative procedure. Results: This therapeutic association enabled four of the patients to resume their occupational activities. Two patients were retired. Radiculalgia: At last follow-up, antalgic effect of neurostimulation persisted for six patients. For one, radiculalgia recurred at eight years. For the last patient, despite rigorous preoperative selection, pain recurred early at two years. Lumbalgia: Improvement persisted at last follow-up in four of the eight patients. Lumbalgia recurred in three at eight to eleven years. This time corresponds to the usual duration of arthrodesis efficacy due to the development of a neo-junction, the reason for which we extened our indications for dynamic neutralisation. The last patient developed a neojunction at two years and underwent extension of the arthrodesis with good antalgesia at ten years. Conclusion: Combining electrical stimulation and spinal restabilisation in the same procedure provides a real antalgesic effect for certain patients with postoperative lumboradicular pain. The quality of the results are less favourable for lumbalgia because the effect of the arthrodesis is less long-lasting. It is hoped that the new Synergy electrode, with promising effect on radiculalgia and lumbalgia and which is currently under evaluation, will meet its expectations

Introduction and Objectives: Indications for surgery in the treatment of lumbar disc herniation are still the subject of some controversy, in spite of previous systematic studies demonstrating its effectiveness. Many believe that this treatment should be avoided in working patients, in whom results of vertebral surgery tend to be poorer. Health-related quality of life indicators permit the objective measurement of the degree to which the health of the patient is improved by a particular type of procedure. They also permit a comparision of health improvement for patients with various types of treatment interventions. The goal of this study is to evaluate the impact of lumbar microdiscectomy on health-related quality of life in working patients. Materials and Methods: A total of 105 patients of working age who underwent surgery at the Vertebral Surgery Unit of an On-the-Job Accident Cooperative were evaluated prospectively. Of these patients, 89 (84.8%) were male, and 51% were working in jobs that involved heavy lifting; 68.6% had high-school or less education or no education. Patients were evaluated before and 3 months after surgical intervention using a validated Spanish version of a questionnaire on the following clinical dimensions: Health-Related Quality of Life (SF-36), Lumbar Spine Function (Oswestry’s questionnaire), Lumbar and Radicular Pain (Visual Analogue Scale). Unvalidated versions of Work Situation and Satisfaction with results (GEER scales) were used. Results: Statistically significant and clinically relevant improvement was observed in the following parameters: Intensity of lumbar pain (preoperative: 61.7; postoperative: 33.5; p< 0.001) and radicular pain (preoperative: 76.1; postoperative: 28.4; p< 0.001), specific lumbar spine function (preoperative: 44.3; postoperative, 18.3; p< 0.001), patient satisfaction and the SF 36 Physical Function items (preoperative: 38.1373; postoperative, 71.152; p< 0.001), physical role (preoperative,6.2092;postoperative,24.8366; p< 0.001), bodily pain (preoperative, 24.5196; postoperative, 51.0882; p< 0.001), general health (preoperative, 59.2607; postoperative, 62,901; p< 0.044), vitality (preoperative, 45.8333; postoperative, 58.2843; p< 0.001), social function (preoperative: 55.6373; postoperative: 73.8971; p< 0.001), and mental health (preoperative: 61.9706; postoperative, 70.9706; p< 0.001). A statistically significant improvement was not found in emotional role (preoperative: 65.6766; postoperative, 72.9373; p=0.182). Discussion and Conclusions: Apart from the impact on their work situation, working patients who underwent microdiscetomy for lumbar disc herniation enjoyed significant short-term clinical improvement in multiple areas of their health

Aims

Short-stemmed femoral implants have been used for total hip arthroplasty (THA) in young and active patients to conserve bone, provide physiological loading, and reduce the incidence of thigh pain. Only short- to mid-term results have been presented and there have been concerns regarding component malalignment, incorrect sizing, and subsidence. This systematic review reports clinical and radiological outcomes, complications, revision rates, and implant survival in THA using short-stemmed femoral components.

The August 2015 Spine Roundup360 looks at: Steroids may be useful in avoiding dysphagia in anterior cervical discectomy and fusion (ACDF); Perhaps X-Stop ought to stop?; Is cervical plexus block in ACDF the gateway to day case spinal surgery?; Epidural past its heyday?; Steroids in lumbar back pain; Lumbar disc replacement improving; Post-discectomy arthritis

Aims

The aim of this study was to evaluate the time course of changes in parameters of diffusion tensor imaging (DTI) such as fractional anisotropy (FA) and apparent diffusion coefficient (ADC) in patients with symptomatic lumbar disc herniation. We also investigated the correlation between the severity of neurological symptoms and these parameters.