Percutaneous lumbar discectomy: a systematic review / Discectomia percutânea lombar: uma revisão sistemática

Introduction: Low back pain is a clinical condition with a multifactorial etiopathogenesis, which has a high socioeconomic impact, especially in the economically active population, as it is associated with frequent absenteeism and reduced quality of life. Through intervertebral disc degeneration, a progressive instability of the compromised region is observed, triggering a harmful positive feedback mechanism that further promotes intervertebral disc disease. Built by the interaction between the predisposing biopsychosocial components, a multidisciplinary therapeutic proposition is suggested. In persistent low back pain, treatment involves surgical procedures such as Percutaneous Lumbar Discectomy. Objectives: to evaluate the scientific evidence regarding the clinical outcomes and safety of this surgery. Method: systematic review duly registered in Prospero (CRD42022370811), based on the PICOD question, elaborated from a Boolean search in different databases for scientific articles, evaluated and selected in a paired way based on the eligibility criteria. In addition to extracting data related to the proposed objectives, the articles included were evaluated in relation to their level of evidence and strength of recommendation. Results: among the 12 articles included, it was observed that it is a clinically effective and safe procedure. In the set of evidences gathered, they are of high and moderate level of evidence with respective strength of recommendation strong/good and weak/moderate. Conclusion: Percutaneous Lumbar Discectomy promotes significant reduction of pain and increase in body functionality, in addition to preserving local musculoskeletal structures and preventing post-surgical joint instability. It is, therefore, a safe and clinically effective minimally invasive procedure for patients with herniated discs.

Introdução: a lombalgia é uma condição clínica de etiopatogenia multifatorial, que desencadeia um elevado impacto socioeconômico especialmente na população economicamente ativa, por associar-se ao absenteísmo frequente e à redução da qualidade de vida. Observa-se mediante a degeneração do disco intervertebral, uma instabilidade progressiva da região comprometida desencadeando um mecanismo de feedback positivo prejudicial que promove ainda mais a doença do disco intervertebral. Edificada pela interação entre os componentes biopsicossocial predisponentes, sugere-se uma proposição terapêutica multidisciplinar. Na dor lombar persistente o tratamento envolve procedimentos cirúrgicos como a Discectomia Percutânea Lombar. Objetivo: avaliar as evidencias científicas relativas aos desfechos clínicos e à segurança desta cirurgia. Método: revisão sistemática devidamente registrada no Prospero (CRD42022370811), fundamentada na pergunta PICOD acrônimo para Paciente, Intervenção, Comparação, Desfechos (outcomes) e Design, elaborada a partir de busca booleana em diferentes bases de dados por artigos científicos, avaliados e selecionados de forma pareado com base nos critérios de elegibilidade. Além da extração de dados relativos aos objetivos propostos, os artigos incluídos foram avaliados em relação ao respectivo nível de evidencia e força de recomendação. Resultados: dentre os 12 artigos incluídos, observou-se que se trata de um procedimento clinicamente efetivo e seguro. No conjunto de evidencias reunidas são de alto e moderado nível de evidencia com respectiva força de recomendação forte/boa e, fraca/moderada. Conclusão: a Discectomia Percutânea Lombar promove relevante redução da dor e aumento da funcionalidade corporal, além de preservar as estruturas musculoesqueléticas locais e prevenir a instabilidade articular pós-cirúrgica. Trata-se, portanto, de um procedimento minimamente invasivo seguro e clinicamente efetivo para os pacientes portadores de hérnia discal.

Biomechanical Study on Contiguous Three-Level Cervical Hybrid Surgery and Anterior Cervical Discectomy and Fusion / 医用生物力学

Objective To compare the biomechanical effects of contiguous three-level cervical Hybrid surgery[anterior cervical discectomy and fusion (ACDF) + cervical disc arthroplasty ( CDA)] and three-level ACDF. Methods The finite element model of C1-T1 cervical-thoracic spine was developed based on CT data. Three models were simulated by the implantation of Prestige LP and Zero-P prostheses, including two Hybrid models (AFA, Prestige LP implanted at C3-4 and C5-6 segments and Zero-P implanted at C4-5 segment; FAF, Zero-P implanted at C3-4 and C5-6 segments and Prestige LP implanted at C4-5 segment) and three-level ACDF model(FFF). The changes in range of motion (ROM) of adjacent levels during flexion, extension, lateral bending and axial rotation, the overall ROM, as well as the intradiscal pressure ( IDP) and facet contact force ( FCF) of adjacent levels were compared. Results The ROM in adjacent levels and the overall ROM of the AFA modelwere closer to the intact model, and the maximum increases in the ROM of the adjacent levels for the FAF and FFF models were 15. 0% and 23. 4% , respectively. For AFA, FAF and FFF models, the maximum increases in the maximum IDP of adjacent levels were 19. 0% , 66. 7% , 147. 6% , and the maximum increases in FCF were 17. 4% , 55. 7% , 80. 1% , respectively. Conclusions This study provides biomechanical basis for three-level cervical Hybrid surgery in treating patients with the contiguous three-level cervical degenerative disc disease.

Anterior lumbar interbody fusion (alif): epidemiological and radiological profile / Artrodese lombar anterior: perfil epidemiológico, radiológico / Artrodesis lumbar anterior: perfil epidemiológico, radiológico

ABSTRACT: Objective: Evaluate the epidemiological and radiographic data of patients submitted to the Anterior Lumbar Interbody Fusion (ALIF) technique and the possible complications related to this procedure. Methods: A longitudinal and retrospective study was carried out to analyze electronic medical records and image files of patients who underwent spinal surgery using the ALIF technique between February 2019 and January 2021. Epidemiological data such as age, gender, and level of surgery were analyzed. Radiographic evaluations of lumbar lordosis from L1 to S1 were performed using the COBB technique and the anterior and posterior height of the disc space. The presence of intraoperative and postoperative complications in the patients was analyzed. Results: Initially, 70 patients were analyzed. The most prevalent operated level was L5-S1. The length of stay of the patients varied between 36 and 72 hours. Intraoperative bleeding ranged from 20mL to 400mL. Three patients had significant venous lesions. Differences between anterior and posterior lordosis and height measurements were significant (p < 0.001). Lordosis had a mean increase of 10.3°, anterior height had a mean increase of 7.9mm, and posterior height of 4.0mm. Six cases of intra and postoperative complications were observed. Conclusion: The patients showed improvement in the radiological parameters of the anterior and posterior height of the vertebral discs, with a significant increase in lumbar lordosis. Complication rates were 9.8%, and we had a short hospital stay. Level of Evidence II; Retrospective Longitudinal Study.

RESUMO: Objetivo: Avaliar os dados epidemiológicos e radiográficos de pacientes submetidos à técnica de Artrodese Lombar Anterior (ALIF) e avaliar as possíveis complicações relacionadas a este procedimento. Métodos: Realizou-se um estudo longitudinal e retrospectivo com análise dos prontuários eletrônicos e arquivos de imagem dos pacientes submetidos a cirurgia da coluna pela técnica de ALIF, no período entre fevereiro de 2019 e janeiro de 2021. Dados epidemiológicos como idade, sexo e nível de cirurgia foram analisados. Foram feitas avaliações radiográficas da lordose lombar de L1 a S1 através da técnica de COBB e da altura anterior e posterior do espaço discal. Foram analisados a presença de complicações intra e pós-operatórias dos pacientes. Resultados: Foram analisados inicialmente 70 pacientes. O nível operado mais prevalente foi L5-S1. O tempo de internamento dos pacientes variou entre 36 e 72 horas. O sangramento intraoperatório variou de 20mL a 400mL. Três pacientes apresentaram lesões venosas importantes. As diferenças entre as medidas de lordose e altura anterior e posterior foram significativas (p < 0,001). A lordose teve aumento médio de 10,3°, a altura anterior teve aumento médio de 7,9mm e a altura posterior de 4,0mm. Foram observados 06 casos de complicações intra e pós-operatórias. Conclusão: Os pacientes apresentaram melhora nos parâmetros radiológicos de altura anterior e posterior dos discos vertebrais, com um aumento da lordose lombar significativo. As taxas de complicações foram de 9,8 % e tivemos um curto período de internação hospitalar. Nível de Evidência II; Estudo Longitudinal e Retrospectivo.

RESUMEN: Objetivo: Evaluar los datos epidemiológicos y radiográficos de pacientes sometidos a la técnica de Artrodesis Lumbar Anterior (ALIF) y evaluar las posibles complicaciones relacionadas con este procedimiento. Métodos: Se realizó un estudio longitudinal y retrospectivo con análisis de historias clínicas electrónicas y archivos de imágenes de pacientes intervenidos de columna vertebral mediante la técnica ALIF, en el período comprendido entre febrero de 2019 y enero de 2021. Datos epidemiológicos como edad, sexo y nivel quirúrgico fueron analizados. Las evaluaciones radiográficas de la lordosis lumbar de L1 a S1 se realizaron mediante la técnica COBB y la altura anterior y posterior del espacio discal. Se analizó la presencia de complicaciones. Resultados: Se analizaron 70 pacientes. El nivel operado más prevalente fue L5-S1. El tiempo de estancia de los pacientes varió entre 36 y 72 horas. El sangrado intraoperatorio osciló entre 20 ml y 400 ml. Tres pacientes tenían lesiones venosas importantes. Las diferencias entre la lordosis anterior y posterior y las medidas de altura fueron significativas (p < 0,001). La lordosis tuvo un aumento medio de 10,3°, la altura anterior tuvo un aumento medio de 7,9 mm y la altura posterior de 4,0 mm. Se observaron seis casos de complicaciones intra y postoperatorias. Conclusiones: Los pacientes mostraron mejoría en los parámetros radiológicos de altura anterior y posterior de los discos vertebrales, con aumento significativo de la lordosis lumbar. Las tasas de complicaciones fueron del 9,8% y hubo una corta estancia hospitalaria. Nivel de Evidencia II; Estudio Longitudinal y Retrospectivo.

Percutaneous cement discoplasty in the treatment of degenerative disc disease. case series / Cimento discoplastia percutânea no tratamento da doença degenerativa do disco. série de casos / Cemento discoplastia percutánea en el tratamiento de la enfermedad discal degenerativa. serie de casos

ABSTRACT Introduction: Percutaneous cement discoplasty (PCD) is a minimally invasive surgical technique, which provides segmental stabilization and an indirect decompression effect in cases of severe degenerative disc disease with vacuum phenomenon, useful in patients with comorbidities that contraindicate invasive surgical procedures. Materials and methods: A retrospective analysis of 6 patients undergoing PCD was carried out, reporting the demographic variables, the segments treated and the clinical result evaluated by means of the visual analog pain scale (VAS) both in the presurgical and in the 6-month follow-up. Finally, a literature review was carried out. Results: 6 cases of PCD were included, of which 5 had a diagnosis of dyscarthrosis and 1 dyscarthrosis with spondylolisthesis. 4 female and 2 male patients. In 3 patients, PCD was performed in 1 segment and in 3 patients in multiple segments. Regarding the clinical result, an improvement was presented in 5 of the patients (mean 5.6 VAS points), 1 of the patients did not present improvement and required another surgical intervention. Conclusions: PCD is a minimally invasive technique useful in the treatment of spine pain secondary to degenerative disc disease in those patients with comorbidities that contraindicate a major procedure. Indirect foraminal decompression by PCD in one or more segments appears to contribute to pain relief. Level of Evidence III. Series of cases and controls.

RESUMO Introdução: O cimento discoplastia percutânea (PCD) é uma técnica cirúrgica minimamente invasiva, que proporciona estabilização segmentar e efeito descompressivo indireto nos casos de doença discal degenerativa grave com fenômeno de vácuo, útil em pacientes com comorbidades que contra-indicam procedimentos cirúrgicos agressivos. Materiais e métodos: Foi realizada uma análise retrospectiva de seis pacientes submetidos à PCD, relatando as variáveis demográficas, os segmentos tratados e o resultado clínico avaliado por meio da escala visual analógica de dor (EVA) tanto no pré-cirúrgico quanto no de seis meses acompanhamento. Por fim, foi realizada uma revisão da literatura. Resultados: foram incluídos seis casos de PCD, dos quais cinco apresentavam diagnóstico de disartrose e um de disartrose com espondilolistese. Quatro pacientes do sexo feminino e dois do sexo masculino. Em três pacientes, o PCD foi realizado em um segmento e em três pacientes em vários segmentos. Em relação ao resultado clínico, houve melhora em cinco dos pacientes (média 5.6 pontos EVA), um dos pacientes não apresentou melhora e necessitou de nova intervenção cirúrgica. Conclusões: A PCD é uma técnica minimamente invasiva útil no tratamento da dor da coluna secundário à doença degenerativa do disco em pacientes com comorbidades que contra-indicam um procedimento de grande porte. A descompressão foraminal indireta por PCD em um ou mais segmentos parece contribuir para o alívio da dor. Nível de Evidência III; Série de casos e controles.

RESUMEN Introducción: La cemento discoplastia percutánea (PCD) es una técnica quirúrgica de mínima invasión, la cual brinda estabilización segmentaria y un efecto de descompresión indirecta en caso de enfermedad discal degenerativa severa con fenómeno de vacío, útil en pacientes con comorbilidades que contraindican procedimientos quirúrgicos más agresivos. Materiales y métodos: Se realizó un análisis retrospectivo de 6 pacientes sometidos a PCD, reportando las variables demográficas, los segmentos tratados y el resultado clínico evaluado mediante la escala visual análoga del dolor (EVA) tanto en el prequirúrgico como en el seguimiento a 6 meses. Finalmente se realizó una revisión de la literatura. Resultados: Se incluyeron 6 casos de PCD, de los cuales 5 presentaron diagnóstico de discartrosis y 1 discartrosis con espondilolistesis. 4 pacientes de género femenino y 2 masculino. En 3 pacientes se realizó PCD en 1 segmento y en 3 pacientes en múltiples segmentos. Respecto al resultado clínico se presentó mejoría en 5 de los pacientes (promedio 5.6 puntos EVA), 1 de los pacientes no presento mejoría y requirió de otra intervención quirúrgica. Conclusiones: La PCD es una técnica de mínima invasión útil en el tratamiento del dolor de columna secundario a enfermedad degenerativa discal en aquellos pacientes con comorbilidades que contraindiquen un procedimiento mayor. La descompresión foraminal indirecta mediante PCD en uno o varios segmentos parece contribuir a la mejoría del dolor. Nivel de Evidencia III. Serie de casos y controles.

Plasma rico en plaqueta en el tratamiento de la enfermedad degenerativa discal / Platelet-rich plasma in the treatment of degenerative disc disease

Introducción: La enfermedad degenerativa discal es una entidad frecuente y uno de los principales motivos de consulta. Genera altas tasas de discapacidad, años útiles perdidos, así como altos costos económicos por asistencia médica y grandes pérdidas monetarias. Su tratamiento es generalmente conservador, aunque en la actualidad se incluyen terapias biológicas novedosas. Objetivo: Describir las principales propiedades biológicas que hacen del plasma rico en plaquetas una terapéutica efectiva para la enfermedad degenerativa discal. Métodos: Se realizó una revisión no sistemática de la bibliografía basada en artículos que se publicaron en bases de datos indexadas en Infomed como Hinari, Ebsco, Scielo, Pubmed, Cubmed, Cocrhane, Scopus, LILACS; en idioma español, inglés y portugués, durante los últimos diez años. Desarrollo: Se expusieron características clínico epidemiológicas de la enfermedad degenerativa discal, así como las propiedades biológicas que le permiten al plasma rico en plaqueta tener una función activa en la regeneración del disco intervertebral o el retraso de la cascada de degradación de este. Se resaltan los principales estudios de acuerdo a la vía de administración del plasma rico en plaquetas y sus resultados. Conclusiones: De acuerdo con lo publicado por los autores, el plasma rico en plaquetas es una alternativa efectiva en el tratamiento de la enfermedad degenerativa discal por la producción de factores derivados de las plaquetas, que intervienen en la degeneración del disco intervertebral, siendo la vía intradiscal la que más se emplea(AU)

Introduction: Degenerative disc disease is a frequent condition and one of the main reasons to attend the consultation. It generates high rates of disability, useful years lost, as well as high economic costs for medical assistance and large monetary losses. Its treatment is generally conservative, although novel biological therapies are currently included. Objective: To describe the main biological properties that make platelet-rich plasma an effective therapy against degenerative disc disease. Methods: A nonsystematic review of the bibliography was carried out based on articles published, during the last ten years, in databases indexed in Infomed, such as Hinari, Ebsco, Scielo, Pubmed, Cubmed, Cocrhane, Scopus, and LILACS, in Spanish, English and Portuguese. Development: Clinical-epidemiological characteristics of degenerative disc disease were presented, as well as the biological properties that allow platelet-rich plasma to have an active function in the regeneration of the intervertebral disc or the delay of its degradation cascade. The main studies are highlighted, according to the route of administration of platelet-rich plasma and their results. Conclusions: According to what has been published by authors, platelet-rich plasma is an effective alternative in the treatment of degenerative disc disease, due to the production of factors derived from platelets, which intervene in the degeneration of the intervertebral disc, being the intradiscal pathway the most used(AU)

Clinical management of dogs with presumptive diagnosis of cervical intervertebral disc disease: 78 cases (2006-2017) / Tratamento clínico de cães com diagnóstico presuntivo de doença do disco intervertebral cervical: 78 casos (2006-2017)

This study aimed to identify dogs with a presumptive diagnosis of cervical intervertebral disc disease (IVDD; C1-C5 or C6-T2) submitted to clinical management and evaluate the outcome. This study also aimed to demonstrate the age, sex, and treatment response according to the neurological degree, and verify whether those factors could potentially influence the outcome. The data were obtained from patients with a neurological dysfunction, admitted at the Veterinary Hospital from January 2006 to March 2017. In addition to patient records, the tutors answered a questionnaire related to the success of therapy. A hundred and seventy-seven neurological records were evaluated, and 78 were included in the study according to the inclusion criteria. The most frequent breeds were Dachshunds, followed by mixed-breed dogs. Regarding the neurological dysfunction degree, 58.97% presented grade I (only neck pain), 25.64% were grade II (ambulatory tetraparesis), and 15.38% grade III (nonambulatory tetraparesis). Absolute and partial space rest were performed in 75.64% and 24.36% of the cases, respectively. The minimum rest time was one week and could come up to four weeks. Most dogs were small-sized (≤15kg). The recovery was satisfactory in 87.17% of dogs and unsatisfactory in 12.83%. Regarding recurrence, we observed that 10.3% of dogs presented satisfactory recovery. The clinical treatment for dogs with cervical IVDD can be indicated with adequate clinical response to dysfunction degrees ranging from I to III, either at rest or in restricted space and with a low rate of relapse.(AU)

O objetivo desse estudo foi identificar cães com diagnóstico presuntivo de doença do disco intervertebral cervical (DDIV; C1-C5 ou C6-T2) submetidos ao tratamento clínico e avaliar a resposta a terapia instituída e o índice de recidiva. Esse estudo também visou demonstrar a idade, o gênero e a resposta ao tratamento de acordo com o grau neurológico, a fim de verificar se esses parâmetros podem ser utilizados como fatores prognósticos para a evolução clínica desses pacientes. Foram revisados os registros neurológicos do Hospital Veterinário Universitário de janeiro de 2006 a março de 2017. Realizaram coleta de dados a partir dos registros e por meio de um questionário respondido pelos tutores. Avaliaram 177 fichas neurológicas de cães e obtidas informações para inclusão no estudo em 78 delas. As raças mais frequentes foram Dachshunds, seguido dos cães sem raça definida. Quanto ao grau de disfunção neurológica, 58,97% apresentavam grau I (somente dor), 25,64% estavam em grau II (tetraparesia ambulatória) e 15,38% em grau III (tetraparesia não ambulatória). O repouso absoluto e em espaço restrito foram realizados em 75,64% e 24,36% dos casos, respectivamente e com duração de no mínimo uma semana, podendo chegar a mais de quatro semanas. A maioria dos animais era de pequeno porte (≤15kg). A recuperação foi satisfatória em 87,17% dos cães e insatisfatória em 12,83%. Quanto à recidiva, esta foi observada em 10,3% dos pacientes com recuperação satisfatória. O tratamento clínico para cães com DDIV cervical pode ser indicado com adequada resposta clínica para graus de disfunção que variam de I a III, seja em repouso absoluto ou em espaço restrito e com baixo índice de recidiva.(AU)

Clinical management of dogs with presumptive diagnosis of thoracolumbar intervertebral disc disease: 164 cases (2006-2017) / Tratamento clínico de cães com diagnóstico presuntivo de doença do disco intervertebral toracolombar: 164 casos (2006-2017)

This study aimed to identify dogs with presumptive diagnosis of cervical intervertebral disc disease (IVDD) submitted to clinical management and to evaluate the outcomes. Data were obtained from the medical records of patients with neurological dysfunction assisted at a University Veterinary Hospital from 2006 to 2017. In addition to the patients' records, dog owners responded to a questionnaire on the success of therapy. Four hundred and thirteen neurological records were evaluated, and 164 met the inclusion criteria of the study. The most common breed was Dachshund, followed by mongrels. Classification of neurological dysfunction in the study sample was as follows: 15.9% with grade I, 25.6% with grade II, 26.8% with grade III, 8.5% with grade IV, and 23.2% with grade V. Outcome was satisfactory in 71.6% of the dogs and unsatisfactory in 28.4% of them. Recurrence was observed in 27.7% of those with satisfactory outcomes. The clinical treatment of dogs with thoracolumbar IVDD is satisfactory, particularly for animals with milder disease grades (I, II, and III). There is possibility of recurrence with conservative therapy and clinical signs may be more severe.(AU)

O objetivo desse estudo foi identificar cães com diagnóstico presuntivo de DDIV toracolombar submetidos ao tratamento clínico, a fim de avaliar a resposta à terapia instituída. Foram revisados os registros neurológicos de cães atendidos pelo Serviço de Neurologia e Neurocirurgia Veterinária no período de 2006 a 2017 de um Hospital Veterinário Universitário. Foi realizada coleta de dados a partir dos registros e por meio de um questionário respondido pelos tutores. Foram avaliadas 413 fichas neurológicas de cães e obtidas informações para inclusão no estudo em 164 delas. As raças mais frequentes foram dachshunds, seguido de cães sem raça definida. Quanto ao grau de disfunção neurológica foi definido como grau I para 15,9% dos cães, grau II para 25,6%, grau III para 26,8%, grau IV para 8,5% e grau V para 23,2%. A recuperação foi satisfatória em 71,6% dos cães e insatisfatória em 28,4%. Dos que se recuperaram satisfatoriamente, 27,7% tiveram recidivas. Com base nos resultados obtidos pode-se concluir que o tratamento clínico em repouso absoluto e administração de anti-inflamatórios e analgésicos opióides para cães com DDIV toracolombar é efetivo, principalmente para cães em graus mais leves da doença (grau I, II e III). Há possibilidade de recidiva com esse tipo de terapia cujos sinais clínicos poderão ser mais graves.(AU)

Involvement and significance of large transmembrane protein piezo1 in orthopedic related diseases / 中国组织工程研究

BACKGROUND: Recent studies found that mesenchymal stem cells, osteoblasts and osteoclasts, cartilage cells, nucleus pulposus cells, and osteosarcoma cells can receive mechanical stimulation from extracellular environment through Piezo1 protein so as to activate cell signal transduction pathways, affecting cell proliferation, differentiation, migration and apoptosis, which determines physiological and pathological processes of physiological structure of bone, joint degeneration, and fracture healing. OBJECTIVE: To review Piezo1 related to osteoporosis and degenerative osteoarthropathy, summarize the latest advances by reviewing the latest discovery of Piezo1 in other orthopedic diseases, and provide ideas for novel treatment strategies for orthopedic related diseases. METHODS: A computer search was conducted on the literatures related to the research progress of Piezo1 in orthopedic diseases in CNKI and PubMed from inception to January 2020. The Chinese keywords were “mechanically sensitive ion channel proteins, osteoporosis, degenerative osteoarthropathy, orthopedic diseases”, and the English keywords were “Piezo1, osteoporosis, degenerative osteoarthropathy, orthopedic diseases”. A full web search was conducted, and finally 60 literatures were included for review and discussion. RESULTS AND CONCLUSION: (1) Piezo1 can release biological signals and regulate osteoclast activity during the development of osteoporosis by directly detecting the mechanical load in osteoblastic lineage cells. (2) In the progression of degenerative osteoarthropathy, Piezo1 on the cartilage cell membrane was able to effectively recognize stimuli of different strengths and types of external mechanical stress and eventually induce chondrocyte apoptosis. (3) In bone metabolic diseases, degenerative arthritis of joints and other orthopedic diseases, Piezo1 is involved in the pathological process of the disease. The emergence of Piezo1 provides a more specific molecular basis for the application of mechanical stimulation in orthopedics, opens a new thinking and perspective, and also lays a “hint” for the future dual drug administration and precision medicine.

Efficacy of a Novel Annular Closure Device after Lumbar Discectomy in Korean Patients: A 24-Month Follow-Up of a Randomized Controlled Trial

OBJECTIVE: Lumbar discectomy is an effective treatment for lumbar disc herniation (LDH); however, up to 2–18% of patients with LDH have experienced recurrent disc herniation. The purpose of this study was to evaluate the efficacy of a novel annular closure device (ACD) for preventing LDH recurrence and re-operation compared with that of conventional lumbar discectomy (CLD).METHODS: In this prospective randomized controlled trial, we compared CLD with discectomy utilizing the Barricaid® (Intrinsic Therapeutics, Inc., Woburn, MA, USA) ACD. Primary radiologic outcomes included disc height, percentage of preoperative disc height maintained, and re-herniation rates. Additional clinical outcomes included visual analog scale (VAS) scores for back and leg pain, Oswestry Disability Index (ODI) scores, and 12-item short-form health survey (SF-12) quality of life scores. Outcomes were measured at preoperation and at 1 week, 1, 3, 6, 12, and 24 months postoperation.RESULTS: Sixty patients (30 CLD, 30 ACD) were enrolled in this study. At 24-month follow-up, the disc height in the ACD group was significantly greater than that in the CLD group (11.4±1.5 vs. 10.2±1.2 mm, p=0.006). Re-herniation occurred in one patient in the ACD group versus six patients in the CLD group (χ²=4.04, p=0.044). Back and leg VAS scores, ODI scores, and SF-12 scores improved significantly in both groups compared with preoperative scores in the first 7 days following surgery and remained at significantly improved levels at a 24-month follow-up. However, no statistical difference was found between the two groups.CONCLUSION: Lumbar discectomy with the Barricaid® (Intrinsic Therapeutics, Inc.) ACD is more effective at maintaining disc height and preventing re-herniation compared with conventional discectomy. Our results suggest that adoption of ACD in lumbar discectomy can help improve the treatment outcome.

Efficacy of a Novel Annular Closure Device after Lumbar Discectomy in Korean Patients: A 24-Month Follow-Up of a Randomized Controlled Trial

OBJECTIVE: Lumbar discectomy is an effective treatment for lumbar disc herniation (LDH); however, up to 2–18% of patients with LDH have experienced recurrent disc herniation. The purpose of this study was to evaluate the efficacy of a novel annular closure device (ACD) for preventing LDH recurrence and re-operation compared with that of conventional lumbar discectomy (CLD). METHODS: In this prospective randomized controlled trial, we compared CLD with discectomy utilizing the Barricaid® (Intrinsic Therapeutics, Inc., Woburn, MA, USA) ACD. Primary radiologic outcomes included disc height, percentage of preoperative disc height maintained, and re-herniation rates. Additional clinical outcomes included visual analog scale (VAS) scores for back and leg pain, Oswestry Disability Index (ODI) scores, and 12-item short-form health survey (SF-12) quality of life scores. Outcomes were measured at preoperation and at 1 week, 1, 3, 6, 12, and 24 months postoperation. RESULTS: Sixty patients (30 CLD, 30 ACD) were enrolled in this study. At 24-month follow-up, the disc height in the ACD group was significantly greater than that in the CLD group (11.4±1.5 vs. 10.2±1.2 mm, p=0.006). Re-herniation occurred in one patient in the ACD group versus six patients in the CLD group (χ²=4.04, p=0.044). Back and leg VAS scores, ODI scores, and SF-12 scores improved significantly in both groups compared with preoperative scores in the first 7 days following surgery and remained at significantly improved levels at a 24-month follow-up. However, no statistical difference was found between the two groups. CONCLUSION: Lumbar discectomy with the Barricaid® (Intrinsic Therapeutics, Inc.) ACD is more effective at maintaining disc height and preventing re-herniation compared with conventional discectomy. Our results suggest that adoption of ACD in lumbar discectomy can help improve the treatment outcome.

Fisioterapia na recuperação funcional e qualidade de vida de cães paraplégicos por doença do disco intervertebral (Hansen tipo I) toracolombar submetidos à cirurgia descompressiva / Physiotherapy in functional recovery and quality of life of paraplegic dogs due to thoracolumbar intervertebral disc disease (Hansen type I) submitted to decompressive surgery

Este estudo retrospectivo incluiu cães paraplégicos com ausência de percepção a dor profunda secundário a doença do disco intervertebral toracolombar e submetidos à cirurgia descompressiva. Teve como objetivo comparar a recuperação funcional e a qualidade de vida (QV) quando submetidos a um protocolo em um centro especializado ou a domicílio realizado pelo tutor. Vinte e oito cães foram distribuídos no grupo A (GA) e submetidos ao protocolo domiciliar e 38 denominados grupo B (GB) em um centro especializado. Recuperaram a habilidade de caminhar 43% dos cães em uma média de 40 dias de pós-operatório (PO) no GA e 42% em uma média de 36 dias no GB. Em 53% dos casos (35/66) os cães permaneceram paraplégicos sem percepção a dor profunda ao final do período de 90 dias de PO. Vinte e cinco tutores do GA e 26 do GB responderam um questionário sobre a QV, com no mínimo seis meses de PO. A avaliação do tempo de sobrevida dos animais, realização de eutanásia e nota atribuída a QV demonstraram que os cães do GB provavelmente foram beneficiados pelo estreito acompanhamento e orientação aos tutores até 90 dias PO.(AU)

The retrospective study included paraplegic dogs affected by thoracolumbar intervertebral disc disease with absence of deep pain perception and submitted to a decompressive surgical technique. The aim was to compare functional recovery and quality of life (QOL) of dogs that underwent a home physiotherapy protocol to dogs that were cared in a specialized center. Twenty-eight dogs were placed in group A (GA, home physiotherapy protocol) and other 38 patients were placed in group B (GB, physiotherapy protocol in a specialized center). Forty three percent (43%) of the patients recovered the ability to walk in an average of 40 postoperative (PO) days in GA and 42% in an average of 36 days in GB. In 53% of the cases (35/66) the dogs remained paraplegic without deep pain perception at the end of physiotherapeutic protocols. Twenty-five owners from GA and 26 from GB answered a questionnaire about QOL, with a minimum of six PO months. The evaluation of the animals survival time, euthanasia and the QOL score demonstrated that dogs that underwent a physiotherapeutic treatment in a specialized center probably were benefited by the close monitoring and orientation to owners until 90 days of PO.(AU)

Undiagnosed Peripheral Nerve Disease in Patients with Failed Lumbar Disc Surgery

STUDY DESIGN: Retrospective study (level of evidence=3). PURPOSE: We examine the relationship between residual symptoms after discectomy for lumbar disc herniation and peripheral nerve (PN) neuropathy. OVERVIEW OF LITERATURE: Patients may report persistent or recurrent symptoms after lumbar disc herniation surgery; others fail to respond to a variety of treatments. Some PN neuropathies elicit symptoms similar to those of lumbar spine disease. METHODS: We retrospectively analyzed data for 13 patients treated for persistent (n=2) or recurrent (n=11) low back pain (LBP) and/or leg pain after primary lumbar discectomy. RESULTS: Lumbar re-operation was required for four patients (three with recurrent lumbar disc herniation and one with lumbar canal stenosis). Superior cluneal nerve (SCN) entrapment neuropathy (EN) was noted in 12 patients; SCN block improved the symptoms for eight of these patients. In total, nine patients underwent PN surgery (SCN-EN, n=4; peroneal nerve EN, n=3; tarsal tunnel syndrome, n=1). Their symptoms improved significantly. CONCLUSIONS: Concomitant PN disease should be considered for patients with failed back surgery syndrome manifesting as persistent or recurrent LBP.

Avaliação clínica de cães com doença do disco intervertebral (Hansen tipo I) submetidos à descompressão cirúrgica: 110 casos / Clinical evaluation of dogs with intervertebral disc disease (Hansen type I) submitted to surgical decompression: 110 cases

O objetivo deste estudo foi identificar cães com doença do disco intervertebral toracolombar (Hansen tipo I) submetidos ao tratamento cirúrgico em um serviço de rotina em neurologia de um hospital veterinário universitário no período de 2006 a 2014, e obter informações a respeito da idade, do sexo, da raça, local da extrusão, interpretação da mielografia, avaliação dos graus de disfunção neurológica, recuperação funcional desses cães e observar a ocorrência de recidiva dos sinais clínicos da doença. A raça mais frequente foi Dachshund (69%), seguida dos cães sem raça definida (14,5%). Os locais mais afetados foram entre T12-T13 (31,9%) e L1-L2 (19,1%). Dos 110 cães, 74 (67,3%) tiveram melhora dos sinais clínicos após o procedimento cirúrgico, sendo 54 (49,1%) considerados satisfatórios e 20 (18,2%), parcialmente satisfatórios. Destes cães, seis (8,1%) cães estavam em grau II, 19 (25,7%) em grau III, 35 (47,3%) em grau IV e 14 (18,9%) em grau V. Pode-se concluir que o tratamento cirúrgico promove recuperação funcional satisfatória na maioria dos cães com extrusão de disco toracolombar. O prognóstico para recuperação funcional após o tratamento cirúrgico é tanto melhor quanto menor for o grau de disfunção neurológica e o percentual de recidiva é baixo em animais submetidos a este tipo de terapia.(AU)

The aim of this study was to identify dogs with thoracolumbar intervertebral disc disease (Hansen type I) submitted for surgical treatment on a routine service in neurology in a university veterinary hospital in 2006-2014, and to get information about age, sex, breed, site of extrusion, interpretation of myelography, evaluation of the degree of neurological dysfunction, functional recovery of these dogs, and to verify the recurrence of clinical signs of disease. The most common breed was Dachshund (69%), followed by mixed breed (14.5%). The most affected sites were between T12-T13 (31.9%) and L1-L2 (19.1%). Of the 110 dogs, 74 (67.3%) improved clinical signs after surgery, 54 (49.1%) satisfactory and 20 (18.2%), in part satisfactory. From these dogs, six (8.1%) dogs were in grade II, 19 (25.7%) in grade III, 35 (47.3%) in grade IV, and 14 (18.9%) in grade V. It can be concluded that satisfactory surgical treatment promotes functional recovery in most dogs with thoracolumbar disk extrusion. The prognosis for functional recovery after surgical treatment is better the lower the degree of neurological dysfunction and the recurrence percentage is lower in dogs subjected to this type of therapy.(AU)

Relationship between level of serum triglyceride and early pain after posterior lumbar interbody fusion / 局解手术学杂志

Objective To investigate the relationship between the level of serum triglyceride and early pain after posterior lumbar interbody fusion.Methods A total of 79 patients who were admitted into our hospital from March 2016 to December 2016 were selected into the study,and these patients were divided into two groups according to the degree of pain which means 32 cases in the minor pain group and 47 cases in the intermediate pain group.The difference of serum triglyceride level 3 days after operation were compared between the two groups.Pearson correlation analysis was performed to test the correlation between the level of serum triglyceride and early post-surgical pain.Logistic regression analysis was performed to test the risk factors for early post-surgical pain.Results The data indicated the level of pain was significant higher in the intermediate pain group than that of the minor pain group.Level of serum triglyceride had a significantly positive correlation with the level of post-surgical pain and it was the risk factor of pain after posterior lumbar interbody fusion.Conclusion The level of serum triglyceride is the risk factor of early post-surgical pain of lumbar single level interbody infusion,and it should be adjusted in the perioperative treatment.

Influence of endoscopic lumbar discectomy on limb function and quality of life in patients with lumbar intervertebral disc protrusion / 中国基层医药

Objective To explore and analyze the influence of endoscopic lumbar discectomy on limb function and quality of life in patients with lumbar disc prolapse.Methods 90 cases of lumbar intervertebral disc protrusion were selected,and they were divided into control group and observation group according to the operation method,45 cases in each group.The control group was given open lumbar disc excision treatment,the observation group was given percutaneous endoscopic lumbar disc resection treatment.The perioperative therapeutic index,physical function and quality of life were compared between the two groups.Results The intraoperative blood loss,time in bed,hospital stay,postoperative VAS score of the control group were (60.21 ± 20.32) min,(30.36 ± 14.25) mL,(26.96 ± 9.69) d,(8.21 ± 2.36) d,(5.12 ± 1.36) points,respectively,which of the observation group were (58.96 ± 19.88) min,(12.88 ± 10.28) mL,(100.69 ± 18.75) d,(12.99 ± 3.88) d,(1.98 ± 0.33) points,respectively.Compared with the control group,the observation group had less intraoperative blood loss,shorter time in bed,shorter hospital stay,lower postoperative VAS score,the differences were statistically significant (t =4.25,4.66,5.12,5.78,6.12,all P ＜ 0.05).The excellent and good rate of the control group was 89.89％,which of the observation group was 93.33％,there was no significant difference between the two groups (x2 =7.68,P ＞ 0.05).After treatment,the physical function,role function,emotional function,cognitive function and social function score of the control group were (7.89 ± 0.78) points,(7.99 ± 1.25) points,(7.84 ± 0.65) points,(7.65 ± 0.75) points,(7.45 ± 0.77) points respectively,which of the observation group were (8.96 ± 1.78) points,(8.75 ± 1.12) points,(8.56 ± 0.88) points,(8.42 ± 0.66) points,(8.56 ± 1.47) points,respectively.Compared with before treatment,the physical function,role function,emotional function,cognitive function and social function score in the two groups after treatment were higher.After treatment,compared with the control group,the scores increased more significantly in the observation group (t =6.55,7.56,7.88,7.56,7.89,all P ＜ 0.05).Conclusion Endoscopic resection and open lumbar disc excision technique in treatment of patients with lumbar intervertebral disc protrusion of lumbar can obtain similar curative effect,but the former has less incision,less intraoperative blood loss,postoperative recovery fast,can better improve the patients' quality of life.

Cauda Equina Syndrome by Facet Synovial Pseudocyst Secondary to Epidural Injection / 대한정형외과학회잡지

A 77-year-old woman presented with bilateral leg weakness, accompanied by severe axial back and radicular pain, after a L4–5 epidural injection. She had been receiving misappropriated epidural injections for the last few months. A contrast-enhanced magnetic resonance image showed rim enhancing, spinal canal compromising cystic lesion at the posterior epidural space of L4–5. During surgery, a severely central compromised non-communicating cystic lesion located at posterior epidural space was resected. A histological report of this lesion confirmed a pseudocyst containing a degenerated synovial tissue. Herein, we report our experience of cauda equine syndrome after epidural injection with successful treatment.

Nucleoplasty: Percutaneous Plasma Disc Decompression for the Treatment of Lumbar Disc Herniation

STUDY DESIGN: A review of the literature regarding nucleoplasty. OBJECTIVES: This aim of this article is to provide current information on nucleoplasty as a therapeutic intervention for herniated disc or discogenic back pain in degenerative disc disease. SUMMARY OF LITERATURE REVIEW: Nucleoplasty as a therapeutic intervention for discogenic pain is performed with increasing frequency, and has been reported to involve few complications and to have satisfactory clinical results. MATERIALS AND METHODS: Review of the literature. RESULTS: In nucleoplasty, the intervertebral disc is approached percutaneously. In this paradigm, a bipolar high frequency device in combination with ablation and coagulation is used to create a channel in the intervertebral disc in order to reduce intervertebral disc volume and to decrease intervertebral pressure and inflammatory markers. Standard indications for nucleoplasty have not been established, but it has been reported that the procedure had excellent outcomes regardless of the presence of radiculopathy or the results of discography. Many studies have reported their outcomes using various categories, because the procedure is comparatively new. Concomitantly, long-term follow-up studies remain to be performed, and each study reported a different follow-up period. CONCLUSIONS: Nucleoplasty has been found to show an excellent prognosis for discogenic back pain and a low incidence of complications. Moreover, since it is a minimally invasive procedure, it offers improved possibilities for return to daily life and work. If degenerative changes have not progressed to a great extent or the intervertebral level remains intact, nucleoplasty may be considered prior to surgery. Due to the lack of reports on the subject, prospective analyses in the future are required.

The Clinical Correlations between Diabetes, Cigarette Smoking and Obesity on Intervertebral Degenerative Disc Disease of the Lumbar Spine

STUDY DESIGN: Retrospective analysis of a nationwide private insurance database. Chi-square analysis and linear regression models were utilized for outcome measures. PURPOSE: The purpose of this study was to investigate any relationship between lumbar degenerative disc disease, diabetes, obesity and smoking tobacco. OVERVIEW OF LITERATURE: Diabetes, obesity, and smoking tobacco are comorbid conditions known to individually have effect on degenerative disc disease. Most studies have only been on a small populous scale. No study has yet to investigate the combination of these conditions within a large patient cohort nor have they reviewed the combination of these conditions on degenerative disc disease. METHODS: A retrospective analysis of insurance billing codes within the nationwide Humana insurance database was performed, using PearlDiver software (PearlDiver, Inc., Fort Wayne, IN, USA), to identify trends among patients diagnosed with lumbar disc degenerative disease with and without the associated comorbidities of obesity, diabetes, and/or smoking tobacco. Patients billed for a comorbidity diagnosis on the same patient record as the lumbar disc degenerative disease diagnosis were compared over time to patients billed for lumbar disc degenerative disease without a comorbidity. There were no sources of funding for this manuscript and no conflicts of interest. RESULTS: The total number and prevalence of patients (per 10,000) within the database diagnosed with lumbar disc degenerative disease increased by 241.4% and 130.3%, respectively. The subsets of patients within this population who were concurrently diagnosed with either obesity, diabetes, tobacco use, or a combination thereof, was significantly higher than patients diagnosed with lumbar disc degenerative disease alone (p <0.05 for all). The number of patients diagnosed with lumbar disc degenerative disease and smoking rose significantly more than patients diagnosed with lumbar disc degenerative disease and either diabetes or obesity (p <0.05). The number of patients diagnosed with lumbar disc degenerative disease, smoking and obesity rose significantly more than the number of patients diagnosed with lumbar disc degenerative disease and any other comorbidity alone or combination of comorbidities (p <0.05). CONCLUSIONS: Diabetes, obesity and cigarette smoking each are significantly associated with an increased diagnosis of lumbar degenerative disc disease. The combination of smoking and obesity had a synergistic effect on increased rates of lumbar degenerative disc disease. Patient education and preventative care is a vital goal in prevention of degenerative disc disease within the general population.

Clinical and Radiographic Results of Artificial Disc Replacement Combined with Anterior Cervical Discectomy and Fusion Versus Two-Level Anterior Cervical Discectomy and Fusion in Two-Level Cervical Disc Disease

STUDY DESIGN: Retrospective case-control study. OBJECTIVES: To compare the clinical and radiographic outcomes of a hybrid construct (HC) of cervical artificial disc replacement (CADR) combined with anterior cervical discectomy and fusion (ACDF) (group I) with 2-level ACDF (group II) in patients with 2-level cervical disc disease. SUMMARY OF LITERATURE REVIEW: ACDF is reported to potentially promote degenerative changes in the adjacent segment. CADR has been expected to reduce the risk of adjacent segment degeneration. However, its clinical course has yet to be sufficiently clarified. MATERIALS AND METHODS: Twenty-six patients underwent 2-level cervical disc surgery. Single-level CADR combined with ACDF was performed in 14 patients. Twelve patients underwent 2-level ACDF. Clinical profiles were assessed using the neck disability index (NDI) and visual analogue scale scores of arm and neck pain. Dynamic lateral cervical radiographs were obtained preoperatively and at 1, 6, 12, and 18 months postoperatively. The range of motion (ROM) of the overall cervical spine (C2-7) and the adjacent segments was measured. RESULTS: Group I showed superior NDI 18 months postoperatively (p 0.05). CONCLUSIONS: The HC group showed comparable clinical and radiographic outcomes to those of the 2-level ACDF group. HC can be used selectively in the treatment of patients with 2-level cervical disc disease.

Update in the treatment of intervertebral disc disease by coblation nucleoplasty / 天津医药

The intervertebral disc disease is a group of clinical diseases with complex etiology, various clinical symptoms and poor conservative treatment effect. The traditional treatment methods include conservative treatment, local injection and open surgery. In recent years, minimally invasive spine surgery has made great progress and development, and its clinical effect has been fully affirmed. Coblation nucleoplasty (CN) has been mainly used in the treatment of contained disc herniation since it has been used in clinical treatment. Its application is not favorable because of narrow indications, uncertain clinical efficacy and other reasons. At present, the application of CN in the intervertebral disc diseases has been reported in many literatures, and its working principle, operation safety, indications and efficacy have been analyzed and extended. Those literatures play an important role in its clinical application. Therefore, in this paper, the application status of CN in the intervertebral disc diseases is reviewed.