Treatment of Low Back Pain by Treating the Annular High Intensity Zone (HIZ) Lesions Using Percutaneous Transforaminal Endoscopic Disc Surgery.

BACKGROUND: The study design was a retrospective case series. The objective was to find the clinical success rate of percutaneous transforaminal endoscopic disc surgery in patients suffering from discogenic chronic low back pain who were showing high intensity zone (HIZ) with degenerated disc as the only abnormality in the magnetic resonance imaging (MRI). The HIZ in the posterior annulus in degenerated disc is recognized as a pain generator. There are only a few studies available in the literature addressing the effect of identification and treatment of HIZ in the chronic low back pain patient. METHODS: We retrospectively evaluated the case records of all the patients who were treated by percutaneous endoscopic disc surgery for relief of symptoms as determined by visual analog scale (VAS) score, Oswestry Disability Index (ODI), Mac Nab criteria, and the consumption of analgesics, who had the predominant symptom of chronic low back pain, and whose lumbar spine MRI showed degenerated disc with HIZ and no other cause of back pain, like facet joint arthritis or sacroiliac joint arthritis. RESULTS: A total of 23 patients were identified to include in the study. Mean preoperative duration of low back pain was 13.1 months. Mean follow up after the procedure was 29 months. At final follow up, 69.6% of the patients were not taking any pain medicines, 17.36% were on frequent analgesic medicines, 13.04% were on occasional analgesics. There was statistically significant reduction in VAS at 6 weeks postop and final follow up after surgery and the ODI at final follow up; 82.6% of patients had an excellent/good outcome as per Mac Nab criteria. There were no complications or reoperations in any of the patients. CONCLUSIONS: Visualization and ablation of the chronic annular pathology in HIZ may give an effective and minimally invasive treatment for one of the back pain causes.

Incidence of deep vein thrombosis after major spine surgeries with no mechanical or chemical prophylaxis.

STUDY DESIGN: Retrospective cohort study. CLINICAL QUESTION: What is the incidence of deep vein thrombosis (DVT) and pulmonary embolism (PE) after major spine surgery when no prophylactic measures were used? METHODS: A prospective evaluation of 121 patients who underwent 128 major spine surgeries was conducted to determine the incidence of clinically identifiable DVT. As a matter of practice, no patient was given thromboprophylaxis, either mechanical or chemical. RESULTS: Only one patient developed the signs and symptoms of DVT, which was further confirmed by a Doppler study. The overall incidence of DVT was 0.78%. There was no clinically evident case of PE. CONCLUSIONS: Considering the low rate of incidence of DVT and PE, routine screening and prophylaxis for DVT appears unwarranted in major spine surgery. [Table: see text].