Spinal magnetic resonance imaging in cats: differences in clinical significance of intervertebral disk extrusion, intervertebral disk protrusion, and degenerative lumbosacral stenosis.

OBJECTIVE: To determine the occurrence of degenerative changes affecting the vertebral column in cats, assess their clinical significance, and determine the occurrence in cats with intervertebral disk herniation compared to other spinal diseases. ANIMALS: 114 client-owned cats. METHODS: Hospital records were retrospectively reviewed for cats with suspected myelopathy that had undergone spinal MRI. Signalment; history; neurological examination; neurolocalization; primary diagnosis; presence, type, and location of intervertebral disk herniation; and presence and location of other degenerative spinal changes (intervertebral disk degeneration [IVDD], spondylosis deformans [SD], end plate changes, dorsal compressions [DC], and foraminal stenosis [FS]) were recorded. RESULTS: 70% of cats showed at least 1 spinal degenerative change. The most common change was IVDD, followed by SD and intervertebral disk protrusion (IVDP), while intervertebral disk extrusion (IVDE), end plate changes, DC, and FS were uncommon to rare. Primary complaint was attributed to a degenerative condition in 22% of cats, including 100% with IVDE, 9% with IVDP, and 43% with degenerative lumbosacral stenosis (DLSS). The occurrence of degenerative spinal changes and number of intervertebral disks affected by IVDD significantly increased with age and body weight. Age was positively correlated with the occurrence of SD and DLSS. Intervertebral disk degeneration, IVDP, SD, DC, and FS were more prevalent in the lumbosacral junction. Cats with IVDD were significantly more likely to show IVDE and IVDP. CLINICAL RELEVANCE: This study revealed that in a population of cats presenting for signs of myelopathy, IVDE was always responsible for the clinical presentation, DLSS was commonly considered incidental, and IVDP was infrequently related to neurological signs.

Association of Abdominal Aortic Calcification and Clinical Outcomes in LDH Patients Treated with Endoscopic Lumbar Discectomy.

INTRODUCTION: To determine any significant associations between abdominal aortic calcification (AAC) and clinical manifestations of pain symptoms following endoscopic lumbar discectomy. METHODS: Patients sequentially presenting with a history of unilateral radiculopathy with or without back pain, and with magnetic resonance imaging (MRI)-confirmed diagnosis of posterolateral disc herniation between August 2021 and December 2023 were eligible for inclusion in the study. All patients underwent endoscopic discectomy at our center during the study period. AAC stages were classified based on the Kauppila classification system using lateral lumbar radiographs. RESULTS: Between August 2021 and December 2023 a total of 120 patients were included in the study for analysis, of whom 82 (68.3%) exhibited mild AAC and 38 (31.7%) had moderate-severe AAC. Analyses using the multivariate linear regression model revealed a significant correlation between AAC comorbidity and postoperative clinical outcomes. At 1 year post-surgery, the mean change in leg pain following endoscopic lumbar discectomy was significantly less for patients with moderate-severe AAC (5.0 points) than for patients with mild ACC (p < 0.001). Even after adjusting for relevant confounders, this difference remained significant. Similar results were also observed in the postoperative improvement of back pain, the Oswestry Disability Index score, and the physical functioning, role physical, and bodily pain components of the 36-item Short Form Health Survey questionnaire. There was no significant difference in the rate of repeat surgery or post-surgical new-onset back pain between patients with different levels of severity of AAC at 1 year post-surgery. CONCLUSIONS: There is a significant association between the severity of AAC and clinical outcomes among patients with lumbar disk herniation who underwent endoscopic lumbar discectomy. AAC may serve as a prognostic factor in predicting surgical outcomes and guiding management strategies for patients with lumbar disk herniation following endoscopic lumbar discectomy.

Guided Imagery Effects on Pain, Anxiety, and Sleep for Lumbar Discectomy Patients.

PURPOSE: Pain, sleep problems, and anxiety due to all these are common problems in patients who have had herniated disk surgery. This study aims to analyze the effect of the guided imagery technique on the patients' pain, anxiety, and sleep levels before and after a lumbar disk herniation (LDH) operation. DESIGN: This study was conducted as a prospective randomized controlled clinical trial. METHODS: The research was conducted with 60 patients who underwent LDH surgery and met the inclusion criteria. Patients were divided into experimental and control groups according to a computer-generated randomization list. The treatment group (n = 31) applied guided imagery techniques twice, once in the preoperative and postoperative periods. The control group (n = 29) was provided with routine care. "Introductory Information Form," "Surgery-Specific Anxiety Scale," "Richard-Campbell Sleep Questionnaire," and "Visual Analogue Scale (VAS)" were used. The data were analyzed using the Shapiro-Wilk test, paired sample t test, independent sample t test, Pearson chi-square exact test, and repeated measures two-way analysis of variance. In all results, P < .05 was considered statistically significant. FINDINGS: The preoperative anxiety level of the treatment group was lower compared to the anxiety level of the control group (P < .05). The sleep score of the treatment group in the preoperative period was higher than the sleep score of the control group (P < .05). The sleep score of the treatment group in the postoperative period was found to be higher than the sleep score of the control group (P < .05). The pain average of the treatment group in the postoperative period was lower than the pain average of the control group (P < .05). CONCLUSIONS: Our study results revealed that guided imagery applied in the preoperative and postoperative periods effectively decreased pain and anxiety levels and increased the sleep quality of patients with LDH.

Development of a predictive model for 1-year postoperative recovery in patients with lumbar disk herniation based on deep learning and machine learning.

Background: The aim of this study is to develop a predictive model utilizing deep learning and machine learning techniques that will inform clinical decision-making by predicting the 1-year postoperative recovery of patients with lumbar disk herniation. Methods: The clinical data of 470 inpatients who underwent tubular microdiscectomy (TMD) between January 2018 and January 2021 were retrospectively analyzed as variables. The dataset was randomly divided into a training set (n = 329) and a test set (n = 141) using a 10-fold cross-validation technique. Various deep learning and machine learning algorithms including Random Forests, Extreme Gradient Boosting, Support Vector Machines, Extra Trees, K-Nearest Neighbors, Logistic Regression, Light Gradient Boosting Machine, and MLP (Artificial Neural Networks) were employed to develop predictive models for the recovery of patients with lumbar disk herniation 1 year after surgery. The cure rate score of lumbar JOA score 1 year after TMD was used as an outcome indicator. The primary evaluation metric was the area under the receiver operating characteristic curve (AUC), with additional measures including decision curve analysis (DCA), accuracy, sensitivity, specificity, and others. Results: The heat map of the correlation matrix revealed low inter-feature correlation. The predictive model employing both machine learning and deep learning algorithms was constructed using 15 variables after feature engineering. Among the eight algorithms utilized, the MLP algorithm demonstrated the best performance. Conclusion: Our study findings demonstrate that the MLP algorithm provides superior predictive performance for the recovery of patients with lumbar disk herniation 1 year after surgery.

The Three-Step Approach for Lumbar Disk Herniation with Anatomical Insights Tailored for the Next Generation of Young Spine Surgeons.

Background/Objectives: Lumbar disc herniation, a complex challenge in spinal health, significantly impacts individuals across diverse age groups. This article delves into the intricacies of this condition, emphasising the pivotal role of anatomical considerations in its understanding and management. Additionally, lumbar discectomy might be considered an "easy" surgery; nevertheless, it carries significant risks. The aim of the study was to present a groundbreaking "three-step approach" with some anatomical insight derived from our comprehensive clinical experiences, designed to systematise the surgical approach and optimise the outcomes, especially for young spine surgeons. We highlighted the purpose of the study and introduced our research question(s) and the context surrounding them. Methods: This retrospective study involved patients treated for lumbar disc herniation at a single institution. The patient demographics, surgical details, and postoperative assessments were meticulously recorded. All surgeries were performed by a consistent surgical team. Results: A total of 847 patients of the 998 patients initially included completed the follow-up period. A three-step approach was performed for every patient. The recurrence rate was 1.89%. Furthermore, the incidence of lumbar instability and the need for reoperation were carefully examined, presenting a holistic view of the outcomes. Conclusions: The three-step approach emerged as a robust and effective strategy for addressing lumbar disc herniation. This structured approach ensures a safe and educational experience for young spinal surgeons.

Revision Lumbar Spine Surgeries: An Early Career Neurosurgery Experience.

BACKGROUND: The aims and ambitions of a surgeon in the early years of his professional career are to make a good reputation by providing excellent patient outcomes and avoiding complex and difficult surgeries. Revision lumbar spine surgeries (RLSSs) pose a significant challenge in terms of surgical management, as the moribund anatomy increases the risk of complications, adding to an unlikely outcome. OBJECTIVE: We conducted this study to determine the clinical indications and outcomes of RLSSs performed by an early career neurosurgeon. MATERIALS AND METHODS: This cross-sectional study was conducted after approval from the hospital's ethical committee, and data was collected in late December of 2022 and early January 2023, from retrospective records for a single early career neurosurgeon. A form was filled with each patient's data, such as age, gender, time since surgery, indication for surgery, operative findings, types of surgery performed, etc. All variables were noted for the patient and were further categorized, based on the clinical records, into many sub-categories. RESULTS: Almost 400 lumbar spine surgeries were performed by the surgeon, and about 45 (11.25%) were revision surgeries, and the full record was available for 42 surgeries. These patients' ages ranged from 22 to 70 years, and the mean age was about 46.74±13.29 SD. The common symptoms leading to revision surgeries were numbness and pain in 17 (40.5%) patients each; common per-operative findings were recurrent disc in eight patients (19%), infection in nine patients (21.4%), and fibrosis/adhesions in 16 (38.1%); most common surgeries performed were diskectomy in 11 (26.2%) and diskectomy plus release of adhesions in 12 (28.6%); complications occurred in 14 (33%), and good to excellent outcomes was recorded in 29 (69%) cases.  Conclusion: RLSSs are difficult compared to first-time lumbar spine surgeries, and the moribund anatomy predisposes to complications, and better shall be dealt with great care and, at the minimum, shall be embarked upon as a team.

Genetic predisposition of BMP7 polymorphisms to lumbar disk herniation in the Chinese Han population.

Bone morphogenetic protein 7 (BMP7) can induce skeletal formation, promote the differentiation of chondrocytes and osteoblasts, and ameliorate intervertebral disc degeneration. The study was designed to evaluate the relationship of BMP7 variants to LDH risk in the Chinese Han population. BMP7 variants were genotyped with the Agena MassARRAY system among 690 LDH patients and 690 healthy controls. The odds ratio (OR) and 95% confidence interval (CI) were calculated by logistic regression. Multi-factor dimension reduction (MDR) (version 3.0.2) software was used to evaluate the effect of BMP7 variant-variant interaction on the susceptibility to LDH. Here, the risk-reducing association between rs230189 and LDH occurrence was found (p = 0.005, OR = 0.79). Specially, rs230189 was associated with decreased LDH risk in females (p = 0.001, OR = 0.60), elder group (p = 0.025, OR = 0.76), subjects with BMI < 24 kg/m2 (p = 0.027, OR = 0.48), nonsmokers (p = 0.001, OR = 0.66), and nondrinkers (p = 0.011, OR = 0.72). Moreover, rs1321862 might be the risk factor for LDH susceptibility among the participants with BMI < 24 kg/m2 (p = 0.024, OR = 1.84). MDR results displayed that rs230189 was the greatest attribution factor on LDH risk in the single-locus model, with an information gain of 0.44%. The present study demonstrated that BMP7 rs230189 g.55771443A>C may play a protective role against LDH risk. Our findings may help to understand the potential mechanism of BMP7 in LDH susceptibility.

Development and validation of a nomogram to predict the risk of residual low back pain after tubular microdiskectomy of lumbar disk herniation.

OBJECTIVE: Tubular microdiskectomy (tMD) is one of the most commonly used for treating lumbar disk herniation. However, there still patients still complain of persistent postoperative residual low back pain (rLBP) postoperatively. This study attempts to develop a nomogram to predict the risk of rLBP after tMD. METHODS: The patients were divided into non-rLBP (LBP VAS score < 2) and rLBP (LBP VAS score ≥ 2) group. The correlation between rLBP and these factors were analyzed by multivariate logistic analysis. Then, a nomogram prediction model of rLBP was developed based on the risk factors screened by multivariate analysis. The samples in the model are randomly divided into training and validation sets in a 7:3 ratio. The Receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA) were used to evaluate the diskrimination, calibration and clinical value of the model, respectively. RESULTS: A total of 14.3% (47/329) of patients have persistent rLBP. The multivariate analysis suggests that higher preoperative LBP visual analog scale (VAS) score, lower facet orientation (FO), grade 2-3 facet joint degeneration (FJD) and moderate-severe multifidus fat atrophy (MFA) are risk factors for postoperative rLBP. In the training and validation sets, the ROC curves, calibration curves, and DCAs suggested the good diskrimination, predictive accuracy between the predicted probability and actual probability, and clinical value of the model, respectively. CONCLUSION: This nomogram including preoperative LBP VAS score, FO, FJD and MFA can serve a promising prediction model, which will provide a reference for clinicians to predict the rLBP after tMD.

Construct validation of the Japanese Core Outcome Measures Index and the impact of diseases on patient-reported outcome measures in preoperative patients with lumbar spinal stenosis and disk herniation: a single-center observational study.

PURPOSE: The primary objective was to validate the construct validity of the Japanese Core Outcome Measures Index (COMI) in preoperative patients aged 60 years or older undergoing lumbar spine surgery for lumbar spinal stenosis (LSS) and lumbar disk herniation (LDH). Additionally, as a secondary aim, we explored the impact of these diseases on quality of life (QOL). METHODS: The analysis included 199 preoperative patients aged 60 and above who were scheduled for lumbar spine surgery. To assess QOL, Japanese versions of the COMI, Oswestry Disability Index (ODI), EuroQol-5 Dimension-3 Level (EQ-5D-3L), and SF-12v2 were employed. The study assessed the validity of the COMI and compared demographic and clinical characteristics between the LSS (147 cases) and LDH (52 cases) groups. It used multivariate covariance analysis (MANCOVA) to examine the impact of diseases (LSS and LDH) on each patient-reported outcome measure while considering covariates. RESULTS: Compared to the LSS group, the LDH group showed more difficulty with the COMI summary score (LSS/LDH [mean]: 6.9/8.1, p < 0.001), ODI score (46.8/57.4, p < 0.001), and EQ-5D utility (0.53/0.43, p < 0.001). The LDH group also reported more difficulties in the COMI-function, COMI-symptom-specific well-being, COMI-disability, ODI-personal care, ODI-social life, and SF-12v2-bodily pain subscales. MANCOVA demonstrated that these results were not influenced by covariates such as gender and medical history. CONCLUSIONS: This study highlights the distinct impact of LSS and LDH on preoperative QOL in older patients undergoing lumbar spinal surgery. Tailored interventions are essential to address the specific challenges posed by these conditions and improve patient-centered outcomes and postoperative recovery.

Psychological Factors Can Affect the Clinical Outcome of Chemonucleolysis with Condoliase in Patients with Lumbar Disk Herniation.

Introduction: Condoliase-based chemonucleolysis is a minimally invasive intermediate treatment option between conservative approaches and surgical interventions for lumbar disk herniation (LDH). In this study, the effects of psychological factors on the clinical outcomes of condoliase therapy for LDH were assessed. Methods: This study involved patients with LDH who received condoliase injections over a 1-year follow-up period. Data from the visual analog scale (VAS) scores for leg and back pain, Oswestry Disability Index, and Hospital Anxiety and Depression Scale (HADS), which was utilized for the psychological assessment, were collected. Using magnetic resonance imaging, changes in disk height and degeneration were evaluated. Data were assessed at baseline and 1-month, 3-month, and 1-year follow-ups. Condoliase therapy was considered effective in patients whose VAS score for leg pain improved by ≥50% at 1 year from baseline and who did not require surgery. The patients were divided into two groups: those who reported effective treatment (Group E) and those who did not (Group I). Between these two groups, comparative analyses were carried out. Results: In this study, a total of 102 patients (70 men; mean age, 43.8±18.2 years) were included. Condoliase therapy was effective in 76 patients (74.5%). Thirty-five patients (34.3%) showed psychological factors (HADS-Anxiety [HADS-A]≥8 or HADS-Depression [HADS-D]≥8) preoperatively and had a significantly lower rate of effectiveness than did those without psychological factors. Group I demonstrated significantly higher baseline back pain VAS, HADS, and HADS-D scores when compared with Group E. Logistic regression analysis identified females and the baseline HADS-D score as independent factors that were related to the effectiveness of condoliase therapy. Conclusions: The patients with psychological factors tended to experience residual pain resulting in adverse effects on the clinical outcomes of chemonucleolysis with condoliase.

Altered serum cytokines in patients with symptomatic disk herniation and depressive symptoms.

Purpose: An increasing number of studies have indicated the important role of cytokines in the development of depressive disturbances (DD). In medically ill patients, cytokines can provoked sickness behavior, the signs of which resemble DD. This results in alterations in behavior to limit energy expenditure and redirect it to cope with particular diseases. The aim of our study was to investigate the role of pro-inflammatory IL-6, TNF-α, and IL-1ß and anti-inflammatory IL-10 and TGF-ß in DD observed in patients suffering from pain caused by disk herniation (DH) qualified for surgery. Patients and methods: The intensity of DD assessed by using Beck Depression Inventory, pain intensity, and functional impairment were evaluated in 70 patients with DH who were qualified for surgery. Pro-inflammatory serum levels of TNF-α, IL-1, IL-6, anti-inflammatory TGF-ß, and IL-10 were measured. Results: Elevated serum levels of TGF-ß, IL-10, and IL-6 were found in the group with moderate and severe depressive symptoms (SD) compared with the groups with mild (MD) or no depressive symptoms (ND). TGF-ß levels were negatively correlated with pain intensity, as assessed using the Present Pain Intensity scale in SD. Functional impairment measured using the Oswestry Disability Index was the most advanced in SD group. Conclusion: Results of our study can suggest association between depressive disturbances and anti-inflammatory cytokines TGF-ß and IL-10. Functional impairment of SD group is more severe but serum levels of TGF-ß and IL-10, which are involved in the healing processes, are increased.

Utility of somatosensory- and motor-evoked potential change thresholds in surgical treatment for thoracic spinal stenosis based on different pathologies.

BACKGROUND CONTEXT: Thoracic spinal stenosis (TSS) is secondary to different pathologies that differ in clinical characteristics and surgical outcomes. PURPOSE: This study aimed to determine the optimal warning thresholds for combined somatosensory-evoked potentials (SSEP) and motor-evoked potentials (MEP) for predicting postoperative neurological deterioration in surgical treatment for TSS based on different pathologies. Additionally, we explored the correlation between SSEP/MEP monitoring and postoperative spinal neurological function. STUDY SETTING: Retrospective study. PATIENT SAMPLE: Two hundred and five patients. OUTCOME MEASURES: We obtained perioperative modified Japanese Orthopedic Association (mJOA) scores to assess spinal neurological function. METHODS: The data collected in this study included demographic data, intraoperative neurophysiological monitoring (IONM) signals, and perioperative neurological function assessments. To determine the optimal IONM warning threshold, a receiver operating characteristic (ROC) curve was used. Additionally, Pearson correlation analysis was conducted to determine the correlation between IONM signals and clinical neurological conditions. RESULTS: A total of 205 consecutive patients were eligible. Forty-one patients had thoracic disc herniation (TDH), 14 had ossification of the posterior longitudinal ligament (OPLL), 124 had ossification of the ligamentum flavum (OLF), and 26 had OPLL+OLF. The mean mJOA scores before surgery and 3 months after surgery were 7.0 and 7.9, respectively, resulting in a mean mJOA recovery rate (RR) of 23.1%. The average postoperative mJOA RRs for patients with TDH, OPLL, OLF, and OPLL+OLF were 24.8%, 10.4%, 26.8%, and 11.2%, respectively. Patients with OPLL+OLF exhibited a more stringent threshold for IONM changes. This included a lower amplitude cutoff value (a decrease of 49.0% in the SSEP amplitude and 57.5% in the MEP amplitude for short-term prediction) and a shorter duration of waveform change (19.5 minutes for SSEP and 22.5 minutes for MEP for short-term prediction). On the other hand, patients with TDH had more lenient IONM warning criteria (a decrease of 49.0% in SSEP amplitude and 77.5% in MEP amplitude for short-term prediction; durations of change of 25.5 minutes for SSEP and 32.5 minutes for MEP). However, OPLL patients or OLF patients had moderate and similar IONM warning thresholds. Additionally, there was a stronger correlation between the SSEP amplitude variability ratio and the JOA RR in OPLL+OLF patients, while the correlation was stronger between the MEP amplitude variability ratio and the JOA RR for the other three TSS pathologies. CONCLUSIONS: Optimal IONM change criteria for prediction vary depending on different TSS pathologies. The optimal monitoring strategy for prediction varies depending on TSS pathologies.

The Transaxillary Approach as a Direct Route in the Management of Upper Thoracic Spine Pathology: A Technical Note with Case Series.

This retrospective case series of prospective data aims to describe the transaxillary approach for the treatment of upper thoracic spine pathology. Various surgical techniques and approaches have been reported across the literature to address upper thoracic spine pathology, including the cervicothoracic approach, anterior transsternal approach, posterolateral approach, supraclavicular approach, and lateral parascapular approaches. These techniques are invasive. A minimally invasive, less morbid, and direct access approach to the pathology of the upper thoracic spine has not been reported in the literature. Patients with pathology affecting the first thoracic vertebra up to the sixth thoracic vertebra were classified into the upper thoracic spine group. Patients with pathology below the sixth thoracic vertebra were excluded. Patients not having a minimum follow-up of 12 months were also excluded. The study analyzed 18 patients. The mean preoperative modified Japanese Orthopedic Association score was 7.2±1.44, which improved to 10.16±1.2 (p<0.05). The majority (14/18) of the patients had an excellent outcome. Three patients had good outcomes, and one patient had a fair outcome. Five cases of intraoperative dural leak were recorded, and one patient had postoperative neurological deficit. The transaxillary approach is a safe, viable, muscle-sparing, and minimally invasive approach for ventral pathologies of the upper thoracic spine.

Eficacia de las infiltraciones epidurales en el abordaje del dolor y la discapacidad por radiculopatía lumbosacra aguda y subaguda / Efficacy of epidural infiltration in the management of pain and disability due to acute and subacute lumbosacral radiculopathy

Antecedentes y objetivos: Las infiltraciones epidurales (IEE) constituyen una alternativa en el tratamiento del síndrome de radiculopatía lumbosacro (SRL). El objetivo de estudio es evaluar la eficacia de las IEE en la intensidad del dolor, mejora de la recuperación funcional y retorno a la actividad laboral. Material y métodos: Se realizó un estudio prospectivo en una cohorte de 100 pacientes consecutivos remitidos a la unidad del dolor por SRL de más de 3 meses de duración. Se analizó la eficacia de las inyecciones de corticoides y anestésicos locales por diferentes vías (interlaminar, caudal y transforaminal) a los 15 días, un mes y 3 meses de la infiltración, en cuanto a la intensidad del dolor mediante la escala analógica visual (EAV), evolución del grado de discapacidad y la reincorporación laboral. Resultados: Noventa y nueve pacientes se incluyeron en el estudio. El 46,5% fueron varones y el 53,5% mujeres. La edad media fue de 57,47±11,1 años. En la mayoría (58,6%) de los casos se optó por la vía caudal, seguida de la transforaminal (23,2%), e interlaminar (18,2%). Las IEE produjeron una reducción significativa del dolor en todos los periodos estudiados (EAV: 7,78±1,5 basal; 6,2±0,9 a los 15 días; 6,3±1,2 al mes; 6,15±1,3 a los 3 meses; p<0,05). La vía de acceso más eficaz fue la transforaminal. El 70% de los pacientes en situación de incapacidad laboral retornaron a su trabajo tras el tratamiento. Discusión y conclusiones: El tratamiento mediante las IEE redujo la intensidad del dolor por SRL, mejoró la situación funcional y la reincorporación a la actividad laboral.(AU)

Backgrund and objective: Epidural infiltrations are used for treatment of low back pain and sciatica. linked to lumbar radiculopathy (lumbosacral radicular syndrome). This study evaluates the efficacy of epidural infiltration by different routes to reduce pain intensity, disability and return to work. Methods: Is a prospective observational study in one hundred consecutive patients sent to pain unit for severe lumbo-sacral radiculopaty. We analyze the efficacy on pain relief (Visual Analogue Scale) and funcional status at two weeks, one month, and three months after epidural injection of local anesthetics and esteroids with differents approachs (interlaminar, caudal and transforaminal). Results: Ninety nine patients (46.5% men, 53.5 women) were finally enrrolled in the study. Mean age was 57.47±11.1 years. The caudal approach was used in 58.6% patients, 23.2% transforaminal approach, and 18.2% interlaminar approach. A significant pain relief was found in all times studied (EAV 7.48±1.5 basal; 6.2±0,9 at 15 days; 6.3±1.2 at one month; 6.15±1.3 at 3 months, P<.05). Transforaminal approach was superior to caudal or interlaminal. Seventy percent in time off work patients returned to work after epidural inyections. Conclusions: Epidural local anesthetics with esteroids injections for lumbo-sacral radiculopathy were effective for low back pain, improved functional status and promoted return to work. Transforaminal approach is superior to others.(AU)

Optimizing prediction accuracy for early recurrent lumbar disc herniation with a directional mutation-guided SVM model.

Percutaneous endoscopic lumbar discectomy (PELD) is one of the main means of minimally invasive spinal surgery, and is an effective means of treating lumbar disc herniation, but its early recurrence is still difficult to predict. With the development of machine learning technology, the auxiliary model based on the prediction of early recurrent lumbar disc herniation (rLDH) and the identification of causative risk factors have become urgent problems in current research. However, the screening ability of current models for key factors affecting the prediction of rLDH, as well as their predictive ability, needs to be improved. Therefore, this paper presents a classification model that utilizes wrapper feature selection, developed through the integration of an enhanced bat algorithm (BDGBA) and support vector machine (SVM). Among them, BDGBA increases the population diversity and improves the population quality by introducing directional mutation strategy and guidance-based strategy, which in turn allows the model to secure better subsets of features. Furthermore, SVM serves as the classifier for the wrapper feature selection method, with its classification prediction results acting as a fitness function for the feature subset. In the proposed prediction method, BDGBA is used as an optimizer for feature subset filtering and as an objective function for feature subset evaluation based on the classification results of the support vector machine, which improves the interpretability and prediction accuracy of the model. In order to verify the performance of the proposed method, this paper proves the performance of the model through global optimization experiments and prediction experiments on real data sets. The accuracy of the proposed rLDH prediction model is 93.49% and sensitivity is 88.33%. The experimental results show that Level of herniated disk, Modic change, Disk height, Disk length, and Disk width are the key factors for predicting rLDH, and the proposed method is an effective auxiliary diagnosis method.

Role of surgery in primary lumbar disk herniation: WFNS spine committee recommendations.

Objective: To provide the most up-to-date recommendations on the role of surgery in first-time lumbar disk herniations (LDH) in order to standardize surgical management. Methods: We performed a literature search in PubMed, Scopus, and Embase from 2012 to 2022 using the following keywords: "lumbar disk herniation AND surgery". Our initial search yielded 2610 results, which were narrowed down to 283 papers after standardized screening critera were applied. The data from these 283 papers were presented and discussed at two international meetings of the World Federation of Neurosurgical Societies (WFNS) Spine Committee, where the Delphi method was employed and ten spine experts voted on five final consensus statements. Results: and Conclusions: The WFNS Spine Committee's guidelines cover four main topics: (1) role and timing of surgery in first-time LDH; (2) role of minimally invasive techniques in LDH; (3) extent of disk resection in LDH surgery; (4) role of lumbar fusion in the context of LDH. Surgery for LDH is recommended for failure of conservative treatment, cauda equina syndrome, and progressive neurological impairment, including severe motor deficits. In the latter cases, early surgery is associated with faster recovery and may improve patient outcomes. Minimally invasive techniques have short-term advantages over open procedures, but there is insufficient evidence to make a recommendation for or against the choice of a specific surgical procedure. Sequestrectomy and standard microdiscectomy demonstrated similar clinical results in terms of pain control, recurrence rate, functional outcome, and complications at short and medium-term follow-up. Lumbar fusion is not recommended as a routine treatment for first-time LDH, although it may be considered in specific patients affected by chronic axial pain or instability.

Back morphology and walking patterns mean 13.8 years after surgery for lumbar disk herniation in adolescents.

Introduction: In many pain conditions, there is lingering pain despite healed tissue damage. Our previous study shows that individuals who underwent surgery for lumbar disk herniation (LDH) during adolescence have worse health, more pain, and increased disk degeneration mean 13 years after surgery compared with controls. It is unclear if walking patterns segregate surgically treated LDH adolescents and controls at mean 13-year follow-up. Objectives: Here, we analyzed the relationship between gait, back morphology and other health outcomes in a cohort of individuals treated surgically because of lumbar disk herniation compared with controls. Methods: We analyzed gait during a walking paradigm, back morphology at the site of surgery, and standardized health outcomes, among individuals who received surgery for LDH as adolescents, "cases" (n = 23), compared with "controls" (n = 23). Results: There were gait differences in head (P = 0.021) and trunk angle (P = 0.021) between cases and controls in a direction where cases exhibited a posture associated with sickness. The gait variance was explained by subjective pain and exercise habits rather than objective disk degeneration. Conclusion: Over a decade after surgery for LDH during adolescence, health among cases is worse compared with controls. The head and trunk angles differ between cases and controls, indicating that the residual pain lingers and may cause changes in movement patterns long after a painful episode in early life. Gait may be a useful target for understanding maintenance of pain and disability among individuals treated surgically for LDH during adolescence.

Research on the multidimensional brain remodeling mechanisms at the level of brain regions, circuits, and networks in patients with chronic lower back pain caused by lumbar disk herniation.

Introduction: Chronic lower back pain (cLBP), frequently attributed to lumbar disk herniation (LDH), imposes substantial limitations on daily activities. Despite its prevalence, the neural mechanisms underlying lower back pain remain incompletely elucidated. Functional magnetic resonance imaging (fMRI) emerges as a non-invasive modality extensively employed for investigating neuroplastic changes in neuroscience. In this study, task-based and resting-state fMRI methodologies are employed to probe the central mechanisms of lower back pain. Methods: The study included 71 chronic lower back pain patients (cLBP group) due to LDH and 80 age, gender, and education-matched healthy volunteers (HC group). The subjects are mainly middle-aged and elderly individuals. Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and Japanese Orthopedic Association Scores (JOA) were recorded. Resting-state and task-based fMRI data were collected. Results/discussion: No significant differences were observed in age, gender, and education level between the two groups. In the cLBP group during task execution, there was diffuse and reduced activation observed in the primary motor cortex and supplementary motor area. Additionally, during resting states, notable changes were detected in brain regions, particularly in the frontal lobe, primary sensory area, primary motor cortex, precuneus, and caudate nucleus, accompanied by alterations in Amplitude of Low Frequency Fluctuation, Regional Homogeneity, Degree Centrality, and functional connectivity. These findings suggest that chronic lower back pain may entail reduced excitability in sensory-motor areas during tasks and heightened activity in the sensory-motor network during resting states, along with modified functional connectivity in various brain regions.

Correlates of sexual function in women with acute lumbar disc herniation in Iran: a cross-sectional study.

Evidence suggests that lumbar disc herniation (LDH) influences sexual function to a great deal. However, most existing studies have been conducted on men. Thus, the current study aimed to assess sexual function and its correlates in women with acute LDH. This descriptive cross-sectional study was conducted on 350 women of reproductive age with acute LDH in Fasa, Iran in 2023. The mean score of female sexual function was 21.33 (3.38). Almost 80% of women had sexual dysfunction. Women scored lower on sexual desire and the higher on lubrication. As the severity of LDH increased, arousal, lubrication and sexual pain score decreased and low back pain (LBP) score increased (p < 0.05). The number of sexual activities after disc herniation was significantly lower in the women with sexual dysfunction (p < 0.001). Regression analysis showed a significant association between sexual dysfunction and LBP intensity (OR = 1.13, CI 1.02-1.26, p = 0.01) and lumbar disc herniation intensity (OR = 2.22, CI 1.07-4.62, p = 0.03). Lumbar disc herniation (LDH) may significantly affect women's sexual function. Severity of low back pain and severity of lumbar disc herniation were found to be risk factors for sexual dysfunction in this population.

Cervical Nerve Root Block Using a Curved Blunt Needle and Posterior Approach.

BACKGROUND: Cervical transforaminal epidural steroid injections have become less popular due to the risk of catastrophic complications they pose. However, cervical nerve root blocks are useful for surgical planning in patients with cervical radicular pain syndromes. OBJECTIVES: Our aim was to find a method of performing cervical selective nerve root blocks that removed the risk of catastrophic complications. STUDY DESIGN: Retrospective case review. SETTING: Academic multidisciplinary spine center. METHODS: Among patients, 50 consecutive cases were retrospectively reviewed for immediate pain scores and follow-up results. In the intervention, a posterior approach using a curved blunt needle was employed for cervical selective nerve root blocks to minimize the risk of arterial injection. To measure the outcomes, we used quantitative pain severity scores and qualitative responses. RESULTS: This technique detailed in this study has a high immediate analgesic effect that can be used for diagnostic purposes. It is not known if this technique has prognostic value with respect to surgery. The prolonged response rate is about 50%, which is in line with other techniques. LIMITATIONS: This study had no control group. CONCLUSION(S): Cervical selective nerve root blocks using a curved blunt needle and a posterior approach are effective in selectively identifying nerves that cause clinical symptoms. This technique minimizes the risk of arterial or spinal cord impingement and therefore may be safer than transforaminal selective nerve root blocks.