New contributions on chronic low back pain: disc infection or contaminated cultures?

There is controversy about the likely infectious origin of chronic low back pain, because it has been suggested the possibility of a relationship with infection by Cutibacterium acnes (C. acnes). The aim of this study is to compare four methods to determine the presence of a likely infection caused by C. acnes in surgical disc samples. This work is a cross-sectional observational study in which there are included 23 patients with microdiscectomy indication. Disc samples were taken during surgery and analysis was done by culture, Sanger sequencing, next-generation sequencing (NGS), and real-time PCR (qPCR). Furthermore, clinical data collection was conducted, and it was analyzed the presence of the Modic-like changes on the magnetic resonance imaging. In 5 of the samples from among the 23 patients (21.7%), C. acnes was isolated by culture. However, in none of the samples could its genome be detected through Sanger sequencing, the less sensitive method. Only the qPCR and NGS were able to detect very few copies of the genome of this microorganism in all the samples, with no significant quantitative differences being observed between the patients in whom isolation of the microorganism by culture was evident or not. Furthermore, there were no significant relationships identified between the clinical variables, including Modic alterations and positive cultures. The most sensitive methods to the detect C. acnes were NGS and qPCR. The data obtained do not suggest association between the presence of C. acnes and the clinical process and support the hypothesis that C. acnes is found in these samples only because it is a contamination from the skin microbiome.

Variability of Clinical and Angiographic Results Based on the Treatment Preference (Endovascular or Surgical) of Centers Participating in the Subarachnoid Hemorrhage Database of the Working Group of the Spanish Society of Neurosurgery.

OBJECTIVES: Since the introduction of endovascular treatment for cerebral aneurysms, hospitals in which subarachnoid hemorrhage is treated show different availability and/or preferences towards both treatment modalities. The main aim is to evaluate the clinical and angiographic results according to the hospital's treatment preferences applied. METHODS: This study was conducted based on use of the subarachnoid hemorrhage database of the Vascular Pathology Group of the Spanish Neurosurgery Society. Centers were classified into 3 subtypes according to an index in the relationship between endovascular and surgical treatment as: endovascular preference, high endovascular preference, and elevated surgical preference. The clinical results and angiographic results were evaluated among the 3 treatment strategies. RESULTS: From November 2004 to December 2017, 4282 subarachnoid hemorrhage patients were selected for the study: 630 (14.7%) patients from centers with surgical preference, 2766 (64.6%) from centers with endovascular preference, and 886 (20.7%) from centers with high endovascular preference. The surgical preference group obtained the best angiographic results associated with a greater complete exclusion (odds ratio: 1.359; 95% confidence interval: 1.025-1.801; P = 0.033). The surgical preference subgroup obtained the best outcome at discharge (65.45%), followed by the high endovascular preference group (61.5%) and the endovascular preference group (57.8%) (odds ratio: 1.359; 95% confidence interval: 1.025-1.801; P = 0.033). CONCLUSIONS: In Spain, there is significant variability in aneurysm exclusion treatment in aneurysmal subarachnoid hemorrhage. Surgical centers offer better results for both surgical and endovascular patients. A multidisciplinary approach and the maintenance of an elevated quality of surgical competence could be responsible for these results.

Estudio volumétrico por resonancia magnética de la fosa posterior y sus componentes en la neuralgia del trigémino idiopática / Volumetric measurement of the posterior fossa and its components using magnetic resonance imaging in idiopathic trigeminal neuralgia

Introducción. El conflicto neurovascular se considera hoy día un dogma indiscutible en la fisiopatología de la neuralgia del trigémino idiopática (NTI). Sin embargo, son cada vez más los trabajos que aportan información acerca de otros factores que favorecen dicho conflicto o la neuralgia por sí misma. Objetivos. Medir el volumen de los espacios y subestructuras de la fosa posterior en pacientes con NTI y controles e investigar la asociación entre un espacio reducido de dichas estructuras y la incidencia de NTI. Sujetos y métodos. Se realizan resonancias magnéticas de alta resolución (1,5 T) a 20 pacientes diagnosticados de NTI y a 20 controles sanos y se obtienen secuencias coronales y axiales (1 mm de espesor) potenciadas en T2 para realizar un estudio volumétrico de las cisternas pontomesencefálicas, el cavum de Meckel y el tronco principal del nervio trigémino. Resultados. Considerando la mitad de la cisterna pontomesencefálica a cada lado de la línea media, el volumen de la hemicisterna del lado afectado era significativamente menor que el del lado sano en pacientes con NTI (p = 0,004) y también al compararla con las hemicisternas de los controles. No se encontraron diferencias significativas con el cavum de Meckel ni con el propio nervio trigémino. Se buscó también la presencia de conflicto neurovascular y en un 10% de los pacientes no se identificó dicho fenómeno en el lado afectado. Conclusiones. Los datos obtenidos en nuestro trabajo apoyan la teoría de que un espacio reducido de las cisternas de la fosa posterior que contienen el nervio trigémino podría favorecer la incidencia de NT (AU)

Introduction. The neurovascular conflict is now considered an unquestionable dogma in the pathophysiology of idiopathic trigeminal neuralgia (ITN). However, there are more and more papers that provide information about other factors that promote such conflict or neuralgia itself. Aims. To measure the volume of the substructures of the posterior fossa in patients with ITN and controls and to investigate the association between a reduced volume of these structures and the incidence of ITN. Subjects and methods. In 20 patients with unilateral ITN and 20 healthy participants, high resolution 1.5 T magnetic resonance imaging scans including axial and coronal sequences T2-weighted with a slice thickness of 1 mm were performed with the aim of a volumetric study of pontomesencephalic cistern, Meckel’s cave and trigeminal nerve. Results. Measuring the pontomesencephalic cistern on each side of the midline, the volume of the affected side cistern was significantly lower than the healthy side one in patients with ITN (p = 0.004) and also when compared with controls hemicisterns. No significant differences in the Meckel’s cave nor the trigeminal nerve were found. The incidence of neurovascular conflict was also studied resulting in 10% of patients with ITN where the conflict was not identified. Conclusions. Our data support the theory that a small volume of the posterior fossa cisterns containing the trigeminal nerve may increase the incidence of ITN (AU)

[Volumetric measurement of the posterior fossa and its components using magnetic resonance imaging in idiopathic trigeminal neuralgia]. / Estudio volumetrico por resonancia magnetica de la fosa posterior y sus componentes en la neuralgia del trigemino idiopatica.

INTRODUCTION: The neurovascular conflict is now considered an unquestionable dogma in the pathophysiology of idiopathic trigeminal neuralgia (ITN). However, there are more and more papers that provide information about other factors that promote such conflict or neuralgia itself. AIMS. To measure the volume of the substructures of the posterior fossa in patients with ITN and controls and to investigate the association between a reduced volume of these structures and the incidence of ITN. SUBJECTS AND METHODS: In 20 patients with unilateral ITN and 20 healthy participants, high resolution 1.5 T magnetic resonance imaging scans including axial and coronal sequences T2-weighted with a slice thickness of 1 mm were performed with the aim of a volumetric study of pontomesencephalic cistern, Meckel's cave and trigeminal nerve. RESULTS: Measuring the pontomesencephalic cistern on each side of the midline, the volume of the affected side cistern was significantly lower than the healthy side one in patients with ITN (p = 0.004) and also when compared with controls hemicisterns. No significant differences in the Meckel's cave nor the trigeminal nerve were found. The incidence of neurovascular conflict was also studied resulting in 10% of patients with ITN where the conflict was not identified. CONCLUSIONS: Our data support the theory that a small volume of the posterior fossa cisterns containing the trigeminal nerve may increase the incidence of ITN.