Bacterial identification in herniated intervertebral discs: a prospective cohort study.

BACKGROUND CONTEXT: Reports of Cutibacterium acnes isolated in cultures of intervertebral disc samples suggest it as possibly responsible for inflammatory conditions causing Modic changes on spinal magnetic resonance imaging (MRI). PURPOSE: Our objective was to investigate the prevalence of C. acnes in samples of intervertebral disc of patients with lumbar disc herniation; to investigate prognostic factors and the relationship of Modic changes with infection 1 year after microdiscectomy. STUDY DESIGN: Prospective cohort study. PATIENT SAMPLE: In this single-center study, patients consecutively operated on for disc herniation had samples of the disc, multifidus muscle and ligamentum flavum (as an indication of contamination) extracted for culture. OUTCOME MEASURES: Age, sex, alcohol and tobacco consumption, body mass index; function, pain, and Modic chances in MRI before surgery and MRI 1 year later; rate of disc, muscle and ligament infection (primary outcome); diabetes and corticoid use (confoundings). METHODS: The protruded disc, muscle and ligament samples were sent for culture analysis in up to 30 minutes. A subsample of 17 patients underwent next-generation sequencing (NGS) molecular analysis too. We performed descriptive analysis and comparison of groups of patients with and without infection or contamination using Student's t, Mann-Whitney, chi-square, or Fisher's exact tests as appropriate, and pre- and postsurgical comparisons with the Wilcoxon test. RESULTS: From January 2018 to September 2019, 112 patients underwent open lumbar microdiscectomy, 67 (59.8%) men. Cultures showed 7 (6.3%) positive cases in the disc (2 with C. acnes), 3 (2.7%) in the ligament, and 12 (10, 7%) in muscle. No evidence of a difference in Modic alterations pre- or postoperatively was found between patients with and without positive culture 1 year after surgery. No association was found between culture positivity and functional or pain differences either. NGS results were all negative for C. acnes. CONCLUSIONS: We identified infective bacterial presence in the herniated disc in less than 2% of patients with disc herniation. C. acnes was not identified in any disc microbiome analysis. No significant association was observed between positivity for tissue infection and any clinical prognostic factor.

Effectiveness of intradiscal ozone injections for treating pain following herniated lumbar disc: A systematic review and meta-analysis.

BACKGROUND: Low back pain and sciatica caused by herniated lumbar discs (HLDs) are common complaints among patients visiting pain clinics. Among the various therapeutic methods, intradiscal ozone injections have emerged as an effective alternative or additional treatment option for HLDs. OBJECTIVE: This meta-analysis aimed to investigate the effectiveness of intradiscal ozone injections in the treatment of HLDs. METHODS: We searched the PubMed, Embase, Cochrane Library, and Scopus databases for relevant studies published until January 25, 2024. We included studies that investigated the efficacy of intradiscal ozone injections in patients with HLDs. We evaluated the methodological quality of individual studies using the Cochrane Collaboration tool. RESULTS: At ⩾ 6 months after treatment, the therapeutic effect of intradiscal ozone injections in patients with HLDs was greater than that of steroid injections (treatment success rate, 6 months: odds ratio = 3.95, 95% confidence interval [CI] [2.44, 6.39], P< 0.01) or conventional medications (changes in the Visual Analog Scale [VAS], 6 months: standardized mean difference [SMD] = 1.65, 95% CI [1.08, 2.22], P< 0.01; 12 months: SMD = 1.52, 95% CI [0.96, 2.08], P< 0.01) but similar to that of microdiscectomy (changes in VAS, 18 months: SMD =-0.05, 95% CI [-0.67, 0.57], P= 0.87). At < 6 months after treatment, the reduction in the VAS score after intradiscal ozone injections was higher than that after steroid injections (changes in VAS, 1 month: SMD = 2.53, 95% CI [1.84, 3.21], P< 0.01). CONCLUSION: Intradiscal ozone injections may be a useful therapeutic tool in patients with HLDs. Compared with other conventional treatment methods such as steroid injections and oral medications, intradiscal ozone injection has great long-term (⩾ 6 months) effectiveness.

Exploration of the correlation between facet joints cross-sectional area asymmetry and cervical disc herniation.

PURPOSE: To evaluate the association between facet joints cross-sectional area asymmetry (FCAA) and cervical intervertebral disc herniation (CDH). METHODS: Overall, we retrospectively recruited 390 consecutive patients with CDH who underwent surgical treatment at our institution and 50 normal participants. Clinical variables and radiological findings related to CDH were collected. RESULTS: Patients with CDH were more likely to have a higher absolute value of the facet asymmetry factor (FAF) (p < .001), in which the FAF value of the left group was significantly higher than the other groups (p < .001) and the right group was lower than the central group (p < .001). 9.62% (C3/4), 12.19% (C4/5), 8.70% (C5/6), and 8.14% (C6/7) were determined as cutoff values for each variable that maximized sensitivity and specificity. Furthermore, multivariate analysis showed that cross-sectional area asymmetry of the facet joint (FCAA) was an independent risk factor for the occurrence of CDH. Also, the Chi-square test showed a significant difference in the distribution of the degeneration classification of the disc between the facet-degenerated group and the nondegenerated group at C5/6 (p = 0.026) and C6/7 (p = 0.005) in the facet asymmetry (FA) group. CONCLUSIONS: FCAA is evaluated as an independent risk factor for CDH and associated with the orientation of disc herniation. And facet joint orientation may also play a role in cervical spine degeneration rather than facet joint tropism.

Temporomandibular Joint Disc Reduction And Fixation.

OBJECTIVE: To evaluate the clinical effectiveness and stability of open suture versus micro-screw anchored disc reduction and fixation in treating disc displacement without reduction in the anterior temporomandibular joint. METHODS: A total of 38 patients (51 sides) with anterior disc displacement without reduction (ADDwR) of the TMJ treated in our hospital from August 2021 to January 2023 were selected, including 19 cases in group A (23 sides) treated with open temporomandibular joint disc reduction and anchorage, and 19 cases in group B (28 sides) treated with temporomandibular joint disc reduction and suture. The Magnetic Resonance Imaging (MRI) data of the two groups before and after operation were compared to evaluate the effective rate of articular disc reduction, the change of articular disc length, The Maximal Interincisal Opening (MIO) and Numeric Rating Scale (NRS) were measured before and after operation. RESULTS: In group A, the MRI effective rate 6 months after disc reduction was 95.65% (22/23), the disc length gain was 1.74mm, MIO was 40.32±5.067mm, and NRS was 0.47±0.697. The MRI effective rate 6 months after disc reduction in group B was 100% (28/28). The disc length gain was 1.78mm, MIO was 41.58±3.746mm, and NRS was 0.00. There was no significant difference between the two groups (P>0.05). CONCLUSIONS: TMJ disc reduction and suture and open TMJ disc anchorage can effectively reduce the TMJ disc. The TMJ disc stability is high at 6 months after operation, and the pain and mouth opening can be improved, which is worthy of further promotion in clinical practice.

Clinical effect of digitalized designed and 3D-printed repositioning splints in the treatment of anterior displacement of temporomandibular joint disc.

OBJECTIVE: To compare the treatment effectiveness of digitized and 3D-printed repositioning splints with that of conventional repositioning splints in the treatment of anterior displacement of the temporomandibular joint disc. METHODS: This retrospective study included 96 patients with disc displacement of the anterior temporomandibular joint. They were treated with either digitally designed and 3D-printed repositioning splints or traditional splints and followed up for at least six months. Changes in signs and symptoms such as pain and mouth opening before and after treatment were recorded to evaluate treatment outcomes. RESULTS: During the first month of treatment, both the digitally designed and 3D-printed repositioning splint groups (Group B) and the traditional repositioning splint group (Group A) showed significant increases in mouth opening, with increases of 4.93 ± 3.06 mm and 4.07 ± 4.69 mm, respectively, and there was no significant difference between the two groups. Both groups had a significant reduction in visual analog scale (VAS) pain scores, with Group B showing a greater reduction of 1.946 ± 1.113 compared to 1.488 ± 0.978 in Group A (P < 0.05). By the sixth month, Group B's mouth opening further improved to 38.65 ± 3.22 mm (P < 0.05), while Group A's mouth opening did not significantly improve. Regarding pain, Group A's VAS score decreased by 0.463 ± 0.778 after one month, and Group B's score decreased by 0.455 ± 0.715; both groups showed significant reductions, but there was no significant difference between the two groups. CONCLUSION: Compared with traditional repositioning splints, digitally designed and 3D-printed repositioning splints are more effective at reducing patient pain and improving mouth opening. 3D-printed repositioning splints are an effective treatment method for temporomandibular joint disc displacement and have significant potential for widespread clinical application.

The utilization of decision trees on orthopantomographic and lateral panoramic graphs for the diagnosis of unilateral anterior disc displacement of the temporomandibular joint.

BACKGROUND: Investigation is to utilize decision trees in conjunction with orthopantomography (OPT) and lateral panoramic graphy (LPG) to diagnose unilateral anterior disc displacement (ADD) of the temporomandibular joint. METHODS: In this study, 161 patients with images obtained through all three imaging methods, MRI, OPT, and LPG, were selected from the archives. The participants were categorized into two groups: the study group, comprising 89 patients with unilateral anterior disc displacement, and the control group, consisting of 72 healthy individuals. Measurements, including 2 angles (antero-posterior angle and superior-inferior angle) and 3 distance parameters (anterior joint space distance, superior joint space distance, and posterior joint space distance), were conducted on each imaging modality dataset. To assess the obtained measurement data within each patient, the differences from each measurement were calculated. Statistical analysis of the measurement differences between the control and study groups was carried out with independent t test, and decision trees were generated using the SPSS 25 decision tree module 5.0. RESULTS: In ADD patients, it was statistically significantly found that the APA increased while the SIA decreased for angle measurements. But for linear measurements, AS increased while the SS and PS decreased in MRI, OPT, and LPG. CONCLUSION: ADD can be diagnosed in OPT and LPG. The identification of the specific type of ADD that occurs in the temporomandibular joint is not feasible.

Analysis of clinical changes and magnetic resonance imaging features of 37 patients with temporomandibular joint disc condylar complex with anterior disc displacement without reduction.

OBJECTIVES: This study aims to investigate clinical outcomes, imaging changes, and age differences with regard to temporomandibular joint disc condylar complex with anterior disc displacement without reduction (ADDWoR). METHODS: A total of 37 patients (45 lateral joints) with ADDWoR who were admitted to The First Affiliated Hospital of Zheng Zhou University from January 2016 to June 2023 were selected. The patients were composed of 4 males and 33 females and had an average age of 23.5 years. The average course of the disease was 14.4 months. Clinical and magnetic resonance imaging (MRI) data were collected at the end of initial diagnosis and follow-up, and the length and thickness of the articular disc, the angle of the disc condyle, and the height of the condyle were measured. The statistical significance of the changes was assessed using SPSS 25.0 software package. RESULTS: At the end of follow-up, disc displacement in three patients (three lateral joints) was healed. Approximately 48.4% of the patients felt that limitation of mandibular movement was not alleviated; 58.3% of patients reported that pain during mouth opening was not reduced; 54.5% reported pain while chewing; 33.3% of the patients showed facial deviation, and only one showed remission. The mean disk-condyle angle increased from 61.63° to 67.81°. The average length of articular disc shortened from 8.20 mm to 7.27 mm, and the height of the condyle significantly decreased from 23.17 mm to 22.76 mm (P<0.05). The absorption ratio of the condyle increased, and no significant differences in the changes of joint soft and hard tissues between the adolescent and adult groups (P>0.05). CONCLUSIONS: In different age groups of patients with ADDWoR, clinical symptoms cannot be completely relieved. The disc is anteriorly displaced and shortens, condylar height decreases, and secondary facial asymmetry and mandibular retraction occur.

Clinical and MRI-Based Assessment of Patients with Temporomandibular Disorders Treated by Controlled Mandibular Repositioning.

BACKGROUND: Occlusal splints and anterior repositioning splints (ARSs) are widely accepted treatments for temporomandibular disorders (TMDs). However, there is uncertainty with regard to the most suitable amount of mandibular repositioning. The aim of this study is to evaluate the clinical and functional effects of the therapeutic position (ThP) established based on the Controlled Mandibular Repositioning (CMR) method. METHODS: In this clinical trial, 20 subjects with 37 joints with disc displacement with reduction were recruited. The initial standard functional diagnostic protocol, MRI, and digital condylography were performed, and ThP was calculated with the CMR method. After a 6-month follow-up, the standard diagnostic protocol was repeated. The change in disc position was evaluated by means of MRI after 6 months of CMR therapy. RESULTS: The MRI findings in the parasagittal plane demonstrated that out of the 37 joints presenting disc displacement, 36 discs were successfully repositioned; thus, the condyle-disc-fossa relationship was re-established. Therefore, the success rate of this pilot study was 97.3%. The mean position of the displaced discs was at 10:30 o'clock of the TMJ joint and at 12:00 o'clock after CMR therapy. CONCLUSIONS: The ThP determined using the CMR approach reduced all of the anteriorly displaced discs (except one). The CMR method allowed to define an optimum ThP of the mandible thus supporting patients' effective adaptation to treatment position.

Exploring the effect of disc displacement on the risk and severity of condylar erosion in adult temporomandibular disorder patients: A CBCT and MRI study.

OBJECTIVE: The objective of the study was to investigate the relationship between types of disc displacement (DD) diagnosed by magnetic resonance imaging (MRI), and the risk (presence or absence) and severity of condylar erosion (CE) graded using cone-beam computed tomography (CBCT) in adult Temporomandibular disorders (TMD) patients. METHODS: A total of 353 TMD patients (283 females, 70 males) underwent MRI scans to categorise DD as normal (NA), anterior displacement with reduction (ADDR), or anterior displacement without reduction (ADDNR). CE severity was graded on a scale of 0-3 (absence, mild, moderate or severe) using CBCT. To establish the plausibility and cut-off points for CE diagnosis, the severity of CE was then further divided into three classifications: Grade 0 versus 1 + 2 + 3; Grades 0 + 1 versus 2 + 3; Grades 0 + 1 + 2 versus 3. Logistic regression analysis was performed, adjusting for age, gender and joint correlation. RESULTS: ADDNR significantly increased the risk of CE compared with NA (OR = 10.04, 95% CI: [6.41, 15.73]) and showed a significant increase in CE severity across all classifications (ORs = 10.04-18.95). The effects of ADDNR were significant in both genders (p < .001) and had a greater impact in females. ADDR was predominantly associated with mild CE. CONCLUSIONS: ADDNR significantly increased the risk and severity of CE independent of gender when compared to NA, whereas ADDR was mainly associated with mild CE. Slight cortical discontinuity may represent a subclinical diagnosis requiring further investigation.

Comparing Quality of Life: Discectomy Surgery versus Epidural Corticosteroid Injection for Lumbar Disc Herniation.

BACKGROUND: Selecting an efficient treatment for patients with radiculopathy caused by lumbar disc herniation (LDH) unresponsive to conservative management remains a challenging task under investigation, yielding varying results. This study aims to compare the outcomes of the 2 most prevalent invasive treatments. METHODS: In this retrospective longitudinal study, we enrolled patients with confirmed refractory symptomatic LDH who sought treatment at Valiasr Hospital and underwent either discectomy surgery or epidural steroid injection (ESI) between 2019 and 2022. The outcome measures included pain intensity using the Visual Analog Scale (VAS) and quality of life (QoL) using the SF-36 questionnaire. RESULTS: A total of 202 individuals (112 in the discectomy group and 90 in the ESI group) consisting of 90 males and 112 females, with a mean age of 50.9 ± 13.5 years, underwent analysis. In the univariate analysis, QoL scores were significantly higher in the discectomy group (57.4 ± 2.4) compared to the ESI group (44.2 ± 2.4) (P < 0.01). Furthermore, the surgery group exhibited a significantly greater reduction in the Leg VAS score after treatment compared to the ESI group (mean difference: -2.59, 95% confidence interval (CI): -3.45 to -1.70, P < 0.01). After adjusting for the most important confounding variables using multiple linear regression analysis, the association between surgery and higher QoL scores remained statistically significant (Unstandardized Coefficients B = 7.65, 95% CI: 0.55, 14.76, P = 0.03). CONCLUSIONS: Our findings indicate that discectomy surgery has a more pronounced effect on patient outcomes and is a preferable treatment option for LDH patients.

A comparative study on the clinical efficacy of percutaneous endoscopic lumbar discectomy and conventional open surgery in the treatment of lumbar disc herniation.

Objective: To analyze the efficacy of single-channel percutaneous endoscopic lumbar discectomy (PELD) and conventional open surgery in the treatment of lumbar disc herniation (LDH). Methods: This is a retrospective study. A total of 66 patients with LDH admitted to Tianjin Medical University from June 2017 to June 2018 were divided into two groups: the observation group (single-channel PELD) and the control group (posterior lumbar interbody fusion), with 33 cases in each group. The two groups were compared in terms of visual analogue scale(VAS), oswestry disability index (ODI), Japanese Orthopaedic Association Score(JOA), perioperative indicators, clinical efficacy, postoperative complications, changes in inflammatory factors and serum T lymphocyte subsets. Results: The operation time, incision length, intraoperative blood loss, time in bed, hospital stay in the observation group were all lower than those in the control group. At 7d after treatment, the improvement of ODI, VAS and JOA in the observation group were better than that in the control group. At the last follow-up, there was no significant difference in Cobb angle and lumbar lordosis angle between the two groups. The levels of serum IL-1, IL-6 and TNF-α in the observation group were lower than those in the control group. The degree of reduction of serum CD3+ and CD4+ in the observation group were higher than those in the control group. And the level of elevation of CD8+ in the observation group was lower than that in the control group. Moreover, there was no significant difference in CD4+/CD8+ level between the two groups. The excellent rate of surgical results in the observation group was higher than that in the control group. Complications occurred in both groups, with no significant difference between the two groups. Conclusions: Single-channel PELD can achieve superior clinical efficacy over conventional open surgery in the treatment of LDH.

Feasibility of simultaneous TMJ arthroscopy in ADDwoR patients undergoing orthognathic surgery for jaw deformity.

This study evaluated the feasibility of simultaneous temporomandibular joint (TMJ) arthroscopy and orthognathic surgery as a new treatment strategy for anterior disc displacement without reduction (ADDwoR) patients with severe jaw deformities. Twelve ADDwoR patients with facial deformities who underwent arthroscopy and orthognathic surgery between September 2015 and December 2019 were retrospectively evaluated. Pre- and postoperative maximum incisal opening (MIO) and joint pain were recorded. Computed tomography (CT) and three-dimensional cephalometric analysis were performed at 3 (T1) and ≥6 (T2) months postoperatively. Magnetic resonance imaging (MRI) of the TMJ was performed before, ≤7 days after and ≥6 months after surgery. The lateral profile radiological findings, the symmetry of the maxilla and mandible, and the MRI measurements were compared. Anterior disc displacement did not recur, and the maximum incisal opening (MIO) increased from 27.4 mm to 32.7 mm after surgery (p < 0.05). No significant differences were found in the lateral profile, symmetry indices or condylar height via MRI between T1 and T2. Joint morphology and the position of both the maxilla and mandible remained stable during postoperative follow-up, while joint symptoms were markedly relieved and facial appearance was noticeably improved. Combined arthroscopy and orthognathic surgery is effective and recommended for ADDwoR patients with jaw deformities.

Association between the Thickness of Lumbar Subcutaneous Fat Tissue and the Presence of Hernias in Adults with Persistent, Non-Traumatic Low Back Pain.

We aimed to analyze the association between the average lumbar subcutaneous fat tissue thickness (LSFTT) at each intervertebral level and the presence of hernias in patients with low back pain from an insurance network hospital in Mexico. This observational prospective study included 174 patients with non-traumatic lumbago who underwent magnetic resonance imaging with a 1.5T resonator. Two independent radiologists made the diagnosis, and a third specialist provided a quality vote when needed. The sample size was calculated with a 95% confidence interval using random order selection. Anonymized secondary information was used. Percentages and means with confidence intervals were tabulated. The area under the curve, specificity, and sensitivity of LSFTT were calculated. A regression analysis was performed to analyze the presence of hernias with LSFTT using each intervertebral level as a predictor. The odds of herniation at any intervertebral level increased directly with LSFTT. The average LSFTT predicted the overall presence of hernias; however, the LSFTT at each intervertebral level better predicted hernias for each intervertebral space. The area under the curve for LSFTT in predicting hernias was 68%. In conclusion, the average LSFTT was associated with the overall presence of hernias; patients with more hernias had higher LSFTT values.

Correlation between craniocervical posture and upper airway dimension in patients with bilateral anterior disc displacement.

OBJECTIVE: To investigate the relationship between upper airway dimension and craniocervical posture in adult patients with bilateral anterior disc displacement and to provide some references for clinical diagnosis and plan formulation in orthodontics. METHODS: Based on RDC/TMD (Research Diagnostic Criteria for Temporomandibular Disorder), 98 Patients were divided into three groups by two experienced TMJ (Temporomandibular Joint) specialists: bilateral disc normal position group (BN), bilateral anterior disc displacement with reduction group (ADDWR) and bilateral anterior disc displacement without reduction group (ADDWoR). Inter-group comparison and correlation analysis were performed after 11 craniocervical posture and 15 upper airway dimension measurements finished with Dolphin and Uceph software in Two or Three-dimensional. RESULTS: Anterior disc displacement often accompanied with extension of craniocervical posture, as ADDWR and ADDWoR groups have significantly higher cervical curvature and inclination than BN group (P < 0.05). Simultaneously anterior disc displacement often associated with constrained upper airway dimension for the total and each segment upper airway volume were significantly smaller in ADDWR and ADDWoR than BN group (P < 0.05). Correlation analysis revealed that C0-C1 (the distance from the base of the occipital bone (C0) to the posterior arch of the atlas (C1)) is significantly related to the total and each segment upper airway volume reduction (P < 0.05). CONCLUSION: There exists markedly close correlation between anterior disc displacement and craniocervical posture forward extension, which may be physiologically adaptive cervical extension to keep oropharyngeal airway unobstructed as upper airway dimension constrained by anterior disc displacement. CLINICAL RELEVANCE: These findings allow us to infer the potential consequences if the treatment of anterior disc displacement would result in an improvement of intervertebral relationships and upper airway constraint.

Imaging evaluation of disc position and status after temporomandibular joint arthroscopic disc repositioning and suturing surgery.

Objective: This study aimed to explain the change of disc position at different over-corrected place after arthroscopic disc repositioning and suturing surgery. Study design: Patients treated with temporomandibular joint arthroscopic disc repositioning and suturing surgery were reviewed. All patients underwent magnetic resonance imaging (MRI) before, immediately after surgery and at 2-year follow-up. The position of disc was checked and the change was compared. Results: 133 patients were included in the final analysis with 203 TMJ sides. The incidence rate for anterior movement of the disc after surgery was 33.0 %. Disc repositioned between 12 and 1 o'clock showed smaller movement rate of 22.6 %, while higher movement rate of 53.6 % was seen when repositioned between 2 and 3 o'clock. Conclusions: After arthroscopic disc repositioning and suturing surgery for ADD patients, the repositioned disc showed tendency to move forward. 12 to 1 o'clock was optional disc site for repositioning while excessive over-correction was not recommended.

Treatment of painful temporomandibular joint disc displacement without reduction: network meta-analysis of randomized clinical trials.

There is currently no consensus on the best treatment for painful temporomandibular disc displacement without reduction (DDwoR), and no network meta-analysis (NMA) of randomized clinical trials (RCTs) comparing all types of treatments for this condition has been conducted. The objective of this study was to compare and rank all treatments for DDwoR, including conservative treatments, occlusal splints, low-level laser therapy (LLLT), arthrocentesis (Arthro) alone, Arthro plus intra-articular injection (IAI) of platelet-rich plasma (PRP), Arthro plus IAI of hyaluronic acid (HA), Arthro with exercises, Arthro plus occlusal splints, and manipulative therapy. Outcome variables were pain intensity on a visual analogue scale (VAS) and maximum mouth opening (MMO, mm). The mean difference with 95% confidence interval was estimated using Stata software. The GRADE system was used to assess the certainty of the evidence. A total of 742 patients from 16 RCTs were included in the NMA. Both direct meta-analysis and NMA showed that Arthro with IAI of co-adjuvants provided better pain reduction in the short term (≤3 months) than Arthro alone. However, the quality of the evidence was very low. In the intermediate term, Arthro alone or combined with co-adjuvants provided better pain reduction than conservative treatment, but with low-quality evidence. Conservative treatment significantly increased MMO in the short term compared to other treatments. In conclusion, the results of this NMA suggest that arthrocentesis with intra-articular injection of adjuvant medications may be superior to conservative treatments in reducing pain intensity at long-term follow-up, while no significant differences were found for the MMO outcome. However, the quality of evidence was generally low to very low, and further RCTs are needed to confirm these findings.

The benefits of performing temporomandibular joint arthrocentesis with catheters and a vacuum pump: A randomized control trial.

This study aims to compare the effectiveness of two different techniques of double puncture arthrocentesis with and without the addition of catheters and a vacuum pump for management of temporomandibular joint (TMJ) disc displacement without reduction (DDWOR). A total of 48 patients with DDWOR were randomly and blindly allocated into two treatment groups (N = 24): Group 1, TMJ arthrocentesis with the addition of catheters and a vacuum pump to the second needle; Group 2, TMJ arthrocentesis without any addition device. The following variables were registered and compared between groups: patient's pain perception (visual analogue scale [VAS; 0-10]); maximal interincisal distance [MID; mm]; joint effusion (JE, presence or absence); facial edema (FE; presence or absence); and the operation duration (OP; minutes). Patients in Group 1 presented with significantly lower VAS scores (p < 0.001) and presence of FE (p = 0.03) in the post-operative period, also an increase in MID values (p = 0.026), and a reduction in JE (p = 0.022) after 3 months. Besides that, in this group, the procedure was performed significantly faster (p < 0.001). Performing arthrocentesis with the addition of a vacuum pump makes the procedure faster and yields better results in terms of pain, facial swelling, mouth opening and joint effusion.

Correlation between temporomandibular joints and craniocervical posture in patients with bilateral anterial disc displacement.

OBJECTIVE: To study the changes of temporomandibular joints and craniocervical posture in adult patients with bilateral anterior disc displacement, and to explore their correlation, which may provide some clinical value for clinical diagnosis and treatment planning. METHODS: Ninety-eight adult patients were divided into 3 groups: 29 patients in bilateral disc normal position group (BN), 33 patients in bilateral Anterior Disc Displacement With Reduction group (ADDWR) and 36 patients in bilateral Anterior Disc Displacement Without Reduction group (ADDWoR). Dolphin and Uceph software were used to measure 14 items of temporomandibular joint and 11 items of craniocervical posture for comparison and correlation analysis between groups. RESULTS: There were significant differences in bilateral joint space between three groups. Compared with the BN, the anteroposterior diameter of the condyle was significantly reduced, the condyle was significantly displaced posteriorly and superiorly in the ADDWR and ADDWoR, but the joint fossa width and joint fossa depth did not change significantly. Cervical curvature and inclination were greater in patients with anterior disc displacement than BN, indicating that the craniocervical posture of adult patients with anterior disc displacement was extended and protrusive. CONCLUSION: Anterior disc displacement of the temporomandibular joint can displace the condyle upwards and posteriorly and reduce the anteroposterior diameter of condyle, and then make the condyle closer to the wall of articular fossa to induce joint symptoms. Additionally, craniocervical postural position is significantly affected, which may be related to compensate for the effects of airway space.

Analysis of joint protein expression profile in anterior disc displacement of TMJ with or without OA.

OBJECTIVE: Anterior disc displacement (ADD) is a common clinical issue and may cause osteoarthritis (OA). However, the research of protein changes in synovial fluid as disease development marker and potential treatment clue is still insufficient. MATERIALS AND METHODS: We conducted the high-resolution mass spectrometry (MS) of synovial fluid collected from 60 patients with normal disk position to ADD and ADD with osteoarthritis (OA). The proteins with significant changes among the 3 groups were analyzed by biological information and further validated by in primary rat condyle chondrocytes and OA animal model. RESULTS: FGL2, THBS4, TNC, FN1, OMD etc. were significantly increased in ADD without OA (p < 0.05), which reflected the active extracellular matrix and collagen metabolism. FGFR1, FBLN2, GRB2 etc. were significantly increased in ADD with OA group (p < 0.05), which revealed an association with apoptosis and ferroptosis. Proteins such as P4HB, CBLN4, FHL1, VIM continuously increase in the whole disease progress (p < 0.05). Both the in vitro and in vivo results are consistent with protein changes detected in MS profile. CONCLUSION: This study firstly provides the expression changes of proteins from normal disc condyle relationship toward ADD with OA, which can be selected and studied further as disease progress marker and potential treatment targets.

Posterior Percutaneous Endoscopic Cervical Discectomy for Single-Level Soft, Huge Central Disc Herniation.

BACKGROUND: Posterior percutaneous endoscopic cervical discectomy (PPECD) has been proven safe and effective for foraminal cervical disc herniation (CDH). However, central CDH has long been considered as the contraindication of PPECD, because the path is obstructed by the spinal cord and nerve root. OBJECTIVES: To preliminarily assess the feasibility, safety, and effectiveness of PPECD for single-level soft, huge central CDH. STUDY DESIGN: A retrospective cohort study. SETTING: Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College). METHODS: Between 2017 and 2020, 31 patients diagnosed with single-level soft, huge central CDH were treated by PPECD. Primary outcomes included the measures of neck and radicular pain based on the numeric rating scale (NRS) and cervical neurologic status based on the Japanese Orthopedic Association (JOA) score. The global outcome was assessed using the Odom's criteria at one-year follow-up. RESULTS: Compared to the baseline, there was a constant and significant reduction of NRS-rated pain and improvement of JOA-rated cervical neurologic status postoperatively (P < 0.01). According to the Odom's criteria, 96.8% (30/31) of patients had satisfactory postoperative clinical improvement (excellent or good outcomes) at one-year follow-up. Complications included C5 nerve root palsy and spinal cord injury. The total complication rate was 16.5% (2/31), but these complications were temporary and not catastrophic. LIMITATIONS: The limitations of this study include the volume of the sample, a short follow-up period, and the lack of a control group. CONCLUSIONS: Our preliminary experience indicates that PPECD is a feasible and promising alternative for symptomatic single-level soft, huge central CDH.