Two Cases of Iatrogenic Lumbar Foraminal Disc Herniations

Study Design. A case report. Objective. We report two cases of iatrogenic deterioration of lumbar foraminal disc herniations following lumbar disc injections. Summary of Background Data. Complications associated with discography were reported. However, only a few reports have thus far referred to the iatrogenic deterioration of lumbar foraminal disc herniations. Cases. 60-year-old and 74-year-old men were treated with MR images of L4-5 foraminal disc herniations without fragment in the spinal canal. The patients underwent discography and disc block for its diagnosis and treatment. After disc injections, both patients complained of deterioration of L4 radiculopathy. Results. On disco-CT or reexamined MR images after disc injections, herniated fragment was migrated from neural foramen to cranial central spinal canal with was not shown in previous MR images. The herniated fragments were extirpated by means of osteoplastic laminoplasty or transforaminal lumbar interbody fusion with facetectomy. The herniated fragments were migrated from neural foramen to cranial central spinal canal. Conclusions. The injection of liquid medicine into the nucleus led the intradiscal pressure increased, and the disc fragment might prolapsed through the raptured region of annulus fibrosus and migrated to cranial central spinal canal by anatomical reason. The disc injection may have a risk for deterioration of foraminal disc herniation. Our report is instructive for the management of discography for the diagnosis of foraminal disc herniations.

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Does Size Matter? An Analysis of the Effect of Lumbar Disc Herniation Size on the Success of Nonoperative Treatment

Global Spine Journal ◽

10.1177/2192568219880822 ◽

2019 ◽

Vol 10 (7) ◽

pp. 881-887 ◽

Cited By ~ 1

Author(s):

Anmol Gupta ◽

Shivam Upadhyaya ◽

Caleb M. Yeung ◽

Peter J. Ostergaard ◽

Harold A. Fogel ◽

...

Keyword(s):

Lumbar Disc Herniation ◽

Disc Herniation ◽

Conservative Management ◽

Spinal Canal ◽

Lumbar Disc ◽

Nonoperative Treatment ◽

Herniated Disc ◽

Mri Scan ◽

Cronbach's Alpha ◽

Disc Herniations

Study Design: Retrospective study. Objective: In this study, we examined whether the size of a lumbar disc herniation (LDH) is predictive of the need for surgical intervention within 2 years after obtaining an initial magnetic resonance imaging (MRI) scan. We hypothesized that a fragment that occupied a larger percentage of the spinal canal would not predict which patients failed conservative management. Methods: Using the ICD-10 code M51.26, we identified patients at a single academic institution, across the 2-year period from 2015 to 2016, who received a diagnosis of primary lumbar radicular pain, had MRI showing a disc herniation, and underwent at least 6 weeks of nonoperative management. Patients experiencing symptoms suggesting cauda equina syndrome and those with progressive motor neurological deficits were excluded from analysis, as were patients exhibiting “hard” disc herniations. Within the axial view of an MRI, the following measurements were made on AGFA-IMPACS for a given disc herniation: the length of both the canal and the herniated disc along the anterior-posterior axis, the average width of the disc within the canal; the total canal area, and the area of the disc herniation. Data analysis was conducted in SPSS and a 2-tailed reliability analysis using Cronbach’s alpha as a measure of reliability was obtained. Results: A total of 368 patients met the inclusion and exclusion criteria for this study. Of these, 14 (3.8%) had L3-L4 herniations, 185 had L4-L5 herniations (50.3%), and 169 had L5-S1 herniations (45.9%). Overall, 336 (91.3%) patients did not undergo surgery within 1 year of the LDH diagnosis. Patients who did not receive surgery had an average herniation size that occupied 31.2% of the canal, whereas patients who received surgery had disc herniations that occupied 31.5% of the canal on average. A Cronbach’s alpha of .992 was observed overall across interobserver measurements. After controlling for age, race, gender, and location of herniation through a logistic regression, it was found that the size of the herniation and the percentage of the canal that was occupied had no predictive value with regard to failure of conservative management, generating an odds ratio for surgery of 1.00. Conclusions: The percentage of the spinal canal occupied by a herniated disc does not predict which patients will fail nonoperative treatment and require surgery within 2 years after undergoing a lumbar spine MRI scan.

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An Extreme Lateral Access for the Surgery of Lumbar Disc Herniations Inside the Spinal Canal Using the Full-Endoscopic Uniportal Transforaminal Approach–Technique and Prospective Results of 463 Patients

Spine ◽

10.1097/01.brs.0000186327.21435.cc ◽

2005 ◽

Vol 30 (22) ◽

pp. 2570-2578 ◽

Cited By ~ 144

Author(s):

Sebastian Ruetten ◽

Martin Komp ◽

Georgios Godolias

Keyword(s):

Spinal Canal ◽

Lumbar Disc ◽

Transforaminal Approach ◽

Disc Herniations

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Detection of Degenerative Changes on MR Images of the Lumbar Spine with a Convolutional Neural Network: A Feasibility Study

Diagnostics ◽

10.3390/diagnostics11050902 ◽

2021 ◽

Vol 11 (5) ◽

pp. 902

Author(s):

Nils Christian Lehnen ◽

Robert Haase ◽

Jennifer Faber ◽

Theodor Rüber ◽

Hartmut Vatter ◽

...

Keyword(s):

Neural Network ◽

Lumbar Spine ◽

Diagnostic Accuracy ◽

Nerve Root ◽

Spinal Canal ◽

Spinal Canal Stenosis ◽

Degenerative Changes ◽

High Diagnostic Accuracy ◽

Canal Stenosis ◽

Disc Herniations

Our objective was to evaluate the diagnostic performance of a convolutional neural network (CNN) trained on multiple MR imaging features of the lumbar spine, to detect a variety of different degenerative changes of the lumbar spine. One hundred and forty-six consecutive patients underwent routine clinical MRI of the lumbar spine including T2-weighted imaging and were retrospectively analyzed using a CNN for detection and labeling of vertebrae, disc segments, as well as presence of disc herniation, disc bulging, spinal canal stenosis, nerve root compression, and spondylolisthesis. The assessment of a radiologist served as the diagnostic reference standard. We assessed the CNN’s diagnostic accuracy and consistency using confusion matrices and McNemar’s test. In our data, 77 disc herniations (thereof 46 further classified as extrusions), 133 disc bulgings, 35 spinal canal stenoses, 59 nerve root compressions, and 20 segments with spondylolisthesis were present in a total of 888 lumbar spine segments. The CNN yielded a perfect accuracy score for intervertebral disc detection and labeling (100%), and moderate to high diagnostic accuracy for the detection of disc herniations (87%; 95% CI: 0.84, 0.89), extrusions (86%; 95% CI: 0.84, 0.89), bulgings (76%; 95% CI: 0.73, 0.78), spinal canal stenoses (98%; 95% CI: 0.97, 0.99), nerve root compressions (91%; 95% CI: 0.89, 0.92), and spondylolisthesis (87.61%; 95% CI: 85.26, 89.21), respectively. Our data suggest that automatic diagnosis of multiple different degenerative changes of the lumbar spine is feasible using a single comprehensive CNN. The CNN provides high diagnostic accuracy for intervertebral disc labeling and detection of clinically relevant degenerative changes such as spinal canal stenosis and disc extrusion of the lumbar spine.

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Gravity determines the direction of nerve roots sedimentation in the lumbar spinal canal

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04032-y ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Jun Yang ◽

Zhiyun Feng ◽

Nian Chen ◽

Zhenhua Hong ◽

Yongyu Zheng ◽

...

Keyword(s):

Lumbar Spine ◽

Mr Imaging ◽

Spinal Canal ◽

Ventral Side ◽

Lateral Position ◽

Dorsal Side ◽

Mr Images ◽

Nerve Roots ◽

Cross Sectional ◽

Dural Sac

Abstract Objectives To investigate the role of gravity in the sedimentation of lumbar spine nerve roots using magnetic resonance (MR) imaging of various body positions. Methods A total of 56 patients, who suffered from back pain and underwent conventional supine lumbar spine MR imaging, were selected from sanmen hospital database. All the patients were called back to our hospital to perform MR imaging in prone position or lateral position. Furthermore, the sedimentation sign (SedSign) was determined based on the suspension of the nerve roots in the dural sac on cross-sectional MR images, and 31 cases were rated as positive and another 25 cases were negative. Results The mean age of negative SedSign group was significantly younger than that of positive SedSign group (51.7 ± 8.7 vs 68.4 ± 10.5, P < 0.05). The constitutions of clinical diagnosis were significantly different between patients with a positive SedSign and those with a negative SedSign (P < 0.001). Overall, nerve roots of the vast majority of patients (48/56, 85.7%) subsided to the ventral side of the dural sac on the prone MR images, although that of 8 (14.3%) patients remain stay in the dorsal side of dural sac. Nerve roots of only one patient with negative SedSign did not settle to the ventral dural sac, while this phenomenon occurred in 7 patients in positive SedSign group (4% vs 22.6%, P < 0.001). In addition, the nerve roots of all the five patients subsided to the left side of dural sac on lateral position MR images. Conclusions The nerve roots sedimentation followed the direction of gravity. Positive SedSign may be a MR sign of lumbar pathology involved the spinal canal.

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