Posterior Epidural Migration of Sequestrated Lumbar Disc Fragments Into the Bilateral Facet Joints

Neurosurgery ◽  
2011 ◽  
Vol 69 (5) ◽  
pp. E1148-E1151 ◽  
Author(s):  
Tzuu-Yuan Huang ◽  
Kung-Shing Lee ◽  
Tai-Hsin Tsai ◽  
Yu-Feng Su ◽  
Shiuh-Lin Hwang
Keyword(s):  
Differential Diagnosis ◽  
Facet Joint ◽  
Lumbar Disc ◽  
Synovial Cyst ◽  
Leg Pain ◽  
Hybrid Technique ◽  
Facet Joints ◽  
Disc Disease ◽  
First Case ◽  
Rod System

Abstract BACKGROUND AND IMPORTANCE Symptomatic lumbar disc herniation is common. Migration of a free disc fragment is usually found in rostral, caudal, or lateral directions. Posterior epidural migration is very rare. We report the first case with posterior epidural migration and sequestration into bilateral facet joints of a free disc fragment. CLINICAL PRESENTATION A 78-year-old female presented with low back pain and right leg pain. Plain radiographs showed lumbar spondylolisthesis. Magnetic resonance imaging revealed a posterior epidural mass and intrafacet mass, which was hypointense on T1-weighted images and hyperintense on T2-weighted images. The lesion in the left L3-4 facet joint had rim enhancement, whereas the right one was not contrasted after gadolinium injection. Preoperative differential diagnosis included abscess, tumor, hematoma, or synovial cyst. An interbody cage fusion at L3-4 and L4-5 for spondylolisthesis was performed, and a hybrid technique was applied with the Dynesys flexible rod system at L3-S1 for multisegment degenerative disc disease. The lesion proved to be an epidural disc fragment with sequestration into bilateral facet joints. CONCLUSION A free disc fragment should be considered in the differential diagnosis of posterior epidural lesions, and even in the facet joint.

Hypertrophic Synovitis of the Facet Joint Causing Root Pain

2008 ◽  
Vol 1 ◽  
pp. CMAMD.S411
Author(s):  
Koichi Iwatsuki ◽  
Toshiki Yoshimine ◽  
Masanori Aoki ◽  
Kazuhiro Yoshimura
Keyword(s):  
Facet Joint ◽  
Cauda Equina ◽  
Radicular Pain ◽  
Leg Pain ◽  
Facet Joints ◽  
Resonance Imaging ◽  
Disc Disease ◽  
Articular Surfaces ◽  
Synovial Cysts ◽  
Magnetic Resonance Imaging Mri

Osteoarthritic changes in the facet joints are common in the presence of degenerative disc disease. Changes in the joint capsule accompany changes in the articular surfaces. Intraspinal synovial cysts that cause radicular pain, cauda equina syndrome, and myelopathy have been reported; however, there have been few reports in orthopedic or neurosurgical literature regarding hypertrophic synovitis of the facet joint presenting as an incidental para-articular mass. Here, we report a case of hypertrophic synovitis causing root pain. We describe the case of a 65-year-old man suffering from right sciatica and right leg pain in the L5 nerve-root dermatome for 1 year; magnetic resonance imaging (MRI) revealed an enhanced mass around the L4–5 facet joint. We investigated this mass pathologically. After right medial facetectomy, the symptoms resolved. Pathological investigation revealed this mass was hypertrophic synovitis. Hypertrophic synovitis of the facet joint might cause root pain.

Encouraging Medium-term Results of Wallis Second Generation Dynamic Stabilisation Device

2018 ◽  
Vol 20 (2) ◽  
pp. 149-156
Author(s):  
Awaiz Ahmed ◽  
Abdulla Jawed ◽  
Murali Venkatesan ◽  
James Doyle
Keyword(s):  
Oswestry Disability Index ◽  
Second Generation ◽  
Lumbar Disc ◽  
Leg Pain ◽  
Medium Term ◽  
Disc Disease ◽  
Lumbar Disc Disease ◽  
Dynamic Stabilisation ◽  
The Mean

Background. Aim of this prospective study was to evaluate safety and efficacy of second generation Wallis system for degenerative lumbar disc disease. Material and methods. 25 patients underwent discectomy and insertion of Wallis system. Outcome assessment was done using Modified Oswestry disability index (ODI) and visual analogue scale (VAS) for backache and leg pain. Results. The mean follow-up was 20.5 months. The mean VAS for backache and leg pain showed significant improvement from 7.2 to 3.0 (p<0.001) and mean modified Oswestry disability index showed significant improvement from 59.1 to 24.7 (p<0.001). Only one patient (4%) underwent revision surgery for persistent pain due to granulation tissue deep to the implant. There were no other complications. Conclusion. The Wallis spine system is a safe and effective implant for treating degenerative lumbar disc disease.

scholarly journals Percutaneous Endoscopic Lumbar Discectomy for L5-S1 Disc Herniation: Consideration of the Relation between the Iliac Crest and L5-S1 Disc

2016 ◽  
Vol 19 (2;2) ◽  
pp. E301-E308
Author(s):  
Kyung-Chul Choi
Keyword(s):  
Disc Herniation ◽  
Iliac Crest ◽  
Facet Joint ◽  
Lumbar Disc ◽  
Lumbar Discectomy ◽  
Leg Pain ◽  
Herniated Disc ◽  
Percutaneous Endoscopic Lumbar Discectomy ◽  
Endoscopic Lumbar Discectomy ◽  
Foraminal Height

Background: Percutaneous transforaminal techniques for the treatment of lumbar disc herniation have markedly evolved. Percutaneous endoscopic lumbar discectomy (PELD) for L5-S1 disc herniation is regarded as challenging due to the unique anatomy of the iliac crest, large facet joint, and inclinatory disc space. Among these, the iliac crest is considered a major obstacle. There are no studies regarding the height of the iliac crest and their appropriate procedures in PELD. Objectives: This study discusses PELD for L5-S1 disc herniation and the appropriate approach according to the height of iliac crest. Study Design: Retrospective evaluation. Methods: 100 consecutive patients underwent PELD via the transforaminal route for L5-S1 disc herniation by a single surgeon. The study was divided into 2 groups: the foraminoplasty group requiring foraminal widening to access the herniated disc and the non-foraminoplasty group treated by conventional posterolateral access. Radiological parameters such as iliac height, the relative position of the iliac crest to the landmarks of the L5-S1 level, iliosacral angle and foraminal height, and disc location were considered. Clinical outcomes were assessed by the Visual Analogue Scale (VAS, 0 – 10) for back and leg pain, the Oswestry Disability Index (ODI, 0 – 100%), and the modified MacNab criteria. Results: The overall VAS scores for back and leg pain decreased from 6.0 to 2.3 and from 7.5 to 1.7. The mean ODI (%) improved from 54.0 to 11.6. Using modified MacNab criteria, a good outcome was 92%. Foraminoplasty was required in 19 patients. Iliac crest height was significantly higher in the foraminoplasty group than the non-foraminoplasty group (37.7 mm vs 30.1 mm, P < 0.001). In the foraminoplasty group, the iliac crest is above the mid L5 pedicle on lateral radiography in all cases. There were no significant differences in foraminal height, foraminal width, iliosacral angle, or disc height between the 2 groups. In addition, there were no differences in clinical outcome between the 2 groups. Limitations: This study is a retrospective analysis and simplifies the complexity of the L5-S1 level and iliac bone using two-dimensional radiography. Conclusion: In high iliac crest cases where the iliac crest is above the mid L5 pedicle in lateral radiography, foraminoplasty may be considered for transforaminal access of L5-S1 disc herniation. Conventional transforaminal access can be utilized with ease in low iliac crest cases where the iliac crest is below the mid-L5 pedicle. Key words: Percutaneous endoscopic lumbar discectomy, transforaminal, L5-S1, iliac crest, foraminoplasty

scholarly journals An Unusual Case of Radicular Pain Caused by Bilateral Lumbar Synovial Cyst: A Case Report and Review of the Literature

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
David Ruiz-Picazo ◽  
José Ramírez-Villaescusa ◽  
Ana Verdejo-González
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Treatment Options ◽  
Synovial Cyst ◽  
Radicular Pain ◽  
Magnetic Resonance Images ◽  
Leg Pain ◽  
Low Back ◽  
Disc Disease ◽  
Management Options

Introduction. Spinal synovial cysts (SSCs) constitute an uncommon degenerative lesion of the spine. They are usually asymptomatic but they may also cause symptoms of variable severity. SSCs are benign growths adjoining the facet joints that may induce low back pain, lumbar radiculopathy, and neurological deficit. There are different treatment options that range from conservative management to interventions like image-guided epidural steroid injection or direct cyst puncture and finally to open or endoscopic spinal canal decompression and spinal bone fusion with/without instrumentation. A discussion of current management options for this unusual disease is presented. Material and Methods. A 52-year-old female patient presented with low back pain and left leg pain. Plain radiography demonstrated instability at the L4-L5 level. Magnetic resonance images (MRIs) revealed a bilateral cystic lesion at the L4-L5 level with associated instability and degenerative disc disease at the level L5-S1. Initially, conservative treatment was performed by aspiration of the left cyst and infiltration with corticosteroids with improvement of the pain for 1 year. After this period, the radicular and the low back pain reoccurred. Results. Following leg pain recurrence, a hybrid L4-S1 fusion was performed. After surgery, there was clinical improvement and six months later, the patient returned to daily activities. The radiological study after five-year follow-up shows adequate implant position, without signs of loosening, compatible with solid fusion. Conclusion. After reviewing the literature, the optimal management for patients with symptomatic lumbar synovial cyst must be very individualized, which is essential to achieve a favorable outcome.

Relationship between Severity of Lumbar Disc Disease and Disability Scores in Sciatica Patients

Neurosurgery ◽  
2002 ◽  
Vol 50 (6) ◽  
pp. 1253-1260 ◽  
Author(s):  
François Porchet ◽  
Vincent Wietlisbach ◽  
Bernard Burnand ◽  
Karine Daeppen ◽  
Jean-Guy Villemure ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Pain Score ◽  
Odds Ratio ◽  
Lumbar Disc ◽  
Pain Scale ◽  
Leg Pain ◽  
Imaging Findings ◽  
Disc Disease ◽  
Lumbar Disc Disease ◽  
Sf 36

Abstract OBJECTIVE To study the association between the clinical examination and the radiological assessment of lumbar disc disease in patients with sciatica. METHODS The study included 394 consecutive sciatica patients. The patients’ disabilities were evaluated by a visual analog pain scale, the Prolo functional-economic rating scale, the modified Roland-Morris disability questionnaire, and the health-related quality of life short form (SF-36) questionnaire. Radiological imaging findings were independently classified according to the Modic criteria into five groups of increasing severity of disc disease. Stepwise multivariate logistic regression was used to determine which scores were significant independent predictors of a severe disc disease (extrusion or sequestration). RESULTS Of these patients, 9.6% had no disc disease, 3.3% had a bulging, 11.4% had a protrusion, 68.5% had an extrusion, and 7.1% had a disc sequestration. Statistically significant positive linear associations with the severity of disc disease were found for the leg pain scale, the Roland-Morris and Prolo disability scales, and the SF-36 scores related to physical functioning, physical role, and bodily pain (all P &lt; 0.005). A poor (&lt;5) Prolo score (odds ratio, 2.91; 95% confidence interval, 1.74–4.87), a higher leg pain score (odds ratio, 1.16 per centimeter increase; 95% confidence interval, 1.07–1.27), and a lower low back pain score (odds ratio, 0.90 per centimeter decrease; 95% confidence interval, 0.82–0.98) were retained in the multivariate logistic model as independent predictors of severe disc disease. CONCLUSION The positive correlation between disability status and imaging findings validates both assessment methods. Routine use of disability scores brings a useful contribution to the assessment of sciatica patients.

scholarly journals Alternative strategies for lumbar discectomy: intradiscal electrothermy and nucleoplasty

2002 ◽  
Vol 13 (2) ◽  
pp. 1-6 ◽  
Author(s):  
William C. Welch ◽  
Peter C. Gerszten
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Lumbar Disc ◽  
Lessons Learned ◽  
Leg Pain ◽  
Low Back ◽  
Disc Disease ◽  
Discogenic Pain ◽  
Discogenic Low Back Pain ◽  
Disc Material

In recent years the general trend in spinal surgery has been one of reductionism and minimalization. A number of techniques have recently been developed that are applicable in the treatment of lumbar disc herniation and discogenic pain due to degenerative disc disease. The purpose of this manuscript is to examine two newer percutaneous disc treatment techniques, intradiscal electrothermal therapy (IDET) anuloplasty and nucleoplasty. The authors review the appropriate clinical treatment criteria, techniques, and lessons learned after performing these procedures in more than 100 patients. The IDET involves the percutaneous insertion of a specially designed thermal resistance probe followed by controlled heating of the intervertebral disc. This may result in disc shrinkage and reduction in pain. The nucleoplasty procedure involves the percutaneous removal of disc material by using a low-temperature resister probe to disintegrate and evacuate disc material, followed by thermal treatment of adjacent residual disc material. To date, no study has been published in which investigators examine the outcomes of this procedure for the treatment of radicular leg pain and low-back pain. Both IDET and nucleoplasty appear to be safe procedures. The IDET procedure may be an alternative to lumbar interbody fusion. Although its long-term role is being defined, this technique appears to provide intermediate-term relief of pain in a population of patients with discogenic low-back pain. Nucleoplasty may provide a percutaneous alternative to microdiscectomy in selected cases.

scholarly journals Facet joint changes after application of lumbar nonfusion dynamic stabilization

2016 ◽  
Vol 40 (1) ◽  
pp. E6 ◽  
Author(s):  
Soo Eon Lee ◽  
Tae-Ahn Jahng ◽  
Hyun Jib Kim
Keyword(s):  
Spinal Surgery ◽  
Facet Joint ◽  
Dynamic Stabilization ◽  
Leg Pain ◽  
Adjacent Segment ◽  
Facet Joints ◽  
Joint Degeneration ◽  
Facet Joint Degeneration ◽  
Lumbar Spinal Surgery ◽  
Lumbar Spinal

OBJECTIVE The long-term effects on adjacent-segment pathology after nonfusion dynamic stabilization is unclear, and, in particular, changes at the adjacent facet joints have not been reported in a clinical study. This study aims to compare changes in the adjacent facet joints after lumbar spinal surgery. METHODS Patients who underwent monosegmental surgery at L4–5 with nonfusion dynamic stabilization using the Dynesys system (Dynesys group) or transforaminal lumbar interbody fusion with pedicle screw fixation (fusion group) were retrospectively compared. Facet joint degeneration was evaluated at each segment using the CT grading system. RESULTS The Dynesys group included 15 patients, while the fusion group included 22 patients. The preoperative facet joint degeneration CT grades were not different between the 2 groups. Compared with the preoperative CT grades, 1 side of the facet joints at L3–4 and L4–5 had significantly more degeneration in the Dynesys group. In the fusion group, significant facet joint degeneration developed on both sides at L2–3, L3–4, and L5–S1. The subjective back and leg pain scores were not different between the 2 groups during follow-up, but functional outcome based on the Oswestry Disability Index improved less in the fusion group than in the Dynesys group. CONCLUSIONS Nonfusion dynamic stabilization using the Dynesys system had a greater preventative effect on facet joint degeneration in comparison with that obtained using fusion surgery. The Dynesys system, however, resulted in facet joint degeneration at the instrumented segments and above. An improved physiological nonfusion dynamic stabilization system for lumbar spinal surgery should be developed.

The long-term results of chymopapain chemonucleolysis for lumbar disc disease

1986 ◽  
Vol 65 (1) ◽  
pp. 1-8 ◽  
Author(s):  
Robert J. Maciunas ◽  
Burton M. Onofrio
Keyword(s):  
Surgical Procedures ◽  
Lumbar Disc ◽  
Leg Pain ◽  
Long Term Results ◽  
Disc Disease ◽  
Lumbar Disc Disease ◽  
Content Type ◽  
Work Related ◽  
Effective Treatment Modality

✓ The long-term clinical outcome is evaluated for 268 patients after chymopapain chemonucleolysis for radicular complaints referrable to documented intervertebral disc disease. The follow-up period for 92% of these patients was 10 years. No complications due to chymopapain toxicity were observed; 80.1% of patients were relieved of their presenting radicular leg pain and 75.1% were employed at a capacity equal to or more strenuous than before injection. Chemonucleolysis was demonstrated to be a safe and effective treatment modality, with long-term results that compare favorably with those of similarly selected patients undergoing open surgical procedures. In the patients whose chymopapain therapy failed, the outcome of subsequent open surgical procedures was not necessarily compromised by prior chemonucleolysis. A higher rate of failure and subsequent surgical intervention was seen in those patients with injections performed soon after an unsuccessful open procedure on the same side and at the same interspace, those with workmen's compensation or litigation pending, those with a history of work-related injury, those whose employment involved heavy manual labor or extensive driving, and those whose preinjection spine x-ray films indicated retrograde spondylolisthesis.

scholarly journals The Clinical Diagnostic Value of Lumbar Intervertebral Disc Herniation Based on MRI Images

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Kangxing Zheng ◽  
Zihuan Wen ◽  
Dehuai Li
Keyword(s):  
Intervertebral Disc ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Facet Joint ◽  
Lumbar Disc ◽  
Herniated Disc ◽  
Intervertebral Disc Herniation ◽  
Facet Joints ◽  
Lumbar Intervertebral Disc ◽  
Lumbar Intervertebral Disc Herniation

MRI was used to measure the changes in the angle of the facet joints of the lumbar spine and analyze the relationship between it and the herniated lumbar intervertebral disc. Analysis of the causes of lumbar disc herniation from the anatomy and morphology of the spine provides a basis for the early diagnosis and prevention of lumbar disc herniation. There is a certain correlation between the changes shown in MRI imaging of lumbar disc herniation and the TCM syndromes of lumbar intervertebral disc herniation. There is a correlation between the syndromes of lumbar disc herniation and the direct signs of MRI: pathological type, herniated position, and degree of herniation. Indirect signs with MR, nerve root compression and dural sac compression, are related. The MRI examination results can help syndrome differentiation to improve its accuracy to a certain extent. MRI has high sensitivity for the measurement of the angle of the facet joints of the lumbar spine and can be used to study the correlation between the changes of the facet joint angles and the herniated disc. Facet joint asymmetry is closely related to lateral lumbar disc herniation, which may be one of its pathogenesis factors. The herniated intervertebral disc is mostly on the sagittal side of the facet joint, and the facet joint angle on the side of the herniated disc is more sagittal. The asymmetry of the facet joints is not related to the central lumbar disc herniation, and the angle of the facet joints on both sides of the central lumbar disc herniation is partial sagittal.

scholarly journals Clinical Outcomes of Trans-Sacral Epiduroscopic Laser Decompression (SELD) in Patients with Lumbar Disc Herniation

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Seong Son ◽  
Sang Gu Lee ◽  
Yong Ahn ◽  
Woo Kyung Kim
Keyword(s):  
Clinical Outcomes ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Leg Pain ◽  
Herniated Disc ◽  
Low Back ◽  
Invasive Treatment ◽  
Disc Disease

Objective. Nowadays, trans-sacral epiduroscopic laser decompression (SELD) using slender epiduroscopy and laser is one of the preferred options for minimally invasive treatment in lumbar disc diseases. However, SELD is still in the initial stages of the global field of spine surgery, and the clinical outcomes in patients with lumbar disc herniation are not established yet. Therefore, the authors investigated patients undergoing SELD to report the clinical results. Methods. Between November 2015 and November 2018, a total of 82 patients who underwent single-level SELD for lumbar disc herniation with a minimum follow-up of 6.0 months were enrolled. A retrospective review of clinical data was conducted. Clinical outcomes were evaluated using the visual analogue scale (VAS) for low back and leg pain and Odom’s criteria. Also, surgical outcomes, including complications and symptom recurrences, and radiological outcomes were analyzed. Results. Low back pain and leg pain as determined by the VAS improved from an average of 5.43 ± 1.73 and 6.10 ± 1.67 to 2.80 ± 1.43 and 3.58 ± 2.08 at the final follow-up (p<0.001). According to Odom’s criteria, the success rate defined as excellent or good results at the final follow-up was 58.5%. There were no surgery-related complications such as neurologic deficits, infection, or epidural hematomas, except for transient mild paralysis in 3 patients and procedure-related nuchal pain in 2 patients. The rate of additional procedures was 17.0% (6 patients received revision surgery and 8 patients received an additional nerve block) during the follow-up. Conclusion. Our findings showed that SELD for lumbar herniated disc disease achieved less favorable clinical outcomes compared with those of previous studies. Further study is needed to clarify the influencing factors on the clinical outcomes of SELD.

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