scholarly journals Imaging in Thoracic Disc Prolapse: A Study of 25 Patients and Review of Literature

2020 ◽  
Vol 1 (1) ◽  
Keyword(s):  
Lumbar Disc ◽  
Disc Prolapse ◽  
Mr Images ◽  
Disc Space ◽  
End Plate ◽  
Grade 5 ◽  
Type Ia ◽  
Lower Thoracic Spine ◽  
Grade 3 ◽  
Thoracic Disc

Purpose: Unlike cervical and lumbar disc, thoracic disc prolapse (TDP) has limited literature. Many studies have focused on surgical technique of TDP. The aim of this study is to highlight the radiological features of TDP that would help surgeons in understanding the peculiar features of such uncommon entity and also planning the surgery. Materials and Methods: All the patients surgically treated for TDP between May 2010 and June 2018 were included in the study. A retrospective collection of all the radiographs, CT and MR images were done. Results: A total of 25 subjects, two patients had double level disc prolapse; hence, a total of 27 discs were analyzed. On radiographs, end-plate was concave (n = 9), straight (n = 12), cupid bow shaped (n = 6), calcification in disc space (n = 5), and calcification within the canal (n = 14). EP junction failures were type IA (n = 10), type IB (n = 6), type ID (n = 2), and type II (n = 9). On MRI, central disc prolapse (n = 10), right paracentral (n = 12), and left paracentral (n = 5). According to Pfirmann grading, three discs were Grade 2; five discs as Grade 3; 14 as Grade 4; and five as Grade 5. Fourteen discs had >40% canal occupancy. Schmorl nodes were noted (n = 17). Conclusion: Lower thoracic spine has a higher incidence of TDP. Calcification is commonly seen in cases of TDP, either in the disc space or within the canal. Most of the cases present with >40% of canal occupancy. End plate defect, a variant of schmorl node, may be a possible contributor to disc prolapse. Keywords: Thoracic disc prolapse, radiology, calcification.

scholarly journals The comprehensive anatomical spinal osteotomy and anterior column realignment classification

2018 ◽  
Vol 29 (5) ◽  
pp. 565-575 ◽  
Author(s):  
Juan S. Uribe ◽  
Frank Schwab ◽  
Gregory M. Mundis ◽  
David S. Xu ◽  
Jacob Januszewski ◽  
...  
Keyword(s):  
Interobserver Reliability ◽  
Spinous Process ◽  
Pedicle Subtraction Osteotomy ◽  
Anterior Column ◽  
Disc Space ◽  
Interspinous Ligament ◽  
Radiographic Outcomes ◽  
Grade 5 ◽  
Grade 3 ◽  
Additional Resection

OBJECTIVESpinal osteotomies and anterior column realignment (ACR) are procedures that allow preservation or restoration of spine lordosis. Variations of these techniques enable different degrees of segmental, regional, and global sagittal realignment. The authors propose a comprehensive anatomical classification system for ACR and its variants based on the level of technical complexity and invasiveness. This serves as a common language and platform to standardize clinical and radiographic outcomes for the utilization of ACR.METHODSThe proposed classification is based on 6 anatomical grades of ACR, including anterior longitudinal ligament (ALL) release, with varying degrees of posterior column release or osteotomies. Additionally, a surgical approach (anterior, lateral, or posterior) was added. Reliability of the classification was evaluated by an analysis of 16 clinical cases, rated twice by 14 different spine surgeons, and calculation of Fleiss kappa coefficients.RESULTSThe 6 grades of ACR are as follows: grade A, ALL release with hyperlordotic cage, intact posterior elements; grade 1 (ACR + Schwab grade 1), additional resection of the inferior facet and joint capsule; grade 2 (ACR + Schwab grade 2), additional resection of both superior and inferior facets, interspinous ligament, ligamentum flavum, lamina, and spinous process; grade 3 (ACR + Schwab grade 3), additional adjacent-level 3-column osteotomy including pedicle subtraction osteotomy; grade 4 (ACR + Schwab grade 4), 2-level distal 3-column osteotomy including pedicle subtraction osteotomy and disc space resection; and grade 5 (ACR + Schwab grade 5), complete or partial removal of a vertebral body and both adjacent discs with or without posterior element resection. Intraobserver and interobserver reliability were 97% and 98%, respectively, across the 14-reviewer cohort.CONCLUSIONSThe proposed anatomical realignment classification provides a consistent description of the various posterior and anterior column release/osteotomies. This reliability study confirmed that the classification is consistent and reproducible across a diverse group of spine surgeons.

scholarly journals Lumbar disc degeneration: association between osteophytes, end-plate sclerosis and disc space narrowing

2007 ◽  
Vol 66 (3) ◽  
pp. 330-333 ◽  
Author(s):  
S. R Pye ◽  
D. M Reid ◽  
M. Lunt ◽  
J. E Adams ◽  
A. J Silman ◽  
...  
Keyword(s):  
Disc Degeneration ◽  
Lumbar Disc ◽  
Lumbar Disc Degeneration ◽  
Disc Space Narrowing ◽  
Disc Space ◽  
End Plate

scholarly journals Adenosine-induced Asystole during AVM Embolization

2021 ◽  
Author(s):  
V. Hellstern ◽  
P. Bhogal ◽  
M. Aguilar Pérez ◽  
M. Alfter ◽  
A. Kemmling ◽  
...  
Keyword(s):  
Demographic Data ◽  
Clinical Results ◽  
Endovascular Embolization ◽  
Neurological Deficits ◽  
Residual Shunt ◽  
Grade 5 ◽  
Martin Grade ◽  
Grade 3 ◽  
Brain Avms

Abstract Background Adenosine induced cardiac standstill has been used intraoperatively for both aneurysm and arteriovenous malformation (AVM) surgery and embolization. We sought to report the results of adenosine induced cardiac standstill as an adjunct to endovascular embolization of brain AVMs. Material and Methods We retrospectively identified patients in our prospectively maintained database to identify all patients since January 2007 in whom adenosine was used to induce cardiac standstill during the embolization of a brain AVM. We recorded demographic data, clinical presentation, Spetzler Martin grade, rupture status, therapeutic intervention and number of embolization sessions, angiographic and clinical results, clinical and radiological outcomes and follow-up information. Results We identified 47 patients (22 female, 47%) with average age 42 ± 17 years (range 6–77 years) who had undergone AVM embolization procedures using adjunctive circulatory standstill with adenosine. In total there were 4 Spetzler Martin grade 1 (9%), 9 grade 2 (18%), 15 grade 3 (32%), 8 grade 4 (18%), and 11 grade 5 (23%) lesions. Of the AVMs six were ruptured or had previously ruptured. The average number of embolization procedures per patient was 5.7 ± 7.6 (range 1–37) with an average of 2.6 ± 2.2 (range 1–14) embolization procedures using adenosine. Overall morbidity was 17% (n = 8/47) and mortality 2.1% (n = 1/47), with permanent morbidity seen in 10.6% (n = 5/47) postembolization. Angiographic follow-up was available for 32 patients with no residual shunt seen in 26 (81%) and residual shunts seen in 6 patients (19%). The angiographic follow-up is still pending in 14 patients. At last follow-up 93.5% of patients were mRS ≤2 (n = 43/46). Conclusion Adenosine induced cardiac standstill represents a viable treatment strategy in high flow AVMs or AV shunts that carries a low risk of mortality and permanent neurological deficits.

scholarly journals Caudal epidural steroid injection ultrasound-guided versus fluoroscopy-guided in treatment of refractory lumbar disc prolapse with radiculopathy

2020 ◽  
Vol 51 (1) ◽  
Author(s):  
Mohamed Ahmed Elashmawy ◽  
Reham M. Shaat ◽  
A. M. Abdelkhalek ◽  
Ebrahim El Boghdady
Keyword(s):  
Steroid Injection ◽  
Lumbar Disc ◽  
Epidural Steroid Injection ◽  
Successful Outcome ◽  
Post Injection ◽  
Disc Prolapse ◽  
Lumbar Disc Prolapse ◽  
Straight Leg Raising ◽  
Epidural Steroid ◽  
Caudal Epidural

Abstract Background Lumbar disc prolapse is a localized herniation of disc beyond intervertebral disc space and is the most common cause of sciatica; the aim of this study is to investigate the efficacy of ultrasound (US)-guided caudal epidural steroid injection (CESI) compared with fluoroscopy (FL)-guided CESI in treatment of patients with refractory lumbar disc prolapse (LDP) with radiculopathy. Results At the beginning of the study, there was no significant difference between both groups in all parameters. (a) Group 1 had significantly improved the straight leg raising and modified Schober tests, VAS, and ODI at 1-month and 3-month post-injection evaluation in comparison to baseline recordings (p < 0.001); (b) Group 2 had significantly improved the straight leg raising and modified Schober tests, VAS, and ODI at 1-month and 3-month post-injection evaluation in comparison to baseline recordings (p < 0.001); and (c) US-guided CESI was not statistically different from the FL-guided CESI in the improvement of the straight leg raising (p = 0.87, 0.82) and modified Schober tests (p = 0.87, 0.82) as well as VAS (p = 0.40, 0.43) and ODI (p = 0.7, 0.2) at 1-month and 3-month post-injection evaluation. In a multivariate analysis using CI = 95%, the significant predictors for a successful outcome were duration < 6 months (p = 0.03, OR = 2.25), target level not L2-3/L3-4 (p < 0.001, OR = 4.13), and LDP other than foraminal type (p = 0.002, OR = 3.78). However, age < 40 years was found to be non-significant in predicting a successful outcome (p = 0.38, OR = 0.98). Conclusion US is excellent in guiding CESI with similar treatment outcomes as compared with FL-guided CESI. Trial registration ClinicalTrials.gov Identifier: NCT03933150.

Disc space-targeted angled axial MR images of the lumbar spine: a potential source of diagnostic error

2007 ◽  
Vol 36 (12) ◽  
pp. 1147-1153 ◽  
Author(s):  
Kush Singh ◽  
Clyde A. Helms ◽  
David Fiorella ◽  
Nancy A. Major
Keyword(s):  
Lumbar Spine ◽  
Diagnostic Error ◽  
Mr Images ◽  
Disc Space ◽  
Potential Source
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