Image processing lumbar spine to highlight the location of the herniated disc

Low back pain is a common disease. A common cause of this problem is a herniated disc in the lumbar spine. Lumbar disc herniation represents the displacement of the disc (annular fibrosis or medullary nuclei). While most cases, the pain will disappear in a few days to a few weeks; however, it can last for three months or more. Detection and diagnosis are the two most important tasks in a computer-aided diagnostic system. In this article, we use images taken from the results of the MRI imaging of the patient. Through the use of image inversion to highlight the position of degenerative discs. This result wishes to provide a simple and inexpensive diagnostic image processing method to help doctors quickly determine the degree of disc herniation, the status of lumbar discs, they can give the appropriate treatment to the patient.

Download Full-text

Genotypic and Antimicrobial Characterisation ofPropionibacterium acnesIsolates from Surgically Excised Lumbar Disc Herniations

BioMed Research International ◽

10.1155/2013/530382 ◽

2013 ◽

Vol 2013 ◽

pp. 1-7 ◽

Cited By ~ 37

Author(s):

Jess Rollason ◽

Andrew McDowell ◽

Hanne B. Albert ◽

Emma Barnard ◽

Tony Worthington ◽

...

Keyword(s):

Lumbar Disc Herniation ◽

Disc Herniation ◽

Lumbar Disc ◽

Herniated Disc ◽

Type Ii ◽

Type Ia ◽

Disc Herniations ◽

Typing Methods ◽

Human Infections ◽

Clinical Conditions

The anaerobic skin commensalPropionibacterium acnesis an underestimated cause of human infections and clinical conditions. Previous studies have suggested a role for the bacterium in lumbar disc herniation and infection. To further investigate this, five biopsy samples were surgically excised from each of 64 patients with lumbar disc herniation.P. acnesand other bacteria were detected by anaerobic culture, followed by biochemical and PCR-based identification. In total, 24/64 (38%) patients had evidence ofP. acnesin their excised herniated disc tissue. UsingrecAand mAb typing methods, 52% of the isolates were type II (50% of culture-positive patients), while type IA strains accounted for 28% of isolates (42% patients). Type III (11% isolates; 21% patients) and type IB strains (9% isolates; 17% patients) were detected less frequently. The MIC values for all isolates were lowest for amoxicillin, ciprofloxacin, erythromycin, rifampicin, tetracycline, and vancomycin (≤1mg/L). The MIC for fusidic acid was 1-2 mg/L. The MIC for trimethoprim and gentamicin was 2 to ≥4 mg/L. The demonstration that type II and III strains, which are not frequently recovered from skin, predominated within our isolate collection (63%) suggests that the role ofP. acnesin lumbar disc herniation should not be readily dismissed.

Download Full-text

Comparative Study between Full-Endoscopic Discectomy and Microendoscopic Discectomy for the Treatment of Lumbar Disc Herniation

Medicina ◽

10.3390/medicina56120710 ◽

2020 ◽

Vol 56 (12) ◽

pp. 710

Author(s):

Muneyoshi Fujita ◽

Tomoaki Kitagawa ◽

Masahiro Hirahata ◽

Takahiro Inui ◽

Hirotaka Kawano ◽

...

Keyword(s):

Lumbar Disc Herniation ◽

Disc Herniation ◽

Lumbar Disc ◽

Disc Height ◽

Leg Pain ◽

Height Loss ◽

Common Disease ◽

Low Back ◽

Endoscopic Discectomy ◽

Microendoscopic Discectomy

Background and objectives: Lumbar disc herniation (LDH) is a common disease in the meridian of life. Although surgical discectomy is commonly used to treat LDH, there are several different strategies. We compared the outcomes of uniportal full-endoscopic discectomy (FED) with those of microendoscopic discectomy (MED) in treating LDH. Materials and Methods: FED was performed using a 4.1-mm working channel endoscope, and MED was performed using a 16-mm diameter tubular retractor and endoscope. Data of patients with LDH treated with FED (n = 39) or MED (n = 27) by the single surgeon were retrospectively reviewed. Patient background information and operative data were collected. Pre- and postoperative low back and leg pain were evaluated using the numerical rating scale (NRS) score. Pre- and postoperative disc height index (DHI) values were calculated from plain radiographs, and the disc height loss was evaluated using the ratio (DHI ratio); Results: The median (interquartile range (IQR) Q25–75) operation times for FED and MED were 42 (33–61) and 43 (33–50) minutes, respectively. The median (IQR Q25–75) pre- and postoperative NRS scores for low back pain were 5 (2–7) and 1 (0–4), respectively, for FED and 6 (3–8) and 1 (0–2), respectively, for MED. The median (IQR Q25–75) pre- and postoperative NRS scores for leg pain were 7 (5–8) and 0 (0–2), respectively, for FED and 6 (5–8) and 0 (0–2), respectively, for MED. These data were not different between the FED and MED groups. The median (IQR Q25–75) DHI ratios of FED and MED were 0.94 (0.89–1.03) and 0.90 (0.79–0.95), respectively. The DHI ratio was significantly higher (p < 0.05) in the FED group than in the MED group, and there was less blood loss; Conclusions: The pain-relieving effect of FED in treating LDH was almost identical to that of MED. However, FED was superior to MED in preventing disc height loss, which is one of the indicators of postoperative disc degeneration.

Download Full-text

Unilateral facetectomy approach for lateral lumbar disc herniation

Journal of Neurosurgery ◽

10.3171/jns.1991.74.5.0754 ◽

1991 ◽

Vol 74 (5) ◽

pp. 754-756 ◽

Cited By ~ 75

Author(s):

Eddy Garrido ◽

P. Noel Connaughton

Keyword(s):

Disc Herniation ◽

Lumbar Fusion ◽

Lumbar Disc ◽

Herniated Disc ◽

Spinal Instability ◽

Content Type ◽

X Ray ◽

Flexion And Extension ◽

Fine Print

✓ Forty-one patients with herniated lumbar discs in a lateral location underwent unilateral complete facetectomy for removal of their disc herniation. The diagnosis was made by computerized tomography in all patients. The follow-up period varied between 4 and 60 months, with an average of 22.4 months. All patients underwent dynamic lumbar spine x-ray films with flexion and extension exposures at various times during their follow-up period. The results were excellent in 35 patients, good in three, and poor in three. One patient suffered spinal instability postoperatively and required lumbar fusion because of back pain. Unilateral facetectomy gives an excellent view of the affected nerve root and the herniated disc, and the risk of spinal instability is very low.

Download Full-text

Disappearing cervical disc

Neurosurgical FOCUS ◽

10.3171/foc.1996.1.6.5 ◽

1996 ◽

Vol 1 (6) ◽

pp. E4 ◽

Cited By ~ 1

Author(s):

Richard M. Westmark ◽

Kaye D. Westmark ◽

Volker K. H. Sonntag

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Computerized Tomography ◽

Disc Herniation ◽

Lumbar Disc ◽

Spontaneous Resolution ◽

Herniated Disc ◽

Cervical Disc ◽

Resonance Imaging ◽

Herniated Lumbar Disc

The authors report the case of a 48-year-old woman who experienced spontaneous resolution of a large herniated disc at C6-7. Spontaneous resolution of a herniated lumbar disc was first documented by computerized tomography. This case is another example of a rare spontaneous resolution of a cervical disc herniation documented by magnetic resonance imaging.

Download Full-text

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

January 2018 - Pain Physician ◽

10.36076/ppj/2016.19.e301 ◽

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

Download Full-text

Analysis of Revision Surgery of Microsurgical Lumbar Discectomy

Asian Spine Journal ◽

10.4184/asj.2018.12.1.140 ◽

2018 ◽

Vol 12 (1) ◽

pp. 140-146 ◽

Cited By ~ 3

Author(s):

Taku Inada ◽

Sei Nishida ◽

Taigo Kawaoka ◽

Toshiyuki Takahashi ◽

Junya Hanakita

Keyword(s):

Disc Herniation ◽

Revision Surgery ◽

Lumbar Disc ◽

Lumbar Discectomy ◽

Herniated Disc ◽

Pathological Changes ◽

Video Footage ◽

Primary Surgery ◽

Surgery Group ◽

Significant Difference

<sec><title>Study Design</title>A retrospective study.</sec><sec><title>Purpose</title>Our objectives were to determine the association between the pathological changes of disc herniation and the interval between primary and revision surgeries and to investigate the frequency and site of the dural laceration in the primary and revision surgeries.</sec><sec><title>Overview of Literature</title>Among 382 patients who underwent microsurgical lumbar discectomy, we investigated 29 who underwent revision surgery to analyze recurrent herniation pathologies and complications to determine the manner in which lumbar disc herniation can be more efficiently managed.</sec><sec><title>Methods</title>Of 29 patients, 22 had recurrent disc herniation at the same level and site. The pathological changes associated with compression factors were classified into the following two types depending on intraoperative findings: (1) true recurrence and (2) minor recurrence with peridural fibrosis (>4 mm thickness). The sites of dural laceration were examined using video footage and operative records.</sec><sec><title>Results</title>The pathological findings and days between the primary and revision surgeries showed no statistical difference (<italic>p</italic>=0.14). Analysis of multiple factors, revealed no significant difference between the primary and revision surgery groups with regard to hospital days (<italic>p</italic>=0.23), blood loss (<italic>p</italic>=0.99), and operative time (<italic>p</italic>=0.67). Dural lacerations obviously increased in the revision surgery group (1.3% vs. 16.7%, <italic>p</italic><0.01) and were mainly located near the herniated disc in the primary surgery group and near the root shoulder in the revision surgery group, where severe fibrosis and adhesion were confirmed. To avoid dural laceration during revision surgery, meticulous decompressive manipulation must be performed around the root sleeve.</sec><sec><title>Conclusions</title>We recommend that meticulous epidural dissection around the scar formation must be performed during revision surgery to avoid complications.</sec>

Download Full-text

Analysis of curative effect: percutaneous transforaminal endoscopic discectomy for lumbar disc herniation with buttock pain as the main symptom

10.21203/rs.3.rs-492938/v1 ◽

2021 ◽

Author(s):

Jun-Yan An ◽

Jun Zhang ◽

Jiu-Ping Wu ◽

Tong Yu ◽

Wu Xue ◽

...

Keyword(s):

Clinical Symptom ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Average Length ◽

Lumbar Disc ◽

Common Disease ◽

Buttock Pain ◽

Endoscopic Discectomy ◽

Percutaneous Transforaminal Endoscopic Discectomy

Abstract Background . Lumbar disc herniation (LDH) is a common disease in spinal surgery which often causes acute radicular pain. However, LDH with buttock pain (BP) as the main clinical symptom is rare. Herein, we retrospectively evaluated the efficacy and safety of percutaneous transforaminal endoscopic discectomy (PTED) in the treatment of LDH with the buttock as the primary clinical symptom. Methods . Totally 12 patients have LDH (L4-5) with BP who underwent PTED from January 2019 to June 2020 were enrolled. All patients performed magnetic resonance imaging (MRI) and computed tomography (CT) preoperatively, 1 week postoperatively, and at follow-up. The pain relieve were evaluated by the Visual analog scale (VAS), the functional recovery was assessed by Oswestry disability index (ODI) and Roland-Morris questionnaire (RMQ). Parameters were evaluated preoperatively, immediately after surgery, 1 month, 3 months and 6 months after surgery, respectively. Moreover, the lumbar function was determined by modified MacNab criteria. Results . Pain relieve was found in 11 patients postoperatively. The VAS, ODI and RMQ scores were improved significantly at the latest follow up visit compared to preoperative (P < 0.05). One patient suffered from LDH recurrence one month after operation and received revision surgery, then achieved satisfied effect. Two patients experienced residual BP after operation and obtained good clinical outcomes by conservative treatment. No other surgical complications were found during follow up period. The average length of follow-up was 6.68 ± 0.67 months. Conclusion. PTED is a safe and efficacious method in treating LDH with BP.

Download Full-text

Risk Factors for Early Recurrence After Transforaminal Endoscopic Lumbar Disc Decompression

January 2018 - Pain Physician ◽

10.36076/ppj/2019.22.e133 ◽

2019 ◽

Vol 2 (22.2) ◽

pp. E133-E138

Author(s):

Chan Hong Park

Keyword(s):

Risk Factors ◽

Disc Herniation ◽

Smoking Status ◽

Lumbar Disc ◽

Early Recurrence ◽

Herniated Disc ◽

Endoscopic Recurrence ◽

Imaging Results ◽

Key Words Disc Herniation ◽

A Prospective Study

Background: Transforaminal endoscopic lumbar disc decompression (TELD) has emerged as a treatment alternative to open lumbar discectomy, but rates of herniated lumbar disc (HLD) recurrence after TELD are higher by comparison. Objectives: We conducted this study to identify factors correlating with early HLD recurrence after TELD. Study Design: Retrospective study. Setting: The Department of Anesthesiology and Pain Medicine, Neurosurgery at Spine Health Wooridul Hospital. Methods: As a retrospective review, we examined all patients undergoing TELD between 2012 and 2017, analyzing the following in terms of time to recurrence: age, gender, body mass index (BMI), comorbid conditions (diabetes mellitus [DM], hypertension [HTN]), smoking status, nature of disc herniation (central, paramedian, or foraminal), Modic changes, migration grade (rostral vs. caudal track + degree), herniated disc height (Dht) and base size (Dbase), and the presence of spondylolisthesis on magnetic resonance imaging. Results: During the 5-year study period, 1,900 patients underwent TELD procedures, resulting in 209 recurrences (11.0%). In 27 of these patients (12.9%), herniation recurred within 24 hours after surgery. Recurrences most often developed within 2-30 days (n = 76). The smaller the size of a herniated disc, the earlier it recurred. Recurrences were unrelated to gender, BMI, DM or HTN, smoking status, migration grade, nature (Dht or Dbase of herniated disc), or the presence of spondylolisthesis. Limitations: In addition to variables assessed herein, other clinical and radiologic parameters that may be important in recurrent disc herniation should be included. Furthermore, only univariate analyses were performed, making no adjustments for potential confounders, therefore, independent risk factors could not be assessed. A prospective study would likely generate more precise results, especially in terms of standardized sampling and data classification. Finally, multiple causes for primary discectomy failures may have rendered our patient groups nonhomogeneous, and inequalities in surgical options or physician-dictated surgical choices may have had an effect. Conclusions: In patients undergoing TELD procedures, smaller-sized herniated discs are linked to early recurrences. Key words: Disc herniation, lumbar, endoscopic, recurrence, early

Download Full-text

P88 Identifying risk factors for multiple revisional lumbar spine surgery

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp-2019-abn.145 ◽

2019 ◽

Vol 90 (3) ◽

pp. e45.1-e45

Author(s):

M El Sheikh ◽

K Badran ◽

O Kouli ◽

M Abdelsadg ◽

M Fadelalla ◽

...

Keyword(s):

Risk Factors ◽

Lumbar Spine ◽

Spine Surgery ◽

Disc Herniation ◽

Lumbar Disc ◽

Morbidity Rate ◽

Lumbar Spine Surgery ◽

Neurosurgical Department ◽

Primary Surgery ◽

Diabetes Status

ObjectivesRecurrent lumbar spine surgery due to disc herniation is a contributor to debilitating pain, disability, and carries a high patient morbidity rate1 We identified risk factors for recurrent lumbar disc herniation post-surgical intervention.DesignRetrospective Cohort Study.SubjectsAll adult lumbar spine revisions for disc herniation performed in the Neurosurgical Department at Ninewells Hospital.MethodsThe number of revisions from 2013 to 2017 for each patient was recorded and two groups were identified. The first group consisted of patients who had one revision and the second group consisted of patients who had recurrent revisions (more than one) Possible factors influencing the likelihood of recurrent revisions were also noted, including age, gender, BMI, operation length, level of surgery, time from primary surgery to revision, smoking and diabetes status.Results140 patients had revision surgeries, of which 87 (62.1%) had one revision while 53 (37.1%) had recurrent operations. Younger patients (p=0.025) and patients with higher BMI (p=0.01) were more likely to have a higher number of revisions. Patients with DM (p=0.015) were associated with a higher likelihood of recurrent revisions. Other factors had little effect on the likelihood of recurrent revisions (p>0.05).ConclusionsIdentifying risk factors that influence the recurrence of lumbar revisions helps improve patient outcome and decrease incidence of revisions.

Download Full-text

Evaluation of the post-operative lumbar spine with MR imaging

Acta Radiologica ◽

10.1080/02841859709172126 ◽

1997 ◽

Vol 38 (6) ◽

pp. 1035-1042 ◽

Cited By ~ 2

Author(s):

P. Grane ◽

M. Lindqvist

Keyword(s):

Lumbar Spine ◽

Contrast Enhancement ◽

Disc Herniation ◽

Nerve Root ◽

Clinical Symptoms ◽

Lumbar Disc ◽

Nerve Roots ◽

Contrast Administration ◽

Repeat Surgery ◽

Lumbar Nerve Root

Purpose: Two new signs of lumbar nerve-root affection have been reported in recent years on the basis of MR examinations, namely: thickening in nerve roots; and contrast enhancement in nerve roots. the aim of this study was to assess contrast enhancement in nerve roots in a standardised way, and to evaluate the clinical significance of contrast enhancement and of nerve-root thickening in the symptomatic post-operative lumbar spine Material and Methods: A total of 121 patients (who had previously been operated on for lumbar disc herniation) underwent 152 MR examinations, mainly on a 1.5 T system. Focal nerve-root enhancement was identified by visual assessment. Intradural enhancement was also quantified by pixel measurements that compared the affected nerve roots before and after contrast administration. Non-affected nerve roots were used as reference Results: Enhanced nerve roots in the dural sac increased at least 40–50% in signal intensity after contrast administration compared to pre-contrast images and also compared to non-affected nerve roots. Intradural nerve-root enhancement was seen in 10% of the patients and focal enhancement in the root sleeve was seen in a further 26%. Nerve-root thickening was seen in 30%. Good correlation with clinical symptoms was found in 59% of the patients with intradural enhancement, in 84% with focal enhancement, and in 86% with nerve-root thickening. the combination of thickening and enhancement in the nerve root correlated with symptoms in 86% of the patients Conclusion: Nerve-root enhancement (whether focal or intradural) and thickening in the nerve root are significant MR findings in the post-operative lumbar spine. in combination with disc herniation or nerve-root displacement, these two signs may strengthen the indication for repeat surgery. However, root enhancement within 6 months of previous surgery may be a normal post-operative finding

Download Full-text