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 Comparison of Clinical Outcomes of Two-Level PELD and Foraminoplasty PELD for Highly Migrated Disc Herniations: A Comparative Study

2019 ◽  
Vol 2019 ◽  
pp. 1-8
Author(s):  
Xinbo Wu ◽  
Guoxin Fan ◽  
Shisheng He ◽  
Xin Gu ◽  
Yunfeng Yang
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Postoperative Complications ◽  
Clinical Outcomes ◽  
Nucleus Pulposus ◽  
Lumbar Disc ◽  
Leg Pain ◽  
Low Back ◽  
Satisfaction Rate ◽  
Disc Herniations

Objective. The aim of this study is to compare the clinical outcomes of two-level percutaneous endoscopic lumbar discectomy (PELD) and foraminoplasty PELD in treating highly migrated lumbar disc herniations. Methods. Patients with highly migrated lumbar disc herniations were enrolled from May 2014 to June 2016. Low back pain and leg pain were evaluated by the Visual Analog Scale (VAS), and functional outcomes were assessed with the Oswestry Disability Index (ODI). The satisfaction rate of clinical outcomes was assessed according to the modified MacNab criteria. In addition, the intraoperative duration and postoperative complications were also recorded. Results. Forty patients, 14 cases in two-level PELD group and 26 cases in foraminoplasty PELD group, were included. The VAS scores of low back pain (P=0.67) and leg pain (P=0.86), as well as the ODI scores (P=0.87), were comparative between two-level PELD and foraminoplasty PELD groups. The satisfaction rate of clinical outcomes based on the modified MacNab criteria in the two-level PELD group was equivalent to that in foraminoplasty PELD group (92.9% versus 92.3%, P=0.92). In addition, the intraoperative duration of two-level PELD group was longer than that of foraminoplasty PELD group (80.2 ± 6.6 min versus 64.1 ± 7.3 min, P<0.01). The postoperative complications in the two-level PELD group (postoperative dysesthesia: N = 1) were relatively fewer as compared to those in the foraminoplasty PELD group (postoperative dysesthesia: N = 1; recurrence: N = 1; nucleus pulposus residues: N = 1). Conclusions. Both two-level PELD and foraminoplasty PELD are safe and effective surgical procedures for the patients with highly migrated lumbar disc herniations. Moreover, the two-level PELD technique has merits in reducing the incidence of postoperative nucleus pulposus residue.

scholarly journals Diagnosing Discogenic Low Back Pain Associated with Degenerative Disc Disease Using a Medical Interview

PLoS ONE ◽  
2016 ◽  
Vol 11 (11) ◽  
pp. e0166031 ◽  
Author(s):  
Juichi Tonosu ◽  
Hirohiko Inanami ◽  
Hiroyuki Oka ◽  
Junji Katsuhira ◽  
Yuichi Takano ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Degenerative Disc Disease ◽  
Low Back ◽  
Medical Interview ◽  
Disc Disease ◽  
Degenerative Disc ◽  
Discogenic Low Back Pain

scholarly journals Discogenic low back pain: interventional treatment

Pain medicine ◽  
2018 ◽  
Vol 3 (3) ◽  
pp. 16-26
Author(s):  
V I Smolanka ◽  
V M Fedurtsya ◽  
B B Pavlov
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Adult Population ◽  
Intervertebral Discs ◽  
Interventional Treatment ◽  
Therapeutic Effects ◽  
Low Back ◽  
Discogenic Pain ◽  
Discogenic Low Back Pain ◽  
Common Causes

Low back pain (LBP) is one of the most common causes of disability in the adult population. A significant place in its genesis is occupied by a degenerative-dystrophic diseases of intervertebral discs. The article highlights the classification and mechanism of discogenic pain origin. Various types of interventions aredescribed for this pathology: indications, specificities of carrying out manipulations and therapeutic effects, efficiency and possible complications of procedures.

scholarly journals Magnetic resonance imaging findings in patients with low backache

2017 ◽  
Vol 18 (2) ◽  
pp. 11-15 ◽  
Author(s):  
Narayan Bikram Thapa ◽  
Suraj Bajracharya
Keyword(s):  
Magnetic Resonance Imaging ◽  
Low Back Pain ◽  
Back Pain ◽  
Magnetic Resonance ◽  
Lumbar Disc ◽  
Low Back ◽  
Resonance Imaging ◽  
Lumbar Disc Degeneration ◽  
Disc Disease ◽  
Annular Tear

 Introduction: Low backache is commonly experienced by adults at some time during their lives. Though it is caused by degenerative changes, spinal stenosis, neoplasm, infection and trauma, lumbar disc degeneration is the most commonly diagnosed abnormalities associated. As Magnetic Resonance Imaging (MRI) is non invasive imaging technique with excellent spatial and contrast resolution, it has become the investigation of choice in evaluation of patients with low back pain. This study was designed to determine the patterns of degenerative disc disease on MRI in patients with low backache.Methods: A retrospective hospital based study was done by reviewing MRI report of 202 patients who underwent MRI of lumbar spine for complaint of chronic low back pain, radicular pain, neurogenic claudication or various other symptoms and signs suggestive of lumbar degenerative disc disease from January 2014 till June 2014. The patients having MRI findings of acute spinal infection, recent trauma, tumors, spinal dysraphism and metabolic conditions were excluded from the study.Results: Out of the 202 patients included in the study, 116 patients (57.4%) were male and 86 patients (42.6%) were female. The mean age of the study population was 44.26 ±15.61 (13-83) years. Multiple contiguous level disc disease was the most common type of involvement which was noted in 109 (54%) patients. Grade 4 lumbar disc degeneration (graded as per classification given by Pfirrmann et al) was noted in 65.3% (132) cases followed by Grade 2 in 25.2%(51) cases and Grade 1in 5.5% (11) cases. The most common involvement was observed at L4-L5 level (76.7%) and L5-S1 levels (55.9%) followed by L3-L4 (30.6%) in decreasing order of frequency. The most common category was disc bulge note in 46.5% (94) of cases. Nerve root compression was observed in 56% (114) of the total cases. Nerve root compromise was also noted most frequently compressing L5 nerve (28.23% of cases). Annular tear was observed in 14.4% (29) of cases and among them 20% (6) of cases had torn at two intervertebral discs. It is most frequently noted involving L4-L5 intervertebral disc (72.5% of cases), followed by L5-S1 (24.2% of cases).Conclusion: Disc generation is most common at L4-L5 level with multiple contiguous involvement of grade 4. Annular tear though not common can occur and is also common at L4-L5 level.Journal of Society of Surgeons of Nepal, 2015; 18 (2)                        

scholarly journals A Randomized, Double-Blind, Active-Controlled Trial of Fluoroscopic Lumbar Interlaminar Epidural Injections in Chronic Axial or Discogenic Low Back Pain: Results of 2-Year Follow-Up

2013 ◽  
Vol 5;16 (5;9) ◽  
pp. E494-E504
Author(s):  
Laxmaiah Manchikanti
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Disc Herniation ◽  
Local Anesthetic ◽  
Controlled Trial ◽  
Low Back ◽  
Discogenic Pain ◽  
Double Blind ◽  
Epidural Injections ◽  
Discogenic Low Back Pain

Background: Chronic low back with or without lower extremity pain is extremely common, expensive, and disabling. Although it is responsible for a very small proportion of patients, disc herniation is the primary focus of modalities of treatments. In fact, chronic low back pain without disc herniation is common. Multiple modalities of treatments are utilized in managing axial or discogenic pain without disc herniation including surgery, intradiscal therapies, and epidural injections. There is, however, continued debate on the effectiveness, indications, and medical necessity of all modalities of treatments in managing axial or discogenic pain in the lumbar spine. Objectives: To assess the effectiveness of lumbar interlaminar epidural injections in managing chronic axial or discogenic low back pain with epidural injections of local anesthetic with or without steroids. Study Design: A randomized, double-blind, active-controlled trial. Setting: A private practice, specialty referral, interventional pain management practice in the United States. Methods: In this study, a total of 120 patients were randomly allocated to one of 2 groups of 60 patients receiving either local anesthetic alone or local anesthetic with steroids. The primary outcome measure was at least a 50% improvement in the numeric rating scale (NRS) and Oswestry Disability Index (ODI). Outcomes were assessed at 3, 6, 12, 18, and 24 months post treatment. Results: Significant pain relief and functional status improvement, defined as a reduction in scores from baseline of at least 50% or more, were observed in 72% of patients receiving local anesthetic alone and 67% of patients receiving local anesthetic with steroids. Opioid intake was reduced from the baseline in each group for 2 years. Limitations: The results of the study are limited by the lack of a placebo group. Conclusion: Lumbar interlaminar epidural injections of local anesthetic with or without steroids are effective in patients with chronic axial low back pain of discogenic origin without facet joint pain, disc herniation, and/or radiculitis. Key words: Lumbar disc herniation, axial or discogenic pain, lumbar interlaminar epidural injections, local anesthetic, steroids, controlled comparative local anesthetic blocks

Lumbar Disc Disorders

2018 ◽  
Author(s):  
Daniel Kline ◽  
Michael DePalma
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Imaging Techniques ◽  
Lumbar Disc ◽  
Adult Population ◽  
Treatment Options ◽  
Diagnosis And Treatment ◽  
Low Back ◽  
Accurate Identification ◽  
Discogenic Low Back Pain

This chapter focuses on the diagnosis and treatment of discogenic low back pain. Discogenic low back pain is a prevalent condition that affects a large percentage of the adult population. Diagnosis and treatment of this condition remain challenging despite ongoing advances. Provocation lumbar discography has allowed for more accurate identification of painful discs than conventional imaging techniques. Current research focusing on regenerative treatment options may hold promise for the future.

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.

Non-surgical management of lumbar disc disease

1977 ◽  
Vol 15 (25) ◽  
pp. 98-99
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Metabolic Bone Disease ◽  
Lumbar Disc ◽  
Uterine Disease ◽  
Low Back ◽  
Disc Disease ◽  
Lumbar Disc Disease ◽  
Metabolic Bone ◽  
Objective Evidence

Persistent low back pain is often ascribed to lumbar disc disease. Frequently no objective evidence supports this and the management is designed solely to alleviate symptoms. Inflammatory arthritis, metabolic bone disease, ligamentous injuries, metastases, infections, uterine disease, retroperitoneal lesions involving the lumbo-sacral plexus, renal disease, intraspinal lesions and depression may also cause low back pain and should be considered in the management of the patient. Occasionally appropriate special investigations are necessary. Lumbar disc lesions may cause acute, sub-acute or chronic symptoms and the management differs accordingly.

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