scholarly journals Is disc herniation “secondary” to spinal instability? Is it a protective natural response?

2021 ◽  
Vol 12 (3) ◽  
pp. 213
Author(s):  
Atul Goel
Keyword(s):  
Disc Herniation ◽  
Spinal Instability ◽  
Natural Response

Unilateral facetectomy approach for lateral lumbar disc herniation

1991 ◽  
Vol 74 (5) ◽  
pp. 754-756 ◽  
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.

scholarly journals Short-term clinical outcomes of percutaneous transforaminal endoscopic discectomy in treating adolescents under 25 years old with massive lumbar disc herniation

2020 ◽  
Author(s):  
Hai-Chao He ◽  
Yong-jin Zhang
Keyword(s):  
Clinical Outcomes ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Leg Pain ◽  
Spinal Instability ◽  
Lower Limb Pain ◽  
Endoscopic Discectomy ◽  
Adolescent Patients ◽  
Percutaneous Transforaminal Endoscopic Discectomy

Abstract Background: In the last decades, endoscopic techniques to treat lumbar disc herniation (LDH) have gained popularity in clinical practice. However, few studies have described the safety and efficacy of percutaneous transforaminal endoscopic discectomy (PTED) in treating adolescent massive LDH. This study aims to evaluate the surgical outcomes of PTED in treating adolescent patients with massive LDH. Methods: Between October 2012 and December 2018, retrospective analysis of 13 adolescent patients with single segment massive LDH at the Department of Spinal Surgery of Affiliated Dongyang Hospital of Wenzhou Medical University. All patients were followed up for at least 12 months (range 12–20 months). The patients’ lower limb pain was evaluated using visual analogue scale (VAS) scores and the Oswestry Disability Index (ODI). Patient satisfaction was evaluated using the MacNab outcome scale. Clinical outcomes were measured preoperatively, at 3 days, 1 months, 3 months, 6 month and 12 months postoperatively. Results: The VAS score for leg pain was 7.08 ±1.12 preoperatively and 3.23±1.01, 3.0 ± 1.01, and 2.62 ± 0.51, and 2.32± 0.48, and 1.46± 0.52, at 3 days, 1 months, 3 months, 6 months and 12 months postoperatively respectively. The ODI scores was 51.51 ±3.08 preoperatively and 21.74±1.15, 14.81 ± 1.50, and 2.78 ± 0.64, at 3 months, 6 months and 12 months postoperatively respectively. These postoperative scores were all significantly different when compared with preoperative scores (P < 0.001). According to the modified MacNab outcome scale, excellent was obtained in 7 patients, good was obtained in 5 patients, and fair was obtained in 1 patient, and 92.31% of these patients had excellent and good outcomes at the final follow-up. There were no complications related to surgery, and no spinal instability was detected. Conclusion: The PTED is an effective and safe surgical method for the treatment of adolescent patients with massive LDH, but high-quality randomized controlled trials are still required to further verify these findings.

scholarly journals Minimally Invasive Lateral Approach for Anterior Spinal Cord Decompression in Thoracic Myelopathy

2021 ◽  
Author(s):  
Edna E. Gouveia ◽  
Mansour Mathkour ◽  
Erin McCormack ◽  
Jonathan Riffle ◽  
Olawale A. Sulaiman ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Minimally Invasive ◽  
Disc Herniation ◽  
Interbody Fusion ◽  
Case Series ◽  
Lateral Approach ◽  
Spinal Instability ◽  
Decompression Procedure ◽  
Thoracic Disc ◽  
Mini Open

Myelopathy can result from a thoracic disc herniation (TDH) compressing the anterior spinal cord. Disc calcification and difficulty in accessing the anterior spinal cord pose an operative challenge. A mini-open lateral approach to directly decompress the anterior spinal cord can be performed with or without concomitant interbody fusion depending on pre-existing or iatrogenic spinal instability. Experience using stand-alone expandable spacers to achieve interbody fusion in this setting is limited. Technical advantages, risks and limitations of this technique are discussed. We conducted a retrospective chart review of all patients with thoracic and upper lumbar myelopathy treated with a lateral mini-open lateral approach. Review of the literature identified 6 other case series using similar lateral minimally invasive approaches to treat thoracic or upper lumbar disc herniation showing efficient and safe thoracic disc decompression procedure for myelopathy. This technique can be combined with interbody arthrodesis when instability is suspected.

Cervical brucellar spondylodiscitis mimicking a cervical disc herniation with epidural abscess: a case report

2014 ◽  
Vol 0 (0) ◽  
Author(s):  
Ahmet Aslan ◽  
Ünal Kurtoğlu ◽  
Mustafa Özgür Akça ◽  
Sinan Tan ◽  
Uğur Soylu ◽  
...  
Keyword(s):  
Case Report ◽  
Disc Herniation ◽  
Epidural Abscess ◽  
Cervical Disc Herniation ◽  
Cervical Disc

Recurrence Rate of Lumbar Disc Herniation After Standard Discectomy and Microdiscectomy: A 5-Year Study

2019 ◽  
Vol 12 (2) ◽  
pp. 139-146
Author(s):  
Mladen E. Ovcharov ◽  
Iliya V. Valkov ◽  
Milan N. Mladenovski ◽  
Nikolay V. Vasilev
Keyword(s):  
Recurrence Rate ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Surgical Techniques ◽  
Reoperation Rate ◽  
University Hospital ◽  
Recurrence Rates ◽  
Chi Square ◽  
Common Procedure

Summary Lumbar disc herniation (LDH) is the most common pathology in young people, as well as people of active age. Despite sophisticated and new minimally invasive surgical techniques and approaches, reoperations for recurrent lumbar disc herniation (rLDH) could not be avoided. LDH recurrence rates, reported in different studies, range from 5 to 25%. The purpose of this study was to estimate the recurrence rates of LDH after standard discectomy (SD) and microdiscectomy (MD), and compare them to those reported in the literature. Retrospectively, operative reports for the period 2012-2017 were reviewed on LDH surgeries performed at the Neurosurgery Clinic of Dr Georgi Stranski University Hospital in Pleven. Five hundred eighty-nine single-level lumbar discectomies were performed by one neurosurgeon. The diagnoses of recurrent disc herniation were based on the development of new symptoms and magnetic resonance/computed tomography (MRI/CT) images showing compatible lesions in the same lumbar level as the primary lumbar discectomies. The recurrence rate was determined by using chi-square tests and directional measures. SD was the most common procedure (498 patients) followed by MD (91 patients). The cumulative reoperation rate for rLDH was 7.5%. From a total number of reoperations, 26 were males (59.1%) and 18 were females (40.9%). Reoperation rates were 7.6% and 6.6% after SD and MD respectively. The recurrence rate was not significantly higher for SD. Our recurrence rate was 7.5%, which makes it comparable with the rates of 5-25% reported in the literature.

23. Coley's toxin and spontaneous tumour regression

2007 ◽  
Vol 30 (4) ◽  
pp. 39 ◽  
Author(s):  
D. S. Hayre
Keyword(s):  
New York ◽  
Primary Tumour ◽  
Bone Cancer ◽  
Tumour Regression ◽  
Strong Reaction ◽  
Young Surgeon ◽  
Naturally Occurring ◽  
Excellent Health ◽  
Natural Response ◽  
Fever Response

William Coley, a young surgeon at New York Memorial Hospital, was traumatized by the loss of his first patient to bone cancer in 1891. He was unable to save this young patient and she succumbed to her Sarcoma within 3 months of surgery. He searched the hospital archive to learn more about Sarcoma and discovered the case of a patient with a large sarcoma who had undergone five unsuccessful surgeries over a 3 year period. This case had been determined to be hopeless. After the last of these operations, the patient became very ill from an erysipelas infection. Coley was astonished to read that after the fever broke and the patient had recovered, the tumour had vanished. Seven years later, the patient was still alive and well. Coley concluded that whatever had caused the fever must also have destroyed the cancer. Coley searched for and found this patient still in excellent health. Coley reasoned that if a chance infection could make tumours vanish, then a purposefully induced infection could do the same. The hypothesis was tested by infecting his next 10 patients with Streptococcus pyogenes to cause Erysipelas. Some of the patients were difficult to infect, some died, and some had a strong reaction and their disease regressed. Coley switched to deactivated S. pyogenes to avoid the mortality observed with the live strain. Afterxperimentation with various formulations, a combination of S pyogenes and Serratia marcescens was decided upon and became known as Coley’s Toxin. The preferred method of delivery was injection of the toxin directly into the primary tumour or metastases in increasing doses to avoid immune tolerance. Fever response in the patient was essential to imitate a naturally occurring infection and the body’s natural response. Though Coley met with success, this therapy was abandoned as chemotherapy became more popular. Hoption Cann SA, Gunn HD, van Netten JP, van Netten C. Dr William Coley and tumour regression: a place in history or in the future. Post Graduate Medical Journal 2003; 79:672-680. Hobohm U. Fever and Cancer in Perspective. Cancer Immunology & Immunotherapy 2001; 50:391-396. Grange JM, Standord JL, Stanford CA. Campbell De Morgan’s ‘Observations on cancer’, and their relevance today. Journal of the Royal Society of Medicine 2002 (June); 95:296-299.

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