Disc Herniation
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2021 ◽  
Vol 15 ◽  
Liuqing Yang ◽  
Yuzhao Huang ◽  
Jiahui Ma ◽  
Zhenxing Li ◽  
Rui Han ◽  

BackgroundLumbosacral radicular pain (LSRP) can be caused by disc herniation, spinal stenosis, and failed back surgery syndrome. The clinical effect of pulsed-radiofrequency (PRF) combined with transforaminal epidural steroid injection (TESI) for radiating pain in different population remains unclear.MethodsWe retrospectively reviewed the medical recordings of patients with LSRP caused by different etiologies, who underwent PRF and TESI treatment. The primary clinical outcome was assessed by a 10-point Visual Analog Scale (VAS) pre- and post-treatment.ResultsA total of 34 LSRP patients were identified and classified into 3 subgroups (disc herniation, spinal stenosis, and failed back surgery syndrome). The overall immediate pain reduction was 4.4 ± 1.1 after procedure. After a median follow-up of 9.5 months, the VAS decreased from 6.5 ± 1.0 to 2.4 ± 1.9 at the last follow-up.ConclusionPRF combined with TESI is an effective approach to treat persistent LSRP in distinct population.

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Jay Moran ◽  
Joseph B. Kahan ◽  
Christopher A. Schneble ◽  
Michele H. Johnson ◽  
Shin Mei Chan ◽  

Anterior surgical approaches to the cervical spine have allowed for treatment of common and complex pathologies with excellent outcomes. During the approach, complications can result from injury to the surrounding structures. The transverse processes usually protect the vertebral artery (VA) as it enters at C6 and courses cranially through the transverse foramina to C2 (referred to as the V2 segment). This is a case report of a patient who presented with myeloradiculopathy attributed to a C4-C5 disc herniation, severe canal stenosis, and marked bilateral neural foraminal stenosis. Preoperative imaging showed the right VA entering the C4 transverse foramen. This anatomic variant on a routine MRI led to further imaging and precautions when performing an uneventful anterior cervical discectomy and fusion (ACDF) at C4-C5. A high VA entry point into the transverse foramen above C6 could increase the risk of iatrogenic vascular injury in anterior approaches to the cervical spine. Rarely reported, the currently presented case describes a patient with a C4 right VA entry variant and highlights the importance of proper surgical planning.

2021 ◽  
Maria Holsen ◽  
Veronica Hovind ◽  
Haji Kedir Bedane ◽  
Knut Ivar Osvoll ◽  
Jan-Erik Gjertsen ◽  

Abstract BackgroundStandardised surgery rates for common orthopedic procedures vary across geographical areas in Norway. The aim in this study is to explore whether area-level factors related to demand and supply in publicly funded healthcare are associated with geographical variation in surgery rates for six common orthopedic procedures. MethodsCross-sectional population based study of the 19 hospital referral areas in Norway. Adult admissions for arthroscopy for degenerative knee disease, arthroplasty for osteoarthritis of the knee and hip, surgical treatment for hip fracture, and decompression with or without fusion for lumbar disc herniation and lumbar spinal stenosis over 5 years (2012-2016) were included. Extremal quotients, coefficients of variation and systematic components of variance were used to estimate variation in age and sex standardised surgery rates. Linear regression analyses were conducted to explore the association between standardised surgery rates and proportion of population in urban areas, unemployment, proportion of persons living in low-income households, proportion of persons with a high level of education, and mortality. ResultsArthroscopy for degenerative knee disease showed the highest level of variation and the number of arthroscopies decreased during the period. There was considerable variation in procedures for lumbar disc herniation and lumbar spinal stenosis, moderate to low variation for arthroplasty for osteoarthritis of the knee and hip, and least variation in surgical treatment for hip fracture. Association between surgery rates and socioeconomic and supply factors were weak for arthroscopy for degenerative knee disease and decompression for lumbar disc herniation and spinal stenosis. Standardised surgery rates for arthroplasty for osteoarthritis of the knee and hip, and surgical treatment for hip fracture were not associated with the supply and demand factors included in this study.ConclusionsVariation in surgery rates were particularly high for arthroscopy for degenerative knee disease, and these rates decreased considerably during the five-year period. Factors reflecting socioeconomic circumstances, health and supply have a weak association to orthopedic surgery rates at an area-level. Whether this reflects the equity of universal health care services, or if area-level factors are not detailed enough to detect an existing association is being explored in two ongoing Norwegian studies.

2021 ◽  
Vol 4 (5) ◽  
pp. 24
Gabriel Calle ◽  
Lucio Huayhua ◽  
Alexis Martinez

The results obtained from a group of patients suffering from discoradicular conflict syndrome treated with paravertebral oxygen-ozone injections were analyzed. From a total number of 8500 patients treated with ozone during the period 2002/2015, 880 patients underwent intradiscal injection and 7620 patients were treated with paravertebral ozone injections. This paper analyses a subgroup of 1850 patients (24.28% of the patients who were treated with paravertebral injections), including those patients who underwent the total 10-session treatment, complied with a 5-year follow-up and with the sample homogeneity parameters following a predictability therapeutic effectiveness (PET) index devised for such purpose (PET index O3) by us in 2009. The outcomes were assessed based on the VAS score and modified Mac Nab criteria. Definite results determined positive post-treatment outcomes considered excellent and good in 81% of the cases. Such effectiveness percentage resulted lower than the one achieved with the intradiscal injection technique (89%), and higher than the percentage seen in papers on the selective nerve root block technique.

2021 ◽  
Vol 4 (5) ◽  
pp. 64
Jose Baeza-Noci ◽  
Rosa Maria Pinto-Bonilla

The safety and efficacy of ozone injections in the spine for lumbar disc herniation has been proved in two systematic reviews with one metaanalysis. Many other papers with lower evidence level were published before encouraging its use for this pathology and other degenerative spinal diseases. Fail back surgery syndrome (FBSS) is a terrible situation with no clear treatment option presently. Some authors have dared to use ozone injections in these patients, based on its antiinflammatory action and its highly save portfolio. Due to the great disability and dramatic situation of FBSS patients, a systematic review is mandatory in order to clarify the potential role of ozone in this pathology.

2021 ◽  
Vol 5 (4) ◽  
pp. 424
ND Withanage ◽  
S Perera ◽  
H Peiris ◽  
S Prathapan ◽  
LV Athiththan

Objective: Present study was aimed to develop a regression model for selected sociodemographic, behavioural and occupational factors with lumbar disc herniation (LDH) and lumbar disc hearniation and degeneration (LDHD) in a selected population in comparison to healthy individuals.Materials & Methods: The study was conducted using 104 cases with disc herniation and controls (n=104) without LDH. Analysis was conducted in sub groups of patients with LDH (n=67) and LDHD (n=37) in comparison to control subjects. Pre-tested questionnaire was administered to all participants to gather information.Results & Discussion: Among the cases 35.6 % presented with LDHD while 64.4 % had only LDH. Among the socio-demographic characters, body mass index <25 kgm-2 was a significant protective factor for both LDHD (OR=0.31; 95% CI=0.13-0.72) and LDH (OR=0.39; 95% CI=0.20-0.77). Involvement in daily activities with heavy (OR=5.1; 95 % CI=2.1-11.8) and moderate strain (OR=3.1; 95 % CI=1.5-6.6) to back, sitting more than eight hours per day (OR=5.1; 95 % CI=1.0-25.7), smoking (OR=5.0; 95 % CI=1.5-16.4) and sleeping in supine position (OR=2.09; 95% CI=1.09-4.06) were significant risk factors for LDH. Only daily physical activities with heavy strain act as a significant risk factor (OR=3.1; 95 % CI=1.1-8.5) for the development of LDHD. Types of mattresses used did not have a significant difference among cases and controls. Majority of cases (56.7 %) did not know the causative factor that led to LDH. According to the regression model, BMI, smoking and involvement in physical activities with moderate and heavy strain to back were considered as significant risk factors for the development of LDH or LDHD.Conclusion: In regression model BMI, smoking and daily physical activities with moderate and heavy strain to back were found to be the significant risk factors for development of LDH or LDHD.International Journal of Human and Health Sciences Vol. 05 No. 04 October’21 Page: 424-434

2021 ◽  
Vol 12 ◽  
pp. 363
Guisela Quinteros ◽  
Ratko Yurac ◽  
Juan José Zamorano ◽  
Máximo-Alberto Díez-Ulloa ◽  
Edson Pudles ◽  

Background: Lumbar disc herniation (LDH)/radiculopathy is the most frequent cause of lost workdays in people under 50 years of age. Although there is consensus about how to assess these patients, the optimal management strategy is still debated. Methods: An online survey was sent to spine surgeons who are members of the Iberian-Latin American Spine Society to assess how they treat LDH with radiculopathy. Results: There were 718 surgeons who answered the survey; 66% reported that 76–100% of their monthly clinic work was due to spine issues. The most frequently used conservative treatment modalities included non-opioid analgesics and nonsteroidal anti-inflammatory drugs (NSAIDs) (90.5%), followed by physical therapy (55.2%) and pregabalin (41.4%). Notably, 40% of surgeons in the public sector believed that conservative treatment failed if symptoms persisted beyond 6–12 weeks, while 39% of private surgeons deemed conservative management insufficient if it had failed to provide symptomatic relief with 3–6 weeks. Of interest, 78% utilized epidural steroid injections (ESI); 51.7% preferred the transforaminal, 27.2% the interlaminar, and 7.5% the caudal approaches. The most frequent indications for surgery included: cauda equina syndrome, progressive neurological deficits, and intractable pain. Traditional microdiscectomy was the most common technique (68.5%) utilized, followed by 7.5% advocating endoscopic disc resection, and just 6.4% favoring the tubular discectomy. Conclusion: There is considerable heterogeneity among Iberian and Latin American spine surgeons in the treatment of LDH/radiculopathy. Although most begin with the utilization of NSAIDs and non-opioid analgesics, followed by ESI (88%), surgery was recommended for persistent symptoms/signs for those failing between 3 and 6 weeks (private sector) versus 6–12 weeks (public sector) of conservative therapy.

2021 ◽  
Vol 12 ◽  
pp. 353
George Fotakopoulos ◽  
Alexandros Brotis ◽  
Kostas Andreas Fountas

Background: Lumbar disc herniation (LDH) usually presents with lower extremity symptoms and signs, but rarely with bladder and bowel complaints. Here, we present a 61-year-old female who suffered solely from fecal incontinence (FI) attributed to a large LDH. Case Description: The patient presented with FI, but had a normal neurological examination. When the lumbar magnetic resonance imaging of showed a large central L5S1 LDH, the patient underwent an urgent diskectomy. Six months later, her symptoms had improved. Conclusion: Patients with large central LDHs may present with FI alone warranting urgent/emergent disc removal.

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