Surgical outcomes of patients with degenerative lumbar disc disease post-IntraSPINE® device fixation: Three-year prospective study

Background: Lumbar degenerative disc disease is one of the most common conditions associated with chronic low back pain. IntraSPINE® is a novel inter-laminar device that allows more physiological rocking-type movements in flexion and extension. Aim: To evaluate the results of patients with symptomatic Lumbar degenerative disc disease treated with an IntraSPINE® device and followed up over a 3-year period. Materials and Methods: A Prospective longitudinal research study involving patients with imaging-confirmed Lumbar degenerative disc disease in whom conservative treatment was unsuccessful. Outcome measures were changes over baseline score on the Oswestry Disability Index (ODI), and low back and radicular pain assessed at 6, 12, 24 and 36 months postoperatively. Overall success, a composite outcome that included key safety and clinical considerations, was assessed. Secondary outcomes included satisfaction with symptoms, employment status and post-surgery medical interventions. To compare differences in longitudinal clinical score patterns over 36 months, a mixed-effect model ANCOVA with repeated measurements was performed, with adjustment for low back and radicular pain score and ODI score at baseline. Results: 231 patients were recruited and 180 completed the study. A significant improvement in ODI score (p=0.0597), as well as in VAS (Visual Analogue Scale) scores for back (p= 0.0228) and leg pain (p<0.0001) was observed during the follow-up. For ODI score, the mean percentage decrease from inclusion to month 36 was 64.5%. These scores were respectively 66.2% for radicular pain and 46.4% for low back pain. In 73% of cases, surgery was considered successful. 89% of working patients returned to work and 68% of patients were very satisfied at month 12. Only four patients presented intraoperative complications.

Percutaneous laser disc decompression and microdiscectomy in patients with lumbar degenerative disc disease: results of a randomized controlled trial

Введение. Чрескожная лазерная декомпрессия межпозвонковых дисков (ЧЛДД) представляет собой современный минимально инвазивный метод хирургического лечения пациентов с дегенеративным заболеванием межпозвонковых дисков. ЦЕЛЬ. Изучить и сравнить клиническую эффективность методик чрескожной лазерной декомпрессии дисков и микродискэктомии у пациентов с дегенеративным заболеванием поясничных межпозвонковых дисков.Методы и материалы. Согласно критериям соответствия, в исследование включены 324 пациента, данные о которых рандомизированы. Среди всех пациентов, включенных в настоящее рандомизированное контролируемое исследование, у 218 респондентов выполнена ЧЛДД поясничного отдела позвоночного столба и у 106 пациентов выполнена поясничная микродискэктомия. Пациенты случайным образом распределены на группы с применением методики блоковой рандомизации в соотношении 2:1.Результаты. Сравнение параметров комбинированной первичной конечной точки исследования продемонстрировало достоверное преимущество клинико-инструментальных показателей в группе пациентов, которым выполнена операция ЧЛДД поясничного отдела позвоночника (р<0,02). Спустя 36-месячный период послеоперационного наблюдения в группе респондентов, которым выполнена процедура ЧЛДД, отмечено достоверное снижение выраженности болевого синдрома в поясничном отделе позвоночного столба на 74 % (с (7,9±1,5) до (2,1±2,5) см), и в группе пациентов, перенесших операцию микродискэктомии, верифицировано снижение выраженности болевого синдрома на 68 % (с (7,9±1,5) до (2,6±3,0) см). Улучшение качества жизни пациентов по Oswestry Disability Index после ЧЛДД и поясничной микродискэктомии было сопоставимо и составило 67 % (с (57±14) до (19±18) %) и 61 % (с (59±14) до (24±20) %) соответственно. Частота встречаемости нежелательных явлений в течение всего периода послеоперационного наблюдения в группе респондентов, которым выполнена ЧЛДД, составила 30 %, а в группе пациентов, перенесших поясничную микродискэтомию, – 43 % (р=0,02). ЗАКЛЮЧЕНИЕ. Исследование наглядно продемонстрировало наличие схожих клинических исходов у пациентов, перенесших ЧЛДД поясничного отдела позвоночника и поясничную микродискэктомию.><0,02). Спустя 36-месячный период послеоперационного наблюдения в группе респондентов, которым выполнена процедура ЧЛДД, отмечено достоверное снижение выраженности болевого синдрома в поясничном отделе позвоночного столба на 74 % (с (7,9±1,5) до (2,1±2,5) см), и в группе пациентов, перенесших операцию микродискэктомии, верифицировано снижение выраженности болевого синдрома на 68 % (с (7,9±1,5) до (2,6±3,0) см). Улучшение качества жизни пациентов по Oswestry Disability Index после ЧЛДД и поясничной микродискэктомии было сопоставимо и составило 67 % (с (57±14) до (19±18) %) и 61 % (с (59±14) до (24±20) %) соответственно. Частота встречаемости нежелательных явлений в течение всего периода послеоперационного наблюдения в группе респондентов, которым выполнена ЧЛДД, составила 30 %, а в группе пациентов, перенесших поясничную микродискэтомию, – 43 % (р=0,02).Заключение. Исследование наглядно продемонстрировало наличие схожих клинических исходов у пациентов, перенесших ЧЛДД поясничного отдела позвоночника и поясничную микродискэктомию.

Diagnosis of lumbar degenerative disc disease by using Lp-spaces related to generalized interval-valued m-polar neutrosophic choquet integral Operator

Innovative and astonishing developments in the field of spine analysis can commence with this manuscript. The lumbar disks ([Formula: see text] to [Formula: see text]) are most commonly impaired by degeneration due to their long-standing degeneration and associated strain. We investigate the indications, purposes, risk factors, and therapies of lumbar degenerated disc disease (L-DDD). We assume that the degeneration of five discs creates many effects, making it difficult to differentiate between the different types of degenerated discs and their seriousness. Since the indeterminacy and falsity portions of science or clinical diagnosis are often ignored. Due to this complexity, the reliability of the patient’s progress report cannot be calculated, nor can the period of therapy be measured. The revolutionary concept of interval-valued m-polar neutrosophic Choquet integral aggregation operator (IVmPNCIAO) is proposed to eliminate these problems. We associate generalized interval-valued m-polar neutrosophic Choquet integral aggregation operator (GIVmPNCIAO) with the statistical formulation of [Formula: see text]-spaces and use it to identify the actual kind of degenerative disc in the lumbar spine. For the classification of interval-valued m-polar neutrosophic numbers (IVMPNNs), we set the ranking index and score function. These concepts are appropriate and necessary in order to better diagnose degeneration by associating it with mathematical modeling. We construct a pre-diagnosis map based on the fuzzy interval [0,1] to classify the types of degenerative discs. We develop an algorithm by using GIVmPNCIAO based on interval-valued m-polar neutrosophic sets (IVMPNNs) to identify the degenerative disc appropriately and to choose the most exquisite treatment for the corresponding degeneration of every patient. Furthermore, we discuss the sensitivity analysis with parameter [Formula: see text] in GIVmPNCIAO to investigate the patient’s improvement record.

Comparison of lumbar degenerative disc disease using conventional fast spin echo T2W MRI and T2 fast spin echo dixon sequences

Objectives: To compare the grading of lumbar degenerative disc disease (DDD), Modic end-plate changes (MEPC) and identification of high intensity zones (HIZ) on a combination of sagittal T1weighted turbo spin echo (T1W TSE), T2weighted fast spin echo (T2W FSE) and short tau inversion recovery (STIR) sequences (routine protocol) with a single sagittal T2W FSE Dixon MRI sequence which provides in-phase, opposed-phase, water only and fat only images in a single acquisition (Dixon protocol). Methods: 50 patients underwent lumbar spine MRI using the routine protocol with the addition of a T2W FSE Dixon sequence. DDD grade, MEPC and HIZ for each disc level were assessed on the routine and Dixon protocols. Each protocol was reviewed independently by three readers (consultant musculoskeletal radiologists with 26-, 8- and 4 years’ experience), allowing assessment of inter-reader agreement and inter protocol agreement for each assessed variable. Results: The study included 17 males and 33 females (mean age 51 years; range 8–82 years). Inter-reader agreement for DDD grade on the routine protocol was 0.57 and for the Dixon protocol was 0.63 (p = 0.08). Inter-reader agreement for MEPC on the routine protocol was 0.45 and for the Dixon protocol was 0.53 (p = 0.02), and inter-reader agreement for identification of the HIZ on the routine protocol was 0.52 and for the Dixon protocol was 0.46 (p = 0.27). Intersequence agreement for DDD grade ranged from 0.61 to 0.97, for MEPC 0.46–0.62 and for HIZ 0.39–0.5. Conclusion: A single sagittal T2W FSE Dixon MRI sequence could potentially replace the routine three sagittal sequence protocol for assessment of lumbar DDD, MEPC and HIZ resulting in ~60% time saving. Advances in knowledge: Grading of lumbar DDD, presence of Modic changes and high intensity zones were compared on sagittal T1W TSE, T2W FSE and STIR sequences with a T2W FSE Dixon sequence, with fair-to-good correlation suggesting that three conventional sequences could be replaced by a single Dixon sequence.

An Analysis of the Clinical and Radiological Prognostic Factors Affecting the Outcomes of Lumbar Intradiscal Biacuplasty

Purpose:Intradiscal biacuplasty (IDB) has been proven to be effective for treating lumbar degenerative disc disease (DDD). However, there hasn’t been a reported prognostic factor for IDB. The present study meticulously evaluate the general and radiographic features which may serve as markers for predicting the therapeutic outcome of IDB.Methods:Forty-two patients suffering from chronic discogenic low back pain for more than 6 months and subsequently received lumbar cool radiofrequency IDB were enrolled. Twenty-three patients completed follow-up questionnaires at 1, 3, 6, and 12 months. The surgical outcomes were reported using visual analogue scale (VAS), Oswestry disability index (ODI), and the consumption of nonsteroidal anti-inflammatory drugs (NSAID). Furthermore, a univariate analysis was performed to identify prognostic factors associated with pain relief from age, gender, body mass index (BMI), and pre-operative lumbar magnetic resonance imaging reading. Results:Significant reductions were found in estimated VAS and ODI at the post-operative period at 1, 3, 6, and 12 months (P < 0.001). The NSAID dosage was significantly decreased at 3- and 6-month follow-up (P < 0.05). No procedure-related complications were detected. The prognosis of IDB was not related to disc height, Pfirrmann grading or Modic endplate change. However, disc extrusions were associated with promising outcomes (VAS improvement ≥ 50%) on pain relief (P < 0.05).Conclusion:IDB is a good choice for treating lumbar DDD. Patients with a disc extrusion may have a higher success rate of IDB, which can be used as an indicator in the physician’s decision-making process.