Lumbar Disc
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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 4 (5) ◽  
pp. 57
Mario Muto ◽  
Francesco Giurazza ◽  
Ricardo Pimentel Silva ◽  
Gianluigi Guarnieri

Radicular lumbar back pain is an important public health problem not already provided with a unequivocal treatment approach. Medical and physical therapies represent the first solution, however when these are not successful, the second therapeutic step is still controversial and mini-invasive treatment may play an important role. In these cases oxygen-ozone therapy has been proved to be a very safe and effective option that is widely used with different modalities. This paper, by reviewing oxygen-ozone therapy literature data, aims to propose an effective procedural technique and to clarify patient’s selection criteria; furthermore complications and follow-up management are also considered.

2021 ◽  
Vol 8 ◽  
Fei-Long Wei ◽  
Tian Li ◽  
Quan-You Gao ◽  
Yi Yang ◽  
Hao-Ran Gao ◽  

Objective: Therapeutic options for lumbar disc surgery (LDH) have been rapidly evolved worldwide. Conventional pair meta-analysis has shown inconsistent results of the safety of different surgical interventions for LDH. A network pooling evaluation of randomized controlled trials (RCT) was conducted to compare eight surgical interventions on complications for patients with LDH.Methods: PubMed, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched for RCT from inception to June 2020, with registration in PROSPERO (CRD42020176821). This study is conducted in accordance with Cochrane guidelines. Primary outcomes include intraoperative, post-operative, and overall complications, reoperation, operation time, and blood loss.Results: A total of 27 RCT with 2,948 participants and eight interventions, including automated percutaneous lumbar discectomy (APLD), chemonucleolysis (CN), microdiscectomy (MD), micro-endoscopic discectomy (MED), open discectomy (OD), percutaneous endoscopic lumbar discectomy (PELD), percutaneous laser disc decompression (PLDD), and tubular discectomy (TD) were enrolled. The pooling results suggested that PELD and PLDD are with lower intraoperative and post-operative complication rates, respectively. TD, PELD, PLDD, and MED were the safest procedures for LDH according to complications, reoperation, operation time, and blood loss.Conclusion: The results of this study provided evidence that PELD and PLDD were with lower intraoperative and post-operative complication rates, respectively. TD, PELD, PLDD, and MED were the safest procedures for LDH according to complications, reoperation, operation time, and blood loss.Systematic Review Registration: PROSPERO, identifier CRD42020176821.

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 2021 ◽  
pp. 1-9
Huaili Ding ◽  
Lijun Liao ◽  
Peichun Yan ◽  
Xiaolin Zhao ◽  
Min Li

Objective. To study and analyze the changes of intervertebral foramen height and area of the degenerative L4-5 intervertebral disc under different pushing heights by the finite element method. Methods. CT and MRI images of T12-S1 segments were obtained from a healthy volunteer who met the inclusion criteria. A DR machine was used to capture images of the lumbar lateral section before and after simultaneous pushing of the L4 and L5 spinous processes by manipulation called Daogaijinbei, and the measurement showed that the displacement changes of L4 and L5 were both approximately 10 cm, so the pushing height was set at 0–10 cm. A three-dimensional finite element model of the entire normal lumbar spine was established using Mimics 16.0, Geomagic Studio 2014, Hypermesh 13.0, MSC.Patran 2012, and so on. The disc height and nucleus area of the lumbar disc of the normal entire lumbar disc model were adjusted to establish models of the L4-5 disc with mild, moderate, and severe degeneration. Changes of disc height and area of the L4-5 degenerative intervertebral disc under different pushing heights were calculated. Results. The size of the L4-5 intervertebral foramen was analyzed from the height and area of the intervertebral foramen, and the results showed the following: (1) as for the normal lumbar disc and a lumbar of the L4-5 disc with mild and moderate degeneration, the height of the L4-5 intervertebral foramen and its area both increased during pushing between 0 and 8 cm. After the pushing height reached 8 cm, the height and area of the L4-5 intervertebral foramen gradually became stable; (2) as for the L4-5 disc with severe degeneration, during the process of pushing, the height and area of the L4-5 intervertebral foramen increased slightly, but this change was not obvious. Conclusions. After the spinal manipulation, the sizes of the L4-5 intervertebral foramen of the L4-5 disc with mild and moderate degeneration were significantly larger than those before pushing; in contrast, the size of L4-5 intervertebral foramen of the L4-5 disc with severe lumbar degeneration was not significantly changed.

2021 ◽  
Vol 10 (14) ◽  
pp. 3174
Ralph Läubli ◽  
Robin Brugger ◽  
Tatiana Pirvu ◽  
Sven Hoppe ◽  
Dominik Sieroń ◽  

Background: The aim of this study was to determine whether the presence of disproportionate vertebral bodies is a risk factor for disc herniation (DH). Methods: Sixty-seven consecutive patients (m: 31 f: 36) who underwent lumbar discectomy for symptomatic DH at one level between L3 and S1 were retrospectively included. The last three motion segments (3 × 67 = 201) were assessed on sagittal MRI scans. A disproportionate motion segment was defined as the difference of more than 10% of the antero-posterior diameter of two adjacent endplates. Results: DH was present in 6/67 (9%), 26/67 (38.8%), and 35/67 (52.2%) patients at L3/4, L4/5, and L5/S1, respectively. A total of 14 of 67 patients demonstrated a disproportionate motion segment at the discectomy level (20.9%). A total of 23 of the 201 (11.4%) investigated motion segments met our criteria for a disproportionate motion segment. In our study population, when one of the 201 segments was disproportionate, the positive predictive value (PPV) for DH increased toward the lower segments: the PPV at the L5/S1 level was 83.0%. The odds ratio of disproportion for DH was the highest at the L5/S1 level, with 6.0 ± 0.82 (p = 0.017). Conclusions: The presence of a disproportionate motion segment in the lower spine may lead to a significant higher risk for DH in patients undergoing discectomy.

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