Artykuły w czasopismach na temat „Intradiscal Complications”
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Cohen, Steven P., Daniel Wenzell, Robert W. Hurley, Connie Kurihara, Chester C. Buckenmaier, Scott Griffith, Thomas M. Larkin, Erik Dahl i Bennie J. Morlando. "A Double-blind, Placebo-controlled, Dose–Response Pilot Study Evaluating Intradiscal Etanercept in Patients with Chronic Discogenic Low Back Pain or Lumbosacral Radiculopathy". Anesthesiology 107, nr 1 (1.07.2007): 99–105. http://dx.doi.org/10.1097/01.anes.0000267518.20363.0d.
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Abstract Background: In recent years, convincing evidence has emerged implicating tumor necrosis factor α as a causative factor in radiculopathy and discogenic back pain. But although preliminary open-label studies demonstrated promising results for the treatment of low back pain with tumor necrosis factor-α inhibitors, early optimism has been tainted by a controlled study showing no significant benefit in sciatica. To determine whether outcomes might be improved by a more direct route of administration, the authors evaluated escalating doses of intradiscal etanercept in 36 patients with chronic lumbosacral radiculopathy or discogenic low back pain. Methods: A double-blind, placebo-controlled pilot study was conducted whereby six patients received 0.1, 0.25, 0.5, 0.75, 1.0, or 1.5 mg etanercept intradiscally in each pain-generating disc. In each escalating dose group of six patients, one received placebo. A neurologic examination and postprocedure leukocyte counts were performed in all patients at 1-month follow-up visits. In patients who experienced significant improvement in pain scores and function, follow-up visits were conducted 3 and 6 months after the procedure. Results: At 1-month follow-up, no differences were found for pain scores or disability scores between or within groups for any dose range or subgroup of patients. Only eight patients remained in the study after 1 month and elected to forego further treatment. No complications were reported, and no differences were noted between preprocedure and postprocedure leukocyte counts. Conclusions: Although no serious side effects were observed in this small study, a single low dose of intradiscal etanercept does not seem to be an effective treatment for chronic radicular or discogenic low back pain.
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Cohen, Steven P., Thomas Larkin, Salahadin Abdi, Audrey Chang i Milan Stojanovic. "Risk Factors for Failure and Complications of Intradiscal Electrothermal Therapy: A Pilot Study". Spine 28, nr 11 (czerwiec 2003): 1142–47. http://dx.doi.org/10.1097/01.brs.0000067269.31377.6a.
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Wegener, Bernd. "Experimental Evaluation of the Risk of Extradiscal Thermal Damage in Intradiscal Electrothermal Therapy (IDET)". Pain Physician 1;15, nr 1;1 (14.01.2012): E99—E106. http://dx.doi.org/10.36076/ppj.2012/15/e99.
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Background: In 2000 the intradiscal electrothermal therapy (IDET) procedure for the treatment of discogenic pain was introduced. The technique involves the positioning of an intradiscal catheter with a temperature-controlled thermal resistive heating coil at the inner posterior annulus. The therapeutic mechanism of IDET combines the thermocoagulation of native nociceptors and in-grown nonmyelinated nerve fibers with collagen shrinkage, stabilizing annular fissures. Thermal nerve root injuries were described with IDET. The temperature in relation to the distance from the catheter tip was investigated. The intradiscal temperature distribution during treatment with IDET was also described. Objective: To examine the temperature distribution outside the disc near neural structures and the risk of thermal damage to nerve tissue during a correctly performed IDET procedure. Study Design: Experimental study. Setting: Biomechanical laboratory of an academic orthopedic surgery department. Methods: Testing was performed on cadaveric human lumbar spines with 10 intact intervertebral discs in a circulating water bath. Five thermocouples were attached to different locations on the disc. The temperature was recorded for 26 minutes. In addition, surface temperatures were recorded using an infrared camera. For the application of IDET, we used the Electrothermal 20S Spine System by Smith & Nephew and the standard clinical protocol. Results: The shape of the recorded temperature curves was quite heterogeneous. Inside the spinal canal, temperatures as high as 45.2°C were recorded for a very short time. Temperature monitoring with the infrared camera demonstrated a change in temperature clearly restricted to the nucleus of the disc. Limitations: The temperature distribution depends on the exact position of the IDET probe, which will never be 100% identical between individual experiments. Conclusion: This study shows that temperatures generated within the spinal canal during IDET do not appear to be high enough to cause nerve damage. Key words: IDET, thermal nerve damage, thermal complications, intradiscal electrothermal therapy
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Hosseini, Pooria, Gregory M. Mundis, Robert K. Eastlack, Ramin Bagheri, Enrique Vargas, Stacie Tran i Behrooz A. Akbarnia. "Preliminary results of anterior lumbar interbody fusion, anterior column realignment for the treatment of sagittal malalignment". Neurosurgical Focus 43, nr 6 (grudzień 2017): E6. http://dx.doi.org/10.3171/2017.8.focus17423.
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OBJECTIVESagittal malalignment decreases patients’ quality of life and may require surgical correction to achieve realignment goals. High-risk posterior-based osteotomy techniques are the current standard treatment for addressing sagittal malalignment. More recently, anterior lumbar interbody fusion, anterior column realignment (ALIF ACR) has been introduced as an alternative for correction of sagittal deformity. The objective of this paper was to report clinical and radiographic results for patients treated using the ALIF-ACR technique.METHODSA retrospective study of 39 patients treated with ALIF ACR was performed. Patient demographics, operative details, radiographic parameters, neurological assessments, outcome measures, and preoperative, postoperative, and mean 1-year follow-up complications were studied.RESULTSThe patient population comprised 39 patients (27 females and 12 males) with a mean follow-up of 13.3 ± 4.7 months, mean age of 66.1 ± 11.6 years, and mean body mass index of 27.3 ± 6.2 kg/m2. The mean number of ALIF levels treated was 1.5 ± 0.5. Thirty-three (84.6%) of 39 patients underwent posterior spinal fixation and 33 (84.6%) of 39 underwent posterior column osteotomy, of which 20 (60.6%) of 33 procedures were performed at the level of the ALIF ACR. Pelvic tilt, sacral slope, and pelvic incidence were not statistically significantly different between the preoperative and postoperative periods and between the preoperative and 1-year follow-up periods (except for PT between the preoperative and 1-year follow-up, p = 0.018). Sagittal vertical axis, T-1 spinopelvic inclination, lumbar lordosis, pelvic incidence–lumbar lordosis mismatch, intradiscal angle, and motion segment angle all improved from the preoperative to postoperative period and the preoperative to 1-year follow-up (p < 0.05). The changes in motion segment angle and intradiscal angle achieved in the ALIF-ACR group without osteotomy compared with the ALIF-ACR group with osteotomy at the level of ACR were not statistically significant. Total visual analog score, Oswestry Disability Index, and Scoliosis Research Society–22 scores all improved from preoperative to postoperative and preoperative to 1-year follow-up. Fourteen patients (35.9%) experienced 26 complications (15 major and 11 minor). Eleven patients required reoperation. The most common complication was proximal junctional kyphosis (6/26 complications, 23%) followed by vertebral body/endplate fracture (3/26, 12%).CONCLUSIONSThis study showed satisfactory radiographic and clinical outcomes at the 1-year follow-up. Proximal junctional kyphosis was the most common complication followed by fracture, complications that are commonly associated with sagittal realignment surgery and may not be mitigated by the anterior approach.
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Theron, J., H. Huet i O. Coskun. "Cervical Automated Discectomy". Interventional Neuroradiology 2, nr 1 (marzec 1996): 35–44. http://dx.doi.org/10.1177/159101999600200104.
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The lumbar automated discectomy system described by Onik has been used in the treatment of cervical disk herniations whose symptomatology resisted medical treatment. Experience on 150 patients is reported showing a 74.5% success rate. This series performed in most cases on an outpatient basis had no complications. Up to 1992 failure cases were treated by intradiscal injections of triamcinolone with 62% of success. This complementary technique was abandonned after the description of epidural calcifications secondary to this type of injections in the lumbar area. Since 1992, failure cases have been managed differently with injections of steroids in the cervical joints, especially when a hypertrophy of the ligamentum flavum supposedly a sign of an inflammatory posterior component of the pain was demonstrated on the CT. Nine patients received intradiscal injections of microdoses (600 IU) of chymopapaine with excellent results. No patient has had open surgery since 1992. It is concluded that percutaneous automated discectomy is a very promising and safe technique which can be used as a first choice technique for most cervical disk herniations resisting medical treatment.
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Giurazza, Francesco, Gianluigi Guarnieri, Kieran J. Murphy i Mario Muto. "Intradiscal O2O3: Rationale, Injection Technique, Short- and Long-term Outcomes for the Treatment of Low Back Pain Due to Disc Herniation". Canadian Association of Radiologists Journal 68, nr 2 (maj 2017): 171–77. http://dx.doi.org/10.1016/j.carj.2016.12.007.
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The management of low back pain should always start with a conservative approach; however, when it fails, intervention is required and at that moment the most appropriate choice remains unclear. Before invasive surgery, minimally invasive techniques can be adopted. In European trials and in a trans-Canadian clinical trial 03 ozone has been used successfully. In total over 50,000 patients have been treated safely. Ozone is a gas normally present in the atmosphere with potent oxidizing power; it has been used for percutaneous intradiscal injection combined with oxygen (O2O3) at very low concentrations for 15 years in Europe. The main indication is back pain with or without radicular pain but without motor deficits, which is refractory to 4-6 weeks of conservative therapies. Its mechanism of action on the disc is mechanical (volume reduction by subtle dehydration of the nucleus pulposis) and antinflammatory. The intradiscal ozone injection is performed with a thin needle (18-22 gauge) image guided by computed tomography or angiofluoroscopy and is usually complimented by periganglionic injection of corticosteroids and anesthetics. This combination gives immediate pain relief and allows time for the ozone to act. It is a cost-effective procedure that presents a very low complication rate (0.1%). The radicular pain is resolved before the back pain does, as is seen with microdiscectomy. Peer-reviewed publications of large randomized trials, case series, and meta analysis from large samples of patients have demonstrated the procedure to be safe and effective in the short and the long terms, with benefits recognized up to 10 years after treatment. We aim to review the principles of action of O2O3 and report the injection techniques, complications, and short- and long-term outcomes.
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Beyaz, Serbülent Gökhan. "Six-Month Results of Cervical Intradiscal Oxygen-Ozone Mixture Therapy on Patients with Neck Pain: Preliminary Findings". January 2018 1, nr 21;1 (15.07.2018): E499—E456. http://dx.doi.org/10.36076/ppj.2018.4.e449.
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Background: Numerous techniques have been developed for the treatment of disc herniation. Oxygen-ozone (O2 -O3 ) mixture therapy is a minimally invasive percutaneous treatment for disc herniation. Objective: The aim of the study is to investigate the 6-month efficacy and safety of O2 -O3 mixture therapy in patients with cervical disc herniation (CDH) and chronic neck pain. Study Design: This is a cross-sectional, single-center study. Setting: The study was conducted from January 2012 to May 2016 on patients visiting Sakarya University Training and Research Hospital’s pain clinic. Methods: Each patient was evaluated before the procedure (baseline) and at 2 weeks (W2), 6 weeks (W6), and 6 months (M6) after the procedure using the visual analog scale (VAS) and the Oswestry Disability Index scores. Results: A total of 44 patients with CDH underwent the same treatment with an O2 -O3 mixture. Significant pain relief was observed compared with preoperative pain at W2, W6, and M6 according to patient self-evaluation (P = 0.01). The mean VAS score was 7.89 ± 1.13 before the procedure, 4.22 ± 1.62 at W2, 3.03 ± 1.66 at W6, and 2.27 ± 1.25 at the end of M6. No significant complications or side effects were reported during or after the procedure. Limitations: Our study was conducted retrospectively, which resulted in problems obtaining follow-up data. In addition, this study was performed in a small patient group. Conclusion: Based on our results, intradiscal injection of an O2 -O3 mixture treatment showed a beneficial long-term effect. Key words: Cervical disc herniation, chemonucleolysis, injection, intradiscal, oxygen-ozone mixture, percutaneous treatment
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Muto, M., i F. Avella. "Percutaneous Treatment of Herniated Lumbar Disc by Intradiscal Oxygen-Ozone Injection". Interventional Neuroradiology 4, nr 4 (grudzień 1998): 279–86. http://dx.doi.org/10.1177/159101999800400403.
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We report our experience of treating lumbar herniated disc by intradiscal injection of an oxygen-ozone mixture. Ozone (03, MW = 48) is a triatomic molecule, having antiviral, disinfectant and antiseptic properties. Several mechanisms of action have been proposed to explain the efficacy of the treatment: analgesic action; anti-inflammatory action; oxidant action on the proteoglycan in the nucleus pulposus. We treated 93 patients (50 women, 43 men) aged from 24 to 45 yrs (average age 38 yrs) from June 1996 to April 1998. All patients presented sciatica and/or low back pain, lasting two or more months; patients had in the mean time received both medical and physical therapy with mild or no benefit. Diagnostic tests in all patients included plain film x-ray, CT and/or MR at the level of the lumbar spine disclasing a herniated or protruded disc with nerve root or thecal sac compression. We divided patients to be treated in to two groups: the first one group included 35 patients already selected for surgery who presented herniated or protruded disc with radicular pain with associated neurological deficit (hypoesthesia and partial loss of reflex). Those patients had already had medical and physical therapy for two or more months and agreed to try the percutaneous treatment before surgery. CT or MR in this group demonstrated the presence of intraforaminal, extra or sub-ligamentary and sequestrated herniated disc. The second group included 58 patients with radicular pain but without neurological deficit; patients in this group had received medical and/or physical therapy for two or more months and CT showed the presence of a small subligamentary herniated or protruded disc. We considered the results according to the modified MacNab method. In the first group we had “failure” in all patients; in seven cases the symptoms improved for one month, but recurred later on. In the second group 45 patients had “success” showing complete clinical recovery within five to six days after treatment, all remained without symptoms up to six months or more of follow-up. The remaining 13 patients presented the same symptoms again within three months after a temporary clinical recovery. The goal of this study was to present this new technique that can also be compared with a previous study of different percutaneous treatment. Clinical and neuroradiological indications and the contraindications are well known, and must be followed to achieve good results and avoid complications.
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Gao, Chang, Min Zong, Wen-tao Wang, Lei Xu, Da Cao i Yue-fen Zou. "Analysis of risk factors causing short-term cement leakages and long-term complications after percutaneous kyphoplasty for osteoporotic vertebral compression fractures". Acta Radiologica 59, nr 5 (7.08.2017): 577–85. http://dx.doi.org/10.1177/0284185117725368.
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Background Percutaneous kyphoplasty (PKP) is a common treatment modality for painful osteoporotic vertebral compression fractures (OVCFs). Pre- and postoperative identification of risk factors for cement leakage and follow-up complications would therefore be helpful but has not been systematically investigated. Purpose To evaluate pre- and postoperative risk factors for the occurrence of short-term cement leakages and long-term complications after PKP for OVCFs. Material and Methods A total of 283 vertebrae with PKP in 239 patients were investigated. Possible risk factors causing cement leakage and complications during follow-up periods were retrospectively assessed using multivariate analysis. Cement leakage in general, three fundamental leakage types, and complications during follow-up period were directly identified through postoperative computed tomography (CT). Results Generally, the presence of cortical disruption ( P = 0.001), large volume of cement ( P = 0.012), and low bone mineral density (BMD) ( P = 0.002) were three strong predictors for cement leakage. While the presence of intravertebral cleft and Schmorl nodes ( P = 0.045 and 0.025, respectively) were respectively identified as additional risk factors for paravertebral and intradiscal subtype of cortical (C-type) leakages. In terms of follow-up complications, occurrence of cortical leakage was a strong risk factor both for new VCFs ( P = 0.043) and for recompression ( P = 0.004). Conclusion The presence of cortical disruption, large volume of cement, and low BMD of treated level are general but strong predictors for cement leakage. The presence of intravertebral cleft and Schmorl nodes are additional risk factors for cortical leakage. During follow-up, the occurrence of C-type leakage is a strong risk factor, for both new VCFs and recompression.
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Azulay, N., M. Forgerit, E. G. Alava, A. Deplas, R. Vialle, S. Ragot i J. P. Tasu. "A novel radiofrequency thermocoagulation method for treatment of lower back pain: thermal conduction after instillation of saline solution into the nucleus pulposus—preliminary results". Acta Radiologica 49, nr 8 (październik 2008): 934–39. http://dx.doi.org/10.1080/02841850802247681.
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Background: Radiofrequency heating of the intervertebral disc has been proposed for the treatment of chronic low back pain using two methods: a flexible needle inserted into the annulus fibrosus achieving a full 360° penetration, or a rigid needle inserted into the nucleus pulposus. The first technique is effective on pain, but the clinical benefit of the second is uncertain. Purpose: To evaluate a technique for radiofrequency heating of the lumbar intervertebral disc by a needle placed into the nucleus pulposus. Material and Methods: The method was tested in 17 patients according to the criteria used in previous intradiscal radiofrequency studies. Before and after treatment, disability was assessed by the Oswestry disability score. A pain reduction of at least 50% was considered a success. Results: Fifteen patients were responders at 1 month (88%), nine at 3 months (53%), and 12 at 6 months (70.6%). No complications were observed. Conclusion: A new method of providing discal radiofrequency treatment for lower back pain had a substantial clinical benefit in 71% of the observed patients. A prospective study comparing this new method with placebo should be conducted to confirm these initial results.
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Veihelmann, Andreas. "Spinal Injections, Epidural Neurolysis and Denervation for Specific Low Back Pain and Sciatica". Zeitschrift für Orthopädie und Unfallchirurgie 157, nr 04 (27.11.2018): 417–25. http://dx.doi.org/10.1055/a-0767-7428.
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Abstract Background Many members of the adult population suffer acute low back pain at some stage in life. A specific cause is found in only a rather small number of these patients. Some of the patients develop chronic low back pain and this is a major source of disability. On the other hand, there has been a great increase in Germany in the number of spinal operations due to degenerative spine disease and, in turn, unnecessary surgery on the spine is under debate. Methods This is a narrative review of different minimally invasive spine procedures in the treatment of specific low back pain. The effectiveness of spinal injections, radiofrequency of the facet joints as well as epidural adhesiolysis/neurolysis are described. An analysis of the literature was performed via PubMed, Medline and the Cochrane Database. Results Facet-, epidural and intradiscal steroid injections for specific pain generators in the degenerative spine show different short- and long-term results; they are able to improve low back pain in specific patients with chronic low back pain and may be able to prevent some of these patients from having to undergo open surgery. Furthermore, there are promising results from interventions such as epidural neurolysis for sciatica and radiofrequency of the medial branch of the dorsal root for the treatment of axial facet-related back pain. Facet and intradiscal steroid injections give only short-term effects in axial low back pain and should therefore only be considered reluctantly, whereas the different forms of epidural steroid injections in patients with sciatica due to radicular compression offer a well proven adjuvant treatment option within a conservative therapeutic regimen. The overview of the literature with the use of different steroids has shown that use of non-particulate steroids show better results with respect to the safety and avoidance of major complications, especially when used at the cervical spine. However, in Germany the use of these steroids is still off label and patients have to give informed consent prior to injection. In summary, careful use of spinal injections and interventions within a conservative physiotherapeutic regimen seem to improve chronic back pain and, in turn, to be able to prevent some patients from having to undergo spine surgery.
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Nagad, Premik, Saurabh Rawall, Vishal Kundnani, Kapil Mohan, Sanganagouda S. Patil i Abhay Nene. "Postvertebroplasty instability". Journal of Neurosurgery: Spine 16, nr 4 (kwiecień 2012): 387–93. http://dx.doi.org/10.3171/2011.12.spine11671.
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Vertebroplasty provides excellent pain relief and functional restoration for osteoporotic fractures. Short-term complications such as cement leak and embolism are well described. Incident fractures are the only well-reported long-term complications. The authors describe the cases of 5 patients who presented with back pain caused by instability or worsening neurological status 13 months (range 8–17 months) after vertebroplasty. They further classify this postvertebroplasty instability into intervertebral instability and intravertebral instability, depending on the apex of abnormal mobility. One patient presented with cement migration and progressive collapse of the augmented vertebral body. Another patient presented with an additional fracture. Both cases were classified as intravertebral instability. The cases of 3 other patients presenting with adjacent endplate erosion, vacuum disc phenomenon, and bridging osteophyte formation were classified as having intervertebral instability. Long-term effect of cements on the augmented vertebral body and adjacent endplates and discs is a cause for concern. Vertebroplasty acts as a mechanical stabilizer and provides structural support but does not bring about union. Micromotion has been shown to persist for years after vertebroplasty. This study describes persistent instability after vertebroplasty in a series of 5 cases. The authors propose that postvertebroplasty instability occurs due to collapse of soft osteoporotic bone and endplates around cement. All 3 cases of intervertebral instability were associated with an intradiscal cement leak. With increased longevity and higher functional demands of the geriatric population, the durability of this “rock (cement) between cushions (of osteoporotic bone)” arrangement (as seen in vertebroplasty) will be increasingly challenged.
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Bosnjakovic, P., S. Ristic, M. Mrvic, A. E. Miljkovic, T. Vukicevic, G. Marjanovic i L. Macukanovic-Golubovic. "Management of painful spinal lesions caused by multiple myeloma using percutaneous acrylic cement injection". Acta chirurgica Iugoslavica 56, nr 4 (2009): 153–58. http://dx.doi.org/10.2298/aci0904153b.
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Background and purpose: Spinal lesions with marked destruction are common site of morbidity in patients with multiple myeloma causing serious clinical symptoms. The aim of the study was to evaluate the therapeutic benefit of percutaneous vertebroplasty (PVP) in treating vertebral body lesions in patients suffering from multiple myeloma. Materials and methods: Twenty nine patients (55 vertebral bodies) were treated after complete diagnostic evaluation, preparation and obtaining informed consent. Needle position and acrylic material injection was performed under fluoroscopic guidance. Results: Average visual analogue score dropped from 7.8 before to 2.3 after the intervention. Soft tissue leak was present at 9 treated levels, small epidural cement collection at 5, venous leak at 4 and intradiscal leak at 3 levels without any clinically manifest complications. The effects of PVP were stable in all of the patients at 12 months follow-up. Subjective outcome scores collected through follow-up showed improvement of +1.45 in pain, + 1.15 in ambulation and + 1.23 in medication use. There were recurrence of back pain in 9 patients at non-treated levels due to the new lesions. Conclusion: In our series, PVP of painful lesions caused by multiple myeloma provides immediate and long-term pain relief. The procedure is safe and, despite of the present leakage of cement, may be performed on outpatients basis.
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Beyaz, Serbülent Gökhan. "Long-term Clinical Effects of DiscoGel for Cervical Disc Herniation". January 2018 1, nr 21;1 (15.01.2018): E71—E78. http://dx.doi.org/10.36076/ppj.2018.1.e71.
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Background: Radiopaque gelified ethanol (RGE; DiscoGel®, Gelscom SAS, France) is used as a chemonucleolysis substance in treating intradiscal herniation, showing good results without complications. It has also been used in cervical disc herniations (CDHs), demonstrating the potential efficacy of this substance. Objective: The aim of the study is to investigate the long-term effectiveness and safety of DiscoGel® in patients with CDH and chronic neck pain. Study Design: This is a cross-sectional, single-center study. Setting: The study was conducted from November 2013 to May 2016 on patients visiting Sakarya University Training and Research Hospital’s pain clinic . Methods: Each patient was evaluated before the procedure (baseline) and at 1, 3, 6, and 12 months after the procedure, using the visual analog scale (VAS) score for pain, the Oswestry Disability Index score to measure degree of disability, and estimate quality of life for those with pain; this coincides with scores on the Neuropathic Pain Questionnaire (DN4) for differential diagnoses. Results: Thirty-three patients with CDH underwent the same treatment with DiscoGel® between November 2013 and May 2016. Significant pain relief was noted, as opposed to preoperative pain, at 1, 3, 6, and 12 months after the procedure according to each patient’s self-evaluation (P = 0.01). Differences in VAS, ODI, and DN4 scores between 1, 3, 6, and 12 months with the same variables were not statistically significant. There were no complications with the procedure. Limitations: Our study was conducted retrospectively, which led to problems with long-term follow-up data. In addition, this study was performed with a small group of patients. Conclusions: RGE is a potential alternative to surgery for patients with pain at the cervical level. However, we concluded that more studies with longer follow-up intervals with RGE will be necessary for assessment of the technique’s efficiency. Key words: Cervical pain, herniation, neuropathic pain, injection, DiscoGel®, chemonucleolysis
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Viswanathan, Vibhu K., Ranjit Ganguly, Amy J. Minnema, Nicole A. DeVries Watson, Nicole M. Grosland, Douglas C. Fredericks, Andrew J. Grossbach, Stephanus V. Viljoen i H. Francis Farhadi. "Biomechanical assessment of proximal junctional semi-rigid fixation in long-segment thoracolumbar constructs". Journal of Neurosurgery: Spine 30, nr 2 (luty 2019): 184–92. http://dx.doi.org/10.3171/2018.7.spine18136.
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OBJECTIVEProximal junctional kyphosis (PJK) and failure (PJF) are potentially catastrophic complications that result from abrupt changes in stress across rigid instrumented and mobile non-fused segments of the spine (transition zone) after adult spinal deformity surgery. Recently, data have indicated that extension (widening) of the transitional zone via use of proximal junctional (PJ) semi-rigid fixation can mitigate this complication. To assess the biomechanical effectiveness of 3 semi-rigid fixation constructs (compared to pedicle screw fixation alone), the authors performed cadaveric studies that measured the extent of PJ motion and intradiscal pressure changes (ΔIDP).METHODSTo measure flexibility and ΔIDP at the PJ segments, moments in flexion, extension, lateral bending (LB), and torsion were conducted in 13 fresh-frozen human cadaveric specimens. Five testing cycles were conducted, including intact (INT), T10–L2 pedicle screw-rod fixation alone (PSF), supplemental hybrid T9 Mersilene tape insertion (MT), hybrid T9 sublaminar band insertion (SLB1), and hybrid T8/T9 sublaminar band insertion (SLB2).RESULTSCompared to PSF, SLB1 significantly reduced flexibility at the level rostral to the upper-instrumented vertebral level (UIV+1) under moments in 3 directions (flexion, LB, and torsion, p ≤ 0.01). SLB2 significantly reduced motion in all directions at UIV+1 (flexion, extension, LB, torsion, p < 0.05) and at UIV+2 (LB, torsion, p ≤ 0.03). MT only reduced flexibility in extension at UIV+1 (p = 0.02). All 3 constructs revealed significant reductions in ΔIDP at UIV+1 in flexion (MT, SLB1, SLB2, p ≤ 0.02) and torsion (MT, SLB1, SLB2, p ≤ 0.05), while SLB1 and SLB2 significantly reduced ΔIDP in extension (SLB1, SLB2, p ≤ 0.02) and SLB2 reduced ΔIDP in LB (p = 0.05). At UIV+2, SLB2 similarly significantly reduced ΔIDP in extension, LB, and torsion (p ≤ 0.05).CONCLUSIONSCompared to MT, the SLB1 and SLB2 constructs significantly reduced flexibility and ΔIDP in various directions through the application of robust anteroposterior force vectors at UIV+1 and UIV+2. These findings indicate that semi-rigid sublaminar banding can most effectively expand the transition zone and mitigate stresses at the PJ levels of long-segment thoracolumbar constructs.
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Ezeldin, Mohamed, Marco Leonardi, Ciro Princiotta, Massimo Dall’olio, Mohammed Tharwat, Mohammed Zaki, Mohamed E. Abdel-Wanis i Luigi Cirillo. "Percutaneous ozone nucleolysis for lumbar disc herniation". Neuroradiology 60, nr 11 (11.09.2018): 1231–41. http://dx.doi.org/10.1007/s00234-018-2083-4.
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Abstract Purpose All percutaneous minimally invasive disc treatments are typically indicated to contained disc herniations. Our study’s aim is to evaluate prospectively the efficacy of ozone nucleolysis in the treatment of either contained or uncontained lumbar disc herniations. Methods Fifty-two patients, aged 27–87 years, with symptomatic herniated lumbar discs, without migration, sequestration, or severe degenerative disc changes, who failed conservative treatment, were included in our study. The patients underwent fluoroscopic-guided intradiscal oxygen-ozone mixture injection (5 ml) at a concentration of 27–30 μg/ml and periradicular injection of the same O2-O3 mixture (10 ml), steroid (1 ml), and local anesthetic (1 ml). Clinical outcomes were evaluated, based on the Oswestry Disability Index (ODI) and pain intensity (0–5) scale results, obtained initially and at 2- and 6-month controls. Our results were analyzed by ANOVA and chi-squared (χ 2) tests. Results Our initial results obtained at 2-month control were promising, indicating a significant decrease in pain disability and intensity in 74% (37) and 76% (38) of the patients respectively, and minimally increased to 76% (38) and 78% (39) at 6-month control (P < 0.001 and CI 99.9%). The mean preprocedure ODI and pain intensity scores were 35 ± 14.36 and 2.38 ± 0.90, respectively, which were reduced to 19.36 ± 13.12 and 1.04 ± 0.92 at 6-month control. Our failure had been mostly related to long symptoms duration of more than 1 year. No complications were recorded. Conclusion Ozone nucleolysis is a safe cost-effective minimally invasive technique for treatment of contained and uncontained lumbar disc herniations.
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Helm II, Standiford. "Effectiveness of Thermal Annular Procedures in Treating Discogenic Low Back Pain". Pain Physician 3;15, nr 3;5 (14.05.2012): E279—E304. http://dx.doi.org/10.36076/ppj.2012/15/e279.
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Background: Persistent low back pain refractory to conservative treatment is a common problem that leads to widespread impairment, resulting in significant costs to society. The intervertebral disc is a major source of persistent low back pain. Technologies developed to treat this problem, including various surgical instrumentation and fusion techniques, have not reliably provided satisfactory results in terms of either pain relief or increased function. Thermal annular procedures (TAPs) were first developed in the late 1990s in an attempt to treat discogenic pain. The hope was that they would provide greater value than fusion in terms of efficacy, morbidity, and cost. Three technologies have been developed to apply heat to the annulus: intradiscal electrothermal therapy (IDET), discTRODE, and biacuplasty. Since nerve ingrowth and tissue regeneration in the annulus is felt to be the source of pain in discogenic low back pain, when describing the 3 above techniques we use the term “thermal annular procedures” rather than “thermal intradiscal procedures.” We have specifically excluded studies treating the nucleus. TAPs have been the subject of significant controversy. Multiple reviews have been conducted resulting in varying conclusions. Study Design: A systematic review of TAPs for the treatment of discogenic low back pain. Objective: To evaluate the effectiveness of TAPs in treating discogenic low back pain and to assess complications associated with those procedures. Methods: The available literature on TAPs in treating discogenic low back pain was reviewed. The quality assessment and clinical relevance criteria utilized were the Cochrane Musculoskeletal Review Group criteria for interventional techniques for randomized trials, and the criteria developed by the Newcastle-Ottawa Scale criteria for observational studies. The level of evidence was classified as good, fair, or limited (or poor) based on the quality of evidence developed by the U.S. Preventive Services Task Force. Data sources included relevant literature identified through searches of PubMed and EMBASE from 1966 through December 2011, and manual searches of the bibliographies of known primary and review articles. Outcome Measures: The primary outcome measure was pain relief of at least 6 months. Secondary outcome measures were improvements in functional status. Results: For this systematic review, 43 studies were identified. Of these, 3 randomized controlled trials and one observational study met the inclusion criteria. Using current criteria for successful outcomes, the evidence is fair for IDET and limited (or poor) for discTRODE and biacuplasty procedures regarding whether they are effective in relieving discogenic low back pain. Since 2 randomized controlled trials are in progress on that procedure, assessment of biacuplasty may change upon publication of those studies. Limitations: The limitations of this systematic review include the paucity of literature and nonavailability of 2 randomized trials which are in progress for biacuplasty. Conclusion: In summary, the evidence is fair for IDET and limited (or poor) for discTRODE and biacuplasty is being evaluated in 2 ongoing randomized controlled trials. Key words: Spinal pain, chronic low back pain, discogenic pain, thermal procedures, annular procedures, IDET, biaculoplasty, disctrode
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He, Xf, YY Xiao, YH Li, W. Lu, Y. Chen, HW Chen, J. Pen i in. "Percutaneous Intradiscal O2-O3 Injection to Treat Cervical Disc Herniation". Rivista di Neuroradiologia 18, nr 2_suppl (październik 2005): 75–78. http://dx.doi.org/10.1177/19714009050180s215.
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We evaluated the safety and therapeutic effect of treating cervical disc herniation with O2-O3 mixture injection into the intradiscal space. 58 patients with 126 herniated discs verified by MRI were selected for the study, and all patients presented the symptoms of upper limb, cervical and shoulder pain. The procedures were guided by fluoroscopy (28 cases) and by CT (30 cases). The puncture route was defined between the right common carotid artery and trachea clearance. 1∼2 ml O2-O3 mixture at 30–40 ug/mL was injected into each herniated disc space. 58 patients were followed up from three to 30 months after treatment. The therapeutic effect showed that 33 cases (56.9%) had excellent recovery, 11 cases (19.0%) had significant relief of symptoms, and 14 cases (24.1%) resulted in treatment failure. No serious complication occurred. The therapeutic method developed by using O2-O3 mixture injection in cervical intradiscal space was a safe and effective method for the treatment of cervical disc herniation.
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Palm, Hans-Georg, Patricia Lang, Madlen Haentzsch, Benedikt Friemert, Carsten Hackenbroch i Hans-Joachim Riesner. "Diagnostic Accuracy of Fluoroscopy, Radiography, and Computed Tomography in Detecting Cement Leakage in Kyphoplasty". Journal of Neurological Surgery Part A: Central European Neurosurgery 79, nr 06 (7.05.2018): 502–10. http://dx.doi.org/10.1055/s-0038-1641734.
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Purpose Cement leakage is a typical complication of kyphoplasty for vertebral fractures. It is unclear if cement application intraoperatively can be improved by using other techniques of visualization and which kind of postoperative imaging should be recommended to detect cement extravasation accurately. Objective To compare the rates of cement leakage detected by intraoperative fluoroscopy, postoperative radiography, and postoperative computed tomography (CT) in a retrospective study. Patients and Methods The study included 78 patients (60 women and 18 men; 115 vertebral bodies) who were treated with two kinds of kyphoplasty. The patients underwent intraoperative fluoroscopy and postoperative radiography and CT. After surgery, the images were evaluated to compare cement leakage rates and locations in the three visualization techniques. Leakage locations were described as epidural, intradiskal, extravertebral, or intravascular. Results Compared with CT, intraoperative fluoroscopy regularly detected intradiskal leakage (75%) but had a considerably lower sensitivity for visualizing epidural (21%), extravertebral (31%), and intravascular (51%) cement leakages. A comparison of radiography and CT showed that radiography had a high sensitivity for detecting intradiskal (82%) and intravascular (70%) cement extrusions but a lower sensitivity in identifying epidural (42%) and extravertebral (50%) leaks. Therefore, the CT scan overall was best in detecting location and accuracy. Conclusion CT detected more cement leaks than any of the other investigated techniques, especially epidural, extravertebral, and intravascular cement leakages. To achieve the best accuracy, only CT provides complete information.
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Amoretti, Nicolas, Jean Baqué, Stéphane Litrico, Nicolas Stacoffe i William Palmer. "Serious Neurological Complication Resulting from Inadvertent Intradiscal Injection During Fluoroscopically Guided Interlaminar Epidural Steroid Injection". CardioVascular and Interventional Radiology 42, nr 5 (2.01.2019): 775–78. http://dx.doi.org/10.1007/s00270-018-2151-5.
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Teng, Gao-Jun. "Nomogram for Predicting Intradiscal Cement Leakage Following Percutaneous Vertebroplasty in Patients with Osteoporotic Related Vertebral Compression Fractures". May 2017 4, nr 20;4 (10.05.2017): E513—E550. http://dx.doi.org/10.36076/ppj.2017.e550.
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Background: Intradiscal cement leakage (ICL) is a common complication following percutaneous vertebroplasty (PVP). However, the risk factors for such a complication are under debate and there is no accurate predictive nomogram to predict ICL. Objectives: To establish an effective and novel nomogram for ICL following PVP in patients with osteoporotic-related vertebral compression fractures (OVCFs). Study Design: This was a retrospective study approved by the Institutional Review Board of our institution. Setting: This study consists of patients from a large academic center. Methods: Patients with OVCFs who underwent their first PVP in our department between January 2007 and December 2013 were included in this study. All the potential risk factors of ICL after PVP were recorded. Univariate and multivariate analyses were used to identify the independent risk factors. The nomogram was then created based on the identified independent risk factors. Results: A total of 241 patients and 330 vertebrae were included. The mean age of the patients was 73.5 (SD 7.9) years old, and the mean number of treated vertebrae was 1.4 per person. ICL was observed in 93 (28.2%) of the treated vertebrae. Greater fracture severity (P = 0.016), cortical disruption of the endplate (P < 0.0001), absence of Kummell’s disease (P = 0.010), and higher computed tomography (CT) values (P = 0.050) were the independent risk factors for ICL. Limitations: The main limitation of this study is that it is a retrospective study. Conclusion: Greater fracture severity, cortical disruption of the endplate, absence of Kummell’s disease, and higher CT values are the independent risk factors for ICL. The novel nomogram gives an accurate prediction of ICL. Key words: Osteoporotic vertebral compression fracture, percutaneous vertebroplasty, intradiscal cement leakage, risk factors, prediction, nomogram
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BENYAHYA, R., M. LEFEVRECOLAU, F. FAYAD, F. RANNOU, S. DEMAILLEWLODYKA, M. MAYOUXBENHAMOU, S. POIRAUDEAU i M. REVEL. "Infiltrations intradiscales d’acétate de prednisolone dans les lombalgies sévères. Recherche de complications radiologiques". Annales de Réadaptation et de Médecine Physique 47, nr 9 (listopad 2004): 621–26. http://dx.doi.org/10.1016/s0168-6054(04)00193-x.
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Zeiger, Evan H., i Edward J. Zampella. "Intervertebral Disc Infection after Lumbar Chemonucleolysis: Report of a Case". Neurosurgery 18, nr 5 (1.05.1986): 616–21. http://dx.doi.org/10.1227/00006123-198605000-00017.
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Abstract Intervertebral disc space infection can be a serious and disabling complication of any procedure that affords entry for bacteria into the susceptible disc space. Most disc space infections occur after cervical or lumbar laminectomies. Discitis has been reported after myelography, lumbar puncture, paravertebral injection, and obstetrical epidural anesthesia. A case of septic discitis occurring after intradiscal therapy with chymopapain is presented. Patients who return for evaluation of recurrent spinal pain after chemonucleolysis, especially those with paravertebral muscle spasm, should be evaluated for the possibility of disc space infection by obtaining an erythrocyte sedimentation rate, peripheral white count, differential cell count, and plain roentgenograms. Radionuclide bone scans, although not specific, may provide further objective evidence leading to the diagnosis of an intervertebral disc space infection.
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Daldoul, C., N. El Amri, S. Laataoui, K. Baccouch, H. Zegaloui i E. Bouajina. "POS1160 BRUCELLAR SPONDYLODISCITIS: CLINICAL AND MAGNETIC RESONANCE IMAGING FINDINGS". Annals of the Rheumatic Diseases 80, Suppl 1 (19.05.2021): 858.3–858. http://dx.doi.org/10.1136/annrheumdis-2021-eular.4153.
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Background:Osteoarticular involvement is one of the most common complications of brucellosis and it can occur in up to two thirds of patients infected. Vertebral involvement during brucellosis is considered not only as the most prevalent localization but also as the most severe one.Objectives:The aim of the present study was to describe the clinical and the magnetic resonance imaging features of brucellar spondylodiscitis.Methods:We conducted a retrospective study including 21 patients who have been hospitalized for spinal brucellosis from 1998 to 2019. The diagnosis of brucellosis was based on clinical symptoms, MRI findings and isolation of brucella species in blood or tissue specimens and/or a positive Wright agglutination test.Results:Twenty-one patients were included. The mean age was 57.5 years [33-74] (13 males and 8 female). The geographical origin of the patients was rural in 76% of the cases. The median duration of symptoms progression before diagnosis was 4.5 months [1-8].The main symptom leading to seek medical care was an inflammatory back pain and it was found in all cases. It was associated with unilateral radiculopathy in 8 cases and with a bilateral radiculopathy in 1 case. The other clinical features found were fever in 17 patients, sweats in 14 cases, weight loss in 10 cases and hepatomegaly in 1 patient. The physical examination revealed tenderness on palpation in 12 cases, a motor weakness of the two lower limbs in 2 cases. Brucella agglutination test was ≥1/160 in all cases. Blood cultures were negative in all cases. The median erythrocyte sedimentation rate (ESR) and serum C-reactive protein level were 40 mm and 11mg/dl) respectively. Spondylodiscitis was located in the lumbar dorsal and cervical spine in respectively 10, 8 and 3 cases. The most affected level was the L4-L5 level in 5 cases followed by the T10-T11 level in 3 cases. The involvement of more than 2 vertebrae was found in 4 cases. Associated sacroiliitis was found in one patient. All MRI images of the affected vertebrae showed hypo intense signal on T1 weighted image and hyper intense signal on T2 weighted image. Disc space narrowing was found in 8 cases. Vertebral body osteolysis was found in 10 cases. Epidural collection was documented in 3 cases with a size up to 5cm. Paravertebral and peri-vertebral abscesses were detected in 5 cases. Intradiscal abscesses were observed in 3 cases. Cord compression and involvement of root nerve were noted in respectively 5 and 1 cases. Biopsy was performed in 5 cases, but bacteriological examination was contributory to the diagnosis in 1 case. All patients received antibiotic treatment with a combination of two or three drugs, corticosteroids were prescribed in 5 patients and one patient underwent a surgical intervention. The evolution was good 16 in patients, three patients suffered from chronic back pain, one patient had persistent neuropathic pain and one patient had paresis.Conclusion:Brucella spondylodicitis is still a serious public health problem in developing countries. MRI findings associated with clinical symptoms may establish the diagnosis even if bacteriological examinations are negativesDisclosure of Interests:None declared.
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Churojana, Anchalee, Dittapong Songsaeng, Rujimas Khumtong, Anek Suwanbundit i Guillaume Saliou. "Is Intervertebral Cement Leakage a Risk Factor for New Adjacent Vertebral Collapse?" Interventional Neuroradiology 20, nr 5 (1.01.2014): 637–45. http://dx.doi.org/10.15274/inr-2014-10079.
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This retrospective study evaluated the relationship between intervertebral cement leakage and new adjacent vertebral fracture and describes the different characteristics of cement leakage. Increased risk of new adjacent vertebral fracture (NF) has been reported to be a complication of cement leakage in vertebroplasty. In our observation, an incidental intervertebral cement leakage may occur during vertebroplasty but is commonly asymptomatic. The study focused on osteoporotic collapse patients who had percutaneous vertebroplasty (PV) between 2005 and 2007. We divided patients into leakage and non-leakage groups and compared the incidence of NF. Leakage characteristics were divided into three types: Type I intervertebral-extradiscal leakage, Type II intradiscal leakage and Type III combined leakage. Visual analog scale for pain and the Karnofsky Performance Status at 24 h, three months, six months and one year were compared between groups and types of leakages. Among 148 PVs (102 patients) there were 30 leakages (20.27%) and 21(14.19%) NFs. The incidence of NF did not significantly differ between leakage and non-leakage groups (P<0.05). Type II was the most common type of leakage (15/30). Reduction of average pain and improvement of Karnofsky Performance Status score did not differ between groups (P<0.05). Type II had decreased pain score < type I and III at 24 h (P < 0.01), three months and six months (P < 0.1) but not at one year (P<0.10). Type II also had decreased pain score < non-leakage group only at 24 h (P<0.05). Intervertebral cement leakage is not an increased risk for NF, influenced outcomes of pain relief or improvement of physical function. Intradiscal leakage (Type II) is the most common characteristic of cement leakage and probably related to delayed pain relief.
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Han, K. ‐R, C. Kim, J. ‐S Eun i Y. ‐S Chung. "Extrapedicular approach of percutaneous vertebroplasty in the treatment of upper and mid‐thoracic vertebral compression fracture". Acta Radiologica 46, nr 3 (maj 2005): 280–87. http://dx.doi.org/10.1080/02841850510021058.
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Purpose: To evaluate the clinical outcome of the extrapedicular approach of percutaneous vertebroplasty (PVP) for upper and mid‐thoracic vertebral compression fractures in patients. Material and Methods: Extrapedicular vertebroplasty was performed in painful compression fractures at T4–T8 levels. The assessment criteria were changes over time in visual analog scale (VAS) and mobility score. We evaluated the volume of cement injected, the size of needle required, and complications. Results: Procedures were performed in 27 patients with a total of 34 affected vertebral bodies. Early (within a week) and one year later, clinical follow‐ups showed that pain intensity had decreased by 50% one day after operation and later by 70–80%. Mobility scores of all patients were improved immediately after the procedure. Average volume of polymethylmethacrylate (PMMA) per vertebral body was 3.8±1.2 ml. Leakage of PMMA occurred in one vertebral level (intradiskal space), but did not cause clinical complications. Conclusion: PVP of upper and mid‐thoracic spine with an extrapedicular approach is an efficient and safe procedure for treating painful thoracic vertebral compression fracture under a cautious patient selection and meticulous technical procedure.
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Jesse, Mary Kristen. "Effect of the Location of Endplate Cement Extravasation on Adjacent Level Fracture in Osteoporotic Patients Undergoing Vertebroplasty and Kyphoplasty". Pain Physician 5;18, nr 5;9 (14.09.2015): E805—E814. http://dx.doi.org/10.36076/ppj.2015/18/e805.
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Background: The most widely researched risk/complication following vertebroplasty (VP) or kyphoplasty (KP) is that of adjacent level fracture (ALF). Current literature results regarding the effect of intradiscal extravasation of cement on the risk of ALF is conflicting with about half of the studies concluding there is no added risk with endplate extravasation and half of the studies reporting opposite conclusions. Objective: The purpose of the study is to further stratify the data to determine whether specifically the location and extent of endplate cement extravasation more strongly affect ALF risk in osteoporotic patients following either VP or balloon KP. Study Design: Retrospective cohort study. Setting: University teaching hospital Methods: One hundred and fifty-six cemented levels in 80 patients, treated at a single center between 2008 and 2012 were reviewed. Age, gender, T-score, body mass index, and osteoporosis type (primary or secondary) were recorded. An ALF was defined as a fracture: 1) in a non-cemented vertebra; 2) adjacent to a cemented level; and 3) not due to trauma or malignancy. Location of the cement extravasation (anterior, middle, or posterior third of the vertebral body) and extravasation extent (percentage of the intervertebral disc height occupied by the bolus) were measured. A logistic modeling strategy permitted examining the association between the location and extent of extravasation and the odds of ALF. Results: ALF occurred in 14 of the 52 patients (27%) and 20 of the 98 levels (20.4%) remaining after exclusions. Odds of ALF were 5.9 times higher (95% CI: 1.6 to 21.2, P = 0.008) with extravasation when compared to no leakage. Odds of ALF in a given patient were 22.6 times higher (95% CI: 3.0 to 170.9, P = 0.003) with anterior extravasation when compared to no leakage. Leakage in the middle or posterior thirds and extent of extravasation were not associated with ALF. Limitations: Limitations of the study include the retrospective study design and small sample size as well as the retrospective implementation of follow-up criteria posing risk of selection bias. Conclusions: Cement endplate extravasation isolated to the anterior third of the vertebral body is associated with is significantly higher odds of ALF after VP or KP in patients with osteoporosis. Key words: Adjacent vertebral fracture, intradiscal leak, osteoporotic compression
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Das, G., S. Ray, S. Ishwarari, M. Roy i P. Ghosh. "Ozone Nucleolysis for Management of Pain and Disability in Prolapsed Lumber Intervertebral Disc". Interventional Neuroradiology 15, nr 3 (wrzesień 2009): 330–34. http://dx.doi.org/10.1177/159101990901500311.
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The prevalence rate of low back pain in a number of studies ranged from 22% to 65% in one year, and lifetime prevalence ranged from 11% to 84%. Over the years many percutaneous minimally invasive therapeutic modalities have evolved. Intradiscal oxygen-ozone therapy has also showed promising results. We undertook a prospective cohort study to evaluate the therapeutic outcome of oxygen-ozone therapy on patients with lumber disc herniation in the Indian population. After obtaining ethical committee and investigational review board permission, 53 consecutive patients complying with selection criteria were treated with a single session of oxygen-ozone therapy. All presented with clinical signs of lumber nerve root compression supported by CT and MRI findings. All patients received 3–7 ml of ozone-oxygen mixture at an ozone concentration of 29–32 mc/ml of oxygen. Therapeutic outcome was assessed after three weeks, three months, six months, one year and two years on a visual analog scale and Oswestry low back pain disability questionnaire. Pain intensity was significantly reduced following treatment (VAS baseline 7.58 ± 0.86, after three weeks 2.75 ± 1.42 and after two years 2.64 ± 2.14). Similarly the Oswestry disability index showed a remarkable improvement in the functional status of the patients (p<0.05). No major complication was observed in this case series. Oxygen-ozone treatment is highly effective in relieving low back pain due to lumber disc herniation.
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Diao, Hao, Hua Xin i Zhongmin Jin. "Prediction of in vivo lower cervical spinal loading using musculoskeletal multi-body dynamics model during the head flexion/extension, lateral bending and axial rotation". Proceedings of the Institution of Mechanical Engineers, Part H: Journal of Engineering in Medicine 232, nr 11 (17.09.2018): 1071–82. http://dx.doi.org/10.1177/0954411918799630.
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Cervical spine diseases lead to a heavy economic burden to the individuals and societies. Moreover, frequent post-operative complications mean a higher risk of neck pain and revision. At present, controversy still exists for the etiology of spinal diseases and their associated complications. Knowledge of in vivo cervical spinal loading pattern is proposed to be the key to answer these questions. However, direct acquisition of in vivo cervical spinal loading remains challenging. In this study, a previously developed cervical spine musculoskeletal multi-body dynamics model was utilized for spinal loading prediction. The in vivo dynamic segmental contributions to head motion and the out-of-plane coupled motion were both taken into account. First, model validation and sensitivity analysis of different segmental contributions to head motion were performed. For model validation, the predicted intervertebral disk compressive forces were converted into the intradiskal pressures and compared with the published experimental measurements. Significant correlations were found between the predicted values and the experimental results. Thus, the reliability and capability of the cervical spine model was ensured. Meanwhile, the sensitivity analysis indicated that cervical spinal loading is sensitive to different segmental contributions to head motion. Second, the compressive, shear and facet joint forces at C3–C6 disk levels were predicted, during the head flexion/extension, lateral bending and axial rotation. Under the head flexion/extension movement, asymmetric loading patterns of the intervertebral disk were obtained. In comparison, symmetrical typed loading patterns were found for the head lateral bending and axial rotation movements. However, the shear forces were dramatically increased during the head excessive extension and lateral bending. Besides, a nonlinear correlation was seen between the facet joint force and the angular displacement. In conclusion, dynamic cervical spinal loading was both intervertebral disk angle-dependent and level-dependent. Cervical spine musculoskeletal multi-body dynamics model provides an attempt to comprehend the in vivo biomechanical surrounding of the human head-neck system.
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Lutz, Gregory. "Infections Following Interventional Spine Procedures: A Systematic Review". Pain Physician, 19.03.2021, 101–16. http://dx.doi.org/10.36076/ppj.2021.24.101-116.
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BACKGROUND: Interventional spine procedures, such as discography, epidural steroid injections (ESIs), facet joint procedures, and intradiscal therapies, are commonly used to treat pain and improve function in patients with spine conditions. Although infections are known to occur following these procedures, there is a lack of comprehensive studies on this topic in recent years. OBJECTIVES: To assess and characterize infections following interventional spine procedures. STUDY DESIGN: Systematic review. METHODS: Studies that were published from January 2010 to January 2020 and provided information on infections or infection rates following discography, ESIs, facet joint procedures, and intradiscal therapies were included. PubMed (Medline), EMBASE, and Cochrane Library databases were searched, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Infection data were extracted from included studies, and infection rates were calculated for each procedure type. Case reports and infection-only articles were not included in infection rate calculations. RESULTS: Seventy-two studies met the eligibility criteria and were included in the systematic review. The overall incidence of infection across all studies was 0.12% (231/200,588). The majority of studies (n = 51) were linked to ESIs. Infections related to ESIs were more common than those related to discography or facet joint procedures (0.13% [219/174,431] vs. 0% [0/269] or 0.04% [9/25,697], respectively). Intradiscal therapies had the highest calculated rate of infections (1.05%; 2/191). Quality assessments of the included studies ranged widely. LIMITATIONS: There was an abundance of case reports in comparison to other study designs; to minimize skewing of the analysis, case reports and infection-only articles were not included in the infection rate. Studies that reported combined infection data for multiple procedures could not be included. Many cohort studies and case series were of lower quality because of their retrospective nature. Additionally, the true incidence of infections related to these procedures is unknown because the majority of these infections often go unreported, and information on regions of the spine and procedure details are often lacking. CONCLUSIONS: Based on our systematic review, the risk of infections following interventional spine procedures appears to be low overall. More studies focusing on infectious complications with larger sample sizes are needed, particularly for intradiscal therapies, in which the microbiome may be an underlying cause of disc infection. To achieve a true incidence of the risk of infections with these procedures, large prospective registries that collect complication rates are necessary. KEY WORDS: Infectious complications, infection incidence, interventional spine procedure, epidural steroid injection, discography, facet joint procedure, intradiscal therapies, biologics
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Guo, Ji, Weifeng Zhai, Licheng Wei, Jianpo Zhang, Lang Jin, Hao Yan, Zheng Huang i Yongwei Jia. "Radiological and clinical outcomes of balloon kyphoplasty for osteoporotic vertebral compression fracture in patients with rheumatoid arthritis". Journal of Orthopaedic Surgery and Research 16, nr 1 (6.07.2021). http://dx.doi.org/10.1186/s13018-021-02573-5.
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Abstract Background This study was conducted to investigate the outcomes and complications of balloon kyphoplasty (KP) for the treatment of osteoporotic vertebral compression fracture (OVCF) in patients with rheumatoid arthritis (RA) and compare its radiological and clinical effects with OVCF patients without RA. Methods Ninety-eight patients in the RA group with 158 fractured vertebrae and 114 patients in the control group with 150 vertebrae were involved in this study. Changes in compression rate, local kyphotic angle, visual analog scale (VAS) and Oswestry disability index (ODI) scores, conditions of bone cement leakage, refracture of the operated vertebrae, and new adjacent vertebral fractures were examined after KP. In addition, patients in the RA group were divided into different groups according to the value of erythrocyte sedimentation rate (ESR), c-reactive protein (CRP), and whether they were glucocorticoid users or not to evaluate their influence on the outcomes of KP. Results KP procedure significantly improved the compression rate, local kyphotic angle, and VAS and ODI scores in both RA and control groups (p<0.05). Changes in compression rate and local kyphotic angle in the RA group were significantly larger than that in the control group (p<0.05), and patients with RA suffered more new adjacent vertebral fractures after KP. The outcomes and complications of KP from different ESR or CRP groups did not show significant differences. The incidence of cement leakage in RA patients with glucocorticoid use was significantly higher than those who did not take glucocorticoids. In addition, RA patients with glucocorticoid use suffered more intradiscal leakage and new adjacent vertebral fractures. Conclusions OVCF patients with RA obtained more improvement in compression rate and local kyphotic angle after KP when compared to those without RA, but they suffered more new adjacent vertebral fractures. Intradiscal leakage and new adjacent vertebral fractures occurred more in RA patients with glucocorticoid use. Trial registration Retrospectively registered.
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La Torre, Domenico, Giorgio Volpentesta, Carmelino Stroscio, Caterina Bombardiere, Domenico Chirchiglia, Giusy Guzzi, Dorotea Pugliese, Emilio De Bartolo i Angelo Lavano. "Percutaneous intradiscal injection of radiopaque gelified ethanol: short- and long-term functional outcome and complication rate in a consecutive series of patients with lumbar disc herniation". British Journal of Pain, 29.04.2020, 204946372091718. http://dx.doi.org/10.1177/2049463720917182.
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Lumbar disc herniation (LDH) is a common cause of low back pain (LBP) and/or radicular pain (RP). Over the years, different therapies have been proposed to treat symptomatic LDH, including different minimally invasive techniques and open surgical methods. Recently, percutaneous intradiscal injection of radiopaque gelified ethanol (RGE) DiscoGel® has emerged as an effective therapeutic option in patients with LDH. Nevertheless, only few studies addressed the reliability of this technique. The purpose of this study was to evaluate the efficacy and safety of this procedure. We analysed surgical and outcome data of patients with small or medium LDH treated by DiscoGel between 2012 to 2015. Outcome variables included pain relief, the limitation on physical activity and severity of depression status. Overall, complication rate was defined as the occurrence of any perioperative adverse events. A total of 94 consecutive patients were enrolled in the study. Pain relief was achieved in 90.6% and 88.8% of patients at 1- and 4-year follow-up, respectively. At the last follow-up, at least a satisfactory result was achieved in 92.5% of patients. Similar results were obtained in the limitation on physical activity. Depression status did not significantly change after treatment. There was no mortality, and no patients experienced permanent sequelae. In well-selected patients, DiscoGel has proved effective in maintaining excellent functional results in terms of pain relief and limitation on physical activity while minimizing the overall rate of complications related to these kinds of surgical procedures.
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Ali, Yakub M., Jahangir M. Sarwar, Mohammad S. Hossain, Manash C. Sarker, Mohammad N. Kayes i Muhammed M. Rahman. "Percutaneous laser disc decompression: A minimally invasive procedure for the treatment of intervertebral disc prolapse – the Bangladesh perspective/Perkutane Laser-Diskusdekompression: Ein minimal-invasives Verfahren zur Behandlung von Bandscheibenvorfall – Ein Erfahrungsbericht aus Bangladesch". Photonics & Lasers in Medicine 2, nr 3 (1.01.2013). http://dx.doi.org/10.1515/plm-2012-0036.
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AbstractThe purpose of this paper is to assess the clinical effectiveness of percutaneous laser disc decompression (PLDD) for patients with radicular pain due to intervertebral disc hernia and to describe our experience in this field in Bangladesh.PLDD is a procedure in which herniated intervertebral discs are treated by the reduction of intradiscal pressure by laser energy. This is introduced by a needle inserted into the nucleus pulposus under local anesthesia and fluoroscopic monitoring. Small volume nucleus vaporization results in a sharp fall in intradiscal pressure, with the consequent migration of herniation away from the nerve root. PLDD has been reported to be a safe, effective, minimally invasive treatment option for patients with a herniated disc.This observational random prospective analysis was carried out during the period from November 2007 to December 2011. PLDD was performed on 4622 herniated discs of 2580 patients (1420, male; 1160, female), whose age ranged between 18 and 85 years. A total of 47 cases were failed back surgery syndrome (FBSS). All patients were followed up (ranging from 1 month to 36 months, with a median of 12 months) and were evaluated according to MacNab criteria.Amongst the 2580 patients, 2296 (89.0%) reported immediate pain relief, 230 (8.9%) patients were uncertain and the remaining 54 (2.1%) did not have immediate pain relief. In the subsequent follow up, according to MacNab criteria a good response was seen in 1935 (75.0%) cases and a fair response in 335 (13.0%) cases. The response to the treatment was poor in 310 patients (12.0%). A second session of PLDD was performed on 292 (11.3%) patients made up of 162 patients (6.3%) due to multi-level (>2 discs) prolapse, 102 patients (3.9%) due to an extensive prolapse of one or two discs and 28 patients (1.0%) because of a relapse. In two cases of a prolapsed dorsal spine (TPLDD is an effective and minimally invasive procedure which has almost no side effects or complications, can be performed under local anesthesia, results in no scarring or spinal instability, and still does not hinder the scope of open surgery in failed cases. PLDD is also effective in cases of FBSS.
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Mrkovački, Janko, Sanja Srzentić Dražilov, Vesna Spasovski, Amira Fazlagić, Sonja Pavlović i Gordana Nikčević. "Case Report: Successful Therapy of Spontaneously Occurring Canine Degenerative Lumbosacral Stenosis Using Autologous Adipose Tissue-Derived Mesenchymal Stem Cells". Frontiers in Veterinary Science 8 (23.09.2021). http://dx.doi.org/10.3389/fvets.2021.732073.
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The management of degenerative lumbosacral stenosis (DLSS) in dogs usually requires aggressive, costly surgical treatments that may themselves present complications, while do not fully resolve the symptoms of the disease. In this study, the dog diagnosed with severe DLSS, with hind limb paresis, was treated using a new and least invasive treatment. Cultured autologous adipose tissue-derived mesenchymal stem cells (AT-MSCs) were injected bilaterally at the level of L7-S1, in the vicinity of the external aperture of the intervertebral foramen of DLSS patient. In the previously described treatments of spontaneous intervertebral disc degeneration in dogs, intradiscal injections of MSCs did not lead to positive effects. Here, we report a marked improvement in clinical outcome measures related to the ability of a dog to walk and trot, which were expressed by a numeric rating scale based on a veterinary assessment questionnaire. The improved status persisted throughout the observed time course of 4.5 years after the AT-MSC transplantation. To the best of our knowledge, this is the first case of successful therapy, with long-term positive effect, of spontaneously occurring canine DLSS using presented treatment that, we believe, represents a contribution to current knowledge in this field and may shape both animal and human DLSS treatment options.
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CEYLAN, AYŞEGÜL, i İBRAHİM AŞIK. "Percutaneous plasma laser disc coagulation and navigable ablation decompression in the treatment of cervical disc herniation: A single center experience." TURKISH JOURNAL OF MEDICAL SCIENCES, 17.01.2019. http://dx.doi.org/10.3906/sag-1805-191.
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Backgraund and aim: We aimed to compare the effectivity of PDCT (Percutaneous Disc Coagulation Therapy) and L-DISQ (navigable ablation decompression treatment) in patients who were diagnosed with cervical disc herniation. Methods: Visual Analogue Scale (VAS), Neck Pain Index (NPI) were recorded initially and at the 1st, 3rd, 6th and 12th months after the procedures. Patient Satisfaction Scale (PSS) were recorded 12th months after the procedures. Results: Mean VAS scores were 7.55 and 3.1 points in PDCT group and 7.6 and 3.00 points in L-DISQ group mean NPI scores were 34.2 and 20.75 points in PDCT group and 34.1 and 20.4 points in L-DISQ group initially and at the 12th month. When compared between months, there was a significant decrease in time-dependent VAS and NPI scores in both PDCT and L-DISQ groups (p=0.001). Some complications include esophageal, vascular and neural injuries, hoarseness, Horner syndrome, infections, dural puncture and muscle spasm. The only difference between groups was the rate of cervical spasm within one month after the procedure; 75% in PDCT group and 15% in L-DISQ group. Conclusion: The diameter of the canal of cervical vertebrae is narrower than of the lumbar and thoracic regions, therefore the smaller part of disc may be sufficient to create clinical signs. The respond to decompression therapies are faster in case cervical percutaneous procedures are performed correctly. Proper patient selection and practitioner’s experience are important in treatment success. Key Words: Navigable ablation, intradiscal decompression, PDCT, cervical herniation
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Zhang, Tian-yu, Pei-xun Zhang, Feng Xue, Dian-ying Zhang i Bao-guo Jiang. "Risk factors for cement leakage and nomogram for predicting the intradiscal cement leakage after the vertebra augmented surgery". BMC Musculoskeletal Disorders 21, nr 1 (30.11.2020). http://dx.doi.org/10.1186/s12891-020-03810-4.
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Abstract Background Vertebral augmentation is the first-line treatment for the osteoporosis vertebral compression fractures. Bone cement leakage is the most common complication of this surgery. This study aims to assess the risk factors for different types of cement leakage and provides a nomogram for predicting the cement intradiscal leakage. Methods We retrospectively reviewed 268 patients who underwent vertebral augmentation procedure between January 2015 and March 2019. The cement leakage risk factors were evaluated by univariate analysis. Different types of cement leakage risk factors were identified by the stepwise logistic analysis. We provided a nomogram for predicting the cement intradiscal leakage and used the concordance index to assess the prediction ability. Results A total of 295 levels of vertebrae were included, with a leakage rate of 32.5%. Univariate analysis showed delayed surgery and lower vertebral compression ratio were the independent risk factors of cement leakage. The stepwise logistic analysis revealed percutaneous vertebroplasty was a risk factor in vein cement leakage; delayed surgery, preoperative compression ratio, and upper endplate disruption were in intradiscal cement leakage; age, preoperative fracture severity, and intravertebral vacuum cleft were in perivertebral soft tissue cement leakage; no factor was in spinal canal cement leakage. The nomogram for intradiscal cement leakage had a precise prediction ability with an original concordance index of 0.75. Conclusions Delayed surgery and more vertebral compression increase the risk of cement leakage. Different types of cement leakage have different risk factors. We provided a nomogram for precise predicting the intradiscal cement leakage.
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Vladimirovna Baranova, Iryna, Yurii A. Bezsmertnyi, Halyna V. Bezsmertnaya, Kateryna P. Postovitenko, Iryna A. Iliuk i Alla F. Gumeniuk. "Analgetic effect of ozone therapy: myths of reality?" Polish Annals of Medicine, 2020. http://dx.doi.org/10.29089/2020.20.00099.
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Introduction: Administration of an oxygen-ozone mixture is one of the innovative techniques used in single-drug or complex therapeutic schemes for treatment of many degenerative-dystrophic pathologies of the musculoskeletal system and related neurological complications. Aim: The aim was to determine the mechanisms of physiological action of the oxygen-ozone mixture in order to substantiate its efficacy for treatment of chronic pain syndrome with underlying degenerative-dystrophic pathologies of the musculoskeletal system. Material and methods: The article covers biochemical and pathomorphological studies that explain the mechanism of the pain syndrome and the potential effect of the ozone therapy. Results and discussion: The treatment schemes and benefits of different routes of ozone administration (intramuscularly, intravenously, intradiscally and intraarticularly) were analyzed. Diverse research data demonstrated influence on the causes of chronic pain, pathophysiological phases, and possible complications. The prospects of further studies for development of the most effective techniques for treatment of various pain syndromes were assessed. Conclusions: Ozone therapy is one of the alternative rehabilitation methods with a substantial pain relieving effect. As of today, the possibility of using the oxygen-ozone mixture for treatment of chronic back pain related to intervertebral disk hernia and fibromyalgia has been substantially confirmed.