scholarly journals IFN-γ Correlations with Pain Assessment, Radiological Findings, and Clinical Intercourse in Patient after Lumbar Microdiscectomy: Preliminary Study

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Piotr Kamieniak ◽  
Joanna M. Bielewicz ◽  
Cezary Grochowski ◽  
Jakub Litak ◽  
Agnieszka Bojarska-Junak ◽  
...  
Keyword(s):  
Rating Scale ◽  
Lumbar Disc ◽  
Plasma Concentrations ◽  
Radicular Pain ◽  
Nerve Compression ◽  
Mcgill Pain Questionnaire ◽  
Lumbar Microdiscectomy ◽  
Before And After ◽  
Disc Herniations ◽  
Ifn Γ

Objectives. We investigated the influence of pain decrease after lumbar microdiscectomy on the interferon gamma (IFN-γ) serum level in patients with lumbar disc herniations. The study challenges the mechanism of sciatica pain and the role of IFN-γ in radicular pain development. Material and Methods. We performed clinical and immunoenzymatic assessment in a group of 27 patients with lumbar radicular pain due to disc herniations before and 3 months after surgery. Clinical status was assessed with the use of the Numeric Rating Scale (NRS), the Pain Rating Index and Pain Intensity Index of McGill Pain Questionnaire (SF-MPQ), the Oswestry Disability Index (ODI), and Beck Depression Inventory (BDI). The plasma concentrations of IFN-γ were ascertained by an immunoenzymatic method. Results. We observe significant correlations between the results of the pain in the back region assessment NRS back scale after the surgery with the level of IFN-γ before the procedure ( r s = 0.528 ; p = 0.008 ) and after the procedure ( r s = 0.455 ; p = 0.025 ). These are moderate and positive correlations—the decrease in pain is correlated with the lower IFN-γ level. Additionally, there are significant correlations between the results of the PRI scale and the IFN-γ level. The PRI score before surgery correlates positively with IFN-γ after surgery ( r s = 0.462 ; p = 0.023 ), and the PRI score after surgery correlates positively with IFN before surgery ( r s = 0.529 ; p = 0.005 ) and after surgery ( r s = 0.549 ; p = 0.003 ). All correlations are moderate in severity—severe pain before surgery correlates with a higher level of IFN-γ after surgery and also higher IFN-γ before surgery. There were significant differences in the IFN-γ level before ( Z = − 2.733 ; p = 0.006 ) and after ( Z = − 2.391 ; p = 0.017 ) surgery in the groups of patients with and without nerve compression. In the group of patients with nerve compression, the level of IFN-γ before and after surgery was lower. Conclusions. Less pain ratio after operation correlates with the level of IFN-γ. In the group of patients without significant nerve compression confirmed by MRI scans, the level of IFN-γ before and after surgery was higher than that in the group with nerve root compression.

Anterior Lumbar Microdiscectomy and Interbody Fusion for the Treatment of Recurrent Disc Herniation

Neurosurgery ◽  
2001 ◽  
Vol 48 (2) ◽  
pp. 334-338 ◽  
Author(s):  
A. Giancarlo Vishteh ◽  
Curtis A. Dickman
Keyword(s):  
Interbody Fusion ◽  
Lumbar Disc ◽  
Posterior Longitudinal Ligament ◽  
Radicular Pain ◽  
Neurological Deficits ◽  
Herniated Disc ◽  
X Rays ◽  
Lumbar Microdiscectomy ◽  
Disc Herniations

Abstract OBJECTIVE To demonstrate the feasibility of anterior lumbar microdiscectomy in patients with recurrent, sequestered lumbar disc herniations. METHODS Between 1997 and 1999, six patients underwent a muscle-sparing “minilaparotomy” approach and subsequent microscopic anterior lumbar microdiscectomy and fragmentectomy for recurrent lumbar disc extrusions at L5–S1 (n = 4) or L4–L5 (n = 2). A contralateral distraction plug permitted ipsilateral discectomy under microscopic magnification. Effective resection of the extruded disc fragments was accomplished by opening the posterior longitudinal ligament. Interbody fusion was performed by placing cylindrical threaded titanium cages (n = 4) or threaded allograft bone dowels (n = 2). RESULTS There were no complications, and blood loss was minimal. Follow-up magnetic resonance imaging revealed complete resection of all herniated disc material. Plain x-rays revealed excellent interbody cage position. Radicular pain and neurological deficits resolved in all six patients (mean follow-up, 14 mo). CONCLUSION Anterior lumbar microdiscectomy with interbody fusion provides a viable alternative for the treatment of recurrent lumbar disc herniations. Recurrent herniated disc fragments can be removed completely under direct microscopic visualization, and interbody fusion can be performed in the same setting.

Biportal Endoscopic Excision of Facetal Cyst in the Far Lateral Region of L5S1: 2-Dimensional Operative Video

2019 ◽  
Vol 18 (6) ◽  
pp. E233-E233
Author(s):  
Sagar B Sharma ◽  
Guang-Xun Lin ◽  
Hussam Jabri ◽  
Naveen Davangere Siddappa ◽  
Jin-Sung Kim
Keyword(s):  
Lumbar Disc ◽  
Radicular Pain ◽  
Lumbar Spine Surgery ◽  
Foraminal Stenosis ◽  
Lateral Border ◽  
Landing Point ◽  
Fusion Procedure ◽  
Free Mobility ◽  
Disc Herniations ◽  
Far Lateral

Abstract Unilateral biportal endoscopy (UBE) is a recently introduced technique that utilizes 2 portals, one for endoscopy and one as a working portal, in contrast to full endoscopy, which utilizes a single portal. The advantages are a favorable learning curve and free mobility of instruments in the operative field. UBE is successful in addressing cervical and lumbar disc herniations, lumbar stenosis, and foraminal/extraforaminal pathologies, such as herniations and foraminal stenosis. However, there is no report of UBE for a far-lateral L5S1 facet cyst. The patient was an 85-yr-old female with a left lower limb radicular pain with magnetic resonance imaging evidence of the facet cyst compressing the L5 nerve root. Conventional treatment of such a condition would either be an L5S1 fusion procedure or a standalone decompression via the Wiltse paramedian approach. Because the patient had no instability, we decided to do a standalone decompression using the UBE technique. The UBE technique has the advantages of any minimal access procedure, including small incisions, minimal tissue dissection, good magnification, and preservation of anatomic structures. A written informed consent was obtained from the patient before the procedure. The procedure was done under general anesthesia using a 30° endoscope, a radiofrequency probe, and standard lumbar spine surgery instruments. The initial landing point of the endoscope and instruments is via triangulation at the lateral border of the isthmus of L5. The postoperative clinical and radiological outcomes were satisfactory (VAS Back and Leg, 0; Oswestry disability index, 15 at 3 mo).

scholarly journals Effect of minocycline on lumbar radicular pain: a prospective pilot study

2020 ◽  
Vol 24 (3) ◽  
pp. 197-201
Author(s):  
Sanaz Sha'abani ◽  
◽  
Sasan Gazerani ◽  
Maryam Ragheb ◽  
Amir-Hossein Mirgalou-Bayat ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Pain Intensity ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Emotional Experience ◽  
Life Quality ◽  
Radicular Pain ◽  
Lumbar Pain ◽  
Controlled Clinical Trial ◽  
Before And After

Introduction: Pain is an unpleasant sensory and emotional experience. Evidence suggests a role for microglia in chronic pain and inhibition of microglia leads to decrease of chronic pain intensity in animal models. Minocycline, a semisynthetic tetracycline derivative, is a selective inhibitor of microglia. Several studies have shown pain intensity improvement by minocycline in animal model of pain, but a few studies showed effectiveness on chronic pain improvement in humans. This prospective, self-controlled clinical trial investigated whether minocycline is effective for chronic pain management. Methods: Twenty-two patients, between the ages of 20 and 80 years with radicular lumbar pain with a numerical rating scale >4, who were unresponsive to other medications and had pain duration of >6 weeks were included in the trial. Results: Pain intensity, neuropathic pain and life quality scores assessed before and after treatment. All scores showed significant improvement after 2 weeks of treatment: 56%, 74% and 14%, respectively. Conclusion: Findings of this study suggest minocycline can effectively improve patients’ pain scores and quality of life, even in those with long-term duration of chronic pain and warrants further study.

Unilateral surgical approach for lumbar disc herniation with contralateral symptoms

2012 ◽  
Vol 17 (2) ◽  
pp. 124-127 ◽  
Author(s):  
Taşkan Akdeniz ◽  
Tuncay Kaner ◽  
İbrahim Tutkan ◽  
Ali Fahir Ozer
Keyword(s):  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Surgical Approach ◽  
Lumbar Disc ◽  
Radicular Pain ◽  
Leg Pain ◽  
Motor Deficits ◽  
Disc Herniations ◽  
Herniated Lumbar Disc ◽  
Contralateral Symptoms

Object In most cases of lumbar disc herniation, the primary problem is usually limited to radicular pain due to nerve compression on the herniated side, which is generally limited to the side of operation. The aim of this study was to reevaluate the side of the surgical approach in a selected group of patients with leg pain and contralateral lumbar disc herniation. Methods Included in this study were a total of 5 patients with lumbar disc herniations who presented with contralateral symptoms and neurological signs. In all cases, patients underwent a microdiscectomy from the side ipsilateral to the herniated lumbar disc, the side contralateral to the motor deficits and leg pain. Results The symptoms and signs, to some extent, resolved during the immediate postoperative period. There were no postoperative complications. Conclusions The findings confirm that performing a laminotomy via the side of the herniation is sufficient for this group of patients.

scholarly journals Evaluation of the effectiveness of transforaminal epidural steroid injection in far lateral lumbar disc herniations

2021 ◽  
Vol 74 (1-2) ◽  
pp. 27-32
Author(s):  
Sevket Evran ◽  
Salim Katar
Keyword(s):  
Surgical Treatment ◽  
Functional Capacity ◽  
Pain Control ◽  
Steroid Injection ◽  
Lumbar Disc ◽  
Radicular Pain ◽  
Disc Herniations ◽  
Transforaminal Epidural Steroid Injection ◽  
Far Lateral ◽  
Epidural Steroid

Far lateral lumbar disc herniations (FLDH) consist approximately 0.7-12% of all lumbar disc herniations. Compared to the more common central and paramedian lumbar disc herniations, they cause more severe and persistent radicular pain due to direct compression of the nerve root and dorsal root ganglion. In patients who do not respond to conservative treatments such as medical treatment and physical therapy, and have not developed neurological deficits, it is difficult to decide on surgical treatment because of the nerve root damage and spinal instability risk due to disruption of facet joint integrity. In this study, we aimed to evaluate the effect of transforaminal epidural steroid injection (TFESI) on the improvement of both pain control and functional capacity in patients with FLDH. A total of 37 patients who had radicular pain caused by far lateral disc herniation which is visible in their lumbar magnetic resonance imaging (MRI) scan, had no neurological deficit and did not respond to conservative treatment, were included the study. TFESI was applied to patients by preganglionic approach. Pre-treatment Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) scores of the patients were compared with the 3rd week, 3rd month and 6th month scores after the procedure. The mean initial VAS score was 8.63 ± 0.55, while it was 3.84 ± 1.66, 5.09 ± 0.85, 4.56 ± 1.66 at the 3rd week, 3rd month and 6th month controls, respectively. This decrease in the VAS score was found statistically significant (p = 0.001). ODI score with baseline mean value of 52.38 ± 6.84 was found to be 18.56 ± 4.95 at the 3rd week, 37.41 ± 14.1 at the 3rd month and 34.88 ± 14.33 at the 6th month. This downtrend of pa­tient’s ODI scores was found statistically significant (p = 0.001). This study has demonstrated that TFESI is an effective method for gaining increased functional capacity and pain control in the treatment of patients who are not suitable for surgical treatment with radicular complaints due to far lateral lumbar disc hernia.

Effects of Repetitive Transcranial Magnetic Stimulation on Hypothalamic-Pituitary-Adrenal axis of Patients With Depression

2011 ◽  
Vol 26 (S2) ◽  
pp. 1143-1143
Author(s):  
M. He ◽  
Z. Gu ◽  
X. Wang ◽  
X. Tian
Keyword(s):  
Transcranial Magnetic Stimulation ◽  
Hpa Axis ◽  
Magnetic Stimulation ◽  
Rating Scale ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Plasma Concentrations ◽  
Control Group ◽  
Plasma Acth ◽  
Hypothalamic Pituitary Adrenal ◽  
Before And After

ObjectiveTo investigate the effects of sleep electroencephalogram-modulated repetitive transcranial magnetic stimulation (SEM-rTMS) and conventional rTMS (C-rTMS) on the activity of hypothalamic-pituitary-adrenal (HPA) axis in patients with depression.MethodsIn a double-blind, randomized controlled trial, 164 patients diagnosed with depression were randomized to treatment with SEM-rTMS (n = 57), C-rTMS (n = 55) or sham rTMS (n = 52) for 30 min every day for 10 d. Before and after treatment plasma concentrations of adrenocorticotropic hormone (ACTH) and cortisol (CORT) were measured, and the 24-item Hamilton Depression Rating Scale (HAMD-24) was used for assessment.ResultsThe HAMD-24 scores and plasma ACTH and CORT concentrations of these depressive patients before treatment were significantly different from those of the normal control group (P < 0.05). The HAMD-24 scores and plasma ACTH and CORT concentrations in the SEM-r TMS group and conventional rTMS group were decreased significantly (P < 0.05). There was a significant positive correlation between the HAMD-24 scores and plasma ACTH (n = 240, r = 0.105, P = 0.048) and CORT concentrations (n = 240, r = 0.126, P = 0.023) in the patients with depression before and after treatment.ConclusionThe antidepressant effect of rTMS, including SEM-rTMS, may be related to its decreasing HPA axis activity. (This trail was registered. No: ChiCTR-TRC-00000465).

Microendoscopic approach to far-lateral lumbar disc herniation

1999 ◽  
Vol 7 (5) ◽  
pp. E7 ◽  
Author(s):  
Kevin T. Foley ◽  
Maurice M. Smith ◽  
Y. Raja Rampersaud
Keyword(s):  
Disc Herniation ◽  
Lumbar Disc ◽  
Radicular Pain ◽  
Motor Deficits ◽  
Outpatient Basis ◽  
Single Level ◽  
Disc Herniations ◽  
Far Lateral ◽  
Paramedian Incision ◽  
Lateral Disc Herniation

The purpose of this study was to determine the feasibility of performing far-lateral lumbar discectomy by using the microendoscopic discectomy (MED) technique. The authors studied 11 consecutive patients with unilateral, single-level radiculopathy secondary to far-lateral disc herniation. There were eight men and three women, with an average age of 43 years. In all patients magnetic resonance imaging and/or computerized tomography scanning documented far-lateral disc herniations. Six patients experienced motor deficits, nine patients sensory abnormalities, and five depressed reflexes. All patients complained of radicular pain, which failed to improve with conservative care. After induction of epidural anesthesia, single-level, unilateral percutaneous discectomies were performed using the MED technique. Five discectomies were performed at L3-4 and six at L4-5. There were four contained and seven sequestered disc herniations. All surgeries were performed on an outpatient basis. Follow up ranged from for 12 to 27 months. Improvement was shown in all patients postoperatively. Using modified Macnab criteria to assess results of surgery, there were 10 excellent results and one good result. None of the patients experienced residual motor deficits, four had residual decreased sensation, and one still had some degree of nonradicular pain. There were no complications. Although various open techniques exist for the treatment of far-lateral disc herniation, MED is unique in that far-lateral pathological entities can be directly visualized and removed via a 15-mm paramedian incision. The percutaneous approach avoids larger, potentially denervating and destabilizing procedures. The need for general anesthesia can be avoided, and surgery is performed on an outpatient basis, thereby reducing hospital cost and length of stay.

scholarly journals Caudal Lumbar Disc Herniations Are More Likely to Require Surgery for Symptom Resolution

2020 ◽  
pp. 219256822090584
Author(s):  
Anmol Gupta ◽  
Shivam Upadhyaya ◽  
Caleb M. Yeung ◽  
Peter J. Ostergaard ◽  
Harold A. Fogel ◽  
...  
Keyword(s):  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Nonoperative Management ◽  
Lumbar Disc ◽  
Strong Association ◽  
Cauda Equina ◽  
Radicular Pain ◽  
Motor Deficits ◽  
Disc Herniations ◽  
The Impact

Study Design: Retrospective study. Objectives: We examined the impact that location of a lumbar disc herniation has on the likelihood that a patient will require surgery after at least 6 weeks of nonoperative management. Methods: Using ICD-10 codes M51.26 and M51.27, we identified patients at a single academic institution from 2015 to 2016 who received a diagnosis of primary lumbar radicular pain, had magnetic resonance imaging confirming a lumbar disc herniation, and underwent at least 6 weeks of nonoperative management. Patients experiencing symptoms suggesting cauda equina syndrome or progressive motor deficits were excluded. Results: Five hundred patients met inclusion/exclusion criteria. Twenty-nine (5.8%) had L3-L4 herniations, 245 (49.0%) had L4-L5 herniations, and 226 (45.2%) had L5-S1 herniations. Overall, 451 (90.2%) patients did not undergo surgery within 1 year of diagnosis. Nonsurgical patients had an average herniation size occupying 31.2% of the canal, compared with 31.5% in patients who underwent surgery. While herniation size, age, sex, and race failed to demonstrate a statistical association with the likelihood for surgery, location of disc herniation demonstrated a strong association. L3-L4 and L4-L5 herniations had odds ratios of 0.19 and 0.45, respectively, relative to L5-S1 herniations ( P = .0047). Patients were more than twice as likely to require a surgery on an L5-S1 herniation in comparison with an L4-L5 herniation ( P < .05). L3-L4 herniations rarely required surgery. Conclusions: Patients with caudal lumbar disc herniations were more likely to require surgery after at least 6 weeks of conservative management than those with disc herniations in the mid-lumbar spine.

scholarly journals CERVICAL ENDOSCOPIC DISC SURGERY: PRECISE APPROACH FOR MINIMALLY INVASIVE DECOMPRESSION

2018 ◽  
Vol 17 (3) ◽  
pp. 206-211
Author(s):  
Artem Gushcha ◽  
Sergey Arestov ◽  
Andrey Vershinin ◽  
Alexey Kashcheev ◽  
Vladimir Tjurnikov ◽  
...  
Keyword(s):  
Lumbar Disc ◽  
Neck Disability Index ◽  
Surgical Techniques ◽  
Radicular Pain ◽  
Cervical Disc ◽  
Results Of Treatment ◽  
Technological Advances ◽  
Significant Difference ◽  
Disc Herniations ◽  
Therapeutic Study

ABSTRACT Objective: Technological advances in recent decades have led to a complexity of choice of the most effective method for treating cervical disc herniations. The idea of removing disc herniations using endoscope techniques is not new, and is successfully used in the treatment of lumbar disc herniations. But in the case of the cervical spine, full endoscopic procedures only started to be performed at the beginning of 2014, by Yang JS and coauthors, and their effectiveness was and still is a matter of controversy. The proposed method of endoscopic portal disc herniation removal was used for the past two years, and its results were compared with the anterior microsurgical approach using a single-level cage implantation. Methods: Twenty-five patients were included in this study, with a comparator group of 25 patients operated by ordinary anterior cervical discectomy with a single-disc fusion. All patients were operated on by the same group of surgeons. Results: During the analysis of VAS data, it was confirmed that the degree of local and radicular pain in the two groups was not significantly different (p > 0.05). According to the Neck Disability Index (NDI) there was a significant difference between the two groups in relation to the endoscopic patient group. Data using the Odom criteria showed significantly better results for the endoscopic group. During the research it was observed that the patients in the endoscopically operated group were discharged from hospital more quickly, after 3 [2; 5] days compared to 5 [4; 6] days in the microsurgery group. Conclusion: The method performed is a safe and reliable alternative to convenient surgical techniques. Level of Evidenced II; Therapeutic study, investigating the results of treatment.

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