scholarly journals An Unusual Case of Radicular Pain Caused by Bilateral Lumbar Synovial Cyst: A Case Report and Review of the Literature

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
David Ruiz-Picazo ◽  
José Ramírez-Villaescusa ◽  
Ana Verdejo-González
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Treatment Options ◽  
Synovial Cyst ◽  
Radicular Pain ◽  
Magnetic Resonance Images ◽  
Leg Pain ◽  
Low Back ◽  
Disc Disease ◽  
Management Options

Introduction. Spinal synovial cysts (SSCs) constitute an uncommon degenerative lesion of the spine. They are usually asymptomatic but they may also cause symptoms of variable severity. SSCs are benign growths adjoining the facet joints that may induce low back pain, lumbar radiculopathy, and neurological deficit. There are different treatment options that range from conservative management to interventions like image-guided epidural steroid injection or direct cyst puncture and finally to open or endoscopic spinal canal decompression and spinal bone fusion with/without instrumentation. A discussion of current management options for this unusual disease is presented. Material and Methods. A 52-year-old female patient presented with low back pain and left leg pain. Plain radiography demonstrated instability at the L4-L5 level. Magnetic resonance images (MRIs) revealed a bilateral cystic lesion at the L4-L5 level with associated instability and degenerative disc disease at the level L5-S1. Initially, conservative treatment was performed by aspiration of the left cyst and infiltration with corticosteroids with improvement of the pain for 1 year. After this period, the radicular and the low back pain reoccurred. Results. Following leg pain recurrence, a hybrid L4-S1 fusion was performed. After surgery, there was clinical improvement and six months later, the patient returned to daily activities. The radiological study after five-year follow-up shows adequate implant position, without signs of loosening, compatible with solid fusion. Conclusion. After reviewing the literature, the optimal management for patients with symptomatic lumbar synovial cyst must be very individualized, which is essential to achieve a favorable outcome.

Efficacy of Duloxetine in Chronic Low Back Pain with a Neuropathic Component

2016 ◽  
Vol 124 (1) ◽  
pp. 150-158 ◽  
Author(s):  
Regina P. Schukro ◽  
Matthias J. Oehmke ◽  
Angelika Geroldinger ◽  
Georg Heinze ◽  
Hans-Georg Kress ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Chronic Low Back Pain ◽  
Pain Treatment ◽  
Treatment Phase ◽  
Radicular Pain ◽  
Leg Pain ◽  
Low Back ◽  
Double Blind ◽  
Vas Score

Abstract Background Among patients with chronic low back pain (CLBP), approximately 37% show signs of a neuropathic pain component (radicular pain). Treatment of this condition remains challenging. Therefore, the current study aimed to investigate the efficacy of duloxetine in the treatment of CLBP patients with neuropathic leg pain. Methods The study was conducted as a prospective, randomized, placebo-controlled, double-blind crossover trial. CLBP with a visual analog scale (VAS) score greater than 5 and a neuropathic component that was assessed clinically and by the painDETECT questionnaire (score > 12) were required for inclusion. Patients were randomly assigned to either duloxetine or placebo for 4 weeks followed by a 2-week washout period before they crossed over to the alternate phase that lasted another 4 weeks. Duloxetine was titrated up to 120 mg/day. The primary outcome parameter was mean VAS score during the last week of treatment in each phase (VASweek4). Results Of 41 patients, 21 patients completed both treatment phases. In the intention-to-treat analysis (n = 25), VASweek4 was significantly lower in the duloxetine phase compared with placebo (4.1 ± 2.9 vs. 6.0 ± 2.7; P = 0.001), corresponding to an average pain reduction of 32%. The painDETECT score at the end of each treatment phase was significantly lower in the duloxetine phase compared with placebo (17.7 ± 5.7 vs. 21.3 ± 3.6 points; P = 0.0023). Adverse events were distributed equally between the duloxetine (65%) and placebo phases (62%) (P = 0.5). Conclusion In this crossover study, duloxetine proved to be superior to placebo for the treatment of CLBP with a neuropathic leg pain.

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

2021 ◽  
Vol 8 (1) ◽  
pp. 01-10
Author(s):  
Doan Co-Minh
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Degenerative Disc Disease ◽  
Radicular Pain ◽  
Low Back ◽  
Disc Disease ◽  
Mixed Effect ◽  
Lumbar Degenerative Disc Disease ◽  
Degenerative Disc ◽  
Prospective Longitudinal

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

scholarly journals Alternative strategies for lumbar discectomy: intradiscal electrothermy and nucleoplasty

2002 ◽  
Vol 13 (2) ◽  
pp. 1-6 ◽  
Author(s):  
William C. Welch ◽  
Peter C. Gerszten
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Lumbar Disc ◽  
Lessons Learned ◽  
Leg Pain ◽  
Low Back ◽  
Disc Disease ◽  
Discogenic Pain ◽  
Discogenic Low Back Pain ◽  
Disc Material

In recent years the general trend in spinal surgery has been one of reductionism and minimalization. A number of techniques have recently been developed that are applicable in the treatment of lumbar disc herniation and discogenic pain due to degenerative disc disease. The purpose of this manuscript is to examine two newer percutaneous disc treatment techniques, intradiscal electrothermal therapy (IDET) anuloplasty and nucleoplasty. The authors review the appropriate clinical treatment criteria, techniques, and lessons learned after performing these procedures in more than 100 patients. The IDET involves the percutaneous insertion of a specially designed thermal resistance probe followed by controlled heating of the intervertebral disc. This may result in disc shrinkage and reduction in pain. The nucleoplasty procedure involves the percutaneous removal of disc material by using a low-temperature resister probe to disintegrate and evacuate disc material, followed by thermal treatment of adjacent residual disc material. To date, no study has been published in which investigators examine the outcomes of this procedure for the treatment of radicular leg pain and low-back pain. Both IDET and nucleoplasty appear to be safe procedures. The IDET procedure may be an alternative to lumbar interbody fusion. Although its long-term role is being defined, this technique appears to provide intermediate-term relief of pain in a population of patients with discogenic low-back pain. Nucleoplasty may provide a percutaneous alternative to microdiscectomy in selected cases.

Low Back Pain and Radicular Pain

2017 ◽  
Author(s):  
Marc A. Huntoon
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Degenerative Disc Disease ◽  
Radicular Pain ◽  
Low Back ◽  
Zygapophyseal Joint ◽  
Disc Disease ◽  
Physician Visits ◽  
Pain Syndromes ◽  
The World

Low back pain is one of the most common pain syndromes in the world and a leading cause of disability and physician visits. Although degenerative disc disease and zygapophyseal joint spondylotic changes are common and lead to more permanent problems such as spinal stenosis, the interplay of biological and psychosocial factors is largely key to the chronification of many back pain disorders.

scholarly journals Coflex interspinous implant placement leading to synovial cyst development: case report

2018 ◽  
Vol 29 (3) ◽  
pp. 265-270 ◽  
Author(s):  
Seba Ramhmdani ◽  
Marc Comair ◽  
Camilo A. Molina ◽  
Daniel M. Sciubba ◽  
Ali Bydon
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Facet Joint ◽  
Cauda Equina ◽  
Synovial Cyst ◽  
Leg Pain ◽  
Segmental Motion ◽  
Low Back ◽  
The Right ◽  
Lumbar Spinal

Interspinous process devices (IPDs) have been developed as less-invasive alternatives to spinal fusion with the goal of decompressing the spinal canal and preserving segmental motion. IPD implantation is proposed to treat symptoms of lumbar spinal stenosis that improve during flexion. Recent indications of IPD include lumbar facet joint syndrome, which is seen in patients with mainly low-back pain. Long-term outcomes in this subset of patients are largely unknown. The authors present a previously unreported complication of coflex (IPD) placement: the development of a large compressive lumbar synovial cyst. A 64-year-old woman underwent IPD implantation (coflex) at L4–5 at an outside hospital for low-back pain that occasionally radiates to the right leg. Postoperatively, her back and right leg pain persisted and worsened. MRI was repeated and showed a new, large synovial cyst at the previously treated level, severely compressing the patient’s cauda equina. Four months later, she underwent removal of the interspinous process implant, bilateral laminectomy, facetectomy, synovial cyst resection, interbody fusion, and stabilization. At the 3-month follow-up, she reported significant back pain improvement with some residual leg pain. This case suggests that facet arthrosis may not be an appropriate indication for placement of coflex.

Subclinical Infection and Disc Dysbiosis as a Cause of Degenerative Disc Disease and Low Back Pain

2020 ◽  
Author(s):  
S. Rajasekaran ◽  
S. Dilip Chand Raja ◽  
Chitraa Tangavel ◽  
M. Raveendran ◽  
K. S. Sri Vijay Anand ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Degenerative Disc Disease ◽  
Low Back ◽  
Subclinical Infection ◽  
Disc Disease ◽  
Degenerative Disc
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