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Search Results: 1 - 10 of 924 matches for " intervertebral disc. "
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Discogenic pain: Who cares?  [PDF]
José Pedro Lavrador, Nuno Simas, Edson Oliveira, Joaquim Cruz Teixeira, Diogo Sim?o, Sérgio Livraghi
Health (Health) , 2013, DOI: 10.4236/health.2013.511261

Chronic low back pain has a huge impact on daily living and a negative economic and professional effect. It is a matter of debate and concern for all health professionals involved, particularly spine surgeons. Recent discoveries on the innervation and biochemical properties of the intervertebral disc clarify the role of this structure as a possible cause of chronic low back pain. However, multiple causes may be present in the same patient making the diagnosis a challenging process. Discogenic pain is defined as a chronic low back pain induced by a degenerative disc disease. There are no specific characteristics of discogenic pain, although it has a higher incidence in younger age, it is usually localized medially in the back, worsens with axial loading and improves with recumbence. In the last decades we have assisted the emergence of multiple treatment techniques. However, neither the conservative treatment nor the interventional management has strong evidence in treating discogenic pain. Randomized control clinical trials are sought to improve patient outcome. Meanwhile, we believe each patient should be approached on an individual base. Discogenic pain: we care.


Sistema de fixa??o dinamica de coluna lombar Dynesys: experiência clínica em 30 pacientes num período médio de 1 ano
Sousa, Paulo Rogério Costa de;Pereira, Leonardo Oliveira;
Coluna/Columna , 2012, DOI: 10.1590/S1808-18512012000100003
Abstract: objective: using a new concept of dynamic stability instead of conventional fusion, in order to reproduce the results so far achieved by several services in brazil and worldwide. methods: we evaluated 30 patients undergoing dynamic fixation of the lumbar spine. nineteen were men and 11 women with a mean age of 40.11 years (22-56), nine of them needed two adjacent levels of stabilization (l4-l5 and l5-s1). the diseases being treated were disc protrusion in 8 cases, discopathy in 16 cases and degenerative spinal stenosis in 6 cases. follow-up was done on an outpatient basis, ranging from 8 to 13 months, with an average of 12.3, using clinical parameters, analogue pain scale and oswestry, and ratings given by patients for satisfaction with the procedure, improvement of quality of life and return to work activities. results: the percentage of patients who achieved full return to work activities was 76.6% (21 patients) in the first three months, the others had returned to work until the middle of the fifth month. there was significant improvement in low back pain demonstrated by the decrease of vas (preoperative: 8.6 and 12 months; postoperative: 1.8). regarding quality of life there was significant improvement observed by the reduced scoreof oswestry (preoperative: 68,6 e 12 months; postoperative: 22.5). all patients returned to work after six months postoperatively. conclusion: based on the results, the dynamic system has proven to be effective in the treatment of diseases to which it is intended.
The Clinical Outcomes of Transforaminal Percutaneous Endoscopic Discectomy in Treating Lumbar Disc Herniation: A Review  [PDF]
Bheemasetty Rakesh, Yun Tao Wang
Open Journal of Orthopedics (OJO) , 2018, DOI: 10.4236/ojo.2018.82008
Abstract: Percutaneous endoscopic lumbar discectomy (PELD) is a minimally invasive technique started during the late 20th century. This process is done through microscopic view under local anesthesia. There is a growing but still insufficient evidence that lumbar EDS shows slightly better results in terms of minor tissue damage, shorter hospital stay, faster return to ordinary daily activities, and patient satisfaction. Recurrence rate still remains a matter of debate, and is related with the surgical skills of the surgeon. The complication rate seems to be similar in both of the techniques i.e., open and endoscopic. More randomized controlled trials, systematic reviews and meta-analysis are needed to clarify whether lumbar EDS can be considered comparable if not superior to standard open discectomy. In spite of lacking defined clinical evidence, lumbar EDS is without doubt a rapidly expanding PELD and its future developments are incredibly promising. Due to less complication rate this technique can be considered as a gold standard compared to the open discectomy. The surgeons still require more cadaveric practices for learning the curve and to approach the herniated disc area. The main objective of this review article is to show the clinical outcomes of the Transforaminal Percutaneous Endoscopic Discectomy in treating the lumbar disc herniation.
Avaliac?o da placa vertebral terminal na coluna cervical em diferentes faixas etárias e sua correla??o com a espessura do disco intervertebral
Vieira, Juliano Silveira Luiz;Herrero, Carlos Fernando Pereira da Silva;Porto, Maximiliano Aguiar;Barbosa, Marcello Henrique Nogueira;Garcia, Sérgio Britto;Ramalho, Leandra Náira Zambelli;Defino, Helton Luiz Aparecido;
Revista Brasileira de Ortopedia , 2009, DOI: 10.1590/S0102-36162009000100003
Abstract: objective: to evaluate, by means of histomorphometry, terminal vertebral plate thickness, intervertebral disc thickness and its correlation on different age groups, seeking to identify its correlation. methods: c4-c5 and c5-c6 cervical segments removed from human cadavers of both genders were assessed and divided into five groups of 10-year age intervals, from 21 years old. tvp and intervertebral disc thickness evaluation was made by means of histomorphometry of histological slides stained with hematoxylin and eosyn. lower c4 tvp, upper c5 tvp, and upper c6 tvp de were compared between each other and to the interposed intervertebral disc thickness between relevant tvp. results: the thickness of terminal vertebral plates adjacent to the same id did not show statistic differences. however, the comparison of upper and lower vertebral plates thickness on the same cervical vertebra (c5), showed statistical difference on all age groups studied. we found a statistical correlation coefficient above 80% between terminal vertebral plate and adjacent intervertebral disc, witha proportional thickness reduction of both structures on the different cervical levels studied, and also on the different age groups assessed. conclusion: terminal vertebral plate shows a morphologic correlation with the intervertebral disc next to it, and does not show correlation with the terminal vertebral plate on the same vertebra.
Score Evaluation of MRI Sequence Type Related Artifacts after Interbody Fusion with Metallic Implants—A Spine Specimen Study  [PDF]
Thorsten Ernstberger, Gottfried Buchhorn, Gabert Heidrich
Open Journal of Medical Imaging (OJMI) , 2012, DOI: 10.4236/ojmi.2012.22010
Abstract: Introduction: According to anterior spine fusion intervertebral disc spacers made of titanium or cobalt-chromium al-loys are of special interest. With regard to postoperative problems implant related artifacts can lead to a decreased MRI evaluation. The focus of this study was to compare the respective implant artifact artifact range dependend on different MRI sequences. To simplify artifact evaluation we introduced in this study a new developed 0-1-2 score. Material and Methods: We performed an MRI artifact evaluation of 2 different metallic intervertebral disc spacers (cobalt-chromium and titanium alloy). A carcass porcine spine was employed. Considering 12 defined spinal regions of interest we evaluated the respective implant artifact properties independent from the total artifact volume by using a new developed 0-1-2 score. The artifact range was documented for 15 different MRI-sequences. Results: For the titanium spacer as well as the cobalt-chromium-spacer an MRI evaluation of the implant/disc space situation could not be carried out. In contrast to the cobalt chromium spacer the titanium spacer allowed a good differentiation of the spinal canal opposite to the implant. Optimal MRI imaging results for both metallic intervertebral disc spacers could be achieved considering TSE sequences. Conclusion: A comparison of these two metallic spacers showed in all examined sequences clear advantages in favour of the titanium spacer. The best MRI representation of both tested implants by reducing implant related artifacts could be achieved with fast spin echo (TSE-) sequences. In spite of the use of TSE sequences a variability of susceptibility artifacts has to be included with regard to implant shape and material. With regard to the results of this study the easy use of a new developed artifact score represented a useful help to compare implant related MRI artifact properties independent from the actual implant related total artifact volume.
Analysis of Degenerative Discs in Lumbar Spondylolisthesis Using MRI T2 Mapping  [PDF]
Tsuneo Takebayashi, Hiroyuki Takashima, Mitsunori Yoshimoto, Yoshinori Terashima, Hajime Tsuda, Kazunori Ida, Toshihiko Yamashita
Open Journal of Radiology (OJRad) , 2012, DOI: 10.4236/ojrad.2012.23014
Abstract: Background: Spinal instability, including lumbar degenerative spondylolisthesis (DS), mainly results from degeneration of intervertebral discs (IVD) and the facet joints (FJ). Characterization of the relationship between IVD degeneration in cases of lumbar degenerative spondylolisthesis (DS), and T2 values may be useful for accurate noninvasive evaluation and subsequent treatment. Thus, the goal of this study was to measure T2 values of IVDs in cases with (DS) and without (NS) spondylolisthesis, and to characterize changes of IVDs in DS. Methods: A total of 40 subjects who presented with L4 spondylolisthesis comprised the DS group. Another 40 subjects who did not have lumbar spondylolisthesis, constituted the NS group. T2 values of IVDs were measured and compared in these groups. Results: T2 values for IVDs tended to be lower in the DS group than in the NS group, and these values were significantly different (p < 0.01) within the anterior annulus fibrosus (AF). No significant differences in T2 values between Meyerding grades I and II were observed in any areas of IVDs. Conclusions: It is speculated that in the early stages, the degeneration of the anterior AF develops and is related to the onset of lumbar spondylolisthesis, while in later stages, degeneration of facet joints influences the progression of spondylolisthesis.
A Flat Sagittal Spinal Alignment Is Common among Young Patients with Lumbar Disc Herniation  [PDF]
Olof Thoreson, Joel Beck, Klas Halldin, Helena Brisby, Adad Baranto
Open Journal of Orthopedics (OJO) , 2016, DOI: 10.4236/ojo.2016.69038
Abstract: Background: Recent studies suggest a correlation between spinal sagittal alignment and different types of lumbar pathologies due to different load patterns on the lumbar spine. The main objective of this study was to investigate the preoperative spinal sagittal alignment in young patients (<25 years) undergoing lumbar disc herniation surgery. Methods: Information regarding preoperative clinical examinations was collected from the patient medical charts. Preoperative MRI examinations were used to classify lumbar types according to four sagittal spinal alignment groups (1: a long thoracic kyphosis, 2: a flat back, 3: a normal spine and 4: an increased thoracic kyphosis). Other MRI findings were also noted. Classification of lumbar types was performed independently by three spine surgeons. To compare two sample proportions the 2-sample z-test was performed. Results: The distribution of lumbar curve types was: Type 1, 17% (9 patients); Type 2, 62% (33 patients); Type 3, 17% (9 patients) and Type 4, 4% (2 patients). The distribution of operated levels was: L3 - L4, 2% (1 patient); L4 - L5, 47% (25 patients); L5 - S1, 42% (22 patients) and L4 - L5 + L5 - S1, 9% (5 patients). Conclusions: A majority of the young patients (62%) that underwent surgery due to herniated disc in the lumbar spine were classified as Type 2 indicating a flat back. Future studies are needed to increase the knowledge about spinopelvic sagittal alignment and the correlation to spinal pathologies.
The Charité III Artificial Disc lumbar disc prosthesis: assessment of medium-term results
G. Gioia,D. Mandelli,F. Randelli
Journal of Orthopaedics and Traumatology , 2007, DOI: 10.1007/s10195-007-0080-1
Abstract: The intervertebral disc prosthesis seems to have gained its place in spinal surgery. The first 45 disc replacements (36 patients) performed at our institution have been followed for 5–9 years with standard radiography, CT, MRI and clinical evaluation. Two prostheses failed and needed further surgery. The mean Oswestry Disability Index score dropped from 44% to 9% and the pain score recorded on a visual analogic scale (VAS) dropped from 8 to 1.4. 92% of patients had excellent or good results and gave a positive answer to the question “Would you be ready to sustain again this same surgical procedure?” In 4 cases, a tendency towards prosthesis subsidence was observed. With time, 6 patients showed periprosthetic calcifications. One patient developed retrograde ejaculation. In conclusion, intervertebral disc prosthesis is a well established procedure that achieves good mid-term results, but doubts still remain about the longterm outcome. Care about right indication, eventual complications and assessment of long-term results are key points for the future of this procedure.
Cervical Disc Replacement: A Systematic Review of Medline Indexed Literature  [PDF]
Sudarshan Munigangaiah, John P. McCabe
International Journal of Clinical Medicine (IJCM) , 2013, DOI: 10.4236/ijcm.2013.47A1006
Abstract: Anterior Cervical Discectomy and Fusion (ACDF) currently remains as the gold standard treatment for cervical disc herniation and Degenerative Disc Disease (DDD) refractory to conservative management. Even though anterior cervical fusion provides excellent clinical results, it has been implicated in abnormal kinematic strain on adjacent disc level resulting in symptomatic adjacent segment disease. Anterior cervical disc replacement (ACDR) is an alternative procedure to anterior cervical discectomy and fusion. The aims of cervical disc replacement were to preserve the motion at the index level and to protect the adjacent levels from accelerated symptomatic degeneration. The aim of this systematic review was to evaluate the outcomes of cervical disc replacement published in MEDLINE indexed literature. A literature search was carried out in medical electronic database MEDLINE. Keywords used for the search were Cervical vertebrae, Cervical spine, Neck, Intervertebral disc, Total disc replacement, Arthroplasty, Replacement, Treatment outcome. Two authors reviewed titles and abstracts of all two hundred and thirty six hits. The articles that satisfied the inclusion criteria were critically appraised while remaining articles were discarded. Anterior cervical disc replacement is a relatively new technology in spinal surgery. There are several short and intermediate term follow-up studies to prove the safety and efficacy of ACDR with satisfactory clinical and radiological outcomes. More intermediate to long-term follow-up studies are needed to prove the safety and efficacy of ACDR.
Modelo de degenera??o do disco intervertebral por pun??o da cauda de ratos Wistar: avalia??o histológica e radiográfica
Pereira, Ana Carolina de C. Issy;Castania, Vitor;Jong, Joost J. A. de;Defino, Helton L. A.;Pitol, Dimitrius Leonardo;Iyomasa, Mamie Mizusaki;Del Bel, Elaine;
Coluna/Columna , 2010, DOI: 10.1590/S1808-18512010000400020
Abstract: objective: to report the induction of intervertebral disc degeneration of the rat caudal spine by needle puncture and its radiographic and histologic characterization. methods: adult male wistar rats were anesthetized, submitted to the x-ray and then to the needle puncture (20g) of intervertebral disc between the sixth and seventh (proximal segment) and the eighth and ninth (distal segment) coccygeal vertebrae. radiographies were taken 30 days after lesion for analysis of intervertebral disc height. the intermediate disc (7-8) to injured segments was not punctured and was considered as control. all segments were removed, fixed and demineralized, processed and stained with hematoxylin-eosin for histological evaluation. results: radiographic analysis revealed significant reduction in disc height of lesioned discs compared to control. similarly, histological analysis revealed significant changes in the nucleus pulposus and annulus fibrosus of the lesioned discs (proximal and distal) relative to the control. there was no difference in the intensity of injury between the proximal and distal discs. conclusion: the experimental model of tail intervertebral disc degeneration by needle puncture reproduced the steps of the intervertebral disc degeneration, assessed by different instruments, and it can be used for experimental evaluation of new therapeutic interventions for intervertebral disc degeneration process.
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