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Search Results for : Disc Displacement
Merck Online Lab
Diagnosis Therapy Rehabilitation Imaging Clinical Laboratory
Human nucleus pulposus cell cultures and disc degeneration grading systems: comment on the article by Le Maitre et al.
Author(s): Wang, HQ; Yu, XD; Liu, ZH; Li, XK; Luo, ZJ
Journal: Arthritis Rheum 2010 Mar 12; Vol. 62, Issue 1; Page(s) 301-2
[Medline ID - 19180480]

ABSTRACT NOT AVAILABLE

Clinical results and development of heterotopic ossification in total cervical disc replacement during a 4-year follow-up.
Author(s): Suchomel, P; Jur; ák, L; Benes, V; Brabec, R; Brad; ác, O; Elgawhary, S
Journal: Eur Spine J 2010 Jul 16; Vol. 19, Issue 2; Page(s) 307-15
[Medline ID - 20035357]

Cervical total disc replacement (CTDR) aims to decrease the incidence of adjacent segment disease through motion preservation in the operated disc space. Ongoing data collection and increasing number of studies describing heterotopic ossification (HO) resulting in decreased mobility of implants, forced us to carefully evaluate our long-term clinical and morphological results of patients with CTDR. We present the first 54 consecutive patients treated with 65 Pro discC prostheses during a 12-month period (2/2004-3/2005). All patients signed an informed consent and were included in prospective long-term study approved by hospital ethical committee. The 1- and 2-year follow-up analysis were available for all patients included and 4-year results for 50 patients (60 implants). Clinical (neck disability index-NDI, visual analog scale-VAS) and radiological follow-up was conducted at 1-, 2- and 4-years after the procedure. The Mehren/Suchomel modification of McAfee scale was used to classify the appearance of HO. Mean preoperative NDI was 34.5%, VAS for neck pain intensity 4.6 and VAS for arm pain intensity 5.0. At 1-, 2- and 4-year follow-up, the mean NDI was 30.7, 27.2, and 30.4, mean VAS for neck pain intensity 2.5, 2.1 and 2.9 and mean VAS for arm pain intensity pain 2.2, 1.9 and 2.3, respectively. Significant HO (grade III) was present in 45% of implants and segmental ankylosis (grade IV) in another 18% 4 years after intervention. This finding had no clinical consequences and 92% of patients would undergo the same surgery again. Our clinical results (NDI, VAS) are comparable with fusion techniques. Although, advanced non-fusion technology is used, a significant frequency of HO formation and spontaneous fusion in cervical disc replacement surgery must be anticipated during long-term follow-up.

Computer-aided diagnosis of lumbar disc pathology from clinical lower spine MRI.
Author(s): Alomari, RS; Corso, JJ; Chaudhary, V; Dhillon, G
Journal: Int J Comput Assist Radiol Surg 2010 Jun 26; Vol. 5, Issue 3; Page(s) 287-93
[Medline ID - 20033498]

PURPOSE: Detection of abnormal discs from clinical T2-weighted MR Images. This aids the radiologist as well as subsequent CAD methods in focusing only on abnormal discs for further diagnosis. Furthermore, it gives a degree of confidence about the abnormality of the intervertebral discs that helps the radiologist in making his decision. MATERIALS AND METHODS: We propose a probabilistic classifier for the detection of abnormality of intervertebral discs. We use three features to label abnormal discs that include appearance, location, and context. We model the abnormal disc appearance with a Gaussian model, the location with a 2D Gaussian model, and the context with a Gaussian model for the distance between abnormal discs. We infer on the middle slice of the T2-weighted MRI volume for each case. These MRI s cans are specific for the lumbar area. We obtain our gold standard for the ground truth from our collaborating radiologist group by having the clinical diagnosis report for each case. RESULTS: We achieve over 91% abnormality detection accuracy in a cross-validation experiment with 80 clinical cases. The experiment runs ten rounds; in each round, we randomly leave 30 cases out for testing and we use the other 50 cases for training. CONCLUSION: We achieve high accuracy for detection of abnormal discs using our proposed model that incorporates disc appearance, location, and context. We show the extendability of our proposed model to subsequent diagnosis tasks specific to each intervertebral disc abnormality such as desiccation and herniation.

Spontaneous regression of lumbar herniated disc.
Author(s): Chang, CW; Lai, PH; Yip, CM; Hsu, SS
Journal: J Chin Med Assoc 2010 Mar 11; Vol. 72, Issue 12; Page(s) 650-3
[Medline ID - 20028647]

Intervertebral disc herniation of the lumbar spine is a common disease presenting with low back pain and involving nerve root radiculopathy. Some neurological symptoms in the majority of patients frequently improve after a period of conservative treatment. This has been regarded as the result of a decrease of pressure exerted from the herniated disc on neighboring neurostructures and a gradual regression of inflammation. Recently, with a dvances in magnetic resonance imaging, many reports have demonstrated that the herniated disc has the potential for spontaneous regression. Regression coincided with the improvement of associated symptoms. However, the exact regression mechanism remains unclear. Here, we present 2 cases of lumbar intervertebral disc herniation with spontaneous regression. We review the literature and discuss the possible mechanisms, the precipitating factors of spontaneous disc regression and the proper timing of surgical intervention.

The impact of workers' compensation on outcomes of surgical and nonoperative therapy for patients with a lumbar disc herniation: SPORT.
Author(s): Atlas, SJ; Tosteson, TD; Blood, EA; Skinner, JS; Pransky, GS; Weinstein, JN
Journal: Spine (Phila Pa 1976) 2010 Mar 3; Vol. 35, Issue 1; Page(s) 89-97
[Medline ID - 20023603]

STUDY DESIGN: Prospective randomized and observational cohorts. OBJECTIVE: To compare outcomes of patients with and without workers' compensation who had surgical and nonoperative treatment for a lumbar intervertebral disc herniation (IDH). SUMMARY OF BACKGROUND DATA: Few studies have examined the association between worker's compensation and outcomes of surgical and nonoperative treatment. METHODS: Patients with at least 6 weeks of sciatica and a lumbar IDH were enrolled in either a randomized trial or observational cohort at 13 US spine centers. Patients were categorized as workers' compensation or nonworkers' compensation based on baseline disability compensation and work status. Treatment was usual nonoperative care or surgical discectomy. Outcomes included pain, functional impairment, satisfaction and work/disability status at 6 weeks, 3, 6, 12, and 24 months. RESULTS: Combining randomized and observational cohorts, 113 patients with workers' compensation and 811 patients without were followed for 2 years. There were significant improvements in pain, function, and satisfaction with both surgical and nonoperative treatment in both groups. In the nonworkers' compensation group, there was a clinically and statistically significant advantage for surgery at 3 months that remained significant at 2 years. However, in the workers' compensation group, the benefit of surgery diminished with time; at 2 years no significant advantage was seen for surgery in any outcome (treatment difference for SF-36 bodily pain [-5.9; 95% CI: -16.7-4.9] and physical function [5.0; 95% CI: -4.9-15]). Surgical treatment was not associated with better work or disability outcomes in either group. CONCLUSION: Patients with a lumbar IDH improved substantially with both surgical and nonoperative treatment. However, there was no added benefit associated with surgical treatment for patients with workers' compensation at 2 years while those in the nonworkers' compensation group had significantly greater improvement with surgical treatment.

Comparison of effectiveness according to different approaches of epidural steroid injection in lumbosacral herniated disk and spinal stenosis.
Author(s): Lee, JH; Moon, J; Lee, SH
Journal: J Back Musculoskelet Rehabil 2010 Apr 7; Vol. 22, Issue 2; Page(s) 83-9
[Medline ID - 20023335]

PURPOSE: This study was to compare the effectiveness of the translaminar, caudal, and transforaminal technique with small and large volume of injectate in the treatment of lumbosacral herniation of intervetebral disc (HIVD) or spinal stenosis (SS). METHOD: Medical records reviewed retrospectively were of patients with radicular pain over 3 months and had diagnosed as HIVD or SS. Patients who underwent four weeks of treatments such as analgesics, anti-inflammatory drugs, or physical therapy for radicular pain with no improvement and afterwards received ESI were selected. Exclusion criteria was those who had suffered trauma, patients with other serious diseases, patients demonstrating adverse reactions to the medications, and patients with more than two levels of disease. The number of HIVD and SS group is 95 and 138, respectively. Visual Analog Scale (VAS) pain score, Patient Satisfaction Index (PSI), and Roland 5-point pain score were compared between different epidural approaches at pretreatment, 2 weeks, 1 month, and 2 months after treatment. RESULTS: Higher ratio of successful results was found in translaminar and transforaminal techniques than caudal technique in VAS in the HIVD group and in VAS and PSI in the SS group. Reduction of Roland score was maintained until 2 months in all techniques in HIVD and SS groups. In SS group, transforaminal groups showed more reduction of Roland score than caudal approach. No difference was found between small and large volume of transforaminal techniques. CONCLUSION: Translaminar and transforaminal approach were more effective than caudal approach in HIVD and SS groups. Especially, effectiveness of transforaminal approach was more prominent in SS group as compared with HIVD group.

The relationship between chronic type III acromioclavicular joint dislocation and cervical spine pain.
Author(s): Gumina, S; Carbone, S; Arceri, V; Rita, A; Vestri, AR; Postacchini, F
Journal: BMC Musculoskelet Disord 2010 Mar 24; Vol. 10; Page(s) 157
[Medline ID - 20015356]

BACKGROUND: This study was aimed at evaluating whether or not patients with chronic type III acromioclavicular dislocation develop cervical spine pain and degenerative changes more frequently than normal subjects. METHODS: The cervical spine of 34 patients with chronic type III AC dislocation was radiographically evaluated. Osteophytosis presence was registered and the narrowing of the intervertebral disc and cervical lordosis were evaluated. Subjective cervical symptoms were investigated using the Northwick Park Neck Pain Questionnaire (NPQ). One-hundred healthy volunteers were recruited as a control group. RESULTS: The rate and distribution of osteophytosis and narrowed intervertebral disc were similar in both of the groups. Patients with chronic AC dislocation had a lower value of cervical lordosis. NPQ score was 17.3% in patients with AC separation (100% = the worst result) and 2.2% in the control group (p < 0.05). An inverse significant nonparametric correlation was found between the NPQ value and the lordosis degree in the AC dislocation group (p = 0.001) wheras results were not correlated (p = 0.27) in the control group. CONCLUSIONS: Our study shows that chronic type III AC dislocation does not interfere with osteophytes formation or intervertebral disc narrowing, but that it may predispose cervical hypolordosis. The higher average NPQ values were observed in patients with chronic AC dislocation, especially in those that developed cervical hypolordosis.

Dural lesions in lumbar disc herniation surgery: incidence, risk factors, and outcome.
Author(s): Str; ömqvist, F; J; önsson, B; Str; ömqvist, B
Journal: Eur Spine J 2010 Jun 3; Vol. 19, Issue 3; Page(s) 439-42
[Medline ID - 20013002]

In lumbar disc herniation surgery, dural lesions seem to be the most common complication today. Studies on incidence of and outcome after a dural lesion are mainly based on retrospective studies. In a prospective study within the framework of the Swedish Spine Register, 4,173 patients operated on for lumbar disc herniation were evaluated using pre- and 1-year postoperative protocols and complication registration. Mean patient age was 41 (18-81) years and 53% of the patients were male. 93% of the operations were performed on the two lowermost lumbar levels. The incidence of dural lesions in the material was 2.7%. In patients with previous disc surgery, the incidence was doubled, 5%, a significant increase (P = 0.02). Patients with dural lesions preoperatively had more back pain and inferior scores in general health and role emotional domains of the SF-36. These factors, however, were because they had been operated on previously, not related to the dural lesion as such. The relative improvement after surgery was similar whether a dural lesion had occurred or not. It is concluded that a dural lesion is a technical complication which must be solved at the time of surgery but which does not bear any negative implications on the long-term outcome for the patient.

Schmorl's nodes distribution in the human spine and its possible etiology.
Author(s): Dar, G; Masharawi, Y; Peleg, S; Steinberg, N; May, H; Medlej, B; Peled, N; Hershkovitz, I
Journal: Eur Spine J 2010 Jun 15; Vol. 19, Issue 4; Page(s) 670-5
[Medline ID - 20012754]

Although Schmorl's nodes (SNs) are a common phenomenon in the normal adult population, their prevalence is controversial and etiology still debatable. The objective was to establish the spatial distribution of SNs along the spine in order to reveal its pathophysiology. In this study, we examined 240 human skeleton spines (T4-L5) (from the Hamann-Todd Osteological Collection) for the presence and location of SNs. To determine the exact position of SNs, each vertebral body surface was divided into 13 zones and 3 areas (anterior, middle, posterior). Our results show that SNs appeared more frequently in the T7-L1 region. The total number of SNs found in our sample was 511: 193 (37.7%) were located on the superior surface and 318 (62.3%) on the inferior surface of the vertebral body. SNs were more commonly found in the middle part of the vertebral body (63.7%). No association was found between the SNs location along the spine and gender, ethnicity and age. This study suggests that the frequency distribution of SNs varies with vertebra location and surface. The results do not lend support to the traumatic or disease explanation of the phenomenon. SNs occurrences are probably associated with the vertebra development process during early life, the nucleus pulposus pressing the weakest part of the end plate in addition to the various strains on the vertebrae and the intervertebral disc along the spine during spinal movements (especially torsional movements).

Choice of surgical approach for ossification of the posterior longitudinal ligament in combination with cervical disc hernia.
Author(s): Yang, HS; Chen, DY; Lu, XH; Yang, LL; Yan, WJ; Yuan, W; Chen, Y
Journal: Eur Spine J 2010 Jun 3; Vol. 19, Issue 3; Page(s) 494-501
[Medline ID - 20012451]

Ossification of the posterior longitudinal ligament (OPLL) is a common spinal disorder that presents with or without cervical myelopathy. Furthermore, there is evidence suggesting that OPLL often coexists with cervical disc hernia (CDH), and that the latter is the more important compression factor. To raise the awareness of CDH in OPLL for spinal surgeons, we performed a retrospective study on 142 patients with radiologically proven OPLL who had received surgery between January 2004 and January 2008 in our hospital. Plain radiograph, three-dimensional computed tomography construction (3D CT), and magnetic resonance imaging (MRI) of the cervical spine were all performed. Twenty-six patients with obvious CDH (15 of segmental-type, nine of mixed-type, two of continuous-type) were selected via clinical and radiographic features, and intrao perative findings. By MRI, the most commonly involved level was C5/6, followed by C3/4, C4/5, and C6/7. The areas of greatest spinal cord compression were at the disc levels because of herniated cervical discs. Eight patients were decompressed via anterior cervical discectomy and fusion (ACDF), 13 patients via anterior cervical corpectomy and fusion (ACCF), and five patients via ACDF combined with posterior laminectomy and fusion. The outcomes were all favorable. In conclusion, surgeons should consider the potential for CDH when performing spinal cord decompression and deciding the surgical approach in patients presenting with OPLL.
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