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Non operative management of spinal intervertebral disc

Justin Gibson, Aria Nouri, Bryan Krueger, Nikita Lakomkin, Rani Nasser, David Gimbel, Joseph Cheng
Degenerative Cervical Myelopathy (DCM) is the most common form of spinal cord impairment in adults and results in disability and reduced quality of life. DCM can present with a wide set of clinical and imaging findings, including: 1) pain and reduced range of motion of the neck, and motor and sensory deficits on clinical exam, and 2) cord compression due to static and dynamic injury mechanisms resulting from degenerative changes of the bone, ligaments, and intervertebral discs on MRI. The incidence and prevalence of DCM has been estimated at a minimum of 4...
March 2018: Yale Journal of Biology and Medicine
Seung Yeop Lee, Tae-Hwan Kim, Jae Keun Oh, Seung Jin Lee, Moon Soo Park
Degeneration of the intervertebral disc results in initial relative instability, hypermobility, and hypertrophy of the facet joints, particularly at the superior articular process. This finally leads to a reduction of the spinal canal dimensions and compression of the neural elements, which can result in neurogenic intermittent claudication caused by venous congestion and arterial hypertension around nerve roots. Most patients with symptomatic lumbar stenosis had neurogenic intermittent claudication with the risk of a fall...
October 2015: Asian Spine Journal
G-S Miao, Z-H Liu, S-X Wei, J-G Luo, Z-J Fu, T Sun
Inflammatory response induced by protrused nucleus pulposus (NP) has been shown to play a crucial role in the process of radicular pain. Lipoxins represent a unique class of lipid mediators that have anti-inflammatory and pro-resolving action. The present study was undertaken to investigate if intrathecal lipoxin A4 (LXA4) could alleviate mechanical allodynia in the rat models of application of NP to the L5 dorsal root ganglion (DRG). Non-compressive models of application of NP to L5 DRG were established and intrathecal catheterization for drug administration was performed in rats...
August 6, 2015: Neuroscience
Cong Xu, Wen-Fei Ni, Nai-Feng Tian, Xu-Qi Hu, Fan Li, Hua-Zi Xu
PURPOSE: The purpose of this study was to quantify the intra- and postoperative complications of an interspinous process device (Coflex) in managing degenerative lumbar diseases and to investigate corresponding therapeutic strategies. METHODS: Between January 2008 and December 2012, we retrospectively analysed a total of 131 patients who underwent decompressive surgery along with the Coflex system for the treatment of degenerative lumbar diseases. The related complications were reported, and appropriate measures were taken...
November 2013: International Orthopaedics
Chih-Hsiang Liao, Jau-Ching Wu, Wen-Cheng Huang, Wei-Hsin Wang, Peng-Yuan Chang, Henrich Cheng, Yang-Shih
Surgical treatment of thoracic disc herniation is technically challenging from anterior, lateral or posterior approaches. Because of the deeply located thoracic discs and non-retractable thoracic thecal sac, standard anterior and lateral procedures for discectomy require extensive tissue dissection causing prolonged lengths of stay in hospital. In this video, the authors present a case of calcified disc herniation at the level of T10/11 causing paraplegia and voiding difficulty. The patient was operated on via an endoscope-assisted minimally invasive transforaminal thoracic interbody fusion (EA-TTIF)...
July 2013: Neurosurgical Focus
H Sharma, S W J Lee, A A Cole
Spinal stenosis and disc herniation are the two most frequent causes of lumbosacral nerve root compression. This can result in muscle weakness and present with or without pain. The difficulty when managing patients with these conditions is knowing when surgery is better than non-operative treatment: the evidence is controversial. Younger patients with a lesser degree of weakness for a shorter period of time have been shown to respond better to surgical treatment than older patients with greater weakness for longer...
November 2012: Journal of Bone and Joint Surgery. British Volume
Dragica Vrabec-Matković, Vesna Budisin, Renato Pahić
Cervical spondylotic myelopathy is a disease of high variability and its progressive form leads to severe disability. This paper reports on a case of a 31-year-old woman with whiplash neck injury sustained at the age of 11, and subsequent neck pain and numbness of arms. Slow progression of symptoms led to tetraparesis, and C3C4 disc herniation along with cervical myelopathy were revealed at the age of 26. Previously, she started a treatment for hypothyroidism. She underwent anterior cervical discectomy and fusion...
August 2011: Medicinski Glasnik
Ganesh Prasad, Syed M R Kabir, Asif Saifuddin, Adrian T H Casey
The treatment of discal cysts is controversial, with different surgical options described in the literature. We present an interesting case of spontaneous resolution of a symptomatic discal cyst. Based on our case report, we recommend non-operative management in the first instance and an up-to-date MRI scan before contemplating surgery.
December 2011: British Journal of Neurosurgery
K Quenum, O Coulibaly, Y Arkha, S Derraz, A El Ouahabi, A El Khamlichi
BACKGROUND: Spinal cord injury with no radiographic bone lesion described as spinal cord injury without radiographic abnormality (SCIWORA) in childhood is less often reported in adults than in children. This study was undertaken to report our experience in the management of nine cases over 25 years. PATIENTS AND METHODS: This was a retrospective study from 1985 to 2009 concerning nine adult patients who sustained spinal cord injury with no radiographic abnormality...
February 2011: Neuro-Chirurgie
F Postacchini, R Postacchini
Removal of a herniated disc with the use of the operative microscope was first performed by Yasargil (Adv Neurosurg. 4:81-2, 1977) in 1977. However, it began to be used more and more only in the late 1980s (McCulloch JA (1989) Principles of microsurgery for lumbar disc disease. Raven Press, New York). In the 1990s, many spinal surgeons abandoned conventional discectomy with naked-eye to pass to the routine practice of microdiscectomy. The merits of this technique are that it allows every type of disc herniation to be excised through a short approach to skin, fascia and muscles as well as a limited laminoarthrectomy...
2011: Acta Neurochirurgica. Supplement
Vivek A Mehta, Matthew J McGirt, Giannina L Garcés Ambrossi, Scott L Parker, Daniel M Sciubba, Ali Bydon, Jean-Paul Wolinsky, Ziya L Gokaslan, Timothy F Witham
BACKGROUND: Posterior lumbar interbody fusion (PLIF) and trans-foraminal lumbar interbody fusion (TLIF) are both accepted surgical approaches for spinal fusion in spondylolisthesis and degenerative disc disease. The unilateral approach of TLIF may minimize the risk of iatrogenic durotomy and nerve root injury; however, there is no definitive evidence to support either approach. We review our experience with TLIF versus PLIF to compare operative complications. METHODS: We retrospectively reviewed 119 consecutive cases of PLIF or TLIF performed for degenerative disc disease or spondylolithesis at a single institution over 5 years and examined the incidences of operative complications and outcomes...
January 2011: Neurological Research
Oliver M Mueller, Thomas Gasser, Arnd Hellwig, Christian Dohna-Schwake, Ulrich Sure
PURPOSE: Instable upper cervical spine injuries (CSI) in very young children are rare and consecutively only few data on the treatment and operative approaches exist in the literature. Hence, we suggest an operative strategy in the case of a 15-month-old infant treated for an instable CSI at the level of C2/3 at our department. Detailed steps of the operation with special consideration to the challenging anatomy of the immature spine are presented. METHODS: A toddler suffered a CSI without neurological deficits after a stair fall...
November 2010: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
M Ortega-Martínez, J M Cabezudo, I Fernández-Portales, L Gómez-Perals, L M Bernal-García
Calcification of intervertebral discs is a rare occurrence in children. Although the etiology of the calcification remains uncertain, it is no related with degenerative diseases. The clinical picture is non specific with neck pain, muscle contractures and, sometimes, low-grade fever. These symptoms generally disappear spontaneously, and surgery rarely becomes necessary. In our review of the literature, we have found only seventeen cases requiring surgical management. Two of these children had been previously diagnosed with calcified intervertebral discs, but at the time no herniation had been ruled out with magnetic resonance imaging (MRI)...
August 2006: Neurocirugía
Yossi Smorgick, Yigal Mirovsky, Nahshon Rand
Degenerative lumbar spinal stenosis (LSS) is a common cause of disabling back and leg pain, and spinal claudication among older persons. As the population grows older this condition is encountered more frequently. The degeneration of the intervertebral discs and the facet joints results in the narrowing of the spinal canal and neural foramina. Non-operative management is often of limited value and includes physical therapy, anti-inflammatory medications, and the injection of epidural steroids. The condition of a substantial portion of the patients does not deteriorate and remains unchanged...
April 2005: Harefuah
Justin F Fraser, Russel C Huang, Federico P Girardi, Frank P Cammisa
Sagittal- or coronal-plane deformity considerably complicates the diagnosis and treatment of lumbar spinal stenosis. Although decompressive laminectomy remains the standard operative treatment for uncomplicated lumbar spinal stenosis, the management of stenosis with concurrent deformity may require osteotomy, laminectomy, and spinal fusion with or without instrumentation. Broadly stated, the surgery-related goals in complex stenosis are neural decompression and a well-balanced sagittal and coronal fusion. Deformities that may present with concurrent stenosis are scoliosis, spondylolisthesis, and flatback deformity...
January 15, 2003: Neurosurgical Focus
Guglielmo Manenti, Giovanni Liccardo, Gianluigi Sergiacomi, Luigi Ferrante, Giancarlo D'Andrea, Daniel Konda, Bernardo Fraioli, Orazio Schillaci, Giovanni Simonetti, Salvatore Masala
BACKGROUND: The aim of our study was to evaluate the incoming interrelations between chronic low back pain and biomechanical changes of the lumbar spine, using an MRI-compatible axial-loading device mimicking the standing position. MATERIALS AND METHODS: Fifty consecutive patients (28 males and 22 females), with both chronic low pack pain and recurrent painful blockages, were selected and studied using a 1.5 T Gyroscan Intera Philips MRI unit (Philips, Best, Holland) and a dedicated axial loading apparatus (MIKAI manufacturing, Genoa, Italy)...
September 2003: In Vivo
B Fromm
Up to 20% of all patients with pectoral symptoms have an underlying orthopedic problem. The most common orthopedic conditions that may mimic chest pain radiating into the left arm include slipped disc, cervicothoracic tension syndrome, blockage of intervertebral or rib joints, and intercostal neuralgia. Less common causes of such pain are arthrosis of the shoulder, spondylocystitis, osteoporotic fractures or tumors of the bone. Management is oriented to the underlying cause, and treatment extends from physiotherapeutic measures (rest, heat treatment) via medication (non-steroidal anti-inflammatory drugs, myotonolytic agents) to operative interventions...
April 25, 2002: MMW Fortschritte der Medizin
L Y Dai, L S Jia, W Yuan, B Ni, H B Zhu
Forty-six patients with lumbar spondylolysis and mild isthmic spondylolisthesis were managed with direct repair of the defect with or without facet joint fusion in the affected segment. There were 24 males and 22 females, ranging in age from 15 to 56 years (average, 38.2 years). These patients had experienced clinical symptoms due to spondylolysis for between 4 months and 20 years (average, 5.3 years). Of 46 patients, 28 had no spondylolisthesis, 11 had Meyerding grade I vertebral slippage and 7 had grade II...
February 2001: European Spine Journal
N G Rainov, V Heidecke, W Burkert
The neurosurgical management in a rare case of vertical axis fracture is presented along with discussion of the supposed pathogenetic mechanisms and the biomechanics underlying this type of cervical spine injury. Comprehensive neuroradiological investigation prior to surgery clearly demonstrated the dislocation of the anterior part of the axis body with concomitant C 2/C 3-disk injury. Therefore, the unstable fracture had to be managed by a one-time combined ventrodorsal approach using anterior C 2-C 3 locking plate fusion and C 2 bilateral dorsal transpedicular screw fixation...
June 1998: Minimally Invasive Neurosurgery: MIN
J M Simpson, C P Silveri, R A Balderston, F A Simeone, H S An
The results for sixty-two patients who had had a diagnosis of diabetes mellitus and lumbar disc disease or spinal stenosis and had been managed with a posterior decompressive procedure were compared, in a retrospective study, with those for sixty-two age and sex-matched non-diabetic (control) patients who had had similar operative procedures. Forty-four of the sixty-two diabetic patients and fifty-five of the non-diabetic patients were available for long-term follow-up (mean, five and seven years, respectively)...
December 1993: Journal of Bone and Joint Surgery. American Volume
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