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The Journal of the American Academy of... Jul 2023Steroids are commonly used in spine pathologies. A broad range of providers from different specialties such as primary care, emergency medicine, and spine surgeons use... (Review)
Review
Steroids are commonly used in spine pathologies. A broad range of providers from different specialties such as primary care, emergency medicine, and spine surgeons use steroids. The indications and controversies of steroid use are discussed in this article. A literature review was conducted on the use of steroids in spine pathologies. Steroids have been successfully used in anterior cervical discectomy and fusion (ACDF) to prevent dysphagia, in spinal cord injuries to improve neurological function, in acute back and neck pain for pain control, and in spinal metastasis. Steroid injections have been used for axial as well as radicular pain. Techniques and complications are further discussed. Local and systemic steroids have been successful in preventing dysphagia after anterior cervical diskectomy and fusion. Steroids failed to improve the neurologic outcomes after spinal cord injuries, and they were associated with multiple complications. Systemic steroids have not been proven to provide better clinical outcomes for acute low back pain. Steroid injections are more effective in radicular pain rather than axial pain. There are not enough high-quality studies on the use of steroids for metastatic spinal cord compression.
Topics: Humans; Deglutition Disorders; Cervical Vertebrae; Low Back Pain; Steroids; Spinal Cord Injuries; Spinal Fusion; Diskectomy; Treatment Outcome
PubMed: 37184471
DOI: 10.5435/JAAOS-D-22-00971 -
Ugeskrift For Laeger Oct 2023The technical development has caused a reintroduction of endoscopic techniques directed towards degenerative spine disease. A summary of the endoscopic procedure is... (Review)
Review
The technical development has caused a reintroduction of endoscopic techniques directed towards degenerative spine disease. A summary of the endoscopic procedure is given in this review. The spinal canal is reached through an inter-laminar or transforaminal access. In comparison with open surgery the percutaneous transforaminal access seems especially advantageous for the removal of paramedian and/or foraminal herniated disc material. However, careful patient selection is required, as the restricted manoeuverability and working zone of the endoscope and patient specific pathoanatomy in some cases will disfavour endoscopy.
Topics: Humans; Intervertebral Disc Displacement; Diskectomy, Percutaneous; Treatment Outcome; Lumbar Vertebrae; Endoscopy; Retrospective Studies
PubMed: 37921109
DOI: No ID Found -
World Neurosurgery Jan 2024The burden of disease regarding lumbar and cervical spine pain is a long-standing, pervasive problem within medicine that has yet to be resolved. Specifically, neck and... (Review)
Review
The burden of disease regarding lumbar and cervical spine pain is a long-standing, pervasive problem within medicine that has yet to be resolved. Specifically, neck and back pain are associated with chronic pain, disability, and exorbitant health care use worldwide, which have only been exacerbated by the increase in overall life years and chronic disease. Traditionally, patients with significant pain and disability secondary to disease of either the cervical or lumbar spine are treated via fusion or discectomy. Although these interventions have proved curative in the short-term, numerous longitudinal studies evaluating the efficacy of traditional management have reported severe impairment of normal spinal range of motion, as well as postoperative complications, including neurologic injury, radiculopathy, osteolysis, subsidence, and infection, paired with less than desirable reoperation rates. Consequently, there is a call for innovation and improvement in the treatment of lumbar and cervical spine pain, which may be answered by a modern technique known as intervertebral disc arthroplasty, or total disc replacement (TDR). Thus, this review aims to describe the management strategy of TDR and to explore updated considerations for its use in practice, both to help guide clinical decision making.
Topics: Humans; Intervertebral Disc Degeneration; Total Disc Replacement; Intervertebral Disc; Diskectomy; Neck Pain; Treatment Outcome; Spinal Fusion; Cervical Vertebrae; Follow-Up Studies
PubMed: 37777178
DOI: 10.1016/j.wneu.2023.09.100 -
Journal of Neurosciences in Rural... 2024A rare case of aneurysm of the lateral sacral artery is reported. This 46-year-old female presented with complaints of bowel and bladder incontinence and decreased...
A rare case of aneurysm of the lateral sacral artery is reported. This 46-year-old female presented with complaints of bowel and bladder incontinence and decreased perianal sensation for the past 15 months. She underwent laminectomy and diskectomy for the diagnosis of a prolapsed disk at peripheral hospital where the surgeon was confronted with a severe and unexpected hemorrhage, and surgery was aborted without effective treatment. Prior medical history includes hypertensive kidney disease with a renal transplant eight years ago. Magnetic resonance imaging and angiographic findings were suggestive of a lateral sacral artery aneurysm. Patient with a history of renal transplant and presenting with cauda equina require a more thorough assessment, and a differential of lateral sacral artery aneurysm should always be kept in mind. Our purpose is to report the pre-operative features of the lateral sacral artery aneurysm and its treatment modalities.
PubMed: 38746530
DOI: 10.25259/JNRP_335_2023 -
Spine Dec 2023Retrospective review of a prospectively maintained multisurgeon registry.
STUDY DESIGN
Retrospective review of a prospectively maintained multisurgeon registry.
OBJECTIVE
To study recovery kinetics and associated factors after cervical spine surgery.
SUMMARY OF BACKGROUND DATA
Few studies have described return to activities cervical spine surgery. This is a big gap in the literature, as preoperative counseling and expectations before surgery are important.
MATERIALS AND METHODS
Patients who underwent either anterior cervical discectomy and fusion (ACDF) or cervical disk replacement (CDR) were included. Data collected included preoperative patient-reported outcome measures, return to driving, return to working, and discontinuation of opioids data. A multivariable regression was conducted to identify the factors associated with return to driving by 15 days, return to working by 15 days, and discontinuing opioids by 30 days.
RESULTS
Seventy ACDF patients and 70 CDR patients were included. Overall, 98.2% of ACDF patients and 98% of CDR patients returned to driving in 16 and 12 days, respectively; 85.7% of ACDF patients and 90.9% of CDR patients returned to work in 16 and 14 days; and 98.3% of ACDF patients and 98.3% of CDR patients discontinued opioids in a median of seven and six days. Though not significant, minimal (odds ratio (OR)=1.65) and moderate (OR=1.79) disability was associated with greater odds of returning to driving by 15 days. Sedentary work (OR=0.8) and preoperative narcotics (OR=0.86) were associated with decreased odds of returning to driving by 15 days. Medium (OR=0.81) and heavy (OR=0.78) intensity occupations were associated with decreased odds of returning to work by 15 days. High school education (OR=0.75), sedentary work (OR=0.79), and retired/not working (OR=0.69) were all associated with decreased odds of discontinuing opioids by 30 days.
CONCLUSIONS
Recovery kinetics for ACDF and CDR are comparable. Most patients return to all activities after ACDF and CDR within 16 days. These findings serve as an important compass for preoperative counseling.
Topics: Humans; Cervical Vertebrae; Spinal Fusion; Total Disc Replacement; Neck; Diskectomy; Analgesics, Opioid; Retrospective Studies; Treatment Outcome
PubMed: 37728119
DOI: 10.1097/BRS.0000000000004830 -
Journal of Visualized Experiments : JoVE Sep 2023With technical advancements, the full-endoscopic transforaminal approach for lumbar discectomy (ETALD) is gaining popularity. This technique utilizes various tools and...
With technical advancements, the full-endoscopic transforaminal approach for lumbar discectomy (ETALD) is gaining popularity. This technique utilizes various tools and instruments, including a dilator, a beveled working sleeve, and an endoscope with a 20-degree angle and 177 mm length, equipped with a 9.3-diameter oval shaft and a 5.6 mm diameter working channel. Additionally, the procedure involves using a Kerrison punch (5.5 mm), rongeur (3-4 mm), punch (5.4 mm), tip control radioablator applying a radiofrequency current of 4 MHz, fluid control irrigation and suction pump device, 5.5 mm oval burr with lateral protection, burr round, and the diamond round. During the surgery, it is essential to identify significant landmarks, including the caudal pedicle, ascending facet, annulus fibrosis, posterior longitudinal ligament, and the exiting nerve root. The steps of the technique are relatively easy to follow, especially when utilizing the appropriate instruments and having a good understanding of the anatomy. Research studies have demonstrated comparable outcomes to open microdiscectomy techniques. ETALD presents itself as a safe option for lumbar discectomy, as it minimizes tissue disruption, results in low postoperative surgical site pain, and allows for early mobilization.
Topics: Humans; Intervertebral Disc Displacement; Diskectomy, Percutaneous; Lumbar Vertebrae; Endoscopy; Diskectomy; Pain, Postoperative; Treatment Outcome; Retrospective Studies
PubMed: 37747222
DOI: 10.3791/65508 -
Journal of Orthopaedic Science :... Nov 2023Lumbar disc herniation (LDH) is most common in men aged 20-40 at the L4/5 level; however, left-right differences have not been reported. Improving our understanding of...
BACKGROUND
Lumbar disc herniation (LDH) is most common in men aged 20-40 at the L4/5 level; however, left-right differences have not been reported. Improving our understanding of left- and right-side LDH may facilitate the estimation of mechanical load on intervertebral discs. Here, we assessed left-right differences in LDH via a retrospective analysis of LDH cases.
METHODS
Among 10,972 surgical cases of LDH identified in the Nagoya Spine Group database, 2899 in which right- and left-LDH sides were observable in a single vertebral segment were identified (mean age 46.3 ± 16.6 years, 2028 males). The following characteristics of patients with right- and left-LDH were compared: age, LDH level, surgical technique, operative time, blood loss, length of hospital stay, preoperative Japan Orthopaedic Association (JOA) score, and JOA recovery rate.
RESULTS
LDH occurred on the right and left sides in 1358 and 1541 patients, respectively, with patients with right-side LDH significantly older than those with left (47.9 ± 16.6 versus 45.0 ± 16.5, respectively; p < 0.001). No between-group differences in sex, age, LDH level, surgical technique, operative time, blood loss, length of hospital stay, preoperative JOA score, or JOA recovery rate were observed. The occurrence of right-side LDH increased with age, occurring in 42.7%, 45.1%, 49.9%, and 54.7% of patients aged 10-29, 30-49, 50-69, and 70-89 years, respectively.
CONCLUSION
Left-side LDH was observed more frequently than right; however, right-side LDH incidence increased with age. No significant between-group differences regarding symptoms, treatments, or outcomes were observed.
Topics: Male; Humans; Adult; Middle Aged; Child; Intervertebral Disc Displacement; Retrospective Studies; Treatment Outcome; Lumbar Vertebrae; Diskectomy
PubMed: 36371340
DOI: 10.1016/j.jos.2022.10.003 -
Clinical Spine Surgery Nov 2023A narrative review. (Review)
Review
STUDY DESIGN
A narrative review.
OBJECTIVE
This review discusses the short and long-term complications associated with cervical disc arthroplasty (CDA).
SUMMARY OF BACKGROUND DATA
CDA is a safe and effective motion-sparing alternative to fusion for the treatment of cervical disc pathology in patients with cervical radiculopathy or myelopathy. Although CDA offers advantages over fusion within a narrower set of indications, it introduces new technical challenges and potential complications.
METHODS
A systematic search of several large databases, including Cochrane Central, PubMed, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry, was conducted from January 2005 to August 2023 to identify published studies and clinical trials evaluating cervical disc replacement complications and outcomes.
RESULTS
Short-term complications are primarily related to surgical approach and include dysphagia reported as high as ~70%, laryngeal nerve injury ~0%-1.25%, Horner syndrome ~0.06%, hematoma ~0.01%, gross device extrusion ~0.3%, whereas long-term complications include adjacent segment disease reported at ~3.8%, osteolysis ~44%-64%, heterotopic ossification ~7.3%-69.2%, implant failure ~3.3%-3.7%, and implant wear, which varies depending on design.
CONCLUSIONS
Approaches for mitigating complications broadly include meticulous dissection, intraoperative techniques, and diligent postoperative follow-up. This review emphasizes the need for a comprehensive understanding and management of complications to enhance the safety, reproducibility, and success of CDA. As CDA continues to evolve, there remains a critical need for ongoing research to delve deeper into evaluating risk for complications and long-term patient outcomes.
Topics: Humans; Intervertebral Disc Degeneration; Treatment Outcome; Diskectomy; Reproducibility of Results; Cervical Vertebrae; Arthroplasty; Spinal Fusion
PubMed: 37752635
DOI: 10.1097/BSD.0000000000001541