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The Journal of the American Academy of... Nov 2011Pediatric disk herniation is a rare condition that should be considered in the differential diagnosis of the child with back pain or radiating leg pain. Because... (Review)
Review
Pediatric disk herniation is a rare condition that should be considered in the differential diagnosis of the child with back pain or radiating leg pain. Because pediatric disk herniation is relatively uncommon, there is typically a delay in diagnosis compared with time to diagnosis of adult disk herniation. Pediatric disk herniations are often recalcitrant to nonsurgical care, but such measures should be attempted in patients who present with isolated pain symptoms and have a normal neurologic examination. Twenty-eight percent of adolescent disk herniations involve apophyseal fractures; this presentation has a higher rate of surgical intervention than do herniations without fracture. Surgical management of pediatric disk herniation involves laminotomy and fragment excision. Short-term data demonstrate excellent pain relief, with 1% of children requiring repeat surgery for lumbar disk pathology in the first year. Long-term data suggest that 20% to 30% of patients will require additional surgery later in life.
Topics: Child; Diagnosis, Differential; Humans; Intervertebral Disc Displacement; Laminectomy; Magnetic Resonance Imaging; Physical Examination; Prognosis; Risk Factors
PubMed: 22052641
DOI: 10.5435/00124635-201111000-00001 -
Frontiers in Physiology 2023The sarcomere is the smallest functional unit of muscle contraction. It is delineated by a protein-rich structure known as the Z-disk, alternating with M-bands. The... (Review)
Review
The sarcomere is the smallest functional unit of muscle contraction. It is delineated by a protein-rich structure known as the Z-disk, alternating with M-bands. The Z-disk anchors the actin-rich thin filaments and plays a crucial role in maintaining the mechanical stability of the cardiac muscle. A multitude of proteins interact with each other at the Z-disk and they regulate the mechanical properties of the thin filaments. Over the past 2 decades, the role of the Z-disk in cardiac muscle contraction has been assessed widely, however, the impact of genetic variants in Z-disk proteins has still not been fully elucidated. This review discusses the various Z-disk proteins (alpha-actinin, filamin C, titin, muscle LIM protein, telethonin, myopalladin, nebulette, and nexilin) and Z-disk-associated proteins (desmin, and obscurin) and their role in cardiac structural stability and intracellular signaling. This review further explores how genetic variants of Z-disk proteins are linked to inherited cardiac conditions termed cardiomyopathies.
PubMed: 36935760
DOI: 10.3389/fphys.2023.1143858 -
Survey of Ophthalmology 2016Optic disk drusen occur in 0.4% of children and consist of acellular intracellular and extracellular deposits that often become calcified over time. They are typically... (Review)
Review
Optic disk drusen occur in 0.4% of children and consist of acellular intracellular and extracellular deposits that often become calcified over time. They are typically buried early in life and generally become superficial, and therefore visible, later in childhood, at the average age of 12 years. Their main clinical significance lies in the ability of optic disk drusen, particularly when buried, to simulate true optic disk edema. Misdiagnosing drusen as true disk edema may lead to an invasive and unnecessary workup for elevated intracranial pressure. Ancillary testing, including ultrasonography, fluorescein angiography, fundus autofluorescence, and optical coherence tomography, may aid in the correct diagnosis of optic disk drusen. Complications of optic disk drusen in children include visual field defects, hemorrhages, choroidal neovascular membrane, nonarteritic anterior ischemic optic neuropathy, and retinal vascular occlusions. Treatment options for these complications include ocular hypotensive agents for visual field defects and intravitreal anti-vascular endothelial growth factor agents for choroidal neovascular membranes. In most cases, however, children with optic disk drusen can be managed by observation with serial examinations and visual field testing once true optic disk edema has been excluded.
Topics: Child; Fluorescein Angiography; Fundus Oculi; Global Health; Humans; Incidence; Optic Disk; Optic Disk Drusen; Tomography, Optical Coherence; Visual Acuity; Visual Fields
PubMed: 27033945
DOI: 10.1016/j.survophthal.2016.03.007 -
Survey of Ophthalmology 2002Optic disk drusen occur in 3.4 to 24 per 1,000 population and are bilateral in approximately 75%. Disturbance in the axonal metabolism in the presence of a small scleral... (Review)
Review
Optic disk drusen occur in 3.4 to 24 per 1,000 population and are bilateral in approximately 75%. Disturbance in the axonal metabolism in the presence of a small scleral canal--regardless of eyelength--is considered responsible for the development. The drusen increase in size, becoming more visible with age due to continuing calcium apposition, and they are associated with visual field defects in a considerable number of patients. Patients do not usually notice these defects, despite their progressive nature over the years, and this indicates an insidious course. A correct diagnosis of optic disk drusen is mandatory, although effective treatment is not yet available. It is most important to differentiate optic disk drusen from papilledema in order to avoid unnecessary neurological examinations, but also to avoid overlooking genuine neurologic disorders. Because optic disk drusen can cause severe visual field defects, patients require individual consultation regarding work issues and whether or not to drive. Optic disk drusen can be accompanied by vascular complications as well. In some cases these vascular changes--for example, choroidal neovascularization--are treatable. Patients with optic disk drusen should undergo regular visual field, IOP, and nerve fiber layer examinations. In patients with deteriorating visual field and borderline IOP, we recommend antiglaucomatous therapy.
Topics: Diagnosis, Differential; Diagnostic Techniques, Ophthalmological; Fluorescein Angiography; Fundus Oculi; Humans; Optic Disk Drusen; Tomography; Visual Acuity; Visual Fields
PubMed: 12504737
DOI: 10.1016/s0039-6257(02)00357-0 -
World Neurosurgery Jan 2018Low back pain is the principal cause of long-term disability worldwide. We intend to address one of its main causes, degenerative disk disease, a spinal condition... (Review)
Review
Low back pain is the principal cause of long-term disability worldwide. We intend to address one of its main causes, degenerative disk disease, a spinal condition involving degradation of an intervertebral disk. Following unsuccessful conservative treatment, patients may be recommended for surgery. The two main surgical treatments for lumbar degenerative disk disease are lumbar fusion: traditional standard surgical treatment and lumbar disk arthroplasty, also known as lumbar total disk replacement. Lumbar fusion aims to relieve pain by fusing vertebrae together to eliminate movement at the joint, but it has been criticized for problems involving insignificant pain relief, a reduced range of motion, and an increased risk of adjacent segment degeneration. This leads to development of the lumbar total disk replacement technique, which aims to relieve pain replacing a degenerated intervertebral disk with a moveable prosthesis, thus mimicking the functional anatomy and biomechanics of a native intervertebral disk. Over the years a large range of prosthetic disks has been developed. The efficacy and current evidence for these prostheses are discussed in this review. The results of this study are intended to guide clinical practice and future lumbar total disk replacement device choice and design.
Topics: Humans; Intervertebral Disc; Intervertebral Disc Degeneration; Low Back Pain; Lumbar Vertebrae; Total Disc Replacement
PubMed: 28987839
DOI: 10.1016/j.wneu.2017.09.153 -
Survey of Ophthalmology 2019Optic disk pit, one of the optic disk cavitary anomalies, is generally congenital and unilateral and occurs equally in males and females. Optic disk pit maculopathy is... (Review)
Review
Optic disk pit, one of the optic disk cavitary anomalies, is generally congenital and unilateral and occurs equally in males and females. Optic disk pit maculopathy is characterized by intraretinal and subretinal fluid at the macula, causing visual deterioration. The origin of the macular fluid and the mechanism of transition to the subretinal space in optic disk pit maculopathy pathophysiology are not yet fully understood. With the evolution of imaging modalities, especially optic coherence tomography, our knowledge of this disorder continues to increase. Although many different treatments have been tried, there is no consensus on the most effective.
Topics: Eye Diseases, Hereditary; Humans; Macula Lutea; Macular Degeneration; Optic Disk; Tomography, Optical Coherence; Visual Acuity
PubMed: 30797884
DOI: 10.1016/j.survophthal.2019.02.006 -
Survey of Ophthalmology 2007Assessment of optic disk size is an important, but often overlooked, component of the diagnostic evaluation for glaucoma. Measured values of optic disk size vary with... (Review)
Review
Assessment of optic disk size is an important, but often overlooked, component of the diagnostic evaluation for glaucoma. Measured values of optic disk size vary with the measurement technique utilized. Available methods for disk size measurement and their respective strengths and limitations will be discussed. Further, actual disk size varies with race and possibly other demographic characteristics. Disk size is also associated with variation of specific anatomical structures of the optic nerve head and the retinal nerve fiber layer. These disk size- dependent variations may influence the susceptibility to glaucoma or the likelihood of glaucoma diagnosis. This manuscript reviews the published evidence relating to disk size and glaucoma.
Topics: Age Factors; Diagnostic Techniques, Ophthalmological; Ethnicity; Glaucoma; Humans; Ocular Hypertension; Optic Disk; Optic Nerve Diseases; Sex Factors
PubMed: 17212989
DOI: 10.1016/j.survophthal.2006.10.002 -
Joint Bone Spine Dec 2001Experimental studies on the role for mechanical stresses in the genesis of disk degeneration and herniation are reviewed. Simple mechanical stimulations of functional... (Review)
Review
Experimental studies on the role for mechanical stresses in the genesis of disk degeneration and herniation are reviewed. Simple mechanical stimulations of functional vertebral segments cannot cause a disk herniation: a complex mechanical stimulation combining forward and lateral bending of the spine followed by violent compression is needed to produce posterior herniation of the disk. Intervertebral disk degeneration seems to influence the development of posterior disk herniation or foraminal disk protrusion. Furthermore, direct mechanical stimulation of the disk tissue or cells generates complex metabolic and cellular responses that lead to qualitative and quantitative modulation of disk matrix proteins. Thus, it is becoming increasingly likely that physical and metabolic factors act in concert to produce disk herniation.
Topics: Animals; Humans; Intervertebral Disc; Intervertebral Disc Displacement; Stress, Mechanical
PubMed: 11808996
DOI: 10.1016/s1297-319x(01)00325-6 -
Joint Bone Spine Dec 2001This article reviews the role of metabolic factors, including metalloproteinases and cytokines, in the occurrence of degenerative disk disease and disk herniation. Given... (Review)
Review
This article reviews the role of metabolic factors, including metalloproteinases and cytokines, in the occurrence of degenerative disk disease and disk herniation. Given that mechanical factors alone cannot cause disk degeneration, studies must explore metabolic, genetic, nutritional, and age-related factors. Zinc metalloproteinases exert particularly important effects, not only directly, but also indirectly through promotion of neovascularization. The production of these enzymes is dependent on a number of cytokines and on the cell changes they induce. This complex effect acts both on disk matrix degeneration and on the pain generated by contact between the protruding disk and the nerve roots. However, it can have a favorable effect by promoting resorption of the herniated disk. Available data on the role for mechanical factors on the disk chondrocyte metabolism and on metalloproteinase production show that mechanical and metabolic factors interact closely to produce disk disorders.
Topics: Chondrocytes; Cytokines; Humans; In Vitro Techniques; Intervertebral Disc; Intervertebral Disc Displacement; Low Back Pain; Matrix Metalloproteinases
PubMed: 11808997
DOI: 10.1016/s1297-319x(01)00324-4 -
Journal of Orthopaedic Case Reports Sep 2022While the body of research investigating anterior cervical disk fusion (ACDF) for symptomatic cervical disk herniations in high-level athletes is large, evidence for...
INTRODUCTION
While the body of research investigating anterior cervical disk fusion (ACDF) for symptomatic cervical disk herniations in high-level athletes is large, evidence for cervical disk replacement (CDR) is sparse. The amount of patients able to return to sport after an ACDF is estimated to be 73.5%, causing surgeons to search for alternatives with better outcomes in this population. This case report describes the successful treatment of a symptomatic collegiate American football player with C6-C7 disk herniation and C5-C6 central canal stenosis.
CASE REPORT
This is a 21-year-old American football safety who underwent a C5-6 and C6-7 cervical disk arthroplasty. Three weeks postoperatively, the patient demonstrated nearly complete resolution of weakness, full resolution of radiculopathy, and normal cervical range of motion in all planes.
CONCLUSION
The CDR may be considered as an alternative to the ACDF in the treatment of high-level contact athletes. Compared to the ACDF, CDR has been shown in prior studies to decrease the long-term risk of adjacent segment degeneration. Future studies comparing ACDF to CDR in the high-level contact sport athlete population are needed. CDR appears to be a promising surgical intervention for symptomatic patients in this population.
PubMed: 36873322
DOI: 10.13107/jocr.2022.v12.i09.3008