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Spine Surgery and Related Research May 2024The major symptoms of lumbar disc herniation (LDH) are low back pain, radiative lower extremity pain, and lower limb movement disorder. Patients with LDH suffer from... (Review)
Review
The major symptoms of lumbar disc herniation (LDH) are low back pain, radiative lower extremity pain, and lower limb movement disorder. Patients with LDH suffer from great distress in their daily life accompanied by severe economic hardship and difficulty in self-care, with an increasing tendency in the aging population. PubMed and the Cochrane Central Register of Controlled Trials were searched for relevant studies of spontaneous resorption or regression in LDH after conservative treatment and for other potential studies, which included those from inception to June 30, 2023. The objective of this narrative review is to summarize previous literatures about spontaneous resorption in LDH and to discuss the mechanisms and influencing factors in order to assess the probability of spontaneous resorption by conservative treatment. Spontaneous resorption without surgical treatment is influenced by the types and sizes of the LDH, inflammatory responses, and therapeutic factors. If the lumbar disc herniated tissue comprises a higher percentage of cartilage or modic changes have been shown on magnetic resonance imaging (MRI), resorption in LDH is prevented. The bull's eye sign on enhanced MRI, which is a ring enhancement around a protruding disc, is a vital indicator for easy reabsorption. In addition, the type of extrusion and sequestration in LDH could forecast the higher feasibility of natural reabsorption. Moreover, the higher the proportion of protrusion on the intervertebral disc tissue within the spinal canal, the greater the likelihood of reabsorption. Therefore, which illustrates the feasibility of conservative treatments for LDH. Nonsurgical management of LDH with clinical symptoms is recommended by the authors.
PubMed: 38868799
DOI: 10.22603/ssrr.2023-0152 -
Spine Surgery and Related Research May 2024Precise prediction of hospital stay duration is essential for maximizing resource utilization during surgery. Existing lumbar spinal stenosis (LSS) surgery prediction...
INTRODUCTION
Precise prediction of hospital stay duration is essential for maximizing resource utilization during surgery. Existing lumbar spinal stenosis (LSS) surgery prediction models lack accuracy and generalizability. Machine learning can improve accuracy by considering preoperative factors. This study aimed to develop and validate a machine learning-based model for estimating hospital stay duration following decompression surgery for LSS.
METHODS
Data from 848 patients who underwent decompression surgery for LSS at three hospitals were examined. Twelve prediction models, using 79 preoperative variables, were developed for postoperative hospital stay estimation. The top five models were chosen. Fourteen models predicted prolonged hospital stay (≥14 days), and the most accurate model was chosen. Models were validated using a randomly divided training sample (70%) and testing cohort (30%).
RESULTS
The top five models showed moderate linear correlations (0.576-0.624) between predicted and measured values in the testing sample. The ensemble of these models had moderate prediction accuracy for final length of stay (linear correlation 0.626, absolute mean error 2.26 days, standard deviation 3.45 days). The c5.0 decision tree model was the top predictor for prolonged hospital stay, with accuracies of 89.63% (training) and 87.2% (testing). Key predictors for longer stay included JOABPEQ social life domain, facility, history of vertebral fracture, diagnosis, and Visual Analogue Scale (VAS) of low back pain.
CONCLUSIONS
A machine learning-based model was developed to predict postoperative hospital stay after LSS decompression surgery, using data from multiple hospital settings. Numerical prediction of length of stay was not very accurate, although favorable prediction of prolonged stay was accomplished using preoperative factors. The JOABPEQ social life domain score was the most important predictor.
PubMed: 38868786
DOI: 10.22603/ssrr.2023-0255 -
Spine Surgery and Related Research May 2024Recently, patient satisfaction has gained prominence as a crucial measure for ensuring patient-centered care. Furthermore, patient satisfaction after lumbar spinal canal...
INTRODUCTION
Recently, patient satisfaction has gained prominence as a crucial measure for ensuring patient-centered care. Furthermore, patient satisfaction after lumbar spinal canal stenosis (LCS) surgery is an important metric for physician's decision of surgical indication and informed consent to patient. This study aimed to elucidate how patient satisfaction changed after LCS surgery to identify factors that predict patient dissatisfaction.
METHODS
We retrospectively reviewed time-course data of patients aged ≥40 years who underwent LCS surgery at multiple hospitals. The participants completed the Zurich Claudication Questionnaire (ZCQ) and the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) before surgery and then 6 months and 1 year postsurgery. Patient satisfaction was categorized according to the postoperative score of the satisfaction domain of the ZCQ: satisfied, score ≤2.0; moderately satisfied, 2.0< score ≤2.5; and dissatisfied, score >2.5.
RESULTS
The study enrolled 241 patients. Our data indicated a satisfaction rate of around 70% at 6 months and then again 1 year after LCS surgery. Among those who were dissatisfied 6 months after LCS surgery, 47.6% were more satisfied 1 year postsurgery. Furthermore, 86.2% of those who were satisfied 6 months after LCS surgery remained satisfied at 1 year. Multivariable analysis revealed that age (relative risk, 0.5; 95% confidence interval, 0.2-0.8) and preoperative score of psychological disorders on the JOABPEQ (relative risk, 0.2; 95% confidence interval, 0.03-0.08) were significantly associated with LCS surgery dissatisfaction. In addition, the receiver operating characteristic curve analysis revealed that the cutoff value for the preoperative score of psychological disorder of the JOABPEQ was estimated at 40 for LCS surgery dissatisfaction.
CONCLUSIONS
Age and psychological disorders were identified as significant predictors of dissatisfaction, with a JOABPEQ cutoff value providing potential clinical applicability.
PubMed: 38868782
DOI: 10.22603/ssrr.2023-0256 -
Brain & Spine 2024Despite the relatively low prevalence of metastatic cervical spinal tumor, these entities give rise to more profound complications than thoracic and lumbar spinal tumor....
INTRODUCTION
Despite the relatively low prevalence of metastatic cervical spinal tumor, these entities give rise to more profound complications than thoracic and lumbar spinal tumor. However, it is regrettable that experimental investigation has thus far shown a dearth of attention to metastatic cervical spinal tumor.
RESEARCH QUESTION
What is the conceptualization and realization of quadriparesis resulting from metastatic cervical spinal tumor?
MATERIAL AND METHODS
Using Fischer 344 rats as the experimental cohort, this study orchestrated the engraftment of tumor cells procured from the 13762 MAT B III cell line (RRID: CVCL_3475), which represents mammary adenocarcinoma. These cells were engrafted into the vertebrae of the cervical spine. A comprehensive inquiry encompassing behavioral assessments, histological evaluations, and microangiographic analyses conducted after the aforementioned cellular transplantation was subsequently pursued.
RESULTS
The incidence of cervical paralysis was 61.1%. Notably, the evolution of paralysis was unfurled by two distinctive temporal phases within its natural history. A meticulous histological examination facilitated delineation of the tumor's posterior expansion within the spinal canal. Simultaneously, the tumor exhibited anterior and lateral encroachment on the spinal cord, inducing compression from all sides. Augmented by microangiographic investigations, conspicuous attenuation of stained blood vessels within the affected anterior horn and funiculus of the spinal cord was observed.
DISCUSSION AND CONCLUSION
The pathological advancement of paralysis stemming from metastatic cervical spinal tumor is now apprehended to unfurl through a biphasic phase. The initial phase is characterized by gradual unfurling spanning several days, juxtaposed against the second phase marked by swift and accelerated progression.
PubMed: 38868600
DOI: 10.1016/j.bas.2024.102842 -
Zhongguo Yi Liao Qi Xie Za Zhi =... May 2024To select high-quality and cost-effective dural (spinal) membrane repair materials, in order to reduce the cost of consumables procurement, save medical insurance funds,...
OBJECTIVE
To select high-quality and cost-effective dural (spinal) membrane repair materials, in order to reduce the cost of consumables procurement, save medical insurance funds, and optimize hospital operation and management.
METHODS
Taking the BS06B disease group (spinal cord and spinal canal surgery without extremely severe or severe complications and comorbidities, mainly diagnosed as congenital tethered cord syndrome) as an example, a retrospective analysis was conducted on the relevant data of surgical treatment for congenital tethered cord syndrome conducted in our hospital from January 2021 to June 2023. Safety and efficacy indicators in clinical application (incidence of postoperative epidural hemorrhage, incidence of postoperative purulent cerebrospinal meningitis, incidence of cerebrospinal fluid leakage, surgical duration, and postoperative hospital stay) were compared.
RESULTS
There was no difference in safety and effectiveness between different brands of dura mater repair materials.
CONCLUSION
For the repair of small incisions in dura mater surgery, high-quality and cost-effective dura mater repair materials can be selected to reduce hospital costs and control expenses for the disease group.
Topics: Dura Mater; Retrospective Studies; Humans; Neural Tube Defects; Spinal Cord
PubMed: 38863099
DOI: 10.12455/j.issn.1671-7104.230638 -
Neurosurgical Review Jun 2024
Single-staged three columns reconstruction of thoracolumbar AO Spine A4 burst fracture with traumatic canal stenosis causing neurological deficit using posterior open monoaxial pedicle screw distraction fixation, laminectomy, and titanium jack implant expansion kyphoplasty to avoid the need for...
Topics: Humans; Spinal Fractures; Laminectomy; Thoracic Vertebrae; Pedicle Screws; Lumbar Vertebrae; Kyphoplasty; Male; Spinal Stenosis; Titanium; Fracture Fixation, Internal; Plastic Surgery Procedures; Adult
PubMed: 38862732
DOI: 10.1007/s10143-024-02476-z -
Clinical Anatomy (New York, N.Y.) Jun 2024The upper end of the central canal of the human spinal cord has been repeatedly implicated in the pathogenesis of various diseases, yet its precise normal position in...
The upper end of the central canal of the human spinal cord has been repeatedly implicated in the pathogenesis of various diseases, yet its precise normal position in the medulla oblongata and upper cervical spinal cord remains unclear. The purpose of this study is to describe the anatomy of the upper end of the central canal with quantitative measurements and a three-dimensional (3D) model. Seven formalin-embalmed human brainstems were included, and the central canal was identified in serial axial histological sections using epithelial membrane antigen antibody staining. Measurements included the distances between the central canal (CC) and the anterior medullary fissure (AMF) and the posterior medullary sulcus (PMS). The surface and perimeter of the CC and the spinal cord were calculated, and its anterior-posterior and maximum lateral lengths were measured for 3D modeling. The upper end of the CC was identified in six specimens, extending from the apertura canalis centralis (ACC) to its final position in the cervical cord. Positioned on the midline, it reaches its final location approximately 15 mm below the obex. No specimen showed canal dilatation, focal stenosis, or evidence of syringomyelia. At 21 mm under the ACC in the cervical cord, the median distance from the CC to the AMF was 3.14 (2.54-3.15) mm and from the CC to the PMS was 5.19 (4.52-5.43) mm, with a progressive shift from the posterior limit to the anterior third of the cervical spinal cord. The median area of the CC was consistently less than 0.1 mm. The upper end of the CC originates at the ACC, in the posterior part of the MO, and reaches its normal position in the anterior third of the cervical spinal cord less than 2 cm below the obex. Establishing the normal position of the upper end of this canal is crucial for understanding its possible involvement in cranio-cervical junction pathologies.
PubMed: 38860594
DOI: 10.1002/ca.24196 -
Frontiers in Neurology 2024To observe changes in the cauda equina nerve on lumbar MRI in patients with central lumbar spinal stenosis (LSS).
BACKGROUND
To observe changes in the cauda equina nerve on lumbar MRI in patients with central lumbar spinal stenosis (LSS).
METHODS
878 patients diagnosed with LSS by clinical and MRI were divided into the redundant group (204 patients) and the nonredundant group (674 patients) according to the presence or absence of redundant nerve roots (RNRs). The anteroposterior diameter of the spinal canal (APDS) and the presence of multiple level stenosis, disc herniation, thickening of ligamentum flavum (LF) and increased epidural fat were assessed on MRI. Univariate and multivariate logistic regression analyses were performed to explore the predictors of LSS combined with RNRs.
RESULTS
Patients with LSS combined with RNRs had thicker epidural fat, smaller APDS and more combined multifaceted stenosis. Female patients and older LSS patients were more likely to develop RNRs; there was no difference between two groups in terms of disc herniation ( > 0. 05). Age, APDS, multiple level stenosis, and increased epidural fat were significantly correlated with the formation of LSS combined with RNRs ( < 0.05).
CONCLUSION
A smaller APDS and the presence of multiple level stenosis, thickening of LF, and increased epidural fat may be manifestations of anatomical differences in patients with LSS combined with RNRs. Age, APDS, multiple level stenosis, and increased epidural fat play important roles. The lumbar spine was measured and its anatomy was observed using multiple methods, and cauda equina changes were assessed to identify the best anatomical predictors and provide new therapeutic strategies for the management of LSS combined with RNRs.
PubMed: 38859971
DOI: 10.3389/fneur.2024.1385770 -
BMC Urology Jun 2024Wilms tumor (WT), also known as nephroblastoma, is rare in adults, accounting for merely 3% of all nephroblastomas or 0.2 cases per million individuals. Extrarenal Wilms... (Review)
Review
BACKGROUND
Wilms tumor (WT), also known as nephroblastoma, is rare in adults, accounting for merely 3% of all nephroblastomas or 0.2 cases per million individuals. Extrarenal Wilms tumor (ERWT) emerges outside the renal boundaries and comprises 0.5 to 1% of all WT cases, with even rarer incidences in adults. Oncogenic mutations associated with ectopic nephrogenic rests (NR) may contribute to ERWT development. Diagnosis involves surgical resection and pathology examination. Due to scarce cases, adults often rely on pediatric guidelines. We thoroughly searched PubMed, Scopus, and Web of Science databases to establish our case's uniqueness. To the best of our knowledge, this is the first documented incidence of extrarenal Wilms tumor within the spinal canal in the adult population.
CASE PRESENTATION
A 22-year-old woman with a history of congenital lipo-myelomeningocele surgery as an infant presented with a 6-month history of back pain. This pain gradually resulted in limb weakness, paraparesis, and loss of bladder and bowel control. An MRI showed a 6 × 5 × 3 cm spinal canal mass at the L4-S1 level. Consequently, a laminectomy was performed at the L4-L5 level to remove the intramedullary tumor. Post-surgery histopathology and immunohistochemistry confirmed the tumor as ERWT with favorable histology without any teratomatous component.
CONCLUSION
This report underscores the rarity of extrarenal Wilms tumor (ERWT) in adults, challenging conventional assumptions about its typical age of occurrence. It emphasizes the importance of clinical awareness regarding such uncommon cases. Moreover, the co-occurrence of spinal ERWTs and a history of spinal anomalies warrants further investigation.
Topics: Humans; Wilms Tumor; Female; Spinal Canal; Young Adult; Incidence; Kidney Neoplasms; Spinal Neoplasms
PubMed: 38858693
DOI: 10.1186/s12894-024-01508-6 -
Cureus May 2024Spontaneous spinal epidural hematoma (SSEH) is the accumulation of blood in the epidural space of the spinal cord. Acute SSEH is a rare phenomenon that presents with a...
Spontaneous spinal epidural hematoma (SSEH) is the accumulation of blood in the epidural space of the spinal cord. Acute SSEH is a rare phenomenon that presents with a wide variety of neurologic symptoms and most often is a surgical emergency. We present a previously healthy 34-year-old male with sudden onset progressive weakness and tingling in the right lower extremity that progressed to the left lower extremity while bench pressing weights, resulting in complete lower extremity paralysis. Magnetic resonance imaging (MRI) revealed a 3.0 cm extradural mass centered in the dorsal and left lateral canal. After a T1-T4 hemilaminectomy was performed which was followed by inpatient rehabilitation, the patient had a favorable outcome improving from The American Spinal Injury Association Impairment Scale (AIS) grade A, complete impairment, to AIS grade C, incomplete impairment on discharge. Initially, the patient had complete motor and sensory paralysis below the level of T4, and upon discharge, the patient was able to attain modified independence in activities of daily living, mobility, and transfer. Due to the lack of risk factors for SSEH in this patient, the etiology is most likely related to the Valsalva maneuver while weightlifting. Lesions in the thoracic region with rapid progression of neurologic symptoms are indicators of poor prognosis, so this case highlights the importance of prompt recognition and intervention for improved outcomes to prevent devastating neurologic defects.
PubMed: 38854357
DOI: 10.7759/cureus.59889