Disc herniation in the lumbar spine during growth: Long-term results of operative treatment in 18 patients

We studied 18 patients who had undergone surgery for herniated lumbar discs between the ages of 11 and 17 years. The inclusion criteria for girls was an age of 15 years or below and for boys 17 or below at surgery. The mean follow-up time was 10 years and the clinical outcome was good. Age at surgery and length of the follow-up had no effect on the result. The radiological disc height at follow-up did not correlate with the follow-up time or age of the patient at operation. MRI scans at follow-up from ten patients operated at less than 15 years of age revealed multilevel disc degeneration but favourable clinical results.     

Modic changes following lumbar disc herniation

Only a small proportion (20%) of patients with LBP can be diagnosed based on a patho-anatomical entity. Therefore, the identification of relevant subgroups, preferably on a patoanatomical basis, is strongly needed. Modic changes have been described by several authors as being closely linked with LBP. The aims of this study were to describe the prevalence of Modic changes, their development as well as their association to LBP, previous disc contour, and surgery in patients with previous severe sciatica. This is a longitudinal cohort study where the patients were recruited from an RCT comparing two active conservative treatments, the 181 patients, who at baseline had radicular pain in or below the knee; all underwent a physical examination and MRI. MRI’s, pain history and physical examination of 166 patients were obtained at follow-up 14 months later. The prevalence of Modic changes type 1 increased from 9% at baseline to 29% at follow-up. At that time, a strong association between Modic changes and non-specific LBP was noted. Apparently, Modic changes type 1 was more strongly associated with non-specific lumbar pain than Modic changes type 2. The development of new Modic changes was closely related to the level of a previous disc herniation. A lumbar disc herniation is a strong risk factor for developing Modic changes (especially type 1) during the following year. Furthermore, Modic changes are strongly associated with LBP.     

Disc replacement using Pro-Disc C versus fusion: a prospective randomised and controlled radiographic and clinical study

Anterior cervical discectomy and fusion (ACDF) may be considered to be the gold standard for treatment of symptomatic degenerative disc disease within the cervical spine. However, fusion of the segment may result in progressive degeneration of the adjacent segments. Therefore, dynamic stabilization procedures have been introduced. Among these, artificial disc replacement by disc prosthesis seems to be promising. However, to be so, segmental motion must be preserved. This, again, is very difficult to judge and has not yet been proven. The aim of the current study was to first analyse the segmental motion following artificial disc replacement using a disc prosthesis. A second aim was to compare both segmental motion as well as clinical result to the current gold standard (ACDF). This is a prospective controlled study. Twenty-five patients with cervical disc herniation were enrolled and assigned to either study group (receiving a disc prosthesis) or control group (receiving ACDF, using a cage with bone graft and an anterior plate.) Radiostereometric analysis was used to quantify intervertebral motion immediately as well as 3, 6, 12 and 24 weeks postoperatively. Further, clinical results were judged using visual analogue scale and neuro-examination. Cervical spine segmental motion decreased over time in the presence of disc prosthesis or ACDF. However, the loss of segmental motion is significantly higher in the ACDF group, when looked at 3, 6, 12 and 24 weeks after surgery. We observed significant pain reduction in neck and arm postoperatively, without significant difference between both groups (P > 0.05). Cervical spine disc prosthesis preserves cervical spine segmental motion within the first 6 months after surgery. The clinical results are the same when compared to the early results following ACDF.     

Antimicrobial Activity of Various Extracts of Ocimum Basilicum L. and Observation of the Inhibition Effect on Bacterial Cells by Use of Scanning Electron Microscopy

The antimicrobial activities of chloroform, acetone and two different concentrations of methanol extracts of Ocimum basilicum L. were studied. These extracts were tested in vitro against 10 bacteria and 4 yeasts strains by the disc diffusion method. The results indicated that the methanol extracts of O. basilucum exhibited the antimicrobial activity against tested microorganisms. While the chloroform and acetone extracts had no effect, the methanol extracts showed inhibition zones against strains of Pseudomonas aeruginosa, Shigella sp., Listeria monocytogenes, Staphylococcus aureus and two different strains of Escherichia coli. The cells of microorganisms, which were treated and untreated with plant extracts, were observed by using the scanning electron microscope. It was observed that the treated cells were damaged.     

Does T2 inversion aid in identifying disc pathologies?

ObjectiveT2 inversion sequence is used in routine radiology practice mainly to heighten contrast resolution within the region to be studied but no evidence exists in current literature to assess it's true efficacy for lumbar disc degeneration. The objective of this study was to analyse T2 inversion and evaluate it's efficacy in assessment of lumbar disc pathology,.Materials and methodsThis retrospective single-centre study included 50 randomly selected patients presenting with back pain and radiculopathy. T2 inversion sequence was obtained in both axial and sagittal planes in addition to routine sequences. All the Magnetic Resonance Imaging (MRI) procedures were performed on 3T. One senior Musculoskeletal (MSK) radiologist, 2 general radiologists and a spinal surgeon blinded to final results reviewed images for the various disc pathologies individually analysing conventional and T2 inversion images. Data was analysed using Fischer's test and Chi² test with a p value of <0.05 considered as significant.ResultsFifty randomly selected patients (mean age was 47.3 years(range 35–55 years) with back pain and radicular symptoms were included. The spectrum of disc pathologies included protrusions, annular fissures, discal cysts and calcified discs. Based on the above findings, T2 inversion sequence is not proved to be an alternative imaging sequence to routine MR imaging sequences for the depiction of various disc pathologies.ConclusionT2 inversion sequence does not increase the depiction of various lumbar disc pathologies in comparison with conventional sequences when used by experienced MSK radiologists. It may highlight abnormalities better for relatively inexperienced readers such as general radiologists and spinal surgeons.     

Reliability of the assessment of disc degeneration on the lateral DXA scans

IntroductionGiven the prevalence and costs induced by osteoarthritis (OA), it is necessary to find a cheap and safe technique to evaluate it reliably.ObjectiveTo assess the value of the lateral dual energy X-ray absorptiometry (DXA) spine scans for the diagnosis of disc degeneration.MethodSeventy-seven individuals aged 18 and over, with or without disc degeneration, had both lateral thoracolumbar spine radiographs and DXA spine scans (≤ 6 months between both exams). Disc degeneration was assessed using the Lane score. The images of 20 randomly selected individuals were assessed by two readers.ResultsAlmost 13% of the thoracic levels were not assessable on the DXA scans. For the identification of the intervertebral levels on the DXA scans as interpretable or not, the intra-reader agreement was good (κ = 0.81) and the inter-reader agreement was fair (κ = 0.27–0.36). For the diagnostic criteria (osteophytes, disc space narrowing, osteosclerosis, overall grade), the intra-reader agreement was excellent for the radiographs (κ = 0.89–0.92), good for the DXA scans (κ = 0.64–0.83) and fair to moderate for the between-method comparison (κ = 0.25–0.44). The inter-reader agreement was moderate to good for the radiographs (κ = 0.49–0.66) and fair to good for the DXA scans (κ = 0.32–0.74). In the per patient analysis (the most severe grade), the intra-reader agreement was excellent for the radiographs (κ = 0.85–0.94), moderate to excellent for the DXA scans (κ = 0.53–0.85) and poor to good for the between-methods comparison (κ = 0.17–0.63).ConclusionOur results do not support the use of DXA scans for the assessment of thoracolumbar disc degeneration.     

利用重组人骨形态发生蛋白-2诱导椎间盘成骨的实验研究

目的确定在兔子的椎间盘内注射重组人骨形态发生蛋白-2（recombinant human bone morphogenetic protein-2，rhBMP-2）诱导椎体间融合的可行性。方法将24只成年新西兰大白兔，随机分为2组，每组12只。用微量注样器将含有rhBMP-2200μg的生理盐水溶液20μl和等量的生理盐水分别注射到成年新西兰大白兔的L4～5椎间盘的髓核内。术后10、30、60及90天进行X线照相和组织学检查。结果注射椎间盘未见免疫排斥反应。实验组可见纤维环和软骨终板成骨并在相邻椎体间形成骨桥。对照组的椎间盘内未见骨形成。结论利用注射的方法，rhBMP-2可诱导椎间盘成骨，达到椎体间融合的目的。     

超声刀在MED治疗腰椎间盘突出症中的应用

目的 探讨超声刀应用于后路脊柱显微内窥镜椎间盘摘除术(Microendoscopic Discectomy MED)治疗腰椎间盘突出症中的优势与疗效.方法 我院自2005年1月～11月将根据患者症状、体征、体查、CT和或MRI确诊的腰椎间盘突出症患者97例随机分为两组,超声刀 MED组45例,采用超声刀处理椎板下缘等骨性结构;而常规MED手术组52例采用枪钳或电动磨钻处理.结果 超声刀 MED组与常规MED组平均手术时间分别为42 min和75 min,平均术中失血量分别为29 ml和61 ml,平均术后引流量分别为13 ml和29 ml,差异均有显著性(P＜0.05);两组所有病例获得13月(6～17月)随访,按Macnnab标准,优良率分别为95.6%和92.3%,差异无显著性(P＞0.05).结论 超声刀切割骨骼的同时不损伤软组织,且有同步止血功能,操作安全方便,能缩短MED手术时间,不失为脊柱手术一种理想的辅助工具.     

Management of occult intrasacral meningocele associated with lumbar disc prolapse

Occult intrasacral meningocele is an uncommon condition that may produce chronic low back pain, sciatica, and bladder dysfunction. We describe a patient suffering from low back pain and radicular symptoms, in whom multimodality radiological examinations showed an intrasacral meningocele and a lumbar disc prolapse. The protuded disc was considered to be the cause of the clinical symptoms in this patient rather than the meningocele. Surgical removal of the protuded disc was performed without interference with the meningocele. Postoperatively there was recovery of the preoperative deficits. Clinical and radiographic findings in occult intrasacral meningocele are discussed and criteria for differential diagnosis with disc prolapse are stressed.     

腰痹舒治疗腰椎间盘突出症临床疗效分析

用中药腰痹舒治疗腰椎间盘突出症 3 1例 ,治愈 2 8例 ,有效 3例。治疗后随访 6～ 1 8个月 ,无 1例复发。与牵引、按摩、秋水仙碱内服对照组比较 ,中药疗效显著优于对照组 (P<0 .0 5 )。经 CT检查 ,腰痹舒治愈后椎间盘的后突压迫、粘连均有不同程度的解除。提出可根据症状、体征将腰椎间盘出症的腰腿痛分为 1 0级。作为判断病情和疗程的主要指标。其治疗宜通经、化瘀散寒为主。