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Published 07.01.2016 | Author : admin | Category : Men Women Love

WARNING: Remember Folks, this information is for educational purpose only and should never be used to make a decision regarding proposed medical treatment intervention(s). This is the second study from a reputaible journal that I've seen that casts doubt on the notion that weak trunk muscle strength is related to lower back pain. CONCLUSIONS: Surgically treated patients with a herniated lumbar disc had more complete relief of leg pain and improved functionA  and satisfaction compared with nonsurgically treated patients over 10 years.
Department of Orthopaedics, Sahlgrenska University Hospital, GA¶teborg University,GA¶teborg, Sweden. STUDY DESIGN: Assessment of activated T and B cells in a subcutaneous chamber filled with autologous nucleus pulposus using flow cytometry and immunohistochemistry. RESULTS: As compared with the empty chambers, the proportion of activated T cells (CD4+ and CD8+) was significantly higher in the exudate of theA  nucleus pulposus filled chamber.
CONCLUSIONS: The present findings indicate that nucleus pulposus attracts activated T and B cells. The researchers found that in patients with sciatica (radiculopathy) the epidural fat (the fat that surrounds the inflammed nerve roots) is soaked with the biochemical TNF-a, which was found in very high in concentration when compared to the epidural fat from patients with pure discogenic pain (back pain without sciatica). Provocative discography, although not without controversy, continues to be the proverbial gold standard when it comes to deciding which disc(s) needs to be fused.
Symptomatic patients who had Magnetic Resonance Imaging findings of degenerative disc disease and who failed conservative treatment were identified. 08-10-07: Can a Leaking Annular Tear cause Radiculopathy (Sciatica) without physical compression of the root? The theory of chemical radiculitis had been put forward about 30 years ago, but as yet it has not been proved by clinical studies. I've finally found a good research investigation to support my contention that until Percutaneous Discectomy Methods are proven via randomized controlled trials, they should be avoided. Surgical management of cervical and lumbosacral radiculopathies: indications anda€?outcomes. Department of Neurological Surgery, Johns Hopkins University School of Medicine,a€?725 North Wolfe Street, 817 Hunterian Boulevard, Baltimore, MD 21205, USA. The most common indication for the surgical management of compressive cervicala€?and lumbar radiculopathies is a herniated disc in a patient who has not improveda€?with conservative management.
07-01-07: Chromosome 21 may carry a gene for predisposition of lumbar disc herniation and sciatica. 07-01-07: The Chinese have released the 5 year results of the first cervical human disc transplant pilot study. The co-inverntor of X-Stop has in the past published the results of his randomized controlled investigation into the efficacy of X-stop (Spine.
07-07-07: Degenerated Facet Joints--like IDD--may leak cytokines onto the posterior nerve roots and create radiculopathy. 06-18-07: Nucleoplasty Investigation Touts a 88% success rate for treatment of contained small to moderate sized disc herniations: Really? 06-18-07: Some new evidence for the theory that sciatica is related to an autoimmune attack. This Spine published investigation lends support to my personal favorite theory that autoimmune attack is the culpret in sciatica. 06-18-07: Surgery for disc herniation induced sciatica a quicker fix, but at one year, there's not much difference as if no surgery was performed. 12-30-06: New Investigation published in Spine that compares traditional endoscopic discectomy to endoscopic discectomy with add Chymopapain. Although I'm still not a big fan of endoscopic discectomy, and won't be until they compare it to traditional microscopic discectomy in a randomized double blind controlled trial (which they should have a long time ago, I like the idea of the added Chymopapain to the procedure; Chymopapain was probably this countries best non-invasive treatment for contained disc herniation until the lawyers attacked it a la silicon breast implant.
STUDY DESIGN: A prospective randomized study involving 280 consecutive cases of lumbar disc herniation managed either by an endoscopic discectomy alone or an endoscopic discectomy combined with an intradiscal injection of a low dose (1000 U) of chymopapain.
STUDY DESIGN: An in vivo serial magnetic resonance imaging study of diffusion characteristics in human lumbar discs over 24 hours in healthy volunteers and patients with low back pain. 12-30-06: Fusion treatment demonstated as efficacious for chronic pain as the result of spondylolisthesis in a well done randomized controlled trial that compared fusion to exercise. BACKGROUND: Today there is some evidence-based medicine support for a positive short-term treatment effect of fusion in chronic low back pain in spondylolisthesis and in nonspecific degenerative lumbar spine disorders.
Systematic literature review of spinal decompression via motorized traction fora€?chronic discogenic low back pain. Department of Anesthesia, Stanford University School of Medicine, Stanford,a€?California 94305-5640, USA. OBJECTIVE: The objective of this study was to systematically review the literature to assess the efficacy of nonsurgical spinal decompression achieved with motorized traction for chronic discogenic lumbosacral back pain. A multicenter, prospective, randomized trial evaluating the X STOP interspinousa€?process decompression system for the treatment of neurogenic intermittenta€?claudication: two-year follow-up results. Zucherman JF, Hsu KY, Hartjen CA, Mehalic TF, Implicito DA, Martin MJ, Johnsona€?DR 2nd, Skidmore GA, Vessa PP, Dwyer JW, Puccio ST, Cauthen JC, Ozuna RM.
STUDY DESIGN: A randomized, controlled, prospective multicenter trial comparing the outcomes of neurogenic intermittent claudication (NIC) patients treated with the interspinous process decompression system (X STOP) with patients treated nonoperatively. Quality of life of lumbar stenosis-treated patients in whom the X STOPa€?interspinous device was implanted. Hsu KY, Zucherman JF, Hartjen CA, Mehalic TF, Implicito DA, Martin MJ, Johnsona€?DR 2nd, Skidmore GA, Vessa PP, Dwyer JW, Cauthen JC, Ozuna RM. OBJECT: This study was conducted to compare the quality of life (QOL) in patients with neurogenic intermittent claudication (NIC) secondary to lumbar spinal stenosis (LSS). Conclusion: The studies indicated that leakage of chemical mediators or inflammatory cytokines, which are produced in the painful disc, into epidural space through annular tear could lead to injury to adjacent nerve roots, and it might constitute the primary pathophysiologic mechanism of radiating leg pain in patients with discogenic low back pain but with no disc herniation. SUMMARY AND BACKGROUND DATA: According to the Sackett and Haynes criteria for establishing diagnostic test validity, no test without a gold standard external standard can be meaningfully applied. METHODS: Over a 5-year period using a strict enrollment protocol, 32 patients with low back pain and a positive single-level low-pressure provocative discogram, underwent spinal fusion.
RESULTS: In the control-spondylolisthesis group, 23 of 32 patients (72%) met the highly effective success criteria compared with 8 of 30 in the presumed discogenic pain cohort (27%). CONCLUSIONS: Positive discography was not highly predictive in identifying bona fide isolated intradiscal lesions primarily causing chronic serious LBP illness in this first study comparing discography results to a gold standard. STUDY DESIGN: Retrospective data review of positive disc injections at low pressures among subjects without chronic low back pain (LBP) illness compared to patients with chronic LBP undergoing Discography.
11-24-06: Infliximab, as an off-lable (and very expensive) treatment for sciatica, does not bode well in this randomized controlled trial into its efficacy.
Department of Physical Medicine and Rehabilitation, Oulu University Hospital, Oulu, Finland.
11-24-06: In a well done and rare randomized controlled trial, CHARITE (An artificial disc) demonstrates efficacy equal to anterior interbody fusion with a few perks.
Rodriguez-Garcia J, Sanchez-Gastaldo A, Ibanez-Campos T, Vazquez-Sousa C, Cantador-Hornero M, Exposito-Tirado JA, Cayuela-Dominguez A, Echevarria-Ruiz de Vargas C. A descriptive transversal study of 117 patients operated for herniated lumbar disc during the first six months of the year 2003 is reported. OBJECTIVE: To evaluate the relationships between low back pain (LBP), maximal isometric trunk muscle strength, and body sway among young adults. OBJECTIVE: To assess 10-year outcomes of patients with sciatica resulting from a lumbar disc herniation treated surgically or nonsurgically. Patients undergoing surgery had worse baseline symptoms and functional status than those initially treated nonsurgically.
Nevertheless, improvement in the patient's predominant symptom and work and disability outcomes were similar regardless of treatment received.
OBJECTIVES: To examine if subcutaneously placed autologous a€?nucleus pulposus may attract activated T and B cells in an animal model. The proportion of activated B cells expressing immunoglobulin kappa (Igkappa) was also significantly elevated in the exudate ofA  the nucleus pulposus chambers. However, since the cell population in the nucleus pulposus of young pigs may differ from that of adult humans, the obtained data may not be directly transferred to the human situation of a disc herniation. OBJECTIVE: To determine whether inflammatory cytokines [tumor necrosis factor (TNF)-alpha, interleukin (IL)-1beta, IL-6 and IL-8] are elevated in tissues intimately surrounding involved nerve roots of patients suffering from radiculopathy form herniated disc (HD).
2007 Jun 19; [Epub ahead of print] Discography: can pain in a morphologically normal disc be due to an adjacent abnormal disc?
The aim of the current studies was to determine whether the annular tear of a painful disc proved by discography is the cause of radiating leg pain (radiculopathy) in patients with discogenic low back pain.
Even though a herniated disk is a common condition,a€?it is paramount that the examining physician considers an extensive differentiala€?diagnosis when evaluating radiculopathies, especially in patients with a historya€?of cancer, multiple medical illnesses, secondary gain, or advanced age. The evidence for other minimally invasive techniques remains unclear except for chemonucleolysis using chymopapain, which is no longer widely available.[Spine.
Their government truly seems to understand the importance of science and does not hamstring their researchers as the good old USA does--to our future detriment--secondary to politics. In 2007, John Hopkins School of Medicine's SP Cohen, et al published the results of their investigation into the off-lable use of Etanercept for the treatment of sciatica. When examination of the lumbar spine reveals only common degenerative changes, the relationship of these findings to a patient's back pain is unclear.
In this study, nucleus pulposus was extrated from live pigs and then inplanted in the pigs own subcutaneous tissue in special chambers (there was a control chamber without nucleus pulposus).
OBJECTIVES: To document the temporal pattern of diffusion in normal human lumbar discs and to study the influence of the vascularity of bone and the status of endplate on diffusion in the normal and degenerate discs.
DESIGN: Computer-aided systematic literature search of MEDLINE and the Cochranea€?collaboration for prospective clinical trials on adults with low back pain in the English literature from 1975 to October 2005. Using the 36-Item Short Form (SF-36) questionnaire, the authors compared the results obtained in patients treated with the X STOPa€?Interspinous Process Decompression (IPD) System with those obtained in patients who underwent nonoperative therapies. For what it's worth, there are old investigations that have demonstrated annular tears are NOT always on the side of the radiculopathy. OBJECTIVE: To test the hypothesis that false-positive injections during Discography can effectively be eliminated by defining the positive injection criteria to include only those discs in which pain is produced with low injection pressure injections. The surgery for herniated disc is the most common operation at the level of the lumbar spine.
In order to evaluate the incidence of failed surgery and the related factors, the clinical records were retrospectively analyzed. SUMMARY OF BACKGROUND DATA: Thea€?results of previous studies evaluating the association between trunk muscle strength and LBP are conflicting and heterogeneous.
SUMMARY OF BACKGROUND DATA: There is littlea€?information comparing long-term outcomes of surgical and conservative therapy of lumbar disc herniation in contemporary clinical practice. By 10 years, 25% ofa€?surgical patients had undergone at least one additional lumbar spine operation, and 25% of nonsurgical patients had at least one lumbar spine operation.
For patientsa€?in whom elective discectomy is a treatment option, an individualized treatment plan requires patients and their physicians to integrate clinical findings with patient preferences based on their symptoms and goals. SUMMARYA  OF BACKGROUND DATA: Nucleus pulposus has been suggested to trigger an autoimmuneA  response if exposed to the immune system, for example, in association with disca€?herniation. The analysis of the remaining chamber tissue revealed a significantly higher amount of T cells (CD45RC) in the nucleus pulposus chambers than in the empty chambers. SUMMARY OF BACKGROUND DATA: Proinflammatory cytokines are postulated to play an important role in radiculopathy from HD. The patients, who experienced pain with injection into a morphologically normal disc adjacent to a morphologically abnormal disc, were included in the study. Forty-two patients with discogenic low back pain at single disc level with concomitant radiating leg pain were studied in order to analyse the relationship between site of annular tear and side of radiating leg pain.
Discectomy versus discectomy with fusion versus discectomy with fusion and instrumentation: a prospective randomized study.
Thisa€?consideration has become even more important as imaging studies have improved,a€?because previously undetected degenerative changes are now clearly visualized ona€?MRI and CT scans. Five years ago, they implanted flash-frozen cervical intervertebral discs into five patients and report on the outcomes, which are reported as favorable. One-year results of X Stop interspinous implant for the treatment of lumbar spinal stenosis. Unfortunately, they discovered that this very expensive treatment is no better than that of a placebo (suger pill). A Double-blind, Placebo-controlled, Dose-Response Pilot Study Evaluating Intradiscal Etanercept in Patients with Chronic Discogenic Low Back Pain or Lumbosacral Radiculopathy. A prospective controlled study of limited versus subtotal posterior discectomy: short-term outcomes in patients with herniated lumbar intervertebral discs and large posterior anular defect.
Disk degeneration, anular fissures, small protrusions, and facet arthritis are commonly found in individuals with little or no back pain. Although I haven't got the entire article as of yet, I took issue with the claim that nucleoplasty treatment resulted in a 88% success rate at one year.
After killing the pigs, the chambers with nucleus pulposus were attached by the immune system and the emply chambers were not. Transforaminal posterolateral endoscopic discectomy with or without the combination of a low-dose chymopapain: a prospective randomized study in 280 consecutive cases. SUMMARY OF BACKGROUND DATA: Despite a low complication rate, posterolateral endoscopic nucleotomy has made a lengthy evolution because of an assumed limited indication.
SUMMARY OF BACKGROUND DATA: Diffusion is the only source of nutrition to the discs, but no firm data are available on pattern of diffusion in humans. The long-term effect of posterolateral fusion in adult isthmic spondylolisthesis: a randomized controlled study. PURPOSE: To determine the long-term outcome of lumbar fusion in adult isthmic spondylolisthesis. I've yet to find a negative investigation into X-Stop's efficacy as a treatment intervention for stenosis. SUMMARY OF BACKGROUND DATA: Patients suffering from NICa€?secondary to lumbar spinal stenosis have been limited to a choice between nonoperative therapies and decompressive surgical procedures, with or without fusion.
METHODS: Patients with LSS were enrolled in a prospective 2-year multicenter study and randomized either to the X STOP or nonoperative group.
However, only one randomized trial has directly compared discectomy with conservative treatment.
Absent a gold standard reference, there can be no validity assessment or systematic improvement of test accuracy. Adjusting for surgical morbidity and dropout failure, by either criteria of success, the best-case positive predictive value of discography was calculated to be 50% to 60%.
SUMMARY OF BACKGROUND DATA: The use of lumbar Discography as a diagnostic tool remains controversial. The failed surgery rates range between 10% and 40%, conforming what is known as Failed Back Surgery Syndrome (FBSS).
Ninety one patients were interviewed by phone using the Health Questionnaire SF-36, in order to analyze the non clinical factors related to FBSS, such as labour reincorporation, satisfaction with surgery, realization of rehabilitation treatment and quality of life after surgery. At 10-year follow-up, 69% of patients initially treated surgically reporteda€?improvement in their predominant symptom (back or leg pain) versus 61% of those initially treated nonsurgically (P = 0.2). T-cell activation represents a hallmark in the generation of an autoimmune response, subsequently leading to the differentiation of B cells, butA  a causal association between the exposure of nucleus pulposus to the systemic circulation and T and B cell activation is still lacking.
Although TNF-alpha has been found in human HD, it is not known whether TNF-alpha concentrations are increased in symptomatic patients.
In laymana€™s terms, the surgeons operated on a disc that he though was bad when in fact was was good.a€?a€?Obviously, we need a bigger study, but this sure was interesting. These patients subsequently had repeat discograms, during which the adjacent abnormal disc was first anesthetized with 2% lidocaine and the discogram was repeated at the adjacent normal level.
Electromyogram and motor nerve conduction velocity were monitored to examine nerve root injury. These improved studies, however, do not replace a thorougha€?history and physical examination, because a patient's signs and symptoms may nota€?correlate with the radiographic findings.
It would seem, however, that these new discs will eventually meet the same fate as the originals, since DDD is secondary to diminished blood flow through the endplates, which is something can not be repaired. Still, when compared to the alternative--fusion--it's probably worth a try if you suffer from stenosis related claudication. Correlation between inflammatory cytokines released from the lumbar facet joint tissue and symptoms in degenerative lumbar spinal disorders. Evaluation of intervertebral disc herniation and hypermobile intersegmental instability in symptomatic adult patients undergoing recumbent and upright MRI of the cervical or lumbosacral spines. Cohen SP, Wenzell D, Hurley RW, Kurihara C, Buckenmaier CC, Griffith S, Larkin TM, Dahl E, Morlando BJ. Furthermore, many studies have shown that serious disability in this group is associated with abnormal psychological profiles, multiple chronic pain processes, and compensation issues. Contradictingly, in the abstract (see below) the average Oswestry score at one year post-nucleoplasty was 20! The results of nucleoplasty in patients with lumbar herniated disc: a prospective clinical study of 52 consecutive patients. This indicates that the immune system--at least in pigs, which have a similar disc to ours--does attached nucleus pulposus. Chemonucleolysis, however, proven to be safe and effective, has not continued to be accepted by the majority in the spinal community as microdiscectomy is considered to be more reliable.
More data on this important subject are required to improve our understanding of disc degeneration and to probe research possibilities for preventing the same. STUDY DESIGN: Prospective, randomized controlled study comparing a 1-year exercise program with instrumented and non-instrumented posterolateral fusion with average long-term follow-up of 9 years (range, 5-13). Studies were included if the intervention group received motorized spinal decompression and the comparison group received sham or anothera€?type of nonsurgical treatment. The SF-36 survey was used to assess the QOL before treatment and at 6 weeks, 6 months, 1 year, and 2 years posttreatment.
This is the first study to apply an external gold standard evaluation of the diagnostic validity of discography in any manner.
Studies have shown that disc injections among subjects asymptomatic of clinical LBP will produce painful injections in a significant proportion of subjects, rendering the interpretation of positive diskograms in clinical practice problematic.
Here we report the 1-year results of a randomized controlled trial (FIRST II, Finnish Infliximab Related STudy) evaluating the efficacy and safety of a single infusion of infliximab for sciatic pain. Data were collected pre- and perioperatively at 6 weeks and at 3, 6, 12, and 24 months following surgery.
METHODS: The subjectsa€?(n = 874) belonged to a subcohort of the Northern Finland Birth Cohort 1986 (mean age 19 years). METHODS: Patients recruited from the practicesa€?of orthopedic surgeons, neurosurgeons, and occupational medicine physicians throughout Maine had baseline interviews with follow-up questionnaires mailed atA  regular intervals over 10 years. A larger proportion of surgical patients reported that their low back and leg pain were much better or completely gone (56% vs. METHODS: Autologous nucleus pulposus was harvested from the intervertebral disc of 9 pigs and placedA  subcutaneously in perforated titanium chambers. The current studies found that there was a significant positive correlation between the site of annular tear and the side of radiation pain. University of Calgary Spine Program, Foothills Hospital and Medical Centre, Calgary, Canada.
Putative susceptibility locus on chromosome 21q for lumbar disc disease (LDD) in the Finnish population.
Nevertheless, this is a great effort and may, someday, be yet another treatment option for DDD. Intervertebral disc transplantation in the treatment of degenerative spine disease: a preliminary study.
Department of Preventive Medicine, Medical School, SA?A?o Paulo University, SA?A?o Paulo, SP, Brazil. Conversely, longitudinal studies have found that the severity of chronic pain illness in this group appears to correlate much less well with presence or extent of degenerative findings than with these psychosocial or generalized neurophysiological comorbid conditions. Department of Orthopaedics, Sahlgrenska University Hospital, GA?A¶teborg University, GA?A¶teborg, Sweden.
METHOD: A total of 280 consecutive patients with a primary herniated, including sequestrated, lumbar disc with predominant leg pain, was randomized. METHODS: The diffusion pattern over 24 hours following gadodiamide injection was studied in 150 discs (96 normal and 54 degenerate).
Stockholm Soder Hospital, Department of Orthopedic Surgery, Stockholm Soder Hospital, 118 83 Stockholm, Sweden.
PATIENT SAMPLE: 111 patients aged 18 to 55 years with adult lumbar isthmic spondylolisthesis at L5 or L4 level of all degrees, and at least 1-year's duration of severe lumbar pain with or without sciatica. An analysis ofa€?variance was used to compare individual pre- and posttreatment mean SF-36 domain scores between the two groups and within each treatment group.
It has been argued that lumbar disc injections at low pressure may be clinically different from those at higher pressure and that a guideline accepting only of low-pressure injections will effectively eliminate false positives.
METHODS: Inclusion criteria were unilateral sciatic pain with a disc herniation concordant with the symptoms and signs of radicular pain. The key clinical outcome measures were a Visual Analog Scale assessing back pain, the Oswestry Disability Index questionnaire, and the SF-36 Health Survey. In order to control for the effect of the titanium chamber, an additional empty chamber was placed subcutaneously in each pig. Department of Orthopaedics, General Hospital of Armed Police, 69 Yongding Road, 100039 Beijing, China.
Abnormalities of electromyogram and reduction of motor nerve conduction velocity were found on the side of radiating leg pain. OBJECTIVE: The need for interbody fusion after anterior cervical discectomy for radiculopathy remains controversial. Department of Orthopedic Surgery, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima 960-1295, Japan. Hospital De Madrid, Department of Radiology, Plaza Del Conde Del Valle De Suchil, 28015 Madrid, Spain. PURPOSE: To carry out a systematic review and meta-analysis of the efficacy of chemonucleolysis in the treatment of lumbar disc herniation.
Cohen, Associate Professor, Pain Management Division, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland; Anesthesia Service, Department of Surgery, Walter Reed Army Medical Center.
Department of Orthopaedic Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Rm. Not surprisingly, the surgical treatment of this poorly defined discogenic pain illness has been somewhat disappointing.
Why in the world the creators of nucleoplasty haven't tested this technique via double-blind randomized controlled trial (the gold standard) is beyond me--maybe they are scared that the results will show nucleoplasty is no better than discectomy or even non-surgical conservative care or even placebo!
A clinical follow-up was performed at 3 months, and at 1 and 2 years after the index operation with an extensive questionnaire, including the visual analog scale for pain and the MacNab criteria. OUTCOME MEASURES: Pain and functional disability was quantified by pain (VAS), the Disability Rating Index (DRI), the Oswestry Disability Index (ODI) work status, and global assessment of outcome by the patient into much better, better, unchanged or worse.
The primary outcomes measure was the Zurich Claudication Questionnaire, a patient-completed, validated instrument for NIC. METHODS: A total of 69 volunteers with no clinically significant LBP undergoing experimental lumbar Discography were analyzed. The aims of this study are to know the incidence of the herniated disc lumbar failed surgery in our area, identify those factors influencing its development, and study behavioural parameters as the return to work and the quality of life at a middle term after surgery, also its relation with the success or failure surgery. LBP symptoms were inquired with a questionnaire, which was completeda€?concurrently with the examinations. METHODS: Twenty-three lumbar HD along with adjacent EF (EFHD) were harvested from patients with radicular syndrome. The purpose of this study was to assess clinical and radiographic outcomes in patients with cervical radiculopathy after discectomy without fusion (ACD), discectomy with intervertebral fusion (ACDF), and discectomy with intervertebral fusion and instrumentation (ACDFI).
There is no controversy, however, ina€?stating that achieving good outcomes, regardless of technique, is predicated ona€?proper patient selection. Collagen Research Unit, Biocenter and Department of Medical Biochemistry and Molecular Biology, University of Oulu, Oulu, Finland.
OBJECTIVE: To prospectively assess the clinical outcome of patients with symptomatic lumbar spinal stenosis before and at periodic intervals after X Stop implantation and to compare the data with previous studies. PURPOSE: The purpose of the study was to determine the difference in findings between recumbent and upright-sitting MRI of the cervical and lumbosacral spine in patients with related sign and symptoms. METHODS: Clinical trials were selected from 3 electronic databases (The Cochrane Controlled Trials Register, MEDLINE, and EMBASE). The prospective study population consisted of 30 patients undergoing a posterior lumbar subtotal discectomy for lumbar disc herniation. Randomized trials of lumbar fusion compared with various nonsurgical strategies have shown neither consistently good outcomes with surgery nor clear benefit over nonsurgical treatments.

OBJECTIVES: To examine if subcutaneously placed autologous nucleus pulposus may attract activated T and B cells in an animal model.
Enhancement percentage for each time period, peak enhancement percentage for each region, and the time taken to achieve peak enhancement percentage (Tmax) were used to define and compare diffusion characteristics and plot a time-intensity curve to document the 24-hour temporal pattern. Because of this low number, we also analyzed three nonrandomized case series studies of spinal decompression systems. RESULTS: At every follow-up visit, X STOP patients had significantly better outcomes in each domain of the Zurich Claudication Questionnaire. CONCLUSIONS: The results of this study demonstrate that the X STOP device is significantly more effective than nonoperative therapy in improving the QOL in patients with LSS. Criteria for discectomy included (in addition to a symptomatic disc herniation on MRI) neural entrapment (straight leg raising [SLR] < or =60 degrees ) with either a short-term (2-4 weeks) severe or long-term (4-12 weeks) moderate leg pain. Patients in the CHARITE artificial disc group recovered faster than patients in the control group. Latent Class Analysis (LCA) was used to cluster the subjects according to their LBP symptoms. Treatment group differences persisted after adjustmentA  for other determinants of outcome in multivariate models. Flow cytometry and immunohistochemistry were used for analysis of T-helper cells (CD4+), cytotoxic T cells (CD8+), and B cells (Igkappa) in the chamber exudates and T cells (CD45RC) in the remaining blood clot tissue of the chamber. As controls, 14 intervertebral discs (IVDs) and 10 samples of EF (EFC) were obtained from patients without radicular syndromea€?undergoing spine surgery. Two patients had a previous L4-Sacrum anterior and posterior fusion while 2 patients had L5-Sacrum anterior and posterior fusions. In the first linkage study on LDD, a common musculoskeletal disorder, a genome-wide scan was performed on 14 Finnish families. BACKGROUND: Spinal fusion can be complicated by accelerated degeneration of the adjacent segments. SUMMARY OF BACKGROUND DATA: The X Stop Interspinous Process Distraction Device is a relatively new interspinous implant designed for patients with symptomatic spinal stenosis particularly neurogenic claudication. However, no reports have shown whether inflammatory cytokines in the facet joint leads to pain. Wenzell, Department of Surgery, Madigan Army Medical Center, Tacoma, Washington (currently in Iraq). This group was compared to a historical cohort of 46 patients treated with limited discectomy alone. In the randomized controlled trial (RCT) with the best surgical results, the improvement in pain intensity score was only 2 points (on a 10-point scale), and the disability improvement by Oswestry Disability Index was only 10 to 12 points (on a 100-point scale).
PURPOSE: To evaluate the efficacy of nucleoplasty technique in patients with leg pain caused by radicular encroachment.
SUMMARY OF BACKGROUND DATA: Nucleus pulposus has been suggested to trigger an autoimmune response if exposed to the immune system, for example, in association with disc herniation. The correlation of blood flow of the bone as measured by peak enhancement percentage of vertebral body, the status of the endplate zone as measured by the peak enhancement percentage, and Tmax of the endplate zone were correlated with the diffusion of the disc.Univariate analysis of variance, multiple comparisons, appropriate tests for significance, and stepwise linear regression analysis were used for analysis of the data using SPSS software. METHODS: The patients were randomly allocated to treatment with 1) a 1-year exercise program (n=34), 2) posterolateral fusion without pedicle screw instrumentation (n=37), or 3) posterolateral fusion with pedicle screw instrumentation (n=40). As the overall quality of studies was low and the patient groups heterogeneous, a meta-analysis was not appropriate and a qualitative review was undertaken. The results are comparable with those reported in other studies involving traditionaldecompressive techniques for LSS and suggest that the X STOP implant can provide an effective treatment compared with nonoperative and conventional surgical therapies.
Spinal level of the herniation may be an important factor modifying effectiveness of surgery, but this hypothesis needs verification.
Pressure measurements during injection were made, and the pressure at which a significant pain response was elicited was recorded. Outcomes included patient-reported symptoms ofa€?leg and back pain, functional status, satisfaction, and work and disability compensation status. Change in the modified a€?Roland back-specific functional status scale favored surgical treatment, and theA  relative benefit persisted over the follow-up period. Tissue explants were incubated ex vivo for 48 hours and the concentrations of cytokines were measured by elisa in the supernatants.
These four patients had solid fusions on Computerized Tomography scan and had developed adjacent segment degeneration according to MRI. The analysis resulted in identification of a putative susceptibility locus for the disease on chromosome 21. Previously, a randomized study has shown a 75% improvement in symptoms and physical function at 1-year post-X Stop implantation for lumbar spinal stenosis. This study was designed to characterize the correlation between inflammatory cytokines released from facet joint tissue and symptoms in degenerative lumbar spinal disorders. A?a‚¬A? Assistant Professor, Pain Management Division, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland.
OBJECTIVE: To compare clinical outcomes after limited versus subtotal discectomy for lumbar disc herniations.
Common degenerative findings are often interpreted as recent developments and the probable anatomic cause of the new symptoms. T-cell activation represents a hallmark in the generation of an autoimmune response, subsequently leading to the differentiation of B cells, but a causal association between the exposure of nucleus pulposus to the systemic circulation and T and B cell activation is still lacking. Peul WC, van Houwelingen HC, van den Hout WB, Brand R, Eekhof JA, Tans JT, Thomeer RT, Koes BW; Leiden-The Hague Spine Intervention Prognostic Study Group . Sample sizes averaged 121 patients (range 27-292), with six of the seven randomized studies reporting no difference with motorized spinal decompression and one study reporting reduced pain but not disability. This result was compared to the pain response and pressure profiles of 52 patients undergoing Discography for chronic LBP illness in consideration of treatment.
There were noa€?statistically significant differences between the clusters in trunk muscle strength or body sway. Despite these differences, work and disability status at 10 years were comparable among those treateda€?surgically or nonsurgically. Overall, each patient underwent an average of four discograms, at the lowest mobile disc segments.
INTRODUCTION: Lumbar disc disease (LDD) is a common musculoskeletal disorder that affects approximately 5% of the adult population. Successful transplantations of intervertebral disc autografts, fresh allografts, and fresh-frozen allografts-ie, a non-fusion strategy-in which the mobility and stability of the spinal segment were preserved have been done in a primate model. The only other study is a preliminary report of only 10 patients with variable intervals of clinical outcome assessment. The purpose of this study was to seek involvement of inflammatory facet joint for radiculopathy in lumbar spinal canal stenosis with clinical and anatomical studies. The images were acquired on the Uprighttrade mark MRI unit (Fonar Corporation, Melville, NY). To date no prospective study has established a baseline MR status of the lumbar spine in subjects without significant LBP problems and prospectively surveyed these subjects for acute changes shortly after new and serious LBP episodes. In a large population-based study, approximately 18% of patients who had spinal fusion for degenerative conditions experienced procedure-related complications; 20% of these patients went on to reoperation over the next 5 years. METHODS: Autologous nucleus pulposus was harvested from the intervertebral disc of 9 pigs and placed subcutaneously in perforated titanium chambers.
The three unrandomized studies (no control group) of motorized spinal decompression found a 77% to 86% reduction in pain. CONCLUSIONS: The X STOP provides a conservative yet effective treatment for patients suffering from lumbar spinal stenosis.
CONCLUSION: LBP does not seem to be associated with maximal isometric trunk muscle strength or body sway in young adults.
All of the patients were found to have a painful but morphologically normal disc adjacent to a painful and morphologically abnormal disc. Our aim was to determine the feasibility, safety, and long-term clinical results of disc transplantation in human beings. METHOD: Forty consecutive patients were enrolled and surgically treated with X Stop implantation.
METHODS: Lumbar facet joint cartilage and synovial tissues in 40 cases of posterior lumbar surgery were harvested to measure tumor necrotizing factor-alpha (TNFalpha), interleukin-1beta (IL-1beta), and interleukin-6 (IL-6) during operation. Differences were sought between the recumbent and upright-sitting positions at all levels imaged, in both planes. A trial of more aggressive discectomy (subtotal) was undertaken to determine if the rate of reherniation could be decreased with this technique. This method can identify new versus old MR findings possibly associated with the acute symptomatic episode.
OUTCOME MEASURES: Visual analogue scale (VAS) was administered and Oswestry disability questionnaires were filled out at preprocedure and postprocedure 2 weeks, 6 months, and 1 year.
Alterations in endplate zone produced distinct magnetic resonance imaging signs of disturbance in diffusion, which offered a reliable noninvasive method of identifying endplate cartilage damage. CONCLUSIONS: These data suggest that the efficacy of spinal decompression achieved with motorized traction for chronic discogenic low back pain remains unproved. In the continuum of treatment options, the X STOP offers an attractive alternative to both conservative care and decompressive surgery. Diskogram morphology, pain response, and concordance, as well as magnetic resonance imaging, plain radiographs, psychometric testing (Distress and Risk Assessment Method), and compensation history were documented for each group.
The morphologically abnormal disc was anesthetized and the discography repeated on the normal disc.
MATERIALS AND METHODS: Medical history data were collected from 186 members of 14 Finnish families with LDD. METHODS: Five patients, average age 47 years, with cervical disc herniation underwent transplantation of fresh-frozen composite disc allografts after disc excision.
The X Stop device was implanted at the stenotic segment, which was either at 1 or 2 levels in each patient.
The visual analogue scale (VAS) and Roland-Morris disability questionnaire (RDQ) were used to examine the correlation between cytokine concentration and symptoms. RESULTS: The total number of cases of pathology was 68, including instances of posterior disc herniation and anterior and posterior spondylolisthesis. METHODS: A total of 30 patients undergoing a posterior lumbar discectomy for lumbar disc herniation were treated with an aggressive (subtotal) resection of intervertebral disc material after removal of the extruded or protruded fragments. PURPOSE: To determine if new and serious episodes of LBP are associated with new and relevant findings on MRI.
METHODS: We randomly assigned 283 patients who had had severe sciatica for 6 to 12 weeks to early surgery or to prolonged conservative treatment with surgery if needed.
No significant differences were observed between instrumented and non-instrumented patients in any variable studied. This may be, in part, due to heterogeneous patient groups and the difficulties involved in properly blinding patients to the mechanical pulling mechanism.
A low-pressure positive was defined as significant pain elicited less than 22 psi more than opening pressure. CONCLUSIONS: This prospective, randomized, multicenter study demonstrated that quantitative clinical outcome measures following lumbar total disc replacement with the CHARITE artificial disc are at least equivalent to clinical outcomes with anterior lumbar interbody fusion. Segmental kyphosis was noted in 75% of the ACD patients postoperatively compared with 17% preoperatively. Serial MRI and static and dynamic radiographs were used to monitor the status of the grafts and the sagittal stability and mobility of the segment.
They were clinically evaluated at the preoperative, 3-month, 6-month, and 1-year stage with clinical questionnaires (Zurich Claudication Questionnaire, Oswestry Disability Index, and SF-36). Coloring agent was injected into facet joints of fresh cadavers to find leakage of pigment from the facet joint into the spinal canal.
This group was compared against a historical cohort of 46 patients treated with limited discectomy alone. STUDY DESIGN: Prospective observational study with baseline and post-LBP MRI monitoring of 200 subjects over 5 years. METHODS: All procedures were performed under local anesthesia and fluoroscopic guidance on an outpatient basis. The primary outcomes were the score on the Roland Disability Questionnaire, the score on the visual-analogue scale for leg pain, and the patient's report of perceived recovery during the first year after randomization. There were no infections or patients with any form of permanent iatrogenic nerve damage, and no patients had a major complication.
CONCLUSIONS: Serial postcontrast magnetic resonance imaging studies offer a reliable method of assessing the diffusion of the discs and the functional status of the endplate cartilage.
In the exercise group the pain was significantly reduced but not the functional disability.
Scientifically more rigorous studies with better randomization, control groups, and standardized outcome measures are needed to overcome the limitations of past studies. RESULTS: The number and percent of individuals with at least 1 low-pressure positive disc in the experimental group were 17 of 69 (25%) and in the clinical LBP group 14 of 52 (27%).
These results support earlier reports in the literature that total disc replacement with the CHARITE artificial disc is a safe and effective alternative to fusion for the surgical treatment of symptomatic disc degeneration in properly indicated patients. The authors recommend anesthetizing painful abnormal discs prior to discography of the adjacent discs. A second fine mapping confirmed the susceptibility of chromosome 21 with a two-point LOD score of 2.06 (D21S1922). FINDINGS: Good union of the graft endplates was seen by the end of 3 months after surgery in all patients. RESULTS: Sixteen patients failed to complete all the questionnaires at all time intervals and hence were excluded, leaving 24 patients who had completed all questionnaire at all time interval. RESULTS: Inflammatory cytokines were detected in the joint tissues in the lumbar spinal canal stenosis (LSCS) and lumbar disc herniation (LDH) groups. CONCLUSIONS: Chemonucleolysis with chymopapain was superior to placebo and was as effective as collagenase in the treatment of lumbar disc prolapse.
Reherniation rates and clinical outcomes were determined by independent evaluation at 6, 12, and 24 months after surgery.
RESULTS: As compared with the empty chambers, the proportion of activated T cells (CD4+ and CD8+) was significantly higher in the exudate of the nucleus pulposus filled chamber. Repeated-measures analysis according to the intention-to-treat principle was used to estimate the outcome curves for both groups.
CONCLUSIONS: A high percentage of patient satisfaction could be obtained with a posterior lateral endoscopic discectomy for lumbar disc herniation, and a statistically significant improvement of the results was obtained when an intradiscal injection of 1000 U of chymopapain was added. Endplate cartilage damage increases with age and produces considerable changes in diffusion. Compared with the 2-year follow-up a significant increase in functional disability was observed, as measured by the DRI, but not the ODI, in the surgical group at long term. CONCLUSION: Higher concentrations of TNF-alpha were found in EF from patients with radiculopathy from HD compared with patients suffering from other type of back pain. This technique may avoid unnecessary dismissal of patients from treatment because of an appropriate response to discography. CONCLUSION: Patient selection and surgical decompression remain the key to achieving desirable clinical outcomes after cervical discectomy for radiculopathy. At a minimum follow-up of 5 years, the neurological symptoms of all patients had improved from before surgery levels. By 12 months, 54% of these 24 patients reported clinically significant improvement in their symptoms, 33% reported clinically significant improvement in physical function, and 71% expressed satisfaction with the procedure.
A positive reaction rate of IL-1beta was significantly higher in the LSCS group than in the LDH group. Results for studies comparing chemonucleolysis with surgery were heterogeneous, making it difficult to interpret the summary measure of effect. MRI outcomes: disc degeneration, herniation, annular fissures, end plate changes, facet arthrosis, canal stenosis, spondylolisthesis, and root impingement.
Channels were created in the nucleus by advancing the radiofrequency probe (ablating) and withdrawing it (coagulation).
The proportion of activated B cells expressing immunoglobulin kappa (Igkappa) was also significantly elevated in the exudate of the nucleus pulposus chambers.
The present study has described reliable signs by which these damages can be identified in vivo. In the exercise group no significant changes were observed between the 2-year and the long-term follow-up. Positive injections correlated with anular disruption, abnormal psychometric findings, and chronic pain states.
The response (irrespective of the treatment) was significantly better with shorter symptom duration and less SLR restriction at baseline. Within a 2-year follow-up period, the technique of reconstruction plays no role in clinical results. Interestingly, the locus for another spinal disorder, ossification of the posterior longitudinal ligament (OPLL), has been mapped to chromosome 21q, partially overlapping with our candidate region. 29% of the patients required caudal epidural after 12 months after surgery for recurrence of their symptoms of neurogenic claudication.
IL-1beta-positive cases in the LSCS group showed higher VAS scores for leg pain and higher RDQ scores.
METHODS: 200 subjects with a lifetime history of no significant LBP problems, and a high risk for new LBP episodes were studied at baseline with physical examination, plain radiographs, and MR imaging.
Of 142 patients designated for conservative treatment, 55 (39%) were treated surgically after a mean of 18.7 weeks. The method can be applied in any type of lumbar disc herniation, including the L5-S1 level. Aging and degeneration have been shown to be two separate processes by documenting clear-cut differences in diffusion. Cross-sectional analysis: Between the surgical and conservative group no significant differences were observed in any outcome measurement at long-term follow-up except for global assessment, which was significantly better for surgical patients. CONCLUSIONS: The analysis shows that the rate of low-pressure painful injections in subjects without chronic LBP illness is approximately 25%, and correlates with both anatomic and psychosocial factors. Patients in the infliximab group appeared to especially benefit in cases of a L4-L5 (or L3-L4) herniation and if a Modic change was colocalized at the symptomatic level. Two candidate genes with aggrecanase activity, ADAMTS-1 and ADAMTS-5, were analyzed in the region, suggesting linkage, leading to the identification of 13 sequence variations. CONCLUSION: The results of this prospective observational study indicate that X Stop offers significant short-term improvement over a 1-year period. Intraspinal canal tissues including lumbar nerve root were stained by injection of methylene blue into the facet joints. But although preliminary open-label studies demonstrated promising results for the treatment of low back pain with tumor necrosis factor-alpha inhibitors, early optimism has been tainted by a controlled study showing no significant benefit in sciatica. Time to return to work was longer, and pain medication usage was higher in the subtotal discectomy group at 12-month follow-up. There was no significant overall difference in disability scores during the first year (P=0.13).
The present data encourage use of diffusion studies as a noninvasive method to assess the physiologic status of the disc and endplate and to study the effect of drugs, smoking, mechanical loading, exercises, etc.
Of surgical patients 76% classified the overall outcome as much better or better compared with 50% of conservatively treated patients (p=0.015).
CONCLUSIONS: Although the long-term results of this randomized trial do not support the use of infliximab compared with placebo for lumbar radicular pain in patients with disc herniation-induced sciatica, further study in a subgroup of patients with L4-L5 or L3-L4 herniations, especially in the presence of Modic changes, appears to be warranted. None of the variations were disease-causing, however, because they were observed equally in affected and healthy individuals. It is a safe, effective, and less invasive alternative for treatment of lumbar spinal stenosis.
CONCLUSIONS: IL-1beta in facet joint cartilage in LSCS was associated with leg pain and a decline of quality of life.
To determine whether outcomes might be improved by a more direct route of administration, the authors evaluated escalating doses of intradiscal etanercept in 36 patients with chronic lumbosacral radiculopathy or discogenic low back pain.
Despite a trend toward a higher reherniation rate, the patient satisfaction at 2-year follow-up was higher in the limited discectomy group. Quality of life as estimated by the SF-36 at long term was not different between treatment groups in any of the eight domains studied but was considerably lower than for the normal population. CONCLUSIONS: We report here on the first putative susceptibility locus for LDD in the Finnish population.
Inflammatory cytokines produced in degenerated facet joint may leak into the intraspinal space through the lateral part of the ventral facet joint capsule.
CONCLUSIONS: The more aggressive removal of remaining intervertebral disc material may decrease the risk of reherniation, but the overall outcome was less satisfactory, especially during the first year after surgery. New MR imaging, taken within 6 to 12 weeks of the start of a new LBP episode, was compared with baseline (asymptomatic) images. The observations in the present study may nevertheless explain some of the local tissue reactions occurring in association with disc herniation and nerve root involvement, thereby providing further insight into the pathophysiology of sciatica. CONCLUSIONS: Posterolateral fusion in adult lumbar isthmic spondylolisthesis results ina modestly improved long-term outcome compared with a 1-year exercise program. INTERPRETATION: Despite signs of mild disc degeneration, the motion and stability of the spinal unit was preserved after transplantation of fresh-frozen allogenic intervertebral discs in our patients. These results suggest the involvement of inflammatory cytokines in degenerated lumbar facet joints regarding the genesis of pain production.
In both groups, however, the probability of perceived recovery after 1 year of follow-up was 95%.
Although the results show that some of the previously reported short-term improvement is lost at long term, patients with fusion still classify their global outcome as clearly better than conservatively treated patients. With further refinements, such transplantations could be an effective treatment for degenerative disc disease. A neurologic examination and postprocedure leukocyte counts were performed in all patients at 1-month follow-up visits.
CONCLUSIONS: The 1-year outcomes were similar for patients assigned to early surgery and those assigned to conservative treatment with eventual surgery if needed, but the rates of pain relief and of perceived recovery were faster for those assigned to early surgery.
Furthermore, because the long-term outcome of the patients conservatively treated most likely reflects the natural course, one can also conclude that no considerable spontaneous improvement should be expected over time in adult patients with symptomatic isthmic spondylolisthesis. In patients who experienced significant improvement in pain scores and function, follow-up visits were conducted 3 and 6 months after the procedure. Analgesic consumption was stopped or reduced in 42 patients (85%) at 6 months and in 46 patients (94%) 1 year after the procedure. Substantial pain, functional disability and a reduced quality of life will in most patients most likely remain unaltered over many years.
Overall patient satisfaction was 81% at 2 weeks, 85% at 6 months, and 88% at the latest follow-up. This seems to validate the importance of weight-bearing imaging in the spine that might be expected to unmask positional enlarging disc herniations and worsening spondylolisthesis. Only eight patients remained in the study after 1 month and elected to forego further treatment.
The most common progressive findings were disc signal loss (10%), progressive facet arthrosis (10%), or increased end plate changes (4%). No complications were reported, and no differences were noted between preprocedure and postprocedure leukocyte counts.
Only two subjects, both with primary radicular complaints, had new findings of probable clinical significance (4%). CONCLUSIONS: Our results encourage us to use nucleoplasty in carefully selected patients with leg pain caused by radicular encroachment.
The latter finding was possibly due to the fact that upright seated position is actually partial flexion that might be expected to reduce some cases of hypermobile posterior spondylolisthesis. New findings were not more frequent in subjects with LBP episodes developing after minor trauma than when LBP developed spontaneously.
CONCLUSION: Findings on MR imaging within 12 weeks of serious LBP inception are highly unlikely to represent any new structural change. Most new changes (loss of disc signal, facet arthrosis, and end plate signal changes) represent progressive age changes not associated with acute events.
Primary radicular syndromes [however] may have new root compression findings associated with root irritation.

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