Lumbar Facet Joint Disease: What, Why, and When?

Low back pain (LBP) affects over 60% of individuals in their lifetime and is a leading cause of disability and increased healthcare expenditure. Facet joint pain (FJP) occurs in 27% to 40% of LBP patients but is often overlooked or misdiagnosed. Additionally, there is no clear correlation between the clinical examination, radiological findings, and clinical presentation, complicating the diagnosis and treatment of FJP.

Clinical Examination, Diagnosis, and Conservative Treatment of Chronic Low Back Pain: A Narrative Review.

Chronic low back pain is one of the most frequent reasons for medical consultation. It is important to make the correct diagnosis to select the most appropriate treatment in a stepwise approach. In this narrative review, we focus on the clinical examination, the diagnosis, and the conservative treatment of chronic non-specific low back pain.

Remineralization of lytic spinal metastases after radiation therapy - A retrospective cohort study comparing conventional external beam radiation therapy with stereotactic ablative body radiation.

Introduction: Osteolytic spinal metastases (SM) have a higher risk of fracture. In this study we aim to confirm the remineralization of lytic SM after radiation therapy. Secondary the influence of SBRT compared to cEBRT and tumor type will be analyzed.

Treatment of ambulatory patients with metastatic epidural spinal cord compression: a systematic review and meta-analysis.

Objective: Approximately 10% of patients with spinal metastases develop metastatic epidural spinal cord compression (MESCC), which left undiagnosed and untreated can lead to the loss of ambulation. Timely diagnosis and efficient multidisciplinary treatment are critically important to optimize neurological outcomes. This meta-analysis aimed to determine the most efficient treatment for ambulatory patients with MESCC.

Epidemiology of spinal metastases, metastatic epidural spinal cord compression and pathologic vertebral compression fractures in patients with solid tumors: A systematic review.

Introduction: Spinal metastases (SM) are a frequent complication of cancer and may lead to pathologic vertebral compression fractures (pVCF) and/or metastatic epidural spinal cord compression (MESCC). Based on autopsy studies, it is estimated that about one third of all cancer patients will develop SM. These data may not provide a correct estimation of the incidence in clinical practice.

Effectiveness of an Annular Closure Device to Prevent Recurrent Lumbar Disc Herniation: A Secondary Analysis With 5 Years of Follow-up.

Importance: Patients with large annular defects following lumbar microdiscectomy for disc herniation are at increased risk for symptomatic recurrence and reoperation.

Objective: To determine whether a bone-anchored annular closure device in addition to lumbar microdiscectomy resulted in lower reherniation and reoperation rates vs lumbar microdiscectomy alone.

Design, Setting, And Participants: This secondary analysis of a multicenter randomized clinical trial reports 5-year follow-up for enrolled patients between December 2010 and October 2014 at 21 clinical sites.

Risk factors for early reherniation after lumbar discectomy with or without annular closure: results of a multicenter randomized controlled study.

Background: Reherniation after lumbar discectomy is classified as a failure and occurs in 3 to 18% of cases. Various risk factors for reherniation such as age, sex, body mass index, smoking, and size of annular defect have been reported. The aim of this study was to identify risk factors for early reherniation after one-level lumbar discectomy with or without annular closure within 3 months after surgery.

Outcome and toxicity of hypofractionated image-guided SABR for spinal oligometastases.

Background: To investigate progression free survival (PFS), local control (LC) and overall survival (OS) outcomes for patients treated with spine hypofractionated stereotactic ablative radiotherapy (SABR) and to evaluate possible predictors of rapid progression in view of a correct patient selection for this potentially curative SABR.

Materials And Methods: A cohort of 59 patients with spinal metastases were treated with SABR. Patient selection criteria were the following: histologically proven diagnosis of a solid tumor, a World Health Organization (WHO) score ≤ 2, life expectancy > 6 months, Spinal Instability Neoplastic Score (SINS) ≤ 12 points and presenting with radically treated oligometastatic disease (≤5 lesions) or stable polymetastatic disease with an oligoprogressive lesion.

Clinical Implications of Vertebral Endplate Disruptions After Lumbar Discectomy: 3-Year Results from a Randomized Trial of a Bone-Anchored Annular Closure Device.

Objective: Vertebral endplate disruptions (VEPD) are common findings on imaging after lumbar surgery. The objective of this study was to explore the clinical implications of VEPD development following lumbar discectomy with or without implant with a bone-anchored annular closure device (ACD).

Methods: This was a multicenter randomized controlled trial of patients with large postsurgical annular defects after limited lumbar discectomy who were randomized to additionally receive an ACD or no additional treatment.

Clinical performance of a bone-anchored annular closure device in older adults.

Lumbar discectomy is a common surgical procedure in middle-aged adults. However, outcomes of lumbar discectomy among older adults are unclear. Lumbar discectomy patients with an annular defect ≥6 mm width were randomized to receive additional implantation with a bone-anchored annular closure device (ACD, n=272) or no additional implantation (controls, n=278).

Comparison of treatments for lumbar disc herniation: Systematic review with network meta-analysis.

Study Design: Systematic review with network meta-analysis.

Objective: To compare patient outcomes of lumbar discectomy with bone-anchored annular closure (LD + AC), lumbar discectomy (LD), and continuing conservative care (CC) for treatment of lumbar disc herniation refractory to initial conservative management.

Summary Of Background Data: Several treatment options are available to patients with refractory symptoms of lumbar disc herniation, but their comparative efficacy is unclear.

Annular closure in lumbar microdiscectomy for prevention of reherniation: a randomized clinical trial.

Background Context: Patients with large annular defects after lumbar discectomy for disc herniation are at high risk of symptomatic recurrence and reoperation.

Purpose: The present study aimed to determine whether a bone-anchored annular closure device, in addition to lumbar microdiscectomy, resulted in lower reherniation and reoperation rates plus increased overall success compared with lumbar microdiscectomy alone.

Design: This is a multicenter, randomized superiority study.

Poly(I:C) primes primary human glioblastoma cells for an immune response invigorated by PD-L1 blockade.

Prognosis of glioblastoma remains dismal, underscoring the need for novel therapies. Immunotherapy is generating promising results, but requires combination strategies to unlock its full potential. We investigated the immunomodulatory capacities of poly(I:C) on primary human glioblastoma cells and its combinatorial potential with programmed death ligand (PD-L) blockade.

Validation of topographic hybrid single-photon emission computerized tomography with computerized tomography scan in patients with and without nonspecific chronic low back pain. A prospective comparative study.

Background Context: The evidence for the treatment for nonspecific chronic low back pain (ns CLBP) is very weak. Besides the complexity of the pain experience, a good biological marker or tool enabling identification of a pain generator is lacking. Hybrid imaging, combining single-photon emission computerized tomography (SPECT) with computerized tomography (CT) scan, has been proposed as useful in the diagnostic workup of patients with CLBP.

Trabecular metal spacers as standalone or with pedicle screw augmentation, in posterior lumbar interbody fusion: a prospective, randomized controlled trial.

Purpose: This prospective randomized comparative trial compared radiological and clinical outcome of Trabecular Metal™ (TM) spacers in PLIF, used as standalone (SA) devices, to TM spacers in PLIF with pedicle screw fixation (PF), in patients with single-level degenerative disc disease (DDD).

Methods: Patients (n = 80) with chronic low back pain and single-level degenerative disc were randomly assigned to the SA PLIF (n = 40) or PLIF with PF (n = 40). The primary radiological outcome was the evaluation of a long-term (±6 years; range 6.

A prospective multicenter registry on the accuracy of pedicle screw placement in the thoracic, lumbar, and sacral levels with the use of the O-arm imaging system and StealthStation Navigation.

Study Design: An international, multicenter, prospective, postmarketing clinical registry to record the accuracy of pedicle screw placement, using the O-arm Complete Multidimensional Surgical Imaging System with StealthStation Navigation.

Objective: To evaluate the accuracy of pedicle screw placement in common neurosurgical practice and assess the patient's radiation exposure.

Summary Of Background Data: Several imaging techniques have been used to increase accurate pedicle screw placement.

Clinical outcome of monosegmental total disc replacement for lumbar disc disease with ball-and-socket prosthesis (Maverick): prospective study with four-year follow-up.

Background: Arthrodesis is considered to be the reference treatment for degenerative disc disease (DDD), if the symptoms are refractory to conservative management. The drawback of arthrodesis is, besides a percentage of non-union, the reduced mobility that might generate an increased load and risk for degeneration of the adjacent levels. Total disc replacement (TDR) implants may overcome this problem.

Electromagnetic navigation technology for more precise electrode placement in the foramen ovale: a technical report.

Introduction. Interventional pain management techniques require precise positioning of needles or electrodes, therefore fluoroscopic control is mandatory. This imaging technique does however not visualize soft tissues such as blood vessels.

Pulsed radiofrequency treatment of the Gasserian ganglion in patients with idiopathic trigeminal neuralgia.

Pulsed radiofrequency treatment has been described as a minimal invasive alternative to radiofrequency thermocoagulation for the management of chronic pain syndromes. We present here our first five high-risk patients with idiopathic trigeminal neuralgia who were treated with pulsed radiofrequency after multidisciplinary assessment; with a mean follow-up of 19.2 months (range 10-26).