Background: Treatment of symptomatic lumbar disc herniation with Modic type I endplate changes is complex and challenging, requiring systemic and local therapies which include conservative therapy, epidural infiltrations, percutaneous therapeutic techniques, and surgical options. The clinical management of symptomatic lumbar disc herniation involving Modic type I endplate changes is uniquely challenging because it requires alleviating pain caused by both the herniated disc and the endplate osteochondritis. Through different approaches, percutaneous lumbar discectomy (PLD) and percutaneous cementoplasty (PCP) have been introduced into clinical practice as alternatives to traditional surgical and radiotherapy treatments of symptomatic lumbar disc herniation and other spine diseases.
Objective: To evaluate the feasibility of PLD and PCP for symptomatic lumbar disc herniation with Modic type I endplate changes.
Study Design: PLD and PCP in 7 patients with symptomatic lumbar disc herniation with Modic type I endplate changes and its clinical effects were retrospectively evaluated.
Setting: This study was conducted by an interventional therapy group at a medical center in a major Chinese city.
Methods: Seven consecutive patients (2 men, 5 women; median age, 74.14 ± 5.34 years; age range, 68 - 82 years) who underwent percutaneous lumbar discectomy and cementoplasty for the treatment of symptomatic lumbar disc herniation with Modic type I changes between May 2013 and August 2015 were retrospectively analyzed. The MacNab Criteria, visual analog scale (VAS), and Oswestry Disability Index (ODI) for pain were assessed before and one week, 6 months, and one year after the procedure. Furthermore, the procedure duration, hospital stay length, and complications were assessed.
Results: The VAS of the back and leg decreased from 6.14 ± 0.69 (range, 5 - 7) and 7.29 ± 0.76 (range, 6 - 8) preoperatively to 2.29 ± 1.38 (range, 1 - 5) and 2.71 ± 0.60 (range, 1 - 6) one week, 1.86 ± 0.69 (range, 1 - 3) and 2.00 ± 0.58 (range, 1 - 3) 6 months, and 1.71 ± 0.76 (range, 1 - 3) and 1.85 ± 0.69 (range, 1 - 3) one year postoperatively. The ODI dropped from 76.86 ± 7.45 (range, 70 - 82) preoperatively to 26.29 ± 19.47 (range, 16 - 70) one week, 19.14 ± 2.79 (range, 16 - 24) 6 months, and 18.57 ± 2.99 (range, 16 - 24) one year postoperatively. The mean procedure duration was 55.71 ± 6.07 minutes (range, 50 - 65 minutes). The average length of hospital stay was 7.57 ± 1.27 days (range, 6 - 10 days). No obvious complications were noted.
Limitations: This was a retrospective study with a relatively small sample size.
Conclusion: PLD plus PCP is a feasible technique for symptomatic lumbar disc herniation with Modic type I endplate changes.
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Zhonghua Yu Fang Yi Xue Za Zhi
December 2024
Department of Clinical Laboratory Medicine, People's Hospital of Ningxia Hui Autonomous Region, Ningxia Medical University, Yinchuan750002, China.
In order to investigate the clinical manifestations and laboratory findings associated with brucellosis for the purpose of facilitating prompt clinical diagnosis and effective treatment, as well as to offer a laboratory reference for the prevention of brucellosis outbreaks. In this study, a retrospective cohort design was employed to gather epidemiological characteristics, clinical symptoms, and associated laboratory data from 391 patients diagnosed with bacterial culture-positive brucellosis at the People's Hospital of Ningxia Hui Autonomous Region between 2019 and 2023. The patients were categorized into four age groups, with each group representing a 20 years age interval.
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From the Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda MD (Colantonio, Fredericks, Cady, Schlaff, Helgeson, and Wagner), the Department of Orthopaedic Surgery, Uniformed Services University of Health Sciences, Bethesda MD (Colantonio, Fredericks, Elsenbeck, Schlaff, Christensen, Helgeson, and Wagner), the Department of Orthopaedic Surgery, Martin Army Community Hospital, Ft. Benning GA (Elsenbeck), and the Department of Orthopaedic Surgery, Naval Hospital Pensacola, Pensacola FL (Christensen).
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Gastroenterological Surgery, Tohoku Medical and Pharmaceutical University, Sendai, JPN.
Lumbar hernia (LH) is a rare abdominal wall hernia that occurs within the anatomic boundaries of the 12th rib, iliac crest, external oblique muscles, erector spinae muscles, and vertebral column. Secondary LH after urological surgery is rare, and the limited evidence hinders consensus on optimal surgical treatment. Here, we present a case of laparoscopic intraperitoneal onlay mesh (IPOM) repair for a large, symptomatic secondary LH after retroperitoneoscopic nephrectomy (RN) with mid-term postoperative outcomes.
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Department of Anaesthetics and Intensive Treatment Unit (ITU), Birmingham Heartlands Hospital, Birmingham, GBR.
Multiple sclerosis is an inflammatory, autoimmune demyelinating condition and poses diagnostic challenges due to varied presentations. This case report presents a divergence from typical clinical presentations of multiple sclerosis (MS), as the initial presentation resembled symptoms of a brain stem stroke. Conventionally, MS suspicion arises in the presence of previous neurological deficits or signs of optic neuritis.
View Article and Find Full Text PDFAsian J Anesthesiol
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School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, Jounieh, Lebanon.
Background: Lumbar epidural injections have been studied as symptomatic treatments for lumbar spinal stenosis (LSS). However, results about their efficacy have been controversial, and data regarding their use is scarce. Our purpose in this article is to study the efficacy of epidural injections in the management of pain and disability in patients suffering from spinal stenosis, to study the factors which can affect their efficacy, and to discuss whether they could replace surgery or not.
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