Transforaminal percutaneous endoscopic discectomy for lumbar disc herniation in athletes under the local anesthesia.

BACKGROUND: Percutaneous endoscopic discectomy (PED) has been reported to be less invasive and effective procedure for lumbar disc herniation (LDH). Damage to the back muscle is considered minimal, which is particularly important for athletes. However, the results of PED for LDH in athletes have not been reported well. The purpose of this study was to evaluate the clinical outcomes of PED for LDH in athletes. METHODS: We retrospectively analyzed 21 athlete patients with LDH who had undergone PED. All patients received athletic rehabilitation immediately after surgery. The clinical outcomes were evaluated from the visual analogue scale (VAS) for leg pain and low back pain (LBP), the Oswestry Disability Index (ODI), complications and periods of return to sport. RESULTS: There were 18 men and 3 women, and the mean age at the time of surgery was 22.9 years (range: 15-43 years). The mean VAS scores for leg pain before and after surgery were 64.3 ± 2.7 mm and 12.4 ± 1.4 mm, respectively. The mean VAS scores for LBP before and after surgery were 62.1 ± 2.2 mm and 10.5 ± 1.1 mm, respectively. The mean ODI scores before and after surgery were 31.3 ± 14.0% and 14.6 ± 7.1%, respectively. The VAS for leg pain, as well as the LBP and ODI, significantly improved after surgery. There were no complications related to the surgery. Ninety-five percent (20/21) returned to play sports at the same performance level as before the procedure by an average of 9.2 weeks after PED. CONCLUSIONS: PED is a minimally invasive and effective procedure for patients with LDH, especially in athletes. Not only the patients' leg pain but also their discogenic LBP improved. PED has the benefits of preservation of normal posterior structures and a faster return to sports.

Optimization of mirror therapy to excite ipsilateral primary motor cortex.

BACKGROUND: Mirror illusion therapy (mirror therapy) is based on the experimental substrate of a visual illusion of active hand movement to excite ipsilateral primary motor cortex (iM1). PURPOSE: We tested whether iM1 excitability could be modulated by enabling or disabling vision of the active hand during mirror therapy. METHOD: Motor cortical activations of healthy right-handed participants were identified by magnetoencephalography. Participants performed voluntary index finger extension of their dominant and non-dominant hands, separately, while viewing mirror reflection images of their active hand superimposed upon their hidden inactive hand. This was performed either with vision of the active hand (uncovered viewing condition) or without vision of the active hand (covered viewing condition). RESULTS: In the covered viewing condition, the iM1could be excited in all participants (n = 10) and this excitation did not differ whether the active hand was the dominant or non-dominant hand. However, in the uncovered viewing condition, dominant and non-dominant hands were able to excite iM1 only in some participants (n = 4 and n = 7, respectively). Moreover, the participants' responses to the illusion validation questionnaire revealed that the covered viewing condition could cause clearer visual illusion for the active hand than the uncovered viewing condition. CONCLUSION: Disabling vision of the active hand during mirror therapy was more effective to excite iM1 responses by creating more immersive visual illusion of the active hand.

Magnetic field-based delivery of human CD133⁺ cells promotes functional recovery after rat spinal cord injury.

STUDY DESIGN: Experimental animal study of spinal cord injury (SCI), using a cell delivery system. OBJECTIVE: To investigate the therapeutic effects of transplantation of peripheral blood-derived CD133 cells, with a magnetic delivery system in a rat SCI model. SUMMARY OF BACKGROUND DATA: There are no reports on intrathecal transplantation of peripheral blood-derived CD133 cells, with a magnetic cell delivery system to treat SCI. METHODS: Magnetically isolated peripheral blood-derived CD133 cells were used as the cell source. Contusion SCI was induced by an Infinite Horizon impactor in athymic nude rats. CD133 cells or phosphate-buffered saline was administered via a lumbar puncture immediately after SCI, and a magnetic field was applied to rats for 30 minutes. Animals were analyzed at specific times after transplantation by several methods to examine cell tracking, functional recovery, and histological angiogenesis and neurogenesis. RESULTS: A combination of cell transplantation and application of a magnetic field at the site of injury caused significant functional recovery. Transplantation of the cells alone in the absence of the magnetic field showed no effect beyond that observed in control rats. CONCLUSION: The combination of intrathecal transplantation of CD133 cells and application of a magnetic field at the site of injury is a possible therapeutic strategy to treat rat SCI and may therefore find application in clinical settings.