Endoscopic Posterior Cervical Foraminotomy Under Lateral Decubitus Position with Local Anesthesia.

BACKGROUND: Endoscopic posterior cervical foraminotomy is gaining popularity among endoscopic spine surgeons for the treatment of radiculopathy caused by foraminal stenosis. METHODS: This study describes a technique using the lateral decubitus position for endoscopic posterior cervical foraminotomy under monitored anesthesia care and local anesthesia only. RESULTS: A total of 10 patients with contraindications to general anesthesia underwent the procedure, resulting in improvement in cervical radicular pain with no perioperative complications. CONCLUSIONS: The findings suggest that this approach is a viable alternative for patients at high risk of general anesthesia care, expanding the surgical options for the treatment of radiculopathy.

Prevalence of Neuropathic Pain and Patient-Reported Outcomes in Korean Adults with Chronic Low Back Pain Resulting from Neuropathic Low Back Pain.

STUDY DESIGN: A noninterventional, multicenter, cross-sectional study. PURPOSE: We investigated the prevalence of neuropathic pain (NP) and patient-reported outcomes (PROs) of the quality of life (QoL) and functional disability in Korean adults with chronic low back pain (CLBP). OVERVIEW OF LITERATURE: Among patients with CLBP, 20%-55% had NP. METHODS: Patients older than 20 years with CLBP lasting for longer than three months, with a visual analog scale (VAS) pain score higher than four, and with pain medications being used for at least four weeks before enrollment were recruited from 27 general hospitals between December 2014 and May 2015. Medical chart reviews were performed to collect demographic/clinical features and diagnosis of NP (douleur neuropathique 4, DN4). The QoL (EuroQoL 5-dimension, EQ-5D; EQ-VAS) and functional disability (Quebec Back Pain Disability Scale, QBPDS) were determined through patient surveys. Multiple linear regression analyses were performed to compare PROs between the NP (DN4≥4) and non-NP (DN4<4) groups. RESULTS: A total of 1,200 patients (females: 65.7%; mean age: 63.4±13.0 years) were enrolled. The mean scores of EQ-5D, EQ-VAS, and QBPDS were 0.5±0.3, 55.7±19.4, and 40.4±21.1, respectively. Among all patients, 492 (41.0%; 95% confidence interval, 38.2%-43.8%) suffered from NP. The prevalence of NP was higher in male patients (46.8%; p<0.01), in patients who had pain based on radiological and neurological findings (59.0%; p<0.01), and in patients who had severe pain (49.0%; p<0.01). There were significant mean differences in EQ-5D (NP group vs. non-NP group: 0.4±0.3 vs. 0.5±0.3; p<0.01) and QBPDS (NP group vs. non-NP group: 45.8±21.2 vs. 36.3±20.2; p<0.01) scores. In the multiple linear regression, patients with NP showed lower EQ-5D (ß=-0.1; p<0.01) and higher QBPDS (ß=7.0; p<0.01) scores than those without NP. CONCLUSIONS: NP was highly prevalent in Korean patients with CLBP. Patients with CLBP having NP had a lower QoL and more severe dysfunction than those without NP. To enhance the QoL and functional status of patients with CLBP, this study highlights the importance of appropriately diagnosing and treating NP.

Efficacy of epidural neuroplasty versus transforaminal epidural steroid injection for the radiating pain caused by a herniated lumbar disc.

OBJECTIVE: To compare the treatment effects of epidural neuroplasty (NP) and transforaminal epidural steroid injection (TFESI) for the radiating pain caused by herniated lumbar disc. METHODS: Thirty-two patients diagnosed with herniated lumbar disc through magnetic resonance imaging or computed tomography were included in this study. Fourteen patients received an epidural NP and eighteen patients had a TFESI. The visual analogue scale (VAS) and functional rating index (FRI) were measured before the treatment, and at 2 weeks, 4 weeks and 8 weeks after the treatment. RESULTS: In the epidural NP group, the mean values of the VAS before the treatment, and at 2 weeks, 4 weeks and 8 weeks after the treatment were 7.00±1.52, 4.29±1.20, 2.64±0.93, 1.43±0.51 and those of FRI were 23.57±3.84, 16.50±3.48, 11.43±2.44, 7.00±2.15. In the TFESI group, the mean values of the VAS before the treatment, and at 2 weeks, 4 weeks and 8 weeks after the treatment were 7.22±2.05, 4.28±1.67, 2.56±1.04, 1.33±0.49 and those of FRI were 22.00±6.64, 16.22±5.07, 11.56±4.18, 8.06±1.89. During the follow-up period, the values of VAS and FRI within each group were significantly reduced (p<0.05) after the treatment. But there were no significant differences between the two groups statistically. CONCLUSION: Epidural NP and TFESI are equally effective treatments for the reduction of radiating pain and for improvement of function in patients with a herniated lumbar disc. We recommend that TFESI should be primarily applied to patients who need interventional spine treatment, because it is easier and more cost-effective than epidural NP.

First case of Nocardia nova spinal abscess in an immunocompetent patient.

Nocardia are a group of aerobic actinomycetes that are filamentous gram-positive, weakly acid-fast, and cause opportunistic infection in immunocompromised patients. Primary Nocardia infection mostly involves lung, skin and less commonly, the central nervous system (CNS). Among Nocardia CNS infections, spinal infection is extremely rare. We describe the first case of a spinal abscess caused by Nocardia nova in an immunocompetent patient who experienced a penetrating facial injury six months earlier. Nocardia species were isolated from intradural spinal abscesses and identified by 16S rRNA, hsp65 and secA1 sequence analyses. Surgical excision and treatment with amikacin, cefotaxime, and oral erythromycin was successful.

First case of Nocardia nova spinal abscess in an immunocompetent patient

Nocardia are a group of aerobic actinomycetes that are filamentous gram-positive, weakly acid-fast, and cause opportunistic infection in immunocompromised patients. Primary Nocardia infection mostly involves lung, skin and less commonly, the central nervous system (CNS). Among Nocardia CNS infections, spinal infection is extremely rare. We describe the first case of a spinal abscess caused by Nocardia nova in an immunocompetent patient who experienced a penetrating facial injury six months earlier. Nocardia species were isolated from intradural spinal abscesses and identified by 16S rRNA, hsp65 and secA1 sequence analyses. Surgical excision and treatment with amikacin, cefotaxime, and oral erythromycin was successful.

Anterior cervical interbody constructs: effect of a repetitive compressive force on the endplate.

Graft subsidence following anterior cervical reconstruction can result in the loss of sagittal balance and recurring foraminal stenosis. This study examined the implant-endplate interface using a cyclic fatigue loading protocol in an attempt to model the subsidence seen in vivo. The superior endplate from 30 cervical vertebrae (C3 to T1) were harvested and biomechanically tested in axial compression with one of three implants: Fibular allograft; titanium mesh cage packed with cancellous chips; and trabecular metal. Each construct was cyclically loaded from 50 to 250 N for 10,000 cycles. Nondestructive cyclic loading of the cervical endplate-implant construct resulted in a stiffer construct independent of the type of the interbody implant tested. The trabecular metal construct demonstrated significantly more axial stability and significantly less subsidence in comparison to the titanium mesh construct. Although the allograft construct resulted in more subsidence than the trabecular metal construct, the difference was not significant and no difference was found when comparing axial stability. For all constructs, the majority of the subsidence during the cyclic testing occurred during the first 500 cycles and was followed by a more gradual settling in the remaining 9,500 cycles.

Correlation of ProDisc-C failure strength with cervical bone mineral content and endplate strength.

STUDY DESIGN: This study was designed to evaluate the effectiveness of preoperative computed tomography (CT) scan in predicting endplate strength. OBJECTIVE: To demonstrate a correlation between the cervical trabecular bone density and the failure strength of the endplate. SUMMARY OF BACKGROUND DATA: Cervical total disc arthroplasty devices have to transmit the force to the endplate for the remainder of the patients' life. One potential complication at this interface is endplate fracture and implant subsidence, which usually occurs early postoperatively and may be related to weakness of the boney endplate. METHODS: Six fresh human cadaver cervical spines were harvested and scanned for the determination of trabecular density using a peripheral quantitative CT (QCT) scanner. The specimens were then disarticulated and the inferior endplate of each vertebral segment was biomechanically tested using a 2-mm indentation probe to determine average endplate strength. The superior endplate of each vertebral body was then fitted with the appropriately sized ProDisc-C endplate and biomechanically tested until failure. Regression analyses were used to compare the interface failure stress of the implant with the bone mineral content and the average endplate stress as measured with the indentation probe. RESULTS: The average bone mineral content of the specimens was 322+/-57 mg/cm. The average endplate strength and stress measured by the indentation test was 176+/-129 N and 56+/-34 N/mm, respectively. The average ProDisc-C/endplate failure load and failure stress were 1875+/-1023 N and 10.2+/-4.1 N/mm, respectively. There was a direct correlation between the ProDisc-C/endplate failure stress and the bone mineral content measured by peripheral QCT (R=0.48, P<0.01). There was also a significant correlation between ProDisc-C/endplate failure stress and the endplate indentation stress. CONCLUSIONS: This study demonstrates the utility of a preoperative QCT scan in predicting the failure stress of the cervical endplate before total disc replacement. This information may potentially decrease early complications of device subsidence or endplate fracture.