Management of lumbar disc herniation with radiculopathy: Results of an Iberian-Latin American survey.

BACKGROUND: Lumbar disc herniation (LDH)/radiculopathy is the most frequent cause of lost workdays in people under 50 years of age. Although there is consensus about how to assess these patients, the optimal management strategy is still debated. METHODS: An online survey was sent to spine surgeons who are members of the Iberian-Latin American Spine Society to assess how they treat LDH with radiculopathy. RESULTS: There were 718 surgeons who answered the survey; 66% reported that 76-100% of their monthly clinic work was due to spine issues. The most frequently used conservative treatment modalities included non-opioid analgesics and nonsteroidal anti-inflammatory drugs (NSAIDs) (90.5%), followed by physical therapy (55.2%) and pregabalin (41.4%). Notably, 40% of surgeons in the public sector believed that conservative treatment failed if symptoms persisted beyond 6-12 weeks, while 39% of private surgeons deemed conservative management insufficient if it had failed to provide symptomatic relief with 3-6 weeks. Of interest, 78% utilized epidural steroid injections (ESI); 51.7% preferred the transforaminal, 27.2% the interlaminar, and 7.5% the caudal approaches. The most frequent indications for surgery included: cauda equina syndrome, progressive neurological deficits, and intractable pain. Traditional microdiscectomy was the most common technique (68.5%) utilized, followed by 7.5% advocating endoscopic disc resection, and just 6.4% favoring the tubular discectomy. CONCLUSION: There is considerable heterogeneity among Iberian and Latin American spine surgeons in the treatment of LDH/radiculopathy. Although most begin with the utilization of NSAIDs and non-opioid analgesics, followed by ESI (88%), surgery was recommended for persistent symptoms/signs for those failing between 3 and 6 weeks (private sector) versus 6-12 weeks (public sector) of conservative therapy.

Proposal for a new trajectory for subaxial cervical lateral mass screws.

PURPOSE: Lateral mass screws combined with rods are the standard method for posterior cervical spine subaxial fixation. Several techniques have been described, among which the most used are Roy Camille, Magerl, Anderson and An. All of them are based on tridimensional angles. Reliability of freehand angle estimation remains poorly investigated. We propose a new technique based on on-site spatial references and compare it with previously described ones assessing screw length and neurovascular potential complications. METHODS: Four different lateral mass screw insertion techniques (Magerl, Anderson, An and the new described technique) were performed bilaterally, from C3 to C6, in ten human spine specimens. A drill tip guide wire was inserted as originally described for each trajectory, and screw length was measured. Exit point was examined, and potential vertebral artery or nerve root injury was assessed. RESULTS: Mean screw length was 14.05 mm using Magerl's technique, 13.47 mm using Anderson's, 12.8 mm using An's and 17.03 mm using the new technique. Data analysis showed significantly longer lateral mass screw length using the new technique (p value < 0.00001). Nerve potential injury occurred 37 times using Magerl's technique, 28 using Anderson's, 13 using An's and twice using the new technique. Vertebral artery potential injury occurred once using Magerl's technique, 8 times using Anderson's and none using either An's or the new proposed technique. The risk of neurovascular complication was significantly lower using the new technique (p value < 0.01). CONCLUSION: The new proposed technique allows for longer screws, maximizing purchase and stability, while lowering the complication rate.

Model of Disc Degeneration in Rat Tail Induced Through a Vascular Isolation of Vertebral Endplates.

Back pain is a major health problem. The degenerative cascade of the spine begins in the intervertebral disc, due to an impairment in the blood supply through the vertebral endplates. Our objective was to develop a novel disc degeneration model based on these premises, akin to the process in humans, in contrast to other proposed models (puncture, enzyme injection, aberrant loads,…) Material and methods: 37 Sprague-Dawley rats, 2 arms: (a) histological (n = 17, one died), en- bloc sections, Van Gieson staining, (Nisimura-Mochida criteria) and also collagen VI staining (tissue oxidative stress), four animals were euthanized every 2 weeks (2-8); and (b) imaging (n = 20, six wound sloughs), MRI 9.4 Tesla protocol, sequential disc volumetric analysis (24 h-8 weeks) in all animals. Disc degeneration was induced by means of vascular isolation of tail discs endplates either from one side or both. RESULTS: Isolation from both sides caused a progressive degeneration of the disc (p < 0.001 vs. controls), bigger than isolation from one side (p < 0.01 vs. both sides and p < 0.05 vs. controls), as rated by volumetric reduction; furthermore, tissue structural changes (Nisimura-Mochida) and collagen VI deposition confirmed these results. CONCLUSION: the model here described represents a novel and translational tool that reproduces the intervertebral disc degeneration in a similar way to that taking place in human beings.