Evaluation of Sexual Function in Patients with Lower Lumbar Disc Herniation: A Comparison of Pre- and Postoperative Status.

BACKGROUND: Neuroregulation of sexual functions requires coordination of parasympathetic, sympathetic, and somatosensory neuronal pathways. The nerves formed by the lower lumbar plexus provide the innervation of the urogenital organs. Lower lumbar disc hernias (LDHs) might impair the neuroregulation of sexual functions by compressing the neural structures. This prospective study aims to evaluate the effect of lower LDHs on libido and sexual dysfunctions. METHODS: A total of 61 sexually active patients diagnosed with single-level LDH who underwent unilateral microdiscectomy were included in the study. The patients' healthy sex partners were included in study as controls. The International Sexual Function Index-5 (IIEF-5) and Female Sexual Function Index (FSFI) were used for sexual assessment of male and female participants, respectively. Visual Analog Scale (VAS) was used for pain assessment. RESULTS: According to the FSFI scores, all 20 female patients had preoperative sexual dysfunction, which improved in 15 (75%) patients after surgery (p < 0.001). According to the IIEF-5 score for men, 38 of 41 male patients had preoperative sexual dysfunction, which improved in 26 (68.4%) patients postoperatively (p < 0.001). CONCLUSION: The preoperative sexual dysfunctions of LDH patients improved significantly after the microdiscectomy.

Establishing Safe Surgical Parameters for Placement of C2 Pedicle Screws: A Retrospective Study.

BACKGROUND: The study aimed to evaluate the safety and feasibility of transpedicular instrumentation for the C2 vertebra and to establish the precise anatomical parameters and boundaries within which this procedure can be safely and effectively performed. METHODS: This retrospective study analyzed 66 patients who underwent C2 transpedicular screw fixation. Preoperative and postoperative axial, sagittal, and coronal computed tomography (CT) scans were examined. Anatomical measurements were taken to determine the horizontal and vertical distances from the C2 pedicle projection to the vertebral foramen using CT images. Based on the anatomical location of the vertebral artery within the C2 vertebral foramen, the patients were divided into four subgroups using the horizontal pedicle width (HPW) and vertical pedicle width (VPW) of the C2 spine. RESULTS: The average age of the patients included in the study was 46.48 years. The patient population comprised 32 (48.5%) males and 34 (51.5%) females. Based on the anatomical measurements, the distribution of C2 vertebra types was as follows: type 1 accounted for 68.9%, type 2 for 3.8%, type 3 for 16.7%, and type 4 for 10.6%. Significantly narrower pedicle widths were observed in types 2 and 4 compared to other vertebra types. Type 2 had the largest medial angle (MA), while type 4 had the narrowest MA. In terms of the sagittal plane, type 4 exhibited the widest MA and type 3 had the narrowest MA, but these differences were not statistically significant. Among the cases, 12 (18.1%) involved the vertebral foramen, with 1 case (8.3%) showing screw-related vertebral artery injury (0.75% of all screws). No vertebral artery injuries were observed with the other transpedicular screws. CONCLUSION: Preoperative anatomical measurements for patients undergoing transpedicular instrumentation on the C2 vertebra should include planning CT images on three planes: axial, sagittal, and coronal.

Posterior Cervical Discectomy via Keyhole Foraminotomy: A Case Series Comparing Microdiscectomy with Endoscope-Assisted Discectomy.

AIM: To report the clinical outcomes of microdiscectomy (MD) and endoscope assisted discectomy (EAD) techniques via the posterior approach in patients with cervical disc herniations (CDHs). MATERIAL AND METHODS: The data were obtained from retrospective review of the patient?s charts and the latest follow-up examination. RESULTS: A total of 83 cases with CDH who were treated by posterior cervical discectomy (PCD), between 2010 and 2019, were reviewed. MD was used in 42 patients (male: 20, female: 22) with a mean age of 51.1 years. In MD group, all patients had pain, and 26 of them had additional weakness. Visual analogue scale (VAS) neck score was 7.72, VAS arm score was 8.83; PROLO score was 7.41. EAD was used in 41 patients (male: 26, female: 15) with a mean age of 38.7 years. In EAD group, all patients had pain, and 20 of them had additional weakness. VAS neck and arm scores were 7.75, and 8.72, respectively; PROLO score was 7.44. Mean follow-up time was 24.7 months. The scores at the latest exam are as follows: in MD group, VAS score for neck was 2.32, for arm 1.11; PROLO score was 9.58; in EAD group, VAS score for neck was 2.18 and for arm 0.97; PROLO score was 9.66. Both surgical techniques were success with statically significance (p?0.05) according to the scores.The techniques were equally effective while postoperative VAS (p > 0.412) and PROLO (p > 0.980) scores were similar in both groups. CONCLUSION: Both approaches are effective for selected patients with soft cervical disc herniation in which settled lateral location. Both techniques allow working with two handle, therefore facilitating the gentle manipulation that can obtain for avoiding hazardous effect to spinal cord and nerve root.