Evaluation of Hemodynamic Changes and Fluid Response during Anesthesia in Lumbar Disc Hernias with Pleth Variability Index (PVI).

The study aimed to assess the pleth variability index (PVI) in patients undergoing lumbar disc herniation surgery under general and spinal anesthesia, exploring its correlation with fluid responsiveness, position, and hemodynamic parameters. Methods: This prospective study included 88 ASA 1-2 patients, aged 18-65, undergoing 1-3 h elective lumbar disc herniation surgery. Patients in groups GA and SA were observed for demographic, operative, and hemodynamic parameters at specified time points. (3) Results: PVI values were comparable between the GA and SA groups. After 250 mL of fluid loading, both groups showed a significant decrease in basal PVI at T2. Prone positions in GA exhibited higher PI values than in SA. The transition from a prone to supine position maintained PVI, while pulse and MAP decreased.; (4) Conclusions: PVI values were comparable in elective lumbar disc herniation surgery with general and spinal anesthesia. Both groups exhibited significant a PVI decrease at T2 after 250 mL of fluid loading, indicating fluid responsiveness. In general anesthesia, the prone position showed a lower MAP and higher PI values compared to spinal anesthesia. PVI and PI, sensitive to general anesthesia changes, could have beneficial additions to standard hemodynamic monitoring in spinal anesthesia management.

The Impact of Complex Loadings on the Structure of the L2-L3 Intervertebral Disc in a Sheep Spine Cadaver Model: A Biomechanical and Histological Evaluation.

Background The human vertebral column generates movements under versatile, dynamic loads. Understanding how the spine reacts to these movements and loads is crucial for developing new spine implants and surgical treatments for intervertebral disc injuries. Mechanically uni-axial compression models have been extensively studied. However, the spine's daily loading is not limited to compression, so it is crucial to measure its behavior in all movements (flexion-extension, rotation, and axial compression). Methods This study utilized L1-L5 segments from 19 healthy adult sheep spines. The L2-L3 disc of the first spine underwent only histological evaluation without biomechanical testing to define basic histological parameters. The remaining 18 were divided into three groups of six and subjected to biomechanical tests. Different mechanisms for three groups of spinal segments were prepared, and tests were performed on Shimadzu AG-IS 10 KN (Universal Drawing Press, Kyoto, Japan). An axial load (800 N) was applied to the first group, an axial load with 15 degrees of flexion to the second group, and an axial load with 10 degrees of rotation plus 15 degrees of flexion to the third group. A biomechanical evaluation of the maximum elongation amounts (MEAs) was performed and compared between the groups. Then, the L2-L3 discs were removed from the sheep spines, and a histological examination of the discs was conducted using Hematoxylin-Eosin (HE), Alcian Blue (AB), and Masson's Trichrome (MT) staining. Results The mean MEA ± Standard Deviation (Range) was 1.39 ± 0.38 (0.91-1.94) for Group 1, 2.02 ± 0.75 (0.91-3.01) for Group 2, and 2.47 ± 1.09 (0.64-3.9) for Group 3. Biomechanically, although MEAs increased from Group 1 to Group 3 (meaning that the mean MEAs increased as the number of types of applied force increased), there was no statistically significant difference between the groups regarding the MEAs (P = 0.092). Histologically, no significant differences were observed between all groups after HE staining. In all groups, hypercellularity, edema in the connective tissue, separation between tissue layers, delamination, and signs of swelling and necrosis in the cells were observed similarly. For the AB staining, there was a decrease in the glycosaminoglycan (GAG) structure in the tissue samples compared to the control tissue, but no significant differences were observed between the groups. However, it was observed that the stratification in Group 3 was slightly more deteriorated than in the other groups. For the MT staining, collagen structure deterioration was observed in all groups. It was observed that the amount of collagen was significantly reduced compared to the control tissue. Conclusion As a result, when the axial load is applied biomechanically, there is more displacement of the vertebral discs in Group 3 with multidimensional movements. Furthermore, histological studies revealed deterioration between tissue layers when exposed to complex movements, and the degradation of stratification in group 3 compared to other loading combinations in groups 2 and 3 may indicate the role of complex loads in the formation of disc herniation.

Cooled Radiofrequency Treatment for Radicular Pain Related to Lumbar Disc Herniation.

BACKGROUND: Lower back and radicular pain are leading causes of disability and loss of quality of life, especially due to its high prevalence in the general population. Cooled radiofrequency treatment (CRT) has emerged as a novel non-invasive technique for the management of discogenic pain with safe and effective results. The aim of this study was to evaluate the effectiveness of CRT in the treatment of radicular pain secondary to a lumbar hernia in patients with chronic neuropathic pain after receiving conservative treatment that did not achieve adequate pain management. METHODS: A prospective study of patients undergoing CRT for the management of discogenic low back pain was carried out. When attending the first evaluation and corroborating the lumbar hernias by magnetic resonance imaging (MRI), treatment was offered one month of physiotherapy before CRT. To assess the evolution of the patients, measurements were taken before and after the intervention with the visual analog scale (VAS) and the Oswestry low back pain disability scale (OLBPDS) scores. RESULTS: A total of 74 patients (mean age: 48.42 ± 14.32 years, 66.11% female) were included, who were undergoing a total of 134 herniated intervertebral lumbar discs. When comparing the initial perception of low back pain and after finding a non-significant partial improvement with one month of physiotherapy treatment, it was observed that the patients who were offered CRT showed an average improvement in discogenic pain of 79.92% (p = <0.0001, 95% CI: -7.010 to -6.379) in 98.64% of cases. This was accompanied by an increase in their functionality of daily living activities, as measured by OLBPDS. No patients presented significant adverse events, and in the only case where the desired pain management was not obtained, the patient's discomfort did not worsen. CONCLUSIONS: Intradiscal biacuplasty by CRT is a considerable treatment for lumbar radiculopathy. Postoperative results demonstrated its effectiveness and safety in the management of radicular pain without the presence of significant adverse effects.

Preemptive caudal anesthesia on back pain after lumbar discectomy: a randomized and controlled study.

OBJECTIVE: In this randomized and prospective research, we aimed to relieve surgical and muscle-related pain early after lumbar disc operations with caudal preemptive analgesia. MATERIALS AND METHODS: A total of 120 patients with single-level lumbar disc herniation were included in this study. The caudal epidural injection was performed for all patients 20 min before surgery. The patients were divided into three groups. Non-steroidal anti-inflammatory drugs or tramadol use were recorded. Pre-operative and post-operative pain was interpreted through a visual analog scale. RESULTS: There was a difference between the groups in all post-operative measurements (p < 0.05), between Group 1 and Group 3, and between Group 2 and Group 3. A statistical significance has been achieved between the groups at the 1st h, 2nd h, 4th h, and 24th h (p < 0.05). The difference between the pain intensities of the patients at the 24th h and the 1st week was statistically significant in Groups 1 and 2 (p < 0.05). Evaluation of the effects of medical treatments reduced the severity of back pain and foot pain. CONCLUSION: The preemptive bupivacaine or in combination with methylprednisolone caudal injection is an effective and safe method to reduce post-operative pain and ameliorate functional capacity for the treatment of lumbar disc herniation.

OBJETIVO: En esta investigación prospectiva aleatorizada, nuestro objetivo fue aliviar el dolor quirúrgico y muscular temprano después de las operaciones de disco lumbar con analgesia preventiva caudal. MATERIALES Y MÉTODOS: en este estudio se incluyeron un total de 120 pacientes con hernia de disco lumbar de un solo nivel. La inyección epidural caudal se realizó para todos los pacientes 20 minutos antes de la cirugía. Los pacientes fueron divididos en tres grupos. Se registró el uso de AINE o tramadol. El dolor preoperatorio y postoperatorio se interpretó a través de una escala analógica visual. RESULTADOS: Hubo diferencia entre los grupos en todas las medidas postoperatorias (p < 0.05), entre el grupo 1 y el grupo 3, y entre el grupo 2 y el grupo 3. Se ha logrado una significación estadística entre los grupos a la 1a hora, 2a hora, 4 y 24 horas (p < 0.05). La diferencia entre las intensidades de dolor de los pacientes a la hora 24 y la primera semana fue estadísticamente significativa en los Grupos 1 y 2 (p < 0.05). La evaluación de los efectos de los tratamientos médicos redujo la gravedad del dolor de espalda y de pie. CONCLUSIÓN: La bupivacaína preventiva, o en combinación con la inyección caudal de metilprednisolona, es un método eficaz y seguro para reducir el dolor posoperatorio y mejorar la capacidad funcional para el tratamiento de la hernia de disco lumbar.

A Simple New Cost-Effective Retractor System for Exposure in Lumbar Microdiscectomy: 1-Year Outcome Analysis.

OBJECTIVE: To introduce a new technique for retraction in lumbar microdiscectomy, the rubber band technique (RT), and compare 1-year clinical outcomes of the technique with standard microdiscectomy (SM). METHODS: In this retrospective analysis, 81 consecutive patients with single-level lumbar disc herniation underwent lumbar microdiscectomy by either RT or SM. The primary outcome was Oswestry Disability Index score 1 year after surgery. Secondary outcomes included Short-Form Health Survey (SF-36) physical functioning subscale score, SF-36 bodily pain subscale score, and visual analog scale back pain and leg pain scores. Other parameters were operative time, hospital stay, skin incision, complications, and redo surgery. RESULTS: Of 81 patients, 93% (76 patients) had complete data up to 1-year follow up. The RT group comprised 39 patients (20 males, 19 females), and the SM group comprised 37 patients (19 males 18 females). Primary and secondary outcomes Oswestry Disability Index score, SF-36 physical functioning score, SF-36 bodily pain score, VAS back and leg pain scores, complications, and redo surgery did not differ significantly between the treatment groups at follow-up points (P > 0.05). Skin incision was smaller in the RT group compared with the SM group (P = 0.0001). CONCLUSIONS: Over the 1-year follow-up period, clinical outcomes of patients treated with RT were comparable to patients treated with SM. RT appears to be an alternative safe, effective, and economical approach for lumbar microdiscectomy.

How Can we Improve the Comfort Level and Sleep Quality After Surgery?

PURPOSE: The aim of this study was to determine the effect of progressive relaxation exercises on the comfort level and sleep quality of patients undergoing lumbar disc herniation surgery. METHODS: The study was conducted between July 2015 and October 2016 in the neurosurgery clinic. The sample consisted of 96 patients (n = 56, experimental patients; n = 40 control patients) randomized into groups. The data was collected by using the personal information form, The Perianesthesia Comfort Questionnaire, The General Comfort Questionnaire and Visual Analog Sleep Scale. FINDINGS: In the postoperative General Comfort Scale that there was a statistically significant difference between the mean of the control group and experimental group on the final test (P < .05). When the Visual Analog Sleep Scale mean of the experimental and control group patients were compared between the groups, there was a statistically significant difference on the postoperative 2nd day and 3rd day (P < .05). CONCLUSION: This study supports previous work that progressive relaxation exercises are feasible and effective to improve patient comfort levels after lumbar disc surgery.

Metanalysis on the effectiveness of low back pain treatment with oxygen-ozone mixture: Comparison between image-guided and non-image-guided injection techniques.

Low back pain (LBP) is a common disorder affecting an increasing number of people worldwide, whose diagnosis is focused on the identification of triggering causes. First line therapy usually starts from conservative approaches, whereas second line treatments include a spectrum of minimally invasive techniques, before resorting to more invasive surgical approaches. Among minimally invasive techniques, percutaneous oxygen-ozone injections represent one of the most common and cost-effective procedures. Aim of this study is to provide a metanalysis on literature evidences on percutaneous oxygen-ozone injections, comparing image-guided to non-image-guided techniques for LBP treatment. Imaging-guided procedures showed better performances compared to non-image-guided techniques based only on anatomical landmarks, with higher therapeutic efficacy and lower age-related variability in clinical results.

[Effect of electroacupuncture combined with caudal epidural injection on functional rehabilitation of patients with lumbar hernia].

OBJECTIVE: To observe the effect of electroacupuncture (EA) combined with caudal epidural injection on subjective pain, walking capability, lumbar flexibility and muscle strength in patients with lumbar disc hernia (LDH). METHODS: Sixty LDH patients were randomly allocated to the control group and the research group. The patients of the control group received ultrasound guided caudal epidural injection, and those of the research group received EA combined with ultrasound guided caudal epidural injection. Bilateral Jiaji (EX-B2) and adjunct points Guanyuanshu (BL26), Shenshu (BL23), Chengfu (BL36), Huantiao (GB30), Zhibian (BL54), etc. on the affected side were stimulated with EA (2 Hz/16 Hz, 5-8 mA) for 30 min each time, once every other day for 4 weeks, with 2 days' rest between every two weeks. The patients' pain was evaluated by using visual analogue scale (VAS), walking capability assessed by timed-up and go (TUG) test (time of walking back and forth in 3 m distance), lumbar flexibility (range of motion, ROM) detected by using an inclinometer and the strength of the lumbar flexor and extensor determined by using a push-pull dynamometer. RESULTS: After the treatment, self-comparison showed that the VAS score and TUG-measured time in both groups were significantly decreased (P<0.01, P<0.05), and the post-bucking ROM and extension ROM in the research group, and the lumbar flexor and extensor muscle strength in both groups were obviously increased compared with their own pre-treatment (P<0.05). Comparison between two groups showed that the VAS score and TUG-measured time of the research group were significantly lower than those of the control group (P<0.01), while the lumbar flexor's ROM as well as the extensor's strength were significantly higher in the research group than in the control group (P<0.05). CONCLUSION: For patients with LDH, EA combined with caudal epidural injection can alleviate pain, improve the walking capability, lumbar flexibility and strength of the lumbar extensor, and the therapeutic effect of the combined treatment is significantly better than that of simple caudal epidural injection.

Plasma rico en plaqueta en el tratamiento de la enfermedad degenerativa discal / Platelet-rich plasma in the treatment of degenerative disc disease

Introducción: La enfermedad degenerativa discal es una entidad frecuente y uno de los principales motivos de consulta. Genera altas tasas de discapacidad, años útiles perdidos, así como altos costos económicos por asistencia médica y grandes pérdidas monetarias. Su tratamiento es generalmente conservador, aunque en la actualidad se incluyen terapias biológicas novedosas. Objetivo: Describir las principales propiedades biológicas que hacen del plasma rico en plaquetas una terapéutica efectiva para la enfermedad degenerativa discal. Métodos: Se realizó una revisión no sistemática de la bibliografía basada en artículos que se publicaron en bases de datos indexadas en Infomed como Hinari, Ebsco, Scielo, Pubmed, Cubmed, Cocrhane, Scopus, LILACS; en idioma español, inglés y portugués, durante los últimos diez años. Desarrollo: Se expusieron características clínico epidemiológicas de la enfermedad degenerativa discal, así como las propiedades biológicas que le permiten al plasma rico en plaqueta tener una función activa en la regeneración del disco intervertebral o el retraso de la cascada de degradación de este. Se resaltan los principales estudios de acuerdo a la vía de administración del plasma rico en plaquetas y sus resultados. Conclusiones: De acuerdo con lo publicado por los autores, el plasma rico en plaquetas es una alternativa efectiva en el tratamiento de la enfermedad degenerativa discal por la producción de factores derivados de las plaquetas, que intervienen en la degeneración del disco intervertebral, siendo la vía intradiscal la que más se emplea(AU)

Introduction: Degenerative disc disease is a frequent condition and one of the main reasons to attend the consultation. It generates high rates of disability, useful years lost, as well as high economic costs for medical assistance and large monetary losses. Its treatment is generally conservative, although novel biological therapies are currently included. Objective: To describe the main biological properties that make platelet-rich plasma an effective therapy against degenerative disc disease. Methods: A nonsystematic review of the bibliography was carried out based on articles published, during the last ten years, in databases indexed in Infomed, such as Hinari, Ebsco, Scielo, Pubmed, Cubmed, Cocrhane, Scopus, and LILACS, in Spanish, English and Portuguese. Development: Clinical-epidemiological characteristics of degenerative disc disease were presented, as well as the biological properties that allow platelet-rich plasma to have an active function in the regeneration of the intervertebral disc or the delay of its degradation cascade. The main studies are highlighted, according to the route of administration of platelet-rich plasma and their results. Conclusions: According to what has been published by authors, platelet-rich plasma is an effective alternative in the treatment of degenerative disc disease, due to the production of factors derived from platelets, which intervene in the degeneration of the intervertebral disc, being the intradiscal pathway the most used(AU)

Erector spinae block for postoperative pain management in lumbar disc hernia repair.

PURPOSE: Lumbar disc herniation is the most common spinal disorder and various less invasive techniques such as microdiscectomy have been described. However, postoperative pain management in patients undergoing discectomy is still commonly inadequate. Erector spinae plane (ESP) block is a relatively easier technique with lower risks of complications, and can be performed to provide postoperative analgesia for various procedures. The current study aimed to determine the effect of ESP block on postoperative analgesia in patients who underwent elective lumbar disc herniation repair surgeries. METHODS: Fifty-four ASA I-II patients aged 18-65 years scheduled for elective discectomy surgery were included in the study. Patients were randomized either to the ESP or control group. Ultrasound-guided ESP block with 20 mL of 0.25% bupivacaine was performed preoperatively in the ESP group patients and a sham block was performed with 20 mL normal saline in the control group patients. All the patients were provided with intravenous patient-controlled analgesia devices containing morphine. Morphine consumption and numeric rating scale (NRS) scores for pain were recorded 1, 6, 12, and 24 h after surgery. RESULTS: A significantly lower morphine consumption was observed at 6, 12, and 24 h timepoints in the ESP group (p < 0.05 for each timepoint). Total morphine consumption at 24 h after surgery decreased by 57% compared to that of the control group (11.3 ± 9.5 mg in the ESP group and 27 ± 16.7 mg in the control group). NRS scores were similar between the two groups. CONCLUSION: This study showed that ESP block provided effective analgesia in patients who underwent lumbar disc herniation surgery. CLINICAL TRIALS REGISTRY: NCT03744689.

Investigation of Effectiveness of Pulsed Radiofrequency With Multifunctional Epidural Electrode for Low Back Pain.

AIM: Low back pain affects many people at some point in their life. Whenever pharmacologic and other conservative treatments of chronic pain fail, ablative and interventional methods are attempted on the assumption that interrupting nerve conduction prevents central pain cognition. Pulsed radiofrequency using multifunctional epidural electrodes can be used for multiple etiologies of chronic low back and leg pain with a low complication rate and minimal side effects. METHODS: The records of the 188 patients who underwent pulsed radiofrequency with multifunctional epidural electrode between October 2014 and March 2017 in Algology clinic were examined retrospectively. Visual analogue scale (VAS) for pain, response to straight leg raising test (SLR), lumbar range of motion, analgesic use, patient satisfaction score, need for open operation or other interventional procedure were collected. RESULTS: VAS and SLR tests were found to be significantly improved compared with the preoperative values. The VAS scores at the 10th day and first, third and sixth months were significantly decreased compared to baseline scores (p<0.001). Also, SLR tests were significantly improved compared to baseline scores at the same intervals (p<0.001). CONCLUSION: Pulsed radiofrequency with multifunctional epidural electrode is a safe and effective method for low back pain which is caused by several pathologies.

[Everyone Has Low Back Pain: Degenerative Lumbar Spinal Disorders and Their Treatment Options]. / Jeder hat doch Rückenschmerzen: degenerative lumbale Wirbelsäulenerkrankungen und ihre Behandlungsmöglichkeiten.

Everyone Has Low Back Pain: Degenerative Lumbar Spinal Disorders and Their Treatment Options Abstract. Back pain is one of the most widespread diseases. Up to 84 % of people have low back pain at some point in their lives. Unspecific back pain is treated conservatively. As supportive measure, interventional pain therapy can be performed. Surgery for low back pain should be considered in selected cases only. However, accompanying neurological symptoms are frequent, such as radiation, i.e. sciatica. Typical etiologies are disc herniation or - increasingly frequent, and due to the aging population increasingly frequent - spinal canal stenosis. Surgery has a better prognosis in cases where conservative management failed. If severe neurological symptoms are present, surgery is indicated. Osteoporotic compression fractures cause acute back pain. The decision whether these patients should undergo kypho- or vertebroplasty should be based on guidelines.

The Effect of Paravertebral Ozone Injection in the Treatment of Low Back Pain.

AIM: Paravertebral ozone injection is a new treatment method described in the literature for low back pain. The aim of this study was to compare the pre- and post-treatment pain scores of patients undergoing paravertebral ozone/oxygen (O3 /O2 ) injections for low back pain. METHODS: From September 2018 to December 2018, 122 patients who underwent paravertebral ozone injections due to low back pain were examined retrospectively; 62 patients who met the study criteria were included. The patients were injected with 15 µg/mL (50 mL) O3 /O2 gas in the paravertebral space. The subjects were treated every 7 days for 6 total session. The VAS and Oswestry Disability Index (ODI) scores were assessed before treatment and after treatment (first and third months). The patients' body mass indexes (BMIs) were measured before the injections. RESULTS: There were 12 male patients and 50 female patients. The mean age was 51.9 (range 25 to 71) years. The mean duration of pain was 9.1 (3 to 24) months. Significant improvements were observed in the statistical comparison of VAS and ODI scores between the pre-injection and first month controls (P < 0.000). There was no significant difference in the statistical comparison of VAS and ODI scores between the first and third months (P < 0.05). There was no statistically significant difference between BMI and pain scores (P > 0.213). CONCLUSION: Paravertebral O3 /O2 gas is a reliable and effective treatment for the treatment of lumbar disc herniation, radicular pain, and mechanical back pain due to low back pain.

What every spine surgeon should know about transforaminal lumbar interbody fusion surgery for herniated discs.

PURPOSE: The aim of this study is to report our experiences on managing large lumbar disc herniations with several symptoms by surgery with transforaminal lumbar interbody fusion (TLIF) and to shed light for spine surgeons about TLIF surgery. METHODS: We retrospectively evaluated our database of patients with various lumbar spine pathologies who underwent TLIF surgery from 2014 to 2017. We separated 18 patients who had been operated on for extruded disc herniation, which causes severe pain and radicular symptoms. The pain was quantified by visual analog scores (VAS). The disability status were pre-operatively and post-operatively evaluated by the Oswestry Disability Index (ODI). We evaluated the patients for at least two years. Interbody fusion was detected by routine radiographs at six, 12, and 24 months after surgery. RESULTS: An ODI outcomes analysis demonstrated a statistically significant improvement in the six and 24-month mean scores compared with the pre-operative scores on the same scales. Patients' mobility improved significantly after surgery, as indicated by the decrease in the Oswestry Disability Index from 72 to 23 over two years (p < 0.001). Pain rapidly decreased in all patients and continued to decrease at the time of the latest follow-up. The mean pre-operative VAS scores for pain was 8.8; it had improved to 2.4 after surgery (p < 0.05). Within the follow-up period of two years, the ascertained mean VAS declined from 8.8 to 1.4 (p < 0.001). The average disc space height at the herniated levels was fairly well maintained. No patient had evidence of implant failure. Interbody fusion was graded as definitely solid in 100% of cases two years post-operatively. One patient displayed a superficial wound infection. Following appropriate debridement and antibiotics, the wound healed without sequelae. No major complications were observed, including permanent neurological deficit, pulmonary embolism, peri-operative cardiac event, or death. CONCLUSIONS: The findings of our study and those in the literature showed that primary herniated disc patients with radicular and chronic low back pain, degenerative changes, bi-radicular symptoms, and instability are required to have fusion after a discectomy. Being a heavy-duty worker is also a criterion for fusion surgery. TLIF is performed by a unilateral approach preserving the interlaminar surface on the contralateral side, which can be used as a site for additional fusion. As an effective results TLIF procedure should be chosen for fusion surgery.

Possible pathogenic mechanism of gluteal pain in lumbar disc hernia.

Recent reported results by Fang et al. published in BMC Musculoskeletal Disorders have added to the weight of evidence supporting association between gluteal pain and lumbar disc hernia. Their clinical finding shows the L4/5 level is the main level responsible for gluteal pain in lumbar disc hernia. Indeed, many possible mechanisms may explain why patients experience pain in the gluteal area. In this Correspondence, we would like to highlight several possible mechanisms of LDH-related gluteal pain based on detailed analysis of the sensory innervation of the gluteal region. We hope this can better explain the phenomenon found by Fang et al. We believe the principle mechanism is compression/irritation of L5 or S1 dorsal rami (intraspinal portion), which produce gluteal pain by irritating superior/medial cluneal nerve and referred pain from facet joints and sacroiliac joints. In addition, the presence of proximal sciatica could also induce gluteal pain. Lastly, fibers in the superior or inferior gluteal nerve could be compressed/irritated in LDH, inducing LDH-related gluteal pain. However, additional studies are needed in the future to delineate the exact mechanism(s).

Surgical management for lumbar disc herniation in pregnancy.

Lumbar disc herniation is a common surgical spine pathology that may be presented during pregnancy. The state of pregnancy complicates the diagnosis and therapeutical management of this entity. Specific considerations rule the decision for surgical intervention, the optimal timing of it and the type of selected procedure in a pregnant patient, due to the potential risks for the fetus. In the last 30 years, evolution in the field of spine surgery has provided options other than open standard discectomy. The well-established concept of "minimal intervention" has led to the development of microdiscectomy and other innovative, full-endoscopic techniques for lumbar discectomy. The aim of the present study is to review the surgical management of lumbar disc herniation in pregnancy and investigate the potential role of minimally invasive spine surgery in this specific population.

An evaluation of internet use by neurosurgery patients prior to lumbar disc surgery and of information available on internet.

OBJECTIVE: The aim of this study was to evaluate the Internet use of a group of lumbar disc surgery candidates in order to determine the rate of Internet search by the patients on their disorders and more importantly the reliability of the accessed websites. PATIENTS AND METHODS: Fifty patients who were scheduled for lumbar disc surgery were divided into 2 groups, namely patients who accepted the surgery at the first offer and those who wanted to think over. Educational level information was obtained and patients were asked whether they had searched their disorder and offered surgery on the Internet. Then, a questionnaire was administered and the reliability of the websites was evaluated. Correction: The first 30 websites on the first 3 pages of Google® search engine, the most commonly used search engine in Turkey, were evaluated with the DISCERN® instrument. RESULTS: Of 50 patients, 33 (66%) had conducted a search for the surgery on the Internet. All university graduates, 88.2% of high school graduates, and 18.7% of primary-secondary school graduates had conducted an Internet search. The quality and reliability of the information was high (4.5 points) for 2 (7.1%) websites, moderate (2.3 points) for 6 websites (21.4%) and poor (1 point) for 20 websites (71.4%) as scored with the DISCERN® instrument. The mean DISCERN® score of was 1.1 for websites of health-related institutions or healthcare news, 2.75 for personal websites of physicians and 2.5 for personal websites of non-physicians. The mean DISCERN® score of all websites was 1.5. CONCLUSION: Most of the patients undergoing lumbar disc surgery at our clinic had searched information about the surgical procedure on the Internet. We found that 92.9% of the websites evaluated with the DISCERN® instrument had inadequate information, suggesting low-level reliability.

Similar result after non-elective and elective surgery for lumbar disc herniation: an observational study based on the SweSpine register.

PURPOSE: Surgery for lumbar disc herniation (LDH) is most often elective, but intense pain may require more urgent, non-elective, treatment. It was hypothesized that non-elective treatment could be associated with a less favourable outcome than elective surgery. The aim of this study was to compare 1-2-year outcome after non-elective and elective surgery for treatment of para-median LDH using data from the Swedish Spine register (SweSpine). METHODS: Pre- and postoperative data were available for 301 non-elective and 2364 elective cases. Patient reported outcome measures (PROMs) were; Visual Analogue Scale (VAS) leg and back pain, Oswestry Disability Index (ODI), EuroQol five-Dimensions (EQ-5D) and patient satisfaction. Postoperative p values were adjusted for baseline differences. RESULTS: Preoperative mean (SD) in the non-elective and elective groups were for VAS leg pain 81 (22) and 65 (24), for VAS back pain 51 (33) and 45 (28), for ODI 66 (20) and 45 (17) and for EQ-5D 0.024 (0.35) and 0.31 (0.33), respectively, (p for all <0.001). Postoperative VAS leg pain was 23 (28) in the non-elective group and 20 (26) in the elective group (p = 0.19). Corresponding figures were for VAS back pain 25 (27) and 24 (27) (p = 0.69), ODI 19 (17) and 17 (17) (p = 0.052) and for EQ-5D 0.70 (0.28) and 0.73 (0.29) (p = 0.73). Patient satisfaction did not differ between the groups (p = 0.78). CONCLUSIONS: Even if non-elective patients preoperatively had substantially more pain, higher disability and poorer quality of life than elective patients, postoperative differences were clinically small. Patient satisfaction did not differ.

Could red cell distribution width and mean platelet volume be a predictor for lumbar disc hernias?

BACKGROUND AND PURPOSE: Lumbar disc herniation (LDH) causes major disabilities worldwide. Several studies in the literature had reported the correlation between radiculopathy and inflammatory markers. Mean platelet volume (MPV), red cell distribution width (RDW) and neutrophil to lymphocyte (N/L) ratio are parameters of hemogram which have been found to be associated with inflammatory conditions. Purpose - Since inflammation has an important role in lumbar disc hernias, and RDW, MPV and N/L ratio are also known to be in correlation with inflammation, we have investigated these parameters of the patients with lumbar disc hernias and compared them with the results of the healthy subjects. METHODS: Our study group was composed of patients with lumbar disc hernia, whereas the control group was consisted of healthy volunteers whom visited our outpatient clinics for a routine check-up. Patient characteristics and hemogram parameters of the study cohort were obtained from computerized database system of our institution. SPSS software (SPSS 15.0 for Windows, Chicago, IL, USA) was used for the analysis. RESULTS: There was no significant difference between study and control groups in terms of WBC, neutrophil count, lymphocyte count, neu\lym ratio, Hb, Htc, MCV, and PLT levels (all p>0.05). RDW was significantly increased in study group [15.6 (12.3-22.5)] when compared to control group [14.5(11.9-16.3)] (p=0.004). And MPV in the study group [9.25 (6.38-14.5)] was also significantly increased in comparison to the control subjects [8.8 (6-10.1)] (p=0.013). CONCLUSION: In this retrospective study, we found that, RDW and MPV values in hemograms were increased in patients with lumbar disc herniation when compared to the control group. Conclusions - We suggest that, elevated RDW and MPV may help physicians in decision taking to order radiological imagings in patients with symptoms which can be associated with possible LDH diagnosis. However, for the sake of precision, prospective studies with larger populations are needed.

Microdiscectomia lombar: acessos interlaminar e intertransverso com uso de afastador de Caspar tubular cilíndrico e dreno de Penrose como auxiliar no afastamento da musculatura ­ estudo de 502 casos / Lumbar Microdiscectomy: Interlaminar and Intertransverso Access using Tubular Retractor Caspar Cylindrical and Penrose Drain as an Aid in Muscular Retraction ­ Study of 502 Cases

Os autores fazem uma revisão da literatura abordando conhecimentos neuroanatômicos da raiz e do gânglio da raiz dorsal. Descrevem a técnica para os acessos interlaminar e intertransverso com o uso de afastador de Caspar tubular cilíndrico e dreno de Penrose como auxiliares no afastamento da musculatura. Basearam-se em 502 casos operados em 25 anos. O objetivo deste trabalho é descrever uma técnica com incisão pequena na pele, baixa agressividade para as estruturas anatômicas, sem perda funcional da musculatura paravertebral, campo cirúrgico amplo, facilidade de execução com as duas mãos, alta hospitalar precoce em torno de 24 horas e baixo custo.

The authors review the literature addressing neuro-anatomical knowledge of the root and root ganglion dorsal. Describe the technique for the interlaminar and intertransverso access using tubular retractor Caspar cylindrical Penrose drain as an aid in muscular retraction. Based-seem 502 cases operated in 25 years. The objective of this paper is to describe a technique with small skin incision, low aggressiveness anatomical structures without functional loss of paraspinal musculature, broad surgical field, easy work with both hands, high early hospital about 24 hours and low cost.