[Innervation of the intervertebral disc]. / La inervación del disco intervertebral.

Until very recently, intervertebral disc innervation was a subject of considerable debate. Nowadays, the introduction of inmunohistochemical techniques associated to specific antibodies and studies with retrograde tracers in nerves have allowed greater understanding of disc innervation in physiological and pathological conditions and also endings characteristics and their patterns of distribution in both situations. The existing controversies regarding structural basis of discogenic pain, have raised the interest of knowing the influence of innervation in back pain from discal origin and its characteristics. Today, we know that pathologic neoinnervation accompanying radial fissures is an important factor in the genesis of discogenic pain; within a complex mechanism in which other neurobiomechemical, inflammatory and biomechanical factors are involved.

Complexity analysis of the cerebrospinal fluid pulse waveform during infusion studies.

PURPOSE: Nonlinear dynamics has enhanced the diagnostic abilities of some physiological signals. Recent studies have shown that the complexity of the intracranial pressure waveform decreases during periods of intracranial hypertension in paediatric patients with acute brain injury. We wanted to assess changes in the complexity of the cerebrospinal fluid (CSF) pressure signal over the large range covered during the study of CSF circulation with infusion studies. METHODS: We performed 37 infusion studies in patients with hydrocephalus of various types and origin (median age 71 years; interquartile range 60-77 years). After 5 min of baseline measurement, infusion was started at a rate of 1.5 ml/min until a plateau was reached. Once the infusion finished, CSF pressure was recorded until it returned to baseline. We analysed CSF pressure signals using the Lempel-Ziv (LZ) complexity measure. To characterise more accurately the behaviour of LZ complexity, the study was segmented into four periods: basal, early infusion, plateau and recovery. RESULTS: The LZ complexity of the CSF pressure decreased in the plateau of the infusion study compared to the basal complexity (p=0.0018). This indicates loss of complexity of the CSF pulse waveform with intracranial hypertension. We also noted that the level of complexity begins to increase when the infusion is interrupted and CSF pressure drops towards the initial values. CONCLUSIONS: The LZ complexity decreases when CSF pressure reaches the range of intracranial hypertension during infusion studies. This finding provides further evidence of a phenomenon of decomplexification in the pulsatile component of the pressure signal during intracranial hypertension.

Ischemic Complications After High-Grade Glioma Resection Could Interfere With Residual Tumor Detection With 18F-Fluorocholine PET/CT.

Ischemic complications after resection of high-grade glioma are frequent and may constitute potential cause of false-positive results in postsurgical evaluation using F-fluorocholine PET/CT. On the other hand, hypoxia caused by ischemia promotes invasive glioma growth. We present 3 cases of patients with different grades of ischemic injury after resection of high-grade glioma. The combined interpretation of diffusion-weighted imaging and apparent diffusion coefficient map on MRI, in this clinical setting, is mandatory to avoid PET/CT misinterpretations.

Pharyngeal perforation after anterior cervical spine surgery treated by transoral endoscopic surgery.

BACKGROUND: Anterior cervical fixation has been used since 1967 for multiple pathologies like traumatism, compressive myelopathy, or spinal infections. METHODS: We report the case of a patient who had undergone cervical spine surgery 10 years previously and presented to our clinic with a pharyngeal fistula due to surgical screw displacement that was treated by transoral endoscopic surgery. RESULTS: The immediate postoperative period occurred without incidence and complete odynophagia resolution. The patient was discharged home the fourth day after surgery. Follow-up after 1 year showed no evidence of spinal fixation hardware mobilization. CONCLUSION: We consider the transoral endoscopic approach a feasible low comorbidity technique to treat anterior cervical plate mobilization with pharyngeal and pharyngoesophageal perforations.