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Fulltext Radiofrequency-induced intradiscal nucleoplasty chronic low back pain secondary to lumbar disc herniation

Lee D, Loh E, Kueh C, Poi J, Francis T, Koh KC, et al.

Malays Orthop J, 2013 Jul;7(2):18-20.
PMID: 25722820 MyJurnal DOI: 10.5704/MOJ.1307.009

We set out to assess the efficacy of radiofrequency-induced intradiscal nucleoplasty in reducing pain in symptomatic patients with MRI-defined lumbar disc herniation and their satisfaction with the procedure. We compared the patients' pain intensity and severity of disability scores before and after undergoing the procedure in a retrospective questionnaire. These patients reported statistically significant reduction of pain intensity and disability level after the procedure. We conclude that radiofrequencyinduced intradiscal nucleoplasty is an acceptable alternative minimally invasive procedure in relieving the symptoms of patients with lumbar disc herniation.

Matched MeSH terms: Intervertebral Disc Degeneration
Biomechanical investigation on the influence of the regional material degeneration of an intervertebral disc in a lower lumbar spinal unit: A finite element study

Masni-Azian, Tanaka M

Comput Biol Med, 2018 07 01;98:26-38.
PMID: 29758454 DOI: 10.1016/j.compbiomed.2018.05.010

Intervertebral disc degeneration involves changes in its material properties that affect the mechanical functions of the spinal system. However, the alteration of the biomechanics of a spinal segment through specific material degradation in a specific region is poorly understood. In this study, the influence of the constitutive material degeneration of disc tissues on the mechanics of a lower lumbar spinal unit was examined using a three-dimensional nonlinear finite element model of the L4-L5 functional spinal unit. Different grades of disc degeneration were simulated by introducing a degeneration factor to the corresponding material properties to represent fibrous nucleus, increased fibre and ground substance laxity, increased fibre stiffness and total annular fracture along posterior and posterolateral regions. The model was loaded with an axial compression of 500 N and pure moments of up to 10 Nm to simulate extension, flexion, lateral bending and axial rotation. To validate the model, the spinal motion and intradiscal pressure of healthy and degenerated discs with existing in vitro data were compared. The disc with a fibrous nucleus and the presence of intradiscal pressure increase the spinal instability during flexion and axial rotation, and the absence of intradiscal pressure increases the spinal instability in all directions. Bulging displacement and shear strains in the disc with total fracture and ground substance laxity are high in all of the loading cases. Our study could provide useful information to enhance our understanding of the influence of each constitutive component of the intervertebral disc on the mechanics of the spinal segment.

Matched MeSH terms: Intervertebral Disc Degeneration/physiopathology*
Fulltext Fluoroscopy assisted minimally invasive transplantation of allogenic mesenchymal stromal cells embedded in HyStem reduces the progression of nucleus pulposus degeneration in the damaged ntervertebral [corrected] disc: a preliminary study in rabbits

Subhan RA, Puvanan K, Murali MR, Raghavendran HR, Shani S, Abdullah BJ, et al.

ScientificWorldJournal, 2014;2014:818502.
PMID: 24983002 DOI: 10.1155/2014/818502

This study was conducted to develop a technique for minimally invasive and accurate delivery of stem cells to augment nucleus pulposus (NP) in damaged intervertebral discs (IVD). IVD damage was created in noncontiguous discs at L4-L5 level; rabbits (N = 12) were randomly divided into three groups: group I treated with MSCs in HyStem hydrogel, group II treated with HyStem alone, and group III received no intervention. MSCs and hydrogel were administered to the damaged disc under guidance of fluoroscopy. Augmentation of NP was assessed through histological and MRI T2 mapping of the NP after eight weeks of transplantation. T2 weighted signal intensity was higher in group I than in groups II and III (P < 0.05). Disc height index showed maximum disc height in group I compared to groups II and III. Histological score of the degenerative index was significantly (P < 0.05) lower in group I (8.6 ± 1.8) than that in groups II (11.6 ± 2.3) and III (18.0 ± 5.7). Immunohistochemistry staining for collagen type II and aggrecan staining were higher in group I as compared to other groups. Our results demonstrate that the minimally invasive administration of MSCs in hyaluronan hydrogel (HyStem) augments the repair of NP in damaged IVD.

Matched MeSH terms: Intervertebral Disc Degeneration/pathology*; Intervertebral Disc Degeneration/therapy*
Fulltext Unusual Posterior Epidural Migration of Intervertebral Herniated Disc: A Report of Two Cases

Tamburrelli FC, Perna A, Oliva MS, Giannelli I, Genitiempo M

Malays Orthop J, 2018 Nov;12(3):47-49.
PMID: 30555647 DOI: 10.5704/MOJ.1811.012

Disc herniation is one of most common causes of spine surgery. Because of the presence of posterior longitudinal ligaments, disc fragments often migrate into the ventral epidural space. A posterior epidural herniation of a disc fragment is a rare occurrence. We report two cases of posterior migrated disc fragments, with, radiological and clinical findings. Because of the rarity of a posterior migration of the intervertebral disc fragments, a differential diagnosis can be challenging. This painful syndrome associated with neurological lower limb deficits can be confused initially, with other posterior epidural space-occupying lesions such as tumours, abscess or hematomas. A gadolinium-enhanced MRI scan is the gold standard for a correct diagnosis. Early surgical decompression of the spine with a posterior approach remains the optimal technique in ensuring the best possible outcome for the patient.

Matched MeSH terms: Intervertebral Disc Degeneration
The efficacy of pulsed radiofrequency intervention of the lumbar dorsal root ganglion in patients with chronic lumbar radicular pain

Marliana A, Yudianta S, Subagya DW, Setyopranoto I, Setyaningsih I, Tursina Srie C, et al.

Med J Malaysia, 2020 03;75(2):124-129.
PMID: 32281592

INTRODUCTION: In recent years, pulsed radiofrequency (PR) has been used as a minimally invasive pain intervention. However, various studies on the efficacy of PR as modalities for the treatment of radicular pain in lumbar disc herniation have had varied results.
OBJECTIVE: This study aims to determine the efficacy of PR in reducing radicular pain among lumbar disc herniation patients compared with conservative treatment.
METHODS: This study was conducted using the before-andafter quasi experimental design. There were 50 subjects that fulfilled the inclusion and exclusion criteria and they were divided into an intervention group (n=25) and control group (n=25). The intervention group was given once PR in the dorsal root ganglion. All subjects were assessed for Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) before treatment, at 1- , 2- and 4-week after treatment.
RESULTS: At1-, 2- and 4-week, the VAS reduction in the intervention group was statistically significant compared to the control group. Four weeks after the intervention, the VAS score decreased in the intervention group (mean VAS -78.5, SD 16.8) more significantly compared to the control group (p<0.001). The ODI score decreased in the intervention group (mean ODI -61.8, SD 20.1) more significantly than in the control group (p<0.001).
CONCLUSION: Finding showed that at1- , 2- and 4-weekPR was more efficacious in reducing radicular pain among lumbar disc herniation patients compared to the conservative therapy.

Matched MeSH terms: Intervertebral Disc Degeneration
Measurement of range of motions of L3-L4 healthy spine through offsetting reflective markers and in silico analysis of meshed model

Kosalishkwaran G, Parasuraman S, Singh DKJ, Natarajan E, Elamvazuthi I, George J

Med Biol Eng Comput, 2019 Oct;57(10):2305-2318.
PMID: 31444622 DOI: 10.1007/s11517-019-02026-6

Degenerative disc disease (DDD) is a common condition in elderly population that can be painful and can significantly affect individual's quality of life. Diagnosis of DDD allows prompt corrective actions but it is challenging due to the absence of any symptoms at early stages. In studying disc degeneration, measurement of the range of motion (RoM) and loads acting on the spine are crucial factors. However, direct measurement of RoM involves increased instrumentation and risk. In this paper, an innovative method is proposed for calculating RoM, emphasizing repeatability and reliability by considering the posterior thickness of the spine. This is achieved by offsetting the position of markers in relation to the actual vertebral loci. Three geometrically identical finite element models of L3-L4 are developed from a CT scan with different types of elements, and thereafter, mesh element-related metrics are provided for the assessment of the quality of models. The model with the best mesh quality is used for further analysis, where RoM are within ranges as reported in literature and in vivo experiment results. Various kinds of stresses acting on individual components including facet joints are analysed for normal and abnormal loading conditions. The results showed that the stresses in abnormal load conditions for all components including cortical (76.67 MPa), cancellous (69.18 MPa), annulus (6.30 MPa) and nucleus (0.343 MPa) are significantly greater as compared to normal loads (49.96 MPa, 44.2 MPa, 4.28 MPa and 0.23 MPa respectively). However, stress levels for both conditions are within safe limits (167-215 MPa for cortical, 46 MPa for the annulus and 3 MPa for facets). The results obtained could be used as a baseline motion and stresses of healthy subjects based on their respective lifestyles, which could benefit clinicians to suggest corrective actions for those affected by DDD.

Matched MeSH terms: Intervertebral Disc Degeneration