Introduction Although transforaminal interbody fusion (TLIF) and anterior lumbar interbody fusion (ALIF) combined with posterior fusion (AP) have similar fusion rates, it is unclear if choice of approach has an impact on post-operative complications. Research question Is the incidence of residual leg and/or back pain requiring additional treatment after one- or two-level TLIF and AP similar? Material and methods Adult patients who underwent one- or two-level TLIF or AP for degenerative pathology were identified and matched using age, sex, body mass index (BMI), American Society of Anesthesiologists (ASA), insurance status, smoking status, revision and number of levels fused. The incidence of radicular leg and back pain requiring emergency department visit/readmission or same level surgical intervention was compared between the two groups. Results Of the 319 TLIF and 288 AP cases, 119 cases in each cohort were matched. TLIF patients had shorter operative times (203 min vs 258 min, P<0.001) and hospital stays than the AP patients (3.76 days vs 4.98 days, P<0.001). The incidence of residual leg pain (7 vs 5, P=0.769) and back pain (13 vs 15, P=0.841) was similar between the two groups. Except for constipation, which was more common in the AP group, the incidence of complications was similar between the two groups. Conclusions Patients undergoing one- or two-level TLIF showed shorter operative time and hospital stay compared with those undergoing AP. The incidence of leg radiculopathy and back pain was similar between the two groups. Surgeons should consider these findings as part of the decision-making process regarding which approach to use in patients requiring a lumbar interbody fusion.

UNASSIGNED: Lumbar spinal stenosis is a common finding in the adult population. Lumbar Epidural Steroid Injections (ESIs) are often used in management of this condition, with conflicting evidence regarding their efficacy. Previous research has suggested a negative impact of ESIs on the postoperative outcomes when ESIs are administered preoperatively prior to spine surgery in this population. Our retrospective study was performed to gain greater insight into the impact of preoperative ESIs on postoperative outcomes following spine surgery in management of lumbar stenosis.
UNASSIGNED: Our objective is to determine how preoperative ESIs impact postoperative outcomes following spine surgery in management of lumbar stenosis.
UNASSIGNED: Retrospective cohort involving 95 patients (39 patients who received ESI in the preoperative timeframe and 56 patients who did not) who underwent surgical management of lumbar stenosis. Data for patients with preoperative ESI was compared to those without preoperative ESI administration.
UNASSIGNED: Institutional.
UNASSIGNED: Not Applicable.
UNASSIGNED: PROMIS (Patient-Reported Outcomes Measurement Information System) scores, VAS (Visual Analog Scale) pain scores, ODI (Oswestry Disability Index), NDI (Neck Disability Index).
UNASSIGNED: At baseline (time of surgery), the ESI group had significantly higher ODI, PROMIS pain, PROMIS pain interference, VAS leg and lower PROMIS physical function, but no significant difference in PROMIS satisfaction, VAS back and NDI, compared to the Non-ESI group. At 3 months after surgery, both the ESI and Non-ESI groups demonstrated a significant decrease in VAS back, VAS leg, PROMIS pain and ODI from baseline scores. The improvement in PROMIS pain at 3 months after surgery was larger in the ESI group than the Non-ESI group.
UNASSIGNED: Preoperative ESI administration did not lead to worsening of disability, function, or pain symptoms in the short-term postoperative period following surgical management of lumbar stenosis. Patients had short term improvements in radicular pain following surgical management of lumbar stenosis, regardless of preoperative ESI administration.

UNASSIGNED: In males, prostate cancer is the second most diagnosed cancer worldwide and the sixth leading cause of cancer death. Radiation therapy is a common treatment modality for prostate cancer but carries a multitude of adverse effects, ranging from radiation cystitis to post-radiation neuropathy. Proton beam therapy has gained attention as a valuable alternative, due to its improved precision with targeted dose delivery and reduced toxicity. However, the risk for radiation-induced complications, such as radiation-induced lumbar radiculopathy, is not fully understood and requires further investigation.
UNASSIGNED: We present a 68-year-old man with delayed-onset lumbosacral polyradiculitis following proton precision beam therapy for localized prostate cancer. The patient underwent proton therapy treatment for the prostate and seminal vesicles with favorable results and tumor remission. However, five months after completing radiation therapy, the patient presented with chronic lower extremity pain, weakness, and bilateral lower extremity paresthesias. MRI showed diffuse hyperintensity of bilateral L5-S3 nerve roots and an intramuscular edema-like signal involving the bilateral obturator externus and internus muscles, likely due to radiation. Additionally, EMG findings suggested the presence of chronic bilateral L5 radiculopathy.
UNASSIGNED: The clinical manifestation of delayed-onset radiation-induced lumbosacral plexopathy is a rare and uncommon complication of external beam radiation therapy that presents as radicular or myelopathic symptoms based on the location and severity of the inflammation. This case highlights the need for continued follow-up post-radiation and emphasizes the need for a comprehensive review of the oncological history of cancer patients.

UNASSIGNED: Current knowledge of intervertebral discal cysts is restricted to case reports and surgical case series, typically in young adult males presenting with back pain and radiculopathy.
UNASSIGNED: We review our single-center experience to describe presentation, management, and outcomes of these rare lesions.
UNASSIGNED: We performed a retrospective electronic search of our institution database using key words \"discal cyst,\" \"disc cyst\" and variations. Clinical presentation, imaging findings, management and outcomes were reviewed and tabulated.
UNASSIGNED: Nine patients were identified (4 female), with mean age 49.1 years. Three patients had prior surgery at the level of the cyst. Seven patients presented with back pain, five with additional radiculopathy, one patient with radiculopathy alone, and one asymptomatic. Most discal cysts occurred at L5-S1, were left-sided, paracentral in location with a T2 hypointense rim and variable enhancement. One patient underwent primary cyst resection. Amongst 6 patients who underwent primary image-guided procedures, two had sustained pain relief, three proceeded to cystectomy, microdiscectomy and/or posterior decompressive surgery, and two were lost to follow-up.
UNASSIGNED: Our retrospective cohort includes a wider age group with more heterogeneous clinical features, treatment approaches and response to therapy than that described in the literature. CT or fluoroscopy-guided steroid injection provided short-term symptomatic relief with several cases managed definitively with surgery. Further research is required to better understand and manage these rare lesions.
UNASSIGNED: Discal cysts and pseudocysts occur in a wider range of patients and with more heterogenous presentations than previously described. Imaging-guided intervention can provide short-term symptomatic relief, but further research is required to optimize long-term management.

UNASSIGNED: Determine the efficacy, effectiveness, and safety of fluoroscopically- or ultrasound-guided caudal epidural steroid injections (ESIs) with or without catheter placement for the treatment of chronic low back (CLBP), radicular pain, and/or chronic post-surgical back pain (CPSBP).
UNASSIGNED: Systematic review.
UNASSIGNED: Adults ≥18 years with CLBP, radicular pain, or CPSBP ≥3 months.
UNASSIGNED: Fluoroscopically- or ultrasound-guided caudal ESI with or without a catheter including epidural neuroplasty.
UNASSIGNED: Sham, placebo procedure, active standard care treatment, or none.
UNASSIGNED: The primary outcome was the proportion of individuals with reduction of pain by ​≥ ​50%. Secondary outcomes included functional improvement, analgesic use, subsequent spinal surgery, healthcare utilization, and mean improvement in pain. Reported adverse events were also cataloged.
UNASSIGNED: Four reviewers independently assessed publications before January 2, 2022 in PubMed, Ovid MEDLINE, and Scopus. Quality of evidence was evaluated using the Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) framework.
UNASSIGNED: Of 364 records screened, 23 publications met inclusion criteria. The success rates for the primary outcome could only be extrapolated from one study. Another study used a composite improvement scale that included pain and functional outcomes. The reported success rates in these two studies ranged from 40 to 58% at three months, 25%-67% at six months, and 58%-61% at one year. Data on secondary outcomes were limited; however, rates of functional improvement as measured by mean improvement in Oswestry Disability Index (ODI) ranged from 2% to 55%.
UNASSIGNED: There is moderate-quality evidence that caudal ESIs using an in-dwelling catheter for two days is an effective treatment for pain and dysfunction associated with disc herniation with radicular pain and for CPSBP at three, six, and 12 months. There is low-quality evidence supporting the effectiveness of other caudal ESI techniques for pain and dysfunction associated with central lumbar spinal stenosis with neurogenic claudication, discogenic CLBP, and CLBP without disc herniation or radiculitis.

UNASSIGNED: Cervical transforaminal epidural steroid injections (CTFESI) are commonly used in the treatment of upper extremity radicular pain. Recently, a modification of the conventional technique has been developed and validated which has a theoretical safety advantage of less risk of needle contact of the spinal nerve and vertebral artery. The new approach involves a needle trajectory under fluoroscopic guidance which is directly based upon the specific superior articular process angle measurement on MRI.
UNASSIGNED: The purpose of this study was to evaluate the discontinuation rate of the modified approach CTFESI procedure in a non-sedated patient population. The study was also undertaken to confirm the safety of the procedure in an office-based setting.
UNASSIGNED: A retrospective review was performed of the authors\' (DL, SH) practice to identify all CTFESI using the modified approach, performed between October 2018 through January 2021 through a query of the investigators\' (DL and SH) electronic medical record system. Any discontinued CTFESI procedure was identified. The reason for discontinuation was determined through medical record review. In addition, any significant neurologic or cardiovascular event occurring during or immediately following any completed or discontinued CTFESI was identified. Mild vasovagal reaction was not considered a significant complication.
UNASSIGNED: A total of 973 CTFESI procedures were performed using the modified approach during the study period. Twelve procedures, 1.2% (95% CI 0.7-2.1%) were discontinued. Nine were aborted due to vascular flow not resolved with needle repositioning. Only three, 0.3% (95% CI 0.1-0.9) were aborted due to patient intolerance. There were zero significant neurologic or cardiovascular complications.
UNASSIGNED: The performance of the modified approach CTFESI appears to be well tolerated with a very low rate, 0.3%, of discontinuation due to intolerance in non-sedated patients. The zero incidence of neurologic or cardiovascular complication contributes to the current literature on the safety of this procedure.

Peripheral neuropathy and radiculopathy often result in skeletal muscle disorders, typically leading to muscle atrophy. Concurrent muscle hypertrophy or persistently elevated creatine kinase (CK) is rare. While muscle hypertrophy is commonly observed in myogenic diseases, such as muscular dystrophy, acromegaly, inflammatory myopathies, and hypothyroidism, reports of muscle hypertrophy caused by neuropathy are infrequent. We encountered a patient with persistently elevated CK levels and unilateral lower leg muscle hypertrophy associated with neuropathy. The patient had cauda equina syndrome symptoms and pain in the left lower leg. Lumbar spine magnetic resonance imaging (MRI) revealed central spinal stenosis, which was believed to be the cause of the symptoms. Lower-limb MRI revealed high signal intensity in the gastrocnemius muscle on fat-suppressed T2-weighted imaging. Surgical treatment improved the radiculopathy, hypertrophy, and pain in the left lower leg. During the one-year follow-up, improvement was confirmed with both MRI and nerve conduction studies. Calf muscle hypertrophy associated with neuropathy has been reported; however, no reports have demonstrated pre- and postoperative changes with MRI and nerve conduction studies. We report a patient with lower leg muscle hypertrophy and persistent CK elevation associated with neuropathy, along with a literature review.

暂无摘要。

To explore whether the potential instability of the cervical spine and cervical muscle degeneration in patients with cervical spondylotic radiculopathy (CSR) affect the efficacy of cervical traction, and whether cervical traction can aggravate the potential instability of the cervical spine. We divided the 113 recruited CRS patients into three groups based on the differences in horizontal displacement and abnormal angle, and measured the degree of cervical muscle degeneration in the patients through MRI. Considering functional scores, VAS, NDI and PCS scores of the three groups post-treatment were significantly improved. Through the intergroup analysis, we found that the improvement in functional scores in the mild and moderate instability trend groups was better than that in the severe group. Through MRI measurements, we found that the degree of cervical muscle degeneration was significantly increased in the severe instability trend group. Regarding the changes in X-Ray imaging parameters pre- and post-treatment, no significant differences were observed pre- and post-treatment. For patients with CSR, the more serious their predisposition for cervical instability was, the more severe the degree of cervical muscle degeneration was, which means the worse the curative effect was, but cervical traction did not aggravate the potential degree of cervical instability.

暂无摘要。