European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
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Comparative Study
Lumbar disc high-intensity zone: the value and significance of provocative discography in the determination of the discogenic pain source.
Disagreement still exists in the literature as to the significance of the high-intensity zone (HIZ) demonstrated on magnetic resonance imaging (MRI) as a potential pain indicator in patients with low back pain. A prospective blind study was therefore conducted to evaluate the lumbar disc high-intensity zone with the pain provocation response of lumbar discography. Consecutive patients with low back pain unresponsive to conservative treatment and being considered for spinal fusion were subjected to MRI followed by lumbar discography as a pre-operative assessment. ⋯ The sensitivity, specificity and positive predictive value for pain reproduction were high, at 81%, 79% and 87% respectively. The nature of the HIZ remains unknown, but it may represent an area of secondary inflammation as a result of an annular tear. We conclude from our study that the lumbar disc HIZ observed on MRI in patients with low back pain is likely to represent painful internal disc disruption.
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Multicenter Study Clinical Trial
Posterior endoscopic discectomy (and other procedures).
Percutaneous approaches to lumbar discectomy were somewhat controversial, because of their limited indications. They have not proven to be as effective as standard open lumbar disc surgery, because of longer operating times and some technical problems in addressing all the different aspects of lumbar disc herniations. ⋯ MED, and METR'x which evolved from it,. allow the surgeon to address not only contained lumbar disc herniations, but also free-fragment disc pathology and symptomatic lateral recess stenosis secondary to bony hypertrophy. The surgical technique is summarized and some preliminary clinical results of a prospective multicenter study with 13 months' mean follow-up are presented.
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Indications and timing of surgical treatment for cervical radiculopathy and myelopathy, and the long-term results for the conditions, were reviewed. Advances in spinal imaging and accumulation of clinical experience have provided some clues as to indications and timing of surgery for cervical myelopathy. Duration of myelopathy prior to surgery and the transverse area of the spinal cord at the maximum compression level were the most significant prognostic parameters for surgical outcome. ⋯ When surgery is properly carried out, long-term surgical results are expected to be good and stable, and the natural course of myelopathy secondary to cervical spondylosis may be modified. However, little attention has been paid to the questions "When and what can surgery contribute to treatment of cervical radiculopathy?". A well-controlled clinical study including natural history should be done to provide some answers.
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Endoscopic surgery of the thoracic spine has up to now been considered as an experimental procedure. Reports published in recent years have shown that the results achieved with this technique are as good as, or for some indications superior to, those reported for classic open approaches. A review of the indications, limitations, advantages and disadvantages is presented. Although there is still resistance to acknowledging the effectiveness of this procedure, experience has shown that the results are as good, complications are fewer and postoperative recovery is improved, thus shortening the total hospitalization time.
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Meta Analysis
Anterior thoracoscopic spine release in deformity surgery: a meta-analysis and review.
Videoassisted thoracoscopic surgery (VATS) allows the surgeon to perform an anterior thoracoscopic spine release for spinal deformities. It is an alternative to open thoracotomy. Several years after its introduction the present author gives an update on the indications, surgical techniques, results, and complications of this new technology. ⋯ The VATS procedure has been used with success in most series for pediatric curves (average Cobb angle of 65 degrees or kyphosis of 75 degrees). No report of the surgical outcome (balance, rate of fusion, rib hump correction, cosmetic correction, pain, and patient satisfaction) was available for any series. Further prospective study including these parameters will be required to determine the real benefit of such procedures to the patient, bearing in mind that the correction of spinal deformities is the result of the surgeon's experience, skill, and the available technology.