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
-
Intervertebral disc organ culture has the capacity to control mechanical and chemical boundary conditions while keeping the tissue largely intact, and allowing interventions that would be impossible or unethical on animal studies. Recent studies on ex vivo organ culture has mostly involved small animals, or been limited to development and validation studies. In this study, bovine caudal discs were used. ⋯ No significant differences were seen in viability of the outer annulus region with time, or in any loading groups. We conclude that our system is capable of keeping bovine caudal discs alive for at least 8 days without significant changes in GAG content, or cell metabolism, and that static loading was slightly better able to maintain cell viability than diurnal loading. This system offers promise for the future studies on large intervertebral discs requiring measurements of multiple mechanical and biological dependent variables on the same tissue.
-
We conducted a cross-sectional study of 40 radiculopathy patients in comparison with norm data from healthy subjects using a new electrophysiological method. Early manifestations of dorsal root impairment escape objective diagnosis by conventional somatosensory-evoked potentials due to the overlapping innervation of the affected dermatome by thickly myelinated mechanoreceptive afferents projecting to adjacent intact roots. Evidence suggested less intersegmental overlap for thermonociceptive afferents rendering laser-evoked potentials (LEP) sensitive to monosegmental dorsal root damage. ⋯ Clinical testing yielded more frequent pathological results for pain compared to mechanosensibility. The study confirmed our preliminary evidence of LEP sensitivity to objectively document dorsal root impairment in patients suffering from acute monosegmental radiculopathy. This result opens the perspective of electrophysiologically differentiating the presence or absence of dorsal root pathology in patients with similar clinical symptoms but possibly different prognoses, which require different therapies.
-
Since many years we routinely use diagnostic selective nerve root blocks (SNRB) at our department when evaluating patients with cervical radiculopathy. Frequently patients who also presented with headache reported that the headache disappeared when the nerve root responsible for the radicular pain was blocked with local anaesthetics. Headache has been described as a companioning symptom related to cervical radiculopathy but has never before been evaluated with SNRB performed in the lower cervical spine. ⋯ After selective nerve root block, 59% of the patients with headache reported 50% or more reduction of headache and of these 69% reported total relief. A significant correlation was seen between reduced headache intensity and reduced pain in the neck, shoulder and arm. The result indicates that cervical root compression from degenerative disease in the lower cervical spine producing radiculopathy might also induce headache.
-
The purpose of this study was to analyze the association between the severity of inflammatory endplate changes (Modic) on MRI and the clinical response to intradiscal injection of corticosteroids (IDIC) in chronic low back pain (LBP). A total of 74 patients with LBP and inflammatory Modic changes who showed no response to 3-month conservative treatment received lumbar IDIC. Two spine specialists and a radiologist assessed independently the endplate marrow changes of the injected discs. ⋯ At 3 and 6 months, IDIC tended to be more effective in the Modic I and Modic I-2 groups but not significantly. No complications such as infection or hematoma were reported. IDIC could be a short-term efficient treatment for patients with chronic LBP and predominantly inflammatory endplate changes when conservative treatments have failed.
-
A Neurometer device is an electrical nerve stimulator used to determine the current perception threshold (CPT) evoked by stimulating A-beta fibers at 2,000 Hz, A-delta fibers at 250 Hz and C fibers at 5 Hz. CPT evaluation is used for analyzing peripheral nerve dysfunction. In this study, the sensory disturbance of the lower-extremity was quantitatively analyzed using CPT testing before and after lumbar discectomy. ⋯ The leg pain improved in all patients. Likewise, CPT at 5 Hz, which stimulated C fiber, decreased significantly for both improved and unchanged groups. CPT measured by a Neurometer is very useful in assessing lower-extremity sensory functions before and after surgery for lumbar disc herniation.