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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The authors retrospectively reviewed a series of 18 hard thoracic herniated discs (HTHD) operated by thoracoscopy. Isolated cases of HTHD have been reported in the literature, but no series describing these lesions has been published. Seventy-two percent of the herniated discs were situated between T8 and T12. ⋯ The lesion was intradural in three patients (17%) and adherent to the dura mater in eight (44%). Among these 11 patients, surgery was complicated by a dural tear in the first seven that led to a high risk of cerebrospinal fluid fistula: four of these seven patients had required surgical revision. In the last four, the zone of adhesion of the HTHD to the dura mater was preserved, successfully preventing dural tear.
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We investigated back muscle fatigue and endurance in patients with lumbar disc herniation before and after surgery, and established the degree of association between perceived fatigue and objectively measured fatigue. Additionally, the relationships between muscle fatigue and endurance time on the one hand, and activity, participation, self-efficacy and health on the other, were investigated to clarify the grades of association between these factors. Forty-three consecutive patients with lumbar disc herniation were tested before surgery and 4 weeks after surgery. ⋯ The L5 slope correlated with the Roland-Morris, the Oswestry and some items of the SF-36 only in women with correlation coefficients between 0.53 and 0.77. We conclude that the effects of surgery reduced muscle fatigue for the men. There is an association between muscle fatigue and endurance with activity limitations, participation restrictions, self-efficacy and health in patients undergoing surgery for lumbar disc herniation.
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Comparative Study
Percutaneous discography: comparison of low-dose CT, fluoroscopy and MRI in the diagnosis of lumbar disc disruption.
To compare the diagnostic accuracy of low-dose computed tomography (CT), magnetic resonance imaging (MRI) and fluoroscopy in percutaneous discography in patients scheduled for lumbar spondylodesis. ⋯ Low-dose CT and MRI discography have a similar accuracy in the assessment of disc disruption and they are superior to fluoroscopic discography.
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Editorial Comment
Lumbar disk herniation: are the symptoms relevant for surgery?
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Little is known about the methodological quality of guidelines for low back pain treatment. We evaluated the methods used by the developers according to established standards. ⋯ A small number of the available guidelines for low back pain treatment achieved acceptable results for specific quality criteria. In general, the methods to develop the guidelines' therapeutic recommendations need to be more rigorous, more explicit and better explained. In addition, greater importance should be placed on the recommendations for chronic pain.