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Background: Aortoiliac injury after intervertebral disc surgery is an uncommon but potentially fatal complication. This case study emphasizes how crucial it is to identify this uncommon complication, which can manifest itself in a variety of ways, including leg oedema, heart failure, and deep vein thrombosis. This case is unique in that it presents with an uncommon post-spinal surgery complication of fistulized pseudoaneurysm of the common iliac artery and vein. This combination calls for an immediate diagnosis and careful care. Case presentation: A 36-year-old female patient presented with progressively worsening orthopnea, accompanied by chest pain and palpitations. Her medical history revealed gradually increasing right lower limb swelling since three months, following a discectomy procedure for the management of lower back pain associated with a herniated lumbar disc at the L5-S1 level. Doppler ultrasonography demonstrated an arterialized flow within the right common iliac vein. Subsequent computed tomography angiography identified a pseudoaneurysm of the right common iliac artery, which had formed a fistulous connection to the right common iliac vein. This uncommon complication was likely attributable to prior disc surgery. The patient received endovascular intervention, which was executed in two primary stages: first, embolization of the right internal iliac artery was performed, followed by the exclusion of the arteriovenous fistula through the deployment of a covered stent graft within the right common iliac artery. The intervention successfully resolved both the pseudoaneurysm and the arteriovenous fistula. Conclusions: This case report underscores the importance of considering vascular complications in patients presenting with unusual symptoms following intervertebral disc surgery, even after a significant time lapse. While both open surgical and endovascular approaches can yield good results in treating such complications, the endovascular method, as demonstrated in this case, is associated with minimal morbidity. This approach offers a less invasive alternative that can effectively manage complex vascular injuries resulting from disc surgery. Clinicians should be aware of this rare but serious complication to ensure timely diagnosis and appropriate management, potentially improving patient outcomes in similar cases. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the association between facet joints cross-sectional area asymmetry (FCAA) and cervical intervertebral disc herniation (CDH). Methods: Overall, we retrospectively recruited 390 consecutive patients with CDH who underwent surgical treatment at our institution and 50 normal participants. Clinical variables and radiological findings related to CDH were collected. Results: Patients with CDH were more likely to have a higher absolute value of the facet asymmetry factor (FAF) (p <.001), in which the FAF value of the left group was significantly higher than the other groups (p <.001) and the right group was lower than the central group (p <.001). 9.62% (C3/4), 12.19% (C4/5), 8.70% (C5/6), and 8.14% (C6/7) were determined as cutoff values for each variable that maximized sensitivity and specificity. Furthermore, multivariate analysis showed that cross-sectional area asymmetry of the facet joint (FCAA) was an independent risk factor for the occurrence of CDH. Also, the Chi-square test showed a significant difference in the distribution of the degeneration classification of the disc between the facet-degenerated group and the nondegenerated group at C5/6 (p = 0.026) and C6/7 (p = 0.005) in the facet asymmetry (FA) group. Conclusions: FCAA is evaluated as an independent risk factor for CDH and associated with the orientation of disc herniation. And facet joint orientation may also play a role in cervical spine degeneration rather than facet joint tropism. [ABSTRACT FROM AUTHOR]

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Copyright of Journal of Acupuncture & Tuina Science is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Acupuncture & Tuina Science is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives: To evaluate the diagnostic performance of two novel MRI signs for extruded disc (ED) and uncontained ED (ruptured disc, RD) in the cervical spine using intraoperative findings as reference. Methods: This retrospective study included patients who underwent cervical spine MRI and surgery for disc pathology with intraoperative confirmation of RD from September 1, 2016, to January 31, 2021. Two radiologists determined whether the disc was extruded or ruptured with and without the aid of two novel MRI signs suggesting RD (sign 1: blurred margin of the disc; sign 2: mushroom-shaped disc). The diagnostic performance was analyzed using surgical findings as reference. Intra- and interobserver agreements were measured for each MRI sign. Results: A total of 91 patients totaling 131 discs were enrolled (mean age: 56.02 ± 12.93; range: 26–88; 62 men and 29 women), of whom 62 were surgically confirmed with RD. When the diagnosis was based exclusively on existing ED definitions, ED was diagnosed with 62.9–79.0% sensitivity and 80.2% accuracy, whereas RD was diagnosed with 35.5–45.2% sensitivity and 67.9–71.0% accuracy. However, when the two novel MRI signs were used as an aid in the diagnosis, ED was diagnosed with 95.2–96.8% sensitivity and 84.0–88.5% accuracy, while RD was diagnosed with 95.2–96.8% sensitivity and 84.0–89.3% accuracy. Intra- and interobserver agreement was substantial (k = 00.77–0.86, 0.69–0.79, respectively, p < 0.001). Conclusions: The detection of two novel MRI signs on preoperative MRI can lead to a more accurate RD diagnosis. Key Points: • The diagnostic sensitivity of MRI for cervical ruptured disc is very low (about 35–45 %) using the standardized definition of lumbar disc nomenclature. • Two novel MRI signs can lead to a more accurate diagnosis of the surgically confirmed ruptured disc in the cervical spine. • These two novel MRI signs showed substantial intra-and interobserver reliabilities. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to evaluate the performance and safety of a new hernia blocking system (HBS), implanted after a limited discectomy, to prevent recurrence of lumbar disc herniation.Prospective, multicenter (6 sites), cohort clinical investigation. Thirty patients with a postero-lateral disc herniation between L4-S1 and large annular defects (> 6 mm wide), who underwent a limited discectomy and were treated with a new HBS (DISC care, NEOS Surgery S.L.), were included.This article presents details about the investigational device, its surgical technique, intraoperative parameters, and up to 6 months follow-up outcomes. The primary endpoint of the study was to assess the incidence of early symptomatic reherniation. In addition, disc height, leg and back pain (NRS 0–10), Oswestry Disability Index (ODI), quality of life (EQ-5D-5L) and device safety, were evaluated. Clinicaltrials.gov: NCT04188236; date: 27th November 2019.Thirty patients (43.3% female, 41.7 ± 10.9 years) were implanted with the device under evaluation in a mean of 16 ± 9.6 min. Six months after surgery, no symptomatic reherniation was detected and disc height was maintained in all patients included. All patients had a significant reduction in leg pain (> 2 points in the NRS), 92.9% improved > 15 points in the ODI and 82.6% significantly improved their quality of life (≥ 12 points in EQ VAS score). No product-related serious adverse events nor reoperations occurred.The implantation of an HBS is a feasible and safe procedure that prevents early disc herniation recurrence in patients at high risk of reherniation.Methods: The aim of this study was to evaluate the performance and safety of a new hernia blocking system (HBS), implanted after a limited discectomy, to prevent recurrence of lumbar disc herniation.Prospective, multicenter (6 sites), cohort clinical investigation. Thirty patients with a postero-lateral disc herniation between L4-S1 and large annular defects (> 6 mm wide), who underwent a limited discectomy and were treated with a new HBS (DISC care, NEOS Surgery S.L.), were included.This article presents details about the investigational device, its surgical technique, intraoperative parameters, and up to 6 months follow-up outcomes. The primary endpoint of the study was to assess the incidence of early symptomatic reherniation. In addition, disc height, leg and back pain (NRS 0–10), Oswestry Disability Index (ODI), quality of life (EQ-5D-5L) and device safety, were evaluated. Clinicaltrials.gov: NCT04188236; date: 27th November 2019.Thirty patients (43.3% female, 41.7 ± 10.9 years) were implanted with the device under evaluation in a mean of 16 ± 9.6 min. Six months after surgery, no symptomatic reherniation was detected and disc height was maintained in all patients included. All patients had a significant reduction in leg pain (> 2 points in the NRS), 92.9% improved > 15 points in the ODI and 82.6% significantly improved their quality of life (≥ 12 points in EQ VAS score). No product-related serious adverse events nor reoperations occurred.The implantation of an HBS is a feasible and safe procedure that prevents early disc herniation recurrence in patients at high risk of reherniation.Results: The aim of this study was to evaluate the performance and safety of a new hernia blocking system (HBS), implanted after a limited discectomy, to prevent recurrence of lumbar disc herniation.Prospective, multicenter (6 sites), cohort clinical investigation. Thirty patients with a postero-lateral disc herniation between L4-S1 and large annular defects (> 6 mm wide), who underwent a limited discectomy and were treated with a new HBS (DISC care, NEOS Surgery S.L.), were included.This article presents details about the investigational device, its surgical technique, intraoperative parameters, and up to 6 months follow-up outcomes. The primary endpoint of the study was to assess the incidence of early symptomatic reherniation. In addition, disc height, leg and back pain (NRS 0–10), Oswestry Disability Index (ODI), quality of life (EQ-5D-5L) and device safety, were evaluated. Clinicaltrials.gov: NCT04188236; date: 27th November 2019.Thirty patients (43.3% female, 41.7 ± 10.9 years) were implanted with the device under evaluation in a mean of 16 ± 9.6 min. Six months after surgery, no symptomatic reherniation was detected and disc height was maintained in all patients included. All patients had a significant reduction in leg pain (> 2 points in the NRS), 92.9% improved > 15 points in the ODI and 82.6% significantly improved their quality of life (≥ 12 points in EQ VAS score). No product-related serious adverse events nor reoperations occurred.The implantation of an HBS is a feasible and safe procedure that prevents early disc herniation recurrence in patients at high risk of reherniation.Conclusions: The aim of this study was to evaluate the performance and safety of a new hernia blocking system (HBS), implanted after a limited discectomy, to prevent recurrence of lumbar disc herniation.Prospective, multicenter (6 sites), cohort clinical investigation. Thirty patients with a postero-lateral disc herniation between L4-S1 and large annular defects (> 6 mm wide), who underwent a limited discectomy and were treated with a new HBS (DISC care, NEOS Surgery S.L.), were included.This article presents details about the investigational device, its surgical technique, intraoperative parameters, and up to 6 months follow-up outcomes. The primary endpoint of the study was to assess the incidence of early symptomatic reherniation. In addition, disc height, leg and back pain (NRS 0–10), Oswestry Disability Index (ODI), quality of life (EQ-5D-5L) and device safety, were evaluated. Clinicaltrials.gov: NCT04188236; date: 27th November 2019.Thirty patients (43.3% female, 41.7 ± 10.9 years) were implanted with the device under evaluation in a mean of 16 ± 9.6 min. Six months after surgery, no symptomatic reherniation was detected and disc height was maintained in all patients included. All patients had a significant reduction in leg pain (> 2 points in the NRS), 92.9% improved > 15 points in the ODI and 82.6% significantly improved their quality of life (≥ 12 points in EQ VAS score). No product-related serious adverse events nor reoperations occurred.The implantation of an HBS is a feasible and safe procedure that prevents early disc herniation recurrence in patients at high risk of reherniation. [ABSTRACT FROM AUTHOR]

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Copyright of Journal of Acupuncture & Tuina Science is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives: To determine the diagnostic accuracy of dual-energy CT (DECT) virtual noncalcium (VNCa) reconstructions for assessing thoracic disk herniation compared to standard grayscale CT. Methods: In this retrospective study, 87 patients (1131 intervertebral disks; mean age, 66 years; 47 women) who underwent third-generation dual-source DECT and 3.0-T MRI within 3 weeks between November 2016 and April 2020 were included. Five blinded radiologists analyzed standard DECT and color-coded VNCa images after a time interval of 8 weeks for the presence and degree of thoracic disk herniation and spinal nerve root impingement. Consensus reading of independently evaluated MRI series served as the reference standard, assessed by two separate experienced readers. Additionally, image ratings were carried out by using 5-point Likert scales. Results: MRI revealed a total of 133 herniated thoracic disks. Color-coded VNCa images yielded higher overall sensitivity (624/665 [94%; 95% CI, 0.89–0.96] vs 485/665 [73%; 95% CI, 0.67–0.80]), specificity (4775/4990 [96%; 95% CI, 0.90–0.98] vs 4066/4990 [82%; 95% CI, 0.79–0.84]), and accuracy (5399/5655 [96%; 95% CI, 0.93–0.98] vs 4551/5655 [81%; 95% CI, 0.74–0.86]) for the assessment of thoracic disk herniation compared to standard CT (all p <.001). Interrater agreement was excellent for VNCa and fair for standard CT (ϰ = 0.82 vs 0.37; p <.001). In addition, VNCa imaging achieved higher scores regarding diagnostic confidence, image quality, and noise compared to standard CT (all p <.001). Conclusions: Color-coded VNCa imaging yielded substantially higher diagnostic accuracy and confidence for assessing thoracic disk herniation compared to standard CT. Key Points: • Color-coded VNCa reconstructions derived from third-generation dual-source dual-energy CT yielded significantly higher diagnostic accuracy for the assessment of thoracic disk herniation and spinal nerve root impingement compared to standard grayscale CT. • VNCa imaging provided higher diagnostic confidence and image quality at lower noise levels compared to standard grayscale CT. • Color-coded VNCa images may potentially serve as a viable imaging alternative to MRI under circumstances where MRI is unavailable or contraindicated. [ABSTRACT FROM AUTHOR]

Objectives: This study evaluates GRAPPATINI, an accelerated T2 mapping sequence combining undersampling and model-based reconstruction to facilitate the clinical implementation of T2 mapping of the lumbar intervertebral disc. Methods: Fifty-eight individuals (26 females, 32 males, age 23.3 ± 8.0 years) were prospectively examined at 3 T. This cohort study consisted of 19 patients, 20 rowers, and 19 volunteers. GRAPPATINI was conducted with the same parameters as a conventional 2D multi-echo spin-echo (MESE) sequence in 02:27 min instead of 13:18 min. Additional T2 maps were calculated after discarding the first echo (T2-WO1ST) and only using even echoes (T2-EVEN). Segmentation was done on the four most central slices. The resulting T2 values were compared for all four measurements. Results: T2-GRAPPATINI, T2-MESE, T2-EVEN, and T2-WO1ST of the nucleus pulposus of normal discs differed significantly from those of bulging discs or herniated discs (all p < 0.001). For the posterior annular region, only T2-GRAPPATINI showed a significant difference (p = 0.011) between normal and herniated discs. There was a significant difference between T2-GRAPPATINI, T2-MESE, T2-EVEN, and T2-WO1ST of discs with and without an annular tear for the nucleus pulposus (all p < 0.001). The nucleus pulposus' T2 at different degeneration states showed significant differences between all group comparisons of Pfirrmann grades for T2-GRAPPATINI (p = 0.000–0.018), T2-MESE (p = 0.000–0.015), T2-EVEN (p = 0.000–0.019), and T2-WO1ST (p = 0.000–0.015). Conclusions: GRAPPATINI facilitates the use of T2 values as quantitative imaging biomarkers to detect disc pathologies such as degeneration, lumbar disc herniation, and annular tears while simultaneously shortening the acquisition time from 13:18 to 2:27 min. Key Points: • T2-GRAPPATINI, T2-MESE, T2-EVEN, and T2-WO1STof the nucleus pulposus of normal discs differed significantly from those of discs with bulging or herniation (all p < 0.001). • The investigated T2mapping techniques differed significantly in discs with and without annular tearing (all p < 0.001). • The nucleus pulposus' T2showed significant differences between different stages of degeneration in all group comparisons for T2-GRAPPATINI(p = 0.000–0.018), T2-MESE(p = 0.000–0.015), T2-EVEN(p = 0.000–0.019), and T2-WO1ST(p = 0.000–0.015). [ABSTRACT FROM AUTHOR]

Objectives: To investigate biomechanical changes in lumbar disc herniations. Methods: Patients with lumbar disc herniation verified on a 1.5–3-T magnetic resonance imaging (MRI) scanner were imaged in a weight-bearing 0.25-T MRI scanner in (1) standing position, (2) conventional supine position with relative lumbar flexion, and (3) supine position with a forced lumbar extension by adding a lumbar pillow. The L2-S1 lordosis angle, the disc cross-sectional area, the disc cross-sectional diameter, and the spinal canal cross-sectional diameter were measured for each position. Disc degeneration and nerve root compression were graded, and the pain intensity was reported during each scan position. Results: Forty-three herniated discs in 37 patients (36.7 ± 11.9 years) were analyzed in each position. The L2-S1 lumbar angle increased in the standing position (mean difference [MD]: 5.61°, 95% confidence interval [95% CI]: 3.44 to 7.78) and with the lumbar pillow in the supine position (MD: 14.63°, 95% CI: 11.71 to 17.57), both compared with the conventional supine position. The herniated disc cross-sectional area and diameter increased during standing compared with during conventional supine position. No changes were found in the spinal canal cross-sectional diameter between positions. Higher nerve root compression grades for paracentral herniations were found during standing compared with during conventional supine position. This was neither found with a lumbar pillow nor for central herniations in any position compared with conventional supine. Conclusion: Disc herniations displayed dynamic behavior with morphological changes in the standing position, leading to higher nerve root compression grades for paracentral herniated discs. Key Points: • Lumbar herniated discs increased in size in the axial plane during standing. • Increased nerve root compression grades for paracentral herniated discs were found during standing. • Weight-bearing MRI may increase the diagnostic sensitivity of nerve root compression in lumbar disc herniations. [ABSTRACT FROM AUTHOR]

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Background: Surgery on extraforaminal lumbar disc herniation (ELDH) is a commonly performed procedure. Operating on this type of herniation is known to come with more difficulties than on the frequently seen paramedian lumbar disc herniation (PLDH). However, no comparative data are available on the effectiveness and safety of this operation. We sought out to compare clinical outcomes at 1 year following surgery for ELDH and PLDH. Methods: Data were collected through the Norwegian Registry for Spine Surgery (NORspine). The primary outcome measure was change at 1 year in the Oswestry Disability Index (ODI). Secondary outcome measures were quality of life measured with EuroQol 5 dimensions (EQ-5D); and numeric rating scales (NRSs). Results: Data of a total of 1750 patients were evaluated in this study, including 72 ELDH patients (4.1%). One year after surgery, there were no differences in any of the patient reported outcome measurements (PROMs) between the two groups. PLDH and ELDH patients experienced similar changes in ODI (− 30.92 vs. − 34.00, P = 0.325); EQ-5D (0.50 vs. 0.51, P = 0.859); NRS back (− 3.69 vs. − 3.83, P = 0.745); and NRS leg (− 4.69 vs. − 4.46, P = 0.607) after 1 year. The proportion of patients achieving a clinical success (defined as an ODI score of less than 20 points) at 1 year was similar in both groups (61.5% vs. 52.7%, P = 0.204). Conclusions: Patients operated for ELDH reported similar improvement after 1 year compared with patients operated for PLDH. [ABSTRACT FROM AUTHOR]

Background: There is limited evidence on the comparative performance of private and public healthcare. Our aim was to compare outcomes following surgery for lumbar disc herniation (LDH) in private versus public hospitals. Methods: Data were obtained from the Norwegian registry for spine surgery. Primary outcome was change in Oswestry disability index (ODI) 1 year after surgery. Secondary endpoints were quality of life (EuroQol EQ-5D), back and leg pain, complications, and duration of surgery and hospital stays. Results: Among 5221 patients, 1728 in the private group and 3493 in the public group, 3624 (69.4%) completed 1-year follow-up. In the private group, mean improvement in ODI was 28.8 points vs 32.3 points in the public group (mean difference − 3.5, 95% CI − 5.0 to − 1.9; P for equivalence < 0.001). Equivalence was confirmed in a propensity-matched cohort and following mixed linear model analyses. There were differences in mean change between the groups for EQ-5D (mean difference − 0.05, 95% CI − 0.08 to − 0.02; P = 0.002) and back pain (mean difference − 0.2, 95% CI − 0.2, − 0.4 to − 0.004; P = 0.046), but after propensity matching, the groups did not differ. No difference was found between the two groups for leg pain. Complication rates was lower in the private group (4.5% vs 7.2%; P < 0.001), but after propensity matching, there was no difference. Patients operated in private clinics had shorter duration of surgery (48.4 vs 61.8 min) and hospital stay (0.7 vs 2.2 days). Conclusion: At 1 year, the effectiveness of surgery for LDH was equivalent in private and public hospitals. [ABSTRACT FROM AUTHOR]

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Objective: To observe the clinical efficacy of acupuncture at abdomen acupoints plus tuina for lumbar intervertebral disc herniation (LIDH).Methods: A total of 70 patients with LIDH were randomized into an observation group and a control group, with 35 cases in each group. The observation group was treated with acupuncture at abdomen acupoints plus tuina, while the control group was treated only with tuina treatment. The clinical efficacy was observed after one course of treatment.Results: The cure rate and the total effective rate of the observation group were 83.3% and 96.7%, respectively. The cure rate and the total effective rate of the control group were 39.4% and 78.8%, respectively. There were significant differences in the cured rate and the total effective rate between the two groups (both P<0.05). There was no significant difference in Japanese Orthopedic Association (JOA) score between the two groups before treatment (P>0.05). After treatment, the JOA scores of both groups increased significantly, and the intra-group differences were statistically significant (both P<0.05); the JOA score of the observation group was significantly higher than that of the control group (P<0.05).Conclusion: Acupuncture at abdomen acupoints plus tuina has a better therapeutic effect than tuina alone in the treatment of LIDH. [ABSTRACT FROM AUTHOR]

Purpose: Chiropractic care is popular for low back pain, but may increase the risk for acute lumbar disc herniation (LDH). Low back pain is a common early (prodromal) symptom of LDH and commonly precedes LDH diagnosis. Our objective was to investigate the association between chiropractic care and acute LDH with early surgical intervention, and contrast this with the association between primary care physician (PCP) care and acute LDH with early surgery.Methods: Using a self-controlled case series design and population-based healthcare databases in Ontario, Canada, we investigated all adults with acute LDH requiring emergency department (ED) visit and early surgical intervention from April 1994 to December 2004. The relative incidence of acute LDH with early surgery in exposed periods after chiropractic visits relative to unexposed periods was estimated within individuals, and compared with the relative incidence of acute LDH with early surgery following PCP visits.Results: 195 cases of acute LDH with early surgery (within 8 weeks) were identified in a population of more than 100 million person-years. Strong positive associations were found between acute LDH and both chiropractic and PCP visits. The risk for acute LDH with early surgery associated with chiropractic visits was no higher than the risk associated with PCP visits.Conclusions: Both chiropractic and primary medical care were associated with an increased risk for acute LDH requiring ED visit and early surgery. Our analysis suggests that patients with prodromal back pain from a developing disc herniation likely seek healthcare from both chiropractors and PCPs before full clinical expression of acute LDH. We found no evidence of excess risk for acute LDH with early surgery associated with chiropractic compared with primary medical care. [ABSTRACT FROM AUTHOR]

Purpose: Chiropractic spinal manipulation treatment (SMT) is common for back pain and has been reported to increase the risk for lumbar disc herniation (LDH), but there is no high quality evidence about this. In the absence of good evidence, clinicians can have knowledge and beliefs about the risk. Our purpose was to determine clinicians' beliefs regarding the risk for acute LDH associated with chiropractic SMT.Methods: Using a belief elicitation design, 47 clinicians (16 chiropractors, 15 family physicians and 16 spine surgeons) that treat patients with back pain from primary and tertiary care practices were interviewed. Participants' elicited incidence estimates of acute LDH among a hypothetical group of patients with acute low back pain treated with and without chiropractic SMT, were used to derive the probability distribution for the relative risk (RR) for acute LDH associated with chiropractic SMT.Results: Chiropractors expressed the most optimistic belief (median RR 0.56; IQR 0.39-1.03); family physicians expressed a neutral belief (median RR 0.97; IQR 0.64-1.21); and spine surgeons expressed a slightly more pessimistic belief (median RR 1.07; IQR 0.95-1.29). Clinicians with the most optimistic views believed that chiropractic SMT reduces the incidence of acute LDH by about 60% (median RR 0.42; IQR 0.29-0.53). Those with the most pessimistic views believed that chiropractic SMT increases the incidence of acute LDH by about 30% (median RR 1.29; IQR 1.11-1.59).Conclusions: Clinicians' beliefs about the risk for acute LDH associated with chiropractic SMT varied systematically across professions, in spite of a lack of scientific evidence to inform these beliefs. These probability distributions can serve as prior probabilities in future Bayesian analyses of this relationship. [ABSTRACT FROM AUTHOR]

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Copyright of Journal of Acupuncture & Tuina Science is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Expert medical opinions in follow-up situations after injuries of the cervical spine have to evaluate the functional deficits with respect to the statics, range of motion, stability, muscular balance and additional existing functional disorders caused by the interventional access. The estimation is made more difficult because functional deficits of the cervical spine show only a low correlation with the objective radiological findings so that an assessment based exclusively on radiological results is not sufficient. Additionally, due to the complexity of the function of the cervical spine, the standard tables on impairment of earning capacity (MdE) do not include exact guidelines for assessment. Questions of causality have to be answered with respect to assessment of subsequent adjacent level degeneration after fusion, traumatic disc herniations and patients with posttraumatic spinal cord damage and pre-existing degenerative diseases of the cervical spine. Expert medical opinions in cases of whiplash-associated disorders, i.e. trauma-associated functional disorders with no morphological correlate, can be based on the guidelines published by the medical societies for trauma, orthopedics and neurology and criteria published in standard textbooks. [ABSTRACT FROM AUTHOR]

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Purpose: To test whether the localization of worsening of pain during coughing, sneezing and straining matters in the assessment of lumbosacral nerve root compression or disc herniation on MRI.Methods: Recently the diagnostic accuracy of history items to assess disc herniation or nerve root compression on magnetic resonance imaging (MRI) was investigated. A total of 395 adult patients with severe sciatica of 6-12 weeks duration were included in this study. The question regarding the influence of coughing, sneezing and straining on the intensity of pain could be answered on a 4 point scale: no worsening of pain, worsening of back pain, worsening of leg pain, worsening of back and leg pain. Diagnostic odds ratio's (DORs) were calculated for the various dichotomization options.Results: The DOR changed into significant values when the answer option was more narrowed to worsening of leg pain. The highest DOR was observed for the answer option 'worsening of leg pain' with a DOR of 2.28 (95 % CI 1.28-4.04) for the presence of nerve root compression and a DOR of 2.50 (95 % CI 1.27-4.90) for the presence of a herniated disc on MRI.Conclusions: Worsening of leg pain during coughing, sneezing or straining has a significant diagnostic value for the presence of nerve root compression and disc herniation on MRI in patients with sciatica. This study also highlights the importance of the formulation of answer options in history taking. [ABSTRACT FROM AUTHOR]

Purpose: The aims of this study were to assess lumbar multifidus fatigue (LM) and transversus abdominis activation (TrA) in individuals with lumbar disc herniation associated with low back pain.Methods: Sixty individuals were divided into the lumbar herniation (LHG, n = 30) and control groups (CG, n = 30). Fatigue of the LM was assessed using surface electromyography during the Sorensen effort test, and activation of the TrA with a pressure biofeedback unit. Pain intensity was determined using a visual analog scale and the McGill pain questionnaire. The Oswestry disability questionnaire and the Borg scale for self-evaluating exertion were used to assess functional disability.Results: Fatigue was significantly more intense and the TrA activation was insufficient (p < 0.01) in individuals with disc herniation relative to the control group. The LHG had mild functional disability and moderate pain. There were differences in the initial exertion self-evaluation between groups, which were not observed in the final exertion evaluation.Conclusion: Individuals with lumbar disc herniation associated with low back pain have increased fatigue of the LM and decreased activation of the TrA, when compared to the control group. [ABSTRACT FROM AUTHOR]

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Copyright of Journal of Acupuncture & Tuina Science is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Der Schmerz is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Acupuncture & Tuina Science is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Acupuncture & Tuina Science is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

A group of lumbar discherniation cases was treated with posterior discectomy and decompression with Spotlight working channel. We retrospectively studied these patients. To study and analyze the clinical efficacy and technical features of discectomy which is carried out with the Spotlight channel technology. The development of the minimally invasive spine surgery technology promotes new instruments and materials. For minimally invasive spine surgery in channel technology, the newly launched Depuy working channel-Spotlight, which is a new generation of wide viewing angle, single-hole device for minimally invasive spine operations, has good prospects for clinical application. From March 2011 to March 2012, 21 patients who were diagnosed with lumbar disc herniation were treated with posterior discectomy and decompression with Spotlight working channel, then the lumbar and leg pain visual analogue scale (VAS) scores of before and after surgery and that of the follow-ups and the Oswestry Disability Index were analyzed. All patients were successfully operated, and also they received follow-ups for more than 1 year. The postoperative lumbar and leg pain VAS scores improved significantly compared with the preoperative ones ( P < 0.05) and can effectively maintain ( P > 0.05). The three time points of lumbar pain VAS were 7.80 ± 0.49, 1.51 ± 0.52 and 1.47 ± 0.59. The leg pain VAS were 7.53 ± 0.50, 1.58 ± 0.58 and 1.49 ± 0.67. During the follow-ups of the cases in this group, no case of disc herniation relapsed. Patients were satisfied with that. The Spotlight channel system is one of the surgical approaches to 'minimally invasive spine technology with direct vision'. It has a good range of surgical indications. It can be carried out flexibly and used widely, which means it will be easier for the surgeons to master. [ABSTRACT FROM AUTHOR]

Objective: To compare the therapeutic efficacies between electroacupuncture (EA) and medication for cervical intervertebral disc herniation (CIDH). Methods: Totally 420 patients with CIDH were randomized into two groups by random number table. 210 patients in the EA group were intervened by EA at Dazhui (GV 14), Dazhu (BL 11), and Houxi (SI 3); 210 patients in the medication group were treated by oral administration of Meloxicam tablets. Results: The average ranks of both short and long term efficacies in the EA group were significantly lower than that in the medication group (both P<0.01); there were significant differences in comparing the total effective rates of both short and long terms between the two groups (both P<0.01). It shows that EA group has better therapeutic efficacy than the medication group. Conclusion: EA is better than medication in comparing both short-term and long-term therapeutic efficacies in treating CIDH. [ABSTRACT FROM AUTHOR]

Objective: To observe the clinical effects of acupoint sticking therapy for lumbar intervertebral disc herniation. Methods: Seventy patients with lumbar intervertebral disc herniation were randomly divided into two groups by the visit order, 35 cases in each group. The treatment group was treated with acupoint sticking therapy and the control group was treated with tuina. After treatment, the clinical effects, pain integral and Japanese Orthopedic Association (JOA) scores were compared between the two groups. Results: The total effective rate, pain integral and improvement of JOA scores were better in the treatment group than in the control group ( P<0.05). Conclusion: Acupoint sticking therapy is affirmative in the therapeutic effects and better than tuina treatment for lumbar intervertebral disc herniation. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Acupuncture & Tuina Science is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Acupuncture & Tuina Science is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Acupuncture & Tuina Science is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Acupuncture & Tuina Science is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Acupuncture & Tuina Science is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Lumbar disc herniation (LDH) is a common disorder among adults with degenerated lumbar intervertebral discs. However, its occurrence in childhood and adolescence is much less frequent mostly because children and adolescents tend to have a healthier lumbar spine as compared with adults. This difference indicates that children and adolescents are far from being just little adults. Over the years, there have constantly been published studies concerning this entity where the findings suggested that pediatric LDH is, in many ways, different from that in adults. To date, the prevalence, the etiological and the diagnostic features of pediatric LDH have been fully described in the literature whereas the characteristics regarding to the treatment is yet to be reviewed in details. The aim of the present review is to provide a collective opinion on the treatment of pediatric LDH as well as its outcome. It reviewed the relevant information available in the literature and compared the results among and within various treatments. It was found that pediatric patients responded less favorably to conservative treatment as compared with adults. In addition, the outcome of surgery remained to be satisfactory for at least 10 years after the initial operation, even though it appeared to deteriorate slightly. To the best of our knowledge, this is the first literature review focusing on the treatment of pediatric LDH. [ABSTRACT FROM AUTHOR]

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Inflammation and irritation of the nerve roots has been indicated as an important factor in the pain associated with symptomatic disc herniations. Tumour necrosis factor a (TNFa) is now believed to be involved in this pathway. TNFa causes connective tissue cells in culture to synthesise a glycoprotein, TNFa-stimulated gene-6 (TSG-6). TSG-6 is found in inflammatory diseases of related connective tissues, such as articular cartilage in rheumatoid arthritis, but is not present in unaffected individuals. In order to determine if TSG-6 occurred in intervertebral disc (and cartilage endplate), we have investigated the presence of TSG-6 and its binding protein, inter-a-inhibitor (IaI), in 58 herniated and 15 non-herniated discs. Immunostaining for the cytokines, IL-1a, IL-1ß and TNFa, has also been carried out. We have demonstrated that both TSG-6 and IaI occur commonly in human intervertebral disc matrix with at least some TSG-6 in 98% of discs studied and IaI in all of them. Staining for TSG-6 was greatest in herniated discs, particularly close to blood vessels. IaI immunostaining was frequently widespread throughout the disc but there was little in the cartilage endplate. It has been proposed that these molecules have widespread effects, including extracellular matrix stabilisation, down-regulation of the protease network and reduction of inflammation. Hence, the occurrence of TSG-6 and IaI in disc tissue could have implications in the aetiopathogenesis and future therapeutics of intervertebral disc disease. [ABSTRACT FROM AUTHOR]

The diagnostic utility of scalp-recorded somatosensory evoked potentials (SEP) in patients with sciatica has generally been regarded as low. The purpose of the present study was to determine the validity of sensory nerve SEP in different subgroups of sciatic patients. A total of 65 consecutive patients with sciatica showing disc pathology and/or facet joint hypertrophy on lumbar computed tomography (CT) and/or myelography were studied. Symptomatic myelographically compressed nerve roots were defined as truly compromised roots. Asymptomatic myelographically normal nerve roots were defined as truly normal roots. Bilateral sensory nerve SEP representing nerve roots L4, L5, and S1 were performed in all patients. Evaluation of SEP included the use of P1 latency inter-root comparison. The false-positive rate of SEP was low. Pathological L4, L5, and S1 SEP therefore strongly indicate true compromise of the corresponding nerve roots. The true-positive rate was higher in patients with facet joint hypertrophy with or without additional disc disease than in patients with disc pathology only, and highest if the sciatic sensory symptoms were present during the SEP registration. Diagnostic validity was not influenced by previous episodes of sciatica, the duration of the present episode, or the number of spinal levels with ipsilateral myelographically compressed nerve roots. Pathological SEP strongly indicate sensory radiculopathy in patients with sciatica. Diagnostic efficacy is higher in patients with facet joint hypertrophy than in patients with disc pathology only and highest when the sciatic symptoms are present during registration. [ABSTRACT FROM AUTHOR]

Summary The authors report the case of a 10-year-old girl with intervertebral disc calcifications from the levels C6/C7 to Th1/Th2, presenting with a herniated calcified intervertebral disc at the C7/Th1 level, causing spinal cord compression with subsequent progressive paresis and sensory loss of her left leg. After anterior cervical discectomy and fusion the neurological deficits completely resolved within 2 weeks. It can be concluded that calcification of an intervertebral disc is a rare syndrome in childhood, causing progressive neurological deficit only in a few reported cases. Although the treatment of choice is conservative, surgery is required in patients who develop progressive neurological deficit. [ABSTRACT FROM AUTHOR]

A positive result of re-operation in patients with recurrent symptoms after lumbar disc surgery is likely only if a new disc herniation is present. An improved ability to differentiate between recurrent disc herniation and scar tissue by contrast enhanced CT and MRI is suggested in earlier studies. In a prospective study 29 patients were selected for operation for suspected recurrent disc herniation. The inclusion of the patients was based on clinical symptoms and signs and myelography or non-enhanced CT. All patients were examined by CT and MRI both with and without intravenous contrast pre-operatively. The examinations were evaluated blind on a five point scale and statistical analysed by a regret function. Intravenous contrast improved the diagnostic power of both CT and MRI. MRI was superior to CT in both non-enhanced and enhanced examinations. MRI with intravenous contrast enhancement is proposed as the primary examination in patients with suspected recurrent disc herniation. [ABSTRACT FROM AUTHOR]