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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., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Purpose: Although studies have suggested that gut microbiota may be associated with intervertebral disk disease, their causal relationship is unclear. This study aimed to investigate the causal relationship between the gut microbiota and its metabolic pathways with the risk of intervertebral disk degeneration (IVDD), low back pain (LBP), and sciatica., Methods: Genetic variation data for 211 gut microbiota taxa at the phylum to genus level were obtained from the MiBioGen consortium. Genetic variation data for 105 taxa at the species level and 205 metabolic pathways were obtained from the Dutch Microbiome Project. Genetic variation data for disease outcomes were obtained from the FinnGen consortium. The causal relationships between the gut microbiota and its metabolic pathways and the risk of IVDD, LBP, and sciatica were evaluated via Mendelian randomization (MR). The robustness of the results was assessed through sensitivity analysis., Results: Inverse variance weighting identified 46 taxa and 33 metabolic pathways that were causally related to IVDD, LBP, and sciatica. After correction by weighted median and MR-PRESSO, 15 taxa and nine pathways remained stable. After FDR correction, only the effect of the genus&#95;Eubacterium coprostanoligenes group on IVDD remained stable. Sensitivity analyses showed no evidence of horizontal pleiotropy, heterogeneity, or reverse causation., Conclusion: Some microbial taxa and their metabolic pathways are causally related to IVDD, LBP, and sciatica and may serve as potential intervention targets. This study provides new insights into the mechanisms of gut microbiota-mediated development of intervertebral disk disease., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Purpose: Astronauts returning from long ISS missions have demonstrated an increased incidence of lumbar disc herniation accompanied by biomechanical and morphological changes associated with spine elongation. This research describes a ground-based study of the effects of an axial compression countermeasure Mk VI SkinSuit designed to reload the spine and reduce these changes before return to terrestrial gravity., Methods: Twenty healthy male volunteers aged 21-36 without back pain participated. Each lay overnight on a Hyper Buoyancy Flotation (HBF) bed for 12 h on two occasions 6 weeks apart. On the second occasion participants donned a Mk VI SkinSuit designed to axially load the spine at 0.2 Gz during the last 4 h of flotation. Immediately after each exposure, participants received recumbent MRI and flexion-extension quantitative fluoroscopy scans of their lumbar spines, measuring differences between spine geometry and intervertebral kinematics with and without the SkinSuit. This was followed by the same procedure whilst weight bearing. Paired comparisons were performed for all measurements., Results: Following Mk VI SkinSuit use, participants evidenced more flexion RoM at L3-4 (p = 0.01) and L4-5 (p = 0.003), more translation at L3-4 (p = 0.02), lower dynamic disc height at L5-S1 (p = 0.002), lower lumbar spine length (p = 0.01) and greater lordosis (p = 0.0001) than without the Mk VI SkinSuit. Disc cross-sectional area and volume were not significantly affected., Conclusion: The MkVI SkinSuit restores lumbar mobility and lordosis following 4 h of wearing during hyper buoyancy flotation in a healthy control population and may be an effective countermeasure for post space flight lumbar disc herniation., (© 2023. The Author(s).)

Purpose: Intracranial hypertension (IH) can complicate cerebral venous thrombosis (CVT), potentially causing permanent visual loss. Current knowledge on risk factors for the development of IH following CVT is scarce. We applied a compound classifier (CSF opening pressure > 25 cmH 2 O, papilledema, or optic disc protrusion on MRI) as a surrogate for IH and studied the predictive value of thrombus location, the number of thrombosed segments, and thrombus volume., Methods: We prospectively included 26 patients with acute CVT and complete MRI data. IH was defined by CSF opening pressure > 25 cmH 2 O, papilledema, or optic disc protrusion on MRI. Using high-resolution contrast-enhanced venography, we determined the thrombus location, number of thrombosed segments, and thrombus volume. We analyzed their association with IH by logistic regression, their predictive power by the area under the receiver operating characteristic curve, and their association with CSF opening pressure by linear regression., Results: IH occurred in 46% of CVT patients and was associated with higher thrombus volume (AUC 0.759, p = 0.025) and superior sagittal sinus thrombosis both alone (OR 2.086, p = 0.049) and combined with transverse sinus thrombosis (OR 2.014, p = 0.028). Effects in patients presenting CSF opening pressure > 25 cm H 2 O and the compound classifier were consistent. Thrombus volume > 4 ml was the single most important predictor of higher CSF opening pressure (ß = 0.566, p = 0.035), increasing IH risk., Conclusion: Larger thrombus volume, dominant transverse sinus occlusion, and extensive superior sagittal combined with transverse sinus thrombosis were associated with IH. Thrombus volumetry might identify patients at risk for IH and direct further clinical evaluation., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Video-assisted thoracic surgery (VATS) has been growing in popularity over the past 2 decades as an alternative to open thoracotomy for the treatment of several spinal conditions, and in the field of minimally invasive surgery, it now acts as a keyhole to the thoracic spine., Materials and Methods: Most VATS approaches are from the right side for pathologies involving the middle and upper thoracic spine because there is a greater working spinal surface area lateral to the azygos vein than that lateral to the aorta. Below T-9, a left-sided approach is made possible because the aorta moves away from the left posterolateral aspect of the spine to an anterior position as it passes through the diaphragm., Results: VATS has been used extensively in spinal deformities such as scoliosis. The use of VATS in spine surgery includes the treatment of thoracic prolapsed disk diseases, vertebral osteomyelitis, fracture management, vertebral interbody fusion, tissue biopsy, anterior spinal release, and fusion without or with instrumentation (VAT-I) for spinal deformity correction. As the knowledge and the comfort of using such techniques have expanded, the indications have extended to corpectomy for tumor resections., Discussion and Conclusions: In the field of minimally invasive surgery, VATS now acts as a keyhole to the thoracic spine and an alternative to open thoracotomy for the treatment of several spinal conditions.Although VATS can be performed in such spine conditions, it is most beneficial in the treatment of scoliotic deformity, which requires taking a multilevel approach, from the upper to the lower thoracic spine., (© 2023. The Author(s), under exclusive license to Springer Nature Switzerland AG.)

Introductionː Cervical disk arthroplasty is a potential alternative procedure to anterior cervical decompression and fusion for the treatment of cervical disk disease. The aim of the study was to perform a systematic literature review on long-term clinical and radiological outcomes after Bryan cervical disk arthroplasty.Material and Methodsː A systematic literature review was performed according to PRISMA guidelines via PubMed and Embase, Scopus, and the Cochrane Library database by using the following keywords: "Bryan prosthesis"; "cervical disk arthroplasty"; "outcomes"; and "long-term follow-up." Eight articles with at least 10 years of follow-up were considered for eligibility.Resultsː In total, 481 patients were enrolled in the studies. Because of the occurrence of multiple treated levels, 588 arthroplasties were performed, divided as follows: 12 C3/4 cervical disk arthroplasties (2.01%), 63 C4/5 (10.71%), 325 C5/6 (55.27%), and 188 C6/7 (31.97%). The mean preoperative cervical lordosis was 13.6 ± 9.3°, whereas the last follow-up value was 12.8 ± 8.7°. In the last follow-up, the mean segmental range of motion was 8.2 ± 3.3°.Discussion: Recent studies have suggested that cervical disk arthroplasty should be safely performed in healthy young patients with disk degeneration who may need future revision surgery. The results suggest that this procedure preserves native cervical spinal biomechanics at long-term follow-up with acceptable adjacent segments disease and periprosthetic ossifications.Conclusionsː Cervical disk arthroplasty has good long-term device survival, motility, adjacent segment degeneration, and clinical outcomes. Therefore, it represents a valid alternative for the treatment of cervical spine degenerative pathologies, especially in young patients., (© 2023. The Author(s), under exclusive license to Springer Nature Switzerland AG.)

Objective: To determine the effect of endplate reduction on the final healing morphology and degenerative changes in intervertebral discs., Methods: Forty-eight patients with single-level thoracolumbar fractures with endplate injury were included. All patients underwent posterior reduction and pedicle screw fixation, and postoperative imaging was used to determine whether endplate reduction was successful. The healing morphology of the endplate was divided into three types: increased endplate curvature, irregular healing and traumatic Schmorl node. MRI was performed at baseline and at the last follow-up evaluation to observe changes in disc degeneration (disc height and nucleus pulposus signal) and Modic changes., Results: The reduction rate in the central area was significantly lower than that in the peripheral area (P = 0.017). In patients with successful reduction, 90.9% (20/22) of the endplates healed with increased curvature. In patients with an unsuccessful endplate reduction, 63.4% (26/41) of the endplates healed irregularly, and 34.1% (14/41) of the endplates formed traumatic Schmorl nodes. Endplate reduction was closely related to the final healing morphology of the endplate (P < 0.001), which had a significant protective effect on the degeneration of the intervertebral disc. At the last follow-up evaluation, there was no statistically significant correlation between different endplate healing morphologies and new Modic changes., Conclusions: The reduction rate in the central area is significantly lower than that in the peripheral area. Although all of the intervertebral discs corresponding to fractured endplates had degenerated to different degrees, successful endplate fracture reduction can obviously delay the degeneration of intervertebral discs., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Purpose: Our study aimed to evaluate non-inferiority of ProDisc-C to anterior cervical discectomy and fusion (ACDF) in terms of clinical outcomes and incidence of adjacent segment disease (ASD) at 24-months post-surgery in Asian patients with symptomatic cervical disc disease (SCDD)., Methods: This multicentre, prospective, randomized controlled trial was initiated after ethics committee approval at nine centres (China/Hong Kong/Korea/Singapore/Taiwan). Patients with single-level SCDD involving C3-C7-vertebral segments were randomized (2:1) into: group-A treated with ProDisc-C and group-B with ACDF. Assessments were conducted at baseline, 6-weeks, 3/6/12/18/24-months post-surgery and annually thereafter till 84-months. Primary endpoint was overall success at 24-months, defined as composite of: (1) ≥ 20% improvement in neck disability index (NDI); (2) maintained/improved neurologic parameters; (3) no implant removal/revision/re-operation at index level; and (4) no adverse/severe/life-threatening events., Results: Of 120 patients (80ProDisc-C,40ACDF), 76 and 37 were treated as per protocol (PP). Overall success (PP) was 76.5% in group-A and 81.8% in group-B at 24-months (p = 0.12), indicating no clear non-inferiority of ProDisc-C to ACDF. Secondary outcomes improved for both groups with no significant inter-group differences. Occurrence of ASD was higher in group-B with no significant between-group differences. Range of motion (ROM) was sustained with ProDisc-C but lost with ACDF at 24-months., Conclusion: Cervical TDR with ProDisc-C is feasible, safe, and effective for treatment of SCDD in Asians. No clear non-inferiority was demonstrated between ProDisc-C and ACDF. However, patients treated with ProDisc-C demonstrated significant improvement in NDI, neurologic success, pain scores, and 36-item-short-form survey, along with ROM preservation at 24-months. Enrolment difficulties resulted in inability to achieve pre-planned sample size to prove non-inferiority. Future Asian-focused, large-scale studies are needed to establish unbiased efficacy of ProDisc-C to ACDF., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Purpose: To estimate the prevalence of depression in degenerative spine disease (DSD) patients., Methods: The PubMed, EMBASE, and PsycINFO were systematically searched, the relevant studies that reported the depression prevalence of in DSD patients were identified. Data were extracted independently by 2 reviewers. Subgroup analysis and sensitivity analysis were also performed., Results: 24 articles met the inclusion criteria and were selected for the current study. The pooled prevalence estimate of depression in DSD patients before operative treatment was 30.8% [95% CI 24.0-38.5%]. Nine articles reported the prevalence rate in DSD patients after operative treatment, and the pooled prevalence estimate was 27.0% [95% CI 19.9-35.4%]. There were significant differences for prevalence estimates before operative treatment in types of disorders (Q = 4.56, P = 0.10), spine surgery history (Q = 5.55, P = 0.02), representativeness of sample (Q = 11.00, P = 0.00), and validity of assessment method (Q = 3.32, P = 0.07). The prevalence estimates in patients with lumbar spine stenosis, lumbar disc herniation and cervical spondylotic myelopathy were 24.0%, 40.9% and 37.3%, respectively. Studies that included patients with a history of spine surgery yielded a more extreme prevalence estimate than studies excluding those (36.9% vs 24.3%). For results of patients after operative treatment, significant differences for prevalence estimates were showed in different degrees of pain (Q = 4.72, P = 0.03), screening instruments (Q = 4.83, P = 0.09), and representativeness of sample (Q = 15.70, P = 0.00)., Conclusion: The systematic review indicated increased prevalence of depression in DSD patients. In consideration of the relationship between depression and poor surgical outcome, we should pay more attention to identifying strategies for preventing and treating depression in DSD patients., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Purposes: This study aimed to investigate the histopathological changes that occur within 2 weeks following spinal cord injury (SCI) in dogs., Methods: Eight adult female Beagle dogs were included in this study, and SCI was induced using an epidural balloon catheter. Two dogs were killed at each of the following four time points: immediately after the procedure and 1 day, 1 week, and 2 weeks after the procedure. Neurological status was evaluated with five categories. Histopathological changes were visually observed for stained sections of formalin-fixed spinal cord to evaluate hemorrhage, spongiosis, necrosis, and gliosis morphologically., Results: Along the 2 weeks post-injury, severe hemorrhage was observed at the primary injury site, the average diameter of which expanded quickly from 8 to 10 mm in 1 day and then decreased to 5 mm in 1 week. This indicates that the bleeding cavity expanded at the initial injury site to produce ascending and descending hemorrhage. The hemorrhage at the injury site resolved in 2 weeks. In contrast, spongiosis, parenchymal necrosis, and gliosis were first inconspicuous or mild and then became severe in 1 week or 2 weeks. Hemorrhage, hematoma, and other similar changes occurred at the regions approximately 20-mm rostral and caudal to the primary injury site. These changes were observed in both gray matter and white matter., Conclusions: This study is the first to assess the sequential histopathological changes in the acute and intermediate phases following SCI in dogs. Our findings enhance the usefulness of the canine intervertebral disk disease model in the assessment of secondary spinal cord histopathology in human SCI., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Purpose: To clarify the current state of knowledge on the association of endplate structural defects and back pain., Methods: Five databases were searched for studies reporting on the association between endplate structural defects and back pain. Covidence and comprehensive meta-analysis software were used for article screening and selection and pooling of extracted data. Overall quality of evidence was assessed using GRADE., Results: Twenty-six studies comprised of 11,027 subjects met inclusion criteria. The presence of moderate heterogeneity (I 2  = 73%; p = 0.001) prevented the pooling of estimates across all studies. However, it was possible to pool studies of specific endplate defect phenotypes, such as erosion (OR: 2.69; 95% CI: 1.35-5.50) and sclerosis (OR: 1.97; 95% CI: 1.50-2.58), which yielded significant associations with back pain. Schmorl's nodes were also associated with most individual back pain phenotypes (OR: 1.53-1326, I 2  = 0-7.5%) and back pain overall (OR: 1.63, 95% CI: 1.37-1.94, I 2  = 26%) in general population samples. The pooling of data from all studies of specific back pain phenotypes, such as frequent back pain (OR: 2.83; 95% CI: 1.77-4.52) and back pain incidence (OR: 1.65; 95% CI: 1.30-2.10), each yielded significant association with endplate structural defects and was supported by low heterogeneity (I 2  =  < 7.5.%)., Conclusion: Overall, there is moderate quality evidence of an association between back pain and endplate structural defects, which is most evident for erosion, sclerosis and Schmorl's nodes. Going forward, research on specific endplate defect phenotypes and back pain case definitions using strong study designs will be important in clarifying the extent of associations and underlying mechanisms. The study was prospectively registered in Prospero (CRD42020170835) on 02/24/2020., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Cauda equina syndrome following transforaminal lumbar interbody fusion (TLIF) is very rare, and the causes implicated include inadequate decompression, retained disc fragments, epidural haematoma, gel foams, fat pad grafts, retained sponges, intradural masses and ischaemia of conus. This is a rare case report of pseudoaneurysm of dorsal branch of lumbar artery presenting with delayed onset incomplete cauda equina syndrome following TLIF., Objective: To describe the very rare case of lumbar artery pseudoaneurysm causing delayed onset incomplete cauda equina syndrome following TLIF and its management with endovascular embolisation., Method: An 80-year-old female presented with incomplete cauda equina syndrome on 14th post-operative day following TLIF. On evaluation, computed tomography (CT) scan and magnetic resonance imaging (MRI) revealed haematoma with heterogeneous signal intensity, which was pulsatile in ultrasonogram. Doppler and contrast-enhanced CT revealed pseudoaneurysm from posterior branch of left lumbar L4 artery, which was managed with endovascular embolisation., Result: After endovascular embolisation, the patient had immediate relief from radiating pain in left lower limb and regained full motor power and perianal sensation at the end of 3 weeks. Post-procedure ultrasonography done on the tenth day revealed complete resolution of the pseudoaneurysm., Conclusion: This case presentation shows the necessity of diagnosing epidural haematomas due to vascular aneurysm in patients with post-operative radiculopathy and neurodeficit and the effectiveness of endovascular embolisation in treating such a threatening condition.

Purpose: In this paper, we propose a simplified four-step retropharyngeal approach, whose aim is getting straight to the upper cervical spine minimizing complications., Methods: While the classical retropharyngeal approach includes about 11 steps, ours is a four-step approach: patient positioning, skin-platysma incision, hyoid bone superolateral dissection and retropharyngeal blunt exposure. We avoid several steps of the classical anterior retropharyngeal approach, particularly dissection of submandibular gland, facial veins, external carotid artery and thyroid artery, bellies of the digastric muscle, hypoglossal nerve, thyrohyoid membrane and the internal branch of superior laryngeal nerve., Results: We have adopted this technique for five patients: two patients had a C2-C3 herniated disk with myelopathy, two patients had unstable Hangman fracture with no bone fusion after 2-month treatment with rigid collar, and one patient had a C2-C3 osteophyte with dysphagia. The intraoperative time needed for reaching the retropharyngeal space was 15 (first case), 9 (second case), 7 min (third case-illustrative case-and fourth case), 8 min (fifth case). No complications occurred., Conclusion: Our simplification, avoiding several steps, is simple, effective, safe, and rapid and requires a simple learning curve.

Purpose: Sciatic symptoms due to lumbar disc herniation are likely to be caused not solely by mechanical compression of the nerve root, but also by pain-inducing elements from inflammatory processes. Key components in the inflammatory reaction are M1 and M2 macrophages, with the M1 type being associated with pro-inflammatory processes and M2 with anti-inflammatory-processes., Method: The present systematic review summarizes all studies on associations between M1 and M2 macrophages and their related inflammation factors and pain symptoms in lumbar disc herniations. Literature search was performed using an optimally sensitive search string. Studies were selected for inclusion by means of predefined inclusion and exclusion criteria and subsequently graded for risk of bias. A total of 14 studies were included. Overall risk of bias was moderate (8/14), and three studies had high risk of bias and three has low risk of bias., Results: Regarding M1-related cytokines, high levels of TNF-α, TNFR1, IL-6, IL-8, and IFN-γ were all associated high VAS scores. In contrast, high levels of TNFR2 were associated with lower VAS scores. Moreover, no associations were found for IL-1a and IL-1β. Results regarding M2-related cytokines revealed the opposite: high levels of both IL-4 and IL-10 were associated with lower VAS scores. No associations were established for TGF-β. Moreover, the presence of macrophages (CD68) was negatively associated with VAS scores., Conclusion: While M1-related pro-inflammatory cytokines worsen pain symptoms, M2-related anti-inflammatory cytokines alleviate pain symptoms. Nevertheless, the present evidence is limited, and further research on the underlying pathophysiological mechanism in sciatica is required. These slides can be retrieved under Electronic Supplementary Material.

Background: To document the role of sub-clinical infections in disc disorders and investigate the existence of microbiome in intervertebral discs (IVD)., Methods: Genomic DNA from 24 lumbar IVDs [8-MRI normal discs (ND) from brain dead yet alive organ donors, 8-disc herniation (DH), 8-disc degeneration (DD)] was subjected to 16SrRNA sequencing for profiling the diversity of human disc microbiome in health and disease. The disc microbiome was further compared to established human gut and skin microbiomes., Results: All healthy MRI normal discs from brain dead yet alive organ donors also had a rich bacterial presence. A total of 424 different species (355-ND, 346-DD, and 322-DH) were detected, with 42.75% OTUs being classified at kingdom level, 44% at the phylum level, 22.62% at genus level, and 5.5% at species level. Varying biodiversity and abundance between healthy and diseased discs were documented with protective bacteria being abundant in normal discs, and putative pathogens abundant in DD and DH. Propionibacterium acnes had a similar but lower abundance to other pathogens in all three groups ND (3.07%), DD (3.88%), DH (1.56%). Fifty-eight bacteria were common between gut and IVD microbiomes, 29 between skin and IVD microbiomes, and six common to gut/skin/IVD., Conclusion: Our study challenges the hitherto concept of sterility in healthy IVD and documented a microbiome even in MRI normal healthy discs. The varying abundance of bacteria between ND, DD, and DH documents 'dysbiosis' as a possible etiology of DD. Many known pathogens were identified in greater abundance than Propionibacterium acnes, and there was evidence for the presence of the gut/skin/spine microbiome axis.

Purpose: Degenerative disc disease (DDD) is a common condition causing low-back pain, disability and, eventually, neurological symptoms. This investigation aimed to investigate intervertebral disc DDD-related changes, evaluating histomorphology and cytokines secretion, and their clinical-radiological correlations., Methods: This is a monocentric prospective observational study. A cohort of patients who underwent microdiscectomy for DDD, from June 2018 to January 2019, were enrolled. Discs samples were examined for histomorphology, chondrons count, immunohistochemistry for Hif-1α, Nf200 and Egr-1. Demographical and clinical data were also collected., Results: Twenty patients were finally included. MRI evaluation showed a Modic I alteration in nine patients and a Modic II in 11. The disability grade was low-moderate (ODI score was ≤ 40%) in eight patients and high (ODI score > 40%) in 12. The Modic I was associated with a low-moderate disability in two (22%) patients and to a high disability in seven (88%) (p < 0.01). In Modic I group and in ODI > 40% groups, there were a significative higher mean disability grade 48.4 (± 8.3)%, number of chondrons per section, cells per chondron, Nf200+ nerve fibers and Hif-1α expression, compared with Modic II and ODI ≤ 40% groups, respectively. There were no differences in terms of Egr-1 expression., Conclusions: The discs with Modic I MRI signal could represent potential targets for medical treatments, whereas Modic II seems to be a more likely point of no return in a degenerative process. Therefore, further investigations are to better investigate inflammatory pathways and degenerative mechanisms in DDD.

Purpose: To summarize the scope of nomenclature and measurement methods used to document endplate defects in the health sciences literature., Methods: The scoping review followed the York framework and was reported according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. The databases of PubMed, Scopus, Embase and CINAHL were searched using key terms. Screening and selection were conducted by two independent reviewers. A standardized, pilot-tested form was used for extracting data, which were analyzed descriptively., Results: The review included 211 studies, originating from 29 countries, with the USA (18.8%) and China (12.26%) as leading contributors. Thirty-four different terms for structural endplate defects were reported, but were never defined in most studies (65%). Of the 34 different terms used, some appeared to represent the same phenomenon, while the same terms were occasionally defined differently between studies. Schmorl's nodes were most commonly investigated (n = 99 studies) and defined similarly across studies, with the main difference relating to whether the indentation (node) was required to have a sclerotic margin. There were also similarities in definitions for endplate sclerosis. However, there was great variability in the definitions of other terms, such as lesions, irregularities, abnormalities, erosions and changes., Conclusion: With the possible exception of Schmorl's nodes, we lack a common language for effectively communicating structural endplate findings. This review provides a foundation and impetus for standardizing terminology and core measures to improve communication and synthesis of the growing body of endplate research to advance related knowledge. These slides can be retrieved under Electronic Supplementary Material (paragraph). Then process the ppt slide as graphical image.

Further developments in disease diagnosis and treatment are of immense relevance for advancements in medical care of the population. A detailed cost-benefit analysis of direct and indirect costs is usually unavailable. In the current article, these aspects are investigated using prospectively collected randomized data over two years. Specifically, the surgical treatment of a herniated lumbar disc is addressed, and whether a newly introduced technique (e.g., annular closure device) can lead to a better quality of care and increased patient satisfaction when performed during the standard operation, while also being economically viable.

The aim of this study was to assess the efficacy of the Wallis interspinous device for treating lumbar disc herniation (LDH) as well as to investigate whether the device could reduce the incidence of recurrent herniation in comparison with disc excision alone. A total of 72 patients with LDH were treated with primary discectomy and the Wallis interspinous device was implanted in 36. Clinical outcomes were evaluated with a visual analog scale (VAS) for low back and leg pain and the Oswestry Disability Index (ODI) before and after surgery. The incidence of recurrent disc herniation after the operation was also evaluated. There was a significant improvement (p < 0.01) in the clinical outcomes assessed by the VAS and ODI scores compared with preoperative values in both groups. Up to the final follow-up, there were no significant differences between the two groups in VAS and ODI scores (p > 0.05). In addition, there was no significant difference regarding the incidence of recurrent disc herniation between the two groups (13.9% vs. 16.6%, p > 0.05). Of the patients five underwent second discectomy or fusion surgery. The Wallis interspinous device was unable to improve the already good clinical outcome after discectomy for LDH and prevent or reduce recurrence of herniated disc in the current follow-up interval. Whether the device for should be used for LDH should be carefully considered before surgery.

Background: Sufficient decompression of the nerve root canal is still regarded as the method of choice when operating on patients with lumbar disc herniation (LDH) with lumbar lateral recess stenosis; however, tissue-sparing procedures are becoming more popular. Endoscopic techniques offer advantages and the benefits of rehabilitation, which have become the standard in many surgical operations when operating on the spine. A significant issue has been the upgrading of instruments to provide enough bone resection under continuous visual control., Material and Methods: We examined patients who had LDH with lateral recess stenosis and compared the results of nerve root canal decompression using percutaneous endoscopic lumbar discectomy (PELD) with a microsurgical laminotomy (ML) technique. In this study 40 patients with full endoscopic decompression or microsurgery were followed up for 2 years. In addition to general and specific parameters, the following two parameters were also used for the investigation: the Visual Analog Scale (VAS) and the Oswestry Disability Index (ODI)., Results: Except for 1 patient in whom repair was done by fusion and 1 who was lost to follow-up, 38 patients remained in the study over the 2 years. The mean operating time in the PELD group was longer (p < 0.05), but intraoperative and postoperative blood loss was less than in the ML group (p < 0.05). The postoperative results were better than before surgery, and the VAS and ODI parameters indicated a clear improvement in leg pain and daily activities in both groups (p > 0.05). Of the patients three suffered increasing back pain (2 ML, 1 PELD)., Conclusion: The results indicated that the PELD can provide an effective supplement and serve as an alternative for LDH with lateral recess stenosis compared with the ML technique when the indication criteria are fulfilled. The PELD also has the advantage of being a minimally invasive intervention.

Background: The most frequent causes of degenerative constrictions of the spinal canal are disk herniations and spinal stenoses. The lumbar and cervical spine is the most affected., Surgical Procedures: After conservative treatments have been exhausted, surgical intervention may be necessary. Today, microsurgical decompression is regarded as the standard procedure in the lumbar region, while in the cervical spine, microsurgical anterior decompression and fusion are standard. Full-endoscopic techniques for decompression are becoming increasingly widespread worldwide. The development of various surgically created approaches and appropriate instrument sets have made the full-endoscopic operation of disk herniations and spinal stenosis possible. This development has also permitted resection of soft disk herniations in the cervical spine. The use of the approaches depends on anatomical and pathological inclusion and exclusion criteria., Results: The clinical results of standard procedures have been achieved, which must be regarded as a minimum criterion for the introduction of new technologies. On the basis of EBM criteria, it can be established that using the full-endoscopic techniques developed, adequate decompression is achieved in the defined indications with reduced traumatization, improved visibility conditions, and positive cost benefits. Today, full-endoscopic operations may be regarded as an expansion and alternative within the overall concept of spinal surgery.