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Opioids are widely used for perioperative pain control in dogs undergoing spinal surgery, but alternatives may be required because data suggest that opioids exacerbate inflammation in the injured spinal cord and veterinary access to opioids may become more restricted in the future.To compare recovery of ambulation and other functions between spinal cord-injured dogs receiving peri-operative fentanyl and those receiving a ketamine-dexmedetomidine combination.A total of 102 client-owned dogs undergoing decompressive surgery for thoracolumbar intervertebral disc herniation.Randomized clinical trial. Dogs were randomized 1:1 to fentanyl or a ketamine-dexmedetomidine combination for intra and postoperative analgesia. Primary outcome was time to recovery of ambulation; secondary outcomes were the postoperative Colorado Acute Pain Scale, the short-form Glasgow Composite Measure Pain Scale, time to recovery of voluntary urination and time to unassisted eating.No difference was found in time to recovery of ambulation between groups (adjusted sub-hazard ratio, 0.83; 95% confidence interval [CI], 0.55-1.24; P = .36) or in pain scores (Colorado: χThere was no evidence that, at the doses used, fentanyl impaired ambulatory outcome after surgery for thoracolumbar intervertebral disc herniation in dogs. Pain control appeared similar between groups. Secondary outcomes suggested minor benefits associated with ketamine-dexmedetomidine. The ketamine-dexmedetomidine combination appears to be a reasonable alternative to peri-operative opioids.

Reherniation and reoperation rates of 4.5%-36% are reported in canine patients treated for intervertebral disc herniation (IVDH). Decision-making for surgical reintervention can prove challenging, especially since common postoperative changes are poorly described on MRI. The purpose of this single-center, retrospective, descriptive study was to describe the MRI characteristics of the surgical site in dogs treated for thoracolumbar IVDH and presenting for ongoing or recurrent neurological signs. Twenty-one patients were included for a total of 42 MRI studies. Chondrodystrophic breeds, specifically Dachshunds, were overrepresented. Mean number of days between surgery and second MRI was 335 (range 2-1367). Metallic susceptibility artifacts were seen in seven of 21 cases (33%), but these were limited in extent, spanning on average 1.3 vertebral bodies. In 11 cases, spinal cord compression suspected to be clinically significant was found at the surgical site; the extradural compressive material consisted of intervertebral disc material only, or a combination of intervertebral disc material and hematoma or inflammatory changes in 10 cases, and a displaced articular process and fibrous tissue in one case. The latter is a newly described complication of mini-hemilaminectomies. Paravertebral soft tissue changes and vertebral new bone formation varied according to the postoperative stage at which the patients were imaged. The results of this study supported the use of MRI as a diagnostic modality for spinal imaging following IVDH surgery, and showed that the presence of extradural disc material at a spinal surgical site is common along with various vertebral and paravertebral changes., No source of funding

Thoracolumbar intervertebral disc extrusion (TL-IVDE) is the most common cause of acute paraparesis and paraplegia in dogs; however, guidelines on management of the condition are lacking.To summarize the current literature as it relates to diagnosis and management of acute TL-IVDE in dogs, and to formulate clinically relevant evidence-based recommendations.None.A panel of 8 experts was convened to assess and summarize evidence from the peer-reviewed literature in order to develop consensus clinical recommendations. Level of evidence available to support each recommendation was assessed and reported.The majority of available literature described observational studies. Most recommendations made by the panel were supported by a low or moderate level of evidence, and several areas of high need for further study were identified. These include better understanding of the ideal timing for surgical decompression, expected surgical vs medical outcomes for more mildly affected dogs, impact of durotomy on locomotor outcome and development of progressive myelomalacia, and refining of postoperative care, and genetic and preventative care studies.Future efforts should build on current recommendations by conducting prospective studies and randomized controlled trials, where possible, to address identified gaps in knowledge and to develop cost effectiveness and number needed to treat studies supporting various aspects of diagnosis and treatment of TL-IVDE.

To compare the effect of percutaneous endoscopic lumbar discectomy (PELD) using a double-cannula guide tube (DGT), traditional PELD, and open lumbar discectomy (OLD) to treat large lumbar disc herniations (LLDHs).Seventy patients who presented with LLDH without cauda equina syndrome and were treated with surgery in our hospital from October 2015 to October 2017 were included. The detailed index included the visual analog scale (VAS) for back and radicular leg pain and the Oswestry Disability Index (ODI) in the immediate preoperative period and at the final follow-up. The operation time, radiation exposure time, surgical satisfaction rate, and modified MacNab criteria score were also recorded.The leg and back pain of the patients in these groups improved significantly in the postoperative period. No significant differences were observed in leg pain improvement between the other two groups; however, patients in the PELD group (with or without DGT) presented with significantly higher improvement in back pain than the OLD group (t = 9.965, p 0.001). The final ODI scores were 12.1 ± 4.9, 11.2 ± 2.9, and 16.4 ± 3.6 in the PELD, PELD-DGT, and OLD groups, respectively. Patients in the PELD and PELD-DGT groups presented with significantly lower postoperative ODI scores than those in the OLD group (t = 20.834, p 0.001). The mean postoperative hospital stays were significantly shorter in the PELD group and PELD with DGT group than in the OLD group (t = 46.688, p 0.001). The mean operation time was significantly shorter in the PELD-DGT group than those in the PELD group (t = 25.281, p = 0.001). No perioperative complications were observed in either group. Based on the modified MacNab criteria, excellent and good outcomes were achieved in 20 out of 21 patients (95.2%) in the PELD group, 23 out of 24 patients (95.8%) in the PELD-DGT group, and 22 out of 25 patients (88.0%) in the OLD group. The rates of excellent and good outcomes were higher in the PELD and PELD-DGT groups than in the OLD group, but there were no significant differences (χPELD using DGT is a safe and effective option for LLDH and features advantages such as improvements in back pain, a lower hospitalization cost than OLD, a shorter operation time, and less fluoroscopy than traditional PELD.

To evaluate the clinical outcome and quality of life in elderly patients in poor conditions with unilateral symptomatic degenerative lumbar spinal stenosis (DLSS) who were treated with percutaneous endoscopic lumbar discectomy (PELD) assisted by double tubes.This study was designed retrospectively. From June 2017 to June 2018, 31 consecutive elderly patients who were presented with unilateral symptomatic DLSS, underwent PELD assisted by double tubes under local anesthesia. American Society of Anesthesiology score (ASA) was used to evaluate the patients' conditions. The operative time, intraoperative blood loss, hospital stay, and complications were evaluated. Clinical outcomes were assessed by the visual analog scale (VAS), Oswestry disability index (ODI), and modified Macnab criteria. Short Form 36 (SF-36) was used to evaluate the life quality. The CT or MRI was used to evaluate the spinal area.Thirty-one patients were enrolled and 25 cases achieved at least a 24-month follow-up. Three patients were lost to follow-up and three patients died from other diseases. A total of 76% (19/25) of the patients presented an ASA score of more than 3. The mean operative time was 67.80 min, the mean blood loss was 18.2 ml, and the hospital stay was 6.92 days. The postoperative 12-month follow-up VAS score significantly decreased compared with that before the operation (1.12 ± 0.73 vs. 5.12 ± 1.81, p 0.01). Although the VAS score decreased at the final follow-up, there was no significant difference compared with that at the 12-month follow-up (0.92 ± 0.64 vs. 1.12 ± 0.73, p = 0.549). So did the ODI. Also, there was no difference in the ODI scores between the 12-month follow-up and the final follow-up (12.52 ± 5.58 vs. 9.44 ± 6.32, p = 0.172). The overall excellent rate was 92% (23/25) at the final follow-up. The scores of the physical function, mental function, and social function of SF-36 after the operation improved significantly compared with those before operation (p 0.05). But there was no difference in the physical function score (84.00 ± 6.29 vs 84.40 ± 6.18, p = 0.871), mental function score (81.76 ± 8.01 vs 81.68 ± 6.67, p = 0.974), or social function score (115.50 ± 13.64 vs 118.50 ± 12.03, p = 0.437) between the 12-month follow-up and the final follow-up. There were no differences in the VAS, ODI, and SF-36 between the LPELD assisted by double tubes is effective for unilateral symptomatic DLSS in elderly patients with comorbidities and could improve life quality.

Intervertebral disc degeneration (IDD) causes a variety of signs and symptoms, such as low back pain (LBP), intervertebral disc herniation, and spinal stenosis, which contribute to high social and economic costs. IDD results from many factors, including genetic factors, aging, mechanical injury, malnutrition, and so on. The pathological changes of IDD are mainly composed of the senescence and apoptosis of nucleus pulposus cells (NPCs), the progressive degeneration of extracellular matrix (ECM), the fibrosis of annulus fibrosus (AF), and the inflammatory response. At present, IDD can be treated by conservative treatment and surgical treatment based on patients' symptoms. However, all of these can only release the pain but cannot reverse IDD and reconstruct the mechanical function of the spine. The latest research is moving towards the field of biotherapy. Mesenchymal stem cells (MSCs) are regard as the potential therapy of IDD because of their ability to self-renew and differentiate into a variety of tissues. Moreover, the non-coding RNAs (ncRNAs) are found to regulate many vital processes in IDD. There have been many successes in the in vitro and animal studies of using biotherapy to treat IDD, but how to transform the experimental data to real therapy which can apply to humans is still a challenge. This article mainly reviews the treatment strategies and research progress of IDD and indicates that there are many problems that need to be solved if the new biotherapy is to be applied to clinical treatment of IDD. This will provide reference and guidance for clinical treatment and research direction of IDD.

Background Nowadays, percutaneous endoscopic lumbar discectomy (PELD) has become a popular surgical option for the management of LDH, On the basis of the approach to the herniation disc materials, PELD could be classified into percutaneous endoscopic transforaminal discectomy (PETD) and percutaneous endoscopic interlaminar discectomy (PEID). During PETD procedure, especially in in-and-out approach, accurate determination of whether the posterior longitudinal ligament is needed resection seems particularly important.In the study, we tried assessing comparative clinical outcome, surgical duration and complications between the two different surgical methods of LDH treated by PETD via inside-and-out approach. Methods A total of 135 symptomatic LDH patients who were treated by PETD resecting the posterior longitudinal ligament (68 patients) or remaining the posterior longitudinal ligament (67 patients) during the surgery were included in the study. Visual analog scale (VAS) score, Oswestry disability index (ODI) and modified MacNab criteria were used to evaluate clinical outcomes. Operation time, blood loss, recurrence of LDH and other complication such as dural tear, nerve injury, intervertebral infection, etc. of these two groups were recorded. Clinical evaluation was performed preoperatively, immediately postoperatively, and at each follow-up visit (1 month, 3 months, and final follow-up). Results There were 38 males and 30 females in the group A that resecting the posterior longitudinal ligament (mean age = 52.40 ± 8.73 years) and 35 males and 32 females in the group B that remaining the posterior longitudinal ligament (mean age = 53.50 ± 9.24 years). The mean operation time of the group A and the group B respectively, were 82.7 ± 18.5 min and 115.6 ± 24.6 min (P 0.05). There was no significant difference in the complication rate, the excellent/good ratio and the recurrence rate between the two groups (P > 0.05). Conclusion Whether the posterior longitudinal ligament is resected do not make any difference on curative effect in PETD via inside-and-out approach, and remaining the ligament when it’s intact is preferred because of its shorter operation time.

Painful lumbar radiculopathy is a neuropathic pain condition, commonly attributed to nerve root inflammation/compression by disc herniation. The present exploratory study searched for associations between pain intensity and inflammatory markers, herniated disc size, infection, psychological factors and pain modulation in patients with confirmed painful lumbar radiculopathy scheduled for spine surgery.Prior to surgery, 53 patients underwent the following evaluation: pain intensity measured on a 0-10 numeric rating scale (NRS) and the Short-Form McGill Pain Questionnaire; sensory testing (modified DFNS protocol); pain processing including temporal summation and conditioned pain modulation (CPM); neurological examination; psychological assessment including Spielberger's Anxiety Inventory, Pain Sensitivity Questionnaire and the Pain Catastrophizing Scale. Pro-inflammatory cytokine levels (IL-1b, IL-6, IL-8, IL-17, TNFα, IFNg) and microbial infection (ELISA and rt-PCR) in blood and disc samples obtained during surgery. MRI scans assessments for disc herniation size/volume (MSU classification/ three-dimensional volumetric analysis).Complete data were available from 40 (75%) patients (15 female) aged 44.8 ± 16.3 years. Pain intensity (NRS) positively correlated with pain catastrophizing and CPM (r = 0.437, p = 0.006; r = 0.421, p = 0.007; respectively), but not with disc/blood cytokine levels, bacterial infection or MRI measures. CPM (p = 0.001) and gender (p = 0.029) were associated with average pain intensity (adjusted RThis exploratory study suggests that pain catastrophizing, CPM and gender, seem to contribute to pain intensity in patients with painful lumbar radiculopathy. The role of mechanical compression and inflammation in determining the intensity of painful radiculopathy remains obscure.Pain catastrophizing, CPM and gender rather than objective measures of inflammation and imaging seem to contribute to pain in patients with painful radiculopathy.

Magnetic resonance imaging (MRI) is a standard test for diagnosis and treatment planning in dogs with degenerative thoracolumbar intervertebral disc disease (IVDD). However, published studies evaluating three-dimensional fast-spin echo (3D-FSE) pulse sequences for dogs with IVDD are currently limited. Aims of this retrospective, observational study were to compare findings from T2-weighted two- and three-dimensional fast spin-echo sequences (2D- and 3D-FSE, respectively) for a group of small breed dogs with thoracolumbar IVDD. Inclusion criteria were dogs with IVDD that underwent 1.5-Tesla MRI using both 2D-FSE and 3D-FSE sequences. For each dog and sequence, five pathologic indices were recorded: epidural fat discontinuation, vertebral canal compromise, spinal cord signal change, disc degeneration, and nerve root compression. Two independent investigators also scored visibility of the facet joint, intervertebral foramen, nerve roots, spinal cord grey-white matter differentiation, intervertebral discs, and epidural fat. The Wilcoxon signed-rank test was used to evaluate the between-sequence differences in pathologic indices and visibility scores. Interobserver agreement was measured using Cohen's weighted kappa along with 95% confidence intervals. A total of 21 dogs were sampled. The 3D-FSE sequences had higher pathologic indices of vertebral canal compromise (P = 0.020) and spinal cord signal change (P = 0.046) than 2D-FSE sequences. Furthermore, 3D-FSE sequences had higher visibility scores for the facet joint, intervertebral foramen, and nerve root structures (P 0.001). Findings from the current supported the use of 3D-FSE sequences over 2D-FSE sequences for the evaluation of IVDD and visualization of spinal structures in small breed dogs.

Reduced pelvic limb reflexes in dogs with spinal cord injury typically suggests a lesion of the L4-S3 spinal cord segments. However, pelvic limb reflexes might also be reduced in dogs with a T3-L3 myelopathy and concurrent spinal shock.We hypothesized that statistical models could be used to identify clinical variables associated with spinal shock in dogs with spinal cord injuries.Cohort of 59 dogs with T3-L3 myelopathies and spinal shock and 13 dogs with L4-S3 myelopathies.Data used for this study were prospectively entered by partner institutions into the International Canine Spinal Cord Injury observational registry between October 2016 and July 2019. Univariable logistic regression analyses were performed to assess the association between independent variables and the presence of spinal shock. Independent variables were selected for inclusion in a multivariable logistic regression model if they had a significant effect (P ≤ .1) on the odds of spinal shock in univariable logistic regression.The final multivariable model included the natural log of weight (kg), the natural log of duration of clinical signs (hours), severity (paresis vs paraplegia), and pelvic limb tone (normal vs decreased/absent). The odds of spinal shock decreased with increasing weight (odds ratio [OR] = 0.28, P = .09; confidence interval [CI] 0.07-1.2), increasing duration (OR = 0.44, P = .02; CI 0.21-0.9), decreased pelvic limb tone (OR = 0.04, P = .003; CI 0.01-0.36), and increased in the presence of paraplegia (OR = 7.87, P = .04; CI 1.1-56.62).A formula, as developed by the present study and after external validation, could be useful for assisting clinicians in determining the likelihood of spinal shock in various clinical scenarios and aid in diagnostic planning.

Objectives The objective is to determine whether the preoperative duration of symptoms can affect the clinical and functional outcomes after microdiscectomy. Method This study is a single blind randomized controlled trial with level 1 evidence. From 3 January 2016 to 15 February 2017, 122 adult patients with symptomatic lumbar disc herniation were divided randomly by computer system into three groups were treated by microdiscectomy at 6 weeks, 3 months and 6 months from onset of symptoms respectively. Ninety‐seven patients, age (19–47) years, 42 males and 55 females, were analyzed at the end of this study with 3 years of follow up. Primary outcome measures are Oswestry Disability Index (ODI), Roland‐Morris Questionnaire (RMQ) and Visual Analogue Scale (VAS) for back pain and leg pain. Secondary outcome measures are post‐operative complications, length of hospital stay and time of return to daily activities. Results There was significant difference in VAS for back pain among study groups (P = 0.002) at 2 weeks). There were significant differences in VAS for leg pain among study groups (P, Patients, with symptomatic lumbar disc herniation and failure of conservative management for 6 weeks, will have better clinical and functional outcomes when surgical treatment of microdiscectomy was done as early as possible.

INTRODUCTION We aimed to identify imaging-based findings that can differentiate between spinal subchondral bone metastasis with focal pathologic endplate fracture and oedematous Schmorl's nodes that have been histopathologically confirmed. METHODS Between March 2010 and April 2016, 11 patients who had undergone spinal magnetic resonance (MR) imaging or computed tomography (CT) with final radiologic reports that included 'subchondral bone metastasis with focal pathologic endplate fracture' or 'edematous Schmorl's node' and had also undergone percutaneous imaging-guided spinal biopsies were included. Two radiologists retrospectively evaluated the following imaging features in consensus: size, location, presence of sclerotic margin, presence of intralesional or perilesional enhancement and opposite endplate enhancement of the involved disc, presence of disc height loss and presence of metabolic uptake at a corresponding lesion on nuclear medicine imaging. RESULTS A total of 11 patients, including six patients with spinal subchondral bone metastasis with focal pathologic endplate fracture and five patients with oedematous Schmorl's nodes, were included in this study (median age, 58 years; range, 50-63 years; six men). Sclerotic margin (P = 0.002) and enhancement on the opposite endplate of the involved disc (P = 0.047) were significantly different between oedematous Schmorl's node and subchondral bone metastasis with focal pathologic endplate fracture. CONCLUSION Sclerotic margin and enhancement on the opposite endplate of the involved disc suggest oedematous Schmorl's node rather than subchondral bone metastasis with focal pathologic endplate fracture. Decreased disc height is likely to be an oedematous Schmorl's node rather than subchondral bone metastasis with focal pathologic endplate fracture.

Objective After percutaneous endoscopic lumbar discectomy (PELD), most patients with lumbar disc herniation (LDH) experience relief from the typical symptoms of low back and leg pain. However, for a small number of patients, these symptoms are relieved immediately after surgery but aggravated soon after, and then relieved after short‐term full rest or conservative treatment. The aim of the study was to demonstrate this short‐term recurrent phenomenon, termed rebound pain. Methods A retrospective study was conducted on 144 patients who underwent single‐segment PELD from May 2017 to June 2020. Postoperative patients were divided into a rebound pain group and a non‐rebound pain group. For the former group, general information, symptom characteristics and visual analogue score (VAS) changes in rebound pain were summarized. For both groups, postoperative efficacy was evaluated by recent VAS of low back and leg pain in the remission stage, the Oswestry disability index (ODI) and the modified MacNab criteria at the last follow‐up. Logistic regression analysis was used to identify predictors for rebound pain. Results The VAS and ODI exhibited significant improvements at the last follow‐up of average 15.4 months (P 45 days was found as a protective factor for rebound pain (p = 0.031). Conclusion Although rebound pain with multiple characteristics and a short duration had no significant effect on long‐term postoperative efficacy, its high incidence often caused unnecessary concern in both patients and doctors. As a result, careful differentiation of rebound pain from other postoperative complications is needed., For patients with lumbar disc herniation, most received relief from low back and leg pain after percutaneous endoscopic lumbar discectomy (PELD). However, 10.4% of patients had short‐term pain recurrence after PELD, termed rebound pain, which could be alleviated by adequate rest and conservative treatment.

Objective To investigate the prevalence of lumbosacral transition vertebrae (LSTVs) in both the normal population and the lumbar disc herniation (LDH) population and to determine the risk factors for LDH. Methods Between January 2019 and September 2020, all patients aged 18–39 years and underwent an anteroposterior (AP) X‐ray of the lumbar vertebrae were retrospective reviewed in our institution. Those patients who were diagnosed with LDH were eligible for inclusion in the LDH group. During the same period, those patients admitted to our hospital who underwent an anteroposterior X‐ray of the lumbar spine and had not been diagnosed with LDH were included in the control group. Those patients with disease that might affect the lumbar anatomy were excluded from both groups. The type of LSTV was classified according to the Castellvi classification. The height of the lumbar vertebral lamina was evaluated through the h/H index. The inter‐ and intra‐observer reliability was evaluated by one senior radiologist and one senior orthopedist using intraclass correlation coefficient (ICC). The association between the LSTV and the herniation level was also investigated. Binary logistic regression was used to explore the association of different factors between the LDH group and the control group. Results Two hundred LDH patients (115 male and 85 female) and 200 individuals (108 male and 92 female) were investigated retrospectively. The prevalence of LSTVs was 71.5% (n = 143) in the LDH group and 34.0% (n = 68) in the control group. The most frequent LSTV types were type Ib and type IIa. The inter‐ and intra‐observer ICCs of the measurement of “h/H” index and the classification of LSTV were all “excellent” (ICC > 0.90). The median h/H index in the control group was significantly higher than that in the LDH group (0.28 (0.26, 0.31) vs 0.34 (0.31, 0.37), P = 0.000). The distribution of the Castellvi classification in the L4/5 and L5/S1 herniation patients was significantly different (P = 0.048). LSTVs, BMI and the h/H index were closely associated with LDH, with odds ratios of 3.06 (95% CI: 2.12–4.43), 1.23 (95% CI: 1.13–1.33) and 0.09 (95% CI: 0.05–0.15), respectively. The incidence of L4/5 disc herniation in patients with an LSTV was significantly more common than that in patients with L5/S1 disc herniation (P = 0.048). Conclusion The prevalence of LSTVs was 34.0% in the control group and 71.5% in the LDH group; LSTVs and BMI were positively correlated with LDH, and h/H was negatively correlated with LDH., The prevalence of LSTVs was 34.0% in the control group and 71.5% in the LDH group, and subtype Ib was the most common. LSTVs and BMI were positively correlated with LDH, and h/H was negatively correlated with LDH.

Intervertebral disc disease (IVDD) is a common musculoskeletal disease affecting about 5% of all individuals. It is characterized by lumbar disc herniation, which causes nerve root irritation, either mechanically or via inflammatory mediators, and results in radiating pain, known as sciatica. Numerous studies have been conducted to identify the causes and risk factors for IVDD. Lifting heavy loads, torsional stress, and motor vehicle driving are among the best-identified environmental risk factors. However, it has become evident recently from family and twin studies that genetic factors may also be important in IVDD. This hypothesis was strengthened by the identification of two collagen IX alleles associated with sciatica and lumbar disc herniation. In addition, disc degeneration has been shown to be related to an aggrecan gene polymorphism, a Vitamin D receptor and matrix metalloproteinase-3 gene alleles. This review highlights the genetic role and occupational aspects of IVDD.

Objective The study introduced uniportal‐bichannel spinal endoscopic system (UBiSES) and explored the feasibility of applying UBiSES to conduct lumbar foraminoplasty in percutaneous endoscopic transforaminal discectomy (PETD). Methods This is a cohort study. 36 patients confirmed as L5/S1 lumbar disc herniation (LDH) in our hospital from March, 2019 to November, 2019 were enrolled. 36 patients were divided into two groups named the UBiSES group (n = 18, male: female = 8:10) and the TESSYS group (n = 18, male: female = 10:8). The average age of the UBiSES group and the TESSYS group were 40.94 ± 12.39 years old and 39.78 ± 13.02 years old respectively. PETD via uniportal‐bichannel foraminoplasty assisted by UBiSES was adopted on the UBiSES group while PETD via conventional foraminoplasty was performed on the TESSYS group. One experienced surgeon with more than 4000 cases of lumbar surgery performed PETD on all patients. The demographic data, the duration of working cannula placement (minutes), decompression time (minutes), radiation exposure time (seconds), complications, Visual Analogue Scale (VAS), Oswestry Disability Index (ODI) scores and modified MacNab criteria were recorded and analyzed. The magnetic resonance imaging (MRI) and computed tomography (CT) were conducted to evaluate the radiographic improvement. Results PETD via lumbar foraminoplasty was successfully performed in all cases. The follow‐up points were 3 months, 6 months, and 12 months. The average follow‐up period of all patients was 15.78 ± 2.29 months. There was no statistic difference in age (P = 0.81), sex (P = 0.51) and follow‐up (P = 0.14) between two groups. The duration of working cannula placement was 19.08 ± 2.30 min in the UBiSES group and 24.90 ± 4.71 min in the TESSYS group and there was significant difference between two groups (P, Lumbar foraminoplasty is a crucial and challenging step in PETD. In conventional TESSYS, surgeons could not get a direct view of the anatomic structure around the foramen during foraminoplasty with bone reamers or trephines, which is difficult to control the direction and may cause some unexpected complications including neural injury and bleeding. Also, the articular surface of facet joints is not in a sagittal plane or coronal plane, and oblique articular surface makes reamers and trephines easier deviated to ventral direction, which leads to unsatisfactory foraminoplasty. As an original designed technique, UBiSES allows operation with two surgical instruments simultaneously under full‐time and real‐time visualization in just one incision, which could be less invasive and more efficient. Uniportal‐bichannel foraminoplasty assisted by UBiSES could control the direction easier and get a satisfactory bone resect at the dorsal side of foramen with extensive view and space.

Objectives Hydrotherapy is a common part of the postoperative care after surgical treatment of thoracolumbar intervertebral disc extrusion in dogs. There are currently no guidelines on when to commence hydrotherapy after surgery. Early hydrotherapy may be associated with an increased risk of postoperative complications including surgical site infection and neurological deterioration. The goal of this study was to report the prevalence and types of postoperative complications in dogs receiving early hydrotherapy. Materials and methods Eighty-three dogs commencing hydrotherapy within 5 days after surgical treatment for thoracolumbar intervertebral disc extrusion were included in a retrospective descriptive study. All postoperative complications were recorded. Results Ten minor and 16 major complications were recorded in a total of 26 dogs. The majority of recorded complications were unlikely, but not excluded to be, caused by the initiation time of hydrotherapy. One dog developed a surgical site infection and one dog had a confirmed further extrusion of the originally operated intervertebral disc, which may have been influenced by early initiation of hydrotherapy. Clinical significance Early hydrotherapy is possibly associated with occurrence of postoperative complications. Associations between the reported complications and early hydrotherapy, and possible benefits of early hydrotherapy, need to be further investigated before early initiation of hydrotherapy can be recommended.

OBJECTIVE To evaluate the intervertebral disk, vertebral endplates, and spinal cord for perioperative changes secondary to percutaneous laser disk ablation (PLDA) and correlate findings to clinical outcomes in dogs receiving thoracolumbar PLDA. STUDY DESIGN Blinded study. ANIMALS Thirty dogs. METHODS Magnetic resonance imaging (MRI) was performed before PLDA (control/Group C), immediately following PLDA (Group I), and 3 months later (perioperative/Group P). Dogs were followed 3 years. Groups and dogs were randomized for evaluation. Two radiologists were blinded to each MRI study and dog. Each radiologist evaluated the disk, vertebral body, and spinal cord at each disk space receiving PLDA. RESULTS Mean disk degeneration was increased in Group P at L1-2 (p

The involvement of intervertebral disc (IVD) tissues, whole blood (WB) cytokines, and chemokines in pain in patients with lumbar degenerative disc disease (LDD) is unknown. We investigated the relationships between inflammatory cytokines and chemokines in human IVD tissues and WB samples and their association with pain. Expression levels of chemokines and cytokine gene expression were measured in samples from 20 patients with LDD and compared between IVD tissues and WB samples. The associations between WB chemokine and cytokine gene expression levels and pain intensity (numeric rating scale) were also analyzed. The mRNA of C-C chemokine ligand 20 (CCL20), C-C chemokine receptor 6 (CCR6), interleukin-6 (IL-6), IL-1β, IL-17, and tumor necrosis factor-α (TNF-α) was expressed in degenerated IVD tissues. Pearson's product-moment correlation analysis produced positive correlations between CCR6 and IL-6 expression levels in IVD tissues (r = 0.845, p

Background Apart from the absence of nociception, there is no readily available prognostic test for dogs presenting with paraplegia secondary to acute intervertebral disc extrusion (IVDE). Objective To assess if serum C‐reactive protein (CRP) can predict the postoperative outcome in paraplegic dogs undergoing surgery for IVDE and to assess the association between serum CRP and presence/absence of nociception on admission, and serum CRP and presence/absence of intramedullary changes seen on magnetic resonance imaging (MRI). Animals One hundred dogs that underwent surgery at our hospital between 2018 and 2020 because of acute paraplegia secondary to IVDE and in which serum CRP was measured. Methods Retrospective observational cohort study. Dogs were classified as 4 or 5 according to the modified Frankel score (MFS) depending on presence/absence of nociception, respectively. MRI images were reviewed and the T2‐weighted hyperintensity: L2 vertebral body length was measured. Postoperative outcome was defined as positive if nociception, ambulation or both returned after decompressive surgery. Results The median (95% CI) serum CRP was 4 (4‐5) and 6 (4‐7) mg/L in MSF4 and MSF5, respectively (P = .03). A weak linear relationship (R 2 = 0.049, P = .03) was found between CRP and the T2‐weighted hyperintensity: L2 vertebral length. Outcome data was available for 85 dogs: CRP was 4 (4‐5) and 5 (4‐10) mg/L in positive and negative outcome dogs, respectively (P = .32). Conclusion and Clinical Importance Serum CRP did not predict outcome after surgery in dogs with paraplegia secondary to IVDE.

Objective To assess the clinical efficacy of one‐stage percutaneous endoscopic lumbar discectomy (PELD) for symptomatic double‐level contiguous adolescent lumbar disc herniation (ALDH). Methods This retrospective study included 16 patients who presented with back and/or leg pain due to double‐level disc herniation underwent PELD for symptomatic lumbar disc herniation (0.27%,16/5877) from January 2014 to September 2019. After follow‐up period of 17.3 months in average, numeric rating scale (NRS) scores and modified Macnab criteria were used to assess the preoperative and postoperative clinical results. Quantitative data were expressed as mean standard deviation (SD) and the data for the variation in the NRS scores before and after the operation were compared using the Wilcoxon two‐sample test. Analyses were performed with IBM SPSS Statistics for Windows, version 19.0 (IBM, Armonk, NY, USA). Values of P, Adjustment of working cannula intraoperatively for symptomatic double‐level contiguous adolescent lumbar disc herniation.

Objectives Transforaminal epidural steroid injection (TFESI) is widely used to manage lumbosacral radicular pain due to herniated lumbar disc (HLD). Objectives We evaluated the long-term outcomes of TFESI in patients with lumbosacral radicular pain due to a HLD by the location, type, and size of the HLD. Methods In total, 114 patients who received the initial TFESI at least 4 years ago completed a phone interview. We investigated the presence of radicular pain, degree of current pain, current pain medications and TFESIs, additional TFESIs, progression to surgery, and trouble in performing daily life activities and occupational job duties. We classified the included patients by the location, type, and size of the HLD, and evaluated whether these factors affected the long-term outcomes of TFESI. Results At least 4 years after the initial TFESI, radicular pain was completely resolved in 45% of the patients. However, 30% patients were on oral painkillers or repetitive TFESIs or had undergone surgery and 15% had difficulty in performing daily life activities and occupational job duties. A larger number of patients with extruded lumbar disc herniation required additional TFESIs than those with protruded lumbar disc herniation. Apart from this, the outcomes did not significantly differ by the location, type, and size of the HLD. Conclusions Our findings provide useful information to clinicians managing radicular pain due to HLD.

Symptomatic lumbar disc herniation (LDH) is widely treated using percutaneous endoscopic lumbar discectomy (PELD). In the present PELD surgery, performing decompression under endoscope still takes a long time to explore the rupture site of annulus fibrosus, resulting in prolonged operation time and over‐invasion of the undegenerated annulus fibrosus. A wide range of intraoperative exploration also induces an iatrogenic injury of the normal annulus fibrosus, even aggravating intervertebral disc degeneration, which may lead to early postoperative recurrence in severe case. Hence, it is important to seek a precise decompression in PELD surgery. Under this kind of realization, more spinal surgeons possibly choose a disc staining before performing decompression. However, the classical disc staining technique still has its shortcomings. First of all, an appropriate dose of staining cannot be accurately mastered, even induces unqualified staining effect. Second, the duration of surgery and the times of fluoroscopy will be increased. Finally, what surgeons see under the endoscope is the staining result but not the staining process. Hence, this is accomplished more effectively by designing procedures that perform fully visible disc staining under spinal endoscope. There is no specific research to discuss the technique note of endoscopic staining in PELD surgery. We have come up with a new original technology of endoscopic staining with methylene blue injection in PELD for treatment of LDH., This current study is to display a series cases using a new and original endoscopic disc staining. This modified technique can fully observe the process of disc staining. It also minimizes the iatrogenic injury of the intraoperative undegenerated annulus fibrosus. In addition, the learning curve is smooth and it is easy to master this technique for experienced orthopedic and neurosurgical spine specialists.

Objective To investigate the anatomic location and distribution of lesions on magnetic resonance imaging (MRI) in the sacroiliac (SI) joints in patients with axial spondyloarthritis (SpA), women with and without postpartum pain (childbirth within 4-16 months), patients with disc herniation, cleaning staff, runners, and healthy persons. Methods In a prospective cross-sectional study of 204 participants, MRI of the entire cartilaginous compartment of the SI joint was scored blindly by 2 independent, experienced readers, according to Spondyloarthritis Research Consortium of Canada definitions of SI joint inflammation and structural lesions in each SI joint quadrant or half and in each of 9 slices. The locations of the lesions (unilateral/bilateral, upper/lower, sacral/iliac, and anterior/central/posterior slices) were analyzed based on concordant reads. Results Bone marrow edema (BME) occurred in all quadrants in nearly all participant groups, but rarely bilaterally, except in patients with axial SpA and women with postpartum pain. Fat lesions were mainly found in axial SpA and occurred in all quadrants, but mostly bilaterally in sacral quadrants. Erosion was rare, except in axial SpA, where it was mainly iliac and often bilateral. Sclerosis was exclusively iliac and most frequent in women with postpartum pain. Conclusion The location and distribution of common SI joint lesions in axial SpA and non-axial SpA were reported, and group-specific patterns were revealed. BME distributed bilaterally or unilaterally, both locally and more widespread in the SI joint, is common in both postpartum women with pain and axial SpA patients, which limits the use of BME to differentiate these groups. This study indicates that the presence of fat lesions, especially when widespread, and/or erosion, particularly when located centrally or posteriorly, are diagnostically important and should be investigated further.

OBJECTIVES The aim of this study was to retrospectively investigate factors predicting a successful outcome after ozone chemonucleolysis (OCN) in patients with radicular pain and poor response to conservative treatments. METHODS Univariable and multivariable logistic regression analysis was used to identify the predictors of good outcome after OCN. Good outcome was defined as 33% Oswestry Disability Index (ODI) reduction (model 1) or 13-point ODI improvement (model 2) at 1 month after OCN. RESULTS Two hundred seventy-three patients were analyzed. A significant pain reduction (pre-operative Numerical Rating Scale [NRS] 6.7 ± 1.5, postoperative NRS 2.6 ± 2.2, P

Objective The aim of this study was to compare the clinical efficacy of percutaneous endoscopic interlaminar discectomy (PEID) and percutaneous endoscopic transforaminal discectomy (PETD) in treating L5/S1 disc herniation. Methods A retrospective analysis of 76 patients with L5/S1 intervertebral disc herniation was performed. There were two surgical treatment groups: one with patients receiving PEID and the other with patients receiving PETD. The two groups were compared by length of surgery, times of intraoperative X‐ray exposure, postoperative time in bed, length of hospital stay, operative complications, patient's assessment of pain using a visual analogue scale (VAS), and disability using the Oswestry disability index (ODI) before and after surgery. Results Subjects in the PEID group were in surgery for 60.90 ± 13.11 min and needed intraoperative X‐ray exposure 4.10 ± 1.09 times. Patients in this group were ambulatory by 7.52 ± 1.08 h after surgery and were hospitalized for 5.05 ± 0.92 days. In contrast, patients in the PETD group were in surgery for 84.06 ± 15.58 min and needed intraoperative X ray exposure 12.81 ± 8.46 times. These patients were ambulatory by 7.06 ± 0.91 h after surgery and remained in the hospital for 4.94 ± 0.80 days. Based on these data, operation time and fluoroscopy time were significantly less (P, (A, B) Schematic diagram of percutaneous endoscopic transforaminal discectomy. (C, D) Schematic diagram of percutaneous endoscopic interlaminar discectomy.

Objective To report the clinical and MRI features, and histologic findings of thoracolumbar discal pseudocyst in dogs. Materials and methods The records of eight dogs with thoracolumbar discal cyst-like structures were retrospectively collected to record their clinical signs, MRI features and surgical and histologic findings. Results Eight dogs with surgically and histologically confirmed thoracolumbar discal pseudocysts were included in the case series. Six dogs presented with acute onset and two dogs presented with subacute onset of thoracolumbar myelopathy. MRI showed compressive thoracolumbar myelopathy due to a round to oval-shaped epidural mass lesion communicating with the intervertebral disc, iso/hypointense on T1WI and mostly hyperintense on T2WI, associated with a variable contrast-enhancing wall, compatible with a cyst-like structure. These structures were surgically visualised and removed through a mini-hemilaminectomy or hemilaminectomy and submitted for histologic investigation. One dog also underwent cytologic examination of the cystic content. Similar to that in humans, histology revealed a cyst-like nature with a wall consisting of dense fibrous connective tissue containing clusters of chondroid cells accompanied by groups of notochordal cells and occasional erythrocytes; however, a real epithelial lining was missing and the term pseudocyst seemed more appropriate. Clinical significance This report describes clinical signs, and MRI and histologic findings of discal pseudocysts in dogs with thoracolumbar myelopathy. Despite being rare, discal pseudocysts should be considered as a differential diagnosis in dogs with acute onset thoracolumbar myelopathy.

Introduction Diagnosis is the key to improving spinal surgery outcomes. Improvements in the diagnosis of radiculopathy have created new indications for full-endoscopic spine surgery. We assessed the finite element method (FEM) to visualize and digitize lesions not detected by conventional diagnostic imaging. Methods We used FEM in two patients: a lumbar patient and a cervical patient. The lumbar patient was a 67-year-old woman with a history of rheumatoid arthritis; she also had osteoporosis and pulmonary fibrosis. She had left L3 radiculopathy due to an L3 vertebral fracture. The cervical patient was a 61-year-old woman with left C6 radiculopathy due to C5-C6 disc herniation. We performed full endoscopic foraminotomy per the patients's request. Based on preoperative and postoperative CT Digital Imaging and Communications in Medicine data of 0.5-mm slices, 3-D imaging data were reproduced, and kinetic simulation of FEM was performed. Results Postoperatively, both patients' radiculopathy disappeared, improving their activities of daily living and enabling them to walk and work. Also, the total contact area and maximum contact pressure of the nerve tissue decreased from 30% to 80% and from 33% to 67%, respectively. Conclusions A new method for perioperative evaluation and simulation, FEM can be to visualize and digitize the conditions of the lesion causing radiculopathy. FEM that can overcome both time and economic constraints in routine clinical practice is needed.

Background Quantitative magnetic resonance imaging (QMRI) techniques of magnetization transfer ratio (MTR) and diffusion tensor imaging (DTI) provide microstructural information about the spinal cord. Objective Compare neurologic grades using the modified Frankel scale with MTR and DTI measurements in dogs with thoracolumbar intervertebral disk herniation (IVDH). Animals Fifty‐one dogs with thoracolumbar IVDH. Methods Prospective cohort study. Quantitative MRI measurements of the spinal cord were obtained at the region of compression. A linear regression generalized estimating equations model was used to compare QMRI measurements between different neurological grades after adjusting for age, weight, duration of clinical signs, and lesion location. Results Grade 5 (.79 × 10−3 mm2/s [median], .43−.91 [range]) and axial (1.47 × 10−3 mm2/s, .58−1.8) diffusivity were lower compared to grades 2 (1.003, .68−1.36; P = .02 and 1.81 × 10−3 mm2/s, 1.36−2.12; P < .001, respectively) and 3 (1.07 × 10−3 mm2/s, .77−1.5; P = .04 and 1.92 × 10−3 mm2/s, 1.83−2.37;P < .001, respectively). Compared to dogs with acute myelopathy, chronic myelopathy was associated with higher mean (1.02 × 10−3 mm2/s, .77−1.36 vs. .83 × 10−3 mm2/s, .64−1.5; P = .03) and radial diffusivity (.75 × 10−3 mm2/s, .38−1.04 vs. .44 × 10−3 mm2/s, .22−1.01; P = .008) and lower MTR (46.76, 31.8−56.43 vs. 54.4, 45.2−62.27; P = .004) and fractional anisotropy (.58, .4−0.75 vs. .7, .46−.85; P = .02). Fractional anisotropy was lower in dogs with a T2‐weighted intramedullary hyperintensity compared to those without (.7, .45−.85 vs. .54, .4−.8; P = .01). Conclusion and Clinical Relevance Mean diffusivity and AD could serve as surrogates of severity of spinal cord injury and are complementary to the clinical exam in dogs with thoracolumbar IVDH.

Objective To illustrate the posterior longitudinal ligament is one of the tissue candidates who can contribute to low back pain (LBP). Methods This is a retrospective study. A series of 72 patients who underwent single-level percutaneous endoscopic lumbar discectomy performed for lumbar disc herniation with LBP from June 2014 to June 2016 were examined. There are 42 males and 30 females. The ages of patients were 40 to 57 years, and the mean age was 49.8 years. The symptomatic disc level was at L4-5 in 43 patients and L5 S1 in 29 patients. Thirty-two patients (19 patients in L4-5 disc level, 13 patients in L5 S1 disc level) had LBP (which was limited to the lower back and buttock area) before the operation. All of the operative approaches were performed under local anesthesia. A posterior body diagram (15 cm × 10 cm) was made for this study to record the pain distribution. The centered foci of low back pain were subjectively recorded before, during, and after the operation. The transforaminal endoscopic spine system technology was used in this study. Radiological examinations (X-ray, computed tomography, and magnetic resonance imaging) were performed prior to and after surgery. The Visual Analogue Score (VAS) and Oswestry Disability Index (ODI) scores were taken before and after the surgery to observe the degree of pain. The VSA and ODI score before and after operation were expressed as mean ± SD, and compared by t-test for statistical analysis. Results When inciting the posterior longitudinal ligament during the operation, all 72 patients had provoked low back pain. Forty-three patients with symptomatic discs at L4-5 had pain foci in the lower back and upper gluteal region under the L4 spinous process. Twenty-nine patients with symptomatic discs at L5 S1 had pain foci in the gluteal region under the S1 spinous process. The pain localizations of L4-5 and L5 S1 were different. After the surgery, the provoked low back pain disappeared, and had not returned in any of the patients at the 6-month follow-up. After the operation, one patient suffered from lower limb pain that he did not have before the operation, and the lower limb pain abated a few days later. Three patients had cerebrospinal fluid leakage and were treated with higher pressure applied on the incision and bed rest for 10 days. During the 6-months follow-up period, the mean VAS decreased from 5.97 ± 1.10 to 2.13 ± 0.78. The mean ODI score decreased from 23.14 ± 3.28 to 7.92 ± 1.85. Conclusions The intervertebral posterior longitudinal ligament may be one of the tissues from which low back pain originates.

Objectives The aim of this study was to investigate the long term effects of posterior lumbar interbody fusion (PLIF), applied after recurrent lumbar disc herniation (rLDH), on pain relief and clinical outcome improvement. Methods The current study is a retrospective study. We observed 22 cases from 85 patients that had undergone PLIF during February 2003 to October 2012 and all patients were followed for at least 5 years. The average age of those patients were 53 years, among them there were eight men and 14 women. Plain radiography and dynamic plain films were obtained, pre‐operation, for every patient. Magnetic resonance imaging (MRI) or computed tomography (CT) was conducted to confirm the diagnosis of rLDH before the operation. All surgeries were performed from posterior approach by the same surgeon using PLIF. Quality of life (QOL) and clinical outcomes were assessed by Numerical Rating Scale (NRS), Japanese Orthopaedic Association (JOA) scoring system, and Oswestry Disability Index (ODI) before revision surgery and at 1 week, 3 months, 12 months, and 24 months postoperative. These were also examined every time they came back to the hospital for a review. Results All patients were discharged and no serious comorbidities occurred. Three cases with wound infections and one case with dural laceration were cured and discharged. The end point of follow‐up was August 2018 and the mean follow‐up after revision surgery was 85 months. There were significant differences in NRS. It decreased from 7.32 ± 1.17 to 2.77 ± 1.31 (P 0.05) in ODI scores. The average JOA score improved from 5.00 ± 1.08 to 8.18 ± 1.59 (P

Lumbar disc herniation (LDH) is a relatively common spinal disease, but its pathogenesis is still unknown. Numerous studies have shown that LDH is closely correlated with inflammation, and it has been found to be related to some single nucleotide polymorphisms (SNPs). Our purpose is to explore the correlation between gene polymorphisms of GSDMC and LDH risk, which is of great significance for the study of the pathogenesis of LDH. DNA was extracted from 508 LDH patients and 508 controls. We select SNPs with minor allele frequency >5% in GSDMC gene from 1,000 genome project (http://www.internationalgenome.org/). Then, genotyping was performed using Agena MassARRAY. We used unconditional logistic regression analysis to calculate odds ratios (ORs) and 95% confidence intervals (CIs). The haplotype construction and analysis in GSDMC were applied to detect the association. We identified that rs77681114 in the GSDMC gene was significantly associated with a decreased risk of LDH in the alleles model (OR = 0.81, 95% CI = 0.66-0.99, p = .049) and the log-additive model (OR = 0.81, 95% CI = 0.65-0.99, p = .049) adjusted by age and gender. The haplotype "AG" constructed by rs77681114 and rs4285452 (OR = 1.24, 95% CI = 1.01-1.53, p = .039) was associated with increased risk of LDH. After age and gender stratification, rs77681114 protected LDH risk at age 49 or older in allelic model (p = .010), co-dominant model (p = .006), dominant model (p = .029), recessive model (p = .011) and log-additive model (p = .005). Rs77681114 had protective effect on female LDH risk in both co-dominant models (p = .033) and recessive models (p = .043). These studies indicated that genetic polymorphisms of GSDMC can relatively reduce the risk of LDH.

Objective To report recovery of ambulation of dogs treated with extended thoracolumbar durotomy for severe spinal cord injury caused by intervertebral disc herniation. Study design Descriptive cohort. Animals Twenty-six consecutive paraplegic dogs presented with loss of deep pain sensation after acute thoracolumbar intervertebral disc herniation. Methods Each dog underwent routine diagnostic assessment and surgery for removal of extradural herniated intervertebral disc, followed by a four-vertebral body length durotomy centered on the herniated disc. Each dog was followed up until it was able to walk 10 steps without assistance or until 6 months after surgery. Results Sixteen of 26 dogs recovered to walk unaided (all but one also recovered fecal and urinary continence), and six dogs did not; four dogs were lost to follow-up. One dog was euthanized because of signs consistent with progressive myelomalacia. There was no evidence of detrimental effects of durotomy within the period of study. Using Bayesian analysis, we found a point estimate of successful outcome of 71% with 95% credible interval from 52% to 87%. Conclusion Extended durotomy seemed to improve the outcome of dogs in our case series without increase in morbidity. Clinical significance Extended durotomy appears safe and may improve the outcome of dogs with severe thoracolumbar mixed contusion and compressive injuries associated with acute intervertebral disc extrusion.

OBJECTIVE To evaluate the proportion of non-ambulatory dogs with cervical intervertebral disc herniation (IVDH) in a private clinic and to compare signalment and outcome between those that underwent single or multiple ventral slot decompression (VSD). DESIGN Retrospective cohort study. METHODS After screening 43,378 medical records (January 2010-September 2016), those of 185 dogs with non-ambulatory tetraparesis or tetraplegia along with cervical IVDH that had undergone single (123) or multiple (62) VSD were included in this study. Data on signalment, preoperative neurological status, location of affected intervertebral disc(s), time to ambulation and short-term outcome were compared between single and multiple VSD groups. RESULTS The proportion of non-ambulatory dogs with IVDH was 35.3%. The prevalence of non-ambulation was higher in male dogs (0.56%) than in female dogs (0.26%; P

Degenerative spine imaging findings have been extensively studied in the lumbar region and are associated with pain and adverse clinical outcomes after surgery. However, few studies have investigated the significance of these imaging "phenotypes" in the cervical spine. Patients with degenerative cervical spine pathology undergoing anterior cervical discectomy and fusion (ACDF) from 2008 to 2015 were retrospectively and prospectively assessed using preoperative MRI for disc degeneration, narrowing, and displacement, high-intensity zones, endplate abnormalities, Modic changes, and osteophyte formation from C2-T1. Points were assigned for these phenotypes to generate a novel Cervical Phenotype Index (CPI). Demographics were evaluated for association with phenotypes and the CPI using forward stepwise regression. Bootstrap sampling and multiple imputations assessed phenotypes and the CPI in association with patient-reported outcomes (Neck Disability Index [NDI], Visual Analog Scale [VAS]-neck, VAS-arm) and adjacent segment degeneration (ASDeg) and disease (ASDz). Of 861 patients, disc displacement was the most common (99.7%), followed by osteophytes (92.0%) and endplate abnormalities (57.3%). Most findings were associated with age and were identified at similar cervical vertebral levels; at C5-C7. Imaging phenotypes demonstrated both increased and decreased associations with adverse patient-reported outcomes and ASDeg/Dz. However, the CPI consistently predicted worse NDI (P = .012), VAS-neck (P = .007), and VAS-arm (P = .013) scores, in addition to higher odds of ASDeg (P = .002) and ASDz (P = .004). The CPI was significantly predictive of postoperative symptoms of pain/disability and ASDeg/Dz after ACDF, suggesting that the totality of degenerative findings may be more clinically relevant than individual phenotypes and that this tool may help prognosticate outcomes after surgery.

Macrophages, particularly M1 macrophages, produce proinflammatory cytokines and contribute to the degenerative process in injured intervertebral discs (IVDs). We previously showed that macrophages in both intact and injured IVDs increased following IVD injury. Resident macrophages and macrophages recruited from the peripheral blood have distinct roles in tissue. However, it remains to be determined whether increased macrophages derive from resident or recruited macrophages. We investigated the origin of M1 macrophages in injured IVDs using green fluorescent protein (GFP) transgenic bone marrow chimeric mice. The M1 macrophage marker, CD86, increased in both disc-derived resident macrophages and bone marrow-derived macrophages (BMMs) after lipopolysaccharide/interferon γ stimulation in vitro. Following IVD injury, the proportion of cells positive for the CD86 ligand, the F4/80 antigen, and the surface glycoprotein CD11b (CD86+ CD11b+ F4/80+) significantly increased in GFP+ populations at days 3, 7, and 14. In contrast, CD86+ CD11b+ F4/80+ cells in GFP- populations significantly increased on day 3, and thereafter decreased on days 7 and 14. The proportion of CD86+ CD11b+ F4/80+ cells in the GFP+ populations was significantly higher than that in the GFP- populations at days 1, 3, 7, and 14. Monocyte chemoattractant protein-1 expression in disc-derived macrophages, but not in BMMs, increased following interleukin-1β stimulation. Our results suggest M1 macrophages following IVD injury originate from recruited macrophages. Resident macrophages may behave differently in IVD injury. The role of resident macrophages needs to be clarified. Further investigation is needed.

Background:\ud As they have been seldomly described in the veterinary literature, the aims of this retrospective study were to describe the clinical presentation, MRI findings and long-term outcome after medical or surgical treatment of dogs presenting with foraminal and far lateral thoracolumbar intervertebral disc herniations.\ud \ud Methods:\ud Retrospective multicentre study of dogs diagnosed with foraminal and far lateral thoracolumbar intervertebral disc herniations between 2009 and 2020 in seven referral hospitals.\ud \ud Results:\ud Thirty-seven dogs were included. Dachshunds and mixed breeds were most affected. Median age at presentation and duration of clinical signs were 6 years and 14 days, respectively. Pain was the most frequent clinical finding (92%), particularly on spinal palpation and/or hip manipulation, followed by pelvic limb lameness (71%). Eighty-seven percent of herniations occurred at L5-L6 or L6-L7. A good to excellent outcome was seen in 95% of surgically and 90% of medically treated dogs.\ud \ud Conclusion:\ud Although much less frequently recognised than herniation affecting the vertebral canal, foraminal and far lateral thoracolumbar intervertebral disc herniations should be considered in the differential diagnosis list of chondrodystrophic dogs presenting with pain and pelvic limb lameness. Most dogs had a good to excellent outcome following medical or surgical treatment.

Background Osteochondritis dissecans is a condition wherein there is a subchondral bone lesion that causes pain, inflammation, and cartilage damage. Dominant Familial Osteochondritis Dissecans is a rare and severe form of osteochondritis dissecans (OCD). It is caused by heterozygous pathogenic variants in the gene encoding Aggrecan; ACAN. Aggrecan, a proteoglycan, is an essential component of the articular and growth plate cartilage. Methods Herein, we report three individuals from one family; the proband who presented with short stature, a lower limb bone exostosis, and bilateral knee and elbow OCD at the age of 13 years old. His twin brother presented with isolated short stature and his father with short stature and lumbar disc herniation. Results Next‐generation sequencing of the ACAN gene in the proband identified a frameshift variant which is also present in the brother and father with short stature. The proband was treated surgically with bilateral elbow microfracture, after the failure of conservative therapy. Conclusion To the best of our knowledge, this is the first patient with an aggrecanopathy who presents with osteochondritis dissecans due to a frameshift variant. This family presents with variable expressivity which might be attributed to modifier genes., Dominant Familial Osteochondritis Dissecans is a rare and severe form of osteochondritis dissecans (OCD). It is caused by heterozygous pathogenic variants in the gene encoding Aggrecan; ACAN. Herein, we report 3 individuals from one family; the proband who presented with short stature, a lower limb bone exostosis, and bilateral knee and elbow OCD at the age of 13 years old. Next‐generation sequencing of the ACAN gene in the proband identified a frameshift deletion and this variant was also present in the brother and father with short stature. To the best of our knowledge, this is the first patient with an aggrecanopathy who presents with osteochondritis dissecans due to a frameshift mutation.

BACKGROUND: Hyperproteinorrachia (raised cerebrospinal fluid total protein [CSF-TP]) without pleocytosis (HP) (also known as albuminocytologic dissociation) is identified in dogs with different neurologic diseases. However, the association between survival and increased CSF-TP is unknown. OBJECTIVES: (a) Identify conditions commonly associated with HP in dogs and (b) investigate whether higher CSF-TP concentrations or other relevant factors are associated with 1-year survival. METHODS: This is a retrospective study that identified dogs with HP (Cisternal CSF-TP >0.30 g/L, Lumbar CSF-TP >0.45 g/L with total nucleated cell concentrations [TNCCs] and RBC counts within RIs) from 2008 to 2019: recording signalment, weight, vital parameters, inflammation, neuroanatomic localization, CSF-TP, sampling site, final diagnosis, etiologic classification, and 1-year survival. Corrected CSF-TP was calculated as CSF-TP minus 0.3 (cisternal) or 0.45 (lumbar or unknown). Descriptive statistics were produced, CSF-TP differences between groups (eg, neuroanatomic localizations) were evaluated using the Mann-Whitney U test or Kruskal-Wallis test (post-hoc testing). The Cox proportional hazards model was used for survival data. Statistical significance was set at a P < 0.05. RESULTS: In all, 39 dogs had HP, associated with 17 conditions, including neoplasia (n = 6), meningoencephalitis of unknown origin (n = 4) (MUO), and intervertebral disc disease (n = 4) (IVDD) as the most common conditions. There was no significant difference between the CSF-TP/corrected CSF-TP between 1-year survivors and non-survivors, nor was there a difference between different neuroanatomic localizations or etiologic classifications (P > 0.05). Neoplasia, after adjustment for age, was the only variable associated with a worse survival (P = 0.01 HR: 2.08 (95% CI: 1.65-39.2). CSF-TP was not associated with age (P > 0.05). CONCLUSIONS: HP in dogs is associated with a wide range of conditions; the most common conditions are neoplasia, MUO, and IVDD. Higher CSF-TP levels do not correlate with a worse 1-year survival; however, they do correlate with neoplastic lesions.

Objective Whether cervical disc arthroplasty (CDA) is superior to anterior cervical discectomy and fusion (ACDF) remains controversial, especially in relation to long‐term results. The present study aimed to evaluate the long‐term safety and efficiency of CDA and ACDF for cervical disc disease. Methods We performed this study according to the Cochrane methodology. An extensive search was undertaken in PubMed, Embase, and Cochrane databases up to 1 June 2019 using the following key words: “anterior cervical fusion,” “arthroplasty,” “replacement” and “artificial disc”. RevMan 5.3 (Cochrane, London, UK) was used to analyze data. Safety and efficiency outcome measures included the success rate, functional outcome measures, adverse events (AE), adjacent segment degeneration (ASD), secondary surgery, and patients’ satisfaction and recommendation rates. The OR and MD with 95% confidence interval (CI) were used to evaluate discontinuous and continuous variables, respectively. The statistically significant level was set at P

Background Urinary (UI) and fecal (FI) incontinence occur in up to 7.5% and 32% of dogs, respectively, after thoracolumbar acute noncompressive nucleus pulposus extrusion (ANNPE). Hypotheses/Objectives To investigate clinical, diagnostic, and therapeutic predictors of UI and FI in dogs with ANNPE affecting the T3‐L3 spinal cord segments. Animals Hundred and eighty‐seven dogs with T3‐L3 ANNPE diagnosed based on clinical and MRI findings. Methods Multicenter retrospective study. Data were obtained from medical records and telephone questionnaires and analyzed by logistic regression. Results UI and FI were reported in 17 (9.1%) and 44 (23.5%) dogs, respectively. Paraplegic dogs were 3 times (95% CI = 1.25, 10.87) more likely to develop UI (P = .018) and 4 times (95% CI = 1.94, 12.56) more likely to develop FI (P = .001) compared to nonparaplegic dogs. Dogs with an intramedullary hyperintensity greater than 40% of the cross‐sectional area of the spinal cord at the same level on transverse T2‐weighted MRI images were 4 times more likely to develop UI (95% CI = 1.04, 21.72; P = .045) and FI (95% CI = 1.56, 10.39; P = .004) compared to dogs with smaller lesions. FI was 3 times (95% CI = 1.41, 7.93) more likely in dogs that were not treated with nonsteroidal anti‐inflammatory drugs (NSAIDs) after diagnosis compared to dogs administered NSAIDs (P = .006) and 2 times (95% CI = 1.12, 5.98) more likely in dogs presented with clinical signs compatible with spinal shock compared to dogs without (P = .026). Conclusion and Clinical Importance The identification of clinical, diagnostic, and therapeutic predictors of UI and FI in dogs with T3‐L3 ANNPE can help to approach these autonomic dysfunctions occurring after spinal cord injury.

Aim Paravertebral ozone injection is a new treatment method described in the literature for low back pain. The aim of this study was to compare the pre- and post-treatment pain scores of patients undergoing paravertebral ozone/oxygen (O3 /O2 ) injections for low back pain. Methods From September 2018 to December 2018, 122 patients who underwent paravertebral ozone injections due to low back pain were examined retrospectively; 62 patients who met the study criteria were included. The patients were injected with 15 µg/mL (50 mL) O3 /O2 gas in the paravertebral space. The subjects were treated every 7 days for 6 total session. The VAS and Oswestry Disability Index (ODI) scores were assessed before treatment and after treatment (first and third months). The patients' body mass indexes (BMIs) were measured before the injections. Results There were 12 male patients and 50 female patients. The mean age was 51.9 (range 25 to 71) years. The mean duration of pain was 9.1 (3 to 24) months. Significant improvements were observed in the statistical comparison of VAS and ODI scores between the pre-injection and first month controls (P 0.213). Conclusion Paravertebral O3 /O2 gas is a reliable and effective treatment for the treatment of lumbar disc herniation, radicular pain, and mechanical back pain due to low back pain.

Objective To examine the results of an anular closure device for prevention of lumbar disc reherniation in daily routine practice. Methods Fifty patients with large anular defects were treated with limited discectomy and a bone‐anchored anular closure device. The device physically occludes the defect in the anulus fibrosus and is intended for prevention of lumbar disc reherniation. Pain scores on a visual analogue scale, back function on the Oswestry Disability Index, and neurological status were noted. Symptomatic reherniation and reoperation rates were assessed at each follow‐up. Surgical findings and complications, device‐related and/or procedure‐related, were recorded. Follow‐up was 6, 12, 26, and 52 weeks. Results Mean anular defect height/width was 4.6 mm/10.1 mm. The overall symptomatic reherniation and reoperation rate was 2%. During the 1‐year follow‐up period, mean back pain decreased from 43 to 8 (P < 0.001), leg pain decreased from 71 to 4 (P < 0.001), and the Oswestry Disability Index decreased from 46 to 5 (P < 0.001). Among 15 patients with preoperative neurological deficits, improvements in neurological function were noted in 14 (93%). There were no serious device‐related complications. Conclusions The presented study shows promising early results in using the anular closure device. The procedure is safe with significantly fewer reherniations than for patients with large anular defects without anular closure. Further studies with longer follow‐up periods are warranted to prove these findings for long‐term outcomes.

Background The clinical course of motor deficits from lumbosacral radiculopathy appears to improve with or without surgery. Strength measurements have been confined to manual muscle testing (MMT) and have not been extensively followed and quantified in prior studies. Objective To determine if motor weakness and patient-reported outcomes related to lumbosacral radiculopathy improve without surgical intervention over the course of 12 months. Design Prospective observational cohort. Setting Outpatient academic spine practice. Participants Adults with acute radicular weakness due to disk herniation. Methods Forty patients with radiculopathy and strength deficit were followed over a 12-month period. Objective strength and performance tests as well as survey-based measurements were collected at baseline and then every 3 months. Patients underwent comprehensive pain management and rehabilitation and/or surgical approaches as determined in coordination with the treating specialist. This study was approved by the institutional review board of Colorado. Main outcome measurements Testing of strength was through MMT, handheld dynamometer, and performance-based testing. Furthermore, visual analog scale, modified Oswestry Disability Index, and 36-Item Short Form Health Survey (SF-36) were used to measure pain and disability outcomes. Results Of the 40 patients, 33 (82.5%) did not have surgery; 7 (17.5%) had surgery. Twenty-four of the 33 patients (60%) did not undergo surgery and were followed for 12 months (Comprehensive Pain Management and Rehabilitation, Complete [CPM&R-C]), and 9 (22%) did not have surgery and lacked at least one follow-up evaluation (Comprehensive Pain Management and Rehabilitation, Incomplete [CPM&R-I]). No statistically significant differences were found on baseline measures of strength deficits and SF-36 domains between the CPM&R-C, Surgery, and CPM&R-I groups. Pain and disability scores in the Surgery group were significantly higher than in the CPM&R-C at baseline. There were statistically significant improvements in all areas of strength, pain, and function when comparing measurements at the 12-month follow-up to baseline in the CPM&R-C group. Conclusions Individuals with motor deficits due to lumbosacral radiculopathy improve over time regardless of treatment choice. Most did not choose surgery, and almost all of these patients regained full strength at 1 year. Strength recovery typically occurred in the first 3 months, but there was ongoing recovery over the course of a year. Level of evidence II.

Objectives Dentists may have a higher risk of developing lumbar herniated intervertebral disc (HIVD) due to prolonged sitting and improper postures during work. We conducted this study to delineate this issue, which is still unclear. Methods This nationwide population‐based study was conducted using Taiwan National Health Insurance Research Database. We identified 10 734 dentists, 72 066 non‐dentist health‐care providers (HCPs), and an identical number of age‐ and gender‐matched participants from the general population. The risk of developing lumbar HIVD among dentists, non‐dentist HCPs, and general population was compared by tracing their medical histories between 2007 and 2011. Results The cumulative incidence rate of lumbar HIVD among dentists during the 5‐year follow‐up period was 1.40%. After adjusting for age, gender, and comorbidities, the risk of developing lumbar HIVD was found to be lower among dentists than that among the general population (adjusted odds ratio [AOR]: 0.80, 95% confidence interval [CI]: 0.64‐1.00) and non‐dentist HCPs (AOR: 0.81, 95% CI: 0.68‐0.96). Conclusions Dentists in Taiwan have a lower risk of developing lumbar HIVD than that among other occupations. Although this result is different from the general cognition, it does not imply that the prevention of lumbar HIVD in dentists is not important. Further studies are warranted to better address this issue.

Objectives To describe the MRI features and prevalence of paravertebral muscle signal intensity changes in dogs with acute intervertebral disc extrusion and to search for associations between the signal changes and clinical history, signalment, neurological examination, serum creatine kinase activity and MRI characteristics of the disc herniation. Materials and methods Medical records and MRI examinations from 688 dogs with surgically confirmed acute intervertebral disc extrusion were reviewed retrospectively. T2-weighted and STIR MRI sequences were available for 276 cases and were examined for paravertebral muscle signal intensity changes. When present, extension, lateralisation and signal characteristics of these changes were recorded. Exclusion criteria were muscle injections 24 hours before MRI scan, trauma and previous spinal surgery. Results Nineteen dogs met the inclusion criteria. There were signal changes in the multifidus muscle, mostly in the thoracolumbar region and often extending caudally from the level of the intervertebral disc herniation. Two cases had paravertebral muscle signal intensity changes in the cervical region. MRI signal changes were seen more frequently in the muscles of non-ambulatory dogs. Clinical history and neuro-examination did not allow differentiation between dogs with and without paravertebral muscle signal intensity changes. Clinical significance Paravertebral muscle signal intensity changes were observed infrequently in the epaxial musculature of 6.9% dogs with acute intervertebral disc extrusion in both the thoracolumbar and cervical regions. The pathophysiological processes responsible for these MRI changes remain unknown.

Background Interleukin (IL)‐1 is a cytokine superfamily, which involved in the inflammatory process and immune response in human body. IL‐1 receptor antagonist (IL1RN) has been found to be associated with risk of lumbar disk herniation (LDH) in Finland samples. However, to date, there was no investigation focus on the polymorphisms of IL1RN in Chinese Han LDH patient. Materials and Methods We conducted a case–control study based on 498 LDH patients and 463 controls. Five single‐nucleotide polymorphisms (SNPs) in IL1RN were genotyped. Results As a result, we found that the AG and GG genotypes of rs3181052 were associated with decreased risk LDH under the dominant model (OR = 0.74, 95%CI: 0.57–0.96, p = .025). In the stratification analysis, the frequency of the “A” allele of rs17042888 was significantly lower in elder LDH cases than in controls (OR = 0.723, 95%CI: 0.544–0.961, p = .025). In addition, the AG and AA genotypes of rs17042888 were associated with decreased risk of LDH in elder group under the dominant model (OR = 0.69, 95%CI: 0.49–0.98, p = .038). The GG genotype of rs315919 was identified have correlation with decreased risk of LDH in elder group under the recessive model (OR = 0.60, 95%CI: 0.37–0.97, p = .034). Conclusions Our data showed that IL1RN may be a susceptibility gene for risk of LDH in Chinese Han population., Our data showed that IL1RN may be a susceptibility gene for risk of LDH in Chinese Han population.

OBJECTIVES To assess lumbar multifidus muscle stiffness in patients with unilateral lumbar disk herniation (LDH) causing nerve root compression using shear wave elastography (SWE). METHODS Thirty-three patients with unilateral subarticular LDH (L3-L4, L4-L5, and L5-S1) causing nerve root compression, diagnosed by magnetic resonance imaging, were enrolled in the study. Exclusion criteria were bilateral or multilevel LDH confirmed on magnetic resonance imaging, bilateral leg symptoms, and patients with a history of any spinal operation, malignancy, trauma, infection, spondylolisthesis, severe lateral recess stenosis, spinal canal stenosis, and substantial comorbidities. Two observers separately evaluated the multifidus muscle using SWE. Shear wave elastographic examinations of the muscle were performed slightly below the herniation using the spinous process of the vertebra as a landmark. The stiffness of the muscle between affected and normal sides was compared. Moreover, the correlation between the stiffness and duration of the symptoms and the correlation between the stiffness and severity of the nerve compression were also calculated. RESULTS The mean stiffness values of the multifidus muscle on the affected side (mean ± SD: observer 1, 14.08 ± 3.57 kPa; observer 2, 13.70 ± 4.05 kPa) were significantly lower compared to the contralateral side (observer 1, 18.81 ± 3.95 kPa; observer 2, 18.28 ± 4.12 kPa; P