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

Background: Lumbar disc herniation (LDH) is a common cause of lower back pain and radiculopathy. In recent years, the enhanced recovery after surgery (ERAS) concept has been increasingly applied in orthopedics and gastrointestinal surgery. Purpose: To investigate the effect of using rapid rehabilitation surgical care for lumbar disc herniation by meta-analysis. Data source: Google Scholar, PubMed Medical, Cochrane and Embase databases were used for the analysis. Research selection: An initial search yielded a total of 322 relevant articles. Duplicate pieces of literature were screened using Endnote. In addition, non-randomized controlled trials and studies with a sample size of less than 30 were excluded. A total of seven papers were included in this study. Main outcomes: The Rapid Rehabilitation Surgical Nursing (RRSN) group showed significantly higher patient satisfaction (RR = 1.24; 95% CI: 1.06, 1.26; p < 0.01) and self-assessed health (Total MD = 5.67; 95% CI: 4.27, 7.06; p < 0.01) compared to the Normal Nursing (NN) group. Pain levels (MD = −0.66; 95% CI: −0.97, −0.36; p < 0.01), disability levels (MD = −18.64; 95% CI: −32.53, −4.76; p < 0.01), anxiety risk (SAS-MD = −4.33; 95% CI: −6.23, −2.44; p < 0.01), and depression risk (SDS-MD = −4.29; 95% CI: −7.50, −1.07; p < 0.01) were significantly lower in the RRSN group compared to the NN group. According to the GRADE classification, the certainty for patient satisfaction is high, while the certainty for post-care pain, functional capacity, risk of psychological disorders, and self-assessed health status is moderate. Conclusions: Rapid recovery surgical nursing can significantly improve postoperative recovery of lumbar disc herniation, increase patient satisfaction, reduce the risk of psychological disorders, improve lumbar function, and alleviate patient pain. [ABSTRACT FROM AUTHOR]

Introduction. The literature describes several ways to approach the thoracic spinal segment, but there are still many dilemmas regarding what is best to do after a complete discectomy, regardless of the surgical approach chosen. The incidence of postoperative kyphosis is higher if a posterior surgical approach to the spine is performed, and there are no clearly defined indications for the application of intervertebral fusion (IF) after an anterior approach. The aim of the paper was to highlight the low morbidity of the transthoracic multidisciplinary approach, as well as a potential solution for a good, natural IF of the adjacent vertebrae without expanding and prolonging the duration of the surgical procedure itself. Case report. A 44-year-old woman presented with severe anterior compressive myelopathy caused by a calcified thoracic disc herniation in the space between the T10-11 vertebrae. A minimally invasive, open, transthoracic approach was performed with decompression of the spinal canal at the specified level a nd IF was achieved with an autologous rib graft during the same procedure. A control examination of the thoracolumbar segment using the magnetic resonance imaging showed that there is no more compression of the spinal cord and also showed a good IF without an increase in the level of kyphosis. Conclusion. Significant thoracic disc herniation is a rare and challenging surgical lesion. The anterior mini-open transthoracic approach provides good exposure to the relevant structures and is considered minimally invasive. The benefits of subsequent IF after the transthoracic surgical approach should always be taken into account for each individual patient, thus minimalizing the postoperative morbidity. [ABSTRACT FROM AUTHOR]

Background: Recent advancements in cervical interlaminar epidural steroid injections have given rise to the modified paramedian interlaminar (mPIL) approach. The objective of this study was to perform an analysis of the contrast spread pattern within the cervical epidural space, taking into account different needle tip positions in the mPIL approach. Methods: A total of 48 patients were included in the study and randomly assigned to either the medial or lateral group based on the needle tip's position in the anterior–posterior view. The primary outcome measured was the contrast flow under fluoroscopic visualization. As a secondary outcome, we analyzed the location of the needle tip position in both lateral and contralateral oblique views. Clinical effectiveness was assessed by measuring pain intensity and functional disability post‐procedure. Results: Significant disparities were noted in the ventral distribution of contrast between the medial and lateral groups. In the lateral images, needle tips in the lateral group were positioned more ventrally compared to those in the medial group. Both groups exhibited statistically significant improvements in neck and radicular pain, as well as functional status, 4 weeks after treatment, with no significant differences between them. Conclusions: Our results suggest that the ventral dispersion of contrast material during cervical interlaminar epidural steroid injections using the mPIL approach may vary depending on the needle tip location. [ABSTRACT FROM AUTHOR]

This trial assessed the efficacy of naproxen in patients with sciatica in outpatient clinics across 4 Norwegian hospitals. A total of 123 adults with radiating pain below the knee (≥4 on a 0-10 numeric rating scale) and signs consistent with nerve root involvement were included. Participants were randomized to receive either naproxen 500 mg or a placebo twice daily for 10 days. The primary outcome, daily leg pain intensity measured on a 0 to 10 numeric rating scale throughout the treatment period, revealed a statistically significant difference in favor of naproxen, with an adjusted mean difference of −0.5 (95% CI −0.8 to −0.1, P = 0.015). In the naproxen group, the treatment effect was significantly related to time, and over the whole 10-day period, the average adjusted difference was −0.6 (95% CI −0.8 to −0.5). Mean numbers needed to treat for 30% and 50% improvement were 9.9 (95% CI 4.7-15.0) and 20.7 (8.7-32.7), respectively. The adjusted mean difference for back pain was −0.4 (95% CI −0.8 to 0.0), and for Roland Morris Disability Questionnaire for Sciatica, it was −1.5 (95% CI −3.0 to 0.0). No differences were found for sciatica bother someness or consumption of rescue medication or opioids. Participants in the naproxen group exhibited an adjusted odds ratio of 4.7 (95% CI 1.3-16.2) for improvement by 1 level on the global perceived change scale. In conclusion, naproxen treatment showed small, likely clinically unimportant benefits compared with placebo in patients with moderate-to-severe sciatica. [ABSTRACT FROM AUTHOR]

Background: In recent years, radiomics has been shown to be an effective tool for the diagnosis and prediction of diseases. Existing evidence suggests that imaging features play a key role in predicting the recurrence of lumbar disk herniation (rLDH). Thus, this study aimed to evaluate the risk of rLDH in patients undergoing percutaneous endoscopic lumbar discectomy (PELD) using radiomics to facilitate the development of more rational surgical and perioperative management strategies. Method: This was a retrospective case-control study involving 487 patients who underwent PELD at the L4/5 level. The rLDH and negative groups were matched using propensity score matching (PSM). A total of 1409 radiomic features were extracted from preoperative lumbar MRI images using intraclass correlation coefficient (ICC) analysis, t-test, and LASSO analysis. Afterward, 6 predictive models were constructed and evaluated using ROC curve analysis, AUC, specificity, sensitivity, confusion matrix, and 2 repeated 3-fold cross-validations. Lastly, the Shapley Additive Explanation (SHAP) analysis provided visual explanations for the models. Results: Following screening and matching, 128 patients were included in both the recurrence and control groups. Moreover, 18 of the extracted radiomic features were selected for generating six models, which achieved an AUC of 0.551–0.859 for predicting rLDH. Among these models, SVM, RF, and XG Boost exhibited superior performances. Finally, cross-validation revealed that their accuracy was 0.674–0.791, 0.647–0.729, and 0.674–0.718. Conclusion: Radiomics based on MRI can be used to predict the risk of rLDH, offering more comprehensive guidance for perioperative treatment by extracting imaging information that cannot be visualized with the naked eye. Meanwhile, the accuracy and generalizability of the model can be improved in the future by incorporating more data and conducting multicenter studies. [ABSTRACT FROM AUTHOR]

This retrospective case series evaluated the effectiveness of minimally invasive spine surgery-transforaminal lumbar interbody fusion (MIS-TLIF) using the "trial-in-situ" technique for reducing high-grade spondylolisthesis. The surgical management of grade ≥III spondylolisthesis has been controversial, with various methods documented in the literature, including in-situ fusion, in-situ trans-sacral delta fixation, distraction techniques, and external reduction techniques. Recently, MIS techniques have gained popularity. This study analyzed 18 cases of high-grade spondylolisthesis treated with MIS-TLIF using the "trial-in-situ" technique. The clinical outcomes were assessed using the Visual Analog Scale (VAS) and the modified Oswestry Disability Index (mODI) scores. The spinopelvic parameters and sagittal balance were also analyzed. Preoperatively, the spinopelvic parameters were deranged, with a mean pelvic tilt of 28.31°, which improved to 13.91° postoperatively. Similarly, the sacral slope improved from 45.65° to 38.01°. VAS and mODI scores improved postoperatively, indicating the effectiveness of the "trial-in-situ" technique in reducing high-grade spondylolisthesis and achieving a better sagittal profile and spinopelvic parameters. The findings indicate that MIS-TLIF using the "trial-in-situ" technique is a viable and effective method for treating high-grade spondylolisthesis. [ABSTRACT FROM AUTHOR]

Reports of Cutibacterium acnes isolated in cultures of intervertebral disc samples suggest it as possibly responsible for inflammatory conditions causing Modic changes on spinal magnetic resonance imaging (MRI). Our objective was to investigate the prevalence of C. acnes in samples of intervertebral disc of patients with lumbar disc herniation; to investigate prognostic factors and the relationship of Modic changes with infection 1 year after microdiscectomy. Prospective cohort study. In this single-center study, patients consecutively operated on for disc herniation had samples of the disc, multifidus muscle and ligamentum flavum (as an indication of contamination) extracted for culture. Age, sex, alcohol and tobacco consumption, body mass index; function, pain, and Modic chances in MRI before surgery and MRI 1 year later; rate of disc, muscle and ligament infection (primary outcome); diabetes and corticoid use (confoundings). The protruded disc, muscle and ligament samples were sent for culture analysis in up to 30 minutes. A subsample of 17 patients underwent next-generation sequencing (NGS) molecular analysis too. We performed descriptive analysis and comparison of groups of patients with and without infection or contamination using Student's t, Mann-Whitney, chi-square, or Fisher's exact tests as appropriate, and pre- and postsurgical comparisons with the Wilcoxon test. From January 2018 to September 2019, 112 patients underwent open lumbar microdiscectomy, 67 (59.8%) men. Cultures showed 7 (6.3%) positive cases in the disc (2 with C. acnes), 3 (2.7%) in the ligament, and 12 (10, 7%) in muscle. No evidence of a difference in Modic alterations pre- or postoperatively was found between patients with and without positive culture 1 year after surgery. No association was found between culture positivity and functional or pain differences either. NGS results were all negative for C. acnes. We identified infective bacterial presence in the herniated disc in less than 2% of patients with disc herniation. C. acnes was not identified in any disc microbiome analysis. No significant association was observed between positivity for tissue infection and any clinical prognostic factor. [ABSTRACT FROM AUTHOR]

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

This retrospective case series evaluated the effectiveness of minimally invasive spine surgery-transforaminal lumbar interbody fusion (MIS-TLIF) using the “trial-in-situ” technique for reducing high-grade spondylolisthesis. The surgical management of grade ≥III spondylolisthesis has been controversial, with various methods documented in the literature, including in-situ fusion, in-situ trans-sacral delta fixation, distraction techniques, and external reduction techniques. Recently, MIS techniques have gained popularity. This study analyzed 18 cases of high-grade spondylolisthesis treated with MIS-TLIF using the “trial-in-situ” technique. The clinical outcomes were assessed using the Visual Analog Scale (VAS) and the modified Oswestry Disability Index (mODI) scores. The spinopelvic parameters and sagittal balance were also analyzed. Preoperatively, the spinopelvic parameters were deranged, with a mean pelvic tilt of 28.31°, which improved to 13.91° postoperatively. Similarly, the sacral slope improved from 45.65° to 38.01°. VAS and mODI scores improved postoperatively, indicating the effectiveness of the “trial-in-situ” technique in reducing high-grade spondylolisthesis and achieving a better sagittal profile and spinopelvic parameters. The findings indicate that MIS-TLIF using the “trial-in-situ” technique is a viable and effective method for treating high-grade spondylolisthesis.

Abstract Background In recent years, radiomics has been shown to be an effective tool for the diagnosis and prediction of diseases. Existing evidence suggests that imaging features play a key role in predicting the recurrence of lumbar disk herniation (rLDH). Thus, this study aimed to evaluate the risk of rLDH in patients undergoing percutaneous endoscopic lumbar discectomy (PELD) using radiomics to facilitate the development of more rational surgical and perioperative management strategies. Method This was a retrospective case-control study involving 487 patients who underwent PELD at the L4/5 level. The rLDH and negative groups were matched using propensity score matching (PSM). A total of 1409 radiomic features were extracted from preoperative lumbar MRI images using intraclass correlation coefficient (ICC) analysis, t-test, and LASSO analysis. Afterward, 6 predictive models were constructed and evaluated using ROC curve analysis, AUC, specificity, sensitivity, confusion matrix, and 2 repeated 3-fold cross-validations. Lastly, the Shapley Additive Explanation (SHAP) analysis provided visual explanations for the models. Results Following screening and matching, 128 patients were included in both the recurrence and control groups. Moreover, 18 of the extracted radiomic features were selected for generating six models, which achieved an AUC of 0.551–0.859 for predicting rLDH. Among these models, SVM, RF, and XG Boost exhibited superior performances. Finally, cross-validation revealed that their accuracy was 0.674–0.791, 0.647–0.729, and 0.674–0.718. Conclusion Radiomics based on MRI can be used to predict the risk of rLDH, offering more comprehensive guidance for perioperative treatment by extracting imaging information that cannot be visualized with the naked eye. Meanwhile, the accuracy and generalizability of the model can be improved in the future by incorporating more data and conducting multicenter studies.