European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
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Proinflammatory cytokines have been identified in herniated intervertebral discs in humans, and such cytokines have experimentally been demonstrated to be important in the pathophysiological mechanisms of disc herniation. Cerebrospinal fluid (CSF) and serum concentrations of interleukin (IL)-1beta IL-6, IL-8, interferon (IFN)-gamma and tumour necrosis factor (TNF)-alpha were investigated using the enzyme-linked immunosorbent assay (ELISA) technique in 39 patients with lumbar disc herniation and sciatica. Pain duration and pain intensity (visual analogue scale, VAS) were recorded at inclusion, and a clinical examination was performed evaluating neurological findings. ⋯ The observation of increased concentrations of IL-8 in CSF in patients with a short duration of symptoms supports the concept of the initial involvement of inflammatory mechanisms after a disc herniation. The finding that most of the patients with increased concentrations of IL-8 in CSF had an extrusion or a sequestration may suggest that the increase in IL-8 is related to mechanical nerve root compression, but may also indicate a biochemical effect exerted by the herniated disc on the surrounding tissue. Further studies on the potential role of IL-8 as a biomarker for disc herniation are warranted.
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Randomized Controlled Trial Clinical Trial
Day-case conventional discectomy: a randomised controlled trial.
A prospective randomised trial compared the results of conventional lumbar discectomy performed as day cases with those performed on an in-patient basis. The aim of the study was to investigate whether conventional discectomy can be performed safely on a day-case basis. ⋯ The rate of complications was unchanged. It is concluded that conventional discectomy can be undertaken safely as day-case surgery and may indeed speed up the recovery process.
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Burst fractures may be stable or unstable, so the choice of treatment may be controversial; almost all cases are surgical type. Deciding on the best method and approach is difficult, due to the many possible options and the fact that good results are achieved in only 60-70% of cases. The main problems to be resolved are the residual kyphosis or the recurrence due to loss of reduction. ⋯ There was evidence of arthrodesis in all six patients within 9 months. The use of an anterior approach to treat burst fractures is well recognized; however, treatment with vertebral shortening using a posterior approach has the advantages of less bleeding, shorter surgical time and less residual kyphosis, as a result of putting together two flat surfaces of healthy bone. The residual kyphosis in the present series, after the 2-year follow up, was less than 1 degrees , which is lower than the 5 degrees - 10 degrees reported in the literature.
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The most frequent clinical presentation of sciatica suggests injury of sensor root fibers alone. To evaluate whether thermal quantitative sensory testing (QST) is applicable in the study of sensory dysfunction in lumbosacral disc herniations, 36 men and 30 women with L4/5 or L5/S1 disc herniations underwent thermal QST of the L4, L5, and Si dermatomes. For both levels of disc herniation, there was a significant difference for all temperature modalities, i.e., cold, warmth and heat pain, between all dermatomes as well as between the side of the herniated disc and the corresponding asymptomatic side. ⋯ We conclude that thermal QST measurements reflect and document sensory dysfunction in patients with lumbosacral disc herniation. The method offers a new means both to study the time course of a spontaneous recovery of sensory dysfunction and to evaluate the result of different treatment options. However, thermal QST seems to have the same poor predictive value for identifying the anatomic location of a herniated lumbar disc as conventional electrophysiologic methods.