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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The case of a 26 year-old woman with high grade spondylolisthesis, history of diastematomyelia and tethered cord, with acute onset of back pain and bilateral sciatica after a fall. This comment will focus on three issues: indication for surgery, indication for reduction and levels to be included in fusion. Surgery is indicated in this case for intermittent urinary incontinence and saddle anesthesia, and failure of conservative treatment to control pain. ⋯ Reduction is indicated in patients with high torque through L5-S1. L5 severity index (SI) correlates with the magnitud of torque through L5-S1. Similarly, the decision to include L4 in fusion can be made based on the value of SI for L4.
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The symptoms of lumbar disc herniation, such as low back pain and sciatica, have been associated with local release of cytokines following the inflammatory process induced by the contact of the nucleus pulposus (NP) with the spinal nerve. ⋯ Together our results indicate that specific cytokines released during the inflammatory process induced by the herniated intervertebral disc play fundamental role in the development of the two modalities of hyperalgesia (mechanical and thermal) and that the maintenance of this inflammation may be the most important point for the chronification of the pain.