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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Multicenter Study Comparative Study
Estimates of success in patients with sciatica due to lumbar disc herniation depend upon outcome measure.
The objectives were to estimate the cut-off points for success on different sciatica outcome measures and to determine the success rate after an episode of sciatica by using these cut-offs. A 12-month multicenter observational study was conducted on 466 patients with sciatica and lumbar disc herniation. ⋯ In conclusion, the success rates at 12 months varied from 49 to 58% depending on the measure used. The proposed cut-offs may facilitate the comparison of success rates across studies.
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We present clinical findings, radiological characteristics and surgical modalities of various posterior approaches to thoracic disc herniations and report the clinical results in 27 consecutive patients. Within an 8-year period 27 consecutive patients (17 female, 10 male) aged 30-83 years (mean 53 years.) were surgically treated for 28 symptomatic herniated thoracic discs in our department. Six of these lesions (21%) were calcified. ⋯ The rate of major complications was 7.1% (2/28). Surgical treatment of thoracic disc herniations via posterior approaches tailored to the individual patient produces satisfying results referring to clinical outcome. Posterior approaches remain a viable alternative for a large proportion of patients with symptomatic thoracic disc herniations.
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Intervertebral disc (IVD) degeneration suggests a complex process influenced by genetics, lifestyle and biomechanics, which accounts for the development of low back pain (LBP) and lumbar radiculopathy, a major cause of musculoskeletal disability in humans. The family of Akt/PKB kinases is a principal mediator in the signal transduction pathways, which contribute to transcriptional regulation, cell growth, proliferation, apoptosis, and survival ability. The purpose of this study was to evaluate the transcriptional profile of the AKT family genes in human herniated discs and the involvement of the PI3K-Akt signaling pathway in human IVD degeneration. ⋯ Finally, Akt1/PKB transcription presented a stepwise activation as disc herniation deteriorated. Our findings provide evidence on the transcriptional activation of the Akt/PKB pathway indicating that it is involved in lumbar disc degeneration. There is need for further studies to elucidate the exact role and down-stream signaling action of Akt/PKB isoforms in the pathogenesis of lumbar disc herniation.
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Piriformis syndrome after percutaneous endoscopic lumbar discectomy via the posterolateral approach.
Percutaneous endoscopic lumbar discectomy (PELD) can be performed under local anesthesia with intravenous analgesics. To define the incidence of piriformis syndrome (PS) after PELD via the posterolateral approach under local anesthesia compared to that of general patients presenting with low back pain with/without lower leg pain. The incidence and time of occurrence of positive FAIR test after PELD within a 3-month follow-up period were evaluated retrospectively, and compared with the prevalence of general patients who visited the pain clinic for LBP with/without lower leg pain. ⋯ The prevalence of PS in general patients was 317/2,320 (13.7%); however, the incidence of PS after PELD within a 3-month follow-up period was 61/151 (40.4%), peaking at 32 days. High anxiety scale scores during operation led to increased incidence of PS after PELD. PELD under local anesthesia with high level of anxiety may increase the incidence of PS after walking, peaking around the first month, compared with the results for general patients with low back pain with/without lower leg pain.