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 objective of this systematic review is to summarize scientific evidence concerning the predictive value of bio-psychosocial risk factors with regard to the outcome after lumbar disc surgery. Medical and psychological databases were used to locate potentially relevant articles, which resulted in the selection of 11 studies. Each of these studies has a prospective design that examined the predictive value of preoperative variables for the outcome of lumbar disc surgery. ⋯ Findings showed relatively consistently that a lower level of education, a higher level of preoperative pain, less work satisfaction, a longer duration of sick leave, higher levels of psychological complaints and more passive avoidance coping function as predictors of an unfavourable outcome in terms of pain, disability, work capacity, or a combination of these outcome measures. The results of this review provide preliminary opportunities to select patients at risk for an unfavourable outcome. However, further systematic and methodologically high quality research is required, particularly for those predictors that can be positively influenced by multidisciplinary interventions.
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The aim of the study is to determine if leg pain can be caused by contralateral lumbar disk herniation and if intervention from only the herniation side would suffice in these patients. Five patients who had lumbar disk herniations with predominantly contralateral symptoms were operated from the side of disk herniation without exploring or decompressing the symptomatic side. Patients were evaluated pre- and postoperatively. ⋯ Our data clears that sciatica can be caused by contralateral lumbar disk herniation. When operation is considered, intervention only from the herniation side is sufficient. It is probable that traction rather than direct compression is responsible from the emergence of contralateral symptoms.
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Degenerated intervertebral disc has lost its normal architecture, and there are changes both in the nuclear and annular parts of the disc. Changes in cell shape, especially in the annulus fibrosus, have been reported. During degeneration the cells become more rounded, chondrocyte-like, whereas in the normal condition annular cells are more spindle shaped. ⋯ In the anterior area of the annulus fibrosus the distribution was more even between these two cell types. bFGF was expressed in the anterior annulus fibrosus more often in chondrocyte-like disc cells than in fibroblast-like disc cells. Control discs showed cellular immunopositivity for only TGFbeta-1 and -2 and TGFbeta receptor type II. We suggest that growth factors create a cascade in intervertebral disc tissue, where they act and participate in cellular remodelling from the normal resting stage via disc degeneration to disc herniation.
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Despite the importance of intervertebral disc (IVD) degeneration both in research and clinical practice, the underlying biological mechanism of this phenomenon remains obscure. The current study investigated the effects of neonatal pinealectomy on the development of IVD degeneration process in chicken. Thirty chicks (3 days of age) were divided into two equal groups: unoperated controls (Group X) and pinealectomized chicks (Group Y). ⋯ Histologically, an appearance of normal IVD was observed in Group X, while the presence of a degenerated IVD was observed in Group Y. From the results of the current study, it is evident that surgical pinealectomy in new-hatched Hybro Broiler chicks has a significant effect on serum melatonin level as well as on the development of IVD degeneration and spinal malformation. In the light of these results from present animal study, melatonin may play a role in the development of IVD degeneration in human beings, but this suggestion need to be validated in the human setting.
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Previous studies have demonstrated that sciatica patients have poorer postural control than healthy controls and that postural control remains unchanged 3 months after lumbar discectomy in sciatica patients. The aims of the current study were to investigate whether static balance control recovers in pain-free discectomy patients long-term after lumbar discectomy. Next is to determine whether static balance responses of asymptomatic and symptomatic lumbar discectomy patients differed from each other and from healthy controls. In addition, the influence of the extent of disc resection (unilateral/bilateral removal) and the side of operation on static balance control were investigated. ⋯ As for long-term following lumbar discectomy, there is no complete recovery of postural control. Patients seem to develop visual compensation mechanisms for underlying sensory-motor deficits, which are, however, sufficient in case of pain relief only. Further study is needed to determine the cause of the balance disturbances in lumbar discectomy patients.