Fusion versus nonfusion treatment for recurrent lumbar disc herniation

Ahsan, Kamrul; Khan, Shahidul Islam; Zaman, Naznin; Ahmed, Nazmin; Montemurro, Nicola; Chaurasia, Bipin

doi:10.4103/jcvjs.jcvjs_153_20

Cited by 32 publications

(27 citation statements)

References 31 publications

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“…Given these differences, we believe that large-scale research should be carried out in a bigger multiethnic population group to confirm the associations of this anatomical variation in relation with the PM, which would also provide more information on the frequency of the variations. Although, in recent years, the development of new neurosurgical techniques and 3D devices have helped surgeons to improve their knowledge of surgical anatomy, real laboratory anatomical dissections are needed to safely perform surgeries [ 25 , 26 , 27 , 28 ]. The exact position of the SN during surgical procedures around the hip and the variability that has been described may reduce the risk of iatrogenic injury.…”

Section: Discussionmentioning

confidence: 99%

Anatomical Variations of the Sciatic Nerve Exit from the Pelvis and Its Relationship with the Piriformis Muscle: A Cadaveric Study

Reynoso

Ramirez

Nurmukhametov

et al. 2022

Neurology International

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Background: The sciatic nerve (SN) is the widest nerve of the human body that exits the pelvis through the greater sciatic foramen, usually below the piriformis muscle (PM), and descends between the greater trochanter of the femur and ischial tuberosity of the pelvis to the knee. The aim of this paper is to examine and identify the SN variations in relation to the PM, its prevalence, pattern, and course. Methods: A prospective-descriptive cross-sectional study was carried out to determine the frequency of anatomical variations in the exit of the SN in relation with the PM in 20 anatomical bodies (corpses) of both genders, in equal numbers. Results: The dissection of 40 SNs in corpses of both sexes in equal numbers showed that the SN exited inferior to the PM in 37 lower limbs (92.5%); between the fascicles of the PM and inferior to the PM in two lower limbs (5%); and in one thigh, between the fascicles of the PM and superior to the PM (2.5%). Our study reported that the SN divides in its terminal branches more commonly in the proximal part of the popliteal fossa in 55% of cases, in the gluteal region in 35% of cases, and in the middle third of the thigh in 10% of cases. Conclusions: Anatomical variations of the SN in relation to the PM are challenging for the diagnostic and therapeutic procedure in many clinical and surgical cases. Rapid recognition of the SN changes makes surgical approaches more accurate and effective. Our study confirmed that the SN exits the pelvis most commonly below the PM, although some anatomical variations may occur.

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Section: Discussionmentioning

confidence: 99%

Anatomical Variations of the Sciatic Nerve Exit from the Pelvis and Its Relationship with the Piriformis Muscle: A Cadaveric Study

Reynoso

Ramirez

Nurmukhametov

et al. 2022

Neurology International

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“…Untreated LBP can cause permanent disability y [ 48 ]. LBP can occur due to multiple reasons such as disk herniation [ 49 , 50 ], osteoporosis [ 51 ], weight [ 52 ], etc. Osteoporotic fractures were one of the major causes of LBP.…”

Section: Discussionmentioning

confidence: 99%

“…The FE-based lumbar spine modeling methodology developed in this study can be used to study various downstream applications such as disk herniation and osteoporosis [ 49 , 50 ]. With opportunistic screening, it will be possible to predict different clinical conditions such as vertebral fractures, weekend disc, or so before herniation occurs.…”

Section: Discussionmentioning

confidence: 99%

Patient-Specific Finite Element Modeling of the Whole Lumbar Spine Using Clinical Routine Multi-Detector Computed Tomography (MDCT) Data—A Pilot Study

et al. 2022

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(1) Background: To study the feasibility of developing finite element (FE) models of the whole lumbar spine using clinical routine multi-detector computed tomography (MDCT) scans to predict failure load (FL) and range of motion (ROM) parameters. (2) Methods: MDCT scans of 12 subjects (6 healthy controls (HC), mean age ± standard deviation (SD): 62.16 ± 10.24 years, and 6 osteoporotic patients (OP), mean age ± SD: 65.83 ± 11.19 years) were included in the current study. Comprehensive FE models of the lumbar spine (5 vertebrae + 4 intervertebral discs (IVDs) + ligaments) were generated (L1–L5) and simulated. The coefficients of correlation (ρ) were calculated to investigate the relationship between FE-based FL and ROM parameters and bone mineral density (BMD) values of L1–L3 derived from MDCT (BMDQCT-L1-3). Finally, Mann–Whitney U tests were performed to analyze differences in FL and ROM parameters between HC and OP cohorts. (3) Results: Mean FE-based FL value of the HC cohort was significantly higher than that of the OP cohort (1471.50 ± 275.69 N (HC) vs. 763.33 ± 166.70 N (OP), p < 0.01). A strong correlation of 0.8 (p < 0.01) was observed between FE-based FL and BMDQCT-L1-L3 values. However, no significant differences were observed between ROM parameters of HC and OP cohorts (p = 0.69 for flexion; p = 0.69 for extension; p = 0.47 for lateral bending; p = 0.13 for twisting). In addition, no statistically significant correlations were observed between ROM parameters and BMDQCT- L1-3. (4) Conclusions: Clinical routine MDCT data can be used for patient-specific FE modeling of the whole lumbar spine. ROM parameters do not seem to be significantly altered between HC and OP. In contrast, FE-derived FL may help identify patients with increased osteoporotic fracture risk in the future.

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“…However, the rarity of the FLDH inherently limits the number of patients, and therefore finding statistical significance between techniques via an under-powered study is unlikely. Recurrence of an FLDH poses an additional challenge not addressed herein, and optimal treatment is controversial even in conventional revision discectomy vs. fusion [ 25 ]. The advantages of docking at the caudal level TP are salient and without any other modifications to prior reports.…”

Section: Discussionmentioning

confidence: 99%

A Modified Approach for Minimally Invasive Tubular Microdiscectomy for Far Lateral Disc Herniations: Docking at the Caudal Level Transverse Process

2022

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Background and Objectives: The use of minimally invasive retractor systems has significantly decreased the amount of tissue dissection and blood loss, and the duration of post-operative recovery after far-lateral disc herniations (FLDH). In this technical note, the technique of docking the tubular retractor on the caudal transverse process is described for an efficient approach with a decreased need for manipulation of the exiting nerve root. Materials and Methods: The case reported is that of a woman affected by a right-sided FLDH at the L4–5 level causing an L4 radiculopathy with weakness and numbness. A review of the literature for FLDH regarding the key anatomy used during a far lateral approach was also performed. Results: The patient showed a significant improvement of her dorsiflexion weakness and radiating leg pain at her 2-week and 5-week post-operative visits, and at a 6-month follow-up she had near-complete relief of her symptoms, including resolution of foot numbness. Prior techniques for tubular microdiscectomy for FLDH report docking on the facet joint, pars interarticularis, and the cranial transverse process. Conclusions: This technical note details that the utility of docking a tubular retractor at the caudal transverse process improves upon already established techniques for minimally invasive tubular discectomy for FLDH.

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Fusion versus nonfusion treatment for recurrent lumbar disc herniation

Cited by 32 publications

References 31 publications

Anatomical Variations of the Sciatic Nerve Exit from the Pelvis and Its Relationship with the Piriformis Muscle: A Cadaveric Study

Anatomical Variations of the Sciatic Nerve Exit from the Pelvis and Its Relationship with the Piriformis Muscle: A Cadaveric Study

Patient-Specific Finite Element Modeling of the Whole Lumbar Spine Using Clinical Routine Multi-Detector Computed Tomography (MDCT) Data—A Pilot Study

A Modified Approach for Minimally Invasive Tubular Microdiscectomy for Far Lateral Disc Herniations: Docking at the Caudal Level Transverse Process

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