Relationship between biomechanical and biochemical parameters of spinal motion segments and recurrent lumbar disc herniation

Abstract

Objective. To identify natural radiological parameters of degenerative spinal motion segments and biochemical changes in intervertebral disc tissues, which have a significant connection with the hernia recurrence after microdiscectomy. Material and Methods. The MRI, radiography and biochemical parameters of the nucleus pulpous and annulus fibrosus tissues from patients operated for L4-L5 and L5-S1 herniation were assessed and statistically analyzed. Two groups of patients were examined: Group I (n = 50)-with recurrent hernias, Group II (n = 50)without recurrence during three years. Results. Significant correlation was observed between recurrent lumbar disc herniation after microdiscectomy and the following biomechanical parameters: height of the intervertebral disc (p = 0.001; r = 0.69), segmental sagittal range of motion (p = 0.001; r = 0.61), lumbar lordosis (p = 0.001, r = 0.78), stage of the intervertebral disc degeneration (p = 0.001; r = 0.46), and type of hernia (p = 0.001, r = 0.45). The quantitative and qualitative characteristics of proteoglycans/glycosaminoglycans of the nucleus pulposus and annulus fibrosus differed significantly in patients of the studied groups, but significant correlation with recurrent hernias was not found (r < 0.3). Conclusion. The preserved intervertebral disc height, hypermobility of the spinal motion segment, the smoothness of the lumbar lordosis, moderate intervertebral disc degeneration, and the disc protrusion have significant connection with the recurrence of lumbar intervertebral disc herniation after microdiscectomy.

Aberrant Biomarkers, Leg Anatomy and Pain Parameters are the Risk Factors in Lumbar-Herniated Disc: a Novel Diagnostic Protocol

“…In the present study, it was suggested the novel diagnostic protocol to detect the LHD evidenced by the aberrant anatomical features, anamalous levels of biomarkers such as IL-10, TNF-α, CK-MM and AldoA and abnormal indices values on pain parameters, functional disabilities and obesity as per international acclaimed outcome measurements along with radiological images as assessed by KL grading scale as cost-effective diagnostic protocol compared to MRI or CT scan or Discogram or Myelogram and others tools as costly affairs especially in developing countries like India [44][45][46][47][48]. From past, the main diagnostic tool for detecting LHD is MRI or X-ray [8,[11][12][13][14][15][16][17].…”

“…According to him, LHD can be correlated to abnormal anatomy of musculo-skeletal features of both legs (unpublished). In this context, researchers have studied only ROM at lumbar region [19][20].In recent research, MRI and X-ray revealed the biomechanical abnormalities such as Pfirrmann grade of IVD degeneration, discheight index, segmental sagittal range of motions, central angle of lumbar lordosis, Modic criteria, herniation type, presence of listhesis of the lumbar spine instead of abnormal anatomical features of legs [48]. These parameters may not be cost-effective for the patients of developing country like India.…”

“…Ganguly and had already been investigated cost- In case of biochemical parameters, the elevated levels of IL-10, TNF-α, CK-MM, and AldoA observed in patients with LHD have confirmed that these biomarkers are predictive risk factors that may be monitored and serve as one of the best diagnostic protocols quickly and in affordable low-cost even in the early progressive stage of LHD where there is no pain syndrome or discomfort or deformities observed in the lower extremities or joints confirmed with X-rays or MRI images only at advance stage but not in early progressive stage. It has been studied that the quantitative and qualitative characteristics of proteoglycans/glycosaminoglycans of the nucleus pulposus and annulus fibrosus from IVD tissues of LHD patients through microdiscectomy, which may also be costly affair [48]. Patho-physiologically, LHD has been established by the combination of the mechanical compression of the nerve resulted with the bulging nucleus pulposus and the local elevated level of inflammatory chemokines (small cytokines).…”

Efficacy of the Clinical-Instrumental Algorithm in the Treatment of Spinal Tandem Stenosis

“…The rate of disease recurrence due to failed back surgery syndrome is 25%, and in such cases, a new surgical intervention is required. 20,21 This scenario calls for more in-depth study of the formation of tandem stenoses of the vertebral canal of degenerative genesis, and for the development of objective criteria for preoperative diagnosis and surgical tactics.…”

Multicenter Analysis of Surgical Treatment Effectiveness for Patients With Symptomatic Tandem Stenosis of the Cervical and Lumbar Spine Based on Differentiated Clinical-Instrumental Algorithm

“…Течение дегенеративного заболевания позвоночника с длительной адаптационной реакцией биомеханики пДс нередко предопределяет отсутствие эффекта хирургического лечения вследствие декомпенсации состояния пациента и возникновения нарушения кровообращения в области компримированных нервных стволов или спинного мозга. число неудовлетворительных результатов хирургического лечения дегенеративных заболеваний позвоночника составляет 28,3-53%, при этом рецидивы заболевания в виде «синдрома неудачно оперированного позвоночника» в 25% наблюдений требуют повторного хирургического вмешательства [20,21]. Все это требует углубленного изучения формирования тандем-стенозов позвоночного канала дегенеративного генеза, обусловливая необходимость разработки объективных критериев предоперационной диагностики и хирургической тактики.…”