Cervical adjacent segment pathology following fusion:Is it due to fusion?

Adjacent segment pathology affects 25% of patients within ten years of anterior cervical diskectomy and fusion(ACDF). Laboratory studies demonstrate fused segments increase adjacent level stress including elevated intradiscal pressure and increased range of motion. Radiographic adjacent segment pathology(RASP) has been associated to ACDF in multiple statistically significant studies. Randomized controlled trials(RCTs) comparing anterior cervical discectomy and arthroplasty(ACDA) and ACDF have confirmed ACDF accelerates RASP. The question of greatest clinical interest is whether ACDA, artificial disc surgery, results in fewer adjacent level surgeries than ACDF. Current RCT follow up results reveal only non statistically significant trends favoring ACDA yet the post operative periods are only two to four years. Statistically significant increased RASP in ACDF patients however is already documented. The RCT patients' average ages are in the mid forties with an expected longevity of up to forty more years. Early statistically significant increased RASP in the ACDF patients supports our prediction that given sufficient follow up of ten or more years, fusion will lead to statistically significant higher rate of adjacent level surgery compared to artificial disc surgery.

The Outcome of Minimally Invasive Discectomy in Single Level Lumbar Disc Prolapse

Lumbar disc surgery in carefully selected patients who have failed conservative treatments can significantly improve quality of life. Minimally invasive treatment of lumbar disc herniation has been popularized in recent years. The aim of the study was to assess the outcome of minimal invasive (loupe) discectomy among lumbar disc prolapse patients in Sulaimani. A prospective study carried out in Shar and Sulaimani Teaching hospitals in Sulaimani city for period from 1st of February, 2013 to end of June, 2014 on sample of 30 patients with single level lumbar disc prolapse admitted to orthopedic units. The data were collected by the researcher through direct interview and filling a prepared questionnaire. The outcome of surgery was evaluated by comparing the symptoms (back pain, leg pain, and leg parathesia) and the muscle power grading (EHL & FHL) of the patients pre- and post-operatively. Mean age of studied patients was 39.1 ± 9.3 years. Males were more than females. Disc prolapse level was L4-L5 among 17 and L5-S1 among 13 patients. Studying the symptoms pre- and post-operatively, revealed significant decrease in leg pain, leg parathesia and back pain post-operatively (p < 0.001). Studying EHL & FHL power grading pre- and post-operatively, revealed significant increase in muscle power grades 4 and grade 5 postoperatively (p < 0.001). We concluded that minimal invasive discectomy is good and safe treatment option for lumbar disc prolapse.

Microendoscopic discectomy,a less traumatic procedure for lumbar disk herniation

Objective: To investigate the change of serum levels of interleukin-6 (IL-6), C-reactive protein (CRP) and creatine kinase ( CK ) in patients undergoing microendoscopic discectomy (MED) and open discectomy.Methods: Forty-four patients with single level lumbar disk herniation were treated, either by MED ( Group A, n = 22) or open discectomy ( Group B, n = 22). Peripheral venous blood samples were taken before surgery and at 24 and 48 hours postoperatively. The operating time,intraoperative blood loss, postoperative hospital stay were recorded. The pain severity of incision was evaluated by visual analog scale after operation and the clinical outcome was evaluated by Oswestry disability index. Statistical comparison was performed by the analysis of variance and Student's t test.Results: The data showed that patients in Group A had a less intraoperative blood loss ( P ＜ 0.05 ), shorter operating length ( P ＜ 0.05), shorter postoperative hospital stay (P ＜ 0.05) and less postoperative pain of incision than those in Group B. Serum levels of IL-6 ( mean, 31.60 ng/L ± 9.88 ng/L vs 39.16 ng/L ±11. 14 ng/L, P＜0.05) and CK ( mean, 167.91 U/L ±51.85 U/L vs 401.55 U/L ± 108.86 U/L, P ＜ 0. 05 ) all get to the peak at 24 hours after operation and Group A with the response statistically less than Group B. Serum level of CRP peaked at 24 hours in Group A ( mean, 12.68 mg/L ± 7.10 mg/L vs 20.82 mg/L± 8. 79 mg/L, P ＜ 0. 05 ) and peaked at 48 hours after surgery in Group B ( mean, 10.77 mg/L ± 5.25 mg/L vs 29.95 mg/L ± 14. 85 mg/L, P ＜0. 05). The clinical outcomes of both groups were the same at 6 months after surgery.Conclusions: Both MED and open discectomy have made good clinical outcomes, however, the less change of IL-6, CRP and CK after operation proves that MED procedure is less traumatic to patients than open discectomy.

Techniques and applications of endoscopic spine surgery.Part Ⅰ:overview of current techniques

Background Spinal pain is a serious health and social-economic problem.Endoscopic spine surgery as a treatment option for spinal pain has gained tremendous attention and growth in the past 2 decades,and a variety of endoscopic techniques have been invented to treat a wide range of spinal conditions.Purposes The purposes of this 2-part review article are to 1) overview the published techniques of endoscopic spine surgery,2) summarize the applications of these techniques in treating various spinal conditions,and 3) evaluate the clinical evidence of the safety and effectiveness of these endoscopic techniques in treating some of the most common spinal conditions.The first part of the review article provides an overview of currently most commonly used techniques.Methods We searched the PubMed database for publications concerning endoscopic spine surgery and reviewed the relevant articles published in the English language.Results Discectomy and foraminotomy are the most common types of spine surgery that can currently be done endoscopically.Endoscopic techniques have been used to treat a wide range of spinal disorders located in the lumbar,cervical,as well as the thoracic regions of the spine.