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Spine-Journal April 1, 2009
Ultrastructural Analysis on Lumbar Disc Herniation Using Surgical Specimens: Role of Neovascularization and Macrophages in Hernias
Ausgabe: Vol 34-7-655
Autoren: Miyazaki, Tsuyoshi; Yayama, Takafumi; Kubota, Masafumi; Nomura, Eiki; Kobayashi, Shigeru; Meir, Adam; Kokubo, Yasuo; Uchida, Kenzo; Takeno, Kenichi; Mwaka, Erisa; Baba, Hisatoshi
Zusammenfassung
The mechanisms responsible for the spontaneous regression of lumbar disc herniation (LDH) were studied by examining herniated tissue collected at operation from patients with LDH.The aim of the present study was to investigate the role of neovascularization and macrophages in hernias when spontaneous regression of LDH occurred.Spontaneous regression of LDHs has already been demonstrated by diagnostic imaging with tools such as magnetic resonance imaging. However, there have been few studies on the mechanisms of spontaneous regression based on pathologic examination of herniated tissue. In particular, there has been no detailed work on the role of macrophages, which are thought to be closely associated with spontaneous regression.The magnetic resonance imaging and operative findings of 73 patients who underwent surgery were investigated, and specimens collected during surgery were examined by light and transmission electron microscopy. Capillaries that invade the hernia and macrophages derived from monocytes migrating out of these capillaries are considered to be important factors in the regression of the herniated disc. Macrophages contain lysosomes filled with collagen-degrading enzymes that break down substances after phagocytosis, whereas primary lysosomes are secreted by these cells and break down intercellular substances such as collagen. Both of these mechanisms are closely involved in the regression of herniation.
Schlussfolgerung
The inflammatory response that occurs around hernia tissue in the epidural space is believed to play an important role in herniated disc resorption, although it may also have a harmful effect on the adjacent nerve root. Therefore, control of the inflammatory reaction is an important challenge when treating patients with disc herniation.
© 2009 Lippincott Williams & Wilkins, In
Spine-Journal April 1, 2009
Magnetic Resonance Imaging Interpretation in Patients With Symptomatic Lumbar Spine Disc Herniations: Comparison of Clinician and Radiologist Readings
Ausgabe: Vol 34-7-701
Autoren: Lurie; Doman; Spratt; Tosteson; Weinstein
Zusammenfassung
Retrospective review of imaging data from a clinical trial in order to compare the interpretation of lumbar spine magnetic resonance imaging (MRIs) by clinical spine specialists and radiologists in patients with lumbar disc herniation. MRI is the imaging modality of choice for evaluation of the lumbar spine in patients with suspected lumbar disc herniation. Guidelines provide standardization of terms to more consistently describe disc herniation. The extent to which these guidelines are being followed in clinical practice is unknown. We abstracted data from radiology reports from patients with lumbar intervertebral disc herniation enrolled in the Spine Patient Outcomes Research Trial. We evaluated the frequency with which morphology (e.g., protrusions, extrusions, or sequestrations) was reported as per guidelines and when present we compared the morphology ratings to those of clinicians who completed a structured data form as part of the trial. We assessed agreement using percent agreement and the κ statistic. There were 396 patients with sufficient data to analyze. Excellent agreement was observed between clinician and radiologist on the presence and level of herniation (93.4%), with 3.3% showing disagreement regarding level, of which a third could be explained by the presence of a transitional vertebra. In 3.3% of the cases in which the clinician reported a herniation (protrusion, extrusion, or sequestration), the radiologist reported no herniation on the MRI. The radiology reports did not clearly describe morphology in 42.2% of cases. In the 214 cases with clear morphologic descriptions, agreement was fair (κ = 0.24) and the disagreement was asymmetric (Bowker's test of symmetry P < 0.0001) with clinicians more often rating more abnormal morphologic categories. Agreement on axial location of the herniation was excellent (κ = 0.81). There was disagreement between left or right side in only 3.3% of cases (κ = 0.93).
Schlussfolgerung
Radiology reports frequently fail to provide sufficient detail to describe disc herniation morphology. Agreement between MRI readings by clinical spine specialists and radiologists was excellent when comparing herniation vertebral level and location within level, but only fair comparing herniation morphology.
© 2009 Lippincott Williams & Wilkins, Inc
Spine-Journal January 1, 2009
Cutaneous Silent Periods in the Assessment of Mild Cervical Spondylotic Myelopathy
Ausgabe: Vol. 34-1-24
Autoren: Stetkarova, Ivana MD, PhD; Kofler, Markus MD
Zusammenfassung
A retrospective clinical study in order to estimate the recurrence rate of lumbar disc herniation after open discectomy in active young men using survival analysis. There are few reports on the recurrence rate of lumbar disc herniation in young adults, even though this age group shows a higher incidence of disc herniation than the other age groups. In addition, most of the studies on the recurrence rate of disc herniation have reported percentages without regard to the effect of the time course.Medical records were retrospectively reviewed and phone call surveys were undertaken for 241 patients aged from 20 to 39 who had undergone open discectomies over a period of 14 years. A diagnosis of recurrence was based on the development of new symptoms and magnetic resonance imaging showing compatible lesions in the same segment as the initial diagnosis. The recurrence rate was calculated using a survival analysis based on the Kaplan-Meier product-limit method and the log-rank test was used to evaluate the effect of patient age, level of occurrence, and type of herniated disc on the recurrence rate.The overall recurrence rate was 7.1% (17 patients) at a mean follow-up of 8.55 years, and the cumulative survival rate was 91.5% at a follow-up of 14 years. Survival analysis estimated a higher rate of recurrence at longer follow-up, although there was no recurrence after ninth year from the primary surgery. The recurrence rate was significantly higher for protruded discs compared with other types.
Schlussfolgerung
Survival analysis provides a more accurate estimation of true recurrence rate. Protruded discs are more likely to show recurrence than other types
© 2009 Lippincott Williams & Wilkins, Inc
