脊柱杂志

Background: Despite numerous reports on mini-open transforaminal lumbar interbody fusion (TLIF), there exists a few studies to compare directly mini-open TLIF and conventional-open TLIF procedures. This study evaluated the usefulness and safety of mini-open TLIF for degenerative lumbar diseases and instabilities.

Material and methods: Sixty-eight patients underwent TLIF with pedicle screw fixation for degenerative disc disease or spondylolisthesis with more than 12 months follow-up; 22 patients underwent mini-open TLIF and 46 patients underwent conventional-open TLIF. Data of incision, perioperative parameters, complications, fusion rate, and clinical data were reviewed. Results: The length of incision was shorter in mini-open TLIF group (p=0.04), but satisfaction rate of incision was not statistically different (p=0.18). The VAS and mODI were significant lower in mini-open TLIF (p=0.037, 0.031, respectively) at postoperative 7 days. Less estimated blood loss and less change in hemoglobin and blood pressure during operation was observed in mini-open TLIF group than conventional-open TLIF group. The fusion rate was also not statistically different. The complication including the pedicle screw fracture, bony spur, adjacent level instability was observed in 14% in the mini-open TLIF group and 10% in the conventional-open TLIF group (p=0.63).

Conclusion: The mini-open TLIF with pedicle screw fixation provides excellent clinical results and may be an operation of choice for lumbar spinal fusion. The long-term clinical, functional and radiological results were similar in the mini-open and conventional-open TLIF. But, the mini-open TLIF is a viable alternative to the conventional-open TLIF with advantage of lesser blood loss, less change of hemoglobin and blood pressure, shorter incision, and lesser postoperative pain.

Purpose: Cervicaland Lumbar degenerative disc diseases (DDD) are a common disease of advanced age characterized by progressive changes in the intervertebral disc and associated structures. There have been great efforts for years to explain its pathophysiological mechanism(s). This study aims to provide the expression of IL-8 in a population of patients with lumbar disc herniation, cervical stenosis and vertebral fracture.

Material and methods: We compared the level of IL-8 expression in the non-degenerated and degenerated intervertebral disc samples obtained from patients who underwent surgery for vertebral fracture (non degenerated disc), lumbar disc herniation and cervical stenosis (degenerated disc), whose clinical and radiological features were suggestive of disc degeneration. IL-8 expression was studied by using the western blot, immunohistochemistry and enzyme linked immune absorbent assay methods. This study includes comparison of IL-8 concentration in groups based on patient’s age and diagnosis.

Results: Significantly higher levels of IL-8 expressions were found in patient with advance age, more in vertebral fracture as compared to lumbar disc herniationand cervical stenosis patients. Conclusion: The findings suggest that both local inflammatory responses occur in lumbar disc herniation, cervical stenosis and vertebral fracture patients. Using specific cytokines either by local or systemic application may reverse the degenerative process.

Background: Paragangliomas of the filum terminale are very rare tumors. Those are benign lesions and do not produce catecholamines, show male predominance and rarely metastasize. Total surgical resection is usually curative. We reviewed available literature in this respect and show our experience.

Methods: Studies on paragangliomas of the filum terminale reported in the English literature were analyzed to date. The references of each article were analyzed and classified according to the following criteria: age, sex, first symptoms, treatment, and outcome.

Results: Paragangliomas of the filum terminale are rare benign tumors. To the best of our knowledge, in the English-language literature, only 36 previous cases of paraganglioma of the filum terminale have been reported to date. Reports of familiar occurrence and association with leiomyosarcomas, chordomas or pituitary adenomas suggest a genetic basis for the tumor. As we can see in the literature the reported mean age at presentation is 49.8 years. The most common presenting symptoms are low back pain associated occasionally with sciatic pain.

Conclusion: The aim of surgery is total resection that is usually curative. In cases of incomplete removal long-term follow-up is essential.

Background: Low back pain (LBP) due to acute disc herniation is a common disease bellow the age 45 years of age. Nowadays several types of treatment modalities used to manage these patients. The economic burden of LBP is heavy. LBP rank fifth among category of diseases in cost of hospital care. LBP has higher indirect costs due to absenteeism from work and disability than any other disease. This study was performed to assess the clinical outcomes of non-surgically treatment of LBP patients after six months follow up.

Material & methods: Present prospective study was performed among 50 lumbar radicular patients with clinical signs and symptoms of acute lumbar disc herniation (less than three months). Their diagnosis was confirmed by Magnetic Resonance Imaging (MRI) study. The patties were treated conservatively during six months. Study outcome variables were pain and disability that were assessed by Visual Analog Scale (VAS) and Oswestry Disability Questionnaire (ODQ).

Results: Twenty (40%) female and 30 (60%) male were participated in the study. During the follow up period, five (10%) patients (four male) were referred to neurosurgeon due to poor response to conservative treatment and motor weakness. Pain of patients according to VAS after six months conservative treatment significantly improved than initial evaluation of patients (3.11 ± 1.83, 7.1 ± 1.43 P = 0.00). Disability score of patients significantly improved with conservative treatment in follow up period (25.82 ± 16.92, 53.66 ± 17.66; P = 0.00).

Conclusion: Results of our study showed that conservative treatment in patients with acute lumbar disc herniation causes significant pain relief and disability improvement without any notable side effect.