Intervertebral disc degeneration is main cause of various spinal degenerative conditions, and results in a significant socio-economic burden and morbidity to those affected. Intervertebral disc degeneration is a multifactorial process that has no known curative method. Hence, various factors that cause intervertebral disc degeneration, especially biochemical ones, were discussed in this study.
Intervertebral Disc Degeneration* ; Intervertebral Disc* ; Regeneration*

The purpose of this study is to introduce the various methods of indirect decompression of minimally invasive procedures available for treatment of lumbar spine surgery. A review of the literature, as well as our personal experience with minimally invasive approaches to the lumbar discs, was performed. The minimally invasive procedures for treatment of lumbar disc disease include the following: 1) chemonucleolysis; 2) automated percutaneous lumbar discectomy (APLD); 3) nucleoplasty; 4) microdecompressor; 5) percutaneous laser discectomy; and 6) hydrodiscectomy. Although all percutaneous techniques are reported to have high success rates, to date no studies have demonstrated any of these being superior to microsurgical discectomy, which continues to be regarded as the standard with which all other techniques must be compared.
Decompression ; Diskectomy ; Humans ; Intervertebral Disc Degeneration ; Intervertebral Disc Displacement ; Spine

STUDY DESIGN: Experimental study. PURPOSE: The aim of the study was to develop a finite element (FE) model to study the long-term effects of various types of lumbar spinal interventions on the discs adjacent to the fused segment. OVERVIEW OF LITERATURE: Earlier FE studies have been limited to one particular type of fusion and comparative quantification of the adjacent disc stresses for different types of surgical interventions has not been reported. METHODS: A computer aided engineering (CAE) based approach using implicit FE analysis assessed the stresses in the lumbar discs adjacent to the fused segment following anterior and posterior lumbar spine fusions at one, two and three levels (with and without instrumentation). RESULTS: It was found that instrumentation and length of fusion were the most significant factors in increasing adjacent level stresses in the lumbar discs. CONCLUSIONS: In the present study, a calibrated FE model that examined spinal interventions under similar loading and boundary conditions was used to provide quantitative data which would be useful for clinicians to understand the probable long-term effect of their choice of surgical intervention.
Intervertebral Disc ; Intervertebral Disc Degeneration ; Lumbar Vertebrae ; Spinal Fusion* ; Spine

STUDY DESIGN: Experimental study. PURPOSE: The aim of the study was to develop a finite element (FE) model to study the long-term effects of various types of lumbar spinal interventions on the discs adjacent to the fused segment. OVERVIEW OF LITERATURE: Earlier FE studies have been limited to one particular type of fusion and comparative quantification of the adjacent disc stresses for different types of surgical interventions has not been reported. METHODS: A computer aided engineering (CAE) based approach using implicit FE analysis assessed the stresses in the lumbar discs adjacent to the fused segment following anterior and posterior lumbar spine fusions at one, two and three levels (with and without instrumentation). RESULTS: It was found that instrumentation and length of fusion were the most significant factors in increasing adjacent level stresses in the lumbar discs. CONCLUSIONS: In the present study, a calibrated FE model that examined spinal interventions under similar loading and boundary conditions was used to provide quantitative data which would be useful for clinicians to understand the probable long-term effect of their choice of surgical intervention.
Intervertebral Disc ; Intervertebral Disc Degeneration ; Lumbar Vertebrae ; Spinal Fusion* ; Spine

STUDY DESIGN: Experimental study. PURPOSE: The study aimed to develop a finite element (FE) model to determine the stress on the discs adjacent to the fused segment following different types of floating lumbar spinal fusions. OVERVIEW OF LITERATURE: The quantification of the adjacent disc stress following different types of floating lumbar fusions has not been reported. The magnitude of the stress on the discs above and below the floating fusion remains unknown. METHODS: A computer-aided engineering-based approach using implicit FE analysis was employed to assess the stress on the lumbar discs above and below the floating fusion segment (L4–L5) following anterior and posterior lumbar spine fusions at one, two, and three levels (with and without instrumentation). RESULTS: Both discs suprajacent and infrajacent to the floating fusion experienced increased stress, but the suprajacent disc experienced relatively high stress level. Instrumentation increased the stress on the discs suprajacent and infrajacent to the floating fusion, but the magnitude of stress on the suprajacent disc remained relatively high. CONCLUSIONS: The FE model was employed under similar loading and boundary conditions to provide quantitative data, which will be useful for clinicians to understand the probable long-term effects of floating fusions.
Intervertebral Disc ; Intervertebral Disc Degeneration ; Lumbar Vertebrae ; Spinal Fusion ; Spine*

In conventional percutaneous disc surgery, introducing instruments into disc space starts by inserting a guide needle into the triangular working zone. However, landing the guide needle tip on the annular window is a challenging step in endoscopic discectomy. Surgeons tend to repeat the needling procedure to reach an optimal position on the annular target. Obturator guiding technique is a modification of standard endoscopic lumbar discectomy, in which, obturator is used to access triangular working zone instead of a guide needle. Obturator guiding technique provides more vivid feedback and easy manipulation. This technique decreases the steps of inserting instruments and takes safer route from the peritoneum.
Diskectomy ; Endoscopes ; Intervertebral Disc Degeneration ; Intervertebral Disc Displacement ; Needles ; Peritoneum

OBJECTIVE: This study was designed to investigate automated pressure-controlled discography (APCD) findings, to calculate the elastance of intervertebral discs, and to assess the relationship between the calculated elastance and disc degeneration. METHODS: APCD was performed in 19 patients. There were a total of 49 intervertebral discs treated. Following intradiscal puncture, a dye was constantly injected and the intradiscal pressure was continuously measured. The elastance of the intervertebral disc was defined as unit change in intradiscal pressure per fractional change in injected dye volume. Disc degeneration was graded using a modified Dallas discogram scale. RESULTS: The mean elastance was 43.0 +/- 9.6 psi/mL in Grade 0, 39.5 +/- 8.3 psi/mL in Grade 1, 30.5 +/- 22.3 psi/mL in Grade 2, 30.5 +/- 22.3 psi/mL in Grade 3, 13.2 +/- 8.3 psi/mL in Grade 4 and 6.9 +/- 3.8 psi/mL in Grade 5. The elastance showed significant negative correlation with the degree of degeneration (R2 = 0.529, p = 0.000). CONCLUSION: APCD liberates the examiner from the data acquisition process during discography. This will likely improve the quality of data and the reliability of discography. Elastance could be used as an indicator of disc degeneration.
Humans ; Intervertebral Disc ; Intervertebral Disc Degeneration ; Low Back Pain ; Punctures

OBJECTIVE: To determine the relationship between magnetic resonance imaging (MRI) and discography in visualization of disc degeneration. METHOD: Forty-eight patients with suspected discogenic pain in lumbar spines and degenerative changes of the lumbar intervertebral discs in T2-weighted magnetic resonance imaging were studied. Five types of discogram (cottonball, lobular, irregular, fissured, and ruptured) were classified by identifiable features in shape and density of radio-opaque shadow. Three types of MRI (bulging, protrusion, and extrusion) were classified by degrees of disc herniation. The correlation between two imaging techniques of lumbar intervertebral discs were analyzed using Spearman's correlation coefficient. RESULTS: Of sixty-three discs, MRI finding of the disc herniation revealed as follows: bulging, 17 discs; protrusion, 20 discs; extrusion, 26 discs. Discography revealed as follows: cottonball, 15 discs; lobular, 2 discs; irregular, 11 discs; fissured, 10 discs; ruptured, 25 discs. 46 discs of 63 discs showed internal structural abnormalities (irregular, fissured, or ruptured). There was no statistically significant correlation between MRI and discography in visualization of the disc degeneration (r=0.081). CONCLUSION: Severity of the lumbar intervertebral disc degeneration in MRI was not correlated with degenerative severity of discographic imaging. Supplementary discography may be useful in evaluation of patients with discogenic pain since discographic imaging when compared to MRI visualizes disc degeneration more accurately.
Humans ; Intervertebral Disc ; Intervertebral Disc Degeneration* ; Magnetic Resonance Imaging* ; Spine

STUDY DESIGN: Radiological analysis. PURPOSE: To investigate sacralization of L5 on radiological studies of degenerative spondylolisthesis at L4-L5. OVERVIEW OF LITERATURE: Degenerative spondylolisthesis commonly develops at L4-L5. Sacralization of L5 is thought to cause stress concentration at this level, which accentuates degenerative changes and promotes development of degenerative spondylolisthesis. However, there has been no study dedicated to determining whether the presence of sacralization at L5 influences the radiological findings in degenerative spondylolisthesis at L4-L5. METHODS: Seventy-eight patients with degenerative spondylolisthesis at L4-L5 were classified into two groups according to the presence of L5 sacralization: with (n=54) and without (n=24). Four radiographic parameters were measured and compared between the two groups: anterior slippage of L4 on L5 (% slip), facet orientation of L4-L5 (degrees), facet osteoarthritis of L4-L5 by Fujiwara's criteria (1~4 grades), and disc degeneration of L4-L5 by Frymoyer's criteria (grades 1~5). RESULTS: There was no significant difference in the degree of anterior slippage of L4 on L5 (17.02+/-6.21 versus 16.65+/-4.87, p=0.809), facet orientation (54.99+/-12.18 versus 56.23+/-4.35, p=0.642), facet osteoarthritis (3.43+/-0.59 versus 3.53+/-0.37, p=0.527), or disc degeneration (4.50+/-0.51 versus 4.35+/-0.61, p=0.340) between the two groups. CONCLUSIONS: Our study shows that the influence of sacralization of L5 on radiological findings in degenerative spondylolisthesis at L4-L5 may be less significant than previously expected. Further studies in large patient groups are needed to clarify the role of L5 sacralization on the development of degenerative spondylolisthesis at L4-L5.
Humans ; Intervertebral Disc Degeneration ; Orientation ; Osteoarthritis ; Spondylolisthesis

OBJECTIVE: To quantify pain pressure threshold(PPT) in the patients with lumbar intervertebral disc herniation before and after treatment, and to study the clinical effects of the PPT test in lumbar intervertebral disc herniation. METHODS: From January to December 2017, 59 patients with lumbar intervertebral disc hernation were treated, and another 59 normal persons were recruited as the normal control group. Visual analogue scale (VAS) was used to measure the patient's subjective pain intensity at admission, and the pain threshold of lumbar posterior joints was measured by the tenderness gauge. The pain threshold was measured three times with an interval of 1 min at the most painful posterior joints and the contralateral posterior joints, and the average value was recorded as the T-value.All patients were treated with one course of conservative treatment ( spine fixed-point rotation reduction plus routine dehydration and anti-inflammation). VAS score and pain threshold of posterior lumbar joints were measured after the treatment. One lumbar posterior joint was randomly selected in the normal control group to measure the pain threshold. RESULTS: (1)The patient group and the normal control group were comparable. There was no significant difference in age, body height, body weight and BMI between the two groups(>0.05). (2) The pressure pain threshold test was consistent:variance analysis on the T-value before treatment [(4.72±2.14) kg / cm, (4.96±2.10) kg / cm, (5.11±2.09) kg / cm] of the affected posterior joint, the T-value after treatment [(7.38±2.36) kg / cm, (7.62±2.51) kg / cm, (7.58±2.47) kg / cm], the T-value of before treatment [(7.18±2.80) kg / cm, (7.19±2.68) kg / cm, (7.20±2.69) kg / cm] of the contralateral posterior joint, T value after treatment [(9.54±2.89) kg / cm, (9.76±3.01) kg / cm, (9.77±3.09) kg / cm]; and normal joint T-value [(12.23±1.56) kg / cm, (12.51±1.48) kg / cm, (12.6±1.63) kg / cm] showed that there were no significant differences in the three successive measurements of pain threshold (>0.05). (3) After conservative treatment, the pain threshold of the affected side[(7.58±2.38) kg / cm] and the contralateral lumbar posterior joints [(9.70±2.92) kg / cm] increased significantly, but T-value of the affected side was still lower than that of the contralateral side, and T value of the both sides were lower than that of the normal group [(12.48±1.44) kg / cm]. The T-value of the affected side and the contralateral side had significant difference between before and after treatment (<0.05). After treatment, there was significant difference in T-value between the affected side and the contralateral side (<0.05);there were significant differences in T-value among the affected side, contralateral side and the normal group(<0.05). (4)Greater the subjective pain intensity of the patient was lower the posterior joint pain threshold of the affected side would be. As the subjective pain intensity decreased, the posterior joint pain threshold of the lumbar spine also increased. There was a significant difference in the VAS score before and after treatment (<0.05). Multiple regression analysis showed that the correlation coefficient r between the VAS score before and after treatment and the corresponding T-value of the affected side were significantly different(<0.05), and the corresponding T-value of the contralateral side were not significantly different(>0.05). CONCLUSION The pressure pain threshold test can accurately evaluate the pain intensity and its changing patterns in the lumbar posterior joint. The pain pressure threshold test is clinically significantin the lumbar disc herniation.
Humans ; Intervertebral Disc ; Intervertebral Disc Degeneration ; Intervertebral Disc Displacement ; Lumbar Vertebrae ; Pain ; Pain Threshold