scholarly journals Spinal Biomechanical Modelling in the Process of Lumbar Intervertebral Disc Herniation in Middle-Aged and Elderly

2021 ◽  
Vol 2021 ◽  
pp. 1-12
Author(s):  
Xinyu Zhang ◽  
Zhe Zhao ◽  
Chunlei Niu ◽  
Zengbiao Ma ◽  
Jianlei Hou ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Three Dimensional ◽  
Biomechanical Properties ◽  
Lumbar Spine Surgery ◽  
Articular Process ◽  
Lower Lumbar Spine

Lumbar disc herniation is one of the common clinical diseases of the lower lumbar spine in orthopedics. The purpose is to remove the herniated disc nucleus pulposus tissue, remove the compressed part of the disease, and relieve symptoms, such as nerve pain. In the past, biomechanics research mostly relied on in vitro measurements, but the complicated internal environment of the human body prevented us from further measurement and research. However, with the development of computer technology, the use of computer CT scanning, software three-dimensional reconstruction, and displacement study three-dimensional spine biomechanics method makes the research of biomechanics into in vitro simulation stage and has gradually become the focus of current research. The postoperative biomechanics was simulated and the comparison model was established at the same time. At the same time, we combined the clinical follow-up data and studied the clinical data for the treatment of postoperative recurrence of lumbar disc herniation. We compared and analyzed the initial operation method and the experimental results and obtained the prevention of recurrence. The results showed that when one inferior articular process was removed, the lumbar spine appeared unstable to rotate to the opposite side; when one inferior articular process was completely removed, the movement of the lumbar spine in all directions was unstable. Better research on the biomechanical properties of the spine will help the diagnosis and treatment of clinical lumbar disc herniation. Therefore, when performing posterior lumbar spine surgery, not only should the exposure of the surgical field and thorough decompression be considered, but also the biomechanical properties of the lumbar spine should be comprehensively evaluated.

scholarly journals In Vitro Model for Lumbar Disc Herniation to Investigate Regenerative Tissue Repair Approaches

2021 ◽  
Vol 11 (6) ◽  
pp. 2847
Author(s):  
Laura Zengerle ◽  
Elisabeth Debout ◽  
Bruno Kluger ◽  
Lena Zöllner ◽  
Hans-Joachim Wilke
Keyword(s):  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Tissue Repair ◽  
Lumbar Disc ◽  
Biomechanical Properties ◽  
Test Method ◽  
In Vitro Test ◽  
Worst Case ◽  
Vitro Test

Featured Application: Development of a lumbar disc herniation model with which regenerative tissue repair approaches can be investigated under physiological loading conditions and worst-case scenarios out of patients’ daily-life.Abstract: Lumbar disc herniation (LDH) is the most common reason for low back pain in the working society. New regenerative approaches and novel implants are directed towards the restoration of the disc or its biomechanical properties. Aiming to investigate these new therapies under physiological conditions, in this study, a model for LDH was established by developing a new physiological in vitro test method. In 14 human lumbar motion segments, different daily-life and worst-case activities were simulated successfully by applying a physiological range of motion and axial loading in order to create physiological intradiscal pressure. An LDH could be provoked in 11 of the 14 specimens through vertical and round annular defects of different sizes. Interestingly, the defect and the LDH hardly influenced the biomechanical properties of the disc. For the investigation of regenerative approaches in further experiments, the recommendation based on the results of this study is to create an LDH in non-degenerated motion segments by the application of the new physiological in vitro test method after setting the round annular defects to a size of 4 mm in diameter.

Computer Three-Dimensional Reconstruction and Pain Management for Lumbar Disc Herniation Treated by Intervertebral Foramen Endoscopy

2019 ◽  
Vol 9 (8) ◽  
pp. 1776-1781
Author(s):  
Zhaowen Peng ◽  
Wenwen Zhao ◽  
Shaohua Hu
Keyword(s):  
Lumbar Spine ◽  
Pain Management ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Three Dimensional ◽  
Operation Time ◽  
Control Group ◽  
Intervertebral Foramen ◽  
Experimental Group

Objective: Lumbar disc herniation leads the numbness and pain in the waist and lower limbs. Intervertebral foramen endoscopy is a minimally invasive procedure for the treatment of disc herniation. Adequate preoperative evaluation is conducive to this percutaneous skin surgery. The purpose of this study is to improve the efficacy of intervertebral foramen endoscopy in the treatment of lumbar disc herniation by preoperative computer three-dimensional reconstruction combined with pain management. Method: Fifty patients with lumbar disc herniation who met the indications of intervertebral foramen endoscopy were randomly divided into experimental group and control group. The control group was operated according to experience based on the common axial image. The experimental group was punctured according for three-dimensional visualization model of lumbar spine. Preoperative simulated puncture catheterization and perioperative pain management was applied. The catheterization time, operation time under endoscopy, fluoroscopy times during operation, the Visual Analogue Scale (VAS) and Japanese Orthopaedic Association (JOA) scores before and 1 d, 1 m and 3 m after operation were compared between two groups. Result: The three-dimensional visualization model of lumbar spine was reconstructed based on thin-layer data. According to the results of software measurement, the skin puncture point was located and the puncture angle was obtained. Compared with the control group, the catheterization time, operation time under endoscopy, fluoroscopy times during operation in experimental group were significantly reduced. There was no statistical difference in VAS and JOA scores between two groups before operation. Compared with control group, the VAS scores in experimental group at 1 d, and 1 m after operation were decreased statistically, while the JOA scores were increased statistically. Conclusion: Three-dimensional visualization model of lumbar spine and virtual operation planning can directly judge the feasibility of intervertebral foramen endoscopy in the treatment of lumbar disc herniation, improve the efficiency of operation, and further improve postoperative efficacy with pain management.

Lumbar disc herniation surgery in adolescents and young adults

2019 ◽  
Vol 101-B (12) ◽  
pp. 1534-1541 ◽  
Author(s):  
Tobias Lagerbäck ◽  
Hans Möller ◽  
Paul Gerdhem
Keyword(s):  
Young Adults ◽  
Lumbar Spine ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Adolescents And Young Adults ◽  
Lumbar Spine Surgery ◽  
Patient Reported

AimsThe purpose of this study was to investigate the risk of additional surgery in the lumbar spine and to describe long-term changes in patient-reported outcomes after surgery for lumbar disc herniation in adolescents and young adults.Patients and MethodsWe conducted a retrospective study design on prospectively collected data from a national quality register. The 4537 patients were divided into two groups: adolescents (≤ 18 years old, n = 151) and young adults (19 to 39 years old, n = 4386). The risk of additional lumbar spine surgery was surveyed for a mean of 11.4 years (6.0 to 19.3) in all 4537 patients. Long-term patient-reported outcomes were available at a mean of 7.2 years (5.0 to 10.0) in up to 2716 patients and included satisfaction, global assessment for leg and back pain, Oswestry Disability Index, visual analogue scale for leg and back pain, EuroQol five-dimension questionnaire (EQ-5D), and 36-Item Short-Form Health Survey (SF-36) Mental Component Summary and Physical Component Summary scores. Statistical analyses were performed with Cox proportional hazard regression, chi-squared test, McNemar’s test, Welch–Satterthwaite t-test, and Wilcoxon’s signed-rank test.ResultsAny type of additional lumbar spine surgery was seen in 796 patients (18%). Surgery for lumbar disc herniation accounted for more than half of the additional surgeries. The risk of any additional surgery was 0.9 (95% confidence interval (CI) 0.6 to 1.4) and the risk of additional lumbar disc herniation surgery was 1.0 (0.6 to 1.7) in adolescents compared with the young adult group. Both age groups improved their patient-reported outcome data after surgery (all p < 0.001). Changes between short- (mean 1.9 years (1.0 to 2.0)) and long-term follow-up (mean 7.2 years (5.0 to 10.0)) were small.ConclusionThe risk of any additional lumbar spine surgery and additional lumbar disc herniation surgery was similar in adolescents and young adults. All patient-reported outcomes improved from preoperative to the short-term follow-up, while no likely clinically important differences between the short- and long-term follow-up were seen within both groups. Cite this article: Bone Joint J 2019;101-B:1534–1541

scholarly journals A Study of Lumbar Disc Herniation and Facet Joint Asymmetry

2019 ◽  
Vol 103 (1-2) ◽  
pp. 87-94
Author(s):  
Qi Lai ◽  
Yuan Liu ◽  
Runsheng Guo ◽  
Xin Lv ◽  
Qiang Wang ◽  
...  
Keyword(s):  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Facet Joint ◽  
Lumbar Disc ◽  
Patients Âgés ◽  
Lower Lumbar Spine ◽  
Significant Difference ◽  
Facet Joint Degeneration ◽  
Disc Herniations ◽  
Lumbar Facet

Purpose: To investigate the association of facet joint asymmetry with lumbar disc herniation at the lower lumbar spine. Methods: A total of 90 patients (ages 18–40 years) with single-level disc herniation (L3–L4, L4–L5, or L5–S1) were included in the study. Facet asymmetry was defined as a difference of 10° in facet joint angles between right and left sides. Normal discs in the same segment of other individuals were used as a control. Patients had facet asymmetry measured for L3 to S1 through 3.0T magnetic resonance imaging, and information was collected, including age, sex, degenerative degree of lumbar facet joints, and the presence or absence of lumbar disc herniation and type. Results: At the L3 to L4 level, 2 cases had facet asymmetry in 8 patients with lumbar disc herniation, compared with 17 cases of facet asymmetry in 82 patients without disc herniation (P = 0.7776, r = 0.030). At the L4 to L5 level, there were 21 cases of facet asymmetry in 45 patients with lumbar disc herniation, compared with 5 cases of asymmetry in 45 patients without disc herniation (P = 0.00019, r = 0.392). At the L5 to S1 level, there were 25 cases of facet asymmetry in 37 patients with lumbar disc herniation, compared with 11 cases of facet asymmetry in 53 patients without disc herniation (P = 0.0000, r = 0.492). There were 23 cases of facet asymmetry in 28 disc herniations of side type compared with 2 cases of facet asymmetry in 9 herniations of center type (P = 0.0008, r = 0.364). There was no significant difference in the relationship between age, facet joint degeneration, and lumbar facet joint asymmetry (P &gt; 0.05). Conclusion: Facet asymmetry is significantly associated with lumbar disc herniation at the L4 to L5 and the L5 to S1 levels, whereas there is an obvious association with the side type of lumbar disc herniation at the L5 to S1 level.

scholarly journals Three-Dimensional Biomechanical Finite Element Analysis of Lumbar Disc Herniation in Middle Aged and Elderly

2022 ◽  
Vol 2022 ◽  
pp. 1-11
Author(s):  
Shiyuan Wan ◽  
Bin Xue ◽  
Yanhao Xiong
Keyword(s):  
Finite Element ◽  
Intervertebral Disc ◽  
Lumbar Disc Herniation ◽  
Vertebral Body ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Three Dimensional ◽  
Surgical Methods ◽  
Left And Right ◽  
The Impact

Lumbar intervertebral disc protrusion disease refers to the degeneration of intervertebral disc, rupture of fibrous ring, nucleus pulpous protrusion and stimulation or compression of nerve root. The import command in Mimics medical 3D reconstruction software was used to erase the irrelevant image data and obtain vertebral body images. The original 3D model of each vertebral body was built by 3D computing function. A three-dimensional finite element model was established to analyze the effect of different surgical methods on the mechanical distribution of the spine after disentomb. The stress distribution of the spine, intervertebral disc, and left and right articular cartilage at L4/L5 stage and the position shift of the fourth lumbar vertebra were analyzed under 7 working conditions of vertical, forward flexion, extension, left and right flexion, and left and right rotation. The results showed that the established model was effective, and the smaller the area of posterior laminar decompression was, the lesser the impact on spinal stability was. The PELD treatment of lumbar disc herniation had little impact on spinal biomechanics and could achieve good long-term biomechanical stability. Combining the clinical experiment method and finite element simulation, using the advantages of finite element software to optimize the design function can provide guidance for the design and improvement of medical devices and has important significance for the study of clinical mechanical properties and biomechanics.

P88 Identifying risk factors for multiple revisional lumbar spine surgery

2019 ◽  
Vol 90 (3) ◽  
pp. e45.1-e45
Author(s):  
M El Sheikh ◽  
K Badran ◽  
O Kouli ◽  
M Abdelsadg ◽  
M Fadelalla ◽  
...  
Keyword(s):  
Risk Factors ◽  
Lumbar Spine ◽  
Spine Surgery ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Morbidity Rate ◽  
Lumbar Spine Surgery ◽  
Neurosurgical Department ◽  
Primary Surgery ◽  
Diabetes Status

ObjectivesRecurrent lumbar spine surgery due to disc herniation is a contributor to debilitating pain, disability, and carries a high patient morbidity rate1 We identified risk factors for recurrent lumbar disc herniation post-surgical intervention.DesignRetrospective Cohort Study.SubjectsAll adult lumbar spine revisions for disc herniation performed in the Neurosurgical Department at Ninewells Hospital.MethodsThe number of revisions from 2013 to 2017 for each patient was recorded and two groups were identified. The first group consisted of patients who had one revision and the second group consisted of patients who had recurrent revisions (more than one) Possible factors influencing the likelihood of recurrent revisions were also noted, including age, gender, BMI, operation length, level of surgery, time from primary surgery to revision, smoking and diabetes status.Results140 patients had revision surgeries, of which 87 (62.1%) had one revision while 53 (37.1%) had recurrent operations. Younger patients (p=0.025) and patients with higher BMI (p=0.01) were more likely to have a higher number of revisions. Patients with DM (p=0.015) were associated with a higher likelihood of recurrent revisions. Other factors had little effect on the likelihood of recurrent revisions (p>0.05).ConclusionsIdentifying risk factors that influence the recurrence of lumbar revisions helps improve patient outcome and decrease incidence of revisions.

scholarly journals Coronal magnetic resonance imaging of three-dimensional fast-field echo with water-selective excitation improves the sensitivity and reliability of identification of extraforaminal lumbar disc herniation

2019 ◽  
Vol 47 (12) ◽  
pp. 6053-6060
Author(s):  
Jingyu Jia ◽  
Rui Ding ◽  
Xijuan Liu ◽  
Wugen Li ◽  
Xi Xiong ◽  
...  
Keyword(s):  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Three Dimensional ◽  
Selective Excitation ◽  
Resonance Imaging ◽  
3D Mri ◽  
Conventional Mri ◽  
Sensitivity Specificity ◽  
Fast Field

Objective The complete view of the nerve root, including the extraforaminal zone, can be displayed by coronal magnetic resonance imaging (MRI) of three-dimensional (3D) fast-field echo with water-selective excitation (CMRI). However, its sensitivity, specificity, and reliability for the diagnosis of extraforaminal lumbar disc herniation are unclear. We compared the sensitivity, specificity, and reliability of conventional MRI, CMRI, and 3D MRI for the identification of extraforaminal lumbar disc herniation. Methods This study involved 140 patients (68 with extraforaminal lumbar disc herniation and 72 with paramedian disc herniation). Their mean age was 44.57 ± 14.59 years. Conventional MRI, CMRI, and 3D MRI of all patients were evaluated by five experts. The reliability, sensitivity, and specificity of the three imaging techniques for identification of extraforaminal lumbar disc herniation were compared using kappa statistics and the chi-squared test. Results CMRI showed higher agreement (0.843) than conventional MRI (0.671) and 3D MRI (0.771) for the identification of extraforaminal lumbar disc herniation. CMRI demonstrated higher sensitivity (95.6% vs. 91.2%) than conventional MRI (85.3% vs. 70.6%) and 3D MRI (92.6% vs. 86.7%) regardless of whether performed by junior or senior surgeons. Conclusions CMRI is helpful for identification of extraforaminal disc herniation by junior and senior orthopedic surgeons.

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