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Intervertebral Disc Anatomy
Published in Kelechi Eseonu, Nicolas Beresford-Cleary, Spine Surgery Vivas for the FRCS (Tr & Orth), 2022
Kelechi Eseonu, Nicolas Beresford-Cleary
The intervertebral disc is a heterogeneous structure that contributes to flexibility and load support in the spine. The three anatomic zones—anulus fibrosus, nucleus pulposus and cartilage endplates—are structurally and mechanically quite distinct but also highly coupled so that together they contribute to mechanical functions. Annulus fibrosus
Low Back Pain
Published in Benjamin Apichai, Chinese Medicine for Lower Body Pain, 2021
The intervertebral discs lie between the vertebral bodies and consist of two regions, with the central, more gelatinous nucleus pulposus surrounded by a fibrous ring, the annulus fibrosus. The discs are separated from the adjacent vertebrae by a thin layer of hyaline cartilaginous tissue, the cartilage endplates.
Neurourology, urodynamics, and urogynecology
Published in J Kellogg Parsons, E James Wright, The Brady Urology Manual, 2019
Matthew E Nielsen, E James Wright
Intervertebral disc disease: Majority of herniated discs at L3/L4, L4/L5, L5/S12A common medicolegal referral1–18% of cases may have an element of voiding dysfunction (most commonly areflexia with normal compliance, resulting in retention, hesitancy, straining to void)Severe cases may result in the loss of voluntary anal or urethral sphincter controlMay be associated with sensory loss (S1/S2: lateral foot, S2/S4: perineal)Laminectomy may not reverse dysfunction (controversy in literature – 60% vs 22% in two large studies); prelaminectomy urodynamics are ideal, but not always possible.
A comparative finite element analysis of artificial intervertebral disc replacement and pedicle screw fixation of the lumbar spine
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2022
Jayanta Kumar Biswas, Anindya Malas, Sourav Majumdar, Masud Rana
This finite element analysis based study compares the biomechanical performance of CFR-PEED rod for pedicle-screw fixation and artificial intervertebral discs. The results indicated that the CFR-PEEK rod provides better flexibility. It reduces adjacent segments effects well as the stress-shielding effect at the screw-bone interface. It also reduces the risk of screw loosening and breakage possibility. So, it may be concluded that the CFR-PEEK rod may be the alternative rod material to avoid the adverse effects of rigid type rod fixation. After proper experimental validation, CFR-PEEK rod may be recommended for clinical trial. On the other hand, the results also indicated that artificial intervertebral disc replacement can also provide sufficient flexibility, reduce adjacent segments effect, and provide sufficient load transfer capability. The artificial intervertebral disc may be another option for the treatment of DDD. However further improvement is needed to reduce the hypermobility observed on the implanted segments. Future work will focus on experimentation on CFR-PEEK rod including fatigue test and modification of the artificial intervertebral disc to decrease hypermobility.
How effective is a multimodal physical rehabilitation protocol in patients advised surgery for chronic lumbar radicular pain? A retrospective analysis of 189 patients with a minimum follow-up of 1 year
Published in European Journal of Physiotherapy, 2022
Sara Ansari, Gautam M. Shetty, Garima Anandani, C. S. Ram
Recent treatment guidelines for chronic LBP emphasise on physical and psychological therapies and self-management, and less emphasis on pharmacological and surgical treatment [6,9,10]. Several physiotherapeutic programmes have been used in conservative management of LBP including modalities such as electric stimulation, LASER therapy, and magnetic stimulation [11–16]. Kerr et al. [17] in an intent-to-treat analysis of a randomised observational cohort at 8 years showed no difference between surgical and nonoperative treatment for the primary outcome measures such as SF-36 bodily pain, SF-36 physical function, and Oswestry Disability Index (ODI) in patients with intervertebral disc herniation and symptomatic radiculopathy. Although several studies have shown significant improvement in outcomes after physiotherapy in patients with LBP [17,18], the literature is lacking on the effectiveness of rehabilitation in patients who have been advised surgery for chronic LRP by their spine surgeons.
Comparison of dynamic response of three TLIF techniques on the fused and adjacent segments under vibration
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2021
A three-dimensional nonlinear finite element model of the intact L1–L5 lumbar spine was used in this study. The geometry of the spine was obtained by computer scanning tomographic specimens. The model mainly includes vertebrae, intervertebral discs, endplates, and various ligaments, as shown in Figure 1. Each vertebral body is composed of the outer 0.5–1.0 mm cortical bone and the inner cancellous bone. The intervertebral disc consists of the annular matrix, annulus fibrosus, and nucleus pulposus. The annulus ground substance (AGS), consisting of six fiber layers, encloses the nucleus pulposus. The Young’s modulus of the fiber ring decreases proportionally from the outer layer to the inner layer. There is a 0.5 mm thick endplate between the vertebral body and the intervertebral disc (Figure 1). The lumbar ligaments are active in tension only. The facet joint was modeled by surf-to-surf. The material properties were assumed to be homogeneous and isotropic, and the data were adopted from the literature (Wu and Ya 1976; Goel et al. 2007; Tsai et al. 2016; Guo and Li 2020) and are given in Table 1.