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Diabetic Neuropathy
Published in Jahangir Moini, Matthew Adams, Anthony LoGalbo, Complications of Diabetes Mellitus, 2022
Jahangir Moini, Matthew Adams, Anthony LoGalbo
Lumbar radiculopathy is also called sciatica since the nerve roots making up the sciatic nerve are often involved. It may be caused by an injury or occur without warning. Often, it is due to a structural abnormality such as a herniated disc or bone spur, or caused by mechanical stretching or trauma. Discs can be damaged by strenuous activity or congenital defects also. Causes of cervical radiculopathy include material from a ruptured disc, degenerative bone changes, arthritis, and injuries that compress the nerve roots. Cervical foraminal stenosis may also be causative. Risk factors include smoking, previous radiculopathy, and lifting heavy items. Thoracic radiculopathy is caused by a compressed nerve root in the thoracic area of the spine. Causative factors include narrowing of the space where the nerve roots exit the spine. This can be due to bone spurs, stenosis, or disc herniation. Radiculopathy is usually a mechanical root compression caused by diabetes mellitus. Diabetic thoracic polyradiculopathy is present in 15% of insulin-dependent patients and in 13% of noninsulin-dependent patients. Other causes include spondylosis, metastatic tumors, trauma, scoliosis, and tuberculosis.
Spinal Cord Disease
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Degenerative spine disease: Herniated disc.Vertebral bone spurs.Acquired central spinal stenosis.
Surgery of the Cervical Spine
Published in Timothy W R Briggs, Jonathan Miles, William Aston, Heledd Havard, Daud TS Chou, Operative Orthopaedics, 2020
Anterior decompression for spinal canal or foraminal stenosis Presenting symptoms – myelopathy, radiculopathy, neurological deficitHerniated disc from degenerative or traumatic causesOsteophytesBony element (traumatic causes)Subluxation of the vertebra due to degenerative processTumourInfectionCongenitally narrow canalOssification of posterior longitudinal ligament
The Current State of Cervical Endoscopic Spine Surgery: an Updated Literature Review and Technical Considerations
Published in Expert Review of Medical Devices, 2020
AECTcD, which was first introduced in the mid-2010s, is characterized by the selective discectomy is performed through the vertebral keyhole instead of the transdiscal route [34] (Figure 1B). The classical anterior transdiscal approach inevitably causes the disc space to collapse after surgery. In contrast, this novel transcorporeal approach can be performed through an intravertebral keyhole without disruption of the central nucleus. Postoperatively, the vertebral working hole often closes spontaneously. Selective decompression with maternal disc preservation is the main benefit of AECTcD. Moreover, this approach is more useful for removing migrated CDH [35–37]. The patient undergoes the procedure in the supine position under general anesthesia. The vertebral target is usually determined as the vertebral body immediately below the target disc. A standard anterior percutaneous approach is performed to the vertebra target point. A puncture needle complex is inserted into the vertebral body and advanced until the tip reaches near the posterior margin of the target vertebra. The needle is replaced with a blunted guidewire, and the dilator is introduced to enlarge the hole. Subsequently, a working sheath is inserted over the dilator, and the hole can be extended using a trephine and a high-speed diamond burr. The surgeon then can remove the herniated disc or hypertrophied ligament using endoscopic forceps and punches. Finally, the decompressed cord can be confirmed through blunt hook and endoscopic visualization.
Paracetamol for low back pain: the state of the research field
Published in Expert Review of Clinical Pharmacology, 2020
Bart Koes, Marco Schreijenberg, Alexander Tkachev
In most people with low back pain, the precise cause of the pain is unknown. In only a small proportion (up to 5–10%) of patients presenting in primary care underlying pathologies, such as malignancies, fracture, infections can be identified. When specific pathologies explaining the back pain are not present, the complaints are labeled as being nonspecific. It hampers adequate treatment that in most cases no cause of the pain can be found, since no causal treatment can thus be applied. Consequently, many treatments for low back pain are focused on reduction of symptoms. There are many treatments available for people with back pain. This includes non-pharmacological treatments (patient education, exercises, manual therapies) and pharmacological treatments (mostly pain medications, including paracetamol) [16]. Some patients suffering from low back pain also receive surgery. Especially patients with persisting radicular pain (>6–8 weeks) in the leg due to a herniated disk are regarded as surgical candidates. At the same time, there is good evidence that recovery rates after 1 and 2 years follow up are more or less similar between patients receiving disc surgery or prolonged conservative care [17]
Nerve root entrapment with pseudomeningocele after percutaneous endoscopic lumbar discectomy: A case report
Published in The Journal of Spinal Cord Medicine, 2020
Wei Shu, Haipeng Wang, Hongwei Zhu, Yongjie Li, Jiaxing Zhang, Guang Lu, Bing Ni
A 52-year-old man presented with complaints of progressive, severe sciatic pain. The symptoms were aggravated by coughing and straining, and relieved by bed rest. He also complained of numbness and tingling sensation in the right great toe. There was no previous history of surgery or traumatic injury to the spine. Spinal MRI showed a large median and right paramedian disc herniation between the L4 and L5 vertebrae (Fig. 1(A,B)). He underwent transforaminal PELD at the L4-L5. All procedures were performed according to the standard transforaminal endoscopic selective discectomy technique.4 An 18-gauge spinal needle was inserted into the disc through the foraminal approach guided by the fluoroscopic image. The gravity flow system was used to irrigate, and the infusion bag was suspended from 1.5 m above the patients’ back level. The selective fragmentectomy and decompression was then conducted using endoscopic forceps under clear endoscopic visualization. Dural tear or CSF leakage was not observed during the procedure. The patient had a good postoperative recovery and showed improvement in right leg pain. Unfortunately, he was readmitted for progressive right leg pain after six weeks, which radiated from the right buttock to the foot. No headache or swelling on the back was presented. On physical examination, the straight leg raise test was positive only on the right side, with a 30-degree angle raise. Postoperative magnetic resonance imaging (MRI) confirmed the removal of the herniated disc, accompany with the para-spinal fluid collection (Fig. 1(C,D)).