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World Neurosurg 2020 05 5;137:119-125. Epub 2020 Feb 5.

Department of Neurosurgery, Cedars Sinai Medical Center, Los Angeles, California, USA. Electronic address:

Background: Lumbar total disc replacement is increasingly becoming a more common treatment for discogenic low back pain refractory to conservative measures. Nevertheless, several complications have been reported, including, among others, wound infection, vascular injury, retrograde ejaculation, postsympathectomy syndrome, ileus, and cerebrospinal fluid (CSF) leak. Although CSF leakage is rare, we discuss a case of CSF leakage and the diagnosis and management of CSF leakage after lumbar total disc replacement. Read More

Zh Nevrol Psikhiatr Im S S Korsakova 2019 ;119(8):153-159

Rostov State Medical University, Rostov-on-Don, Russia.

In 2018, the World Health Organization introduced a new version of the International Classification of Diseases (ICD-11), which is preliminary and introductory in nature and will come into force on 1 January 2022. One of the most changed sections compared to ICD-10 is the section characterizing the spine pain syndrome and other manifestations of discogenic pathology. The article describes the terms and codes for the degenerative lesion of the intervertebral disk (IVD) in accordance with the requirements of ICD-11, which also agree with the definitions of the 2nd revision of the nomenclature and classification of the pathology of the lumbar IVD from 2014. Read More

Med Sci Sports Exerc 2017 04;49(4):627-632

1Sports Medicine, Athletics Department, University of Oklahoma, Norman, OK; 2Department of Community Health and Family Medicine, University of Florida, Gainesville, FL; 3Sports Medicine, University of Alabama at Birmingham, Birmingham, AL; and 4Florida Orthopaedic Institute, Tampa, FL.

We report six cases of a novel syndrome of acute, exertional low back pain in football players, five in college and one in the National Football League. All six are African Americans with sickle cell trait (SCT). The acute low back pain is severe and can be disabling, and the condition can be confused with muscle strain, discogenic pain, stress fracture, or other problems in athletes. Read More

J Pak Med Assoc 2014 Aug;64(8):949-51

Piriformis syndrome is a rare entity resulting in severe unilateral isolated buttock pain shooting in nature, non discogenic in origin. MR imaging of pelvis plays an important role in such patients to see the normal anatomy of piriformis muscle and its relationship with sciatic nerve. A 35-year-old woman presented with one year history of radiating leg pain with normal MR lumbosacral spine. Read More

Acta Orthop Suppl 2013 Feb;84(349):1-35

Department of Orthopaedics, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands.

Chronic low back pain (CLBP) is one of the main causes of disability in the western world with a huge economic burden to society. As yet, no specific underlying anatomic cause has been identified for CLBP. Imaging often reveals degenerative findings of the disc or facet joints of one or more lumbar motion segments. Read More

Pain Physician 2012 Jul-Aug;15(4):E363-404

Millennium Pain Center, Bloomington, IL, USA.

Background: Intervertebral disc herniation, spinal stenosis, intervertebral disc degeneration without disc herniation, and post lumbar surgery syndrome are the most common diagnoses of chronic persistent low back and lower extremity symptoms, resulting in significant economic, societal, and health care impact. Epidural injections are one of the most commonly performed interventions in the United States in managing chronic low back pain. However the evidence is highly variable among different techniques utilized - namely interlaminar, caudal, and transforaminal - and for various conditions, namely - intervertebral disc herniation, spinal stenosis, and discogenic pain without disc herniation or radiculitis. Read More

Zh Nevrol Psikhiatr Im S S Korsakova 2009 ;109(12):60-5

Optimal conservative therapy of discogenic lumbosacral radiculopathy is a matter of debates. Contemporary guidelines recommend measures that predominantly have an influence on nociceptive mechanisms. However the mixed nature of pain in patients with discogenic radiculopathy requires approaches used for treatment of neuropathic pain. Read More

Neurosurg Focus 1999 Dec;7(6):e9

Procedures involving anterior surgical decompression and fusion are being performed with increasing frequency for the treatment of a variety of pathological processes of the spine including trauma, deformity, infection, degenerative disease, failed-back syndrome, discogenic pain, metastases, and primary spinal neoplasms. Because these operations involve anatomy that is often unfamiliar to many neurological and orthopedic surgeons, a significant proportion of the associated complications are not related to the actual decompressive or fusion procedure but instead to the actual exposure itself. To understand the nature of these injuries, a detailed anatomical study and dissection was undertaken in six cadaveric specimens. Read More

J Neurosurg Spine 2005 Feb;2(2):99-115

Institute for Spinal Disorders, Cedars Sinai Medical Center, Los Angeles, California, USA.

Object: Because lumbar magnetic resonance (MR) imaging fails to identify a treatable cause of chronic sciatica in nearly 1 million patients annually, the authors conducted MR neurography and interventional MR imaging in 239 consecutive patients with sciatica in whom standard diagnosis and treatment failed to effect improvement.

Methods: After performing MR neurography and interventional MR imaging, the final rediagnoses included the following: piriformis syndrome (67.8%), distal foraminal nerve root entrapment (6%), ischial tunnel syndrome (4. Read More

Acta Chir Orthop Traumatol Cech 2002 ;69(2):117-21

I. ortopedická klinika FN, LF UK a SPAM, Bratislava.

The authors describe a case of a 12 years old boy who suffered from pain in the lumbar region, limitation of dynamics in lumbosacral spine with a gradual deterioration of the condition. The patient was afebrile. The pain was getting worse and the classic radiographs did not show at the beginning any pathological changes. Read More

Klin Khir 1998 (6):14-6

The puncture laser discectomy was conducted in 273 patients with discogenic lumbosacral radiculitis while the conservative therapy inefficacy, pain syndrome in a lumbago stage present and lumboischialgia with absent prominent locomotive disorders and if the intervertebral disc hernia has the size up to 0.6 cm. Read More

Bratisl Lek Listy 1998 Nov;99(11):605-9

Neurochirurgická klinika Lekárskej fakulty Univerzity P.J. Safárika v Kosiciach.

Several experimental and clinical studies suggest an important role of the quality and quantity of the material compressing the lumbosacral spinal cord radices in the development of cauda equina syndrome. These facts inspired the author to find out if the repair of neurological functions depends also on these factors. Clinical investigations of 81 persons (30 women and 51 men) were performed at minimum time of two years after the operation of the cauda equina discogenic syndrome. Read More

Eur Spine J 1998 ;7(2):125-31

Spinal Surgery Unit, London Clinic, UK.

The radiographic fusion rates, graft behaviour and clinical outcome of 41 patient with simultaneous combined anterior lumbar interbody fusion and posterior arthrodesis with translaminar screws were reviewed independently. In all patients a femoral cortical allograft (FCA) ring filled with autologous iliac crest cancellous bone was used anteriorly to replace the disc and achieve interbody fusion. The follow-up averaged 30. Read More

Lik Sprava 1998 Jan-Feb(1):143-5

Percutaneous laser discectomy (PLD) was performed in 273 patients with herniated disc-induced lumbosacral radiculitis. Indications for PLD were based on clinical and neurological findings and results of MR tomography: no benefit from conservative treatment, pain syndrome in the lumbago stage and sciatica not presenting with severe paresis and with herniated intervertebral discs down to 6 mm in size across. Read More

Spine (Phila Pa 1976) 1995 Dec;20(24 Suppl):126S-137S

Department of Orthopedic Surgery, University of Wisconsin, Madison, USA.

Study Design: A literature review.

Objectives: To clarify the surgical indications for spinal fusion in the various lumbar conditions.

Summary Of Background Data: This article summarizes the published literature regarding the treatment of lumbar degenerative conditions. Read More

Zh Nevropatol Psikhiatr Im S S Korsakova 1987 ;87(4):512-6

Study of biopsy material obtained from 612 surgical patients with vertebrogenic diseases of spinal radicles at the lumbosacral level and collation of the morphologic findings with the clinical picture of the disease revealed a correlation between the clinical manifestations and the inflammatory process in the vascularized tissues of the vertebral column. The severity of pain was found to depend on the degree of inflammatory changes in the epidural cellular tissue and spinal membranes. The frequency and severity of inflammatory reactions make it possible to consider inflammation, along with compression and ischemia, an important pathogenetic mechanism of the development, progression and course of the discogenic radicular syndrome and to recommend the inclusion of antiinflammatory drugs in multiple modality treatment of the disease as a method of pathogenetic therapy. Read More

Geriatrics 1975 Jan;30(1 Sz):73-6

Acta Chir Orthop Traumatol Cech 1968 Aug;35(4):368-70