European Spine Journal最新文献

Purpose: Thoracic disc herniation (TDH) is a spinal condition with significant clinical implications due to its proximity to the spinal cord and unique anatomical challenges. Despite advancements in imaging and surgical techniques, the relationship between herniation characteristics and clinical outcomes remains poorly understood. This study aims to analyze the clinical and radiological features of TDH in a large cohort of surgically treated patients, focusing on volumetric assessments and a novel classification system based on anatomical landmarks.

Methods: A retrospective review was conducted on 994 patients who underwent surgical treatment for TDH at a single institution over 20 years. Patient demographics, clinical presentations, and radiological characteristics were analyzed. Two systems were used to classify TDH based on radiologic axial area (A, B, and C) and radiologic laterality (central, unilateral, and bilateral, subscripted as X₀, X_1, and X₂, respectively). The ratio of hernia to canal volumes was calculated, and associations between hernia characteristics and symptoms were examined.

Results: The mean age was 49.2 years, with a slight female predominance (58.7%). Most herniations (71.5%) occurred in the lower thoracic spine, with T7-T8 being the most common level. Hernias were primarily central (67.4%) and filled an average of 45% of the spinal canal. Type B hernias (intermediate size) were the most frequent (48%), followed by the more prominent type C (32.6%) and the smaller type A (19.4%). Pain was reported by 99.1% of patients, with 65% describing it as severe. Motor deficits were present in 20.1% of patients, sensory deficits in 26.1%, and gait abnormalities in 18.2%. Larger hernias (types B and C) were associated with fewer motor and reflex impairments compared to smaller hernias (type A), potentially reflecting adaptive spinal cord remodeling. Unilateral lesions were linked to a higher likelihood of neurological deficits, while bilateral lesions were associated with increased pain and reduced gait impairment.

Conclusions: TDH presents with diverse clinical and radiological features. Despite their size, larger hernias have shown lower odds of neurological impairments, suggesting compensatory mechanisms. This study underscores the importance of volumetric assessments and systematic classification to better understand and manage TDH. Further research is needed to explore the natural history and long-term outcomes of TDH.

Purpose: To describe patient outcomes and associated factors after surgical treatment for lumbar disc herniation (LDH) with motor deficit.

Methods: A prospective observational study was conducted of all patients with LDH and motor deficit treated in one of nine centers in France between August 2023 and April 2024. The inclusion criteria were age ≥ 18 years, a Medical Research Council (MRC) muscle strength score ≤ 3 out of 5 in at least one muscle group, absence of spondylolisthesis and absence of scoliosis. Clinical evaluations were performed preoperatively, on day 1 after surgery and at 1-3 and 10-12 months' follow-up. The main outcome variable was complete motor recovery (MRC score = 5).

Results: Eighty-three of the 144 included patients (58%) had complete motor recovery. Complete motor recovery was independently associated with earlier treatment (odds ratio (OR) [95% confidence interval], 0.73 [0.57 to 0.91] per 10 day increase) less severe preoperative weakness (OR, 6.0 [1.8 to 21.8] for MRC score ≥ 2 vs. < 2), day 1 postoperative resolution of radicular pain (OR, 2.5 [1.1 to 6.1] for pain score = 0 vs. > 0) and day 1 gains in muscle strength (OR, 6.9 [2.7 to 19.4] for increase in MRC score vs. no increase). Complete motor recovery was significantly associated with sensory recovery.

Conclusion: The strongest predictor of complete motor recovery after surgery for LDH was day 1 postoperative improvement in muscle strength. This prognosis was also associated with lower postoperative radicular pain, shorter time to treatment, higher preoperative muscle strength. These results can help inform clinicians and patients on likely outcomes after LDH surgery.