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Deep gluteal syndrome (DGS) is an underdiagnosed entity characterized by pain and/or dysesthesias in the buttock area, hip or posterior thigh and/or radicular pain due to a non-discogenic and extrapelvic sciatic nerve entrapment in the subgluteal space. The development of periarticular hip endoscopy has led to an understanding of the pathophysiological mechanisms underlying piriformis syndrome, which has supported its further classification. The whole sciatic nerve trajectory in the deep gluteal space can be addressed by an endoscopic surgical technique, allowing the treatment of the diverse causes of sciatic nerve entrapment. Endoscopic decompression of the sciatic nerve appears useful in improving function and diminishing hip pain in sciatic nerve entrapments within the subgluteal space.

Low back pain is a common adult complaint throughout the developed world. The majority of acute low back pain episodes will relent spontaneously. Evaluation is not needed immediately if there are no red flags. A small number of patients with acute disk herniation will require surgery based upon severity of pain and real or impending neurological deficits. Many can be relieved of radicular pain by perineural steroid injection and/or a short course of oral steroids. Rapid mobilization and return to function are helpful.

The goal of this chapter is to inform the reader about the most common spine injections currently used to diagnose and treat post-lumbar surgery syndrome (PLSS). Due to the influence of payors and policymakers on surgical decision-making, PLSS will also be briefly presented within an epidemiologic, historic, and socioeconomic context. Payors, policymakers, researchers, and other stakeholders have sounded an “alarm” over the increase in spine surgeries. They have sounded the same alarm over the proliferation of interventional procedures in nonoperative spine practices. Detractors argue that some of these procedures are dubious, risky, and scientifically unproven and do not lead to long functional improvement. Some interventions have stood the test of time, e.g., epidural injections, diagnostic facet and sacroiliac joint blocks, and medial branch neurotomy, but other treatments such as pulsed radiofrequency treatments of spinal nerves or various intradiscal therapies are recent interventions and may or may not be in common use in the future. With the meteoric rise in spine injections over the last decade, often without appropriate indications, spine interventionalists have come under intense scrutiny to justify the medical necessity of their procedures. Ultimately, both patient and the physician are the losers with performance of medically unnecessary spine injections. Because spine interventionalists did not utilize rigorous indications for successful diagnostic and therapeutic interventions in the last decade, payors and policymakers intervened.

Spinal cord hydatidosis is a rare disease, with an incidence of less than 1 %. Cysts are usually multiple and mostly extradurally located. The clinical symptoms vary depending on the part of the spinal cord that has been involved, size of the cysts, and interaction between the expanding cysts and adjacent structures. Neurological examination reveals paraparesis or paraplegia, back pain or radicular pain, numbness or sensory loss, and sphincter disturbance. Diagnosis is established based on the imaging techniques such as plain radiographs, computed tomography, and magnetic resonance imaging of the spine. Histopathological findings definitely confirm the diagnosis. The most common treatment is surgical removal of the cysts combined with medicamentous treatment (albendazole and/or mebendazole) before and after surgery to prevent metastatic infestation.

Thoracic disc herniation (TDH) is a relatively rare condition with an incidence ranging from 1:1,000 to 1:1,000,000 patients annually (McInerney and Ball, Neurosurg Focus 9(4):1–8, 2000). In comparison to the cervical and lumbar spines, symptomatic disc disease is also much less common in the thoracic spine. Its infrequency and lack of a characteristic presentation make TDHs difficult to diagnose. In addition, they can be technically and surgically demanding to treat. As a result, operations for a thoracic disc herniation compromise only 0.14–4 % of all disc excisions (Stillerman and Chen, J Neurosurg 88:623–633, 1998). Over time, several techniques to perform surgical decompression of thoracic disc disease have evolved. These vary depending on location of pathology, patient presentation, and surgeon preference or experience. The main goal, however, is to safely decompress the neural elements.

The cervical spine is formed by seven vertebrae which are naturally aligned in lordosis. Their main function is to provide support to the cranium and to serve as a bridge connecting it with the remaining spinal segments. Simultaneously, it provides protection for vital neural structures.

Minimally invasive or “minimal access surgery” (MAS) is being utilized with increasing frequency to reduce approach-related morbidity in the lumbar spine. This paper describes our minimal access technique for posterior bilateral transforaminal lumbar interbody fusion (TLIF) and spinal instrumentation in a patient with high-grade spondylolisthesis grade (Myerding Grade III) with 5-year follow-up. A 24-year-old lady presented with mechanical back pain and left leg L5 radiculopathy. On examination, she was a thin lady with an obvious step deformity in the lower lumbar spine and otherwise, a normal neurological examination. Imaging showed a grade III isthmic L5–S1 spondylolisthesis with foraminal stenosis and focal kyphotic alignment of 20° [slip angle (SA) = 70°]. Conservative measures had failed, and a decision was made to proceed with a MAS-TLIF approach. The estimated blood loss was less than 100 ml, operating time 150 min, and post-operative hospital stay was 4 days. Post-operatively the patient had significant improvement of back and radicular pain. Improvement in ODI was substantial and sustained at 5 years. A solid fusion was achieved at 8 months. The slip percentage improved from 68 % (pre-op) to 28 % (post-op) and the focal alignment to 20° lordosis (SA = 110°). A MAS approach for selected patients with a mobile high-grade spondylolisthesis is feasible, safe and clinically effective, with the added benefit of reduced soft-tissue disruption. Our result of this technique suggests that the ability to correct focal deformity, and achieve excellent radiographic and clinical outcome is similar to the open procedure.

According to text books and the princeps paper of Verbiest, the typical complaints of patients presenting with lumbar spinal stenosis (LSS) are neurogenic claudication, radicular pain and neurological impairment like motor deficit or sensory disturbance [1]. In daily clinical practise, it appears that the symptoms associated with LSS range from none to one or several of the following: neurogenic claudication, radicular pain, motor deficit, sensory alterations or deficit and low back pain (LBP). The latter is often the major symptom that leads the patient to seek treatment. LBP is significant in up to 75% of the patients with LSS.

Lumbar spinal imaging in radicular pain and related conditions , Lumbar spinal imaging in radicular pain and related conditions , کتابخانه دیجیتال جندی شاپور اهواز

In 1934, Mixter and Barr reported nineteen cases of rupture of the intervertebral disc with the involvement of the spinal canal, and so ushered in the “dynasty of the disc”. Their paper described compression of the spinal cord, cauda equina or exiting nerve root by the her-niated material, and included four cases with a cervical localisation, four cases in the thoracic spine, ten in the lumbar spine and lumbosacral transition, and one in the sacral region! The concept of nerve root compression by herniated disc material as a cause of low back and lower extremity pain dominated etiologic and therapeutic thinking on the subject of sciatica for several decades, and its evolution is discussed in more detail in Chap. 1. Although much about the pathogenesis of sciatica and related conditions is still unclear, it is generally accepted that simple mechanical compression of an otherwise healthy nerve root by itself does not cause radicular pain: various humoral and auto-immune inflammatory factors are also at work (see Chaps. 1 and 5).

Spinal cord neoplasms are an uncommon cause of back pain, radicular pain, or sensorymotor defi cits. Primary tumors that involve the spinal cord or nerve roots may arise from glial cells located within the parenchyma of the cord, Schwann cells of the nerve roots, or meningeal cells covering the cord. Metastatic spinal cord tumor can result from dissemination of a primary systemic cancer or, more rarely, from drop metastasis of primary intracranial lesions. According to the literature, spinal tumors are divided on the basis of their location into three major groups: intradural intramedullary, intradural extramedullary, and extradural tumors. Intradural tumors are contained in the thecal sac and they can originate within the spinal cord tissue, classifi ed as intramedullary, or adjacent but extrinsic to the cord, classifi ed as extramedullary lesions.

Sciatica, or pain in the distribution of the sciatic nerve due to a condition afflicting the nerve itself, is a fairly common occurrence with a yearly incidence of 1–5% (Frymoyer 1988). Clinical descriptions of sciatica go back to the times of Hippocrates and Cotugno, and the etiology of this affliction has puzzled medical practitioners for equally long. Much is still unclear.