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ffective than placebo in reducing short-term leg pain (MD -4.93, 95% CI -8.77 to -1.09 on a 0-100 scale), short-term disability (MD -4.18, 95% CI -6.04 to -2.17 on a 0-100 scale) and may be slightly more effective in reducing short-term overall pain (MD -9.35, 95% CI -14.05 to -4.65 on a 0-100 scale). There were mostly minor adverse events (i.e., without hospitalization) after epidural corticosteroid injections and placebo injections without difference between groups (RR 1.14, 95% CI 0.91-1.42). The quality of evidence was at best moderate mostly due to problems with trial design and inconsistency.

A review of 25 placebo-controlled trials provides moderate-quality evidence that epidural corticosteroid injections are effective, although the effects are small and short-term. There is uncertainty on safety due to very low-quality evidence.

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Animal experimental study.

The aim of this study was to investigate the optimal time of hydrogel injection for regenerating intervertebral disc degeneration (IDD) based on T1ρ magnetic resonance imaging (MRI).

Currently, different approaches are being pursued to regenerate the IDD. However, the optimal timing for the regenerative intervention is unclear.

The slowly, progressive IDD models were established in 18 rhesus monkeys. read more On the basis of the MR T1ρ values of the discs, the rhesus monkeys were divided into severe (T1ρ values <81 ms), moderate (T1ρ values 81∼95 ms), and mild (T1ρ values 96∼110 ms) degeneration groups. Biocompatible hydrogel was injected into the central part of the nucleus pulposus of the discs under fluoroscopic guidance. Treatment effects were investigated using radiography, T1ρ MRI, and histology until 12 months postoperatively.

After injection, the T1ρ values of all the discs increased significantly at 1 month postoperatively, and then remained at approximately 110 ms in the mild and moderate groups during the whole observation period, with no significant difference compared to the values at 1 month (P > 0.05). However, in the severe group, the T1ρ values decreased significantly after 1 month and leveled at approximately 70 ms after 6 months, with significant difference compared to the values at 1 month (P < 0.05). In the mild and moderate groups, there were no significant differences between preoperative histological scores and those at 12 months (P > 0.05). However, the histological score in the severe group at 12 months was significantly higher than the preoperative scores (P < 0.05).

This study suggested that the moderate degenerative stage of IDD (T1ρ values from 95 to 80 ms) could be the optimal time for hydrogel injection aimed at the regenerative intervention, based on T1ρ-MR imaging technique and quantitative analysis.

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A randomized, double-blinded controlled trial.

This study tested the effect of single-dose wound infiltration with multiple drugs for pain management after lumbar spine surgery.

Patients undergoing spine surgery often experience severe pain especially in early postoperative period. We hypothesized that intraoperative wound infiltration with multiple drugs would improve outcomes in lumbar spine surgery.

Fifty-two patients who underwent one to two levels of spinous process splitting laminectomy of lumbar spine, were randomized into two groups. Infiltration group received intraoperative wound infiltration of local anesthetics, morphine sulfate, epinephrine, and nonsteroidal anti-inflammatory drugs at the end of surgery, and received patient-controlled analgesia (PCA) postoperatively. The control group received only PCA postoperatively. The primary outcome measures were amount of morphine consumption and visual analogue scale (VAS) for pain. The secondary outcome measures were Oswestry Disability Index (O= 0.262 for ODI and P = 0.296 for RMDQ). There were no significant differences of patient satisfaction, length of stay, and side effects between both groups (P = 0.256, P = 0.262, P = 0.145 respectively).

Intraoperative wound infiltration with multimodal drugs reduced postoperative morphine consumption, decreased pain score with no increased side effects.

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Laboratory investigation with phantom spine models.

The aim of this study was to demonstrate the ability of Augmented Reality system to track instruments from different companies without major modifications.

Augmented Reality is an emergent technology with applications in industrial, military, gaming, and medical fields. AR applications in Spine surgery are actively being developed. Features of headpiece ergonomics, digital processing power, intuitive interface, and reliable accuracy are being optimized for successful adaptation of technology into the field. System versatility across various instrumentation sets is important for cost-effectiveness and efficiency in application.

In this project, five phantom spine models were instrumented L1-S1 with pedicle screws from five major companies. AR assistance was used for all. Each screwdriver was equipped with a generic 3D printed navigation marker for tracking.

Every instrumentation set was successfully paired with AR navigation imaging. Sixty pedicle screws were inserted with an average time of 1.6 min/screw. There was an evidence of learning curve with fastest time achieved of 1 min/screw. All five systems had equivocal radiographic outcomes. There were two breached screws (3%).

Any currently available instrumentation set can readily pair for tracking with Augmented Reality system. Active tracking of the drivers allowed for improved accuracy making AR system very attractive as an adjunct to the current instrumentation techniques.

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The study is designed as a retrospective cohort study.

The aim of this study was to identify modifiable and nonmodifiable risk factors of postoperative urinary retention in spine surgery patients.

Postoperative urinary retention is a common complication in patients undergoing operative procedures requiring anesthesia. Current studies have shown significant risk factors for postoperative urinary retention, but most are nonmodifiable and subsequently of limited usefulness in preventing this complication. Several new studies have shown possible modifiable risk factors, but current data are inconsistent in terms of their statistical significance.

A total of 814 consecutive patients who underwent open posterior lumbar laminectomy and fusion were included in the retrospective cohort study. Pre, intra-, and postoperative characteristics were collected in all patients to identify risk factors for postoperative urinary retention.

Glycopyrrolate use (odds ratio [OR] 2.60; P = 0.001), decreased body mass index (OR 0.