The Disc and Degenerative Disc Disease: Remove or Regenerate?

Foreword
Foreword 2
Preface
Contents
1: Anatomy and Biomechanics of the Intervertebral Disc
1.1 Anatomy of the Intervertebral Disc
1.2 Biomechanical Properties of the Intervertebral Disc
1.2.1 Hydrostatic Pressure
1.2.2 Osmotic Pressure
1.2.3 Permeability
1.2.4 Viscoelasticity
1.2.5 Nonlinearity
1.2.6 Elasticity
1.2.7 Anisotropy
1.3 Biomechanics of the Intervertebral Disc
1.3.1 Unloaded Disc
1.3.2 Response to Compression
1.3.3 Response to Bending and Torsion
1.4 Mechanotransduction in Intervertebral Disc
1.5 Summary
References
2: Imaging of Degeneration, Inflammation, Infection, Ossification, and Calcification of the Intervertebral Disk
2.1 Introduction
2.2 Imaging of the Disk: Normal and Variants with Imaging Correlation
2.2.1 The Normal Intervertebral Disk
2.2.2 Plain Radiographs
2.2.3 CT Scan
2.2.4 MRI Scan
2.2.5 Anatomical Variants
2.3 Disk Degeneration
2.3.1 Spondylosis Deformans
2.3.1.1 Definition
2.3.1.2 Pathogenesis
2.3.1.3 Imaging
2.3.2 Intervertebral (Osteo)Chondrosis
2.3.2.1 Definition
2.3.2.2 Pathogenesis
2.3.2.3 Imaging
2.3.3 Kümmel Phenomenon
2.3.3.1 Definition
2.3.3.2 Imaging
2.3.4 Schmorl’s Nodes
2.4 Inflammation
2.4.1 Ankylosing Spondylitis
2.4.1.1 Definition
2.4.1.2 Pathogenesis
2.4.1.3 Imaging
2.4.2 Other Inflammatory Spondyloarthropathies
2.5 Infection
2.5.1 Pyogenic Spondylodiscitis
2.5.1.1 Definition
2.5.1.2 Pathogenesis
2.5.1.3 Imaging
2.5.1.4 Differential Diagnosis
2.5.2 Tuberculosis (Pott’s Disease)
2.5.2.1 Definition
2.5.2.2 Pathogenesis
2.5.2.3 Imaging
2.5.3 Fungal Spondylodiscitis
2.5.3.1 Definition
2.5.3.2 Imaging
2.5.4 Brucellosis
2.6 Calcification and Ossification of the Intervertebral Disk and Adjacent Structures
2.6.1 Disk Calcification
2.6.2 Diffuse Idiopathic Skeletal Hyperostosis
2.6.3 Ossification of the Posterior Longitudinal Ligament
References
3: Clinical Examination and History Taking in Patients with Suspected Degenerative Disc Disease
3.1 Introduction
3.2 Pathophysiology of Degenerative Disc Disease
3.3 Evaluation of a Patient with Suspected Degenerative Disc Disease
3.4 Cervical Spine Degenerative Disc Disease
3.4.1 History of Presentation
3.4.2 Physical Exam
3.4.3 Imaging
3.5 Lumbar Spine Degenerative Disc Disease
3.5.1 History of Presentation
3.5.2 Physical Exam
3.5.3 Imaging
3.6 Case Presentations
3.6.1 Case 1
3.6.2 Case 2
3.6.3 Case 3
3.7 Conclusion
References
4: Conventional Neuroradiology of Degenerative Disc Disease
4.1 Anatomy
4.2 Aging of the Disc
4.3 Disc Degeneration
4.4 Epidemiology
4.5 Conventional Radiography
4.6 Computed Tomography (CT)
4.7 Magnetic Resonance Imaging (MRI)
4.7.1 MRI Protocol
4.7.2 MRI Findings
4.8 Nomenclature
4.8.1 Degenerative Disc Disease (DDD)
4.8.1.1 Grading Methods
4.8.1.2 I Annulus Fibrosus Tears (Annular Fissures)
4.8.1.3 High-Intensity Zone (HIZ)
4.8.1.4 II Disc Bulging
4.8.1.5 III Disc Herniations
4.8.1.6 Disc Protrusion
4.8.1.7 Disc Extrusion
4.8.1.8 Sequestration
4.8.1.9 Disc Calcification
4.8.1.10 Vertebral Endplates
4.8.1.11 Schmorl Nodes
4.8.1.12 Spondylosis Deformans
4.9 Correlation
4.10 Correlation of Imaging Findings and Clinical Presentation
4.11 Progression of DDD
4.12 Differential Diagnosis
References
5: Advanced Imaging: DWI, DTI, PWI, and MR-Spectroscopy of the Disc
5.1 Technical Challenges
5.1.1 Anatomical
5.2 Artifacts
5.2.1 CSF-Pulsation Artifacts
5.2.2 Swallowing, Breathing, and Movement Artifacts
5.2.3 Magnetic Susceptibility Artifacts
5.3 Diffusion-Weighted Imaging, Diffusion Tensor Imaging, and Diffusion Kurtosis Imaging
5.4 Perfusion-Weighted Imaging
5.4.1 EndPlate Perfusion
5.4.2 Disc Perfusion
5.5 MR Spectroscopy
5.5.1 Introduction
5.5.2 Lumbar Disc Biomarkers
5.6 The NOCISCAN-LS “Virtual Discography” Exam and System
5.6.1 Introduction
5.6.2 Voxel Prescription
5.6.3 MRS Data Acquisition
5.6.4 MRS Data Processing
5.6.5 NOCISCORE Lumbar Disc Classification
5.6.6 Limitations
5.7 Clinical Results of MRS
5.7.1 MRS Experience in the US
5.7.2 MRS Experience in Europe
5.7.3 Clinical Examples of Patients Treated Before MRS Acquisition
5.7.4 Implications
References
6: Imaging of the Postoperative Spine
6.1 Introduction
6.2 Imaging Techniques
6.2.1 Conventional Radiography
6.2.2 Computed Tomography
6.2.3 Magnetic Resonance Imaging
6.3 Clinical Evaluation
6.4 Normal Radiological Findings in the Postoperative Spine
6.5 Common Radiologic Findings in Postoperative Spine
6.5.1 Postoperative Fluid Collections
6.5.2 Postoperative Infections
6.5.3 Implant-Related Complications
6.6 Recurrent Disc Herniation and Epidural Fibrosis
6.6.1 Recurrent Disc Herniation
6.6.2 Epidural Fibrosis
6.7 Sterile Arachnoiditis and Radiculitis
6.7.1 Sterile Arachnoiditis
6.7.2 Sterile Neuritis
6.8 Accelerated Degenerative Changes, Adjacent Segment Disease, and Spinal Stenosis
6.9 Pseudrathrosis
6.10 Summary and Problem-Solving Approach to Common Challenges
6.10.1 Infection or Postoperative Change
6.10.2 Abscess or Sterile Postoperative Fluid Collection
6.10.3 Recurrent Disc Herniation or Fibrosis (Scar)
6.10.4 Hardware Failure or Acceptable Postoperative Appearance
6.10.5 Failed Fusion or Too-Early-to-See Radiographic Fusion?
6.11 Conclusion
References
7: Epidural Steroid Injections: Are They Still Useful?
7.1 Background
7.2 Anatomy
7.3 Approach
7.4 Patients’ Selection: Indication
7.5 Rationale for the Use of ESI
7.6 Risk
7.7 Efficacy
7.8 Axial Lower Back Pain
7.9 Spinal Stenosis
7.10 Sciatic Pain
7.10.1 IESI
7.10.2 TFESI
7.10.3 Meta-Analysis
7.11 Conclusion
References
8: Evidentiary Basis of Percutaneous Discectomy
8.1 Background
8.2 Discussion
8.3 Chemonucleolysis
8.4 Automated Percutaneous Lumbar Discectomy (APLD)
8.5 Percutaneous Laser Disc Decompression (PLDD)
8.6 DeKompressor
8.7 Nucleoplasty
8.8 Percutaneous Endoscopic Lumbar Discectomy
8.9 Conclusion
References
9: Minimally Invasive Treatment of Herniated Disc: How to Remove the Disc with Chemical Tools
9.1 Introduction
9.2 Ozone Mechanism of Action
9.3 The Selection of Patients: Indication and Contraindications
9.4 Neuroradiological Technique
9.5 Complication and Results
9.6 Radiopaque Gelled Ethanol (DiscoGel®)
9.7 Conclusion
References
10: Minimally Invasive Treatment of Herniated Discs: How to Remove the Disc with Physical Tools
10.1 Introduction
10.2 Indications
10.3 Techniques of Percutaneous Disc Access
10.3.1 Oblique View for Disc Access
10.3.2 L5–S1 Disc Access: Special Considerations
10.3.3 Transdural Posterior Approach
10.3.4 Approach to Cervical Discs
10.4 Techniques for Disc Removal with Physical Tools
10.4.1 Mechanical
10.4.2 RF Thermal Ablation
10.4.3 Coblation
10.4.4 Laser
10.5 Complications
10.6 Postoperative Care and Follow-up
References
11: Endoscopic Percutaneous Discectomy
11.1 Introduction
11.2 Indications and Standard Approaches
11.3 Surgical Techniques
11.3.1 Interlaminar (IL) Approach
11.3.2 Transforaminal Approach (TF)
11.3.2.1 Posterolateral Transforaminal
11.3.2.2 Far-lateral Transforaminal
11.3.2.3 Extraforaminal
11.4 Postoperative Care
11.5 Complications
11.6 PELD for Recurrent Herniations
11.7 Conclusion
11.8 Highlights
References
12: Regenerative Options to Restore the Disc
12.1 Clinical Problem
12.2 Anatomical and Pathophysiological Update and Possible Implications for Regeneration
12.2.1 Basivertebral Nerve
12.2.2 Propionibacterium acnes
12.3 Treatment Options
12.3.1 Nucleus Replacement
12.3.2 Augmentation Techniques
12.3.3 Regenerating Techniques
12.3.3.1 Platelet-Rich Plasma
12.4 Other Injectable Treatments Techniques of Discogenic Pain
12.4.1 DiscoGel®
12.4.2 Methylene Blue
12.4.3 Ablation of the Basivertebral Nerve
12.5 MRI Spectroscopy-Related Patient Examples and Proposed Treatment Guidelines
12.5.1 Example 1 (Figs. 12.9a, b and 12.10a, b)
12.5.2 Example 2 (Figs. 12.11, 12.12, and 12.13)
12.5.3 Example 3 (Figs. 12.14 and 12.15)
12.5.4 Example 4 (Figs. 12.16 and 12.17)
12.5.5 Example 5 (Figs. 12.18 and 12.19)
References
13: New Biomaterials for Degenerative Disc Disease
13.1 Introduction
13.2 Intradiscal Biologic Treatments
13.2.1 Fibrin Adhesives
13.2.2 Bone Morphogenic Protein
13.2.3 Growth Differentiation Factor
13.2.4 Alpha-2-Macroglobulin
13.2.5 Platelet-Rich Plasma
13.2.6 Mesenchymal Stem Cells/Medicinal Signalling Cells
13.3 Level I Data with Allogeneic MSCs
13.3.1 Rexlemestrocel-L (Mesoblast)
13.3.2 Ongoing Clinical Trials
13.3.3 Progenitor Stem Cells (VIA Disc® by Vivex)
13.4 Intervertebral Disc Injection Protocol
13.4.1 Eligibility
13.4.2 Standards for Pre-procedural, Intra-procedural, and Post-procedural Treatment
13.4.2.1 Pre-procedure
Risks, Benefits, and Alternatives
13.4.2.2 Intra-procedure
13.4.2.3 Post-procedure
13.5 Noninfectious Reactions Seen with Intradiscal Biologics and Other Materials
13.6 Intradiscal Exosomes
13.7 Conclusions
References
14: Surgical Disc Replacement and Fusion Techniques
14.1 Case 1
14.1.1 Technical Notes
14.2 Case 2
14.2.1 Surgical Technique
14.3 Case 3
14.3.1 Surgical Technique
14.4 Case 4
14.4.1 Surgical Technique
14.5 Discussion
14.6 Conclusion
References