Intravascular Injection of Contrast During Lumbar Discography: A Previously Unreported Complication

Objective.  Report a case of intravascular contrast injection during lumbar discography. Setting.  An academic University spine center. Patient.  Forty-year-old woman with L5-S1 degenerative disk disease and persistent low back pain. Intervention.  The patient failed to respond to multiple conservative treatments. In consideration of surgical treatment, discography was requested. Results.  A 22G needle was inserted to the central nucleus by a left posterolateral approach. Discography was performed at L4-5 and L5-S1. Testing was performed with pressure manometry, beginning with the L4-5 disk. The pressure increased with contrast injection in the manner of a normal disk. At 45 psi there was a sudden drop to 20 psi. Lateral views obtained during contrast injection demonstrated flow from a central nucleogram cephalad into the anterior epidural space. Images obtained with live fluoroscopy demonstrated a vascular flow pattern, confirmed with lateral and anterior-posterior views. The needle tip was repositioned anterior and superior. Repeat injection resulted in an identical vascular pattern. From the time the pressure dropped, contrast flowed in the vascular pattern without propagation of the nucleogram or increase in intradiscal pressure. The patient was asymptomatic throughout the injection at L4-5. Injection at L5-S1 demonstrated a severely degenerative nucleogram and reproduced the patient's usual low back pain. Conclusions.  Vascular uptake of contrast can occur during lumbar discography, even when the needle tip is ideally located.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73849/1/j.1526-4637.2008.00532.x.pd

Poster 260: Inadvertent Cervical Radicular Artery Injection Using a Pencil‐Point (Whitacre) Needle: A Case Report

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/147116/1/pmr2s216b.pd

Poster 274: Revision Surgery after Plasma Disk Decompression for Treatment of Symptomatic Lumbar Intervertebral Disk Herniations

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/146978/1/pmr2s223.pd

The Use of Epidural Corticosteroids for Cervical Radiculopathy: An Interlaminar Versus Transforaminal Approach

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/146929/1/pmr2178.pd

Poster 259: A Quantitative Study of Morphologic Changes in the Lumbar Spine After Medial Branch Radiofrequency Neurotomy

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/146961/1/pmr2s116b.pd

A Quantitative Study of Intervertebral Disc Morphologic Changes Following Plasma‐Mediated Percutaneous Discectomy

Objective To quantitatively evaluate interval magnetic resonance imaging ( MRI ) changes in disc morphology following plasma‐mediated percutaneous discectomy. Design/Setting A retrospective comparison of pretreatment and posttreatment MRIs at a single university spine clinic. Subjects From a group of 60 consecutively treated patients, 15 met the study inclusion and exclusion criteria. All had either failed treatment or had other clinical reasons for a posttreatment MRI . Methods Two independent physicians electronically measured disc protrusion size and disc height at the treatment discs and adjacent discs on pre‐ and posttreatment MRI scans. Additionally, images were compared for gross anatomic changes including disc degeneration by P firrman classification, new disc herniations, high intensity zone ( HIZ ), vertebral endplate changes, post‐contrast enhancement, and changes in segmental alignment. P earson r correlation was used to determine interobserver reliability between the two physicians' MRI measurements. Paired t ‐tests were calculated for comparisons of pre‐ and posttreatment MRI measurements, and an ANOVA was performed for comparison of pre‐ to posttreatment changes in disc height measurements at treatment levels relative to adjacent levels. Results Correlation was high for measurement of disc height change ( r  = 0.89; P  < 0.0001) and good for anteroposterior protrusion size change ( r  = 0.51; P  = 0.0512). Disc height at treated discs demonstrated a small but statistically significant mean interval reduction of 0.48 mm ( P  = 0.0018). This remained significant when compared with the adjacent control discs ( P  < 0.0001). Pretreatment mean disc protrusion size (4.74 mm; range 3.75–6.55 mm) did not differ significantly ( P  = 0.1145) from posttreatment protrusion size (4.42 mm; range 2.55–7.95 mm). Gross anatomic changes at treatment levels included reduced disc protrusion size (N = 6), enlarged protrusion (N = 3), resolution of HIZ (N = 3), and improvement in endplate signal changes (N = 1). Also, 11/15 posttreatment MRIs included post‐contrast images that showed epidural fibrosis (N = 1), rim enhancement (N = 2), and enhancement of the posterior annulus (N = 4). Conclusions Based on MRI examinations, subtle anatomic changes may occur following plasma‐mediated percutaneous discectomy. Further study is required to determine the clinical relevance of these changes.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/109360/1/pme12525.pd

Duration of Fluoroscopicâ Guided Spine Interventions and Radiation Exposure Is Increased in Overweight Patients

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/146881/1/pmr2291.pd

Correlation of Paraspinal Atrophy and Denervation in Back Pain and Spinal Stenosis Relative to Asymptomatic Controls

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/146797/1/pmr239.pd

A scoping review of biopsychosocial risk factors and co-morbidities for common spinal disorders

OBJECTIVE: The purpose of this review was to identify risk factors, prognostic factors, and comorbidities associated with common spinal disorders. METHODS: A scoping review of the literature of common spinal disorders was performed through September 2016. To identify search terms, we developed 3 terminology groups for case definitions: 1) spinal pain of unknown origin, 2) spinal syndromes, and 3) spinal pathology. We used a comprehensive strategy to search PubMed for meta-analyses and systematic reviews of case-control studies, cohort studies, and randomized controlled trials for risk and prognostic factors and cross-sectional studies describing associations and comorbidities. RESULTS: Of 3,453 candidate papers, 145 met study criteria and were included in this review. Risk factors were reported for group 1: non-specific low back pain (smoking, overweight/obesity, negative recovery expectations), non-specific neck pain (high job demands, monotonous work); group 2: degenerative spinal disease (workers\u27 compensation claim, degenerative scoliosis), and group 3: spinal tuberculosis (age, imprisonment, previous history of tuberculosis), spinal cord injury (age, accidental injury), vertebral fracture from osteoporosis (type 1 diabetes, certain medications, smoking), and neural tube defects (folic acid deficit, anti-convulsant medications, chlorine, influenza, maternal obesity). A range of comorbidities was identified for spinal disorders. CONCLUSION: Many associated factors for common spinal disorders identified in this study are modifiable. The most common spinal disorders are co-morbid with general health conditions, but there is a lack of clarity in the literature differentiating which conditions are merely comorbid versus ones that are risk factors. Modifiable risk factors present opportunities for policy, research, and public health prevention efforts on both the individual patient and community levels. Further research into prevention interventions for spinal disorders is needed to address this gap in the literature