fibrin and Back-Pain

Our current hypothesis is that mechanical damage in the spine such as a disc prolapse can lead directly to pain. However, pain arising for this reason is usually of short duration. In many subjects, however, the mechanical problems lead to vascular damage and, in particular, venous obstruction and dilatation with endothelial damage, fibrin deposition, and intravascular thromboses. In turn, this is associated with perineural and intraneural fibrosis. There is a defect in the fibrinolytic system in the peripheral blood that may be the result of vascular damage but in turn may contribute to the persistence of this problem. Therefore, it seems likely that in many patients with chronic mechanical back pain there are important vascular, fibrotic, and inflammatory components to the problem. Treatment in the future should be directed specifically at these aspects of the disorder and hopefully can lead to better control of symptoms.

Topics: Arachnoiditis; Back Pain; Biomechanical Phenomena; Fibrin; Fibrosis; Humans; Lumbar Vertebrae; Spinal Osteophytosis; Vascular Diseases

Symptomatic Tarlov cysts are a common cause of chronic pain. Many methods have been reported to treat this disease, with variable results. Most previous reports concerning the treatment methods of symptomatic Tarlov cysts were either sporadic case reports or series of limited cases.. This study aimed to further optimize the management for patients with symptomatic Tarlov cysts (TCs) by analyzing the results of 82 patients who were treated with different strategies.. Three different strategies were applied to 82 patients with symptomatic TCs and their clinical effects were evaluated in 13 months to 12 years follow-up.. A pain management practice, a medical center, major metropolitan city, China.. From June 2003 to August 2015, a total number of 82 patients with symptomatic TCs were treated with 3 different methods (microsurgical cyst fenestration and imbrication, C-arm fluoroscopy guided percutaneous fibrin gel injection, and conservative management) in the first affiliated hospital of Chongqing Medical University. The pain severity was assessed according to visual analog scale (VAS), and imaging changes were evaluated by magnetic resonance imaging (MRI). Patient improvements in pain and neurologic function were evaluated during a follow-up the period of 13 months to 12 years.. All the patients who underwent microsurgical cyst fenestration and imbrication had either complete (7 patients, 50%) or substantial (7 patients, 50%) resolution of their preoperative symptoms and neurological deficits. However, 3 patients (21%) had cerebrospinal fluid (CSF) leakage and 3 patients (21%) suffered from recurrent symptoms. In C-arm fluoroscopy guided percutaneous fibrin gel injection group, 34 patients (61%) had complete resolution and 22 patients had (39%) substantial resolution, and no CSF leakage or recurrence occurred. Only 3 patients (25%) got substantial resolution in the conservative management group, but 9 patients (75%) had aggravation.. An observational study with a relatively small sample size.. C-arm fluoroscopy guided percutaneous fibrin gel injection therapy could be recommend as a better consideration for symptomatic TCs.. Tarlov cysts, C-arm fluoroscopy guided, fibrin gel, microsurgical cyst fenestration, conservative management.

Topics: Adult; Aged; Back Pain; China; Female; Fibrin; Follow-Up Studies; Gels; Humans; Male; Microsurgery; Middle Aged; Outcome and Process Assessment, Health Care; Retrospective Studies; Tarlov Cysts; Young Adult

Topics: Animals; Arachnoiditis; Back Pain; Fibrin; Humans; Inflammation; Intervertebral Disc Displacement; Radiculopathy